Volume 3, Issue 14, April 21, 2005

A Call to Arms

Author: Dr. Siegfried Othmer

It is now estimated that some 17% of soldiers returning from Iraq and Afghanistan are plagued with lingering mental health issues that are not being well met within the VA system. Even if the intention were there to address these issues, the capability is not---neither financially nor technically. As we know, the reaction of the Veteran’s Administration to the work of Eugene Peniston was to move him to a desk job in Bonham, Texas, there to await his retirement. That is how management deals with inconvenient facts, and how established power snuffs out innovation. But we can help from where we sit.

There is an opportunity here for us, but also a real challenge. Since medical care is supposed to be available at no charge to our veterans, the government sets the bar on pricing irrespective of whether the required service is actually available. We have no choice but to meet the government’s price point. I therefore suggest that we collectively offer to treat veterans with neurofeedback at no charge. The most needy veterans right now are estimated to number around 2,000. That’s less than one per neurofeedback practitioner in the country, a number I estimate at about 6,000. But perhaps only about a third of practitioners will end up participating in this venture. On the other hand, not every veteran in need will actually arrive at our door. I expect that things will sort out in a way that each practitioner may end up with one or a few soldiers to work with. A practitioner may offer to treat just one at no charge, or perhaps just one at a time. In that manner, excess demand can be handled with a waiting list.

If there is interest in this among our readership, then we will try to promote this offering through a national campaign with paid news releases and notification on our respective websites. I would also try to draw in sponsorship from the professional organizations, the AAPB and the ISNR, and from the major practitioner networks (Thought Technology, J&J, BrainMaster, NeuroCarePro, Roshi, LENS, BioExplorer, ESII). Rob Kall at FutureHealth may lend a hand as well with publicity through his OpEdNews website.

Let us know how you feel about this through our on-line poll on the Bulletin Board:

A Letter from the Incoming President of the AAPB, Richard Sherman:

Some excerpts:

Another issue we need to address is just how much emphasis we want our association to put on "mind-body" concepts. We have already included the statement "an international society for mind-body research, health care, and education" in the banner of our web site and all of our letterhead materials. We are adding the ability for people searching the web for "mind-body" to be directed to our web site. Suggestions on how much more to do vary from offering more professional training and conference time on the topic to actually changing the name of the Association. Share your opinion with me.

Write to Richard at rsherman@nwinet.com

Through your answers to surveys, etc., you, our members, have declared your belief that applied psychophysiology / biofeedback is a profession. Until the profession is recognized, it will be very difficult for its professionals to practice. Certainly we won't be licensed and independent practice with reasonable compensation is not easy. The question is how to proceed. Once again, we need your ideas! Please send them to me so your board can begin a program of implementation.

This brings up the topic again of the future of the profession that I raised in the newsletter just prior to the AAPB meeting, and again afterward. As it happens, the appropriate place of home use of neurofeedback, and the necessity of supervision of remote use, is a current hot topic on one of the public lists.

On this occasion, I would like to write about the fate of unlicensed practice in the event that licensure in biofeedback/neurofeedback were to come about. Will there be a continuing role for the unlicensed practitioner even as the field matures? This topic concerns me not only because of the significant number of people in our readership who fall into that category but because of the fear that the strait-jacketing of licensure will hinder innovation. Finally, this represents for me an over-riding civil liberties issue.

The theme of civil liberties draws me back to the dramatic gesture by Mahatma Gandhi of placing a glass of seawater over a candle in order to evaporate the water and extract the salt. He did this in order to ridicule the British monopoly on salt production in India. The British were not amused. They had to mount a response to this insolence, so they hauled Gandhi off to prison. But we know who won in the end. Self-regulation is similarly accessible to the man in the street. One does not need a license to instruct someone in the breath, in paced breathing, in abdominal breathing, in over-breathing. One does not need a license to instruct in the regulation of finger temperature using common thermometers available at a gardening or hardware store. One does not need a license to instruct someone in the regulation of galvanic skin response using a cheap ohmmeter from Radio Shack. Or the GSR-2 for that matter. These are surely matters that will be part of the common property of all mankind. They cannot be effectively restricted. Call this the “reductio ad absurdum” argument for the unlicensed practice of self-regulation procedures.

There is also the Australian model to consider. Last year the regulatory body determined that restrictions on what licensed professionals could do with neurofeedback/biofeedback were appropriate at this stage, but no such restrictions would apply to individuals. So citizens of Australia were free to avail themselves of this technology to their hearts’ content. This provides a kind of escape route for us as well. Operation of the relevant instrumentation could be left entirely to the client. This may be particularly helpful in states such as Massachusetts, where psychologists may not touch their patients as a matter of law. It may also be an escape hatch in New York, where restrictions on the practice of biofeedback are contemplated, or in Florida, Texas, and Utah, where such limits are already established in law.

We will shortly be in a position to deliver neurofeedback services over the Internet, so that the clinician need not be co-located with the client, or even in the same state. This will allow a breach of all attempts at local regulation. Licensure is at this point entirely a matter of State regulation. Corporations registered in Delaware for their own convenience can wreak mischief all over the country without impediment. And credit card companies locate in Nebraska for the same reason. Laws there favor them, and they are not hindered by other State laws when operating in other states. Similarly, anyone operating legally in California, where alternative health procedures by unlicensed professionals enjoy legal protection, can serve the entire nation without sanction.

We are also witnessing the breaching of the boundary between therapy/training and entertainment, in the development of SmartBrainGames. No one will insist on a mental health professional standing by as the child plays a video game. Yet learning is taking place, and functional adaptation of neurophysiological mechanisms is being promoted. It does not seem likely that this development will ever be reeled back in and strait-jacketed through regulation.

Finally, if all else fails there is the L. Ron Hubbard remedy of embedding the self-regulation strategy in a more encompassing model of religious or spiritual practice. I suspect that Hubbard was well aware that he was beyond the reach of the regulatory bodies if he placed his GSR instrument, the E-meter, within an overtly religious context. So our final refuge also lies in the free exercise clause of the second Amendment.

The largest potential applications of neurofeedback will ultimately be outside of the clinical setting entirely—in education, in sports, in the corporate world, in entertainment, in optimum performance, and in enhancing spiritual practice. We want to be at the heart of things, where things are flourishing and unfolding, not merely at the margins where things break down. This takes us entirely out of the realm of procedure, of diagnosis, of reimbursement through conventional channels, even of established norms of doing the work. We are only beginning to move down this path. Our contribution will be in terms of knowledge transfer and professional guidance and coaching rather than in terms of being the gatekeepers to life-altering potentialities.

Comforted in the knowledge that such escape routes exist now and will continue to exist, I can look at licensure in terms of its positive aspects: enhanced stature of the field; organized pathways of professional education; improved reimbursement environment, etc. But the process scares me. The ISNR both here and in Australia saw real fissures around the issue of professional ethics, certification, and entitlement to membership. The battle around licensure will inevitably fracture the community even more, if that is possible.

The Internet flourished as it did because it was a commons with easy access. Self-regulation is similarly accessible to every man. It is not intrinsically costly. It is a non-rival good. As Thomas Jefferson said, if you take light from my taper, I have no less. Much of self-regulation consists simply of knowledge that is easily promulgated. That is our role, both as licensed and as unlicensed professionals.

Dr. Siegfried Othmer