Case Study: Joey
Joey is a slender 13 year-old boy, who could be mistaken for ten or eleven, with dark brown hair and large, soft brown eyes. He comes to me diagnosed with PDD NOS, hypotonia of unknown etiology (a “low tone baby”) dyslexia, expressive language disorder, Non Verbal LD, short term memory impairment, fine and gross motor difficulties and possible incipient schizophrenia. He had a normal gestation and delivery but did have jaundice after birth. Apgar scores were normal. He did not walk independently until he was 18 months, did not speak single words until the age of 31/2 and not in sentences until age 6. In neurofeedback terms, this boy could be described as suffering a “timing disorder NOS”. He attends a special school for learning disabled boys. Everyone likes him. He is cooperative and easy to get along with. He perseveres with the very difficult tasks of math, reading and trying to articulate. He can, for good reason, feel frustrated and is often impulsive. As soon as an idea occurs to him, he has to act on it. There is no malice in him. He is on ___mg Wellbutrin.
Joey has a very compelling internal reality. People come from around the world and enter his body. They are there to be trained as trainers and to go out to help others by, in turn, entering their bodies and doing for them what they learned to do in him. This corps of trainers is responsible for the well being of 5 billion people, soon to be 9 billion. He described how they all drink coffee all night (amazingly, this boy sleeps well, although he has had three episodes of sleep walking). They have to be on the phones all night because of the difference in time zones (sic) and the level of their responsibility. He reported all of this to me without hesitation, genuinely and earnestly. As you will see, he is able to provide me with excellent feedback on the way he is affected by neurofeedback through reporting from and on this interior system.
Joey also believes that he is from a different planet and that there are others here with him that none of us can see. They speak their own language. In our time together he will make reference to these origins but unlike the international training company and the high school that he runs, he doesn’t tell me much about this.
Beginning TOVA scores:
Inattention- 0
Impulsivity- 73
Response Time- 96
Variability- 81
Joey begins neurofeedback.
With some gentle prompting from his mother, Joey looks at me and shakes my hand, limply. Handshakes are one of the first skills I teach troubled children. This boy is more jumbled than troubled but he still does not know how to shake hands. Next time I will teach him and then shaking hands will feel good to him-it will give him propreoceptive feedback and a felt connection between us. Because of his apparent need for training of both hemispheres, the global nature of his difficulties, his good attachment to his mother and his
history of sleep walking, I decide to begin training at T3-T4, expecting to bring the frequency reward lower during the course of the session. If he were autistic or attachment disordered, or there was less evidence of left hemisphere difficulty, I would have begun at T4 or C4. Throughout the session, he talked about the people in his body and the coffee they were drinking so that they could answer all the phones to make plans for the upcoming meeting of five billion people. He enjoys their presence, says they never rest, that they (and he) feel constantly busy in this important work.
Protocol: I began at 10-13 Hz, 2-7 inhibit and went down to 5-8 Hz, by the end of the session.
The next day, Joey reports that after the training the people inside his head were “so quiet it felt as if they’d left”. “They are working again today”. He did not like their absence last night. But he also said that “they liked the training (NF), a little bit”. There is, of course, a possible problem here. This child has lived in this system all of his life. Rapid changes in it could be hard for him. Helping him to adjust to these changes may well become the central therapeutic challenge. At the end of session 2 we were down to 4-7 Hz and he says that he feels good! And calm. His speech is slower paced. He gives me a firm handshake and smiles at me.
This child has been assessed multiple times and he comes to me with many descriptors but essentially with no real diagnosis. Since we don’t yet have ‘diffuse bi-hemispheric dysrhythmia’ as a DSM category, I can only attempt to describe the “feel” of him and “the look” in the best terms(and those least frightening to his parents) that I have available. Schizophrenia has been suggested and ruled out on several occasions, perhaps, again, because he doesn’t have that ‘feel’. His internal system is facilitating his relatedness, not replacing it. He is with me and describing this elaborate internal world as opposed to being in the internal world and barely related to me. For the same reasons, he does not feel autistic. This “world” may represent many things but I think it is primarily an elaborate and concrete narrative of the effort it takes for him to organize himself, to get his legs to walk and his voice to speak and the good he wishes to do with this great expenditure of resources. It is a description of circuits being overwhelmed by demand; a description of not only his mental processes but of his brain. We all spin our narrative selves from the firings of the brain. Due to his disability, Joey’s narrative may be closer to the source than most of ours.
We trained for 30 minutes each session. I am doing nothing more than neurofeedback and listening, as he generously introduces me to his interior world. We are new to each other. Joey is engaged in neurofeedback training daily when he is home from his special school.
Session 3:
Joey is back after a one day break. His response to my inquiry is enthusiastic. “Good!” We talked about the internal system’s reliance on
coffee which he defended because they had to stay awake, “there was too much to do”. I asked him if he knew that caffeine was a drug. He didn’t know this. I said that in all of my work with peak performers, it was the goal to reduce reliance on drugs; that I was for a drug free environment, was he? Perhaps neurofeedback could make it possible to do all this work efficiently without drugs. Joey hedges his bets. He can’t quite imagine this system functioning around the clock on multiple time zones without using caffeine but he also does not at all like the idea of drugs. We will see how this plays out for him over time but with the discussion of coffee, I have tried to provide a context, acceptable to him, for the changes he has already begun to feel.
His mother reports that he seemed to stand straighter than usual when he was on the treadmill. On the drive to the session, he was talking with her about planning a Lego city instead of the people in his body. In general, however, Joey is good on making plans, but poor on executing them. He read a book with his mother with less frustration than expected even though he is making the typical number of mistakes. His sleep and appetite are good, as usual.
Joey seems to be tolerating T3-T4 well. This session is 12 minutes at 4-7 and 9 minutes at 3-6. Mother is most concerned about his articulation, and since I want to understand, from him, the nuances of his experience, so am I. I introduced F7-F8. (In a little boy suffering anoxic brain damage at birth this protocol had a dramatic impact. It not only enhanced his ability to articulate but his comprehension of what was being read to him.) I trained Joey here at 2-5 Hz. He reported being a little tired after F7-F8, but good.
Session 4:
After the last session his mother called to report that Joey is “peaceful”. There is some increased hesitation in his speech that wasn’t there before the last training but that he has happened n the past. Otherwise, there is no change. I had asked her to be aware of any change in speech fluency because of the introduction of F7-F8. He is reading without protesting and without any evident frustration. The increased hesitation makes me suspect that the frontal reward frequency may be too low.
Joey, of course, has his own feedback. He pointed at F7-F8 and said, “These guys used to drink only coffee, now they are drinking ginger ale”.(!) He feels too that it is important that these guys get off drugs,(i.e. caffeine). He reports that he feels good and that “most people have a day off today”. There is only the “repair crew”. There are nine of them and only three are drinking coffee. They are reporting to him that “things look good, that they will be finished soon and that they won’t have to return in quite awhile.”
I don’t see any evidence of fear or loss about the changes he seems to be experiencing. A week later, the young woman who came in before him shared this observation: “I wanted to tell you about something. I was waiting for my ride and I saw a little boy arrive here with his father. He really wanted to see you. He ran up the stairs ahead of his dad. You could tell he really wanted to be here.”
During the training the day before I went at low as 3-6 Hz at T3-T4. While training, he reports no difference from his state at the beginning at 3-6 and there is no evidence that I have gone too low. At 2-5 Hz, after only a few minutes, he tells me that his hands feel heavy and demonstrates this by lifting his arms with elbows still on the chair in a pantomime of weight. This is not the kind of response during training that worries me, generally speaking. It is usually transient. But Joey is a precise reporter and I want to respond to his reports immediately, both because I think they are likely to be very accurate-he is oddly quite “tuned into” his body – and because I want to enhance his sense of agency. I went up to 2.5-5.5 and the heavy feeling went away. It may be important to note that he reported this body sensation directly as a body sensation. There were no middle men. He wanted me to train again at F7-F8 and so did I, so we trained a half a Hertz higher at 2.5-5.5 for three minutes.
Session 5:
This is Joey’s fifth session. He is clearly enjoying being at the office. He is at ease and begins his report. “Five of the repair crew are off caffeine. Four still want to drink it.” He fell asleep easily and awoke early to use the bathroom. When he saw the snow, he was excited but was able to go back to sleep. His father, who is with him today and who is not entirely unlike his son, reports that this is unusual. Joey would not have been able to return to bed, much less to sleep. There is, it seems, increased flexibility of state.
We continue training pretty much as before – T3-T4 at 2.5-5.5, 2-7 inhibit for twenty-one minutes, the frequency at which he had been comfortable last session, and 2.5-5.5 at F7-F8 for nine. Joey’s father had reported not much change in speech and mother who had called before they arrived still heard some hesitation in the gait of his speech. I don’t want to go much lower because of his learning disabilities and my prior experience in other situations, in which training too low frontally had increased dyslexic confusions. I don’t know quite where to ‘place’ this symptom in the frequency domain, although it is clear to me that it relates directly to the training.
During the session, Joey comments. At four minutes he says: “The company called up and said no more coffee, putting bad things in coffee.” At 7 minutes he says that “the repair people are finding other bodies to work in”. Joey reports that he himself is feeling good. “It is a little busy [in his body], due to the holiday season.” Again he asked for F7-F8, saying that it felt good to him. Before switching placements, the people asked him to set his watch (!!). I wonder if he is telling me about a timing change. Could it be that all of his metaphor about timing zones and the amount of resources required to keep them all communicating is a rather direct communication to me about timing faults?
At the end of the T3-T4 epoch, he reports that the crew “training for the job do not want to get off caffeine.” This could mean that we are training too high, that his brain still feels like it is on caffeine or that we trained too low and that he feels the need for more stimulation. To date, I have taken the caffeine to signify overarousal. I will stick to that hypothesis even with the rather sudden turn of events later that day.
Joey’s mother called to report that he was very ‘hyper’. He could not sit through dinner without jumping up to attend to whatever had just occurred to him to do. As we talked about it, his mother agreed that his behavior seemed more impulsive than hyper. He had to act, it was purposeful, it just could not be postponed. The family had never seen this behavior before. After dinner, he went to his room and initiated a project, also something they had never seen him do. He recorded the ‘sounds of his planet’, the strange noises of the place he comes from. He wrote about himself and smiled and laughed, appropriately, at himself and at what he was writing. I wonder if he is constructing an archive.
Both mother and Joey report that he has been happy. He slept well and he is still craving and ‘sneaking’ chocolate. Mother, who is an OT, felt that it was harder for him to articulate, that he wasn’t placing his tongue in the right place to make the ‘th’ sound. This was not new; it was an old pattern, but one he’d learned to correct. As has been true since the beginning of the training, he is reading without frustration even though he makes a lot of mistakes. He still has no bilateral movement but mother reports that he stands more upright.
I think it’s time to try a new protocol. I decided to keep nine minutes of T3-T4 (2-5) in the picture, mostly in an attempt to keep the hemispheres talking to each other and to address, however minimally, the profound left hemisphere deficits. My objective at the beginning of this boy’s training is to help him quiet himself. I began at T4-P4 at 6-9 reward, 2-7 inhibit. At 6 minutes, he reports not feeling the training so I dropped it to 5-8 then to 4-7 Hz. Altogether, at T4-P4, he trained for 15 minutes. He liked the right side training at 4-7 Hz and told me that “the files are being cleaned out. It smells bad in there, like someone forgot a sandwich.” A little later, “All the old files are getting a good cleaning.” He told me this with alot
of delight.
He was feeling this mostly in the back of his head. This is where his
“files” were – right where he makes alpha, in “the back of his mind”.
(quotation marks mine, just where I think we may all find some old memories. He did not want to train at F7-F8. We didn’t. It is of note that at the same frequency today that several days ago led to heavy hands (T3-T4, 2-5 Hz), he felt fine. He shook my hand with a firm handshake, one that was close to being his own.
I asked his mom about whether it was unusual for Joey to talk about his
body sensations directly, as he had about his hands when he was training earlier in the week. She said that typically he would only be able to say that his hands felt “funny”. “Funny” is his ubiquitous descriptor for strange body sensations. It was unusual, she said, that he used the word ‘heavy’ to describe his hands. Of course, I am now not sure whether I gave this word to him. I am sure that he showed me that they were heavy and used the word readily. I wish I knew, just because you like to recognize openings in another’s mind and not create them in your own.
Session 7:
Joey reports that his body feels ‘quiet.’ There are only three phones going and they are needed because “people are getting ready for the first meeting of the winter”. He continues “cleaning out old,
junky folders.” Mom reports that he has been calm. There were no signs of the impulsivity he was experiencing yesterday.
Mom lets me know that Joey never makes any reference to the people in his body when he is at school. He can clearly inhibit talking about the system even if he can’t inhibit the system itself. He was however talking to himself last night, a habit of his. At school, he avoids social sanctions against this behavior by going into the bathroom when it starts.
As the session is beginning, Joey reports that an old man is coming to
his body that he has not met before and that he is planning to die at
midnight on the 103rd anniversary of his birth. He believes that this man may have run the training program at one time.
At 14 minutes into the session, Joey shares an important update: the old man has died on the airplane on his way to his body. Smiling, he says that this is good because “it is upsetting to other people inside to see someone die.” My assumption is that Joey is telling us something important with this story but I can’t decode it.
After this session he went to school. His mother spoke with him a few days later and he said that his body felt funny. She said it became clear to her when she explored this with him that he was sad about being away from home. This was the second time in his life that he had ever expressed sadness. The first was when he had started at the school two years ago and felt worried that none of the therapists there would be able to help him. I asked her if he cried. She said that Joey had never cried. This is also the case for her. In fact, she reports that no one in her family cries. I will look for the capacity to cry as a positive training indicator, for both Joe and his mom.
(To better understand her son’s experience, she is training as well)
He had never before expressed homesickness. It seemed to pass quickly though. His mother offered to get him for the weekend before the Christmas break and he said that he would be alright, that he could wait until Christmas. This, too, was unusual for Joey and his mother thought it a good sign.
His teacher reported that he seemed to be ‘getting things’ with a little more ease. His mother said that she asked him how his classes were and he answered her, directly, for the first time. He said they
were learning about gravity, and he went on to try to describe what the
lesson was. He couldn’t make this clear. It was a first that he used such a word as ‘gravity’. He was also complaining about headaches. I am not worried about his sadness. I never address sadness with training. Any emotion that flows is, to me, a positive emotion. But the headaches are a concern and probably mean that I have trained him too low, at least for his present brain.
Session 8:
Joey returned from school last night and he reports, in session today, that people in his body are not as loud. He has had to kick three people out who have been drinking coffee. There are two new doctors in his body who are researching how to make better coffee, coffee presumably that is less harmful but can still keep the night operators awake for their important duties. Lots of people, he reports, left at midnight, to go on vacation. They are, he assures me, coming back. Once again, nine are left and some of these were sleeping as he gave me this update.
He reports some headache after the last training but not bad. He says it feels easier to remember what is going on in class, but he does not remember my name. He’s a little embarrassed to admit this and I
share with him that I am terrible with names too. I realize, at this
moment, that he had never seen my name written, so I sat next to him on the couch and wrote it out. I asked him if my name reminded him of
anything – like a burning ocean. I was attempting to provide an image to see if this would aid his recall. I don’t think he saw it. It was itself an unimaginable and incongruent image and he doesn’t have the facility with language that puns require. (Punning may be a good indicator of sensory integration capacity). So he drew a blank until he remembered his teacher’s name which he had forgotten just moments before. There is also some element of performance anxiety in this forgetting. I think he feels put on the spot and then unable to ‘perform’ memory. Today he planned, executed and finished a rather elaborate Lego project.
He was rattling off the account of all the activity in his head when I
asked him if he would stop for a second and breathe. I thought, in the speed and excitement of the moment, that he might be producing some of the very activity he was reporting. He stopped immediately and tried to take a breath but had great difficulty coordinating this activity. He was quiet and was clearly taking an internal inventory. He wants to tell me that there are some number of new doctors. He counts on his fingers as he looks inward. There are two old doctors and two new doctors. Different areas of his body require different doctors (specialists). “Four at night and four during the day”. I think doctors are always on duty, like an emergency room.
No change in placement but I bring the frequency down on the right at T4-P4 in steps to 2-5 Hz. During training, he begins to jiggle his foot. (the impetus to reduce frequency) I asked him about that and he said he was thinking. His foot was thinking, or helping him to think. (this could, of course, also be an indication that we have gone too low and he needs, as it were, to wind himself up). He pointed to the electrodes and said, “People are taking notes and learning how to do this”.
When his mother and I speak of him in the third person, his body tension, as represented in the amplitude of high beta frequencies, goes up. I reported this, saying ours would too, but Joey said that he isn’t listening to us (this seems to be both the case and not the case) because he is “teaching people how to do this (neurofeedback) and to help others with their brains”. I asked him if he needed any help answering their questions on how the brain worked and he politely declined the offer. He could answer their questions himself.
