Informed Consent in Deep Brain Stimulation – Ethical Considerations in a Stress Field of Pride and Prejudice

other nations already had prohibited this technique. While in the aftermath of the approval of chlorpromazine as first medicament for the treatment of psychiatric diseases in 1954 psychopharmacological therapy progressively began to revolutionize the psychiatric world, surgical methods for the treatment of psychiatric diseases involving gross damage of brain tissue were abandoned. However, encouraged by former success with invasive methods and supported by a growing knowledge regarding neuroanatomy and neural circuits underlying psychiatric and neurological diseases, novel and innovative surgical techniques came up. By now the somewhat prestressed term “psychosurgery” gave way to the broader idea of “neuromodulation,” which summarizes not only invasive methods like deep brain stimulation (DBS) and vagus nerve stimulation, but also noninvasive techniques such as transcranial magnetic stimulation. The ambivalent history of psychosurgery in mind, it is utterly comprehensible that even a reversible though (minimally) invasive technique like DBS reactivates ancient fears. Furthermore, with the observation of psychiatric side effects following DBS of the subthalamic nucleus in patients suffering from Parkinson’s disease in the late 1990s (Bejjani et al., 1999; Hariz et al., 2010; Kuhn et al., 2010) psychiatric diseases came in the focus of DBS. Particularly since this amelioration of possible indications of DBS, the to some extent disreputable inheritance of psychosurgery has been brought up frequently. However, DBS has not only proven to be an effective tool for the therapy of movement disorders such as Parkinson’s disease, essential tremor, and dystonia, but it also has been successfully applied for the treatment of various psychiatric disorders such as obsessive-compulsion disorder (OCD), depression, Gilles-de-la-Tourette Syndrome, alcoholism, minimal conscious Informed consent in deep brain stimulation – ethical considerations in a stress field of pride and prejudice