Skip to main content
SpringerLink
Log in

Ethical Objections to Deep Brain Stimulation for Neuropsychiatric Disorders and Enhancement: A Critical Review

  • Reference work entry
  • First Online:
Handbook of Neuroethics

Abstract

Over the last decades, deep brain stimulation has become an established treatment for movement disorder. However, the recent clinical research investigating the application of the technique for neuropsychiatric disorders as well as the potential to use DBS in a wider range of conditions has brought ethical controversy. This chapter examines some of the ethical objections against extending the use of DBS beyond the treatment of movement disorders. The first part of this chapter focuses on the objections related to the past uses of psychosurgery and examines the ethical weight of invasiveness and reversibility, two commonly used concepts in ethical discussions about DBS. The second part examines objections related to freedom and autonomy, including the slippery slope arguments related to “mind control,” as well as the issue of control over the parameters of the stimulation in the context of cognitive liberty. The third part briefly discusses the objection to the enhancement uses of DBS, highlighting different contexts in which DBS can be used for enhancement while arguing for a systematic consideration of ethically relevant factors instead of the reliance on the treatment/enhancement distinction. The final part addresses the objection to DBS related to threats to identity. First, the ethical weight of discontinuity under psychological continuity approaches to identity is discussed. Next, the focus turns to the narrative approach to identity and Schechtman’s objection to the use of DBS, and it is argued that although the narrative approach brings valuable insights, the normative conclusions we can draw from it are limited.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 999.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 999.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Notes

  1. 1.

    Doctors’ and society’s reasons to either provide access to the intervention or not are a separate issue

  2. 2.

    This holds whether or not a change in a given trait was intended. Narratives are typically thought to incorporate both voluntary and involuntary aspects of experience.

References

  • Agid, Y., Schupbach, M., Gargiulo, M., Mallet, L., Houeto, J., Behar, C., & Welter, M. L. (2006). Neurosurgery in Parkinson’s disease: The doctor is happy, the patient less so? Journal of Neural Transmission, 70, s409–s414.

    Article  Google Scholar 

  • Andrade, P., Nobless, L. H. M., Temel, Y., Ackermans, L., Lim, L. W., Steinbusch, H. W. M., & Visser-Vandewalle, V. (2010). Neurostimulatory and ablative treatment options in major depressive disorder: A systematic review. Acta Neurochirurgica, 152, 565–577.

    Article  Google Scholar 

  • Baker, L. R. (2000). Persons and bodies: A constitution view. Cambridge, UK: Cambridge University Press.

    Book  Google Scholar 

  • Bauer, R., Pohl, S., Klosterkotter, J., & Kuhn, J. (2008). Deep brain stimulation in the context of addiction – A literature-based systematic evaluation. Fortschritte der Neurologie – Psychiatrie, 76, 396–401.

    Article  Google Scholar 

  • Baumeister, A. A. (2000). The Tulane electrical brain stimulation program – A historical case study in medical ethics. Journal of the History of the Neurosciences, 9(3), 262–278.

    Article  Google Scholar 

  • Baylis, F. (2011). “I am who I am”: On the perceived threats to personal identity from deep brain stimulation. Neuroethics. doi:10.1007/s12152-011-9137-1.

    Google Scholar 

  • Bell, E., & Racine, E. (2012). Ethical guidance for the use of deep drain stimulation in psychiatric trials and emerging uses: Review and reflections. In D. Denys, M. Feenstra, & R. Shuurman (Eds.), Deep brain stimulation: A new frontier in psychiatry (pp. 273–288). Berlin, Germany: Springer.

    Chapter  Google Scholar 

  • Bell, E., Mathieu, G., & Racine, E. (2009). Preparing the ethical future of deep brain stimulation. Surgical Neurology, 72(6), 577–586.

    Article  Google Scholar 

  • Brody, H. (1994). “My story is broken; can you help me fix it?”: Medical ethics and the joint construction of narrative. Literature and Medicine, 13(1), 79–92.

