Neurosurgery for Mental Disorder (NMD)

brain-surgery-treatmentNeurosurgery for Mental Disorder (NMD) is the modern name for psychosurgery.  NMD is a very controversial medical field that has not yet undoubtedly proven its merits.  The whole medical process is a collaboration between psychiatrists and neurosurgeons in which the goal is to remove or destroy a small piece of the brain to mitigate severe depression or acute obsessive-compulsive disorder (OCD).

Important Facts about NMD

NMD is a very high risk procedure and recommended only if all therapies, including psychiatric drugs and electroconvulsive therapy (ECT), have been totally unsuccessful.  Because of the high risk of adverse effects, a few doctors usually recommend this treatment as a very last resort.  Patients with this recommendation need to give their consent before NMD can be performed on them.

Other key factors to be knowledgeable of before considering NMD:

  • NMD is not a cure.  The surgery is done just to decrease the symptoms of the acute mood disorder or OCD but the patient still has to go through psychotherapy and other psychiatric treatments.
  • NMD cannot be reversed.  The surgery is permanent and therefore whatever side effects there may be can become permanent as well.
  • NMD is an extremely rare surgical procedure.  Only 4 people in the U.K. received this treatment in the years 2013-2014.
  • There are two alternative treatments to NMD:  deep brain stimulation (DBS) and vagus nerve stimulation (VNS).  While NMD involves taking out a small part of the brain, DBS stimulates parts of the brain with implanted electrodes.  DBS has proven to work with severe depression and OCD however in some cases, symptoms come back when the stimuli is removed.  VNS involves surgery where a device is planted into your chest.  The device’s electrodes are connected to the vagus nerve located at the neck where it sends timed pulses through the nervous system.
  • NMD is not done to change or modify a person’s behaviour.  If there are any changes, these are usually side effects, not a procedural aim.
  • In the U.K., NMD is not recommended for anorexia, personality disorders, and schizophrenia.
  • NMD is not a lobotomy, a type of neurosurgery done in the past to treat schizophrenia.  Lobotomy had been a controversial procedure and is not, or perhaps very rarely, done today.  Although a small percentage benefited from the procedure, most patients were left mentally dull, vacant, and incapacitated.

The NMD Procedure

The purpose of NMD is to break the connections between the nerves in small parts of the limbic system which is thought to be creating the mental issues.  The frontal lobes of the brain hold the limbic system which is responsible for emotional responses and some involuntary physical responses such as blood pressure regulation and heart rate changes.

The operation involves drilling a small hole through your skull to allow a fine probe controlled by special imaging software to be guided to a specific area of the frontal lobe.  Once in the right spot, an electrical current is pulsed through the probe to destroy a miniscule area of brain tissue.  After this, the probe is then removed and the skull cuts are either stitched or glued.

Effects to Mental Capacity and Personality

Since cases are very few, there is no conclusive evidence of the effectiveness or ineffectiveness of NMD.  To glean data from just the few, these are the findings of its post operative effects.

No evidence has surfaced to claim that NMD causes any loss in mental or thinking ability.  In fact, the operation itself may have dampened or relieved patients of symptoms so that it allows them now to think more clearly and have better concentration.

There are, however, very few patients that have undergone personality changes from the operation.

Side Effects of NMD

NMD can cause:

  • Apathy or disinterest.  Some patients who went through surgery for severe depression were reported to be indifferent to their issues which used to upset them before the operation.
  • Weight gain
  • Headaches which can be severe and last for several days

High Risks of NMD

Because NMD touches the brain, it carries high risks common to most brain surgeries:

  • Confusion
  • Epileptic seizures
  • Damage to blood vessels which may cause stroke
  • Feeling of pressure in the frontal area.  This pressure is caused by fluid build-up by the brain tissues as part of the healing process.  Confusion may also result from this fluid build-up and the condition can last for a month after surgery.

