Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-13T03:23:19.409Z Has data issue: false hasContentIssue false
  • English
  • Français

Deep Brain Stimulation, Continuity over Time, and the True Self

Published online by Cambridge University Press:  16 September 2016

SVEN NYHOLM  and
ELIZABETH O’NEILL
Get access Rights & Permissions [Opens in a new window]

Abstract:

One of the topics that often comes up in ethical discussions of deep brain stimulation (DBS) is the question of what impact DBS has, or might have, on the patient’s self. This is often understood as a question of whether DBS poses a threat to personal identity, which is typically understood as having to do with psychological and/or narrative continuity over time. In this article, we argue that the discussion of whether DBS is a threat to continuity over time is too narrow. There are other questions concerning DBS and the self that are overlooked in discussions exclusively focusing on psychological and/or narrative continuity. For example, it is also important to investigate whether DBS might sometimes have a positive (e.g., a rehabilitating) effect on the patient’s self. To widen the discussion of DBS, so as to make it encompass a broader range of considerations that bear on DBS’s impact on the self, we identify six features of the commonly used concept of a person’s “true self.” We apply these six features to the relation between DBS and the self. And we end with a brief discussion of the role DBS might play in treating otherwise treatment-refractory anorexia nervosa. This further highlights the importance of discussing both continuity over time and the notion of the true self.

Keywords

deep brain stimulation (DBS)personal identityselfanorexia nervosa
Type
Articles
Information
Cambridge Quarterly of Healthcare Ethics , Volume 25 , Special Issue 4: Clinical Neuroethics , October 2016 , pp. 647 - 658
Copyright
Copyright © Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Notes

1. Schüpbach, M, Gargiulo, M, Welter, ML, Mallet, L, Béhar, C, Houeto, JL, et al. Neurosurgery in Parkinson’s disease: A distressed mind in a repaired body? Neurology 2006;66(12):1811–16.CrossRefGoogle Scholar

2. E.g., Schechtman, M. Philosophical reflections on narrative and deep brain stimulation. Journal of Clinical Ethics 2010;2(21):133–9;Google Scholar Baylis F. “I am who I am”: On the perceived threat to personal identity from deep brain stimulation. Neuroethics 2013;6(3):513–26; Lipsman N, Glannon W. Brain, mind and machine: What are the implications of deep brain stimulation for perceptions of personal identity, agency, and free will? Bioethics 2013;27(9):465–70; Klaming L, Haselager P. Did my brain implant make me do it? Questions raised by DBS regarding psychological continuity, responsibility for action and mental competence. Neuroethics 2013;6(3):527–39; Witt K, Daniels C, Reiff J, Krack P, Volkmann J, Pinsker MO. Deep brain stimulation and the search for identity. Neuroethics 2013;6(3):499–511.

3. Kraemer, F. Me, myself, and my brain implant: Deep brain stimulation raises questions of personal authenticity and alienation. Neuroethics 2013;6(3):483–97;Google Scholar Maslen, H, Pugh, J, Savulescu, J. Authenticity and the stimulated self: Neurosurgery for anorexia nervosa. AJOB Neuroscience 2015;6(4):69–71 Google Scholar.

4. Mantione, M, Figee, M, Denys, D. A case of musical preference for Johnny Cash following deep brain stimulation of the nucleus accumbens. Frontiers in Behavioral Neuroscience 2014;8:1–18.CrossRefGoogle Scholar

5. Leentjens, AFG, Visser-Vanderwalle, V, Temel, Y, Verhey, FRJ. Manipuleerbare wilsbekwaamheid: Een ethisch problem bij elektrostimulatie van de nucleus subthalamcius voor ernstige ziekte van Parkinson. Nederlands Tijdschrift Geneeskunde 2004;148(28):1394–8.Google Scholar

6. Agid, Y, Schüpbach, M, Gargiulo, M, Mallet, L, Houeto, JL, Behar, C. Neurosurgery in Parkinson’s disease: The doctor is happy, the patient less so? Journal of Neural Transmission, Supplemental 2006;70:409–14.CrossRefGoogle Scholar

7. Bell, E, Maxwell, B, McAndrews, MP, Sadikot, AF, Racine, E. A review of social and relational aspects of deep brain stimulation in Parkinson’s disease informed by healthcare provider experiences. Parkinson’s Disease 2011. doi:10.4061/2011/871874.CrossRefGoogle ScholarPubMed

8. See note 6, Agid et al. 2006, at 412.

9. Herzog, J, Reiff, J, Krack, P, Witt, K, Schrader, B, Müller, D. Manic episode with psychotic symptoms induced by subthalamic nucleus stimulation in a patient with Parkinson’s disease. Movement Disorders 2003;18(11):1382–4, at 1383.CrossRefGoogle Scholar

10. See note 4, Mantione et al. 2014, at 1.

11. See note 6, Agid et al. 2006.

12. See note 2, Lipsman, Glannon 2013, at 466.

13. E.g., see note 2, Baylis 2013.

14. See note 2.

15. A further way to think of this distinction between numerical identity and narrative identity is to view it as a distinction between the minimal conditions for continuity over time (i.e., numerical identity) to more extensive and qualitative conditions for personal identity over time (i.e., narrative identity).

