Trepanation: A most extreme form of quackery
April 22nd, 2010
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If there’s anything that can be said in favor of this idiotic procedure, it’s that at least it usually tends to be self-inflicted by those who actively seek it and is not normally something that quacks convince people, who would otherwise not do such an act, to do. However, this is not always the case. In 2000, at least two men were arrested in Utah for practicing medicine without a license after preforming trepanations on several individuals. The practitioners claimed that they could provide relief for a variety of conditions ranging from depression to addictions. There is, of course, no scientific evidence of this being the case.
Warning: The following video contains some slightly graphic scenes of an actual medical trepanation. It’s only brief and relatively clinical, but if you’re really squeamish you may not want to watch. However, the second of the two videos is not graphic at all.
There are a number of individuals and organizations that push the procedure and advocate the benefits of trepanation. One of the most vocal is Bart Hughes, who, despite often being called one, is not a doctor at all. As recently as this year, Hughes has been publishing various articles and press releases claiming that the procedure has numerous benefits and can enhance human consciousness. There is even an international trepanation advocacy group.
It is true that trepanation has a long history in both Western culture and other places in the world. That said, “Well doctors in the middle ages did it,” is generally not recognized as a means of validating as good medicine. Whether or not it ever had any therapeutic value is, at best, questionable, although few medical procedures of centuries past did. Skulls with apparently intentionally created holes have been found in Asia, Europe and the Americas. A few show signs of healing, indicating that not only was the hole created on purpose, but that the individual survived the procedure.
It is a fallacy to presume that there must be some special significance to a custom that was independently developed in multiple cultures. In the case of trepanation there are examples of the practice from around the world, and some have used this as evidence that various societies must have discovered the effectiveness of the procedure. There is, however, a simpler explanation. Headaches are a common complaint in humans and have a number of causes. They can range from irritating to nearly debilitating. An individual suffering from persistent or severe headaches may feel as if there is pressure inside their head that must be relieved or that there was some need to release bad energy or spirits from their head. Lacking an understanding of medicine and the human body, it’s easy to see how putting a hole in the skull might seem like the logical thing to do.
In modern times, trepanation does continue to be used as a valid medical procedure, though not because it is therapeutic in and of itself. The act of cutting or drilling a hole into the skull is used as a means of gaining access to the brain for surgery or to repair severe skull fractures, where damaged portions of bone need to be removed. It may also be necessary when treating Epidural hematoma, as a means of alleviating blood pooling.
In most cases the bone is replaced. If it cannot be, because the bone is damaged or because the area need to be operated on further, measures are taken to provide protection. Bone is replaced when possible and occasionally replace with a prosthetic. Restoration of the removed area is known as a cranioplasty.
It should be stressed that while it is occasionally necessary to open the skull, modern medicine does not recognize any benefit from an otherwise healthy person walking around with a gaping hole in their cranium. Operations which would lead to such a condition are only employed when absolutely necessary.
The purported benefits from this procedure are based on a complete lack of understanding of anatomy and the function of the brain. Putting a hole into ones skull does not in any way shape or form increase blood flow to the brain or the volume of blood in the brain. The human brain does not receive its blood supply from the scalp. It has its own dedicated blood vessels. The amount of blood which flows through the small capillaries in the scalp tissue is comparatively small, and making a hole in the skull is not going to cause any new blood vessels to form.
Increasing the “volume of blood in the brain” is not necessarily a good thing. Having blood pool in one area can be very dangerous. The blood vessels of the brain do a good job in keeping blood constantly flowing both into and out of the brain, constantly keeping it nourished and oxygenated. There’s no reason to fool with this unless there is a major problem to begin with.
While the brain sure as hell is not going to be sucking any oxygen in through a hole in the head, the hole and the act of making it can have extremely severe and potentially fatal complications. A few of these include: going in too far and causing a debilitating or deadly brain injury, causing a blood clot or other damage that could lead to a stroke or other severe or fatal complications and infection of the brain or the lining of the brain (brain infections can be very serious), bleeding and leaving fragments of bone in the brain.
