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The lobotomy was designed to cut tissue connecting the prefrontal cortex to the thalamus. Since transorbital lobotomies are not guided or visualized if any way, they’re basically cutting blind into brain tissue.
It should be obvious why a tiny slip could have drastically different outcomes for differing patients. They’re slicing the brain, and can’t see where they’re slicing.
In her early young adult years, Rosemary Kennedy experienced seizures and violent mood swings. In response to these issues, her father arranged a prefrontal lobotomy for her in 1941 when she was 23 years of age; the procedure left her permanently incapacitated and rendered her unable to speak intelligibly.
Joseph Kennedy decided that Rosemary should have a lobotomy; however, he did not inform his wife of this decision until after the procedure was completed. The procedure took place in November 1941. James W. Watts, who carried out the procedure with Walter Freeman (both of George Washington University School of Medicine), described the procedure to author Ronald Kessler as follows:
