The allure of the new
As human beings, we are attuned to notice the special or different. We also tend to like simple answers to complex questions. Perhaps they make us feel more in control of the complicated environments we find ourselves in. I wondered about this during a recent trawl for ‘depression cures’ on news websites. Suggestions included 9-stone weight loss, magic mushrooms(complete with obligatory 3D brain picture to enhance credibility), laughing gas and ketamine. It seems that we are on the lookout for simple-sounding and miraculous cures for our ailments. After all, the prospect that things can be fixed ever faster and with less effort sounds great. With a bias towards the novel and apparently miraculous, I wonder how we can appraise new, glamorous or cutting edge treatments? Can we judge such shiny new arrivals fairly?
A recent example of such a new treatment is Deep Brain Stimulation (DBS) DBS seems to be helpful to people experiencing a range of motor-related physical problems, and is most commonly used with people experiencing Parkinson’s disease. Implantation of electronic devices to help people to overcome physical conditions seems to make sense, and qualitative explorations of the impact of DBS for people with primary dystonia (a condition characterised by involuntary muscle spasms) suggest its effects can be life-transforming.
But, there is a danger here that may come from the magnetic attraction of the shiny and new. In particular I was somewhat concerned to learn of possible mission creep for DBS. If it’s good for the difficulties above might it also help with other problems? DBS is currently being piloted for use with people experiencing emotional distress. This results from mood-related side-effects that were reported by people being treated for physical conditions with DBS. People diagnosed with depression and people diagnosed with Obsessive Compulsive Disorder (OCD) have been part of pilot trials to see whether DBS can help them. Some of the language used in the reporting of these trials seems, at the very least, detached from the human experience of depression:
‘DBS to different sites allows interfering with dysfunctional network function implicated in major depression.’ (Link).
And, in relation to OCD:
‘OCD is essentially the result of faulty wiring in the brain.’ (Link)
Such explanations for an effect of DBS seem to locate the problems people are experiencing very much within them, implying that their difficulties are due only to faulty connections, rather than being related to ways that they are trying to navigate difficulties that they are experiencing or have experienced in the past. Viewing a treatment in this way takes agency away from the person, and might make changes they experience seem artificial, or divorced from their realities. If they feel better when their stimulator battery is topped up, or settings are modified, then is that something they can feel ownership of? Do they decide their settings, or does a professional set them, potentially implying expert-knowledge of what might be the best emotional state for them?
Who decides what the correct state of mind someone should experience is? What if people felt better when nothing had apparently been changed in relation to the DBS implants: is it a result of their efforts, related to the DBS, or to something else? Given control over one’s own implants, might it become possible to become somewhat lost, chasing some idealised emotional state, unsure if what one was feeling in the present was genuine? There is an overlap here with possible interpretations people might make with medications. However, people have more control over their medications: they can often choose to stop taking them, and if they do, there is no hardware to surgically remove.
According to the National Institute of Mental Health DBS carries risks associated with any type of brain surgery. For example, the procedure may lead a number of unwanted effects including: bleeding in the brain or stroke, infection, disorientation or confusion, mood changes, movement disorders, light-headedness and trouble sleeping.
Because the procedure is still experimental, other side effects that are not yet identified may be possible. Long-term benefits and side effects are unknown. Perhaps it’s therefore unsurprising that, regarding DBS, OCD-UK states:
‘OCD-UK do not recommend DBS as a treatment for OCD and remain concerned that the dangers associated with the procedure continue to be overlooked by the medical community when much safer and less invasive treatments remain available.’
If DBS for distress is found to be effective, and safety concerns can be addressed, who will decide who receives surgery? Will people experiencing the conditions decide? Will the state decide? Are we at risk of re-treading the path forged by Walter Freeman II, inventor and prolific practitioner of the ‘ice pick’ lobotomy, who seemed to genuinely believe that his intervention was a panacea for mental health issues? He seemed pretty confident about the emotional state people should be in. There may also be there parallels with the continued administration of electroconvulsive therapy, whose evidence is tenuous at best. I also wonder if, as well as novelty, we also value treatments which are dramatic. Part of a primal urge to physically destroy the source of our suffering, as suggested by prehistoric remains found with injuries indicative of trepannings?
So when we are presented with miraculous-sounding cures, perhaps we need to exercise healthy scepticism and, whilst not automatically dismissing them, ask some relatively straightforward questions:
- On which evidence shall our decisions be based?
- In whose interests was that evidence collected and presented?
- Who stands to benefit from the treatment? This extends beyond potential recipients to the companies producing them, and the reputations of the people associated with them.
- And last but never least, do the potential benefits outweigh the risks?