16. See note 2, Klaming, Haselager 2013; note 2, Witt et al. 2013.

17. See note 2, Schechtman 2010; note 2, Baylis 2013.

18. Cf. Levy, N. Enhancing authenticity. Journal of Applied Philosophy 2011;28(3):308–18.CrossRefGoogle Scholar

19. Cf. Gilbert F. The burden of normality: From “chronically ill” to “symptom free.” New ethical challenges for deep brain stimulation postoperative treatment. Journal of Medical Ethics 2012;38(7):408–12.

20. This quote comes from act 1, scene 3, of Hamlet. See Hapgood R, ed. Hamlet Prince of Denmark. Cambridge: Cambridge University Press; 1999, at 126.

21. Kierkegaard, S. Fear and Trembling and the Sickness unto Death. Princeton, NJ: Princeton University Press; 2013, at 281.Google Scholar

22. Horner, C. 7 ways mindfulness can unlock your authentic self. Huffington Post 2015 Oct 5; available at http://www.huffingtonpost.com/christine-horner/7-ways-mindfulness-can-unlock-your-authentic-self_b_8241838.html (last accessed 14 Oct 2015).Google Scholar

23. See, e.g., Schlegel, R, Hicks, J, Arndt, J, King, L. Thine own self: True self-concept accessibility and meaning in life. Journal of Personality and Social Psychology 2009;96(2):473–90;Google Scholar Newman, G, Bloom, B, Knobe, J. Value judgments and the true self. Psychology Bulletin 2013;40(2):1–14;Google Scholar Kernis M, Goldman B. Authenticity, social motivation, and wellbeing. In: Forgas JP, Williams KD, Laham SM, eds. Social Motivation: Conscious and Unconscious Processes. Cambridge: Cambridge University Press; 2004:210–27.

24. Johnson, J, Robinson, M, Mitchell, E. Inferences about the authentic self: When do actions say more than mental states? Journal of Personality and Social Psychology 2004;87(5):615–30;CrossRefGoogle ScholarPubMed Strohminger N, Nichols S. The essential moral self. Cognition 2014;131(1):159–71.

25. The Ellen DeGeneres Show, season 13, episode 1; 2015 Sept 18.

26. See note 23, Newman et al. 2013; note 24, Strohminger, Nichols 2014; Newman, G, De Freitas, J, Knobe, J. Beliefs about the true self explain asymmetries based on moral judgment. Cognitive Science 2015;39(1):96–125.CrossRefGoogle ScholarPubMed

27. See note 23, Newman et al. 2013; note 26, Newman et al. 2015.

28. Kant, I. Groundwork for the Metaphysics of Morals. Cambridge: Cambridge University Press; 1785/2012, at 4:457.Google Scholar

29. See note 23, Newman et al. 2013; note 26, Newman et al. 2015.

30. Cf. Parfit, D. Reasons and Persons. Oxford: Clarendon; 1984.Google Scholar

31. Felicitas Kraemer’s discussion of DBS and authenticity helps to bring this out (see note 3, Kraemer 2013). She criticizes Agid et al. (see note 6, Agid et al. 2006) for labeling the issues they discuss as “social maladaptions,” and the basis for this criticism appears to be that this choice of words conjures up a negative association, whereas there might not be anything bad (as Kraemer sees things) about becoming more impulsive.

32. Wu H, Van Dyck-Lippens P, Santegoeds R, van Kuyck K, Gabriëls L, Lin G. Deep-brain stimulation for anorexia nervosa. World Neurosurgery 2013;80(3–4):1–10.

33. Tan, J, Hope, T, Stewart, A. Anorexia nervosa and personal identity: The accounts of patients and their parents. International Journal of Law and Psychiatry 2003;26(5):533–48;CrossRefGoogle ScholarPubMed Tan J, Hope T, Stewart A, Fitzpatrick R. Competence to make treatment decisions in anorexia nervosa: Thinking processes and values. Philosophy, Psychiatry, & Psychology. Author manuscript; available in PubMed Central 2007 Dec 7, (1–31). Last accessed 6 June, 2016. Published in final edited form, with the same time, in Philosophy, Psychiatry, & Psychology. 2006 Dec; 13(4):267–82.

34. See note 33, Tan et al. 2003. at 539

35. See note 33, Tan et al. 2007, at 20.

36. See note 33, Tan et al. 2007.

37. See note 3, Maslen et al. 2015; Maslen, H, Pugh, J, Savulescu, J. The ethics of deep brain stimulation for the treatment of anorexia nervosa. Neuroethics 2015;8(3):215–30.CrossRefGoogle ScholarPubMed

38. Hope, T, Tan, J, Stewart, A, McMillan, J. Agency, ambivalence and authenticity: The many ways in which anorexia nervosa can affect autonomy. International Journal of Law in Context 2013;9(1):20–36, at 30.CrossRefGoogle Scholar

39. See note 37, Maslen et al. 2015, at 227.

40. See note 37, Maslen et al. 2015, at 227.

41. See note 37, Maslen et al. 2015, at 227.

42. See note 37, Maslen et al. 2015, at 228.

43. We are assuming here that we should mainly consider cases in which there is at least one mind-set in which the patient him- or herself thinks in terms of values that incline him or her to want to consent to the DBS. We are not discussing the possible case in which the patient is so set on the values associated with AN that there is no mind-set in which the patient is inclined to agree that he or she needs healthcare.

44. The authors wish to thank Frederic Gilbert, the editors and anonymous reviewers of CQ, and our departmental colleagues at Eindhoven University of Technology for their helpful feedback on this material.