Deep Brain Stimulation: Inducing Self-Estrangement
Despite growing evidence that a significant number of patients living with Parkison’s disease experience neuropsychiatric changes following Deep Brain Stimulation (DBS) treatment, the phenomenon remains poorly understood and largely unexplored in the literature. To shed new light on this phenomenon, we used qualitative methods grounded in phenomenology to conduct in-depth, semi-structured interviews with 17 patients living with Parkinson’s Disease who had undergone DBS. Our study found that patients appear to experience postoperative DBS-induced changes in the form of self-estrangement. Using the insights from patients’ subjective perceptions of postoperative self-change provides a potent explanation of potential DBS-induced self-estrangement.
KeywordsDeep brain stimulation Estrangement Identity Neuropsychiatric effects Parkinson’s disease Personality Phenomenology Responsibility Self Self-report
Special thank to Neuroethics anonymous reviewers and editor for their insightful comments; as well Dr David Basser, Dr James Stuart and Timothy Krahn. Funding from the Australian Research Council Discovery Early Career Researcher Award (project number DE150101390), University of Tasmania (Project Number G0022813), as well a grant from the National Science Foundation (NSF Award EEC-1028725) are gratefully acknowledged.
Compliance with Ethical Standards
This study was conducted in compliance with the Tasmanian Human Research Ethics Committee regulations. Patient Consent and Minimal Risk Ethics Application Approval, entitled “H0014820 Deep Brain Stimulation and Postoperative Self-Adjustment Phenomenon” are also in compliance with the Tasmanian Human Research Ethics Committee regulations. Ethical Approval was obtained in May 2015.
- 1.Medtronic 2016. FDA Approves Medtronic Deep Brain Stimulation for People with Parkinson’s Disease with Recent Onset of Motor Complications. http://newsroom.medtronic.com/phoenix.zhtml?c=251324&p=irol-newsArticle_Print&ID=2139957. Last retrieved May 08 2017
- 8.Maier, F., C.J. Lewis, N. Horstköetter, et al. 2013 Nov. Patients' expectations of deep brain stimulation, and subjective perceived outcome related to clinical measures in Parkinson's disease: A mixed-method approach. Journal of Neurology, Neurosurgery, and Psychiatry 84 (11): 1273–1281. doi: 10.1136/jnnp-2012-303670.CrossRefGoogle Scholar
- 9.Hariz, et al. 2011. Patients’ perceptions of life shift after deep brain stimulation for primary dystonia A qualitative study. Movement Disorders 26 (11): 2101–2106.Google Scholar
- 11.Agid, Y., M. Schüpbach, M. Gargiulo, et al. 2006. Neurosurgery in Parkinson’s disease: The doctor is happy, the patient less so? Journal of neural transmission. Supplementum 70: 400–414.Google Scholar
- 12.Gilbert, et al. 2017. I miss being me: Phenomenological effects of deep brain stimulation. American Journal of Bioethics Neuroscience 8 (2). doi: 10.1080/21507740.2017.1320319.
- 17.Schönberg, M.R., B.N. Maddux, D.E. Riley, C.M. Whitney, P.K. Ogrocki, D. Gould, and R.J. Maciunas. 2015. Five-months-postoperative neuropsychological outcome from a pilot prospective randomized clinical trial of thalamic deep brain stimulation for Tourette syndrome. Neuromodulation 18 (2): 97–104.CrossRefGoogle Scholar
- 18.Speziale, H.J.S., and D.R. Carpenter. 2007. Qualitative research in nursing: Advancing the humanistic imperative. 4th ed. Philadelphia: Lippincott Williams & Wilkins.Google Scholar
- 22.Baylis, F. 2013. I am who I am. On the perceived threats to personal identity from deep brain stimulation 6: 513–526.Google Scholar
- 23.Schechtman, M. 2010. Philosopphical reflections on narrative and deep brain stimulation. Journal of Clinical Ethics 21 (2): 133–139.Google Scholar
- 25.Dings, R., and L. de Bruin. 2015. Situating the self: understanding the effects of deep brain stimulation. http://link.springer.com/article/10.1007%2Fs11097-015-9421-3.
- 28.Gilbert, F. 2013. Deep Brain Stimulation and Postoperative Suicidality Among Treatment Resistant Depression Patients: Should Eligibility Protocols Exclude Patients with a History of Suicide Attempts and Anger/Impulsivity?. AJOB Neuroscience 4 (1): 28–35. doi: 10.1080/21507740.2012.740143.
- 29.Viaña, J.M.N., Vickers, J.C., Cook, M.J., Gilbert, F. 2017. Currents of memory: recent progress, translational challenges, and ethical considerations in fornix deep brain stimulation trials for Alzheimer’s disease. Neurobiology of Aging. doi: 10.1016/j.neurobiolaging.2017.03.001.
- 30.Gilbert, F., Harris, A., and Kapsa, R. 2014. Controlling brain cells with light: Ethical considerations for optogenetics trials, American Journal of Bioethics: Neuroscience 5 (3): 3–11. doi: 10.1080/21507740.2014.91121.
- 31.Viaña, J.M.N., Bittlinger, M.A., Gilbert, F. 2017. Ethical considerations for deep brain stimulation trials in patients with early-onset Alzheimer’s disease, Journal of Alzheimer’s Disease. doi: 10.3233/JAD-161073.
- 32.Gilbert, F. 2015. A Threat to Autonomy? The Intrusion of Predictive Brain Implants. AJOB Neuroscience 6 (4): 4–11.Google Scholar
- 33.Bretzner, F., Gilbert, F., Baylis, F., and Brownstone, R. 2011. Target populations for first-in-human embryonic stem cell research in spinal cord injury. Cell Stem Cell 8: 468–475.Google Scholar
- 34.Gilbert, F., Vranic, A., Hurst, S. 2013. Involuntary & Voluntary Invasive Brain Surgery: Ethical Issues Related to Acquired Aggressiveness. Neuroethics. 6: 115–128. doi: 10.1007/s12152-012-9161-9.