Abstract
The article proposes a theoretical model to account for changes in self due to Deep Brain Stimulation (DBS). First, we argue that most existing models postulate a very narrow conception of self, and thus fail to capture the full range of potentially relevant DBS-induced changes. Second, building on previous work by Shaun Gallagher, we propose a modified ‘pattern-theory of self’, which provides a richer picture of the possible consequences of DBS treatment.
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Notes
Notice that our aim here is to provide an accurate picture of the effects of DBS on the patients’ self. We do not wish to make normative claims about whether these effects are beneficial to the patient’ or not. Furthermore, an important question is whether the changes reported by these patients are indeed direct (causal) effects of the DBS treatment. For example, it is possible that patients’ self-perception has changed because their condition has radically improved. Answering this question is not critical to the project of this paper, however, since we simply want to explain the effects of DBS treatment on the patient’s self (irrespective of whether they are direct or indirect).
For example, the aspect of agency is present in multiple accounts (Lipsman and Glannon 2013; Baylis 2011; De Haan et al. 2013 and perhaps also Synofzik and Schlaepfer 2008). However, it remains unclear how agency is defined and/or understood, and how it is related to the other aspects proposed by these accounts: Baylis’ notion of agency seems relevant in as far as it allows people to create their own narratives, De Haan et al. (2013) use agency to explain how people act on their environment, and Lipsman and Glannon (2013) discuss agency in connection with the sense of free will.
We thank an anonymous reviewer for pointing this out.
See Strawson (1999) for an attempt to describe the wide variety of self-concepts: “[T]he cognitive self, the conceptual self, the contextualized self, the core self, the dialogic self, the ecological self, the embodied self, the emergent self, the empirical self, the existential self, the extended self, the fictional self, the full-grown self, the interpersonal self, the material self, the narrative self, the philosophical self, the physical self, the private self, the representational self, the rock bottom essential self, the semiotic self, the social self, the transparent self, and the verbal self (cf. e.g., James 1890; Stern 1985; Dennett 1991; Gibson 1993; Neisser 1994; Cole 1997; Butterworth 1998; Gazzaniga 1998; Legerstee 1999; Gallagher and Marcel 1999; Pickering 1999; Sheets-Johnstone 1999).”
As Gallagher (2013) remarks, it is not clear that we have to choose between these concepts. Many of them were developed in the plural. James (1890), for example, distinguished between the physical self, the social self, and the private self. Neisser (1988) discussed five types of self-knowledge corresponding to the ecological self, the interpersonal self, the conceptual self, the extended self, and the private self. Despite the terminology suggesting a plurality of selves, however, Neisser (1991) carefully refers to them as aspects of self – e.g., the ecological aspect of self.
And when they do argue against other views, their arguments are (for the most part) not very convincing. For instance, Schechtman (2010) argues that, when it comes to explaining the effects of DBS treatment, focusing on the psychological aspect is not “the most helpful way to think about identity in the cases we have discussed, and gives very little guidance as to how threats to identity can be avoided” (p. 136) This, however, is not really an argument. Also, Schechtman remains silent on other aspects such as embodiment, agency or affect.
Gallagher himself is inspired by pattern theories of emotion (Izard 1972; Izard et al. 2000; Mendoça 2012; Newen and Welpinghus forthcoming), which take “emotion” as a cluster concept that includes a sufficient number of characteristic features.
Although we think that Gallagher’s list makes a lot of sense, here we use it for illustrative purposes only, simply because we do not have the time to discuss and defend all the aspects on the list. Notice, however, that our proposal does not depend on whether Gallagher’s list is in fact correct. Our aim in this paper is to develop a pattern theory of the self, and to explain how this theory can be applied at the level of pattern types and pattern tokens. We leave open the question which aspects should ultimately be part of these patterns.
The DSM-V lists two additional criteria: C. The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance, and D. The disturbance is not better explained by the symptoms of another mental disorder. We do not mention them in the text, however, because they are not positive indicators of OCD.
Importantly, in this last case, the continuity of the self may be explained in terms of a second-order pattern, which consists of at least two first-order patterns or ‘sub-selves’ - an ‘academic’ pattern (within a university context, the self acts/thinks/feels like this), and a ‘private’ pattern (within a domestic context, the self acts/thinks/feels like that).
Of course these two options do not exclude each other. In fact, one could argue that, from a methodological point of view, it would be best to start with a simple pattern of aspects and then slowly increase the number of aspects and contextual factors taken into consideration.
See, for example, the account of OCD put forward by De Haan et al. (2013).
Notice that these newly established aspects do not necessarily have to be listed in the DSM-V (see, e.g., De Haan et al. 2013), which increases the personalized nature of the therapy.
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Dings, R., de Bruin, L. Situating the self: understanding the effects of deep brain stimulation. Phenom Cogn Sci 15, 151–165 (2016). https://doi.org/10.1007/s11097-015-9421-3
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DOI: https://doi.org/10.1007/s11097-015-9421-3