Ancient Medical Practice Opens Minds
Doug Yovanovich

Most alternative medical practices require a certain amount of belief, will, and positive thought. Here's one that requires an open mind - literally.

From infancy, the human brain has been encased in membranes and hard mineral matter with the soft spot on top closed, for protection. According to some alternative practitioners, this shouldn't have happened - your brain needs some space to expand, contract, shift, and absorb worldly nutrients.

Trepanation, the oldest known surgical procedure in the world, is touted as a solution to the headspace problem. It's the act of drilling a hole in one's head.

By now you've had a lot drilled into your head - metaphorically, at least. Advocates of the bizarre procedure say trepanation improves blood flow around the brain and gives it an expansion window to adjust naturally to gravity, air pressure, headaches, and assorted mental strains. It's like a permanent high, says one trepanned individual - a permanent high from a raised level of consciousness that gives your brain the energy and creative capacity it had during childhood. It relieves cranial pressure and gives grey matter more nutrients in more places. Trepanation, they say, is the cure for the unstimulated adult brain. Doctors maintain it exists only as a cult phenomenon.

A Look Back
Reports of trepanation (or trephination) have been spotty throughout history, but there is little doubt of its existence dating back to neolithic times.

Trepanned skulls have been found around North America - even some in southwestern British Columbia, according to an American group that promotes research on the subject. Old medical documents have described the operation, or one similar to it, in most parts of the world. At some point or another, installing a hole in the skull was a well-known procedure in many cultures.

"Some archaeologists are convinced this was done for ceremonial or magical purposes, or some have speculated maybe for treating migraine or inter-cranial pressure," says SFU psychologist Dr. Barry Beyerstein, who is an associate editor of the journal Scientific Review Of Alternative Medicine.

"There's lots of archaeological evidence. It's quite clear that the skulls were operated on while the owner was still alive, because there is evidence of needling."

Ancient societies in Peru and Europe had the tools for it, and legends persist of shaman-surgeons drilling many a willing patient. In prehistoric Peru, doctors opened up the skull and then sealed it up again with silver plates, adding to the mystery of the operation. Having an exposed brain was viewed as risky - a prevailing wisdom - so the holes were generally not left open.

Evidence from Incan mummies' grave sites is a testament to how skilled the practitioners were. "A piece of the skull is removed, the brain examined or operated upon, and a plate fitted into the skull," read a 1950 True magazine report. "This had been performed so expertly that bone had grown up around and over some of the silver plates, proving that the Incas had not soon died." In contemporary unearthing, some mummies were poached for their cranial silver. A museum in Cuzco still features these neatly incised skulls.

Not all patients got the silver treatment. Sometimes a piece of coconut or seashell would suffice. This is the origin of the colloquial use of "coconut" to refer to one's head. In fact, the operation was perfected on coconuts before doctors attempted to scrape or drill live humans.

Trepanation was practiced in some respect or another until the 19th century, when our modern notion of germs and bacteria prevailed. By then, the risk of infection outweighed the alleged benefits, so the number of doctors willing to perform it declined. Medical historian Forcht Dagi said the mortality rate was so high from the rampant infections of contemporary hospitals that trepanation, for any reason, declined markedly until the introduction of modern antisepsis at the end of the century.

What for?
Trepanning has had three distinct purposes: physical repair of the brain, curing mental illness, and exorcising religious or spiritual issues. All of these prevail today, although the medical community only advocates the first one - consensus says the other two are quackery. An alternative movement centred on the internet continues to promote trepanation for curing mental illness and spiritual elevation.

As seen in the Incan cases, the procedure was usually for physiological operations, but aside from the inductive investigation of artifacts, little is known about why it was necessary or what was discovered under there. Historical accounts indicate that in Borabora, Tahiti, and Marquesas, medicine huts performed the operation to treat intractable headache, neuralgia, vertigo, and cranial fractures.

Modern neurosurgery has learned a lot from its checkered history.

