Staying in the Loop: Relational Agency and Identity in Next-Generation DBS for Psychiatry

Abstract

In this article, we explore how deep brain stimulation (DBS) devices designed to “close the loop”—to automatically adjust stimulation levels based on computational algorithms—may risk taking the individual agent “out of the loop” of control in areas where (at least apparent) conscious control is a hallmark of our agency. This is of particular concern in the area of psychiatric disorders, where closed-loop DBS is attracting increasing attention as a therapy. Using a relational model of identity and agency, we consider whether DBS designed for psychiatric regulation may require special attention to agency. To do this, we draw on philosophical work on relational identity and agency, connecting it with reports from people using first-generation DBS devices for depression and obsessive-compulsive disorder. We suggest a way to extend a notion of relational agency to encompass neural devices.

Keywords:

• brain–computer interfaces
• deep brain stimulation
• depression
• mental health
• neuromodulation
• personal identity

FUNDING

This study was supported by a grant from the National Science Foundation. ▪

Notes

1. This raises a further question about whether feelings of alienation due to the experience of uncertain agency are harmful. Elsewhere, Kraemer argues that feelings of alienation are harmful because they signal inauthenticity (Kraemer 2011). Gilbert (2015a; 2015b), on the other hand, locates the harm of alienation in the felt powerlessness that can accompany a lost (or threatened) sense of agency. We owe this helpful point to a reviewer.

2. One worry to consider here is that our relationships with other people may change, given the presence of a neural prosthetic device. For instance, some participants in Klein and colleagues' (2016) focus group noted that having the implant affected how their family members perceived them and their concerns: “I think there's this expectation which I find with my family, that, if you're not feeling well, ‘go flip a switch and you'll be better’ or ‘Go get your settings adjusted!’ That's [my family's] answer to everything!”