In the Existential Hope in Practice essay series, our fellows write about concrete ideas and practical examples of how to build a great future.
Minds that can meet the future
By Elisa Kallioniemi
In brief:
Brain disorders affect hundreds of millions of people, yet our treatments remain blunt: medications with broad side effects, therapy that helps many but isn't enough for all.
A new approach is emerging: non-invasive brain stimulation that reads neural activity in real time and responds precisely, adapting to each individual.
If it works, “treatment-resistant” could become rare, and brain health could be supported as precisely as heart rhythms or glucose levels.
Challenges ahead include: incomplete scientific understanding and limited funding, burdensome and out-of-date regulation, and issues of unequal access.
This is not about enhancement but about relieving people from suffering to enable them to flourish.
A glimpse of what’s possible
A person with treatment-resistant depression sits in a clinic. For three years, mornings have felt impossible. Four medications, two therapists, countless adjustments. Some drugs dulled everything. Others did nothing. For many people, these treatments work. But for millions, they don’t. They’ve watched relationships strain under the weight of a condition that no one can see and nothing seems to fix.
Now, a device near their head reads their brain activity in real time. It finds patterns of brain activity associated with dysfunctional circuit states and delivers a magnetic pulse timed to the millisecond. They feel nothing dramatic in the moment. But over the following weeks, something shifts. The fog lifts, not completely, but enough. For the first time in years, a good day doesn’t feel like an accident.
This is not 2050. This is happening now, in research clinics, with technology that already exists. The question is no longer whether we can treat the brain directly. It’s how fast we can get there.
What is this technology?
The approach is called transcranial magnetic stimulation, or TMS. A device held near the head that generates brief magnetic pulses that pass through the scalp and skull to activate specific brain regions. It’s been approved for depression since 2008 and is already used in clinics worldwide. No surgery, no implants, no anesthesia.
But here’s what’s changing: we’re learning to make it adaptive.
Traditional TMS works like a preset program. A clinician targets a brain region, delivers the same stimulation pattern to every patient, and hopes it helps. It often does, but the approach overlooks something obvious: every brain is different, and it changes moment to moment.
In the next generation, TMS will be used in combination with real-time monitoring of brain activity. This creates a closed feedback system in which brain activity is monitored, brain waves are recognized, and the timing of impulses is adjusted to maximize effectiveness.
Consider the contrast between a thermostat and a static heater. While one just pumps out heat, the other responds to environmental changes and regulates accordingly. We have had devices that control temperature, heart rhythms, and glucose levels. What we lacked was something for the brain.
Why? Because the brain is vastly more complex. Reading its signals, interpreting them in real time, and responding meaningfully is an engineering problem we are only now beginning to solve. Advances in machine learning, faster processing, and decades of basic neuroscience research are converging to make it possible.
This convergence is why the present moment matters. Twenty years ago, we could stimulate the brain, but we couldn’t read its activity fast enough to respond in real time. Ten years ago, we had the sensors, but not the algorithms to interpret what they measured. Today, advances in AI, cheaper computing, and decades of foundational neuroscience are finally coming together. For the first time, adaptive brain stimulation is not a theoretical possibility but an engineering problem with a plausible path to solution.
It does not involve improving healthy brains or constructing science fiction-like interfaces. Instead, it involves providing clinicians with a precise tool to complement the ones they currently have.
What could we achieve?
Imagine a future where being “treatment-resistant” becomes the exception instead of the norm. Imagine a future where being diagnosed with depression, chronic pain, or even mild cognitive impairment doesn’t require months or years of trial and error to find the right medication. Imagine having a device that adapts to and evolves with your brain, delivered without any invasive procedure.
Consider chronic pain, a medical condition that affects more individuals worldwide than diabetes, heart disease, and cancer combined. Pain is a hard-to-treat disorder since it cannot be seen. Two patients with similar physical ailments may experience them differently, and there is no way for the physician to visualize the brain’s processes. Current treatments include opioid-based medications, which help many people but carry risks of dependence and diminishing effectiveness over time. For others, management means learning to live with pain rather than resolving it. The use of precision brain stimulation provides an alternative route. Initial studies have shown that there is a specific pattern in the brain when it processes pain, and that, when targeted with stimulation, the experience of pain can be reduced by modulating the circuits involved in pain processing.
For aging populations, the implications may be even larger. Cognitive decline is one of the most feared aspects of growing older. It’s not just forgetting names. It’s losing the ability to live independently, to manage finances, to recognize the people you love. Dementia cases worldwide are projected to nearly triple by 2050, and by the time it’s diagnosed, significant neural damage has already occurred. We have no drugs that reverse it. We barely have drugs that slow it.
Precision brain stimulation offers a different timeline: intervention earlier, before decline becomes irreversible. A person in their sixties noticing that words don’t come as easily, that focus scatters more quickly, could receive targeted stimulation to support the circuits starting to falter. Not a cure, but maintenance, the way we maintain cardiovascular health through a lifetime of care rather than waiting for a heart attack. The goal isn’t to live forever. It’s to stay yourself for longer. With populations aging worldwide, even modest gains in cognitive longevity could reshape what the last decades of life look like for hundreds of millions of people.
Step back, and a larger picture emerges. Every civilization depends on human minds. Every scientific breakthrough, every institution, every democracy depends on billions of brains functioning well enough to learn, adapt, and solve problems together. Depression, chronic pain, and cognitive decline don’t just burden individuals. They reduce humanity’s collective capacity to face its biggest challenges. If we can treat these conditions at scale, we don’t just reduce suffering. Reducing the burden of brain disorders not only helps individuals. It increases society’s ability to learn, innovate, and solve difficult problems.
