Mental illness can be debilitating, leaving sufferers in desperate need of relief. Many don’t get it: Medication and therapy have no effect on 30 to 60 percent of those with obsessive-compulsive disorder (OCD), Popular Science reports.

“For these patients who are the sickest of the sick they should be allowed the best option at a normal life,” says a neurosurgeon. Psychosurgery might be it.

Sure, drilling into a person’s skull to carve a path for a laser that then melts away half a teaspoon of brain tissue conjures thoughts of the sketchy lobotomies of the 1930s, but science has come a long way since then.

Today, scientists know that OCD—the only illness approved for psychosurgery treatment—has been linked to just a few spots in the brain. One of those is the anterior cingulate cortex, the part of the brain that alerts you when a task needs doing, and leaves you satisfied once it’s complete, surgeon Sameer Sheth tells Wired.

Those with OCD focus on a particular stimulant and don’t get the satisfaction, which is why he or she might wash repeatedly but not feel clean; in “really severe cases,” people can be rendered “incapacitated,” a psychiatrist adds.

If symptoms are especially bad despite therapy and drugs, psychosurgery can be a last resort; only 20 percent qualify. Using a stereotactic frame—essentially a “giant protractor,” per Wired—and CT and MRI scans, surgeons map a route from the skull to the anterior cingulate cortex.

“We do a small procedure, see how patients respond, and from that we can learn how to better do the next experiments,” Sheth says. And the experiments work: Full relief comes in about 50 percent of cases, reports Wired, which notes the process might soon be available for those with depression.