Ethical evaluation of deep brain stimulation as a treatment for Parkinson’s disease is complicated by results that can be described as involving changes in the patient’s identity. The risk of becoming another person following surgery is alarming for patients, caregivers and clinicians alike. It is one of the most urgent conceptual and ethical problems facing deep brain stimulation in Parkinson’s disease at this time. In our paper we take issue with this problem on two accounts. First, we elucidate what is (...) meant by “becoming another person” from a conceptual point of view. After critically discussing two broad approaches we concentrate on the notion of “individual identity” which centers on the idea of “core attitudes”. Subsequently we discuss several approaches to determine what distinguishes core attitudes from those that are more peripheral. We argue for a “foundational-function model” highlighting the importance of specific dependency relations between these attitudes. Our second aim is to comment on the possibility to empirically measure changes in individual identity and argue that many of the instruments now commonly used in selecting and monitoring DBS-patients are inappropriate for this purpose. Future research in this area is advised combining a conceptual and an empirical approach as a basis of sound ethical appraisal. (shrink)

Building upon an earlier critique of the Food and Drug Adminstration (FDA) granting of a humanitarian device exemption for deep brain stimulation in treatment-resistant obsessive compulsive disorder, this article considers how we regulate and finance DBS. It suggests that these devices are mosaic in nature: both potentially therapeutic and probative and that their dual roles need to be appreciated to maximize their therapeutic and investigational potential.

Self-knowledge is based on several different forms of information, so distinct that each one essentially establishes a different 'self. The ecological self is the self as directly perceived with respect to the immediate physical environment; the interpersonal self, also directly perceived, is established by species-specific signals of emotional rapport and communication; the extended self is based on memory and anticipation; the private self appears when we discover that our conscious experiences are exclusively our own; the conceptual self or 'self-concept' draws (...) its meaning from a network of socially-based assumptions and theories about human nature in general and ourselves in particular. Although these selves are rarely experienced as distinct (because they are held together by specific forms of stimulus information), they differ in their developmental histories, in the accuracy with which we can know them, in the pathologies to which they are subject, and generally in what they contribute to human experience. (shrink)

This first volume contains discussions of the brain, methods for analyzing behavior, thought, consciousness, attention, association, time, and memory.

Although philosophical approaches to the self are diverse, several of them are relevant to cognitive science. First, the notion of a 'minimal self', a self devoid of temporal extension, is clarified by distinguishing between a sense of agency and a sense of ownership for action. To the extent that these senses are subject to failure in pathologies like schizophrenia, a neuropsychological model of schizophrenia may help to clarify the nature of the minimal self and its neurological underpinnings. Second, there is (...) good evidence to suggest that although certain aspects of the minimal self are primitive and embodied, other aspects may be accessed only in reflective consciousness. Employing a modified concept of the minimal self, it may be possible to construct a robotic form of non-conscious self-reference that depends on an interaction between the robotic body and its environment. In contrast to the minimal self, the narrative self involves continuity over time and is directly relevant to discussions of memory and personal identity. There is growing consensus among philosophers and cognitive scientists about the importance of narrative and its relation to episodic memory and left-hemisphere functions. There are, however, at least two different views of how the narrative self is structured. On one model it is nothing more than an abstract point. On a more extended view, proposed here, the self is a rich amalgam of narratives that allows for the equivocations, contradictions, and self-deceptions of personal life. Even in this case, however, neurocognitive models contribute to our understanding of how narrative identity is structured. (shrink)

