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Review and thoughts: A Symphony in the Brain [Oct. 18th, 2005|04:41 pm]
The American Caliban
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What do I do when something new falls into my life? I read a book about it. It's just how things are done in my family. Since I've started neurofeedback therapy I went on the search for books on the subject. There aren't many, and most of them are $150 tomes for practitioners. I found the one pop science book on the subject and ordered it: Jim Robbins' A Symphony in the Brain.

The first hurdle to surmount is the writing. Robbins is a magazine journalist, and the book reads like every other pop psych book written by a magazine journalist. It's heavy on the personal stories and light on science. Way too much of the material is from interviews. There's about 50 pages of filler, mostly history. And, in the tradition of books about medical breakthroughs, it's packed with case histories of success.

More seriously, Robbins doesn't reveal a fact I know from other sources: he was commissioned by one of the players in the story. More about this below.

The history of neurofeedback begins with a UCLA researcher named Barry Sterman and his graduate student, Margaret Ayers. They developed a method for using biofeedback with EEG to help patients control their own brain waves. The technique showed promise and Ayers left to take it into clinical practice, causing the first of many wars in this field. She took with her the technician who had built the original machine, and started a company called Neuropathways. She did therapy and also sold hardware and software.

As usual there was a lot of resistance from medical and psychological experts to this new treatment. There weren't any good large-scale studies of its efficacy, so clinicians wouldn't touch it, and no grant money could be scared up to do such studies. Marginalized as she was, Ayers took on the defensive, messianic role of the radical truth-bringer oppressed by closed-minded conservatives. Robbins tells this story pretty well. You can see that there was merit in the therapy and that new ideas were treated unfairly, and you can also see that everyone involved was prickly enough to make things worse. However, Ayers had a lot of success helping patients who were in coma states, where no other treatment even seemed possible, and began to take clients with severely unhappy children who were violent or otherwise uncontrollable and had failed attempts at other help.

The narrative then moves on to a couple named Siegfried and Sue Othmer, and stays with them for the rest of the book. They brought their son to Ayers after the usual series of failures in other treatments for his severe neurological and psychiatric problems. The neurofeedback worked so well that they became enthusiastic converts to this new idea. In fact, they became so enamored of it that they bought equipment and trained themselves in its use. They and Ayers and Ayers' computer programmer planned a joint venture to spread the good news and get more trained practitioners and equipment distributed.

This relationship also broke down in a mess of broken verbal agreements, patents, lawsuits, and accusations of bad faith. The Othmers started their own venture, EEG Spectrum, and began training and selling equipment themselves.

The rest of the book is taken up with examples of neurofeedback's uses in epilepsy, ADD, injury, drug dependence, and personality disorders. Some of the case histories are fascinating. Unfortunately the practitioners and clients have a breathless enthusiasm for neurofeedback that breeds skepticism. In a chapter on ADD treatment, for example, Robbins and his interview subjects come perilously close to saying that drug therapy for psychiatric problems is the same thing as drug abuse, and that the "medical establishment" are drug dealers who don't want to lose their hapless victim-patients. There is about a 20 page attack on the idea of treating ADD patients with drugs, and many of the arguments are essentially religious. This is unnecessary and brings down the tone of the whole narrative, and should have been eliminated.

This points to the real problem with the book, which is that Robbins has given us a pop psych cheerleading exercise about the wonders of neurofeedback that lacks critical bite. He does take trouble to interview some opponents of the technique but they're straw men he sets up to knock down. And as above with the drug rant, there are a number of places where the tired old idea that "they" don't want you to know about the real thing that will cure you pops up. There's a bestselling book with a title like "The natural cures they won't tell you about" that plays on this unreasonable idea that physicians and psychologists want their patients to be sick and take expensive drugs and treatments. It's very unhelpful and also untrue, as you'll find out if you spend a little time around "them".

The problem with new treatments like this, and with their proponents like Ayers and the Othmers, is that they're crusaders and not scientists. At a certain point in her career Ayers walked away from research because she saw so much potential for immediate clinical use. Her patients benefited but medical science did not. And the Othmers are neither clinical professionals nor scientists; they're boosters. The fact that both of these parties make their living selling training and equipment for neurofeedback does not help things at all. Psychological therapies in the world of "alternative medicine" turn into cults too easily, and more so when charismatic leaders with a lot at stake take charge of them.

