Brain Topography

, Volume 27, Issue 1, pp 46–54 | Cite as

Neuromodulation, Agency and Autonomy

  • Walter Glannon
Original Paper


Neuromodulation consists in altering brain activity to restore mental and physical functions in individuals with neuropsychiatric disorders and brain and spinal cord injuries. This can be achieved by delivering electrical stimulation that excites or inhibits neural tissue, by using electrical signals in the brain to move computer cursors or robotic arms, or by displaying brain activity to subjects who regulate that activity by their own responses to it. As enabling prostheses, deep-brain stimulation and brain–computer interfaces (BCIs) are forms of extended embodiment that become integrated into the individual’s conception of himself as an autonomous agent. In BCIs and neurofeedback, the success or failure of the techniques depends on the interaction between the learner and the trainer. The restoration of agency and autonomy through neuromodulation thus involves neurophysiological, psychological and social factors.


Agency Autonomy Brain–computer interfaces Deep-brain stimulation Neurofeedback Neuromodulation 



I am grateful to the other participants in the symposium, “Changing the Brain, Changing Society: Clinical and Ethical Implications of Neuromodulation Techniques” at the Brocher Foundation, Hermance, Switzerland in June 2012 for their comments on a presentation on which this paper is based. I also thank an anonymous reviewer for Brain Topography for comments on an earlier version of this paper, which was made possible through the support of a grant from the John Templeton Foundation. The opinions expressed in the paper are those of the author and do not necessarily reflect those of the John Templeton Foundation.


