The Pleasure Shock: The Rise of Deep Brain Stimulation and Its Forgotten Inventor

by Lone Frank

The electrifying, forgotten history of Robert Heath's brain pacemaker, investigating the origins and ethics of one of today's most promising medical breakthroughs: deep brain stimulation

The technology invented by psychiatrist Robert G. Heath in the 1950s and '60s has been described as among the most controversial experiments in US history. His work was alleged at the time to be part of MKUltra, the CIA's notorious "mind control" project. His research subjects included incarcerated convicts and gay men who wished to be "cured" of their sexual preference. Yet his cutting-edge research and legacy were quickly buried deep in Tulane University's archives. Investigative science journalist Lone Frank now tells the complete sage of this passionate, determined doctor and his groundbreaking neuroscience.

More than fifty years after Heath's experiments, this very same treatment is becoming mainstream practice in modern psychiatry for everything from schizophrenia, anorexia, and compulsive behavior to depression, Parkinson's, and even substance addiction.

Lone Frank uncovered lost documents and accounts of Heath's trailblazing work. She tracked down surviving colleagues and patients, and she delved into the current support for deep brain stimulation by scientists and patients alike. What has changed? Why do we today unquestioningly embrace this technology as a cure? How do we decide what is a disease of the brain to be cured and what should be allowed to remain unprobed and unprodded? And how do we weigh the decades of criticism against the promise of treatment that could be offered to millions of patients?

Elegantly written and deeply fascinating, The Pleasure Shock weaves together biography, scientific history, and medical ethics. It is an adventure into our ever-shifting views of the mind and the fateful power we wield when we tinker with the self.

Genres: Nonfiction, Science, Biography, Psychiatry, Medicine, Popular Science

320 pages, Hardcover

First published March 20, 2018

About the author

Lone Frank is a Danish science journalist, author and PhD in neurobiology. Since 1998 she has written for newspapers. She is also a commentator and lecturer and has worked in radio and television; including organized and participated in science series on television, talking about controversial issues such as heritability of IQ and race and intelligence. She received her master's degree in biology on a thesis about "the transcriptional regulation of glutamate receptors in cerebral ischemia" from Aarhus University in 1992.

In September 2011 her book, My Beautiful Genome: Exposing Our Genetic Future, One Quirk at a Time was released to positive reviews. The book is based on a number of genetic-based tests, which aims to clarify the biological context of human personal development. It was also released in German, Norwegian and Dutch.

(Source)

Reviews

[Desmond Brown · Rating 3 out of 5]

The subject of this book is Robert Heath, MD, a psychiatrist who spent the majority of his career at Tulane Medical School in New Orleans. During that time, from roughly 1950-1980, he was a charismatic teacher, researcher, and practitioner, best known for developing innovative methods of treating severe mental illness. The problem is that many of these methods were invasive, based on faulty scientific premises and primitive techniques, ethically dubious even by the standards of his day, and finally ineffective. But the work was certainly interesting enough and important enough to justify this book. Heath was part of the vanguard of biological psychiatrists in the 1950's, those who wanted to move past Freudian ideas and study mental health in the context of the brain and its biology and physiology.

The book had added interest for me in that I was in medical school at Tulane during the twilight of Heath's career, when his reputation was still strong, and we sometimes encountered live monkeys with their heads immobilized in stereotactic tongs in the back elevator near his lab. There are many ethically troubling scenes that are presented in passing and without analysis, possibly because they were unremarkable at the time: the use of prisoners and indigent patients as research subjects without adequate informed consent, psychiatric treatment of homosexuality, poorly designed experiments that inflicted real suffering without any reasonable hope of benefitting the patient or producing meaningful results. There is no mention of the well-documented practice of using indigent Black patients from Charity Hospital as research subjects, subjects memorably described by Heath's collaborator Harry Bailey MD as being "everywhere, and cheaper than cats." Bailey used a different term for the Black patients; he is not mentioned in this book.

Finally, I note that this is the second book in a row that I have read that involves ethically questionable behavior by physicians working at both the hospital where I did my training (Charity Hospital of New Orleans) and the hospital where I currently work (Boston Medical Center, formerly Boston City Hospital.)

[Frederik Roager Madsen · Rating 5 out of 5]

Psykiatrien og neurologien har udviklet sig massivt gennem det sidste århundrede. Der er sket et paradigmeskift for forståelsen af psykiske sygdomme. Tidligere blev de beskrevet freudiansk, hvor miljø og en traumatiserende barndom var årsagsforklaringen. I dag er der bred enighed om at ubalancer i hjernen også er en del af forklaringen. Det har ført til, at der benyttes store mængder medicin til behandling af psykiske sygdomme, samt brug af andre metoder som dyb hjernestimulation med elektroder implementeret i hjernen. Lone Frank beskriver i denne non-fiction Robert Heath som har været med under dette paradigmeskift og var med til at sætte gang i brugen af dyb hjernestimulation. Hvordan han tilsyneladende er gået for vidt i sin forskning og senere bliver så godt som glemt i historiebøgerne og af nutidige forskere. Lone frank formår at sætte denne videnskabsmand i et nyt lys ved at møde tidligere kollegaer og familie til Robert Heath. Hun formår at beskrive en mand med en stor passion for at hjælpe psykiske patienter, men også en mand som er hovedrolle for kritik i en turbulent tid indenfor psykiatrien. Sidst men ikke mindst evner Lone Frank at lave paralleller mellem den nutidige brug af dyb hjernestimulation og Robert Heaths ideer og eksperimenter.

