“I Am Who I Am”: On the Perceived Threats to Personal Identity from Deep Brain Stimulation

This article explores the notion of the dislocated self following deep brain stimulation (DBS) and concludes that when personal identity is understood in dynamic, narrative, and relational terms, the claim that DBS is a threat to personal identity is deeply problematic. While DBS may result in profound changes in behaviour, mood and cognition (characteristics closely linked to personality), it is not helpful to characterize DBS as threatening to personal identity insofar as this claim is either false, misdirected or trivially true. The claim is false insofar as it misunderstands the dynamic nature of identity formation. The claim is misdirected at DBS insofar as the real threat to personal identity is the discriminatory attitudes of others towards persons with motor and other disabilities. The claim is trivially true insofar as any dramatic event or experience integrated into one’s identity-constituting narrative could then potentially be described as threatening. From the perspective of relational personal identity, when DBS dramatically disrupts the narrative flow, this disruption is best examined through the lens of agency. For illustrative purposes, the focus is on DBS for the treatment of Parkinson’s disease.     

Finger movements lighten neural loads in the recognition of ideographic characters

The role of finger writing movements in recognizing Japanese ideographic characters (Kanji) was investigated using functional magnetic resonance imaging at 3 T. A total of 12 healthy native Japanese-speaking volunteers were studied while counting the number of strokes in ideographic characters. In experiment 1, a representation of the pronunciation of an ideographic character was displayed using Japanese syllabic characters. Volunteers were required to count the strokes of the ideographic character corresponding to the displayed phonogram. This procedure included retrieval and generation of ideographic characters. In experiment 2, the ideographic character itself was displayed and the volunteers counted its strokes. This procedure focused on visuospatial imagery processes. Each experiment was conducted under two different motor conditions. One condition allowed the subject to use finger movements to count the strokes, while the other disallowed any finger movements. In both experiments, movement-allowed conditions duly activated the primary motor area. The phonogram-displayed and movement-disallowed condition induced an augmented activation in a part of the left premotor area, which was assumed to be Exner's area. This area might have been activated by a demand for sequential generation of character graphemes that corresponded to the phonogram displayed. The ideographic-character-displayed and movement-disallowed condition activated the dorsal occipitoparietal areas and the primary visual area, which might be involved in the visuospatial mental imagery processes. These results suggest that execution of finger movements during stroke counting of ideographic characters lightens the neural loads for grapheme generation on Exner's area and for the visuospatial imagery processes on the dorsal pathway.     

The role of possible selves in identity formation: a short-term longitudinal study

This study is an attempt to replicate and extend previous findings on the relationship between identity and possible selves. In an effort to assess if the earlier findings by Dunkel (2000, Journal of Adolescence, 23, 513-529) could be generalized, different measures of identity and possible selves were used. Likewise, a longitudinal approach was utilized in order to evaluate the hypothesis that possible selves are a mechanism used in the process of identity formation. As predicted, identity exploration was positively correlated to the number of possible selves generated, and changes in identity exploration predicted changes in the number of possible selves generated. It was also found that identity commitment was associated with the consistency of hoped for possible selves across time, which may reflect the role of commitment in setting and working toward personal goals. Previous results related to identity status and possible selves pruning, balance, and valence were not replicated.     

Threats to Neurosurgical Patients Posed by the Personal Identity Debate

Decisions about brain surgery pose existential challenges because they are often decisions about life or death, and sometimes about possible personality changes. Therefore they require rigorous neuroethical consideration. However, we doubt whether metaphysical interpretations of ambiguous statements of patients are useful for deriving ethical and legal conclusions. Particularly, we question the application of psychological theories of personal identity on neuroethical issues for several reasons. First, even the putative “standard view” on personal identity is contentious. Second, diverse accounts of personal identity have been introduced into the neuroethical debate, which are incompatible. Third, the criteria for “diagnosing” the supposed changes in “identity” are ambiguous and indeterminate. Fourth, the metaphysical theories of personal identity imply highly questionable ethical and legal revisions, namely the denial of advance directives, particularly of Ulysses contracts, and, for patients with brain cancer, even therapeutic nihilism.We discuss three examples in which ideas from the personal identity debate in metaphysics are straightforwardly applied to discuss ethical issues of neurosurgery. We discuss revisions of the current medico-legal practice that have been proposed on grounds of psychological theories of personal identity. We argue that the established status quo in law and clinical practice is beneficial to the patients concerned. Furthermore, it is metaphysically neutral, which is an important principle of liberal, democratic, pluralistic societies.We recommend a pragmatic approach: (1) empirical research on personality changes arising from brain disorders or interventions, (2) comprehensive information about risks of personality changes, and (3) advance directives, particularly Ulysses contracts.     

