Introduction

Over the last few years, the human brain has swiftly shifted from being a mostly unnoticed bystander to a ubiquitous participant in the world. Products varying from books, food, drinks, games to baby toys are promoted to be ‘good for your brain’, and people are repeatedly reminded to take care of their brains by various media: ‘You think what you eat’, warns a newspaper headline, ‘Ice cream can control your brain’, threatens e-mail spam, ‘Reclaim your brain’, orders a pop-up encountered while surfing the internet, ‘You can train your brain by daily brain gym’, a health insurance reminds us. Although there is debate about the precise impact that these messages have on people's ideas and behaviour (Rose, 2003; Pickersgill et al, 2011; Choudhury et al, 2012), people are nonetheless made more aware of their brains, and their brains’ supposed involvement in what they do and are. This process is not only a commercial trend, it is also treated as a serious responsibility by several neuroscientific associations, demonstrated in brain awareness weeks that teach people both about their brains’ capacities and the ways that they can be diminished.Footnote 1

People have always worked on their selves through techniques such as sporting, dieting, meditating or going to a therapist (Foucault, 1988; Rose, 1998). Depending on which part of the self is considered to be the effector of their conduct – for example, their sub-consciousness, body, soul or brain – people use different methods to constitute their selves in a good ‘ethical’ way (Foucault, 1992). Increasingly, people are taught that both the cause of their behaviour and the solution for their problems are located in their brain, and as a result, they are more and more inclined to work on their brains to become better, happier, more peaceful, or smarter people. Current techniques for working on brains vary from pharmaceuticals, to special diets, games, technical devices or therapies (see for example Thornton, 2011).

In this article, I will analyse the practice of an increasingly popular brain technique. Neurofeedback is a system that gives people feedback on their brain waves, which they are expected to try to improve. The person doing neurofeedback is connected to an electroencephalograph (EEG), a device that records electrical activity along the scalp, which is in turn connected to a computer that transforms this information into graphs or games the user can try to affect by modifying the electrical activity detected on the scalp. In most cases, a practitioner tunes the program to the desired frequencies, in order to give the client feedback in very simple ways: green (good) or red (bad) graphics, a happy or unhappy smiley, music or silence, movement or no movement, or beep or no beep. Neurofeedback therapy is currently offered predominantly by psychologists and is usually recommended for use by children with attention hyperactive deficit disorder (ADHD), but it is promoted for all ages and all kinds of psychiatric and medical disorders, as well as for cognitive enhancement and music or sport performances (for example, Gruzelier et al, 2006; Arns et al, 2009; Coben et al, 2010). In spite of its rising popularity and claimed therapeutic results, however, neurofeedback is not an approved therapy and its scientific results are still under debate (for example, Loo and Barkley, 2005; van As et al, 2010; Logemann et al, 2010).

To study the process of neurofeedback, I undertook several activities in the United Kingdom and The Netherlands: visiting neurofeedback clinics to observe neurofeedback demonstrations, attending a meeting for practitioners, attending a neurofeedback training course, observing a neurofeedback experiment to enhance the creativity of school children, and, finally, engaging in 11 in-depth interviews with researchers (R), practitioners (P) and clients (C).Footnote 2 During these interviews and observations, several different and often unexpected actors were mentioned: EEGs acted unpredictably, parents intervened in the treatment of their children, and computers sometimes appeared to have the knowledge that the practitioner lacked. In other words, although neurofeedback is a technology of the self, clearly modifying the subjects’ understanding and experience of themselves, there are also many other actors involved, both human and non-human. Brain scans, test results and computer programs appear to be just as important as practitioners, scientists and clients.

To demonstrate how human and non-human actors interact, I will use the ideas of the sociologist of science Andrew Pickering, who writes about scientific practices as ‘dances of agency’ (Pickering, 1995). This concept of a dance is useful to illustrate how human and non-human actors struggle, collaborate and swap roles in a process that creates a new self for the neurofeedback client. This self is new, not so much in the sense that it is improved or restored, although this might also be the case according to the persons involved, but in the sense that it is extended with a brain, and various other entities (brain waves, coloured spots, computer entities) that have appeared in the neurofeedback process.

Quarks and Selves

Neurofeedback can be seen as a ‘bottom-up’ therapy, in the sense that it is practiced in society before its efficacy is being proven through research. The lack of scientific evidence, and consequently the lack of regulations, protocols and rules, makes neurofeedback an interesting case of ‘science in the making’ (Latour, 1987), but one that is better studied in society, where it is already in action, than in the laboratory. As I am more interested in the process of neurofeedback than in assessing its efficacy, and because this therapy distinguishes itself from other therapies with the obvious role it gives to non-humans like the computer, I will examine neurofeedback with a symmetrical approach. That is to say, this article seeks to take the explanations and acts of clients, practitioners and scientists as of comparable significance as the behaviours of non-human actors.

However, including the acts of non-human actors to describe a therapy also requires some nuance. Neurofeedback is a materialistic therapy that tries to improve people's brain waves with technologies, but the overall aim is a change in the human subject (the self). That is, while it makes sense to include the acts of non-humans in my description of the neurofeedback process, it is also important to emphasize the differences between human and non-human actors. Hence, I will use a concept developed by Andrew Pickering, who describes scientific practices as a ‘dance of agency’: a ‘constitutive back and forth between human agents who contrive specific material set-ups, and the agency of those set-ups themselves – what they do’ (Pickering, 2009, p. 4). The ‘dance of agency’ seeks to include the performances of humans and non-humans in any given account, without making them equivalent.Footnote 3 For Pickering, the relation between humans and non-humans is symmetrical, in the sense, and during the time, that they together perform ‘a dance of agency’. However, human and non-human agents are asymmetrical, in the sense that humans have intentions (goals, plans), whereas non-humans do not, and because we describe practices from a human point of view (Pickering, 1995).

