Abstract
Deep brain stimulation (DBS) is an effective treatment for the debilitating motor symptoms of Parkinson’s disease and other neurological disorders. However, clinicians and commentators have noted that DBS recipients have not necessarily experienced the improvements in quality of life that would be expected, due in large part to what have been described as the ‘psychosocial’ impacts of DBS. The premise of this paper is that, in order to realise the full potential of DBS and similar interventions, clinical services need to be arranged in such a way that these psychosocial dimensions are recognised and managed. Our starting point is that the psychosocial effects of DBS ‘in the field’ present us with analytically-useful disruptions: they disturb and foreground deeply held assumptions relating to the individual, health and its treatment, and which in a crude form manifest as the myth of technological solutionism within health care. Drawing on scholarship in medical sociology and science and technology studies (STS), we argue that DBS brings to the fore the relational dimensions of personhood, and demonstrates the emotional and social turmoil that can result if the relational dimensions of personhood are ignored by clinical services. In light of this, we argue that DBS should be implemented within a regime of care. Drawing on ethnographic research of a paediatric DBS clinical service, we provide an example of a regime of care, and conclude by reflecting on what other DBS services might learn from this paediatric service.
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Notes
Drug regimens can be altered by neurologists or general practitioners who are more widely available, and as other studies have illustrated (Baszanger 1989), patients can also gain a sense of independence by juggling their medications.
We are aware that using the term ‘cyborgs’ may exacerbate a sense of abnormality and stigma among DBS recipients. It is important to add, then, that the underlying premise of the STS scholarship described here is that all humans are hybrids of human & ‘non-human’ components, in so far as our capacity to act ‘autonomously’ depends on assemblages of technologies and objects, from public utility infrastructures to computer systems. For the most part, these assemblages are mundane, unremarkable, and hence, largely invisible (Latour 1993).
These practices have been captured in the first author’s recent ethnographic account of the team (Gardner 2017b)—it is this account which serves as our reference here.
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Gardner, J., Warren, N. Learning from deep brain stimulation: the fallacy of techno-solutionism and the need for ‘regimes of care’. Med Health Care and Philos 22, 363–374 (2019). https://doi.org/10.1007/s11019-018-9858-6
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DOI: https://doi.org/10.1007/s11019-018-9858-6