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Plastic fantastic
In Context
Book Plastic fantastic
The Brain that Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science by Norman Doidge. Penguin Books, 2008. Pp 448. £9.99. ISBN 978-1423368014
990
There is a common English adage that you can’t teach an old dog new tricks: as people get older they become entrenched in their habitual behaviour and less adept at new challenges. Activities such as learning to play a musical instrument or mastering a new language are much easier when we are children, but such tasks are not insurmountable postadolescence, even if they do require more effort to master as we mature. The historical view is that the brain is receptive to learning only during childhood, and is then closed to new concepts and influences and can only use what is locked in during this formative period. However, if this were true, we would be incapable of acquiring any new skill sets or adapting to new environments. Therefore, there must be some room for adaptability. In The Brain That Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science, the psychiatrist, psychoanalyst, researcher, author, essayist, and poet Norman Doidge adds another string to his bow as he hits the road, like the Jack Kerouac of neurology, to meet with the neuroscientists and neurologists who exploit the plastic nature of the brain in their therapies: the plasticians. Doidge describes the iterative experiments in brain mapping and micromapping that have explained the empirical observation of the concept of localisationism, in which specific functions are evolutionarily hard wired to discrete areas in the brain. These experiments have also shown that the spatial distribution of bodily functions is not only topologically organised throughout the brain, but is also not as static as was previously thought. In the absence of afferent stimuli, the brain can rewire itself to compensate; for example, in response to the loss of afferent input from a finger, the neurons that control the adjacent fingers will invade the area that previously regulated the lost digit. This concept puts intercranial space as prime real estate, where a darwinian micro-natural-selection battle is being waged. In this battle our plastic brains are in a state of flux and will constantly hone, refine, and remodel themselves, even without external impetus or stimulation, to ensure the most efficient use of the limited space available, dictated by the most used neural networks. From such remodelling comes the term plasticity and the notion that behaviour shapes our brains—behaviourism. There are two phases of plasticity in human beings: criticalphase plasticity during infancy, in which all experiences shape the developing brain; and adult-period plasticity, which requires determined effort and repetitive reinforcement to make its changes. New challenges and deviations from routine cause neurons to fire together, thus forging a putative network that can be reinforced on the molecular level by neurochemicals, such as dopamine and brain-
derived neurotrophic factor; the converse can also happen for neglected pathways. Doidge repeatedly quotes three mnemonics that encapsulate the basis of neuroplasticity: neurons that wire together, fire together; neurons that fire apart, wire apart; and use it or lose it. Doidge then takes to the open highway to meet the purveyors of some unconventional therapies based on neuroplasticity that encourage patients with conditions such as autism and learning deficits to play to their weaknesses, thus building pathways to circumvent the destructive ones, and also of some rehabilitative, cognitive, and occupational therapies for patients with physical disability (eg, due to stroke or Parkinson’s disease). He also delves into the dark side of the plastic brain—the plastic paradox—whereby undesirable traits can also become entrenched. Here, Doidge applies the plastic brain as a model to explain recalcitrant behaviours such as all-consuming addictions to pornography, extreme sadomasochistic sexual practices, a penchant for unsuitable partners, the effects of childhood trauma or abuse on adult behaviour, or the self-destructive and ever-increasing cycle of obsessive compulsive behaviour, and how they can be conquered by adopting a plastic approach. Much emphasis is placed by Doidge on the need to reconcile the plastic brain to our cultural identities, which span epochs and divide populations, whereas the subject matter could also contribute to the debate on the different influences of our envirnoment or our genes on our personas. He also presents the concepts of localisationism and behaviourism as mutually exclusive. A more accurate summation of the data would be of cooperation: despite continual remodelling, a brain still looks and functions as a brain is expected to, and only in extreme cases does remodelling result in great upheavals that would undermine localisationism. The style of presentation is one that seems to be ubiquitous in current science literature aimed at the general public; the reader is overloaded to acquiescence under a deluge of anecdotes designed to humanise and empathise with the patients and their physicians by describing perhaps more of the minutiae of their lives than is needed for general biographical and contextual purposes, and possibly more than you would ever want to know. Doidge takes this technique to the next level, wherein the protagonists are described in semi-romanticised terms: they have square jaws and heads of cascading hair that is tousled in the breeze, as they drive their sports cars from their vineyard weekend retreats to minister to their patients. At a time when we are being encouraged to be more environmentally friendly, perhaps a little less excess plastic packaging would be more appropriate.
