Center Assistant Professor Dr. Laura Cabrera is first author of the article “The re-emergence of psychiatric neurosurgery: insights from a cross-national study of newspaper and magazine coverage,” published in the March 2018 issue of Acta Neurochirurgica, The European Journal of Neurosurgery. The work of Dr. Cabrera and co-authors Merlin Bittlinger, Hayami Lou, Sabine Müller, and Judy Illes was supported by their European Research Area Network (ERA-NET) NEURON project “Media Coverage of Psychiatric Neurosurgery: Cross-national Investigations of Public Reactions and Attitudes.”
Abstract: Background: Surgical approaches to treat psychiatric disorders have made a comeback. News media plays an essential role in exposing the public to trends in health care such as the re-emergence of therapeutic interventions in psychiatric neurosurgery that were set aside for decades, and in shaping attitudes and acceptance to them. Method: We conducted an analysis of media articles covering all types of psychiatric neurosurgery published in Canada, USA, Germany, and Spain between the years 1960 and 2015. We applied both quantitative and qualitative methods to elucidate patterns of reporting for conditions, themes and tone, across geographic regions, time, and for type of intervention. Results: Coverage of psychiatric neurosurgery has surged since 2001 and is largely consistent across the countries examined. It focuses on depression and deep brain stimulation, and is explicit about historical context. The tone of coverage becomes more positive for Canada, USA and Spain over time; the tone of coverage from Germany remains cautious. Identity and privacy are among the few ethical and philosophical issues raised, notably in the German press. Conclusions: The focused and optimistic attention to contemporary psychiatric neurosurgery in the media, but inattention to ethical issues, places an extra burden on functional neurosurgeons, psychiatrists, and other frontline health professionals to attend to queries from patients and policy makers about the full range of relevant emergent and emerging interventions and the mental health issues to which they may beneficially apply.
The full text is available online through Springer Nature (MSU Library or other institutional access may be required to view this article).
Center Assistant Professor Dr. Laura Cabrera and co-author Judy Illes (University of British Columbia) have a comment article in the February 2018 issue of The Lancet Neurology. Their article is titled “Balancing ethics and care in disorders of consciousness.”
Summary: Neuromodulatory interventions that rely on the premise that stimulation activates or promotes brain circuit signals are being applied to a wide range of therapeutic targets in neurological and psychiatric disorders. The numbers of patients with whom these interventions are being tested, the range of approaches, and the variety of methods are all on the rise. Paralleling these trends are the increasing numbers of countries doing clinical trials, and the coverage of them in the press.
The full text is available online through The Lancet (MSU Library or other institutional access may be required to view this article).
Episode 5 of No Easy Answers in Bioethics is now available! This episode features guests Dr. Laura Cabrera, Assistant Professor in the Center for Ethics and Humanities in the Life Sciences and the Department of Translational Science & Molecular Medicine, Dr. Robyn Bluhm, Associate Professor in the Philosophy Department and Lyman Briggs College, and undergraduate research assistant Rachel McKenzie. Together at Michigan State University they have collaborated on research regarding psychiatric interventions, including pharmacological interventions as well as neurosurgery, like deep brain stimulation. In this episode they share some highlights from their internally-funded Science and Society at State project, which focused on the public perceptions of such psychiatric interventions.
This episode was produced and edited by Liz McDaniel in the Center for Ethics. Music: “While We Walk (2004)” by Antony Raijekov via Free Music Archive, licensed under a Attribution-NonCommercial-ShareAlike License. Full transcript available.
About: No Easy Answers in Bioethics is a podcast series from the Center for Ethics and Humanities in the Life Sciences in the Michigan State University College of Human Medicine. Each month Center for Ethics faculty and their collaborators discuss their ongoing work and research across many areas of bioethics—clinical ethics, evidence-based medicine, health policy, medical education, neuroethics, shared decision-making, and more. Episodes are hosted by H-Net: Humanities and Social Sciences Online.
Image description: Dr. Cabrera’s undergraduate research assistant Julia Porter poses for a photo with their poster “Is low data reporting prevalent in clinical trials of psychiatric deep brain stimulation?” Photo courtesy of Laura Cabrera.
