Brain surgery to promote behavioural or affective changes in men remains one of the most controversial topics at the interface of medicine, psychiatry, neuroscience and bioethics. Rapid expansion of neuropsychiatric deep brain stimulation has recently revived the field and warrants a careful appraisal of its two sides, namely the promise to help severely devastated patients on the one hand and the dangers of premature application without appropriate justification on the other. Here, we reconstruct the vivid history of the field and examine its present status to delineate the progression from crude free-hand operations into a multi-disciplinary treatment of last resort. This is accomplished by a detailed re-assessment of numerous case reports and small-scale open- or controlled trials in their historical and social context. The different surgical approaches, their rationale and their scientific merit are discussed in a manner comprehensible to readers lacking extensive knowledge of neurosurgery or psychiatry, yet with sufficient documentation to provide a useful resource for practitioners in the field and those wishing to pursue the topic further.