This study presents findings from a clinical trial involving implantation of Brain–Computer Interfaces (BCIs) into a quadriplegic patient. It explores the psychological consequences of being integrated into a continuous BCI feedback loop, focusing on how such intimate interaction can enhance users’ sense of empowerment and ownership. At the same time, it reveals complex ethical tensions surrounding autonomy and agency.
Our results suggest that prolonged engagement with BCIs can lead to a profound sense of integration; where users begin to perceive themselves as part of the system. While this can foster a heightened sense of control, it also introduces risks such as overreliance, borderline addiction, and psychological distress, particularly when users are abruptly disconnected from their devices.
A key insight from our study is the emergence of what we term being-of-the-loop: a phenomenal state in which a symbiosis develops between the user and the AI system, giving rise to a de novo agency that neither could achieve alone. In this state, the BCI is no longer experienced as an external tool but as a constitutive part of the self, fundamentally reshaping how users perceive control, authorship, and action. While this integration can foster empowerment and restored capabilities, it also creates a fragile dependence: autonomy becomes entangled with the system’s functioning, rendering users vulnerable to identity disruption when the loop is severed. These findings raise ethical concerns about decisional vulnerability, informed consent, epistemic dependency and the psychological risks of disconnecting a technology that has become embedded within—and transformative of—the user’s lived experience.