Intracranial research in psychiatry – What are today’s ethical constraints?

Abstract: A decade into the BRAIN initiative launched by the NIH in 2013, intracranial surgical research in psychiatry –defined as contemporary psychosurgery– is undergoing a (silent) renaissance. There is increasing interest in nontherapeutic intracranial research to elucidate the basis of psychiatric disorders like depression or schizophrenia, e.g., through direct recordings of neuronal activity. However, it is unclear what today’s ethical constraints are for intracranial research in psychiatric disorders. Unlike issues like psychedelic research, this type of research receives little attention, which is odd given psychosurgery’s troubled past.

Intracranial research poses significant risks. It is typically considered permissible only as an add-on to clinically indicated surgery, e.g., epilepsy or brain tumor surgery. The question is whether similar methods can be applied to psychiatric conditions like depression as part of the mission to unravel their neurophysiological basis, even when the disorder is not treated by surgery. Research ethics guidelines refer to the need for “greater caution” in psychiatry research, with attention to specific “vulnerabilities” while unclear on the grounding for said greater caution.

This gap prevents research ethics from adequately articulating the ethical constraints on contemporary psychosurgery research. I argue that standard characterizations of what makes this group at risk for harm are inadequate: appeals to the likelihood of incapacity, stigma, socio-economic factors, or undue pressure are insufficient because they are not specific to psychiatric disorders. Instead, the ethics of psychiatry research should be informed primarily by the field’s overlooked ontological assumptions as a way forward to ethical innovation.