One of the central characteristics of this dance of agency is a process of ‘tinkering’ (Knorr-Cetina, 1981), ‘bricolage’ (Latour and Woolgar, 1979) or, in Pickering's terms, ‘tuning’, which scientists perform in their practices. In his book, The Mangle of Practice (1995), for example, Pickering demonstrates how the quark was constructed through a process of trial and error, by describing a scientist who assembles a set-up, stands back to see what happens, reconfigures the apparatus, sees what happens, reassembles the set-up, and so on:

As a classic human agent, Morpurgo assembled his apparatus, switched it on, and then, surrendering his active role, stood back to watch what would happen – literally, through a microscope. Swapping roles, the material world was in turn free to perform as it would: the grains levitated and moved away from their equilibrium positions when the electric field was applied. And immediately a problem arose. The very first grain acted strangely. (Pickering, 1995, pp. 79, 80)

Important in Pickering's ideas is that this acting ‘strangely’ of the grain should be taken seriously and not symbolically or semiotically. Pickering proposes a shift from an epistemological to an ontological way of thinking (Pickering, 1995, 2007, 2009, 2010). He criticizes modern scientists for their representational approach, in which they leave no space, and even veil, the performative aspects of our world.Footnote 4 Instead of this, Pickering proposes a performative idiom for thinking about science, which describes the interplay between epistemology and ontology. He describes scientific practices as engendering ontological changes and gives examples of humans and machines together performing ‘ontological theatre’: they play (or dance) together and bring new forms of being into the world. Pickering writes that these dances of agency ‘conjure up an image of the material world not as fixed, static and knowable, but as endlessly lively. The world performs – does things – [… it] is a place of endlessly emergent performativity’ (Pickering, 2009, pp. 4,5).

Material agents, like the grain, do not only perform, their performances often count as a resistance. That is to say, material or other agents (a concept) do not always do what was intended by the human agent. Such resistances induce a new action in the form of an accommodation: the scientist has to make a revision to his or her strategy, for example, by tuning the set-up or changing his or her concepts of the world. In Pickering's words, dances of agency are structured as ‘a dialectic of resistance and accommodation’ (Pickering, 1995, p. 22).

In addition to these aspects – symmetry, tuning, ontological theatre, and resistance – the metaphor of a dance is also useful. A dance is lively and fluid.Footnote 5 Actors are noticeably moving together, but it is not always possible to define who or what is leading at what moment, let alone what will happen next. As long as there are enough actors, a dance allows stepping in or out, or making an unexpected movement. These characteristics of a dance are also relevant for describing the neurofeedback process because the ‘choreography’ of this practice is not always very clear, while its liveliness is.Footnote 6

In Pickering's description of scientific practices, the choreography of the open-ended dance of agency can become ‘relatively fixed’ (Pickering, 1995, p. 102), and this is where an important difference between scientific practices and therapies appears. Hunting for quarks and changing brain waves can be compared, in the sense that humans and non-humans together perform a dance of agency, but the comparison falls short concerning the endpoint. After all, the purpose of a therapy is not a changed brain, but a changed client. Constructing a quark is a ‘temporal’ process, which means that it has an endpoint somewhere, for example when the material quark and the concept of a quark are ‘interactively stabilized’ (Pickering, 1995, pp. 17, 83). The moment when the effects of neurofeedback on the subject are finished or elaborated, on the other hand, usually remains unclear. There is, so to speak, no intended agency to be captured as in the case of the quark. This vagueness concerning the endpoint, however, makes it only more interesting to describe neurofeedback as a dance of agency, as the product of this practice – a new self for the client– remains not very fixed or stable, but endlessly lively.

Searching for Feedback

Neurofeedback is not a new phenomenon. In the 1960s and 1970s, it was known as EEG-biofeedback, and several psychologists studied its effects on epilepsy, relaxation and hyperactivity (Kamiya, 1969; Sterman and Friar, 1972; Lubar and Shouse, 1976). In this period, it became quite a popular technique for ‘enhancing’ people's ‘alpha state’, which referred to a moment when larger alpha waves (8–12 hertz (Hz)) dominated, understood as a state of peace, relaxation or meditation. Probably as a result of this spiritual connotation, EEG-biofeedback almost entirely disappeared from the scientific and therapeutic stages.Footnote 7 Recently – since the ‘decade of the brain’, one could say – the technique reappeared, renamed as neurofeedback, in commercial clinics in the United States and Europe, but now it is promoted for all kind of psychiatric and medical diagnoses, as well as a means of achieving peak performance in a variety of fields. With its reappearance, the idea of a good brain state, as presented by practitioners, has also changed. In the 1960s and 1970s, people mainly tried to improve the activity of their alpha waves, but these days a healthy brain is understood as a moderate brain in which the amplitudes of all brain waves (alpha, beta, theta, delta and sometimes gamma)Footnote 8 are balanced against each other.

In their striving for a healthy brain, neurofeedback users can, for example, watch a movie and whenever their brain produces the desired amplitude of brain frequency ranges – as defined by a practitioner or computer program – the screen brightens or enlarges.Footnote 9 In this way, users receive feedback of their brain activity they are normally not aware of, and can try to influence this. What someone exactly has to do to change his or her brain waves, however, remains unclear. Neurofeedback clients and practitioners refer to different agencies to explain the process. Clients for example appoint their subconscious, their will power, the practitioner, or the computer as the actor that trains their brain. The statement ‘you don’t have to do anything’ also recurs in client interviews. Practitioners, on the other hand, use a variety of metaphors to describe the process: someone refers to buses, where the client is the passenger and the client's brain is the driver; others describe it as akin to riding a bicycle; someone describes the brain as a field of weeds through which the client walks, creating a path; and one practitioner evokes childhood ‘warmer and colder’ games. Expressions like ‘you don’t have to do anything, it is the brain that does the work’ are repeatedly used by practitioners as well.

