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• The Janus-faced character of DBS - A Reply to Walter Glannon
  Uta Bittner
  Published on: 8 June 2009

• Published on: 8 June 2009

  The Janus-faced character of DBS - A Reply to Walter Glannon

  • Uta Bittner, Postgraduate; Ph.D. student
  • Other Contributors:
    • Henriette Krug

  In J Med Ethics 2009 (35) Walter Glannon [i] claims that deep brain stimulation (DBS) improves symptoms of some conditions, but could also have impact on thought, personality, and behaviour. His argument – although rich and in detail – misses three important points:

  (1) Why should the disruption of thematic unity of one`s life story always be a harm? Glannon appeals to our intuitions when he claims that cohere...

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  In J Med Ethics 2009 (35) Walter Glannon [i] claims that deep brain stimulation (DBS) improves symptoms of some conditions, but could also have impact on thought, personality, and behaviour. His argument – although rich and in detail – misses three important points:

  (1) Why should the disruption of thematic unity of one`s life story always be a harm? Glannon appeals to our intuitions when he claims that coherence is one of our aims. But intuitions must not be true. A life can be worth living and happy, though not being coherent throughout lifetime. Thus, a more detailed examination of the phenomenon of coherence as an universal aim would be helpful.

  (2) Glannon examines the question of “how much alteration of one`s thought and personality in treating a neurological or psychiatric disorder with DBS would be consistent with a patient`s rational choice to undergo the procedure”[ii]. The answer should include two aspects: first, one needs to compare personality alterations induced through DBS with alterations caused by other influences (education, pharmaceuticals, etc.). Second, one needs to give criteria in order to define the point when an alteration is no longer a change in degree but in quality, e.g., a total change of personality. While doing this, one must be aware of not entering the well-known “sorites-problem” (“heap-paradox”).

  (3) DBS can be switched on and off immediately. But it is not, as Glannon claims, just a kind of “trade-off […] between acceptable quality of life regarding motor control and alteration of the mind.” (Glannon, p. 289) It might be much more: both states are connected with a specific self -awareness and self-description as well as with a subjective experience of one`s own. We therefore need to understand how it feels [iii] for the patient to be under DBS treatment. Additional research approaches, e.g. biographical patient stories as well as feedback from the patient`s social environment (e.g. spouse) may help to explain the Janus-faced character of DBS.[iv]

  REFERENCES: [i] Glannon, W Stimulating brains, altering minds, J Med Ethics 2009: 35; 289-292. [ii] Glannon, p. 289 [iii] For the subjective character of experience see Nagel T. (1974) What Is It Like to Be a Bat? Philos Rev, 83 (4):435-450. [iv] Following Glannon`s model case, being free to move but manic may be considered a comfortable state for the patient but a problem for his spouse, who postoperatively does not find the person restored he has loved previously.

  Authors of the eLetter are: Uta Bittner & Henriette Krug

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  Conflict of Interest:
  None declared.

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