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This paper is a survey of the results of ten years of psychosurgery. The most striking and consistent personality changes following prefrontal lobotomy are an increase of 'unself-consciousness' and a change in 'feeling tone'. These patients
emerge from the operation with an immature personality but seem to improve with time. There are defects in foresight and insight which remain permanent, but anxiety is diminished. It is denied that they become apathetic.
Freeman and Watts advocate caution in establishing indications for this procedure. Prefrontal lobotomy is an operation of last resort and should be performed only in patients who no longer have a reasonable hope of spontaneous recovery and only after conservative measures have failed. However, the authors apparently contradict themselves by stating that in their experience they have found that this operation is indicated while the patient is still fighting his disease. 'When emotion subsides and the patient accepts his dream world in lieu of reality, surrenders to his fantasies, then there is little that surgery can accomplish.' Prefrontal lobotomy performed on patients with dementia præcox within the first two years of illness resulted in eighty-five percent 'good results' compared with only thirty-one percent 'good results' when it was done later.
They claim to have achieved 'good results' with obsession-tension states, chronic anxiety syndromes, involutional depressions, and schizophrenic states. From the brief case reports in the appendix of this paper, it is difficult to ascertain what they consider 'good results'. The return to work and the cessation of agitation may indicate an improvement within the personality, but it may also indicate less of a personality. Since Freeman and Watts are not psychoanalytically oriented, they do not probe into the dynamics or structure of the personalities involved. It would be necessary to examine such patients psychoanalytically, both pre- and post-operatively