The patients on whom Freeman and Watts had primarily operated before Rosemary were severely ill adults — people with long-standing psychosis, incapacitating depression, or other conditions that had failed to respond to available treatments. Even in those cases, the results were variable and often involved significant losses of personality and function. The procedure’s reported successes were defined in terms that critics would later challenge: reduced agitation, easier management by staff, discharge from institutional care — outcomes that measured institutional convenience as much as patient wellbeing.
Rosemary Kennedy was different from those patients in one critical respect: she did not have a severe psychiatric illness in the sense Freeman and Watts had primarily worked with. James Watts himself, in a statement quoted by biographer Ronald Kessler and referenced in the Wikipedia article on Rosemary Kennedy, said that he believed Rosemary had depression rather than intellectual disability as her primary condition. Whether this assessment was medically accurate or retrospectively constructed to make the decision seem more defensible is impossible to determine from the available record. What is clear is that the procedure had never been performed on a patient whose primary diagnosis was intellectual disability rather than severe mental illness — and that this distinction mattered enormously, though it is not established that Freeman or Watts communicated this clearly to the Kennedy family.
Joe Kennedy, by the accounts that exist, went looking for a solution to Rosemary’s situation. He found Freeman and Watts. What conversation he had with them — what risks they described, what outcomes they promised or implied, what the degree of uncertainty was — is not preserved in the historical record in any direct document.