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Neuroethics

pp 1–10 | Cite as

Pragmatism and the Importance of Interdisciplinary Teams in Investigating Personality Changes Following DBS

  • Cynthia S. KubuEmail author
  • Paul J. Ford
  • Joshua A. Wilt
  • Amanda R. Merner
  • Michelle Montpetite
  • Jaclyn Zeigler
  • Eric Racine
Article
  • 37 Downloads

Abstract

Gilbert and colleagues (2018) point out the discrepancy between the limited empirical data illustrating changes in personality (and related concepts of identity, agency, authenticity, autonomy, and self, i.e., PIAAAS) following implantation of deep brain stimulating (DBS) electrodes and the vast number of conceptual neuroethics papers implying that these changes are widespread, deleterious, and clinically significant. Their findings are reminiscent of C. P. Snow’s essay on the divide between the two cultures of the humanities (representing the conceptual publications) and the sciences (representing the empirical work). This division in the literature raises significant ethical concerns surrounding unjustified fear of personality changes in the context of DBS and negative perceptions of clinician-scientists engaged in DBS. These concerns have real world implications for funding future innovative, DBS trials aimed to reduce suffering as well as hampering true interdisciplinary scholarship. We argue that the philosophical tradition of pragmatism and the value it places on empirical inquiry, experiential knowledge, and inter-disciplinary scholarship – reflecting diverse ways of knowing – provides a framework to start to address the important questions Gilbert and colleagues raise. In particular, we highlight the importance of expert clinician knowledge in contributing to the neuroethical questions raised by Gilbert and colleagues. Finally, we provide illustrative examples of some of our interdisciplinary empirical research that demonstrate the iterative cycle of inquiry characteristic of pragmatism in which conceptual neuroethics questions have led to empirical studies whose results then raise additional conceptual questions that give rise to new empirical studies in a way that highlights the contributions of the humanities and the sciences.

Keywords

Deep brain stimulation Personality Parkinson’s disease Ethics Pragmatism 

Notes

Acknowledgements

CSK and PJF received funding by the National Institute of Neurological Disorders and Stroke, Award Number RC1NS068086 and the National Institute of Mental Health, Award Number R01MH114853. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Neurological Disorders and Stroke, National Institute of Mental Health, or the National Institutes of Health. ER acknowledges the support of a FRQ-S (Fonds de recheche du Québec – Santé) career award. CSK would also like to acknowledge and thank J. J. Fins, whose scholarship and advice over the years helped shape some of the ideas expressed in this paper.

