Monday, February 22, 2010

The Brain That Changes Itself by Norman Doidge

There’s an interesting story behind this one. Couple of months ago I was attending a professional education meeting and heard a talk by an engineer and neuroscientist who now helps professionals use the latest discoveries of brain science to develop practical strategies for making better decisions, leading organizations, and managing change.

After her talk I went up to introduce myself and ask her a question. It was a question I knew I couldn’t ask of just anybody, but about which I thought she might have an informed opinion.

“Where do you come down on the question of dualism?”

Her eyes went wide when she realized she had found a fellow brain geek.

Dualism, in case you’re not aware, is the concept that our brain has a non-material, spiritual dimension that includes consciousness and possibly an eternal attribute. Some folks call this dimension “the mind” to distinguish it from “the brain”, which dualists view as purely physical. The religious-minded are almost all dualists, and think of this dimension as “the soul.”

I was curious where an actual neuroscientist—the first one I had ever met in person, as far as I knew—would come down on this question. Steven Novella, the neurologist and host of The Skeptic’s Guide to the Universe, has often said that he is not a dualist—that for him, “the mind is simply what the brain does.”

The speaker at my conference admitted it was a difficult and complicated question. Her own assessment was, ultimately, the brain was something larger than all of its parts, that there really was something transcendent going on. When I told her I leaned more in the other direction, but also admitted to being no more than an enthusiastic amateur, she recommended that I read Doidge’s book.

Well, now I have—and it was an interesting read. It central theses is that the brain exhibits something called “plasticity”—that it can be rewired and retrained throughout life, a notion that runs contrary to a hundred years of brain theory, but which is gaining more and more acceptance. Each chapter in Doidge’s book presents a case study of someone who consciously or unconsciously used the plasticity of their brain to change fundamental behaviors or regain functionality medical science predicted was impossible.

My own reaction is that this is fascinating stuff—but so what? Doidge makes a compelling argument that the brain is not as we once believed it to be. But is there a “mind” that does all this rewiring? Or is plasticity an inherent property of brains the way wetness is an inherent property of water? As I read chapter after chapter, I became convinced the latter was more likely true.

In one chapter Doidge compares the brain to a muscle. He knows the brain is not a muscle, but plasticity means that, like a muscle, the more it is used the stronger it gets. Fine. The body is replete with these kinds of examples. Yet none of us talk about the “mind” that exists within the muscle, the “mind” that causes it to reshape itself. If we’re going to use the muscle analogy for the brain, why equivocate on this point? Muscle builds up when it is used through a natural, biochemical process. It does not require a “mind.” Why do we think the brain is any different?

But Doidge keeps trying to steer us towards dualism. His text is littered with references to the “mind” and the “brain,” as if he understands them to be two different things, although he never goes so far as to provide definitions. The closest he gets is when he describes the views of French philosopher Rene Descartes, who argued…

…that mind and brain are made of different substances and are governed by different laws. The brain, he claimed, was a physical, material thing, existing in space and obeying the laws of physics. The mind (or the soul, as Descartes called it) was immaterial, a thinking thing that did not take up space or obey physical laws. Thoughts, he argued, were governed by the rules of reasoning, judgment, and desires, not by the physical laws of cause and effect. Human beings consisted of this duality, this marriage of immaterial mind and material brain.

Doidge goes on to admit that although Descartes’ view of the mind/brain division dominated science for four hundred years, he could never credibly explain how the immaterial mind could influence the material brain. My reaction—of course he couldn’t. Stating that the mind is something that does not obey physical laws is, by definition, admitting that it does not, in fact, exist. Or at least it is something whose existence cannot be demonstrated. But Doidge doesn’t want to go that far. Despite all the evidence in his own book that “we” are simply a manifestation of physical events going on in our brains, the farthest he will go is to say that “the firm line that Descartes drew between mind and brain is increasingly a dotted line.”

Dotted? All of his case studies demonstrate that no such line exists at all. Take, for example, the case of Bob Flanagan, a masochist who turned his fixation on pain into performance art. His backstory is intriguing, and clearly shows how easily disparate brain circuits can be wired together based on external stimuli.

