Stimulating More Than the Patient's Brain: Deep Brain Stimulation From a Systems Perspective

Epistemological assumptions, both conscious and unconscious, impact people’s understanding of themselves and others. More specifically, beliefs about the relationship between brain and mind and how they relate to one’s personality and psychological well-being might influence the reaction to neurological or neurosurgical interventions. Mecacci and Haselager’s (2014) argument on how various conceptual frameworks on the mind–brain relationship could influence psychosocial maladaptations around treatment with deep brain stimulation (DBS) offers a valuable perspective. The authors argue how an embodied embedded framework could help to prevent or overcome maladaptations: “Unburdening the brain of its central and monopolizing role could contribute to mitigation of psychological maladaptations and improve the quality of the whole therapeutic approach” (31). Thinking in a dualistic framework, even though it can be reassuring, may no longer be tenable once confronted with DBS and the clinical explanations offered. On the other hand, neurocentric materialism as a prevalent alternative view may jeopardize patients’ psychological well-being by disturbingly positing DBS’s power over the entire person. A third, holistic viewpoint, which is neither dualistic nor braincentric, promises to allow improved psychological outcome and further suggests a more intuitive conceptualization of the mind– brain-world relationship including context and technological elements, such as DBS, in particular. We suggest systems theory to offer such a holistic view that can likely be elaborated and communicated to beneficially influence the therapeutic process. Applying this theory, Gregory Bateson already argued that a patient’s change toward a more correct epistemology about his mind and its relation to the rest of the world, including other persons, may be a step towards greater well-being (Bateson 2000). To Bateson, characteristics of mind are attributable to self-regulating loops where parts transform and transmit information. Segments of such loops can be, and in fact often are, located outside the organism. Importantly, no part within such a system has unilateral control over the others or over the whole. With this systemic understanding, a person is made up of numerous loops, ranging from the physiological to the societal level. As DBS treatment has profound physiological effects, it is commonly understood as being effective only via physiological loops. However, those physiological loops are not the whole story. As all loops are mutually interconnected, there is constant “spillover” between the physiological ones and those on higher levels, which are making up a person. In particular, the conceptual frameworks held by the patient and his surrounding may well additionally influence his psychological well-being by virtue of “social loops,” thus also affecting the treatment. According to Bateson’s holistic approach, a patient undergoing DBS treatment should seek to develop a “complementary premise” between himself and the device precisely because the device, once implanted, constitutes a part of himself. In contrast, a neurocentric stance might posit “DBS versus the self,” falsely implying that one part is capable of controlling the other. According to a systems view this would constitute an epistemological error, as one part cannot exert unilateral control over the whole, nor vice versa. Consequently, neither the brain alone, nor parts of the brain in isolation, nor DBS, can control a person in his or