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Deep Brain Stimulation: Inducing Self-Estrangement

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Abstract

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.

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Notes

  1. This study expands upon some hypotheses that were initially sketched in [12].

  2. As such, our questions were indirect; we did not explicitly ask about experiences of postoperative self-estrangement. Our questionnaire used script in [12]. See [12] annexe entitled “Semi-structured Interview Script”.

  3. By “without solicitation” we mean that patients mentioned these changes of sexual activity without us directly inquiring about this specific topic. If we had included in our questionnaire specific questions targeting perceived changes to sexuality, perhaps we could have found more data on that particular topic.

  4. Notably, not all perceptions of self-change as associated with DBS entail estrangement of the self from itself. Some changes simply affect a limited number of capacities. We discuss this in the next paragraphs.

  5. As seen above, in some cases the emotions that patients experienced were not theirs; in other cases, they weren’t typical of the kinds of emotions experienced by their pre-surgery self.

  6. She did have more capacity (i.e the strength needed) to lift the pool table at age 21 than at age 54, but in neither case did she have sufficient capacity to achieve the goal of lifting the pool table. She misjudged her capacity post-operatively at age 54.

  7. This is certainly relevant in persons like the patient who tried to move the pool table (responsibility for bad consequences after making bad personal decisions) and even persons like patient Patient 6 who became so energetic about gardening – he could not understand why his wife could not keep up with him (he wasn’t aware of the impact his actions were having on those around him).

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Acknowledgements

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.

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  1. Center for Sensorimotor Neural Engineering, Department of Philosophy, University of Washington, Seattle, WA, USA

    Frederic Gilbert

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  1. Frederic Gilbert
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Correspondence to Frederic Gilbert.

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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.

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Gilbert, F. Deep Brain Stimulation: Inducing Self-Estrangement. Neuroethics 11, 157–165 (2018). https://doi.org/10.1007/s12152-017-9334-7

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