The Symphony

For an eight-year-old named Jake the rest of the world has disappeared as he sits quietly in a darkened room and stares intently at a computer screen with a yellow Pac-Man gobbling dots as it moves across a bright blue background. A soft, steady beeping is the only sound. Jake is not using a joystick or keyboard to control the cartoon character; instead, a single thin wire with a dime-sized, gold-plated cup is fastened to his scalp with conducting paste. The sensor picks up the boy's brain waves — his electroencephalogram (literally, electric head picture), or EEG — and as he changes his brain waves by relaxing or breathing deeply or paying closer attention, he also controls the speed of the Pac-Man.

This is more than a game for the boy. Jake was born in crisis: he arrived more than three months before his due date, in July of 1990, and weighed just over a pound. He required open-heart surgery when he was three days old and spent the first two months of his life in an intensive care unit for infants. He survived, but with serious damage to his brain. The most severe symptoms showed up at the age of four when he entered his parents' room one evening drooling and unable to speak. He went into a grand mal seizure and fell unconscious on the floor. After that, the seizures came frequently, usually at night as he was falling asleep. Antiseizure medications blunted the severity of the seizures but could not prevent their onset. His parents, Ray and Lisa, kept an overnight bag packed for frequent trips to the emergency room, where the slight boy received injections of Valium to arrest the seizures. The sight of the needle going into their son filled them with apprehension. He also had small absence, or petit mal, seizures throughout the day, when his mind would go elsewhere, when he could neither hear nor speak for five or ten seconds. He was diagnosed with a speech problem and cerebral palsy, which diminished his fine-and gross-motor skills. Even at age seven, when I met him, he had not learned to tie his shoes, zip his zipper, or button his shirt. His learning disabilities were numerous and included attention deficit disorder and hyperactivity. He had speech problems and ground his teeth together constantly, something called bruxism. His sleep was troubled, and he often woke up ten or eleven times in the night. Despite this list of problems, there is a bright little boy inside of Jake, with a wonderful and sometimes peculiar sense of humor.

At the age of five, Jake started taking two heavy-duty antiseizure medications: Depakote and Tegretol. Both are depressants, both control seizures, and both have serious and worrisome side effects. The boy seemed logy and often tired. "We felt Jake was losing his personality," Lisa told me. "He was zoned out all the time."

I have known Jake's family since he was born; the incredible story of his birth made him something of a celebrity in our town of Helena, Montana. A local insurance company put his smiling baby picture up on billboards with the line "Baby Jake will always be special to Managed Care Montana," and talked about how its coverage had paid almost all of the approximately $350,000 in medical bills. On assignment in Santa Fe for a story about different technologies designed to enhance brain performance, I had heard about neurofeedback and thefact that its first and most effective use was with epilepsy. (Neurofeedback works on the same principle as other kinds of biofeedback except that it provides information about the brain, hence the prefix neuro.) At a Christmas party, I mentioned it to Jake's parents, who were eager to investigate an alternative to drugs. They researched the therapy on the Internet, made a series of appointments over a week, and drove three hundred miles to the nearest neurofeedback site in Jackson, Wyoming. They turned the week into a vacation, swimming in the motel pool, hiking in the Grand Tetons, watching elk at a wildlife refuge, and taking Jake to the local hospital for two one-hour "brain training" sessions per day on the computerized EEG biofeedback program.

Jake's brain has places where the electrical activity is not as stable as it should be. Research shows that the brain's electrical signals are subject to change and that people can be taught how to change them. All neurofeedback does is help guide the client to a specific frequency range and help him or her stay there. The brain does the rest. A technician has set the computer Jake is playing Pac-Man on so that when Jake spends time in those hard-to-reach frequencies, the Pac-Man gobbles dots and beeps like crazy. When he is not in those frequencies, the Pac-Man stops gobbling and turns black. Jake knows nothing about brain waves or his EEG, he simply knows that when the Pac-Man is gobbling and beeping, he is winning, and so he has learned how to adjust his brain waves to make the Pac-Man gobble dots all the time. It was easy: he caught on in just one session. As he spends more time in those frequencies his brain has trouble generating, his brain learns to function there on its own. This exercise makes the brain more stable.

