Biology 103
2002 First Paper
On Serendip

Are you unable to deal with life's little miseries? Feeling stressed? Lethargic? Depressed? You could take a vacation. Or you could try meditation. Or yoga. Or you could try to achieve a permanent high by drilling a hole into your skull. Trepanation, or the drilling of a hole in the skull, is one of the oldest surgical procedures, some trepanned skulls even dating back to 3000 B.C. The oldest skulls have been found in the Danube Basin, but trepanned skulls have been found in virtually every country, even in America, with the highest concentration found in Peru and Bolivia (1). The word trepanation is derived from the Greek, meaning "auger or borer". More specifically, trepanation means "an opening made by a circular saw of any type" (1). Trepanation has been performed over the centuries for various reasons, including a means to liberate the demons or spirits from the heads possessed. Trepanation was also performed for therapeutic reasons, such as for epilepsy, headaches, infections, insanity, and a whole range of maladies. A third reason for trepanning is religious, where the rondelles, or disks of bone from the skulls, were collected and used for charms and talismans which were believed to have power to protect the wearer from illness and accidents. Nowadays the procedure is believed to help the individual expand his or her consciousness, and initiate a spiritual awakening that leaves the trepanned individual forever changed. Devotees of trepanation swear that a hole in their head gives them greater energy, improved concentration and mental capacity, elimination of stress-related diseases, and relief from other ailments that "come packaged with adulthood," leaving them feeling like kids again (2). Can drilling a hole into your head really hold such miraculous restorative powers that cure such a host of life's ills? Are solid-skulled humans one hole away from nirvana (5)?

Those who wish to be trepanned would have difficulty finding a surgeon in the United States to perform such a procedure; in fact, none will. Trepanation is performed in America only to relieve acute pressure on the brain, usually caused by a blow to the head (3). Any legitimate medical practitioner refuses to perform or recognize trepanning as a therapeutic practice, although a few international black market neurosurgeons will do so for the right price. Doctors interested in neurosurgery are required to take five to seven years of intense training to learn the techniques that make trepanning safe, and the notion of trepanning for recreational purposes has been called "quackery," "horseshit," "pseudoscience," and "nonsense" (4). Risks of drilling a hole into the skull include meningitis, blood clots, stroke, epilepsy, and the risk of a bone fragment embedding in the brain during the drilling (7).

However, the desire for a permanent high overrides the risk factors, and those who wish to be trepanned bypass the medical community and do the procedure themselves, usually with fellow supporters standing by in case of an emergency. Almost all of the information available on the procedure is based on first-hand accounts, including a video entitled "Heartbeat in the Brain", where devotee Amanda Fielding had her whole self-trepanation carefully recorded. Ms. Fielding wears old clothes and tapes sunglasses to her face so the blood will not impair her vision as she works. She starts by shaving her head and applying a local anesthetic to the spot to be trepanned, the ideal location being where the skull sutures have ossified, as there is less of a chance there is a blood vessel in that area. An incision is made with a scalpel, and then she starts in with the electric drill (6). In order to have the therapeutic effect, the hole needs to have between a one-quarter and one-half inch diameter. As soon as the skull is penetrated, the bleeding is prodigious. The skull piece is removed, the mess is cleaned, and the hole is bandaged. As the wound heals, skin grows over it, leaving behind a small indentation (7).

The miraculous restorative powers of trepanation has its origin in an alleged mechanism called "brainbloodvolume," coined by the founder of modern trepanning, Bart Hughes, a Dutch librarian. Mr. Hughes was almost a Dr. Bart Hughes, but was thrown out of medical school in Amsterdam in the 1960s because he failed part of his medical exams and because of his advocacy for marijuana use. While in Ibiza, Mr. Hughes was taught that standing on his head for extended periods of time would get him intoxicated, and at a later date, after ingesting the drug mescaline, the mechanism of brainbloodvolume became clear to him. "[I realized] that it was the increase of brainblood that gave the expanded consciousness. An improvement of function must have been caused by more blood in the brain which meant there must have been less of something else. Then I realized that it must be the volume of cerebrospinal fluid was decreased" (8). Mr. Hughes believes that gravity and age rob an individual of his or her creativity and energy that was once possessed during childhood. Babies have high brainbloodvolume because the soft spot (the fontanel) on the head gives the brain room to pulse. As the babies grow, the soft spot hardens and the brain does not have the room to expand. The hardening of the skull, combined with gravity, saps the blood from the head, making the brainbloodvolume plummet (2). Trepanation supposedly reverses the blood loss by expanding the blood vessels in the brain, allowing them to supply more oxygen and glucose to brain tissue as well as speedily remove toxins (7).

Given the circumstances and conditions in which the mechanism of brainbloodvolume was conceived, could it hold merit? Two researchers at the U.S. Health Service conducted a study on cerebral circulation, and concluded that the mechanism is far too complex to understand at the present time. However, they also made two tentative conclusions: the first, that the necessary level of cerebral circulation is maintained by uninterrupted fluctuations of cerebral spinal fluid (CFS), and the second, the limits of the speed of CSF volume fluctuations by the physical and neural characteristics of the brain are fundamental to the protection of the central nervous system from mechanical injury due to fast and unexpected shocks (9). The two tentative conclusions indicate that "the mechanisms of cerebral circulation are maintained by a complex and delicate balance that, far from deficient, can only operate if left unaltered" (7).

Along with the two researchers, other well-respected medical practitioners have vehemently opposed trepanation. They state that brain flow, not brain volume, is related to brain function, and there is no evidence that drilling a hole into the skull will increase blood flow to the brain. Furthermore, since trepanation only affects the skull, nothing they are doing will affect the brain. That is, trepanners do not touch the dura, the compartment that has cerebrospinal fluid in it, so the changes they are claiming to happen cannot be anatomically possible. Rather, doctors and scientists believe that the experienced benefits of the procedure are most likely due to the placebo effect. While dozens of people around the world are being trepanned, it is safe to say that trepanation will not become a trend in today's society; rather, it will appeal only to the radical portion of the population. As the fields of medicine and psychology learn from their past mistakes, medical procedures of the past are abandoned and believed to be better off forgotten. The primitives do not always know best. Perhaps the holes in the heads might really make trepanned individuals feel good after all - just not for the reasons they believe.

References

1)Trephination, an Ancient Surgery

2)You Need it Like...A Hole in the Head, by Michael Colton

3)Brief History of Trepanation, from the International Trepanation Advocacy Group website

4)Cutting the Cranium, by Willow Lawson

5)The Hole Story, by Jon Bowen

6)The People With Holes in Their Heads, by John Mitchell

7)The Therapeutic Benefits of Trepanation - Try to Have an Open Mind, by Daniel Witt

8)The Hole to Luck, interview with self-trepanner Bart Hughes

9)Hemodynamics of Cerebral Circulation, by Yu Moskalenko and A. Naumenko from the International Trepanation Advocacy Group website


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