During a neurofeedback course for novice practitioners, several games were demonstrated. One of these was a caterpillar game, in which the client has to speed up three caterpillars representing his or her theta, beta and SMR frequencies (Sensory Motor Rhythm, 12–15 Hz). Playing this game is actually playing a competition between your own brain waves. The client is connected to three electrodes – one on the scalp that measures the brain's activity and two on the earlobes to ground these measurements – and watches a screen with a pink, a green and a blue caterpillar moving forward. The practitioner, at the same time, watches a computer screen and sees fluctuating brain waves. On the basis of these fluctuations (and the chosen protocol), the practitioner may decide, for example, to give feedback when high beta decreases and theta and SMR increase. She (or he) tunes the feedback thresholds and can give the assignment: ‘Watch your blue caterpillar; they all have to speed up’. Thereupon, a period of passively waiting begins for her. The client, sitting at the other side of the computer, sees (perhaps) that his (or her) blue caterpillar has decelerated, and has to do ‘something’ to make it speed up again. He tries to concentrate, relax, focus on one point, or do nothing at all, and waits to see if and when the blue caterpillar will accelerate. When it does, or if it takes too long, the practitioner can become active again. She can, for example, decide that beta is reducing, but that theta and SMR are still not at high enough levels, and she changes the threshold bars again, and sits back to see what will happen now. The client, who probably thought he mastered the neurofeedback training, suddenly notices that the pink and green caterpillar, representing theta and SMR, stop moving, and have to do something to make them speed up again.Footnote 10

That is to say, in turn, and from different angles, the client and the practitioner initiate a dance of agency that takes the form of ‘a dialectic of resistance and accommodation’ (Pickering, 1995), in which the caterpillars (or smileys, or sounds), the brain waves and the human actors are alternately passive or active. This tinkering to make the feedback work, however, is only one part of the story. To make the therapy as a whole a success, many more actors are involved that struggle, collaborate and swap roles. In the following, I will trace the other, less obvious actors that are important in the complete neurofeedback process, from their help in creating and motivating the client, to their performances during the training and their assistance in collecting the results.

Creating the Client

Although neurofeedback can be something people do ‘on their own’ – for example with their own neurofeedback devices at home – the help of ‘others’ is usually very important, such as that offered by practitioners who promote this form of brain training, or parents who characterize their child as abnormal. As Foucault demonstrated, this often well-intended ‘help of others’ also regulates the behaviour of the individual. That is to say, neurofeedback clients do not only work on themselves, they are also ‘made up’ into clients, and ‘disciplined’ to improve their brains, for example by worrying parents, brain awareness campaigns, educative projects and individual brain scans (Foucault, 2004; Hacking, 2006, 2007; Rabinow and Rose, 2006).

The influence of others becomes obvious when listening to and observing the work of practitioners. Especially in the treatment of children and young adults, practitioners often mention the role of parents, teachers or psychiatrists who encourage the person to improve. Not infrequently, this encouragement to change coincides with some intimidation. One practitioner, talking about a teenager who successfully recovered from a depression, clearly illustrates the disciplining power of others (Foucault, 2004):

This client had much resistance against doing anything at all. And neurofeedback just turned the switch. He said this already happened after 3 sessions. (…) The idea was a compulsory admission [in a psychiatric hospital], but the waiting list was very long. They wanted compulsory admission to stuff him with medicines so to say, just to see if this would … to stimulate him to get up early, to see if it would have any effect. (P5)

This client clearly had few options. However, also when there seems to be no pressure at all, the wish or urge to improve oneself is generally inspired by others. Several neurofeedback clients, for example, state that they would like to change because they want to ‘fit in’, or because they feel ‘different’ to others.

However, while the influence of others might prompt a desire to change, it does not automatically lead to the choice of neurofeedback as treatment. Before people become neurofeedback clients, they first have to believe that it is possible or necessary to work on themselves by changing their brain waves. They must be convinced that their problems or failures are abnormal – often evidenced by a psychiatric label such as ADHD, depression or autism – and that the cause and solution of their complaints lies in their brain (Dumit, 2003; Rose, 2007). This is not always obvious for everyone, as a researcher examining the efficacy of neurofeedback illustrates: ‘People first have to recognize that they have ADHD. They must understand that it is a problem before they want to make such an effort to resolve the problem’ (R1).

Defining the problem must be followed by defining the problem as a brain problem. Trying to make people aware of their brains is becoming a key part of scientific and popular scientific discourse, and neurofeedback practitioners contribute where they can. Practitioners are often very active on the internet, they are willing to be in the media, they welcome potential clients into their clinics during ‘open days’, and they are happy to demonstrate their practices during educational events such as museum exhibitions. One practitioner offered her help to a science museum, where she could demonstrate neurofeedback to the audience. She explains: ‘What did it look like? Well, actually I just hooked them up. People love to see their brain waves. Yes. So it is great if you can teach: “this is a slow wave”, “this is a fast one”, “this is what we do” ’ (P2).

