The Pleasure Shock: The Rise of Deep Brain Stimulation and Its Forgotten Inventor

by Lone Frank

Overview

The electrifying, forgotten history of Robert Heath's brain pacemaker, investigating the origins and ethics of one of today's most promising medical breakthroughs: deep brain stimulation

The technology invented by psychiatrist Robert G. Heath in the 1950s and '60s has been described as among the most controversial experiments in US history. His work was alleged at the time to be part of MKUltra, the CIA's notorious "mind control" project. His research subjects included incarcerated convicts and gay men who wished to be "cured" of their sexual preference. Yet his cutting-edge research and legacy were quickly buried deep in Tulane University's archives. Investigative science journalist Lone Frank now tells the complete sage of this passionate, determined doctor and his groundbreaking neuroscience.

More than fifty years after Heath's experiments, this very same treatment is becoming mainstream practice in modern psychiatry for everything from schizophrenia, anorexia, and compulsive behavior to depression, Parkinson's, and even substance addiction.

Lone Frank uncovered lost documents and accounts of Heath's trailblazing work. She tracked down surviving colleagues and patients, and she delved into the current support for deep brain stimulation by scientists and patients alike. What has changed? Why do we today unquestioningly embrace this technology as a cure? How do we decide what is a disease of the brain to be cured and what should be allowed to remain unrobed and unprodded? And how do we weigh the decades of criticism against the promise of treatment that could be offered to millions of patients?

Elegantly written and deeply fascinating, The Pleasure Shock weaves together biography, scientific history, and medical ethics. It is an adventure into our ever-shifting views of the mind and the fateful power we wield when we tinker with the self.

Product Details

ISBN-13:	9781101986547
Publisher:	Penguin Publishing Group
Publication date:	03/20/2018
Sold by:	Penguin Group
Format:	eBook
Pages:	320
File size:	1 MB

About the Author

LONE FRANK is an acclaimed science writer and the author of two previous books in English, My Beautiful Genome (Oneworld, 2011)--which was shortlisted for the Royal Society's Winton Prize for Science Books--and Mindfield (Oneworld, 2009). She has also been a presenter and coproducer of several TV documentaries with global distribution and is currently working on a feature-length, internationally financed, English-language documentary about Heath and deep brain stimulation. Before her career as a science writer, she earned a PhD in neurobiology and worked in the US biotech industry. She lives in Copenhagen.

Read an Excerpt

Chapter 1

Singing the Brain Electric

The year 1951 was a little over a month old when the small group of men in lab coats gathered in the operating theater. Anticipation hung heavy in the air but everyone went out of their way not to act as if this was just like any other day at the office.

The surgeon, a psychiatrist, and the others in turn offered their commentary on the unusually cold New Orleans winter. As they talked, a young woman lay before them on the operating table, conscious but not fully present. For the past six months she had been hospitalized, silent, and withdrawn, and almost immobile. If an aide started brushing her teeth or combing her hair, she would complete the task, but only torpidly.

DIAGNOSIS: Schizophrenic reaction, catatonic type, read her medical record.

The file noted that she was an only child, and had lived all of her twenty-six years with her parents in the countryside. They reported that she had always been a quiet and obedient child. "She's a good girl," her mother said.

At the same time, the woman's health was fragile. There was a long litany of complaints: discomfort, diffuse pain, general fatigue, repeated fainting spells. The year before her hospitalization, these episodes morphed into a chronic condition of irritable confusion and a morbid obsession with her guilt. With tears running down her cheeks, the good girl begged her parents again and again for forgiveness from sins neither of them could recognize-including imaginary sexual transgressions she supposedly committed in her early childhood. Finally, her parents had decided to try a private clinic that promised a definitive treatment for their daughter's overexcitement: a series of electric shock treatments.

The shock therapy helped a bit, but the woman quickly developed an exaggerated fear of disease. She was particularly anxious that her body was producing insidious, malignant cancers. Eventually, the worries became too much for her, and she attempted to kill herself with her father's hunting rifle.

