The use of somatic interventions to control or treat mental symptoms dates back to ancient times (Clower et al., 2002; Kalinowsky, 1986; Tourney, 1967). Evidence for burr holes drilled into the skull to "cure the demons" goes back to the Neolithic age. The notions that convulsions and fever may help mental disorders have been known since Hippocrates, while in medieval times, make-believe surgeries were performed to extract the "stone of madness."

In the 17th century, Descartes hypothesized that the ventricles were the reservoir of vital fluids and basis for the rational mind. This deemphasized the brain's role. Conversely, modern somatic treatments for mental illness are rooted in the conceptualization that neural tissue is responsible for behavior. This started in 1796, when Gall proposed that different brain regions were responsible for different functions, a system he called phrenology. Although this notion was revolutionary and would prove essential to our current understanding of brain function, he and his followers were later involved in pseudo-science and contributed little to the functional neuroanatomy of the mind (Critchley, 1965).

Textbook of Biological Psychiatry. Edited by Jaak Panksepp Copyright © 2004 by Wiley-Liss, Inc. ISBN: 0-471-43478-7

Almost a decade later, modern scientific conceptualization of brain functions and localizations began to emerge from animal experiments, cadaver dissections, and clinical observations conducted by Broca (Broca, 1865), Jackson (Jackson, 1873), and others. Also, the notion of neuronal transmission based on electrochemical signals replaced the 19th-century hydraulic neuronal transmission model (Tourney, 1967). These ideas of regional brain functional localization and electrochemical neuronal transmission would later evolve into the contemporary neuronal network models that guide and inform much of the current applications of somatic treatments in disorders such as obsessive compulsive disorder and depression. As the biological underpinnings of the complexity of the mind are still being worked out, current somatic interventions are being used both for understanding the neurobiology of mental illness as well as for treating disease (George et al., 1999b).

This chapter will discuss the current applications of somatic interventions in neu-ropsychiatric diseases, beginning with the oldest form of treatment—electroconvulsive therapy (ECT)—as well as a new variant of ECT called magnetic seizure therapy (MST). We will then discuss in order of increasing invasiveness transcranial magnetic stimulation (TMS), vagus nerve stimulation (VNS), deep brain stimulation (DBS), and finally neurosurgery for psychiatric conditions.

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