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Bodily Felt Freedom: an Ethical Perspective on Positive Aspects of Deep Brain Stimulation

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Abstract

The critical aspects of deep brain stimulation (DBS) are usually the focus of the ethical debate about the implantation of electrodes into the brain of patients with Parkinson’s disease (PD). Above all, potential postoperative side effects on personality caused by DBS mark the debate. However, rehabilitation of agility and mobility by DBS can be posited against critical aspects. Therefore, the purpose of this article is to emphasize the hitherto neglected positive aspects of that technology. A detailed study of the rehabilitation of controlled movements will thus be the object of this article. The possibility to move again in a controlled way will be discussed as freedom of movement. The concept freedom of movement is being linked to the observation of feelings of euphoria and joy that can occur after surgery for patients with PD stimulated in the subthalamic nucleus (STN). This is done based on phenomenological analysis and qualitative interviews, in which the relation between freedom of movement and feelings of joy becomes clear. The aim here is to show that these feelings of exaltation express an essential feeling of freedom – a bodily felt freedom – which is grounded in movement and can be regained by STN-DBS.

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Notes

  1. The fluctuations in the effects of the medication are due to the difficulties in keeping the level of dopamine constant in the course of the disease.

  2. By now, DBS is also used in early phases of the PD [2].

  3. The patients in this study all undergo STN-DBS. For the sake of simplicity I will from now on use mainly the term DBS.

  4. Ineichen gives an overview of works that addresses positive aspects of DBS [8]. See also Gilbert [5].

  5. The concept of “basic autonomy“(basale Autonomie) refers to Christian Weingärtner’s work [17]. He introduces the concept in the discussion of the autonomy of challenged people.

  6. Bodily felt freedom and basic autonomy are two closely related concepts: bodily felt freedom denominates an aspect of basic autonomy, namely the feeling of being free, while the concept of basic autonomy adds a reference to the environment, that is, independence from it. Generically, bodily felt freedom first enables basic autonomy, later it is being incorporated in the phenomenon of basic autonomy.

  7. The terms “synchronization” (and also e.g. „inhibition“and “activity”) comes actually from medical literature; it is e.g. used to describes the beta oscillation of PD [31, 32]. To what extent the descriptions of the article match with the neurological findings cannot be assessed here.

  8. During a state of euphoria, one patient heard himself repeat: “You just do it now, I said. I said, that’s not right! Yes, you just do it now! Because I would have.... it came…uh, I did want this. (One) could say of course, well, maybe it influences our will, our human desire, the stimulation”.

  9. There might be a potential link between euphoria and increased impulsivity, which leads to imprudent decisions [34, 35].

  10. In this article, I will not discuss relation between movement activity and thinking activity in further detail. This will be part of my dissertation about the bodily felt freedom (leibliche Freiheit).

  11. The observation that basic autonomy is artificially created raises the problem on how to evaluate this “external” factor [5, 18, 20, 36]. Is the feeling of freedom, caused by DBS, only an illusion? At this point, the question cannot be sufficiently answered. However, to experience the specific feeling of freedom conceptualized in this article, one does not need to be free in terms of metaphysical conditions [9, 20, 37, 38].

  12. A period of time spent with stimulation was important for the article in order to find examples for bodily felt freedom expressed in joy after the surgery.

  13. The conducted focus group took place during the symposium and included three patients, with whom I had already conducted interviews, two doctors and conference participants.

  14. The study is a project that is part of the Cluster of Excellence BrainLinks-BrainTools. It focuses on the ethical implications of neurotechnologies (Mechanized Brains) and an offshoot to examine the value of movements with respect to movement disorders. The principal investigator is Prof. Dr. Oliver Müller.

  15. The reflexive aspect, expressed in felt, cannot be found in babies. They are still totally engaged in sensing and only develop a certain distance to sensing with time.

  16. The objective body – which in the phenomenology of the body is different to the felt body or lived body – is not central regarding the development of movement in children, because the objective body presupposes a reflexive self [10,11,12,13, 15, 16].