This year the INS meeting theme was “Honoring our History, Forging our Future,” bringing together a diverse group of scholars, scientists, clinicians, and professionals dedicated to the responsible use of advances in brain science. The intellectually stimulating and dynamic conference payed homage to the first fifteen years of neuroethics. Dr. Cabrera presented two posters. The first, “Ethical issues and somatic psychiatric treatments: professionals vs. public concerns,” discussed results from her past S3 grant with colleague Dr. Robyn Bluhm. Her second poster, “Is low data reporting prevalent in clinical trials of psychiatric deep brain stimulation?” was co-authored with Julia Porter, an undergraduate research assistant in Dr. Cabrera’s lab.
Dr. Cabrera also participated in a panel lead by Karen Herrera-Ferrá on the “Inclusion of Latin America within the globalization of neuroethics,” as part of the Neuroethics Program Leaders Council meeting which took place on November 11th.
Society for Neuroscience
Dr. Cabrera was one of the faculty organizing a short course on “Neuroethics and Public Engagement: Why, How, and Best Practices” as part of the pre-conference events. This was a very well-attended course with great participant engagement.
Dr. Cabrera also chaired, together with Edith Brignoni-Perez, the Neuroethics Social on November 13th. The event used films to discuss ethical issues in the portrayals of learning disabilities and neurodevelopmental disorders.
Over the past two months, we have witnessed two more mass shootings in Las Vegas and Sutherland Springs, TX. Once again, these incidents bring up the debates surrounding gun legislation and access to mental health care. In reference to the Texas shooting, President Trump commented, “This is a mental health problem at the highest level. It’s a very, very sad event.” Soon after, it was revealed that Devin Kelley, the Texas shooter, had briefly escaped from a mental hospital in 2012 after he made death threats against his superiors in the Air Force. Both the president and the media emphasized the connection between mental illness and mass shootings. In fact, Johns Hopkins University found that over one-third of all news stories about mental illness were connected to violence. Psychiatric journals are also more likely to publish articles connecting mental illness with aggression than mental illness and victimhood, even though persons with mental illness are ten times more likely to be victims of violent crimes, including police shootings. It is no wonder that 63% of Americans blame mass shootings on the failure of the mental health system.
When confronted with a mass shooting, it is hard not to assume that mass shooters are mentally ill. After all, what sane person could commit such a horrible act? The media and even psychiatric professionals are quick to look for associations between mental illness and mass shootings. After Adam Lanza took the lives of twenty children and six adults at Sandy Hook Elementary School, new research on the brains of mass shooters began. More recently, the brain of Stephen Paddock, who killed 59 people in Las Vegas, was shipped to the Las Vegas coroner’s office for a neuropathological examination to look for any “mental aberrance” to explain his behavior, even though neuropathologists admit correlating brain structures with behavior is “cloudy business.”
Image description: a cardboard sign is tied to a tree, with lettering that reads “stop gun violence :(” in blue and red. Image source: Tony Webster/Flickr Creative Commons.
Research shows us, however, that the link between gun violence and mental illness is far more complicated than it would appear. In general, it is hard to generalize about mass shooters because they are relatively rare. Although there is some evidence to show persons with severe or untreated mental illness might be at increased risk for violence when experiencing psychotic episodes or between psychiatric hospitalizations, many of these studies have been heavily critiqued for overstating connections between serious mental illness and violence. On aggregate, there is not a strong connection between mental illness and gun violence.
Close to 18% (43.4 million) of adults in the U.S. have some form of mental illness, which is on par with other countries, yet Americans are ten times more likely to die from guns than other citizens in high-income countries. The American Psychiatric Association found that around 4% of violent crimes perpetrated in America are attributable to mental illness and only 1% of discharged psychiatric patients commit violence against strangers using a gun. Persons with mental illness are less likely than those without a mental illness to use a gun to commit a crime. The vast majority of people with severe mental illness, including schizophrenia, bipolar disorder, and severe depression are no more likely than any other person to be violent. There is simply no clear causal link between mental illness and gun violence.
There are a number of problems with associating mass shootings with mental illness. First, it stigmatizes millions of people living with mental health conditions. Research shows that negative attitudes surrounding mental illness prevent people from seeking treatment. Linking mental illness with violence threatens to restrict the rights and freedoms we afford ordinary citizens. Second, the burden of identifying would-be shooters has now fallen on psychiatrists who are not necessarily equipped to identify violent gun criminals. A number of states now mandate psychiatrists assess their patients for their potential to commit a violent gun crime, but psychiatrists are not great predictors of gun violence, and some research shows they are no more able to predict gun violence than laypersons. Psychiatrists who fail to identify mass shooters may now be held liable for crimes they fail to predict. Third, linking gun violence to mental health therapies may not help to reduce gun violence. Few of the persons who are most at risk for committing a violent gun crime have been involuntarily hospitalized, and therefore would not be subject to existing legal restrictions on firearms. Finally, the focus on mental health obscures other reasons for our nation’s gun violence problem. By focusing almost exclusively on mental health, we fail to identify the myriad of other factors, including historical, cultural, legal, and economic conditions that contribute to gun violence in our country.