Clearly Joey is learning something of value to him and something that he wants to share. This is the kind of boy he is.
Session 9:
My daughter Blake, a child therapist and neurofeedback practitioner, worked with Joey during the time I was away on retreat over
Christmas. She had filled in for me once before and she asked him if he remembered her name. He did. He also remembered my name. He told her that two new people had entered his body to train, one whose name is Blake and one whose name is Sebern. He had a brief headache after training but it disappeared quickly. His sleep and appetite are
good.
His mother reported that Joey was working on the computer (looking up Lego information) and that he got stuck at a website that he didn’t want to be at. He told her that he was “frustrated”. The fact that he used the vocabulary of emotion signals a significant change. In these circumstances in the past he would have used the word “funny” if asked to describe his feeling. They made candles when they returned home and Joey was focused and relaxed. He reports that he feels good physically and that there aren’t a lot of people presently in his body. Only nine. There is some coming and going of the trainers and there is still active testing related to caffeine consumption. He has instructed those who are present to follow along with his NF training and to use this to train others.
About twelve minutes into the session, Joey says that he is being asked what the red and blue lines at the end of each period mean. Blake explained what they are and he said that was what he thought. Soon after, he reports that he is feeling relaxed (training at T4-P4 at 2-5 HZ after 6 minutes at T3-T4 at 2.5-5.5 HZ )and that those people who are focusing on the NF will be trying it on their own and will ask him questions. About ten minutes later, he tells Blake that some people want to keep doing the training at school, at night but that he isn’t happy with this idea because he is worried that they will make a mistake and mess up his body. I wonder when he says this if he is expressing worry about Blake and me, if he is trying to tell us that we might be making a mistake. He has been getting headaches and he has felt training effects in his body. I will listen specifically for this worry. He is, it seems, internalizing us and the training. Neurofeedback is becoming his own endeavor and he isn’t sure, really sure, that it won’t hurt him. All reports are positive except that there is no change in the clarity of his speech. He is able to make the ‘th’ sound but in general multisyllabic words are still tripping him up. He often misses the ‘lifter’. None-the-less, he is cooperating with his mother’s speech lessons. Joey is earnest and sincere in all his efforts. He is a boy who really tries. It is just very hard for him to speak, to remember and to move in a coordinated way. But his handshake is terrific. He is making his presence known.
Session 10:
After the last session Joey and his mom went for a walk in the woods and he was engrossed with people inside him who were “ordering parts from Japan and China on computers”. Blake asked him what kind of computers and he said, “Neurofeedback computers”. They were looking into “creating a neurofeedback laptop system that could be mobile”. (His mother knows of such systems and has probably spoken to him about them.) One person (only one!) is bored with the neurofeedback games. Joey reports no negative effects but mother is concerned that his speech sounds a little “slurry”.
Not only did he remember Blake’s name, she now has 3 or 6 namesakes within, and there were some people who have the name Sebern as well. But there is also a trouble maker in the mix. One person that he trained before (before NF) is smoking, he is breaking the rule. This person has been out drinking and he may have robbed someone. About seven minutes into the training, Blake compliments Joey on how he is keeping his body tension low and he responded, “How could that be when I am yelling at the person who is smoking”. He doesn’t want to have to kick him out; he doesn’t want to kick anyone out. Later he reports that this man has been sent to a doctor for training and that he will stay if he complies with the treatment. Near the end of the session, Joey reports that the smoking person, the rule breaker is in treatment with the doctor and for now can stay in the system. I wonder who or what this is in Joey?
Once I begin training, I pay special attention to the content of dreams. If dreams or fantasies become aggressive, this is just as significant a training indicator to me as it would be if the person had acted aggressively. It is an early warning system. This does not represent a concern about impure thoughts. It also does not represent the neutrality or analytic curiosity of my therapeutic training. It is, to me, an indication that I am pushing the nervous system in some way that is not beneficial to the pursuit of regulation, equanimity and relatedness. The same will apply here as Joey represents the nature of his internal life in these characters, these articulated aspects of himself. He is a cooperative soul, not one for robbery or breaking the rules. But a smoking, drinking mugger has shown up now and this indicates the need for a protocol shift.
Joey has begun to talk more about his complex inner world. He is not at
all reticent to do this. Some of it will come as a surprise for one so
young. Joey has been married twice and is presently still married to his second wife. Both former and present wives are reticent about having their names spoken so he doesn’t say them. He doesn’t remember when he married his first wife but he does say that she had to go away on a lot of business trips. He has had a child with this woman, a boy named Mono. (Joey was born in South America, his mother is North American, his father, South American. Mono is Spanish for monkey.) He is not sure how old his son is. His first wife returned to her first husband. Soon after, he married his present wife. All of them work at the SimpsonSchool, named after Homer Simpson. This is a network of schools which were begun three years ago. Joey is the principal of these schools which are located now in California, Arizona, New Mexico, New York and Washington, D.C. (not in Massachusetts or Vermont). A new one is forming in South America. These schools are co-ed and include middle school, high school and college. They focus on vocational education, making bicycles and electronic equipment. There are no elementary grades, which is the level that Joey is actually, presently in.
It is interesting that these are co-ed schools. I am not sure of this, but it has seemed that all the internal people, with the possible exception of those named Blake and Sebern who have entered the system recently, are male. Of course, there are also the wives. Joey attends a school for LD boys. The course of his married life does not parallel that of his parents and the placement of the schools are not in the places where he has actually lived, although they may be places he has visited. And then there is the son, Mono, in Spanish meaning monkey and in English, the single one. Although I remain interested in the possibility of idiosyncratic meaning in all this, I don’t think, at this point, that it has much depth. It feels more like mental Lego
blocks, something to keep his mind occupied when he is unable to use it for more creative pursuits. I think this elaborate world speaks to his loneliness and I think, as well, to his refusal to be helpless to his brain. Could Mono represent the wish to be the only child, it could. It could also speak to how singular he is or how alien. It could also be a more random brain product, a blue block in a set of red ones.
It may be how matter-of-fact Joey is when he is telling us all this, but there is an interesting way in which, although his internal world is complex with intriguing history and sets of relationships, none of these revelations make Joey himself seem either more complex or more crazy. This is a preservative inner world which has a lot of numerical detail and is heavily populated with what seem to be hard working, altruistic, mostly male people, but it is also a flat world. His mood is mostly good, with rare excursions into irritability, and in some essential way, he too, is flat. He has an elaborate inner world but no inner self, no emotional self. There will be a time when Joey begins to feel, and when he does he will also become more aware of the extent of the disability he has lived with. This, I imagine, will be a difficult passage.
The training today is T3-T4 2-5 Hz, 2-7 inhibit for 9 minutes and T4-P4 at 2-7 for twelve.
Session 11:
“Peaceful”. This is the word that Joe’s mother uses first to describe her son’s state. But Joey doesn’t report feeling much calmer even though the people inside are slowing down some. There is some fighting going on inside for more pencils and pens to take notes on the neurofeedback. It’s not peaceful inside because of yelling at a person who did not finish his paperwork. “Sometimes the feelings on the inside are not the same as on the outside”, he reports. Sleep has been good and he has had no unpleasant effects-no headache or stomach ache. No bad dreams.
When switching from T3-T4 at 6 minutes to T4-P4, Joey reports that the
person who was “in charge of filing cabinets” has left because he was
“drinking coffee”. A new person has come to do the job because “it is so boring”. The job requires a person to be available to open drawers with a key, to access information, including mail. Is he talking about quieting when he talks of fewer people drinking coffee, or is he trying to be compliant with my anti-drug campaign? I don’t really know. Mom adds that Joe often refers to the parietal area as where he has “information clogs”. It looks like P3-P4 may be in order for this boy.
In the midst of the session, Joey volunteers that he has just had an old thought that he doesn’t need to think about anymore. His mother sees this as good news because Joey tends to perseverate. A bit later, he reports that “nine more people came into [his] body to do neurofeedback and that it is now overbooked”. He was asking people to make more room. “But it is good because these people brought laptops”. Of course, Joey’s whole system could be seen as a well populated perseveration.
Unfortunately (I think), at the end of the neurofeedback session even more people were heading in. They all seemed interested in neurofeedback, but there is a sense of frenzy, of rush, even while Joe himself looks calmer. Maybe it’s an expression of appreciation of neurofeedback (he loves to come), but I am looking for less activity in the system, not more flights to catch, or people to manage. There has, thankfully, been no mention recently of the convention of 5 billion. Even if they are all doing neurofeedback, that’s too many.
Today’s protocols: T3-T4 at 2.5-5.5, 2-7 inhibit for 6 minutes; T4-P4 at 2-5, 2-7 inhibit for 24 minutes.
Session 12:
It is the day after Christmas and I am back from retreat. Joey has dyed his hair blond! He reports that it is not too noisy inside and when I ask him, he says that he is paying less attention to the internal world. His main concern today was how to keep the second floor of his Lego building from collapsing. “It needs Lego steel”, he said with a smile. He still wants chocolate whenever he can get it. With a gentle reminder from his mom, Joey hands me a candle that he has made which is quite beautiful and with it a note that he has written, “I am glad you are working on my brain”. I thanked him for both the gift and the card and I asked him if he really felt glad that I working on his brain. He answered with absolute certainty and sincerity, “Yes.”
Mom reports that he lost his necklace this AM, a very important necklace and in his agitation over this loss, he hit his older brother. It wasn’t clear exactly what provoked him, if anything other than baseline agitation and fear over the loss, but it is very unusual for Joey to act aggressive physically, or verbally for that matter. His mother would have expected his agitation at the loss of his necklace, but not his striking out. He calmed down quickly but only after finding the precious object. She also feels that he has become somewhat defiant. This may also be, as she suggests, that “he is clearer now about what he wants and doesn’t want”. He refused oatmeal that was made for him this AM, something he would not have done. It didn’t appeal to him.
Generally, his spirits have been good and he has been a pleasure to be with, as usual. He wrote an e-mail to a girl he knows in Israel who has severe CP, to help cheer her up.
I dropped T3-T4 out of the protocol. I could not see what, if anything, it was contributing and had some concern that it might be exacerbating his moments of negativity and reactivity. I have seen this before in others. I added T3-F3, 6 minutes at 12-15 HZ for speech and attention. I think craving chocolate also indicates the need for some left side training. Chocolate consumption is now linked to depression and seretonin production. We hadn’t made much progress initially at F7-F8 on speech, so I want to try something else that stays in the areas for receptive and expressive speech. The frequency is based on how low I’ve gone on the right without discomfort and my overall assessment that this boy is primarily over aroused. T3-F3 makes him a little sleepy after six minutes, but he likes it.
Since I think everything that someone does, feels, thinks, eats, and
dreams relates first to neurofeedback (actually to timing phenomenon), until it can be ruled out, I am left wondering if I have pushed his nervous system too low, so he feels without resources or too high so that he is feeling driven, aggressive. I think, in part because he is training so low already and in part because of that ‘winding up’ action that we saw recently, that too low is the better guess so I begin to bring him back up at T4-P4. When we get to 3-6, he likes this. Initially, he hadn’t felt very much at 3-6 Hz but he has been training and his brain changes. That is what we expect. So frequency changes too-not always, but often.
Joey is very attentive to his training. He focuses on the screen, even
while trying to manage all the ruckus within. He seems to ‘get’ the task and to able to discern what he feels, if not yet able to describe it well in words. I always forget, and he always reminds me, that he loves the dolphin, a stuffed animal that vibrates when he meets EEG thresholds. When I give it to him, he tells me it’s not on and I reply that it’s time for me to get with the program. I hit ‘T’ and it starts. The weight of it soothes him, I think, as well as providing tactile feedback. The training, it’s clear, would not, for him, be the same without it.
Today’s protocols: T3-F3 at 12-15 HZ, 2-7 inhibit for 6 minutes; T4-P4
at 2.5-5.5 for 17 minutes and then up to 3-6 for 7 minutes, both at 2-7 inhibit.
He reports feeling tired after T3-F3. Otherwise, “Good”.
Session 13&14:
I made protocol changes at our last meeting together. I could not see any positive (or clearly negative) contribution of T3-T4 so I am trying T3-F3 in its place, to address speech and general frontal activation. I am also beginning to go up on the right side. So my protocol now is T3-F3 at 12-15 HZ for 6 minutes and T4-P4 at 3-6
HZ for 21 minutes, 3.5-6.5 for 3 minutes at the end.
There is little of note after the last session except that both Joey and his mother report that he is feeling good. Mom says he is ‘peaceful’ and’ easy to be with’. Sleep is good. Appetite is fine. All objective markers are good, not dramatic at all, but good. During the training today, Joey reports that he likes both sites and that his “head feels calm and quiet” with right side training. But at the end he does offer that he is feeling tired so we raise the frequency to 3.5-6.5 and he reports liking this frequency better.
The next day, session 14, father reports that Joey was in great spirits. Joey agrees and is animated in describing that the internal world is busy but quieter than normal because “people are still away on vacation and they are expected back in nine days.” Phones are not ringing much, but he expects that to change when they return. Last night, “nine people finished training”, which now means neurofeedback training, at least as part of the mix, and are ready to start training others as soon as they get the computers. He also reports that more people want to “come in and train on the neurofeedback system”. About half way through the session, Joey discovers that, in fact, the computers arrived at midnight.
I wonder about the significance of the number 9 to this boy. It comes up repeatedly. And then, there is midnight, the almost mystical time of
transformation from night into day. It is a time of great darkness and there is still a long wait for dawn, but midnight is a hallowed and often scary time in almost all systems of mystery.
One gets the sense that Joey is looking forward to the return of the
post-holiday crowds and all the activity. Again, in the language of
defenses, you might wonder if he is frightened by how quiet and perhaps
lonely it is, that he is bringing these people back to keep him company and to keep feelings at bay. Inside his head, Joe might be thought of as a ‘workaholic’, keeping himself distracted from sadness by faxes and reports and phone calls. He is also called upon to be the manager of vast internal systems. And, of course, we all are. For most of us the narrative of our states begins outside the brain; for Joey it starts within as he tries to communicate and make sense of what might otherwise be chaos. He is attempting a self-regulating, self-organizing narrative.
Session 15:
Joey was singing yesterday, singing while on his way to go skiing. His
brother reports that after listening to his new CDs, Joe was remembering, repeating and singing the choruses. Singing is new behavior which suggests a few intriguing possibilities. Singing may well signal that he is developing new timing capacities, particularly in the right hemisphere. It could mean that he is feeling less self-conscious and willing to try to sing, a behavior that many of us are, reasonably, cautious about. And he is remembering lyrics. This is also a new capacity. Remembering lyrics may suggest that he is beginning to positively affect left hemisphere function.
Joey’s presenting problems include seriously impaired short-term and working memory, as well as auditory processing problems. It is, of course, difficult to imagine how one could have a good memory with major auditory processing problems which manifest clearly by age 2. Mom, who is an attentive Occupational Therapist reports that he has good bilateral action in his legs while skiing but that his arms still do not move bi-laterally and in rhythm with his gait. There is no change in the clarity of his speech.
Joe himself has no complaints. Things in his head are “medium quiet”. He makes the hand motion for metza-metz. There are phones, copiers, printers all going and there are people walking around. It has the feel of the offices of the New York Times. “Only three people on Coke (cola) and only one person on coffee.” In response to my question, he says that it might be easier for him to think. He has been snow-shoeing – a good activity in the two feet of snow we have here, as well as skiing. The rest of the time he is surfing the web looking for stories about animals and animal care.
He sits down to train and does so with admirable attention and earnestness. It is inspiring to watch him, actually. I, of course, forget the dolphin and he is pleased to remind me, politely, that he would like to have it. He holds it to his chest. He does report times that he is talking to those inside, settling a dispute, checking on someone new who has arrived, or giving instructions, some of them about neurofeedback. In fact, this dialogue with the internal (as distinct from internal dialogue), may be going on constantly and in preference to communication with those outside of him. This feels neither psychotic nor anti-social. I would be concerned, however, that left unaddressed, his disorder could develop psychotic dimensions of disregulation. For now, I imagine his speech is fluid and easy inside his head. And, of course, there, he is in charge, even if a little overworked.
I decide to target speech areas specifically, and individually to see if we can discern a difference. Articulation is such a large part of his problem and I would like to see some clear impact on it, if possible, before he returns to school. So, I make another shift in protocol. At the end of the training, he is smiling and yawning.
Protocols: F7-A1 at 12.5-15.5 for 3 minutes. He starts to blink his
eyes repeatedly, so we go down 12-15 HZ. His blinking stops immediately. Then T3-A1 at 12-15 HZ for 6 minutes. So 12 minutes left side training and then T4-P4 at 3.5-6.5 for 18 minutes. All with 2-7 inhibit.
