Me, Myself, and my Social Constructs

By Ashley Oldshue

“He began to search among the infinite series of impressions which time had laid down, leaf upon leaf, fold upon fold softly, incessantly upon his brain”
--- Virginia Woolf, To the Lighthouse

Image courtesy to Tomas Castelazo, Wikimedia Commons
Identity is a motif that runs central to our lives, it is woven into our language, our learning, and our literature. Virginia Woolf, in her novel To the Lighthouse, describes identity as a flipbook of images (Woolf, 1981, p. 169). She asserts that when we look at someone, we do not hold a single, uniform concept of them. Instead, we see a series of images and interactions running like a flipbook in our heads. It is in this idea of who they are that we are able to add pages and evolve over time. However, no one deed can erase all the rest. Everybody is made up of good and bad, and these inconsistencies together form an identity. However, what if someone did change so drastically that it was like reading a whole new book?

Similar questions about identity and the role of theory of mind emerged repeatedly throughout the 2018 Neuroethics Network Conference. Held at the Institut du Cerveau et de la Moelle épinière (ICM), the premier Brain and Spine Institute in Paris, this conference featured speakers from neuroscience, psychology, philosophy, business, medicine, and more. Everyone, from professors to ethicists to students, were all discussing and dissecting ethical questions that are at the forefront of neuroscience.

One speaker in particular, a philosopher from Eindhoven University of Technology, addressed theory of mind, identity, and this concept of the “true self.”  Dr. Sven Nyholm has worked with ethics of neurotechnology, deep brain stimulation (DBS), happiness and well-being (Sven Nyholm).  A large portion of his discussion centered around how we attribute mental states to others.  In cases of dementia, addiction, or depression that can result in large behavioral changes, there is often a dissonance created between the mental attributions people have of the diagnosed individual and the changes in behavior they see.  One of his primary methodologies, as described in his talk, consists of patient interviews.  Patients themselves or their loved ones will often report that this individual is “someone else” or that the person they once knew is “no longer there.”

Image courtesy to Shamir R, Noecker A and McIntyre C,
Wikimedia Commons
Can this, in fact, be the case?  Is there a “true self” that can be lost or found?  How do we act towards someone who appears to be a stranger to us?  What implications does this have for the treatment of these individuals?  For example, DBS has been widely used to treat cases of depression, obsessive compulsive disorder (OCD), and Parkinson’s Disease (PD).  However, there have been many reports of a “dislocated self” following treatment, even if symptoms were successfully treated (Baylis, 2013).  Is this an ethical practice if we think the treatment could pose a threat to someone’s identity?  On the other hand, there was an OCD case where DBS did not help resolve a patient’s compulsive tendencies, but they did report an overall happier disposition and wanted to continue treatment (S. Nyholm, personal communication, June 21, 2018).   Is it ethical to stop treatment because the disorder itself is not being remedied?  This can be a difficult concept to grasp not only for the individual themselves but their loved ones, their doctors, and their caregivers as well.

A question raised by an audience member at ICM introduced the idea of a coherent life narrative.  We generally see our lives as a somewhat linear progression, with a coherent thread of commonality running through our experiences, a true self.  However, we must also ask ourselves if this need for coherence is a reflection of our “true self” or a social construct (ICM, personal communication, June 20, 2018).  Dr. Dan P. McAdams, a psychology professor at Northwestern University, elaborates on this concept of coherence, asking “are good life stories always coherent?” (McAdams, 2006).  He further claims that “the problem of narrative coherence is the problem of being understood in a social context” (McAdams, 2006), that we impose on ourselves and on others the expectations of how an articulate story should look.  Woolf alludes to this social construct as well in her investigation of identity and self-concept, stating, “For now she need not think about anybody…All the being and the doing, expansive, glittering, vocal, evaporated; and one shrunk, with a sense of solemnity, to being oneself, a wedge-shaped core of darkness, something invisible to others” (Woolf, 1981, p. 62).