  17. To get more insights about the observations regarding will in the development of infants, we can connect will to Stein’s conception of the soul as the principle of what forms matter (the body is an expression of that). As we can see, there is a will to form matter. Without this kind of will, there is no plausible explanation for why beings want to stay alive, why they want to live; we can therefore also speak of the will to live, which captures the body. The fact that such views are not common in science these days (anymore) is not due to the “Sache” but to biases or a limited perspective, as Stein would say [28].

  18. Schmitz would not agree with Stein’s view of the body and the thesis on the will introduced here. He uses his “bodily” terminology. That is why the term “felt body” used here goes beyond the understanding of Schmitz. However, since I think “feeling” is significant to bodily felt freedom, “felt body” seems to fit better than “lived body” (even though the felt body is actualized by the will to live).

  19. The word “unfocused“originates from a patient who will be quoted in detail later.

  20. Adopting a term introduced by Hermann Schmitz, we may say that infants still live in a measureless expanse (maßlose Weite). He speaks of this, however, in the outcome of a man who has already come to himself (his view is not genetic). On this basis one could reach a state of measureless expanse, which means to get out of the body (Ausleibung). Compare also Seewald’s discussion of being fused (Verschmolzensein) versus having a core (Kernhaftigkeit) [45].

  21. It is usually assumed that self-awareness in its basic form develops from interaction with the environment [48]. This article in contrast, proposes the view that the sense of oneself develops first through “interaction” with one’s own body.

  22. In Schmitz, the felt body becomes the shelter of many emotions, which describes the vital state of a person. Here, the focus is on the “emotions” which are felt through movements. The principal factor is the feeling of freedom, which could be associated with the concept of “Weitung” (widening) or “epikritische Weitung” of Hermann Schmitz [46].

  23. The unremarkable feelings of freedom are comparably to the “feelings of being alive” [48].

  24. It is important to note that PD is not always negatively experienced by patients [5].

  25. The German dictionary term “Bewegungsfreiheit” primarily denotes the “space which is available to a sufficient degree to move arms and legs”. “Space to move around or roam in”, “free run” and “leeway” are synonyms. In a metaphoric sense, freedom of movement means “independence”, “without constraints” or “autonomous action”. “Bewegungsfreiheit” denotes also a basic right “to enter every admissible place” (Art. 2, Abs. 2, S. 2 German Grundgesetz).

  26. The surgery already has a positive effect on many patients, even without activating the stimulator. This is called the Micro-Lesioning-Effect (MLE). The possible difference between the MLE and stimulation will not be discussed here. The focus of this article is on the feeling that appears through the regaining of freedom of movement.

  27. Euphoria, however, is also a phenomenon known to occur because of medication. Medication too, can cause relief and a fast change between body control.

  28. In the debate the effects of euphoria would classified into the range of internal coercions [33]. The patients, however, feel controlled from outside.

  29. These addictions can also occur as a result of the therapy with drugs.

  30. It must be noted, however, that the patients in this study are stimulated in the nucleus accumbens, whereas the patients in the present study undergo STN-DBS.

  31. The surgery was over a year ago at the time of the interview.

  32. She spent 8 years with the stimulation when interviewed.

References

  1. La Mettrie, De, and Julien Offray. 1965. Der Mensch eine Maschine / L'homme machine. Leipzig: Reclam.

    Google Scholar 

  2. Schuepbach, W.M.M., J. Rau, K. Knudsen, J. Volkmann, P. Krack, L. Timmermann, T.D. Hälbig, et al. 2013. Neurostimulation for Parkinson's disease with early motor complications. New England Journal of Medicine 368 (7): 610–622. https://doi.org/10.1056/NEJMoa1205158.

    Article  Google Scholar 

  3. Christen, Markus, Christian Ineichen, Merlin Bittlinger, Hans-Werner Bothe, and Sabine Müller. 2014. Ethical focal points in the international practice of deep brain stimulation. AJOB Neuroscience 5 (4): 65–80. https://doi.org/10.1080/21507740.2014.939380.

