Author: Doidge, Norman
Publisher: Viking Press
Reviewed By: Jane Hall, Vol. XXVII, No. 4, pp. 38-40
Psychiatrist, psychoanalyst, writer, and researcher Norman Doidge delivers a revolutionary message in The Brain That Changes Itself, a very important and informative book that should be read by all. Dr. Doidge takes the reader by the hand and carefully explains that the brain can and does change throughout life. Contrary to the original belief that after childhood the brain begins a long process of decline, he shows us that our brains have the remarkable power to grow, change, overcome disabilities, learn, recover, and alter the very culture that has the potential to deeply affect human nature.
Clear, fascinating, and gripping is how I would describe this invitation to understand how the brain can work. I say “can work” because Dr. Doidge gives new hope to everyone from the youngest to the oldest among us; from the stroke victim to the person born with brain abnormality; from those who can not seem to learn to those whose neurotic suffering has stunted growth through denial and other defenses; and from those who cannot feel to those who feel too much.
The long-held theory that brain functions were localized and specialized has now evolved to embrace the recognition that the brain is plastic and can actually change itself with exercise and understanding. In my mind this is a huge leap in the history of mankind – far greater than landing on the moon – and it is of vital interest for the practice of psychoanalysis among other equally important things.
We meet the patients, scientists and researchers who have pioneered this voyage from brain localization theory (localizationism) to the understanding of brain plasticity. Too numerous to mention, what Dr. Doidge does is introduce these scientists and their work with an ease and grace that brings the reader into their world and work.
In chapter 1, we meet Cheryl, a woman who has completely lost her sense of balance. She must hold on to the wall to walk, but even that does not steady her. And when she does fall, there is no relief for she still feels like she is falling perpetually into an abyss. This excruciating disorder due to total loss of vestibular apparatus makes her life a living hell. Such people are called “wobblers” because that is what they do. They behave and look like they are walking a tight rope. It is not surprising that many “wobblers” have committed suicide.
According to localization theory Cheryl’s case is hopeless. The genetically hardwired processing molecules necessary to feel balance cannot be replaced and there is no cure. Enter Paul Bach-y-Rita and his team who have invented a hat. This hat/helmet, with its tongue display and electrodes, acts as a sensor of movement in two planes thus giving Cheryl the ability to orient herself in space, thereby losing the terrible vertigo that led to wobbling. Cheryl and those like her who wear this seemingly magical hat can experience through the tongue connecting to the brain what is needed to maintain balance by finding new pathways in the brain that process balance.
The broader implications of this discovery are mind-boggling. The elderly, in fear of losing balance due to the weakening of the vestibular sense, often curtail their activities. This device will help them feel secure enough to keep fit. It can also help blind people orient themselves in space thereby giving them a way to see. But the most amazing finding is the residual effect. The longer Cheryl wore the hat, the longer she could keep her balance after she took it off. Over the course of a year Cheryl built her residual effect to four months and now does not use the device at all. She has been cured by her own brain with the help of the device that showed her brain a new road to achieve balance.
Paul Bach-y-Rita’s work has been used with brain trauma, stroke, and Parkinson’s disease showing that the brain is indeed plastic. Such knowledge can ease suffering in many ways. The lesson is that the sensory cortex is plastic and adaptable.
Another hero in the plasticity movement is Michael Merzenich, one of the world’s leading researchers on the subject. Based on his belief in practicing a new skill under the right conditions, he claims that brain exercises can compete with drugs to treat schizophrenia and that cognitive function can improve radically in the elderly. Learning itself increases the capacity to learn by changing the structure of the brain which he likens to a living creature with an appetite needing nourishment and exercise.
Working with a monkey he showed how brain maps are dynamic and work by the ‘use it or lose it’ principle. When a monkey’s middle finger was amputated two other fingers took over the middle finger’s original space, using it themselves. He found that plasticity is a normal phenomenon and by micro-mapping the brain he saw that normal body parts change naturally on the map every few weeks. His biggest opposition came from Nobel Prize winner Torsten Wiesel who believed plasticity existed only in critical periods and never in adults. Wiesel has since recanted, admitting that he was wrong.
