Freeman partnered with neurosurgeon James W. Watts, because Freeman himself had no surgical training, and together they performed the first prefrontal lobotomy in the United States on September 14, 1936, on a patient from Topeka, Kansas named Alice Hood Hammatt. The procedure involved drilling holes into the skull and using a surgical instrument to sever the white matter connecting the frontal lobes to the thalamus.
By 1941, Freeman and Watts had performed well over two hundred of these procedures. They published results claiming improvement in a majority of their patients, and they presented the work at conferences and in journals with the confidence of people who believed they were doing something genuinely useful. The medical establishment’s response was mixed: some neurologists and psychiatrists were enthusiastic, others skeptical, and the American Medical Association had not formally endorsed the procedure. But the lobotomy was being discussed, performed, and written about as a legitimate treatment for severe psychiatric conditions, and the number of practitioners was growing.
What Freeman and Watts were not transparent about — and what the evidence suggests they either did not understand or chose not to acknowledge — was the significant damage the procedure could cause. The frontal lobes of the human brain are involved in a range of essential functions: planning, personality, social behavior, emotional regulation, impulse control, and the ability to connect past experience to present decisions. Severing the connections between the frontal lobes and the rest of the brain did not simply quiet problematic behavior. It could eliminate the capacity for complex thought, emotional nuance, and self-directed action.