Steven J Goodrick www.thelancet.com/neurology Vol 7 November 2008
Book Plastic fantastic
The Brain that Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science by Norman Doidge. Penguin Books, 2008. Pp 448. £9.99. ISBN 978-1423368014
990
There is a common English adage that you can’t teach an old dog new tricks: as people get older they become entrenched in their habitual behaviour and less adept at new challenges. Activities such as learning to play a musical instrument or mastering a new language are much easier when we are children, but such tasks are not insurmountable postadolescence, even if they do require more effort to master as we mature. The historical view is that the brain is receptive to learning only during childhood, and is then closed to new concepts and influences and can only use what is locked in during this formative period. However, if this were true, we would be incapable of acquiring any new skill sets or adapting to new environments. Therefore, there must be some room for adaptability. In The Brain That Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science, the psychiatrist, psychoanalyst, researcher, author, essayist, and poet Norman Doidge adds another string to his bow as he hits the road, like the Jack Kerouac of neurology, to meet with the neuroscientists and neurologists who exploit the plastic nature of the brain in their therapies: the plasticians. Doidge describes the iterative experiments in brain mapping and micromapping that have explained the empirical observation of the concept of localisationism, in which specific functions are evolutionarily hard wired to discrete areas in the brain. These experiments have also shown that the spatial distribution of bodily functions is not only topologically organised throughout the brain, but is also not as static as was previously thought. In the absence of afferent stimuli, the brain can rewire itself to compensate; for example, in response to the loss of afferent input from a finger, the neurons that control the adjacent fingers will invade the area that previously regulated the lost digit. This concept puts intercranial space as prime real estate, where a darwinian micro-natural-selection battle is being waged. In this battle our plastic brains are in a state of flux and will constantly hone, refine, and remodel themselves, even without external impetus or stimulation, to ensure the most efficient use of the limited space available, dictated by the most used neural networks. From such remodelling comes the term plasticity and the notion that behaviour shapes our brains—behaviourism. There are two phases of plasticity in human beings: criticalphase plasticity during infancy, in which all experiences shape the developing brain; and adult-period plasticity, which requires determined effort and repetitive reinforcement to make its changes. New challenges and deviations from routine cause neurons to fire together, thus forging a putative network that can be reinforced on the molecular level by neurochemicals, such as dopamine and brain-
derived neurotrophic factor; the converse can also happen for neglected pathways. Doidge repeatedly quotes three mnemonics that encapsulate the basis of neuroplasticity: neurons that wire together, fire together; neurons that fire apart, wire apart; and use it or lose it. Doidge then takes to the open highway to meet the purveyors of some unconventional therapies based on neuroplasticity that encourage patients with conditions such as autism and learning deficits to play to their weaknesses, thus building pathways to circumvent the destructive ones, and also of some rehabilitative, cognitive, and occupational therapies for patients with physical disability (eg, due to stroke or Parkinson’s disease). He also delves into the dark side of the plastic brain—the plastic paradox—whereby undesirable traits can also become entrenched. Here, Doidge applies the plastic brain as a model to explain recalcitrant behaviours such as all-consuming addictions to pornography, extreme sadomasochistic sexual practices, a penchant for unsuitable partners, the effects of childhood trauma or abuse on adult behaviour, or the self-destructive and ever-increasing cycle of obsessive compulsive behaviour, and how they can be conquered by adopting a plastic approach. Much emphasis is placed by Doidge on the need to reconcile the plastic brain to our cultural identities, which span epochs and divide populations, whereas the subject matter could also contribute to the debate on the different influences of our envirnoment or our genes on our personas. He also presents the concepts of localisationism and behaviourism as mutually exclusive. A more accurate summation of the data would be of cooperation: despite continual remodelling, a brain still looks and functions as a brain is expected to, and only in extreme cases does remodelling result in great upheavals that would undermine localisationism. The style of presentation is one that seems to be ubiquitous in current science literature aimed at the general public; the reader is overloaded to acquiescence under a deluge of anecdotes designed to humanise and empathise with the patients and their physicians by describing perhaps more of the minutiae of their lives than is needed for general biographical and contextual purposes, and possibly more than you would ever want to know. Doidge takes this technique to the next level, wherein the protagonists are described in semi-romanticised terms: they have square jaws and heads of cascading hair that is tousled in the breeze, as they drive their sports cars from their vineyard weekend retreats to minister to their patients. At a time when we are being encouraged to be more environmentally friendly, perhaps a little less excess plastic packaging would be more appropriate.
Steven J Goodrick www.thelancet.com/neurology Vol 7 November 2008