A few years ago, the Journal Science published an article in which several neuroscientists gave their thoughts on what the future held for their field over the coming several years. One researcher suggested it was time for some effort to be given to the matter of spontaneous remission, such as is commonly seen in depression. Clearly there must be a mechanism by which the brain recovers from depression on its own. Despite the fact that spontaneous remission (and self-recovery in general) is so commonplace in mental disorders, it has not had the research interest that it deserves. So we ask: What is the mechanism (or mechanisms) underlying self-remediation, which has such a broad reach across disparate conditions, both medical and psychological in nature?
We may have inadvertently stumbled upon the answer. Perhaps unsurprisingly, these findings are traceable to the multi-dimensional clinical world, rather than to the world of the academic researcher. First, let us frame the problem: The existence of “spontaneous remission” of depression, for example, means that the depressed brain is in principle capable of functioning normally-even without the aid of pharmacology. What then has changed in such a brain? If we can identify what has changed, perhaps that change can be more systematically induced, or at least supported.
We assert that a complete description of brain function must in principle exist which concerns itself entirely with the bioelectrical domain, without reference to mechanisms of neurochemical implementation. Hence neuromodulation must also be explainable in bioelectrical terms. Even though such a description of the brain is only in its beginnings, it is tantalizing to propose that the salient change in brain function accompanying spontaneous remission occurred in the bioelectrical domain. Efficacy of electro-convulsive shock therapy for depression, which also proceeds without pharmacological augmentation, is in support of this proposition.
We further propose that the hierarchical organization of brain function in general, and of neuromodulation in particular, is effected by the rhythmic organization of brain activity, mediated by well-known thalamic rhythmic EEG generators, or pacemakers. It has been known for over twenty years that operant conditioning of these thalamic rhythmic generators can effect remediation of susceptibility to seizures in cats, monkeys and in human subjects. In recent years, clinical work has shown that such operant conditioning can aid in the remediation of a wide variety of psychopathology. The existence of such a possibility has already been foreshadowed for us by the ubiquitous “spontaneous recovery.” What we may have found is a means of systematically replicating, or inducing, the effect we have collectively referred to as “spontaneous” or “self-remediation.”
However, by obtaining these results through systematic training of the brain’s own self-regulatory software, we expect that the brain may benefit more permanently, and this indeed appears to be the case. It has also been found that the EEG-based training of thalamocortical rhythms has much broader application-even to conditions not known for spontaneous recovery, such as Attention Deficit Hyperactivity Disorder; the long-term consequences of stroke and head injury, and dementia in the aged, to cite several examples.
This means, in turn, that the neurophysiological underpinnings of much psychopathology are functional in nature rather than structural. Whereas pharmacologic efficacy has been adduced to demonstrate a “physical” or biological basis or origin for many psychiatric problems, this insight is both dated and beside the point. It goes without saying that all mental events are mediated by physiological processes. Pharmacologic efficacy for mental problems does not imply that we are dealing with immutable structural (i.e., hardware) problems for which psychological and other interventions are ipso facto less appropriate. On the contrary, efficacy of psychotropic medications is dependent upon the structural integrity of the brain.
In this regard, the work of Lewis Baxter at UCLA with obsessive-compulsive disorder is illustrative for the notice that it attracted. Baxter demonstrated that both cognitive therapy and pharmacological treatment of obsessive-compulsive disorders effected comparable changes in the pattern of glucose uptake in the caudate. For the first time, it was demonstrated that the physiological changes evoked by both drugs and successful talk therapy were identical. Since psychological tools are not deemed to produce “structural” change in the nervous system, we must be dealing with a “functional” change. This was progress.
Clinical work with EEG biofeedback over the last decade has proved to us that we can regard many conditions in the DSM-IV in terms of functional deficits in the stability and operating point of certain subsystems in the CNS. This includes in particular those systems governing attention, arousal, emotional regulation, pain regulation, endocrine regulation, immune regulation, etc. Even those conditions where organic, structural injury may be present, as in stroke and traumatic brain injury, are typically accompanied by functional deficits not traceable to the structural injury, and hence potentially remediable.
The discovery of such extensive “functional plasticity” in the brain, and of an effective means of eliciting such plasticity, has the character of an impending scientific revolution. It flies in the face of the “stasis” that is almost an operating assumption of current medical practice for many conditions such as dementia, end-stage bipolar disorder, characterological disorders, dissociative identity disorders, schizophrenia, mental retardation, Tourette Syndrome, stroke and head injury. It also flies in the face of the “stasis” that is assumed by our criminal justice system, and by our approach to the drug problem in our society. We now know enough to be able to assert that the problem of violent, sociopathic, and psychopathic criminality, and of treatment-resistant drug dependency, is susceptible to successful treatment as physiologically based, but largely “functional” disorders for which systematic approaches to remediation have already been developed.