Even if the procedure goes off without a hitch, simply having the hole puts a person in grave danger of a brain injury from a simple bump on the head or other trauma that would otherwise be very minor to anyone with an intact skull.
Finally, I think it’s quite funny to hear proponents of this ridiculous procedure state that it brings you to a higher state of consciousness in the same way that smoking hash or using LSD does (although apparently not as effectively.) Hashish (which is just a concentrated form of marijuana) does not increase a person’s awareness, cognitive function, perception of their environment or any other mental faculties. It actually impairs them, often significantly. The experience may be pleasurable, but if you think you’re smarter when you’re high, then it’s just because, well, you’re high, and thus can’t judge your own intelligence very well.
LSD also doesn’t actually “expand” the mind. What it does is cause regions of the brain to communicate in a manner that causes confusion between internal and external stimuli of various types. The response varies widely from person to person, but it often includes a cognitive shift with dream-like states of hallucination and apparent sensory confusion. The condition can be similar to severe psychosis. It may help with writing really trippy songs, but it does not actually make you smarter or understand things better. Again, it only seems like that.
(Seriously, if you don’t believe me, try being the only person who is stone cold sober in a group of people using the above substances. It does not improve their mental capacity, no matter how much they insist it does.)
This entry was posted on Thursday, April 22nd, 2010 at 4:15 pm and is filed under Bad Science, Culture, History, Just LAME, Not Even Wrong, Quackery, media. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.
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April 22nd, 2010 at 5:18 pm
Having suffered 5-alarm migraines at various time of my life, I can tell you for sure that in an ancient culture, had someone said that these would end by punching a hole in my skull, I would both believe them and beg for the procedure.
It is only because I know it would not help that I haven’t done it to myself on those occasions when I am having an episode. The feeling that it might offer some relief is very strong. But then so is the urge to gouge both my eyes out as well.
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April 22nd, 2010 at 5:22 pm
And indeed, recreational drugs do not enhance the mind in any of the intellectual domains.
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April 22nd, 2010 at 5:30 pm
DV82XL said:
That sounds like a logical explanation for why the practice might come to be in multiple societies with no contact. I assume that all cultures and races are to one degree or another familiar with headaches, migraine or otherwise. So presumably some portion of the population of Europe, Asia, Africa and the Americas did, from time to time have extreme head pain.
I’m lucky enough to not suffer from headaches. However, do you believe that if you had no knowledge of medicine, that a severe headache might give you the feeling that something inside your head might need to be let out or that pressure inside the head to be released? I could see how the feeling that the pain is **inside** the head might make someone want to somehow let it out. Also, when someone has an ache or pain in their body its a tendency to try to rub or massage it, but your skull is in the way, so maybe there was a desire to somehow get at it like that?
Is it reasonable to hypothesize that a headache might make someone think “I just want to open up my skull and let this pressure/tension/pain out!”
If that is a natural reaction then one would expect that this operation would be a direct result of that kind of feeling, even across cultures and continents.
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April 22nd, 2010 at 7:55 pm
Yeah, it’s one of those things I could see independently coming to many societies because I’ve had headaches where it feels like my brain is pushing out on my skull and I want to crack my skull open to give it more room. Of course, that’s not really going to work because that’s not what causes the pain, but it does feel somewhat like that.
Yeah, this is an insane thing to do to oneself and it’s amazing most seem to even get away with it and not kill themselves. It’s so dumb it’s beyond words. How anyone could think this gives their brain more blood is beyond me.
I also agree with you that this guy is nuts for thinking that hashish and lsd somehow bring you to a higher level of consciousness or make you more aware. I’ve personally got nothing against people using drugs recreational as long as they don’t go drive or harm anyone else. However, it’s ridiculous to think that being high increases your mental abilities. It may very well seem that way, especially with LSD, but if you think being stoned is a higher level of mental ability then you’ve probably been smoking too much.
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April 22nd, 2010 at 10:48 pm
I need trepanation like I need a hole in my head!
(Sorry. Someone had to say it.)
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April 22nd, 2010 at 11:14 pm
I can’t believe people can be so stupid.
