Psychosurgery in Sweden 1944–1964

Abstract

“The history of prefrontal lobotomy has been brief and stormy. Its course has been dotted with both violent opposition and with slavish, unquestioning acceptance.”

–George Kisker, 1944 in the Journal of Nervous and Mental Disease

“The psychosurgery era seems to me a sad intermission [in the history of psychiatry] which preferably should be left behind in silence.”

–Dr. Olof Dagberg in his last annual report, from The Psychiatric Hospital, Stockholm, 1965

This study presents results on hitherto unknown data on lobotomies performed at the former State Mental Hospital of Umedalen (from here on called simply “Umedalen”) in the north of Sweden. More than 700 operations were carried out from 1947 through 1960, and we calculated the average rate of postoperative mortality to 7.4 percent, and that 63 percent of those who were operated were women. By considering annual hospital reports to the National Board of Health (Medicinalstyrelsen), we also made the first mapping of early psychosurgery in Sweden; approximately 4,500 lobotomies were performed between 1944 and 1966. Statistical analysis, qualitative content analysis, and discourse analysis were used. The study supports earlier findings of female preponderance in the number of lobotomy operations.

Keywords:

• psychosurgery
• lobotomy
• mortality
• Sweden
• history
• mental hospital
• schizophrenia
• women
• discourse

Acknowledgments

Thanks to Dr. Nils-Olof Bengtsson at the University Hospital in Umeå; Professor Lars Jacobsson, Department of Clinical Sciences, Division of Psychiatry, University of Umeå; Professor Inga-Britt Lindblad, Department of Culture and Media, and Stefan Sjöström Ph.D., Department of Social Work, University of Umeå; and Associate Professor Joel Braslow at UCLA for advice and support. This work was made possible through the financial support of Kempe Foundation at the University of Umeå; the Söderström-Königska Foundation, the Swedish Medical Association (Svenska Läkarsällskapet), Section of the History of Medicine, and the Sweden-America Foundation.

Notes

¹Dr. Gösta Eriksson (1892–1962) M.D., superintendent of the State Mental Hospital of Umedalen. He was employed in 1934 when Umedalen was taken into use and held this position until 1956 when he retired.

²Dr. Schildt, M.D., born in 1899, was employed as a surgeon at the General Hospital of Umeå from 1943–1950, after which he moved to the city of Norrköping, where he got a new position as a surgeon.

³Dr. Olovson, M.D. was born in 1904, graduated from Lund University in 1941, and had his clinical training at the Karolinska Hospital in Stockholm, where he also became an associate professor of anatomy in 1943 and of surgery in 1947. He was appointed as an official expert to the Swedish Board of Health in 1949.

⁴See footnote in Table 1 for explanation.

⁵Sulfocin = sulfur in oil, mainly as “sulfocin” 1 percent. The Danish psychiatrist Schroeder-Knud used it first in 1924 in general paresis, with an idea of using a simpler technique of fever therapy than ad modum Wagner-Jauregg. Sulfocin was given to the patient at night as an injection; the temperature rise occurred six to eight hours later. (From Kalinowsky and Hippius, 1969)

⁶A few cases of psychosurgery on children have been described internationally. Referring to the practice in the US, Williams (1949, pp. 440–41) stated that: “less than thirty children have thus been treated.” Four cases are known from Norway: One 11 eleven-year old and one 12-year-old, both with self-mutilating behavior, had a prefrontal lobotomy; one boy of 14 and one girl of 15 had a transorbital lobotomy (NOU, 1992:25).

⁷The neurosurgeon Gösta Norlèn, at the Neurosurgical Department of Serafimerlasarettet (Serafimer Hospital), was the first to carry out prefrontal lobotomy in Sweden. He started in August 1944 with 48 cases. All but four of the cases in the first series were female patients. They were patients from Beckomberga State Mental Hospital in Stockholm. Other Swedish pioneers of psychosurgery were Olof Sjökvist, Lars Lexell, and Ragnar Frykholm.

⁸The woman was born in 1926 and had a double-sided operation ad modum Freeman 1966. Before the operation she had been given three series of ECT and large doses of chlorpromazine (up to 800 mg/day) due to an insufficiency state of anxious-obsessive and depressive symptoms. Serious thoughts of suicide were frequent and she was a heavy consumer of barbiturates – as much as 15 tablets a day for a couple of years. She was happy with the results of the operation but gained weight, and became a heavy smoker and indifferent to other people. She lost her libido. Doctors, in the case review, argued that her post-operative changes of the personality were a reasonable price to pay taking into account that her anxiety had nearly disappeared. Her medication could successively be reduced, and terminated after one month.

⁹The paper is based on a lecture that Dr. Osterman held for a group of nurses and was published in the official journal for Swedish nurses. A statement is made on the ethical rationale for prefrontal lobotomy and, besides the number of operations carried out, it presents the figures on the decrease in the number of mattresses required in the psychiatric wards after lobotomies. Lobotomy was said to have a positive effect on the cleanliness of patients.

Hansson Holmdahl K. (1951): Frontal lobotomi – kirurgisk erfarenhet av 360 fall. (Frontal lobotomy – surgical experience from 360 cases.). Nordisk Medicin 45: 714–16 with summary in English

Lundquist G. 1949: Från hospital till modernt sjukhus för psykist sjuka (From asylums to modern hospital for mentally ill), in: Modern svensk sinnesjukvård (Modern psychiatric care) Stockholm, Ab Modern Literature

NOU, 1992: 25 Norges offentlige utredninger. Utredning om lobotomi. (Official report from the Norwegian government. Survey on lobotomy.) p. 34

Sargant W., Slater E. (1946): Kroppslig behandling vid sinnessjukdom. Swedish version of An Introduction to Physical Methods of Treatment in Psychiatry. Stockholm, Bokför laget Natur och Kultur.

Umebladet, 1951: Riskabel hjärnoperation lyckas bra på Umedalen. (Risky operation with successful outcome at Umedalen) (newspaper article, January 26).