The Brain That Changes Itself

BrainThatAs a lifelong student and a teacher of various things over the past four decades, I have an abiding curiosity and affection for the new brain science, for neurobiology, and practical applications of the new science that is being recorded.

Accordingly this book, The Brain That Changes Itself (Viking, 2007), was right in my wheelhouse. Though not restricted to either music, or to Blues history, I found it moving and interesting. I hope, after reading my thoughts on it, you will, too.

The Brain That Changes Itself:
Stories of Personal Triumph from the Frontiers of Brain Science
By Norman Doidge, M.D. Viking (2007)

As someone who works with brains (my own and those of others), I found this an amazing read.

In the preface, Dr. Norman Doidge sets out exactly what this scientific mystery story is about:

“This book is about the revolutionary discovery that the human brain can change itself, as told through the stories of the scientists, doctors, and patients who have together brought about these astonishing transformations. Without operations or medications, they have made use of the brains hitherto unknown ability to change. Some were patients who had what were thought to be incurable brain problems; others were people without specific problems who simply wanted to improve the functioning of their brains, or preserve them, as they aged. For four hundred years, this venture would have been inconceivable because mainstream medicine and science believed that brain anatomy was fixed…” p. xiii

But, it is not. The brain is plastic.

And, as scientists learn to take advantage of the sometimes daily, even momentary, plasticity of the brain, that newly discovered property is becoming a stunning resource for the treatment of stroke, autism, dementia, schizophrenia, obsessive compulsive disorder, and learning disabilities, among other ailments. Put simply, our brains are structured by our experience: minute by minute, hour by hour, day by day.

At the level of neuronal activity and interconnections within the brain, neurobiologists have coined a phrase: “If it fires together; it wires together.” The therapeutic advances that are documented in this work take direct advantage of this simple adage in a variety of ways.

Neuronal researcher Michael Merzenich, PhD. plays a significant role in the discovery of the dramatic and ongoing malleability/adaptability of the human brain. Building on the brain mapping of earlier researchers, Merzenich employed microelectrodes that could be inserted next to or in an individual neuron. Instead of brain scans which map (and may miss) thousands of neuronal events, the tedious and time-consuming micro-mapping of the brain has led to this new and remarkable understanding of how brains work.

There are two key facts to hold on to about brain mapping: 1) maps are topographical, which in the language of neurobiologists means that adjacent body parts are mapped to adjacent areas of the brain, and 2) when an area of the brain is deprived of sensory input, it yearns for and searches for input from adjacent areas.

Through laborious scientific exploration, it turns out that this last discovery accounts for compensations like the heightened hearing of those who lose their sight. When the stimuli coming from the eyes ceases, given the competitive plasticity of the organ, the un-stimulated territory of the brain is re-employed as a processor for sound. This gives the sense of hearing additional neuronal real estate that translates into more processing power, which translates into heightened awareness and sensitivity to sound.

The therapeutic management of sensory input (by either quieting or exciting neuronal activity) is leading to remarkable treatment strategies and advances in addressing what were, heretofore, intractable imbalances and disabilities in the brain.

When it comes down to allocating processing power, brain maps are governed by an acute competition for precious resources. In the zero sum game of neuronal resources, the principle of ‘use it or lose it’ definitely applies.

Doidge writes:

“If we stop exercising our mental skills, we do not just forget them: the brain map space for those skills is turned over to the skills we practice instead. If you ever ask yourself, “How often must I practice French, or guitar, or math to keep on top of it?” you are asking a question about competitive plasticity. You are asking how frequently you must practice one activity to make sure its brain space is not lost to another.” p. 59

It matters not just that you practice, but how and what you practice. Inaccurate practice is not ineffective, but the results firmly encode bad habits – which reinforced by each subsequent repetition. Put simply, your brain encodes the errors. As a musician, for instance, every time you stumble over a passage, you are learning to play that passage in that very specific, incorrect way. If you think to yourself, “With enough passes eventually I’ll get it right,” you’re fooling yourself, but not your brain. Your brain is busily building the neural pathways for what you are doing, not what you hope to do.

Again, from Doidge’s chapter “Redesigning The Brain”:

“When a child learns to play piano scales for the first time, he tends to use his whole upper body – wrist, arm, shoulder – to play each note. Even the facial muscles tighten into a grimace. With practice, the budding pianist stops using irrelevant muscles and soon uses only the correct finger to play the note. He develops a ‘lighter touch,’ and if he becomes skillful, he develops ‘grace’ and relaxes as he plays. This is because the childe goes from using a massive number of neurons to an appropriate few, wellmatched to the task. This more efficient use of neurons occurs whenever we become proficient at a skill, and it explains why we don’t quickly run out of map space as we practice or add skills to our repertoire.” p. 67

When a new skill is attempted the entire outer cortext of the brain fires in a lightning storm of awareness and alertness. When you were learning to drive a car, you were likely hyper-alert, unsure of what to pay attention to, having to learn to move feet, hands, eyes (and the vehicle!) in time and space. After driving for years, it is entirely likely that you can move a car safely and effectively through space while thinking of paying your phone bill, changing radio stations, or listening to books on tape. You have learned what to pay attention to in the new environment/skill and what you can safely ignore.

