Second incident of psychosurgery on involuntary patients

The Guardian, March 26 1981

A London surgeon has performed irreversible brain operations on two involuntary patients, it was disclosed yesterday. The news is likely to increase pressure on the Government to introduce new safe-guards for psychosurgery.

By chance, it coincided with an announcement by the Royal College Of Psychiatrists that it has decided to press its own members and the Department of Health to change the procedures for deciding whether such operations should be performed on any patient, voluntarily or involuntarily.

The two involuntary patients, who were being detained in mental hospitals under section 25 of the Mental Health Act, underwent operations at the Brook General Hospital in south London, where more than half of British psychosurgery is carried out.

Dr Paul Bridges, the consultant psychiatrist in charge of the hospital’s psychosurgery unit, disclosed the operations during an open day at the unit. He said they had been performed in the last five years and that he could not immediately remember how the patients had reacted.

Mr Larry Gostin, the legal director of MIND, the mental health group, who was also at the open day, said later: “I think the hospital was wrong to perform operations on sectioned patients. It’s inherently unlikely that a person who is compulsorily detained can give free and effective consent. It also means that the hospital might be legally wide open if something went wrong and the patient sued.”

This is only the second known instance of involuntary patients receiving psychosurgery. The other occasion involved four women patients in Rampton special hospital: two have since killed themselves; one remained unchanged; and one has been discharged, apparently recovered.

The operations at the Brook, known as stereotactic subcaudate tractotomies, involved planting tiny rods of radioactive yttrium 90 into the lower inner quarters of the brain’s frontal lobes. The rods then destroy the brain tissue immediately around them.

The operations were performed by the unit’s neurosurgeon, Dr John Bartlett, who operates in this way at the unit about once a week. At yesterday’s open day, he acknowledged the difficulty of obtaining effective consent from patients who might often be cocooned in mental anguish.

“There is a difference between medical consent and legal consent,” he said. “With some of these patients you are never going to get the full legal consent in a thousand years. But you have to ask if they would thank you for the operation afterwards. It’s also important to consider that you might be guilty of negligence if you failed to act because you didn’t have the full consent.”