Making people aware of their brains can also be a one-to-one process. During a neurofeedback course for novice practitioners the participants openly discuss each other's brain waves. One practitioner remarks about the person who is ‘hooked up’: ‘What nice brain waves! I like these. Sometimes I really don’t like them’ (P10). When one of the participants explains that he reacts inconsistently to coffee, one of the supervisors responds: ‘This means that you have an unstable [brain] arousal’ (P4). What impact these kinds of ‘disclosures’ of people's brain activity can have, is illustrated by a practitioner who reveals in an interview how she was confronted with her own brain map during an EEG-course: ‘Everything suddenly makes sense, now that I have seen that bad beta’ (P2).

After making people aware of their brain problems, practitioners have to convince their potential clients that neurofeedback is an effective therapy. For this, they often use stories of clients who have successfully recovered, as well as metaphors that symbolize the working of neurofeedback. One frequently used metaphor is learning to ride a bicycle. This metaphor also emerges during an open day organized by a neurofeedback clinic when a woman and her adult son receive information that is too technical for them to fully understand. The practitioner explains that neurofeedback takes the unbalances out of the brain, and compares it with the training wheels that can help children to learn to ride a bicycle. The metaphor brightens the faces of the woman and her son, they reply ‘oh, yes, so it works like that’ and decide to go for an intake session. Another metaphor that is used during the open day concerns signposts in your brain that have fallen down, so that you get lost. Neurofeedback is about putting the signposts back. At first glance, signposts and bicycles have nothing to do with the brain, or with the working mechanisms within it, but apparently this does not make them less effective in convincing clients. The opposite is possibly true: using a metaphor from everyday life seems to make people feel more comfortable with the otherwise incomprehensible therapy and their own mysterious brain.

When scientists or practitioners inform people about their brain problems and potentials, they suggest that people are responsible for their own brain health.Footnote 11 In some cases, practitioners literally expound this message. One of the neurofeedback course participants, a neuropsychologist, explains that he is interested in neurofeedback because it provides a solution, instead of only an identification of the problem. He describes colleagues who simply state that ‘broken brains cannot be fixed’, while the great benefit of neurofeedback is that it ‘gives control back to the client’ (P11). A comparable message is proposed by a practitioner responding to a question about the future of neurofeedback:

We got in some kind of mindset in which we handed over our responsibility to the experts. We don’t take responsibility ourselves; we go to a doctor and take medication rather than change ourselves. And I have a feeling that this might be going to change. I think there is something in the air, there is a shift going on. That people want to take responsibility for themselves. (P2)

In other words, neurofeedback practitioners emphasize the message that people are responsible for their own brains and happiness. According to them, stabilizing your broken brains with a pill is not taking enough responsibility. People should change themselves by their brains, by themselves.

In the creation of a neurofeedback client, many actors are – intentionally or unintentionally – involved. Parents, psychiatrists and diagnoses help the client to become aware of his or her problems. Museum demonstrations, campaigns and brain maps make the client aware of his or her brain. And practitioners, metaphors and success cases make him or her aware of the solution. In this awareness process, the responsible agent ‘dances’ around; first, it is the person himself who is responsible (I am so hyperactive), next the responsibility is distracted from the self and connected to a diagnosis (I cannot help it, it is my ADHD), thereupon, the behaviour becomes the responsibility of the brain (it is not my fault, it is my brain), and then the person becomes responsible for his or her own behaviour again (I have to take care of my brain).

Motivating the Mind, Body, Brain

As shown above, a whole process precedes the involvement of a client. However, this does not always mean that a client is also a collaborating actor. In some cases, clients, especially children and teenagers, can be hindering and sabotaging actors. One of the neurofeedback course supervisors talks about a difficult client who admitted after many sessions: ‘I don’t want to be a swot’. According to this practitioner, this was the reason why the neurofeedback did not work for the boy: ‘He was sabotaging the training. Every session was a fight’ (P4).

Because of the problem of unmotivated clients, various tricks and tips are given during the neurofeedback course to practitioners to keep clients alert and motivated. Several encouragements are included in the neurofeedback tools already: clients can watch movies, listen to their favourite music, or play amusing games. For children, there are special toys. During the neurofeedback course the trainers demonstrate the neurofeedback ‘Jedi’ helmet, which makes it possible to lift a plastic ball with your brain waves, and a teddy bear, called ‘Neury Bear’, which gives a rewarding sound – snoring or growling – when the connected child produces the right brain waves. Other tips that the supervisors provide include the use of watches that buzz every 3 minutes to keep children attentive, and for strongly unmotivated children one of the supervisors advises: ‘Put a PlayStation on the neurofeedback device and say “if you have so many points, this PlayStation is yours” ’ (P3).

These kinds of tips and tricks are helpful and sometimes necessary to keep clients motivated, but practitioners use many more strategies to instruct, relax and stimulate their clients. When they talked to each other or to me, the language that they used was very mechanical: connecting the client to the EEG and the computer was often described as ‘hooking up’, tuning the frequencies of the computer program to change someone's brain activity was expressed as ‘screwing up or down’, clients were sometimes described as people with ‘broken brains’ and successfully treating a client was commonly expressed as ‘fixing’ someone. However, these words are usually not employed when the client is around and one practitioner even asked me to delete the word ‘fixing’ from his interview text.