It is easy to blame mass shootings on the “abnormal brain”–it is far more difficult to uncover or come to terms with the systemic causes of gun violence that wreak havoc on our communities. There are good reasons to ensure all Americans have access to mental health services, but access to such care is unlikely to stem the tide of mass shootings in our country. Mental illness has become a convenient scapegoat for politicians on both sides of the aisle when it comes to mass shootings, but it is time we begin to look more closely at other culprits.
Devan Stahl, PhD, is an Assistant Professor in the Center for Ethics and Humanities in the Life Sciences and the Department of Pediatrics and Human Development in the Michigan State University College of Human Medicine.
Join the discussion! Your comments and responses to this commentary are welcomed. The author will respond to all comments made by Thursday, November 30, 2017. With your participation, we hope to create discussions rich with insights from diverse perspectives.
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Center Assistant Professor Dr. Laura Cabrera recently traveled to Riga, Latvia to attend and present at the ERA-NET NEURON (Network of European Funding for Neuroscience Research) Cofund Mid-Term Symposium. Dr. Cabrera presented the poster “Contemporary Psychiatric Neurosurgery: Updates on a Cross-National Comparison of Trends in Media Coverage and Public Attitudes.” Her co-authors are Merlin Bittlinger, Hayami Lou, Sabine Müller, and Judy Illes. Their research is part of an ongoing NEURON-funded project, “Media Coverage of Psychiatric Neurosurgery: Cross-national Investigations of Public Reactions and Attitudes.”
Poster Abstract: Understanding the exposure of patients and the public to contemporary trends in psychiatric neurosurgery is essential to understanding their views and receptivity to them. Toward this goal, we conducted an in-depth content analysis of media articles and reader comments on all types of psychiatric neurosurgery between 1960-2015. We used Factiva and media websites to compile full-length articles published in major newspapers and magazines from ERAnet consortium partners: Canada, the US, Germany, and Spain.
The final dataset comprised of 517 articles and 477 comments (Canada/USA: 201 articles, 183 comments; Germany: 156 articles, 115 comments; Spain: 160 articles, 179 comments). We coded inductively for themes and phenomena of interest. We found that coverage of psychiatric neurosurgery has increased and changed over time, although frequent references to historical milestones are retained. Deep brain stimulation and depression are the main focus. Risk is the disadvantage most commonly mentioned in articles from Canada/USA and Germany, and in reader comments across all countries. German articles almost uniquely, although still minimally, report on ethical issues such as identity and control. Over time, reporting becomes more positive. German media coverage is the most cautious, yet German reader comments are more favorable than those from Canada/USA.
While modern press reports about psychiatric neurosurgery reflect growing optimism, the public is divided. Ongoing studies will further inform the influence of media reporting trends on the values, perceptions, and hopes that people hold toward psychiatric neurosurgery, and the significant ways in which these views may shape policy-making for mental health care.
Center Assistant Professor Dr. Laura Cabrera recently traveled to Denmark and Germany, where she presented at two international conferences.
Photo from the 13th World Congress of Biological Psychiatry, courtesy of Dr. Cabrera.
The 13th World Congress of Biological Psychiatry was held June 18-22 in Copenhagen, Denmark. The World Federation of Societies of Biological Psychiatry (WFSBP) organizes the congress each year in a different location around the world. Dr. Cabrera presented a poster, “Psychiatric Deep Brain Stimulation: Recurrent and Neglected Ethical Issues,” which touched on key findings from her S3 grant. The conference included talks on biomarkers for psychiatric disorders, the use of electroconvulsive therapy and the use of ketamine. There were not many talks discussing deep brain stimulation, however, there was a very interesting debate about deep brain stimulation between Dr. Marwan Hariz and Dr. Thomas Schlapfer, regarding whether it is a worthwhile treatment method in psychiatry.
Photo from the 17th Quadrennial Meeting of the World Society for Stereotactic and Functional Neurosurgery, courtesy of Dr. Cabrera.