It didn't take long for changes to begin to appear in Jake. "It took care of the teeth grinding within two sessions," Lisa told me when they returned from Jackson. "It took care of the sleep problems immediately." As the sessions continued, Jake became more settled, more centered. "We could carry on a conversation in the car on the way home for quite a while, the first time ever that we could carry on a two-way conversation for any length of time. His fine-motor skills improved, and he wanted to cut and draw and zip and button. He could never do any of that," Lisa continued. Unprompted, friends and relatives remarked that Jake seemed calmer and more centered. Later, Jake's parents repeated the protocol for another week. Again they noticed dramatic improvement. Jake went to see his pediatric neurologist, who had been skeptical at the outset, though he had signed off on the treatment. He examined the boy alone for twenty minutes. When he was done, he told Lisa and Ray that the treatment had indeed been effective. "Jake seemed more focused," Dr. Don Wight, the neurologist, told me later. "He could do things cognitively he couldn't do before the training. There was a qualitative and quantitative improvement in the way he was functioning. It was very real."

Jake's parents bought one of the $10,000 neurofeedback units from Neurocybernetics, a California biofeedback manufacturer, and have made it available to the community. Dr. Wight has been trained in the technique and has incorporated it into his practice. Jake has regular sessions with the local neurofeedback technician, Bernadette Pedersen, and continues to improve. In 1999, he received a three-year evaluation for his individualized education program in the public schools. "He had some phenomenal gains," said his mother. "He was an emergent reader going into second grade and after a year of steady training, he was reading at a fourth-grade level. One of the teachers called Jake's rate of improvement explosive, and I think it was."

Had Jake been born twenty years earlier, he would have had to live with his problems. But in the last decade this new treatment — called, variously, neurofeedback, neurotherapy, or EEG biofeedback — has dramatically changed the prognosis for Jake and thousands of other people. It is being used to treat not only epilepsy and learning disabilities, but also a long list of other problems that defy conventional treatment: cocaine, alcohol, and other addictions; vegetative states; serious and mild head injuries; autism; fetal alcohol syndrome; discomfort from menopause and premenstrual syndrome; chronic pain; the symptoms of multiple sclerosis and Parkinson's disease; stroke; post-traumatic stress disorder; wild hyperactivity; Tourette's syndrome; depression; cerebral palsy; and much more.

All of this raises huge questions. What is neurofeedback? Where did it come from? What are brain waves? How can one tool treat so many disparate problems? How can something that works so well, and seems to perform miracles, not be in widespread use? Answers to those questions begin with an understanding of the three-pound organ known as the brain.

The history of efforts to unravel the source of human consciousness goes back thousands of years. Hundreds of ancient skulls with carefully drilled holes have been found in a variety of places around the world. Anthropologists have documented a belief by some native peoples that trepanation, or drilling a hole in the skull, combined with prayer and ritual, could relieve certain physical problems, perhaps epilepsy. At one archaeological site in France, one hundred and twenty skulls were found, forty of them with human-made apertures. Some people apparently survived the "operations," for new bone grew at the edges of some of the holes — which ranged from the size of a dime to nearly half the skull. In Peru, anthropologists examined well-preserved, three-thousand-year-old mummies found near Cuzco and found that 40 percent of them had trepanned skulls. Stanley Finger, a neurologist who has looked at the finds, has estimated that there was a 65 percent survival rate. Whether the holes were made in a ritual or a de facto "medical" operation is unknown, but the mummies provide the earliest known record of making a connection between a person's head and his or her behavior.

In Egypt, a painted papyrus illustrates that three thousand years ago Egyptians recognized that a blow to the head could impair one's vision or coordination. A blow to the left side of the head, according to the papyrus, affected the right side of the body, while a blow to the right side of the head affected the body's left side, a description that proved to be fact. It was the heart, however, that the Egyptians revered, as the dwelling place of the human soul. (For most of human history, in fact, a "cardiocentric" view has dominated.) After death, the Egyptians, practitioners of an elaborate funerary ritual, removed all of the organs from the deceased and stored them in specially made ritual jars, except for one: the brain was simply pulled through the nose and discarded. The Aztecs also believed the heart was the superior organ and that it governed feeling and emotion, though they believed the brain was important for remembering and for knowing.

Hippocrates, writing between 460 and 379 B.C. may have been the first persuasive proponent of the idea that the brain is the source of human intelligence. Building on the work of two of his teachers, Alcmaeon and Anaxagoras, he had the prescient idea that epilepsy was the result of a disturbance in the brain. He believed that the gray matter was the source of many other things as well:

Men ought to know that from nothing else but the brain come joys, delights, laughter and sports and sorrows and griefs, despondency, and lamentations. And by this, in an especial manner, we acquire wisdom and knowledge, and see and hear and know what are foul and what are fair, what are bad and what are good, what are sweet, and what are unsavory. ... And by the same organ we become mad and delirious, and fears and terrors assail u s. ... All these things we endure from the brain, when it is not healthy. ... In these ways I am of the opinion that the brain exercises the greatest power in the man. This is the interpreter to us of those things which emanate from the air, when the brain happens to be in a sound state.

