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Lobotomy Nation: The History of Psychosurgery and Psychiatry in Denmark 1st Edition Jesper Vaczy Kragh full chapter instant download
Lobotomy Nation: The History of Psychosurgery and Psychiatry in Denmark 1st Edition Jesper Vaczy Kragh full chapter instant download
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MENTAL HEALTH IN HISTORICAL PERSPECTIVE
Lobotomy Nation
The History of Psychosurgery
and Psychiatry in Denmark
Jesper Vaczy Kragh
Mental Health in Historical Perspective
Series Editors
Catharine Coleborne, School of Humanities and Social Science,
University of Newcastle, Callaghan, NSW, Australia
Matthew Smith, Centre for the Social History of Health and Healthcare,
University of Strathclyde, Glasgow, UK
Covering all historical periods and geographical contexts, the series
explores how mental illness has been understood, experienced, diagnosed,
treated and contested. It will publish works that engage actively with
contemporary debates related to mental health and, as such, will be
of interest not only to historians, but also mental health professionals,
patients and policy makers. With its focus on mental health, rather than
just psychiatry, the series will endeavour to provide more patient-centred
histories. Although this has long been an aim of health historians, it has
not been realised, and this series aims to change that.
The scope of the series is kept as broad as possible to attract good
quality proposals about all aspects of the history of mental health from
all periods. The series emphasises interdisciplinary approaches to the field
of study, and encourages short titles, longer works, collections, and titles
which stretch the boundaries of academic publishing in new ways.
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
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer
Nature Switzerland AG 2021
This work is subject to copyright. All rights are solely and exclusively licensed by the
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Preface
This book tells the story of one of medicine’s most (in)famous treatments:
the neurosurgical operation commonly known as lobotomy. The book itself
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-century psychiatrists had taken a keen interest in the spiri-
tualists’ conversations with the dead. In order to gain insight into the link
between the two groups, I started searching for information about the
evolution of psychiatry. It was not easy to find. The history of psychiatry
in Denmark has only been sparingly and sporadically recorded. I decided it
was worthy of closer study, and I was fortunate enough to secure funding
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
Note
1. On psychiatry and spiritualism, see Jesper Vaczy Kragh, “Mellem religion og
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
ix
x CONTENTS
Postscript 425
Appendix I: Diagnoses 427
Appendix II: Lobotomy Patients, Vordingborg State
Mental Hospital 431
Appendix III 441
Author Index 443
Subject Index 449
List of Figures
Fig. 2.1 The psychiatric map of Denmark in 1952, with a list of all
psychiatric hospitals, wards and units. The term “branch
institutions” covered the county hospitals that operated
under the state mental hospitals and took in elderly
patients. These county institutions were not authorised
to provide actual treatment and were primarily for elderly,
placid or able-bodied patients (Medical Museion) 40
Fig. 3.1 Chief physician Axel Bisgaard to the left and staff
doctor Sigurd Hansen rightmost. Nurse Lise Madsen
in the middle with the first two patients with dementia
paralytica just before departure to Vienna in 1922
(Medical Museion) 53
Fig. 4.1 Insulin coma therapy at the Danish State Mental
Hospital in Augustenborg in 1943 (Psychiatric Museum
Augustenborg) 76
Fig. 5.1 So-called pyknic body type from a Danish psychiatric
textbook (Medical Museion) 100
Fig. 5.2 On the left, the astenich or “leptoform” body type
that was typical for schizophrenia, according to Danish
psychiatrists. On the right side, angular profile (Medical
Museion) 102
xi
xii LIST OF FIGURES
Fig. 9.4 Indication I and II. Total number of indications for male
and female lobotomy patients from Vordingborg (N =
285) 250
Fig. 9.5 Time spent in hospital, lobotomy patients, Vordingborg.
