In this post Anna Dersken explores the differing ways Sweden has responded to its past of sterilisation and lobotomy, highlighting themes of medical ethics, responsibility, and injustice.
In the 1990s, Sweden—often admired as a model of egalitarian welfare—was forced to confront a dark chapter of its history. Long after repealing laws mandating the sterilisation of marginalised groups and witnessing the rise and fall of lobotomy as a psychiatric treatment, both practices re-emerged in public discourse. This essay explores how Sweden reckoned with these controversial medical interventions, focusing on two distinct approaches to justice: the compensation and apology extended to victims of forced sterilisation, and the quieter, more medicalised response to lobotomy. By comparing these responses, we can examine how notions of state responsibility, medical authority, and the ethics of historical medical violence intersect. Can compensation be offered without assigning guilt? And how did survivors’ testimonies shape Sweden’s re-evaluation of these past injustices?
Sterilisation as a Tool of Eugenics and Social Control
Sweden’s sterilisation programme, introduced in 1934 and expanded in 1941, was part of a broader eugenics movement aimed at “improving” the population (Broberg and Tydén 1991; Tydén 2002, Björkman and Widmalm 2010). The goal was to prevent those considered “unfit” from reproducing: people with mental disabilities, hereditary diseases, or those deemed ‘socially deviant’ (alcoholics, prostitutes), but also families who were poor and had ‘too many’ children (Runcis 1998; Broberg and Roll-Hansen 1996). Public health concerns and economic arguments overshadowed ethical considerations, with sterilisation framed as a necessary measure for societal well-being and endorsed by parties and social groups across the political spectrum (Björkman and Widmalm 2010).
Institutionalised individuals, especially those diagnosed with intellectual disabilities, were particularly vulnerable. A survivor’s letter from the 1990s captures the coercive reality of the sterilisation policy:
“I was sterilised in the fall of 1949, in the hospital ward of Strängnäs. It was a coercion that one had to endure in order to get out of there; otherwise, one had to stay, possibly for indefinite time. […] Afterward, one felt hatred toward all those who had destroyed one’s life, the possibility of starting a family, and hoped to receive compensation for all the suffering one had felt throughout one’s life. In June 1950, I got out and was free from this hell that words cannot describe. Fortunately, I had my father and mother, to whom I could return home.” (Letter to Social Affairs Minister Margot Wallström, August 1997)
For many, sterilisation was not only a medical procedure but also a condition for release from institutions. Often combined with rites of passage, such as religious confirmation or starting work, it became a powerful tool of social control. Under the guise of public health and wellbeing, the practice systematically undermined personal autonomy.
A Turning Point: The 1997 Debate
Sterilisation had faded from public memory until 1997, when the Swedish newspaper Dagens Nyheter revealed that around 62,000 people had been sterilised between 1935 and 1976, many under coercion or without consent (Zaremba 1997a, 1997b). Drawing on historical research, personal testimonies, and critiques of Sweden’s welfare state, the coverage sparked widespread outrage. A heated public debate followed, focusing on media narratives, historical responsibility, and the integrity of state institutions. This public reckoning forced Sweden to confront an uncomfortable question: how could a nation so proud of its progressive welfare model reconcile with such repressive practices in its past?
In response to mounting pressure, the Social Democratic government under Ingvar Carlsson swiftly established a commission to investigate the sterilisation programme. The commission’s task was twofold: to document and analyse the historical facts and to assess the ethical dimensions of these practices. The parliament’s official directive to the commission made the connection between sterilisation and eugenics explicit:
“The design of the laws and their application in practice were, among other things, shaped by a eugenic approach and the belief in racial purity, which prevailed among many decision-makers, researchers, and doctors in Sweden and other countries in the first half of the 20th century. Many of those sterilised became victims of this approach. Swedish society has long since firmly rejected this.” (Sveriges Riksdag 1997a)
In 1999, Sweden introduced a compensation scheme for victims of forced sterilisation. Framed as an ex gratia payment—that is, a gesture of goodwill without legal obligation—it marked the country’s first compensation scheme for historical abuses (Arvidsson 2016). As Christian Democrat Alf Svensson noted at the time:
“It should be in the interest of both the government and political parties to openly address the dark chapters of our history in relation to sterilisation policy.” (TT 1997).
Lobotomy: A Quieter Reckoning
In contrast to the discussion of sterilisation, the debate over lobotomy was much more subdued. Introduced in Sweden in 1944, lobotomy was initially hailed as a groundbreaking psychiatric treatment. By severing neural connections in the brain’s frontal lobe, doctors believed they could alleviate severe mental illnesses and reduce reliance on restraints and sedatives (Ögren and Sandlund 2009). Swedish psychiatrist Gösta Rylander was among the pioneers who popularised the procedure, which soon spread across psychiatric institutions in the country.
However, by the 1960s, the severe side effects of lobotomy (cognitive impairments, emotional flattening, and increased dependency) became widely recognised (Diefenbach et al 1999). The emergence of psychotropic medications offered less invasive alternatives, while cultural critiques, like Ken Kesey’s book One Flew Over the Cuckoo’s Nest (1962), further discredited the practice.