As a new skill becomes focused, what it takes to achieve success boils down to just the discrete neural network of interconnections in the brain required. No more. The activity in the brain moves inward and down into just the networks required. The cortex quiets down and becomes available for the next new experience. In this way, when we explore new territory in the world, we build new connections in the brain.

What neurobiologists have found out by micro-mapping the brain is – the brain is micro-mapping us (our world and our experience) in real time.

Based on the experimental work with plasticity, a number of training principles have emerged: 1) training is more effective if the skill closely relates to everyday life; 2) training should be done in increments that gradually increase in complexity; and 3) work should be concentrated into a short time (a training technique known as “massed practice” which has shown itself to be far more effective than long-term, but less frequent training). p. 155-6

“In all of medicine, few conditions are as terrifying as a stroke, when a part of our brain dies. But [Edward] Taub has shown that even in this state, as long as there is adjacent living tissue, because that tissue is plastic, there may be hope that it might take over.” P. 162

One of the strategies being used to develop new wiring in a brain area is ‘constraint-induced therapy’. It is being used to address both physical and language deficiencies in stroke patients.

In the case of physical incapacities, therapists strategically constrain the use of the unaffected limb (strapping it down physically to the body) and force movement and neural input, however limited and fragmentary, from the affected limb.

As the stimuli come in from the affected limb, they reach for receptors in the brain. Finding them unresponsive, they extend their reach into adjacent areas. Experimental studies have shown remarkable, unanticipated progress among stroke and brain-damaged patients, some of whom have recovered capabilities that they had been assured were irretrievably lost years before, capabilities that have involved both language and movement that were catastrophically lost prior to this constraint-induced retraining of the brain.

Reflecting on this, it seems important to note that we don’t actually “break” a bad habit (or a learned or physically-induced incapacity). Instead, we purposefully send the neurons down a new and different path while quieting input to the old path (either with physical incapacitation or, in cases of language loss, with strictly adhered to and graduated rules about language use).

With concentrated therapy, repetition, and attention, we can establish a new pathway for neurons that, left to our inattention or instincts would follow their previous route.

Over time, in the competitive plastic environment of the brain, the former and now disused pathway will become available for a new use. Essentially, the old habit we own (and hope to ‘break’) will be returned to ‘the commons’ while the newly built and carefully reinforced pathway will become the dominant and preferred route. We don’t break habits. We make new ones.

When it comes our habits of being and our neural networks, we don’t actually fight fire with fire: we fight fire with water. Rather than act in direct opposition, magnifying and reinforcing the problem, our efforts instead move to the opposite side of the body, to an opposite tack, to a new part of the brain, and we establish new connections that over time will effectively render the old pathways obsolete.

In the context of the two adages cited earlier [1.‘If it fires together, it wires together,’ and 2. ‘Use it, or lose it.’], we are beginning to understand that the brain is not machine-like – fixed in time or space – but a living, responsive, and adaptive mechanism for dealing with change. We succeed in establishing a new way of being not by concentrating or getting stuck on the old habit, but by refocusing, by learning to work around the problem, and establish a new path, literally – a new neural pathway.

Animal studies have shown that beings with smaller brains have developmental windows of adaptability that open and close, never to reopen. (Raised with one eye sewn shut, kittens will be totally blind in that eye, not because the eye has been damaged or isn’t sending signals to the brain, but because the part of the brain that would be receiving those signals has been permanently taken over, usually by the sensory input from the other eye. No amount of retraining has succeeded in rendering the perfectly healthy eye that was sewn shut useful again.)

But new understandings of brain science in humans point to the fact that there is nothing a newborn brain can do that one oughtn’t expect of the brain of an 80 year old.

The plasticity of the human brain – its responsiveness to new situations and stimuli – is a life-long trait. And, in the cascading system of neural real estate, whatever goes un-used, will become available for a new use. And new stimuli will reach out in the brain to find real estate in which to establish itself.

Writing about OCD, Doidge notes that: “With obsessions and compulsions, the more you do it, the more you want to do it; the less you do it, the less you want to do it…it is not what you feel while applying the technique that counts, it is what you do…”

“The struggle is not to make the feeling go away. The struggle is not to give in to the feeling – by acting out a compulsion, or thinking about the obsession. This technique won’t give immediate relief because lasting neuroplastic change takes time, but it does lay the groundwork for change by exercising the brain in a new way…” p. 173

Resisting the compulsion for a minute, twenty minutes, thirty minutes – that effort is what appears to lay down new neural circuits that strengthen with consistent practice and effort.

