SPECIAL ISSUE: Maurice Barry Sterman: What Makes Him Great

Impressions from Lynda Thompson

For the past few decades, Barry Sterman has been referred to as the “grandfather of neurofeedback.” Although Barry, with his youthful appearance (still not white haired in his mid-80s), disliked the moniker, it is apt. Without his seminal input, our field might not exist or it might be skewed more toward consciousness, because if Barry is the paternal grandfather, with his animal research and observations/naming of sensorimotor rhythm (SMR), Joe Kamiya represents the softer, maternal grandfather who initially studied alpha states. We are all shaped by our families, so the careful work of these grandfather figures continues to guide daily practice and research initiatives concerning neurofeedback and the broader field of neuromodulation. Barry Sterman (actually, Maurice Barry Sterman, although only his wife calls him Maurice) had his own familial influences. In Barry's family, there was a beloved older sister, Esther, who developed Raynaud's syndrome in young adulthood. This prompted his parents, who had roots in Eastern Europe and then settled in Minnesota, to move to sunny California. It also stimulated his later interest in psychophysiology and motivated him to develop a simple device—perhaps the first biofeedback device for temperature—so she could learn to warm her fingers.

Barry graduated high school in Los Angeles and subsequently enrolled at the University of California, Los Angeles (UCLA). Studies at UCLA took a circuitous route through courses in astrophysics and predentistry. Still, he eventually found his niche in psychology, graduating with his bachelor's degree in 1960 and a PhD in 1963. That tells you something about his drive. Who completes doctoral-level studies in 3 years with five scientific publications (mainly concerning basal forebrain electroencephalography [EEG] patterns, such as Sterman & Clemente, 1962) and a thesis, Brain Mechanisms in Sleep, to their credit? For a listing of Barry's 133 scientific articles, see the 2019 book by Martijn Arns and Maurice B. Sterman, Neurofeedback: How It All Started, which provides a detailed and readable history of our field. It additionally has appendices that contain information published more than 50 years ago that still informs us and should be required reading today.

Two of those papers that were written while a graduate student had Wanda Wyrwicka as a coauthor. She collaborated on a further six papers with Sterman in the 1960s and was the first author of the seminal 1968 publication, “Instrumental Conditioning of Sensorimotor Cortex EEG Spindles in the Waking Cat” (Wyrwicka & Sterman, 1968). That paper is known to (if not actually read by) virtually all neurofeedback practitioners because it was the work that established that brainwaves could be trained by applying learning theory. Further work with both cats and monkeys confirmed the initial findings, and, fortuitously, the further finding was that cats trained to increase SMR were resistant to seizures. That is where Wanda came in again. She told Barry, in her Polish accent (she had studied in Pavlov's labs and was virtually smuggled out of the USSR by Carmine Clemente to bring her expertise to UCLA), “Ve must try this in humans!” Thus came the experiments training people with seizure disorders that were not well controlled with medication to increase SMR, thereby decreasing seizure frequency and severity. A review article by Sterman, published in Clinical Electroencephalography in 2000, summarized a clinically significant (>30%) reduction in seizures in 82% of patients across several studies. Some of those studies were done by Joel Lubar, who later established neurofeedback as an efficacious treatment for attention-deficit/hyperactivity disorder (ADHD). Joel spent almost 10 months in Barry's labs in the mid-70s on a prestigious National Science Foundation grant, while already a professor doing EEG work at the University of Tennessee. He extended the work concerning epilepsy to those with hyperkinesis, a common comorbidity with seizure disorders (Lubar & Shouse, 1976), thus initiating the application of EEG biofeedback to those with ADHD.