  1. Abbott A (2005) Deep in thought. Nature 436:18–19PubMedCrossRefGoogle Scholar
  2. Arns M, de Ridder S, Strehl U et al (2009) Efficacy of neurofeedback for ADHD: the effects on inattention, impulsivity and hyperactivity: a meta-analysis. Clin EEG Neurosci 40:180–189PubMedCrossRefGoogle Scholar
  3. Beauchamp T, Childress J (2008) Principles of biomedical ethics, 6th edn. Oxford University Press, New YorkGoogle Scholar
  4. Benabid A (2003) Deep-brain stimulation for Parkinson’s disease. Curr Opin Neurobiol 13:696–706PubMedCrossRefGoogle Scholar
  5. Benabid A (2007) What the future holds for deep-brain stimulation. Exp Rev Med Dev 4:895–903CrossRefGoogle Scholar
  6. Benedetti F (2011) The patient’s brain. Oxford University Press, OxfordGoogle Scholar
  7. Birbaumer N, Ramos Murguialday A, Cohen L (2008) Brain–computer interface in paralysis. Curr Opin Neurol 21:634–638PubMedCrossRefGoogle Scholar
  8. Bublitz J, Merkel R (2009) Autonomy and authenticity of enhanced personality traits. Bioethics 23:360–374PubMedCrossRefGoogle Scholar
  9. de Charms RC, Maeda F, Glover G et al (2005) Control over brain activation and pain learned by using real-time functional MRI. PNAS 102:18626–18631CrossRefGoogle Scholar
  10. de Haan S, Rietveld E, Denys D (2013) Being free by losing control: what obsessive–compulsive disorder can tell us about free will. In: Glannon W (ed) Free will and the brain: neuroscientific, philosophical and legal perspectives. Cambridge University Press, CambridgeGoogle Scholar
  11. Dworkin G (1988) The theory and practice of autonomy. Cambridge University Press, New YorkCrossRefGoogle Scholar
  12. Frankfurt H (1988) Identification and externality. In: Frankfurt H (ed) The importance of what we care about. Cambridge University Press, New YorkCrossRefGoogle Scholar
  13. Gallagher S (2005) How the body shapes the mind. Clarendon Press, OxfordCrossRefGoogle Scholar
  14. Hochberg L, Serruya M, Friehs G et al (2006) Neuronal ensemble control of prosthetic devices by a human with tetraplegia. Nature 442:164–171PubMedCrossRefGoogle Scholar
  15. Hochberg L, Bacher D, Jarosiewicz B et al (2012) Reach and grasp by people with tetraplegia using a neurally controlled robotic arm. Nature 485:372–375PubMedCentralPubMedCrossRefGoogle Scholar
  16. Kant I (1785/1983) Grounding of the metaphysics of morals, Trans J Ellington, Hackett, IndianapolisGoogle Scholar
  17. Kennedy P, Andreasen D, Bartels J et al (2011) Making the lifetime connection between brain and machine for restoring and enhancing function. Prog Brain Res 194:1–25PubMedCrossRefGoogle Scholar
  18. Leuthardt E, Schalk G, Moran D, Ojemann J (2006) The emerging world of motor neuroprosthetics. Neurosurgery 59:1–14PubMedCrossRefGoogle Scholar
  19. Leuthardt E, Gaona C, Sharma M et al (2011) Using the electrocorticographic speech network to control a brain–computer interface in humans. J Neural Eng. doi: 10.1088/1741-2560/813/036004
  20. Linden D, Habes I, Johnston S et al (2012) Real-time self-regulation of emotion networks in patients with depression. PLoS ONE 7:e38115PubMedCentralPubMedCrossRefGoogle Scholar
  21. Lipsman N, Glannon W (2012) Brain, mind and machine: what are the implications of deep brain stimulation for perceptions of identity, agency and free will? Bioethics. doi: 10.1111/j.1467-8519.2012.01978.x
  22. Lozano A, Mayberg H, Giacobbe P et al (2008) Subcallosal cingulate gyrus deep brain stimulation for treatment-resistant depression. Biol Psychiatry 64:461–467PubMedCrossRefGoogle Scholar
  23. Mallet L, Polosan M, Nematollah J et al (2008) Subthalamic nucleus stimulation in severe obsessive–compulsive disorder. N Eng J Med 359:2121–2134CrossRefGoogle Scholar
  24. Mayberg H, Lozano A, Voon V et al (2005) Deep brain stimulation for treatment-resistant depression. Neuron 45:651–660PubMedCrossRefGoogle Scholar
  25. Mele A (1995) Autonomous agents: from self-control to autonomy. Oxford University Press, New YorkGoogle Scholar
  26. Merkel R, Boer G, Fegert J et al (2007) Intervening in the brain: changing psyche and society. Springer, BerlinGoogle Scholar
  27. Meynen G (2010) Free will and mental disorder: Exploring the relationship. Theor Med Bioeth 31:429–443PubMedCentralPubMedCrossRefGoogle Scholar
  28. Modell JG, Mountz JM, Curtis GJ, Greden JF (1989) Neurophysiologic dysfunction in basal ganglia/limbic striatal and thalamocortical circuits as a pathogenic mechanism of obsessive–compulsive disorder. J Neuropsychiatry Clin Neurosci 1:27–36PubMedGoogle Scholar
  29. Muller S, Walter H (2010) Reviewing autonomy: implications of the neurosciences and the free will debate for the principle of respect for the patient’s autonomy. Camb Q Healthc Ethic 19:205–217CrossRefGoogle Scholar
  30. Odekerken V, Van Laar T, Staal M et al (2013) Subthalamic nucleus versus globus pallidus bilateral deep brain stimulation for advanced Parkinson's disease (NSTAPS study): a randomised controlled trial. Lancet Neurol 12:37–44PubMedCrossRefGoogle Scholar
  31. Schlaepfer T, Cohen M, Frick C et al (2008) Deep-brain stimulation to reward circuitry alleviates anhedonia in refractory major depression. Neuropsychopharmacology 33:368–377PubMedCrossRefGoogle Scholar
  32. Synofzik M, Schlaepfer T, Fins J (2012) How happy is too happy? Euphoria, neuroethics and deep-brain stimulation of the nucleus accumbens. AJOB Neurosci 3(1):30–36CrossRefGoogle Scholar
  33. Tan G, Thornby J, Hammond D et al (2009) Meta-analysis of EEG feedback in treating epilepsy. Clin EEG Neurosci 40:173–179PubMedCrossRefGoogle Scholar
  34. Taylor C (1991) The Ethics of authenticity. Harvard University Press, CambridgeGoogle Scholar
  35. Weiskopf N (2012) Real-time fMRI and its application to neurofeedback. Neuroimage 62:682–692PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of PhilosophyUniversity of CalgaryCalgaryCanada

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