In 2008 I wrote about neuroplasticity as presented in Norman Doidge’s book The Brain That Changes Itself. I urge you to click on the link and read what I wrote there before you continue. The science is fascinating. The brain is far more malleable than we once thought. Areas of the cortex devoted to a sensory input shrink when that input is lost. Neurons from other parts of the brain can be co-opted to take over lost functions. Learning a new skill actually changes the structure and function of the brain: the areas of the cortex devoted to that skill enlarge as the new skill is practiced and perfected.
This is exciting stuff, with potential therapeutic applications in chronic pain, brain damage, and chronic illness. When I reviewed that book, I said I thought Doidge was a bit overenthusiastic; and now he has written a follow-up book that is even more overenthusiastic. In The Brain’s Way of Healing: Stories of Remarkable Recoveries from the Frontiers of Neuroplasticity, he slips into unscientific speculations and relies on anecdotes about patients who have allegedly benefited from practical applications of brain plasticity science. The title is accurate: these are stories, not scientific studies. I continue to find the subject fascinating and to believe that neuroplasticity offers a lot of potential for human healing, but I don’t believe we have learned much about practical ways to accomplish that. Doidge’s book goes beyond the science.
A review in The Guardian says:
Can Parkinson’s be cured by walking, or blindness by “higher judo”? These cures and their emphasis on the patient’s willpower and moral fibre are, at best, bizarre.
A few of the stories
- A doctor conquered chronic pain by flooding his brain with non-pain stimuli and visualizing brain maps and imagining the areas devoted to pain shrinking.
- An elderly Parkinson’s patient reversed his worst symptoms with an intensive fast walking program and a special kind of concentration and was able to stop his medication. He had to keep up the exercise to maintain the improvement, which suggests to me that the brain had not re-wired itself very well.
- A man blind from uveitis stopped all his medications and learned to see again by visualizing (imagining) a blue-black field and doing various exercises.
- A man with MS used a Portable Neuromodulation Stimulator (PoNS) to stimulate the tongue; it restored his ability to sing and to walk without a cane.
- A dyslexic boy listened to Mozart and to recordings of his mother’s voice and is now at the top of his class.
Doidge is impressed by a number of questionable therapies that have not impressed mainstream scientists.
He tells us light is essential to health. The ancient Chinese knew that each organ system has times of day when it is most and least active, presumably responding to natural light exposure. He says light speeds healing, decreases pain, improves sleep, improves vitamin D levels, and may even decrease cancer risk. He complains that people in our modern world are deprived of natural light and its benefits. He thinks light therapy could repair sick brain cells and make them more receptive to re-wiring.
He sings the praises of low-level laser therapy, which supposedly works by helping the body “marshal its own energy and its own cellular resources to heal itself with no side effects.” He describes near-miraculous successes of laser therapy in healing all kinds of health problems, from wounds to depression. Stephen Barrett of Quackwatch is far less enthusiastic. His skeptical look at low level laser therapy agrees with systematic reviews and health insurance company evaluations and concludes:
At this writing [Feb 2015], the bottom line appears to be that LLLT devices may bring about temporary relief of some types of pain, but there’s no reason to believe that they will influence the course of any ailment or are more effective than other forms of heat delivery.
Doidge praises Feldenkrais’ “holistic insights” about body awareness and his Functional Integration therapy, a somatic educational system. A 2005 systematic review concluded:
The evidence for the Feldenkrais Method is encouraging but, due to the paucity and low quality of studies, by no means compelling.
He calls the tongue “the royal road to the brain” and believes the PoNS tongue stimulator resets the brain and effectively treats MS, stroke, Parkinson’s disease, brain damage from traumatic brain injury, and other conditions.
He praises the Bates system of improving visual acuity with eye exercises, although the American Academy of Ophthalmology and other reviewers have never found evidence that it worked.
He is convinced that the Tomatis method can correct a variety of ailments by stimulating hearing and re-training the brain. That method is controversial, to say the least.
He recommends Matrix Repatterning as a first treatment for patients with head injuries because “if the general flow of energy is blocked, the other treatments may not work nearly as well.” Matrix Repatterning is a hands-on approach developed by a chiropractor/naturopath. It has been claimed to eliminate various kinds of pain and improve a wide variety of other symptoms from erectile dysfunction to snoring; it is supported by testimonials but has never been studied scientifically.
He disparages reductionist Western science and advocates a more holistic, more Eastern approach.
An insight into chronic pain
The part I found most intriguing was the possibility of preventing the development of chronic pain syndromes. Since “nerves that fire together wire together,” experiencing continued pain makes it easier for pain impulses to travel down the pain pathways, so that eventually a small stimulus can cause a large pain. Doidge tells about a pain specialist doctor who is injured and demands a higher dose of morphine than they normally use because of his understanding that adequate early pain relief after an injury ought to help prevent the sensitization of those pathways and reduce the risk of developing chronic pain. Patients with chronic pain have altered brain anatomy: they have been re-wired in a way that exaggerates pain perception and perpetuates the experience of pain (central sensitization). Recognition of this phenomenon might shed light on chronic back pain, on reactions to stress, and on some of those ill-defined painful syndromes like CFS (or SEID) and fibromyalgia. It’s easy to understand how it might be involved in PTSD: the neural circuits that learned to respond appropriately to the sound of gunfire in a war zone produce an inappropriate overreaction to a car backfiring in civilian life.
Treatment to “re-train” those neural pathways would be a welcome addition to the medical toolbox, but I don’t think we have a good handle on how to do that yet.
He disparages the reductionism of Western science and tries to conflate neuroplasticity science with ancient Eastern philosophies. His thinking is a bit fuzzy.
I think Doidge is far too gullible about claims for questionable methods to re-wire the brain. He wants them to be true, and confirmation bias kicks in. The methods he recommends have not been adequately tested.
The idea that you can re-wire your own brain is a double-edged sword. It offers hope and empowerment, the sense that you can control your own destiny. But it lends itself to blaming the victim if the treatment is unsuccessful, suggesting the patient didn’t try hard enough. And it comes perilously close to New Age mind-over-matter create-your-own reality woo-woo.
In a sense, the new knowledge about brain plasticity only provides a sophisticated scientific explanation for two simple things we always knew:
- Practice makes perfect.
- Habits are hard to break.
I remember a man who told his children “Do you want to be happy when you grow up? Well, start practicing today!” Words of wisdom.
Brain plasticity is a fascinating field for research, and has great therapeutic potential; but I am skeptical about all the alleged therapeutic achievements in the cases Doidge describes. I applaud his enthusiasm, his passion for his subject, and his desire to help suffering patients; but I think he is holding out false hopes that promise more than is justified by the current evidence. He is recommending some very questionable treatments and he’s asking for a great commitment of time and effort (and sometimes money!) that might not do the patient any good. He’s on the right track, but he’s galloping ahead of the studies that must be done to validate the treatment hypotheses. I await those studies with the greatest interest.
This article was originally published in the Science-Based Medicine Blog.