In a recent review of psychiatric literature, the possibility of "Unattached Burdens" or metaphysical demons was considered as a potential source of dissociative symptoms. This context is important because it highlights a startling oversight. When a patient experiences dissociative symptoms after childhood surgery, the psychiatric establishment often explores esoteric explanations before considering a more mundane, physical one: neurological injury caused by anesthesia.
The simple explanation, often overlooked, is that the anesthetic agents used on children are causing neurological damage to the NMDA system. If this is true, it drastically changes how we should approach treatment, redirecting focus toward targeting the NMDA system specifically. It also raises profound questions about pediatric surgical protocols and the doses of anesthetics we are currently giving to children.
A Case for Neurological Injury
This connection is seemingly basic, yet it appears to be completely outside the scope of consideration for many professionals. Psychiatry and psychology certainly believe in neurotransmitters when prescribing medications, but when it comes to the origin of symptoms, they tend to operate in a paradigm that treats psychological explanations like 'trauma' as real, while biological explanations like 'neurons' are treated as inconceivable.
This is a crucial oversight. Given how precisely available medications can target specific receptors, considering specific neurological phenomena really ought to be within scope. In this specific case, the connection between neurons and symptoms appears to be extremely direct.
What a Study Would Look Like
If we take this hypothesis seriously, it suggests several concrete research paths:
- Clinical Data Analysis: For patients with dissociative symptoms and a history of childhood surgery, researchers should check which anesthetic was given and at what dose. This data could then be analyzed for any association between the anesthetic, its dose, and the severity of the dissociative symptoms. It would also be valuable to compare these patients to the broader population of those who underwent childhood surgery.
- Preclinical Animal Models: Existing studies of anesthesia in juvenile animals could be re-evaluated to see if this hypothesis bears out. If animal models show neurological changes, it would provide strong biological evidence for a connection that the current psychiatric paradigm misses.
Implications Beyond the Specific Case
If these treatments are successful, the implications extend far beyond a specific cohort. Characterizing anesthesia-induced long-term dissociation as having a specific neurological basis can open doors for other patients. Some may have similar neurological damage from other causes. Others might respond to this treatment simply because similar symptoms ultimately respond to similar biological interventions.
Psychiatry's reluctance to consider such direct neurological causes is a significant barrier to progress. There are likely treatments that would work but have not been tried, simply because the underlying biological basis of the symptoms has not been considered closely enough. The focus needs to shift back to the biology, and specifically to the NMDA system, to see what kind of damage may have been done.