By Dr Cathy Wield

The age of ice-picks and leucotomies may be over, but psychosurgery continues today under the much more respectable label NSMD -Neurosurgery for Mental Disorder.  Here in the UK, procedures continue to be offered through the ‘Advanced Intervention’s Service’ (AIS) based in Dundee. I understand that the sanitised term NSMD was deliberately created to distinguish it from psychosurgery and the bad reputation of the past, when patients were subjected to crude operations such as the famous lobotomy.  

In 2001, I underwent NSMD at Ninewells Hospital in Dundee, operated on by neurosurgeon Mr Sam Eljamel, having been referred to him by the AIS, like all their other patients on the NSMD pathway. 

I was not informed when Mr Eljamel’s surgical practice came under scrutiny. He has since left the country, although investigations into his work continues through a public inquiry. For a time, I believed this curtailed the NSMD offered by the AIS, but it has resumed and their patients are now sent to the National Hospital for Neurology and Neurosurgery in Queen’s Square, London for their operations. 

A ‘Biological’ Depression and the Road to Last-Resort Treatment

The psychiatrists said I had a truly biological depression. For six years prior to my referral to the AIS, I was given multiple drugs in multiple combinations for so-called ‘treatment resistant depression’.  Each time there was a change in the drug regime, I was told, with what turned out to be false optimism, that this might finally be the answer. I was heavily sedated. I could not think clearly, I was obsessed with thoughts of self-harm, and I believed I was suicidal. The reality of my hopeless state was that dying by suicide seemed to be the only reasonable option. But if anyone had cared to ask, I didn’t actually want to die, at least not all the time – I just wanted it all to stop. 

What I really wanted was a return to how my life had once been, where I could be at home, a mother to my children, a wife to my loving husband, and a doctor able to care for patients. I wanted to return to my sociable self, enjoying friends, enjoying my community, living as any ‘normal’ person would want to live. Instead, I was locked up on a ward, sleeping in a dormitory, with no activity beyond washing up plastic teacups and queuing for medication at least four times a day and it was driving me mad. Psychiatry thought it was keeping me safe – it achieved the complete opposite. 

Before this single, continuous episode of depression, I had never been given a psychiatric diagnosis. But since starting antidepressants in 1994, I was in and out of psychiatric hospitals often detained under the Mental Health Act. 

The months I spent in hospital were usually marked by extreme boredom, imprisoned as I was, on a grim, third floor inpatient ward. I felt tortured, incapacitated by distress, only made worse by either being ignored, or bullied by the nursing staff. I suffered their contempt and disdain and some seemed to delight in suggesting that I wasn’t getting better because I didn’t want to get better. My self-esteem was at an all-time low, I desperately missed my family, felt completely trapped and couldn’t see a way out of the situation.  

When my psychiatrist told me I had reached the end of the line for further treatment, he hesitated before dropping the bombshell. There was one further possibility – a last resort -psychosurgery or NSMD, as part of a research program for patients with intractable depression or OCD.  I was shocked. It was a lot to take in. 

Assessment, Coercion and Consent Under Duress

I agreed to an assessment and was flown to Scotland to meet the AIS team at Ninewells Hospital.  By this stage, my drug cocktail included a mixture of ‘antidepressants’, ‘antipsychotics’, ‘mood stabilisers’ & ‘adjuvants’, alongside various others to counteract the many adverse effects. My memory was severely impaired by weekly ‘maintenance’ ECT, but this was not considered a contraindication to the various tests of cognitive function or the numerous questionnaires and rating scales which took hours, over several days. 

I remember little of the detail except that the team at the AIS seemed extremely sympathetic to my predicament.

The AIS recorded my cognitive function as being in the bottom 10% of what was expected – though I had no idea what that meant. I couldn’t concentrate to read, I couldn’t sleep unless drugged, I felt unreal and as though my intense emotion was wrapped up so tightly, I could explode. But without any release valve, the internal pressure cooker felt like torture. This was how the drugs made me feel, and there was no way to escape my internal hell. It was in this state that I was asked to weigh up and carefully consider the information I was given about the psychosurgery, the NSMD, they offered. 

Would anyone be asked to make such decisions whilst they were inebriated or recovering from an anaesthetic? Yet, here I was, detained on a section, forcibly medicated, and apparently able to weigh up such information. I felt like I barely existed yet I did have motive to agree to such drastic ‘treatment’ – if only to demonstrate to the sceptical psychiatric team as well as to my family, that I had ‘tried everything’. 

Nobody ever considered the possibility that my psychiatric treatment with multiple drugs could be the cause of my considerable burden of symptoms. Nor did they understand my detention on a psychiatric ward mimicked my traumatic childhood experiences while ‘captive’ at boarding school – even down to the similarities in terms of rules, regulations, bullying and the dormitory existence. Nobody factored in the way I had been cowed throughout my life under the influence of people in authority, particularly powerful men.