This paper suggests that certain traditional ways of analysing the self start off in situations that are abstract or detached from normal experience, and that the conclusions reached in such approaches are, as a result, inexact or mistaken. The paper raises the question of whether there are more contextualized forms of self- consciousness than those usually appealed to in philosophical or psychological analyses, and whether they can be the basis for a more adequate theoretical approach to the self. First, we (...) develop a distinction between abstract and contextualized actions and intentions by drawing on evidence from studies of rehabilitation after brain damage, and we introduce the notion of intentional attitude. Second, we discuss several interesting conclusions drawn from theoretically and experimentally abstract approaches. These conclusions raise some important issues about both the nature of the self and reflexive consciousness. At the same time they indicate the serious limita- tions concerning what we can claim about self and self-consciousness within such abstract frameworks. Such limitations motivate the question of whether it is possible to capture a sense of self that is more embedded in contextualized actions. Specifically, our concern is to focus on first-person approaches. We identify two forms of self-consciousness, eco- logical self-awareness and embedded reflection, that (1) function within the kinds of contextualized activity we have indicated, and (2) can be the basis for a theoretical account of the self. Both forms of self-consciousness are closely tied to action and promise to provide a less abstract basis for developing a theoretical approach to the self. (shrink)

Little, Brown, 1992 Review by Glenn Branch on Jul 5th 1999 Volume: 3, Number: 27.

Deep brain stimulation is a well-accepted treatment for movement disorders and is currently explored as a treatment option for various neurological and psychiatric disorders. Several case studies suggest that DBS may, in some patients, influence mental states critical to personality to such an extent that it affects an individual’s personal identity, i.e. the experience of psychological continuity, of persisting through time as the same person. Without questioning the usefulness of DBS as a treatment option for various serious and treatment refractory (...) conditions, the potential of disruptions of psychological continuity raises a number of ethical and legal questions. An important question is that of legal responsibility if DBS induced changes in a patient’s personality result in damage caused by undesirable or even deviant behavior. Disruptions in psychological continuity can in some cases also have an effect on an individual’s mental competence. This capacity is necessary in order to obtain informed consent to start, continue or stop treatment, and it is therefore not only important from an ethical point of view but also has legal consequences. Taking the existing literature and the Dutch legal system as a starting point, the present paper discusses the implications of DBS induced disruptions in psychological continuity for a patient’s responsibility for action and competence of decision and raises a number of questions that need further research. (shrink)

Response to commentaries on keynote article.

In this article, I will draw on my own work and related publications to present some intuitions and hypotheses about the nature of the self and the mechanisms that lead to the development of consciousness or self awareness in human infants during the first 6 months of life. My main purpose is to show that the origins of a concept of self include the physical and the mental selves. I believe that it is essential when trying to understand what a (...) mental state is, that one identifies the social and physical aspects of the person to whom the mental state belongs. How can one identify a mental state or thought without making reference to a subject who experiences it (Hobson, 1990)? The other important feature of the self is that it is distinguished from other people and inanimate objects. ‘One's concept of self is a concept of a person; one's concept of persons cannot be a concept applicable only to a single individual (oneself), for the reason that in this case it would no longer constitute a concept'(Hobson, 1990, p. 165). I would like to argue that infants must be able to represent their physical and social selves in order to recognize that they are similar and different from other people, and to develop expectations and predictions about the behaviour of others (theory of mind). Unlike Strawson, I do not believe that the social and physical aspects of the self are, or become redundant to the nature of the self. I posit that the mature conscious self is a unique mythical and constantly changing entity, the formation of which is created not by the individual alone, but through continuous dialectical inquiry with other people. (shrink)

Deep brain stimulation (DBS) has in some cases been associated with significant psychological effects and/or personality change. These effects occur sometimes as acute changes experienced intraoperatively or during the initial setting of the stimulator and sometimes as longer term progressive changes in the months following surgery. Sometimes they are the intended outcome of treatment, and in other cases they are an unintended side-effect. In all of these circumstances some patients and caregivers have described the psychological effects of DBS as frightening (...) or disconcerting. I trace the source of these negative reactions to the fear that stimulation-related psychological and personality changes represent a threat to personal identity and agency. This issue has implications both for philosophical theories of personal identity and agency and for clinical concerns. A narrative account of personal identity is developed to illuminate the nature of the threat to identity and agency DBS potentially poses, and to suggest steps that might be taken to mitigate and avoid these threats. (shrink)

