Side effects or symptoms? The feeling of self-estrangement in DBS patients

Some patients reportedly experience serious side-effects from Deep Brain Stimulation including feelings of inauthenticity, alienation and self-estrangement (Kraemer 2011; Müller, Bittner, Krug 2010; Gilbert 2013). Mecacci and Haselager suggest these adverse reactions are due to socio-cultural conceptual frameworks which lead patients to hold the ultramaterialistic perspective that the Self is constituted by the brain only. These authors contend that DBS implants are just prostheses differing from other devices that restore or increase bodily functions only in degree, not in kind. They suggest that if patients were able to conceptualize neurostimulators as prostheses, they would adapt to them without adverse psychological side-effects but this would require a cultural conceptual shift and better doctor-patient communication. We suggest that this conclusion is problematic. On the one hand, we argue that neurological devices are not like other body prostheses because they alter patients’ subjective experience, influencing their sense of agency and body ownership. On the other hand, we argue that the reported feelings of inauthenticity, alienation, and self-estrangement can lead to dysfunctional and potentially pathogenic thoughts that might result in clinical outcomes such as depersonalization and derealization (Sierra 2009) or trigger depressive syndromes that can lead to suicide (Gilbert 2013; Appleby, Duggan, Regenberg, Rabins 2007). We agree with the authors that a change in patients’ self-conceptualization is needed to prevent these symptoms from becoming pathogenic. However, we think this can be achieved only if patients receive psychotherapeutic support as soon as such symptoms occur.