Open Book

The Wonders of Neuroplasticity

Are there practical implications for therapy?

Magazine Issue
September/October 2007
The Wonders of Neuroplasticity

The Brain that Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science
By Norman Doidge

Viking. 427 pp. ISBN: 0-670-03830-X

Train Your Mind, Change Your Brain: How a New Science Reveals Our Extraordinary Potential to Transform Ourselves
By Sharon Begley

Ballantine Books. 283 pp. ISBN: 1-400-06390-6

All supposedly great truths have their foundational stories or myths–Gods creation of the world from the void, Karl Marxs historical conflict between capital and the working class, Isaac Newtons getting beaned on the head by an apple, leading to the discovery of gravity and the development of physics. These stories begin the narrative from which all other truths unfold.

In the world of brain science, foundation truths have existed for more than a century. In 1861, French anatomist Pierre-Paul Broca discovered a region of the brain responsible for speech, which became known as Broca’s area. Anatomists then began to assume that each specific piece of neural real estate had its particular purpose. This was called locationalization. The great Spanish neuroanatomist and Nobel laureate Santiago Ramon y Cajal put a seal on this, arguing in 1913 that the nerve pathways of the adult brain were fixed, ended, and immutable. In other words, the brain might be a soft mesh of tissue, but the way it processed information was set in stone. We were all hardwired, according to Ramon y Cajal.

All this has changed. The brain is now being called plastic, giving way to the term neuroplasticity. In simple terms, this means that areas of the brain that were once thought to be exclusively dedicated to one operation can be recruited for other purposes. For instance, a blind persons visual real estate, if no longer used, might be recruited by another sense or activity. Use it or lose it, is the phrase that’s now commonly bandied about. The first Nobel Prize for the new research related to neuroplasticity was given in 2000 to Eric Kandel, for his work on long-term memory and how neurons change their shape and increase connections to other neurons.

The fact that neurons continue to adapt and increase throughout life has enormous ramifications for medicine and the entire field of human behavior. We each have an estimated 100 billion neurons, making 100 trillion connections. It was once believed that we had only a set number of neurons, once we matured. Now the research shows neurons are created throughout our lives, even into old age. Thats called neurogenesis. So the question of exactly how plastic, or adaptable, the brain is–and which operations and behaviors can be changed (and how much)–is now the subject of intense investigation. Can stroke victims recover their speech? Can the suffering of patients and clients who display painful psychological disorders be relieved by altering the way their neural pathways are programmed?

Books exploring these developments are now tumbling out of publishing houses, for clinicians and general readers. The two books under review are quite different, but touch on much the same research. Train Your Mind, Change Your Brain sounds like a self-help book, but its a serious, journalistic account about ongoing research into neuroplasticity. The author is a Wall Street Journal science columnist with a bent toward Buddhist consciousness studies. The forward is by the Dalai Lama, and Daniel Goleman, of Emotional Intelligence fame, wrote the preface.

Covering some of the same terrain, but in a very different way, is Norman Doidge’s The Brain that Changes Itself. Doidge is a psychiatrist and writer based in Toronto and New York. He teaches at both Columbia University’s Center for Psychoanalytic Training and the University of Toronto. Hes a trained psychoanalyst with a boundless enthusiasm for the new brain science, which isn’t as unusual as it sounds–there’s now an international association for neuropsychoanalysis.

Doidge, an accomplished writer with an ear for drama and scene-setting, has a taste for groundbreaking claims, which can be a problem when reading his book because he’s clearly enamored of the potential breakthroughs in this field. More skeptical and scrupulous researchers might argue that much of what they read here isn’t properly assessed. But he tells compelling stories, and the book is a great introduction to the field because he’s skilled at explaining neuroscience to the general reader.

