email page print pageAll Topic Reviews
Maximizing Effectiveness in Dynamic Psychotherapy Self-Compassion in Psychotherapy101 Healing StoriesA Clinician's Guide to Legal Issues in PsychotherapyA Map of the MindA Primer for Beginning PsychotherapyACT With LoveActive Treatment of DepressionAffect Regulation, Mentalization, and the Development of SelfAlready FreeBad TherapyBecoming an Effective PsychotherapistBefore ForgivingBeing a Brain-Wise TherapistBetrayed as BoysBeyond Evidence-Based PsychotherapyBeyond MadnessBeyond PostmodernismBinge No MoreBiofeedback for the BrainBipolar DisorderBody PsychotherapyBoundaries and Boundary Violations in PsychoanalysisBrain Change TherapyBrain Science and Psychological DisordersBrain-Based Therapy with AdultsBrain-Based Therapy with Children and AdolescentsBrief Adolescent Therapy Homework PlannerBrief Child Therapy Homework PlannerBrief Therapy Homework PlannerBuffy the Vampire Slayer and PhilosophyBuilding on BionCare of the PsycheCase Studies in DepressionCaught in the NetChild and Adolescent Treatment for Social Work PracticeChoosing an Online TherapistChronic DepressionClinical Dilemmas in PsychotherapyClinical Handbook of Psychological DisordersClinical Intuition in PsychotherapyClinical Pearls of WisdomCo-Creating ChangeCognitive Therapy for Challenging ProblemsCompassionConfessions of a Former ChildConfidential RelationshipsConfidentiality and Mental HealthConfidingContemplative Psychotherapy EssentialsControlConversations About Psychology and Sexual OrientationCoping with BPDCouch FictionCounseling in GenderlandCounseling with Choice TheoryCouple SkillsCrazy for YouCreating a Life of Meaning and CompassionCreating HysteriaCritical Issues in PsychotherapyCrucial Choices, Crucial ChangesDeafness In MindDecoding the Ethics CodeDeconstructing PsychotherapyDeep Brain StimulationDemystifying TherapyDepression 101Depression in ContextDialogues on DifferenceDissociative ChildrenDo-It-Yourself Eye Movement Techniques for Emotional HealingE-TherapyEarly WarningEncountering the Sacred in PsychotherapyEnergy Psychology InteractiveErrant SelvesEssays on Philosophical CounselingEssentials of Wais-III AssessmentEthically Challenged ProfessionsEthics and Values in PsychotherapyEthics in Plain EnglishEthics in Psychotherapy and CounselingExpectationExploring the Self through PhotographyExpressing EmotionFacing Human SufferingFairbairn's Object Relations Theory in the Clinical SettingFamily TherapyFavorite Counseling and Therapy Homework AssignmentsFear of IntimacyFlourishingFolie a DeuxForms of Intersubjectivity in Infant Reasearch and Adult TreatmentFoundations of Ethical Practice, Research, and Teaching in PsychologyFreud and the Question of PseudoscienceFrom Morality to Mental HealthFundamentals of Psychoanalytic TechniqueGenes on the CouchGod & TherapyHalf Empty, Half FullHandbook of Clinical Psychopharmacology for TherapistsHandbook of Counseling and Psychotherapy with Lesbian, Gay, and Bisexual ClientsHandbook of Evidence-Based Therapies for Children and AdolescentsHealing the Heart and Mind with MindfulnessHeinz KohutHelping Children Cope With Disasters and TerrorismHigh RiskHistory of PsychotherapyHow Clients Make Therapy WorkHow Psychotherapists DevelopHow to Fail As a TherapistHow to Go to TherapyHypnosis for Inner Conflict ResolutionHypnosis for Smoking CessationI Never Promised You a Rose GardenIf Only I Had KnownIn Others' EyesIn SessionIn Therapy We TrustIn Treatment: Season 1Incorporating Spirituality in Counseling and PsychotherapyInside the SessionInside TherapyIs Long-Term Therapy Unethical?Issues in Philosophical CounselingIt's Not as Bad as It SeemsItís Your HourLearning from Our MistakesLearning Supportive PsychotherapyLetters to a Young TherapistLife CoachingLogotherapy and Existential AnalysisLove's ExecutionerMadness and DemocracyMaking the Big LeapMan's Search for MeaningMetaphoria: Metaphor and Guided Metaphor for Psychotherapy and HealingMind GamesMindfulness and AcceptanceMindfulness-Based Cognitive Therapy for DepressionMindworks: An Introduction to NLPMockingbird YearsMoments of EngagementMomma and the Meaning of LifeMotivational Interviewing: Preparing People For ChangeMulticulturalism and the Therapeutic ProcessMultifamily Groups in the Treatment of Severe Psychiatric DisordersNarrative PracticeOn the CouchOne Nation Under TherapyOur Inner WorldOur Last Great IllusionOutsider ArtOvercoming Destructive Beliefs, Feelings, and BehaviorsOverexposedPathways to SpiritualityPersonality and PsychotherapyPhilosophical CounselingPhilosophical Counselling and the UnconsciousPhilosophical Issues in Counseling and PsychotherapyPhilosophical PracticePhilosophy and PsychotherapyPhilosophy for Counselling and PsychotherapyPhilosophy PracticePhilosophy's Role in Counseling and PsychotherapyPillar of SaltPlan BPlato, Not Prozac!Polarities of ExperiencesPower