198 Summary and discussion The application of DBS for psychiatric disorders in general introduces several complex philosophical issues that warrant consideration. Firstly, intervening directly in the brain - a central locus of consciousness and personality - provokes questions about the potential alteration of a person’s essential nature. Is the post-DBS ‘self’ fundamentally the same, or does the intervention reshape it? Should any such alteration be considered a form of healing, or does it constitute the creation of a new or different individual? This is particularly pertinent in the context of AN, which often becomes deeply intertwined with a patient’s identity. One of the participants of the study indicated that before DBS, the AN was her (sole) identity (that is, the AN was very egosyntonic). Only after treatment with DBS, she noticed the AN becoming more egodystonic, leaving room for her own identity to come to surface. Secondly, questions surrounding free will, autonomy, and the capacity to consent are both ethically and philosophically intricate. If one accepts the brain as the seat of thought and behavior, direct manipulation of neural pathways challenges traditional notions of free will. Post-DBS, is an individual acting solely out of their own volition, or are their actions influenced - or even dictated - by the intervention? This bears implications for personal responsibility and accountability. Additionally, employing DBS presupposes normative definitions of ‘normal’ and ‘healthy’ behavior and cognition. Who, then, is tasked with delineating these norms? While in the context of severe and enduring AN the issue may seem less controversial, psychiatric diagnoses largely rely on classifications and conceptual frameworks, leaving the boundaries between normality and disorder blurred. As DBS gains traction as a treatment for AN, ethical questions about pathologizing individual variance and the scope of its application for cognitive or emotional enhancement inevitably arise. These concerns resonate with broader philosophical critiques, arguing that societal tendencies to medicalize life’s challenges blur the lines between personal and societal responsibility. If we possess the tools to mitigate aspects of the human condition traditionally seen as integral to personal growth and spiritual development, what are the broader implications for human society? The mechanistic worldview, as explored by philosophers like Martin Heidegger and Michel Foucault, considers the body as a machine to be optimized or fixed. Does the application of DBS perpetuate this perspective, and if so, what are the ramifications for our understanding of human existence? While this thesis will not provide definitive answers to these multifaceted questions, they remain crucial considerations for the design and evaluation of future studies on DBS for psychiatric disorders, particularly AN. The complexities of life manifest on numerous scales, and a nuanced approach is imperative.
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