The AIS psychiatrist was an extremely affable and charismatic man. I saw him as a father-figure. He was very kind, very attentive to my condition and so understanding – all completely benign, nothing other than the good bedside manner which one would hope of all doctors, particularly psychiatrists. But such empathy had been sadly lacking in my years as a psychiatric patient, and I wanted to please him. I certainly didn’t want to let him down. I was very vulnerable and very susceptible to coercion.

Once the go-ahead for the psychosurgery had been agreed, I was returned back to the base hospital and moved to the psychiatric intensive care unit under 24-hour-a-day observation. After some months of delay, while wrangling for funding, went on behind the scenes, I was once again transported up to Dundee. This time, I was flanked by two nurses, as I was thought to be an extreme suicide risk. But once we arrived at the newly opened psychiatric unit, the Carseview Centre, based at Ninewells Hospital, I was left unattended. In their relief to get me there the nurses must have forgotten to mention the suicide risk. Soon I was moved to a different room and the observations stepped up. 

During the days leading up to the psychosurgery, I went through another battery of psychiatric rating scales, a filmed interview and more cognitive testing. In addition, I was told that I must ‘pass’ the approval of an independent committee, to ensure that I was freely consenting to the surgery. This was impressed upon me several times, and so I knew I had to prove myself. I was also made aware that the committee had reports from psychologists, nurses, psychotherapists and psychiatrists. Later I discovered that one of the reports contained the statement that without NSMD, I would very likely die. 

The Operation and Its Immediate Aftermath

The day before the operation I was moved to the neurosurgery ward. I was seen by a junior doctor and signed a consent form for brain surgery. I met Mr Eljamel briefly before the surgery. I was scared and completely freaked out when he suggested that I have it done under local anaesthetic. I refused to agree to that.  

When it was over, I had no idea what the operation was or what had been done. I had a terrible headache, and my face was swollen. I had a fever and felt awful for a few days. When I was pretty much back to normal, I asked the psychiatrist what had been done. He expressed dismay that I didn’t know despite all the efforts to ensure I was ‘freely consenting’. 

 I underwent a Bilateral Anterior Cingulotomy, and the psychiatrist went through the details again, explaining the ‘tiny risks’ of stroke and epileptic fits, and he also reiterated what was expected going forwards. He was careful to make sure I understood that ‘Neurosurgery for Mental Disorder’ was not curative. Patients who ‘responded’ to the surgery, would do so about nine months to one year later. In the meantime, I must take the post-surgical drug regimen exactly as prescribed, which had been decided as part of the research protocol, and I must also participate in CBT. 

I felt awful. I felt terrible. I wished I’d never had it done. Once I was well enough, I would be escorted back to the base hospital in England. There would be no further intensive care, and I was told it would be to an entirely new ward because my previous ward refused to have me back; the staff had decided their relationships with me had completely broken down. I felt totally rejected. No one wanted me, not even the nurses and I wouldn’t even get to see some of the other long-term patients I had become familiar with. It was the last straw, and I knew I had to end it all. This time I was determined to end my life, and would make sure I couldn’t be saved. I started planning a trip to the railway line. 

When I later described what happened next, the psychiatrists told me it was a placebo effect. They said it had nothing to do with the NSMD when it felt like a light switched on in my head – literally, as though flood lights came on in my brain. It was over. I was better. It was truly extraordinary, but I questioned it, doubted it. Could this be real? I gave it a few days but I continued to feel good and I thought it must be a miracle. I thought that somehow, I’d been fixed and I would never feel depressed again. Ever. 

Looking back, it really was something of a miracle that I was able to extract myself from the role of detained psychiatric patient, return home to my family and over a few months wean myself off all the drugs. Within a year, I was back at work. 

Of course I remained perplexed and asked the psychiatrists for their explanations repeatedly; they had no answers, except to say that it had never happened to any of their other patients. 

Recovery, Relapse and Final Liberation

With the benefit of hindsight and the knowledge I have gained since then, I now have my own theories. I had never experienced even a fleeting thought of self-harm or suicide until I started antidepressants. I now believe that I am one of the relatively few people who become suicidal as a direct result of these drugs. In short psychiatry’s response to this iatrogenic harm was to admit me to hospital, give me ECT and yet more psychotropic drugs. 

It has left me wondering whether my dramatic improvement was due to the change in prescription to the standardised post operative drug regime.  Before the NSMD, I was on a cocktail of eight different psychotropic drugs – immediately afterwards, not only was the cocktail reduced to two antidepressants plus zopiclone, but the doses were also drastically reduced. Could this have been the reason I suddenly felt better?

Unfortunately, though, my difficulties were far from over. I was invited to write about my experiences and needed to research my medical records. I was only allowed access while the psychiatrist was available nearby, ‘in case I had any questions’. By then, I was a registrar working shifts in A&E, so this meant using precious days off to visit the hospital where I had been a patient.