References

  1. 1.
    Snow C. P. 1998. The two cultures. Cambridge University Press.Google Scholar
  2. 2.
    Gilbert, F., J.N.M. Viana, and C. Ineichen. 2018. Deflating the “DBS causes personality changes” bubble. Neuroethics 19: 1–17.Google Scholar
  3. 3.
    Dewey, J. 1922. Human nature and conduct: An introduction to social psychology. New York: Holt.Google Scholar
  4. 4.
    Racine, E. 2010. Pragmatic Neuroethics: Improving treatment and understanding of the mind-brain. Basic bioethics. Cambridge: MIT Press.CrossRefGoogle Scholar
  5. 5.
    Racine, E. 2016. Can moral problems of everyday clinical practice ever be resolved? A proposal for integrative pragmatist approaches. In Ethics in child health: Principles and cases in Neurodisability, ed. Gabriel M. Ronen, Peter L. Rosenbaum, Eric Racine, Jennifer Johannesen, and Bernard Dan, 33–48. London: MacKeith Press.Google Scholar
  6. 6.
    Miller, F.G., J.J. Fins, and M.D. Bacchetta. 1996. Clinical pragmatism: John Dewey and clinical ethics. The Journal of Contemporary Health Law and Policy 13 (1): 27–51.Google Scholar
  7. 7.
    Revelle, W., J. Wilt, and D.M. Condon. 2011. Individual differences and differential psychology: A brief history and prospect. In The Wiley-Blackwell Handbook of Individual Differences, ed. T. Chamorro-Premuzic, A. Furnham, and S. von Stumm, 2nd ed., 3–38. London: Wiley-Blackwell.Google Scholar
  8. 8.
    Allport, G.W. 1937. The functional autonomy of motives. The American Journal of Psychology 50: 141–156.CrossRefGoogle Scholar
  9. 9.
    Emmons, R.A. 1989. Exploring the relations between motives and traits: The case of narcissism. In Personality psychology: Recent trends and emerging directions, ed. D.M. Buss and N. Cantor, 32–44. New York: Springer-Verlag.CrossRefGoogle Scholar
  10. 10.
    Johnson, J.A. 1997. Units of analysis for the description and explanation of personality. In Handbook of personality psychology, ed. R. Hogan, J.A. Johnson, and S.R. Briggs, 73–93. San Diego: Academic Press.CrossRefGoogle Scholar
  11. 11.
    Revelle, W. 2008. The contribution of reinforcement sensitivity theory to personality theory. In The reinforcement sensitivity theory of personality, ed. P.J. Corr, 508–527. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  12. 12.
    Winter, D.G., O.P. John, A.J. Stewart, E.C. Klohnen, and L.E. Duncan. 1998. Traits and motives: Toward an integration of two traditions in personality research. Psychological Review 105: 230–250.CrossRefGoogle Scholar
  13. 13.
    DeYoung, C.G. 2015. Cybernetic big five theory. Journal of Research in Personality 56: 33–58.CrossRefGoogle Scholar
  14. 14.
    Mayer, J.D. 1998. A systems framework for the field of personality. Psychological Inquiry 9: 118–144.CrossRefGoogle Scholar
  15. 15.
    McAdams, D.P., and J.L. Pals. 2006. A new big five: Fundamental principles for an integrative science of personality. American Psychologist 61: 204–217.CrossRefGoogle Scholar
  16. 16.
    McCrae, R.R., and P.T. Costa. 2008. The five-factor theory of personality. In Handbook of personality: Theory and research, ed. O.P. John, R.W. Robins, and L.A. Pervin, 3rd ed., 159–181. New York: Guilford Press.Google Scholar
  17. 17.
    McRae, R.R., and P.T. Costa. 1999. A five-factor theory of personality. In Handbook of personality: Theory and research, ed. L. Pervin and O. John, 144. New York: Guilford Press.Google Scholar
  18. 18.
    Morey, L.C. 2014. The personality assessment inventory. In Personality assessment, ed. R.P. Archer and S.R. Smith, 181–228. New York: Routledge/Taylor & Francis Group.Google Scholar
  19. 19.
    Butcher, J.N., ed. 2006. MMPI-2: A practitioner’s guide. Washington, DC: American Psychological Association.Google Scholar
  20. 20.
    Barrash J, E. Asp, K. Markon, K. Manzel, S. W. Anderson, C. Tranel. 2011. Dimensions of personality disturbance after focal brain damage: Investigation with the Iowa scales of personality change. Journal of Clinical and Experimental Neuropsychology; 33(8): 833–852.Google Scholar