Session 16:
Joey’s speech may be a little clearer. Mom had reported when Joey’s speech had gotten worse after F7-F8, tried first at 2-5, then at 2.5-5.5, He lost the ‘lifters’, which, of course, had taken him years of speech therapy to develop. This is the kind of result that would have really frightened me when I was new to neurofeedback. Primarily, now, it lets me know that this brain is responsive to the training, but it still cautions me. He was a little clearer in making the distinction between the sound in ‘sink’ and in ‘think’. To test this, his mother asked him where he washed his hands and he momentarily got jumbled and answered, ‘think’. He knew immediately that it was the wrong word, perhaps from the way it felt in his mouth, perhaps from his mother’s face, and he corrected it himself and said ‘sink’. No more detailed report from his father except for, “He is a wonderful kid. Isn’t
that right, Joey?”. Joey nods and looks self-conscious to me, like anyone else who doesn’t quite know what to say to a compliment, particularly to his father’s compliment. Joey hears this regularly from both his parents. They love their son and at the same time you can’t help but hear their anxiety, their deep wish to compensate for the wrong done to his brain. It is full-hearted and it is pained and at moments, it is just acceptance. Acceptance without giving up. I wonder if Joey senses all this too.
He tells me with some delighted anticipation, that “everyone is coming back – it almost sounds like ‘coming home’-for New Years”. “Flying in from all around the world.” Everyone will be here by midnight and they will stay (sigh) to work on his body.” There are 24 in all (one for every hour?). And I thought we had gotten down to the skeleton crew, the maintenance team who thought they’d be done and out for quite awhile. Perhaps he thought this too. I find myself worried that he has had his own private experience of hope and loss of hope, so I look for this in him. I see no sign. No journey is linear. Joe’s won’t be either.
Protocols: T3-A1 at 12-15 HZ for 6 minutes; F7 at 12-15 Hz for 6
minutes and T4-P4 at 3.5-6.5 for 12 minutes and 4-7 for 6 minutes. I made the change because he started to rub his eyes. He corrects for this state by sitting up. (We do this intuitively. The more we recline, the more slow wave activity we make.)I correct for it by raising the frequency. He doesn’t, somewhat uncharacteristically, feel the difference.
Session 17:
It is the New Year, ten days before Joey returns to school and I won’t be able to see him often. I feel as if I am still searching for the right protocol, but perhaps I am really looking more for the dramatic break through. Joey’s brain requires patience of him and it will ask the same of me.
As is his custom, Joey does not report any feelings or internal states, at least those that are not represented by the United Nations within. He reports that everyone has gathered and that he has no physical or emotional distress. Today, in fact, he doesn’t tell me too much about the internal activity, but his mother reports an unusual moment. They were visiting family on New Year’s Day and Joey emerged from the group of children downstairs, looking sad. To himself, in himself, Joey doesn’t have this emotion. He has no reference point for it. Whatever has injured his brain has greatly impacted his emotional range and further impaired any ability to talk about what may arise, unbidden and unknown, somewhere as feeling. (Sadness, it seems, may be missing from the emotional repertoire of the whole family.) So when his mother asked him that day if he was feeling sad, he predictably said “No” and less predictably, gave her a forced smile.
It leads me to wonder what concrete representation there could be of sadness. How could he tell and how could he tell us, if he knew? His mother still felt he had looked sad, even if he didn’t recognize it. As she was telling me about this, I looked at Joey for his response. From what I could discern, he wasn’t tracking the emotional content of her report. She went on to say that he bounced back quickly and was his usual happy self the rest of the time.
Were Joey to experience sadness, I would see this as good news. I don’t, in fact, imagine that he would be able to reorganize his brain function without at some point coming up against the reality of how badly disorganized it has been. In short, I think his gains will require his experiencing his terrible losses. And when he does, he will feel sad. Was that what was happening that day, for that moment? I never see sadness in anyone as a negative training indicator and I never try to train anyone out of it. These are feelings inherent in living in touch with ourselves and with the world we live in and they flow through us. It may well be the case, since no one in the family reports feeling sad, that when Joey does, they will need help letting it happen and letting themselves feel it too, for him and for themselves.
During the training, Joey tells me that three people are still missing and then later on, that he has “Just found out that they got in at midnight, just in time for the New Year.” It is a new year. What will it hold for this boy?
Protocols: T3-A1, 6 minutes, 13-16 HZ; F7, 6 minutes, 11-14 HZ; T4-P4, 18 minutes, 4-7 HZ. 2-7 inhibit at all sites.
Session 18:
Joey is preparing to return to school and he has in the past represented anxiety about transitions as increased activity in the
internal realm. It is as if he is bringing in the reserves to make the move back into boarding school. (Generally speaking, transitions can often be experienced as episodes of acute loss). Given this reality, it is a little difficult to discern the meaning of the report that he is more agitated. But I use my rule of thumb: once you begin neurofeedback, everything is related to neurofeedback unless you can rule it out. So the report that he is rushing when eating and that he is going to bed later and that his older brother feels he is more agitated are data about the training, more than about anxiety, per se, about returning to school. Joey reports that his mood is good and that he is looking forward to going back, but that not everyone inside knows that he is returning soon.(??) During the training, he reports
that his internal world is getting quiet but that there are meetings going on. He isn’t sure what the meetings are about.
Again looking for the optimal protocol for Joe, I decide to try training at C3-C4 instead of T3-T4 and to return to the association cortices with P3-P4. Today’s protocol: P3-P4 at 10-13 HZ for 12 minutes; C3 at 13.5-16.5 HZ for 6 minutes; and C4-P4 for 12 minutes at 6-9 HZ. I am hoping that his brain will give me a clear sign of the path to follow. I think it will if I can be aware enough to discern it.
Sessions 19&20
“It just feels right. I don’t really have specifics”. This is Joey’s
mother’s response to the P3-P4 protocol. She goes on however to report that he has been impatient with her helping him, wanting to do things by himself. Initially she described him as a little more animated but also more impulsive. As she went on, she described some playful behavior that was also somewhat aggressive-he pushed her. He isn’t known to rough-house like that. He is less receptive to her touch.
Of course, I am wondering what’s what here. Joey, although he looks closer to ten, is 13. These behaviors could be those signaling the approach of adolescent autonomy. But then she went on to describe his voice as loud and Joey as easily distracted. OK, this part has nothing to do with normal developmental pressures. This indicates to me, too long or too high on the left side, or both. He has been more talkative with the interior but he is also singing better. He is learning a chant for his bar mitzvah and is beginning to pick up the melody. He read two poems well to prepare for the ceremony, but there is no change in his articulation. Still a little less clear than when we started.
He was re-evaluated by a psychiatrist at Children’s Hospital who has been following him and he felt that Joey was doing well. He maintained him on Welbutrin. When Joey and I talked he said that there was ‘no coffee at all, only 2% caffeine tea’. I asked him if things felt more organized in his body and he said yes but I am not sure if he knew what I was asking.
Overall, he seems a little too jacked up, so I feel I may be too high
everywhere. His mother expresses some concerns that since he does not know how to cue socially, this impulsivity will cause him trouble at school, so I make the following protocol decisions:
Protocols: P3-P4 at 8-11 Hz (down two Hz) for 9 minutes
C3-CZ at 12-15 Hz (down 1.5 Hz) for 3 minutes (down from 6)
C4-P4 at 5-8Hz for 9 minutes, then to 4-7Hz for 9 minutes (down from 6-9)
The next day, the last training before he returns to school, Joey is
smiling and calm. Mother reports a good night, talkative at the dinner table but related to the family. He reports no bad dreams and waking rested. When he was asked about his internal world, he said that he hadn’t spoken to anyone yet today but the question seemed to wake them all up. Or the training does. As this happens, he reports that he doesn’t listen to the audio feedback-he is very attentive to the visuals-because he is talking to the people inside his body. There are seven people today preparing him for his return to school. He also reports that he is getting a new heater in his body, because the old one is not regulating temperature very well. He knows the person from the heating company, a man that used to work for him.
Temperature regulation is an important brain stem function
and it seems as if we may be making him cold. In my experience, this is an indication of a major shift in brain function, and can be an indication that we are training too low. But he has gotten the problem under control evidently, so for now, I am not concerned. He also reports that there are women in his body and that they are in charge of cleaning and vacuuming (he seems to be absorbing cultural sexism without too much difficulty!) He also reports that the group in his body is cooperative with the changes in his internal world.
The only change in protocol is to go to 4-7Hz at C4-P4 for the entire 18 minutes, to help maintain his sense of calm, to enhance his social cueing and to keep him out of trouble with his somewhat tough peers. Tomorrow, he returns to school and I will miss him. His mother will let me know how he is doing at school and I will see him when he comes home for visits.
Session 21:
Joe has been back in school for two weeks and everyone describes him as
“peaceful”. He is still struggling with the clarity of his speech and is having no luck grasping math concepts. His mother reports that he was somewhat “hyped up” after the last training, that his mood has been good and he has been doing fine at school. There is, however, an increase in his “grappling for words”. Perhaps most importantly, he has invited a friend to stay over with him. This is new behavior. His mom says that in the past he had to use the weekends as “recoup time”, and that he never asked to bring someone home. It may be the case that the exterior world of peers is beginning to compete for his attention.
Again, as training starts, the interior system wakes up and he is excited to report that something very good is happening. Animals are being trained to work in people’s bodies, as well as people in the bodies of animals. Dogs and cats are involved in this program but soon it will branch out to wild animals and fish. Blake is working with him today, and she has brought her dog with her. She wonders if Joey is inspired by this. Joey loves animals. In the summer, he rides his bike to the zoo nearby his home, he watches Animal Planet devotedly, he surfs the web looking for articles about animal care and he has a Chocolate Lab whom he loves. He would want animals to have whatever he felt was good for him. He goes on to report that a lot of people
want to do neurofeedback training. During his session, they started training a dog and he is concerned that they may have “messed the dog’s mind up” because it is difficult to keep the dog quiet.
Is he trying to alert us to problems he feels in his own training? Within several minutes it was also difficult for Joey to stay still. He was beginning to fidget. It is always hard to discern the meaning of this particular behavior, even when someone can talk to you about it directly. It could be a manifestation of overarousal, a discharge of excess energy, or an attempt to keep the system alert? Blake, operating on the first assumption, chose to lower the frequency and Joey’s body quieted for the remainder of the session. Given that he felt hyped up after the last training, that he returns to school at the end of the weekend, that his mother expressed some apprehension about his miscuing in a hyped up state and this in-training response, I think, Blake discerned this accurately and made the right protocol adjustment. Neurofeedback training requires continuing assessment and reassessment. The patient’s responses are an invaluable contribution to the decision making process. Although Joe’s way of tracking his brain is far from typical, it is extraordinarily accurate.
The rewards are reduced at all sites by .5 Hz.
The protocols for this session: P3-P4, 9 minutes, at 7.5-10.5; C3-CZ, 3 minutes at 11.5-14.5; C4-P4 for 10 minutes at 3.5-6.5 and then down to 3-6Hz for 8 minutes.
Sessions 22&23:
The reports from school are mixed. He is still unable to decipher math
concepts or to add or subtract without using his fingers and he still
struggles to articulate clearly. But there are gains. His mother called to tell me that Joey, who has always been liked, has begun to invite friends home for the weekend. She sees this as a significant change, since in the past, he has used the weekends to ‘regroup’ from the demands of social interaction. Joey reports that he has a new doctor in his head, actually two new doctors, who are there working on friendship.
Mom reports that he has tried new athletic activities. He went ice
skating, which he has never wanted to do and which he now wants to take up. He also went bowling for the first time. He needed to throw the ball from between his legs, but he also had a strike. These activities have always been available to him, but he hasn’t had the confidence to try them.
His father called also. At Joe’s school, graduating students are required to memorize and deliver the Gettysburg Address. He has never been able to do this, until now.
Session 23, the first after the decision to go to C4-P4 for the entire session, Joey reports that an old worker has returned to tell him about a new job, – as if this boy needs more work!. At the same time, a new job could suggest change. Today there are 19 people in his body, visiting and “playing around”. He reports that the internal people are “getting better jobs”, because he is helping them. During the session two people return who he hasn’t seen since he was five or six. They have come to see all the changes and both remark that things seem “better inside and they wonder why they ever left”.
Protocol today: C4-P4, rewarding 4.5-7.5, inhibiting 2-7.
Session 24:
Joey has been away at school and I haven’t seen him for three weeks. He’s home now for Spring break and he has a lot to tell me. He begins with his unwavering, predictable self report: “Good!” He thinks his memory is working better and that his body is working better. There is no yelling at his body or in his body. So it appears his internal world is quieting down. There is now a maintenance crew in his body fixing phone and computer wires. He said there were two dogs in there too, just hanging out like dogs do, keeping the workers company. He has a secretary now who screens his calls.
He reports that he got a call when he was skiing but he put his answering machine on. It was a good thing that he didn’t let himself become distracted because he was skiing the Double Black Diamond trail and doing so when it was icy. This is an expert trail and he was unafraid and, apparently skied it well, well enough anyway, to tell the tale. He has never done this before, both because he was afraid and also because he lacked the skill, even the capacity for the skill.
He has no bad dreams but says his dreams have changed. He is able to note this but unable to describe the changes. He says he wants to be with people more than he used to. He has asked his mother to teach him Spanish which she is reluctant to do since he can’t yet clearly speak in English. His mother is a native English speaker who speaks Spanish and Joey was born in Spanish speaking country. His father speaks three languages. He does have room in his schedule now to begin a new course of study because he has gone down to part-time as the principal of the SimpsonSchool and is presently looking for a replacement!
Protocol: C4-P4 4.5-7.5 HZ, 2-7 inhibit
Session 25:
Joey has returned from a trip to Legoland with his father and he had a
wonderful time. He says that not much is going on in the internal world, but also that he isn’t seeking them out because they are busy in meetings. When he closes his eyes he can see where they are. Sometimes he knows what is going on even when he’s not paying attention, but usually he has to close his eyes to see them. He told me all this in response to my inquiry. He reports that when he was at Legoland-this boy loves Legos-that all the people were happy; that they all came up to his eyes to see what there was to see. I asked him if he was happy and he said he was. I think he felt particularly and concretely happy in his eyes. Legoland was a visual feast for Joey.
During the training, he had a very specific report. It was the first time he’d done this. He said his brain felt ‘sleepy on the right side’ and the left side is feeling fine. He feels that his left eye is wide open and his right eye wants to close. He corrects his posture, sitting up and is aware that this makes it easier for him to train. He reports that he feels “a little heavy on the right” at the end of training. Of course, I will be watching to see if this frequency is too low. I will only know over time if the in-session report is predictive of the longer term outcome. But in the meantime, I am delighted that he can tell me what he is feeling, as a feeling, directly.
As he is getting ready to leave I asked him if he liked coming for
training. He said “Yes!” “Do the people inside you like coming, here?” He answered yes again and said, “The angry ones come up from deep in my body”-he gestures to his stomach- and they get calm and go back down.”
Joey is making progress and I think he will continue to, but not as quickly or as significantly as could be possible, so today I recommended a brain map, a qEEG. Joe’s mom and I had discussed this as a probability early on in his training but there is the matter of considerable expense. So, the agreement we had was based on progress. We would see how he responded to symptom-based protocols. If his responses were clear-cut and positive, we could forgo the
map. If not, I would recommend it. We’ll see what the Q adds to this
picture, to the training protocols and to the outcome.
Protocol: C4-P4 4.5-7.5; 2-7Hz inhibit.
Session 26:
The report is that everything is very good. Joey is preparing for his Bar Mitzvah and is consulting the Rabbis in his head. Mother’s report is positive too. It is only two days since the last training, so we probably don’t know all of the training effects yet.
He looks tired and with no other reason given, I asked him whether it would feel better to train a little higher. He wanted to try this. Since he is beginning to be able to report very specific effects and I want him to have as much control as possible, I go up 1/2 Hz to 5-8 HZ at C4-P4. He immediately looks better and reports that this time his right eye is wide awake and his left feels sleepy. He comments that this is the opposite pattern from last time and finds this interesting, as do I. Neither of us knows, however, what to make of it.
After three periods, I asked him again, what would feel good-staying where we are, going down or going up. He wants to go up. So until the following report (10 minutes later), we trained at 5.5-8.5. He says that some of “his eye people” have been drinking coffee. Some people have begun to fight in his head. Coffee and fighting-this is not too hard a call- we have gone too high and I ask him about it. I ask him to help make the translation for me and he does. I asked him what he thought about these responses, what does he think they mean. He thinks we should train at a lower frequency and see what happens. One of the problems that Joey’s brain leaves him with is a very concrete representation of feeling states. His people get excited and come to his eyes when he is at Legoland rather than he loves what he sees. So I think it is significant that he is able to make this translation and recommendation. It is much less concrete, although, it still does not require the step- “I feel…”. This is, of course, a difficult sentence for most thirteen year-old boys to complete, (if not most men) but my hope is that one day he will be able to know that he is feeling a feeling and speak to that directly, without all the surrogates.