Issues in the psychiatric treatment of African Americans

African Americans constitute about 12 percent of the United States population. Sixty percent of African Americans live in urban areas, and 25 percent have incomes below the poverty level. Issues in the psychiatric assessment and evaluation of African-American patients include diagnostic bias that has resulted in overdiagnosis of schizophrenia. Use of screening instruments can help standardize assessment, but appropriate screening instruments that have been evaluated and found reliable in this population must be used. Issues in treatment and outcome for African Americans include challenges in establishing rapport in interethnic situations, racial identity as a focus in psychotherapy, and awareness of biological characteristics that affect response to medications. Many African Americans live in high-crime areas where high rates of drug abuse and violence create chronic stresses. Patients with dual diagnoses of chronic mental illness and substance use or abuse need targeted interventions. Strategies for prevention and treatment of the effects of having experienced or witnessed violence have been proposed. Additional research is needed to clarify the true prevalence of specific mental disorders among African Americans and to determine the most effective combinations of treatment strategies for various disorders.     

Personal Construct Theory and the Transformation of Identity in Alcoholics Anonymous

The dominant theoretical approach to alcoholism research presumes linear, causal relationships between individual cognitions and behavioral outcomes. This approach has largely failed to account for the recovery some alcoholics achieve in Alcoholics Anonymous (AA) because AA emphasizes the transformation of identity, framed in terms of relationships rather than cognitions and behaviors. George Kelly’s personal construct theory (PCT) provides a ready means of theorizing that transformation by explaining how AA helps alcoholics resolve four identity-relevant dialectics. The basic postulate of PCT addresses changes in stigma: normal vs. deviant identity. The construction corollary illustrates changes in perspective: subjective vs. objective view of identity. The individuality corollary informs changes in affiliation: unique vs. common identity. And the organization corollary illuminates changes in stability: fluctuating vs. permanent identity. As an alternative to causal approaches focusing on cognition and behavior, PCT should facilitate further research into alcoholism as a disorder of identity transformation.     

Transcranial magnetic stimulation,deep brain stimulation and personal identity: Ethical questions,and neuroethical approaches for medical practice

Neurotechnology provides means to engage micro- and macrostructural networks of the brain to both mitigate the manifestations of several neurological and psychiatric disorders, and alter cognition and motoric activity. Such capacity also generates questions of how these interventions may affect personal identity. This paper discusses the ethical implications regarding changes to personal identity that arise from the therapeutic use of transcranial magnetic stimulation (TMS) and deep brain stimulation (DBS) technologies. In addition, we raise the question of whether changes in personal identity, as a side effect of these interventions, are ethically acceptable and whether such alterations of personality foster patients’ sense of well-being and autonomy. First, we provide a series of case vignettes that afford an overview of the ways that various neurological interventions can affect personal identity. Second, we offer a brief working definition of personal identity in order to delineate an ethical framework that we deem necessary for the responsible use of neurostimulation technologies. In so doing, we argue that neurostimulation therapy, as a doctoring act, should be directed, and adherent to goals of restoring and/or preserving patients’ personal identity. To this end, we offer an ethical framework that we believe enables sound decisions about the right and good use of TMS and DBS.     

Transcranial magnetic stimulation, deep brain stimulation and personal identity: ethical questions, and neuroethical approaches for medical practice

Neurotechnology provides means to engage micro- and macrostructural networks of the brain to both mitigate the manifestations of several neurological and psychiatric disorders, and alter cognition and motoric activity. Such capacity also generates questions of how these interventions may affect personal identity. This paper discusses the ethical implications regarding changes to personal identity that arise from the therapeutic use of transcranial magnetic stimulation (TMS) and deep brain stimulation (DBS) technologies. In addition, we raise the question of whether changes in personal identity, as a side effect of these interventions, are ethically acceptable and whether such alterations of personality foster patients' sense of well-being and autonomy. First, we provide a series of case vignettes that afford an overview of the ways that various neurological interventions can affect personal identity. Second, we offer a brief working definition of personal identity in order to delineate an ethical framework that we deem necessary for the responsible use of neurostimulation technologies. In so doing, we argue that neurostimulation therapy, as a doctoring act, should be directed, and adherent to goals of restoring and/or preserving patients' personal identity. To this end, we offer an ethical framework that we believe enables sound decisions about the right and good use of TMS and DBS.     

Impact of the term schizophrenia on the culture of ideograph: the Japanese experience

The ideographic Chinese writing system (in use in Asian countries that account for about a quarter of the world's population) directly expresses the meaning of schizophrenia as "the disease of disorganized mind." The term directly challenges a deeply ingrained concept of personal autonomy, and this is stigmatizing. Japanese psychiatrists are thus reluctant to tell their patients that they are suffering from schizophrenia, and, as a result, no more than 20 percent of sufferers actually do know about their diagnosis. Because taking medication is based on informed consent and the exercise of the patient's autonomy, such lack of information has important negative effects. It is unlikely that this problem can be resolved by education or information alone, and it may well be the case that in cultures using ideographs, the illness will need to be renamed. This article suggests some alternatives.     