Hippocrates' view, however, was an anomaly, too far ahead of its time to be taken seriously. Aristotle, who came along several decades later, was a primary proponent of the heart-centered human, primarily because he had seen chickens running around after being decapitated. He had also touched both a human heart and a human brain shortly after the death of their owner. The heart was warm to the touch, while the brain was cool and moist, and so he reasoned that the brain was a kind of regulator that "cooled the passions and the spirit" and "the heat and seething" that originated in the heart. Aristotle was so well respected and influential that this view reigned unchallenged for centuries.

Galen, a physician to Roman gladiators and emperors in the second century, played a major role in the evolution of early thought about the brain. He believed there were four substances or "corporal humors": yellow bile, black bile, phlegm, and blood, which combined in a person's heart with "pneuma," a spiritlike substance. This solution traveled to the brain through a mesh of very thin tubes — which he called rete mirabile, or the miraculous network — and was then distributed to nerves throughout the body to produce behavior. Illness came from an imbalance in the fluids. Too much black bile, for example, led to depression and melancholy, while too much blood created a hot temper. The vital part of the brain, Galen claimed, were its ventricles: three hollow structures in the center of the organ that he believed contained this mystical animating substance. The fluid that created intelligence was found in the front ventricle, knowledge or mind in the middle ventricle, and memory in the rear chamber. (Ventricles do in fact exist; they are reservoirs for cerebrospinal fluid.) The rest of the brain, including the gray matter, was thought not to be critical. Adopted by the all-powerful Roman Catholic Church as the truth, Galen's "cell doctrine" reigned for fifteen hundred years, largely because, from the fourth through the fourteenth century, the church banned study of the human body. The dissection of human cadavers was penalized by torture or death, and the evolution of neuroscience virtually ground to a halt.

Then, in 1347, the Black Death seized Europe and killed a third of the population. The church's theories of medicine were proven woefully inadequate, and as a result the monopoly the church held on ideas about humans and their place in the world was broken. The Renaissance blossomed soon after, spurring a new burst of thinking about the human condition. By the sixteenth century, researchers were dissecting cadavers.

An anatomist named Vesalius may have been one of the first to question the cell doctrine. Because ventricles were similar in animals and humans, and animals were not capable of thought, he reasoned, how could ventricles be the source of thought? The difference between humans and animals, he believed, was a larger, more developed brain, and the true source of thought probably lay outside the ventricles. In the seventeenth century, Thomas Willis, an English physician, published a thorough text on the anatomy of the brain, in which he claimed that the brain itself, not the ventricles, controlled memory and volition. His work sparked a new way of thinking and would later convince researchers to abandon the cell doctrine.

Yet the cell doctrine survived for years after Willis's findings. René Descartes, the influential seventeenth-century French philosopher, is one of the most dominant early figures in the study of human behavior, and his influence still deeply impacts beliefs about the brain and the body, and even about reality as we know it. Descartes promoted the concept of dualism, the idea that mind and body are separate. He claimed that the ability to think was a gift from the Creator and the supreme aspect of human existence, while the body was separate and subservient to the mind, little more than a biological machine. His ideas were embraced by the church, and Descartes had laid the foundation for the next three hundred years of reductionism and the modern scientific method, which still dominates Western thinking. Nature is no more than the sum of its parts. Devoid of a soul, on death the human body and brain could be freely dissected and reduced to their component parts.

But the philosopher's work was not finished. If mind and body are separate, how do the two interact in humans? First, he said, involuntary movements were reflexive, an automatic response. Voluntary movements were a different matter. The spiritual belief of the day held that the body was animalistic, an unfit vessel for something so divinely elegant as the human spirit; so how did a godly spirit live in a body and run the show without becoming contaminated? And where? Descartes solved the conundrum of contamination neatly by claiming that the spirit entered the body by, and commanded the network of tubes and fluid from a single point: the tiny pineal gland, an organ in the front of the brain (named for its resemblance to a pine nut). Located there, the divine mind was almost completely untainted by the body; on death it simply floated out of the human "machine" and left it behind. Descartes chose the pineal because it occupied a central place in the brain, because it was near the senses, and because it was surrounded by cerebrospinal fluid, then still believed to be the liquid version of the animal spirits that allowed the body to move. Descartes's interpretation was the first attempt to assign a specific task to a specific part of the brain.