Editing Lobotomy (section)

===Transorbital lobotomy===
The Freeman–Watts prefrontal lobotomy still required drilling holes in the skull, so surgery had to be performed in an operating room by trained neurosurgeons. Walter Freeman believed this surgery would be unavailable to those he saw as needing it most: patients in state mental hospitals that had no operating rooms, surgeons, or [[anesthesia]] and limited budgets. Freeman wanted to simplify the procedure so that it could be carried out by psychiatrists in [[psychiatric hospital]]s.{{sfn|El-Hai|2005|p=184}}

Inspired by the work of Italian psychiatrist [[Amarro Fiamberti]], Freeman at some point conceived of approaching the frontal lobes through the eye sockets instead of through drilled holes in the skull. In 1945 he took an [[icepick]]{{refn|Frank Freeman, Walter Freeman's son, stated in an interview with Howard Dully that: "He had several ice-picks that just cluttered the back of the kitchen drawer. The first ice pick came right out of our drawer. A humble ice-pick to go right into the frontal lobes. It was, from a cosmetic standpoint, diabolical. Just observing this thing was horrible, gruesome." When Dully asked Frank Freeman, then a 79-year-old security guard, whether he was proud of his father, he replied: "Oh yes, yes, yeah. He was terrific. He was really quite a remarkable pioneer lobotomist. I wish he could have gotten further."{{sfn|Dully|2005}}|group=n}} from his own kitchen and began testing the idea on grapefruit{{refn|Rodney Dully, whose son Howard Dully had had a transorbital lobotomy performed on him by Walter Freeman when he was twelve years old, stated in an interview with his son that: "I only met him [Freeman] I think the one time. He described how accurate it [transorbital lobotomy] was and that he had practised the cutting on, literally, a carload of grapefruit, getting the right move and the right turn. That's what he told me."{{sfn|Dully|2005}}|group=n}} and [[cadavers]]. 

The use of lobotomy in the United States was resisted and criticized heavily by American neurosurgeons. However, because Freeman managed to promote the success of the surgery through the media, lobotomy became touted as a miracle procedure, capturing the attention of the public and leading to an overwhelming demand for the operation. In 1945 Freeman streamlined the procedure, replacing it with transorbital lobotomy, in which a picklike instrument was forced through the back of the eye sockets to pierce the thin bone that separates the eye sockets from the frontal lobes. The pick's point was then inserted into the frontal lobe and used to sever connections in the brain (presumably between the prefrontal cortex and thalamus). In 1946 Freeman performed this procedure for the first time on a patient, who was subdued prior to the operation with electroshock treatment.

The transorbital lobotomy procedure, which Freeman performed very quickly, sometimes in less than 10 minutes, was used on many patients with relatively minor mental disorders that Freeman believed did not warrant traditional lobotomy surgery, in which the skull itself was opened. A large proportion of such lobotomized patients exhibited reduced tension or agitation, but many also showed other effects, such as apathy, passivity, lack of initiative, poor ability to concentrate, and a generally decreased depth and intensity of their emotional response to life. Some died as a result of the procedure. However, those effects were not widely reported in the 1940s, and at that time the long-term effects were largely unknown. Because the procedure met with seemingly widespread success, Moniz was awarded the 1949 Nobel Prize for Physiology or Medicine (along with Swiss physiologist [[Walter Rudolf Hess]]).

Lobotomies were performed on a wide scale during the 1940s; Freeman himself performed or supervised more than 3,500 lobotomies by the late 1960s. Freeman performed his first transorbital lobotomy on Ellen Ionesco, a woman who suffered from bouts of manic depression and suicidal ideation. Freeman utilized media coverage and penned editorials for numerous interviews promoting the procedure and achieving accolades for his work in psychiatric care.<ref>{{Cite web |date=2024-07-19 |title=Psychiatry {{!}} Mental Health, Treatment & Diagnosis {{!}} Britannica |url=https://www.britannica.com/science/psychiatry |access-date=2024-08-09 |website=www.britannica.com |language=en}}</ref>

Watts did not favor the transorbital method, and this difference of opinion contributed to the end of their partnership. Watts resisted the technique itself, Freeman's lack of sterile technique when performing it, and the idea of performing the procedure in an outpatient setting. Watts recalled that the hospital reprimanded Freeman, stating that he was "not a surgeon and if he wants to operate he'll have to apply for surgical privileges."<ref>{{Cite journal |last1=Caruso |first1=James P. |last2=Sheehan |first2=Jason P. |date=2017-09-01 |title=Psychosurgery, ethics, and media: a history of Walter Freeman and the lobotomy |url=https://thejns.org/focus/view/journals/neurosurg-focus/43/3/article-pE6.xml |journal=Neurosurgical Focus |language=en-US |volume=43 |issue=3 |pages=E6 |doi=10.3171/2017.6.FOCUS17257 |issn=1092-0684|doi-access=free |pmid=28859561 }}</ref> 

Freeman performed the first transorbital lobotomy on a live patient in 1946. Its simplicity suggested the possibility of carrying it out in mental hospitals lacking the surgical facilities required for the earlier, more complex procedure. (Freeman suggested that, where conventional anesthesia was unavailable, [[electroconvulsive therapy]] be used to render the patient unconscious.){{sfn|El-Hai|2005|ps=}} In 1947, the Freeman and Watts partnership ended, as the latter was disgusted by Freeman's barbarism and neglectful modifications of the lobotomy from a surgical operation into a simple "office" procedure.<ref>{{Cite journal|title=Psychosurgery, ethics, and media: a history of Walter Freeman and the lobotomy.|journal=Neurosurgical Focus|volume=43|issue=3|pages=E6|doi=10.3171/2017.6.FOCUS17257|pmid=28859561|year=2017|last1=Caruso|first1=James P.|last2=Sheehan|first2=Jason P.|doi-access=free}}</ref> Between 1940 and 1944, 684 lobotomies were performed in the United States. However, because of the fervent promotion of the technique by Freeman and Watts, those numbers increased sharply toward the end of the decade. In 1949, the peak year for lobotomies in the US, 5,074 procedures were undertaken, and by 1951 over 18,608 individuals had been lobotomized in the US.{{sfn|Shorter|1997|pp=227–28|ps=}}