He takes us into the world of offbeat characters, both researchers and patients. We meet Michelle, a woman who was born without a left hemisphere. Here’s a woman who’s earned a gold medal in the mental Olympics for neuroplastic gymnastics. As Doidge tells us, the right hemisphere must not only carry out the key functions of the left but also economize on its own functions. So she has problems, but what an amazing creature she is!

Michelle has extraordinary calculating skills. Essentially, she’s a savant, but she also has special needs and disabilities. She gets lost easily, hates to travel, and cant understand certain kinds of abstract thought. She has trouble seeing things coming from the right, but has hyperdeveloped hearing, like blind people. Shes supersensitive to touch and is easily flustered. But for someone who has half her brain missing, she’s an extraordinarily well-adapted person (and you could say even happy). Michelle is a marvel of plasticity, and a testament to the resilience of human beings.

We meet another remarkable woman, Barbara Arrowsmith Young, with so many crippling problems that if most of us had them, we wouldn’t even get out of bed in the morning. She was born with what’s called an asymmetrical brain, meaning that exceptional abilities coexisted with areas of retardation.

Young couldn’t speak well because her Broca’s area didn’t function properly. She couldn’t reason spatially and had no mental map of the space before her, so she was clumsy and crashed about in all directions. She couldn’t tell her left hand from her right, reversed letters (like a dyslexic), couldn’t understand cause and effect, and took hours to finish the simplest school assignments. She was emotionally underdeveloped and plagued with doubt. Who wouldn’t give up with all these deficits?

But by sheer determination, will, and guts, she went on to university, where she studied child development. Amazingly enough, she herself developed a set of computer exercises to strengthen areas of the brain, which she now employs at a school for learning- disabled students that she started in Toronto. Doidge is clearly a fan, although its hard to know how well the program works over time and whether it sticks for most of the students. Still, he tells stories of dyslexic, dispirited kids who went on to college and rose to success as highly paid professionals after they attended Youngs school.

In spite of his supreme confidence of the brains regenerative capacities, Doidge acknowledges that some things can never be put together again. So he must address what he calls the paradox of plasticity: the shadow side of the plastic brain, which makes things worse by entrenching neural patterns, like well-worn ski tracks in the snow. He knows that even a plastic brain has optimal times it can develop with the greatest efficiency. A small example: everyone realizes that learning a second language is effortless when you’re a young child; but past puberty, any new language you learn will come with an accent. The windows of the brain open and close. The trick is to open them again and reinforce the new information being laid down inside.

So what are we left with then when we discover the brain can retool itself? What about those suffering psychological disorders? Here Doidge can be a little disappointing with his hurrahs. He describes his work with obsessive-compulsive disorder patients who’ve been wired into repeating their endlessly maddening behavior. Knowing all he knows about plasticity, Doidges method is still to keep his patients from doing all those strange things. It comes down to breaking the habit (not much Freud, here, but a little cognitive therapy, common sense, and willpower). You don’t have to know anything about neurons to get behind that one. So knowing that the brain is plastic still doesn’t appear to add as many tools to the clinician’s toolbox as we’d hoped: just more explanation.

Doidge does have one useful piece of advice for clinicians: therapists are prone to look for conflict in their patients or clients, although sometimes the problems their patients present may result from learning or cognitive deficits. What comes across as severe frustration and anxiety may be sparked by a learning disability. You should send such clients for a full barrage of psychological tests, which are quite good at spotting that stuff. Get the problem diagnosed properly first before you apply any therapy.

This is where Train Your Mind, Change Your Brain is a useful addition. We meet scientists like Michael Merzenich and Edward Taub, who’s done groundbreaking work to rehabilitate stroke victims, not by compensating for disabilities, but by strengthening areas (like speech and movement functions) that were previously thought lost forever. As a good Wall Street Journal reporter, Begley is exhaustive in her display of the evidence (and she can be more cautious than Doidge, when necessary). Unfortunately, the book can read like an endless newspaper article in which every experiment is detailed; there’s little sense of drama or story.

