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Identifying Relational Applications of Deep Brain Stimulation for Treatment Resistant Depression

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Abstract

The adaptive BCI known as ‘closed-loop deep brain stimulation’ (clDBS) is a device that stimulates the brain in order to prevent pathological neural activity and automatically adjusts stimulation levels based on computational algorithms that detect or predict those pathological processes. One of the prominent ethical concerns raised by clDBS is that, by inhibiting or modulating the undesirable neural states of a cognitive agent automatically, the device potentially undermines her autonomy. It has been argued that clDBS is not a threat because autonomy is fundamentally relational, i.e., it essentially depends on external (e.g., social or cultural) factors. If the relational approach to autonomy includes human-computer interaction, then the mechanisms of clDBS, even if external to the brain and exerting some degree of control over the individual, may support her autonomy. However, DBS applications are substantially different from one another, each involving a specific neurological or psychiatric condition, neural target, mechanism and symptom(s), and therefore at least some of them may not fit into the relational analysis. I examine different clDBS applications for treatment resistant depression and claim that while internal capsule/ventral striatum (VC/VS) clDBS is a case of relational autonomy, subgenual cingulate gyrus (Cg25) clDBS is not. Autonomy (relational or otherwise) requires some degree of self-regulation of our motivational states, which is supported by VC/VS DBS but is absent in Cg25 DBS. In Cg25 DBS the device itself directly influences motivational states, thus substituting or overriding (instead of supporting) the auto-regulatory cognitive processes required for autonomous action.

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Notes

  1. I thank an anonymous reviewer for this observation.

  2. Notice that this also applies to open-loop DBS. What makes VC/VS clDBS a case of relational autonomy is the fact that it supports cognitive control mechanisms, which is also achieved by open-loop DBS. I thank an anonymous reviewer for this observation.

  3. I thank an anonymous reviewer for this analogy.

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Acknowledgements

The author thanks researchers that discussed previous versions of this manuscript, including Nicolás Serrano, Arleen Salles, Salvador Guinjoan, Paula Castelli, Karen Rommelfanger, Peter Zuk, Gabriel Lázaro-Muñoz, Francisco Pereira, Juan Manuel Garrido and Julieta Picasso Cazón.

Funding

Abel Wajnerman Paz, Funding Agency: Agencia Nacional de Investigación y Desarrollo, Award ID: FONDECYT INICIACIÓN 11220327. Juan Manuel Garrido, Funding Agency: Fondo Nacional de Desarrollo Científico y Tecnológico, Award ID: FONDECYT REGULAR 1210091. Francisco Pereira, Funding Agency: Agencia Nacional de Investigación y Desarrollo, Award ID: FONDECYT REGULAR 1200197.

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    Abel Wajnerman-Paz

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Wajnerman-Paz, A. Identifying Relational Applications of Deep Brain Stimulation for Treatment Resistant Depression. Rev.Phil.Psych. (2023). https://doi.org/10.1007/s13164-023-00681-1

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