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Biotechnologies Inside the Self: New Challenges in Clinical Ontology

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Human Dignity of the Vulnerable in the Age of Rights

Part of the book series: Ius Gentium: Comparative Perspectives on Law and Justice ((IUSGENT,volume 55))

Abstract

This study is framed within the objectives of Clinical Ontology, namely, the formulation of true, coherent and accessible discourses in order to help patients manage unavoidable and destructive experiences about the nature of being, becoming, and its limits. First, I analyze four different inauthentic experiences (IE), which are deeply associated with neuro-technological development, and from which are emerging a new and growing vulnerable group of patients. Second, I propose two basis conditions for a successful ontological treatment: (a) the patient should value the unpleasant feelings of IE negatively; and (b) the patient should believe that a better understanding of reality (or at least, of his or her own life) provides a means to neutralize and replace unpleasant feelings with others that are more enjoyable and fulfilling. Finally, I defend that therapeutic technologies are not the only triggers of IE, hence they should not be the only target of investigation of this field.

I do not understand my own behaviour; I do not act as I mean to, but I do things that I hate.

–Romans 7,15

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Notes

  1. 1.

    This complexity also explains why there hasn’t been any genuine innovation in psychiatric drugs since the 1950s. Even the newspapers are now beginning to write about a problem that, for a long time, had only been noted and discussed by a few scientists. See, for instance, V. Bell, ‘Changing brains: why neuroscience is ending the Prozac era’, The Guardian, Sunday 22 September, 2013.

  2. 2.

    Admittedly, however, for these dramatic diseases it is difficult to isolate the real cause of the IE through longitudinal, controlled, and randomized studies. Factors such as illness severity, duration and the effects induced by other medications, etc. introduce noise into the data. At any rate, most of the positive evidence is derived from animal models. For further information, see U.-S. Torres, E. Portela-Oliveira, S. Borgwardt, G.-F. Busatto, ‘Structural brain changes associated with antipsychotic treatment in schizophrenia as revealed by voxel-based morphometric MRI: an activation likelihood estimation meta-analysis’, BMC Psychiatry, No. 13, 2013, p. 342; A.-C. Vernon, S. Natesan, W.-R. Crum, J.-D. Cooper, M. Modo, S.-R. Williams, S. Kapur, ‘Contrasting Effects of Haloperidol and Lithium on Rodent Brain Structure: A Magnetic Resonance Imaging Study with Postmortem Confirmation’, Biological Psychiatry, No. 71, 2012, p. 855; S. Navari, P. Dazzan, ‘Do antipsychotic drugs affect brain structure? A systematic and critical review of MRI findings’, Psychol Med, No. 39, 2009, pp. 1763–77.

  3. 3.

    See in this respect A. Clavenna, M. Bonati, ‘Safety of medicines used for ADHD in children: a review of published prospective clinical trials’, Arch Dis Child. No. 99, 2014: pp. 866–72; J. Graham, T. Banaschewski, J. Buitelaar, et al., ‘European guidelines on managing adverse effects of medication for ADHD’, Eur Child Adolesc Psychiatry, No. 20, 2011, pp. 17–37.

  4. 4.

    See in this respect A.-K. Cho, W.-P. Melega, ‘Patterns of methamphetamine abuse and their consequences’, J Addict Dis, No. 21, 2002, pp. 21–34.

  5. 5.

    See in this respect J. Sheridan, S. Bennett, C. Coggan, A. Wheeler, K. McMillan. ‘Injury associated with methamphetamine use: A review of the literature’, Harm Reduction Journal, No. 3, 2006, pp. 3–14.

  6. 6.

    See in this respect A. Schaefer, I. Burmann, R. Regenthal, K. Arélin, C. Barth, A. Pampel, A. Villringer, D.-S. Margulies, J. Sacher, ‘Serotonergic Modulation of Intrinsic Functional Connectivity’, Current Biology, No. 24, 2014, pp. 2314–2318.

  7. 7.

    See in this respect T.-Z. Tang, R.-J. DeRubeis, S.-D. Hollon, J. Amsterdam, R. Shelton, B. Schalet, ‘Personality Change During Depression Treatment. A Placebo-Controlled Trial’, Arch Gen Psychiatry, No. 66, 2009, pp. 1322–1330.

  8. 8.

