IT鈥橲 like a scene from a classic horror movie. A man sits with his back to the camera, wires flowing from his scalp to an array of electrical equipment. The only noise is a rumbling, industrial sound. 鈥淟isten to this,鈥� says another man in a white lab coat, who bears a passing resemblance to movie star Gregory Peck. 鈥淚t sounds like a plane with its engines misfiring. This is the sound of a sick brain.鈥�
It is 1958 and TV network CBS has descended on Tulane University in New Orleans to broadcast about an experimental treatment for mental illness. Robert Heath, the man in the white coat, is the university鈥檚 chief of neurology and psychiatry, and he is explaining how he treats schizophrenia by implanting electrodes deep in people鈥檚 brains. He uses these to stimulate regions that display abnormal electrical activity 鈥� at the same time, inducing therapeutic pleasure.
This is Heath at the top of his game. He has no idea that 15 years later he will become a scientific pariah accused of conducting exploitative 鈥淣azi experiments鈥�; nor that, today, when deep-brain stimulation (DBS) for treating mental conditions is a hot research area, his contribution will have been swept under the rug. Unfairly, in my view.
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After combing through archive documents and footage, and interviewing former colleagues and a patient of Heath鈥檚, I realised that this pioneer of DBS deserves to be remembered as both ahead of his time and a flawed product of it.
Heath鈥檚 ascension began in 1949. Tulane University was recruiting visionary scientists in an attempt to become 鈥渢he Harvard of the South鈥�. Psychiatrist Heath, 34 at the time, fit the bill. His passion was schizophrenia 鈥� 鈥渢hat most devastating disease in all of medicine鈥� 鈥� and he wanted to try a radical approach.
If putting electrodes in people鈥檚 brains sounds excessively radical, bear in mind that this was before drugs to treat schizophrenia became available. Alternatives included institutionalisation, and infection with malaria as a 鈥渇ever treatment鈥�, which could prove fatal. It was also the heyday of lobotomy. Heath had evaluated people who had been lobotomised as a treatment for schizophrenia, and concluded that this process of destroying connections in the brain鈥檚 frontal cortex did precious little to help, and often caused debilitating, irreversible side effects.
Schizophrenia鈥檚 core issue, he thought, was anhedonia 鈥� the inability to experience pleasure and positive emotion 鈥� which would mean that the structures deep in the brain that give rise to emotions were central to the disease. His idea was to induce pleasure by electrically stimulating these structures, lifting patients from their mental isolation and making them amenable to therapy.
Heath鈥檚 target was the septum, thought at the time to be part of the brain鈥檚 pleasure system. He was onto something: the septum encompasses what is now known as the nucleus accumbens, a key node in our reward circuitry.
After experiments in cats, Heath鈥檚 Tulane team moved to trials in people with schizophrenia who, along with their families, were willing to consider bold alternatives to the standard options. The team put septal electrodes in 20 people. They had 1-hour treatment sessions every week in the lab, some for months, and according to Heath鈥檚 1954 monograph Studies in Schizophrenia, nearly half saw improved symptoms in the year-long follow-up. But the surgery to place the electrodes proved risky: three patients had seizures. Worse, there were two cases of infection and one patient died as a result.
Heath would ultimately conclude that the stimulation had no permanent benefit in people with schizophrenia. But by then, with a new, safer and more precise technique for electrode placement, he had reliably observed that stimulating the septum produced a pleasurable feeling. So he widened his experiments to include people with other diagnoses, including clinical depression.
While treating patients, his team began to map the brain circuits thought at the time to underlie their conditions. Heath stimulated the brain structures under scrutiny and the patient related the experience: pleasure, discomfort, anxiety, sudden recollections.
Archive footage of patient A-10 illustrates the collaborative tone of these sessions. Discharged from the army with paranoid schizophrenia, he had problems with uncontrollable rage. Asked by Heath to recall an episode, irregular activity was picked up by electrodes placed in his hippocampus. Then electrode stimulation of the same spot made the calm man immediately fly into a rage, shouting: 鈥淚 feel fierce! I鈥檒l kill you, doctor!鈥� As hard as such a moment is to watch, it stands in contrast to the calm conversation that follows, in which A-10 explains his stimulation experience to Heath, and compares the feelings to previous incidents.
At this time, psychoanalysis was in its prime and many of Heath鈥檚 contemporaries 鈥� often not inclined towards a biological approach to mental illness 鈥� baulked at such frontier work. But it was quite a different experiment that sparked Heath鈥檚 downfall. In his 1972 paper 鈥溾��, Heath describes an attempt to use pleasure-conditioning to 鈥渃onvert鈥� a homosexual man, dubbed B-19, who complained of 鈥渁lterations to his ability to experience pleasure鈥� and was reportedly suicidal due to 鈥渉is lack of masculinity鈥�.
鈥淏-19 stimulated himself to almost overwhelming euphoria and elation鈥�
With electrodes implanted in his septum, this 24-year-old was given a self-stimulator button to press while he watched heterosexual porn movies in the lab. Heath reported that 鈥淏-19 stimulated himself to鈥� almost overwhelming euphoria and elation, and had to be disconnected, despite his vigorous protests鈥�. After several sessions, B-19 reportedly 鈥渆xpressed desire to attempt heterosexual activity鈥�. A lab-based meeting with a female prostitute 鈥� approved by a state court 鈥� was arranged. The encounter went to plan. B-19 would later report having a long-time girlfriend, but also further sex with men. While this is a fascinating case study, its scientific value is difficult to spot.
At the time, homosexuality was a psychiatric diagnosis, but the times were rapidly changing. After spotting Heath鈥檚 publication, a New Orleans magazine wrote of 鈥淣azi experiments鈥� and soon after, Heath was picketed at a psychiatry conference in the city. His funding started to dwindle and his career entered a nosedive.
Heath鈥檚 rise and fall shows how so much of science is down to personalities, and how timing is everything. Neurologist in Georgia, who introduced modern DBS treatment for depression in 2005, summed up Heath鈥檚 career this way: 鈥淵ou鈥檙e a hero, until you鈥檙e not.鈥�
Today, the oft-repeated creation story of DBS is that it was invented in the 1980s to treat Parkinson鈥檚 disease and only recently became an experimental possibility for people with treatment-resistant forms of depression, anorexia, Tourette鈥檚 syndrome and obsessive-compulsive disorder. A favoured target for several conditions is the nucleus accumbens 鈥� Heath鈥檚 septum. Indeed, it is one of two targets used last year in a aiming to alleviate anhedonia in treatment-resistant schizophrenia.
If Heath鈥檚 work is remembered at all, it is often shorn of the context of his era and he is judged by modern standards. He was controversial, undoubtedly, and in some ways a poor scientist. Nevertheless, I would argue that this sincere pioneer鈥檚 approach didn鈥檛 differ that much from those of modern DBS researchers, albeit with more basic technology.
Few contemporary practitioners know of Heath, but his echo is everywhere.
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This article appeared in print under the headline 鈥淒octor feel good鈥�
