"If you are going to make a big jump in science, you will very likely be unqualified to succeed by definition."
James D. Watson

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The Medicalization of EEG Biofeedback
There are two emerging trends within the field of EEG biofeedback. One branch is trying to gain legitimacy by proving itself within the terms of the traditional medical model. The other finds its roots in truly person-centered psychotherapy, with all its intrinsic complexity, and with the goal of a heightened sense of self and of personal autonomy. Unfortunately, the appearance of the sergeant-at-arms of the prevailing order, namely the FDA, threatens to regiment the field in train with the prevailing medical paradigm.

According to the dictates of convention, we must prove efficacy in controlled studies with respect to each individual canonical disorder. These disorders are treated as if they were all independent; proof for one says nothing about the other. More over, since we happen to be using a physiologically based tool, it is argued that we must prove the results with a physiologically based measure. It is not enough to get clinical results; we must also see change in the EEG. And there must be a unique relationship of protocol to disorder; preferably a single, unique protocol for each.

It is increasingly recognized that the "disease" model of mental disorders has significant shortcomings. Disorder is inherently disorderly. It is not easily compartmentalized into binary criteria: you have it or you don't; you are or you aren't. There is a continuum, and even within each individual there are fluctuations over time. In the T.O.V.A. test, variability is the most reliable indicator of ADHD! This variability extends over all time scales, not only that of the 22-minute test. Biederman (1992) has shown that even by strict diagnostic criteria about 50% of ADHD cases exhibit comorbidity for major depressive disorder, more than one anxiety disorder, or conduct disorder. This does not even consider oppositional-defiant disorder, dysthymia, specific sensory processing problems, sleep disorders, elimination disorders, and Tourette Syndrome. With such a high degree of comorbidity, is it not more correct to regard ADHD as intrinsically heterogeneous? Is "pure" ADHD not a researcher's fiction that serves his own research needs for an arbitrary limitation of variables? We grant that the category exists, because it can be defined to exist and the set is not empty (researchers do find subjects), but it is largely non-representative of the clinical population at large. Even Larry Silver, author of "The Hyperactive Child", is finally coming around to the view that ADHD may be an intrinsically heterogeneous condition (Silver, 1994). That can be taken as an indication of a change in main-stream thinking.

The heterogeneity posited above does not even deal with other neurological conditions that also have attention deficits in their symptomotology, such as traumatic brain injury, birth injury, ischemic attacks in the elderly, and the sequelae of immune dysfunction elicited by silicone breast implants, etc. In fact, attention deficits are ubiquitous among the disorders listed in the DSM-III-R, even if they are not diagnostic for them.

According to the medical model, we would need a person to meet "clinical diagnostic criteria" to legitimize use of the biofeedback "tool". Since the tool uses the EEG, we must have an observable "deficiency" in the EEG, correlated with the disorder, which is to be remedied. And the technique must in fact remediate that deficiency in the EEG before "legitimacy" of the technique can be accepted. Even if this strategy can be defended on its own narrow ground, and even if it results in the acceptance of EEG training by the dominant medically oriented culture, it misses the point and severely under values the technique of EEG training. It perpetuates the patriarchal paradigm in which the repository of essential wisdom lies within the EEG or CAT scan or PET image, as interpreted by its elect acolytes, leaving the "patient" the tyrannized victim of yet another "procedure". "Objective" data override his own experience and observations as having little or no value. By being even more effective than prior modalities, EEG training enhances the opportunity for the health professional to arrogate to him self even more power over the individual.

This view of EEG biofeedback reached the pinnacle of absurdity in an episode that I only know about second-hand. One enthusiastic user of the quantitative EEG, talking to a person who was not pleased with the results of his own EEG training, asked whether a map had been done to determine the appropriate training protocol. When he was told no, he said that that was grounds for a malpractice suit!