Nonrestraint, shock therapies, and brain stimulation approaches: Patient autonomy and the emergence of modern neuropsychiatry

Abstract

This chapter discusses some early developments in patient-centered treatments in nineteenth-century psychiatry as well as the backlash towards physicianoriented and frequently oppressive treatment and research styles in biological psychiatry at the beginning of the twentieth century. The chapter also aims at tracing some of the modern neuromanipulative approaches of deep brain stimulation back to their historical origins and comparing them with more outmoded approaches of the electrophysiological alteration of the human cortex and deep brain structures. In the second part of this chapter, an overview on the development of modern deep brain stimulation methods and related ethical problem fields is provided. This chapter adds another perspective to the neuroethical discussion by putting forward history of medicine and neuroscience case examples regarding the ethical problems involved, focusing on the issue of medical manipulation during the technological development of modern biological psychiatry. It is shown that, following to the Second World War, electrophysiological stimulation and shock approaches were developed, which began to crucially change the treatment options for mentally ill patients. By means of a comparative analysis, it is argued that many contemporary debates which question neuroethical applications are problematic in significant respects. Of major concern, in this regard, is the often blurred conceptual boundary that is furnished by the complex relationships between clinical research, therapeutic intentions, and the perspective on patient autonomy.