Practitioners do not tell their clients about their broken brains that will be fixed by hooking them up to the computer and screwing the frequencies in their head up and down. The opposite is true: practitioners calm down their clients, talk gently to them and make use of several techniques to keep the person motivated.Footnote 12 This is because, as one practitioner phrases, ‘You are not only working with the brain, you are working with the whole person’ (P2). That practitioners indeed work with ‘the whole person’ is clearly demonstrated in interviews with the researchers of, and observations during, a neurofeedback experiment with 11-year-old children. The researcher explains how they keep their subjects at ease (‘I just tell them that they are going to listen to some beautiful sounds’) and what they do when their subjects are not:

[One child] is afraid of doing neurofeedback. [The experimenter] has to walk with him around the building, let him talk to children who already did neurofeedback, and really comfort him. He is a very nervous kid who worries a lot, and he didn’t produce any theta waves yet. (R1)

Other children participating in the experiment are also comforted, encouraged and corrected. When one child worries about her brain wave pattern: ‘Is it good? Is it bad? Is it flat?’, the experimenter responds: ‘No it is fine. Do as you said: find the happy feeling, like when you are singing’ (P2). During and in between the neurofeedback games, the experimenter continuously intervenes with utterances like: ‘Woah, that is a lovely one!’, ‘A great start!’, ‘That looks absolutely fine!’, ‘You are really in the zone, aren’t you?!’ The experimenter comforts the children and keeps their attention in the right place, but in between, she also corrects their posture: ‘Could you put your feet flat on the ground?’, ‘You must sit still’, ‘Keep relaxing’, ‘Nice sitting!’, and during a different session she tells the children to: ‘Lay down on your back’ (P2). Apparently, practitioners do not only work with the brain, and the mind (or the person), but also with the body. To phrase this differently: to train someone's brain, practitioners first need to calm down the mind and correct the body.

Instructing clients, especially children, seems to require more than just a simple explanation. In addition to being instructed in how to perform neurofeedback, participants also have to be stimulated, corrected and reassured. Many tools are developed to keep the attention of adults and children, and psychological strategies can also help to motivate the client. These techniques demonstrate that neurofeedback is not only a matter of head or brain, but also of mind and body: clients have to be calmed down before the training and to be motivated during the process. Furthermore, they have to sit up with their feet flat on the ground, or lay quietly back in darkness with their feet on a footstool.Footnote 13

To phrase this in Pickering's terms; before the brain waves of neurofeedback clients will do what the practitioner wants, there is a lot of resistance from the client's mind and body. To accommodate the mind and the body, practitioners need several tools, tricks and words. So, the ‘failure to achieve an intended capture of agency in practice’ (a cooperative mind and body) and the ‘active human strategy of response to resistance’ (using tricks and tools) takes the form of ‘a dialectic of resistance and accommodation’, that is a ‘dance of agency’ (Pickering, 1995, p. 22).

Choreography of the Dance

Creating a cooperative neurofeedback client requires many actors, from practitioners and parents, advertisements and diagnosis, to the clients’ minds and bodies. Doing neurofeedback is a process of tinkering, in which the client actively does something (or nothing) and passively waits to find out what will happen next, and in which the practitioner, on the other hand, also actively tunes the adjustments on his computer and passively waits to see what will happen. In this section, I will elaborate upon the process of neurofeedback by focusing on the choreography of the dance.

In the first instance, neurofeedback appears to be a practice between an expert and a subject: that is a practitioner and a client. However, when interviewing practitioners it becomes clear that they are not always the ones who are in charge of the process. One of them, for example, describes how he started his neurofeedback career using the same protocol for everyone in the same way and confesses: ‘The unsatisfactory thing was that I actually had no clue what I did’ (P7). Nowadays, this practitioner explains, more research is conducted and more information has become available, but still several processes are unclear, such as why neurofeedback only works in some people and not in others, and what the training actually does on a neuronal level. In spite of these ‘puzzling material performances’ (Pickering, 1995, p. 82), the practitioner has to depart from ‘something’ to decide on what to train and where to train. This ‘something’ can vary from standard protocols to EEG-results, client's diagnosis, to computer information. None of these agents, however, appears to be very reliable.

Standardized protocols, for example, do not always work. One strategy is to define someone's arousal state by questioning the client about his or her habits. Drinking a lot of coffee, for instance, is seen as a characteristic for under-aroused types and drinking too much alcohol for over-aroused types. However, one practitioner explains:

[The practitioner] prefers people to be an A, B, or C, so that you can apply an A, B, or C protocol. If you are an A you are over-aroused, B is under-aroused, and C is unstable. (…) But it has already turned out that it is not always the case that someone is only over-aroused – he can also have some under-aroused characteristics. (P7)Footnote 14

Departing from the client's diagnosis or complaints, on the other hand, does not always have the desired effect either. One practitioner reports:

You start with what people say and you have this recognition and experience. It is empirical, that you think when you hear some complaints: ‘Oh, yes, SMR’, or ‘Now, I will train beta, or alpha for people with anxiety or stress. So, you need to start somewhere, but it also happens that something doesn’t work out. (P6)

The fact that protocols do not straightforwardly define what to train, how much to train and where to train, however, appears not to be a problem for practitioners. One frequently cited study analysing the results of many neurofeedback experiments on ADHD concludes that the effects are positive, irrespective of the specific training.Footnote 15 When these results are demonstrated during a meeting for practitioners, one of the participants jokes: ‘Yes, sometimes I also think: just kicking the brain a bit will also work’.

In spite of this vagueness concerning the training, practitioners continuously state that their clients’ brain waves will be normalized by their practices, and that these effects can be made visible by means of (quantitative) EEGs. By comparing the EEG of a client with a database in which thousands of EEGs are compared and averaged, the deviances can be calculated and visualized in red or yellow (frequencies that are higher than the mean), blue (too low) or green (average) colours. Showing these qEEGs to the client in question can be described as quite literally a form of a normalizing practice (Foucault, 2004). The client sees at a glance if his or her brain frequencies deviate and is immediately offered a way to normalize these. The yellow, red and blue spots in the brain map, one could say, ask to be changed into a green, normal, brain.

