The second great proponent of leucotomy—the physician who renamed it lobotomy and greatly modified the methodology used—was Freeman, professor of neuropathology at George Washington University Medical School in Washington, D.C. In 1936, he tested the procedure on preserved brains from the medical school morgue and repeated Egas Moniz's efforts. After six lobotomies, Freeman and his associate James W. Watts became optimistic that the method was useful to treat patients exhibiting apprehension, anxiety, insomnia, and nervous tension, while pointing out that it would be impossible to determine whether the procedure had effected the recovery or cure of mental problems until a five-year period had passed.
As Freeman and Watts continued to operate, they noticed problems, including relapses to the original abnormal state, a need for repeated surgery, a lack of ability on the part of patients to resume jobs requiring the use of reason, and death due to postsurgical hemorrhage. This led them to develop a more precise technique, using the landmarks on the skull to identify where to drill entry holes, cannulation to assure that lobe penetration depth was not dangerous to patients, and use of a knifelike spatula to make lobot-omy cuts. The extent of surgery also varied, depending upon whether the patient involved was suffering from an affective disorder or from schizophrenia. Their method, the "routine Freeman-Watts lobotomy procedure," became popular throughout the world.
Another method used for prefrontal lobotomy was designed by J. G. Lyerly in 1937. He opened the brain so that psychosurgeons could see exactly what was being done to the frontal lobes. This technique also became popular and was used throughout the United States. Near the same time, in Japan, Mizuho Nakata of Nigata Medical College began to remove from the brain parts of one or both frontal lobes. However, the Freeman-Watts method was most popular as the result of a "do-it-yourself manual" for psychosurgery that Freeman and Watts published in 1942. The book theorized that the brain pathways between cerebral frontal lobes and the thalamus regulate intensity of emotions in ideas, and acceptance of this theory led to better scientific justification of psychosurgery.
Another lobotomy procedure that was fairly widespread was Freeman's transorbital method, designed not only to correct shortcomings in his routine method but also in attempt to aid many more schizophrenics. The simple, rapid, but frightening procedure drove an ice-pick-like transorbital leukotome through the eye socket, above the eyeball, and into the frontal lobe. Subjects were rendered unconscious with ECT, and the procedure was done before they woke up. Use of this method gained many converts and, gruesome as it sounds, the method caused less brain damage than other psychosurgery procedures. It was widely used at state hospitals for the insane and was lauded by the press as making previously hopeless cases normal immediately.
Subsequently developed tereotaxic surgical techniques, such as stereo-tactic cingulatory, enabled psychosurgeons to create much smaller lesions by means of probes inserted into accurately located brain regions, followed by nerve destruction through the use of radioactive implants or by cryogenics. Currently, psychosurgery is claimed to be an effective treatment for patients with intractable depression, anxiety, or obsessional problems and a method that improves the behavior of very aggressive patients. Opponents say that these therapeutic effects can be attained by means of antipsychotic and antidepressant drugs. The consensus is that psychosurgery can play a small part in psychiatric treatment when long-term use of other treatments is unsuccessful and patients are tormented by mental problems.
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