Psycho Surgery was recorded at Mixing Lab A & B studios, Garden Grove, California, and was produced by Bill Metoyer. For this album the band was joined by the guitarist Erik Mendez and the bassist Victor Macias, forming the quintet that is known as Tourniquet's classic line up. After Stop the Bleeding, the band caught the attention of Metal Blade Records, which released this album to the secular market. Intense Records released it to the Christian market.
Psycho Surgery represents the band's more modern and experimental, technical thrash metal style. Vocalist Guy Ritter left his high-pitched falsetto vocals off, singing mostly in his melodic baritone voice, and the elements of 1980s speed metal are nonexistent on this album. Psycho Surgery is characterized by the incorporation of classical music into the guitar riffs: a reviewer described the album as "Slayer plays Beethoven in a slightly rearranged way." The title song begins with a sample of an orchestra warming up for its performance. Psycho Surgery contains technical playing techniques, plenty of different guitar riffs and tempo changes and virtuoisic solos. The album's production is clear, creating a somewhat cold and steril atmosphere that supports the album's medical concept. Drummer Ted Kirkpatrick has a background in pharmacy, and took advantage of this experience by infusing the lyrics with medical terminology as metaphors for social issues. The lyrics take a stance on topics such as discrimination of the developmentally delayed ("Broken Chromosomes"), heretical sects ("A Dog's Breakfast") and parental carelessness ("Dysfunctional Domicile"). The song "Stereotaxic Atrocities" is a sequel to the song on the previous album, "Ark of Suffering", as it also criticizes animal abuse, specifically animal laboratory testing. The same guitar riff appears on the song for a few seconds.
A special feature about Psycho Surgery is the song "Spineless": hip-hop group P.I.D. performs at the beginning of the song for two minutes. Kirkpatrick had originally written the lyrics for the band, but eventually P.I.D.'s Lynch and Hogan made up their own lyrics on spot. The vocals were performed by Barry "G" and Fred "Doug Tray", and K-Mack did the sampling. Rap metal was a fresh style of music at the time, and that is why "Spineless" became a popular song at Tourniquet's concerts. The song "Viento Borrascoso (Devastating Wind)" is a fast instrumental which begins with a sample of a news presenter informing about a tornado, followed by a sound of its forthcoming. The instrumental represents Kirkpatrick's virtuoisic drumming skills. The final song, "Officium Defunctorum," is a doom metal piece written by guitarist and vocalist Gary Lenaire, and tells about the Crucifixion of Christ.
As a result, for Metal Blade Records' distribution, Psycho Surgery made the band more well-known and popular. Following the album's release, the songs "Psycho Surgery," "Spineless," and "Viento Borrascoso" all achieved number 1 positions on several charts. The album was voted as "Favorite Album of the Year" in 1991 by the readers of the HM Magazine. In 1992, Psycho Surgery also achieved 2 GMA Dove Award nominations in the categories "Metal Album of the Year" and "Metal Recorded Song of the Year" for "Psycho Surgery." The album is considered a display of talented musicianship, intelligent lyrics, and originality. In 2010, HM Magazine ranked Psycho Surgery #18 on its Top 100 Christian Rock Albums of All Time list. In the August 2010 issue of Heaven's Metal fanzine, the album ranked #2 on the Top 100 Christian metal albums of all-time list. In an interview with Noisecreep about the list, Doug Van Pelt explained that Psycho Surgery "found this band playing as a five-member band for the first time and they really bent creativity in metal in new directions that have still not been matched. Nobody has ever sounded like this band. I mean, Between the Buried and Me and maybe System of a Down are the closest in stretching creative boundaries. You almost had to pull out a medical dictionary to understand their lyrics. Standout song would have to be the epic 'Broken Chromosomes,' which is a touching song about mistreated kids that are mentally handicapped. Chilling song."
Remastered and reissued (as "Psychosurgery") in 2001 (Pathogenic Records 0002-2) with slightly different artwork and 5 bonus tracks:
10. A Dog's Breakfast (live 2000) 05:35
11. Broken Chromosomes (live 2000) 06:56
12. Stereotaxic Atrocities (demo 1991) 04:28
13. A Dog's Breakfast (demo 1991) 04:41
14. Concert Intro 2000 (live) 00:59
Released again in 2011 by Broken Circles on translucent blue vinyl. Limited to 400 copies. Includes full-color doubles-sided insert.
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