Barry's show-me-the-data approach qualified him as one of the grandfathers of our field. His contribution emphasized the scientifically rigorous side and, as mentioned above, another luminary in our field, the late Joe Kamiya, did work more related to consciousness and mental states. Joe's early work (done in 1958, although published only later) was also rigorously done. It indicated that some people (undergraduates at the University of Chicago who were his subjects) could identify when they were producing alpha. Furthermore, a second experiment showed they could learn, given feedback, to produce that mental state. Joe epitomizes the awareness of mental states, particularly those related to alpha brainwaves, and is closer to psychology's roots in philosophy. At the same time, Barry was the bench scientist who epitomized the application of operant conditioning/instrumental learning and classical conditioning to training brainwaves. Barry would joke, but was half-serious, that moving from animal research to human applications cost him his scientific respectability. It is so much easier to manipulate the variables with animal subjects. He was delighted when Ingrid Philippens picked up the torch and started SMR research at Europe's largest labs for primate research in the Netherlands. Her impressive work showed that marmoset monkeys trained to produce SMR did not develop tremors when Parkinson's disease was induced (Philippens & Vanwersch, 2010). Although her work got attention with an article in New Scientist titled “Monkeys Meditate for Marshmallows” (Geddes, 2011), like Barry's work with epilepsy, neurologists have largely ignored her careful research.

Barry's influence goes beyond the development of EEG biofeedback, partly because he was strongly influenced by Carmine Clemente. The latter became a mentor and a father figure to Barry. When Barry finished his PhD, Clemente was chairman of the Anatomy Department and later became director of the Brain Research Institute at UCLA. He coauthored all of Barry's early publications. Thus, great attention was paid to neuroanatomy and an effort to understand cortical dynamics (Sterman & Clemente, 1962). When with Barry, my late husband, Michael, loved nothing better than to discuss arcane details concerning neuroanatomy and how it provided a rationale for neurofeedback and biofeedback interventions. For practical application of this knowledge, see, for example, the paper about treating a woman with advanced Parkinson's disease (Thompson & Thompson, 2002). Their shared observation that people in our field needed more background in that area led to the writing of Functional Neuroanatomy Organized with Reference to Networks, Lobes of the Brain, 10-20 Sites, and Brodmann Areas (Thompson & Thompson, 2015).

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The emphasis on functional neuroanatomy makes some of Barry's publications hard slogging for practitioners with backgrounds in psychology, social work, and other nonmedical disciplines. Nor is Barry forgiving about those without this background. I had a few battles with him about the need to “dumb it down a bit” when coauthoring a book chapter, Neurofeedback for Seizure Disorders, in 2013 (Sterman & Thompson, 2014). Although forceful about his views, he has always been warm and welcoming to anyone willing to learn. He shares his knowledge generously and has been a mentor to so many in the field of neurofeedback. For Michael and me, it was Barry's work, along with that of Joel Lubar, that gave the field credibility when we started our learning curve in the early 1990s. They both had such solid academic credentials and yet were mainly concerned about the clinical application of the knowledge, not academic prestige.

The first time I met Barry and his beautiful nurse-turned-psychologist wife, Lorraine, was in 1993 at a meeting held in the gorgeous chateau-like Banff Springs Hotel in Alberta. Arriving late due to a flight delay, I dumped my bags and ran to the elevators to try and make the 8 p.m. opening presentation. In contrast to my rushed state, a well-dressed man with a box of slides under his arm was calmly smoking a cigarette while waiting at the same bank of elevators. When asked if he knew where the Northwestern Biofeedback Society meeting was taking place, explaining that I was running late, he announced calmly, “Don't worry. They won't start without me.” That self-assurance was not misplaced. By 1993, Barry had been publishing scientific papers for more than 25 years, and he has gone on with publications for a further 30 years. Speaking with Barry over the Labor Day week in September 2022, he told me that he had just received the galley proofs for his chapter in an upcoming book, Introduction to QEEG and Neurofeedback, Third Edition (Chartier et al., in press). His current interest is drawing on his years of observation to make sense of the interrelationships among motor, sensory, and cognitive activities of the brain, based on surface EEG measurements involving just three electrodes. Back in 1993, his EEG studies for the U.S. Air Force were top of mind. His talk that evening in Banff was “From Tonic-Clonic to Top Gun.” His work with seizure patients, along with his early sleep research, had evolved into research on high-performing brains. What were the patterns during exquisitely tough tasks like in-flight refueling, and what were the brain patterns as a pilot got sleepy on a long-haul flight from the continental United States to Hawaii? And yes, Barry got to fly with top-gun pilots as part of his research. Lorraine made him a shoulder patch with a flying brain for his flight suit. Thus, Barry was also at the forefront of data collection to further the optimal performance applications of neurofeedback.

