Me Myself and My Brain Implant Deep Brain Stimul

Authors: Felicitas Kraemer

Publish Date: 2011/05/12

Volume: 6, Issue: 3, Pages: 483-497

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Abstract

In this article I explore select case studies of Parkinson patients treated with deep brain stimulation DBS in light of the notions of alienation and authenticity While the literature on DBS has so far neglected the issues of authenticity and alienation I argue that interpreting these cases in terms of these concepts raises new issues for not only the philosophical discussion of neuroethics of DBS but also for the psychological and medical approach to patients under DBS In particular I suggest that the experience of alienation and authenticity varies from patient to patient with DBS For some alienation can be brought about by neurointerventions because patients no longer feel like themselves But on the other hand it seems alienation can also be cured by DBS as other patients experience their state of mind as authentic under treatment and retrospectively regard their former lives without stimulation as alienated I argue that we must do further research on the relevance of authenticity and alienation to patients treated with DBS in order to gain a deeper philosophical understanding and to develop the best evaluative criterion for the behavior of DBS patientsDeep brain stimulation DBS is a practice that has been used since the late 1980s mainly for Parkinson patients but also for the treatment of diseases such as epilepsy and for the experimental treatment of psychiatric and other diseases cf 1 21 In DBS for Parkinson patients a socalled ‘brain pacemaker’ is implanted and its electrodes in the brain stimulate either the subthalamic nucleus or the globus pallidus 3 533ff in order to treat movement disorders tremors and freezing that are typical for Parkinson’s disease While DBS can vastly improve motor abilities it is wellknown that DBS can also have psychiatric sideeffects such as hypomania and manic episodes 4 cit in 5 The fact that DBS as a treatment sometimes brings about personality changes invites philosophical considerations about problems of personal authenticity and alienation in this context It raises the question of whether under treatment patients feel no longer like themselves In other words we may wonder whether under treatment patients can remain‚ authentic ‘or become‚ alienated’ from their true selves notions I define below in Section Felt Authenticity and Felt Alienation Some Conceptual ClarificationsIn order to bring out the relevance of the notions of authenticity and alienation to the neuroethics of DBS I focus on several case studies of patients under DBS treatment cf 6 What is significant about these narratives is that they each involve elements of authenticity and alienation although not in a uniform way Some patients claim under treatment that they feel authentic ie like themselves and regard their life with Parkinson’s disease retrospectively as a time of alienation Other patients however claim that the treatment deprives them of their authenticity and that they no longer feel like themselves when under DBS As a first approximation one could say that it seems as if DBS could threaten authenticity and bring about alienation in some cases whereas it generates feelings of authenticity in othersAccordingly in this article I argue for the following thesis We should take into consideration patients ‘feelings of authenticity and alienation when talking about the chances and challenges of deep brain stimulation The concepts of authenticity and alienation are useful heuristic tools not only for a better philosophical understanding of the patients’ experience of DBS but also in some cases the use of these concepts can even lead to a reevaluation of the treatment and its sideeffects and should therefore contribute to future ethical reflection on DBSWhile it is not my aim in the current paper to suggest specific ethical guidelines for treatment I do wish to suggest that future ethical discussions will profit by considering the notions of authenticity and alienation which I outline here I argue that we must do further research on the relevance of authenticity and alienation to patients treated with DBS in order to gain a deeper philosophical understanding and to develop the best evaluative criterion for the behavior of DBS patients If research supports the thesis of the present article then the tools psychologists and doctors currently use to evaluate DBS patients should be complemented by philosophical considerations because the medical accounts alone are failing to take into account the important subjectivedimensions of authenticity and alienation This is deeply problematic because it doesn’t give the doctor patient or family involved the fullest sense of what is going on nor does it give them clear guidelines for how to evaluate the patient’s behavioral changesWhile there is indeed a plethora of literature on the ethics of DBS there is not much literature that deals specifically and systematically with the questions of authenticity and alienation as I do here An exception is the recent article on narrative identity and selfexperience under DBS by Müller et al 7 that brings in the concepts of authenticity and alienation Many of its findings support the thesis of the present article2 However the majority of authors tackle issues related to authenticity in the context of DBS such as personal identity3 8 9 10 11 patient autonomy and responsibility 1 2 12 29 35 36 and happiness cf 13 without actually focusing on authenticity4 Meanwhile Carter et al raise the problem of authenticity in the context of the medication of patients with dopamine sensitive drugs but not in the context of DBS 14 Finally Bolt brings up the issue of authenticity in the context of neuroenhancement 15 However with the exception of Müller et al 7 none of these recent articles on authenticity and neuroethics focus primarily on DBS5 By my lights this is a gap in the literature which this article attempts to begin filling inIn order to support my view I begin in Section Felt Authenticity and Felt Alienation Some Conceptual Clarifications by giving a minimalist definition of what I mean by the concepts of authenticity and alienation In section A Philosophical Interpretation of Some Case Studies from Schüpbach et al 6 I then present three case studies from a psychological report by Schüpbach et al 6 offering a philosophical analysis of these cases in light of authenticity and alienation In Section Conclusions some conclusions follow When analyzing the case studies from a philosophical point of view aspects of the patients’ experience are emphasized which are not fully appreciated in the psychological assessment As we will see for many of the patients their experience involved recognizing exploring and enacting what they regarded as their ‘true selves’The most important aim of this paper is to bring out a subjective side of DBS treatment which has so far not received the attention that it ought to receive My goal in presenting these case studies is to illuminate the ways in which the subjective notions of authenticity and alienation are relevant to the philosophical and ethical discussion of DBS as well as to how we are to evaluate the behavior of DBS patients

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