Feeling depressed? Lethargic? Shell-shocked by life's little bombardments? You could try meditation. Or yoga. Or color therapy. Or herbal remedies. Or, if you prefer drastic measures, you could drill a hole in your head.
The practice of making a hole in the skull, known as trepanation, has been around since the Stone Age. Along with circumcision it's one of our oldest surgical procedures -- archaeologists have found trepanned skulls dating back to 3000 B.C. Hippocrates, in his classic medical text "On Injuries of the Head," endorsed trepanation for the treatment of head wounds. During medieval times, the procedure was thought to liberate demons from the heads of the possessed and, later on, Europeans did it to cure a hodgepodge of maladies ranging from meningitis to epilepsy.
The procedure, from a technical standpoint, is simplicity's model. An instrument called a trepan is used to make the hole. Throughout history, the trepanning tool has developed dramatically, evolving from a crude hunk of sharpened flint in prehistoric times to a hand-cranked auger in the first century to, nowadays, an electric drill. Anyway, the trepan goes into your skull and a chunk of bone is extracted. You bandage yourself up and eventually the skin heals over, leaving only a small indentation to show for the hole in your head.
But why -- with all of today's sophisticated therapies -- go for the hole? The idea is to pump up your "brainbloodvolume," a term coined by Dutchman Bart Huges, the guru of modern-day trepanation. Back in the psychedelic '60s, at the height of the age of mind expansion, Huges decided to expand -- literally -- his own brain. Your level of consciousness, goes Huges' theory, is directly related to the volume of blood in your brain. Babies have naturally high brainbloodvolume, being born with a soft spot at the top of their heads -- the fontanel -- that gives the brain room to pulse. (When you look at a baby's head, you can actually see the pliant tissue at the fontanel throbbing with the baby's heartbeat, pumping oxygen through the brain.) Within the first year, though, that soft tissue hardens into bone.
And therein, says Huges, lies the problem. Once the fontanel seals off, your brain has no proper vent through which to breathe. To make matters worse, the upright stance you adopt as a toddler allows gravity to pull blood away from your head -- the beginning of a lifelong drain. Pulsation decreases. Brainbloodvolume plummets. You get lethargic, estranged, depressed. What can you do?
You can dabble in one or all of modernity's modest remedies, or you can do like Bart Huges and get yourself trepanned. By opening up that hole -- a sort of do-it-yourself fontanel -- you reverse nature's wayward development and return your skull to its original condition. As a result, trepanners say, you'll be happier, more energetic and less prone to crippling bouts of ennui. You'll ascend to the child's plane of acute consciousness from which you disembarked to enter the lowly malaise of adulthood. Basically, you'll feel like a kid again.
Just listen to Pete Halvorson, a Huges disciple who now directs the International Trepanation Advocacy Group (ITAG): "With trepanation, you can willfully and deliberately accelerate your brain metabolism. You have a higher level of consciousness. You're optimistic and upbeat. You look at problems as a source of entertainment. You'll feel good your whole life."
Sounds dreamy, but Halvorson wasn't always so blissed out. In his early 20s he experienced a period of deep, dark depression. ("The door slammed shut on me," is how he puts it.) He tried psychotherapy, he tried various medications. Nothing worked. Then he met Huges, got wise to the brainbloodvolume theory and, in 1972 in Amsterdam, he trepanned himself, making an 8 mm hole in his head with an electric power drill.
Now 52 and running a tree farm in Pennsylvania, Halvorson gives a fairly detached account of the procedure, but all the gory details can be found in "Bore Hole," a book written by Englishman Joseph Mellen about his self-trepanation. Mellen describes drilling into his head with a hand trepan, and then: "After some time there was an ominous sounding schlurp and the sound of bubbling. I drew the trepan out and the gurgling continued. It sounded like air bubbles running under the skull as they were pressed out. I looked at the trepan and there was a bit of bone in it. At last!"
The ensuing state of mind, according to Halvorson, is unmitigated bliss. "When I first trepanned myself, I thought -- and I know this sounds selfish -- but I thought, 'Only a few people deserve this.'"
Halvorson no longer endorses self-trepanation "because we're so close to being in the hands of competent surgeons." But competent surgeons disagree. The medical community collectively refuses to recognize trepanation as a legitimate therapeutic practice. Dr. William Landau, a neurologist in St. Louis, sums it up this way: "There is no scientific basis for this at all. It's quackery."
Dr. Robert Daroff's response is even more concise. "Horseshit," he says. "Absolute, unequivocal bullshit." Daroff is a professor of neurology at University Hospitals of Cleveland and editor in chief emeritus of the journal Neurology. "This is a crackpot notion that's not worthy of my time. And not only that -- it's dangerous. You expose your precious brain, you remove God's covering, there's a risk of infection and all sorts of other problems."
