In reflection on last week’s recitation of considerable adaptive change in clinical neurofeedback strategies over a fairly short period of time [a score of years], one must also observe the countervailing tendency within our field to value consistency and steadfastness in clinical approaches and theoretical models. With respect to such standards, rapid change in one’s clinical approach seems almost reckless. Stasis in one’s position perhaps has even a certain amount of intrinsic merit. Evidence accumulates in the support of one proposition and eventually the proposition becomes a fact. But it may also be true that some of this sense of stasis is a problem of observation. Let me illustrate with an example.

As dusk descends on the freeways drivers gradually turn on their lights, and over a fairly short period of time (say, the length of an average LA commute) one witnesses the transition from nearly all lights being off to nearly all of them being on. Yet one almost never catches sight of a car with its lights just turning on. Similarly, minds may be changing without it being terribly apparent except in the eventual end result. Moreover, while cars don’t mind being seen turning on their lights, scientists may be less willing to let it be known that they have been compelled to change their views, or even worse, that their views may be in a state of flux. (We know how politicians are savaged for the sin of changing their minds!) So it is perhaps unsurprising that we should not actually be able to identify many instances where someone in our field has actually “changed his mind” on some salient issue or another and said so publicly. Mostly, “they” have all been right all along.

Matters are similar when it comes to paleontology research on evolution. All we ever get to see is “fixed” species that represent some considerable adaptation to particular environmental requirements. The fossil record never reveals the actual process of change that we know must have taken place along the way. We know there has to have been “flux,” but we never get to witness it.

Thus I find it quite remarkable that in the June issue of Scientific American, Michael Shermer let it be known that he has ceased to be a skeptic with regard to anthropogenic global warming. The case is remarkable precisely because Shermer gives the strong impression that skepticism is one of his highest personal values. In his view, skepticism has intrinsic merit, and speaks to the obligation of the scientist to remain open to alternative perspectives. At what point does that obligation finally get overridden? Shermer has given us an example. Two principal factors are in play: The first is simply the cumulative effect of all the independent lines of evidence. The second is the possibility that a tipping point can be reached in our climate system beyond which remedies to stave off major change are no longer availing. If nothing else, the time constants are too long, and it may already be too late to start. Even if such tipping point models are merely credible rather than fully persuasive, we have to put aside our lingering uncertainties and start confronting worst-case scenarios.

And now what about neurofeedback? Is there not a similarly compelling societal urgency in the mental health field that should put bounds on the degree to which we allow any residual skepticism to freeze us into inaction? The crowd seems to gather wherever opposition to a new idea surfaces, almost as if invited to a hanging. In the presence of an obvious and unrelieved mental health crisis, this attitude is just plain self-indulgent.

Are there not already multiple independent lines of evidence that cumulatively paint a robust picture of global efficacy for neurofeedback that no individual study, no matter how well constructed and conducted, can match? Shermer was clearly swayed by the “Gestalt” of many independent voices pointing to same dire conclusion rather than by any one salient study. A meta-analysis of neurofeedback would have a positive determination of efficacy as its ineluctable outcome. Perhaps we should put the matter to Michael Shermer for adjudication.

I suspect that we are about to witness a shift in our society’s orientation toward global warming. And this will have essentially nothing to do with the arrival of new, more convincing pieces of evidence. It will have more to do with the reaction to a potential threat to our civilization that we cannot at this point oversee, and it would be utterly cavalier of us to assume a benign outcome if nature were left to her own devices.

This may be a model for us in neurofeedback, and what is happening in the autism community may be a harbinger. Here parents have been experiencing a sense of urgency that is simply not shared by the professionals, and they have taken matters into their own hands. Of course they need the professionals to press forward in research, but they have taken the lead in funding the work that needs to be done, and they have taken the lead in having their own needs met. Autism in the family constitutes an emergency.

The watershed in attitudes we are about to see in connection with global warming may be a model for what is about to happen in neurofeedback. People will become aware of the fact that we offer a remedy and they will insist upon access. The quality of the evidence will be secondary. Just as the medical profession is being dragged forward by the nose in the case of autism, it will be similarly dragged forward with respect to neurofeedback. It will be the lay community that will make the difference.

Consider that there has been essential unanimity within the scientific community with respect to global warming for years, and it has not made any difference in terms of policy. We have the opposite situation in neurofeedback, with a very fractured professional posture with respect to it. It will not ultimately matter. The public will want to have the problem of global warming addressed because the society is facing a crisis that is incalculable and unbounded. Similarly, it will want access to neurofeedback because people are facing crises within their own lives that justify the taking of some risks. The rejoinder that neurofeedback may not be backed by the very best of evidence will be dismissed as frivolous. Parents face very different choices than professionals do, and they will have a different orientation to risk. Sue and I experienced this when we first make the decision to undertake neurofeedback for our son Brian, who had stymied the medical professionals some twenty years ago. Neurofeedback did not have to be good enough to solve all of our son’s problem, it just needed to have enough promise to be worth trying.
And it was.

This entry was posted on Wednesday, June 28th, 2006 at 7:18 pm and is filed under Diffusion of Innovation, Paradigm, Research. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.