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The Hole Story on Trepanation

Article #112 • Written by Greg Bjerg

Hippocrates endorsed its use and it’s the world’s second oldest surgical procedure following circumcision. It’s called trepanation and it literally means drilling a hole in your head.

And if you think it’s a bygone practice, think again.

The practice of making a hole in the skull has been around since the Stone Age -- 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 the middle ages it was thought the procedure was able to liberate demons from the heads of the possessed and, later on, “enlightened” Europeans did it to cure maladies ranging from meningitis to epilepsy.

An instrument called a trepan is used to make the hole. The trepan goes into your skull and a chunk of your skull is extracted. Eventually the skin heals over the hole and you’re left with a small bump. Trepans have evolved from crude sharpened stones in the Neolithic age to hand cranked augers in the dark ages to electric drills used today.

That’s right, today in the 21st Century.

Currently there are doctors in the world who perform trepanation and will perform one on anyone 18 years or older who consents. They even have their own organization, The International Trepanation Advocacy Group, complete with web site. The following explanation comes from ITAC’s site and explains the trepanation’s rationale;

“Within the brain there are two fluid volumes, blood and water (cerebrospinal fluid). Blood supplies the brain cells with energy, water does not. The ratio between the two can and does vary, but total volume remains constant.When the skull seals at the end of growth (Ages 8-21) the brain can no longer pulsate on the heartbeat, since expansion possibility of the brain membranes is suppressed. The arteries and capillaries can no longer expand with each new surge of blood that comes from the heart. Hence a certain amount of blood falls from the brain and is replaced with water.

At this point the energy and spontaneity associated with youth diminishes.

Trepanation, making a hole in the skull, restores the pulse pressure to the brain. The arteries and capillaries can expand again, filling with an increased amout of blood and displacing the same volume of water.A significant amount of energy, lost with adulthood, returns.”

Trepanation is somewhat akin to the practice of blood letting.

The founder of modern trepanation is a Dutch man by the name of Dr Bart Hughes. In 1962 he became convinced that the volume of blood in the brain controls ones degree and state of consciousness. Dr Hughes believed humans have been robbed of a high range of consciousness because we began to walk upright, putting the heart below the brain. This state of affairs could be corrected by standing on ones head, jumping from hot water into cold water, or taking various drugs. He noted that when we are born, our heads are unsealed. We have all heard of the "soft spot" on top of a baby ‘s head. He became convinced that the way to gain back the state of imagination and perception that one experiences as a child was to open a hole in the now-sealed adult skull.

In 1965, after years of experimentation, Dr. Hughes bored a hole in his skull using an electric drill, a scalpel, and a hypodermic needle (to administer a local anesthetic). This must have been the first intentional trepanation in hundreds of years.

He immediately began preaching the benefits of his new state of consciousness achieved. .
People having been trepanned report an increased ability to concentrate and stay in focus with the added benefit of feeling good all the while. They also cite an improved ability to listen. There is also a feeling of increased “consciousness” that they find difficult to describe.

Today’s neurosurgeons are more than naturally skeptical. Brain function decreases with age and even if it were possible, an increased blood flow--which many scientists think is more related to brain function than blood volume--would not reverse the process occurring in an older brain.

But all neurosurgeons readily agree on one point: a hole is the starting point for all neurosurgical procedures. Clinical 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.

Additionally surgeons point out that the risks of blood clots, brain injuries from drilling too deep, and infections outweigh the unproven benefits of trepanation.

It is estimated that between 40 to 60 Americans have been through the trepanation procedure.

Article written by Greg Bjerg, published on 07 February 2006. Greg was born and raised in Iowa and graduated with a degree in Journalism from Drake University. Sadly, he passed away on 20 March 2011.

Edited by Alan Bellows.

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Posted 07 February 2006 at 02:00 pm

How big is the hole? Is it literally just a drill or do you have a chunk missing?

Posted 07 February 2006 at 02:34 pm

What I want is a fistula in there so I can see the gears in my head grind to a halt.
On a serious note, though, I think that this is much more interesting than a lobotomy as it allows less drastic modifications to the brain. The more I read about the effects of lobotomy the more I am led to believe in the idea that the brain is controlled by an exchange of abstract "energies" such as Carl Jung describes.
And for whoever has not seen it, watch the movie Pi. It has a great trepanation scene in it...