Bob was born in 1952 with cystic fibrosis, a genetic disorder of the lungs and pancreas in which the body produces and excessive amount of abnormally thick mucus that clogs the air passages, making it impossible to breathe normally, and leads to chromic digestive problems. He had to fight for every breath and often turned blue from lack of oxygen. Most patients born with this disease die as children or in their early twenties.

Bob’s parents noticed he was in pain from the moment he came home from the hospital. When he was eighteen months old, doctors discovered pus between his lungs and began treating him by inserting needles deep into his chest. He began to dread the procedures and screamed desperately. Throughout childhood he was hospitalized regularly and confined nearly naked inside a bubblelike tent so doctors could monitor his sweat—one of the ways cystic fibrosis is diagnosed—while he felt mortified that his body was visible to strangers. To help him breathe and fight infections, doctors inserted all sorts of tubes into him. He was also aware of the severity of his problem: two of his younger sisters had also had cystic fibrosis; one died at six months, the other at twenty-one years.

Despite the fact that he had become a poster boy for the Orange County Cystic Fibrosis Society, he began to live a secret life. As a young child, when his stomach hurt relentlessly, he would stimulate his penis to distract himself. By the time he was in high school, he would lie naked at night and secretly cover himself with thick glue, for he knew not what reason. He hung himself from a door with belts in painful positions. Then he began to insert needles into the belt to pierce his flesh.

It gets worse. But the essential point is that in Bob’s brain the pathways associated with pain and the pathways associated with pleasure got linked from all those childhood experiences.

Metal in flesh now feels good, gives him erections, and makes him have orgasms. Some people under great physical stress release endorphins, the opiumlike analgesics that our bodies make to dull our pain and that can make us feel euphoric. But Flanagan explains he is not dulled to pain—he is drawn to it. The more he hurts himself, the more sensitized to pain he becomes, and the more pain he feels. Because his pain and pleasure systems are connected, Flanagan feels pain, intense pain, and it feels good.

Children are born helpless and will, in the critical period of sexual plasticity, do anything to avoid abandonment and to stay attached to adults, even if they must learn to love the pain and trauma that adults inflict.

How can anyone read Bob Flanagan’s story and not think that the mind is just what the brain does? It seems straight out of Brave New World or A Clockwork Orange. We are programmable. And some of those programs call into question the very concept of “we.”

And how else do you explain obsessive-compulsive behaviors?

The UCLA psychiatrist Jeffrey M. Schwartz describes a man who feared being contaminated by the battery acid spilled in car accidents. Each night he lay in bed listening for sirens that would signal an accident nearby. When he heard them, he would get up, no matter what the hour, put on special running shows, and drive until he found the site. After the police left, he would scrub the asphalt with a brush for hours, then skulk home and throw out the shoes he had worn.

I don’t want to do these things, doctor. But I can’t stop myself. It’s like someone is in control of my very thoughts and actions. What about the “me” in these situations? Am “I” not in control of my actions? Evidently not…

The causes of severe OCD brain lock vary. In many cases it runs in families and may be genetic, but it can also be caused by infections that swell the caudate.

Wait a minute. Behavior can be caused by an infection? It sure can.

Each time he turns on the magnetic field, the fourth finger on my right hand moves because he is stimulating an area of about 0.5 cubic centimeter in my brain, consisting of millions of cells—the brain map for that finger.

Wait a minute again. Behavior can be caused by a magnetic field? Again, it sure can. In fact, one group of researchers used the same technique—TMS, or transcranial magnetic stimulation—to remove knowledge and behaviors from their subjects.

…when the team applied blocking TMS to the visual cortex of Braille readers to create a virtual lesion, the subjects could not read Braille or feel with the Braille-reading finger.

That is some really scary stuff. With technology like that, people could have their ability to do almost anything removed from them. Even, perhaps, the knowledge of who they are? Or what their body is?

After all, what expose on the brain would be complete without an appearance by V. S. Ramachandran and his work with amputees who still feel and feel pain in their amputated limbs? Ramachandran has come to understand that our sense of our own bodies is a phantom, something our brains have constructed purely for convenience. To demonstrate this to Doidge, he used a simple technique.

