Ethical issues in moral and social enhancement

6.2.3.
 
Arguments against Schechtman’s objection 
However, Schechtman’s argument presented in the 2009 paper is not satisfactory on 
her own terms. In the 2009 paper Schechtman appears to strongly argue that DBS 
can threaten narrative identity. As Baylis (2013) rightly notices, Schechtman’s 
account as presented in 2009 paper leaves open the possibility that personality 
changes can be successfully integrated into a subject’s autobiographical narrative.
19
There is no reason to think that a subject will necessarily be unable to satisfy 
Schechtman’s articulation constraint: to provide a satisfactory account of her 
history, her life situation, and her motivations; to narrate parts of her life in a self-
conscious way; to render her self-narrative intelligible. Suffering and fighting a 
disease, thinking about DBS as a treatment option, the process of consent to DBS, 
the period of adjustment of settings, etc., can all form part of a narrative that 
incorporates changes that arose as a result of psychotherapy, pharmacological 
treatment and DBS alike. In a later paper Schechtman acknowledges that some of 
the change might be absorbed by the flexibility of the narrative, ‘since narrative is a 
dynamic notion, continuity of narrative is thoroughly compatible with even quite 
radical change’ (2010, p. 140). 
It therefore seems that the initial argument presented by Schechtman in the 2009 
paper would need to rely on the implicit assumption that the mechanism of change 
matters crucially. This echoes some of the moral unease expressed over a decade 
ago by Kramer (1993), who, in 
Listening to Prozac
,
 
mentions the unease that he 
experienced when seeing some of his patients change radically after taking 
antidepressants. Yet, given the above rebuttal of the articulation constraint 
argument, the reader is left in the dark as to why the involvement of a technological 
19
This holds whether or not a change in a given trait was intended. Narratives are typically 
thought to incorporate both voluntary and involuntary aspects of experience.

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or medical means should be viewed with 
special
suspicion. One can wonder why, if 
it coincidentally so happened that either a sudden and dramatic life experience, a 
month of practicing qigong or a psychotherapy session produced exactly the same 
physiological changes in brain function (and resulted in the same profile of 
personality changes), we should consider this ‘natural’ way of personality change 
less suspicious than the changes that result from DBS. So Schechtman’s account is 
open to charges of arbitrarily treating interventions as problematic without defining 
what kinds of means are problematic, nor giving convincing arguments as to why 
they are problematic.
A more charitable reading of the argument presented in Schechtman (2009) may get 
at some of our intuitions as to why a change of values, beliefs or character traits 
following DBS may be troubling; it is not that DBS is problematic in virtue of it 
being a technological means of affecting change, but rather because the intervention 
belongs to a class of change-affecting events which are 
difficult to make sense of 
within a personal narrative
. Perhaps a shift in views after intense qigong practice or 
a life-shaking event could be equally problematic, if unaccompanied by reflection 
and integration of the new stance towards life – including giving epistemic and 
genealogical reasons for this stance.
Moreover, even if DBS would undermine a person’s identity-narrative, there is no 
reason to think that biomedically induced disruptions in identity-narratives are 
irreparable. If a person could re-invent a narrative following severe personality 
changes due to head trauma, there is no obvious reason that a person who 
undergoes DBS could not. Thus, rather than pointing to a DBS-induced identity 
dead-end, Schechtman’s account highlights that the integration of personality 
changes into person’s understanding of themselves may be challenging. The 
challenging nature of such changes has been highlighted in some research on 
patients' perspect
ives (Agid et al. 2006, Shupbach et al. 2006). 
However, the 
question about the moral weight of the risk of such identity crisis or narrative 
disruption remains unanswered. 
Another interpretation of Schechtman’s (2009) objection may relate to the intuition 
that the values, desires and beliefs which can be causally traced back to DBS 
somehow lack anchoring in the persons own life. When she argues that 
‘his [the 

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patient’s] current passions and interests – the things he takes as reasons – were 
caused by manipulation of his brain’ (2009, p. 85) this can be interpreted either as 
referring to the new values not being truly his own (a concern perhaps better 
understand as a concern about authenticity) or being somehow baseless, 
epistemically unjustified.
The latter claim represents 
a related, yet separate worry about the epistemic 
justification of new values, beliefs and character traits after DBS. This epistemic 
problem could be especially important if new values, beliefs and character were 
less
justified than the previous ones. However, in situations when previous justifications 
were weak (e.g. a depressed patient who believes that she worthless as a result of 
trauma), justified in the past but not the present (‘My life is full of emotional pain’ 
for a formerly depressed patient) or equally as well or poorly justified as a new 
belief (e.g. I’m a conservative because my father was a conservative, I’m a liberal 
because that is my fancy after DBS), the degree of justification of the beliefs does 
not change. This worry, however, is more closely related to Schechtman’s reality 
constraint on identity-narratives and opens up an altogether different discussion.