Me, Myself and My Brain Implant: Deep Brain Stimulation Raises Questions of Personal Authenticity and Alienation
Patient 1, a 38-year-old female journalist married with one child, had PD (caused by a mutation in the parkin gene) for 30 years […] with motor fluctuations and severe dyskinesias. Before stimulation, in spite of her motor handicap, she was dynamic: ‘Combating the disease gave meaning to my life. I hope that stimulation will allow me to get on with my life and my projects. ‘Six months after the operation, the patient was not satisfied in spite of a 75% improvement of her motor handicap and the withdrawal of her antiparkinson medication. She complained that the stimulator was not well programmed and she wanted to be able to adjust it herself at home. After 18 months of stimulation, she was no longer able to work, had a loss of inspiration and a taste for her work and for life in general. ‘Now I feel like a machine, I’ve lost my passion. I don’t recognize myself anymore. ‘Her family no longer interested her, she was easily exhausted, and had a loss of vitality (in the absence of a depressive syndrome), which led her to interrupt all professional activity. In short, a loss of vitality and a goal in life occurred despite major improvement of her motor symptoms by STN stimulation. ([]: 1812).\nA short analysis of this case reveals that four elements of felt-alienation and the loss of authenticity are at work in the patient’s experience:\nFirst, after successful treatment, the patient feels alienated from her work and indulges in leisure activities instead. This will be surprising to the reader given that she proclaimed that one of her main aims in undergoing the treatment was enhancing her ability to work. However, although her motor disability has improved remarkably, she nevertheless experiences her formerly much-beloved work as alienating after surgery.\nSecond, she experiences alienation from herself because she has lost a goal in life. It seems that this is the case because she no longer has anything to fight for and this has resulted in a loss of energy. She even goes so far as to say,‘I don’t recognize myself anymore’ – presumably because she used to be goal-oriented and energetic, but now has lost her drive, which she identified with. This corresponds with what Schüpbach et al. [] suggest:Fighting PD was a driving force for many patients that was frustrated in 12 (41%) after surgery […] causing disorientation. As expressed by another patient: ‘Before stimulation, I wanted to be like everybody else, I didn’t want to be considered only as sick. I fought for that every day! Now I find myself less impassioned, I regret the period where I did battle. Now it’s the warrior’s repose, I no longer have something to struggle against, my life is empty. I get up every day, but have no goal, no horizon.’ ([]: 1814).\nThird, the patient feels alienated because she feels heteronomous – ‘like a machine’, as she puts it. The case report does not give any details, but this may be due to the fact that a mechanical device is implanted in her brain. Phenomenologically speaking, it could be that the patient perceives the device as an alien technology that, as it were, remote-controls her feelings, behavior and thoughts (cf. []: 169 ff.). Another patient reports feeling ‘like an electronic doll’ ([]: 1815). As Schüpbach et al. put it: ‘The altered body image may result from difficulty in accepting psychologically the implanted material, as previously described in patients with pacemakers and implantable cardioverter defibrillators.’\nWhat is interesting here, however, is that the self-description of some patients of being remote-controlled by an electronic device runs contrary to the patients’ actual gain in autonomy, because their motor abilities usually improve remarkably under treatment. In a certain sense, patients become more autonomous after successful surgery because they have a better command of their body. But in another, Aristotelian sense, a feeling of heteronomy arises: if a person is not entirely ‘self-moved’, but is or feels moved by a force outside her control, she might feel heteronomous. In this case study, the feeling of heteronomy goes hand in hand with the patient feeling alienated from life.\nFourth, this case raises another key issue involving authenticity and alienation: the split between mind and body. The authors of the study even chose this phenomenon to be the report’s subtitle: ‘A distressed mind in a repaired body’. They reveal that some patients experience feelings of alienation from their improved health condition. As the authors also report about other patients, some of them do not yet dare to trust their bodies and are aware of the fact that their disease will come back at some point (‘negative anticipation’). ‘In spite of successful surgery, 8 patients (28%) felt mentally unable to resume a more normal life style. Although with STN stimulation they could, they did not dare to perform activities that had been impossible with PD before surgery. Past experience led to a negative anticipation that was objectively unjustified after surgery. ‘My body is cured, but my mind is still sick,’ said one patient ([]: 1814). This is exemplified by Patient 1: although she describes herself as physically healed, her psychological condition cannot catch up to this new bodily state. This results in a feeling of alienation because the patient experiences her body as being in a state different than the one of her mind.\nTo sum up these findings, this first case study shows a patient who, under treatment, has lost her felt-authenticity and eventually feels alienated from herself in several respects. After treatment, not only does her work-life seem alienating, but also she feels alienated from life-goals she identified with, as well as from her new, improved body (cf. []: 1814). In the following case study, however, the patient experiences an opposite result.