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Articles    H4'ed 11/11/09

Overcoming Obstacles to Neurofeedback Care for Veterans

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I have the impression that my newspaper, The Los Angeles Times, printed more articles on veterans' issues today than they printed articles about Labor on Labor Day. Veterans' issues are ok to write about; we can show that at least our hearts are in the right place. Labor issues have become more inconvenient. But veterans' issues include the matter of returning to the labor force once they have been returned to health.

We now know how to recover veterans from all kinds of mental health issues through neurofeedback comprehensively, cost-effectively and quickly "regardless of whether we are talking about traumatic brain injury, Post-traumatic Stress Disorder, or other less devastating mental dysfunctions. The barriers to the diffusion of our innovation into actual practice are clearly institutional. Meanwhile, lip service continues to be given to the issues.

It is in our ongoing spectator status with regard to veterans' mental health concerns that the issues of labor and of mental health converge. But I need to back up more than fifty years to make the connection. When I first came to political consciousness in the fifties, which I did by reading Reader's Digest in order to learn English, I was imprinted early on by that journal's anti-labor orientation. For example, an article about the docks in Florida mocked the restrictive labor practices in which the unpacking of wooden crates had to be accomplished by a raft of workers each doing their particular thing. The wood workers could not touch the metal bands enclosing the crates, which had to be cut by metal workers, and the metal workers in turn could not handle the wood, etc. It was known as feather-bedding, and indeed it seemed to be a waste of labor productivity.

Not in my consciousness were the extreme conditions that had existed during the Depression. Labor was going to do anything it could to forestall a return to such massive joblessness, and restrictive labor rules were a potent early bulwark. The above kind of feather-bedding has been largely dispensed with in our economy as the Depression receded in memory. Curiously, however, it remains a factor among the professions, an issue that is hardly ever discussed in these terms. While autoworkers have shed restrictive rules, and while Southwest Airlines improves efficiency by having employees take on many different tasks, the health care field is literally organized around feather-bedding. And the higher one goes in the medical pecking order, the greater are the restrictions and the protections. The safety net is now at the top rather than at the bottom.

The more insidious effect of this compartmentalization of health care into insular fiefdoms is that it also partitions the way health issues are framed. Further, it forestalls any investigation into relative effectiveness because that could have the effect of upsetting the status quo. The current approach to PTSD is misguided because it is first and foremost in the hands of psychologists. They typically treat PTSD as a psychological condition when in fact it is at the core a neurophysiological condition. Resolve the precipitating neurophysiological issues and the classic features of PTSD will most likely just disappear "without ever having been explicitly addressed. Now there will indeed be much for a classically trained psychologist to do as the person recovers his life, his marriage, and his career, but this will all come after the resolution of PTSD by other means "-means such as EEG feedback. And the forward-looking psychologist can always adopt neurofeedback for his or her practice and cover all the bases.

The problem of traumatic brain injury (TBI) is of the same kind. Here the condition is in the hands of the medical community, which has never before taken it seriously, and has certainly never known how to deal with it. TBI is largely a functional issue, not a structural one, and this is true even when structural injury is clearly part of the clinical picture. Researchers get hung up talking about axonal shearing and the locus of injury that they cannot do anything about in any event. In the meantime, neurofeedback practitioners have been getting the head injured back to work for decades because the most disabling issues there are just as accessible to us as in PTSD. Neither axonal shearing nor localized injury is a barrier to substantial functional recovery. This is not acknowledged because it comes from outside of the hierarchy, in contradiction of the prevailing paradigm.

What put this nation on the fast track early in its history was not only the unboundedness of the geography and the abundance of resources but the open-endedness of the opportunities. Immigrants had escaped the social rigidities of Europe for a more egalitarian restart. By now, however, economic maturity has also brought with it the rigidity of institutions. Government is encumbered by the overweening influence of wealth and privilege that sees to its own interests. Social mobility is now lower in the United States than in the most class-ridden of countries "England.

So as we enter the phase in which the potential of neurofeedback is about to be more generally appreciated, the reigning issue is not about how we can deliver this service most cost-effectively and quickly to those who need it "-the veterans and our active duty forces foremost "-but rather the question about who gets to control this method professionally. Who gets to speak for this field? Who is inside and who is outside? It's about to get ugly.

Meanwhile, the dirty truth is that we don't really need the disabled veterans in our economy, now that they are dysfunctional. We have just seen unemployment double over the last eighteen months or so, but at only modest cost to our GNP. It is generally acknowledged that the laid-off workers will most likely not step back into the job they stepped out of. The class of the marginally employable is becoming as large a factor in our economy as all of unionized labor. The one is just as irrelevant to the ruling class as the other. So we can see a joining of veterans' issues and of labor concerns.

We are seeing more and more veterans individually reach the breaking point. Beyond the newspaper headlines, however, lie many families under severe duress because of the returning veterans' unacknowledged mental health issues. If we had to live with this, then of course we would do so in the same way that our society accommodates earthquake damage and its societal fallout. But this state of affairs is almost entirely remediable. It just cannot be done within the existing framework of professional rigidities with respect to professional practice and the operative paradigms. The relevant innovation has already occurred. All that is needed is mobilization for implementation. I can't quite see how this could happen within our existing calcified medical service delivery system.

Unless neurofeedback is provided as a remedy to our injured veterans in short order and on a massive scale, a large percentage of them will end up among the marginally employable people. And the moral culpability will be ours.

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Siegfried Othmer, Ph.D. Social Media Pages: Facebook page url on login Profile not filled in       Twitter page url on login Profile not filled in       Linkedin page url on login Profile not filled in       Instagram page url on login Profile not filled in

Siegfried Othmer has been active in neurofeedback for more than twenty years, through instrumentation development, clinical research, and the conduct of professional training courses.
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