    Article  Google Scholar 

  • Csoka, A. B., & Shipko, S. (2006). Persistent sexual side effects after SSRI discontinuation. Psychotherapy and Psychosomatics, 75(3), 187–188.

    Article  Google Scholar 

  • DeGrazia, D. (2005a). Enhancement technologies and human identity. Journal of Medicine and Philosophy, 30(3), 261–283.

    Article  Google Scholar 

  • DeGrazia, D. (2005b). Human identity and bioethics. Cambridge, UK: Cambridge University Press.

    Book  Google Scholar 

  • Edwards, T. C., Zrinzo, L., Limousin, P., & Foltynie, T. (2012). Deep brain stimulation in the treatment of chorea. Movement Disorders, 27, 357–363.

    Article  Google Scholar 

  • Farkas, C.-A. (2013). Potentially harmful side-effects: Medically unexplained symptoms, somatization, and the insufficient illness narrative for viewers of mystery diagnosis. Journal of Medical Humanities, 34(3), 315–328. doi:10.1007/s10912-013-9234-8.

    Article  Google Scholar 

  • Focquaert, F., & DeRidder, D. (2009). Direct intervention in the brain: Ethical issues concerning personal identity. Journal of Ethics in Mental Health, 4(2), 1–7.

    Google Scholar 

  • Frank, A. (1995). The wounded storyteller: Body, illness, and ethics. Chicago, IL: University of Chicago Press.

    Book  Google Scholar 

  • Glannon, W. (2009). Stimulating brains, altering minds. Journal of Medical Ethics, 35, 289–292.

    Article  Google Scholar 

  • Greenberg, B. D., Nuttin, B., & Rezai, A. R. (2006). Education and neuromodulation for psychiatric disorders: A perspective for practitioners. Neurosurgery, 59(4), 717–719.

    Article  Google Scholar 

  • Halpern, C. H., Wolf, J. A., Bale, T. L., Stunkard, A. J., Danish, S. F., Grossman, M., & Baltuch, G. H. (2008). Deep brain stimulation in the treatment of obesity: A review. Journal of Neurosurgery, 109(10), 625–634.

    Article  Google Scholar 

  • Hariz, M. I., & Hariz, G. M. (2012). Hyping deep brain stimulation in psychiatry could lead to its demise. British Medical Journal, 345, e5447.

    Article  Google Scholar 

  • Hariz, M. I., Blomstedt, P., & Zrinzo, L. (2010). Deep brain stimulation between 1947 and 1987: The untold story. Neurosurgical Focus, 29(2), E1.

    Article  Google Scholar 

  • Harris, J. (2011). Moral enhancement and freedom. Bioethics, 25(2), 102–111.

    Article  Google Scholar 

  • Hermans, H. J. M. (2003). The construction and reconstruction of a dialogical self. Journal of Constructivist Psychology, 16, 89–130.

    Article  Google Scholar 

  • Hermans, H. J. M., & Dimaggio, G. (Eds.). (2004). The dialogical self in psychotherapy. New York: Brunner-Routledge.

    Google Scholar 

  • Hernando, V., Pastor, J., Pedrosa, M., Pena, E., & Sola, R. G. (2008). Low-frequency bilateral hypothalamic stimulation for treatment of drug-resistant aggressiveness in a young man with mental retardation. Stereotactic and Functional Neurosurgery, 86(4), 219–223.

    Article  Google Scholar 

  • Hildt, E. (2006). Electrodes in the brain: Some anthropological and ethical aspects of deep brain stimulation. International Review of Information Ethics, 5, 33–39.

    Google Scholar 

  • Holtzheimer, P. E., Kelley, M. E., Gross, R. E., Filkowski, M. M., Garlow, S. J., Barrocas, A., & Mayberg, H. S. (2012). Subcallosal cingulate deep brain stimulation for treatment-resistent unipolar and bipolar depression. Archives of General Psychiatry, 69(2), 150–158.

