, Volume 10, Issue 3, pp 325–335 | Cite as

Deep Brain Stimulation Through the “Lens of Agency”: Clarifying Threats to Personal Identity from Neurological Intervention

Original Paper


This paper explores the impacts of neurological intervention on selfhood with reference to recipients’ claims about changes to their self-understanding following Deep Brain Stimulation (DBS) for treatment of Parkinson’s Disease. In the neuroethics literature, patients’ claims such as: “I don’t feel like myself anymore” and “I feel like a machine”, are often understood as expressing threats to identity. In this paper I argue that framing debates in terms of a possible threat to identity—whether for or against the proposition, is mistaken and occludes what is ethically salient in changes from DBS. Rather, by adopting a relational narrative approach to identity and autonomy, I show that the ethically salient issue from DBS is impacts on autonomous agency—whether one’s actions and beliefs are one’s own, and how DBS may hinder, or foster, embodied, relational autonomy competences. This approach recognizes that if sufficiently significant, impacts on autonomy competences may pose a threat to one’s ability to contribute to the process of authoring one’s own life and so pose a threat to identity formation. I argue this approach resolves the confusion in the literature about whether and how DBS threatens identity and provides a complex picture of how DBS may affect selfhood by disrupting narrative identity formation and revision, distorting agency and/or undermining autonomy.


Personal identity Autonomy Deep brain stimulation Agency Authenticity 



Research for this project was supported by the Australian Research Council Centre of Excellence Scheme (Project Number CE 140100012).