Brain implants, such as Deep Brain Stimulation (DBS), which are designed to improve motor, mood and behavioural pathology, present unique challenges to our understanding of identity, agency and free will. This is because these devices can have visible effects on persons' physical and psychological properties yet are essentially undetectable when operating correctly. They can supplement and compensate for one's inherent abilities and faculties when they are compromised by neuropsychiatric disorders. Further, unlike talk therapy or pharmacological treatments, patients need not ‘do’ (...) anything for the treatment to take effect. If one accepts, as we argue here, that brain implants are unique among implantable types of devices, then this can have significant implications for what it means to persist as the same person and be the source of one's thoughts and actions. By examining two of the most common indications for DBS in current use, namely in the motor (Parkinson's Disease) and psychiatric (Major Depression) domains, we further argue that although DBS, as it is currently applied, does not necessarily represent a unique threat to personal identity and agency per se, it introduces an unprecedented ‘third party’ into the debate on these concepts. In this way, DBS can be used as a tool to begin probing, both conceptually and empirically, some of philosophy's most perennial metaphysical questions. (shrink)

Response to commentaries on keynote article.

Galen Strawson considers the self to be best described as a cognitive, `distinctively mental' phenomenon. He asserts that the mental sense of self comes to every normal human being in childhood and comprises the sense of being a mental presence, of being alone in one's head, with the body `just a vehicle or vessel for the mental thing that is what one really or most essentially is' . His thesis is determinedly cognitivist and it is with this that I take (...) issue. As Reed puts the problem, `cognitivism, with its allegiance to the representational theory of mind and its focus on mental states as internal to the mind, is particularly susceptible to the dualistic separation of self from the environment' . One may add that cognitivism is also susceptible to separating the self from the body. Reed suggests that perception not only provides information for the distinction between self and environment from the outset, but also it provides a means of keeping in contact with the world. Memory provides a means of bridging earlier and later aspects of self and integrating diverse elements of experience. Both perceiving and remembering entail aspects of self but in rather different ways. Perceiving is a spatio-temporal process which provides a continuous flow of information about the embodied self in its encounters with the physical and social world. Autobiographical memory requires a duplication of the self so that `me-experiencing-now' can be related with `a prior me-experiencing-a-prior-environment'. The question of interest is how a perceived self may, through development, give rise to a remembered self. (shrink)

This paper follows a Deweyan suggestion and proposes a structure for emotional activity – pattern of sentiment –as a way to grasp emotional experience in its live occurrence by building upon Dewey’s crucial notion of situation. The first part outlines Dewey’s criticisms of James’s idea of emotion, and verifies the ways in which the recent developments of neuroscience overcome Dewey’s criticisms of James. Given that Dewey’s work is a propitious ground for continuing to renew the discourse about the activities of (...) mind (Mendonça 2003), the second part of the paper outlines a pattern for emotional activity, setting up the first steps for a situational approach of Deweyan inspiration to the nature of emotion. I conclude by pointing out how such a pattern may be a unifying tool for the different emotion theories briefly describing some of the rich directions it provides for future research on philosophy of emotion. (shrink)

This paper suggests that certain traditional ways of analysing the self start off in situations that are abstract or detached from normal experience, and that the conclusions reached in such approaches are, as a result, inexact or mistaken. The paper raises the question of whether there are more contextualized forms of self-consciousness than those usually appealed to in philosophical or psychological analyses, and whether they can be the basis for a more adequate theoretical approach to the self. First, we develop (...) a distinction between abstract and contextualized actions and intentions by drawing on evidence from studies of rehabilitation after brain damage, and we introduce the notion of intentional attitude. Second, we discuss several interesting conclusions drawn from theoretically and experimentally abstract approaches. These conclusions raise some important issues about both the nature of the self and reflexive consciousness. At the same time they indicate the serious limitations concerning what we can claim about self and self-consciousness within such abstract frameworks. Such limitations motivate the question of whether it is possible to capture a sense of self that is more embedded in contextualized actions. Specifically, our concern is to focus on first-person approaches. We identify two forms of self-consciousness, ecological self-awareness and embedded reflection, that function within the kinds of contextualized activity we have indicated, and can be the basis for a theoretical account of the self. Both forms of self-consciousness are closely tied to action and promise to provide a less abstract basis for developing a theoretical approach to the self. (shrink)