Changing yellow, red or blue spots into green appears to be an ‘objective and measurable method’, as one of the clients expresses, but in interviews with practitioners, this relation between the qEEG and the training appears to be less clear. One practitioner firmly declares: ‘In 70% of the cases I see “what you train is what you get” ’. According to this practitioner, it also occurs that the improvement pervades the whole brain, instead of affecting only the trained spot: ‘I train this person and the session data don’t change that much, but then, when I take another EEG, you see the whole brain being normalized’ (P5). Other puzzling performances concern improvements that appear at unexpected places. One practitioner talks about a case study that was demonstrated during a neurofeedback conference: ‘[The practitioner] trained a particular frequency at a particular site according to the brain map. (…) And the [problem] stopped, but the EEG …, the changes were somewhere else completely. Not where they were expected’ (P2). That is to say, the behaviour of the qEEG during a neurofeedback therapy can be described as a ‘puzzling material performance’: when the practitioner trains one specific spot, he or she has to wait and see if the brain will do what is expected, or will be normalized completely, change at a different spot, or does not change at all.Footnote 16

The theory of neurofeedback is based on changing someone's brainwaves, but as demonstrated, there is no one-to-one relationship between the protocol and the complaints, or the training and the qEEG. Furthermore, it is somewhat vague as to who or what is performing at what moment. Some practitioners, for example, leave the whole process to the computer, and clarify: ‘We are not physicians; the computer takes the unbalances out of the brain’ (P8). Another practitioner, who also works as a research assistant, after being asked about the training she gives to the 11-year-old participants, explains: ‘I know how to operate the machine, and how to hook them up and what instruction to begin with, but really in terms of background knowledge of alpha/theta you’d better talk to someone else’ (P2). And another practitioner brings up the computer as a material agent by explaining: ‘I don’t know the program well enough to say how it [the computer] sees what to correct for different people with different baselines’ (P6).

The practitioner is clearly not always the leading agent in the process: he or she struggles with protocols that do not always work, brains that can change unexpectedly, and computer programs that define what should be corrected. To phrase this in Pickering's words: ‘human and material agency are reciprocally and emergently intertwined in a struggle’ (Pickering, 1995, p. 21). As a result, the neurofeedback practice actually becomes a process of ‘trial-and-error-tinkering’, in which the practitioner has to find out which protocol, method or frequency range works for which client. One practitioner plainly demonstrates how he more or less experiments on his clients:

You activate, for example on the left. And you take a specific frequency range, and notice that the person becomes agitated, but still he has to be activated. Well, then you drop down those frequencies you are training, those that are connected with less activation, and see if you can reach your goal now. (P7)

This process of experimenting on the client is a process of trial and error. Sometimes, this trial results in a serious error, but that does not seem to be a problem to the practitioners. One practitioner explains:

[If that happens] I readjust it a little. It is a very subtle process. I had someone with anxiety, and I put the alpha on 10–14 hertz. (…) And this person came back with a worsening of her complaints. Then I screwed it down again and at once it was all right. (P5)

It is mostly the practitioner who decides to change the protocol after conversations with a client, but it can also be the client who calls the practitioner to account. As one practitioner clarifies: ‘This client returned after two weeks and said: “Well, I don’t know what happened, but this is not how it is supposed to be, because at home I kicked in the kitchen door.” He had such a short fuse, and I had activated that’ (P7).

It also happens that the experimenting practitioner and the experiencing client closely work together during the process. One practitioner reports: ‘One of my clients was giving good feedback, and she knew when I was doing it right, when I was doing the training with her. And she would say if she would feel less well, and then we would stop’ (P/E2). She stresses that in this particular case, the perception of the client is more important than the results on the computer screen: ‘If you just do this with the computer: you can do too much left, too much down and then it doesn’t look that right. So you need to pay attention to how the client is feeling’.

Neurofeedback appears to be an experimental practice. It is a process of tinkering (Knorr-Cetina, 1981; Pickering, 1995) between a practitioner who actively tunes his machine, and then passively stands back to watch what will happen with the client. This can be compared with how Pickering analyses scientific practices:

As active, intentional beings, scientists tentatively construct some new machine. Then they adopt a passive role, monitoring the performance of the machine to see whatever capture of material agency it might effect. Symmetrically, this period of human passivity is the period in which material agency actively manifests itself. Does the machine perform as intended? Has an intended capture of agency been effected? Typically the answer is no, in which case the response is another reversal of roles: human agency is once more active in a revision of modeling vectors, followed by another bout of human passivity and material performance, and so on. (Pickering, 1995, pp. 21, 22)

In the case of neurofeedback, it might seem that the practitioner is the intentional being, in the sense that he or she decides on the protocol, tunes the machine, waits for a reaction in the client, and makes some adjustments. However, it could also be the computer that decides on the protocol (for example, by seeing what to correct), and instead of the client it can also be the EEG that responds (change at an unexpected place). Other agents can also become ‘temporally emergent’ like deviant personality types (no A, B or C, but a mixture), feelings (experiencing a low stimulation as too much), or brains (the complaints do not fit the EEG). That is to say, although there is obviously a dance of agency going on, its choreography remains unclear, which makes it very complicated, or even impossible, to predict what will happen next.