    See for an in-depth analysis D. Healy, Relationship between the Pharmaceutical Industry and Depression, New York, New York University Press, 2004.

  9. 9.

    D. Degrazia, ‘Prozac, enhancement, and self-creation’, in C. Elliott, T. Chambers (eds), Prozac as a Way of Life, Chapel Hill, The University of North Carolina Press, 2004, p. 36.

  10. 10.

    E. Wurtzel, Prozac Nation: Young and Depressed in America, New York, Riverhead Books, 1995, p. 327.

  11. 11.

    See in this respect P. Kramer, Listening to Prozac: A Psychiatrist Explores Antidepressant Drugs and the Remaking of the Self, New York, Viking Press, 1993.

  12. 12.

    F. Kraemer, ‘Authenticity Anyone? The Enhancement of Emotions via Neuro-Psychopharmacology’, Neuroethics, No. 4, 2011, pp. 51–64.

  13. 13.

    See in this respect P. Goldie, On Personality, London, Routledge, 2004; J. Vymĕtal, Authenticity in psychology and psychotherapy. Sb Lek, No. 103, pp. 313–21.

  14. 14.

    For a comprehensive overview of the recent development, see S. Miocinovic, S. Somayajula, S. Chitnis, J.-L. Vitek, ‘History, applications, and mechanisms of deep brain stimulation’ JAMA Neurol, No. 70, 2013, pp. 163–71.

  15. 15.

    See in this respect M. Jahanshahi, V. Czernecki, A.-M. Zurowski, ‘Neuropsychological, neuropsychiatric, and quality of life issues in DBS for dystonia’, Mov Disord Suppl, No. 1, 2011, pp. S63–78; M.-S. Siddiqui, I.-U. Haq, M.-S. Okun, ‘Deep brain stimulation in movement disorders’, Continuum: Lifelong Learning in Neurology, No. 16, 2010, pp. 110–130; K. Witt, C. Daniels, J. Reiff, P. Krack, J. Volkmann, M.-O. Pinsker, et al., ‘Neuropsychological and psychiatric changes after deep brain stimulation for Parkinson’s disease: a randomised, multicentre study’, Lancet Neurol, No. 7, 2011, pp. 605–14.

  16. 16.

    For a description of the problems see E. Racine, E. Bell, N. Zizzo, ‘Deep Brain Stimulation: A Principled and Pragmatic Approach to Understanding the Ethical and Clinical Challenges of an Evolving Technology’, Curr Top Behav Neurosci, No. 19, 2015, 243–63; E. Bell, E. Racine, ‘Deep brain stimulation, ethics, and society’, J Clin Ethics, No. 21, 2010, pp. 101–103.

  17. 17.

    See in this respect C.-H. Halpern, J.-H. Rick, S.-F. Danish, M. Grossman, G.-H. Baltuch, ‘Cognition following bilateral deep brain stimulation surgery of the subthalamic nucleus for Parkinson’s disease’, Int J Geriatr Psychiatry, No. 24, 2008, pp. 443–51; J.-H. Heo, K.-M. Lee, S.-H. Paek, M.-J. Kim, J.-Y. Lee, J-Y. Kim, et al., ‘The effects of bilateral subthalamic nucleus deep brain stimulation (STN DBS) on cognition in Parkinson disease’, J Neurol Sci, No. 273, 2008, pp. 19–24.

  18. 18.

    See in this respect M. Schüpbach, ‘Psychosocial adjustment after deep brain stimulation in Parkinson’s disease’, Nature Reviews Neurology, No. 4, 2008, pp. 58–59.

  19. 19.

    See in this respect S. Fassino, G. Abbate Daga, C. Gramaglia, A. Pierò, M. Zibetti, et al., ‘Novelty-seeking in Parkinson’s disease after deep brain stimulation of the subthalamic nucleus: a case-control study’, Psychosomatics, No. 51, 2010, pp. 62–7.

  20. 20.