    Article  Google Scholar 

  4. Friedrich, Orsolya, and Michael Zichy. 2014. Persönlichkeit. Neurowissenschaftliche und neurophilosophische Fragestellungen. Münster: mentis.

    Google Scholar 

  5. Gilbert, Frederic, Eliza Goddard, John Noel M. Viaña, Adrian Carter, and Malcolm Horne. 2017. I miss being me: Phenomenological effects of deep brain stimulation. AJOB Neuroscience 8 (2): 96–109. https://doi.org/10.1080/21507740.2017.1320319.

    Article  Google Scholar 

  6. Levy, Neil. 2007. Neuroethics. Challenges for the 21st century. Cambridge: Cambridge University Press.

    Google Scholar 

  7. Müller, Oliver, Jens Clausen, and Giovanni Maio. 2009. Das technisierte Gehirn. Neurotechnologien als Herausforderungen für Ethik und Anthropologie. Paderborn: mentis.

    Google Scholar 

  8. Ineichen, Christian, and Markus Christen. 2015. Analyzing 7000 texts on the deep brain stimulation: What do they tell us? Frontiers in Integrative Neuroscience 9 (52). https://doi.org/10.3389/fnint.2015.00052.

  9. Dublijevic, Velijki. 2016. Autonomy is political, pragmatic, and postmetaphysical: A reply to open peer commentaries on "autonomy in neuroethics". AJOB Neuroscience 7 (4): W1–W3. https://doi.org/10.1080/21507740.2016.1244125.

    Article  Google Scholar 

  10. Alloa, Emmanuel, Thomas Bedorf, Christian Grüny, and Tobias Nikolaus Klass. 2012. Leiblichkeit. Geschichte und Aktualität eines Konzepts. Tübingen: Mohr Siebeck.

    Google Scholar 

  11. Böhme, Gernot. 2004. Leibsein als Aufgabe. Leibphilosophie in pragmatischer Hinsicht. Kunsterdingen: Die Graue Edition.

    Google Scholar 

  12. Husserl, Edmund. 1993. Ideen zu einer reinen Phänomenologie und phänomenologischen Philosophie. Tübingen: Niemeyer.

    Google Scholar 

  13. Schmitz, Hermann. 1965. Der Leib. Bonn: Bouvier.

    Google Scholar 

  14. Seewald, Jürgen. 1992. Leib und Symbol. Ein sinnverstehender Zugang zur kindlichen Entwicklung. München: Fink.

    Google Scholar 

  15. Stein, Edith. 2018. Zum Problem der Einfühlung. Leipzig: Herder.

    Google Scholar 

  16. Waldenfels, Bernhard. 2000. Das leibliche Selbst. Vorlesungen zur Phänomenologie des Leibes. Frankfurt am Main: Suhrkamp.

    Google Scholar 

  17. Weingärtner, Christian. 2013. Schwer geistig behindert und selbstbestimmt: Eine Orientierung für die Praxis. Freiburg: Lambertus.

    Google Scholar 

  18. Gilbert, Frederic. 2015. A threat to autonomy? The intrusion of predictive brain implants. AJOB Neuroscience 6 (4): 4–11. https://doi.org/10.1080/21507740.215.1076087.

    Article  Google Scholar 

  19. Mele, Alfred R. 1995. Autonomous agents: From self-control to autonomy. New York: Oxford University Press.

    Google Scholar 

  20. Müller, Sabine, and Henrik Walter. 2010. Reviewing autonomy: Implications of the neurosciences and the free will debate for the principle for the patient's autonomy. Cambridge Quarterly of Healthcare Ethics 19: 205–217. https://doi.org/10.1017/S0963180109990478.