What became clear during that first meeting was that Barry, beyond his research and academic credentials, is also a mensch, someone who is not just intellectually stimulating but a caring colleague. It was always fun to spend time with Barry at meetings—especially if you appreciated his jokes, which were matched only by those of his great friend, the late Bernie Brucker of biofeedback fame. Bernie could, literally, make the lame walk. “If there is structure, I can restore function” was his mantra. His knowledge of the neuromuscular system paralleled Barry's mastery of neuroanatomy. Barry admired Bernie's mastery and application of operant conditioning principles. On the other hand, Barry has always been skeptical about neuromodulation techniques that do not follow what we know about how the brain learns and changes. Recruit neuroplasticity—help the brain change by practicing healthy brainwave patterns. This has been a basic tenet of Barry's data-driven work. He also followed Pavlov's dictate, “Observe, observe, observe.” When Barry worked with a patient, he started with a careful assessment. For that purpose, at one point, he created a database for QEEG analysis with David Kaiser called SKIL—Sterman-Kaiser Imaging Labs. Barry sat beside a client and observed what was happening during training. He has continued to work with individual clients, especially those with epilepsy, through his mid-80s.

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Now he has become a patient himself, using SMR training for Parkinson's disease and doing an international collaboration with neurofeedback clinician-scientists like Barry, who themselves are dealing with Parkinson's disease. Perhaps they will help turn the tide concerning the application of learning techniques, despite mainstream medicine being so strongly influenced by the quick-fix emphasis on drugs or even surgical approaches, which has prevailed for the last half-century. When physicians, especially neurologists, discover our field, they do well by reading Barry's publications, as Rusty Turner, my coauthor, elucidates in the remainder of this essay.

Impressions from Robert “Rusty” Turner

As a further reflection, from one who met Dr. Maurice Barry Sterman at the mid-stage of my medical career as a pediatric neurologist, epileptologist, and encephalographer, I often credit Barry with “ruining my career”—said with intended humor and profound respect.

For the 15 years prior to meeting Barry, I was a clinician and clinical researcher increasingly frustrated with the limited successes—and often horrible failures—of traditional/allopathic interventions (pharmaceuticals and surgical interventions) for most neurological conditions afflicting children and adults. This is particularly true with seizures/epilepsy, where we have seen the development of more than 40 antiseizure medications in the past 40 years yet experienced only increasing incidence and prevalence of seizures worldwide.

Continually researching and seeking better solutions to neurological disorders, especially epilepsy, I had heard of neurofeedback, although it was often flippantly referred to by much of the unaware medical profession. However, given that one-third of people with epilepsy never achieve seizure freedom with traditional methods, I was hopeful about different approaches when introduced to QEEG and biofeedback/neurofeedback more than 15 years ago—at a time of relative desperation for the overwhelming number of children and adults suffering from the horrible disease of epilepsy, to say nothing of a host of increasing neurodevelopmental disorders.

Encouraged by a few trusted colleagues to attend a course on QEEG, taught by Barry, Joel Lubar, Cindy Kerson, and Jay Gunkelman—I flew to California after a 2-week-long on-call period, tired, burned out, losing hope for the millions of children suffering from apparently incurable neurological disorders, destined to chase a life of trying medication after medication after medication, chemically suppressing their underlying electromagnetic brain network dysregulation. Little did I know that I was to meet some of the pioneers in the field, clinician-researchers for whom I would shortly develop amazing respect because they have dedicated their careers to truly helping those suffering from a plethora of symptoms involving almost every body system.