    See in this respect A.-F. Leentjens, V. Visser-Vandewalle, Y. Temel, F.-R. Verhey, ‘Manipulation of mental competence: an ethical problem in case of electrical stimulation of the subthalamic nucleus for severe Parkinson’s disease’, Ned Tijdschr Geneeskd, No.148, 2004, pp. 1394–8; A. Funkiewiez, C. Ardouin, E. Caputo, P. Krack, V. Fraix, H. Klinger, et al., ‘Long term effects of bilateral subthalamic nucleus stimulation on cognitive function, mood, and behaviour in Parkinson’s disease’, J Neurol Neurosurg Psychiatry, No. 75, 2004, pp. 834–9; S.-P. Woods, J.-A. Fields, A.-I. Tröster, ‘Neuropsychological sequelae of subthalamic nucleus deep brain stimulation in Parkinson’s disease: a critical review,’ Neuropsychol Rev, No. 12, 2002, pp. 111–26.

  21. 21.

    See in this respect W. Glannon, ‘Stimulating brains, altering minds’, Journal of Medical Ethics, No. 35, 2009, pp. 289–292.

  22. 22.

    F. Neuhouser, ‘Review of Rahel Jaeggi: Entfremdung: Zur Aktualität eines sozialphilosophischen Problems’, Notre Dame Philosophical Reviews, An electronic journal, 2007. http://ndpr.nd.edu/review.cfm?id=10243. Consulted on December 1st, 2014.

  23. 23.

    M. Schüpbach, M. Gargiulo, M.-L. Welter, L Mallet, C. Béhar, J.-L. Houeto, D. Maltête, V. Mesnage, Y. Agid, ‘Neurosurgery in Parkinson disease: A distressed mind in a repaired body?’ Neurology, No. 66, 2006, p. 1814.

  24. 24.

    See in this respect L. Klaming, P. Haselager, ‘Did My Brain Implant Make Me Do It? Questions Raised by DBS Regarding Psychological Continuity, Responsibility for Action and Mental Competence’, Neuroethics, No. 6, 2013, pp. 527–539.

  25. 25.

    See in this respect N. Cowan, ‘Multiple concurrent thoughts: The meaning and developmental neuropsychology of working memory’, Dev Neuropsychol, No. 35, 2010, pp. 447–74.

  26. 26.

    F. Kraemer, ‘Me, Myself and My Brain Implant: Deep Brain Stimulation Raises Questions of Personal Authenticity and Alienation’, Neuroethics, No. 6, 2013, p. 484.

  27. 27.

    A. MacIntyre. Dependent Rational Animals: Why Human Beings Need the Virtues, Chicago: Open Court, 2001. See, especially, the first chapter, “Vulnerability, dependence, animality”, pp. 10–14.

  28. 28.

    For details see M. Haghighi, M. Koeda, T. Takai, H. Tanaka, ‘Development of clinical ontology for mood disorder with combination of psychomedical information’, J Med Dent Sci, No. 56, 2009, pp. 1–15; O. Bodenreider, R. Stevens, ‘Bio- Bio-ontologies: current trends and future directions’, Brief Bioinform, No. 7, 2006, pp. 256–74.

  29. 29.

    This last objective is close to the frame Viktor Frankl proposed for logotherapy, ie life’s meaning. For an extensive and deep analysis see V. Frankl, Man’s Search for Meaning. An Introduction to Logotherapy, Boston, MA, Beacon Press, 2006.

  30. 30.

    F. Svenaeus, ‘Do antidepressants affect the self? A phenomenological approach’, Medicine, Health Care and Philosophy, No. 10, 2007, p. 158.

  31. 31.

    See in this respect M. Heidegger, The Fundamental Concepts of Metaphysics: World, Finitude, Solitude, University Press, Indiana, Bloomington, 1995, pp. 120–121; M. Heidegger, Being and Time, Albany, State University of New York Press, 1996, pp. 188–191.

  32. 32.

    Svenaeus, ‘Do antidepressants affect the self?,… p. 159.

  33. 33.

    See, to this end, M. Ruiter, S.-L. Johnson, ‘Mania risk and creativity: A multi-method study of the role of motivation’, J Affect Disord, No. 170, 2015, pp. 52–8; S.-L. Johnson, G. Murray, B. Fredrickson, E.-A. Youngstrom, S. Hinshaw, J.-M. Bass, T. Deckersbach, J. Schooler, I. Salloum, ‘Creativity and bipolar disorder: touched by fire or burning with questions?’, Clin Psychol Rev, No. 32, 2012, pp. 1–12; A. Hankir, ‘Review: bipolar disorder and poetic genius’, Psychiatr Danub, No. 23 Suppl, 2011, S62-8; R.-M. Holm-Hadulla, M. Roussel, F.-H, Hofmann, ‘Depression and creativity – the case of the German poet, scientist and statesman J. W. v. Goethe’, J Affect Disord, No. 127, 2010, pp. 43–9.

