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Deep Brain Stimulation, Self and Relational Autonomy

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Abstract

Questions about the nature of self and self-consciousness are closely aligned with questions about the nature of autonomy. These concepts have deep roots in traditional philosophical discussions that concern metaphysics, epistemology and ethics. They also have direct relevance to practical considerations about informed consent in medical contexts. In this paper, with reference to understanding specific side effects of deep brain stimulation (DBS) treatment in cases of, for example, Parkinson’s Disease, Obsessive Compulsive Disorder, and Major Depressive Disorder, I’ll argue that it is best to frame discussions of informed consent in terms of relational autonomy and a pattern theory of self.

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Notes

  1. Although Kyselo cites De Haan [70] in this respect, De Haan, even in arguing that the self is relational, does not deny its bodily nature or posit a tension between the bodily and the social character of the self.

  2. It is simply not the case that, “there is nothing social about the organismic or the moving body per se” ([66], [4]). Rather, as Marcel Mauss [71] suggested, “there is simply no such thing as a ‘natural’ way of walking that may be prescribed independently of the diverse circumstances in which human beings grow up and live their lives” (quoted in [72], 335).

  3. One of the reviewers asked me to flesh out this idea further especially in relation to the four dimensions of affordances that de Haan et al. [67] define (in Fig. 1), i.e., range, temporal proximity, salience, and affective allure. I’m suggesting that the relation between self-pattern and affordances is directly relevant to the question of autonomy – the greater number of affordances (i.e., range and temporal proximity) and the quality of the affordances (i.e., salience and affective allure) the more autonomy, which relates directly to one’s sense of agency. How this landscape of affordances might relate to the self-pattern more generally depends in some regard on the kinds of affordances in question. The four dimensions don’t specify whether the affordances are physical, social or cultural affordances, intellectual or cognitive affordances. So in part the question depends on how one categorizes affordances. Clearly, for example, social affordances (number and quality) will relate directly to the intersubjective aspect of the self-pattern. If, as the result of depression, my intersubjective relations shrink or become impoverished, both the number and the quality (especially affective allure) of my social affordances will decrease. Likewise, physical affordances will depend on my bodily condition (any particular condition may rule out some and create others); cultural affordances may depend on my prior history, as well as my learned values, which reflect extended and normative factors in the self-pattern. Cognitive affordances will relate directly to cognitive aspects of the self-pattern – my skills and capacities for memory, imagination, etc. We can complicate the story by considering that salience and affective allure cuts across any affordance in the same way that the affective aspect dynamically relates to all other aspects of the self-pattern.

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Acknowledgements

The author thanks the Humboldt Foundation’s Anneliese Maier Research Award (2012-18) for support of this research.

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  1. Department of Philosophy, University of Memphis, Clement Hall 331, Memphis, TN, 38152, USA

    Shaun Gallagher

  2. Faculty of Law, Humanities and the Arts, University of Wollongong, Wollongong, Australia

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Gallagher, S. Deep Brain Stimulation, Self and Relational Autonomy. Neuroethics 14, 31–43 (2021). https://doi.org/10.1007/s12152-018-9355-x

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