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Psychosurgery in Sweden 1944 - 1958: the practice, the professional and media discourse
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Umeå University, Faculty of Arts, Department of culture and media studies.
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background. The pioneering early experiments of prefrontal lobotomy were performed in 1944 by neurosurgeons in Stockholm in collaboration with psychiatrists. There was a rapid implementation of the new surgical approach. In 1946 and 1947 the two state mental hospitals, Umedalen and Sidsjön, introduced prefrontal lobotomy on a large scale. General surgeons now performed operations, a practice which was established all over Sweden. Prefrontal lobotomy was burdened, in certain city hospitals, by an initially high rate of postoperative mortality reaching more than 15 %. Pre-frontal lobotomy was phased out continuously already before 1950 and refined psychosurgical methods were introduced , but prefrontal lobotomy was still continued which lacked specialised neurosurgical units. The aims of the thesis were to contribute to and deepen the knowledge and understanding of the general and specific questions of early psychosurgery in its professional and social context.

Specific aims: (Explore the practice of prefrontal lobotomy at the Umedalen State Mental hospital and plot the frequency of psychosurgery operations in Sweden.

• Analyze the patients subjected to prefrontal lobotomy at the Umedalen State Mental Hospital 1947-1958, with respect to symptomatology and diagnosis, indications for the operation, gender distribution postoperative mortality, the practice of consent and other clinical factors.

• Explore and analyze what was written on psychosurgery, when and how, and to identify differences, similarities and characteristics of the portrayal of psychosurgery in Swedish and American media 1936-1959.

• Explore and analyze the confluence of the role of the State authority, The Swedish National Board of Health (Medicinalstyrelsen), the professional discourses on lobotomy and the media portrayal, in dealing with problems of implementation and mortality.

Results. Paper I. At the Umedalen State Mental Hospital, 771 prefrontal lobotomies were performed 1947-1958 with an overall postoperative mortality of 7.4 %. Most of the patients operated on from Umedalen were women (61.2%) and most of the patients were diagnosed with schizophrenia. Of all the lobotomies performed in Sweden (approx. 4,500), 28% had been carried out at the Sidsjön and Umedalen State Mental Hospitals.

Paper II. A sample of 105 patients, who were studied in detail from psychiatric records. It was found that 79% had been six years in primary school and only 3% had a higher education. In an analysis of the descriptions of behavioural problems stated in the medical records, it was found that the female candidate for prefrontal lobotomy was described as suffering from different problems more often than the male candidate. Disturbing behaviour, fluctuations of mood and violence against others were the most frequently described symptoms most often referred to with respect to the female lobotomy candidate.

Paper III. In the comparative media study it was found that most of the articles on lobotomy in the Swedish and American media were positive or neutral towards psychosurgery, while very negative articles were least frequent. Neutral articles were more common in Swedish media (43%) while less common in the American media (19%). Articles being very negative towards lobotomy were considerably more often found in the American material (32%) than in the Swedish (14%).

Paper IV. The implementation of lobotomy was rapid in Sweden and more than 4000 lobotomies were performed between 1944 and 1964. It was considered feasible for prefrontal lobotomies to be performed by general surgeons and, from 1951, it can be verified that most hospitals (12/20) had engaged general surgeons for the lobotomy operation while a minority (8/20) had engaged a neurosurgeon. The Swedish State, through the Swedish National Board of Health was responsible of the allocation and surveillance of mental care. With a system consisting of a Chief Inspector of Mental Care, State mental hospitals were inspected annually. Medical superintendents were given full autonomy to decide on the implementation and practice of lobotomy. No indications were found of any significant interference by the Swedish National Board of Health restricting lobotomy.

Main conclusion. Medical superintendents were given full autonomy to decide on the clinical practice of lobotomy. Being left in the periphery of neurosurgical facilities, this led to their engaging general surgeons. Patients were operated on in surgical theatres lacking the sophisticated technical equipment of coping securely with haemorrhages, which were common in the early implementation of the operation. The practice of lobotomy in some mental hospitals was extensive and postoperative deaths were numerous but the Swedish National Board of Health took a defensive role and, even with the annual inspections, there was no important interference with the lobotomy question. Swedish media reported mostly positively on lobotomy, underlining the promising prospects of the new method submitted by the early proponents without critical questioning or independent investigations.