Brain doctors seem to view this invasion of the cranium's hallowed realm as a violation of some universal taboo. More to the point, they don't approve of amateurs like Halvorson dipping their fingers into the neurochemical soup. But they readily agree on one point: a hole is the starting point for all neurosurgical procedures. Trepanation is performed, for example, to evacuate hemorrhages and to relieve pressure in the cranial cavity caused by cerebral ulcers. But, for neurosurgeons, the hole is a means to an end, and they put the bone back in place. Daroff says, "It's just to gain access."
So there's no benefit to having a hole for the hole's sake? The proof, for Dr. Bruce Kaufman, is in the neurological pudding. "Organized neurosurgery would approach it from a scientific basis. Are there case reports to show that this is a beneficial procedure? Not that I'm aware of."
Kaufman, an associate professor of neurological surgery at Washington University School of Medicine, says that over the past couple of decades neurosurgeons have experimented with a therapeutic procedure similar to trepanation. They tried making holes in the skull to treat slit ventrical syndrome, a brain malady brought on when shunts inserted to drain excess fluid end up robbing the brain of its natural buffer. "The brain is stuck in this tight little box," Kaufman says. "We tried bilateral decompression to give the brain more room." Bottom line? "It didn't work. The procedure was abandoned."
Giving the trepanners momentary benefit of the doubt, Kaufman says, "Let's assume there's something to their theory. You create a hole in the skull. The scalp scars down to the tissue that covers the brain. This tissue is called the dura, and it has the consistency, basically, of a shirt." So, after trepanation, the only thing protecting your brain is a shirt? "It's dangerous," Kaufman says.
But Halvorson thinks there's an ulterior motive for the pharma-psycho-medical complex's stand against trepanation. "Trepanation restores you to a youthful state where you're happy and upbeat, and that diverts attention away from Prozac and protracted psychotherapy." In other words, if you're a shrink or a peddler of feel-good drugs, universal bliss is bad for business. "I don't have a problem with pharmaceutical companies making money. What I don't like is something that's beneficial, like trepanation, being excluded."
The consequence of that exclusion struck Halvorson hard last year, when his wife was suffering from multiple sclerosis. "She was emotionally destroyed by her downward progression. We hoped trepanation would slow the process. I wanted her to experience the state of great relief that trepanation brings." But despite repeated requests from Halvorson and his wife, her doctors refused to perform the procedure. They didn't want to get involved in such a non-standard process, Halvorson says. Last March, his wife died.
Nowadays Halvorson is a tireless crusader for trepanation. He uses the ITAG Web site as a pulpit from which to preach the gospel according to Bart Huges, and last April, to bring trepanation before a wider audience, he subjected himself to an appearance on the Howard Stern show. ("Actually, it was a lot of fun," Halvorson says. "Howard was quite intrigued. Afterwards he said, 'Come back with more people with holes in their heads.'")
And more people will be getting holes if Halvorson gets his way; he and his ITAG cohorts -- about 60 trepanned people worldwide -- are lobbying to make trepanation available from surgeons on demand. "We're interested in getting the American Medical Association to make a public statement. They won't go on record. They don't want to jeopardize their reputation," by condemning trepanation when the procedure might turn out to be beneficial.
"I have no problem taking ridicule from the general public," Halvorson says. "But I expect doctors to act as scientists. They have a professional responsibility to respond to this from an academic viewpoint. In the back of their minds they know that something good happens when you open the skull. Eventually they'll come around."
So, while Halvorson and the brain doctors duke it out, we're left to ponder the uncertainties. Is trepanation the final solution to the riddle of the mind-body dichotomy? Or is it a load of medieval hooey hauled into the '90s by new age outlaws? Is trepanation, to use Howard Stern's words, "a cry for help"? Or are we, the solid-skulled majority, just one hole away from nirvana?
If the neurologists are right, seven orifices in your head is plenty. If Halvorson is right, the kingdom of eternal contentment is waiting to be entered through a hole in your skull. And now, according to Halvorson, getting that hole is about to become a lot easier.
"We've located a surgeon in the Western Hemisphere," he says, "who is willing to trepan anyone over the age of 18 who signs a consent form. Right now there are a dozen people in the U.S. chomping at the bit. Within six months, a few dozen will be trepanned."
When that happens, Halvorson will make his triumphant return to the Stern show, with a troop of the freshly trepanned in tow. And when America tunes in for its daily dose of Stern's loudmouthed potty sass, they'll hear instead the soft, pacific voice of Halvorson as he extols, one by one, the blessings of trepanation.
Perhaps Mellen said it best in "The Great Brain Robbery," his ode to trepanation: "All your prayers won't save your soul/Adults, you need a hole."