He is quiet at 5-8. The fighting stops and he reports very little internal activity at all by the end. He has the feel of someone “in the zone”. His concentration and focus were enviable.
Ending protocol: C4-P4 at 5-8, 2-7 inhibit.
During the last training, Joey looked tired and reported feeling tired so I raised the frequency reward at C4-P4 to 5.5-8.5 after nine minutes at 5-8 Hz. He immediately looked better, but people begin to fight in his head and the coffee began to flow, so after ten minutes at 5.5-8.5, I lowered the reward again to 5-8 Hz. At this frequency, he seems to be “In the Zone”. His reports are positive in this session a week later. It is easier to ride his bike [!], his mood is good, no bad dreams and there is the sense that he is beginning to split his attention more equally between the external and the internal world. He still does not spontaneously remember things but seems to have more rapid access after prompting. Prompts, in fact, prompt him and this hasn’t been reliably the case in the past. He reports that the people inside are “pretty quiet today”, that they are drinking coffee, specially
formulated (he doesn’t use this word but he definitely has this concept) so that it has only 6% caffeine. This took “alot of experimentation” but they have figured out how to do it. There are six people in his body. This number usually indicates a “maintenance crew”.
Joey is still quite involved managerially but he has brought about some
interesting changes. He is still fully in charge of “The People Company”, the name of the group within him that is devoted to helping people throughout the world (now being trained in neurofeedback) but he has found a suitable replacement to run the SimpsonSchool. The SimpsonSchool, as it turns out, is something of a conglomerate. As he describes it, the company takes over failing schools, runs them as the SimpsonSchool for as long as required to get them operating well again and then returns them to their community. His replacement is the principal of one of these schools. I don’t know exactly what this means in terms of his regulation and recovery. It could represent that he is less busy inside; or that he requires less internal distraction; or that he can trust others a little more to look after his interests. His description of the whole process does, however, demonstrate a good grasp of the corporate take over reality so dominating the world of business, perhaps quite a bit better than that of the average
thirteen year old.
At the end of the session he does not look tired and reports feeling, “Good!”
Ending protocol: C4-P4 5-8Hz reward; 2-7 inhibit.
Sessions 28&29:
Last time, in response to Joey’s in-session reports and wanting to train him as high as is comfortable for him, I continued to reward him at 5-8 Hz. This time, his mother reports that he has been “off”. He was defiant, his first response has been ‘no’, and he has been talking more with his internal world. He also has been talking about more ‘far out stuff’, like having a rug on top of his brain and rug cleaners in his brain. This is a new delusion/metaphor. In the past Joey has believed that he was born on another planet and that he was an alien visitor. He reads alot about this kind of stuff. This is not new, but it hasn’t been up for him recently. It is up this past week. The behaviors are uncharacteristically aggressive for Joey but they too have occurred once before when I trained him too high. So I will drop back down to 4-7 Hz to see how he does there. It is interesting to see the likely correlation between overarousal and his deeper retreat into the internal world; more active conversation and more bizarre.
He had a brain map this week as well as a consultation for
Hyperbaric Oxygen Therapy. We will see what the map has to tell us in due time. I have no doubt that it will offer some other approaches to training.
Joey returned the next day for session 29. His father reports that he is no longer negative or agitated. His mood is sunny and he is definitively more sociable. Joey tells me that a new filing cabinet that he bought two days ago, fell apart and that his papers are all over the floor. He told me this when I asked him if he still remembered the Gettysburg Address. He goes on to tell me that people are in there cleaning up and that he is lodging a complaint with the company about the faulty filing cabinet. This filing cabinet is in the parietal part of his brain-he points to it-and I think it represents some function of alpha. In a common metaphor, we might say, “It’s in the back of my head/mind”. He’s both more concrete and poetic. He tells me that
he “can’t find the Gettysburg Address right now”, that he is in the process of “reorganizing”. Other than the collapse of the filing cabinet and all the memory it so precariously holds, all is quiet inside. The clean-up/reorganization has no turmoil in it.
Joey started to feel agitated after an episode of sleepiness and reported feeling better at 3.5-6.5. At the end of the training, he said that it was quiet inside, but there was a meeting going on. Commenting on his score, I said, “Look you have one red gem, seven amber gems and one diamond.” He said almost immediately, “Nine gems in all.” I looked at his father and asked, “Does he do that?” and his father smiled and said, “Not before now.”
Ending protocol C4-P4 at 3.5-6.5 reward; 2-7 inhibit.
Session 30:
The report is that Joey has been edgy over the last week. He has not been oppositional, but perhaps a little irritable. Joey reports himself that he has been feeling slightly irritated with his parents. This kind of reflection on his feeling state is unusual.
We will learn later on this week, when he brags about this at school, that he has been out with some friends of his brother who were shoplifting sunglasses. His mother was quite disturbed about the other more responsible boys engaging in this behavior and about the fact that Joe hadn’t told her of it. This was unlike him. I shared with her how alarmed I was when my daughter told her first lie. At the time, a clinically sophisticated friend told me that it was, in fact, a developmental milestone. My four year old was now able to recognize that I didn’t know everything she did. There was enough cognitive capacity and capacity for “otherness” that she could actually form a lie. Joey didn’t really lie, but he did omit, until he couldn’t bear the delicious secret any longer and spilled it at school. He may have had the nascent sense of separateness himself for the first
time.
His edginess may have been related to this caper and his new experience of keeping a secret, more than the protocol. The school principal also reported that Joey was proud of his behavior. This too, understandably, concerned his mother and I made note of it. My sense is that his shoplifting and his pride in it is unrelated to the training. I think he was motivated by his need for peer attention and “normalcy”. But I note it, because I believe that neurofeedback is a rule/out in all behavior of all people who are training.
We didn’t know anything about this at the time of session and didn’t know what to make of the edginess. Too high? Joey reports no increase in sugar craving and no decrease in his love of chocolate. His sleep is still good, with no nightmares but it may be a little harder for him to get up. We decide to keep the protocol where it is.
During the training, about ten minutes in, he reports that an office
supply/school supply store is opening in his body because there are so many people with information in boxes entering the office in his brain. (Clearly, he sees this as a marketing opportunity. This boy, in his own unique way, has a very good grasp of business dynamics.) He points to the frontal region of his brain to indicate where the store is opening. His office, he says, is on the right side. This is exactly where Allan Schore, Siegel and many others would locate the agency in the sense of self. He reports that he has billions of people training to go out into other bodies and that it is his job, in essence, to make the placements. He explains that they cannot go into old people’s bodies because he is worried about how long they will live. These trainers do not know how to leave a body after death. As a result, most of them will work in people who are 20 years old or younger. Later in the session, Joe reports that he is talking to a very important person, the second owner of the People Company, who wants to move into Joey’s side because where he comes from is too loud. Joe ends by reporting that it is quieter in his office and in his head than when he came in(!!)
He leaves after this session to return to school and I won’t see him again until summer vacation. Stay tuned.
Protocol C4-P4 3.5-6.5Hz reward, 2-7Hz inhibit
Session 31:
Joey is home from boarding school. He told me about his accident. He was taking his new bike over a jump and the handle bars caught him at the throat, under his chin. He told me, in that somewhat exaggerated way that little kids can use when repeating a parental warning-“No jumps with my NEW bike!” He had this accident with his new bike, one he wasn’t yet used to. His vocal chords were bruised but have healed more quickly than anticipated and he was able to talk well with me today. A week before this happened, he had his Bar Mitzvah and he was able to stand in front of the group and remember his poems and responses. His parents were very proud of him.
He has two new friends at school, the first friends of his life. Everyone has always liked Joey, but he has never been able to make friends. He did not know how to socially cue and he has gotten better at this. There has not been much change in his academics. He cannot generalize math concepts. He can, for instance, solve the equation of ten dollars minus seven dollars, but he can’t use it in a store to make change. He has two hours of tutoring every morning during the summer and is working at a zoo and a kennel. He loves animals and looks forward to his work.
The results of qEEG arrive. Joe has a number of problems, as we would have predicted. His dominant frequency is 7Hz. This is too low (normal alpha idling for his age is 10-11 Hz) and it predicts learning disability and the likelihood of long term training. Joey also has abnormal amounts of frontal delta at 3Hz and some coherence abnormalities. This is a hard brain to think in or, in a way, even to see out of.
His parents have consulted with a well respected “alternative” MD and Joey will have a month of hyperbaric oxygen therapy (HBOT)in August. Our job, in the meantime, is to see if we can budge this brain out of its slow wave slumber. I will down train delta today.
Protocol: FZ 1.5-4.5 DOWN, 2-7 inhibit, 12 minutes; AFZ 1.5-4.5 DOWN,
2-7 inhibit, 12 minutes.
Session 32:
Joey’s brother Rob brings him to the session today and reports that Joe has been cooperative. It has become brutally hot here quite suddenly, after an unusually cool and rainy spring. When the weather turned, Joey went to the attic, brought down all the fans, washed them and set them up in different rooms. He did this on his own initiative and had never done anything like this before. He didn’t seem to find it unusual but his brother did.
Joey reports that it’s pretty quiet in his head but not as quiet as last time (!). I make the exclamation because last time was five days ago and he remembers his state then. He told me that he has two secretaries in his head, one man and one woman. I asked if they drank coffee and he said no – getting the gist of my question – everyone now drinks decaf. I think his speech is a little clearer and Joey agrees that this could be the case.
I got a copy of the actual Q today and it indicates that the diffuse frontal delta is mostly at 3 Hz. So I will shift my protocol to focus on this frequency.
Protocols: FZ, 12 minutes, AFZ 9 minutes; F7 9 minutes all at 1.5-4-5 Down training and 2-7 inhibit.
Session 33:
Rob reads a written report from his mother saying that Joey is “not himself”. He seems a little sad to her and more easily frustrated. Joey
reports that thoughts “pop in and then fly out” of his head. He cannot grab hold of his thoughts. He reports that it is quiet in his body but that they (the people in his body-probably the night watchmen) are “trying to find out what happened last night”. I don’t know what he is referring to but clearly he is experiencing some level of difficulty. Something is going on and I don’t know exactly what. He also reports having a headache after he saw a movie in the theater. It is unusual for him to have headaches.
My best hunch is that we were bringing delta down too precipitously, that he was relying on this slow wave, or at least accustom to it, to stabilize his functioning. It is often recommended that “exercising the circuitry” may be the most effective thing we can do. The two ideas seem elegant next to each other. I can’t resist the attempt to provide him with some delta, even as we are asking his brain to down train it and to “exercise the circuitry” at the same time. I will down train delta for three minutes and then up train delta for three minutes, then down train again for three minutes. I did this at two sites which I hope will allow him both more stability and more clarity. Neither is what actually occurs.
Session 34:
I saw him again recently during his spring break from school and there is much to report since session 33. This session report follows our attempt to “exercise the circuits” with up and down training of delta. His response, as you will read, was not good but I think it helps us learn something more about at least two operating assumptions about NF.
The first is that excess delta (theta, alpha) is “bad” and should be down trained. In this case, in an earlier session and in this, it looks like delta was not only an indicator of brain injury but simultaneously an important compensatory mechanism. It appears to have played an important role in his stability as well as his disability. The second theory is that what we are doing is “exercising the circuits” and since this is what we are doing it might be most efficient to train a frequency band up and then down (more efficient exercise). It appears to have been quite powerful in this boy’s brain but not more efficient. This is one brain, at one moment in time, and I hesitate to draw any conclusions from this one experience, but it does raise some important issues.
Joey’s mother called me several days after the last training to report that Joey is having a very difficult time. She describes him as depressed, sad, disorganized, unmotivated, frustrated, lonely and bored. She wants her old cheerful, happy, motivated Joey back.
Needless to say I was concerned for him and I saw him the next day. I had changed the down training to training down one period and up the second, down the third at two sites. He was edgy with down training alone, but with “exercising the circuits” he is all of the above.
When he came in I asked him how he was doing and for the first time ever he said, “Not great”. He has always said “Good.” I asked him how his week had been and he tried to tell me but looked as if he was drawing a blank. I withdrew the question and he began an astonishing description of the problems he experienced in thinking. He put his hand at the back of his head, over the occipital area and he said, “If thoughts move fast enough, they make it into the front of my head”. He showed me the pathway, back to front, bringing his palm over the top of his head to his forehead. “But if they don’t, they only make it as far as here (he points to CZ) and then they slip backwards again. Sometimes they only start up and don’t even get as far as here (the parietal area) and they slip back.” If they get to the front of his head he can say them. “Sometimes, they are just stuck, they don’t move at all.” I could feel his frustration viscerally. When he is “thinking just right”, the memory/thought goes around the right side of his head and stops at FP2 (he showed this to me). When he “thinks too hard” they spin around his head and land at FP1. He experiences that as having gone too far. He said, “I could catch the thought if I could slow it down.”
It is important to recognize, I think, that Joey is describing his thought process and he is doing so with alot of clarity. He is describing his brain as his brain. He’s not describing it through the internal world of fax machines and phones and international training teams but how he feels this process in his brain; these are the currents of his thinking and his memory. He hasn’t done this before, not like this. When I asked him about his internal world he said it was spinning around and noisy. The people there were trying to slow it down. When I asked him if he wanted the training to slow his brain down he said, ‘Yes’, and said so with a lot of confidence.
Interestingly, even with this negative or seemingly negative response, Joey wanted to come today. I have the sense that when we down trained delta it sped him up to fast, too soon. He wasn’t used to this processing speed and didn’t know how to handle it. So he shut down. His brother was describing this and said, “I’d ask him something and he just wouldn’t answer”. Joey said, “Rob, that’s because everything was going too fast.” His brother smiled at him and said that now he understood. He thought it was amazing that his little brother could point to the correct areas of the brain associated with memory and initiation of thought. “It’s not like he looked it up in a textbook or anything.” I think it is amazing too.
As we trained at C4-P4, he began to talk again of the filing cabinets. He said that the new one hadn’t been delivered yet and that the ones he has are stuck. They are stuck because they are heated up, which makes it hard to open the drawers. They get hot when he thinks too hard and he has to cool them down so that the drawers will open. I asked him if he remembered an acronym using FORD, that one his boss had told him. He told me ‘Fix Or Repair Daily’, which was a joke he heard three weeks ago. I had added one of my own and he repeated it almost right: ‘Ford On the Roadside, Dead’. It goes ‘Found on the Roadside Dead’ and he corrected it as I began to tell him. I asked him how he remembered these things. He said, “I have a special filing cabinet for car jokes. It’s not in the back”. He swept his finger over his forehead to indicate that they were there somewhere, in the front, and “easier for me to find.” I asked him if he remembered the Gettysburg
Address and he shook his head. “Do you remember any of it?”, and he said, “Four score and twenty years.” and I laughed and said, “That’s exactly how much I remember of it”. He went on to elaborate: “That is in a file cabinet in the back and it stays there until I need it. I don’t need it now.” This is, of course, the economy of memory and memory retrieval. He felt that if he needed it, he could practice it and he would remember it. This demonstrates a new confidence in his memory as well as good insight into the working of his own brain.
Given his request to slow his brain down and his clear distress, as well as that of his family (and me), we returned to his default protocol. By the end of the session, he is talking more and he looks better.
Today’s protocol C4-P4: 5-8 Hz reward; 2-7 inhibit
Session 35:
At the last session we returned to what I considered to be Joey’s default protocol, C4-P4 after trying to apply the “exercise model” in the delta band. As you will remember, he asked for his brain to be slowed down. His mother called two days later and she reported that Joey is “back to who he is”. She is relieved but also quite fascinated to hear what Joey had described to me about his own mental processes. (As usual, I had Joey’s permission to share this with his mother). She also told me that he remembered his math tables for the first time. The parents were amazed and, interestingly, attributed this accomplishment to down training. Apparently his older brother had described Joey as looking and being more himself as soon as they left the session.
When I see Joe, a week later, his language is off. It is difficult for him to retrieve words and he was having a great deal of difficulty retrieving or processing numbers. His mood, however, is greatly improved, although mother reports that he might be a little on the downside. He is not agitated at the dinner table but he is also not motivated to go to the gym.
Joey reports that there is “too much in the front filing cabinets, that’s not going to the back, so stuff is piling up in the front”. “Some filing cabinets are locked or stuck”. He can’t get “the math cabinet” to open at all, so he “just has to look”. This is almost an exact reversal of the process he described with the delta up/down training. Whatever the direction, he may be describing an anterior-posterior disconnect. He is now often tired and has to be woken up. He used to be an early riser. The people in his head are back from vacation and it’s busier inside, even loud, but he expects that it will quiet soon.