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April 23rd, 2010 at 11:14 am
DV82XL said:
Ecstasy or other amphetamines speed up your processing and can give you greater abilities. For example I have been able to lip read and have verified from the people on whom I was “eavesdropping” the accuracy of what I had lip read. I have also been able to solve mathematical problems that had lain outside my grasp in the non-drugged state and upon examination of the solution in a sober state found them to be true.
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April 23rd, 2010 at 11:57 am
Strictly speaking, trepanation *is* therapeutic in cases where the intention is to relieve swelling. In those cases, some portion of the skull is removed surgically, and no other surgery is performed except closing the scalp back up or draining of pooled blood. It’s not being done solely to provide surgical access. If the brain is swelling, it will run out of room and do itself damage — with a swollen brain, it is not so much the swelling as the compression that causes harm. And as in the case you site above, the skull is always repaired afterwards.
Swelling can quickly go from harmless to lethal when the brain is involved; trepanation, sometimes performed with improved instruments in emergency situations, has saved the lives of several people with closed-head injuries.
This is, of course, completely different from the trepanation practiced by the whacko brigade, some of whom particularly endorse the terrifying prospect of “self-trepanation”. There are instructions available on the Internet, I’m told. I haven’t quite had the stomach to check. Some talk about allowing the “third eye” to see (having picked up a bit of Oriental mysticism); others talk about letting the brain “breathe” (whatever that means). Most seem unable to really explain why they think it’s a good idea, or at least a better idea than other options — they seem to think it’s self-evident. I think a fair number are not entirely right in the head.
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April 23rd, 2010 at 12:35 pm
Calli Arcale said:
Yeah, maybe I should have said it differently. It’s not that they believe that having a hole in the skull is actually something that is considered to be good in normal circumstances or have any overall health benefits. It’s done because of an acute condition (swelling) for which there is no other option. It’s also recognized that it’s not a good long term condition to be in. If possible the skull is closed back up as soon as the swelling subsides. If this can’t be done right away then they will return to close it by transplanting bone or using a prosthetic or something.
mike said:
I’m not sure I can agree on ecstasy. I’ve never used it, but I’ve been around many who have. It may very well heighten alertness, but it also is known to cause some really bad issues relating to judgment and inhibition. Those on it are pretty easy to take advantage of or get to do things they ought to know better than doing.
There is really no doubt that stimulants can increase alertness, concentration, focus and generally increase abilities mentally. It’s temporary, though. The disadvantages come with longer term use and resulting dangers of dependence, overdoses, crashing after the fact and so on. If used heavily enough, especially without sleep they definitely can also cause psychosis-like conditions.
That’s a lot different than pot or lsd though, in so far as what kind of effect the user gets. It’s not a disconnection from reality so much as it is being perked up, sometimes to an extreme extent.
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April 24th, 2010 at 12:03 am
drbuzz0,
I agree wholeheartedly on the dangers and long term consequences of drug use, especially the hard drugs.
I am certainly not advocating their use as a substitute for doing one’s math homework. ;~)
Also there is indeed a definite discrepancy between a drugged person’s perception of their abilities and reality.
Upon reflection I’m sorry that my post was off topic re: trepanation.
Cheers
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April 24th, 2010 at 8:28 am
There is some evidence from ancient Maya graveyards that trepanation was performed often, with decent chances of success, and probably for good reasons: To relieve the swelling of the brain caused by blunt trauma. As the weapons of these people often relied on impact, like clubs and slings, such injuries were commonplace. So the practice may very well have made sense back then.
Satan_Klaus
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April 24th, 2010 at 8:44 am
Satan_Klaus said:
It is indeed possible that at the time it had benefits if it was something where they were dealing with trauma to the head. Still, the fact that they left the hole there, where as today it would be closed soon after the swelling subsided, is less than optimal. Of course, at the time, they had no way of preforming a cranioplasty. Making a prosthetic skull inert was certainly beyond the technology of the day. Leaving the hole there would be an unfortunate side effect.
