The brain is an electrochemical system–that is, a physical environment in which both chemical and electrical reactions, phenomena, and structures are present. If so, it stands to reason that the brain can be treated both chemically and electrically. Chemical treatment of the brain is psychopharmacology and currently constitutes the core of the science of psychiatry. Electrical treatment of the brain is the domain of neurofeedback, transcranial stimulation, and related modalities.
Chemical treatment of the brain predominates in the contemporary paradigm of psychiatry and biomedicine, but is there a valid scientific reason for the triumph of psychopharmacology? In other words, why does the concept of the chemical brain hold so much more scientific and social sway than the concept of the electrical brain?
The short answer to this question is: No. There is neither an a priori theoretical reason nor a conclusively empirical rationale to believe that chemical approaches to the brain are more effective than electrical approaches. The premise of neurofeedback is that the brain stuck in distress can be unstuck by changing brainwave patterns–that is, by changing aspects of the brain’s electrical activity. The premise of psychopharmacology is that the brain stuck in distress can be chemically unstuck. Any fair-minded consideration of the research data suggests that both of these premises are valid, which is exactly what we would expect given that the brain is both electrical and chemical.
However, once we start to think of the brain as electrical, then the question of healing becomes more complicated. How easy it is to ingest a pill, for instance, and how comparatively difficult to obtain neurofeedback! Access to psychopharmacology is universal, whereas access to neurofeedback is highly limited–not because of the relative efficacy of these modalities, but because one is far more convenient than the other.
Neither chemical nor electrical approaches to the brain can merit the simple designations of being right or wrong. There can be value in psychopharmacology; there can be value in neurofeedback; and there can be value in both of these modalities working together. There is no single best treatment, no panacea, and no universal solution.
Neurofeedback is, however, much more recent than psychiatry, and the concept of the electrical brain has therefore been slower to make inroads on the turf of psychiatry. In a Kuhnian context, the paradigm of psychiatry is heavily influenced by people who believe, wrongly, that chemical interventions are effective whereas brainwave training is hokum. Although the very foundation of neuroscience is the acceptance and analysis of the brain as an electrochemical system, psychiatry appears to possess a chemical fetish.
Again, if Kuhn was right about paradigms, there is no good reason to think that the underlying science itself is the issue. The issue is that many people were trained to view and treat the brain solely from a chemical point of view. All paradigms have their guardians, and the paradigm of the chemical brain is defended by people who have strongly emotional as well as pecuniary reasons for believing in psychopharmacology as a gold standard.
Consider the practicalities of treatment in the United States. Psychopharmacology is represented by a vast lobbying industry and underwritten by some of the largest companies in the world. Physicians have powerful, non-scientific incentives to prescribe and prioritize pharmaceutical solutions to mental and behavioral problems. The chemical brain is the locus of big business interests, institutional pressure, and an entrenched cadre of guardians. The electrical brain is, so far, the domain of people genuinely interested in gentler approaches to the health of the brain–people who lack the access to research funding, pharmaceutical resources, and institutional prestige enjoyed by those in the camp of the chemical brain.
The concept of the electrical brain, and the role of this concept in a new paradigm of mental and behavioral health, must be championed by therapists. Therapy is widespread and institutionally powerful; therefore, therapists are well-placed to understand and apply the concept of the electrical brain in their own practice, as with the addition of neurofeedback to traditional therapy.
Unfortunately, evangelizing neurofeedback to therapists is difficult. Psychiatrists approached by pharmaceutical companies are already well-educated about the chemical properties of the brain. Therapists approached by neurofeedback technology providers or other neurofeedback evangelists are daunted by this modality’s terminology, equipment, and flood of data. People don’t become therapists in order to work with sensors and data–that’s typically the provenance of the research psychologist, neurologist, or other technical specialist.
Paradigm shifts require changes within social networks. The rise of the new physics at the beginning of the 20th century, for example, was not the inevitable outcome of examining evidence but also a result of how well young physicists organized themselves and spread ideas. For neurofeedback to obtain the scientific and popular currency it deserves, a better job has to be done of orienting therapists to both the use of neurofeedback technology and its underlying theory. Some of the articles posted on this blog will, hopefully, provide a gentler introduction to neurofeedback as understood and approached from the therapist’s point of view.
