psychiatry
9 Jun 2009
How To Fix A Damaged Brain
Norman Doidge offers exciting hope to people with all kinds of brain injury. Shakira Hussein spoke to him about an issue that weighs heavily on her mind
Norman Doidge looked exhausted. It must take it out of you, being one of the most popular drawcards at the Sydney Writers' Festival. He had just given yet another lecture to yet another capacity crowd, and then spent an hour signing yet more copies of his book, The Brain That Changes Itself, for yet another throng of admirers.
Backstage at the Sydney Theatre he sank into an armchair and shut his eyes against the fluorescent lights of the dressing room. When he opened them, he looked so tired that a nice person, a considerate person, would tell him to forget the interview — just take a breather, settle back into that armchair with a nice herbal tea, far from the madding crowd.
Unfortunately for Doidge, I was only willing to let him take a breather for as long as it took to figure out the buttons on my mp3 recorder. Then I wanted to hear about neuroplasticity.
Norman Doidge is a psychiatrist and psychoanalyst, a member of the research faculty at Columbia University and the University of Toronto's department of psychiatry. In The Brain That Changes Itself, he tells the stories of doctors, researchers and patients who are exploring the implications of neuroplasticity — a way of understanding the brain that opens possibilities for people with a wide range of medical conditions, and indeed people with no particular medical condition at all, other than age. As Doidge said when I commented on his packed lectures, neuroplasticity "has implications for everybody: it addresses issues of chronic pain, psychiatry, learning disorders, stroke treatment, brain injury, diffuse brain damage, the aging brain, our understanding of human nature."
Doidge and other writers on neuroplasticity reject what they call the "neurological nihilism" of seeing the brain as a machine that runs down over time, and may be damaged beyond repair by an accident or a stroke. Instead, they talk about the brain as an organ that restructures itself according to how it is used, and one that has the potential to "rewire" itself to adapt to damage.
Doidge's book describes blind people learning to see through the use of a camera connected to a strip of electrodes slipped over the tongue; elderly people turning back their neurological clock to regain the sharp memories they had decades before; and survivors of trauma who have used neuroplasticity as a form of psychoanalysis. Doidge even describes how neuroplasticity provides researchers with a way of understanding and addressing the pain that amputees feel in their "phantom limbs".
They are intriguing stories, and after reading them, I wanted to hear more.
But I didn't just want to hear Norman Doidge talk about neuroplasticity. I want neuroplasticity to work for me. More specifically, I wanted to be told that my brain's amazing plasticity will enable it to adapt to the lesions that appear as a scattering of white dots on my MRIs — a sign of remitting-relapsing multiple sclerosis — not too much of a problem right now, although my balance is not always what it could be. (As I made my unsteady way around the Writers' Festival, I found myself grabbing the shoulders of friends, festival staff, and passers-by, just to stop myself from tipping into the harbour, or onto Bob Ellis.)
I want to find a way to regain control of my brain, to reassert its mastery over my body, over my entire self. Doidge's book seems to offer something that I want so badly that I don't trust my own judgment. A few more stressful doctor's appointments, and I'll be seeking reassurance from astrologers, scientologists, and Appalachian snake-handlers.
Norman Doidge seems a safer bet than any of those, but I am a dumb social scientist — what do I know about neurology? I have to admit that I am more scared of ending up as an object of ridicule than I am of ending up in a wheelchair, so even though I desperately want him to be right, I'm going to make sure I've got the story as straight as possible. If neuroplasticity turns out to be the next "magic water" story, well, I don't want to be Paul Sheehan.
I was so concerned my hopes had blunted my analytical power that I compensated by adopting a skeptical tone that bordered on hostility. I asked Doidge how he deals with the fallout of having written a book that has raised the hopes of so many people, and how he negotiates transforming such hope into realistic expectations.
Doidge responded graciously: "By the way that I wrote the book. There is a noble tradition in medicine which says that when people dare not face the inevitability of death, or the power of disease, and when people are pursuing vain hopes, that the physician should take the side of reality. So that if someone is very ill, you tell them so, and you work towards helping them to find acceptance. If they are dying, you tell them to set their affairs in order, so they can say their goodbyes. But with neurological and psychiatric illnesses — where rehabilitation and all the effort involved may be of value — we had better be sure that we are right when we tell people there's nothing we can do."