Posted 07 February 2006 at 02:37 pm

A modern day trepanned individual...slightly graphic, very bizarre:

This weekend I had a hole drilled through my skull

Posted 07 February 2006 at 04:02 pm

Very interesting article--and interesting link, icenine. As much as I would like to ask more questions and comment, all I can do is come up with the cheesiest puns and one-liners in my head. And every sentence presents another "need-that-like-a-hole-in-the-head"-type opportunity. I'm on overload! (Good for me I got a dremmel. Now I need to make friends with med school drop-outs.)

Posted 07 February 2006 at 05:56 pm

Ouch...must have hurt like hell!!

Posted 07 February 2006 at 09:01 pm

Maybe I misunderstand the stone age reference. How does one new stone ager convince another that he needs a hole drilled in his head with a rock?

Posted 07 February 2006 at 11:23 pm

That is truly amazing.
"Hey there Bob, Wanna drill my head?"

Posted 08 February 2006 at 02:09 am

I saw a programme about this a year or two ago on channel 4. The main person they were following in the documentary didn't seem to interested in the procedure as a means to increase his conciousness. He was more bothered with the apparently euphoric sensation that trepanation caused, especially when he would touch his brain with a metal rod through the trepanned hole. He seemed to really enjoy himself when he did this.

Posted 08 February 2006 at 04:49 am

Madsen, there are very few nerves in your head, and none in your brain. It shouldnt hurt very much, about as much as a large scratch.

Posted 08 February 2006 at 04:56 am

The article IceNine links to is pretty interesting. I especially like that he comes to honest and logical conclusions when he eventually states, "I have come to the frustrating conclusion that the trepanation has had no lasting effect.", and doesn't continue with a false belief that, "I just didn't do it right." However, it's also hard to take someone seriously when they end their journal of a potentially fatal self-surgery with references to "pulling a big bong hit."

Posted 08 February 2006 at 09:44 am

Yes, I've read somewhere that this procedure was frequently performed in the Middle Ages, specifically when people received very devastating head injuries. It was reported that if the person didn't want to undergo trepanation, they would surely die because of the overwhelming blood pressure caused by the erupted arteries. Thus, a hole had to drilled in the skull to let the excess blood drain and thereby relieve the pressure. Suprisingly, the article mentioned that the success rate was very high for this type of surgery, IINM it had a 75% success rate (which, considering the crude methods used at the time - and the almost unsanitary conditions - is pretty remarkable IMHO). So in fact you had a better chance of staying alive if you went through this operation than if you didn't want trepanation. Damn interesting indeed... :-)

Posted 08 February 2006 at 09:45 am

A hole in your head. That sounds fun.

Posted 08 February 2006 at 01:10 pm

Another hole?! I already have 7... : /

Posted 09 February 2006 at 03:57 pm

Wow, that's not one procedure I would ever DIY.

indra c
Posted 15 February 2006 at 03:07 am

Trepanation, a whole new sensation!
...or rather, a new hole sensation!

eeeeewe...not for me and definitely not in my own home!
As for the web-page on pulling bong-hits and drilling holes in the head, seriously disturbing. Respect for the guy though, until he mentioned pulling bong-hits which i thought was detrimental to his article/journal and in (w)hole, a dumb thing to proclaim so publicly.

Posted 28 March 2006 at 09:04 pm

@ chrislewis: Your brain may not have pain sensors, but your scalp and the periosteum (lining over the bone) most definitely does. Drilling a hole in your skull without anaesthesia will hurt.

@ ic3dog: I don't know what article that was but it sounds like nonsense. It should also be noted that trepanning in the Middle Ages often did not penetrate through the skull - rather, only deep grooves were made. Furthermore, if someone had a significant head injury where a craniotomy would be helpful, they would not be in the position to consent to the procedure as they would undoubtedly be unconscious (i.e., comatose) from the head injury.

Thus, without any specific further information, such a high "success" rate would probably be due to (i) self promotion by the medieval trepanners, (ii) no penetration through the skull, (iii) victims only having a mild to moderate head injury to begin with that they would almost certainly have survived without any treatment.

