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UBC Theses and Dissertations

Psychiatric neurosurgery in the modern era : public, media and clinical perspectives Courchesne, Caitlin


Neurosurgical interventions are returning to psychiatry with many familiar and challenging ethical, social and legal questions of the past. Narratives about the benefits, risks, and promise of novel medical and surgical innovations are shaped and circulated among the public, media, and medical communities. Through three studies conducted within the scope of this thesis, I focus on a central research question: What are the perspectives of the public, the media, and clinical stakeholders on the re-emergence of neurosurgical interventions for treatment-refractory mental health disorders? I address this research question through the lens of a pragmatic neuroethics framework using both qualitative and quantitative analyses. In the first study, I explore the perspectives of members of the public toward the re-emergence of psychiatric neurosurgery in three countries. I find optimism about innovations in the mental health landscape but concerns about the preservation of an authentic self, the last resort nature of surgical procedures, the capacity of patients with mental health disorders to consent to invasive interventions, and the lingering societal stigma attached to both psychiatric disorders and treatments for them. In the second study, I explore the experiences of mainstream science writers who report on psychiatric neurosurgery and other innovative medical technologies. I find that these journalists value balanced reporting practices and consider the controversial history of psychosurgery as a contributor to both the newsworthiness of contemporary procedures and the importance of cautious communication. In the third study, I survey North American functional neurosurgeons to obtain an updated account of their practices, predictions and perceptions of modern psychiatric neurosurgery. I uncover a sustained role for ablative procedures despite recent evolution in neuromodulatory interventions. I also find greater support for the use of psychiatric neurosurgery in the treatment of obsessive-compulsive disorder (OCD) than for major depressive disorder (MDD). Overall, the findings unite the voices of key stakeholders and support a commitment to ethical translation of re-envisioned neurointerventions for psychiatric disorders.

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