Actor Michael J. Fox and many others with neurological disorders have had stereotactic surgeries to treat physical symptoms. In Fox's case, it was done by inserting "tiny electrodes into the control areas and actually burned out the area around the tip to reduce the activity in the hyperactive area causing the tremors," Beyerstein said. The instrument for this is still called a trephine.

Opening up the headcase is, of course, a routine procedure in modern operating rooms.

"It's done medically for some skull fractures and closed-head injuries where there's swelling of the brain. Of course, there isn't a lot of room to move in there, and if it begins to swell it can do serious damage," Beyerstein says. "Emergency rooms do the surgery on head-injury cases either to relieve either swelling or accumulated fluids that are occupying space and putting pressure. So that's perfectly valid, but there's no reason any amateur would want to have this done for any conceivable benefit."

But an alternative movement says there is a great benefit. By trepanning the skull of a healthy adult, his or her brain is allegedly relieved of routine pressure says the Trepanation Trust, a research and support group founded by Amanda Feilding, a conceptual artist who trepanned herself in 1971. The alternative logic is that the human brain loses "full pulsation" when its enclosure seals up at a young age. With a hole in the skull, the ratio of cerebrospinal fluid to blood is tilted in favour of more blood, which means more mental energy, says Feilding. She claims her operation has significantly improved her quality of life.

The operation is also believed to have a spiritual side - to get the evil demons out of one's head by giving them a way out - rooted in the same tradition as saying "bless you" when someone sneezes. A demon is thought to escape through the head. The operation was perceived as a favour from the priest caste or ruling caste to those who were possessed. All of this is soundly refuted in modern medicine.

"There's not a whit of truth," says Beyerstein, comparing the risks of puncturing the brain's outer membrane to that of a major stroke.

Trepanation is alternative because there has been no scientific basis for it, he says, noting that mainstream medicine grew out of its spiritual element in the 1800s.

"I can hardly think of a more dramatic treatment. What keeps alternative medicine going in general is the placebo effect. Very little is scientifically sound."

Nonetheless, advocates say the criticism is unjustified.

"This is a very frustrating issue and a hard one to pin down," Feilding says on her website. "Trepanation suffers from the phenomenon seen throughout history whereby new thinking generally meets with a hostile, or at very least a conservative, reaction. Added to this, you have the tendency in the so-called advanced western world to dismiss the practices of primitive cultures, and to forget that they often indulged in good, common sense."

Despite many such assertions, the Trepanation Trust does not provide any empirical data about the operation. Requests for such information went unanswered.

Art Imitates Life?
One of the most compelling analyses of trepanation is found in renaissance art. Case studies are rare, if not impossible, because of the underground nature of the craft today; and a historical analysis of artifacts says little about why people were trepanned or what neurological progress resulted.

A 16th-century painting by Hieronymous Bosch, "The Stone Operation," gives some clues about the cultural significance. It depicts a grey-haired rotund man strapped to a chair, with a practitioner making an incision and remove something from a hole in the man's skull. (See above right.)

One interpretation suggests Bosch was capturing a public ridicule of trepanation: everything it stands for, and everyone who believes in it.

For one, the surgeon sports a funnel on his head - a symbol of a gap in his knowledge. What the doctor is removing is variously interpreted as a stone or a tulip, both symbols of widespread ignorance and misinformation. The "stone operation," as interpreted in the title, is one where a medical charlatan pretends to discover and removing stones from one's head, allegedly curing mental conditions. The caption of Bosch's work has been translated as "Master, dig out the stones of folly, my name is 'castrated daschund,'" the latter phrase being another reference to a simpleton.

Another interpretation suggests trepanation didn't exist - that it was a byprod4uct of medical and spiritual folklore. The funnel is seen as a symbol of stupidity in the medical community at large - that the establishment still believed in religion and devine retribution, and its knowledge was not to be trusted. According to some art historians, the object being removed is actually a lotus, which symbolizes the spirit. That would mean that the elderly man is involuntarily tied to the chair while the medical and religious figures collude to take away his spirit.