"I've described some very dramatic cases, because they illustrate just what neuroplasticity means for our understanding of the brain. They have a resonance that goes beyond individual clinical vignettes. But I would not claim that all strokes — and there are many different kinds of strokes — are anything but cerebral catastrophe. To get back some of what is lost in the stroke requires that the person can pay attention, has not lost the part of the brain that is helpful for motivation, and a number of other things must be in place. So many patients can't be helped — but that said, it so happens that the commonest form of stroke that people survive, where a person is paralysed on one side, can be helped by constraint-induced therapy, a neuroplastically-based treatment."
"People have a right to protect themselves from false hope, and should ask questions. I would say to read the book carefully, and they will see that the treatments I described were all hard work and that the limits of plasticity were respected just as much as its potential."
Doidge is right when he says that the concept of neuroplasticity provides much food for thought for even healthy brains. If our brains can be so profoundly changed according to how we use them — that in a very real sense our brains are what they eat — then many of us are eating way too much junk brain-food. As Doidge says, "It's no accident that TV has so much downmarket content, because as Marshall McLuhan wrote, 'the medium is the message'."
Put simply, our brains respond differently not only to different information, but to the way in which the information is transmitted. "Brain scans show that when you read a book, as opposed to when you listen to it, different parts of the brain analyse the meaning for each. Absorbing information aurally rather than through print exercises the auditory cortex, and McLuhan wrote about how reading books teaches people to make linear arguments, and therefore emphasises the role of reason.
Aural and print media cultures have different impacts upon the mind and brain. Oral traditions, and traditions that value the written word — in contrast to those such as our own that value electronic media — wire up processors differently. We know that Orthodox Jewish children — who are very much in a literary culture — can memorise vast amounts of the Torah and Talmud, just as Muslim children memorise the Qur'an, and until the 1960s, children in our own culture would memorise classical poetry as part of their education. And Homer appears to have been transmitted orally as well by the ancient Greeks. These extraordinary memory skills seem almost beyond belief to those of us who have lost such skills."
Doidge is careful to place caveats on his claims for neuroplasticity, warning that "we should not go from a view of the brain that is overly rigid to seeing it as infinitely plastic. Human beings have a tendency to swing between improbable hopes and improbable fears."
It's a tendency that I recognise in myself. After my discussion with Doidge, I'm swinging towards improbable hope, filled with an evangelical fervour to persuade everybody to learn a new language and acquire new skills — brain-exercise that Doidge says can help keep our brains fit as we age.
Next week, I'll probably swing back towards improbable fear. If you want to contact me, I'll be striding down the aisle of an Appalachian church, clutching a serpent in each hand.
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This is one of the best books I have ever read. The evidence that now exists for the neuroplasticity of the brain is heartening and enlightening on many counts. Much of his research is done with stroke victims but the book also covers obsessive-compulsive disorders; autism, AHDD and a variety of ‘expressions’ of brain function.
It also explains why it is so hard for us to change how we think (and therefore how we feel and how we act). It offers such insight into how people become locked into dysfunctional modes of thought and behaviour …. and, how they can work to free themselves. Fascinating.
Another truly brilliant book, and more technical than Doidge’s, but well worth the read is Evolve Your Brain: The Science of Changing Your Mind, by Joe Dispenza.
A lot of time is spent on NM with people debating different sides of an issue and many finding it hard to understand how the other ‘side’ cannot see their viewpoint, or plain reason…. this article, and the book he wrote, go a long way toward explaining the Why of the What!
Shakira,
I would add, there is no such thing as impossible hope. Hope just is. And there is nothing which is impossible. The body is a miracle. Some things may be unlikely, but never impossible. Allopathic medicine is so doomladen and ‘dictatorial father-like’ that it is hard for people who wish to remain well or get well, to ‘believe’ positive things. Read as much as you can. Joe Dispenza is brilliant. Demand nothing. Trust your body and believe the best.
