Tuesday, August 2, 2016

Transcranial Magnetic Stimulation and Humanity

By Ethan Morris

This post was written as part of a class assignment from students who took a neuroethics course with Dr. Rommelfanger in Paris of Summer 2016.

Ethan Morris is a rising undergraduate senior at Emory University, majoring in Neuroscience and Behavioral Biology with a minor in History. Ethan is a member of the Dilks Lab at Emory and is a legislator on the Emory University Student Government Association. Ethan is from Denver, Colorado and loves to ski.

Do you ever want to turn your brain off, even just for a moment? Most of us have probably wanted to get away from the daily stressors and concerns that plague our lives. But aside from a vacation, how can we truly get away? Some people are beginning to turn this hypothetical question into reality.

One man, Thomas Thwaites, decided he would live as a goat for a few days, choosing to forego life as a human in favor of four-legged prosthetics and an all-grass diet. To achieve goat-hood, Thwaites used an increasingly prominent technology called transcranial magnetic stimulation (TMS) that uses electromagnetic induction to temporarily alter brain function. Thwaites applied TMS to the temporal lobe of his brain, namely his speech areas of cortex, thus electromagnetically impairing his ability to speak like a human so he could become more like a goat.


Thwaites quite literally took a vacation from his brain in order to become a goat. This application of TMS has been in the making for decades. For example, studies have shown that TMS over our prefrontal cortex can seriously (albeit temporarily) impair our ability to make strategic decisions. TMS technology has been applied in clinical contexts as well, with various studies showing the effectiveness of TMS in potential treatment of PTSD and major depression.

Thwaites’ use of TMS may seem harmless; however, the way Thwaites achieved this—through a new brain technology—raises novel questions regarding TMS, trans-humanism, and whether it is ethical to “turn off” parts of our brain, even if it is temporary. Ironically, Thwaites himself said that he opposes the idea of trans-humanism, saying that his decision to become a goat was a “reaction against this cyborg-chip-in-your-brain thing” (Felsenthal, 2016).

It is not difficult to imagine situations where TMS may be misappropriated in the future, particularly when this sort of technology becomes readily available. Those in search of a new recreational drug could apply “doses” of TMS over the visual cortex to cause hallucinations (or phosphenes) and over the prefrontal cortex to impair impulse control and decision-making in order to have a good time. Do-it-yourself enthusiasts are already using technology such as transcranial direct current stimulation (tDCS) to cognitively enhance areas of the brain such as the motor cortex. It is not impossible that people, dissatisfied with their own brain chemistry, may use TMS to “turn off” what they don’t like about their brains. Perhaps in the future, deep-brain TMS could be used to eliminate bad memories, alleviate situational sadness, or target regions of our brain associated with the parts of our personality we do not like (Bersani, 2013).

Image courtesy of The Ohio State University
These uses are highly questionable, particularly because they begin to raise questions about whether we should be able to fundamentally change our brains—thus changing who we are. I personally do not think it is ethical to significantly alter our brain chemistry outside of a clinical setting because it would begin to eliminate the errors, struggles, and characteristics that make us human in the first place. Beyond this, I believe strongly that to appreciate what is good about our lives, we must also experience what is less desirable. Finally, to give only those with access to TMS the ability to cognitively depress unwanted brain function would exacerbate existing socioeconomic divisions. For example, consider a job interview between two equally qualified candidates, but only one had the financial resources to apply TMS before the interview to temporarily eliminate anxiety. The applicant with TMS would likely appear confident and calm while the other candidate may be subject to normal human nervousness and jitters. While this is only one example, it elucidates how access to mental state alterations may add one more component that further disadvantages those without access to this technology.

However, the distinction between enhancement and clinical use is blurry. For example, when does sadness cross the line into major depression? While I believe that TMS is acceptable for treatment of major depression and PTSD, I do not believe it is ethical to use TMS to rid yourself of temporary sadness or an embarrassing memory. This line is convenient in theory, but it may be difficult to apply in real life situations, where there are additional challenges, such as clinical diagnosis accuracy and the agency of ultimate diagnosis (e.g. who gets to decide who has major depression, the patient or the doctor?).

Trans-humanists are a group of people who view immortality as a human right and see technology as the medium through which human enhancement can be achieved. Trans-humanists will likely embrace TMS as another exciting technology for their purposes. Through synergistic use of tDCS to enhance certain cognitive functions and TMS to depress unwanted cognitive functions (e.g. stress, anxiety), trans-humanists may see these technologies as one step closer to a utopian brain. I do not think it is ethical to use repetitive TMS as a means to a utopic brain for a couple reasons. First, it will degrade our humanity, which is by definition imperfect and better for being so. Second, while chronic stress is problematic for our health, acute stress has shown to be a behaviorally adaptive resource for humans. To trans-humanists, TMS may be another tool to elevate humans over our neurobiological constraints, and perhaps over other “normal” humans—raising another issue with cognitive enhancement.

One final consideration to make in the ethical discussion about TMS is the current limits of technology. I believe it is of the utmost importance to regulate TMS use outside of the scientific and clinical realm because we still do not know all of the effects of TMS if it is misused. For example, could too high of a TMS “dosage” cause serious long-term neurological impairments? Ultimately, TMS is an exciting technology with proven benefits in clinical and research environments, but as it becomes increasingly accessible and its uses increasingly non-clinical, there are serious problems that deserve the attention of the public and policy-makers alike.

References

Bersani, F.S., A. Minichino, P.G. Enticott, et al., 2013. Deep transcranial magnetic stimulation as a treatment for psychiatric disorders: A comprehensive review. European Psychiatry, 28(1): 30-39.

Carpenter, L., P.G. Janicak, S.T. Aaronson, et al. 2012. Transcranial magnetic stimulation (TMS) for major depression: A multisite, naturalistic, observational study of acute treatment outcomes in clinical practice. Depression and Anxiety, 29: 587-596.

Felsenthal, J. 2016. Why did this man decide to become a goat? Vogue, May 24. Available at: http://www.vogue.com/13439679/goatman-thomas-thwaites-interview/ (accessed June 10, 2016).

Humanity Plus. Available at: http://humanityplus.org (accessed June 23, 2016)

Johns Hopkins Medicine. Transcranial magnetic stimulation (TMS) service. Available at: http://www.hopkinsmedicine.org/psychiatry/specialty_areas/brain_stimulation/tms/ (accessed June 12, 2016).

Kammer, T. 1999. Phosphenes and transient scotomas induced by magnetic stimulation of the occipital lobe: their topographic relationship. Neuropsychologia, 37: 191-198.

Knoch, D., L.R.R. Gianotti, A. Pascual-Leone, et al. 2006. Disruption of right prefrontal cortex by low-frequency repetitive transcranial magnetic stimulation induces risk-taking behavior. Journal of Neuroscience, 26(24): 6469-6472.

Novakovic, V., L. Sher, K.A.B. Lapidus, J. Mindes, J.A. Golier, R. Yehuda. 2011. Brain stimulation in posttraumatic stress disorder. European Journal of Psychotraumatology, 2: 5609-.

Riggall, K., C. Forlini, A. Carter, et al. 2015. Researchers’ perspectives on scientific and ethical issues with transcranial direct current stimulation: An international survey. Scientific Reports, 5: 10618.

Schneiderman, N., G. Ironson, and S.D. Siegel. 2005. Stress and health: Psychological, behavioral, and biological determinants. Annual Review of Clinical Psychology 1: 607-628.


Want to cite this post?

Morris, Ethan. (2016). Transcranial Magnetic Stimulation and Humanity. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2016/08/transcranial-magnetic-stimulation-and.html

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