IEEE Technology and Society Magazine - June 2015 - 69

presented above, while not exhaustive, demonstrate that
the way in which an individual defines his mind can drastically affect the way one interprets changes to that mind.

Proposed Model of the Mind/Identity/Self
Given that professors of philosophy and cognitive neuroscientists make up a tiny portion of the patient population receiving DBS, it would be naïve to assume that
a neurosurgeon asking "Can you please describe your
mind to me?" would receive an intelligible response.
The typical patient has not had any need to formulate,
let alone articulate, a complicated notion of self or
identity and, therefore, likely has not done so. However,
this knowledge barrier is not unique to surgeries of the
mind. Patients often lack a grasp of relevant anatomical
and physiological information prior to surgery. Those
undergoing total knee replacements, for example, likely
are neither anatomists nor designers of prosthetic joints.
Nonetheless, the surgeon can quickly fill this gap in
knowledge with the use of a model knee and prosthetic
joint in the examining room. There is no fundamental
reason why a neurosurgeon cannot also employ a model
of the mind in a similar fashion to facilitate conversation.
The model proposed here is based on a simple but intuitive conception of the mind (Figure 1). It is divided into four
distinct but interactive parts: 1) Sensation, 2) Values and
Memory, 3) Emotions and Personality, and 4) Movement.
This structure is meant to symbolically represent
the functional nature of the nervous system as well as
capture the individual's intuition about his or her self.
Additionally, the parts of the model of the mind are represented in the shape and color of familiar street signs
in order to frame the individual's level of caution with
regards to potential complications of DBS.
First, sensation (part 1) and movement (part 4) are
represented as green lights because undesired alterations to these are easily recognizable by the clinician
and by the patient. Stimulus parameters can be reprogramed to minimize these effects, which is a standard
feature of the contemporary practice of DBS. Second,
emotion and personality (part 3) are represented by a
yellow caution sign because, while changes to these
parts can be the goal of DBS as in the case of psychiatric DBS, unintended changes to them could occur,
significantly altering the patient's identity. Therefore, the
patient and team must be especially vigilant to the possible changes. Finally, the patient's values and memories
(part 2 - elements of the Lockean and core/periphery
models of identity) are symbolized as a stop sign to highlight the critical importance of respecting them in order
to respect the identity and autonomy of the patient.
While these parts of the mind are highlighted and
identified by name, this work makes no attempt to give an
exhaustive definition of any of the parts. The definition of
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these elements is intentionally left as ambiguous in order
to allow the patient and clinician to explore these issues
together in a non- authoritarian way. It is the author's
belief that this looseness of structure is essential in order
to maximize the patient's freedom to choose how to
express his or her mind and identity. Further, it should be
noted that no effort is made to clearly define the terms
"identity" or "self" and they are used above in largely interchangeable ways to emphasize that point. This equivocation was undertaken with the hopes of maintaining as

Informed consent is a critical element
for the ethical practice of surgery.

much flexibility for patients and their treatment team as
possible when they define these terms together.
Ultimately, it must be emphasized that this model of
the mind/identity/self is not meant to be either authoritarian or definitive. The intent is to give patients the
opportunity to ground their intuitions about their identities in a tangible image so that they can clearly highlight
parts of critical importance to them in a minimally
biased way. Therefore, if the patient chooses to adopt
a Lockean sense of identity and is indifferent to what
happens to his emotions, personality, and values, then
this personal view of identity should be respected by
the team. The important point is that the parts of the
individual's identity that are fundamental to the patient,
whatever those parts may be, should be identified prior
to implantation of DBS electrodes by the patient, and
they should be noted by the treatment team. Once
these parts are established and agreed upon, the subject and clinician should accept that any significant
alteration to them will be viewed as an undesirable side
effect in the same way that stimulations inducing pain,
false sensations, or motor twitching are now, and the
stimulation parameters should be adjusted accordingly.
There are several complications to using this model
with an actual case, involving a particular patient and
particular medical professionals. First, a patient who is
a candidate for a DBS intervention may or may not be
competent (or willing) to engage in a nuanced discussion
that involves complex theory of mind issues. Second, a
medical professional (expert in her or his specialty) may
not be confident or competent to lead such a discussion.
Finally, the uncertainties and ambiguities of philosophy
of mind questions, even among philosophers, suggest

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