Though lobotomy was scrutinised in the 1990s as a form of medical violence, it did not provoke the same public outcry as sterilisation. Social Affairs Minister Margot Wallström, who had also overseen the sterilisation debate, responded by emphasising medical context:
“Although I deeply regret the negative effects of lobotomy on the patients who were treated with this method […], I believe that no new information has emerged that would lead me to make a different assessment than the one already made by Parliament and the government.” (Wallström 1997/98:1048).
By framing lobotomy as a clinical decision made “in accordance with the science and recognised methods of the time,” (Sveriges Riksdag 1997b) the state effectively distanced itself from direct responsibility. Lobotomy was presented as a product of prevailing medical knowledge, rather than a political or systemic failure. Yet, this distinction raises questions. While lobotomy may have reflected contemporary psychiatric practices, the state still bore responsibility for overseeing medical ethics and for responding to harm when treatments were later shown to have caused lasting damage.
Norway’s Path to Recognition and Redress
Norway’s approach to lobotomy offers a striking contrast. In 1990, Norwegian criminologist Joar Tranøy published a study on lobotomies performed at Gaustad Hospital in Oslo, sparking a public debate that echoed Sweden’s earlier reckoning with sterilisation (Tranøy 1990). In response, Norway convened a commission of experts to investigate the ethics of the practice. The commission concluded that lobotomies had often been performed without proper consent and should have been abandoned much earlier, especially given the high mortality rate – around 32% (NOU 1992:25).
Faced with these findings, the Norwegian parliament passed a temporary law in 1996 to compensate lobotomy victims, offering NOK 100,000 to approximately 500 individuals (Haave 2003).
Norway’s broader reflection on medical authority and state oversight of healthcare systems led to this formal recognition of harm: a path Sweden notably did not follow.
Contrasting Frameworks of Responsibility
Why did Sweden issue apologies and compensation for sterilisation but not for lobotomy? The answer lies in how these practices were framed. Sterilisation was part of a state-driven eugenic policy, closely tied to social engineering. Lobotomy, by contrast, was regarded as a medical procedure, the responsibility of individual doctors rather than the state or state authorities.
This framing had significant consequences. Public outcry over sterilisation prompted government action and compensation, while lobotomy remained largely treated as an internal medical matter, with limited public debate and no formal state apology or redress. Medical ethicist Niels Lynöe reflected on this distinction in the journal Läkartidningen in 1997:
“The question of compensation seems to be intimately linked to the question of responsibility and guilt. Can compensation be granted without simultaneously implying (guilt by association) or directly placing responsibility and blame? A similar question has recently arisen in connection with the discussion about the previous sterilisation practices in Sweden. In the latter case, the individual’s integrity and autonomy were violated, and it is therefore more a matter of psychological harm.” (Lynöe 1997).
Lynöe’s reflection highlights a central ethical tension: the extent to which compensation implies acknowledgment of wrongdoing. By framing harm in psychological terms, Lynöe underscores why redress in these cases cannot be confined to technical or legal assessments alone. Sterilisation was deeply tied to identity and life possibilities, especially having children and forming a family. Lobotomy, by contrast, targeted the brain itself and was therefore more readily framed as a clinical intervention on a patient in need, with its personal consequences largely obscured.
Reckoning with the Legacies of Medical Violence
The legacies of state-sanctioned medical interventions, whether through Sweden’s sterilisation policies or the use of lobotomy, highlight the ethical complexities of addressing historical abuses from the vantage point of the present (or in this case, the 1990s). These issues remain acutely relevant today, as histories of medical violence continue to shape contemporary debates.
A striking example is the Danish government’s forced contraception programme in Greenland during the 1960s and 1970s. Revealed only in 2022, this programme saw Danish doctors insert intrauterine devices (IUDs) into thousands of Greenlandic Inuit girls and women, often without their consent or even knowledge (Vinther Nielsen 2022). This policy, part of a broader population control effort following Greenland’s formal decolonisation in 1953, is now under investigation, with findings expected in 2025 (Dyrendom Graugaard, Sørensen, and Stage 2025).
The parallels between Sweden’s sterilisation practices and Denmark’s actions in Greenland demonstrate that the legacy of medical violence is far from resolved. These cases challenge us to reconsider how contemporary healthcare systems should reckon with historical harms. Crucially, accountability must go beyond symbolic gestures. While Sweden’s ex gratia compensation for sterilisation victims represented a meaningful step, the lack of legal responsibility meant that this case could not be used as a framework for similar wrongdoings. Just like the lack of similar recognition for lobotomy survivors reveals persistent gaps in how states confront past abuses.
Genuine accountability demands more than one-off apologies. It must be structural, enduring, and legally grounded.
About the author
Anna Derksen is a historian and academic project manager based in Göttingen, Germany. Her research focuses on modern Nordic and disability history, with particular attention to the impact of welfare, medical, and social policies, as well as the public discourses they generated.
References
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