Still the book is especially useful for therapists in keeping them apprised of advances in the brain science of mood disorders. Begley reminds us not only that the brain can be remolded with its existing neural pathways, but that new neurons and their connections do develop at all ages, in different parts of the brain. Thats one reason SSRIs may work and why it takes weeks for the effect to be felt. But here’s the good news for therapists: talking to your clients lets their neural networks grow, too. Even placebos activated areas of the brain, which is why patients who thought they took antidepressants during experimental trials showed improvement. Thats the message at the heart of this book, which fits in with the overall Buddhist theme. As Begley likes to put it: the mind can change the brain, with the right thinking and training.

The idea that the mind can change itself is, of course, a definition of the therapeutic project. Here, Begley reviews the research by Jeffrey Schwartz and others in their attempt to quiet the OCD circuit. Obsessive-compulsive sufferers describe a feeling that’s as if a hijacker has taken over the brains control. They know their hands aren’t dirty, but they must still wash them, constantly. Brain studies show that OCD is characterized by hyperactivity in two regions: the orbital frontal cortex and the stratum. It’s as if the brains error detector is always firing. Antidepressants work only about 60 percent of the time (and at varying levels). So with 40 percent of patients, something else is required.

At UCLA, Schwartz, a practicing Buddhist, used mindfulness (a combination of nonjudgmental awareness and meditative observation). He got his patients to address the faulty circuits in their brain by acknowledging It isnt me, its my OCD. He trained them to say to themselves: This thing that feels like an urge to check whether I left the iron on is in reality just a brain-wiring problem. PET scans on 18 OCD patients showed an improvement in 12 of the test subjects using this approach.

In discussing another common clinical ailment, Begley reports that cognitive-behavioral therapy (CBT) activates different areas of the brain than antidepressants do (shown by the work of neuroscientist Helen Mayberg). CBT muted activity in the frontal cortex, the seat of reasoning and higher thought, while Paroxetine, an SSRI, actually raised activity there. CBT raised activity in the hippocampus of the limbic system, the brains emotional center, while Paroxetine lowered it. For the thirty-three percent of patients who don’t respond to SSRIs, talk therapies have a different, measurable, brain-altering effect. Begley says these findings are important because of the high rates of relapse in depression and the need for multiple approaches. Cognitive-behavioral therapy targets the thinking brain, reshaping the way you process information and changing your thinking patterns. She also reports that combining cognitive-based therapy and mindfulness training reduces further relapses of depressed patients.

Begley spends time showing how mindfulness training isnt only a complement to therapy, but an essential tool, and presents selected research to back it up. During the last third of the book, she often slips from her reporters objective stance into advocacy for mindfulness and the Buddhist approach to mental training (shes photographed with the Dalai Lama on the back book jacket).

In a large section near the end on attachment therapy, she even wades into the nurture/nature debate, coming down definitely on the side of nurture. You want be have an anxious child? Be an anxious mother. You want a loving child? Be a loving, attached mother. This follows from the Buddhist principle of right thinking. Thats seemingly commonsensical and supported by research evidence. Its also been the cause of decades of guilt on the part of mothers who are attached and have raised nonattached children (just look at the terrible burdens placed on mothers of autistic children).

Theres something about the emerging brain science that seems to propel its proponents to seek large claims. Perhaps in a time when therapies and meds are only partly successful, this area of scientific research and imaging offers hope.

So the brain science barrage is definitely the new kid on the block and its incumbent on therapists to be both excited and discerning about its prospects, welcoming the supposed breakthroughs, but never giving up the mindful awareness that it, too, may yield only some of the answers to fields knotty problems. So, taking a page from these books, when you get too buoyed up by a fabulous new claim, tell yourself: thats the brain circuitry for hopefulness (optimism) speaking! Even the Buddha urged a Middle Way. Well see how it plays out in real time.


Richard Handler

Richard Handler is a radio producer with the Canadian Broadcasting Corporation in Toronto, Canada.