The psychiatrist was kind and always enquired about my wellbeing. The psychiatrists didn’t expect cure, they expected relapse and I made the mistake of admitting I wasn’t sleeping well. Despite clear reasons for my insomnia, it triggered the psychiatric alarm bells, and the panic was contagious; the psychiatrist convinced me it was the first sign of relapse. After a year or so free of psychotropic drugs, reluctantly I was persuaded to reinstate antidepressants – to ‘nip it in the bud’. But this first prescription of trazadone started a slow spiral downwards, and my self-esteem went with it.  

When the newly published memoir gained media attention, I was briefly seen as psychiatry’s poster child for recovery. A thick layer of shame was added to my unresolved childhood trauma, which had originally brought me to psychiatry’s attention in the first place. 

Within a year, I was hospitalised and terrified as I remembered how brutal the first seven-year nightmare under psychiatry had been. I couldn’t forget how the surgeon chose to punish me by suturing a deep wound without anaesthetic, or having ECT while paralysed but awake, as well as the months I endured of constant derision from the nursing staff. 

After a seven-month admission with more ECT, and back on another high dose cocktail of psychotropic drugs, the psychiatrists bombarded me with negative prognostications:
“You have a chronic relapsing depression. You will never fully recover”.
“You must take antidepressants for life”.
“Our aim is relapse prevention to reduce hospital admissions”.
“Forget work. You cannot be a doctor. Avoid stress”. 

I was told the only reason for psychotherapy was to increase my resilience and understand possible triggers for relapse. I was instructed not to discuss the past because my depression was purely ‘biological’. 

We moved away from the supportive AIS team in Dundee, but I was glad because I recognised my increasing dependence on them. The distance helped me rebel, and I finally realised that psychiatry had not helped me at all. I couldn’t accept that I was destined to be a life-long patient. It wasn’t who I wanted to be, and I stopped trusting psychiatry. 

As I weaned myself off first one, then two of the drugs, I was less sedated and could think more clearly. I started to challenge myself. I rediscovered my interests, re-engaged with the community and finally returned to work as an A&E doctor, despite the psychiatrist’s repeated warnings of further relapse. Every success led to more confidence, until I and decided to taper down the doses of the remaining two antidepressants. 

When I moved to the USA, I found a counsellor and finally started to process both the nightmare years a psychiatric patient, and my earlier childhood adversities. I came to understand how being sent away to boarding school at a young age had shaped my responses in adulthood, and for the first time in my life, I learned how to take proper care of myself. 

I will never know what the exact impact was or will be of those pea-sized lesions burnt into my cingulate gyri and I hope I never develop seizures or any other future complications. But I do know that freeing myself from psychiatry’s powerful grip was pivotal to my recovery.  

Now more than ever, I am convinced that psychosurgery/NSMD was unnecessary. But then I am convinced that none of the psychiatric treatment I received was necessary. Perhaps, if I had been listened to when I first sought help, given appropriate support accompanied by a strong message that my feelings were entirely understandable given the circumstances, I would have recovered without further ado.  Instead, I was ‘medicalised’.  Seven terrible years later, the downward spiral culminated in brain surgery – NSMD -carried out by a neurosurgeon who is now the subject of a public inquiry. But the main responsibility for psychosurgery relies on a group of enthusiastic psychiatrists determined to prove that nebulous symptoms are the sign of a diseased brain.

A Critical Perspective

Psychiatric diagnosis relies on lists and clusters of reported symptoms; unlike other medical specialities, there are no gold-standard investigations to diagnose and treat consistent defined physical pathologies. 

Of course, patients experiencing what are commonly known as mental illnesses, suffer as much if not more than many who have the most serious physical illnesses. But in my opinion, however well intentioned, subjecting some of the most vulnerable patients to experimental brain surgery is beyond comprehension.  

Surely, it is time we radically re-think the way we support people with symptoms suggestive of ‘mental illness’ and never again burden them with the excesses of psychiatric treatment. We cannot allow a few mavericks to promote dangerous, irreversible and pointless experimentation on the beautiful and highly complex human brains of some of our most vulnerable individuals in society. 

I am grateful to have survived psychiatry’s repeated assaults on my brain, and I consider myself lucky in that respect. But whatever else happened along the way, my true and robust recovery only when I stepped away from psychiatric treatment. 

1. The Eljamel Public Inquiry (ongoing as of April 2026).
2. Advanced Interventions Service website (current information on NSMD / cingulotomy).

About the author

Dr Cathy Wield is a former A&E doctor and the author of Unshackled Mind: A Doctor’s Story of Trauma, Liberation and Healing (2025). She has a long-standing interest in the harms of psychiatric treatment and the importance of listening to lived experience.