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Watts was recruited into a medical partnership by his colleague [[Walter Jackson Freeman II|Walter Freeman]], who needed the collaboration of a trained surgeon in order to practice the [[leucotomy]], a technique pioneered by the Portuguese neurologist [[Egas Moniz|António Egas Moniz]]. In the procedure developed by Moniz, the "[[white matter]]" in the [[frontal lobe]]s was severed using a [[leucotome]], an instrument Moniz designed specifically for the procedure. Freeman and Watts acquired several of the instruments and performed their first operation in 1936. They eventually modified the procedure to sever more of the white matter, and renamed it ''lobotomy'' in order to distinguish it from the earlier procedure developed by Moniz. Their technique soon became the standard form of the operation, and was known as the "Freeman-Watts Procedure".<ref>[http://www.gwu.edu/gelman/spec/ead/ms0803.xml George Washington University]</ref>
Watts' colleague, however, was less conservative and sought other ways to access the frontal lobes of the brain without the complications associated with conventional brain surgery. Inspired by the work of the Italian psychiatrist [[Amarro Fiamberti]], Freeman developed, without the knowledge or participation of Watts, a procedure for reaching the frontal lobes by inserting a probe under the eyelid and above the tear duct, then hammering it through the thin bone of the eye socket. The instrument was swished around, severing the white matter, and was then repeated on the other side. The whole operation took only minutes under local anesthesia or by using an electroshock machine to render the patient unconscious by passing a large electrical current through the brain, inducing a seizure, then leading to a brief period of post-seizure coma, which was when the procedure would be carried out. This new procedure became known as the [[lobotomy#Walter Freeman|transorbital lobotomy]], also dubbed the "ice pick lobotomy" because the instrument used, an [[orbitoclast]], was very similar to a common ice pick. The new procedure also signaled the end of the professional relationship between Freeman and Watts. After performing the new procedure by himself on ten patients, Freeman finally revealed to Watts what he had been doing. Watts, unlike Freeman, was a trained neurosurgeon and adamantly believed lobotomy should be performed only by a proper surgeon.<ref>{{cite book |last=Valenstein |first=Elliot |year=1986 |title=Great and Desperate Cures: The Rise and Decline of Psychosurgery and Other Radical Treatments for Mental Illness |url=https://archive.org/details/greatdesperatecu0000vale |url-access=registration |isbn=0465027105}}</ref> He insisted that Freeman cease performing operations alone, but it was to no avail and Watts soon left the practice that he had jointly established with Freeman.
The 1950s saw the introduction of the first truly effective [[antipsychotic]] medications, notably [[Thorazine]]. This, combined with a growing discomfort among the medical profession and general public regarding lobotomy, led to a sharp decline in the use of the procedure. In the intervening years, the theoretical basis of lobotomy has been largely discredited.
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