The Prevention Option

by Siegfried Othmer | November 23rd, 2009

Our perspective on this matter is naturally informed by our ongoing work with neurofeedback. If the brain's ability to regulate itself is highly variable, can we alter the landscape to where the brain is functioning at its best more consistently?Even before the usual fire season got underway in Southern California this year, we had one of the largest fires ever in the Angeles National Forest. It was arson-set, and suspicion is cast on an immigrant who developed mental health issues over the past few years. Just fighting the fire cost the state nearly $100M, and that does not count the resource loss, the loss of carbon capture in future years, the impending flooding damage, etc. Arson is notoriously difficult to prosecute. Fingering an arsonist often involves putting evidence together from a number of instances to detect a pattern. This means that the arsonist is taken out of action late in his career, after a lot of damage has already been done. Further, success in that effort means so little in societal terms. At best it takes one arsonist out of circulation, one from a population pool of 16 million people.

The same holds true for pedophiles. By the time they are apprehended, they have typically already offended against a large number of children. Serial killers are typically also caught only after many years of violence. Again, a pattern needs to be detected before a serial killer can even be hypothesized. Financial skullduggery is usually discovered only after many years, or it reveals itself when it collapses of its own internal contradictions. Of course we find some satisfaction in the prosecution of these criminals, but in the larger scheme of things the remedy is unavailing if justice arrives so late upon the scene. How might things be otherwise?

In our emerging understandings on brain function and its failure modes, we are beginning to make sense of the rarer instances of the more severe brain dysfunctions. Consider that even many serial killers and arsonists appear to be dangerous only episodically. In one case it was obvious to the person himself: at rare intervals he was driven to abduct young children. At all other times, this drive was entirely in abeyance. Such variability indicates that we must look to the domain of brain function for an understanding. This phenomenon of the ebb and flow of dysfunction is well known in mental hospitals. It is a nearly universal characteristic of mental disorders. It is also characteristic of addictions.

Women’s prisons are full of people whose violent or otherwise deviant behavior is episodic with a monthly cycle. That demonstrates as clearly as anything could that the behavior is grounded in brain-based dysregulation. There are individuals of both genders who become behaviorally disinhibited with only small amounts of alcohol in their brains. Clearly, the conversation needs to be about the brain.

Our perspective on this matter is naturally informed by our ongoing work with neurofeedback. If the brain’s ability to regulate itself is highly variable, can we alter the landscape to where the brain is functioning at its best more consistently? The answer is yes, categorically. And in doing so, can the brain improve even further from its existing optimal state? The answer is yes again, categorically. Allowing the brain to operate under its own optimal conditions opens the door to even further functional improvements. Moreover, in targeting various brain-based dysfunctions it has become obvious over the years that the same answers keep coming up even for disparate conditions. We aren’t really targeting the specific conditions after all, but rather we are merely using them as markers of our success. The targets of brain training are in nearly all cases very general characteristics of brain function that don’t have any immediate or obvious tie to the condition at issue. This is actually consistent with our experience in psychopharmacology, where serotonin reuptake inhibitors may be deployed for a whole host of conditions.

This means that if the brain is trained even very generically, then a variety of vulnerabilities to dysfunction may be addressed even before they manifest themselves in overt behavior. This is perhaps our only effective way of dealing with those conditions that don’t volunteer themselves at a mental health clinic for help. This includes the arsonist, the child molester, the violent offender, the substance abuser, and the sociopath. All of them over time develop their own narrative to rationalize their behavior. “I have a brain-based problem and I need help” is not among them.

For these people and others like them, prevention is the only option. But how are they to be identified? Professor Adrian Raine at USC has developed some predictive tools around the issue of arousal regulation. Sugar cravings in childhood predict a greater likelihood of behavior problems later. But what do these predictors really convey to us? They are indices of dysregulation, which takes us right back to our working hypotheses: Dysregulation begets further dysregulation; dysregulation underlies deviance.

What if we could normalize the regulation of arousal in these children, as well as their glucose regulation? Would they be better off in terms of socialization? Yes, of course. That’s what we have demonstrated over the last twenty years. In implementing this strategy, we would not have to survey our school children and sift out the potential arsonist among them in order to head off a life of crime. It is necessary merely to recognize features of brain-based dysregulation and to train the brain to better function. We would be training everyone generically, after all—just as in physical education.

This opportunity would be afforded to all children, who would then have the chance to train their brains as well as their bodies and minds. In the vast majority of them, we would be facilitating a higher quality of life rather than forestalling more serious failings. Such functional improvements will be varied and diffuse, and not always reliably traceable to the earlier neurofeedback training. But the society will most clearly see the benefit of a reduction in the most serious violations of societal norms. As the Bell curve tightens, the greatest effect will be out in the tail of the distribution. And the long tail, if any, will be shortened.

At an open house at Pacific Lodge Boys Home in Los Angeles a number of years ago, yellowed newspaper articles from the twenties were on exhibit that made a good case for such a home on the basis of cost-benefit analysis. Perhaps as a result of such considerations, the home was established in 1923. It is still functioning now not many miles from our office. With neurofeedback at our disposal, the cost-benefit ratio has become much more favorable. Given what is at stake, the facilitation of neurofeedback for our youth is now an inescapable moral obligation for our decision-makers.

Siegfried Othmer, PhD

3 Responses to “The Prevention Option”

  1. joan schaeffer says:

    If you change your mind, you change your world. I’m working fairly hard at this!

    If we can change the mind of man, we can change the world.

  2. david says:

    The trick is to integrate such tools into home-based tools that can easily be done on the computer for example, and to leverage social groups to help push these people along.

    I’m currently doing a neurofeedback program called “Play Attention” for ADHD, and I’ve noticed aspects of it already happening. While I’ve got a long bit to go as I’m just starting out, I’ll be excited to see the results it has on me.

    I am for sure very curious about the application to other disorders such as OCD for example, as I know some one with that, and fail to find very much in favor of neurofeedback’s efficacy for OCD. I figure if it were possible the same companies making at home ADHD neurofeedback treatments would be doing so for the OCD people as well.

    if you have any knowledge as to how well Neurofeedback works for the OCD/anorexic type individual, i would love to hear about it as I would be sure to pass it on and investigate a bit further.

    • We do offer home use options, but we train people first at the office to figure out what is best for them.
      In the case of ADHD, the problems are usually resolved well before we talk about home use.
      The Play Attention uses a fairly generic protocol, and if it works for you, that’s great.
      But if you don’t reach your goals, keep searching for something better.
      Regarding OCD, we actually do a decent job with that now, and with anorexia as well.
      But that has only been true for a few years, since we adopted our newer methods.
      In the old days of higher-frequency training we only achieved modest progress in most cases.
      Check out “Therapeutic Applications” on the first page of our website,

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