02Chapter 1. The Hole in the Skull: Neolithic Surgeons

Alsace. A French village called Ensisheim. The year is 1997. Archaeologists’ trowels methodically peel away the layers of earth. Layer by layer. Beneath the mass of soil lies a secret seven millennia old. Deep down — a burial. In it rests the skull of a middle-aged man. And on that skull — two holes: one in the frontal bone, another in the parietal. They were carefully drilled, with perfectly clean edges. Who made them? And why? The riddle reaches back to the Stone Age. The answer is simple and terrifyingly precise: both holes were made while he was alive. The bone itself proves it — the tissue around the openings had begun to heal. But what does that mean? Only one thing: this man survived. Survived after someone, armed with a primitive stone tool, opened his skull. Picture it: a sharp stone slides across the bare crown of his head, crunching through the vault, sinking into living flesh. The smell of blood and exposed brain. Pain that steals your breath. But the heart does not stop. The man did not merely regain consciousness — he lived for many years afterward.

Seven thousand years ago.

No anesthesia. No sterilization. No antibiotics. No anatomical atlases. No understanding of what the brain is or what it does. And yet — he survived.

More than fifteen hundred such skulls have been found around the world—skulls with neatly drilled or sawn holes and signs of healing. Neolithic and Chalcolithic strata in Europe, Asia, Africa, and South America have yielded this unusual collection. Archaeologists estimate that, in some regions, five to ten percent of all studied Neolithic skulls bear traces of trepanation. Five to ten percent! This was no isolated accident. It was a widespread practice.

Long before anyone had the slightest idea how the brain worked, our ancestors were already dissecting it.

Why?

The best answer came from the French physician and anthropologist Paul Broca. In 1867, at a congress of anthropologists in Paris, he presented a report on Peruvian skulls brought back by the American diplomat Ephraim Squier. One of the skulls, from the Peruvian valley of Cusco, had a rectangular hole with signs of healing. Broca — one of the founders of modern neurology, the very man after whom the speech area in the frontal lobe is named — at first refused to believe it. A rectangular hole in an ancient skull?

But the evidence mounted. In the decades that followed, Broca and other researchers established that trepanation had been a systematic medical or ritual practice across dozens of ancient cultures—from Peru to Polynesia, from North Africa to the British Isles. Some societies performed it on children, others mainly on adult men, and still others predominantly on women.

The operation was performed in several ways. Drilling — using circular motions with a sharp flint or obsidian tool. Scraping — gradually grinding away living bone. Cutting — four intersecting incisions and removal of the resulting square of bone. But how did they survive it? The answer lies in cold, hard numbers. Survival rates were astonishing: by some estimates, in the Peruvian Paracas culture, they exceeded 75 percent. Seventy-five out of a hundred. Ponder that. It’s higher than the statistics for neurosurgery in the early twentieth century, when operations were already being performed with all the advances of aseptic technique.

But the main question isn’t how. The main question is: why?

Broca proposed—and specialists have generally accepted the hypothesis ever since—that trepanation was an attempt to treat mental illness. Epilepsy. Seizures. “Possession.” Conditions that ancient people could explain in no other way than as the work of evil spirits that had entered the head.

If there’s an evil spirit there, then you have to give it a way out.

This explanation may seem absurd. But I ask the reader to pause and reflect. This reasoning did not end with the Neolithic. It persists to this day.

In the twentieth century, at the heart of Western civilization, in university hospitals across the United States and Europe, what did the lobotomists do? They drove metal spikes straight into the frontal lobes of living people. Why? To “erase bad thoughts.” Cold metal in the brain. And a life without thoughts. In Soviet psychiatric hospitals, a different form of torture was used. Patients were injected with sulfazine. The official goal? To “shake up the nervous system.” The body writhed, burning from within. Shaken indeed. In Latin American parishes, priests leaned over individuals with schizophrenia and epilepsy. They performed rituals. They exorcised demons. And some of these rituals ended with the death of the patients. The soul left the body. Forever. In Baku and Moscow apartments, another ritual existed. “Systemic therapists” and “regression therapists” whispered to clients: your depression is the unforgiven sin of your grandmother. An ancestral sin. So simple. So terrifying.

They are all the descendants of that Neolithic surgeon who drilled a hole in the skull to let the spirit out.

The only real difference lies in the tools and the vocabulary.

And this is what you need to understand at the very beginning of our book.

We often look upon ancient practices with the arrogance of modern minds. We smile and say, “How could they not have understood?” We believe an abyss of progress separates us from them.

But there is no reliable evidence that trepanation in the Neolithic actually helped with mental illness—then or now. Patients survived, but that does not mean they got better. Survival is not cure. Surgical success is not therapeutic effect. In fact, we know only one thing: someone was ill; someone had their skull opened; someone survived; but whether they were any less ill afterward than before, we do not know.

And now—a question. Is there a single rigorous study confirming that Hellinger family constellations actually resolve clinically significant psychological problems? Not one. Is there a single study proving that Vianna Stibal’s ThetaHealing method has cured even one person of a diagnosed disease? Nothing. Is there a single placebo-controlled study of the efficacy of “past-life regression”? Zero. Silence. And in that silence, only a deafening echo. It hammers back, exposing a terrifying truth: behind the façade of promising miracles yawns an abyss of absent evidence.

The answer is always the same. It doesn’t exist.

Our Neolithic ancestors were, in a sense, our equals. They sought to alleviate suffering with the means at their disposal. And we—in no small part of modern practices—still act in precisely the same way. Only now our tools are more sophisticated, and our vocabulary laced with scientific jargon.

The ancients deserve this much credit: they had an excuse. They did not know what the brain was, did not know what psychosis was, did not know that a hole in the skull does not open a path for evil spirits—because there are no evil spirits. They were operating at the limits of their knowledge. It was an honest mistake.

What could possibly justify today’s “constellation facilitator” who dumps a client’s problems on a great-grandmother’s abortion? What well-meaning delusion might still smolder in the mind of a “ThetaHealing master” when thousands of pages in peer-reviewed journals delivered their verdict long ago: the method is dead? What defense could a million-follower blogger offer — the one peddling “healing from everything” marathons at five thousand rubles a head?

They have no excuse, no Neolithic surgeon to blame. They have only one thing: a lack of conscience and an excess of greed. And the silent complicity of a society that allows it.

In that same Alsatian era, when the man from Ensisheim was living with two holes drilled in his skull, his contemporaries were painting on cave walls and burying their dead with flowers. They already possessed reason. Already, something in them set humans apart from animals. They asked questions about the world and tried to answer them—as best they could.

The history of psychiatry does not begin with Svenborg or Esquirol. It begins with this hole in the skull—with the first human attempt to find the cause of madness inside another’s head and to do something about it.

As we’ll see in the following pages, humanity kept trying for a very, very long time. In different forms. With different words. With varying degrees of cruelty. With varying degrees of naivety.

And still trying.

The book you hold in your hands is an attempt to understand where we stand today on this journey. And whether the holes in the skull might someday, at last, no longer be necessary.