Tuesday, September 13, 2016

Identity Crisis: The Unintended Consequence of Deep Brain Stimulation

By Alec Shannon


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.

Born and raised in the suburbs of Chicago, Alec Shannon is a rising third year student at Emory University where he is majoring in Neuroscience and Behavioral Biology and minoring in French Studies. On campus, he serves as the president of the French Club and vice president of the Emory Undergraduate Medical Review. During the school year, he also dedicates his time playing for the tennis club and projects with Volunteer Emory. He currently works in a movement disorders lab in Emory’s Department of Pharmacology and plans on pursuing a career in medicine.

This summer’s Neuroethics Network Session facilitated a cross-disciplinary conversation on complex questions that the field of neuroscience will be forced to answer in the near future. Although some issues in neuroethics might appear purely speculative, the rapid advancement of technology emerging from neuroscience will require policy-makers to preemptively govern its development. The consequences of these regulations will resonate throughout society and determine how neuroscience will be integrated into professional fields ranging from law enforcement to psychiatry. Individual lectures from experts in these fields explored the ethics of emerging technologies and analyzed how they align with our shared values of society.

Although the lectures presented during the conference covered a broad range of topics from cognitive enhancement to artificial intelligence, core philosophical arguments emerged during these talks that united the different topics under some common themes. The conference particularly emphasized one recurring theme underlying contemporary neuroethical debate—the conflict between our conception of personal identity and the degree to which new technologies should/could modify that conception. Many lectures explored the role of this conflict in real-life contexts and also offered guidelines for how these issues should be approached.

Dr. Sven Nyholm from the Eindhoven University of Technology in the Netherlands introduced the conflict between personal identity and upcoming brain technology in a series of lectures entitled “Who (or what) am I?” This discussion panel focused primarily on developments of an invasive surgical procedure called deep brain stimulation (DBS), a technology originally designed to treat symptoms of Parkinson’s disease that is now being tested for the treatment of psychiatric disorders. This procedure, which involves the placement of electrodes to stimulate deep structures of the brain involves a mechanism of action that is poorly understood by scientists, yet has effectively attenuated many motor symptoms of these diseases (Perlmutter & Mink 2006). Dr. Nyholm added another dimension of uncertainty to DBS in his discussion of its potential to unintentionally modify an individual’s personality and even “sense of self.”

The story of “Mr. B” and Johnny Cash illustrated during Dr. Nyholm’s lecture serves as a real-life testament to these unintended effects of DBS treatment. When Mr. B received DBS for treatment of obsessive-compulsive disorder, he underwent a personality shift so dramatic that it merited a change in identity—the same Mr. B quickly became “Mr. B II” following brain stimulation. In order to analyze the nature of this personality change, Dr. Nyholm alluded to the work of English philosopher John Locke, who once related the concept of personal identity to a narrative with a natural continuity over time. Whether or not DBS constitutes a real threat to the continuity of a personal narrative is a point of contention in the neuroethics community and foremost requires an agreement on how we should define the “true self.”

Image courtesy of WikiCommons
Dr. Nyholm pointed out that the concept of the true self dominates contemporary Western culture and indubitably impacts how we perceive our own personal identities. Underlying the concept of the true self is a common association between the better aspects of our personality and how we identify ourselves; when someone perceives his or her “true self,” the redeeming qualities are typically emphasized over any negative or unattractive traits.

This nuance is an important consideration when discussing the improvements that DBS imparts on patients with various movement disorders; if the treatment facilitates better expression of these redeeming qualities, should we still consider DBS a threat to our personality identity? Alternatively, should we simply perceive DBS as a method for improving our ability to tap into our true selves? We must also approach the conflict from a clinical standpoint and ask whether the possibility of personality changes negate the enhanced quality of life that Parkinson’s patients enjoy following successful stimulation. Many individuals would argue that withholding this treatment from a population suffering from a debilitating and degenerative disease would be ethically incompatible with our expectations for healthcare.

The ethics of DBS and its role in modifying personality parallel many of the discussions held during in-class lectures on technologies that jeopardize our conception of authenticity. While the panel focused primarily on authenticity changes following DBS, a number of psychoactive compounds and external brain-stimulation technologies like transcranial direct-current stimulation (tDCS) also raise similar existential questions.

In the case of stimulant medication for the treatment of ADHD symptomology, the enhancement of certain cognitive measures has been reported to change the personality of users (Ilieva & Farah 2013). By improving areas of executive function, namely focus and attention, these medications can also be considered personality modifiers because they change the way people with ADHD interact with the world. The use of tDCS, which is currently being researched for applications in psychiatric treatments, can also be considered personality modification because of its potential to change certain aspects of personality—including mood and social behavior (Brunoni et al 2012). While these changes are arguably for the better because they facilitate better integration into a fast-paced and demanding society, many ethicists argue that these benefits should not merit a violation to the authentic self despite their therapeutic value.

In response to the fear of threats to the true self, it is important to acknowledge the dynamic nature of the “true self” and remember that this concept often constitutes more positive than negative characteristics of personality. By enhancing expression of the positive characteristics of an individual’s personality with neurotechnologies, there is a possibility that certain treatments like DBS are actually improving authenticity rather than violating it. It is the responsibility of neuroethicists and its diverse community of scholars to determine how these treatments will interact with society’s shared values, including our expectations for healthcare and our view on powerful concepts like individuality and the true self.

References

Brunoni, A. R., Nitsche, M. A., Bolognini, N., Bikson, M., Wagner, T., Merabet, L., Edwards, D.J., Valero-Cabre, A., Rotenberg, A., Pascual-Leone, A., Ferrucci, R., Priori, A., Boggio, P.S., and Fregni, F. (2012). Clinical research with transcranial direct current stimulation (tDCS): Challenges and future directions. Brain Stimulation, 5(3), 175-195. doi:10.1016/j.brs.2011.03.002

Ilieva, I. P., & Farah, M. J. (2013). Enhancement stimulants: Perceived motivational and cognitive advantages. Front. Neurosci. Frontiers in Neuroscience, 7. doi:10.3389/fnins.2013.00198

Perlmutter, J. S., & Mink, J. W. (2006). Deep Brain Stimulation. Annu. Rev. Neurosci. Annual Review of Neuroscience, 29(1), 229-257. doi:10.1146/annurev.neuro.29.051605.112824

Want to cite this post?

Shannon, A. (2016). Identity Crisis: The Unintended Consequence of Deep Brain Stimulation. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2016/09/identity-crisis-unintended-consequence.html


1 comment:

Shlomit Ritz Finkelstein said...

Alec,

The question raised in your blog is important and complex. Could you say more about the specific changes in Mr. B? Without knowing these details, it is difficult to assess what is meant by identity change and to evaluate these changes. Also, was Mr. B II himself asked about these changes and how he feels about them? Would he still choose to have the DBS had he known ahead of time of such possible changes?

Dr. Mahlon DeLong has performed many DBS operations on Parkinson's patients, and Dr. Helen Myberg has performed many DBS operations on patients with depression. They are both at Emory. It would be interesting and insightful for you and your readers to hear their observations and thoughts about this question.

Shlomit