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Deep Brain Stimulation, Authenticity and Value: Further Reflections


In this article, we engage in dialogue with Jonathan Pugh, Hannah Maslen, and Julian Savulescu about how to best interpret the potential impacts of deep brain stimulation on the self. We consider whether ordinary peoples’ convictions about the true self should be interpreted in essentialist or existentialist ways. Like Pugh, Maslen, and Savulescu, we argue that it is useful to understand the notion of the true self as having both essentialist and existentialist components. We also consider two ideas from existentialist philosophy—Jean-Paul Sartre and Simone de Beauvoir’s ideas about “bad faith” and “ambiguity”—to argue that there can be value to patients in regarding themselves as having a certain amount of freedom to choose what aspects of themselves should be considered representative of their true selves. Lastly, we consider the case of an anorexia nervosa patient who shifts between conflicting mind-sets. We argue that mind-sets in which it is easier for the patient and his or her family to share values can plausibly be considered to be more representative of the patient’s true self, if this promotes a well-functioning relationship between the patient and the family. However, we also argue that families are well advised to give patients room to determine what such shared values mean to them, as it can be alienating for patients if they feel that others try to impose values on them from the outside.

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1. Nyholm, S, O’Neill, E. Deep brain stimulation, continuity over time, and the true self. Cambridge Quarterly of Healthcare Ethics 2016;25(4):647–58.

2. Pugh J, Maslen H, Savulescu J. Deep brain stimulation, authenticity and value. Cambridge Quarterly of Healthcare Ethics.

3. Hope, T, Tan, J, Stewart, A, McMillan, J. Agency, ambivalence and authenticity: The many ways in which anorexia nervosa can affect autonomy. The International Journal of Law in Context 2013;9(1):2036.

4. See note 1, Nyholm, O’Neill 2016, at 651–4.

5. Hence contrary to Sabine Müller et al.’s interpretation of our discussion in a recent article of theirs, we were not practicing “metaphysics” when we discussed the true self. Rather, we were interested in people’s values and self-conceptions. Müller S, Bittlinger M, Walter H. Threats to neurosurgical patients posed by the personal identity debate. Neuroethics 2017; online first at: DOI 10.1007/s12152-017-9304-0

6. Levy, N. Enhancing authenticity. Journal of Applied Philosophy 2011;28(3):308–18.

7. Haslam, N, Bastian, B, Bissett, M. Essentialist beliefs about personality and their implications. Personality & Social Psychology Bulletin 2004;30(12):1661–73.

8. See note 7, Haslam et al. 2004; Gelman, S. The Essential Child: Origins Of Essentialism In Everyday Life. New York: Oxford University Press; 2003; Linquist, S, Machery, E, Griffiths, PE, Stotz, K. Exploring the folkbiological conception of human nature. Philosophical Transactions of the Royal Society of London B: Biological Sciences 2011;366(1563):444–53.

9. See note 6, Levy 2011.

10. Erler, A, Hope, T. Mental disorder and the concept of authenticity, Philosophy, Psychiatry, & Psychology 2015;21(3):219–32.

11. See note 1, Nyholm, O’Neill 2016, at 650.

12. The ways that people make judgments about the true self also seem to make room for the possibility that features counted as part of a person’s true self have never been exhibited at all. That is why people think that practices such as meditation can “unlock” the true self, as if it had been dormant throughout a person’s life. See note 1, Nyholm, O’Neill 2016, at 651.

13. See note 2, Pugh et al.; Ekstrom, LW. A coherence theory of autonomy. Philosophy and Phenomenological Research 1993;53(3):599–616.

14. See note 2, Pugh et al.

15. Sartre, JP. Being and Nothingness. New York: Washington Square Press; 1993.

16. De Beauvoir, S. The Ethics of Ambiguity. London: Kensington Books; 1976.

17. Technology can also narrow people’s minds, and in effect make them less free—or at least less flexible—in their personal agency. The polarizing effect of social media is an example of where a technology can seem to make people less free, and more strongly influenced by factors outside of their own agency.

18. Sandel M. The case against perfection. The Atlantic, April 2004; available at: (last accessed 28 Feb 2017).

19. See note 3, Hope et al. 2013.

20. Tan, J, Hope, T, Stewart, A, Fitzpatrick, R. Competence to make treatment decisions in anorexia nervosa: thinking processes and values. Philosophy, Psychiatry, & Psychology 2006;13(4):267–82.

21. See note 1, Nyholm, O’Neill 2016, at 656. Notice that this proposal does not provide guidance about authenticity either in a case in which both of the patient’s conflicting mind-sets involve only tolerable values, or in a case in which both of the mind-sets feature intolerable values. It also does not have anything to say about the authenticity of values outside the tolerable range when they belong to an agent who does not have shifting mind-sets.

22. Tomasello, M. A Natural History of Human Morality. Cambridge, MA: Harvard University Press; 2016; Sterelny, K. Cooperation, culture, and conflict. The British Journal for the Philosophy of Science 2016;67(1):3158; Boyd, R, Richerson, PJ. The Origin and Evolution of Cultures. Oxford: Oxford University Press; 2005.

23. See note 22, Tomasello 2016.

24. See note 22, Tomasello 2016; Stanford K The difference between ice cream and Nazis: The evolutionary function of moral projection.” Lecture, 2011; available at (last accessed 28 Feb 2017), Greene J. Moral Tribes. New York: Penguin Press; 2013.

25. Skitka, LJ, Washburn, AN, Carsel, TS. The psychological foundations and consequences of moral conviction. Current Opinion in Psychology 2015;6:41–4.

26. Cicero. On Old Age. On Friendship. On Divination. Cambridge, MA: Harvard University Press; 1923.

27. Sharon T, Zandbergen D. From data fetishism to quantifying selves: Self-tracking practices and the other values of data. New Media & Society 2016; online first at: DOI: 10.1177/1461444816636090.

28. One of the negative psychosocial effects of DBS that has been observed is that it can have a negative impact on people’s personal relationships. We hypothesize that this is more likely to happen if the side effect of the DBS treatment is that it changes patients’ values and interests in a way that makes them clash with those of family members; for example, their spouses. See Agid Y, Schüpbach M, Gargiulo M, Mallet L, Houeto JL, Behar C. Neurosurgery in Parkinson’s disease: The doctor is happy, the patient less so? Journal of Neural Transmission, Supplement 2006;70:409–14.

29. Hübner, D, White, L. Neurosurgery for psychopaths? An ethical analysis. American Journal of Bioethics 2016;7(3):140–9.

30. Newman, G, Bloom, B, Knobe, J. Value judgments and the true self. Psychology Bulletin 2013;40(2):114.

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Cambridge Quarterly of Healthcare Ethics
  • ISSN: 0963-1801
  • EISSN: 1469-2147
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