Vol.:(0123456789) 1 3 Medicine, Health Care and Philosophy https://doi.org/10.1007/s11019-018-9858-6 SCIENTIFIC CONTRIBUTION Learning from deep brain stimulation: the fallacy of techno- solutionism and the need for ‘regimes of care’ John Gardner 1  · Narelle Warren 2 © Springer Nature B.V. 2018 Abstract Deep brain stimulation (DBS) is an efective treatment for the debilitating motor symptoms of Parkinson’s disease and other neurological disorders. However, clinicians and commentators have noted that DBS recipients have not necessarily experienced the improvements in quality of life that would be expected, due in large part to what have been described as the ‘psychosocial’ impacts of DBS. The premise of this paper is that, in order to realise the full potential of DBS and similar interventions, clinical services need to be arranged in such a way that these psychosocial dimensions are recognised and managed. Our starting point is that the psychosocial efects of DBS ‘in the feld’ present us with analytically-useful disrup- tions: they disturb and foreground deeply held assumptions relating to the individual, health and its treatment, and which in a crude form manifest as the myth of technological solutionism within health care. Drawing on scholarship in medical sociology and science and technology studies (STS), we argue that DBS brings to the fore the relational dimensions of per- sonhood, and demonstrates the emotional and social turmoil that can result if the relational dimensions of personhood are ignored by clinical services. In light of this, we argue that DBS should be implemented within a regime of care. Drawing on ethnographic research of a paediatric DBS clinical service, we provide an example of a regime of care, and conclude by refecting on what other DBS services might learn from this paediatric service. Keywords Science and technology studies (STS) · Cyborgs · Relationality · Chronic illness · Parkinson’s disease · Psychosocial Introduction Deep brain stimulation (DBS) is now widely considered to be an important clinically efective treatment for Parkinson’s (Okun 2014). DBS involves using a cardiac pacemaker-like device to deliver constant electrical stimulation to areas deep within the basal ganglia region of the brain. While this does not halt the progression of the underlying dis- ease, it can substantially reduce motor symptoms such as tremor and rigidity. For many recipients, this can result in a dramatic improvement in their day-to-day function. There is now considerable evidence that this demonstrated clinical beneft of-sets the relatively high-upfront cost of DBS, and it has, then, been deemed as cost-efective (Pietzsch et al. 2016; Eggington et al. 2014). DBS services have therefore been established in many OECD countries, and well-over 150,000 people with Parkinson’s have received DBS world- wide (Medtronic 2017b). For these reasons, DBS is the most important advancement in treatment of Parkinson’s treat- ment since the introduction of levodopa-based treatments in the late 1960s, and perhaps one of the most signifcant therapeutic developments to have emerged out of the neu- rosciences in the last 30 years or so. Clinicians and device manufacturers have been encouraged by the success of DBS for Parkinson’s to explore other therapeutic applications for the DBS technology. It has since been approved in the EU and elsewhere (and partially approved in the US) for the treatment of dystonia (a movement disorder characterised by sustained muscular contraction), it has been approved for the * John Gardner John.gardner@monash.edu Narelle Warren Narelle.warren@monash.edu 1 Health & Biofutures Program, School of Social Sciences, Monash University, W414 Menzies Building, Melbourne 3800, Australia 2 School of Social Sciences, Monash University, Menzies Building, Melbourne 3800, Australia