A Qualitative Study of the Subjective Appraisal of Recovery Among People with Lived Experience of Schizophrenia in Poland

The objective of this study was to explore definitions of recovery among Polish service users with lived experience of schizophrenia and to hear their recommendations regarding elements that should be considered in the planning of a recovery oriented psychosocial intervention. Four semi-structured focus groups were conducted in the Institute of Psychiatry and Neurology in Warsaw, Poland. A total of 28 service users’ narratives were examined using the inductive thematic analysis approach. Five main recovery themes emerged from the combined users accounts, listed in order of frequency: psychological dimension of recovery, relationships with others, wellness strategies, clinical understanding of recovery and support systems. Service user recommendations referred to the above identified recovery themes as well as indications that the intervention should be flexible, individualized, and facilitative of personal growth. The findings indicate that for service users with lived experience of schizophrenia in Poland it is culturally feasible to embrace the person-oriented approach to practice and develop a recovery-oriented psychosocial intervention emphasizing psychological domains of recovery such as positive identity, personal strengths, or meaning and purpose in life alongside the other relevant recovery dimensions. Actions regarding the system level of change are also required.     

How can a mentor support experiential learning?

Mentoring is an emancipatory act. Although the term 'mentor' has been appropriated in some professions to include notions of assessment, the pure conception of mentoring is to encourage personal growth. Within this framework a trusted mentor can be a key person to help reflection. The mentor can help by encouraging questioning of the governing variable(s), support the mentee in their journey from the known into uncharted territory, and focus on learning opportunities.     

Ideographic characters call for extra processing to correspond with phonemes.

Cortical areas used in the copying of Japanese ideographic characters and syllabic characters were studied using functional magnetic resonance imaging in healthy volunteers. Complexity of characters was controlled to illustrate differences resulting from character to sound conversion differences between the ideographic and syllabic characters. Statistical comparisons indicated extensive activation in the fusiform gyrus, posterior portions around the intraparietal sulcus and in the conjunction area of BA 6, 9 and 44 (which is assumed to be Exner's area) during the copying of ideographic characters. These findings suggested that indirectness between ideographic characters and their pronunciation demands extra processing such as semantic mediation and intensive grapheme processing in comparison with syllabic characters.     

Identity development in adolescents living with HIV

The purpose of this project was to qualitatively explore how identity formation may be affected by the presence of HIV disease. Eight HIV-infected adolescents (three males, five females), aged 17-21, participated in a semi-structured interview that combined measures of identity development with open-ended, qualitative questions aimed at eliciting the adolescents' personal stories and experiences of living with HIV. All participants fell into either Diffusion or Achievement identity statuses, which in turn impacted their response to having HIV. The impact that HIV had on the participants' values and future goals varied across the sample. Findings are discussed in terms of clinical intervention implications, contextual variables, and the need for larger, more comprehensive research efforts.     

Metaphoric identity mapping: facilitating goal setting and engagement in rehabilitation after traumatic brain injury

Difficulty re-establishing an organised and compelling sense of personal identity has increasingly been identified as a critical theme in outcome studies of individuals with severe traumatic brain injury (TBI) and a serious obstacle to active engagement in rehabilitation. There exists little empirical support for approaches to identity reconstruction that address common impairments associated with TBI. Similarly, there is as yet little empirical support for theoretically sound approaches to promoting engagement in goal setting for this population. This article has two purposes. First, theory and procedures associated with metaphoric identity mapping are discussed in relation to goal setting in TBI rehabilitation. Second, the results of a qualitative pilot study are presented. The study explored metaphoric identity mapping as a facilitator of personally meaningful goal setting with five individuals with significant disability many years after their injury. Drawing on principles of grounded theory, the investigators extracted data from semi-structured interviews with clients and clinicians, from focus groups with the clinicians, and from observation of client-clinician interaction. Analysis of the data yielded five general themes concerning the use of this approach: All clients and clinicians found identity mapping to be an acceptable process and also useful for deriving meaningful rehabilitation goals. Both clients and clinicians saw client-centred goals as important. Cognitive impairments posed obstacles to this goal-setting intervention and mandated creative compensations. And finally, identity-related goal setting appeared to require a "mind shift" for some clinicians and demanded clinical skills not uniformly distributed among rehabilitation professionals.     

