Doidge doesn’t stop there. He takes the principle of stimulating “unused” circuits of the brain and making them fit for other purposes, into analyses of new therapies for stroke and MS patients, as well as children with learning disorders, attention deficit and even autism. A variety of techniques to stimulate the brain’s innate plasticity is being employed. In many cases this involves an energy source, low-intensity lasers, or light, or heat, which appears to help stimulate neuronal connections. Doidge examines the ways a device applied to the tongue, causing vibration, helped an opera singer with MS to regain his voice. He documents how use of sound, particularly the sound of a mother’s voice, and certain types of chanting, has helped young children with symptoms of autism to overcome those symptoms.
In all of this he is careful to stress that the science behind neuroplasticity is still in an unformed state, and that just because the methods work for some patients, they will not work for all. Even so, not a man shy of ambition, Doidge sees the potential of a whole new medical practice as the ideas develop, which will require the “active involvement of the whole patient in his or her own care: mind, brain and body”, as well as a health profession that focuses not only on the patient’s deficits “but also searches for healthy brain areas that may be dormant and for existing capacities that may aid recovery.” I phoned him in Toronto last week to find out more…
In the seven years since your first book came out, it seems a lot of the stories for this book have come to you. Would it be fair to say you are the “go-to guy” when it comes to neuroplasticity?
I can agree with the first part. Many, many stories came to me and I chose ones that were illustrative of particular facets of healing.
The people you focus on in the book seem to share an unusual willpower. Do neuroplastic techniques require a particular cast of mind?
You are correct that they are unusual, and I think there is a reason. When you are going against paradigm, whether you are a clinician or a patient who is willing to try something, you are going to get someone who is quite high on openness psychologically and very conscientious, because to do a lot of these interventions you have to apply yourself diligently. High openness and extreme conscientiousness don’t often go together, but when they do it’s a killer combination.
It almost requires a faith that neuroplasticity exists…
I would put it slightly differently: you don’t have to believe it, but you have to suspend your disbelief and just do it.
What was the moment of your conversion?
I’m still not completely converted. I still have to pinch myself about what is possible. Having been educated in the period in which belief in the doctrine of the unchanging brain was mainstream, still when I hear about some person who has had brain damage or some other problem I find that my heart sinks. But I also realise that mainstream reaction is not adequate. We really do not know what a particular person will be able to do until we attempt some of these interventions.
Did it help that you were a philosophy student and a poet before you did medical training?
I decided to go into medicine because philosophy of mind opened more questions than it closed. It seemed that studying biology would be very helpful in understanding some of the questions that agitated me. However, when I got to studying the description of the body and brain as just a complex machine with fixed parts, that also seemed inadequate. I went and studied these models in depth to try to understand how they could depict something as animate as the brain and the body using a metaphor of something that is inanimate. It was only when I thought I had mastered that metaphor and I realised that it didn’t hold water that I went to study psychiatry at Columbia.
In some ways, it takes a philosophical cast of mind to grasp the shift in understanding you describe...
Most neuroscientists don’t come from a philosophical background. They basically believe that mind is merely what the brain does. But I have a problem with that because none of these people can really define what mind is or what thought is. The statement that “the mind is only what the brain does” is a statement that only makes sense in a pre-neuroplastic era. Now that we know that mind also changes brain, should we not equally say that “the brain is what mind does”?
One of the things that struck me, reading your books, is how entrenched our ideas of the brain’s essential fixed and unregenerative nature are. Why are those ideas so powerful?
The idea that the brain couldn’t heal came from a number of sources, not least the poor prognosis of many brain problems. It wasn’t a meeting of, you know, the Biological Pessimist Society one day, it was more that clinical evidence of people with brain problems showed that they did not seem to cure themselves spontaneously. There were great quarrels in the 19th century as to whether the brain worked locally or globally. The Frenchman Paul Broca showed that speech problems inevitably occur when a person has a stroke in one area of the brain and the matter seemed to be settled. But even then there were some children who had damage to Broca’s area who could still speak. Still, once that idea took hold, people couldn’t imagine that if your speech area is damaged another area could be trained up to do it. To train a person who has lost the ability to speak to use another area of their brain is very incremental, patient work applied over time by someone who really understands what it takes to grow new connections, and so on. Neurologists said that people could only get better in the first six months or a year after a stroke because they were describing what they saw. It became a dogma and it overlooked the exceptions.
Particularly a western dogma. One of the things your book argues is that in other cultures and at other times there is strong evidence that people have and had access to some of these techniques.
Yes, well I didn’t set out to do that. When I finished my first book I had come to the conclusion that many of the claims that eastern medicine was making, which led to a lot of eye-rolling among western doctors, had at least to be re-examined in the light of neuroplasticity. By the time I had finished The Brain That Changes Itself, there were significant studies, which no one disputes, which show major changes in the structure of the brain of Tibetan monks, for example, brought about through the practice of meditation. I suppose it is not really a hard sell once you have grasped that the brain is plastic, that someone who has spent 30,000 hours meditating might actually have changed the structure of their brain. I mean, a London taxi driver can change his brain by studying routes through the city for a year or two.
But from that it seems quite a long way to imagine that visualising certain scenes can allow someone in chronic pain to actually escape that pain, for example. That is still a major stretch for western medicine.
I hope I ended up showing that it is actually quite feasible once you absorb the idea of how plasticity works. And of course the other big thing that eastern medicine talks about but often has trouble defining is the role of “energy” in its relationship to mind. I was very sceptical about this. I would listen and people would be saying “energy this” and “energy that”. We have to know that we are not talking in some kind of magical way.
What changed your mind about those definitions?