Most importantly, because this technology is non-invasive, it has the potential to scale. Already, these machines are less expensive than the surgical implantation procedures. Costs would decrease even further through continuous development. The advantage this technology has over brain-computer interface technologies is the lack of need for a surgical procedure.
It is not about a future society in which every person must walk around wearing an electronic device on their head. The idea is that brain health will be taken as seriously as cardiovascular health. In other words, the neurological basis of moods, attentiveness, and cognition will be supported by medical treatment.
What’s hard about getting there?
This isn’t a straight path. Several real obstacles stand between where we are and the future just described.
The science isn’t finished. Closed-loop brain stimulation works in research settings, but we’re still learning which brain signals to target, for which conditions, in which patients. The brain varies enormously across individuals. A pattern that predicts symptom relief in one person may mean nothing in another. Developing systems that adapt reliably across this variability will take years of careful research.
Technology outpaces regulation. Organizations such as the FDA are geared toward regulating static therapies; i.e., those with fixed treatment amounts. An adaptive process in which a therapy can adjust its actions based on real-time data cannot be easily reconciled with current approval methods. To ensure safe regulatory approval of such processes, new approaches are needed.
Access might become highly inequitable. The latest technological advancements in medicine are often first adopted by affluent communities. Given that precision brain stimulation may prove costly and available only to large institutions, there is a danger that it will further exacerbate existing inequalities. To solve this problem, certain steps must be taken intentionally. It would include creating devices that are easy to make and inexpensive, educating clinicians not only at academic hospitals but also in the community, and developing a payment system that covers these interventions. The noninvasive aspect of TMS provides a benefit in this case. No operating room is needed. No implants need to be manufactured. However, without proper intentionality, high costs and specialized skills might still keep such treatment out of reach.
There is definitely a need for ethical guidelines. An innovation related to brain activity is bound to raise concerns about its use. Whose will be the data ownership? Where does therapy end and enhancement begin? Is there an effective way of ensuring consent when the outcomes are complicated? There is no easy solution to these questions, but there are valid reasons not to halt the development process.
None of these obstacles is insurmountable. But pretending they don’t exist would undermine the vision’s credibility. The path forward requires honesty about what’s hard.
Why it’s worth pursuing
The coming decades will be defined by challenges that demand clear thinking: climate adaptation, AI governance, and institutional reform. Humanity’s ability to meet these challenges depends in part on whether enough people can actually focus, learn, adapt, and contribute. Right now, hundreds of millions cannot, not because they lack will, but because their brains are burdened by conditions we don’t yet know how to treat effectively.
This is the often-overlooked case for precision brain stimulation. It’s not about making healthy people sharper or giving anyone a competitive edge. It’s about reducing the baseline suffering that holds people back, using tools that can realistically scale.
Imagine telling your grandchildren that there was once a time when millions of people lived with unbearable mental suffering because medicine simply couldn’t see what the brain was doing. Imagine depression becoming as routinely managed as hypertension. That future is not guaranteed, but for the first time, it is plausible.
And there is an underlying meaning too. For much of our history, the workings of the brain were a mystery inside a black box, and we worked indirectly to affect an unseen internal factor through behavioral change or chemistry. Now, we can actually observe and manipulate brain activity in real time.
We don’t know exactly how this technology will develop. The path will be slower and messier than optimists hope, and faster than skeptics expect. What matters now is that serious people are working on it, that funding and attention flow toward the hard problems, and that we build the ethical and regulatory infrastructure before it’s urgently needed rather than after.
Hope is not believing that suffering will disappear. To me, hope comes from seeing problems that once seemed untouchable gradually become solvable through science and engineering. For most of history, the brain was beyond medicine’s reach. Today, for the first time, we are beginning to build tools that can understand and gently guide its activity. If we develop them wisely, future generations may look back on today’s treatment-resistant brain disorders the way we look back on untreated infections: not as an unavoidable part of the human condition, but as problems we chose to solve. As someone building these systems in the lab, I see both the promise and the distance still to travel.
About the author
Elisa Kallioniemi is a biomedical engineer and neuroscientist focused on precision brain stimulation. She directs the Brain Stimulation Laboratory at New Jersey Institute of Technology, where her team works on adaptive stimulation methods, AI-guided targeting, and biomarkers that could make brain disorders visible and treatable. Her goal is to build tools precise enough to match the brain's complexity.
Great article. Definitely, a lot of promise and concerns when thinking about connecting biology and especially one's brain to control loop systems. One of my friends in research wrote a substack blog about using TMS to connect his brain to ChatGPT and solve a maze ( https://substack.com/home/post/p-173953300 ), which highlights the points in this article that the technology is becoming more and more tangible.
VERY glad to see Elisa/NJIT—and hopefully others around the world too—are choosing to focus on learning about & addressing this very real tho still under the radar “epidemic of the mind”. (..which seems to get more & more visible w/each passing month)
And whether born of our human biology & frailty—or not—perhaps we might all readily agree that the ever increasing stream of endless kinds of info & content (..which gets delivered to us via the internet every day) may also factor in. As such, it’s not a big leap to see that, thanks to our senses, & our daily “content fire hose”, it might be that a part of the many mental health issues we are seeing in this “epidemic of the mind” may have a source..