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The ability to generate different responses, and the ability to inhibit inappropriate behaviour, were explored in patients with unilateral cerebral excisions. Site-of-lesion effects were found to interact with the sex of the subject, the time of test-administration, and the nature of the response criteria. In Part I, the Thurstone Word Fluency Test revealed impairments two weeks postoperatively in patients with frontal, temporal, or central-area lesions. In men, removals from the left cerebral hemisphere caused greater deficits than removals from the right, but only left central-area excisions resulted in long-lasting impairments. Patients with left frontal-lobe removals produced few words on a sentence-completion fluency task, but on visual-image fluency, no patient-group was impaired. In Part II, an inability to inhibit impulsive actions on risk-taking tasks was seen after frontal lobectomy, as was a tendency to disregard the instructions on a word-fluency task. These results are consistent with the fact that patients with frontal-lobe lesions described themselves on a behavioural-trait questionnaire as less flexible and more impulsive than did control subjects.

Thesis (Ph. D.)--University of Wisconsin--Madison, 1957. / Typescript. Vita. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 102-111).

This essay reflects my process in the making of a final body of work. In chapter one I investigate and describe two mental disorders commonly associated with women, Hysteria and Borderline, and compare them to the material and the use of pearls. Also giving some background on how mental patients have been treated and to the Swedish psychiatric care. Chapter two is a further discussion on the theme mind/body, offering the reader some insight on how I approach the making. Chapter three is what came after

In Part I of this thesis, recognition of natural scenes was tested in 72 patients with unilateral frontal- or temporal-lobe excisions and 32 normal control subjects (NC). The occurrence of a novel scene in the midst of a series of other scenes normally induces forgetting of the scene that had preceded the novel one. This phenomenon was not observed following right frontal- and right temporal-lobe lesions, and was only partially present after left temporal-lobe excisions that included the hippocampus (LTH). These brain regions were thus seen as part of a circuit that codes novel stimuli. In Part 2, recall of lists of words was examined in 77 patients and 12 normal control subjects. Both the left frontal-lobe (LF) and LTH groups recalled fewer words overall than the other groups; their performance was normal, however, when the words were pre-organized into categories and when category labels were supplied during test. In another experiment it was demonstrated that the LF group was impaired when category exemplars were provided together with the category labels, the LTH group being unaffected in this condition. It was concluded that left frontal-lobe lesions may affect retrieval mechanisms.

