- © 2007 Canadian Medical Association or its licensors
The Brain that Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science Norman Doidge; Penguin Group, 2007; 448 pp. $31.00 ISBN: 978-0-670-03830-5
Patients who read this popular book will have some searching questions for their physicians, especially when they or a family member are facing challenging physical or cognitive rehabilitation problems.
Dr. Norman Doidge, clearly a keen student of history and biography, traces the origins of ideas that the brain is capable of self-modification to the ancient Greeks and to the philosopher Jean-Jacques Rousseau. Doidge is an enthusiastic proponent of this fascinating area of neuroscience and portrays the courage of several determined research scientists who faced antagonism, ridicule and even repeated litigation for their efforts.
He writes: “The idea of the brain as plastic [that it can change itself physically and functionally at any age] has appeared in previous times, in flashes, then disappeared. But even though it is only now being established as a fact in mainstream science, these earlier appearances left their traces and made possible a receptivity to the idea, in spite of the enormous opposition each of the neuroplasticians faced from fellow scientists.”1
This book will encourage curiosity, open-mindedness and hope, as well as provide an annotated bibliography for readers who wish to locate some of the pioneering articles.
With recent advances in molecular biology, human genome mapping and functional medical imaging, the scientific study of neuroplasticity is bound to be fertile ground for Nobel prizes. The recent discovery that neural progenitor cells remain in the brain and spinal cord of adults, where they have the capacity to re-populate specific regions, is very promising and has the potential to lead to major changes in rehabilitation medicine, neurology and psychiatry. Whether the resources will be allocated to deal with developmental disorders in children, and change approaches to early childhood care and education, as well as cognitive preservation in seniors, remains to be seen.
Aspects of neuroplasticity covered in this book include:
• Tactile feedback enabling congenitally blind individuals to “see.”
• A description of the successful rehabilitation of the Catalan scholar Pedro Bach-y-Rita, with pathology findings confirming that a “late” recovery could occur even after a massive lesion in this elderly person.
• Special education approaches to severe learning disabilities and autism.
• Brain mapping experiments that disprove traditional localizationist theories of the brain being “hardwired,” and outline the importance of “critical periods” in brain function development.
• Obsessive–compulsive disorder conceptualized as “brain lock,” and new strategies for psychotherapy.
• “Phantom limb” pain, its prevention and treatment.
On the negative side, some of the chapter headings seem somewhat sensationalistic and the book relies heavily on anecdotal accounts. The latter are persuasive about the results achievable by determined individuals, but may disappoint scholars of evidence-based medicine (who may, in their skepticism, miss the comments about fMRI confirmation of lasting changes in brain function that accompany a number of these cases). In addition, the use of patients' case histories, even with consent and without identifying information, raises some ethical issues that cannot be set aside simply because the book is well-intentioned.
However, this book may well make us ponder on how politics, pride and shame can delay the recognition of important scientific advances and the research that would provide evidence for their effective use in clinical care.
In a second edition, perhaps the author will provide an improved annotated bibliography containing hyperlinks to abstracts of articles catalogued by PubMed, and suggestions for curriculum changes for medical and nursing schools, rehabilitation medicine and elementary teacher education (see online appendix at www.cmaj.ca/cgi/content/full/177/12/1552/DC1).
As work proceeds on the possible introduction of a developmental trauma disorder diagnosis in the next Diagnostic and Statistical Manual of Mental Disorders (expected in 2012), I would have preferred to see a focus on this disorder, rather than an extended section on psychoanalysis as “neuroplastic microsurgery.” When we consider the number of children affected worldwide by poverty, war, childhood abuse and terrorism, and the posttraumatic consequences of these, we need to emphasize science-based, effective and accessible treatment approaches.
Overall, highly recommended; if you choose not to read it yourself, please consider donating a copy to your local medical library or medical school curriculum coordinator.
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