Table Of ContentMENTAL HEALTH IN HISTORICAL PERSPECTIVE
Lobotomy Nation
The History of Psychosurgery
and Psychiatry in Denmark
Jesper Vaczy Kragh
Mental Health in Historical Perspective
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Jesper Vaczy Kragh
Lobotomy Nation
The History of Psychosurgery and Psychiatry
in Denmark
Jesper Vaczy Kragh
Centre for Health Research
in the Humanities
University of Copenhagen
Copenhagen, Denmark
ISSN 2634-6036 ISSN 2634-6044 (electronic)
Mental Health in Historical Perspective
ISBN 978-3-030-65305-7 ISBN 978-3-030-65306-4 (eBook)
https://doi.org/10.1007/978-3-030-65306-4
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Preface
Thisbooktellsthestoryofoneofmedicine’smost(in)famoustreatments:
theneurosurgicaloperationcommonlyknownaslobotomy.Thebookitself
is the serendipitous result of a series of more or less random events that
occurred some years ago, at a time when I knew nothing about high-risk
neurosurgical practices on psychiatric patients. Back then, I was studying
a group of Danes who claimed to commune with the dead—the spir-
itualists from the twentieth century—and the history of psychiatry was
unknown territory to me.1 Nevertheless, I made my way, via a some-
what circuitous route, from spiritualism to psychiatry. It turned out that
early-twentieth-centurypsychiatristshadtakenakeeninterestinthespiri-
tualists’conversationswiththedead.Inordertogaininsightintothelink
between the two groups, I started searching for information about the
evolution of psychiatry. It was not easy to find. The history of psychiatry
inDenmarkhasonlybeensparinglyandsporadicallyrecorded.Idecidedit
wasworthyofcloserstudy,andIwasfortunateenoughtosecurefunding
for a research project in 2002. To this day, my interest in psychiatry has
remained undiminished.
In the course of my research, I was particularly drawn to the somatic
treatments in psychiatry. In the early twentieth century, Danish psychi-
atrists all seemed to agree on the use of therapies like Cardiazol shock,
insulin coma therapy, electroshock and lobotomy on patients admitted
to the big mental hospitals. Accounts ranged from miraculous healing to
severely adverse side-effects, from sky-high recovery rates to zero effect.
v
vi PREFACE
Thepopularityofthelastofthesephysicaltreatments,lobotomy,came
as a particular surprise to me. A picture started to emerge of a Danish
lobotomytradition.Infact,evidencesuggeststhatmorelobotomieswere
performedinDenmarkthananyothercountry,anunofficialworldrecord
that I was surprised to find had failed to make its way into the history
books. Indeed, even in works on the history of Danish medicine, there
was not one word about the thousands of people who had undergone
thissurgicalproceduretotheirprefrontallobes.Whythesilence?Whydid
Danish psychiatrists so enthusiastically embrace this method? Lobotomy
became the focal point of the project, and the question of its widespread
use in Denmark became the starting point for my studies.
Insearchofpotentialexplanationsforthewidespreaduseoflobotomy,
I turned to the international literature on the subject but discovered
no unambiguous answers. In fact, I found only a few in-depth studies,
and even the most illustrious works offered explanations that pointed
in different directions. As a consequence, I started to relate the Danish
example to theories in international research and follow other paths not
covered in the literature.
One such path led me to contemporary perspectives on methods
of physical treatment in twentieth-century psychiatry. For many Danish
psychiatrists, somatic treatments—not just lobotomy, but also elec-
troshock and others—represented a turning point in the history of their
discipline.Theintriguingideathatthesekindsoftreatments,whichwould
besoharshlycriticisedbyposterity,wererevolutionaryforsomanypsychi-
atrists opened up for other questions: How did lobotomy and other
somatic therapies fit into the bigger picture of the way both psychiatry
and society were developing in the early twentieth century?
This book is the result of those studies. The story begins in 1922 and
endsin1983—atleast,insofarasitcanbesaidtoendatall.Thedebate
aboutlobotomyrumbleson,andtothisday,psychosurgeryisstillatopic
of debate in many parts of the world. In the recent past, neurosurgeons
and psychiatrists have stressed that this new form of surgery is a rapidly
evolving discipline, and plans to reintroduce psychosurgery have been on
the agenda in several countries—including Denmark. The most recent
innovationisDeepBrainStimulation,whichhascreatedhighexpectations
inmanycircles.This,ontheotherhand,hasencouragedotherresearchers
to express concern about repeating the mistakes of the past. My book
represents a contribution to that discussion.
PREFACE vii
A note on terminology. In this book, the terms “leucotomy” and
“lobotomy” are both used for the procedures performed from 1935 to
1955,and“psychosurgery”isusedasanumbrellatermthatencompasses
both the early lobotomy/leucotomy and later forms of surgery (stereo-
tactic, etc.) that took off in the late 1950s and used slightly different
techniques. In the UK, leucotomy is often used as a generic term for
all psychosurgical operations, i.e. prefrontal lobotomy (American term)
wouldbecalledprefrontalleucotomyintheUK.Inthisbook,Iprimarily
use the term “leucotomy” to describe the operation invented by Egas
Moniz(whocoinedtheterm)andlobotomytodescribethelatersurgical
procedures introduced by Walter Freeman and James Watts.
Without external funding, this book would not have been possible. In
particular, I would like to express my gratitude to the Povl M. Assens
Foundation. I also received a great deal of help from other institutions
andindividuals,whomIwillthankproperlyinthepostscript.Butnowto
the topic at hand.
Copenhagen, Denmark Jesper Vaczy Kragh
Note
1. Onpsychiatryandspiritualism,seeJesperVaczyKragh,“Mellemreligionog
videnskab. Spiritismen i Norden i 1800 og 1900-tallet,” Scandia. Tidskrift
for historisk forskning, 68 (2002), 53–75; Kragh, “History of spiritualism
in Denmark, 1853–2011,” in: Christopher Moreman (ed.), The Spiritu-
alist Movement. Speaking with the Dead in America and Around the World
(California: Praeger, 2013), 73–82.
Contents
1 White Incisions and Black Butterflies 1
Part I Towards Lobotomy
2 State Mental Health Services—Danish Hospitals
and the Directorate, 1922–1952 31
3 Malaria and the Interwar Years—Malaria Fever
Therapy and Other Innovations in Psychiatry,
1922–1937 47
4 Shock and Coma—Insulin and Cardiazol Shock
Therapy, 1937–1942 69
5 Psychiatric Cooperation—Shock Treatment,
Diagnoses and Psychiatric Textbooks, 1938–1942 93
Part II The Heyday of Lobotomy
6 Something Different—Lobotomy, Electroshock
and Plans for Psychiatry, 1939–1947 121
7 The First of Many—Lobotomy and the State Mental
Hospital in Vordingborg, 1940–1947 149
8 TheApostlesoftheKnife—Lobotomy,theDirectorate
and the General Public, 1946–1956 171
ix
x CONTENTS
9 Last Resort?—Selecting Patients for Lobotomies
in Vordingborg, 1947–1956 219
10 Women and the Problem of Psychopathy—Gender
and Control in Vordingborg, 1947–1956 263
Part III The Demise of Psychosurgery
11 A Question of Consent—Coercion and Consent
to Lobotomy, 1946–1958 291
12 Lobotomia Sequelae—The Side-Effects of Lobotomy,
1955–1983 337
13 The Final Cut—Summary and Conclusion 393
Postscript 425
Appendix I: Diagnoses 427
Appendix II: Lobotomy Patients, Vordingborg State
Mental Hospital 431
Appendix III 441
Author Index 443
Subject Index 449
