Lobotomy in Scandinavian Psychiatry

I found this interesting article online:

Lobotomy in Scandinavian psychiatry 1
Joar Tranøy

Institute for Criminology, University of Oslo

This article surveys the development of the use of lobotomy in Scandinavian psychiatry. Scandinavian mental hospitals lobotomized 2.5 times as many people per capita as mental hospitals in the United States. The use of lobotomy in Scandinavia is chiefly illustrated by patient records from the leading institution in the performance of lobotomies in Scandinavia, Gaustad Mental Hospital, Oslo, Norway. Overcrowding and understaffing at mental hospitals cannot explain the extensive use of lobotomy in Scandinavia since the frequency of lobotomy operations did not correlate with overcrowding and understaffing. Neither can an alleged ignorance of damaging effects be used as a justification since these damaging effects were discussed very early in the development of the surgery. Rather lobotomy seems to have been primarily a way of controlling troublesome patients. The patient's external behavior in its bearing on nursing problems was decisive for the use of lobotomy. The patient's own suffering did not seem to be a significant factor.

Introduction

From the early 1930's until the 1950's Scandinavian psychiatry, like psychiatry elsewhere in the western world, evolved from being the most "isolated" of medical specialties to being a respected branch of modern medicine (Pressman, 1986, p. 1). This development was caused by the breakthrough of somatic treatment methods such as insulincoma, cardiazolcoma, electroshock and lobotomy. Troublesome wards in insane asylums became calmer, and lengths of hospitalizations were reduced. Psychiatrists gained more prestige, and their growing public status and increased representation in medical literature led to greater influence within the field of medicine. Lobotomy, a type of surgery used in the treatment of mental illness, was an important factor in this development.

During this period western psychiatry also suffered from a general crisis characterized by hospital overcrowding and the shortage of ward staff (Valenstein, 1986, pp. 174-177). It is informative to view the development of lobotomy in Scandinavian psychiatry in relationship to the growing prestige of psychiatrists and the hospital conditions of the day. This relationship is illustrated in this article chiefly by events occurring at the leading institution in the performance of lobotomies in Scandinavia, Gaustad Mental Hospital, Oslo, Norway.

Historical Background

The introduction of lobotomy in Scandinavian was hardly easy. The Swedish psychiatrist Gøsta Rylander was one of the men on the Nobel Institute committee who advocated that the Nobel Prize in Medicine should go to Egas Moniz (Valenstein, 1986, p. 225). In 1939 Rylander proposed that lobotomies should be attempted in Sweden:

Once as a young assistant at the Psychiatric University Clinic of Stockholm I gave an account of the just published monograph by Moniz, "Tentatives Operatoires dans le Yraitement de Certain Psychoses", pointing out that anxiety was reduced in these cases. My chief, Professor Wigert, was horrified and forbade every experiment of that type with human beings. Then I approached Olivercrona, the neurosurgeon. He said that psychiatrists damaged the brain by electroshock treatment and that there was no reason to destroy part of it in such a doubtful way as Moniz had done (Laitinen and Livingstone, 1973, p.3).
It was Freeman's 1942 book, Psychosurgery, which was decisive for the beginning of lobotomy in Sweden. Rylander has stated that without Freeman's influence it is doubtful that lobotomy would have been used in Sweden (Laitinen and Livingstone, 1973, p. 1).
The famous Danish psychiatrist, Erik Strømgren, noted that lobotomy encountered initial resistance in Denmark also:

In August 1939 there was an international congress of neurology in Copenhagen. One of the lecturers was Walter Freeman. He reported on a great number of lobotomies. All Scandinavian psychiatrists who listened to Freeman shook their heads, deeply shocked: 'Never in our lives.' But the situation changed rapidly. We heard of good results on schizophrenics. Five years later most of us felt an obligation to offer this operation to the worst of the schizophrenics. In the meantime many good results from this operation had been reliably reported in the United States and England. We could no longer resist this operation. It would have been unethical (Strømgren, 1991).

The example of the United States was decisive for the development of lobotomy in Scandinavia. This can be illustrated by Gaustad Mental Hospital in Oslo, Norway, which was the first institution in Scandinavia to perform lobotomies. The development of lobotomy in Norway was led by this institution and its leader, Ørnulv Ødegård. Ødegård had many contacts in the United States, where he had studied psychiatry before the Second World War. He had been a student of Adolf Meyer, one of the most influential psychiatrists in the United States. Ødegård had learned a pragmatic attitude on methodology from Meyer (Astrup, 1977, p. 7). Ødegård's assistant, Carl W. Sem-Jacobsen, traveled to the United States to complete his study of psychosurgery and later returned to Norway to establish a psychosurgery project at Gaustad Mental hospital in the mid 50's.
Gaustad Mental Hospital was the last Norwegian institution to give up the practice of psychosurgery. It is also interesting to note that Gaustad had been a center for psychosurgery research from the middle of the 1950's with financial support from the Ford foundation and the United States Defense Department.4


There is much, much more ...