In his chapter on Imagination, introducing the work of Alvaro Pascual-Leone, chief of the Beth Israel Deaconess Medical Center at Harvard Medical School, Doidge turned my attention back to music:

“Pascual-Leone taught two groups of people, who had never studied piano, a sequence of notes, showing them which fingers to move and letting them hear the notes as they were played. Then members of one group, the ‘mental practice’ group, sat in front of an electric keyboard, two hours a day for five days, and imagined both playing the sequence and hearing it played. A second ‘physical practice’ group actually played the music two hours a day for five days.

“Both groups had their brains mapped before the experiment, each day during it, and afterward. Then both groups were asked to play the sequence, and a computer measured the accuracy of their performances.

“Pascual-Leone found that both groups learned to play the sequence, and both showed similar brain map changes. Remarkably, the mental practice alone produced the same physical changes in the motor system as actually playing the piece. By the end of the fifth day, the changes in motor signals to the muscles were the same in both groups, and the ‘imagining’ players were as accurate as the ‘actual’ players were on their third day.

“The level of improvement at five days in the mental practice group, however substantial, was not as great as in those who did physical practice.

“But when the mental practice group finished its mental training and was give a single two-hour physical practice session, its overall performance improved to the level of the physical practice group’s performance at five days. Clearly mental practice is an effective way to prepare for learning a physical skill with minimal physical practice.” p. 201-2

In his chapter, Rejuvenation, Doidge addresses neurogenesis – the establishment and uses of neural stem cells in creating new connections in the brain, citing the work of Frederick Gage, among others:

“Gage’s colleague, Gerd Kempermann, raised aging mice in enriched environments, filled with mice toys such as balls, tubes, and running wheels for only forty-five days. When Kempermann sacrificed the mice and examined their brains he found they had a 15% increase in the volume of their hippocampi and 40,000 new neurons (also a 15% increase) compared with mice raised in standard cages.

“Mice live about two years. When the team tested older mice raised in the enriched environment for ten months in the second half of their lives, there was a fivefold increase in the number of neurons in the hippocampus. These mice were better at tests of learning, exploration, movement, and other measures of mouse intelligence than those raised in un-enriched conditions. They developed new neurons, though not quite as quickly as younger mice, proving that long-term enrichment had an immense effect on promoting neurogenesis in an aging brain.” p. 251-2

“If we lived in this room only,” [Gage] told me [the author], “and this was our entire experience, we would not need neurogenesis. We would know everything about this environment and could function with all the basic knowledge we have”…in order to keep the brain fit, we must learn something new, rather than simply replaying already-mastered skills.” p. 252

In a series of significant Appendices following the text, Doidge presents a number of fetching, and sometimes troubling, ideas. In the Culturally Modified Brain appendix he writes:

“Civilization is a series of techniques in which the hunter-gatherer brain teaches itself to rewire itself. And the sad proof that civilization is a composite of the higher and lower brain functions is seen when civilization breaks down in civil wars, and brutal instincts emerge full-force, and theft, rape, destruction, and murder become common place.

“Because the plastic brain can always allow brain functions that it has brought together to separate, a regression to barbarism is always possible, and civilization will always be a tenuous affair that must be taught in each generation and is always, at most, one generation deep.”
p. 298

And:

“It has long been assumed that we absorb culture through universally shared, standard-issue, human perceptual equipment, but perceptual learning shows that this assumption is not completely accurate. To a larger degree than we expected, culture determines what we can and cannot perceive. p. 300

“Culture can influence the development of perceptual learning because perception is not (as many assume) a passive, ‘bottom up’ process that begins when energy in the outside world strikes the sense receptors which then pass signals to the ‘higher’ perceptual centers in the brain. The perceiving brain is active and always adjusting itself. Seeing is as active as touching, when we run our fingers over an object to discover its texture and shape.” p. 303

Over the course of the book two outstanding therapeutic neuro-programming tools are prominently mentioned and profiled:

Fast ForWord
[http://ies.ed.gov/ncee/wwc/reports/adolescent_literacy/fastfw/index.asp]

And

Posit Science
[http://www.brainhq.com/world-class-science/science-team/dr-michael-merzenich] and
[http://www.brainhq.com/]

“We worry,” Doidge writes, “because we are intelligent beings.”

“Intelligence predicts, that is its essence; the same intelligence that allows us to plan, hope, imagine, and hypothesize, also allows us to worry and anticipate negative outcomes.” p. 164

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