Two phrases associated with Merzenich are ‘use it or lose it’ (as with any muscle) and “neurons that fire together wire together” meaning that throwing a ball, for instance, many times in the same way creates a brain map where the thumb map is next to the index finger map, and then the middle finger. So, brain maps work by spatially grouping together events that happen together. Practice makes perfect with minimal effort because fewer neurons are required to perform a task. Proficiency implies a more efficient use of neurons leaving more room on the map for adding skills and executing them more quickly. Paying close attention was found to be essential to long-term plastic change. I would add here that enthusiasm, often involving falling in love with a person, teacher, or game, is an important ingredient in paying close attention. Multi-tasking or divided attention does not lead to lasting change in brain maps.
Fast-ForWord is a training program developed by Mezernich and his colleagues for language-impaired and learning disabled children. Chapter 3, Redesigning the Brain explains how the program was developed and what it does. Raising IQ levels, helping children conquer their disabilities and even changing the lives of the autistic, this chapter is the heart of the book and of great import to the aging population (all of us). Merzenich explains that the reason it becomes hard to find words as we age is that attentional systems become atrophied and have to be engaged for plastic change to occur. He says that ‘fuzzy engrams’ (unsharp) are being fired slowly and are not passed down stream quickly causing muddy streams or noisy brains. “OK,” Merzenich seems to say, “everything is going to hell progressively, but on top of that the brain gets noisier due to lack of exercise.” Acetylochine, a chemical which allows neurons to communicate with each other thus helping the brain tune in and form sharp memories is not even measurable in most elderly people. This is because after middle age a sense of relaxation about who we are and what we do lulls us into repeating skills and favorite activities instead of learning new ones which allows the brain to atrophy. By age seventy a person may not have focused on something new for years thus losing plasticity. Learning new things such as language, doing challenging puzzles, even learning new dance steps revive plasticity. The message is clear. Do something new and challenging and have fun doing it. Then you may remember where you put your keys or why you walked into the kitchen. Turn your senior moments into junior ones! Merzerlich claims that 20 to 30 years of reversal in cognitive ability can occur. As soon as I finish writing this review I am going out to cyberspace to hunt down the Posit Science web site he and his colleagues founded. Last week I started dancing lessons. Maybe next week I’ll start learning Spanish. I am sold.
The story of Mr. L in Chapter 9 illustrates exactly how psychoanalysis changed his character defenses by helping him access his deepest feelings about loss. Mr. L learned that it was safe to give up the denial that protected him for over 40 years from the pain of early loss. He exposed the memories and emotional pain that he had hidden, permitting psychological reorganization. Mr. L changed from an isolated, depressed man unable to commit to anyone, to a man able to experience profound love, marry, and have children. We psychoanalysts see exactly how Mr. L’s analysis worked using the theory of brain plasticity.
In chapter 11, "More Than the Sum of Her Parts," we meet Michelle, born with half a brain. The fact that her right hemisphere took over from her left hemisphere the functions of speech and language, while performing its own functions speaks clearly for neuroplasticity. Michelle leads a comfortable, though somewhat impaired life, enjoys movies, a job, and her family. The story of how one half of her brain took on functions of the missing half is an adventure.