"A feeble suicidal gesture," the medical file reported, but enough to land the young woman in New Orleans's Charity Hospital. She had been put in the women's ward-the white women's ward-where she had spent the past six months. Then, unfortunately, she had started to experience new delusions and hallucinations. Another round of electroshocks provided relief from these symptoms, but had also thrown her into a state of mute isolation.

There was a separate sheet in the medical record, marked "Patient 4," dedicated to the bold experimental treatment under way on this frigid February evening. That night, a young surgeon named Francisco Garcia was conducting a fourth surgery on the young woman's brain under the supervision of his boss, Robert G. Heath. Four hours earlier, they had opened her skull and cautiously placed a single, thin silver electrode through her right frontal lobe all the way down to the bottom of her brain, leaving its conductive tip in what was called the septum. This was Heath's area: a little region of the brain that he believed served as a focus for emotions, desires, and lust. Heath was convinced the septum was the key to waking his patient from her schizophrenic trance. It was the prince to her Sleeping Beauty.

Her shaved head was covered with a white, caplike bandage. On the right side of her pate, the back end of the fixed electrode jutted out like an antenna. In and of itself, the operation was simple, but Garcia was familiar with how difficult it was to place the electrode precisely. He had to cut through one side of the prefrontal cortex, the brain's tightly folded outer layer, and create a small opening into the cavity of the lateral ventricle, one of two fluid filled cavities almost at the brain's center. He then had to guide the electrode, following a chain of anatomical markers leading him to the tiny ventricular channel called the foramen of Monro, which was near the brain's midline. Using a technique called pneumoencephalography, Garcia and his helpers would then pump air into the hollows of the brain and take an X-ray to verify that the electrode was in the place they wanted. The process would give the patient a terrible headache later, but there was no way around it.

The electrode now properly placed, Heath took over. He turned toward the technician, a man called Herb Daigle, and told him it was time to connect the electrode to the power supply. Heath then moved gently to the patient's side. She looked petrified, her eyes nearly closed. When he began to speak to her, he adopted an everyday tone, as if the situation were entirely normal. He was here to help; she should follow his directions. It didn't seem as if she had heard anything, but he did not hesitate: He gave the signal to Herb to turn on the juice. The room went completely silent.

They had agreed to start cautiously and stimulate the patient's septum for one minute at 4 volts and 2 milliamps of current. Nothing. Absolutely no reaction. Throughout, they kept an eye out for any sign of seizures, which had been a complication during the surgery for Patient 2 a month earlier. No one wanted to see that again. They watched her blood pressure just as carefully. From animal experiments, they knew that blood pressure could rise sharply when the deep regions of the brain were tickled. But, again, she had no response. The current was turned off. Yet there was no reaction from the young woman.

After waiting for a moment, Heath nodded and Herb restarted the stimulation. This time, the intensity went up a notch, to three milliamps-higher, but still on the low end. The electric pulse was kept on for a minute and a half this time. They watched the patient's blood pressure but her body appeared to give no resistance to the stimulation. They were not sure what this meant. So, quickly, they drew a small amount of blood to test for changes in the woman's stress hormones. Heath once again spoke to the woman, asking trivial, easy questions: What's your name? Where are you?

"Hos-pital . . ." she whispered suddenly, and, a moment later, "New . . . Orleans . . ." this time more hesitantly, almost inaudibly, as if having a voice were new to her, something she must get used to. Heath, who had been standing in front of her until this moment, bent down and laid a hand on her arm. Looking directly into her eyes, which were now open, he asked whether she was in pain anywhere, if she felt anything special.

After a long pause she answered.

"No pain, Doctor."

The surgeon and the psychiatrist glanced at each other above the patient. Heath was glowing. This was exactly what he had predicted, what he had always known had to happen. At that moment, right there in the operating room, he might even have allowed himself the luxury of imagining a future in which he finally unlocked the mystery of schizophrenia and found a method to break the hardened shell of the disease and drag the person inside back into the real world.

