Aspiring to Autonomy: An Ethical Phenomenology of DBS for Depression Restricted; Files Only
Davis, Keenan (Fall 2023)
Abstract
Mainstream bioethics tends to treat the concept of “autonomy” as little more than the satisfaction of one’s current preferences, a relatively procedural and value-neutral approach. Numerous scholars have critiqued this approach as superficial and proposed instead a “relational” reconfiguration—one that attends to the myriad factors that shape and make possible an individual’s ability to choose. “Relational autonomy,” with its greater sensitivity to embodied and socially embedded context, is an important step in the right direction. However, proponents still typically frame the exercise of autonomy in terms of decision-theory, as the enactment of one’s preferences in a given moment. In reality, autonomy is a capacity that develops over time. Our desires change in response to the demands and affordances of concrete situations, often as we mature and grow. Nowhere is this clearer than in the experiences of patients overcoming treatment-resistant depression through the use of Deep Brain Stimulation (DBS). Bridging the medical and the metaphysical, this dissertation explores those changes to patients’ desires as they seek to recover from psychiatric illness and reestablish the autonomy that had been impaired by their depression. I juxtapose patients’ firsthand accounts with the thought of 20th-century philosophers Emmanuel Levinas and Iris Murdoch to analyze the ways in which autonomy is the cultivated capacity to escape ego-protective coping mechanisms in order to attune well to our shared reality and our responsibilities to others. This ethical phenomenology of recovery culminates with an account of “aspirational autonomy,” in which I argue that autonomy is only intelligible in an aspirational context as individuals orient themselves to the good in response to the normative demands of their relationships of obligation. As the DBS patients demonstrate, autonomy is given substance and direction by a prior heteronomy—by the ability to pay attention and respond to the needs of particular others.
Table of Contents
Chapter 1: Introduction – The Concept of Autonomy …………………………………...………………... 1
Perspectives on the Ethics of DBS ………………………………………………………......…………….. 5
Autonomy in Bioethics ………………………………………………………………………..……………... 12
Ethical Phenomenology …………………..………………………………………………….…………….... 18
Chapter 2: “Survival Mode” – Phenomenology and Methodology …………….…………..……...... 22
Predictive Processing and Psychiatric Illness…………………………………………...…………….. 25
Meaning Matters ………………………………………………………………………………….…………. 30
Phenomenology of “Survival Mode” ……………………………………………..…………….……..... 38
Testimonial Collection ……………………………………………………………………..………………. 42
Chapter 3: “The World Opened Up” – Senses and Sensibility ……………………………………...... 48
Levinas and Murdoch ………..…………………………………………………………………………….. 53
Senses… ……………………………………………………………………………………………………….. 59
Perceiving the World ………………………………………………..…………………………… 62
Freedom of Movement ……………..……………………………………………………………. 66
Emotional Range ……………………………………………………………………………..…… 71
…and Sensibility ………………………..……......................................................................... 76
Stimulating Sensibility ………………………..……………………………………………………………. 81
Chapter 4: “Desire to Connect” – Response and Responsibility ………………………..……........... 85
Response… ………………………..…………………………………………………………………………… 87
Conversation ………………………..……………………………………………………………… 88
Humor ………………………..………………………………………………………………………. 91
Ethical Impulse ………………………..…………………………………………………………… 94
Reciprocal Relationships ………………………..……………………………………………….. 98
Ethical Reflection ………………………..………………………………………………………… 102
Identity and Authenticity ………………………..……................................................. 107
…and Responsibility ………………………..……………………………………………………………….. 114
“A New Autonomy” ………………………..…………………………………………………………………. 123
Chapter 5: “Open Minded” – Attention and Attunement ……………………..………………..…….... 127
Attention ………………………..……………………………………………………………………………… 131
“Deepening of Concepts” ………………………………………………………………...……………..…. 141
“Depression” versus “Wellbeing” ………………………………….…………………..…….... 142
Acted Upon ………………………..………………………………………………………………... 145
Toward Complexity …………………………………………………………..……………..…….. 150
Narrative Efficacy ………………………………………………………………………………………..……. 165
Chapter 6: “Rough Patch” – Practices and Participation ……………………….……………..……...... 167
Unselfing ……………………………………………………………………………………………..……..…. 174
Nature ……………………………………………………………………………..……………..….. 175
Art …………………………………………………………………………………………………..…. 178
Meditation and Prayer ……………………………………………………………….……..……... 181
Interaction ……………………………………………………………………………..………..…… 185
Joint Autonomy …………………………………………………………………………………...………..…. 207
Chapter 7: Conclusion – Self-fulfilling Prophecies ……………………………………………..………...... 212
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