Protocol: C4-P4 5-8 Hz for 21 minutes, 2-7 inhibit
Session 36:
It is five days later and Joey reports that he is feeling “Good”. He went bowling last night and he used the big bowling ball and threw it side arm for the first time. He scored higher than he has ever scored and he made a strike. He said to me, referring of course to his brain, “These filing cabinets are 14 years old. I need some new ones”. Agreed. Now, how to provide them.
Protocol: C4-P4: 5-8 Hz for 22 minutes; 5.5-8.5 Hz for 6 minutes. I shifted up because it was making him tired.
Session 37:
In response to my question, Joey answers, “What’s going on in
my head? That’s a good question.” He goes on to tell me that a meeting has just started and that it’s about going to school. He is missing his friends. This, his mother tells me, is new for him. He has remained very related to them even during the first six weeks of his vacation. He invited one of them to come for the weekend but he was couldn’t make it. He said, I thought with both sadness and acceptance, poignancy really, that “It’s OK. It’s the same every summer. I thought it wouldn’t be the same, but it is.” He really wanted to see his friends. He was lonely for them.
When he talked further about the meeting, taking place in his left frontal lobe, about school, I asked him if it could be the case that he was thinking about going back, that that’s what the meeting was, his thought process, Joey’s thoughts. He understood me and he agreed. At least for that moment, he knew that he was not just the subject of the meeting but that he produced the meeting. The meeting was Joey feeling lonely and thinking about going back to school.
He reports that his new filing cabinets are working well, that his memory is better. Everything feels back to normal. “Everything was just going too fast.”
He is cheerful as he leaves and makes good eye contact and a firm
handshake. I made an issue of his handshake from the beginning. I wanted his presence in it and I wanted him to feel the contact with the other. He almost always remembers and when he does, he smiles at me- we smile at each other.
Protocol: C4-P4 5-8 Hz for 27 Minutes; 3 minutes at 5.5-8.5.
The next week, Joe began his course of three weekly hyperbaric oxygen therapy sessions. The physician, also a neurofeedback practitioner, decided to suspend neurofeedback during the hyperbaric to see if she could discern the effects of the oxygen alone.
Joey is back after a one day break. His response to my inquiry is enthusiastic. “Good!” We talked about the internal system’s reliance on
coffee which he defended because they had to stay awake, “there was too much to do”. I asked him if he knew that caffeine was a drug. He didn’t know this. I said that in all of my work with peak performers, it was the goal to reduce reliance on drugs; that I was for a drug free environment, was he? Perhaps neurofeedback could make it possible to do all this work efficiently without drugs. Joey hedges his bets. He can’t quite imagine this system functioning around the clock on multiple time zones without using caffeine but he also does not at all like the idea of drugs. We will see how this plays out for him over time but with the discussion of coffee, I have tried to provide a context, acceptable to him, for the changes he has already begun to feel.
His mother reports that he seemed to stand straighter than usual when he was on the treadmill. On the drive to the session, he was talking with her about planning a Lego city instead of the people in his body. In general, however, Joey is good on making plans, but poor on executing them. He read a book with his mother with less frustration than expected even though he is making the typical number of mistakes. His sleep and appetite are good, as usual.
Joey seems to be tolerating T3-T4 well. This session is 12 minutes at 4-7 and 9 minutes at 3-6. Mother is most concerned about his articulation, and since I want to understand, from him, the nuances of his experience, so am I. I introduced F7-F8. (In a little boy suffering anoxic brain damage at birth this protocol had a dramatic impact. It not only enhanced his ability to articulate but his comprehension of what was being read to him.) I trained Joey here at 2-5 Hz. He reported being a little tired after F7-F8, but good.
Session 4:
After the last session his mother called to report that Joey is “peaceful”. There is some increased hesitation in his speech that wasn’t there before the last training but that he has happened n the past. Otherwise, there is no change. I had asked her to be aware of any change in speech fluency because of the introduction of F7-F8. He is reading without protesting and without any evident frustration. The increased hesitation makes me suspect that the frontal reward frequency may be too low.
Joey, of course, has his own feedback. He pointed at F7-F8 and said, “These guys used to drink only coffee, now they are drinking ginger ale”.(!) He feels too that it is important that these guys get off drugs,(i.e. caffeine). He reports that he feels good and that “most people have a day off today”. There is only the “repair crew”. There are nine of them and only three are drinking coffee. They are reporting to him that “things look good, that they will be finished soon and that they won’t have to return in quite awhile.”
I don’t see any evidence of fear or loss about the changes he seems to be experiencing. A week later, the young woman who came in before him shared this observation: “I wanted to tell you about something. I was waiting for my ride and I saw a little boy arrive here with his father. He really wanted to see you. He ran up the stairs ahead of his dad. You could tell he really wanted to be here.”
During the training the day before I went at low as 3-6 Hz at T3-T4. While training, he reports no difference from his state at the beginning at 3-6 and there is no evidence that I have gone too low. At 2-5 Hz, after only a few minutes, he tells me that his hands feel heavy and demonstrates this by lifting his arms with elbows still on the chair in a pantomime of weight. This is not the kind of response during training that worries me, generally speaking. It is usually transient. But Joey is a precise reporter and I want to respond to his reports immediately, both because I think they are likely to be very accurate-he is oddly quite “tuned into” his body – and because I want to enhance his sense of agency. I went up to 2.5-5.5 and the heavy feeling went away. It may be important to note that he reported this body sensation directly as a body sensation. There were no middle men. He wanted me to train again at F7-F8 and so did I, so we trained a half a Hertz higher at 2.5-5.5 for three minutes.
Session 5:
This is Joey’s fifth session. He is clearly enjoying being at the office. He is at ease and begins his report. “Five of the repair crew are off caffeine. Four still want to drink it.” He fell asleep easily and awoke early to use the bathroom. When he saw the snow, he was excited but was able to go back to sleep. His father, who is with him today and who is not entirely unlike his son, reports that this is unusual. Joey would not have been able to return to bed, much less to sleep. There is, it seems, increased flexibility of state.
We continue training pretty much as before – T3-T4 at 2.5-5.5, 2-7 inhibit for twenty-one minutes, the frequency at which he had been comfortable last session, and 2.5-5.5 at F7-F8 for nine. Joey’s father had reported not much change in speech and mother who had called before they arrived still heard some hesitation in the gait of his speech. I don’t want to go much lower because of his learning disabilities and my prior experience in other situations, in which training too low frontally had increased dyslexic confusions. I don’t know quite where to ‘place’ this symptom in the frequency domain, although it is clear to me that it relates directly to the training.
During the session, Joey comments. At four minutes he says: “The company called up and said no more coffee, putting bad things in coffee.” At 7 minutes he says that “the repair people are finding other bodies to work in”. Joey reports that he himself is feeling good. “It is a little busy [in his body], due to the holiday season.” Again he asked for F7-F8, saying that it felt good to him. Before switching placements, the people asked him to set his watch (!!). I wonder if he is telling me about a timing change. Could it be that all of his metaphor about timing zones and the amount of resources required to keep them all communicating is a rather direct communication to me about timing faults?
At the end of the T3-T4 epoch, he reports that the crew “training for the job do not want to get off caffeine.” This could mean that we are training too high, that his brain still feels like it is on caffeine or that we trained too low and that he feels the need for more stimulation. To date, I have taken the caffeine to signify overarousal. I will stick to that hypothesis even with the rather sudden turn of events later that day.
Joey’s mother called to report that he was very ‘hyper’. He could not sit through dinner without jumping up to attend to whatever had just occurred to him to do. As we talked about it, his mother agreed that his behavior seemed more impulsive than hyper. He had to act, it was purposeful, it just could not be postponed. The family had never seen this behavior before. After dinner, he went to his room and initiated a project, also something they had never seen him do. He recorded the ‘sounds of his planet’, the strange noises of the place he comes from. He wrote about himself and smiled and laughed, appropriately, at himself and at what he was writing. I wonder if he is constructing an archive.
Both mother and Joey report that he has been happy. He slept well and he is still craving and ‘sneaking’ chocolate. Mother, who is an OT, felt that it was harder for him to articulate, that he wasn’t placing his tongue in the right place to make the ‘th’ sound. This was not new; it was an old pattern, but one he’d learned to correct. As has been true since the beginning of the training, he is reading without frustration even though he makes a lot of mistakes. He still has no bilateral movement but mother reports that he stands more upright.
I think it’s time to try a new protocol. I decided to keep nine minutes of T3-T4 (2-5) in the picture, mostly in an attempt to keep the hemispheres talking to each other and to address, however minimally, the profound left hemisphere deficits. My objective at the beginning of this boy’s training is to help him quiet himself. I began at T4-P4 at 6-9 reward, 2-7 inhibit. At 6 minutes, he reports not feeling the training so I dropped it to 5-8 then to 4-7 Hz. Altogether, at T4-P4, he trained for 15 minutes. He liked the right side training at 4-7 Hz and told me that “the files are being cleaned out. It smells bad in there, like someone forgot a sandwich.” A little later, “All the old files are getting a good cleaning.” He told me this with alot
of delight.
He was feeling this mostly in the back of his head. This is where his
“files” were – right where he makes alpha, in “the back of his mind”.
(quotation marks mine, just where I think we may all find some old memories. He did not want to train at F7-F8. We didn’t. It is of note that at the same frequency today that several days ago led to heavy hands (T3-T4, 2-5 Hz), he felt fine. He shook my hand with a firm handshake, one that was close to being his own.
I asked his mom about whether it was unusual for Joey to talk about his
body sensations directly, as he had about his hands when he was training earlier in the week. She said that typically he would only be able to say that his hands felt “funny”. “Funny” is his ubiquitous descriptor for strange body sensations. It was unusual, she said, that he used the word ‘heavy’ to describe his hands. Of course, I am now not sure whether I gave this word to him. I am sure that he showed me that they were heavy and used the word readily. I wish I knew, just because you like to recognize openings in another’s mind and not create them in your own.
Session 7:
Joey reports that his body feels ‘quiet.’ There are only three phones going and they are needed because “people are getting ready for the first meeting of the winter”. He continues “cleaning out old,
junky folders.” Mom reports that he has been calm. There were no signs of the impulsivity he was experiencing yesterday.
Mom lets me know that Joey never makes any reference to the people in his body when he is at school. He can clearly inhibit talking about the system even if he can’t inhibit the system itself. He was however talking to himself last night, a habit of his. At school, he avoids social sanctions against this behavior by going into the bathroom when it starts.
As the session is beginning, Joey reports that an old man is coming to
his body that he has not met before and that he is planning to die at
midnight on the 103rd anniversary of his birth. He believes that this man may have run the training program at one time.
At 14 minutes into the session, Joey shares an important update: the old man has died on the airplane on his way to his body. Smiling, he says that this is good because “it is upsetting to other people inside to see someone die.” My assumption is that Joey is telling us something important with this story but I can’t decode it.
After this session he went to school. His mother spoke with him a few days later and he said that his body felt funny. She said it became clear to her when she explored this with him that he was sad about being away from home. This was the second time in his life that he had ever expressed sadness. The first was when he had started at the school two years ago and felt worried that none of the therapists there would be able to help him. I asked her if he cried. She said that Joey had never cried. This is also the case for her. In fact, she reports that no one in her family cries. I will look for the capacity to cry as a positive training indicator, for both Joe and his mom.
(To better understand her son’s experience, she is training as well)
He had never before expressed homesickness. It seemed to pass quickly though. His mother offered to get him for the weekend before the Christmas break and he said that he would be alright, that he could wait until Christmas. This, too, was unusual for Joey and his mother thought it a good sign.
His teacher reported that he seemed to be ‘getting things’ with a little more ease. His mother said that she asked him how his classes were and he answered her, directly, for the first time. He said they
were learning about gravity, and he went on to try to describe what the
lesson was. He couldn’t make this clear. It was a first that he used such a word as ‘gravity’. He was also complaining about headaches. I am not worried about his sadness. I never address sadness with training. Any emotion that flows is, to me, a positive emotion. But the headaches are a concern and probably mean that I have trained him too low, at least for his present brain.
Session 8:
Joey returned from school last night and he reports, in session today, that people in his body are not as loud. He has had to kick three people out who have been drinking coffee. There are two new doctors in his body who are researching how to make better coffee, coffee presumably that is less harmful but can still keep the night operators awake for their important duties. Lots of people, he reports, left at midnight, to go on vacation. They are, he assures me, coming back. Once again, nine are left and some of these were sleeping as he gave me this update.
He reports some headache after the last training but not bad. He says it feels easier to remember what is going on in class, but he does not remember my name. He’s a little embarrassed to admit this and I
share with him that I am terrible with names too. I realize, at this
moment, that he had never seen my name written, so I sat next to him on the couch and wrote it out. I asked him if my name reminded him of
anything – like a burning ocean. I was attempting to provide an image to see if this would aid his recall. I don’t think he saw it. It was itself an unimaginable and incongruent image and he doesn’t have the facility with language that puns require. (Punning may be a good indicator of sensory integration capacity). So he drew a blank until he remembered his teacher’s name which he had forgotten just moments before. There is also some element of performance anxiety in this forgetting. I think he feels put on the spot and then unable to ‘perform’ memory. Today he planned, executed and finished a rather elaborate Lego project.
He was rattling off the account of all the activity in his head when I
asked him if he would stop for a second and breathe. I thought, in the speed and excitement of the moment, that he might be producing some of the very activity he was reporting. He stopped immediately and tried to take a breath but had great difficulty coordinating this activity. He was quiet and was clearly taking an internal inventory. He wants to tell me that there are some number of new doctors. He counts on his fingers as he looks inward. There are two old doctors and two new doctors. Different areas of his body require different doctors (specialists). “Four at night and four during the day”. I think doctors are always on duty, like an emergency room.
No change in placement but I bring the frequency down on the right at T4-P4 in steps to 2-5 Hz. During training, he begins to jiggle his foot. (the impetus to reduce frequency) I asked him about that and he said he was thinking. His foot was thinking, or helping him to think. (this could, of course, also be an indication that we have gone too low and he needs, as it were, to wind himself up). He pointed to the electrodes and said, “People are taking notes and learning how to do this”.
When his mother and I speak of him in the third person, his body tension, as represented in the amplitude of high beta frequencies, goes up. I reported this, saying ours would too, but Joey said that he isn’t listening to us (this seems to be both the case and not the case) because he is “teaching people how to do this (neurofeedback) and to help others with their brains”. I asked him if he needed any help answering their questions on how the brain worked and he politely declined the offer. He could answer their questions himself.
Clearly Joey is learning something of value to him and something that he wants to share. This is the kind of boy he is.
Session 9:
My daughter Blake, a child therapist and neurofeedback practitioner, worked with Joey during the time I was away on retreat over
Christmas. She had filled in for me once before and she asked him if he remembered her name. He did. He also remembered my name. He told her that two new people had entered his body to train, one whose name is Blake and one whose name is Sebern. He had a brief headache after training but it disappeared quickly. His sleep and appetite are
good.
His mother reported that Joey was working on the computer (looking up Lego information) and that he got stuck at a website that he didn’t want to be at. He told her that he was “frustrated”. The fact that he used the vocabulary of emotion signals a significant change. In these circumstances in the past he would have used the word “funny” if asked to describe his feeling. They made candles when they returned home and Joey was focused and relaxed. He reports that he feels good physically and that there aren’t a lot of people presently in his body. Only nine. There is some coming and going of the trainers and there is still active testing related to caffeine consumption. He has instructed those who are present to follow along with his NF training and to use this to train others.
About twelve minutes into the session, Joey says that he is being asked what the red and blue lines at the end of each period mean. Blake explained what they are and he said that was what he thought. Soon after, he reports that he is feeling relaxed (training at T4-P4 at 2-5 HZ after 6 minutes at T3-T4 at 2.5-5.5 HZ )and that those people who are focusing on the NF will be trying it on their own and will ask him questions. About ten minutes later, he tells Blake that some people want to keep doing the training at school, at night but that he isn’t happy with this idea because he is worried that they will make a mistake and mess up his body. I wonder when he says this if he is expressing worry about Blake and me, if he is trying to tell us that we might be making a mistake. He has been getting headaches and he has felt training effects in his body. I will listen specifically for this worry. He is, it seems, internalizing us and the training. Neurofeedback is becoming his own endeavor and he isn’t sure, really sure, that it won’t hurt him. All reports are positive except that there is no change in the clarity of his speech. He is able to make the ‘th’ sound but in general multisyllabic words are still tripping him up. He often misses the ‘lifter’. None-the-less, he is cooperating with his mother’s speech lessons. Joey is earnest and sincere in all his efforts. He is a boy who really tries. It is just very hard for him to speak, to remember and to move in a coordinated way. But his handshake is terrific. He is making his presence known.
