This newsletter is a revised version of my first column in NeuroConnections, the joint publication of the ISNR and of the AAPB Neurofeedback Division, which I am currently serving as President. In this forum, the newsletter reaches a larger audience.
It has been observed that Americans remain personally optimistic, by and large, while becoming increasingly pessimistic about what is happening in the society at large. This is certainly the case in our household, as we survey the decline in the relative standing of our country in nearly all measures of social, intellectual, and economic functioning, while at the same time we are highly optimistic about the positive societal potential of the neurofeedback training we have been doing. These divergent perceptions make for an unrelieved sense of urgency about the societal significance of our work. With our methods we are in a position to redress many of societyâ€™s critical ills, and to do so at very moderate costs by comparison to the results that can be achieved.
We confront the challenge that our methods need to be better known in a skeptical world, and made more accessible. The barriers to such progress are almost entirely sociological and political rather than technological or even scientific. The science underlying neurofeedback may still be in its infancy, but we understand matters well enough at the practical level to know how to revolutionize the entire field of mental health and of education.
Right now a preoccupation with rising medical costs is roiling our politics and fracturing our society. The piece that is entirely missing from educated discourse on these topics is the domain of ‘mind-body therapies,’ namely applied psychophysiology. It has been a step-child in research, from Hans Berger working alone to search for the EEG signal to Barry Sterman seeing his research funding for neurofeedback dry up in 1985. It has also been derided in practice by self-appointed experts.
And yet our methods can likely bend the medical cost curve all by themselves, and they can do so in short order. Missing is an articulation of the perspective that many medical challenges are the tragic end points of a long-term trajectory of progressive disregulation, combined with the realization that the timely implementation of a self-regulation strategy can forestall or avoid many of these adverse outcomes.
One has the sense that we are close to a tipping point at which there will be a shift toward more general acceptance of our claims, much like what happened when evidence for the generation of new neurons first made brain plasticity respectable for polite discussion. We can only marginally influence such a tipping point. We can, however, position ourselves for that occurrence. Right now there is one factor above all others that militates against our being seen as scientifically mature, and that is the compartmentalization of thinking at all professional levels within the domain of health care, and the high level of internal dissension it brings in train in all organizations aspiring to address the problem.
Along those lines, one urgent project that confronts our own field is the conceptual re-unification of biofeedback and neurofeedback, and the other is a change in the tenor of our discourse toward one of greater mutual acceptance and tolerance of differences among the different approaches to neurofeedback. Ours is an intrinsically multi-disciplinary enterprise, and it is inevitable that there will be clashing viewpoints during the shakedown phase. No profession has squatters’ rights here. None has a perpetual lease, or title to intellectual property with respect to the core tenets of our discipline.
Over the twenty-two years that I have been attending meetings of the AAPB, I have always been amazed at the degree to which the Balkanization of the biofeedback field sustained itself in the face of the obvious unitary quality of our regulatory regime. Those who practiced EMG training considered themselves so distinct from the whole that eventually they spun off into a separate organization from the AAPB. Those who continued to pursue alpha training eventually found themselves so unwelcome at the AAPB that they too spun off to form their own organization. Years later, the EEG biofeedback contingent also decamped to form the SSNR in 1993. (This is now the ISNR.)
Unfortunately, the virus of compartmentalized thinking migrated with the daughter organizations into their new institutional settings. Right belief needed to be promoted, and heresies expunged. Certainty was claimed for propositions which did not deserve it. Fruitful discourse was aborted. And so here we are, with no end in sight for the basic rifts within the field. The answer, of course, lies in reaching across the breaches in support of our common objectives.
The underlying reality of our discipline is that our regulatory regime functions as an integrated whole. Autonomic regulation is not rigorously separable in the discussion; the division into central and peripheral regulation is not realistically sustainable. Hence the division into separate agendas for biofeedback and neurofeedback is going to be increasingly limiting. It is not that our prior understandings were false. It is rather a question of whether they remain useful. As the integrative nature of our regulatory hierarchy is coming to be understood, the latter perspective is simply going to be more fruitful. We now need to reach across the boundaries we ourselves have established.
Some while ago I heard a program on TED which talked about the advantage of having lots of different ideas contend with one another. The speaker drew the analogy to sexual reproduction, which brings different genetic resources into combination. Just as biological systems are most productive of change at the interface between different communities, so our intellectual growth is promoted by the engagement of divergent perspectives. Instead we tended to have the active resistance to any new initiatives. The result is that the field has fragmented into sub-disciplines divided by the instrumentation being utilized. This is a direct analogy to the fragmentation in the original biofeedback discipline according to the physiological variable being trained. To an extent, our pathology is shared by the field of neurophysiology as a whole. Said neuroscientist Christof Koch, “People are more likely to use each other’s toothbrush than they are to use each other’s protocols.”
When a new finding is brought to the attention of our community, the typical response is to ask whether the aspirational “claim” is already supported by the literature. But if we limited ourselves to living within the comfort zone of published science it would be like driving while looking in the rear view mirror. As Daniel Siegel has said, “If you had to have the science first, we would never get anywhere in science.” First comes the observation; then comes the discernment of a pattern of occurrences; and then we already have the obligation to share what we have observed with colleagues. Anecdote is not a pejorative. Sometimes even a single observation rises to significance. When I first heard from Dan Chartier of a 40-point improvement in IQ score, from 72 to 112, in one of his early clients, it was already sufficient to loosen the moorings on the belief that the IQ was essentially invariant. Something had been accomplished that had no trivial explanation.
In the sometimes lengthy progression from mere conjecture toward solid scientific status, our community should at least benignly tolerate, if not affirmatively value and support, the innovators. The constraints of peer review are often detrimental to the tender shoots of new initiatives. Peer review tends to censor or dismiss anything too far from the beaten path. This is a fact of life in mainstream science that will not change. But that is all the more reason for our community of professionals to provide a buffer to the harsher judgments of the world at large, a safe harbor for innovation within its orbit. While the world at large is bidding us to make harsher judgments, for example with respect to evidence-based criteria, within our own organization we should be moving in the opposite direction, toward softer judgments and greater openness to divergent perspectives.