Psychosurgery in Sweden 1944-1964

Supply or demand? Institutionalization of the mentally ill in the emerging Swedish welfare state, 1900-59

Historical studies on the institutionalization of the mentally ill have primarily relied on data for institutionalized patients rather than the population at risk. Consequently, the underlying factors of institutionalization are unclear. Using Swedish longitudinal microdata from 1900-59 reporting mental disorders, we examine whether supply factors, such as distance to institutions and number of asylum beds, influenced the risk of institutionalization, in addition to demand factors such as access to family. Institutionalization risks were associated with the supply of beds and proximity to an asylum, but also dependent on families' unmet demand for care of relatives. As the supply of mental care met this family-driven demand in the 1930s, the relative risk of institutionalization increased among those lacking family networks.

Shock therapies in Spain (1939-1952) after the Civil War: Santa Isabel National Mental Asylum in Leganés

The first third of the twentieth century changed the therapeutical landscape with the emergence of new treatments for the mentally ill in asylums. However, the historiography of their use in Spanish psychiatric establishments has been scarcely studied. The popularization of barbiturate sleep therapies, insulin shock, cardiazol therapy, electroshock and leucotomy spread from the beginning of the century. However, the Spanish Civil War and Spain's isolation during Franco's autarky (1939-52) made their implementation difficult. Through historiographic research using medical records as documentary sources, this work analyses the socio-demographic conditions of the asylum population during the first decade of Franco's dictatorship. The treatments used in Leganés Mental Asylum are described and are compared with those used in other Spanish psychiatric institutions.

The introduction of leucotomy in Germany: National Socialism, émigrés, a divided Germany and the development of neurosurgery

Thinking about the chronology of the introduction of leucotomy in Germany sheds new light on the hypothesis of a special 'radical' approach of German psychiatry to the treatment of the mentally ill during the period of National Socialism. Moreover, it offers new insights into the transnational and interdisciplinary conditions of the introduction of leucotomy in early divided post-war Germany.

History of lobotomy in Poland

In Poland, there were 176 cases of prefrontal leucotomy performed by Moniz's method between 1947 and 1951. There were also several cases in which alternative psychosurgical techniques were used: prefrontal topectomy by Bilikiewicz and colleagues, and prefrontal topischemia by Ziemnowicz. This article analyses the following: publications by Choróbski, who performed lobotomy in Poland, and by Korzeniowski, who assessed its short-term results; a report by Bornsztajn, who reviewed general results of the method; and clinical research by Broszkiewicz and by Konieczyńska, who assessed Polish patients in terms of long-term results of lobotomy. Negative clinical evaluation of lobotomy led to its abandonment in Poland, a decision strengthened by a regulation that forbade lobotomy in the USSR and impacted Polish psychiatry.

Post-lobotomy epilepsy illustrated by the story of Ellinor Hamsun, the daughter of the famous Norwegian author Knut Hamsun

In Scandinavia, at least 11.500 people were lobotomized in the period 1939–1983. Beside grave personality changes, the surgery caused epilepsy in 10–35% of the patients. Moreover, many died due to perioperative bleedings, convulsive status epilepticus or SUDEP.

Most of the stories of these people are anonymous and their post-lobotomy lives are scarcely documented. If it was not for the fact that Ellinor Hamsun (1916–1987) was the daughter of the famous Nobel Prize winning Norwegian author Knut Hamsun, her lobotomy story and the subsequent iatrogenic epilepsy would probably have remained unknown.

History of leucotomies in Greece

In order to present the social, scientific and institutional context which permitted the use of leucotomies in Greece, we have reviewed the Archives of the Medical Associations, the medical literature of the years 1946-56, a reader's dissertation and the memoirs of two psychiatrists. More than 250 leucotomies were done in the two public psychiatric hospitals in Athens from 1947 to 1954, as well as 40 leucotomies in the public psychiatric hospital in Thessaloniki. Although aware of the side effects, psychiatrists justified the use of the procedure. The performance of leucotomies in Greece declined because of reports of the dangers of the operation and its unpredictable outcome for the patients, but mainly because of the encouraging results with psychotropic drugs in the early 1950s.

Portrayals of lobotomy in American and Swedish media

Psychosurgery has a long history dating back to the 1880s when Gottlieb Burckhardt performed focal cerebral cortical excisions on the brains of six patients diagnosed with schizophrenia. His operations were vividly contested by the medical community of the time. In 1936, when Walter J. Freeman and James W. Watts performed their initial prefrontal lobotomies in the United States, they were met with some professional opposition from superintendents, who would not provide them with patients for the operation. However, Freeman and Watts managed to cope well with the opponents. In newspapers and magazines, the curiosity for lobotomy was obvious. Freeman was instrumental in the way he promoted lobotomy, and he evoked the interest of the press and the journalists for this new surgical treatment on mental illness, something that he regarded as a medico-historical breakthrough. In this chapter, the portrayal of lobotomy in American and Swedish newspapers and magazines is explored and analyzed. How did journalists write about lobotomy for the public in the years spanning 1936 to 1959, a period in which the American and Swedish presses appeared inclined to describe the positive effects of lobotomy, while neglecting the negative and fatal consequences of the operation. There are not only similarities but also interesting differences between the Swedish and the American articles depicting lobotomy. The media can be a powerful factor in the construction of "facts," which can significantly affect decisions made by people about their health issues.

[Egas Moniz: a genius, unlucky looser or a Nobel committee error?]

Portuguese neurologist António Egas Moniz is one of the most intriguing figures in the history of medicine. While an invention of angiography in 1927 is his acknowledged merit, lobotomy, invented in 1935 became a black legend of psychiatry, although sporadically it is performed also today. There are even postulates to withdraw the Nobel Prize, which Moniz received in 1949 for inventing the lobotomy. Moniz in fact re-invented lobotomy, primarily introduced in 1888 by a Swiss psychiatrist Gottlieb Burckhardt and later forgotten. Its popularisation, including its abuses was chiefly done by American neurologists Walter Freeman and James Watts. Aside the science, Moniz was an exceptionally colourful person, a merited politician, Portuguese minister of foreign affairs, the head of its delegation at Versailles in 1918, in 1951 he was even proposed a position of a President of Portugal. He was a versatile humanist and a writer, even a gambling expert. His person is hard for black and white evaluation, definitely deserving a re-evaluation from today's historical perspective.

Psychosurgery in Italy, 1936-39

In 1936 Egas Moniz introduced a new method for treating mental illness--psychosurgery. This new procedure was taken up immediately in a number of countries, including Italy. In most countries its introduction was slow and the numbers of operations were in single figures, but in Italy the introduction was rapid and around a dozen neuropsychiatrists reported much higher numbers of operations performed. Also in Italy the first innovations to the technique, notably the transorbital variation, were introduced. Moreover, all these activities took place without any sign of the protest seen elsewhere. Conditions that allowed the acceptance of this risky procedure seemed to be a consequence of the way in which the professions of neurology and psychiatry had been merged in Italy.

Lobotomy at a state mental hospital in Sweden. A survey of patients operated on during the period 1947-1958

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.