Last fall, I joined the team at Georgetown University to help share the stories of the incredible work happening at our Medical Center.
I had the privilege to attend the seventh annual convocation in November 2014, when Dr. Helen Mayberg received Georgetown University Medical Center’s highest honor, the Cura Personalis Award. Professor of psychiatry, neurology and radiology at Emory University, Mayberg and a panel of Georgetown faculty experts explored clinical, social and ethical issues around the use of deep brain stimulation (DBS) for treatment-resistant depression. To be honest, when I first heard the term “deep brain stimulation,” I thought it sounded like a fantastic scalp massage. However, this was going a little deeper.
After years of studying neuroimaging to understand how depressed brains worked differently, Mayberg and a cross-disciplinary team, plus one patient who felt completely out of options, made the bold decision to try out a new method for treating major depressive disorder. They implanted a stimulating electronic device—like a pacemaker for the brain—in a precisely selected location (in the white matter tracts adjacent to the subgenual cingulate gyrus), and found successful results in four of six patients. Although brain implants were already in use to treat symptoms of Parkinson’s disease, DBS offered new hope for many with treatment-resistant depression.
Hundreds of thousands of people now have surgical brain implants to help alleviate the symptoms of a variety of disorders. At MedStar Georgetown University Hospital, surgeons have been performing deep brain stimulation for Parkinson’s patients for over ten years.
The concept of a sustained, surgically implanted electrical charging device for the brain was completely new to me at the time. The idea that it could be used to treat depression sounded like science fiction. I know many people who have suffered from mental illness in its varied forms and intensities. I couldn’t imagine anyone making the decision to try the solution of a battery-operated brain implant. And yet, the results were compelling, even when the ethics around the procedure raised many questions. Who is treatable? What is the desired functional state of “normal?” What happens when something goes wrong?
The more I learned that day, the more questions I had. What next for this frontier of electronic brain management? Would parents be able to someday modify sassy attitude from teenagers? Could an ill-intentioned political group flip a switch to make the population more compliant? How far would we go?
As the day came to a close, Georgetown’s Rabbi Rachel Gartner arrived to conclude the convocation with a prayer. She had opened the ceremony in the morning with a beautiful, simple blessing. By the time she returned in the afternoon, the people in attendance—faculty, students, clinicians, and university staff—were abuzz with the mind-splitting potential for this expanding technology. The rabbi’s words brought us back to solid ground, while simultaneously lifting the community to new heights. She spoke of the important work taking place in the health care field to shed light on the darkness of depression, which touches so many lives. She grew suddenly quiet, and then softly shared that she had lost her sister to depression the previous year. A powerful silence filled the auditorium. Rabbi Gartner began her prayer:
“For we know that the final destination of life, dear God, is in your hands, but much of the journey you have placed in ours. We are here to make the path as smooth and as beautiful as we can for one another. We are grateful for this day, which celebrates how far we’ve come and fortifies us for the hard work that lies ahead.
We pray this afternoon that you bless Dr. Mayberg, and all those here and everywhere engaged in the holy work of healing, with an ever-renewing love for their work and for humanity. In the words of Rambam: ‘Preserve the strength of their bodies and souls that they will ever be able to help and support rich and poor, good and bad, enemy as well as friend. In the sufferer let them and let us all see only the human being.’
May all who suffer find a healing of body where possible, and a healing of spirit always, soon, speedily, without delay, and let us say, Amen.”
The change in the room was palpable. Her sacred words brought a deeper meaning to the challenging work of depression research and care for the mentally ill. Framing the day—packed with futuristic, frightening yet hope-filled technological advances—with prayer was uniquely Georgetown. Like other top institutions around the country, the university is blazing trails in medical innovation, but at this Jesuit, Catholic institution, the greater purpose of our work is not forgotten.
Jane Varner Malhotra