The really damning thing about A Symphony in the Brain is that it was commissioned by the Othmers and Robbins doesn't reveal this. I only know it because people closer to the story than I revealed it. He makes a pretense of having stumbled upon this and decided on his own to write the book, so I'm not sure how exactly it happened. In any case he's far too closely tied to them and their story. He does give Ayers a fair shake rather than taking their side, which is a good sign.

After finishing this book I thought about my own practitioner and the nature of this treatment. Like the Othmers and Ayers and Robbins, she's a true believer. Neurofeedback approaches the Solution to Everything, kook-style, for true believers. Considering the history of "cures" for ADD and personality disorders over the years (sugar-free diets, weird psychotherapies, cult-like schooling) I can't help feeling very skeptical. In my own case I have nothing to lose but $95 a session unless it turns me into a werewolf or a catatonic, so I'm going ahead with it. I really wish someone would do a proper study with a large patient population on neurofeedback, though. The war between conservatives and radicals is harmful to patients.
LinkReply

Comments:
[User Picture]From: jactitation
2005-10-18 11:51 pm (UTC)
Did you read the article in the NYT about brain scans? It's here.

Thing is, just because something has dubious science behind it doesn't mean it doesn't work. And it helps it get covered to some extent by insurance (although not for you?). So maybe you need a (critical theory) book about the magic of "science".
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[User Picture]From: substitute
2005-10-19 12:01 am (UTC)
You're right that none of this means it doesn't "work". But this stuff is in the Dogmatic Crusade By True Believers stage, and I like controlled studies way more than that. I'm not religious about science, but I think the scientific method is an excellent bullshit filter if used properly.

My own bullshit filter, which is all I've got right now, says that there is indeed something beneficial to these techniques, but that there's no guarantee its proponents are right about what it's good for, how good it is, or why.

Therapeutic crusaders, like other religious people, have a way of touting the successes and blaming the failures that obscures the real pattern of how well their therapy works. They have a bad habit of defining things as nails so they can whack them with their favorite hammer.

I want proper studies done on things like this not just to find out whether they're full of shit, but to find out what it might be good for that they hadn't thought of, too.
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[User Picture]From: brianenigma
2005-10-19 12:35 am (UTC)
Proper studies also tend to reveal long-term benefits and side-effects, while the "crusaders" usually focus on the short-term stuff.

Good luck! There's a lot of weird stuff out there, some of which just magically works. For instance, the whole accupressure thing (for me, at least) just seems to magically work. If I have a headache or sinus issues, there are specific spots on my feet and toes that do wonders to make it go away. Maybe there is some nerve connecting things, maybe it is a placebo effect, or maybe it just feels good enough that I no longer care about or notice the headache or sinuses. At any rate, I know it works for some reason and is repeatable, and that is good enough for me.
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[User Picture]From: tinymammoth
2005-10-19 03:37 am (UTC)
There's some evidence that acupuncture releases opiode compounds, which are the body's natural pain control mechanism.

Weird, huh? Of all the things you would assume completely wouldn't work, poking someone with a needle would be high on my list.
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[User Picture]From: Carroll Straus
2012-12-07 06:58 pm (UTC)

"crisaders" in scinece

ALL scientific breakthroughs go through this. Doctors resisted germ theory, refused to WASH THEIR HANDS-- and killed untold numbers of women. The inventor of the incubator had to use the freak show at Coney Island to get recognition. Your cognitive bias serves no one.
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[User Picture]From: halfjack
2005-10-19 05:38 am (UTC)
The degree to which "anti drug rant" and "neurofeedback" parallel scientology is a little worrying. Not that two groups can't arrive at similar conclusions independantly, but I spook easy.
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[User Picture]From: substitute
2005-10-19 05:47 am (UTC)
The comparison hasn't escaped others. In fact, some people see neurofeedback as a stealth Scientology. There are enough similarities (hook you up to this meter, you make the meter change, you get better). A local ADD clinic, The Drake Institute, does neurofeedback and is very anti-drug and has a loyal and near-cultish following.

My own practitioner, and the guy I know socially who does neurofeedback, don't have that kind of extreme view. They see it as a very useful tool, probably their favorite tool in the box, but not the only one.