Collecting the Results

One of the differences between constructing a quark and doing neurofeedback is the endpoint. The construction of the quark was finished, so to speak, at the moment that the material procedures of the quark and the conceptual accounts of the scientist ‘interactively stabilized’ each other (Pickering, 1995). In the case of neurofeedback, however, the result aimed for is a restored or enhanced self, an effect that is not so easily ‘stabilized’ by a concept or test.Footnote 17 This instability of the result is demonstrated by the efforts practitioners make to help their clients recognize what is improved in their brains, feelings, performances or lives. Practitioners appeal to many actors, from parents, brain maps, to specific results that make the client conscious of his or her changed state. One practitioner explains:

If you ask ‘do you notice anything?’ they mostly answer ‘no’. And if you keep on asking about school, work, or whatever, they often say ‘oh, yes. I do concentrate better’. Or they feel more relaxed, or less aggressive, or have a better outlook, or their marks are improved, or whatever. (…) It is a specific way of asking to find this out, because they do notice something; of course they notice something. And the environment also is very important, especially parents. Or you hear that teachers have said that a child can stand more, or has become more social, or less aggressive. (P6)

This practitioner shows that the improvement can actually be found everywhere: in school or work performances, clients’ psychological well-being, or their behaviour towards others, and can be reflected by various actors such as parents, teachers or grades. It is up to the practitioner to identify these changes, for example by employing a specific way of asking, so that the client can recognize them too. To make sure that the expected change is not missed, some practitioners start every session with asking what has been improved in their client since the last training.

Practitioners give several reasons to explain why it can be hard for clients to recognize the effects of neurofeedback. One researcher states: ‘The improvement is so gradual that people don’t see it is the neurofeedback that has changed them. They see the change as normal, as having a good day’ (R1). According to a practitioner, it can also occur that clients do not notice they are cured from some complaints because they only focus on those problems they still have. Furthermore, it can be the case that the change takes some time before it sets in, as demonstrated by this practitioner talking about a boy whose parents let him quit after 20 sessions, because they hardly noticed an effect: ‘Two months later I sent them an e-mail to see how he was doing. And he had quit his medication, the antipsychotics, and his ADHD-medication was halved. (...) Well, for neurofeedback this is quite a good effect’ (P5).

This construction, or collecting, of the changes is also demonstrated when the same practitioner talks about the recovery of another client:

The first symptom was that he took a book from the bookshelf. His parents thought this was really strange. A couple of sessions, nothing happened but then he started to read texts on trucks. It appeared that his reading level had reached the average for his age. (…) and in fact, I think his IQ is now about 80 or something. And his medication has been reduced. (P5)

There are many cases and examples of clients, parents and practitioners who state that neurofeedback cures or improves the client. Designated successes often concern skills and performances, but sometimes the client's behaviour in specific situations can be a sign of improvement too. One practitioner gives an example of a man who wanted to go to the casino: ‘But when he stood in front of his motorbike he thought “no, I will not go”. He thought this was because of the neurofeedback’ (P6). Furthermore, he states that changes cannot only be signalled in someone's behaviour, performances or development, they can also be psychological:

People have told me that it reduces their stress, they experience some space in their head and the capability to distinguish main and side issues. If everything rushes upon them they can distance themselves from their worries. And, I also think it can give more energy, this neurofeedback. This will help too, that you can increase someone's strength. (P6)

In addition to behavioural and psychological results, physical effects are sometimes also experienced, such as ‘a tingling in the head’, ‘a deep relaxed feeling’, ‘headache’, ‘a feeling of being drugged’, ‘a euphoric feeling’, ‘a feeling of space in the head’, and someone even talks about the feeling of ‘experiencing a cerebral haemorrhage’.

Recognizing and collecting the results of a neurofeedback therapy seems to be a complex practice. According to the accounts of the practitioners, effects can appear inside the client or outside in the world. Sometimes they are recognized spontaneously by the client, but more often, changes are brought up with help of the interviewing techniques of the practitioner, or by external actors who notice and determine the improvement. It also occurs that clients (for example, teenagers) state they are cured, whereas others (for example, parents) declare they are not ready yet. Effects are collected from everywhere: from improved results in school or work, better psychical well-being, physical experiences, more social contacts, a reduction of medication, or in a decision not to go the casino. According to practitioners, progress can appear at every moment: sometimes it only takes one session, sometimes it requires 80 sessions, and sometimes the change starts weeks after the training has stopped.

The success of neurofeedback is quite unpredictable, and actually depends on an agreement between the practitioner and the client concerning many other actors. Listening to users of neurofeedback, however, brings another effect to the fore. In the following, I will demonstrate that some of the actors that emerged during the neurofeedback process also appear in the descriptions of people doing neurofeedback, but now not as actors in the process, but as actors of the self. Hence, I will argue that some of the actors that emerged during the dance of agency are not only ‘temporally emergent’ during the process, but become part of the product: a new self for the client.

Extended Self

By choosing brain training to improve themselves, clients suggest that these selves are, or are in, their brain. However, when clients are questioned about this relation between their brain and their self, by asking what they actually do to train their brain, they make a clear distinction between their selves (I) and their brain (it). One user, for example, explains: ‘I think the computer trains your brain, or actually the computer makes the noise. And your brain tries to stop the noise, because I want to listen to my music. So I think the brain has to work really hard to make sure that I can listen to the rest of my music’ (C15). That is to say, people start doing neurofeedback because they want to improve themselves, but to react on the feedback of their brains they have to distance their selves from their brains. In other words, the self is extended with the brain instead of coinciding with it.Footnote 18

This extension of the self – formerly, a mind and body – with a brain could be considered as a new kind of Cartesianism, as the Canadian philosopher Ian Hacking proposed by stating that neuroscience has created a ‘neurologically nested triad’ of mind, body and brain (Hacking, 2005, 2006b). However, in the expressions of users of neurofeedback, many more actors emerge that do not clearly belong to a mind, body or brain. Users for example speak about ‘my six hertz mystery’, ‘a totally yellow spot which indicated a depression’, ‘those alpha and theta things’, ‘explosions in my brain norm’, ‘all 42 points in my head’, ‘the lack of a certain substance in the brain’, ‘my brain is out of balance’. Apart from summoning all these brain-related entities, clients describe themselves and the neurofeedback process in a rather computerized way. They, for example, talk about a ‘defragmentation of your computer’, ‘cubes put in the right order’, ‘a computer wiring me’, ‘my system is unstable’ and ‘my system resets itself over and over again’. On the other hand, however, clients draw attention to their lives and psychology with statements like ‘it is my life that made me quiet’, ‘the way I live and what I do is too important’, ‘it is hard to readjust your psychology with this method’ and ‘there is also one part of me that doesn’t want to see it at all in this way’.