"Do you see the change?" said Heath to the room, but he was mostly talking to himself. Behind his instruments, Herb was relieved, almost elated. He had helped construct the electrodes in the machine shop, and had spent hours discussing the dimensions and materials with his boss and the neurophysiologists. From the beginning, he had sensed a special quality in Heath, a vision or drive that instilled a passionate desire in everyone around him to deliver their very best. Of course, he was merely a technician, not one of the men confidently assembled around the operating table with their long, prestigious educational pedigrees to back them up. Yet Herb knew he had his role to play in something big, and important.

In total, the little team stimulated the woman's brain six times, at the highest pushing the needle up to 4 milliamps and 8 volts, and holding it there for a good two minutes. She was awake and attentive throughout. She didn't break into long sentences, or elegant argumentation, or even song, but it was the first time in months she had responded to anyone.

Heath made a signal, and finally, the experiment was over. Garcia stepped forward to secure the silver thread sticking out of Patient 4's scalp. They were going to attempt another round of stimulations in a couple of days, and until then, the electrode would have to remain in place. With infinite care, he put a little bone plug into the hole in her scalp, pulled the skin tight around the opening, cleaned the wound, and bandaged it, hoping that would keep everything in place. Inwardly, he crossed his fingers, to ward off the threat of infection. If the site got infected, their work with Patient 4 was effectively done.

Back on the ward, the young woman turned to a nurse and, for the first time in months, spoke on her own initiative. She was tired of all the therapists who had been circling around her bed trying to get her to talk, she complained. She would like to be rid of them.

By the age of thirty-four, Heath had created his own medical fiefdom. He ruled supreme over two floors of the new, boxy building on Canal Street where Tulane University had consolidated its medical research facilities. He had chosen to decorate his territory in the simple, modern, academic style, a classic psychiatristÕs couch snug up against the wall, the clean lines and beige tones exuding competence and efficiency. His laboratories were stocked with the most advanced measuring instruments; he had access to a seemingly endless supply of cats and monkeys on which to run animal models; and his operating suite had been customized to his specifications. There was even a room filled with camera equipment, so that every experiment could be documented on film. Most important, he had surrounded himself with top-notch colleagues who were keen to follow him into unknown territory.

In the anteroom of his office, Heath's efficient secretary, Irene Dempesy, was on top of any problem or administrative nonsense that walked in the door, leaving Heath free to envision a different path forward for psychiatry. From his office, he could lean back in his cozy chair and look out on New Orleans's celebrated, and notorious, French Quarter.

When he had told his colleagues at Columbia University about his offer from Tulane, they had reacted with incredulity. They didn't understand how Heath could want to leave a cushy position and great career prospects in New York to go off to such a backwater. After all, he belonged to an urbane milieu that tended to think there was nothing down South but swampland hicks, illiterates, and corrupt politicians.

He understood their objections. He had a lucrative private psychiatric practice on Park Avenue and a tenure-track position at Columbia. New York City was the promised land of American psychiatry. By comparison, Tulane was a one-horse town, backwards, without any research tradition. In fact, the place did not have its own psychiatry department. Not yet, anyway.

But he also understood that Tulane was offering him the chance to realize his grand ambitions. The new dean of the medical school, Max Lapham, was something of a tornado, a force of nature that could not be held at bay. Lapham was obsessed with the idea of getting his institution into the big league. He regularly talked of creating a "Harvard of the South," which would require, above all else, recruiting innovative researchers. He needed hungry young men (and a few women) who would grab the money, space, and freedom to pursue new ideas.

During a vacation to Atlantic City, Lapham had bumped into a psychiatrist from Columbia who had mentioned his young colleague, Robert Heath, as one such rising star. Heath was a certified neurologist as well as a psychiatrist. He was known for his hard work in the lab. But what piqued Lapham's interest was the report of Heath's character. The psychiatrist said Heath possessed an unusual dynamism and charisma. He was the type who would get people-including the media-excited about his research.

