Current conceptions rightly view neurosurgery and deep brain stimulation as last-resort therapies in psychiatric disease. It is unclear, however, whether this should, or will, always be the case in the future. The impact and transformative potential of DBS will be judged by (i) its safety profile, (ii) the quality of life it provides previously debilitated patients, and (iii) by the knowledge gained, through its use, about the etiology and maintenance of both normal and abnormal brain functioning. Viewed in this way, few treatments in medicine, and certainly fewer in psychiatry and neurosurgery, have the potential to inform all of these, in as substantial and meaningful a way. Here we examine the transformative potential of neuromodulation technology, and argue in favor of a new chapter in the history of mental illness management.