All the energies I describe can be easily defined and measured in western terms. The thing is, there are no lights, colours, smells or sounds inside the brain. There are patterns of electrical information and our sense receptors, our retinas, the cochlea in the ear are, in energy terms, transducers. Meaning that what they do is translate one form of energy – sound, light, heat – into another. It is the latter – electrical patterns of energy in the brain – that in one way or another help or cause the brain to sculpt itself, neuroplastically. Somehow or other, thought itself can do that work. It became apparent that this link between mind, brain and energy really is central to who we are and what we do.
You suggest often that neuroplasticity is settled fact. That doesn’t seem to me to be the case in the medical profession and certainly not beyond it…
Within the lab, within science, within neurophysiology, neuroplasticity is established fact – nobody is challenging it.
If it were to become accepted beyond the lab, the implications are obviously enormous, not least in the hope that it might give to people who suffer some of these conditions. What are the limits?
We don’t know the limits, but I could describe a little of how the world will look if people are actually able to integrate this finding. The whole idea of the patient as the passive recipient of medical intervention would be overturned. With learning disorders, for example, a tremendous amount of human suffering could be avoided if schools did some very simple assessments and gave children some of the very simple interventions that I describe in the two books when they are very young.
The forces ranged against that position, not least from the drug companies, are powerful ones. How would they be overcome?
Well, the first thing I should stress is that I am not in any simple-minded way anti-drug. Half of my own patients are on medication. The difference is that everyone also gets some kind of mind-based intervention as well, be it psychotherapy or some of these other therapies. Too many of our interventions are based on looking at symptoms and not nearly enough on what we might call pathogenesis – underlying causes. Some of these neuroplastic interventions actually work well on pathogenesis. There are people in the book who managed to get off medication. Some of the people in the book who had learning difficulties actually managed to get off the medication and ended up completely cured.
Still a sense of “miraculous” attends much of this, such as Mr Webber restoring his sight. Did that trouble you?
When people hear this story they feel that it is miraculous, but at the same time I knew that this could not be a miracle. I knew that there must be something in nature that allowed this to happen. I really think we have come through an age where science is funded by government and granting agencies and you get a grant by doing the bidding of those bodies. I am not contemptuous of that. But truth be told, the real scientist begins not with a particular task but a sense of wonder at how the world works. I became comfortable with wonder, writing both of these books – it triggers curiosity and pulls you towards it, but it triggers anxiety at the same time because you don’t know what is behind it. I have tried to explain over and over again how mind changes brain structure and function but nobody alive has yet properly defined mind and no one has explained properly how so-called ethereal thought can change so-called material structure. The whole subject is filled with wonder.
Have you applied some of these things to yourself?
I came to plasticity from these very western problems. I do physical exercise. I do tai chi to get into that flow state. I do the brain exercises that are most rigorously backed by science. Then there is the question of attitude changes. I don’t know what will happen in the future: I could of course be struck down by any one of these terrible things in this book. But my sense of what is possible for a person cognitively in the second half of life is much expanded.
There is the danger that false hope can be raised by your reports and stories. How heavily does that responsibility weigh?
I think I might be more aware of it than anyone on the planet right now. I’ve been exposed to a lot of stories that cannot be explained by the usual paradigms. In my world, false hope and false pessimism are evil twin brothers, each worthy competitors for doing harm. Because we’ve had this machine metaphor for the brain, and machines can’t fix themselves, there’s a lot of false pessimism in this area. I try to be extremely careful in the book to never give guarantees but to say in this situation this or that is worth a try.
There are four new interventions in the book just for traumatic brain injury alone. There are stories about people improving with the use of low-intensity lasers for traumatic brain injury. There is good evidence for sound-based interventions. There are a number of different things we can try. The patients who end up in the clinics of neuroplasticians at this early point in the history of the science are almost always people who have tried and failed at all the conventional treatments. They are not easy cases.
Are you confident that this is the beginning?
I sincerely believe that. Michael Faraday was doing work on electromagnetism in the mid 19th century and the implications are still being studied and developed today. This is very early. It is about the interface between mind and brain and this is a huge topic. Because mental acts have the ability to trigger specific circuits that subserve those acts there is a possibility of developing specific interventions for certain problems using the mind or the mind coupled with various natural forms of energy to stimulate the process.
The other hopeful element is that such interventions appear fairly inexpensive…
They are, though almost all require a lot of the patient’s time. One reason neuroplasticity hasn’t been translated from lab to clinical practice more quickly is that it is hard to beat the business model of using medication when you see a patient. Nothing is faster than a red-hot prescription pad. On the other hand, think of the children described in the book who would have been on medication for life for ADD but instead maybe have the equivalent of 40-60 hours of these therapies. I have seen they really take responsibility for their health and their cognitive function.
The obverse of that, you suggest, is the way children are staring at screens and giving themselves different “neuroplastic” problems…
I started to write about that in 2007 and Susan Greenfield picked it up at the same time. Techie people didn’t like it. They said: “Show us the data.” Well, the data is overwhelming at how sedentary life is changing everything about our brains.
Students no longer have to go to a library, they can sit at home and have the library come to them. That’s another two hours walking and carrying books and opportunities for exercise and interaction taken out of your life. In America, children are spending 11 hours in front of one screen or another – anyone who thinks that does not have an effect is dreaming.
I liked your idea that, as far as the brain is concerned, the most interesting things happen in peripheral vision and that by literally focusing too much on what’s in front of us, we risk missing the accidental and serendipitous, where new connections are made…
Yes. Novel things happen when you are concentrating on what you think you know and something occurs in left field. That’s how we evolved, how our brains evolve.
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