Lapham decided to get a look at Heath for himself. In Manhattan, he was greeted by a tall, elegant, almost beautiful man who could have easily nailed a screen test for MGM. He exhibited athletic grace and an inner calm, the latter unusual for someone so young. He quickly saw that Heath deserved his reputation as one of those people who naturally captivated a room when he entered it. And he was surprisingly sharp. He was more than current in his knowledge of the brain and the psyche, but at the same time wasn't afraid to argue-convincingly-for his own original ideas. This was the man for Lapham's dreams for the medical school.

Lapham wooed Heath and his wife, Eleanor, to visit New Orleans, but they were barely arrived when the city was hit by a hurricane. The city was shut down for the next several days. Lapham couldn't believe his bad luck. He was sure these two delicate souls from the well-ordered North were ready to decline his hospitable offer to move to the disheveled South. But Heath had just laughed and professed to the dean how he had fallen in love with the place.

As he would later suggest to one of his interns, it was not so much the New Orleans sights and sounds. Instead, as he was being shown around, he had been taken across the walkway connecting the medical school directly to Charity Hospital, and discovered what to him was a veritable gold mine: degenerate, raving syphilitics; catatonic psychotics petrified like awkward, living statues; melancholics who had completely disappeared into themselves and could no longer get out of bed on their own; volatile paranoids who had to be strapped down to keep them from living out their delusions and harming themselves and others. All of them disturbed, tormented souls. And all of them fantastic "clinical material."

Heath's private passion was schizophrenia, the terrible and mysterious disease that struck the young, crippling and darkening the rest of their lives. "It is the most disabling disorder we have," he explained to his medical students during lectures. "Anyone who goes into medicine must be interested in schizophrenia."

But what sort of illness was it? No one had found any explanatory changes in the brain structure of schizophrenics, or even biochemical irregularities. In fact, the consensus had formed that it was not an ailment at all but a purely psychological disturbance-a "super-neurosis," in the reassuring words of the psychiatrists. Psychiatry at the cusp of the 1950s was, for all practical purposes, synonymous with psychoanalysis. In the period following the Second World War, Freud's doctrines and a small army of his disciples had swarmed into every psychology department in the United States. Independent psychoanalytic institutes outside the aegis of the university were established left and right, and a private market for the "talking cure" was booming.

Table of Contents

Prologue 1

Chapter 1 Singing the Brain Electric 13

Chapter 2 The Second Coming 37

Chapter 3 Treat Yourself 67

Chapter 4 How Happy Is Too Happy? 91

Chapter 5 The Times They Are A-Changin' 123

Chapter 6 The Secret History of Hedonia 149

Chapter 7 A Cure for Violence 179

Chapter 8 Dreams from DARPA 195

Chapter 9 A Grand Mistake 223

Chapter 10 The Machine in the Mind 247

Epilogue 277

Sources 281

Acknowledgments 293

Index 295

Editorial Reviews

★ 01/22/2018
Science writer Frank (My Beautiful Genome) takes a deep dive into the work of a controversial “pioneer by accident,” psychiatrist Robert G. Heath, whose use of electrode stimulation to the brain’s “pleasure center” to treat schizophrenia and depression in the 1950s and ’60s horrified and fascinated academia, the CIA, and the U.S. Senate. This wide-ranging, thoughtful exploration of Heath’s complicated legacy combs through documents, film footage, and interviews with Heath’s colleagues, his son, and a patient. It begins with the treatment of patient B-19, a gay man who was supposed to be cured with electrodes and a prostitute; when Heath died in 1999, his work was largely judged by that perverse episode: “It seems as if he had a vision of something of which he could not clearly see the contours—quite simply because science had not yet reached far enough and the tools were still primitive.” Though Heath’s work has been discredited, he began an approach that’s getting a new look from psychiatry and industry, making one psychosurgeon’s assessment particularly poignant: “You are a hero until you are not.” Frank has written an excellent, balanced portrait of an inventive psychiatrist with a complicated legacy. Agent: Peter Tallack, the Science Factory. (Mar.)