Session 10:
After the last session Joey and his mom went for a walk in the woods and he was engrossed with people inside him who were “ordering parts from Japan and China on computers”. Blake asked him what kind of computers and he said, “Neurofeedback computers”. They were looking into “creating a neurofeedback laptop system that could be mobile”. (His mother knows of such systems and has probably spoken to him about them.) One person (only one!) is bored with the neurofeedback games. Joey reports no negative effects but mother is concerned that his speech sounds a little “slurry”.
Not only did he remember Blake’s name, she now has 3 or 6 namesakes within, and there were some people who have the name Sebern as well. But there is also a trouble maker in the mix. One person that he trained before (before NF) is smoking, he is breaking the rule. This person has been out drinking and he may have robbed someone. About seven minutes into the training, Blake compliments Joey on how he is keeping his body tension low and he responded, “How could that be when I am yelling at the person who is smoking”. He doesn’t want to have to kick him out; he doesn’t want to kick anyone out. Later he reports that this man has been sent to a doctor for training and that he will stay if he complies with the treatment. Near the end of the session, Joey reports that the smoking person, the rule breaker is in treatment with the doctor and for now can stay in the system. I wonder who or what this is in Joey?
Once I begin training, I pay special attention to the content of dreams. If dreams or fantasies become aggressive, this is just as significant a training indicator to me as it would be if the person had acted aggressively. It is an early warning system. This does not represent a concern about impure thoughts. It also does not represent the neutrality or analytic curiosity of my therapeutic training. It is, to me, an indication that I am pushing the nervous system in some way that is not beneficial to the pursuit of regulation, equanimity and relatedness. The same will apply here as Joey represents the nature of his internal life in these characters, these articulated aspects of himself. He is a cooperative soul, not one for robbery or breaking the rules. But a smoking, drinking mugger has shown up now and this indicates the need for a protocol shift.
Joey has begun to talk more about his complex inner world. He is not at
all reticent to do this. Some of it will come as a surprise for one so
young. Joey has been married twice and is presently still married to his second wife. Both former and present wives are reticent about having their names spoken so he doesn’t say them. He doesn’t remember when he married his first wife but he does say that she had to go away on a lot of business trips. He has had a child with this woman, a boy named Mono. (Joey was born in South America, his mother is North American, his father, South American. Mono is Spanish for monkey.) He is not sure how old his son is. His first wife returned to her first husband. Soon after, he married his present wife. All of them work at the SimpsonSchool, named after Homer Simpson. This is a network of schools which were begun three years ago. Joey is the principal of these schools which are located now in California, Arizona, New Mexico, New York and Washington, D.C. (not in Massachusetts or Vermont). A new one is forming in South America. These schools are co-ed and include middle school, high school and college. They focus on vocational education, making bicycles and electronic equipment. There are no elementary grades, which is the level that Joey is actually, presently in.
It is interesting that these are co-ed schools. I am not sure of this, but it has seemed that all the internal people, with the possible exception of those named Blake and Sebern who have entered the system recently, are male. Of course, there are also the wives. Joey attends a school for LD boys. The course of his married life does not parallel that of his parents and the placement of the schools are not in the places where he has actually lived, although they may be places he has visited. And then there is the son, Mono, in Spanish meaning monkey and in English, the single one. Although I remain interested in the possibility of idiosyncratic meaning in all this, I don’t think, at this point, that it has much depth. It feels more like mental Lego
blocks, something to keep his mind occupied when he is unable to use it for more creative pursuits. I think this elaborate world speaks to his loneliness and I think, as well, to his refusal to be helpless to his brain. Could Mono represent the wish to be the only child, it could. It could also speak to how singular he is or how alien. It could also be a more random brain product, a blue block in a set of red ones.
It may be how matter-of-fact Joey is when he is telling us all this, but there is an interesting way in which, although his internal world is complex with intriguing history and sets of relationships, none of these revelations make Joey himself seem either more complex or more crazy. This is a preservative inner world which has a lot of numerical detail and is heavily populated with what seem to be hard working, altruistic, mostly male people, but it is also a flat world. His mood is mostly good, with rare excursions into irritability, and in some essential way, he too, is flat. He has an elaborate inner world but no inner self, no emotional self. There will be a time when Joey begins to feel, and when he does he will also become more aware of the extent of the disability he has lived with. This, I imagine, will be a difficult passage.
The training today is T3-T4 2-5 Hz, 2-7 inhibit for 9 minutes and T4-P4 at 2-7 for twelve.
Session 11:
“Peaceful”. This is the word that Joe’s mother uses first to describe her son’s state. But Joey doesn’t report feeling much calmer even though the people inside are slowing down some. There is some fighting going on inside for more pencils and pens to take notes on the neurofeedback. It’s not peaceful inside because of yelling at a person who did not finish his paperwork. “Sometimes the feelings on the inside are not the same as on the outside”, he reports. Sleep has been good and he has had no unpleasant effects-no headache or stomach ache. No bad dreams.
When switching from T3-T4 at 6 minutes to T4-P4, Joey reports that the
person who was “in charge of filing cabinets” has left because he was
“drinking coffee”. A new person has come to do the job because “it is so boring”. The job requires a person to be available to open drawers with a key, to access information, including mail. Is he talking about quieting when he talks of fewer people drinking coffee, or is he trying to be compliant with my anti-drug campaign? I don’t really know. Mom adds that Joe often refers to the parietal area as where he has “information clogs”. It looks like P3-P4 may be in order for this boy.
In the midst of the session, Joey volunteers that he has just had an old thought that he doesn’t need to think about anymore. His mother sees this as good news because Joey tends to perseverate. A bit later, he reports that “nine more people came into [his] body to do neurofeedback and that it is now overbooked”. He was asking people to make more room. “But it is good because these people brought laptops”. Of course, Joey’s whole system could be seen as a well populated perseveration.
Unfortunately (I think), at the end of the neurofeedback session even more people were heading in. They all seemed interested in neurofeedback, but there is a sense of frenzy, of rush, even while Joe himself looks calmer. Maybe it’s an expression of appreciation of neurofeedback (he loves to come), but I am looking for less activity in the system, not more flights to catch, or people to manage. There has, thankfully, been no mention recently of the convention of 5 billion. Even if they are all doing neurofeedback, that’s too many.
Today’s protocols: T3-T4 at 2.5-5.5, 2-7 inhibit for 6 minutes; T4-P4 at 2-5, 2-7 inhibit for 24 minutes.
Session 12:
It is the day after Christmas and I am back from retreat. Joey has dyed his hair blond! He reports that it is not too noisy inside and when I ask him, he says that he is paying less attention to the internal world. His main concern today was how to keep the second floor of his Lego building from collapsing. “It needs Lego steel”, he said with a smile. He still wants chocolate whenever he can get it. With a gentle reminder from his mom, Joey hands me a candle that he has made which is quite beautiful and with it a note that he has written, “I am glad you are working on my brain”. I thanked him for both the gift and the card and I asked him if he really felt glad that I working on his brain. He answered with absolute certainty and sincerity, “Yes.”
Mom reports that he lost his necklace this AM, a very important necklace and in his agitation over this loss, he hit his older brother. It wasn’t clear exactly what provoked him, if anything other than baseline agitation and fear over the loss, but it is very unusual for Joey to act aggressive physically, or verbally for that matter. His mother would have expected his agitation at the loss of his necklace, but not his striking out. He calmed down quickly but only after finding the precious object. She also feels that he has become somewhat defiant. This may also be, as she suggests, that “he is clearer now about what he wants and doesn’t want”. He refused oatmeal that was made for him this AM, something he would not have done. It didn’t appeal to him.
Generally, his spirits have been good and he has been a pleasure to be with, as usual. He wrote an e-mail to a girl he knows in Israel who has severe CP, to help cheer her up.
I dropped T3-T4 out of the protocol. I could not see what, if anything, it was contributing and had some concern that it might be exacerbating his moments of negativity and reactivity. I have seen this before in others. I added T3-F3, 6 minutes at 12-15 HZ for speech and attention. I think craving chocolate also indicates the need for some left side training. Chocolate consumption is now linked to depression and seretonin production. We hadn’t made much progress initially at F7-F8 on speech, so I want to try something else that stays in the areas for receptive and expressive speech. The frequency is based on how low I’ve gone on the right without discomfort and my overall assessment that this boy is primarily over aroused. T3-F3 makes him a little sleepy after six minutes, but he likes it.
Since I think everything that someone does, feels, thinks, eats, and
dreams relates first to neurofeedback (actually to timing phenomenon), until it can be ruled out, I am left wondering if I have pushed his nervous system too low, so he feels without resources or too high so that he is feeling driven, aggressive. I think, in part because he is training so low already and in part because of that ‘winding up’ action that we saw recently, that too low is the better guess so I begin to bring him back up at T4-P4. When we get to 3-6, he likes this. Initially, he hadn’t felt very much at 3-6 Hz but he has been training and his brain changes. That is what we expect. So frequency changes too-not always, but often.
Joey is very attentive to his training. He focuses on the screen, even
while trying to manage all the ruckus within. He seems to ‘get’ the task and to able to discern what he feels, if not yet able to describe it well in words. I always forget, and he always reminds me, that he loves the dolphin, a stuffed animal that vibrates when he meets EEG thresholds. When I give it to him, he tells me it’s not on and I reply that it’s time for me to get with the program. I hit ‘T’ and it starts. The weight of it soothes him, I think, as well as providing tactile feedback. The training, it’s clear, would not, for him, be the same without it.
Today’s protocols: T3-F3 at 12-15 HZ, 2-7 inhibit for 6 minutes; T4-P4
at 2.5-5.5 for 17 minutes and then up to 3-6 for 7 minutes, both at 2-7 inhibit.
He reports feeling tired after T3-F3. Otherwise, “Good”.
Session 13&14:
I made protocol changes at our last meeting together. I could not see any positive (or clearly negative) contribution of T3-T4 so I am trying T3-F3 in its place, to address speech and general frontal activation. I am also beginning to go up on the right side. So my protocol now is T3-F3 at 12-15 HZ for 6 minutes and T4-P4 at 3-6
HZ for 21 minutes, 3.5-6.5 for 3 minutes at the end.
There is little of note after the last session except that both Joey and his mother report that he is feeling good. Mom says he is ‘peaceful’ and’ easy to be with’. Sleep is good. Appetite is fine. All objective markers are good, not dramatic at all, but good. During the training today, Joey reports that he likes both sites and that his “head feels calm and quiet” with right side training. But at the end he does offer that he is feeling tired so we raise the frequency to 3.5-6.5 and he reports liking this frequency better.
The next day, session 14, father reports that Joey was in great spirits. Joey agrees and is animated in describing that the internal world is busy but quieter than normal because “people are still away on vacation and they are expected back in nine days.” Phones are not ringing much, but he expects that to change when they return. Last night, “nine people finished training”, which now means neurofeedback training, at least as part of the mix, and are ready to start training others as soon as they get the computers. He also reports that more people want to “come in and train on the neurofeedback system”. About half way through the session, Joey discovers that, in fact, the computers arrived at midnight.
I wonder about the significance of the number 9 to this boy. It comes up repeatedly. And then, there is midnight, the almost mystical time of
transformation from night into day. It is a time of great darkness and there is still a long wait for dawn, but midnight is a hallowed and often scary time in almost all systems of mystery.
One gets the sense that Joey is looking forward to the return of the
post-holiday crowds and all the activity. Again, in the language of
defenses, you might wonder if he is frightened by how quiet and perhaps
lonely it is, that he is bringing these people back to keep him company and to keep feelings at bay. Inside his head, Joe might be thought of as a ‘workaholic’, keeping himself distracted from sadness by faxes and reports and phone calls. He is also called upon to be the manager of vast internal systems. And, of course, we all are. For most of us the narrative of our states begins outside the brain; for Joey it starts within as he tries to communicate and make sense of what might otherwise be chaos. He is attempting a self-regulating, self-organizing narrative.
Session 15:
Joey was singing yesterday, singing while on his way to go skiing. His
brother reports that after listening to his new CDs, Joe was remembering, repeating and singing the choruses. Singing is new behavior which suggests a few intriguing possibilities. Singing may well signal that he is developing new timing capacities, particularly in the right hemisphere. It could mean that he is feeling less self-conscious and willing to try to sing, a behavior that many of us are, reasonably, cautious about. And he is remembering lyrics. This is also a new capacity. Remembering lyrics may suggest that he is beginning to positively affect left hemisphere function.
Joey’s presenting problems include seriously impaired short-term and working memory, as well as auditory processing problems. It is, of course, difficult to imagine how one could have a good memory with major auditory processing problems which manifest clearly by age 2. Mom, who is an attentive Occupational Therapist reports that he has good bilateral action in his legs while skiing but that his arms still do not move bi-laterally and in rhythm with his gait. There is no change in the clarity of his speech.
Joe himself has no complaints. Things in his head are “medium quiet”. He makes the hand motion for metza-metz. There are phones, copiers, printers all going and there are people walking around. It has the feel of the offices of the New York Times. “Only three people on Coke (cola) and only one person on coffee.” In response to my question, he says that it might be easier for him to think. He has been snow-shoeing – a good activity in the two feet of snow we have here, as well as skiing. The rest of the time he is surfing the web looking for stories about animals and animal care.
He sits down to train and does so with admirable attention and earnestness. It is inspiring to watch him, actually. I, of course, forget the dolphin and he is pleased to remind me, politely, that he would like to have it. He holds it to his chest. He does report times that he is talking to those inside, settling a dispute, checking on someone new who has arrived, or giving instructions, some of them about neurofeedback. In fact, this dialogue with the internal (as distinct from internal dialogue), may be going on constantly and in preference to communication with those outside of him. This feels neither psychotic nor anti-social. I would be concerned, however, that left unaddressed, his disorder could develop psychotic dimensions of disregulation. For now, I imagine his speech is fluid and easy inside his head. And, of course, there, he is in charge, even if a little overworked.
I decide to target speech areas specifically, and individually to see if we can discern a difference. Articulation is such a large part of his problem and I would like to see some clear impact on it, if possible, before he returns to school. So, I make another shift in protocol. At the end of the training, he is smiling and yawning.
Protocols: F7-A1 at 12.5-15.5 for 3 minutes. He starts to blink his
eyes repeatedly, so we go down 12-15 HZ. His blinking stops immediately. Then T3-A1 at 12-15 HZ for 6 minutes. So 12 minutes left side training and then T4-P4 at 3.5-6.5 for 18 minutes. All with 2-7 inhibit.
Session 16:
Joey’s speech may be a little clearer. Mom had reported when Joey’s speech had gotten worse after F7-F8, tried first at 2-5, then at 2.5-5.5, He lost the ‘lifters’, which, of course, had taken him years of speech therapy to develop. This is the kind of result that would have really frightened me when I was new to neurofeedback. Primarily, now, it lets me know that this brain is responsive to the training, but it still cautions me. He was a little clearer in making the distinction between the sound in ‘sink’ and in ‘think’. To test this, his mother asked him where he washed his hands and he momentarily got jumbled and answered, ‘think’. He knew immediately that it was the wrong word, perhaps from the way it felt in his mouth, perhaps from his mother’s face, and he corrected it himself and said ‘sink’. No more detailed report from his father except for, “He is a wonderful kid. Isn’t
that right, Joey?”. Joey nods and looks self-conscious to me, like anyone else who doesn’t quite know what to say to a compliment, particularly to his father’s compliment. Joey hears this regularly from both his parents. They love their son and at the same time you can’t help but hear their anxiety, their deep wish to compensate for the wrong done to his brain. It is full-hearted and it is pained and at moments, it is just acceptance. Acceptance without giving up. I wonder if Joey senses all this too.
He tells me with some delighted anticipation, that “everyone is coming back – it almost sounds like ‘coming home’-for New Years”. “Flying in from all around the world.” Everyone will be here by midnight and they will stay (sigh) to work on his body.” There are 24 in all (one for every hour?). And I thought we had gotten down to the skeleton crew, the maintenance team who thought they’d be done and out for quite awhile. Perhaps he thought this too. I find myself worried that he has had his own private experience of hope and loss of hope, so I look for this in him. I see no sign. No journey is linear. Joe’s won’t be either.
Protocols: T3-A1 at 12-15 HZ for 6 minutes; F7 at 12-15 Hz for 6
minutes and T4-P4 at 3.5-6.5 for 12 minutes and 4-7 for 6 minutes. I made the change because he started to rub his eyes. He corrects for this state by sitting up. (We do this intuitively. The more we recline, the more slow wave activity we make.)I correct for it by raising the frequency. He doesn’t, somewhat uncharacteristically, feel the difference.