The Law on Patient Consent to NMD

The law on patient consent differ between the England-Wales territory and Scotland.  The Mental Health Act allows NMD for patients in England and Wales if all conditions are true:

  • The patient consents to NMD treatment.
  • A Second Opinion Appointed Doctor (SOAD) and two other appointees by the Care Quality Commission in England or the Healthcare Inspectorate Wales certify that (1) the SOAD approves of the treatment; (2) the patient has the capacity to consent; (3) the patient does consent.

It is very important to note that in England and Wales, patient consent is an absolute requirement for treatment, even if the patient does not have the capacity to give his consent.  In other words, if the patient lacks the capacity to consent, he cannot receive NMD treatment within England and Wales.

Scotland, however, has a different ruling.  NMD can be applied if all conditions are true:

  • An appointed medical practitioner by the Mental Welfare Commission has given his approval of NMD’s benefits for the patient.
  • A further two lay appointees by the Commission certifies whether the patient has the capacity of giving his consent or not.
  • If the patient is capable of consenting, then he is asked for his formal consent.  If the patient is incapable of consenting, he should not be objecting to the treatment.

Under Scottish law, as long as the patient does not object to the surgery, the patient can be given the NMD treatment even if he lacks the capacity to give his permission or consent.

LGBT Mental Health

gay relationships

Jared was fifteen when he fell into a depression and contemplated ending his life several times.  He knew he was gay but loathed himself for it.  His traditional Catholic upbringing frowned on gay, lesbian, bisexual, and transgender (LGBT) orientations.  Because of his mental illness, he pulled out of school, slogged through home school, hardly had a friend, and was under a lot of medication. At 18, he opted to go abroad to study and start a new life.  There he found his sense of belongingness with Mark and his circle of gay friends.  His depression gradually eased up as he accepted his sexual orientation.

LGBT mental health is a problem.  Straight Jacket author, Matthew Todd, writes “Society treats everyone from birth as if they are heterosexual.  If you’re not heterosexual and/or cisgendered (where your gender aligns with the sex you are assigned at birth) then there is huge pressure to suppress that part of yourself.”

A five year survey commissioned by PACE, an LGBT mental health charity, discovered that 34% of lesbians, gays, and bisexuals under the age of 26 have attempted suicide at least once.  About 48% of young transsexuals have also made some suicide attempt at one point in their lives.  Their mental health issues have largely stemmed from homophobic prejudice and bullying within their own families and schools.

LGBT people have to deal with a lot of rejection and hostility from different areas of society in the forms of:

  • Unaccepting demeanour and attitudes from family and friends
  • Bullying or shaming at school
  • Damnation from many religions
  • Danger of violence or embarrassment from strangers in public places
  • Harassment at work
  • Casual homophobic comments
  • Negative portrayals of LGBTs in media

…and a lot more.  With such an onslaught of antipathy from several quarters, it is no wonder LGBT persons have a very difficult time picking up their self-esteem and finding any belongingness in a world that largely ostracises them.

In this regard, many LGBT individuals wrestle with their identities which leave them subject to mental health issues such as:

  • Alcohol and substance abuse and addiction
  • Self-harm; suicide attempts
  • Low self-esteem
  • Major depression
  • Post traumatic stress disorder from bullying
  • Damaged relationships especially within the family circle
  • Generalized anxiety disorder
  • Bipolar disorder

Why is LGBT Mental Health Important?

The mind and body are intrinsically tied.  If the mind is unhealthy, the body also falls into sickness or weakness.  Improving LGBT mental health may ensure the general well-being of LGBT individuals.  If gay, lesbian, bisexuals, and transgenders get the opportunities to bolster their self-esteem by being accepted by their peers and family, health concerns may be decreased in the areas of:

  • Costs for physical and psychiatric care
  • Disease (ex. HIV) transmission and progression
  • The number of psychologically unfit individuals
  • Suicides, self-harm, and self-abuse

Selecting a Therapist for LGBT Issues

Not all therapists are qualified to treat LGBT patients.  Those who are usually have a lot of experience dealing with LGBT issues and may be an LGBT individual himself.  However, there are not many therapists like these that are available in every community.

The good news is that some LGBT specialized therapists have opted to provide distant therapy services through the internet or over the phone.  People considering sex change surgery are usually required to attend therapy first before surgery.  Therapy over the net may answer the availability of such required treatment.