  21. 21.
    Grace, J., and P.F. Malloy. 2001. Frontal systems behavior scale: Professional manual. Lutz: Psychological Assessment Resources, Inc.Google Scholar
  22. 22.
    Cummings JL, M. Mega, K. Gray, S. Rosenberg-Thompson, D. A. Carusi, J. Gornbein. 1994. The neuropsychiatric inventory: Comprehensive assessment of psychopathology in dementia. Neurology; 44 (12): 2308–2314.Google Scholar
  23. 23.
    Ortony, A., D.A. Norman, and W. Revelle. 2005. Effective functioning: A three level model of affect, motivation, cognition, and behavior. In Who needs emotions? The brain meets the machine, ed. J.M. Fellous and M.A. Arbib, 173–202. New York: Oxford University Press.CrossRefGoogle Scholar
  24. 24.
    Parkinson, J. 2002. An essay on the shaking palsy. 1817. The Journal of Neuropsychiatry and Clinical Neurosciences 14 (2): 223–236.CrossRefGoogle Scholar
  25. 25.
    Obesso, J.A., M. Stamelou, C.G. Goetz, W. Poewe, A.E. Lang, D. Weintraub, et al. 2017. Past, present and future of Parkinson’s disease: A special essay on the 200th anniversary of the shaking palsy. Movement Disorders 32 (9): 1264–1310.CrossRefGoogle Scholar
  26. 26.
    Braak, H., J.R. Bohl, C.M. Muller, U. Rub, R.A.I. de Vos, and K. Del Tredici. 2006. Stanley Fahn lecture 2005: The staging procedure for the inclusion body pathology associated with sporadic Parkinson’s disease reconsidered. Movement Disorders 21 (12): 2042–2050.CrossRefGoogle Scholar
  27. 27.
    Heimer, L., and G.W. VanHoesen. 2006. The limbic lobe and its output channels: Implications for emotional functions and adaptive behavior. Neuroscience and Biobehavioral Reviews 30 (2): 126–147.CrossRefGoogle Scholar
  28. 28.
    Phillips, M.L., W.C. Drevets, S.L. Ruach, and R. Lane. 2003. Neurobiology of emotion perception II: Implications for major psychiatric disorders. Biological Psychiatry 54 (5): 515–528.CrossRefGoogle Scholar
  29. 29.
    Phillips, M.L., W.C. Drevets, S.L. Rauch, and R. Lane. 2003. Neurobiology of emotion perception I: The neural basis of normal emotion perception. Biological Psychiatry 54 (5): 504–514.CrossRefGoogle Scholar
  30. 30.
    Pandya, M., C. Kubu, and M. Giroux. 2008. The many faces of Parkinson’s disease: Not just a movement disorder. Cleveland Clinic Journal of Medicine 75 (12): 856–864.CrossRefGoogle Scholar
  31. 31.
    Weintraub, D., J. Koester, M.N. Potenza, A.D. Siderowf, M. Stacy, V. Voon, J. Whetteckey, G.R. Wunderlich, and A.E. Lang. 2010. Impulse control disorder in Parkinson disease. A cross-sectional study of 3090 patients. Archives of Neurology 67 (5): 589–595.CrossRefGoogle Scholar
  32. 32.
    Fenelon, G., F. Mahieux, R. Huon, and M. Ziegler. 2000. Hallucinations in Parkinson’s disease. Prevalence, phenomenology and risk factors. Brain 123: 733–745.CrossRefGoogle Scholar
  33. 33.
    Alexander, G.E., M.R. De Long, and P.L. Strick. 1986. Parallel organization of functionally segregated circuits linking basal ganglia and cortex. Annual Review of Neuroscience 9: 357–381.CrossRefGoogle Scholar
  34. 34.
    Lichter, D.C., and J.L. Cummings. 2001. Frontal-subcortical circuits in psychiatric and neurological disorders. New York: Guilford Press.Google Scholar
  35. 35.
    Rezai, A.R., A. Machado, M. Deogaonkar, H. Azmi, C.S. Kubu, and N. Boulis. 2008. Surgery for movement disorders. Neurosurgery 62 (Suppl2): 809–838.CrossRefGoogle Scholar
  36. 36.
    Gilbert, F., E. Goddard, J.N.M. Viana, A. Carter, and M. Horne. 2017. I miss being me: Phenomenological effects of deep brain stimulation. AJOB Neuroscience 8 (2): 96–109.CrossRefGoogle Scholar
  37. 37.
    Moreno, J. 1999. Bioethics is a naturalism. In Pragmatic bioethics, ed. G. McGee, 5–17. Nashville: Vanderbilt University Press.Google Scholar
  38. 38.
    Racine, E. 2008. Which naturalism for bioethics? A defense of moderate (pragmatic) naturalism. Bioethics 22 (2): 92–100.CrossRefGoogle Scholar
