The lead article in the current issue of the electrical engineer’s magazine, IEEE Spectrum, appears under the heading of “Psychiatry goes Electric” and is titled, “Psychiatry’s Shocking New Tools.” The article is remarkable not so much for what it covers as for the fact that it exists at all in this forum. The article covers vagal nerve stimulators, repetitive transcranial magnetic stimulation (rTMS), dc current stimulation, and finally deep brain stimulation.
The article illustrates the process by which bio-electrical therapeutic techniques will come to be accepted. Each of these procedures will contribute its piece to the growing realization that the brain must be understood in its bioelectrical functioning, and that such understanding will have important therapeutic implications. The article does dwell at length on the level of scientific evidence that supports each technique, but the cumulative weight of evidence—though individually fragmentary—may well carry the day before any one of the techniques independently reaches technical maturity.
The techniques still reflect the interventionist propensities of Western medicine. One hope for transcranial magnetic stimulation is to use it to generate the seizures of conventional shock therapy, in the hope of avoiding the amnesia that accompanies electro-convulsive shock therapy. But even in its conventional application, rTMS utilizes “powerful magnets to generate currents in well-defined portions of the brain…” The intent is “to use a strong, varying, and concentrated magnetic field to induce the flow of current in a few cubic centimeters…” The power delivered to the magnetic coils is such that “the bottleneck is actually heating in the stimulating coil…,” according to Angel Peterchev, power engineer on the program. One is prompted to ask, is it really necessary to tie into Hoover dam to change brain function?
The new psychiatric techniques may indeed shed light on the whole realm of bioelectrical regulation in the central nervous system, but it is apparent that the researchers involved don’t realize that they are still bludgeoning the nervous system unnecessarily. There is still a lack of understanding of the functioning of self-regulatory systems. An essential feature of such functioning is that it responds very differently to an overt challenge than to a covert one. In the neurofeedback world, we have learned that it is sufficient to work at the very same energetic level at which neuronal assemblies organize themselves. The energy involved in such redirection is almost immeasurably small. (I am thinking here of the ROSHI and of the LENS in particular.) In neurofeedback, no external source of energy is involved at all, yet we are capable of inducing the most profound reorganizations of neuronal function for the most intractable of psychiatric conditions. Finally, in audio-visual stimulation nothing more is being done than to impose a frequency-specific modulation on ongoing neuronal activity.
There is one additional aspect in which the new bioelectrical techniques reflect prevailing medical biases, and that is with respect to the localization of function. This is particularly in play with regard to deep brain stimulation. (In one case of depression, the person’s response to the stimulation was that she felt just as depressed as ever, but now was interested in resuming bowling, a former pastime…) We have been afflicted with the same curse in neurofeedback, but fortunately the technique itself tends toward more general effects quite irrespective of what may intend.
First, we should welcome what is being done in psychiatry research. One salutary fallout may be to clarify which techniques are clearly “medical” in nature and which ones simply involve the re-education of the nervous system. To date some 2000 MDs have become qualified in the technique of vagal stimulation here in the US. The article holds out hope here for a more general solution to the problem of depression, but it is surely obvious that an invasive technique such as vagal stimulators cannot begin to fill the need for a remedy to the world-wide rise in depression syndromes. So we might well see a division of roles between an invasive technique that is reserved for the more intractable cases and a broadly accessible self-regulation-based remedy that is not dependent on medical procedures or medical supervision.
Secondarily, we may see the engineering world get interested in brain phenomenology in a way that we haven’t seen before. This has precedent as well, in that the whole enterprise of CAT scans and magnetic brain imaging really came out of non-medical initiatives. If the engineers and physicists get interested in greater numbers in the problem of the brain as a control system, the rules of evidence will be their own, not those of psychology or medicine. And once they find out that the brain is exquisitely responsive to dynamical control procedures, they will certainly not be intimidated or thrown off the scent by the likes of Russell Barkley. Already we have seen a paper in Physical Review Letters that independently predicted what we are in fact already doing in neurofeedback for Parkinson’s.
Thirdly, we may see a “wholesale” acceptance of neurofeedback once the conceptual blockages begin to be whittled down. With psychiatry sort of leading the way into the bioelectrical domain (by virtue of access to funding and to journal publication), it may come to be realized that we have accomplished a great deal more with neurofeedback than what the “new” psychiatric techniques have on offer. And that may kindle a very different kind of momentum in our direction.