GamesPractical Psychoanalysis for Therapists and PatientsPrinciples and Practice of Sex TherapyPsychologists Defying the CrowdPsychology, Psychotherapy, Psychoanalysis, and the Politics of Human RelationshipsPsychosis in the FamilyPsychotherapyPsychotherapyPsychotherapy and ConfidentialityPsychotherapy As PraxisPsychotherapy for Children and AdolescentsPsychotherapy for Personality DisordersPsychotherapy Is Worth ItPsychotherapy Isn't What You ThinkPsychotherapy with Adolescent Girls and Young WomenPsychotherapy with Children and AdolescentsPsychotherapy without the SelfPsychotherapy, American Culture, and Social PolicyRapid Cognitive TherapyRational Emotive Behavior TherapyRational Emotive Behavior TherapyRationality and the Pursuit of HappinessRebuilding Shattered LivesReclaiming Our ChildrenRecovery OptionsRelationalityRent Two Films and Let's Talk in the MorningSaving the Modern SoulScience and Pseudoscience in Clinical PsychologySecond-order Change in PsychotherapySelf-Compassion in PsychotherapySelf-Determination Theory in the ClinicSelf-Disclosure in Psychotherapy and RecoverySerious ShoppingSex, Therapy, and KidsSexual Orientation and Psychodynamic PsychotherapySigns of SafetySoul Murder RevisitedStaring at the SunStraight to JesusStrangers to OurselvesSubjective Experience and the Logic of the OtherTaking America Off DrugsTales of PsychotherapyTales of UnknowingTalk is Not EnoughTalking Cures and Placebo EffectsTelling SecretsThe Behavioral Medicine Treatment PlannerThe Body in PsychotherapyThe Brief Couples Therapy Homework Planner with DiskThe Case Formulation Approach to Cognitive-Behavior TherapyThe Challenge for Psychoanalysis and PsychotherapyThe Child and Adolescent Psychotherapy Treatment PlannerThe Clinical Child Documentation SourcebookThe Clinical Documentation SourcebookThe Complete Adult Psychotherapy Treatment PlannerThe Couch and the TreeThe Couples Psychotherapy Treatment PlannerThe Crucible of ExperienceThe Cure of SoulsThe Death of PsychotherapyThe Education of Mrs. BemisThe Ethical Treatment of DepressionThe Ethics of PsychoanalysisThe Gay and Lesbian Psychotherapy Treatment PlannerThe Gift of TherapyThe Great Psychotherapy Debate: The Evidence for What Makes Psychotherapy Work The Healing JourneyThe Heart & Soul of ChangeThe Heroic ClientThe Husbands and Wives ClubThe Love CureThe Making of a TherapistThe Mindful TherapistThe Mirror Crack'dThe Mummy at the Dining Room TableThe Neuroscience of PsychotherapyThe Neuroscience of Psychotherapy: Healing the Social BrainThe New Rational TherapyThe Older Adult Psychotherapy Treatment PlannerThe Other Side of DesireThe Pastoral Counseling Treatment PlannerThe Philosopher's Autobiography The Pornographer's GriefThe Portable CoachThe Portable Ethicist for Mental Health Professionals The Present Moment in Psychotherapy and Everyday LifeThe Problem of EvilThe Problem with Cognitive Behavioural TherapyThe Psychodynamics of Gender and Gender RoleThe Psychotherapy Documentation PrimerThe Psychotherapy Documentation PrimerThe Psychotherapy of HopeThe Real World Guide to Psychotherapy PracticeThe Schopenhauer CureThe Sex Lives of TeenagersThe Talking CureThe Therapeutic "Aha!"The Therapist's Guide to PsychopharmacologyThe Therapist's Guide to Psychopharmacology, Revised EditionThe Therapist's Ultimate Solution BookThe Trauma of Everyday LifeThe UnsayableThe Way of the JournalTheory and Practice of Brief TherapyTherapy with ChildrenTherapy's DelusionsTheraScribe 3.0 for WindowsTheraScribe 4.0Thinking about ThinkingThinking for CliniciansThinking for CliniciansThoughts Without a ThinkerThriveToward a Psychology of AwakeningTracking Mental Health OutcomesTrauma, Truth and ReconciliationTreating Attachment DisordersTreatment for Chronic DepressionTreatment Plans and Interventions for Depression and Anxiety DisordersUnderstanding Child MolestersUnspeakable Truths and Happy EndingsWhat the Buddha FeltWhat Works for Whom?What Works for Whom? Second EditionWhen the Body SpeaksWhispers from the EastWise TherapyWittgenstein and PsychotherapyWorking MindsWoulda, Coulda, ShouldaWriting About PatientsYoga Skills for Therapists:Yoga Therapy
Anyone who keeps up with any of the literature in mental health settings is aware of the dismal prognosis (if the STAR-D study is anything to go by, and its pedigree is sound), for getting to remission of the depression symptoms that affect depressed individuals, using just the one medication. The best SSRI of the times is not the major cure that we were all led to believe when Prozac first surfaced, and if the recent research is correct, from Irving Kirsch and colleagues, much of the effect is placebo anyway. We all also know that beating the placebo response is the heart of most pharma research, hard to do when those on the active medication realize that the side effects are real, and hence so is the drug they are on.