All patients, men and women, before lobotomy (N =
313) 252
Fig. 9.6 Total time spent in hospital before lobotomy
and the general patient population in Vordingborg
01/01/1947. Lobotomy patients in blue, general patient
population 1947 in red 253
Fig. 9.7 All diagnoses for male and female lobotomy patients
from Vordingborg (N = 345) 254
Fig. 11.1 Aerial photo of the Neurosurgery Department
at Tagensvej in Copenhagen (Medical Museion) 313
Fig. 12.1 Stereotactic device for precision surgery. The technique
was invented by the American neurosurgeon Henry
T. Wycis in 1947. The image shows device used
at Rigshospitalet in Copenhagen, a so-called Leksell
frame, invented by the Swedish neurosurgeon Lars Leksell
(Medical Museion) 364
List of Tables
xv
CHAPTER 1
Prologue
On 11 November 1935, a 63-year-old woman with a psychiatric diagnosis
of involutional melancholia was admitted to the neurology ward at Santa
Marta Hospital in Lisbon, Portugal.1 She had been suffering from severe
anxiety attacks, insomnia and auditory hallucinations, and was convinced
that her neighbours and the police were hounding her. She had spent
three years as a patient at the Manicome Bombarda asylum, where the
psychiatrists described her as depressed, restless and prone to tears. She
was transferred to Santa Marta to find out whether a special new form
of treatment—as yet unnamed, but later known as frontal leucotomy—
would help. She would be the first patient to undergo the experimental
procedure devised by 61-year-old Professor of Neurology Egas Moniz
and carried out the next day by his assistant, the neurosurgeon Almeida
Lima. The veteran professor, who had previously enjoyed a successful
political career and gained international recognition for his neurological
research, was unable to operate due to chronic arthritis. However, Lima,
thirty years his junior, was accustomed to assisting Moniz in the oper-
ating room. The operation would be the first time in history that deep
incisions were made in the front parts of the brain of a psychiatric patient,
but Lima had no qualms: Moniz was his superior and needed his hands.2
The night before the operation, the patient’s hair was shaved off. The
next morning, her scalp was disinfected with alcohol. She was laid out
its colloquial name in Danish (det hvide snit ), which translates as “the
white incision.”6
The instrument, which Moniz dubbed a “leucotome,” was first used
on 27 December 1935 on a 47-year-old female patient who had been
transferred from Manicome Bombarda to Moniz’s hospital. “The patient
was admitted to our ward at Santa Marta in a highly troubled state,”
Moniz wrote. “She screams, never sits still, and begs not to be hurt.”
The patient refused to be photographed and had to be held down by two
nurses so that Moniz could take a pre-op photograph for the treatise he
was writing on the treatment.7
The woman was prepared for surgery and anaesthetised the same day.
Lima inserted the leucotome four centimetres into the woman’s brain
before pressing the plunger and releasing the wire loop. He then rotated
the instrument and made the first incision. Lima then completed the oper-
ation by making another three incisions. No post-op complications were
recorded, but Moniz noted that “the patient complains of headaches” and
tried to remove her bandages, so he administered an appropriate dose of
the sleeping drug Veronal (barbital).8
However, Moniz had to acknowledge that this operation was not
an unqualified success; she was cured of her anxiety but still seemed
depressed. She also became apathetic—a symptom she had not previ-
ously displayed. In his final notes, Moniz considered a second operation
in order to achieve “a more complete result.”9
After the first leucotomy, the number of incisions increased to six over
the next few operations. In the first series of surgery, which lasted until
February 1936, 20 patients with various psychiatric diagnoses underwent
the procedure at Santa Marta Hospital. In his assessment of the results,
Moniz reported that seven had been cured, seven had improved consid-
erably, and six remained unchanged. According to Moniz, the best results
were in patients with affective disorders, such as involutional melan-
cholia and manic-depressive psychosis. Patients with schizophrenia did
not appear to show much improvement.10
Moniz worked quickly, and very few of his patients were kept under any
form of observation for more than two months after their operations. He
wrote a steady stream of publications about the treatment. In 1937, he
completed a major book about leucotomy and had 13 articles published
in scientific journals in six countries. His peers abroad sat up and took
notice, and within a few months of the publication of the book in 1936,
4 J. V. KRAGH
doctors in the United States, Italy, Romania, Cuba, France and Brazil had
begun to experiment with the new treatment method.11
The speed at which leucotomy was adopted outside Portugal bore
witness to the fact that Moniz’s procedure was not an entirely new idea.
