Nick Stockton at Wired

A BRAIN SURGEON begins an anterior cingulotomy by drilling a small hole into a patient’s skull. The surgeon then inserts a tiny blade, cutting a path through brain tissue, then inserts a probe past sensitive nerves and bundles of blood vessels until it reaches a specific cluster of neural connections, a kind of switchboard linking emotional triggers to cognitive tasks. With the probe in place, the surgeon fires up a laser, burning away tissue until the beam has hollowed out about half a teaspoon of grey matter.

This is the shape of modern psychosurgery: Ablating parts of the brain to treat mental illnesses. Which might remind you of that maligned procedure, the lobotomy. But psychosurgeries are different. And not just because the ethics are better today; because the procedures actually work. Removing parts of a person’s brain is always a dicey proposition. But for people who are mentally ill, when pills and psychiatry offer no solace, the laser-tipped probe can be a welcome relief.

And boy, do they need relief. Yes, cutting into someone’s brain sounds extreme, but physicians perform these procedures only on people who’ve failed to respond to at least three types of medications, and for whom months on a counselor’s couch have had no effect. For decades these kind of surgeries have been out of favor, but now—in certain cases—psychiatrists, neuroscientists, and physicians are finding that they might provide a treatment of last resort. “For these patients who are the sickest of the sick they should be allowed the best option at a normal life,” says Charles Mikell, a neurosurgery resident at Columbia University Medical Center.

For people who need them, psychosurgeries can be highly effective. Success rates are relatively high.