This second interview is with the Australian Broadcasting Corporation (ABC)’s Natasha Mitchell, on her show All in the Mind. Dr. Doidge discusses how thought,  imagination and therapy change the brain, in a discussion that ranges from the first intuitions of plasticity in the ancient Greeks, all the way up to the latest experiments and brain scans. The brain is more plastic than scientists once believed. Here, he discusses the plastic paradox, and sensory subsitution, and treatment of strokes. But what does this mental malleability mean for humanity? More compelling stories from psychiatrist Dr Norman Doidge as he enters the labs and lives of the new 'neuroplasticians'. And, neuroplasticity on the couch - does psychotherapy physically change your brain?

You can read the transcript of this interview at the bottom of this page.

The interview is the first of two parts. 

In part one, Natasha Mitchell, of the Australian Broadcasting Corporation) interviews Dr. Norman Doidge and Dr. Jeffrey Schwartz (whose work Dr. Doidge wrote about in The Brain that Changes Itself). Dr. Doidge explains why we are discovering brain plasticity now, and why, if the brain has always been plastic, we didn’t see it. He explains why the brain is not hardwired, and the work of the “neuroplasticians,” a term he coined for the people doing this work. In part two, (below) Natasha Mitchell interviews Dr. Doidge alone.

You can also read the transcript of this interview at the bottom of this page.

Transcript of All In The Mind

Part 1 of 2: The Power of Plasticity

Natasha Mitchell: And on ABC's Radio National, Natasha Mitchell welcoming you aboard All in the Mind. On the show how your brain has underestimated itself. Once scientific mavericks, the so-called neuroplasticians are radically re-inventing your mind and its discontents.

Norman Doidge: And by thinking and imagining, even by those activities, we can change the structure and function of our brains.

Jeffrey Schwartz: No question it's easier to change it early on. Certain aspects of the change probably are limited just to the early developmental...

Natasha Mitchell: Over the next two programs a profoundly optimistic take on our organ of thought. We are throwing out an old pessimistic and scientific dogma that the adult brain is fixed and rigid with some compelling case studies in the mix. My guests, both in Australia this week for the Neuro Leadership Summit in Sydney are Professor Jeffrey Schwartz an acclaimed neuro-psychiatrist and researcher at the University of California, Los Angeles and co-author of The Mind and Brain—Neuroplasticity and the power of mental force. Joining him, Dr Norman Doidge who has penned a New York Times bestseller The Brain that changes itself about people just like Jeffrey, folk he calls neuroplasticians.

    Dr Doidge is a psychiatrist and psychoanalyst at Columbia University's Centre for Psychoanalytic Training and Research in New York and at the

University of Toronto's Department of Psychiatry.

    Well here we are today to talk about how thoughts actually influence the matter of the brain. Why has it been so fixed in scientific circles, there's

been a fervent resistance hasn't there to the suggestion that the brain is plastic, especially the adult brain. Norman.

Norman Doidge: Well basically since the founding of modern science when Galileo was so effective at showing there were mechanical laws of

movement governing the movements of the planets, biologists tried to look at our individual organs inside our bodies and explain them mechanistically as well. And this began with William Harvey explaining that the heart was a pump, which is of course a machine, it began brilliantly. And then the French philosopher Rene Descartes described the brain as a kind of pump with currents going up and down the nerves and it soon seemed to scientists that for an explanation to be scientific meant it had to be mechanistic. And for about 400 years mainstream neuroscience, probably in responding to the incredible bewildering complexity of the human brain, took refuge in the idea that it was like a complex machine with parts, each performing one function and one alone, and dividing and conquering it. We learn many things about the brain in treating it mechanistically but it was just a metaphor. It's still popular, with the notion of our brains as a hard

wired computer, if you will, which is a complex intelligence machine. But at a certain point you know metaphors can begin to conceal as much as

they reveal and that's what happened in this case. And we misunderstood ourselves and the human brain underestimated itself because in fact in

many instances the brain can actually rewire itself, or restructure itself through thought.

Natasha Mitchell: It seems doesn't it that people were more comfortable with the notion that children's developing brains are plastic but not adult's brains? Jeffrey Schwartz you're a neuroscientist and you were surrounded by this dogma. Your profession of neuroscience has had actually up until very recently a very pessimistic view of the brain hasn't it?