Nor was he the first doctor to consider neurosurgery as a cure for various
forms of human disorders. Trepanation—cutting holes in the skull—is
an ancient practice used in an attempt to cure health problems. One
of the oldest archaeological finds is a 10,000-year-old trepanned skull
from Ukraine. In Denmark, examples have been found dating to the
early Neolithic period, i.e., 4000–3200 BCE. However, it is doubtful
whether this practice was used to treat what we would call mental disor-
ders today.12 Actual surgical intervention—not just opening the skull but
removing specific parts of the brain in order to treat mental disorders—
was first recorded in the late nineteenth century. The earliest operation of
this kind took place in Switzerland.13
In 1888, the Swiss doctor Gottlieb Burckhardt performed the first six
neurosurgery operations on patients with mental disorders, believing it
better to try something new than do nothing at all. He also believed
that mental illnesses arose in specific parts of the brain and that removing
selected areas of the patients’ cerebral cortex might ameliorate or cure
their conditions. Burckhardt was the head of a small psychiatric hospital
in Préfargier, Neuchâtel, and had no real surgical experience. One patient
died after an operation, while others suffered serious injuries. Nonethe-
less, Burckhardt claimed that three of the patients showed signs of
improvement, which led him to think that there was a future for this
kind of treatment. He presented his findings at a major medical congress
in Berlin in 1890.14 But his arguments did not go down well. In fact,
most of the doctors who attended the congress were shocked by the
risks involved and predicted that the idea would soon peter out. Critical
voices were also raised when news of Burckhardt’s experiments reached
Denmark. A report in Hospitalstidende (Hospital Times) in 1892 noted
that “provisionally, surgical treatment for mental disorders, as proposed
by Burckhardt at the most recent International Congress, lacks any basis
in science.”15 The prominent Danish psychiatrist Knud Pontoppidan
also wrote about the Swiss doctor’s experiments. Pontoppidan failed to
discern any glorious future for the treatment and asserted that “apart
from the operation’s uncertainty and danger, the theoretical reasoning
that it is supposed to justify it is far from unassailable.” He concluded,
“given the imperfect state of our knowledge of the topography and
1 WHITE INCISIONS AND BLACK BUTTERFLIES 5
allowed them to practise with the new instruments on the heads of dead
people. In July that year, Freeman found the first patient for the new
treatment—a depressed 63-year-old housewife who had just been referred
to his practice in Washington. In September 1936, Freeman and Watts
performed a leucotomy on the woman—the first procedure of its kind in
the United States. More soon followed, as the duo sought to improve on
Moniz’s technique. Rather than enter the brain via the top of the skull,
they went in from the side, by boring holes in the temple region on both
sides of the head. A blunt instrument resembling a paperknife was then
inserted horizontally into the frontal lobes, and a fan-shaped incision was
made in the white matter. Operating from the side reduced the risk of
severing blood vessels in the brain, but it also meant that the surgeon
could not see where precisely in the brain they were making the incisions.
Freeman and Watts named the surgery “lobotomy,” after the Greek words
for lobe (lobos ) and cut (tomia).
Like Moniz, the American duo quickly published a series of arti-
cles on the new procedure. In 1942, they published a 300-page book
with numerous illustrations and photographs of patients before and after
surgery. The title page featured an image of a skull with boreholes from
a lobotomy, out of which flew four black butterflies. It was a reference to
the French term for depression: “I have black butterflies” (J’ai des papil-
lons noirs ), for which the frontal lobotomy was thought to be the cure.24
The book was favourably received by the American press and helped to
draw worldwide attention to lobotomy in the 1940s.25
Freeman spent the next few years refining the method. In 1945, he
began to promote a simplified operation that did not require major
surgical equipment or preparations. The process was quick and straight-
forward, but also controversial. The anaesthesia consisted of a series
of electroshocks, administered in quick succession. An instrument that
looked like an ice pick was then inserted along the bridge of the nose and
up through the tear duct.26 It was hammered through the thin part of the
skull at the eye socket, further into the frontal lobes, and wiggled from
side to side in order to cut a part of the brain’s white matter. The proce-
dure took less than ten minutes. Freeman liked the simplicity, but Watts
got cold feet after happening upon Freeman performing the procedure
on an unconscious patient in his office. Watts was shocked that Freeman
found it acceptable to perform brain surgery outside the hospital, and
told him he wanted no part in the trials of this new technique.27
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Something remains to be said of the Bauchi province. The
province consists of the Bauchi and Gombe Emirates, the Ningi
Division, an independent community half Muslim, half pagan, of
erstwhile noted freebooters and fighters, and the purely pagan
section, of which the Hill Division is the most important. The total
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the pagan division of Bauchi which, for centuries, has been the
refuge of communities fleeing from Hausa, Fulani and Beri-Beri
(Kanuri) pressure. No fewer than sixty-four distinct languages—not
dialects—are said to have been noted within it. The men are an
upstanding race, lithe rather than muscular, great archers and in
many cases daring horsemen, riding bare-backed, covering
immense distances in a phenomenally short space of time and
shooting accurately (with the bow) while mounted. Most of them go
about absolutely naked but for a sanitary adornment of special
character. For a picture of primitive man commend me to the
spectacle of a naked Bauchi pagan carrying a bow in his hand, on
his back a quiver of arrows; on his head, its horns sticking out on
either side, the gory and newly severed head of an ox—the “Boar of
the Ardennes” in variation and in an African setting of rugged
mountains and dying sun! I observed this sight one evening riding
into Naraguta from a distant mining camp, passing, ten minutes later,
a gorgeously attired Mohammedan Sariki in his many coloured robes
on a richly caparisoned horse. Northern Nigeria is a land of
extraordinary contrasts, which to some extent no doubt is the secret
of its fascination. The women’s clothing is also of the scantiest,
consisting of a bunch of broad green leaves fixed round the waist
and falling over the hips and lower abdomen. Their chastity is
proverbial even among the dissolute camp-followers.
VILLAGE HEAD-MEN.
VILLAGE HEAD-MEN.