Neurofeedback clients bring up many actors to explain themselves, their problems and the neurofeedback process, varying from brain entities, to computer metaphors to psychology. There is obviously not one single actor that determines the new self but a whole range of actors that emerge as language or representations (for example, a ‘yellow spot’) and simultaneously become actors (the cause of the depression, the stimulation to do neurofeedback, the spot that should turn from yellow to green). That is to say, users of neurofeedback constitute themselves as persons with a self and a brain, real-life problems and brain problems, controlling brain waves and will power, and they strongly identify themselves with a computer. This self can be described as an extended or ‘layered’ self made up of various entities that emerged in the neurofeedback process (Brenninkmeijer, 2010).

While it would be easy to dismiss these changes in/of/to the self as merely confused self-perception resulting from a lack of knowledge on the part of practitioners and clients, this does not account for the effect that neurofeedback has on the sense of self. Watching one's brain activity for the very first time, or learning that one's unbalanced neurons can explain why one's life has been so hard has an enormous influence on the way people perceive themselves. According to neurofeedback users, the confrontation with the biological equivalent of their behaviour gave them, for example, the experience of loss (‘I thought I was in control of myself. And that is something completely different than a computer-animated picture with “look, this is how it works” ’ (C15)); of fear (‘I don’t want to be a bio-organic robot’ (C12)); and of relief in no longer being responsible for their problems (‘I just miss a certain substance in my brain’ (C14)).

As Foucault captured with his concept of ‘technologies of the self’, the way people perceive themselves and their problems influences the way in which they explain their behaviour to others and the solutions or ‘technologies’ they seek for working on their selves and their problems (Foucault, 1988). Problems due to a bad childhood, for example, can be solved by consulting a psychotherapist; a weak personality is probably best treated by a mental coach; problematic thinking patterns can be changed by a cognitive psychologist; unbalanced neurotransmitters will be stabilized with pills; and for shooting brain waves, neurofeedback can be a solution.

The fact that someone's self-perception will influence his or her behaviour and with this, someone's relationships, accepted responsibilities, dealing with setbacks, and so on, is easily demonstrated by examples of neurofeedback users. One client, for example, explained that she had to start ‘a whole new way of accepting’ her problems after she learnt that they were due to neurotransmitters. Another user experienced a 6-Hz peak in his frontal lobe and is now trying various brain therapies to get rid of it. Someone else, who appeared to have successfully recovered from his depression through neurofeedback, resumed sessions a few years later because he noticed that he ‘became quieter again’ and ‘before everything goes wrong again, I’d prefer going back’ (C13). All users experienced changes in their selves and their behaviour towards other people as a result of the neurofeedback, and they said they would prefer resuming sessions if their problems returned. Several practitioners I interviewed were originally neurofeedback clients before they bought the equipment themselves and set up their own clinics.

Doing neurofeedback obviously encourages people to do more neurofeedback. Apparently, it does not only change the way people see themselves, their problems and their responsibility, it also changes their behaviour and the way in which they handle new problems. The new way of seeing themselves because of the neurofeedback has created a new way of being themselves. It is important to stress this ontological change because it demonstrates the effects of neurofeedback: irrespective of the clinical results, the effect of neurofeedback is very clear, in the sense that it constitutes a new mode of being oneself.

Neurofeedback as a Dance of Agency

Andrew Pickering proposes a shift from an epistemological to an ontological way of thinking about science. According to Pickering, the world performs, and human and non-human are linked together in dances of agency. Examining these dances closely will demonstrate that the material world is ‘not fixed, static and knowable, but endlessly lively’ (Pickering, 2009). I followed Pickering's idea and described a clinical practice as a dance of agency, or, to use one of Pickering's other fascinating concepts, as ontological theatre. In my exposition of the practice, neurofeedback is not just a simple act between two human agencies and a computer, but a play in which many collaborating and competing actors are involved and together perform a dance in which it is not completely clear which actor is in charge.

I described several necessary steps to make the neurofeedback a success. First, there are many actors working upon the potential client to turn him or her into a cooperative client. Parents and psychiatrists help the person to recognize his or her problems, brain awareness campaigns (leaflets, internet sites, newsletters), turn these problems into brain problems and neurofeedback specialists offer a solution by demonstrating their practices in the media. Next, actors ranging from practitioners, Neury Bears, to footstools, are involved to motivate the client's mind, body and brain. Protocols, individual brains, computer programs and EEGs have to work together in a process of trial and error, and the expected change has to be recognized and pointed out, somewhere inside the client, or outside in the world. The result of this, I argued, is again a dance of agency, but now concerning the self of the client. Several of the actors that ‘temporally emerged’ during the neurofeedback process – brain waves, computers, coloured spots – keep on working on the self of the client.

To phrase my conclusion in Pickering's terms: human and non-human actors are linked together in a dance of agency and examining this dance conjures up an image of the world as endlessly lively. The result of this dance is a new being in the world. While it is not very obvious if and how the client is cured, restored or enhanced, a new kind of self – one that has been extended with all kind of entities that emerged during the process – has clearly been brought into being.