Whether it was magic or medicine, the anecdotes and allegories surrounding this ancient practice give little conclusion, except that it did exist in some fashion. One consideration remains very unclear: why was it widely known, but not widely prescribed? If it was so well known as a treatment for simple melancholia or advanced neurological disorders, one would expect to find more than a few dozen archaeological clues. Like a lot of spiritual folklore, trepanation may have persisted through history as an urban myth, Beyerstein suggests.

"Psychologically, it would be quite damning to admit that you put yourself through all this and discover that there was no effect."

From a website that promotes the health benefits of having a hole in your skull: -www.trepanation.com

What is the point of trepanation?
Blood is the brain's food. The point of trepanation is to get more blood into the capillaries of the brain, so that metabolism is enhanced. For the rest of your life, more of the brain's centres are able to function at the same time; they are lifted from starvation rations to a more generous supply of food. To have more of your brain functioning is an advantage, both physically and mentally.

How would you describe the effects of trepanation?
At the time of the operation, I described the effect as being like the tide coming in. I thought I noticed a lifting or lightening sensation, accompanied by a silence in the head - a feeling of peacefulness or relaxation. Of course, it's very difficult to separate what is psychological (i.e. relief) from what is physiological (i.e. the effects of the small increase in capillary blood volume). I also began to notice a change in my dreams; they became less anxious, and in fact neurotic symptoms in general became less dominant.

I would say from observing myself and others close to me, before and after trepanation, that there is a definite long-term change for the better. Different people express it in different ways - some say more energy, some say more relaxation or less neurosis. I would claim it to be a combination of both. Hopefully, in the not-too-distant future, we will be able to look to scientific data for a more objective analysis of the difference trepanation makes.

How soon after the operation do you notice its effects?
In my experience, there were two stages of effect: the immediate and the long-term. The immediate change felt like being lifted on the tide. Over the next four hours I noticed myself getting slowly higher, combined with a silence in my head, a stopping of the compulsive voice. In the longer term though, I noticed other effects - a loosening up of the personality, a relaxation, as well as an increase in energy and buoyancy.

Is the operation completely safe? Could you talk me through it?
It's important from the outset to make a distinction between trepanation and self-trepanation. The risks associated with self-trepanation are too obvious to need mentioning. Indeed, it is something the Trust would never recommend. As long as a person is trepanned by a qualified, competent surgeon, however, then the answer to your question is "yes - very safe." In fact, trepanation is safer than many of other surgeries. For example, a local anaesthetic around the area to be drilled is all that is required. So, as there's no need for a general anaesthetic -that's one less thing to worry about. And comparing trepanation to other "non-essential" operations, it involves far fewer risks than, say, cosmetic surgery. It's vital to realise that trepanation is not neurosurgery. It is simply the removal of a small piece of bone and is something that physicians do all the time in order to access the brain for subsequent exploration or surgery. The hole is bored using a purpose-built drill which has a "snaplock" that effectively turns the drill off, kicking in the moment the surgeon is through the skull bone. This completely rules out any chance of accidental damage to the meninges (the three layers of membrane surrounding the brain).

Doesn't the hole close over with time? Surely the hole makes your skull somewhat weaker?
The majority view in the medical profession is that skull bone, uniquely in the human body, does not grow back. What is certain is that some scar tissue will form on the freshly cut surfaces of the skull, thereby thickening up the edges of the hole, but not closing it. The amount of scar tissue formed, however, and the degree to which it obstructs the hole is something that needs to be investigated. In general terms, a solid object without a hole in it will be stronger than one with. However, bearing in mind how small the hole is (7-9 mm) and how thick skull bone is, it's hard to imagine how the skull's structural soundness could suffer in any meaningful way. I'm sometimes asked if I'd be frightened of walking through a jungle and being spiked by a thorn. The answer is, "not at all." However, if you were unlucky enough to be stabbed in the head with a long pointed object right on the spot of the trepanation, then yes, the hole would make a difference. Otherwise, it wouldn't.

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