Session 17:
It is the New Year, ten days before Joey returns to school and I won’t be able to see him often. I feel as if I am still searching for the right protocol, but perhaps I am really looking more for the dramatic break through. Joey’s brain requires patience of him and it will ask the same of me.
As is his custom, Joey does not report any feelings or internal states, at least those that are not represented by the United Nations within. He reports that everyone has gathered and that he has no physical or emotional distress. Today, in fact, he doesn’t tell me too much about the internal activity, but his mother reports an unusual moment. They were visiting family on New Year’s Day and Joey emerged from the group of children downstairs, looking sad. To himself, in himself, Joey doesn’t have this emotion. He has no reference point for it. Whatever has injured his brain has greatly impacted his emotional range and further impaired any ability to talk about what may arise, unbidden and unknown, somewhere as feeling. (Sadness, it seems, may be missing from the emotional repertoire of the whole family.) So when his mother asked him that day if he was feeling sad, he predictably said “No” and less predictably, gave her a forced smile.
It leads me to wonder what concrete representation there could be of sadness. How could he tell and how could he tell us, if he knew? His mother still felt he had looked sad, even if he didn’t recognize it. As she was telling me about this, I looked at Joey for his response. From what I could discern, he wasn’t tracking the emotional content of her report. She went on to say that he bounced back quickly and was his usual happy self the rest of the time.
Were Joey to experience sadness, I would see this as good news. I don’t, in fact, imagine that he would be able to reorganize his brain function without at some point coming up against the reality of how badly disorganized it has been. In short, I think his gains will require his experiencing his terrible losses. And when he does, he will feel sad. Was that what was happening that day, for that moment? I never see sadness in anyone as a negative training indicator and I never try to train anyone out of it. These are feelings inherent in living in touch with ourselves and with the world we live in and they flow through us. It may well be the case, since no one in the family reports feeling sad, that when Joey does, they will need help letting it happen and letting themselves feel it too, for him and for themselves.
During the training, Joey tells me that three people are still missing and then later on, that he has “Just found out that they got in at midnight, just in time for the New Year.” It is a new year. What will it hold for this boy?
Protocols: T3-A1, 6 minutes, 13-16 HZ; F7, 6 minutes, 11-14 HZ; T4-P4, 18 minutes, 4-7 HZ. 2-7 inhibit at all sites.
Session 18:
Joey is preparing to return to school and he has in the past represented anxiety about transitions as increased activity in the
internal realm. It is as if he is bringing in the reserves to make the move back into boarding school. (Generally speaking, transitions can often be experienced as episodes of acute loss). Given this reality, it is a little difficult to discern the meaning of the report that he is more agitated. But I use my rule of thumb: once you begin neurofeedback, everything is related to neurofeedback unless you can rule it out. So the report that he is rushing when eating and that he is going to bed later and that his older brother feels he is more agitated are data about the training, more than about anxiety, per se, about returning to school. Joey reports that his mood is good and that he is looking forward to going back, but that not everyone inside knows that he is returning soon.(??) During the training, he reports
that his internal world is getting quiet but that there are meetings going on. He isn’t sure what the meetings are about.
Again looking for the optimal protocol for Joe, I decide to try training at C3-C4 instead of T3-T4 and to return to the association cortices with P3-P4. Today’s protocol: P3-P4 at 10-13 HZ for 12 minutes; C3 at 13.5-16.5 HZ for 6 minutes; and C4-P4 for 12 minutes at 6-9 HZ. I am hoping that his brain will give me a clear sign of the path to follow. I think it will if I can be aware enough to discern it.
Sessions 19&20
“It just feels right. I don’t really have specifics”. This is Joey’s
mother’s response to the P3-P4 protocol. She goes on however to report that he has been impatient with her helping him, wanting to do things by himself. Initially she described him as a little more animated but also more impulsive. As she went on, she described some playful behavior that was also somewhat aggressive-he pushed her. He isn’t known to rough-house like that. He is less receptive to her touch.
Of course, I am wondering what’s what here. Joey, although he looks closer to ten, is 13. These behaviors could be those signaling the approach of adolescent autonomy. But then she went on to describe his voice as loud and Joey as easily distracted. OK, this part has nothing to do with normal developmental pressures. This indicates to me, too long or too high on the left side, or both. He has been more talkative with the interior but he is also singing better. He is learning a chant for his bar mitzvah and is beginning to pick up the melody. He read two poems well to prepare for the ceremony, but there is no change in his articulation. Still a little less clear than when we started.
He was re-evaluated by a psychiatrist at Children’s Hospital who has been following him and he felt that Joey was doing well. He maintained him on Welbutrin. When Joey and I talked he said that there was ‘no coffee at all, only 2% caffeine tea’. I asked him if things felt more organized in his body and he said yes but I am not sure if he knew what I was asking.
Overall, he seems a little too jacked up, so I feel I may be too high
everywhere. His mother expresses some concerns that since he does not know how to cue socially, this impulsivity will cause him trouble at school, so I make the following protocol decisions:
Protocols: P3-P4 at 8-11 Hz (down two Hz) for 9 minutes
C3-CZ at 12-15 Hz (down 1.5 Hz) for 3 minutes (down from 6)
C4-P4 at 5-8Hz for 9 minutes, then to 4-7Hz for 9 minutes (down from 6-9)
The next day, the last training before he returns to school, Joey is
smiling and calm. Mother reports a good night, talkative at the dinner table but related to the family. He reports no bad dreams and waking rested. When he was asked about his internal world, he said that he hadn’t spoken to anyone yet today but the question seemed to wake them all up. Or the training does. As this happens, he reports that he doesn’t listen to the audio feedback-he is very attentive to the visuals-because he is talking to the people inside his body. There are seven people today preparing him for his return to school. He also reports that he is getting a new heater in his body, because the old one is not regulating temperature very well. He knows the person from the heating company, a man that used to work for him.
Temperature regulation is an important brain stem function
and it seems as if we may be making him cold. In my experience, this is an indication of a major shift in brain function, and can be an indication that we are training too low. But he has gotten the problem under control evidently, so for now, I am not concerned. He also reports that there are women in his body and that they are in charge of cleaning and vacuuming (he seems to be absorbing cultural sexism without too much difficulty!) He also reports that the group in his body is cooperative with the changes in his internal world.
The only change in protocol is to go to 4-7Hz at C4-P4 for the entire 18 minutes, to help maintain his sense of calm, to enhance his social cueing and to keep him out of trouble with his somewhat tough peers. Tomorrow, he returns to school and I will miss him. His mother will let me know how he is doing at school and I will see him when he comes home for visits.
Session 21:
Joe has been back in school for two weeks and everyone describes him as
“peaceful”. He is still struggling with the clarity of his speech and is having no luck grasping math concepts. His mother reports that he was somewhat “hyped up” after the last training, that his mood has been good and he has been doing fine at school. There is, however, an increase in his “grappling for words”. Perhaps most importantly, he has invited a friend to stay over with him. This is new behavior. His mom says that in the past he had to use the weekends as “recoup time”, and that he never asked to bring someone home. It may be the case that the exterior world of peers is beginning to compete for his attention.
Again, as training starts, the interior system wakes up and he is excited to report that something very good is happening. Animals are being trained to work in people’s bodies, as well as people in the bodies of animals. Dogs and cats are involved in this program but soon it will branch out to wild animals and fish. Blake is working with him today, and she has brought her dog with her. She wonders if Joey is inspired by this. Joey loves animals. In the summer, he rides his bike to the zoo nearby his home, he watches Animal Planet devotedly, he surfs the web looking for articles about animal care and he has a Chocolate Lab whom he loves. He would want animals to have whatever he felt was good for him. He goes on to report that a lot of people
want to do neurofeedback training. During his session, they started training a dog and he is concerned that they may have “messed the dog’s mind up” because it is difficult to keep the dog quiet.
Is he trying to alert us to problems he feels in his own training? Within several minutes it was also difficult for Joey to stay still. He was beginning to fidget. It is always hard to discern the meaning of this particular behavior, even when someone can talk to you about it directly. It could be a manifestation of overarousal, a discharge of excess energy, or an attempt to keep the system alert? Blake, operating on the first assumption, chose to lower the frequency and Joey’s body quieted for the remainder of the session. Given that he felt hyped up after the last training, that he returns to school at the end of the weekend, that his mother expressed some apprehension about his miscuing in a hyped up state and this in-training response, I think, Blake discerned this accurately and made the right protocol adjustment. Neurofeedback training requires continuing assessment and reassessment. The patient’s responses are an invaluable contribution to the decision making process. Although Joe’s way of tracking his brain is far from typical, it is extraordinarily accurate.
The rewards are reduced at all sites by .5 Hz.
The protocols for this session: P3-P4, 9 minutes, at 7.5-10.5; C3-CZ, 3 minutes at 11.5-14.5; C4-P4 for 10 minutes at 3.5-6.5 and then down to 3-6Hz for 8 minutes.
Sessions 22&23:
The reports from school are mixed. He is still unable to decipher math
concepts or to add or subtract without using his fingers and he still
struggles to articulate clearly. But there are gains. His mother called to tell me that Joey, who has always been liked, has begun to invite friends home for the weekend. She sees this as a significant change, since in the past, he has used the weekends to ‘regroup’ from the demands of social interaction. Joey reports that he has a new doctor in his head, actually two new doctors, who are there working on friendship.
Mom reports that he has tried new athletic activities. He went ice
skating, which he has never wanted to do and which he now wants to take up. He also went bowling for the first time. He needed to throw the ball from between his legs, but he also had a strike. These activities have always been available to him, but he hasn’t had the confidence to try them.
His father called also. At Joe’s school, graduating students are required to memorize and deliver the Gettysburg Address. He has never been able to do this, until now.
Session 23, the first after the decision to go to C4-P4 for the entire session, Joey reports that an old worker has returned to tell him about a new job, – as if this boy needs more work!. At the same time, a new job could suggest change. Today there are 19 people in his body, visiting and “playing around”. He reports that the internal people are “getting better jobs”, because he is helping them. During the session two people return who he hasn’t seen since he was five or six. They have come to see all the changes and both remark that things seem “better inside and they wonder why they ever left”.
Protocol today: C4-P4, rewarding 4.5-7.5, inhibiting 2-7.
Session 24:
Joey has been away at school and I haven’t seen him for three weeks. He’s home now for Spring break and he has a lot to tell me. He begins with his unwavering, predictable self report: “Good!” He thinks his memory is working better and that his body is working better. There is no yelling at his body or in his body. So it appears his internal world is quieting down. There is now a maintenance crew in his body fixing phone and computer wires. He said there were two dogs in there too, just hanging out like dogs do, keeping the workers company. He has a secretary now who screens his calls.
He reports that he got a call when he was skiing but he put his answering machine on. It was a good thing that he didn’t let himself become distracted because he was skiing the Double Black Diamond trail and doing so when it was icy. This is an expert trail and he was unafraid and, apparently skied it well, well enough anyway, to tell the tale. He has never done this before, both because he was afraid and also because he lacked the skill, even the capacity for the skill.
He has no bad dreams but says his dreams have changed. He is able to note this but unable to describe the changes. He says he wants to be with people more than he used to. He has asked his mother to teach him Spanish which she is reluctant to do since he can’t yet clearly speak in English. His mother is a native English speaker who speaks Spanish and Joey was born in Spanish speaking country. His father speaks three languages. He does have room in his schedule now to begin a new course of study because he has gone down to part-time as the principal of the SimpsonSchool and is presently looking for a replacement!
Protocol: C4-P4 4.5-7.5 HZ, 2-7 inhibit
Session 25:
Joey has returned from a trip to Legoland with his father and he had a
wonderful time. He says that not much is going on in the internal world, but also that he isn’t seeking them out because they are busy in meetings. When he closes his eyes he can see where they are. Sometimes he knows what is going on even when he’s not paying attention, but usually he has to close his eyes to see them. He told me all this in response to my inquiry. He reports that when he was at Legoland-this boy loves Legos-that all the people were happy; that they all came up to his eyes to see what there was to see. I asked him if he was happy and he said he was. I think he felt particularly and concretely happy in his eyes. Legoland was a visual feast for Joey.
During the training, he had a very specific report. It was the first time he’d done this. He said his brain felt ‘sleepy on the right side’ and the left side is feeling fine. He feels that his left eye is wide open and his right eye wants to close. He corrects his posture, sitting up and is aware that this makes it easier for him to train. He reports that he feels “a little heavy on the right” at the end of training. Of course, I will be watching to see if this frequency is too low. I will only know over time if the in-session report is predictive of the longer term outcome. But in the meantime, I am delighted that he can tell me what he is feeling, as a feeling, directly.
As he is getting ready to leave I asked him if he liked coming for
training. He said “Yes!” “Do the people inside you like coming, here?” He answered yes again and said, “The angry ones come up from deep in my body”-he gestures to his stomach- and they get calm and go back down.”
Joey is making progress and I think he will continue to, but not as quickly or as significantly as could be possible, so today I recommended a brain map, a qEEG. Joe’s mom and I had discussed this as a probability early on in his training but there is the matter of considerable expense. So, the agreement we had was based on progress. We would see how he responded to symptom-based protocols. If his responses were clear-cut and positive, we could forgo the
map. If not, I would recommend it. We’ll see what the Q adds to this
picture, to the training protocols and to the outcome.
Protocol: C4-P4 4.5-7.5; 2-7Hz inhibit.
Session 26:
The report is that everything is very good. Joey is preparing for his Bar Mitzvah and is consulting the Rabbis in his head. Mother’s report is positive too. It is only two days since the last training, so we probably don’t know all of the training effects yet.
He looks tired and with no other reason given, I asked him whether it would feel better to train a little higher. He wanted to try this. Since he is beginning to be able to report very specific effects and I want him to have as much control as possible, I go up 1/2 Hz to 5-8 HZ at C4-P4. He immediately looks better and reports that this time his right eye is wide awake and his left feels sleepy. He comments that this is the opposite pattern from last time and finds this interesting, as do I. Neither of us knows, however, what to make of it.
After three periods, I asked him again, what would feel good-staying where we are, going down or going up. He wants to go up. So until the following report (10 minutes later), we trained at 5.5-8.5. He says that some of “his eye people” have been drinking coffee. Some people have begun to fight in his head. Coffee and fighting-this is not too hard a call- we have gone too high and I ask him about it. I ask him to help make the translation for me and he does. I asked him what he thought about these responses, what does he think they mean. He thinks we should train at a lower frequency and see what happens. One of the problems that Joey’s brain leaves him with is a very concrete representation of feeling states. His people get excited and come to his eyes when he is at Legoland rather than he loves what he sees. So I think it is significant that he is able to make this translation and recommendation. It is much less concrete, although, it still does not require the step- “I feel…”. This is, of course, a difficult sentence for most thirteen year-old boys to complete, (if not most men) but my hope is that one day he will be able to know that he is feeling a feeling and speak to that directly, without all the surrogates.
He is quiet at 5-8. The fighting stops and he reports very little internal activity at all by the end. He has the feel of someone “in the zone”. His concentration and focus were enviable.
Ending protocol: C4-P4 at 5-8, 2-7 inhibit.
During the last training, Joey looked tired and reported feeling tired so I raised the frequency reward at C4-P4 to 5.5-8.5 after nine minutes at 5-8 Hz. He immediately looked better, but people begin to fight in his head and the coffee began to flow, so after ten minutes at 5.5-8.5, I lowered the reward again to 5-8 Hz. At this frequency, he seems to be “In the Zone”. His reports are positive in this session a week later. It is easier to ride his bike [!], his mood is good, no bad dreams and there is the sense that he is beginning to split his attention more equally between the external and the internal world. He still does not spontaneously remember things but seems to have more rapid access after prompting. Prompts, in fact, prompt him and this hasn’t been reliably the case in the past. He reports that the people inside are “pretty quiet today”, that they are drinking coffee, specially
formulated (he doesn’t use this word but he definitely has this concept) so that it has only 6% caffeine. This took “alot of experimentation” but they have figured out how to do it. There are six people in his body. This number usually indicates a “maintenance crew”.
Joey is still quite involved managerially but he has brought about some
interesting changes. He is still fully in charge of “The People Company”, the name of the group within him that is devoted to helping people throughout the world (now being trained in neurofeedback) but he has found a suitable replacement to run the SimpsonSchool. The SimpsonSchool, as it turns out, is something of a conglomerate. As he describes it, the company takes over failing schools, runs them as the SimpsonSchool for as long as required to get them operating well again and then returns them to their community. His replacement is the principal of one of these schools. I don’t know exactly what this means in terms of his regulation and recovery. It could represent that he is less busy inside; or that he requires less internal distraction; or that he can trust others a little more to look after his interests. His description of the whole process does, however, demonstrate a good grasp of the corporate take over reality so dominating the world of business, perhaps quite a bit better than that of the average
thirteen year old.