The 17th Quadrennial Meeting of the World Society for Stereotactic and Functional Neurosurgery (WSSFN) was held June 26-29 in Berlin, Germany. This year’s theme was “Emerging Techniques and Indications.” Dr. Cabrera attended the meeting and presented a flash talk entitled “The Re-emergence of Psychiatric Neurosurgery: A Cross-National Comparison of Media Coverage.” The event included a pre-meeting workshop on “surgery for psychiatric disorders” as well as very interesting talks covering the history of stereotactic and functional neurosurgery, results from clinical trials around the world, and several techniques, including deep brain stimulation, vagal nerve stimulation, radiosurgery, and focused ultrasound, to name a few.
Center Assistant Professor Dr. Laura Cabrera has a new article in AJOB Neuroscience, titled “Beyond the Technology: Attribution and Agency in Treatments for Mental Disorders.” This publication from Dr. Cabrera and co-authors Rachel McKenzie and Robyn Bluhm is a result of their S3-funded research project, “Psychiatric Interventions: Values and Public Attitudes.”
The full text is available online from Taylor & Francis (MSU Library or other institutional access may be required to view this article).
Center Assistant Professor Dr. Laura Cabrera recently traveled to Stockholm, Sweden to attend and present at the 1st Congress for Ethics and Neurosurgery, held May 4-6. The congress was arranged by the Ethicolegal Committee of the European Association of Neurosurgical Societies (EANS), the Ethics Committee of the World Federation of Neurosurgical Societies (WFNS), the Department of Neurosurgery at Karolinska University Hospital, and the Swedish Society of Medicine.
Dr. Cabrera presented a talk entitled “Media Coverage & Public Perception on Psychiatric Neurosurgery.” The event brought participants from around the world, including Japan, Turkey, Canada, USA, Germany, Switzerland, and the Netherlands. The talks touched on a number of important ethical considerations in neurosurgery, such as innovation and conflicts of interest, value of life, the use of stem-cells in neurological disease, concurrent surgery, and professional responsibility. “Everyone left looking forward to the next edition of the congress,” said Dr. Cabrera.
What are key ethical concerns surrounding the use of psychiatric deep brain stimulation (DBS)? Are those concerns shared broadly for all aspects of DBS or alternatively are they specific to the intended targeted use of that intervention? Dr. Cabrera will discuss results from a recent study conducted by a multidisciplinary research team in which they examined ethical issues discussed in both the scientific and ethics literature around psychiatric DBS. Dr. Cabrera will make the case that understanding the ethics of DBS for psychiatric interventions provides important insight into the way in which ethical concerns for a single technology might vary depending on their intended use. Join us for Dr. Cabrera’s lecture on Wednesday, February 15, 2017 from noon till 1 pm in person or online.
Dr. Cabrera is an Assistant Professor of Neuroethics at the Center for Ethics and Humanities in the Life Sciences. She is also a Faculty Affiliate at the National Core for Neuroethics at University of British Columbia. Her research focuses on the exploration of attitudes, perceptions and values of the general public toward neurotechnologies, as well as the normative implications of using neurotechnologies for medical and non-medical purposes. She received a BSc in Electrical and Communication Engineering from the Instituto Tecnológico de Estudios Superiores de Monterrey (ITESM) in Mexico City, an MA in Applied Ethics from Linköping University in Sweden, and a PhD in Applied Ethics from Charles Sturt University in Australia. Her career goal is to pursue interdisciplinary neuroethics scholarship, provide active leadership, and train and mentor future leaders in the field.
In person: This lecture will take place in C102 East Fee Hall on MSU’s East Lansing campus. Feel free to bring your lunch! Beverages and light snacks will be provided.
Center Assistant Professor Dr. Laura Cabrera is first author of the article “The re-emergence of psychiatric neurosurgery: insights from a cross-national study of newspaper and magazine coverage,” published in the March 2018 issue of Acta Neurochirurgica, The European Journal of Neurosurgery. The work of Dr. Cabrera and co-authors Merlin Bittlinger, Hayami Lou, Sabine Müller, and Judy Illes was supported by their European Research Area Network (ERA-NET) NEURON project “Media Coverage of Psychiatric Neurosurgery: Cross-national Investigations of Public Reactions and Attitudes.”
This post is a part of our 
Recurrent and Neglected Ethical Issues in the Psychiatric Brain Stimulation Discussion
Join us for Dr. Cabrera’s lecture on Wednesday, February 15, 2017 from noon till 1 pm in person or online.
MSU Bioethics 