  34. 34.

    S. Freud [1915], The unconscious, London, Penguin modern classics, 2005.

  35. 35.

    See in this respect M.-A. Holowchak, The Stoics. A guide for the perplexed, New York, Bloomsbury Academic, 2008, p. 19.

  36. 36.

    All the same, this conclusion does not mean that we are talking about the same field. Objectives and methods are what define a scientific field, not its effects.

  37. 37.

    See in this respect V.-F. Guidano, Complexity of the Self, New York, Guilford Press, 1987; V.-F. Guidano, ‘A Constructivist Outline of Human Knowing Processes’, in M.-J. Mahoney (ed.), Cognitive and Constructive Psychotherapies, New York, Springer, 1997, pp. 89–102.

  38. 38.

    Of course, this does not mean that subjectivity is a trivial matter for Clinical Ontology. Its narratives have to take into account the patient’s individual traits and context. However, narratives cannot be everything.

  39. 39.

    E. Juengst, ‘What does enhancement mean?’, in E. Parens (ed), Enhancing human traits, Washington D.C., Georgetown UP, 1998, p. 29.

  40. 40.

    See in this respect J. Savulescu, B. Foddy, M. Clayton, ‘Why we should allow performance enhancing drugs in sport’, British Journal of Sports Medicine, No. 38, 2004, pp. 666–670.

  41. 41.

    See in this respect I. Singh, ‘Not robots: children’s perspectives on authenticity, moral agency and stimulant drug treatments’, J Med Ethics, No. 39, 2013, pp. 359–66; C.-J. Teter, S.-E. McCabe, K. LaGrange, J.-A. Cranford, C.-J, Boyd, ‘Illicit use of specific prescription stimulants among college students: prevalence, motives, and routes of administration’, Pharmacotherapy, No. 26, 2006, pp. 1501–10.

  42. 42.

    G. Galati, ‘Presence, telepresence, images and the self’, Technoetic Arts, No. 9, 2012, pp. 129–134.

  43. 43.

    V. Robin. ‘Digital Spaces – Digital Identity(s)’, in Valerievisual. Readings, and Related Inspirations, 15th September, 2012. http://valerievisual.wordpress.com/2012/09/15/digital-spaces-digital-identitys/Consulted on December 4th, 2014.

  44. 44.

    M. Cash, ‘Extended cognition, personal responsibility, and relational autonomy’, Phenomenology and the Cognitive Sciences, No. 9, 2010, pp. 645–671.

  45. 45.

    A.-R. Hochschild, The managed heart: Commercialization of human feeling, Berkeley, University of California Press, 1983, p. 56.

  46. 46.

    Hochschild, The managed heart,…. 118.

  47. 47.

    See in this respect M. Salmela, ‘What Is Emotional Authenticity?’, Journal for the Theory of Social Behaviour, No. 35, 2005, pp. 209–230.

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Author information

Authors and Affiliations

  1. Medical Education and Bioethics, School of Medicine, University of Navarra, Irunlarrea, Pamplona, Navarra, 31008, Spain

    Luis E. Echarte

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  1. Luis E. Echarte
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Correspondence to Luis E. Echarte .

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  1. Faculty of Law, University of Valencia, Valencia, Spain

    Aniceto Masferrer

  2. Department of Political Sciences, Ethics and Sociology, CEU Cardenal Herrera University, Alfara del Patriarca, Valencia, Spain

    Emilio García-Sánchez

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© 2016 Springer International Publishing Switzerland

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Echarte, L.E. (2016). Biotechnologies Inside the Self: New Challenges in Clinical Ontology. In: Masferrer, A., García-Sánchez , E. (eds) Human Dignity of the Vulnerable in the Age of Rights. Ius Gentium: Comparative Perspectives on Law and Justice, vol 55. Springer, Cham. https://doi.org/10.1007/978-3-319-32693-1_6

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  • DOI: https://doi.org/10.1007/978-3-319-32693-1_6

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  • Print ISBN: 978-3-319-32691-7

  • Online ISBN: 978-3-319-32693-1

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