[Jim · Rating 4 out of 5]

A fascinating portrait of both Dr. Robert Heath and the history and potential of deep brain stimulation. I had trouble putting this book down. I enjoyed how the author showed her work, describing the reporting and research, and that she called out those who stood in her way. Tulane’s reaction, in particular, was bizarre but not surprising to someone who has dealt with their public relations machine.

[Anetq · Rating 4 out of 5]

Lone Frank går som altid på jagt efter sig selv og vores selv - denne gang i den strømførende hjerne. Historien om Dr. Heath er kompleks og der er ikke nogen enkle svar på om hans forsøg med mennesker gik for vidt, om han er et misforstået geni eller måske bare en videnskabsmand hvis forskning gik imod tidens strømninger eller om han blev fældet af sine egne ambitioner.
Men Heath var først til at regne ud, at man kan påvirke det menneskelige humør ved at sætte strøm til dele af hjernen, og dermed hjælpe nogle af de mest håbløse tilfælde af psykiske sygdomme. Det lyder ikke alt sammen stuerent nu om dage - men tiden taget i betragtning, så var præcis indsætning af ledninger og små strømstyrker (på stærkt plagede folk, der vitterligt ikke havde andre muligheder) jo en relativt nænsom behandling i sammenligning med den stærkt udbredte "behandling" lobotobi.

Historien er interessant, researchen er solid og formidlingen fin - og alligevel føles bogen lidt uforløst. Måske bare fordi en klarere dom ville have været lettere?

[Wendy Capron · Rating 4 out of 5]

"If it was possible to become free of negative emotions by a riskless implementation of an electrode - without impairing intelligence and the critical mind - I would be the first patient." The Dalai Lama
I'd be second.

[Amy (amy_reads_stuff on StoryGraph) · Rating 4 out of 5]

An interesting look into the rise and fall of Robert Heath, a mostly forgotten pioneer in deep brain stimulation (my husband works in the DBS field with people who knew these people - hence how we got the book). I enjoyed the set up as a mystery - what did this man do to have been placed on a dusty back shelf by the scientific community? It generally follows this structure of unraveling the mystery, but gets a bit lost in the weeds in the middle. Though some of his approaches were and are controversial, we are still repeating many of them today, without giving him any credit for having pushed the boundaries in the past. Really quite a fascinating tale that even has ties to the mafia! I was left with some questions regarding many of the experiments, especially the taraxein. This may be due to the more casual, friendly writing style the author used rather than a more scientific approach, which I would have liked at times (I needed figures and diagrams!), but I will admit the more informal style made it an easy and quick read.

[Kay · Rating 3 out of 5]

Thank god for 8 hour shifts.
This book is full of technical science and medical research which was fascinating but a bit long winded.
Well researched on electrocution all the way up to 2013.

[Christian Jennings · Rating 3 out of 5]

Good journalistic-type storytelling (****) let down for me by incomplete treatment of the science (so ***). It's a good 3.5.

The basic argument here is that Heath wasn't a monster but a years-ahead-of-his-time pioneer who anticipated modern deep-brain stimulation by several decades. The storytelling (which is very journalistic) is pacy, well-done, and for the most part, great. Where I have issues is with how Frank fits Heath into broader neuroscience or rather doesn't. A few examples:

1. Frank takes issue with modern "brain stimulators" who haven't heard of Heath and can't be "bothered" to find out about him. But she doesn't seem to have "bothered" to find out how Heath fits into the broader picture of modern neuroscience outside deep brain stimulation, which means in the lineage between, say, Walter Hess and Jaak Panksepp that also connects to people like Joseph LeDoux and Lisa Feldman Barrett (neuroscience of emotion), on one hand, and Kent Berridge et al on the other (neuroscience of pleasure wanting/liking). Hess, of course, won the Nobel Prize in 1949 for electrical brain stimulation. No mention of him here. Did she "forget" that Hess "invented" brain stimulation long before Heath?

2. No mention of Panksepp, pioneer of affective neuroscience in nonhuman animals who also worked in the lineage of Hess and Heath. Panksepp mentioned Heath plenty. In the words of Joseph LeDoux, writing in (Anxious: Using the Brain to Understand and Treat Fear and Anxiety), "Panksepp relies heavily on the classic and much publicized work of Robert Heath..." - and LeDoux also mentions him plenty.

3. No mention of Kent Berridge's wanting/liking elucidation of pleasure. Berridge & Kringelbach (2010;https://pmc.ncbi.nlm.nih.gov/articles...) looked in some detail at Heath's work and whether he had actually found "pleasure" in the brain at all, for example in the reactions of B-19 - and argued that he hadn't. The argument would be that Heath was "tickling" wanting rather than liking and that this wasn't a "pleasure shock" at all. So that somewhat undermines the title.

