Sich frei fühlen oder frei sein?

Zusammenfassung

Die Tiefenhirnstimulation (deep brain stimulation, DBS) stellt ein neuartiges Therapieverfahren für Patienten mit therapierefraktärer schwerer Zwangserkrankung dar. Auf die von Zwangspatienten empfundene mangelnde Kontrolle und Entscheidungsfreiheit kann mittels elektrischer Stimulation positiv eingewirkt werden. Es stellt sich die Frage, wie diese „artifizielle Freiheit” von den Patienten erlebt wird. Anhand einer Kasuistik und eines Gruppenvergleichs (mit zwei Kontrollgruppen) wird die Psychologie des Zwangs und insbesondere die subjektive Wahrnehmung von Freiheit und Kontrolle mit der Methode des strukturierten Interviews bei Zwangspatienten unter DBS charakterisiert. Die Patienten erleben unter DBS nicht nur eine Veränderung ihres „Freiheitsgefühls”, sondern vor allem eine Veränderung des Raums ihrer alternativen Handlungsmöglichkeiten, sie „sind” also im praktischen Sinne frei.

Summary

Deep brain stimulation (DBS) is a relatively recent therapeutic intervention for patients with therapy-resistant obsessive compulsive disorder. The experienced lack of personal freedom and control can be positively altered by the use of electrical brain stimulation. This raises the question as to whether this “artificial freedom” is subjectively experienced by the patients. Qualitative data from a case report and from standardized interviews of three groups – OCD-patients treated pharmacologically, DBS-treated OCD-Patients, and student control subjects – are presented and a quantitative statistical analysis of betweengroup comparison are used to discuss the psychological aspects of freedom and control in OCD-patients, in particular, on and off DBS. It turns out that DBS-patients not only report subjective changes of their “feelings of freedom” but rather a change of their freedom of agency. In other words, they experience a change in their actual freedom and not just in the realm of subjective feelings about freedom.

Schlüsselwörter

Zwangserkrankung - Tiefenhirnstimulation - Erfahrung - Kontrolle - Freiheit

Keywords

Obsessive compulsive disorder - deep brain stimulation - subjective experience - cognitive control - personal freedom

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