Me, Myself and My Brain Implant: Deep Brain Stimulation Raises Questions of Personal Authenticity and Alienation
‘Patient 2, a 48-year-old male accountant, worked half-time for 7 years because of PD […]. Before the operation, his wife assisted him in all tasks of daily living, assumed all domestic and financial responsibilities, spent hours with him, and helped him to conceal his disease from his entourage. After 18 months of stimulation, his motor condition was much improved […]. The patient regained confidence in himself and aspired to more autonomy: ‘I want to recover my social standing and establish new relationships outside my couple. During all these years of illness, I was asleep. Now I am stimulated, stimulated to lead a different life.’ Confronted with the radical change in her husband’s behavior, his wife became depressed: ‘Ever since the operation, I feel lost. Before, when he was sick, we were a perfect couple. Now, he wants to live the life of a young man, go out, meet new people, all of that is intolerable! I would rather he be like he was before, always nice and docile!’ The patient persisted in his desire for change: ‘All these years I allowed myself to be carried like a child, because I didn’t have the means to fight. That period is over, I want to get back the position I left open. I am going to take my life in hand, my life before PD.’ In short, a grave marital conflict was caused by the newly regained autonomy of the patient and his wife’s loss of status as caregiver. ([]: 1812)\nThis story differs considerably from the first one. This patient says that under treatment he now feels like himself, whereas before he felt alienated, i.e. not himself. In this case, what is gained from the treatment is authenticity, qua implicit self-ascription at least. The patient claims that in all the years of illness he was ‘asleep’. This can be interpreted as him saying that he was not aware of himself, i.e. not in a self-conscious mode and, therefore, in this sense not really ‘himself’. From a philosophical point of view, this could mean that he did not possess any self-reflective capacities and could not lead his life autonomously.\nAs he puts it after successful surgery: ‘I want to regain my life, my life before PD’. In stating this, he refers to the life before his illness that was really his, his real life, he being conscious of himself and ‘master of his own destiny’, as one could say. During the years of illness, however, according to his own retrospective assessment, he feels he was not himself, i.e. inauthentic, alienated, and not fully conscious. His life was not really his own, existing as someone else’s heteronomous object of care. This is at least how he describes his time of illness in hindsight.\nWith respect to authenticity and alienation, at least three points about his case are important.\nFirst, the patient’s self-ascription of authenticity is interesting. It seems that, after surgery, the patient distinguishes two modi in his life. On the one hand, there is ‘mode one’, the mode he experienced when he was healthy before Parkinson’s disease struck him. This mode he experiences retrospectively as his ‘authentic mode’. On the other hand, there is ‘mode two’, the mode he experienced when he became sick. He says in hindsight that this mode is one in which he was not authentic, but ‘asleep’ and thus alienated. Finally, once he is successfully treated via DBS and switches back to ‘mode one’, he begins to feel authentic again.\nThe second remarkable point is that this contradicts what Patient 1 had reported. Adapting the model from above, she experienced ‘mode two’, i.e. the mode of being diseased, as her most authentic mode. When she was sick, she had something to strive for: to overcome her disease and to lead a meaningful life despite her handicaps. The daily struggle gave her life meaning. When she returns to ‘mode one’ as the mode of health, however, she describes herself as feeling alienated, because she has lost her goal in life. It seems she no longer experiences herself as authentic once she is healthy.\nOn a theoretical level, this points towards the fact that the ascriptions of authenticity and alienation depend on subjective factors. It seems there is no general, trans-individually valid correlation between being healthy and feeling authentic, and being sick and feeling alienated. On the one hand, an existentialist or phenomenological notion of authenticity, which emphasizes mortality, fits for Patient 1: a person is ‘authentic’ (eigentlich) only when she is confronted with her vulnerability and thereby her mortality through her disease (cf. []: 152) and struggles for survival. On the other hand, however, the opposite holds for Patient 2: he defines himself essentially as a healthy person and does not accept the diseased person he used to be as himself. Furthermore, the fact that there is no unifying account of the subjective experience of DBS has implications with respect to how we understand DBS treatment. Whereas the treatment for one person can be authenticity-generating, for another, it has an alienating effect.\nThird, it is worth noting that Patient 2 correlates authenticity, i.e. living his own life, with autonomy. For Patient 2, in order to be himself, he must be autonomous like an adult person, not dependent and heteronomous like a child. He wants to return to the autonomous social- and work-life he led before the disease – and the treatment makes this possible.\nThis, of course, stands in sharp contrast to the second- and third-person perspective of his wife. According to her, her husband is alienated from himself in ‘mode two’, the healthy state. She complains he wants to ‘live the life of a young man’, i.e. a life that is not only inappropriate to him in her eyes, but actually is the life of someone else and not his. Additionally, now that she as the caregiver is no longer needed and wanted, she has lost all meaning in her life. She wants to get divorced, because she feels alienated from her relationship with a person who she no longer views as her husband.\nThe third case presented by Schüpbach et al. [] reveals yet another feature of authenticity and alienation.