Deep Brain Stimulation and the Search for Identity

Ethical evaluation of deep brain stimulation as a treatment for Parkinson’s disease is complicated by results that can be described as involving changes in the patient’s identity. The risk of becoming another person following surgery is alarming for patients, caregivers and clinicians alike. It is one of the most urgent conceptual and ethical problems facing deep brain stimulation in Parkinson’s disease at this time. In our paper we take issue with this problem on two accounts. First, we elucidate what is meant by “becoming another person” from a conceptual point of view. After critically discussing two broad approaches we concentrate on the notion of “individual identity” which centers on the idea of “core attitudes”. Subsequently we discuss several approaches to determine what distinguishes core attitudes from those that are more peripheral. We argue for a “foundational-function model” highlighting the importance of specific dependency relations between these attitudes. Our second aim is to comment on the possibility to empirically measure changes in individual identity and argue that many of the instruments now commonly used in selecting and monitoring DBS-patients are inappropriate for this purpose. Future research in this area is advised combining a conceptual and an empirical approach as a basis of sound ethical appraisal.     

Psychopharmaceutical Enhancers: Enhancing Identity?

The use of psychopharmaceuticals to enhance human mental functioning such as cognition and mood has raised a debate on questions regarding identity and authenticity. While some hold that psychopharmaceutical substances can help users to ‘become who they really are’ and thus strengthen their identity and authenticity, others believe that the substances will lead to inauthenticity, normalization, and socially-enforced adaptation of behaviour and personality. In light of this debate, we studied how persons who actually have experience with the use of psychopharmaceutical medication would view their ‘self’ or their authentic personal identity in relation to the use of medication. We have interviewed a number of adults diagnosed with ADHD and discussed their experiences with medication use in relation to their conceptions of self and identity. In the first part of this paper we illustrate that the concepts of identity and authenticity play an important and sometimes problematic role in experiences of ADHD adults. This shows that the question about identity and psychopharmacology is not merely an ‘academic’ issue, but one that influences everyday lives of real people. In order to answer the question whether psychopharmaceuticals threaten personal identity and authenticity, more than empirical research is needed. We also need to analyse the concepts of personal identity, authenticity and self: what do we mean when we are using statements as ‘a way of living that is uniquely our own’, ‘our true self’, or ‘who we really are’? In the second part of this paper we discuss two important philosophical views on personal identity, authenticity and self: the self-control view as elaborated by Frankfurt, and the self-expression view as proposed by Schechtman. We compare these with the experiences of our respondents to see which view can help us to understand the diverse and often conflicting experiences that people have with medication for ADHD. This will contribute to a better understanding of whether and in which cases personal identity and authenticity are threatened by psychopharmacology.     

My face in yours: Visuo-tactile facial stimulation influences sense of identity

Abstract

Self-face recognition is crucial for sense of identity and self-awareness. Finding self-face recognition disorders mainly in neurological and psychiatric diseases suggests that modifying sense of identity in a simple, rapid way remains a “holy grail” for cognitive neuroscience. By touching the face of subjects who were viewing simultaneous touches on a partner's face, we induced a novel illusion of personal identity that we call “enfacement”: The partner's facial features became incorporated into the representation of the participant's own face. Subjects reported that morphed images of themselves and their partner contained more self than other only after synchronous, but not asynchronous, stroking. Therefore, we modified self-face recognition by means of a simple psychophysical manipulation. While accommodating gradual change in one's own face is an important form of representational plasticity that may help maintaining identity over time, the surprisingly rapid changes induced by our procedure suggest that sense of facial identity may be more malleable than previously believed. “Enfacement” correlated positively with the participant's empathic traits and with the physical attractiveness the participants attributed to their partners. Thus, personality variables modulate enfacement, which may represent a marker of the tendency to be social and may be absent in subjects with defective empathy.     

Understanding Identity Changes in Psychosis: A Systematic Review and Narrative Synthesis

Background and ObjectiveExperiencing psychosis can be associated with changes in how people see themselves as individuals and in relation to others (ie, changes in their identity). However, identity changes receive little attention in treatment, possibly due to a lack of clarity or consensus around what identity change means in people with psychosis. We aimed to create a conceptual framework synthesizing how identity changes are understood in the psychosis literature. MethodsElectronic databases were searched up to April 2020. Studies about identity changes among people with psychotic disorders were analyzed using narrative synthesis by a collaborative review team, including researchers from different disciplines, clinicians, and people who have experienced psychosis. ResultsOf 10 389 studies screened, 59 were eligible. Identity changes are understood in 5 ways as (1) characteristics of psychosis, (2) consequences of altered cognitive functioning, (3) consequences of internalized stigma, (4) consequences of lost roles and relationships, and (5) reflections of personal growth. These 5 understandings are not mutually exclusive. Across a heterogeneous literature, identity changes were mostly framed in terms of loss. ConclusionsOur conceptual framework, comprising 5 understandings, highlights the complexity of studying identity changes and suggests important implications for practice and research. For clinicians, this framework can inform new therapeutic approaches where the experience and impact of identity changes are acknowledged and addressed as part of treatment. For researchers, the conceptual framework offers a way of locating their understandings of identity changes when undertaking research in this area.