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  • Deep Brain Stimulation and Relational Agency:Negotiating Relationships
  • Robyn Bluhm (bio) and Laura Cabrera (bio)


Timothy Brown (2019) invites us to think about the ways in which people who are being treated with deep brain stimulation (DBS) might come to interact with their devices. He suggests that a framework of relational agency can help us to understand both the benefits and the challenges of DBS because DBS systems are, while not full fellow agents, more than mere props; users must sometimes "negotiate and collaborate with their stimulators" (148). We agree that it is important to develop conceptual frameworks that both do justice to the ways that individuals respond to using DBS and give them new ways to think about the device, their relationship to it, and its role in their lives. In this commentary, we consider three aspects of Brown's discussion of DBS and relational agency: (1) the importance of thinking critically about what it means to have a relationship with a DBS device; (2) how the development of "closed loop" implants might change the kinds of relationships that are possible; and (3) the need to consider how an individual's relationship with their device is shaped by their relationship with others in their lives. We see ourselves as building on, or offering suggestions for further developing, Brown's important paper.

What does it mean to have a relationship with one's DBS device?

What does it mean to "develop a relationship" with a DBS device? For Brown, this is not merely a metaphor, he describes DBS users negotiating with or sharing agency with their devices. Yet, he also notes that, at least for now, the devices are not full agents. We therefore need to think carefully about what "agency" and "relationship" mean in this context. This can be done both by considering theoretical approaches to understanding the relationships we have with our technologies and by looking to specific examples that illuminate how users might interact with their DBS devices.

Brown offers Diana Meyers's relational account of autonomy as a theoretical framework for thinking about partnerships with neural technologies. We [End Page 155] will return to this point below; here we want to point out that there are also a number of authors who have written specifically about our relationships with nonhuman "agents." For example, in philosophy of mind, Brown acknowledges the work of Andy Clark (1998), who has developed an approach to in which "mind, body, and world … emerge as equal partners in the construction of robust, flexible behaviours" (5). He and others have shown that we are beings continually extending our performance and locus of agency via negotiations with our environments, including, importantly, our technologies. We constantly have to negotiate how to act in the world given our technologies' features: think of the case of someone who knows that her computer will slow down if she has too many programs open, so in certain situations she will "negotiate" with her computer given her needs. For example, a user might have more programs open at the same time knowing that the computer will take longer to process the information or, when she needs things faster, only use the programs essential for her tasks at hand. Thus, we need to ask what, if anything, is specific to having a brain device that makes these negotiations and collaborations any different?

Similarly, there are several frameworks from science and technology studies (STS) that could shed light on some of this discussion, such as actor network theory (ANT), a theory advanced primarily by Bruno Latour. ANT recognizes that artifacts are parts of a network of actors, and that the artifacts can have just as much agency as the human actors in a network, acting as mediators in human relations (Latour 1993; Johnson 1988). Social constructivism, another STS framework, emphasizes that the ways a technology is used cannot be understood without understanding how that technology is embedded in its social context (e.g., Pinch and Bijker 1987). This latter approach could certainly supplement some of the proposals by relational agency theorists in ways similar to what Brown is suggesting.

Specific examples can also help us to think about our relationships with...


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pp. 155-161
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