What's New in Neurofeedback

• QEEG scan predicts path of depression

The cover article of the May 25 issue of The Economist Magazine is "The future of mind control," about the implications of emerging neurotechnologies for our future. The editors of The Economist are optimists with regard to the future of our species. For this reason, it is surprising that in their first look at the implications of neurotechnologies they would feature the potential down-sides: "People already worry about genetics. They should worry about brain science too." Several years ago, when the Economist last did a technology forecast for medicine, the brain was hardly mentioned.

Even more so than genetics, which already has people up in arms, neurotechnologies can impact directly on who we are as individuals and as a species. "Genetics may yet threaten privacy, kill autonomy, make society homogeneous, and gut the concept of human nature. But neuroscience could do all those things first."

What kind of dystopia do these editors conjure up in their imaginations that should give us pause? "The musicians on stage are on drugs that speed their reflexes, heighten their hearing and assuage their performance anxiety." Musicians are already massively medicating themselves with Inderal for their performance anxiety, so that threshold has already been crossed. Our neurofeedback training has done all of these things for people already. It has speeded up their physiological reaction times. It has extended their capacity for hearing. (One person had the capacity for stereoscopic auditory processing suddenly develop.) And neurofeedback is routinely used for the control of performance anxiety. All this has occurred without much hand-wringing about the ethics of what we were doing. Has the zeal about our work numbed our ethical sensitivities?

Or is the issue fundamentally different if we achieve these results by training, rather than by drug administration? The latter has a threshold quality that training for enhanced performance does not have. This distinction is certainly unambiguous to people in the sports world. Train all you want, but don’t try to get away with performance-enhancing drugs. One cannot imagine neurofeedback being lumped with the drugs in this regard and proscribed along with them.

"Just as with genetics, however, the specter that most terrifies many of those who fear the advance of neurotechnology is that it will one day be capable of ‘enhancing’ human beings." And what might the editors be talking about here? "Drugs to combat shyness, forgetfulness, sleepiness and stress are now in or close to clinical trials." We are already there! Neurofeedback is first and foremost a stress management tool. With some protocols it has the same results as Prozac and Paxil with respect to the subsidence of social anxiety. Neurofeedback trains the regulation of sleep, and thus combats daytime fatigue. Many of our clinicians assess progress in neurofeedback by means of memory tests.

Most recently the victor in a memory contest was someone who trained his brain with neurofeedback. He was able to recall 48 successive decks of playing cards, and did so with only eight errors. One of top hitters in baseball in the United States attributes his performance rank to his neurofeedback training. It is difficult for me to see an ethical problem here. According to the editors of the Economist, the problem comes when the availability of these new techniques effectively "reduce[s] the number of ways acceptable to be a person." Once it is possible "to ‘fix’ faulty personality traits with drugs or implants" perhaps the range of what is considered acceptable in human discourse will change. Perhaps even the "mild cognitive impairment" now associated with aging, and referred to kindly as "senior moments" will become unacceptable. Again, with neurofeedback we have already crossed the threshold of possibility. For us, the issue is no longer abstract. We are able to address characterological disorders with our training, and we can help maintain cognitive function in the elderly.

No doubt the ability to remediate such deficits will be generally welcomed when this becomes known. The real concern about "mild cognitive impairment" is that it is so universally distributed among the elderly as to be in effect a "normal" characteristic. To insist on remediation would be to make the normal treatable. Peter Kramer expressed concern about this in his book, Listening to Prozac. He found himself routinely administering the drug to people who were clearly not clinically depressed, and this posed an ethical dilemma to him as a psychiatrist. The existence of a dichotomous choice--to prescribe or not to prescribe--focused the debate within himself. The absence of the "threshold" in neurofeedback, of a dividing line between training for symptom reduction and for improved quality of life, as well as the absence of an external agent in neurofeedback, changes the debate qualitatively.

Might there be a time when simply to grow old in the usual fashion becomes unacceptable? That remediation will be mandatory? One could imagine the development of a standard by which the elderly must pass a certain "brain scan" screen that would determine whether they retain their driver’s license. Given the current reality that the elderly beyond 75 years of age have an automobile accident rate that surpasses teenagers, I would personally welcome such a screening test. Such restrictions on the elderly are not fundamentally different from those placed on the young of our species. But such constraints on freedom of action could well be seen as effectively mandating remediation. It will hardly qualify our society as dysfunctional regardless of how this issue is decided.

The matter of making the normal treatable is already well advanced. Fisher and Welsh point out that 75% of Americans are now officially "diseased," if hypertension and current standards of cholesterol loading are considered. Even as far back as 1994 Clifton Meador projected "The Last Well Person" as an issue in his JAMA paper. We are well on the way to having nearly everybody covered with a diagnosis. Mandatory treatment might not be far behind. Or we may simply be confronted with unattractive choices that amount to a kind of compulsion.

News & Reviews NEW BOOKS

Getting Rid of Ritalin: How Neurofeedback Can Successfully Treat Attention Deficit Disorder Without Drugs
by Eduardo Castro, Robert W. Hill

Reviews how EEG biofeedback (neurofeedback) is an effective treatment for ADHD in children. --www.amazon.com/exec/obidos/ASIN/1571742549/top100

Brave New Brain: Conquering Mental Illness in the Era of the Genome
by Nancy C. Andreasen

A glimpse into new and future treatments for mental illness (imaging and biochemical tools) with a focus on schizophrenia, bipolar disorder, anxiety disorders, and dementia --www.amazon.com/exec/obidos/ASIN/0195145097/top100

Cocaine: From Medical Marvel to Modern Menace in the United States, 1884-1920
by Joseph F. Spillane, Joseph E. Spillane

How American views about cocaine were transformed at the turn of the century. --www.amazon.com/exec/obidos/ASIN/0801862302/top100

Cerebral Reorganization of Function After Brain Damage
by Harvey S. Levin, Jordan Grafman