There are babies everywhere and the floor is awash in bathwater. When I'm shopping for a brain maintenance person one of my tests is pragmatism. If you believe in the One True Way, you're fired.
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[User Picture]From: kerebearus
2005-10-19 02:07 pm (UTC)

I had to comment on this.

Having worked for the Drake institute I can say without any reserve that it is not a cult. Sure their commercials are very anti-drug (I have seen 5 year olds on Prozac) because they are trying to appeal to parents. Most parents do not realize that stimulant medications are controlled substances- they are not medication that should be handed out like candy. The Drake institute's founder and practioner for the last thirty plus years is the first to admit that meds are useful and necessary in some cases, but that they should be used in moderation and in low doses when possible. He writes prescriptions too. It is a useful tool but not a cureall. I agree that at times he gets a little bit on "the one true way" band wagon but it usually is when he is trying to drum up business and it doesn't translate into his practice.

The problem with a true clinical trial on neurofeedback is 1. funding and 2. mixed diagnosis. Take for example a child with ADHD- chances are three to one that he has another diagnosis-like a develeopmental language disorder. So it is virtually impossible to find enough test subjects that only have one diagnosis. That being said diagnosis of ADHD is not an exact science. We can see slowing in the pre-frontal cortex but that can represent many disorders and does not mean the subject will be symptomatic etc. When conducting a clinical trial test subjects must fall withing certain parameters and most people with ADHD do not fall into narrow parameters. As for funding, I now work for a pharmaceutical trial company. We live and die by the money that we are given by drug companies. There are no longer many organizations that will fund research on an alternative therapy. Most of the companies that build and market neurofeedback machines are hemp eating hippies or foreign, neither are capable of funding or orchestrating a clinical trial. The fact that it has been around for over thirty years will have to suffice for most people until diagnostic techniques are better and definitions of disorders are better understood.
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[User Picture]From: substitute
2005-10-19 06:17 pm (UTC)

Re: I had to comment on this.

You're totally right about the funding problem. No one even wants to do the big study with 800 people and all the trimmings. And the only people doing the less controlled or smaller studies have an ax to grind of some kind, pro or con.

The Drake Institute may not be as bad as their ads, but the ads are pretty bad. The actual therapeutic regimen may be less of a jihad but that's their public face! They ought to change it, it's creepy. I'm sure for desperate parents the strong anti-drug message and "one true way" language is a ray of hope, but for the rest of us it looks like Scientology Lite.

You're right about the hemp eating hippies and foreigners. Marginalized medical therapies always end up this way and it's a mess. The trouble is that the quacks and the not-yet-accepted useful therapies look exactly alike to the patient, and you're stuck doing your own research to find out who is getting good work done and who is either fraudulent or kooky. It's disheartening.
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[User Picture]From: srl
2005-10-19 11:07 pm (UTC)

Re: I had to comment on this.

No one even wants to do the big study with 800 people and all the trimmings.

I bet the Mind/Body Medical Institute, affiliated with Harvard Medical School, would consider it, though.
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From: (Anonymous)
2006-06-26 02:21 pm (UTC)

neurofeedback-ethics

My impressions while reading "Symphony..." were much the same as those quoted in the above review. Journalistic effort at explaining scientific concepts lends no credibility to the neurofeedback process. And frighteningly, 'A Symphony in the Brain' was recommended reading as I began the treatment. After 4 months of treatment, I keep thinking back to college psych classes and the reminder that 'correlation does not imply causation.' Entirely subjective observations are cited as being significant. Last week I glanced at my 'data sheet' and the tech had written 'got a haircut' as being somehow crucial to that session's progress. My greatest concern has been a lack of respect for confidential information. I was referred to neurofeedback treatment by my psychiatrist who had recently started a neurofeedback practice in his own office. After 2 years of confidential psychiatric treatment for chronic pain/depression, I am dealing with information sharing between the psychiatrist and the neurofeedback techs, whose professional credentials are that they attended a 4-day training session. Alice Howe Glen Rock NJ
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[User Picture]From: substitute
2006-06-26 09:39 pm (UTC)

Re: neurofeedback-ethics

Alice:

That's a nightmare. I'm so sorry. I'm fortunate that my own practitioner is herself a psychologist with a research background. She is unlikely to make correlation/causation mistakes and even less likely to share information without a formal permission, which she got from me for communication with my physician.

There aren't good professional standards in the field and that's not helping, not one little bit.
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