    Article  Google Scholar 

  21. Buytendijk, Frederik J.J. 1972. Allgemeine Theorie der menschlichen Haltung und Bewegung. Berlin: Springer.

    Google Scholar 

  22. König, Karl. 2017. Die ersten drei Jahre des Kindes. Stuttgart: Freies Geistesleben.

    Google Scholar 

  23. Rosslenbroich, Bernd. 2014. On the origin of autonomy: A New Look at the Major Transitions in Evolution. New York: Springer.

    Google Scholar 

  24. Bieri, Peter. 2012. Das Handwerk der Freiheit. Über die Entdeckung des eigenen Willens. München: Hanser.

    Google Scholar 

  25. Elias, Norbert. 2010. Über den Prozess der Zivilisation: Soziogenetische und psychogenetische Untersuchungen, Zweiter Band: Wandlungen der Gesellschaft: Entwurf zu einer Theorie der Zivilisation. Frankfurt: Suhrkamp.

    Google Scholar 

  26. Fuchs, Thomas. 2008. Das Gehirn - ein Beziehungsorgan. Eine phänomenologisch-ökologische Konzeption. Stuttgart: Kohlhammer.

    Google Scholar 

  27. Plessner, Helmuth. 1970. Die Stufen des Organischen und der Mensch. Berlin: De Gruyter.

    Google Scholar 

  28. Stein, Edith. 2004. Der Aufbau der menschlichen Person. Vorlesungen zur philosophischen Anthropologie. Freiburg: Herder.

    Google Scholar 

  29. Freud, Sigmund. 1908. Die "kulturelle" Sexualmoral und die moderne Nervosität. Sexual-Probleme 4 (3): 107–129.

    Google Scholar 

  30. Freud, Sigmund. 2009. Das Unbehagen der Kultur. Frankfurt: Fischer.

    Google Scholar 

  31. Eusebio, Alexandre, Hayriye Cagnan, and Peter Brown. 2012. Does suppression of oscillatory synchronisation mediate some of the therapeutic effects of DBS in patients with Parkinson’s disease? Frontiers in Integrative Neuroscience 6 (47).

  32. Kühn, Andrea A., Alexander Tsui, Tipu Aziz, Nicola Ray, Christof Brücke, Andreas Kupsch, Gerd-Helge Schneider, and Peter Brown. 2009. Pathological synchronisation in the subthalamic nucleus of patients with Parkinson’s disease relates to both bradykinesia and rigidity. Experimental Neurology 215 (2): 380–387.

    Google Scholar 

  33. Synofzik, Matthis, Thomas E. Schlaepfer, and Joseph J. Fins. 2012. How happy is too happy? Euphoria, Neuroethics, and deep brain stimulation of the nucleus Accumbens. AJOB Neuroscience 3 (1): 30–36. https://doi.org/10.1080/21507740.2011.635633.

    Article  Google Scholar 

  34. Frank, Michael J., Johan Samanta, Ahmed A. Moustafa, and Scott J. Sherman. 2007. Hold your horses: Impulsivity, deep brain stimulation, and medication in parkinsonism. Science 318 (5854): 1309–1312.

    Google Scholar 

  35. Pote, Inês, Mariam Torkamani, Zinovia-Maria Kefalopoulou, Ludvic Zrinzo, Patrici Limousin-Dowsey, Thomas Foltynie, Maarten Speekenbrink, and Marjan Jahanshahi. 2016. Subthalamic nucleus deep brain stimulation induces impulsive action when patients with Parkinson’s disease act under speed pressure. Experimental Brain Research 234 (7): 1837–1848.

    Google Scholar 

  36. Gilbert, Frederic, Cook Mark, T. O’Brien, and J. Illes. 2017. Embodiment and estrangement: Results from a first-in-human “intelligent BCI” trial. Science and Engineering Ethics: 1–14. https://doi.org/10.1007/s11948-017-0001-5.

