, Volume 11, Issue 2, pp 157–165 | Cite as

Deep Brain Stimulation: Inducing Self-Estrangement

  • Frederic GilbertEmail author
Original Paper


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.


Deep 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

Ethical Approval

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. 1.
    Medtronic 2016. FDA Approves Medtronic Deep Brain Stimulation for People with Parkinson’s Disease with Recent Onset of Motor Complications. Last retrieved May 08 2017
  2. 2.
    Gilbert, F. 2012. The burden of normality: From ‘chronically ill’ to ‘symptom free’. New ethical challenges for deep brain stimulation postoperative treatment. Journal of Medical Ethics 38: 408–412. doi: 10.1136/medethics-2011-100044.Google Scholar
  3. 3.
    Volkmann, J., C. Daniels, and K. Witt. 2010. Neuropsychiatric effects of subthalamic neurostimulation in Parkinson disease. Nature Reviews. Neurology 6 (9): 487–498.CrossRefGoogle Scholar
  4. 4.
    Müller, S., and M. Christen. 2011. Deep brain stimulation in parkinsonian patients—Ethical evaluation of cognitive, affective, and behavioural sequelae. AJOB Neuroscience 2 (1): 3–13.CrossRefGoogle Scholar
  5. 5.
    Clausen, J. 2010. Ethical brain stimulation: Neuroethics of deep brain stimulation in research and clinical practice. European Journal of Neuroscience 32: 1152e62.CrossRefGoogle Scholar
  6. 6.
    de Haan, S., E. Rietveld, M. Stokhof, and D. 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
  7. 7.
    de Haan, S., E. Rietveld, M. Stokhof, and D. Denys. 2013. The phenomenology of deep brain stimulation induced changes in OCD: An enactive affordance-based model. Frontiers in Human Neuroscience 7: 1–14. doi: 10.3389/fnhum.2013.00653.Google Scholar
  8. 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. 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
  10. 10.
    Schüpbach, M., M. Gargiulo, M.L. Welter, et al. 2006. Neurosurgery in Parkinson disease: A distressed mind in a repaired body? Neurology 66: 1811–1816.CrossRefGoogle Scholar
  11. 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. 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.
  13. 13.
    Gilbert, F. 2014. Self-Estrangement &. Deep Brain Stimulation: Ethical issues related to Forced Explantation Neuroethics. 8 (2): 107–114. doi: 10.1007/s12152-014-9224-1.Google Scholar
  14. 14.
    Gilbert, F. 2013. Deep brain stimulation for treatment resistant depression: Postoperative feelings of self-estrangement, suicide attempt and impulsive-aggressive behaviours. Neuroethics 6 (3): 473–481. doi: 10.1007/s12152-013-9178-8.CrossRefGoogle Scholar
  15. 15.
    Smeding, H.M., J.D. Speelman, H.M. Huizenga, P.R. Schuurman, and B. Schmand. 2011. Predictors of cognitive and psychosocial outcome after STN DBS in Parkinson's disease. Journal of Neurology, Neurosurgery, and Psychiatry 82 (7): 754–760.CrossRefGoogle Scholar
  16. 16.
    Pham, U., A.K. Solbakk, I.M. Skogseid, M. Toft, A.H. Pripp, A.E. Konglund, S. Andersson, I.R. Haraldsen, D. Aarsland, E. Dietrichs, and U.F. Malt. 2015. Personality changes after deep brain stimulation in Parkinson's disease. Parkinsons Dis 2015: 490507. doi: 10.1155/2015/490507.Google Scholar
  17. 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. 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
  19. 19.
    Gallagher, S. 2003. Phenomenology and experimental design: Toward a Phenomenologically enlightened experimental science. Journal of Consciousness Studies 10 (9–10): 85–99 Scholar
  20. 20.
    Varela, F. 1996. Neurophenomenology: A methodological remedy to the hard problem. Journal of Consciousness Studies 3: 330–350 Scholar
  21. 21.
    Kraemer, F. 2013. Me, myself and my brain implant: Deep brain stimulation raises questions of personal authenticity and alienation. Neuroethics 6: 483–497.CrossRefGoogle Scholar
  22. 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. 23.
    Schechtman, M. 2010. Philosopphical reflections on narrative and deep brain stimulation. Journal of Clinical Ethics 21 (2): 133–139.Google Scholar
  24. 24.
    Witt, K., J. Kuhn, L. Timmermann, M. Zurowski, and C. Woopen. 2013. Deep brain stimulation and the search for identity. Neuroethics 6: 499.CrossRefGoogle Scholar
  25. 25.
    Dings, R., and L. de Bruin. 2015. Situating the self: understanding the effects of deep brain stimulation.
  26. 26.
    Glannon, W. 2011. Neuropsychological aspects of enhancing the will. The Monist 95 (3): 378–398.CrossRefGoogle Scholar
  27. 27.
    Klaming, L., and P. 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 (3): 527–539.CrossRefGoogle Scholar
  28. 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. 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. 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. 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. 32.
    Gilbert, F. 2015. A Threat to Autonomy? The Intrusion of Predictive Brain Implants. AJOB Neuroscience 6 (4): 4–11.Google Scholar
  33. 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. 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.

Copyright information

© Springer Science+Business Media Dordrecht 2017

Authors and Affiliations

  1. 1.Center for Sensorimotor Neural Engineering, Department of PhilosophyUniversity of WashingtonSeattleUSA

Personalised recommendations