Trepanning is “a surgical intervention in which a hole is drilled or scraped into the human skull.”

First off - AHHHHHHHHHH!!!!

Phew, okay. I’m good now.

Trepanning is one of the oldest known surgical procedures. We have prehistoric evidence with skulls showing trepanation holes. It survives as a medical procedure today, as a means to relieve pressure on the brain in the event of swelling or bleeding in the skull. Today, the tools used are modern, surgical-grade tools, but in Neolithic times a shaman of the tribe might use a sharp stone to slowly scrape a hole through the skin and bone. What surprised me is that many skulls showed evidence of healing after the procedure, which means that people not only survived the surgery, they lived long enough for bone to regrow. Pretty startling that anyone lived when cutting a hole in some human’s head was done with rocks and no hand sanitizer.

Most fascinating to me is that trepanning may also be the very first treatment utilized in the fight against mental illness. I feel fortunate to live in a time when our first reaction to someone in the grip of mania, or a person is hearing voices is NOT to bore one or more holes into their skull. Bipolar disorder, depression, psychosis, schizophrenia, etc. are not new disorders to the human condition. They’ve existed as long as we’ve existed. Imagine yourself as an early human and how confused you would be at someone acting insane. Without any visible injury, our ancestors must have been at a loss for how to deal with their tribe-mate presenting with a severe mental illness.

Could the person be possessed by demons?

Did they experience a vision of god that caused a drastic change in behavior?

Maybe they were cursed?

The why is insignificant; action needed to be taken as mental illness tends to get worse over time when untreated. I’ve been in the hospital, holding my head as if I could squeeze out the darkness. I don’t imagine it took much of a leap for an ancient onlooker to think: “why don’t we drill a hole to let whatever is in the head out?” Thus, trepanning may have been born.

As time passed, technology and techniques improved. The image on the right is the trephination kit used by a 17th century surgeon. Until sterilization became universal, infection was still the most dangerous risk to this type of surgery.

Once more - AHHHHHHHHHHH!!!!

During these times the prevailing theory was that pooling blood could decay and suppurate. An advance on the Greek theory of the four humours — when out of balance, disease occurred. My favorite humour is black bile or “melaina chole,” which is where we get the word “melancholy”. It was thought that the spleen secreted too much black bile into the body and resulted in depression.

We now know that intracranial pressure is the real danger of pooling blood inside the skull, and that depression is a combination of genetic and environmental factors. While the medical community limits trepanning to extremely specific injuries/illnesses, there are some unqualified individuals who advocate its use to cure mental illnesses and even to improve cognition. I find it strange that there are people who would willingly bore a hole in their skull for as-yet unproven claims, especially when they wouldn’t bore a hole in any other bone on their body. Needless to say, I’m not about to sign up for a trepanning session to help with my depression.

This is the first post in a new category called: “History”. Posts in this category will examine the origins of our present treatments for mental illness by looking into humankind’s past efforts. I hope you’ll find these short history lessons informative, and that they give you a greater appreciation for living in our modern age.