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Authentic Self and Last Resort: International Perceptions of Psychiatric Neurosurgery

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Abstract

Psychiatric neurosurgery has resurfaced over the past two decades for the treatment of severe mental health disorders, with improved precision and safety over older interventions alongside the development of novel ones. Little is known, however, about current public opinions, expectations, hopes, and concerns over this evolution in neurotechnology, particularly given the controversial history of psychosurgery. To fill this knowledge gap, we conducted a study with eight focus groups in Vancouver and Montreal (Canada; n = 14), Berlin (Germany; n = 22), and Madrid (Spain; n = 12). Focus group texts were transcribed and analyzed using qualitative content analysis in the language local to each city, guided by the theoretical framework of pragmatic neuroethics. Findings indicate that participants across all cities hold concerns about the last resort nature of psychiatric neurosurgery and the potential impact on the authentic self of patients who undergo these procedures. The views captured serve to advance discussion on the appropriate timing for psychiatric neurosurgery, promote sound health policy for the allocation of this resource, and foster scientific literacy about advances for mental health internationally.

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Funding

This study was funded by ERA-NET NEURON Team Grant: Ethical, Legal and Social Issues (ELSI) #ERN-144241 (JI) and the Federal Ministry of Education and Research of Germany (01GP1621A) (SM and MB). JI is the Canada Research Chair in Neuroethics. ER receives a career award from the Fonds de recherche du Québec – Santé (FRQ-S).

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Authors and Affiliations

  1. Center for Ethics & Humanities in the Life Sciences, Department of Translational Neuroscience, Michigan State University, East Fee Hall, 965 Wilson Road, Rm C211, East Lansing, MI, 48824, USA

    L. Y. Cabrera

  2. The University of British Columbia, Vancouver, Canada

    C. Courchesne

  3. Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy, CCM, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany

    M. Bittlinger & S. Müller

  4. Functional Neurosurgery and Radiosurgery Unit, Ruber International Hospital, Madrid, Spain

    R. Martinez

  5. Institut de Recherches Cliniques de Montréal (IRCM), Department of Medicine and Department of Social and Preventive Medicine, Université de Montréal, Montreal, Canada

    E. Racine

  6. Department of Neurology and Neurosurgery and Biomedical Ethics Unit, McGill University, Montreal, Canada

    E. Racine

  7. Department of Medicine, The University of British Columbia, 2211 Wesbrook Mall, Koerner S124, Vancouver, BC, V6T 2B5, Canada

    J. Illes

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  1. L. Y. Cabrera
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Contributions

LC led the project. CC participated in data collection and led data analysis for Canada; LC participated in data collection and led data analysis for Madrid. MB participated in data collection and led data analysis for Berlin. SM and RM participated in data collection for Berlin and Madrid; ER participated in data collection for Montreal. All authors contributed to the writing. JI is the study Principal and participated in the conceptualization of the work, data analysis, and writing.

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Correspondence to L. Y. Cabrera or J. Illes.

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L. Y. Cabrera, C. Courchesne, M. Bittlinger, S. Müller, R. Martinez, E. Racine, and J. Illes declare that they have no conflict of interest

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Cabrera, L.Y., Courchesne, C., Bittlinger, M. et al. Authentic Self and Last Resort: International Perceptions of Psychiatric Neurosurgery. Cult Med Psychiatry 45, 141–161 (2021). https://doi.org/10.1007/s11013-020-09679-1

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