Bioethicist Françoise Baylis, Ph.D., discusses the implications of this idea in a treatment setting.  She asserts that there is no one, static concept of identity, that people are dynamic collection of all of their relationships over time, socially constructed and context-based (Baylis, 2013).  Therefore, their “story” or narrative is a reflection of the people in their life and can take on any shape or trajectory.  During the onset of her mother’s Alzheimer’s Disease, she reports caregivers often trying to comfort her by saying things like, “that’s not your mother anymore.”  However, Baylis argues that this implication of having lost someone when they are still “living amongst us” can have the opposite effect and be extremely hurtful (Postma, 2016).  Baylis addresses cases of DBS in PD as well that show profound improvement in motor control.  However, there have also been cases of mild to more extreme side effects, such as major depressive disorder or mania.  Baylis emphasizes that personal identity is a dynamic structure and perhaps the “threat” to this structure is misdirected at the treatment, that it actually results from differential treatment by the people in their life.  For example, we are often quick to accept what we view as positive changes, such as elevated mood or increased work ethic, as a natural enhancement to character.  However, we reject changes that are negative, such as increased aggression or impulsivity, as dissonant from someone’s personal identity.  Baylis (2013) states that personal identity is “at the intersection of who [someone] wants to be, and who others will minimally let [them] be”.  There are cases of other brain disorders, such as schizophrenia, where framing of the disorder by loved ones has significant effects on the capacities of the patient.  There are still limits to this nonrestrictive view on identity in that narratives must be ultimately rooted in reality and threats to agency and autonomy are a separate issue.  However, from her experience as a caregiver herself, she views it as our job to support these individuals that have undergone dramatic life experiences such as Alzheimer’s Disease or DBS, to “help them to belong” and “continue to recognize them” even when they cannot themselves (Postma, 2016).

Image courtesy to Adaiyaalam, Wikimedia Commons
Dr. Nyholm takes this conversation one step further. He asserts that, in these discussions about threats to personal identity and narrative coherence that DBS may pose, there is another concept that people hold on to that should be considered: the true self (Nyholm & O’Neill, 2016).  The question of narrative coherence is about continuity over time.  While a drastic turn may produce unfamiliar changes in personality, they are still the same person (Danaher, 2016).  This is similar to Baylis’ argument, who draws this line of distinction between personality and personal identity.  However, through cases of DBS and patient interviews, Nyholm has identified that there is this concept of a true or authentic self.  This perception is not about continuity over time, but is about values.  Nyholm states, “Often we see the best part of ourselves or other peoples as the thing that is representing the true self” (Danaher, 2016).  Therefore, in cases of doing something we regret or qualities of our self that we are not proud of, people are quick to dissociate these from themselves.  This is not a matter of taking responsibility for one’s actions, but a projection that “what we aspire to be is often the thing that we associate with our true selves” (Danaher, 2016).  Therefore, the true self can be likened to the pursuit of the best version of yourself.   DBS should be discussed in its potential to positively or negatively alter one’s concept of their true self.  If a patient undergoes DBS that successfully alleviates them of their obsessive-compulsive tendencies, they could see this as having a positive effect on their true self.  However, consider a case where a PD patient elects to receive DBS to alleviate his motor impairments, even though the treatment enters him into a manic state that require institutionalization (Danaher, 2016).  This begs the questions of how we can incorporate identity and well-being into a conversation about the risks and benefits of certain neurological treatments.

These discussions need to be addressed for DBS at large and in specific cases.  Both Baylis and Nyholm help to draw some distinction between DBS for PD, that primarily produces motor impairment, versus other brain disorders such as depression, that already pose a threat to concepts of identity and true self.  However, if we understand identity to be a dynamic structure and true self-actualization to be a laudable goal, should we be pursuing other applications of DBS outside of diagnosable brain disorders?
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Ashley Oldshue is a fourth-year undergraduate student studying Neuroscience and Behavioral Biology and Visual Arts.  A member Dr. Lena Ting’s Neuromechanics Lab and a recent Beckman Scholar, her research is primarily computational and focuses on modelling muscle-tendon dynamics for sensorimotor control.  She plans to continue this line of research throughout the next year and pursue graduate school in biomedical engineering. 


References


Baylis, F. (2013). “I Am Who I Am”: On the Perceived Threats to Personal Identity from Deep Brain Stimulation. Neuroethics, 6(3), 513-526. doi:10.1007/s12152-011-9137-1

Danaher, J. (2016, May 13). Episode #3 - Sven Nyholm on Love Enhancement, Deep Brain Stimulation and the Ethics of Self Driving Cars. Retrieved from http://philosophicaldisquisitions.blogspot.com/2016/05/episode-3-sven-nyholm-on-love.html

McAdams, D. P. (2006). The Problem of Narrative Coherence. Constructivist Psychology, 19(2), 109-125.

Nyholm, S., & O’Neill, E. (2016). Deep Brain Stimulation, Continuity over Time, and the True Self. Cambridge Quarterly of Healthcare Ethics, 25(04), 647-658. doi:10.1017/s0963180116000372

Postma, R. (2016, May 10). Françoise Baylis. Retrieved from https://www.youtube.com/watch?v=NYasXd6-9eI&feature=youtu.be

Sven Nyholm. (n.d.). Retrieved from https://www.tue.nl/en/research/researchers/sven-nyholm/

Woolf, V. (1981). To the Lighthouse. New York, NY: Houghton Mifflin Harcourt Publishing Company.


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Oldshue, A. (2018). Me, Myself, and my Social Constructs. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2018/11/me-myself-and-my-social-constructs.html

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