Publishers Weekly

Praise for The Pleasure Shock

“[A] wide-ranging, thoughtful exploration…Frank has written an excellent, balanced portrait of an inventive psychiatrist with a complicated legacy.”
–Publishers Weekly (starred review)

“A thoughtful, always interesting look into the workings of the mind—and the sometimes-surprising implications of how those workings have been revealed.”
–Kirkus Reviews

“Frank has traced and interviewed surviving patients, former collaborators, family members and current DBS scientists. The result is a rarity: a thrilling, well-researched read.” 
–Nature

"Compelling... engaging... an accessible and entertaining description of this relatively unknown chapter in the history of DBS."
–The Lancet

"Nuanced and thoughtful."
–The Washington Free Beacon

“A beautifully written, nuanced compendium that unfurls like an engrossing mystery, filled with colorful characters, gripping drama and mind-blowing scientific history in the making, definitely one of the most mesmerizing nonfiction books with New Orleans roots ever.” 
–New Orleans Living

"The Pleasure Shock is a page-turner full of fascinating characters, high-stakes drama, and profound ethical dilemmas. Lone Frank—a trained neuroscientist and gifted storyteller—illuminates the dark roots of a modern-day medical marvel, and her book should be required reading for anyone interested in our ongoing efforts to tame the human mind by tinkering with the human brain."
–Luke Dittrich, award-winning author of Patient H.M.

"Scientists who are ahead of their time are often odd characters.   Robert Heath is a dramatic example. Lone Frank brings his history and dramatic personality to life. She tells the untold story of his  work on deep brain stimulation as a treatment for mental disorders. Was it pioneering or premature? Her nuanced portrait reveals Heath as a scientist-clinician who is neither monster nor hero, but passionate and persistent. I am astounded that I never knew this story despite decades in psychiatry. Others will be as fascinated as I am."
–Dr. Randolph Nesse, author of Why We Get Sick

“The Pleasure Shock is an illuminating expose on yet another dark, misunderstood time in our medical past. I could not put this book down.”
–Paul Ruggieri MD, author of Confessions of a Surgeon

"The Pleasure Shock is not only a fascinating biography of brain-implant pioneer Robert Heath. It also explores a profound and disturbing question: Can we, and should we, use technology to eradicate suffering and evil?" 
–John Horgan, Director, Center for Science Writings, Stevens Institute of Technology, and author of The End of Science

From the Publisher

2017-12-24
Science in the service of power can easily be warped and distorted—but, as this book shows, it can sometimes yield unexpected benefits.Robert G. Heath (1915-1999) was once a widely respected, influential psychiatrist at Tulane University. As neurobiologist-turned-science journalist Frank (My Beautiful Genome: Discovering Our Genetic Future, One Quirk at a Time, 2012, etc.) writes, Heath's biologically oriented work found many acolytes, among them a student who lost his academic chair later in life for having "prescribed too many interesting—and illegal—medications" to the university football team. Some of Heath's work was equally troubling on the ethical front. He likely worked with the CIA on mind control experiments. Moreover, as Frank's book opens, we find him attempting "to convert a homosexual man to heterosexual preferences through brain stimulation," having wired electrodes into the patient's brain's "pleasure center" and hired a female prostitute to effect the conversion. Heath's "brain pacemaker," as he called the electrode device, was applied to dozens of other patients suffering from schizophrenia and depression, a seemingly brutal application save that other remedies were more invasive electroshock treatments and lobotomies. It turns out, writes the author, that although Heath is forgotten or discredited today, he was on to something: what is called "deep brain stimulation" is at the forefront of psychological studies today, with uses that include treating PTSD and traumatic brain injury. Arriving at this conclusion took decades of work in neuroscience, including the ability to study MRI scans of neural centers, among them "brain regions involved with our motivation, our experience of fear, our learning abilities and memory, libido, regulation of sleep, appetite"—in short, activities of interest to industry and government as well as science. Heath's work may then have application after all, writes Frank, even if one psychiatric technician allows along the way that "maybe he shouldn't have done that experiment."A thoughtful, always interesting look into the workings of the mind—and the sometimes-surprising implications of how those workings have been revealed.

Kirkus Review