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November 12, 1973

Brain Surgery in Aggressive EpilepticsSocial and Ethical Implications

Author Affiliations

From the departments of surgery, Harvard Medical School, and neurosurgery, Boston City Hospital (Dr. Mark), and the State University of New York at Purchase and the Department of Behavior Sciences, Institute of Society, Ethics and the Life Sciences, Hastings-on-Hudson, New York (Dr. Neville).

JAMA. 1973;226(7):765-772. doi:10.1001/jama.1973.03230070029007

A little over two years ago, Frank Ervin, a psychiatrist, and one of us (V.H.M.), a neurosurgeon, wrote a book called Violence and the Brain,1 detailing the application of the techniques of neurosurgery to problems of violent behavior. (This book focused on the role and relation of brain abnormalities to abnormal behavior. Surgical examples were part of the exposition.) The public response to that book underscores with great vividness the fact that the medical issues of neurosurgery are no more interesting or vital than the issues of neurosurgery's social role.2-8 We would like to offer some reflections about those social issues.

The most important problem, from the standpoint of the sciences of human behavior, is an unfortunate dichotomy in basic approaches to behavior. Certain kinds of behavior, for instance, paralysis, blindness, and dementia, were put into the province of organic neurology. Physicians working in this field have been