Studies have examined the warmth of the therapeutic relationship, CBT is great, but only against drugs or usual care, but few studies taken head to head with other therapies show it to be superior, and certainly in the complex multi-axial settings in which I worked, you needed more in your toolbox than just one big hammer.
And when all you have is a hammer, everything is a nail. Researchers into Parkinson's suddenly discovered some time ago that flicking the wrong switch brought sudden suicidality to a patient, flicking it back, and they regathered their equanimity instantly. And then there is the tenth cranial nerve, the darling cranial nerve collaborator of the Autonomic Nervous System.
This lead Helen Mayberg of Emory to begin DBS as a means of treating refractory depression. And led Edgar award winning science writer, Jamie Talan, to write this book, looking at depression, Parkinson's, OCD and dystonia.
As mentioned before, some 40 000 patients, mostly Parkinson sufferers, have undergone DBS. The rationale is that of implanting a mechanism similar in concept to a pacemaker that regularly delivers a stimulus to a nervous system element, and by inserting a stimulus into a homeostatically regulated brain system, creates a perturbation that elicits an effect on the target activity, eg the tremor.
Talan thus begins writing about Parkinson's, the mother lode in the author's words, and the 100 years of research that led to this application. She continues to expand and outline on what I have commented on above, and the French Connection. Part two describes how DBS emerged from the investigations of the value of stimulus in dystonia, and other pioneering efforts, such as in Obsessive Compulsive Disorder in psychiatry, as well as depression, Tourette's and Epilepsy. Two unlikely candidates for sharing something in common are pain, and minimal consciousness: yet they are similar, given they are both just about impossible to objectively measure in terms of the patient's experience, the work now of Rezai and Llinas.
With this done, Talan looks to the future, and to the ethics of meddling in brain in this intrusive but oh so promising fashion.
The problem as Talan will show, is the need, like any other surgery, to get it just right, with the failures of individual specialists often showing up at the mainstream clinic's doors. Damasio tells of a patient undergoing some procedure for their Parkinson's only to have an immediate and overwhelming suicidality commence when the wrong area is stimulated by accident. Getting it just right in terms of where and how much to stimulate is an individual goal, and hence, can take months to get right. It's not just the surgery, Talan points out, but the programming of the stimulation, and the entire program beyond the immediate evaluation and surgery. Voltage, amplitude, frequency and duration are not only the parameters that need control, but the observations of others, such as a psychiatrist, in depression. The effects can be paradoxical, bringing on a host of autonomic responses, each to be mapped and programmed, perhaps taking 3-6months. Batteries run out, electrodes break, other hardware problems are common, and require regular visits to the DBS team. There is little training available.
Clearly, and especially in psychiatry, this is not a job for beginners or dilettantes. Informed assessment, training, programming and follow up are all critical.
Talan is a great writer, as her awards suggest, and each chapter has discussions around the guru's who lead the charge in each field, and of these, psychiatry is the most exciting. Each case history is terse and confronting, as Talan is not invested in any of these treatments, and so an honest appraisal of how difficult DBS is, is given in each case. She does not tout this as a miracle, but her excitement is obvious. Clearly, the field is a mass of human experimentation, hence her closing look at the ethics. It's a lucrative field, hence her references to the need for the guru's to fix the mess left by the dilettantes.
There are no diagrams, this is not a "how-to" book, and very few anatomical references are made. This is a book for someone who is curious about the field, a rather large, informative and well written news article, if you will. But like a news item, a compelling read, and a great introduction to the history and progress of DBS, complete with a warning guide, to not try this at home.
Underneath all this of course is the fact that DBS is invasive brain surgery, and hence meant for the most resilient and troubling of human conditions, but at least, a ray of hope, for those worst afflicted.
© 2009 Roy Sugarman
Roy Sugarman Ph.D., Human Performance Institute, Sydney, Australia.