There can be few aspects of modern paleaopathological research more morbidly intriguing than trephination (also known as trepanation), the surgical removal of a disc of bone from the skull of a living individual without causing damage to the underlying blood vessels and brain. The procedure constitutes the earliest form of surgical intervention for which we have objective evidence, and its continued practice amongst both isolated tribal societies and a rare ilk of free-thinking Westerners has cemented its current position at the intersection of age-old and New Age healing.
In its ancient form, trephination was a lengthy and traumatic affair. Prehistoric surgeons experimented with a variety of tools and techniques to facilitate the extraction of bone from the cranium. In Europe, skulls were commonly trephined using the flint-scraping method, whereby an elliptical orifice was created by gradually scraping away the lamina externa (outer table) and diploë and then, with considerable delicacy, the lamina interna (inner table) to expose the dura mater. Elsewhere, the modus operandi involved ‘boring’ a series of small, closely adjoining perforations that extended to the lamina interna. The strands of bone between perforations were then cut, and the resulting piece of bone levered out. Arguably the most macabre approach was the push-plough method, in which a series of curved grooves were scraped into the skull to form a thin recessed circle. Repeated scraping would eventually release a smooth roundel of bone, although this could take several hours, or even days. It is therefore unsurprising to learn that many societies utilised native plants with psychoactive and medicinal properties to provide much-needed pain relief. (The high survival rates in Peruvian trephinations hint at the adoption of an effective surgical antiseptic or anaesthetic, and given the fundamental and spiritual role of the coca plant in their culture, it is likely that its cocaine-bearing leaves fulfilled this function.)
Skulls exhibiting trephination’s telltale orifices have been excavated at sites of almost every archaeological period and location, from Stone Age East Africa to 17th century Scandinavia. There appear to have been centres of concentrated surgical activity in Neolithic France and pre-Incan and Incan Peru, although it is now evident that the procedure predates both cultures by several millennia. The earliest documented trephined skull was recovered from the Vasilyevka II cemetery in the Dnieper Rapids region of the Ukraine (radiocarbon dated to 7,300-6,220 B.C.). The skull belonged to a man who was over 50 years old at death and showed a healed legion of several centimetres in diameter on the left of the frontal bone. The discovery of similar healed trephinations on every habitable continent has widespread implications for our understanding of the movement of prehistoric peoples and ideas. Trephination was being practiced on a global scale long before the earliest known trans-Atlantic and Pacific voyages, yet many academics have refused to believe that such a bizarre procedure could have come about as an independent innovation in more than one location. We are forced to conclude, therefore, that our prehistoric forefathers boasted either a precocious seafaring capability or an instinctive predilection for neurosurgery.
The most arresting aspect of trephination concerns our ancestors’ motivation for indulging in such a hazardous and traumatic procedure. Current consensus holds that trephinations were performed chiefly for the relief of intracranial maladies, such as depressed fractures, scalp wounds, concussion and lesions of a syphilitic nature in Peru. However, due to the fact that the majority of trephined skulls show no signs of trauma, it is likely that alleviation of headaches was the fundamental motive. Other authorities have argued that while trephinations were undoubtedly performed for the relief of intracranial maladies, in prehistory these ailments were ascribed to evil spirits thought to be dwelling within the head. The cure, therefore, was to open the skull and release the spirits. This may have inadvertently improved the patient’s condition, and hence the surgical intervention persisted. The paracetamol generation may have little sympathy for such severe curative methods, but for many centuries it was thought that the bodily organs were the seat of individual emotional attributes, such as courage (to be found in the heart), anger (based in the spleen) and so on, and that these could be manipulated accordingly. It is little wonder then that prehistoric skull surgery was approached in a similarly blasé manner, perhaps stemming from the belief that the brain was the seat of one’s psychological characteristics. Indeed, the anxiety associated with modern neurosurgery is derived largely from the relatively recent realisation of the brain’s fundamental importance as the central control system of the body.
Paul McCartney, in a 1986 interview in Musician magazine, recalls John Lennon asking him and his wife, Linda, “You fancy getting the trepanning done?” They declined. This was during the late ‘60s, when the Beatles were extolling the virtues of LSD, the Velvet Underground had chosen to ‘nullify’ their lives with heroin, and millions of other young people were beginning to appreciate that eluding the semblance of known things through the use of drugs is one of the perennial avocations of mankind. Some nine millennia after its conception, trephination was seized upon by this enlightened bunch as a subtler, safer, and more prolonged remedy for the pain of consciousness.
Among the new proponents of the age-old practice was Amanda Feilding, an Oxford dropout who performed and filmed her own trephination with the aid of a bathroom mirror and an electric drill. Like many others, she reported the onset of a mildly euphoric sensation, of relaxation and peacefulness. (According to trephination advocacy groups these changes result from the restoration of the full pulsation that is lost when the skull is sealed in childhood. Such pulsation inflates the brain’s capillaries, accelerating its metabolism and empowering it to permanently regain its youthful level.) Fielding ran for parliament in the late ‘70s under the banner of “Trepanation for the National Health”, and over the course of two elections she succeeded in convincing 188 voters of their entitlement to free professional trephining. She later married Lord James Neidpath, a former professor at Oxford, where he taught international relations to a young Bill Clinton. Encouraged by his new wife, the couple travelled to Cairo where they found a surgeon willing to trephine Neidpath’s skull for around $2000. Within a few hours Neidpath says he felt the effects. “It seemed to be very beneficial.”
So what does the future hold for trephination and, indeed, other forms of mind-enhancing masochism? Among its primitive practitioners, trephination will persist so long as they do. In the West, meanwhile, it is likely that the development of highly sophisticated virtual worlds will negate the need for conventional avenues of escape. Virtual reality might seem preferable to skull surgery or drug use, but it is no less perilous. As John Gray notes in Straw Dogs: ‘the world disclosed in ordinary perception is a makeshift of habit and convention. Virtual worlds disrupt this consensual hallucination, but in doing so they leave us without a test for a reality that is independent of ourselves’. Rarely does the past challenge the future for shock value.