Seems to me that BPobjie (previous article) has need of some brain repair ..pronto!
Other than that, excellent article, with interesting information. I myself have experience of how damaged nerves can to some extent repair themselves, maybe do some ‘bypass’ so I never cease to be amazed at what the human body and mind is capable of. Good or bad!
With reference to amazing use of children’s memories, Shakira Hussein mentions Orthodox Jews and Muslims. Please do not forget Indigenous Australians, who, at least in times past, had to memorise whole swags of stuff, as they did not have written text. Being able to remember hundreds of songs, dances; and stories that give guidance in traveling through territory (mind maps), ethics, morals, the culture of groups and breeding/marriage lore.
Now, of course, most of this has been lost to cultural and ethnical destruction, so most Indigenous children, particularly the petrol and glue sniffers, remember very little.
They very much need their culture back, to save their brains and bodies. Dazza.
Dazza,
Memorising was the way kids were taught at school up till the seventies …. it’s loss means a loss of ‘brain-maps’ and ‘brain-function.’ This applies to all children regardless.
Aboriginal children need education. All children need the best education. The best education requires some rote learning and memorisation as I am sure will ultimately be realised and therefore returned to the curriculum.
Everybody on the planet has emerged from a culture which had no writing and therefore has a genetic imprint of thousands of years of oral learning. There is nothing exceptional about this. What is required is not a return to a culture where everything is oral but a culture where there is some oral learning but all learning has a place in the modern world.
It is one of the best science books I have read for a long time. Doidge has a great humanistic spirit, writes well and is working in one of the most amazing areas of medicine.
It also helps, I think, that he has a diverse intellect and approach.
The most interesting concepts are the speculative ideas about culture. If Doidge is right, then TV, Tabloids and Twitter really do make you stupid, altering the structure and ability of the brain at a basic level.
Who woulda thunk it ? ROTFLMAO etc.
rosross, can you name me any other peoples who used memory to the extent of the Australian Aborigines? I think not. In the early days, all whites who came into contract with them made reference to the phenominal memory of the people, in all things. These experienced world explorers in many cases had never struck anything like this before. Their very survival depended on it.
I am not in any way indicating a desire that children, indigenous or otherwise, become totally oral, but that the Indigenous children, as well as learning ‘white’ ‘civilisation’ (very questionable), need to go back to their own culture, and learn a respect for their own brains.
And that Rudd and Co. give every assistance to them to do so, instead of the ultra patriarchal (more matriarchal, actually) system they are presently instituting.
If they, the children, and the adults also, do not have pride and respect for themselves, all the education is the world will have no effect.
I would also suggest that the Education Programme being pushed down the Indigenous Children’s throats and into their brains may not be the best thing to allow them to survive and thrive in the future world.
I had some experience of it in a Community called Mimili in SA, and I was left worried, although at that time they were also teaching in Pitjanjatjara and the associate cultures.
I think that this multi-language schooling has since been withdrawn by the Government, something I consider a great mistake. Dazza.
Merlinau
Whilst most of the interest in neuroplasticity has focussed on the potential positive aspects of it, there is another side to this coin.
In particular (and this is my own sphere of speciality) are the effects of what we could call work-related stress experience.
This is to lead to changes in brain function that underpin a number of severe maladaptive outcome like depression and persistent anxiety states, some of which have been shown (at least in animal models) to be inheritable for up to two generations.
I, too, found Doidge’s book fascinating and timely. This past year there has been much new science coming out that reaffirms the work done by the scientists interviewed in Doidge’s book. Researchers now have access to sophisticated brain scanning equipment that can monitor the activity of the human brain on a very fine-tuned level, unheard of in the past.
In a remarkable and exciting example of this, earlier this year researchers from the Karolinska Institutet used this kind of scanning equipment to show that intensive working memory training produced new brain cells (dopamine receptors). And last year a separate team showed that this kind of training increases fluid intelligence.
Exciting times!
Martin
www.mindsparke.com
Effective, Affordable Brain Fitness Software