Psychosurgery in Sweden 1944-1964.

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.

[The unknown history of lobotomy: women, children and idiots were lobotomized]. / Lobotomins okända historia: kvinnor, barn och idioter opererades.

The history of prefrontal lobotomy is an interesting example of medicine regarding as useful a treatment method which present-day consensus evaluates in a contrary fashion. A pilot study of archives from the Swedish state mental hospital Umedalen shows that the frequency of lobotomies as well as postoperative mortality were higher than what has earlier been assumed. The majority of the 704 patients who underwent lobotomy at Umedalen hospital were women. One unexpected finding concerns the numbers of mentally retarded patients and children who were subjected to lobotomy. Case records and other documents from the hospital archives indicate that the operation was performed largely for the benefit of the hospital rather than the patient, with an eye to engendering calm and order on the unruly wards.

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.

[What can we learn from the lobotomy period?]. / Hva kan vi laere av lobotomiperioden?

In 1991 the Ministry of Health and Social Affairs appointed a Commission of Inquiry, precipitated by a heated public debate on lobotomy. A group of four psychiatrists studied the case records of 300 patients lobotomized at Gaustad Hospital. The main review by the medical group focused on the high mortality rate during the 1940s. Also, surgery was done on broader indications than officially recommended, and the information given to the next of kin was often questionable. Since the obligation of the psychiatric profession also involves involuntary treatment, particular caution should be exercised in administering new methods. It is important to ensure control and critique by society. Ethical considerations should be integrated into quality control.