The phenomenological effects of deep brain stimulation (DBS) on the self of the patient remains poorly understood and under described in the literature, despite growing evidence that a significant number of patients experience postoperative neuropsychiatric changes. To address this lack of phenomenological evidence, we conducted in-depth, semistructured interviews with 17 patients with Parkinson's disease who had undergone DBS. Exploring the subjective character specific to patients' experience of being implanted gives empirical and conceptual understanding of the potential phenomenon of DBS-induced self-estrangement. (...) Our study concluded that (1) the more patients preoperatively felt alienated by their illness, the more they experienced postoperative self-estrangement, and (2) the notion of self-estrangement seems to exist in association with certain common qualitative characters, namely, loss of control, which reflects a deteriorative estrangement, and distorted perception of capacities, which reveals a restorative estrangement. These findings indicate that subjective self-reports help us to understand some aspects of the potential phenomenon of DBS-induced self-estrangement. (shrink)

Recently, brain imaging has provided controversial evidence of persisting awareness in some people whose brains are so severely injured that consciousness is minimal or absent, but in whom prolongation of life depends on the provision of continuing medical care. The clinicians understanding of the persistent vegetative state is briefly outlined and the evidence provided by brain imaging of awareness in this condition is reviewed. Information regarding consciousness in progressive acquired dementias are considered in the context of management of these conditions. (...) This leads to the conclusion that quality of consciousness was more important than its presence or absence in managing people with impaired consciousness. (shrink)

A brief poll of my scientific colleagues confirmed that, to a person, they regard addiction as a disease, whereas most non-science acquaintances consider it to be a failure of willpower. Reconciliation of these polarized views seems difficult and rather than finding a middle path, such as suggested by Foddy and Savulescu. I am an entrenched supporter of the view that addiction can be a disease. I first should declare my position as a card-carrying biologist, holding the view that behavior emanates (...) from the brain and, accordingly, that behavior and emotions result from brain function. This brain function also produces addiction and related behaviors, whereas Foddy and Savulescu seem to credit humans with a greater capacity to choose than biological evidence suggests. The second problem relates to definitions of disease: I argue that there are at least three ways addiction might be considered a disease. 1.? ? ? Addiction is a disease because it results in pathology. For example, hypertension is a disease. Hypertension per se does not cause dysfunction, but leads to pathologically definable conditions such as stroke and myocardial infarction. Smoking, like hypertension, can result in pathologies such as emphysema and cancer. The problem is not smoking per se, or even addiction to nicotine, rather it is the consequent diseases caused by tobacco. Nevertheless, if hypertension is a disease, so is smoking. The question of “choosing‘ to persist with smoking has no bearing on whether it is disease. Whether a person chooses to care for their hypertension or ignore it does not alter the fact that they have hypertension; it is still a disease and it will still harm them. Whether addiction affects the capacity to choose is not relevant because it does not alter the fact that smoking causes pathology and hence is a disease. 2.? ? ? Foddy and Savulescu argue that addiction leaves no tell-tale pathology to set it aside from. (shrink)