Do you recognize this expression? It’s one of two synonymous questions referencing complex activities that are beyond the grasp of the average person. The meaning is therefore that the issue under investigation is so familiar to everyone already that any discussion about it can only reach obvious and therefore superfluous conclusions. But it is the other variation on this phrase where I propose to focus here, so that for our purposes, if it’s not rocket science, then it is brain surgery.
This discipline, carried out by trained specialists using precision instruments, aims to cure bodily malfunctions by applying invasive procedures to the most vulnerable and least understood organ in the body, the human brain. Brain surgeries are undertaken for a wide variety of purposes, but I will restrict the discussion here to their application for the purpose of alleviating the scourge of mental illness. This medical condition manifests itself in two distinct problems: first, mentally ill individuals suffer from inexplicable, psychotic mood disorders, which interfere with their ability to function normally around others; and second, these disturbed people engage in a variety of antisocial behaviors, sometimes violent, placing the society at large in the position of needing to protect itself from their behavior.
A few decades ago, brain surgery in the form of frontal lobotomies was hailed as the miracle cure for certain extreme varieties of mental illness. Patients that suffered from psychotic episodes would find themselves committed to asylums where board-certified physicians would surgically remove the white matter in their brain’s frontal lobe, which was deemed to be the source of their antisocial behavior. Worldwide, the procedure was performed on thousands of troubled individuals, including a small number of musicians and the sister of President Kennedy. The developer of the technique was a Portuguese doctor named Egas Moniz, who performed a number of lobotomies himself and was awarded the Nobel Prize in Medicine for his achievements in 1949.
Was Lobotomy an effective cure? The answer depends on the perspective from which the question is asked. As an expediter of social control, it unquestionably transformed hyperactive, sometimes violent offenders into passive, well-behaved citizens. For the lobotomized subjects, though, the operation brought good news and bad news: it served to neutralize the inner demons, which tormented them, but it also left them in catatonic stupors, unable to live productive lives. Over time, this form of brain surgery came to be seen as overly invasive, and the harm to the individual was deemed to outweigh any benefit to the rest of society.
The larger question the lobotomy procedure was attempting to address is at what point does merely nonconformist behavior become more serious and enough of a problem for the larger society that authorities feel justified in the need to intervene medically. Individuals are encouraged to express themselves freely in their speech and actions, so long as they don’t impinge on others’ right to do likewise. Accordingly, the line along which justifiable interventions might divide is the internal-external one. The argument can be made that when an individual’s antisocial actions present a threat to others, forcible restraint seems reasonable, but if that individual merely suffers mental anguish, it is not the authorities’ business to apply remedial measures, unless the individual petitions for assistance.
The phasing out of the use of brain surgery to perform frontal lobotomies was further facilitated by the paradigm shift within the medical community that held that mental illness originated from a chemical imbalance in the brain. One implication of this growing awareness was that, in addition to their other shortcomings, lobotomies represented an imprecise tool for alleviating such an imbalance. Preferred approaches that emerged included the direct intervention in the chemical composition of the patient’s brain through a course of medication drugs (meds) and the external approach of altering that internal chemistry through the application of electro convulsive therapy (ECT), popularly known as shock treatment (ST).
There have also emerged other treatment alternatives to the application of brain surgery to address mental illness. The two most prominent are psychotherapy (the talking cure, not to be confused with behavioral therapy, which seeks to positively reinforce socially desirable behavior and discourage non-acceptable behavior through a regiment of rewards and punishments), and meditation (ohm). With regard to the former, almost by definition, sessions with psychiatrists to explore patients’ feelings about their perceptions of damage incurred from mothers obsessed with the need to inflict guilt on their offspring cannot be an effective means of altering the brain chemistry of those afflicted with mental illness. But, although the latter treatment comes no closer to explicitly addressing chemical imbalances than psychotherapy, there seems to be some evidence that the rigorous pursuit of the practice of meditation can produce positive results in this regard. Although the transmission mechanism is not clear, there seems to be a connection between the calming effect of relaxation exercises and the production of healthy brain chemistry.
Having discussed the advantages current medical research accords to the methods of meds, ECT, and meditation over the default option of brain surgery, it might be worthwhile to evaluate whether these alternative therapies, like lobotomies, also contain negative aspects that might serve to undermine their effectiveness.
With regard to drug treatments, the issue is contained in the existence of side effects. Any substance powerful enough to alter a patient’s brain chemistry enough to change their disposition from self-destructive to optimistic or their behavior from antisocial to constructive, must also admit the possibility that the treatment could be accompanied with unanticipated consequences. The most common side effects are ancillary chemically induced illnesses stemming from either the rejection of the meds by the body’s immune system, chemically-induced dependencies, or interaction effects among the various specific drugs.
ECT presents a different problem. The same jolt of electricity aimed at realigning the body’s brain chemistry could also have the capacity to damage that same brain, and indeed, the entire nervous system. Although not as invasive as brain surgery, it is safe to say that shock treatment is the next most intrusive cure.
That leaves only non-invasive cures as safe forms of therapy, unless drug therapies or ECT can be administered in more measured doses that are more readily absorbed by the individual patient. Unfortunately, while psychotherapy might be safe, it is not very effective in attacking the root cause of mental illness. The one remaining course of treatment, which holds out the possibility of safe and effective therapy, is meditation. Its shortcoming is that it does not enjoy widespread use in modern societies, because most human beings are not temperamentally suited to utilize this form of therapy effectively. Instead, they are compelled to rely on more traditional methods, which is unfortunate, because some of these people might find that their road to sound mental health might lie in meditation rather than in medication.
I will conclude with a case study to apply these concepts to the situation of a fictional mentally ill individual. The raw material is provided in a song by Kenny Rogers entitled, “I just dropped in to see what condition my condition was in.” While the literal circumstances that generated the narrator’s thoughts might well have been the ingestion of one or more psychedelic drugs, the resulting lyrics could certainly be consistent with the ramblings of someone exuding the symptoms of mental illness. They are as follows:
I woke up this mornin’ with the sundown shinin’ in
I found my mind in a brown paper bag within
I tripped on a cloud and fell eight miles high
I tore my mind on a jagged sky
I just dropped in to see what condition my condition was in
I pushed my soul in a deep dark hole and then I followed it in
I watched myself crawlin’ out as I was crawlin’ in
I got up so tight that I couldn’t unwind
I saw so much that I broke my mind
I just dropped in to see what condition my condition was in
Someone painted ‘April Fool’ in big black letters on a ‘Dead End’ sign
I had my foot on the gas as I left the road and blew out my mind
Eight miles outa Memphis and I got no spare
Eight miles straight up downtown somewhere
I just dropped in to see what condition my condition was in.
The narrator of this song certainly qualifies for assignment to the category of“mentally ill”. He describes his surroundings in nonconventional terms, but is he a danger to society or is he merely an artistically inclined nonconformist with a fanciful way of expressing himself? Like many artists, he comes across as very self-absorbed, but is that a crime? If 99% of the society can only express itself through conventional means, surely there must be room for the 1% which sees the world through a fresh pair of eyes.
The only remaining question, if expressing himself freely doesn’t adversely impact anyone else, is whether he is a danger to himself. On this point, the jury is still out. At the very least, he should be encouraged to attend a course in driver’s education, but would society be made better off by restricting his access to psychedelic drugs, or would conventional thinkers merely be deprived of a refreshing exposure to a new way of understanding the world around us?