  39. 39.
    Kubu, C.S., and P.J. Ford. 2007. Ethics in the clinical application of neural implants. Cambridge Quarterly of Healthcare Ethics 16 (3): 317–321.CrossRefGoogle Scholar
  40. 40.
    Kubu, C.S., and P.J. Ford. 2012. Beyond mere symptom relief in deep brain stimulation: An ethical obligation for multi-faceted assessment of outcome. American Journal of Bioethics Neuroscience 3 (1): 44–49.Google Scholar
  41. 41.
    Mathieu, G., E. Bell, and E. Racine. 2011. Subjective outcomes measurement and regulatory oversight for deep brain stimulation outcomes in Parkinson’s disease. AJOB Neuroscience 2 (1): 16–18.  https://doi.org/10.1080/21507740.2010.537535.CrossRefGoogle Scholar
  42. 42.
    Gisquet, E. 2008. Cerebral implants and Parkinson’s disease: A unique form of biographical disruption? Social Science and Medicine 67: 1847–1851.CrossRefGoogle Scholar
  43. 43.
    Kubu, C.S., S.E. Cooper, A. Machado, T. Frazier, J. Vitek, and P.J. Ford. 2017. Insights gleaned by measuring patients’ stated goals for deep brain stimulation: More than tremor. Neurology 88 (2): 124–130.CrossRefGoogle Scholar
  44. 44.
    Kubu, C.S., T. Frazier, S.E. Cooper, A.G. Machado, J. Vitek, and P.J. Ford. 2018. Informed consent and patients’ shifting goals for deep brain stimulation. Neurology 91 (5): 472–478.CrossRefGoogle Scholar
  45. 45.
    Kubu, C.S., P. J. Ford, E. Racine, M. Montpetite, J. Zeigler, T. Frazier, J. Vitek, H. Fernandez, A. Machado. 2018. A patient centered perspective toward assessing personality in the context of PD and DBS. Poster presentation, BRAIN Investigators Meeting, Bethesda, MD, April 7-9, 2018.Google Scholar
  46. 46.
    Kubu, C. S., A. Merner, M. Montpetite, J. Zeigler, P. J. Ford. 2019. Personality change in the context of Parkinson’s disease: What do the patients tell us? Poster presentation, BRAIN Investigators Meeting, Washington, DC, April 11-13, 2019.Google Scholar
  47. 47.
    Kubu, C. S., P. J. Ford, B. Lapin. 2017. Patients’ perceptions of personality change in Parkinson’s disease and following deep brain stimulation. Poster presentation, International Neuroethics Society meeting, Washington, DC, November 10, 2017.Google Scholar
  48. 48.
    Kitcher, P. 2010. Two forms of blindness: On the need for two cultures. Technology in Society 32: 40–48.CrossRefGoogle Scholar
  49. 49.
    Gouinlock, James. 1978. Dewey's theory of moral deliberation. Ethics 88 (3): 218–228.CrossRefGoogle Scholar
  50. 50.
    Racine, E., and M. Sample. 2018. Two problematic foundations of neuroethics and pragmatist reconstructions. Cambridge Quarterly of Healthcare Ethics 27 (4): 566–577.CrossRefGoogle Scholar
  51. 51.
    Racine, E., M.A. Cascio, and A. Bogossian. 2017. Instrumentalist analyses of the functions of health ethics concepts and principles: Methodological guideposts. American Journal of Bioethics 17 (12): 16–18.CrossRefGoogle Scholar
  52. 52.
    Racine E, T. Martin Rubio, J. Chandler J, C. Forlini, & J. Lucke. 2014. The value and pitfalls of speculation about science and technology in bioethics: The case of cognitive enhancement. Medicine, Health Care, and Philosophy;17(3):325–337.Google Scholar
  53. 53.
    Pekarsky, D. 1990. Dewey's conception of growth reconsidered. Educational Theory 40 (9): 283–294.CrossRefGoogle Scholar
  54. 54.
    Fins, J.J. 2019. Once and future clinical neuroethics: A history of what was and what might be. The Journal of Clinical Ethics 30 (1): 27–34.Google Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Center for Neurological Restoration, Cleveland ClinicClevelandUSA
  2. 2.Cleveland Clinic Lerner College of Medicine of Case Western Reserve UniversityClevelandUSA
  3. 3.Department of Psychological SciencesCase Western Reserve UniversityClevelandUSA
  4. 4.Institut de recherches cliniques de MontréalMontrealCanada

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