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Background. The pioneering early experiments of prefrontal lobotomy were performed in 1944 by neurosurgeons in Stockholm in collaboration with psychiatrists. There was a rapid implementation of the new surgical approach. In 1946 and 1947 the two state mental hospitals, Umedalen and Sidsjön, introduced prefrontal lobotomy on a large scale. General surgeons now performed operations, a practice which was established all over Sweden. Prefrontal lobotomy was burdened, in certain city hospitals, by an initially high rate of postoperative mortality reaching more than 15 %. Pre-frontal lobotomy was phased out continuously already before 1950 and refined psychosurgical methods were introduced , but prefrontal lobotomy was still continued which lacked specialised neurosurgical units. The aims of the thesis were to contribute to and deepen the knowledge and understanding of the general and specific questions of early psychosurgery in its professional and social context. Specific aims: (Explore the practice of prefrontal lobotomy at the Umedalen State Mental hospital and plot the frequency of psychosurgery operations in Sweden. • Analyze the patients subjected to prefrontal lobotomy at the Umedalen State Mental Hospital 1947-1958, with respect to symptomatology and diagnosis, indications for the operation, gender distribution postoperative mortality, the practice of consent and other clinical factors. • Explore and analyze what was written on psychosurgery, when and how, and to identify differences, similarities and characteristics of the portrayal of psychosurgery in Swedish and American media 1936-1959. • Explore and analyze the confluence of the role of the State authority, The Swedish National Board of Health (Medicinalstyrelsen), the professional discourses on lobotomy and the media portrayal, in dealing with problems of implementation and mortality. Results. Paper I. At the Umedalen State Mental Hospital, 771 prefrontal lobotomies were performed 1947-1958 with an overall postoperative mortality of 7.4 %. Most of the patients operated on from Umedalen were women (61.2%) and most of the patients were diagnosed with schizophrenia. Of all the lobotomies performed in Sweden (approx. 4,500), 28% had been carried out at the Sidsjön and Umedalen State Mental Hospitals. Paper II. A sample of 105 patients, who were studied in detail from psychiatric records. It was found that 79% had been six years in primary school and only 3% had a higher education. In an analysis of the descriptions of behavioural problems stated in the medical records, it was found that the female candidate for prefrontal lobotomy was described as suffering from different problems more often than the male candidate. Disturbing behaviour, fluctuations of mood and violence against others were the most frequently described symptoms most often referred to with respect to the female lobotomy candidate. Paper III. In the comparative media study it was found that most of the articles on lobotomy in the Swedish and American media were positive or neutral towards psychosurgery, while very negative articles were least frequent. Neutral articles were more common in Swedish media (43%) while less common in the American media (19%). Articles being very negative towards lobotomy were considerably more often found in the American material (32%) than in the Swedish (14%). Paper IV. The implementation of lobotomy was rapid in Sweden and more than 4000 lobotomies were performed between 1944 and 1964. It was considered feasible for prefrontal lobotomies to be performed by general surgeons and, from 1951, it can be verified that most hospitals (12/20) had engaged general surgeons for the lobotomy operation while a minority (8/20) had engaged a neurosurgeon. The Swedish State, through the Swedish National Board of Health was responsible of the allocation and surveillance of mental care. With a system consisting of a Chief Inspector of Mental Care, State mental hospitals were inspected annually. Medical superintendents were given full autonomy to decide on the implementation and practice of lobotomy. No indications were found of any significant interference by the Swedish National Board of Health restricting lobotomy. Main conclusion. Medical superintendents were given full autonomy to decide on the clinical practice of lobotomy. Being left in the periphery of neurosurgical facilities, this led to their engaging general surgeons. Patients were operated on in surgical theatres lacking the sophisticated technical equipment of coping securely with haemorrhages, which were common in the early implementation of the operation. The practice of lobotomy in some mental hospitals was extensive and postoperative deaths were numerous but the Swedish National Board of Health took a defensive role and, even with the annual inspections, there was no important interference with the lobotomy question. Swedish media reported mostly positively on lobotomy, underlining the promising prospects of the new method submitted by the early proponents without critical questioning or independent investigations. / Kompletteras 2012-09

Copy and recall drawings of the Rey Complex Figure obtained during the standard clinical testing of patients with well-localized epileptic foci before and after left frontal-, left temporal-, right temporal-lobe resection were re-scored blind as to lesion site using standard protocol (18 elements scored 0, 1/2, 1, or 2 based on whether they are drawn and placed correctly for a total out of 36). They were also scored for which, and how many, elements were missing, distorted, displaced, and/or repeated. Contrary to previous findings, no main effects of side or lobe or side-by-lobe interactions were found on copy and recall scores obtained either before or after surgery, and all patients' recall improved equally from pre-operative to follow-up testing. Furthermore, patients' lesion site could not be predicted on the basis of any single measure or across all measures of performance. While group differences had been found on the previously assigned scores, the between-group overlap was almost complete and the original scoring was not done blindly. These results suggest that, despite previous claims, the Rey Complex Figure, a widely-used measure of non-verbal memory, is not an effective tool for localizing neural disturbance in temporal- and frontal-lobe epilepsy patients.

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We think of the lobotomy as utterly primitive and brutal; we shudder at the idea of it. The archetypal image of creepiness, violence, and unnecessary brutality was expressed in the book and movie One Flew Over the Cuckoo’s Nest. This procedure weighs heavy on America’s conscience but in 1945 the procedure was characterized as being as gentle as ‘cutting through butter’ and the therapeutic effect was described as ‘cutting out worry’. How did the lobotomy gain such widespread acceptance? One part of the answer is that Walter Freeman advocated for it not just among his colleagues, but through the popular media outlets of his day as well. In this thesis I will claim that, starting in 1936, Walter Freeman influenced the positive portrayal of lobotomies in the American press. He participated in visual culture that promoted a convergence between medical culture and the popular press by cultivating a representation of the procedure that could appeal to both. His tools included narrative accounts, images, and a public dramatization of himself that was hard to resist. I will show how these efforts were quite successful in the beginning, but that by 1947 he started to lose control of the perceptions and narrative he had worked so hard to construct.