Taking out the type of fake rubber hand sold in novelty shops, he sat me at a table and placed the fake hand on it, its fingers parallel to the table edge in front of me, about an inch from the edge. He told me to put my hand on the table, parallel to the fake hand, but about eight inches from the table’s edge. My hand and the fake were perfectly aligned, pointing in the same direction. Then he put a cardboard screen between the fake hand and my own, so I could see only the fake.

Then with his hand he stroked the fake hand, as I watched. With his other hand he simultaneously stroked my hand, hidden behind the screen. When he stroked the fake’s thumb, he stroked my thumb. When he tapped the fake pinkie three times, he tapped my pinkie three times, in the same rhythm. When he stroked the fake middle finger, he stroked my middle finger.

Within moments my feeling that my own hand was being stroked disappeared, and I began to experience the feeling I was being stroked as if coming from the fake hand. The dummy hand had become part of my body image! This illusion works by the same principle that fools us into thinking that ventriloquist’s dummies, or cartoons, or movie actors in films are actually talking because the lips move in sync with the sound.

Later, Ramachandran did the same trick with Doidge, only this time without the fake hand, instead getting Doidge to feel the tapping on the tabletop itself as if it was part of his body.

After all these examples, Doidge actually poses the following question.

...if the brain is so easily altered, how are we protected from endless change? Indeed, if the brain is like Play-Doh, how is it that we remain ourselves?

My answer is not the same as Doidge’s. I say we don’t remain ourselves, because fundamentally, there is no "we." Moment to moment there is the appearance of consistency, but over the span of years there is wholesale change, so much so that the person at twenty is not the same person at forty.

Doidge himself quotes the studies on memory, the ones that show…

Memories are constantly remodeled, “analogous in every way to the process by which a nation constructs legends about its early history.”

What we remember, in other words, is not actually what happened, nor even what we remembered the last time we thought about it. They are constantly being reshaped and recoded in our brain cells, each time we think about them.

And he goes on to cite a case where one of his patients breaks into hysterics during a session…

…experiencing all the emotional pain that his defenses had pushed away, reliving thoughts and feelings he had had as a child—he was regressing and unmasking older memory networks, even ways of talking.

Who is “he” at this point? The adult? The child? Neither? Both? When sixty-year-old memories we’re not even conscious of can be brought to the surface and cause us to act like the infants we used to be, what exactly is the meaning of “we?”

The people in Doidge’s book prove that physical changes in the brain change who we are—not just what we are like, but who we are. Some of them wrap all the pathos of a ruined life into a single paragraph.

His own life is an impressive story of transformation. When Jordan was in elementary school, his father had a devastating stroke that cause a type of brain damage, then poorly understood by physicians, that changed his personality. He had emotional outbursts and what is called, euphemistically, in neurology “social disinhibition”—meaning the release of the aggressive and sexual instincts normally repressed or inhibited. Nor could he seem to grasp the main point of what people were saying. Jordan did not understand what was causing his father’s behavior. Jordan’s mother divorced her husband, who lived the rest of his life in a transient hotel in Chicago, where he dies of a second stroke alone in a back alley.

But Doidge never makes the final conclusion. After railing against old ways of thinking about the brain for 300 pages, he ultimately can’t break away from the oldest of old ways to think about it. After all, even the title of his book implies dualism. “The Brain That Changes Itself.” Doesn’t “itself” imply that there is a ghost in the machine somewhere? Itself? What itself? For all the information it reveals about how the brain works, the book could more appropriately be called “The Brain That Operates in Accordance with Natural Laws We’re Just Beginning to Understand.” I bet that wouldn’t sell as many copies, though.


  1. A great piece of analytic writing on a subject that needs to be communicated in clear lay terms. Having read Doidge's book closely I have to say tho'that I did not have the sense that he was pushing duality in any way. His references to mind etc came across as being epiphenomena of the physical brain, though subject to semantic interpretation. Personally, I feel that it is (excuse the pun) a no-brainer to conclude that dualism is unnecessary. After all, we all play games like chess and read books, both of which exhibit an essence way beyond the their material constituents.

  2. Thanks for the comment, Andre. I agree that Doidge wasn't necessarily "pushing" dualism in his book. I focused on it so much in my post because the neurologist I met at the conference suggested I read Doidge's book when I asked her about it. Like a lot of people, I think Doidge's book doesn't think very deeply about dualism--it just assumes it in the same sort of way Decartes did.