Michael Tam : vitualis' Medical Rants

Posted 24 May 2006 at 08:59 pm

Hmm...that article about the guy who performed his own trepanation is pretty cool. It makes me vaguely interested in the procedure...but...not really. The idea of pressure being relieved is sort of interesting, but it doesn't seem like one tiny hole on one side would really be that effective. Maybe if you remove the whole skull around it...or fill it with a whole bunch of holes (I hear that's not entirely uncommon trepanation circles, of course), it would have more of an effect. But then there would be less blood flow because there would be less tissue carrying it....

Posted 04 June 2006 at 03:05 pm

Another interesting account of modern day trepanation can be found in the Amok Journal: A Compendium of Psycho-physiological Investigations ( which also has other interesting stuff like autoerotic deaths and self mutilation/amputee fetishes.) There is an interview of Dr. Bart Hughes by his "disciple" Joey Mellen who also trepanated himself in the 70's along with his companion Amanda Felding. Mellen wrote a book about the experience called Bore Hole and there is video footage of Amandas trepanation entitled Heartbeat in the Brain. Even more interesting is Dr. Bart Hughes theories of the relation of his blood volume theory to LSD and other hallucinogens. Even if these readings dont make you want to go out and drill a hole in your head they at least give good advice on how to potentially ward off a bad trip.

Posted 08 August 2006 at 03:35 am

One thing: Trepanation only refers to a drilled hole in the head. Trephination is any deliberatly cut hole in the head, such as the stone cut holes from the Neolithic. There are archaeologic examples from almost every geological area in the world. A good reference to get the "real" story on trephination is Ortner's Identification of Pathological Conditions in Human Skeletal Remains. And it includes some lovely pictures.

Dr. Evil
Posted 21 December 2006 at 05:38 pm

Why does the guy in the picture have a funnel on his head?

Posted 21 August 2007 at 07:17 am

Dr. Evil said: "Why does the guy in the picture have a funnel on his head?"

That is the place god speaks into and tells him to do other goofy medical practices. I can just imagine the person who came up with trepanation as a medical practice. He and his buddies were probably drunk, sitting around bullshitting. Then someone said "hey next time someone complains lets just drill a hole in their head" Then they all laughed and threw up their meat. Then the "doctor" that didnt drink that night took it seriously and went trep' crazy on the hung over bunch.

Posted 18 December 2007 at 10:53 am

Dr. Hughes beliefs appear to start out just fine: "... the volume of blood in the brain controls ones degree and state of consciousness. Dr Hughes believed humans have been robbed of a high range of consciousness because we began to walk upright, putting the heart below the brain."

Posted 09 January 2008 at 12:02 am

The article icenine linked to seems to depict a circle of stoners simply drifting through various stages of fascination with whatever tickles their fancy at the time, in this case trepanation. I have friends like this who seem to experience short term obsession with one thing or another before moving onto the next.
His conclusion that trepanation does nothing (which may well be the case) sounds more like a case of boredom setting in, much like a child no longer amused by a toy.
I think in the case of this weed smoking, caffeine chugging guy it may have been his abstinence from these drugs which may have given a heightened sense of consciousness. Hell, I just took two weeks off work of which I spent one week mostly blazed. A day after stopping with the dubes things were definately looking clearer.

Posted 04 March 2008 at 06:12 pm

I guess you need a hole in your head like you need a hole in your head.

Posted 09 August 2008 at 05:16 pm

I dumped a girl because she was into phrenology.

Posted 02 October 2008 at 02:23 pm

The person in the picture looks like the Tinman from The Wizard of Oz haha.

darren anderson
Posted 12 December 2013 at 05:35 pm

Im been thinking about doing it myself .. done loads of reading about it .. and its better than constant head aces

Posted 30 January 2014 at 07:58 pm

I wonder if it could cure dementia

Posted 21 May 2014 at 07:03 pm

Kao_Valin said: "Dr. Evil said: "Why does the guy in the picture have a funnel on his head?"
That is the place god speaks into and tells him to do other goofy medical practices. I can just imagine the person who came up with trepanation as a medical practice. He and his buddies were probably drunk, sitting around bullshitting. Then someone said "hey next time someone complains lets just drill a hole in their head" Then they all laughed and threw up their meat. Then the "doctor" that didnt drink that night took it seriously and went trep' crazy on the hung over bunch."


Posted 21 May 2014 at 07:04 pm

funny people here!!!!

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