Selecting the right therapist or mental health care provider is crucial for an LGBT patient to get the most out of his treatment.  When talking to the therapist, one needs to:

  • be comfortable with his therapist
  • know the background of his therapist’s experience working with LGBT individuals
  • have confidence about giving out personal information or details about one’s sexual orientation or preferences.
  • be open about thoughts and feelings about anxiety, fear, suicide, self-harm, and depression

Safety and Support When Going Online

online support

For many seeking help for mental illness, the web is a complex goldmine of information.  With a wealth of facts just a mouse click away, it is but natural for those seeking to understand their type of mental illness to turn to online for answers and later for support.  Unfortunately, the net is also a vat of disinformation and a playground for hostile individuals and groups.  In this regard, the internet user must know what sites to trust and what social networks, support groups, and chat rooms to be on the lookout for questionable members and activities.

When trawling the net, one must look after his privacy and his well-being especially when using the internet to look for support.  One must learn to deal with cyber abuse and be cautious with online advice from just any support group.  Not everything published on websites are a hundred percent reliable either because anyone, whether they be experts in their field or a common Joe just giving his two cents worth, can post just about anything they want online.

Where to Go For Reliable Information?

If you want to understand more about your mental issue, go to sites that have been certified to carry reliable content.  Ask yourself these questions before deeming any content you read as factual:

  1. Does the content have verifiable factual information or is the content written from just someone’s personal opinion or experience?
  2. Is the content written by an expert in the field?  Are they certified professionals?
  3. Is the content current?  When was it written?
  4. Is the content relevant to your mental health issue or circumstances?

It may be difficult to discern the legitimacy or illegitimacy of many sites.  Fortunately some sites have been certified as reliable by the Information Standard, a mark of accreditation by the National Health Service (NHS England) that certifies the content reliability of certain websites concerned with health and care.  A site marked with the following logo ensures trustworthy information for your guidance:

information-standard-member-logo-positive_full_1

Mind and NHS are good examples of sites that host very dependable, informative health content.

Finding Support Online

If you are thinking of finding a therapist online, it pays to do a little background search on his or her qualifications first?  The mental health therapist, psychologist, or psychiatrist must be accredited by a professional body such as the BACP (British Association for Counselling & Psychotherapy).

Chat groups or forums also exist that deal with specific mental health issues.  There are forums for bipolar patients and support groups for depressed people.  These are online communities with the ideal goals of providing as much factual information and as much support to their members.  Being part of these groups may help you discover new coping strategies and give you a sense of belongingness.  Sometimes, knowing that you are not alone can be a big help.

As much as support groups are beneficial, bear in mind the following:

  • Not all information you glean may be applicable to you.  If a group member swears by a certain medication, it does not mean this medication will work or will have fewer side effects for you as well, even if you and that member share the same diagnosis.  It is always wise to refer the information you get with your GP instead of acting on it on your own.
  • Other people’s comments can trigger some emotional issues.  Your comments may trigger theirs as well.  For example, if someone is saying that he feels like harming himself, you start feeling the same because of the suggestion.  If you feel this is happening, don’t pursue the thread.  Go to some other site.
  • Manage your online relationships.  People you have met online are not ones you have built a relationship with face-to-face; so be careful about giving personal information.  In addition, respect other people’s feelings and opinions even if you don’t agree with them.  Moreover, do not tolerate online mistreatment such as bullying by nipping any first attempts in the bud.
  • Manage expectations.  Do not believe what people write about 100% because it could just be their opinion, not fact.  Furthermore, other people’s experiences are circumstantial to them and may not be relevant to your own situation.

As much as the internet is a great tool for helping you manage your illness, there is still no substitute for face-to-face therapy or consultation with your psychiatrist or general practitioner (GP).  Having said that, online support from a licensed mental health professional through webcam talking therapies or email therapy is the next best thing.  Just be fastidious in establishing your online therapist’s credentials with the BACP, BPS (British Psychological Society), or other accrediting bodies.