    Article  Google Scholar 

  • Invasive. (n.d.). In Merriam-Webster online. Retrieved from http://www.merriam-webster.com/dictionary/invasive. Accessed 26 Nov 2012.

  • Krack, P., Hariz, M. I., Baunez, C., Guridi, J., & Obeso, J. A. (2010). Deep brain stimulation: From neurology to psychiatry? Trends in Neurosciences, 33, 474–484.

    Article  Google Scholar 

  • Kramer, P. D. (1994). Listening to prozac. London, UK: Fourth Estate Paperbacks.

    Google Scholar 

  • Kuhn, J., Lenartz, D., Huff, W., Lee, S., Koulousakis, A., Klosterkoetter, J., & Sturm, V. (2007). Remission of alcohol dependency following deep brain stimulation of the nucleus accumbens: valuable therapeutic implications? Journal of Neurology, Neurosurgery, and Psychiatry, 78, 1152–1153.

    Article  Google Scholar 

  • Kuhn, J., Lenartz, D., Mai, J. K., Huff, W., Klosterkoetter, J., & Sturm, V. (2008). Disappearance of self-aggressive behavior in a brain-injured patient after deep brain stimulation of the hypothalamus: Technical case report. Neurosurgery, 62(5), e1182.

    Article  Google Scholar 

  • Kuhn, J., Gaebel, W., Klosterkoetter, J., & Woopen, C. (2009). Deep brain stimulation as a new therapeutic approach in therapy-resistant mental disorders: Ethical aspects of investigational treatment. European Archives of Psychiatry and Clinical Neuroscience, 259(2), s135–s141.

    Article  Google Scholar 

  • Kuhn, J., Gründler, T. O. J., Lenartz, D., Sturm, V., Klosterkötter, J., & Huff, W. (2010). Deep brain stimulation for psychiatric disorders (trans: Roseveare D.). Deutsches Ärzteblatt International, 107(7), 105–113.

    Google Scholar 

  • Laxton, A. W., Tang-Wai, D. F., McAndrews, M. P., Zumsteg, D., Wennberg, R., Keren, R., & Lozano, A. M. (2010). A phase 1 trial of deep brain stimulation of memory circuits in Alzheimer’s disease. Annals of Neurology, 68(4), 521–534.

    Article  Google Scholar 

  • Lipsman, N., Zenar, R., & Bernstein, M. (2009). Personal identity, enhancement and neurosurgery: A qualitative study in applied neuroethics. Bioethics, 23(6), 375–383.

    Article  Google Scholar 

  • Lipsman, N., McAndrews, M. P., Lozano, A., & Bernstein, M. (2011). Research consent for deep brain stimulation in treatment-resistant depression: Balancing risk with patient expectations. AJOB Neuroscience, 2(1), 39–41.

    Article  Google Scholar 

  • Lipsman, N., Woodside, D. B., Giacobbe, P., Hamani, C., Carter, C., Norwood, S.J., Sutandar, K., Staab, R., Elias, G., Lyman, C. H., Smith, G. S., & Lozano, A. M. (2013). Subcallosal cingulate deep brain stimulation for treatment-refractory anorexia nervosa: a phase 1 pilot trial. The Lancet, 381(9875), 1361–1370.

    Article  Google Scholar 

  • Locke, J. (1975 [1694]). Book II, chapter XXVII, of identity and diversity. In P. H. Nidditch, (Ed.). An essay concerning human understanding. Oxford, UK: Clarendon Press.

    Google Scholar 

  • Lozano, A. M. (2012). Deep brain stimulation therapy. British Medical Journal, 344, e1100.

    Article  Google Scholar 

  • Lu, L., Wang, X., & Kosten, T. R. (2009). Stereotactic neurosurgical treatment of drug addiction. American Journal of Drug and Alcohol Abuse, 35(6), 391–393.

    Article  Google Scholar 

  • Maan, A. K. (2010). Internarrative identity: Placing the self (2nd ed.). Lanham, MD: University Press of America.

