In Context

Book
No miracle, just our brain
To start talking about the end of a book is usually considered
a spoiler. However, the afterword in the paperback edition
of Norman Doidges book The Brains Way of Healing brings
authenticity to Doidges collection of real-life stories of
recovery from brain injury. In the afterword, he addresses the
question that, he says, is likely to be asked: If neuroplasticity
is now accepted in neuroscience, why are these clinical
approaches that make use of it not more widely available and
mainstream? It is a pertinent observationif they work so
well, why do they still have an air of quackery more than the
conviction of hard science?
Doidge explains how neuroplasticity challenges current
models of how the brain works, which understandably
creates not only resistance and scepticism, but also calls
for substantial clinical evidence. Case histories, Doidge
says make hundreds of observations about a few people.
Randomised control studies make a few observations
about many peoplea population. Doidge does not seek
to undermine the value of large-scale studies, but suggests
that the anomaly that refutes popular thought can be the
scientic miracle that breaks an established paradigm. He
quotes neuroscientist Vilayanur S Ramachandra, who said;
Imagine I cart a pig into your living room and tell you that
it can talk. You might say, Oh really? Show me. I then wave
my wand and the pig starts talking. You might respond, My
God! Thats amazing! You are not likely to say, Ah, but thats
just one pig. Show me a few more and then I might believe
you. So, would you spend time looking for more pigs or
study the pig that has shown you that the impossible might
now be possible?
Doidge is not on unchartered territory, as he rightly
points out, but his proposition that the brain is not
permanently damaged when broken, but in fact has the
attributes and properties to repair and rewire itself, has
not yet conquered the hearts (or brains) of the mainstream
scientic community. In Doidges rst book, The Brain
That Changes Itself, he introduced the idea that the brain
has plastic properties. His second book, The Brains Way of
Healing, focuses on how brains damaged from birth, or by
illness or injury can gain or regain some or all cognitive and
motor functionality through neuroplasticity.
Neuroplasticity as a way of healing is discussed in detail in
eight chapters. The brain has for a long time been thought
of as hardwired with circuits that could not be repaired
once damaged. Doidge introduces pain specialist Michael
Moskowitz (Bay Area Pain Medical Associates, Sausalito,
CA, USA), who himself experienced years of chronic pain.
His idea was to counterstimulate, to steal back the neurons
processing pain and use them for other processing activity.
Identifying two brain areas that process pain, the posterior

cingulate and the posterior parietal lobe, he embarked on

an intense visualisation exercise. Each time he felt pain, he
would visualise the brain maps he created with a mantra;
disconnect the network, shrink the map.
Doidge meets John Pepper who, diagnosed with
Parkinsons disease in his fties, ercely advocates exercise,
predominately walking, as the most eective therapy. Pepper
learned conscious walkingwith singular concentration on
sensory movement, engaging a healthy part of his brain,
he was able to overcome his debilitating symptoms. Not
everyone will have the grit, as Doidge terms it, that Pepper
has, but professional opinion has changed from believing
exercise is detrimental to valuing it as preferable, and even
essential, for patients with Parkinsons disease.
With unassuming respect for all he observes, Doidge
proles the pioneers and practitioners of neuroplastic therapy
and healing. He identies the problems of the damaged
brain, namely, learned non-use and the noise caused by
dysrhythmias, and the unique factor that allows neuroplastic
healing, that of the exibility of neuronal networks. He
then summarises four stages of neuroplastic healing as
neurostimulation, neuromodulation, neurorelaxation, and
neurodierentiation and learning.
Each extraordinary story features an extraordinary doctor
with their own extraordinary experience. Doidge dedicates
a chapter to Fred Khan, a general and vascular surgeon, who
chose to be treated by a chiropractor using his Russian laser,
a low intensity light treatment, on his injured shoulder.
It worked and that, Khan explained got him into lasers.
Doidge introduces the highly inuential Mosche Feldenkrais,
physicist, black belt, and healer, who had been working on
French atomic secrets with Nobel Prize winners Frederic and
Irene Joliot-Curie before he ed Nazi invasion and travelled
to England. The lab he left behind had just split an atom of
uranium and generated nuclear power. Feldenkraiss methods
have been adopted and adapted to use dierent forms of
energy to try to stimulate, awaken, and rewire the brain.
For example, Paul Maudale, himself a patient and student
of Alfred Tomatis, inventor of the Electronic Ear, uses music
(mostly Mozart) and sensory stimulation to help children
with learning diculties, or those on the autistic spectrum,
achieve developmental milestones.
Doidges passion for healing might be expected, given his
own medical training as a psychiatrist and psychoanalyst
but, as he says, the true marvel isthe way that the brain
has evolved, with sophisticated neuroplastic abilities and a
mind that can direct its own unique restorative process of
growth. You can read a lot about it in this book.

Lancet Neurol 2016

Published Online
July 8, 2016
http://dx.doi.org/10.1016/
S1474-4422(16)30089-8
The Brains Way of Healing
Norman Doidge
Penguin Random House UK,
2015.
Pp 427. 999.
ISBN 978-0-141-98080-5

Jules Morgan

www.thelancet.com/neurology Published online July 8, 2016 http://dx.doi.org/10.1016/S1474-4422(16)30089-8