  1. 1.
    Schüpbach, M., M. Gargiulo, and M.L. Welter. 2006. Neurosurgery in Parkinson’s disease: a distressed mind in a repaired body? Neurology 66: 1811–1816.CrossRefGoogle Scholar
  2. 2.
    Glannon, Walter. 2009. Stimulating brains, altering minds. Journal of Medical Ethics 35: 289–292.CrossRefGoogle Scholar
  3. 3.
    Lipsman, Nir, and Walter Glannon. 2013. Brain, mind and machine: what are the implications of deep brain stimulation for perceptions of personal identity, agency and free will? Bioethics 27(9): 465–470.CrossRefGoogle Scholar
  4. 4.
    Synofzik, Matthis, and Thomas E. Schlaepfer. 2008. Ethical criteria for deep brain stimulation in psychiatric patients and for enhancement purposes. Biotechnology Journal 3: 1–10.CrossRefGoogle Scholar
  5. 5.
    Schermer, Maartje. 2011. Ethical issues in deep brain stimulation. Frontiers in Integrative Neuroscience 5: 1–5.CrossRefGoogle Scholar
  6. 6.
    Johansson, Veronica, Martin Garwicz, Martin Kanje, Jens Schouenborg, Anders Tingstrom, and Ulf Gorman. 2011. Authenticity, depression and deep brain stimulation. Frontiers in Integrative Neuroscience 5: 1–3.CrossRefGoogle Scholar
  7. 7.
    Kraemer, Felicitas. 2013. Authenticity or autonomy? When deep brain stimulation causes a dilemma. Journal of Medical Ethics 39: 757–760.CrossRefGoogle Scholar
  8. 8.
    Schechtman, Marya. 2010. Philosophical reflections on narrative and deep brain stimulation. The Journal of Clinical Ethics 21: 133–139.Google Scholar
  9. 9.
    Baylis, Françoise. 2013. ‘I Am who I Am’: on the perceived threats to personal identity from deep brain stimulation. Neuroethics 6(3): 513–526.CrossRefGoogle Scholar
  10. 10.
    Mackenzie, Catriona, and Mary Jean Walker. 2014. Neurotechnologies, personal identity, and the ethics of authenticity. In Handbook of neuroethics, ed. Jens Clausen and Neil Levy, 374–392. Netherlands: Springer.Google Scholar
  11. 11.
    Agid, Y., M. Schüpbach, M. Gargiulo, L. Mallet, J.L. Houeto, C. Behar, D. Maltete, V. Mesnage, and M.L. Welter. 2006. Neurosurgery in Parkinson’s disease: the doctor is happy, the patient less so? Journal of Neural Transmission Suppl 70: 409–414.CrossRefGoogle Scholar
  12. 12.
    Blacher, Richard S., and Samuel H. Basch. 1970. Psychological aspects of pacemaker implantation. Archives of General Psychiatry 22: 319–323.CrossRefGoogle Scholar
  13. 13.
    Svenaeus, Fredrik. 2012. Organ transplantation and personal identity: how does loss of and change of organs affect the self? Journal of Medicine and Philosophy 37: 139–158.CrossRefGoogle Scholar
  14. 14.
    de Haan, Sanneke, Erik Rietveld, Martin Stokhof, and Damiaan Denys. 2015. Effects of deep brain stimulation on the lived experience of obsessive-compulsive disorder patients: in-depth interviews with 18 patients. PloS One 10(8): e0135524. doi: 10.1371/journal.pone:0135524.CrossRefGoogle Scholar
  15. 15.
    Klaming, Laura, and Pim Haselager. 2013. Did my brain implant make me do it? Questions raised by DBS regarding psychological continuity, responsibility for action and mental competence. Neuroethics 6: 527–539.CrossRefGoogle Scholar
  16. 16.
    Witt, Karsten, Jens Kuhn, Lars Timmermann, Mateusz Zurowski, and Christiane Woopen. 2013. Deep brain stimulation and the search for identity. Neuroethics 6(3): 499–511.CrossRefGoogle Scholar
  17. 17.
    Elliot, Carl. 2003. Better than well: American medicine meets the America dream. New York: W. W. Norton & Company.Google Scholar
  18. 18.
    Focquaert, F., and D. De Ridder. 2009. Direct intervention in the brain, ethical issues concerning personal identity. Journal of Ethics in Mental Health 4(2): 1–7.Google Scholar
  19. 19.
    Levy, Neil. 2007. Neuroethics. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  20. 20.
    Schermer, Maartje. 2009. Changes in the self: the need for conceptual research next to empirical research. American Journal of Bioethics 9: 45–47.CrossRefGoogle Scholar
  21. 21.
    Schechtman, Marya. 2011. The narrative self. In The Oxford handbook of the self, ed. Shaun Gallagher. Oxford: Oxford University Press.Google Scholar
  22. 22.
    Schechtman, Marya. 2009. Getting our stories straight: self-narrative and personal identity. In Personal identity and fractured selves: perspectives from philosophy, ethics and neuroscience, ed. D.J.H. Mathews, H. Bok, and P.V. Rabins, 65–92. Maryland: John Hopkins University Press.Google Scholar
  23. 23.
    DeGrazia, David. 2005. Enhancement technologies and human identity. Journal of Medicine and Philosophy 30: 261–283.CrossRefGoogle Scholar
  24. 24.
    Mackenzie, Catriona. 2014. Three dimensions of autonomy: a relational analysis. In Autonomy, oppression and gender, ed. Andrea Veltman and Mark Piper, 15–41. Oxford: Oxford University Press.CrossRefGoogle Scholar
  25. 25.
    Schechtman, Marya. 1996. The constitution of selves. Ithaca: Cornell University Press.Google Scholar
  26. 26.
    Baylis, Françoise. 2012. The self in situ: a relational account of personal identity. In Being relational: reflections on relational theory and health law, ed. J. Downie and J.J. Llewellyn, 109–131. Vancouver: UBC Press.Google Scholar
  27. 27.
    Meyers, Diana Tietjens. 1989. Self, society and personal choice. New York: Columbia University.Google Scholar
  28. 28.
    Mackenzie, Catriona, and Natalie Stoljar, eds. 2000. Relational autonomy: feminist perspectives on autonomy, agency, and the social self. New York: Oxford University Press.Google Scholar
  29. 29.
    Mackenzie, Catriona, and Jacqui Poltera. 2010. Narrative integration, fragmented selves, and autonomy. Hypatia 25: 31–54.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2017

Authors and Affiliations

  1. 1.ARC Centre of Excellence for Electromaterials Science, School of PhilosophyUniversity of TasmaniaHobartAustralia

Personalised recommendations