    Google Scholar 

  • Mackenzie, C., & Poltera, J. (2010). Narrative integration, fragmented selves, and autonomy. Hypatia, 25(1), 31–54.

    Article  Google Scholar 

  • Mathews, D. J. H., Rabins, P. V., & Greenberg, B. D. (2011). Deep brain stimulation for treatment-resistant neuropsychiatric disorders. In J. Illes & B. J. Sahakian (Eds.), Oxford handbook of neuroethics (pp. 441–453). Oxford, UK: Oxford University Press.

    Google Scholar 

  • McMahan, J. (2002). The ethics of killing: Problems at the margins of life. Oxford, UK: Oxford University Press.

    Book  Google Scholar 

  • Merkel, R., Boer, G., Fegert, J., Galert, T., Hartmann, D., Nuttin, B., & Rosahl, S. (2007). Intervening in the brain: Changing psyche and society. Berlin, Germany: Springer.

    Google Scholar 

  • Morris, D. B. (2012). Narrative and pain: Towards an integrative model. In R. J. Moore (Ed.), Handbook of pain and palliative care (pp. 733–751). New York: Springer.

    Google Scholar 

  • Müller, S., & Christen, M. (2011). Deep brain stimulation in parkinsonian patients—ethical evaluation of cognitive, affective, and behavioral sequelae, AJOB Neuroscience, 2(1), 3–13.

    Article  Google Scholar 

  • Muzak, J. (2007). “They say the disease is responsible”: Social identity and the disease concept of drug addiction. In V. Raoul, C. Canam, A. D. Henderson, & C. Paterson (Eds.), Unfitting stories: Narrative approaches to disease, disability, and trauma (pp. 255–264). Waterloo, Canada: Wilfred Laurier Press.

    Google Scholar 

  • Olson, E. T. (2003). Personal identity. In S. P. Stich & T. A. Warfield (Eds.), The Blackwell guide to philosophy of mind (pp. 352–368). Malden, MA: Blackwell.

    Google Scholar 

  • Oshima, H., & Katayama, Y. (2010). Neuroethics of deep brain stimulation for mental disorders: Brain stimulation reward in humans. Neurologia Medico-Chirurgica, 50, 845–852.

    Article  Google Scholar 

  • Pacholczyk, A. (2011). DBS makes you feel good! – Why some of the ethical objections to the use of DBS for neuropsychiatric disorders and enhancement are not convincing. Frontiers in Integrative Neuroscience, 5(14).

    Article  Google Scholar 

  • Parfit, D. (1984). Reasons and persons. Oxford, UK: Clarendon.

    Google Scholar 

  • Perry, J. (1972). Can the self divide? The Journal of Philosophy, 69(16), 463–488.

    Article  Google Scholar 

  • Persson, I., & Savulescu, J. (2008). The perils of cognitive enhancement and the urgent imperative to enhance the moral character of humanity. Journal of Applied Philosophy, 25(3), 162–177.

    Article  Google Scholar 

  • Phillips, J. (2003). Psychopathology and the narrative self. Philosophy, Psychiatry and Psychology, 10(4), 313–328.

    Article  Google Scholar 

  • Pressman, J. D. (1998). Last resort: Psychosurgery and the limits of medicine. Cambridge, UK: Cambridge University Press.

    Google Scholar 

  • Racine, E., Waldman, S., Palmour, N., Risse, D., & Illes, J. (2007). “Currents of Hope”: Neurostimulation techniques in U.S. and U.K. print media. Cambridge Quarterly of Healthcare Ethics, 16, 312–316.

    Google Scholar 

  • Ricoeur, P. (1984). Time and narrative (Vol. 1). Chicago: University of Chicago Press.

    Google Scholar 

  • Ricoeur, P. (1985). Time and narrative (Vol. 2). Chicago: University of Chicago Press.

    Google Scholar 

  • Ricoeur, P. (1988). Time and narrative (Vol. 3). Chicago: University of Chicago Press.

