Most evidence indicates that trepanning in early humans was performed for one of three reasons: rituals requiring consumption of brain tissue, excising of head pain or demons, and legitimate medicinal purposes.

       Several early cultures considered the circle of removed bone to be a powerful amulet. Many of the skulls found in military posts had circular pieces missing. Perhaps a charm claimed from the head of a particularly virile foe conferred status on the warrior who wore it.

       Ancient shamans treated head trauma by lifting a flap of skin, and cutting or drilling around the injured area - a process often taking several sessions. This procedure involved removing bone fragments or lancing hemotomas, replacing the plug, and stitching up the scalp.

       In a few cases, the hole was bored in areas of the skull associated with the particularly localized pain of migraines. No data exists to suggest whether this treatment alleviated the problem or just created new ones.

       Modern anthropology indicates that as many as 70% of the medicinal cases survived long enough for the skull to heal completely.

       In 1962, a Peruvian neurosurgeon performed the technique using Aztecan tools in a modern setting on a head-trauma victim. The patient survived.

       Egyptians, Celtic cultures, Chinese, Indian, Aztecs, Mayans, and Incas, Greece and Rome, sub-Saharan Africans, Brazilian hill-tribes, Polynesians, and cultures as far back as the dawn of mankind have known this technique. Most ancient civilizations practiced trephining and perfected it, and the procedure is still used today for many of the same reasons.

       In the Middle Ages, trepanning fell into the hands of charlatans. Some used the removed slabs as treatment for other diseases and found reasons to perform the technique in order to replenish their pharmacopoeia. Mentally ill individuals were trepanned in order to remove a 'stone of madness' from the frontal lobe. While the earlier version avoided invading the meninges, later practitioners lost most of their patients to sepsis due to poor technique.

       The mortality rate was high, close to 100%, though some note-worthy individuals like Prince Philip of Orange were trepanned repeatedly and lived.

       In the early years of psychosurgery, access to the frontal lobes was achieved with a trepanation. A number of violent mentally ill patients were given frontal lobotomies after a successful campaign by Dr. Walter Freeman in the early 20th century. No real evidence existed to support his claims but the practice became a widespread therapeutic procedure through the 1950's. Although a lobotomy occasionally calmed the violent tendencies of the patient, it never returned one to mental health. Instead, zombie-like invalids needing full-time care were created. Frances Farmer, Rosemary Kennedy, and Rose Williams were all victims of this quackery.

       In more modern times, certain medical conditions continue to be treated via precisely drilled trepanation holes with great success. New techniques using laser technology has eliminated many of the traditional uses.

       In a new twist, as a non-traditional use, trepanning is again in vogue as an elective surgery. Advocates claim that restoring the skull, by adding a 'soft spot', to a neonatal configuration enhances brain function by increasing capillary pulsation. Increased blood flow better oxygenates the brain cells and brings about a permanent "expansion of consciousness."

       With any elective surgery, one needs to weigh the benefits against the costs.

       Trepanning, ancient medical art, failed psychotherapy procedure, or New Age whim, has existed for the entire history of man. Will future anthropologists ridicule the barbarism or wonder at the precision of the surgical technique?

       I suspect trepanning will always have some limited legitimate uses, and will keep an open mind - but closed skull - when considering the non-traditional reasons.

       Who knows?

       Someday, like the cited examples, I might need another hole in my head.