At the end of the session he does not look tired and reports feeling, “Good!”
Ending protocol: C4-P4 5-8Hz reward; 2-7 inhibit.
Sessions 28&29:
Last time, in response to Joey’s in-session reports and wanting to train him as high as is comfortable for him, I continued to reward him at 5-8 Hz. This time, his mother reports that he has been “off”. He was defiant, his first response has been ‘no’, and he has been talking more with his internal world. He also has been talking about more ‘far out stuff’, like having a rug on top of his brain and rug cleaners in his brain. This is a new delusion/metaphor. In the past Joey has believed that he was born on another planet and that he was an alien visitor. He reads alot about this kind of stuff. This is not new, but it hasn’t been up for him recently. It is up this past week. The behaviors are uncharacteristically aggressive for Joey but they too have occurred once before when I trained him too high. So I will drop back down to 4-7 Hz to see how he does there. It is interesting to see the likely correlation between overarousal and his deeper retreat into the internal world; more active conversation and more bizarre.
He had a brain map this week as well as a consultation for
Hyperbaric Oxygen Therapy. We will see what the map has to tell us in due time. I have no doubt that it will offer some other approaches to training.
Joey returned the next day for session 29. His father reports that he is no longer negative or agitated. His mood is sunny and he is definitively more sociable. Joey tells me that a new filing cabinet that he bought two days ago, fell apart and that his papers are all over the floor. He told me this when I asked him if he still remembered the Gettysburg Address. He goes on to tell me that people are in there cleaning up and that he is lodging a complaint with the company about the faulty filing cabinet. This filing cabinet is in the parietal part of his brain-he points to it-and I think it represents some function of alpha. In a common metaphor, we might say, “It’s in the back of my head/mind”. He’s both more concrete and poetic. He tells me that
he “can’t find the Gettysburg Address right now”, that he is in the process of “reorganizing”. Other than the collapse of the filing cabinet and all the memory it so precariously holds, all is quiet inside. The clean-up/reorganization has no turmoil in it.
Joey started to feel agitated after an episode of sleepiness and reported feeling better at 3.5-6.5. At the end of the training, he said that it was quiet inside, but there was a meeting going on. Commenting on his score, I said, “Look you have one red gem, seven amber gems and one diamond.” He said almost immediately, “Nine gems in all.” I looked at his father and asked, “Does he do that?” and his father smiled and said, “Not before now.”
Ending protocol C4-P4 at 3.5-6.5 reward; 2-7 inhibit.
Session 30:
The report is that Joey has been edgy over the last week. He has not been oppositional, but perhaps a little irritable. Joey reports himself that he has been feeling slightly irritated with his parents. This kind of reflection on his feeling state is unusual.
We will learn later on this week, when he brags about this at school, that he has been out with some friends of his brother who were shoplifting sunglasses. His mother was quite disturbed about the other more responsible boys engaging in this behavior and about the fact that Joe hadn’t told her of it. This was unlike him. I shared with her how alarmed I was when my daughter told her first lie. At the time, a clinically sophisticated friend told me that it was, in fact, a developmental milestone. My four year old was now able to recognize that I didn’t know everything she did. There was enough cognitive capacity and capacity for “otherness” that she could actually form a lie. Joey didn’t really lie, but he did omit, until he couldn’t bear the delicious secret any longer and spilled it at school. He may have had the nascent sense of separateness himself for the first
time.
His edginess may have been related to this caper and his new experience of keeping a secret, more than the protocol. The school principal also reported that Joey was proud of his behavior. This too, understandably, concerned his mother and I made note of it. My sense is that his shoplifting and his pride in it is unrelated to the training. I think he was motivated by his need for peer attention and “normalcy”. But I note it, because I believe that neurofeedback is a rule/out in all behavior of all people who are training.
We didn’t know anything about this at the time of session and didn’t know what to make of the edginess. Too high? Joey reports no increase in sugar craving and no decrease in his love of chocolate. His sleep is still good, with no nightmares but it may be a little harder for him to get up. We decide to keep the protocol where it is.
During the training, about ten minutes in, he reports that an office
supply/school supply store is opening in his body because there are so many people with information in boxes entering the office in his brain. (Clearly, he sees this as a marketing opportunity. This boy, in his own unique way, has a very good grasp of business dynamics.) He points to the frontal region of his brain to indicate where the store is opening. His office, he says, is on the right side. This is exactly where Allan Schore, Siegel and many others would locate the agency in the sense of self. He reports that he has billions of people training to go out into other bodies and that it is his job, in essence, to make the placements. He explains that they cannot go into old people’s bodies because he is worried about how long they will live. These trainers do not know how to leave a body after death. As a result, most of them will work in people who are 20 years old or younger. Later in the session, Joe reports that he is talking to a very important person, the second owner of the People Company, who wants to move into Joey’s side because where he comes from is too loud. Joe ends by reporting that it is quieter in his office and in his head than when he came in(!!)
He leaves after this session to return to school and I won’t see him again until summer vacation. Stay tuned.
Protocol C4-P4 3.5-6.5Hz reward, 2-7Hz inhibit
Session 31:
Joey is home from boarding school. He told me about his accident. He was taking his new bike over a jump and the handle bars caught him at the throat, under his chin. He told me, in that somewhat exaggerated way that little kids can use when repeating a parental warning-“No jumps with my NEW bike!” He had this accident with his new bike, one he wasn’t yet used to. His vocal chords were bruised but have healed more quickly than anticipated and he was able to talk well with me today. A week before this happened, he had his Bar Mitzvah and he was able to stand in front of the group and remember his poems and responses. His parents were very proud of him.
He has two new friends at school, the first friends of his life. Everyone has always liked Joey, but he has never been able to make friends. He did not know how to socially cue and he has gotten better at this. There has not been much change in his academics. He cannot generalize math concepts. He can, for instance, solve the equation of ten dollars minus seven dollars, but he can’t use it in a store to make change. He has two hours of tutoring every morning during the summer and is working at a zoo and a kennel. He loves animals and looks forward to his work.
The results of qEEG arrive. Joe has a number of problems, as we would have predicted. His dominant frequency is 7Hz. This is too low (normal alpha idling for his age is 10-11 Hz) and it predicts learning disability and the likelihood of long term training. Joey also has abnormal amounts of frontal delta at 3Hz and some coherence abnormalities. This is a hard brain to think in or, in a way, even to see out of.
His parents have consulted with a well respected “alternative” MD and Joey will have a month of hyperbaric oxygen therapy (HBOT)in August. Our job, in the meantime, is to see if we can budge this brain out of its slow wave slumber. I will down train delta today.
Protocol: FZ 1.5-4.5 DOWN, 2-7 inhibit, 12 minutes; AFZ 1.5-4.5 DOWN,
2-7 inhibit, 12 minutes.
Session 32:
Joey’s brother Rob brings him to the session today and reports that Joe has been cooperative. It has become brutally hot here quite suddenly, after an unusually cool and rainy spring. When the weather turned, Joey went to the attic, brought down all the fans, washed them and set them up in different rooms. He did this on his own initiative and had never done anything like this before. He didn’t seem to find it unusual but his brother did.
Joey reports that it’s pretty quiet in his head but not as quiet as last time (!). I make the exclamation because last time was five days ago and he remembers his state then. He told me that he has two secretaries in his head, one man and one woman. I asked if they drank coffee and he said no – getting the gist of my question – everyone now drinks decaf. I think his speech is a little clearer and Joey agrees that this could be the case.
I got a copy of the actual Q today and it indicates that the diffuse frontal delta is mostly at 3 Hz. So I will shift my protocol to focus on this frequency.
Protocols: FZ, 12 minutes, AFZ 9 minutes; F7 9 minutes all at 1.5-4-5 Down training and 2-7 inhibit.
Session 33:
Rob reads a written report from his mother saying that Joey is “not himself”. He seems a little sad to her and more easily frustrated. Joey
reports that thoughts “pop in and then fly out” of his head. He cannot grab hold of his thoughts. He reports that it is quiet in his body but that they (the people in his body-probably the night watchmen) are “trying to find out what happened last night”. I don’t know what he is referring to but clearly he is experiencing some level of difficulty. Something is going on and I don’t know exactly what. He also reports having a headache after he saw a movie in the theater. It is unusual for him to have headaches.
My best hunch is that we were bringing delta down too precipitously, that he was relying on this slow wave, or at least accustom to it, to stabilize his functioning. It is often recommended that “exercising the circuitry” may be the most effective thing we can do. The two ideas seem elegant next to each other. I can’t resist the attempt to provide him with some delta, even as we are asking his brain to down train it and to “exercise the circuitry” at the same time. I will down train delta for three minutes and then up train delta for three minutes, then down train again for three minutes. I did this at two sites which I hope will allow him both more stability and more clarity. Neither is what actually occurs.
Session 34:
I saw him again recently during his spring break from school and there is much to report since session 33. This session report follows our attempt to “exercise the circuits” with up and down training of delta. His response, as you will read, was not good but I think it helps us learn something more about at least two operating assumptions about NF.
The first is that excess delta (theta, alpha) is “bad” and should be down trained. In this case, in an earlier session and in this, it looks like delta was not only an indicator of brain injury but simultaneously an important compensatory mechanism. It appears to have played an important role in his stability as well as his disability. The second theory is that what we are doing is “exercising the circuits” and since this is what we are doing it might be most efficient to train a frequency band up and then down (more efficient exercise). It appears to have been quite powerful in this boy’s brain but not more efficient. This is one brain, at one moment in time, and I hesitate to draw any conclusions from this one experience, but it does raise some important issues.
Joey’s mother called me several days after the last training to report that Joey is having a very difficult time. She describes him as depressed, sad, disorganized, unmotivated, frustrated, lonely and bored. She wants her old cheerful, happy, motivated Joey back.
Needless to say I was concerned for him and I saw him the next day. I had changed the down training to training down one period and up the second, down the third at two sites. He was edgy with down training alone, but with “exercising the circuits” he is all of the above.
When he came in I asked him how he was doing and for the first time ever he said, “Not great”. He has always said “Good.” I asked him how his week had been and he tried to tell me but looked as if he was drawing a blank. I withdrew the question and he began an astonishing description of the problems he experienced in thinking. He put his hand at the back of his head, over the occipital area and he said, “If thoughts move fast enough, they make it into the front of my head”. He showed me the pathway, back to front, bringing his palm over the top of his head to his forehead. “But if they don’t, they only make it as far as here (he points to CZ) and then they slip backwards again. Sometimes they only start up and don’t even get as far as here (the parietal area) and they slip back.” If they get to the front of his head he can say them. “Sometimes, they are just stuck, they don’t move at all.” I could feel his frustration viscerally. When he is “thinking just right”, the memory/thought goes around the right side of his head and stops at FP2 (he showed this to me). When he “thinks too hard” they spin around his head and land at FP1. He experiences that as having gone too far. He said, “I could catch the thought if I could slow it down.”
It is important to recognize, I think, that Joey is describing his thought process and he is doing so with alot of clarity. He is describing his brain as his brain. He’s not describing it through the internal world of fax machines and phones and international training teams but how he feels this process in his brain; these are the currents of his thinking and his memory. He hasn’t done this before, not like this. When I asked him about his internal world he said it was spinning around and noisy. The people there were trying to slow it down. When I asked him if he wanted the training to slow his brain down he said, ‘Yes’, and said so with a lot of confidence.
Interestingly, even with this negative or seemingly negative response, Joey wanted to come today. I have the sense that when we down trained delta it sped him up to fast, too soon. He wasn’t used to this processing speed and didn’t know how to handle it. So he shut down. His brother was describing this and said, “I’d ask him something and he just wouldn’t answer”. Joey said, “Rob, that’s because everything was going too fast.” His brother smiled at him and said that now he understood. He thought it was amazing that his little brother could point to the correct areas of the brain associated with memory and initiation of thought. “It’s not like he looked it up in a textbook or anything.” I think it is amazing too.
As we trained at C4-P4, he began to talk again of the filing cabinets. He said that the new one hadn’t been delivered yet and that the ones he has are stuck. They are stuck because they are heated up, which makes it hard to open the drawers. They get hot when he thinks too hard and he has to cool them down so that the drawers will open. I asked him if he remembered an acronym using FORD, that one his boss had told him. He told me ‘Fix Or Repair Daily’, which was a joke he heard three weeks ago. I had added one of my own and he repeated it almost right: ‘Ford On the Roadside, Dead’. It goes ‘Found on the Roadside Dead’ and he corrected it as I began to tell him. I asked him how he remembered these things. He said, “I have a special filing cabinet for car jokes. It’s not in the back”. He swept his finger over his forehead to indicate that they were there somewhere, in the front, and “easier for me to find.” I asked him if he remembered the Gettysburg
Address and he shook his head. “Do you remember any of it?”, and he said, “Four score and twenty years.” and I laughed and said, “That’s exactly how much I remember of it”. He went on to elaborate: “That is in a file cabinet in the back and it stays there until I need it. I don’t need it now.” This is, of course, the economy of memory and memory retrieval. He felt that if he needed it, he could practice it and he would remember it. This demonstrates a new confidence in his memory as well as good insight into the working of his own brain.
Given his request to slow his brain down and his clear distress, as well as that of his family (and me), we returned to his default protocol. By the end of the session, he is talking more and he looks better.
Today’s protocol C4-P4: 5-8 Hz reward; 2-7 inhibit
Session 35:
At the last session we returned to what I considered to be Joey’s default protocol, C4-P4 after trying to apply the “exercise model” in the delta band. As you will remember, he asked for his brain to be slowed down. His mother called two days later and she reported that Joey is “back to who he is”. She is relieved but also quite fascinated to hear what Joey had described to me about his own mental processes. (As usual, I had Joey’s permission to share this with his mother). She also told me that he remembered his math tables for the first time. The parents were amazed and, interestingly, attributed this accomplishment to down training. Apparently his older brother had described Joey as looking and being more himself as soon as they left the session.
When I see Joe, a week later, his language is off. It is difficult for him to retrieve words and he was having a great deal of difficulty retrieving or processing numbers. His mood, however, is greatly improved, although mother reports that he might be a little on the downside. He is not agitated at the dinner table but he is also not motivated to go to the gym.
Joey reports that there is “too much in the front filing cabinets, that’s not going to the back, so stuff is piling up in the front”. “Some filing cabinets are locked or stuck”. He can’t get “the math cabinet” to open at all, so he “just has to look”. This is almost an exact reversal of the process he described with the delta up/down training. Whatever the direction, he may be describing an anterior-posterior disconnect. He is now often tired and has to be woken up. He used to be an early riser. The people in his head are back from vacation and it’s busier inside, even loud, but he expects that it will quiet soon.
Protocol: C4-P4 5-8 Hz for 21 minutes, 2-7 inhibit
Session 36:
It is five days later and Joey reports that he is feeling “Good”. He went bowling last night and he used the big bowling ball and threw it side arm for the first time. He scored higher than he has ever scored and he made a strike. He said to me, referring of course to his brain, “These filing cabinets are 14 years old. I need some new ones”. Agreed. Now, how to provide them.
Protocol: C4-P4: 5-8 Hz for 22 minutes; 5.5-8.5 Hz for 6 minutes. I shifted up because it was making him tired.
Session 37:
In response to my question, Joey answers, “What’s going on in
my head? That’s a good question.” He goes on to tell me that a meeting has just started and that it’s about going to school. He is missing his friends. This, his mother tells me, is new for him. He has remained very related to them even during the first six weeks of his vacation. He invited one of them to come for the weekend but he was couldn’t make it. He said, I thought with both sadness and acceptance, poignancy really, that “It’s OK. It’s the same every summer. I thought it wouldn’t be the same, but it is.” He really wanted to see his friends. He was lonely for them.
When he talked further about the meeting, taking place in his left frontal lobe, about school, I asked him if it could be the case that he was thinking about going back, that that’s what the meeting was, his thought process, Joey’s thoughts. He understood me and he agreed. At least for that moment, he knew that he was not just the subject of the meeting but that he produced the meeting. The meeting was Joey feeling lonely and thinking about going back to school.
He reports that his new filing cabinets are working well, that his memory is better. Everything feels back to normal. “Everything was just going too fast.”
He is cheerful as he leaves and makes good eye contact and a firm
handshake. I made an issue of his handshake from the beginning. I wanted his presence in it and I wanted him to feel the contact with the other. He almost always remembers and when he does, he smiles at me- we smile at each other.
Protocol: C4-P4 5-8 Hz for 27 Minutes; 3 minutes at 5.5-8.5.
The next week, Joe began his course of three weekly hyperbaric oxygen therapy sessions. The physician, also a neurofeedback practitioner, decided to suspend neurofeedback during the hyperbaric to see if she could discern the effects of the oxygen alone.