  37. Frankfurt, Harry G. 2007. The importance of what we care about. Cambridge: University Press.

    Google Scholar 

  38. Keil, Geert. 2013. Willensfreiheit. Berlin: De Gruyter.

    Google Scholar 

  39. Deppermann, Arnulf. 2014. Das Forschungsinterview als soziale Interaktionspraxis. In Qualitative Forschung, ed. Günter Mey and Katja Mruck, 133–149. wiesbaden: Springer.

    Google Scholar 

  40. Kitzinger, Jenny. 1995. Qualitative research: Introducing focus groups. British Medical Journal 311: 299–302.

    Google Scholar 

  41. König, Karl. 1971. Sinnesentwicklung und Leiberfahrung. Stuttgart: Freies Geistesleben.

    Google Scholar 

  42. Merleau-Ponty, Maurice. 1965. Phenomenology of perception. Trans. Colin Smith. London: Routledge.

    Google Scholar 

  43. Zimmer, Renate. 2017. Handbuch der Sinneswahrnehmung. Freiburg: Herder.

    Google Scholar 

  44. Gehlen, Arnold. 1940. Der Mensch. Seine Natur und seine Stellung in der Welt. Berlin: Junker und Dünnhaupt.

    Google Scholar 

  45. Seewald, Jürgen. 2007. Der Verstehende Ansatz in Psychomotorik und Motologie. München: Reinhardt.

    Google Scholar 

  46. Schmitz, Hermann. 2014. Kurze Einführung in die Neue Phänomenologie. Freiburg: Alber.

    Google Scholar 

  47. Herder, Johann Gottfried. 1772. Abhandlung über den Ursprung der Sprache. Welche den von der königlichen Academie der Wissenschaften für das Jahr 1770 gesezten Preis erhalten hat. Berlin: Voß.

    Google Scholar 

  48. Fingerhut, Joerg, and Sabine Marienberg. 2012. Feelings of being alive. Berlin: De Gruyter.

    Google Scholar 

  49. Zimmer, Renate. 2006. Handbuch der Psychomotorik. Freiburg: Herder.

    Google Scholar 

  50. Engelmeier, Max-Paul. 2017. Euphorie. In Historisches Wörterbuch der Philosophie online, ed. Joachim Ritter, Karlfried Gründer, and Gottfried Gabriel. Basel: Schwabe.

    Google Scholar 

  51. Engelmeier, Max-Paul. 2017. Heiterkeit, das Heitere. In Historisches Wörterbuch der Philosophie online, ed. Gregor Sauerwald. Basel: Schwabe.

    Google Scholar 

  52. Hülshoff, Thomas. 2012. Emotionen. Eine Einführung für betratende, therapeutische und pädagogische Berufe. München: Reinhardt.

    Google Scholar 

  53. Nussbaum, Martha. 1988. Nature, Function and Capability: Aristotle on Political Distribution. Oxford Studies in Ancient Philosophy Supplementary Volume:145–154.

  54. Nussbaum, Martha. 2000. Women and Human Development. The Capabilities Approach. Cambridge: Cambridge University Press.

    Google Scholar 

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Acknowledgements

Special thanks go to Neuroethics anonymous reviewers for their insightful and constructive comments. I am grateful to the audience at the symposium on “Mechanized brains, embodied technologies, restored movements. Philosophical and ethical implications of neurotechnological intervention” at the University of Freiburg in 2017 for their comments and suggestions. Furthermore, I would like to thank Gernot Böhme for the lively discussion of some of the issues covered in this paper. I am grateful to Ines Schröder for English translations and to Andrew Wold for final corrections. Finally, my great thanks go to the patients I conducted interviews with. This work was (partly) supported by BrainLinks-BrainTools, Cluster of Excellence funded by the German Research Foundation (DFG, grant number EXC 1086).

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    Julia Sophia Voigt

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Voigt, J.S. Bodily Felt Freedom: an Ethical Perspective on Positive Aspects of Deep Brain Stimulation. Neuroethics 14, 45–57 (2021). https://doi.org/10.1007/s12152-018-9380-9

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