4. And quite a lot of dated/deprecated stuff like "... limbic system.... often referred to as the 'emotional brain.'" and "They know that fear is generated in the amygdala". This suggests Frank needs to update her knowledge of neuroscience and reread people like LeDoux and Lisa Feldman Barrett (How Emotions Are Made: The Secret Life of the Brain): "Modern neuroscience, however, has shown that the so-called limbic system is a fiction, and experts in brain evolution no longer take it seriously, let alone consider it a system."

So while Frank has explored the links between Heath's work and modern DBS, the links between Heath's work and the rest of affective neuroscience are entirely untouched. There's no good reason for this - e.g. Berridge and Kringelbach published their thoughts on Heath's work eight years before Frank's book was published.

Summarizing and looking again at the title: Heath's work wasn't a "pleasure shock" (Berridge & Kringelbach), he hasn't been forgotten in neuroscience (Panksepp, LeDoux, Berridge, and others refer to him often), and he wasn't the inventor of brain stimulation (that was Hess).

All this is a bit disappointing to someone with a decent grasp of neuroscience, but if you're a casual reader, you can still relish and enjoy the broader story.

[David · Rating 3 out of 5]

I know a fair amount about this subject, am personally acquainted with two of the people she interviewed about contemporary research, and have a departmental colleague who uses tDCS in her studies, and I never heard of Robert Heath, so I guess I can endorse her claim that his pioneering contributions have been forgotten.

I found the question of why that might be somewhat less interesting than did the author -- it's actually pretty normal for researchers, even if they had a substantial impact at the time, to be unknown or little known 50-60 years after publication of their most important work. As such, all the speculation about this controversy or that feud or the other personality quirk caused his neglect seemed in my reading a bit beside the point, not to mention untestable [or untested at any rate -- i was curious what a more quantitatively oriented historian of psychology/psychiatry like Dean Keith Simonton might make of this material].

[Angela Woodward · Rating 4 out of 5]

This is an absorbing biography of a forgotten figure in psychiatry, Robert Heath. Heath worked for years at Tulane exploring many applications of electrical stimulation of the brain, hoping to find a cure for schizophrenia and other mental ailments for which there were few humane treatments in the 1950s. Part of Lone Frank's story is her own discovery of this figure, and her evolving understanding of his work's moral complexity. Tulane barred her from viewing films and other material in its archives, and she traveled the world tracking down people who knew Heath. What eventually sank Heath's career is almost too bizarre to be believed. She gives Heath his proper context in a medical milieu that seems unforgivably arrogant and sure of its own rectitude.

[Nancy · Rating 3 out of 5]

This biography is framed as a bit of a mystery. Lone Frank is refused access to Tulane University's archives that contain the lab notebooks and papers of Robert Heath, a pioneer in deep brain stimulation. She persists and manages to meet many people who knew Dr. Heath and get access to a lot of interesting research material. I came away from the book with the sense that psychiatry was and still is a pretty messy field with some people are tremendously helped by some intervention while others who seem to have the same problem find no help with that treatment. Is deep brain stimulation the answer for a number of problems? Experts in the field disagreed a lot and still do.

[Jae · Rating 5 out of 5]

This book was really fascinating to me, #ThePleasureShock caught my eye because it was about #DeepBrainStimulation and I had been curious about how it came about. Thank you Lone Frank for this treasure chest of historical information neatly compiled and brilliantly painted for digestion. Learn about a forgotten history behind #DBS and the pleasure zone of the #brain. Dr Robert Heath is a complex human being who often walked, and crossed, the line. In these pages we are able to see, as best possible, who he was and what he felt passionate about in medicine. I highly suggest this read! ☆

[Maria · Rating 4 out of 5]

Endnu en velskrevet bog fra Lone Frank, som virkelig forstår at formidle. De narrative greb gør, at bogen fremstår som en spændingsroman med bonusinformation om den tidlige og nuværende forskning inden for dyb hjernestimulation, hjernekirurgi og neurobiologi som behandling af psykiatriske og neurologiske diagnoser. Jeg står tilbage med sympati for bogens hovedperson Robert Heath - eller måske snarere for hans livsprojekt.
Mon ikke det også var Lone Franks hensigt.

[Rasmus Engholm · Rating 4 out of 5]

Jeg læste denne bog som en spændingsroman -måske et lidt tørt emne, men Lone Frank skriver altså så godt og spændende at man glemmer at det ikke er fiktion.

[Bames · Rating 3 out of 5]

3,75

[Chris]

Fascinating story of the neurologist who invented deep brain stimulation, then vanished (or was erased) from scientific history. In addition to the main narrative, the book's themes include the definition of personality, the dangers of hubris, and the evolution of medical ethics. Will be interesting to see Tulane University's response when this is translated into English and released in the United States.

[Anna · Rating 5 out of 5]

Interesting and thought-provoking biography about a pioneer in medical science. I had no idea that deep brain stimulation was invented this early.

[Chris]

I read the Danish version (Lystens Pioneer) and was fascinated. Given my Danish reading comprehension, I need to read the English version to get all the incredible details.