The first lecture I attended at the workshop venue was from someone I had heard of only remotely: a Dr. Barry Sterman. This proved to be a pivotal moment in my career: it plunged me further into expanding into a true practitioner of “health care”—no longer just a “disease manager.” I was spellbound by Barry's initial presentation and immediately spoke to him afterward. He then confidentially shared with me a draft version of a chapter he was coauthoring with Lynda Thompson, Neurofeedback for Seizure Disorders, to be published within the year (Sterman & Thompson, 2014). After more captivating presentations from the other clinicians—the likes of which I had never before heard at a neurology or epilepsy meeting—I went to my hotel and studied Barry and Lynda's “holy grail” manuscript. Its impact “woke me up from The Matrix” of unknowing, thus changing the course of my career.

My respect for this confident yet humble man rapidly grew as I learned of his 50+ years of work at UCLA and elsewhere, delving into the wonders of the brain, sleep medicine, and epilepsy. We have all learned of the serendipitous discovery of what became known as the SMR and its anti-epileptogenic, antiseizure characteristics. Reading the early work and publications of Dr. Sterman and his colleagues was a wake-up call to the foundational neuroscience that characterized this work.

The next few days were a blur of immense learning, occurring in the most wonderful milieu of new colleagues—soon to become close friends. Barry would now be spending hours with me—in person and by phone—as I grappled with the deeper realizations that we, as health care providers, could truly discern and reverse the root causes of network disorders of the brain, including beginning to speak of a “cure” for epilepsy and many other disorders.

Grandiose? Far-fetched? Delusional? According to most allopathic medical providers' sincere but incomplete band-aid mindset, these allegations would be true. But with the whole-person, scientifically based, neuroscientifically founded evidence concerning the efficacy of neurofeedback demonstrated since the 1960s, hope was being restored. From then on, I pursued a path seeking true resolution of symptoms and healing of underlying neurological disorders.

Barry's influence in “destroying my career” continues to be our personal little joke, as he—and subsequently many others—were put in my life to guide me to a more fulfilling season of my career than I ever dreamed possible.

The learning curve was very steep at the beginning—as was my re-learning curve—building and rebuilding on the extraordinary foundational training I received in medical school, internship, residency, and fellowships. My new knowledge added a fourth dimension to what I had traditionally been taught and became directly applicable to the actual healing process so often misunderstood in traditional allopathic medicine.

This led to in-depth training in the long-tested but often incompletely verified modalities of biofeedback, neurofeedback, heart rate variability training, and other aspects of noninvasive neuromodulation. It also led to a significant career move after discovering there was no room for this evidence-based modality at my institution, mainly because it would not bring in the financial gain that was being readily realized from the pharmaceutical and surgical/procedural methods, even though these methods did not lead to discovering or ameliorating root symptoms.

I left the familiar but life-draining security of my tenured academic hospital position and opened a private integrative practice that offered allopathic neurology care and QEEG-guided neurofeedback. Running a business was hard, but what kept me going was seeing the impact of neurofeedback in the lives of the type of patients I had not been able to help before. The brain's ability to self-regulate seemed like a miracle—to me and my patients.

Despite the evidence and experience of noninvasive neuromodulation over more than half a century, most in my profession of medicine remain ignorant of health-restoring, nondrug interventions—interventions that address the roots of disease. One would hope that any thinking, open-minded physician would seriously consider such health-giving modalities. Hippocrates would have been proud! Yet the phenomenon of “contempt prior to investigation” remains deeply entrenched in the medical and research world.

Thus, I continue to be a sponge for learning—and Barry has continued to pour out his wisdom and knowledge on me for more than 10 years. When this pediatric epileptologist from South Carolina calls Barry's cell phone (or shows up at his door), he and his wonderful wife, Lorraine, always show me pure graciousness, learning, hospitality, and cherished friendship. Thank you, Barry, for changing my life!

Maurice Barry Sterman, professor emeritus, Departments of Neurobiology and Biobehavioral Psychiatry, David Geffen School of Medicine, University of California at Los Angeles, fellow of the Association for Applied Psychophysiology and Biofeedback is, indeed, great. It is his combination of scientific rigor with great humanity, plus enthusiasm about the ability to improve lives based on his discoveries and observations over the past six decades, that makes him great.

Respectfully submitted,

Lynda Thompson & Rusty Turner