BERRY LIBERMAN: I want to begin by framing some of your ideas. Neuroplasticity, as you talk about it, is a way of healing rather than curing. Tell me about that distinction—between healing and curing?
NORMAN DOIDGE: I speak mostly of “healing” in my work. Healing comes from the old English word, “haelan,” which means not only cure, but to make whole again. The neuroplastic healing I describe involves restoring lost functions, and people often say they “got their lives back” and feel whole again.
Cure is more about getting rid of a disease or symptoms. In a few of the cases I describe—such as those with Parkinson’s, brain injuries—the patients still have the underlying disease or injury, but they are functioning as they did before they had the illness, and so the “feeling whole again” is what they experience. Their brain laid down new circuits to work around the damaged ones. I also like the holistic nuance of the word healing, because neuroplasticity is about mind, brain and body working together, as a whole. What I show in The Brain’s Way of Healing is that we have overlooked the extent to which we can actually use the body, the senses and the mind to heal the brain.
And so just to go back a step, how do you define the concept of neuroplasticity?
Neuroplasticity is a property of the brain that allows it to change its structure and function in response to activity and mental experience. For about four centuries the mainstream view has been that mind and brain were separate; you could change your mind, but not the structure of the brain. Its circuitry was formed and finalised in childhood. And so if it was damaged or diseased or didn’t develop properly, there was nothing significant that could be done to heal it. So the only change the brain underwent was degeneration, basically. We could never drive positive change. And now we discover this notion that the circuits are unalterable is not true, and there are ways of sculpting our circuits through mental experience and activity.
In my latest book I’m interested in how this can help us to heal the brain. And remember, as with other kinds of healing—say of the skin, the healing at times can be complete, and other times it can be partial. And sometimes, say with burns, it can fail. But what I am describing is moving from a view of the brain that says it can’t heal, in principle, to one where it is a possibility. And that’s a big change.
So in The Brain’s Way of Healing pretty much every person I describe was told, often at major medical centres, they would not get better. And what I do is show these cases getting better with neuroplastic interventions. Now, people sometimes say, “Well, these are miraculous improvements,” but the burden of my book is to show this is not miraculous, that if you understand the laws of neuroplasticity, change is not only possible throughout life, but that the brain works by changing its connections: forming, unforming and reforming networks. And if this is understood, it can sometimes be used for healing, and even self-improvement.
Now, I don’t deal with curing cancers or cellular problems. But I deal with conditions where function is lost—some strokes, brain injuries, learning disorders, Parkinson’s, MS, autism, chronic pain. In one case, a woman had a cancer removed, and the surgery saved her life, but she was left with deficits from the lost tissue, and she was helped. So it’s a long list.
And you write about the plastic paradox—an amazing concept. That the very plasticity of our brains makes us both perfect candidates for change, and simultaneously vulnerable to creating stubborn habits and rigid behaviours.
Yes. The plastic paradox is that the same plasticity that allows us to have flexible behaviours can also lead to behavioural rigidity.
Plasticity is like snow on a hill in winter. If you are a skier you can take many different paths down that hill on your first run, because it is pliable, plastic, modifiable. It’s human that if you had a good run, you may be tempted to take the same path over and over, with few modifications. And so soon you develop tracks in the snow, and soon ruts that are hard to get out of. The same applies in our lives: if we repeat things, they become habits.
We look at the rigid behaviour and project that rigidity back onto our brains. We say, “My brain must be rigid.” But the behaviour actually repeats because your brain made very strong circuits for them! Some “disorders” are a product of our plastic brains changing in a negative direction: habits, chronic pain, aspects of depression, anxiety, OCD, Post-Traumatic Disorder, Parkinson’s and many more kinds of problems.
So how do you access the positive possibilities while keeping in mind the flipside negative potential? Because people can be very disappointed when the techniques you’re saying are here, real and useable don’t cure all circumstances.
Nothing in medicine, as far as I know, except maybe for a cast on a broken arm, cures everything. Actually not even a cast can cure some fractures. It’s a psychological question of how one handles uncertainty. Every serious illness puts us into a state of increased uncertainty about our future. And as the philosopher Spinoza said, “Human beings, when faced with uncertainty, swing between hope and fear.” And to fear, I would add despair. So I never feign certainty.
If a patient seems to fit a profile that might be helped, I explain why and say, “This may be worth a try.” So I spend a lot of time with people explaining principles behind the treatments, and that just because we can help people who some thought couldn’t be helped doesn’t mean we can help all people all the time.
That said, it’s ridiculous to be silent about the remarkable improvements I have seen, or to withhold what I have learned by “reverse engineering” how those improvements occurred. I think one reason people mistakenly assume that a treatment that helps one person with an illness will help another is that we have for too long assumed there is a one-to-one relationship between illness and treatment. We go on the internet asking, “What is the correct approach to autism or MS or a learning disorder?” The problem is there’s a tremendous amount of variation in all of these conditions.
At times we physicians are at fault for perpetuating this idea because there is a direct relationship between an illness and a treatment. For centuries we have known that certain poisons have certain antidotes that almost always work. But this is the low hanging fruit of medicine. When we deal with the illnesses we’ve yet to make progress on, we are often dealing with high levels of complexity. For instance, no two brain injuries are exactly alike. People are hit in different parts of the head. One person had a high IQ and never did drugs, the other person had a low IQ and smoked a lot, never exercised and did a lot of drugs. Neuroplasticity helps to explain a lot of that variation.