"The Brain that Changes Itself" By Dr Norman Doidge

THE BRAIN THAT CHANGES ITSELF. Stories of Personal Triumph from the Frontiers of Brain Science.

Norman Doidge, M.D.

This very readable book, published in 2007, is a rewarding read for anyone interested in that most fascinating organ – the brain.

It is a treasure trove of accounts, à la Oliver Sachs – except that the author is a psychoanalyst! This does not mean however, that the accounts are “psychoanalytic” (although one case is). Chapter 9 (of 11 chapters) is titled “Turning Our Ghosts into Ancestors – Psychoanalysis as a Neuroplastic Therapy” and comes toward the end of the book by which time Doidge has over and over again made the case for “neuroplasticity”.

By neuroplasticity is meant that the organic brain has the capacity to change. Hitherto, it has long been thought that if one sustained brain damage … that was that. There was no hope of brain cells regenerating: what you were born with, had to serve you until you died. Cells that were lost, were lost.

Doidge, offers well substantiated cases of quite extraordinary adaptations to brain damage and disorder, together with evidence for brain regions “taking over” the functions of damaged parts of the brain.

The basis for the book is his own having travelled far and wide to interview the researchers who have published the ground-breaking cases and learned for himself – and often from the patients, or subjects, themselves – what was being claimed.

Given that this review of the book is for PsychoanalysisDownunder – and therefore for a readership with psychoanalytic interests, I will strongly recommend the book for its general interest and now focus on what is of relevance to Psychoanalysis.

Psychoanalysis is interested in “the brain” insofar as it is the organ which allows us to have a mind. Much of the book is concerned with the brain that allows us to feel (as in “sensory function”), to move and to perform mental “tasks” of varying kinds. Our interest is in the psyche and if and how it can change.

Therapists would not undertake psychoanalytically-oriented “work” with their patients if they did not consider that change can be brought about. Nowadays, people (such as Alan Schore, among others) assert that demonstrable changes in brain function can be brought about by psychotherapeutic interventions.

It is this plasticity – the ability to be changed – which is becoming a feature of aspects in our literature which support positive outcomes for psychotherapeutic approaches to treatment.

Doidge’s book is full of accounts supporting neuroplasticity in a wide variety of non-mental disorder clinical conditions … but an underlying inference is that “the brain can change itself”. Apart from Doidge’s own clinical account included in Chapter 9, none of the other cases involves change resultant on a psychotherapeutic relationship.

The clinical case itself is interwoven between highly interesting, but necessarily brief, information about memory research centred around the famous figure of Eric Kandel and Kandel’s own relationship with psychoanalysis as a discipline within psychiatry. In a few pages on “dreams” in this chapter, Doidge quotes a researcher who states that “sleep enhances neuroplasticity during the critical period when most plastic change takes place”. Some might not be too impressed with this sentence itself- but it does represent for me Doidge’s intent to make a case for brain research now showing that the gap between the brain and the psyche is narrowing: whereas before “we” knew that change could be brought about, now it is shown that the brain can change – and some of the circumstances under which it does change.

Whether the undoubted changes in “Mr. L” in Chapter 9, brought about by good psychoanalytic work involving retrieval of relevant memories through working with the transference relationship, involved actual changes in Mr. L’s brain cannot yet be demonstrated. But, by inference, a “brain that changes itself” can be helped to change within a psychotherapeutic relationship.

Another chapter of potential psychoanalytic interest is Chapter 8 “Imagination”. Here Doidge presents research involving “TMS” – transcranial magnetic stimulation. On pages 198 and 199 he details research wherein blind subjects were taught to read Braille. They studied for two hours a day, five days a week – for a year. The researcher, Alvaro Pascual-Leone, mapped the motor cortex of his subjects and found that the “maps” for the “Braille reading fingers” were larger than the maps for other fingers, and larger than maps for fingers of non-Braille readers.

Let me now quote a long passage:

“The subjects were mapped with TMS on Fridays (at the end of the week’s training), and on Mondays (after they had rested for the weekend). Pascual-Leone found that the changes were different on Friday and Monday. From the beginning of the study, Friday maps showed very rapid and dramatic expansion, but by Monday these maps had returned to their baseline size. The Friday maps continued to grow for six months – stubbornly returning to baseline each Monday. After about six months the Friday maps were still increasing but not as much as in the first six months.

Monday maps showed the opposite pattern. They didn’t begin to change until six months into the training; then they increased slowly and plateaued at ten months.”

Pascual-Leone (and Doidge) speculate about what these findings may or may not mean. Those of us interested in the effects of “weekend breaks” in long-term psychoanalytic treatment may think entirely different thoughts!

We might find support for the value of the weekend breaks: that working through the effects of separation and re-union over weekends results in sustained change … in the longer term.

I will leave the reader of this brief review to make up their own mind about the validity of “drawing long bows” such as this to encourage those interested in psychoanalysis to delve into the neuroscience literature – and book’s such as Norman Doidge’s - in search of support for what “we” already know … and surprises as to what we don’t yet know.