    Google Scholar 

  • Ricoeur, P. (1992). Oneself as another. Chicago: University of Chicago Press.

    Google Scholar 

  • Schechtman, M. (1996). The constitution of selves. Ithaca, NY: Cornell University Press.

    Google Scholar 

  • Schechtman, M. (2009). Getting our stories straight: Self-narrative and personal identity. In D. J. H. Mathews, H. Bok, & P. V. Rabins (Eds.), Personal identity and fractured selves (pp. 65–92). Baltimore: Johns Hopkins University Press.

    Google Scholar 

  • Schechtman, M. (2010). Philosophical reflections on narrative and deep brain stimulation. Journal of Clinical Ethics, 21(2), 133–139.

    Google Scholar 

  • Schermer, M. (2011). Ethical issues in deep brain stimulation. Frontiers in Integrative Neuroscience, 5(17).

    Article  Google Scholar 

  • Schiff, N. D., Giacino, J. T., Kalmar, K., Victor, J. D., Baker, K., Gerber, M., & Rezai, A. R. (2007). Behavioural improvements with thalamic stimulation after severe traumatic brain injury. Nature, 448, 600–603.

    Article  Google Scholar 

  • Schuepbach, W. M. M., Rau, J., Knudsen, K., Volkmann, P., Krack, L., Timmermann, T. D., . . . EARLYSTIM Study Group. (2013). Neurostimulation for Parkinson’s disease with early motor complications. New England Journal of Medicine, 368(7), 610–622.

    Article  Google Scholar 

  • Schupbach, M., Gargiulo, M., Welter, M. L., Mallet, L., Behar, C., Houeto, J. L., & Agid, Y. (2006). Neurosurgery in Parkinson disease: A distressed mind in a repaired body? Neurology, 66(12), 1811–1816.

    Article  Google Scholar 

  • Sententia, W. (2004). Cognitive liberty and converging technologies for improving human cognition. Annals of the New York Academy of Science, 1013, 221–228.

    Article  Google Scholar 

  • Smith, G. S., Laxton, A. W., Tang-Wai, D. F., McAndrews, M. P., Diaconescu, A. O., Workman, C. I., & Lozano, A. M. (2012). Increased cerebral metabolism after 1 year of deep brain stimulation in Alzheimer disease. Archives of Neurology, 69(9), 1141–1148.

    Article  Google Scholar 

  • Sontag, S. (1978). Illness as metaphor. New York: Farrar, Straus and Giroux.

    Google Scholar 

  • Strawson, G. (2004). Against narrativity. Ratio, 17(4), 428–452.

    Article  Google Scholar 

  • Synofzik, M., & Schlaepfer, T. E. (2008). Stimulating personality: Ethical criteria for deep brain stimulation in psychiatric patients and for enhancement purposes. Biotechnology Journal, 3(12), 1511–1520.

    Article  Google Scholar 

  • Synofzik, M., & Schlaepfer, T. E. (2011). Electrodes in the brain – Ethical criteria for research and treatment with deep brain stimulation for neuropsychiatric disorders. Brain Stimulation, 4, 7–16.

    Article  Google Scholar 

  • Synofzik, M., Schlaepfer, T. E., & Fins, J. J. (2012). How happy is too happy? Euphoria, neuroethics, and deep brain stimulation of the nucleus accumbens. American Journal of Bioethics Neuroscience, 3(1), 30–36.

    Google Scholar 

  • Unger, P. (1990). Identity, consciousness, and value. Oxford, UK: Oxford University Press.

    Google Scholar 

  • Vice, S. (2003). Literature and the narrative self. Philosophy, 78(1), 93–108.

    Article  Google Scholar 

  • Witt, K., Kuhn, J., Timmermann, L., Zurowski, M., & Woopen, C. (2011). Deep brain stimulation and the search for identity. Neuroethics. doi:10.1007/s12152-011-9100-1.