My favorite parts of the book have to do with stroke victims (those who lose feeling, in chapter 5; and those who have too much feeling and are in pain, chapter 7). Earlier in the book (page 20) we meet Paul Bach-y-Rita’s father, Pedro, who suffered a severe stroke at age 65 paralyzing his face, half of his body and leaving him unable to walk or speak. He was pronounced incurable after the usual rehabilitation course and an institution was recommended. Instead, his son, George, took his poet father Pedro home to Mexico where, with the help of the gardener, they rehabilitated him by starting him crawling, then playing children’s games, and turning everyday life experiences such as washing pots into exercises in order to strengthen his arm. Pedro eventually began typing and speaking and after a year of this unconventional therapy (which included much love I think) he was back teaching full time. He remarried, traveled, hiked in the mountains, and led a full life for seven more years. After he died from a heart attack while climbing a mountain, an autopsy revealed catastrophic damage from the cerebral cortex to the spine which had caused the paralysis and had never healed. There were no brain scans in those days but the autopsy proved that the brain was indeed plastic and could reorganize its functioning completely after long periods of inactivity in an elderly person. This is important because when a patient recovers from a stroke so completely doctors think there was not much damage in the first place. The autopsy showed the vast destruction. A longer discussion of stroke recovery is in chapter 5, “Midnight Ressurections” – a chapter that defies synopsis – and must be read to be thoroughly appreciated.
Chapter Seven, “Pain - The Dark side of Plasticity” introduces us to the neurologist V.S. Ramachandran, described as the Sherlock Holmes of modern neurology. Learning about this man is a fascinating experience in itself. He is heroic in his simplicity and curiosity. “Your own body is a phantom, one that your brain has constructed purely for convenience” says Ramachandran – and this statement has influenced so much of my thinking. His interest became phantom pain – pain that amputees feel after amputation and he discovered that rewired brain maps were the cause. The brain’s plasticity enables rewiring of missing neurons. These discoveries also explain a positive outcome of certain brain remapping and this is in the sexual realm. Phantom orgasm and phantom erection can be experienced in the feet of men with amputated legs and feet leading Ramachandran to wonder about foot fetishes in a neurological way. I will not even try to explain how the mirror box Ramachandran devised to help his patient Philip cope with excruciating pain from an elbow that was amputated works. But, successful amputation of this phantom limb through using the mirror box led others to use it - and there’s more! Ramachandran says that the distorted body images of anorexics and some who go for plastic surgery are caused by the brain and then projected onto the body. So, could one conclude that if one gets the message that he/she is ugly or fat, whether consciously or unconsciously, through loved ones or culture, the brain distorts the perception of the body? Anorectic people actually believe that they are always too fat – defying the reality of scales. It is no coincidence that Ramachandran is from India where his culture was open to what we would call mystical thinking. Psychotic people actually hear voices and hallucinate. Can the theory of brain plasticity be used to explain and even cure such cases. Read this chapter and decide for yourself. The idea that illusion and imagination can conquer chronic pain by restructuring brain maps plastically, without medication, needles, or electricity must be really bad news for the pharmaceutical industry.
The theory from the time of Descartes, that pain receptors send a one way signal to the passive brain, has been refuted. Neurologists Wall and Melzack assert that the pain system is spread throughout the brain and spinal cord making the brain, far from passive receiver, the controller of pain. These men proposed the “gate control theory of pain” and their findings must be read by anyone who has or does experience acute or chronic pain. Therapists who work with such patients will benefit as well.
Dr. Doidge is in the position to use the implications of brain plasticity to explore many psychoanalytic theories, diagnoses, and treatment techniques and I hope he will focus on these issues in his next book. Such phenomena as splitting, hysteria, obsessions and compulsions, and especially addictions must be explored from the theory of brain plasticity. I would venture to say that such concepts as changes in one’s representational world, identification, internalization, and the analyst as new object looked at in terms of brain plasticity is imminent if not already here. If you link Pedro Bach-y-Rita’s remarkable recovery to regression, revisiting an early developmental stage, the regression in psychoanalysis seems explainable in terms of new development and new compromise formations. Although cognitive behavioral therapy would seem viable with all this learning involved, it misses the most important ingredient for change and that is the connection over time with the analyst and the empathy and love experienced.
There is much that I have omitted in this review: discoveries about the culturally modified brain; sex and its vicissitudes, rejuvenation; imagination; acquiring tastes and loves and much more.
The Brain That Changes Itself leaves me with one major question: Why isn’t this book on the top of the bestseller list for all time? Gift shopping will no longer be a problem for me!