Walter Freeman and James Watts collection

The Walter Freeman/James Watts collection, originally donated to the Himmelfarb Library of The George Washington University Medical School in 1980, was transferred to University Archives in April 2000. The collection represents the work of the first American team of doctors in psychosurgery. Dr. Walter Freeman (1895-1972) and his colleague Dr. James Winston Watts (1904-1994), developed a technique for neurosurgery on the frontal lobes of the brain commonly known as "lobotomy." Although considered a somewhat primitive practice by today's standards, this operation achieved a certain amount of success in significant numbers of patients suffering from severe depression, anxiety, and nervousness, and pain. (Success rate figures vary greatly.)\

This collection is of great value to scholars interested in the development of psychosurgery in the United States, since Freeman and Watts were pioneers in the field. (The first and second editions of their book Psychosurgery in the Treatment of Mental Disorders and Intractable Pain, published in 1942 and 1950, respectively, are contained in the collection.) Another collection in U niversity Archives related to this subject is the Thelma Hunt Papers, who was a Professor of Psychology at GW, and collaborated with Freeman and Watts on their book.

Walter Jackson Freeman II (1895-1972) earned world-wide fame for his work in the field of lobotomy. Freeman was born Philadelphia on Nov. 14, 1895 and received an A.B. from Yale in 1916, an M.D. from the University of Pennsylvania in 1920, and a Ph.D. from Georgetown University in 1931. He was professor of neurology at The George Washington University from 1926-1954, and became fascinated with psychosurgery (the scientific treatment of mental disorders by means of brain surgery). Freeman left GW in 1954 but continued his work in California, performing lobotomies and following-up on patients he had cared for up until his death on May 31 1972. He married Marjorie Lorne Franklin in 1924, and they had six children.

James Winston Watts (1904-1994) partnered with Freeman until 1949. He was born in Lynchburg, Virginia and graduated from the Virginia Military Institute and the University of Virginia Medical School in 1928 (where he was elected to Phi Beta Kappa and Alpha Omega Alpha honorary societies). He worked with John Fulton at Yale as a research fellow after medical school, and in 1935 joined the staff of the Department of Neurosurgery and Neurological Surgery at The George Washington University Hospital, where he remained until his retirement in 1969. He was married to Julia Harrison Watts and had two children. After his official retirement, Watts continued to work with the George Washington University Medical Center (including an oral history project) into the late 1980's and he died in 1994.

The study of psychosurgery has its origins in the last decades of the nineteenth century, when Gottlieb Burckhardt, a Swiss physician, performed operations in 1891 to remove parts of the cortex of six schizophrenic patients. After the surgery, some of the patients became calmer, although Burkhardt was criticized by medical authorities at the time for performing such a radical procedure. In the 1930's, Egas Moniz, a Portuguese neuropsychiatrist, built on the work Carlyse Jacobsen and John Fulton had done on primates. He proposed operating on a human subject, surgically cutting the nerve fibers connecting the frontal and prefrontal cortex to the thalamus, which is responsible for relaying sensory information to the cortex. In this way, Moniz reasoned, an interruption of the disruptive thoughts and behaviors of the psychotic patient might occur. Working with a colleague, he developed a surgical technique called leukotomy, in which holes were drilled in the head and a special wire knife, called a leukotome, was inserted into the brain matter. Moniz reported that in several cases severely agitated, anxious, or depressed patients showed improvement in their symptoms, although he cautioned using this technique as a last resort only. Walter Freeman read Moniz's reports, and embraced the idea of leukotomy. In September of 1936 Freeman and Watts operated on a 63 year-old woman who was suffering from depression, agitation, and fear. Following the operation, she was calm and her sense of terror seemed to have disappeared. After performing several more procedures, they published their first report in November, stating that anxiety, confusion, phobias, hallucinations, and delusions had been relieved or erased entirely in some patients. There was a down side to the procedure, which the doctors recognized, saying "Every patient probably loses something by this operation, some sparkle, some spontaneity, some flavor of their personality." Freeman and Watts changed the name of the procedure from "leukotomy" to "lobotomy," to distinguish their technique from that used by Moniz. They perfected what came to be known as the "Freeman-Watts Procedure," after much experimentation, but began to perceive the limitations of this operation early on. The initial professional reaction to the operations drew outraged responses from psychoanalysts and psychiatrists, although these reservations were not voiced to the public at the time. The introduction and wide acceptance around this time of shock therapies soon appeared a more acceptable alternative to lobotomies. Freeman was a neurologist, and neurologists had traditionally taken the view that there were physical causes for mental illness that required physical treatment. Psychiatrists on the other hand had argued that mental disorder was exclusively a problem of the mind. In the end, it was overcrowded institutions and limited mental health budgets that persuaded the medical community to adopt lobotomy as a popular course of treatment. The economic arguments were very strong: a lobotomy could be performed for $250 while it could cost $35,000 or more a year to maintain a patient in a hospital.

Walter Freeman was very good at convincing the press about the promises of lobotomy, and pushed it as a valid procedure. Up until 1945, Freeman had never actually performed a lobotomy himself, and wanted to develop a version of the operation that could be performed not just by neurosurgeons, but by anyone. During the winter of 1945, Freeman tried to develop a trans orbital (entry above the eye) approach to lobotomy, practicing on corpses. The instruments he and Watts were using were not strong enough to penetrate the orbital bone and kept breaking. Needing an implement that was slender, sharp, and strong, Freeman found precisely what he was looking for in a cheap, mass produced ice pick. Adapting it with a special hammer shaped head (which allowed easier manipulation), this instrument was used in the first trans orbital lobotomies in America in a procedure that came to be known as the "ice pick lobotomy." Armed with his new tool, Freeman was convinced that a trans orbital would be a simple piece of surgery not requiring the assistance of a neurosurgeon. He decided that he would operate on his first living patient without telling Watts, not dwelling on his own lack of surgical experience.

By his tenth patient, Freeman felt confident enough to inform Watts of what he had been doing. Watts was not happy, since he believed only a trained neurosurgeon should perform such an operation, and threatened to break with Freeman if he continued. It was the beginning of the end of their relationship and within months Watts left the joint practice they ran. By 1948, when Freeman was elected president of the American Board of Psychiatry and Neurology, the Freeman Watts standard lobotomy had been performed on as many as 20,000 individuals worldwide. In 1949, Egas Moniz won the Nobel Prize for Medicine for his pioneering work in psychosurgery, which in turn lent increased credibility to the practice of lobotomies. Between 1939 and 1951, some 18,000 lobotomies had been performed in the United States alone. By the early 1950's, rumblings about the effects of the lobotomy could be heard, as it was being used as a first, rather than a last resort by doctors. Post operative infections and fatalities were common, with autopsies showing large areas of the brain, not just selective nerves, being destroyed. It was impossible to judge recovery in many patients, and the inert, emotionless, inhuman, quality of those lobotomized began to revolt the public. Lobotomies were finally seen for what they were: not a cure, but a way of managing patients. It was seen by many doctors as just another form of restraint, and as some have put it, a mental straitjacket applied permanently over the brain.

For more information on Freeman/Watts and lobotomy, see the following websites:

http://www.geocities.com/~themistyone/freeman01.htm

http://www.psychosurgery.org/index.htm

N.B. This history note was written in 2005