    Google Scholar 

  • Yamamoto, T., Katayama, Y., Kobayashi, K., Oshima, H., Fukaya, C., & Tsubakawa, T. (2010). Deep brain stimulation for treatment of vegetative state. European Journal of Neuroscience, 32(7), 1145–1151.

    Article  Google Scholar 

Further Reading

  • Baerger, D. R., & McAdams, D. P. (1999). Life story coherence and its relation to psychological well-being. Narrative Inquiry, 9, 69–96.

    Article  Google Scholar 

  • Baumeister, R. F., & Newman, L. S. (1994). How stories make sense of personal experiences: Motives that shape autobiographical narratives. Personality and Social Psychology Bulletin, 20, 676–690.

    Article  Google Scholar 

  • Bavelas, J. B., Coates, L., & Johnson, T. (2000). Listeners as co-narrators. Journal of Personality and Social Psychology, 79, 941–952. – and what about conversation partners during the decision making process and change.

    Article  Google Scholar 

  • Davies, B., & Harré, R. (1990). Positioning: The discursive production of selves. Journal for the Theory of Social Behaviour, 20, 43–63.

    Article  Google Scholar 

  • Hawkins, A. H. (1999). Reconstructing illness: Studies in pathography. West Lafayette, IN: Purdue University Press.

    Google Scholar 

  • Hermans, H. J. M., & Hermans-Jansen, E. (1995). Self-narratives: The construction of meaning in psychotherapy. New York: Guilford Press.

    Google Scholar 

  • Holstein, J. A., & Gubrium, J. F. (2000). The self we live by: Narrative identity in a postmodern world. New York: Oxford University Press.

    Google Scholar 

  • Hydén, L. (1997). Illness and narrative. Sociology of Health and Illness, 19, 48–69.

    Google Scholar 

  • Kleinman, A. (1988). The illness narrative. Suffering, healing and the human condition. New York: Basic Books.

    Google Scholar 

  • Linde, C. (1993). Life stories. Oxford, UK: Oxford University Press.

    Google Scholar 

  • Lodi-Smith, J., Geise, A. C., Roberts, B. W., & Robins, R. W. (2009). Narrating personality change. Journal of Personality and Social Psychology, 96(3), 679–689.

    Article  Google Scholar 

  • McAdams, D. (2001). The psychology of life stories. Review of General Psychology, 5(2), 100–122.

    Article  Google Scholar 

  • Pals, J. L. (2006). Narrative identity processing of difficult life experiences: Pathways of personality development and positive self-transformation in adulthood. Journal of Personality, 74(4), 1079–1110.

    Article  Google Scholar 

  • Strawson, G. (2007). Episodic ethics. In D. Hutto (Ed.), Narrative and understanding persons. Cambridge, UK: Cambridge University Press.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Centre for Social Ethics and Policy, School of Law, University of Manchester, Oxford Road, Manchester, UK

    Anna Pacholczyk

  2. Institute for Science Ethics and Innovation, Faculty of Life Sciences, University of Manchester, Oxford Road, Manchester, UK

    Anna Pacholczyk

Authors
  1. Anna Pacholczyk
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anna Pacholczyk .

Editor information

Editors and Affiliations

  1. Institute for Ethics and History of Medicine, University of Tübingen, Tübingen, Germany

    Jens Clausen

  2. The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia

    Neil Levy

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer Science+Business Media Dordrecht

About this entry

Cite this entry

Pacholczyk, A. (2015). Ethical Objections to Deep Brain Stimulation for Neuropsychiatric Disorders and Enhancement: A Critical Review. In: Clausen, J., Levy, N. (eds) Handbook of Neuroethics. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-4707-4_29

Download citation

  • DOI: https://doi.org/10.1007/978-94-007-4707-4_29

  • Published:

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-007-4706-7

  • Online ISBN: 978-94-007-4707-4

  • eBook Packages: Humanities, Social Sciences and Law

Publish with us

Policies and ethics

Search

Navigation