A Dark Forgotten Past, and Why it Needs to be Remembered

A dark period from the past of psychiatry risks being forgotten, we can't allow that to happen.

Psychiatry has a black spot. A fascinating, controversial and darkly disturbing chapter. A window of time that began in the 1970's with the creation of a hitherto practically unknown psychological disorder, colloquially known as split personality disorder and ended in the 1990's amid a moral panic of epic proportions, involving hundreds of families torn apart by claims of satanic cults that were later refuted. The claims were based on memories implanted in children by psychiatrists using a combination of hypnosis, psychoactive drugs and leading questions. The spate of multiple personality disorder diagnoses and satanic cult claims dissipated almost as quickly as they had begun as patients successfully sued their psychiatrists in the mid 1990's and the position of the media transitioned from frenzied endorsement to skepticism. That's the traditional telling of the story. But did that time really end? That is a question that is now being asked.


In 1973, multiple personality disorder as it was then known, was thrust into public consciousness with the publication of the book Sybil, that went on to sell six million copies and three years later became a feature film. The book and film was based on Shirley Mason, a woman who presented to her psychiatrist, Dr. Cornelia Wilbur with sixteen distinct personalities, which emerged in sessions in which she was given hypnotic drugs such as the infamous Sodium Pentothal, then described as a "truth serum". It is worth reflecting on the fact that this is the same "truth serum" that declassified documents show the CIA has long been interested in for the purposes of interrogation and has been advocated for in the same breath as calls for torture. A short documentary (below) by the New York Times asks the question: "how did a rarely diagnosed psychological disorder turn into a cultural phenomena?" Before Sybil, only 100 cases of multiple personality disorder had ever been reported in the psychological literature. Less than a decade later in 1980, the American Psychiatric Association officially recognized the disorder and the cases rapidly soared into the 1000's. Psychiatrists conducted therapy sessions under hypnotic drugs in which leading questions led to hysterical claims of satanic ritual abuse emerging from patients who before entering therapy had no recollection of the events. Many later recognized the stories they had been led to believe were true, were in fact false, while many of the claims were so implausible that in hindsight it is difficult to understand how anyone ever believed them in the first place.

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Yale scientists restore brain function to 32 clinically dead pigs

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Still from John Stephenson's 1999 rendition of Animal Farm.
Surprising Science
  • Researchers at the Yale School of Medicine successfully restored some functions to pig brains that had been dead for hours.
  • They hope the technology will advance our understanding of the brain, potentially developing new treatments for debilitating diseases and disorders.
  • The research raises many ethical questions and puts to the test our current understanding of death.

The image of an undead brain coming back to live again is the stuff of science fiction. Not just any science fiction, specifically B-grade sci fi. What instantly springs to mind is the black-and-white horrors of films like Fiend Without a Face. Bad acting. Plastic monstrosities. Visible strings. And a spinal cord that, for some reason, is also a tentacle?

But like any good science fiction, it's only a matter of time before some manner of it seeps into our reality. This week's Nature published the findings of researchers who managed to restore function to pigs' brains that were clinically dead. At least, what we once thought of as dead.

What's dead may never die, it seems

The researchers did not hail from House Greyjoy — "What is dead may never die" — but came largely from the Yale School of Medicine. They connected 32 pig brains to a system called BrainEx. BrainEx is an artificial perfusion system — that is, a system that takes over the functions normally regulated by the organ. The pigs had been killed four hours earlier at a U.S. Department of Agriculture slaughterhouse; their brains completely removed from the skulls.

BrainEx pumped an experiment solution into the brain that essentially mimic blood flow. It brought oxygen and nutrients to the tissues, giving brain cells the resources to begin many normal functions. The cells began consuming and metabolizing sugars. The brains' immune systems kicked in. Neuron samples could carry an electrical signal. Some brain cells even responded to drugs.

The researchers have managed to keep some brains alive for up to 36 hours, and currently do not know if BrainEx can have sustained the brains longer. "It is conceivable we are just preventing the inevitable, and the brain won't be able to recover," said Nenad Sestan, Yale neuroscientist and the lead researcher.

As a control, other brains received either a fake solution or no solution at all. None revived brain activity and deteriorated as normal.

The researchers hope the technology can enhance our ability to study the brain and its cellular functions. One of the main avenues of such studies would be brain disorders and diseases. This could point the way to developing new of treatments for the likes of brain injuries, Alzheimer's, Huntington's, and neurodegenerative conditions.

"This is an extraordinary and very promising breakthrough for neuroscience. It immediately offers a much better model for studying the human brain, which is extraordinarily important, given the vast amount of human suffering from diseases of the mind [and] brain," Nita Farahany, the bioethicists at the Duke University School of Law who wrote the study's commentary, told National Geographic.

An ethical gray matter

Before anyone gets an Island of Dr. Moreau vibe, it's worth noting that the brains did not approach neural activity anywhere near consciousness.

The BrainEx solution contained chemicals that prevented neurons from firing. To be extra cautious, the researchers also monitored the brains for any such activity and were prepared to administer an anesthetic should they have seen signs of consciousness.

Even so, the research signals a massive debate to come regarding medical ethics and our definition of death.

Most countries define death, clinically speaking, as the irreversible loss of brain or circulatory function. This definition was already at odds with some folk- and value-centric understandings, but where do we go if it becomes possible to reverse clinical death with artificial perfusion?

"This is wild," Jonathan Moreno, a bioethicist at the University of Pennsylvania, told the New York Times. "If ever there was an issue that merited big public deliberation on the ethics of science and medicine, this is one."

One possible consequence involves organ donations. Some European countries require emergency responders to use a process that preserves organs when they cannot resuscitate a person. They continue to pump blood throughout the body, but use a "thoracic aortic occlusion balloon" to prevent that blood from reaching the brain.

The system is already controversial because it raises concerns about what caused the patient's death. But what happens when brain death becomes readily reversible? Stuart Younger, a bioethicist at Case Western Reserve University, told Nature that if BrainEx were to become widely available, it could shrink the pool of eligible donors.

"There's a potential conflict here between the interests of potential donors — who might not even be donors — and people who are waiting for organs," he said.

It will be a while before such experiments go anywhere near human subjects. A more immediate ethical question relates to how such experiments harm animal subjects.

Ethical review boards evaluate research protocols and can reject any that causes undue pain, suffering, or distress. Since dead animals feel no pain, suffer no trauma, they are typically approved as subjects. But how do such boards make a judgement regarding the suffering of a "cellularly active" brain? The distress of a partially alive brain?

The dilemma is unprecedented.

Setting new boundaries

Another science fiction story that comes to mind when discussing this story is, of course, Frankenstein. As Farahany told National Geographic: "It is definitely has [sic] a good science-fiction element to it, and it is restoring cellular function where we previously thought impossible. But to have Frankenstein, you need some degree of consciousness, some 'there' there. [The researchers] did not recover any form of consciousness in this study, and it is still unclear if we ever could. But we are one step closer to that possibility."

She's right. The researchers undertook their research for the betterment of humanity, and we may one day reap some unimaginable medical benefits from it. The ethical questions, however, remain as unsettling as the stories they remind us of.

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