How do we go forward?

Author: Siegfried Othmer

In the June 25 2004 issue of Science Magazine there is a review article titled “Neuronal Oscillations in Cortical Networks.” The principal significance of this paper is simply that it is appearing in Science. This article could be one of the significant building blocks on which a reconstruction of brain models in the bioelectrical domain can be built, one that is much more congenial to neurofeedback. The next step of the argument is that we have a technique that can intervene with these bio-electrical mechanisms.

The Efficacy Document put out by the ISNR and the AAPB assumes that this additional step in the line of argument can only be accomplished through suitably blinded and controlled studies. Otherwise we are stuck at the starting line. However, when I look at our “near neighbors” in the clinical world, some of these technologies do not seem to be similarly handicapped. For example, Scientific American published an article on virtual reality therapy in its August 2004 issue. The article highlighted the possibilities for managing fear of flying, phobias, and even chronic pain. No one appears to be holding their breath waiting for the definitive controlled studies. So the field of virtual reality is off and running. The question posed is simply whether the appointed task of moderating fear of flying, or fear of tarantulas, can be accomplished. There is no second-guessing afterwards about whether the virtual reality exercise actually had something to do with the recovery.

Closer to home, there is the whole field of brain-computer interfaces. Birbaumer uses his technology of training people to make transient excursions in their slow cortical potentials to allow patients with locked-in syndrome to communicate with the outside world. Painstakingly these folks progressively select portions of the alphabet until they get down to the letter of choice. They only have available transients in their own EEGs to effect the choices. The question of whether this works answers itself as words form on the screen.

Now when the very same technique is employed in order to train people to suppress seizures, success in that venture apparently doesn’t mean anything at all. Nothing can be claimed until blinded controlled studies are done. This is scientific lunacy, but we seem to stuck with it. A way out of this bind is to work with a condition in which there is an effect of the training that is both clinically useful, and about as immediate as putting letters up on the screen. The condition is migraine. Here we have a situation in which an effect of neurofeedback is felt almost immediately by the trainee, and a redirection of the trajectory of a migraine can usually be achieved within thirty minutes. Over a number of training sessions, the incidence of migraines decreases. Here we have a direct linkage of what happens in mere minutes to what happens in an hour, and ultimately to what happens over the course of weeks. It is one seamless story. The same is available in Parkinson’s, where the very same technique that can cause a tremor to subside in the moment will also effect long-term symptom relief.

There is another realm in which controlled studies do not play a decisive role, and that is in the matter of enhancing performance. Sports people will quickly make up their own minds about whether something contributes to their performance, and similarly academic performance is not usually assessed in a controlled paradigm. So there are at least two paths open to us for bypassing the industry insistence that we cannot pass go until the relevant studies are done.

The whole matter of performance enhancement is getting a lot of attention. The current issue of the Economist has a segment in its quarterly Technology Review about the possibilities of super-charging the brain with neurochemical enhancers. The magazine has raised this issue before, and one appreciates their ethical sensitivity. They ask, who should be allowed to take these pills? I would frame the question differently. Who should be allowed to decide for another human being, or for all of them, as to who may take these pills? It is one thing for the world of sports to decide to maintain enhancement-free conditions with respect to chemicals. But what happens when it comes to brain-training techniques, to the mere utilization of information about one’s body? Surely no one can be alienated from information about his or her own bodily systems.

We may not have spent enough mental energy dealing with the ethical issues that our new technologies raise. But already I have the strong sense that I am uncomfortable with any professional holding this kind of power over any individual. Such power has been too commonly abused in the past. The safest repository of this kind of power over the mind of a person is with the person himself. This position also answers the question raised above with respect to controlled studies. The latter are so significant precisely because the professional feels a strong responsibility to be “correct” in advising the client. Once responsibility shifts largely to the individual with respect to their own training, this burden is at least partly lifted as well.

The 17 September issue of Science Magazine reports that an FDA ethics panel has approved a research design in which stimulant medication will be given to a normal control group in a study on ADHD in order to assess differences in stimulant response between normals and ADHD children. This ethics panel is not the final arbiter within the FDA, but it is clear that the ball is in the air on the issue of performance-enhancement medications for the population at large.

I am increasingly relieved that the tortuous path taken by neurofeedback toward acceptance may have been a blessing in disguise in that it has forced us to find a pathway outside of the standard medical paradigm. A much healthier growth can occur when it is the public at large that takes possession of this technology. Ironically, this means that my own fervent hopes for this technology over the years have had to be jettisoned. So be it.

The final keystone in this argument was provided for me by the current issue of Harper’s Magazine, which dissects the techniques employed at Abu Ghraib and finds them to have been exceedingly well targeted. “The purpose of all coercive techniques is to induce psychological regression…” So states the CIA “Human Resource Exploitation Training Manual of 1983. “There is…a kind of psychological shock or paralysis. It is caused by a traumatic or sub-traumatic experience which explodes, as it were, the world that is familiar to the subject as well as his image of himself within that world…At this moment the source is far more open to suggestion, far likelier to comply.” The key, according to the CIA, is loss of autonomy. The victim is made to regress to a state of child-like dependency. Says Christopher Bollas: “…the victim experiences an annihilation of adult personality structures and is time-warped into a kind of infantile position…” (“The Structure of Evil, 1995). Here we have another instance of trauma-based mind control, in this case perpetrated on adults. What happened at Abu Ghraib did not occur randomly at all. It was part of a well-established pattern that had been taught for many years.

The addition of neurofeedback technologies to this already formidable arsenal of subjugation is awesome to contemplate. That can no longer be prevented. What we are in a position to assure is that there is no monopoly on this technology among the elite and the powerful. The final irony is that the attempt to suppress this technique may have been what has brought about this outcome.