The fact that this procedure has value when there is acute swelling or if blood is pooling, of course, says nothing of its effects on an otherwise healthy person to expand the mine or something like that.
mike said:
I don’t mind and it’s worth the discussion. It’s not off topic either. You’re right that there are some drugs that can increase alertness, but I found it funny that the pro-trepanation advocates seem to believe that something like marijuana brings you to a higher plain of existence or expands your consciousness. They even compare the procedure (and use of pot or lsd) to voluntary evolution to a higher level of development.
Bull****, I say! THC might make you feel good, it might make calm you down, make you laugh, make you enjoy certain music more, help you sleep, help give apatite to those who are suffering from nausea and generally work pretty well as a social or recreational drug. It does not, however, bring you to a higher state of consciousness or make you a more developed or aware being.
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April 24th, 2010 at 9:06 am
mike said:
Yeah, stimulant drugs can make your mind more perked up and more alert and capable for a while, which is not really what these guys are talking about. THey seem to think a hole in the head makes you a deeper or higher being or some kind of more wise, more spiritual kind of a thinker or something.
I think you could compare powerful amphetamines or some drug liken those to overclocking your brain. It gives you more speed and more raw power for the time being. However, the trade-off is stability and reliability and also wear and tear. An overclocked processor is a lot faster, but it can be prone to instability and also, it can just burn itself out.
Satan_Klaus said:
Sure, it probably did have some benefits for some narrow situations. Maybe they started doing it for whatever reason (let bad spirits out or something) and realized that for those with blunt trauma to the head that, hey, it seems like they actually do have better odds of surviving with this.
Some ancient medical procedures did have value some of the time. That still doesn’t make them good by modern standards. Carving a crudely shaped hole in the head with a stone tool and then leaving the bone with a gaping hole for the person to live with for the rest of their life is still very crude and ineffective compared to neurosurgery today.
BTW: As to why it evolved in different cultures. I think buzz’s hypothesis of people feeling like pressure inside their head needed to come out is a sound one. It could also be that swelling from head trauma was seen as being relieved by this. It could also be that multiple cultures came up with the idea of spirits being trapped in the head.
Any ways, it just goes to show that you can explain this arising multiple times with a mundane explanation and not need to resort to everyone figuring out that it made them smarter or something.
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April 24th, 2010 at 2:37 pm
It is possible that trepanation was practiced as a form of intensive care for blunt trauma by the South American natives; but I somehow doubt it. These are largely the same cultures that practised human sacrifice and skull shaping; wrapping the skull of infants in such a way as to cause a permanent deformation of the skull.
http://en.wikipedia.org/wiki/File:Head_Shaping.jpg
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April 25th, 2010 at 6:47 pm
Well then, if neither trepanation or drugs can increase awareness, cognitive function, or other mental abilities, then what procedures or substances can? An inquiring mind wants to know.
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April 25th, 2010 at 6:54 pm
Lucario said:
Education
Reading
Experiencing new things including, but not limited to – travel, meeting new people, experiencing different cultures, engaging in intellectual discussions
Developing your own tallent, interests or hobbies (whether they be artistic, musical or even learning to repair cars or fly airplanes or whatever)
Thinking and taking time to think (yeah I realize everyone thinks constantly, but too few appreciate it and actually make an effort to do so)
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April 26th, 2010 at 11:51 am
soylent said:
I’m inclined to agree. Absent evidence that they used it specifically to treat cerebral swelling, I see no reason to expect they did it for actual therapeutic effects. Then again, they did have better anatomical knowledge than a lot of other groups of comparable technological level, as evidenced by the efficient method of heart-removal which was developed. (It takes a fairly detailed understanding of anatomy to realize that the fastest route is actually through the abdomen, not the chest. Then again, the Vikings had this sort of gruesome first-hand understanding and yet never attempted trauma surgery, to our knowledge.) Also, it’s out of character for their understanding of death. Dying in battle was noble; I don’t think they spent a lot of time figuring out how to not die in battle, besides killing the other guy before he can get a whack at you.
Trepanation was also practiced in the Middle Ages, but there we have a reason actually documented: releasing evil spirits.
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July 19th, 2010 at 1:57 pm
“…that would have worked if you hadn’t stopped me!” — Egon, in “Ghostbusters.”
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