For most people a sense of self includes an embodied component: when describing our selves we describe those aspects of our physical bodies which can be easily codified: height, hair colour, sex, eye colour. Even when we consider ourselves we tend not to consider our intellectual cognitive characteristics but our describable anatomy. Wittgenstein's dictum, ‘the human body is the best picture of the human soul’, is relevant here but I would like to go further: the body-part we feel most embodied (...) in is our face, even though it is difficult to describe and so forms little part of how we describe ourselves to others. (shrink)

In this article, I explore select case studies of Parkinson patients treated with deep brain stimulation in light of the notions of alienation and authenticity. While the literature on DBS has so far neglected the issues of authenticity and alienation, I argue that interpreting these cases in terms of these concepts raises new issues for not only the philosophical discussion of neuro-ethics of DBS, but also for the psychological and medical approach to patients under DBS. In particular, I suggest that (...) the experience of alienation and authenticity varies from patient to patient with DBS. For some, alienation can be brought about by neurointerventions because patients no longer feel like themselves. But, on the other hand, it seems alienation can also be cured by DBS as other patients experience their state of mind as authentic under treatment and retrospectively regard their former lives without stimulation as alienated. I argue that we must do further research on the relevance of authenticity and alienation to patients treated with DBS in order to gain a deeper philosophical understanding, and to develop the best evaluative criterion for the behavior of DBS patients. (shrink)

Deep-brain stimulation has been used to treat advanced Parkinson disease and other neurological and psychiatric disorders that have not responded to other treatments. While deep-brain stimulation can modulate overactive or underactive regions of the brain and thereby improve motor function, it can also cause changes in a patient’s thought and personality. This paper discusses the trade-offs between the physiological benefit of this technique and the potential psychological harm.

‘Phenomenology and Agency,’ an invited response to Galen Strawson's article on ‘The Self,’ shows how Strawson's putative phenomenological approach to the problem of the self fails to qualify as phenomenology and in turn fails to undergird his metaphysics of the self. It shows further how an item on his own list of fundamental experiences or conceptions of the self languishes for want of attention: Strawson virtually ignores ‘agency.’ The phenomenological procedure of bracketing, the concept of the non-alien that Husserl presents (...) in his Fifth Cartesian Meditation, and developmental accounts of the self are discussed. Conclusions and implications are specified, including the dual implication that a metaphyiscs offered in advance of a bona fide epistemology is imprudent and that a recognition of the metaphysical corollary of materialism--animism, in the sense of being imbued with life, animated--is required for a veridical concept of ‘the self.’. (shrink)

This article explores the notion of the dislocated self following deep brain stimulation (DBS) and concludes that when personal identity is understood in dynamic, narrative, and relational terms, the claim that DBS is a threat to personal identity is deeply problematic. While DBS may result in profound changes in behaviour, mood and cognition (characteristics closely linked to personality), it is not helpful to characterize DBS as threatening to personal identity insofar as this claim is either false, misdirected or trivially true. (...) The claim is false insofar as it misunderstands the dynamic nature of identity formation. The claim is misdirected at DBS insofar as the real threat to personal identity is the discriminatory attitudes of others towards persons with motor and other disabilities. The claim is trivially true insofar as any dramatic event or experience integrated into one’s identity-constituting narrative could then potentially be described as threatening. From the perspective of relational personal identity, when DBS dramatically disrupts the narrative flow, this disruption is best examined through the lens of agency. For illustrative purposes, the focus is on DBS for the treatment of Parkinson’s disease. (shrink)

Galen Strawson accepts that the common experience of being a social self is of something that continues through time. However, he excludes this from what ‘the self’ means in a stricter ontological sense. Here I will argue that this experience of self as enduring can be taken to be ontologically real as well. I will suggest that selfhood arises from the assimilation of cultural signs by a semiotic process that is a fundamental aspect of nature. I will also consider how (...) the phenomenological encounter with ‘the self’ is conditioned by prior beliefs and their ethical entailments. (shrink)