Pattern theory of self and situating moral aspects: the need to include authenticity, autonomy and responsibility in understanding the effects of deep brain stimulation

Abstract

The aims of this paper are to: (1) identify the best framework for comprehending multidimensional impact of deep brain stimulation (DBS) on the self; (2) identify weaknesses of this framework; (3) propose refinements to it; (4) in pursuing (3), show why and how this framework should be extended with additional moral aspects and demonstrate their interrelations; (5) define how moral aspects relate to the framework; (6) show the potential consequences of including moral aspects on evaluating DBS’s impact on patients’ selves. Regarding (1), I argue that the pattern theory of self (PTS) can be regarded as such a framework. In realizing (2) and (3), I indicate that most relevant issues concerning PTS that require resolutions are ontological issues, including the persistence question, the “specificity problem”, and finding lacking relevant aspects of the self. In realizing (4), I identify aspects of the self not included in PTS which are desperately needed to investigate the full range of potentially relevant DBS-induced changes—authenticity, autonomy, and responsibility, and conclude that how we define authenticity will have implications for our concept of autonomy, which in turn will determine how we think about responsibility. Concerning (5), I discuss a complex relation between moral aspects and PTS—on one hand, they serve as the lens through which a particular self-pattern can be evaluated; on the other, they are, themselves, products of dynamical interactions of various self-aspects. Finally, I discuss (6), demonstrating novel way of understanding the effects of DBS on patients’ selves.

Examination of self patterns: framing an alternative phenomenological interview for use in mental health research and clinical practice

“… 3 Several studies have indicated the viability of the PTS as a basis for understanding mental disorders ( Dings and de Bruin, 2016 ; Fingelkurts and Fingelkurts, 2017 ; Baird, 2019 ; Fingelkurts et al, 2020 , 2021 ; Neustadter et al, 2021 ; Ciaunica et al, 2022 : Dings and de Bruin, 2022 ; Zawadzki, 2022 ; Giommi et al, 2023 ), or more broadly for self-understanding ( Newen, 2018 ; Lindahl and Britton, 2019 ; Motta, 2023 ). …”

Mapping the Dimensions of Agency: The Narrative as Unifying Mechanism

“…However, what is missing in Schönau et al's analysis is the mechanism-the very linkby which these various dimensions can come together. As Zawadzki (2020) points out discussing his account of the self (PTS-moral aspects)-which also includes the agency dimensions indicated by Schönau et al (both authenticity, and responsibility, but also autonomy)-what is crucial in order to unify these various dimensions is narrative.…”