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2007. , 72 p.
Umeå University medical dissertations, ISSN 0346-6612 ; 1096
Keyword [en]
lobotomy, Sweden, schizophrenia, mortality, gender, behaviour, implementation, media, discourse, profession, neurosurgeon, psychiatrist, medical superintendent
National Category
Medical and Health Sciences Psychiatry
Research subject
URN: urn:nbn:se:umu:diva-1084ISBN: 978-91-7264-295-9OAI: diva2:140147
Public defence
2007-05-04, Psykiatriska klinikens föreläsningssal A, sv-planet, NUS, Umeå, 09:00 (English)
Kompletteras 2012-09Available from: 2007-04-13 Created: 2007-04-13 Last updated: 2012-02-21Bibliographically approved
List of papers
1. Psychosurgery in Sweden 1944-1964
Open this publication in new window or tab >>Psychosurgery in Sweden 1944-1964
2005 (English)In: Journal of the History of the Neurosciences, ISSN 0964-704X, E-ISSN 1744-5213, Vol. 14, no 4, 353-367 p.Article in journal (Refereed) Published
urn:nbn:se:umu:diva-15514 (URN)10.1080/096470490897692 (DOI)16338693 (PubMedID)
Available from: 2007-08-02 Created: 2007-08-02 Last updated: 2014-06-03Bibliographically approved
2. Lobotomy at a state mental hospital: a survey of patients operated during the period 1947 to 1958
Open this publication in new window or tab >>Lobotomy at a state mental hospital: a survey of patients operated during the period 1947 to 1958
2007 (English)In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 61, no 5, 355-362 p.Article in journal (Refereed) Published
Abstract [en]

This retrospective survey aims at describing patients subjected to prefrontal lobotomies and the general treatment conditions at Umedalen State Mental Hospital during the period 1947–1958. Data collected from psychiatric and surgical medical records was analysed using quantitative and qualitative content analysis. A total of 771 patients subjected to lobotomy during the years 1947–1958 were identified. From these, a sample of 105 patients was selected for the purpose of obtaining detailed data on socio-economic status, diagnosis, symptomatology, other psychiatric treatments applied before the pre-frontal lobotomy operation, time spent in hospital before operation, praxis of consent and mortality. The diagnosis of schizophrenia was found in 84% of the 771 lobotomized patients. The post-operative mortality was 7.4% (57 deaths), with the highest rate in 1949 (17%). The mean age of the patient at the time of operation was 44.8 years for females and 39.5 years for male patients. The average length of pre-operative time in hospital for females was 10.7 years and for males 3.5 years. It remains unclear why this mental hospital conducted the lobotomy operation to such a comparatively great extent. Factors such as overcrowding of wards and its status as a modern mental hospital may have contributed.

Place, publisher, year, edition, pages
Informa Healthcare, 2007
Gender differences, Indications for lobotomy, Mortality, Prefrontal lobotomy, Schizophrenia
National Category
urn:nbn:se:umu:diva-2237 (URN)10.1080/08039480701643498 (DOI)000250808700007 ()17990197 (PubMedID)

Included in manuscript form in the thesis "The surgical offensives against mental disorder: psychosurgery in Sweden 1944-1958" with the former title "Prefrontal lobotomy in the rural State Mental Hospital of Umedalen - a survey of patients operated on 1947 - 1958"

Available from: 2007-04-13 Created: 2007-04-13 Last updated: 2014-06-03Bibliographically approved
3. Lobotomy i Swedish and American media 1936-1959
Open this publication in new window or tab >>Lobotomy i Swedish and American media 1936-1959
Manuscript (Other academic)
urn:nbn:se:umu:diva-2238 (URN)
Available from: 2007-04-13 Created: 2007-04-13 Last updated: 2010-01-13Bibliographically approved
4. Implementation of lobotomy in Sweden: the role of the state and the professions
Open this publication in new window or tab >>Implementation of lobotomy in Sweden: the role of the state and the professions
(English)Manuscript (Other academic)
urn:nbn:se:umu:diva-2239 (URN)
Available from: 2007-04-13 Created: 2007-04-13 Last updated: 2011-05-17Bibliographically approved

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