Sanneke de Haan

Effects of Deep Brain Stimulation on the Lived Experience of Obsessive-Compulsive Disorder Patients : In-Depth Interviews with 18 Patients

Deep Brain Stimulation (DBS) is a relatively new, experimental treatment for patients suffering from treatment-refractory Obsessive Compulsive Disorder (OCD). The effects of treatment are typically assessed with psychopathological scales that measure the amount of symptoms. However, clinical experience indicates that the effects of DBS are not limited to symptoms only: patients for instance report changes in perception, feeling stronger and more confident, and doing things unreflectively. Our aim is to get a better overview of the whole variety of changes that OCD patients experience during DBS treatment. For that purpose we conducted in-depth, semi-structured interviews with 18 OCD patients. In this paper, we present the results from this qualitative study. We list the changes grouped in four domains: with regard to (a) person, (b) (social) world, (c) characteristics of person-world interactions, and (d) existential stance. We subsequently provide an interpretation of these results. In particular, we suggest that many of these changes can be seen as different expressions of the same process; namely that the experience of anxiety and tension gives way to an increased basic trust and increased reliance on one’s abilities. We then discuss the clinical implications of our findings, especially with regard to properly informing patients of what they can expect from treatment, the usefulness of including CBT in treatment, and the limitations of current measures of treatment success. We end by making several concrete suggestions for further research.

Social affordances in context: what is it that we are bodily responsive to?

We propose to understand social affordances in the broader context of responsiveness to a field of relevant affordances in general. This perspective clarifies our everyday ability to unreflectively switch between social and other affordances. Moreover, based on our experience with Deep Brain Stimulation for treating obsessive-compulsive disorder (OCD) patients, we suggest that psychiatric disorders may affect skilled intentionality, including responsiveness to social affordances.

Becoming more oneself? Changes in personality following DBS treatment for psychiatric disorders: Experiences of OCD patients and general considerations

Does DBS change a patient’s personality? This is one of the central questions in the debate on the ethics of treatment with Deep Brain Stimulation (DBS). At the moment, however, this important debate is hampered by the fact that there is relatively little data available concerning what patients actually experience following DBS treatment. There are a few qualitative studies with patients with Parkinson’s disease and Primary Dystonia and some case reports, but there has been no qualitative study yet with patients suffering from psychiatric disorders. In this paper, we present the experiences of 18 patients with Obsessive-Compulsive Disorder (OCD) who are undergoing treatment with DBS. We will also discuss the inherent difficulties of how to define and assess changes in personality, in particular for patients with psychiatric disorders. We end with a discussion of the data and how these shed new light on the conceptual debate about how to define personality.

Free Will and the Brain: Being free by losing control: what obsessive-compulsive disorder can tell us about free will

According to the traditional Western concept of freedom, the ability to exercise free will depends on the availability of options and the possibility to consciously decide which one to choose. Given that there are different options, the consequence of this view is that the more conscious control one has over one’s actions (as opposed to merely impulsive responses), the freer one is. Since neuroscientific research increasingly shows the limits of what we in fact consciously control, it seems that our belief in free will and hence in personal autonomy is in trouble. If the free will sceptics are right, the consequences would be far-reaching, not only with regard to our self-understanding, but also with regard to ethical and legal matters. A closer look at the phenomenology of Obsessive-Compulsive Disorder (OCD) gives us reason to doubt the traditional concept of freedom in terms of conscious control. Patients suffering from OCD experience themselves as unfree. They feel trapped in their fears, in their obsessions and compulsions, and in fact their daily life is often severely hindered by the imprisonment of their disorders. The question is whether their lack of freedom is due to a lack of will power. Do they have too little conscious control over their thoughts and actions? Or could it be the opposite: are they exerting too much conscious control over their thoughts and actions? In this chapter, we will argue that OCD patients testify to the general condition that exercising an increased conscious control over actions can in fact diminish the sense of agency rather than increase the experience of freedom. Referring to Heidegger (Heidegger 1927/2001) and Merleau-Ponty (Merleau-Ponty 1945/2002), we argue that conscious control and deliberation may be useful when the natural flow of action is disturbed: for instance when a necessary tool is broken or missing (Heidegger 1927/2001) or when one learns a new skill (Dreyfus 2002). However, deliberation itself may also disturb the flow of unreflective action.

Stimulating Good Practice: What an EEC Approach Could Actually Mean for DBS Practice

The fact remains that if indeed a cognitive reorientation can help patients who suffer from a condition of selfestrangement after the implantation of DBS, then this pathway may be attempted not so much as a change of worldview, but rather as a progressive awareness that nothing has changed in their bodies and in their own self, and if anything has changed it has changed for the better. If psychology has its place of autonomy and effectiveness, rather than attempting a difficult conversion between images of the world it will be more promising to rely on the best techniques of behavioural psychotherapy.