Jeffrey Schwartz: Yeah, I mean in psychiatry it's even worse actually in many ways. Yes it's nihilistic because it really does view that there's nothing you can really do. They took this notion from the 60s which was clever when they come up with it in the 60s, for every twisted thought, a twisted molecule, it was a clever little aphorism you know 40 something years ago but they took it so literally that it became a dogma that was genuinely nihilistic and destructive to the notion of people having a will and people having capacity to change their conscious awareness and change their brain in the process. Because if you believe that every twisted thought is really just a twisted molecule, then you're going to have exactly what did happen, which you're going to end up wanting to use mechanical means to treat mental disorders. And the predominant use of drugs in psychiatry is I think anybody who is not really making his or her living off prescribing those drugs, and even many of the people who do, now acknowledge that that had gone way overboard.

Natasha Mitchell: You've got a strong view there. Norman Doidge, this idea that the brain is a flexible, plastic organ—now of course neuroplasticity is the hot term of the moment—let's define it.

Norman Doidge: Well neuro is for neurone the nerve cells in the brain and plasticity means plastic in the sense of changeable. And it's that property of the brain that allows it to change its structure and its function by basically three things. By responding to the world by perceiving the world, by acting in the world and by thinking and imagining. Even by those activities we can change the structure and function of our brains.

Natasha Mitchell: You refer to a dark age of plasticity when it really wasn't, the brain was thought to be very rigid. What allowed us to emerge

from that dark age—and these were scientific mavericks weren't they?

Norman Doidge: Well what allowed us to emerge from it was first of all was the fact that the brain is plastic and there were the occasional reminders. What kept us in it was we lacked the technology to view plastic change where it was happening, which was at a microscopic level. We had CT scans and all sorts of scans but they weren't microscopic and we had to be able to do a kind of movie of the brain over time. So that was important. And two, the mechanistic metaphor, the sense that the brain was like a machine—in some ways of course was quite odd, after all the brain is animate, it's not inanimate and there were all sorts of exceptions to the idea that the brain was like a machine. Occasionally there were examples where people had devastating strokes and would get over them and we tended to say, well they never really had strokes in the first place.

Once we had these movies and ways of examining the brain we could see no, some people had devastating, devastating strokes and if they got rehab that lasted longer than the typical 6 to 8 weeks, where people understood what they were doing and kept at it, the damage was still in the brain but the brain somehow reorganised around it.

Natasha Mitchell: Jeffrey Schwartz you particularly became engaged with the horrible experience of chronic obsessive compulsive disorder and why did that present such an interesting set of questions for you?

Jeffrey Schwartz: I had this awareness about 25 years ago that people who have obsessive compulsive disorder, which is a condition which is manifested by intrusive, unwanted thoughts and urges that things are dirty, things need to be checked, are incomplete in ways that could be dangerous. And early on the 80s we did brain imaging studies and really started to nail down pretty clearly that there were brain related changes that were very probably causally related to the fact that these thoughts were intrusive. When you coupled that with the fact—and this was the critical point—that people with obsessive compulsive disorder generally have an insight, an awareness that this thought doesn't make sense, that gave us an entry point into understanding how people change and manifest their understanding of the change of the relationship between their sense of who

they are and what their brain is doing, we could use that therapeutically to get them to not identify with the thoughts, focus their attention differently

and then my hypothesis was—and that will change the circuit.

Natasha Mitchell: Interestingly the prevailing therapy for obsessive compulsive disorder—and we have to point out that this is a condition that has a horrific impact on people's lives—but the therapy was in fact to make people focus on their thoughts and in fact be exposed to some of the phobias or loops in their mind to the point where therapy was quite distressing for some people. I mean some people had a need to ritualise turning off the tap, on and off, off and on they were told to do that over and over again.

Jeffrey Schwartz: Yes, that was very rapidly shown to make things worse not better so that never became a treatment. But the issue of having people be 'exposed' to stimuli that really caused their obsession, obsessive compulsive symptoms to get worse, and then just be there doing nothing except being exposed and having these very upsetting feelings that would just last for sometimes hours and just waiting for them to go away in what came to be called exposure and response therapy. It leaves us with one critical point, which is when people have the awareness—which not all of excessive compulsive disorder people have to the degree that they need to do therapy—but when they have the awareness that this doesn't make sense enough that they can refocus their attention by having an encouragement to remember this is just your brain; it's not you, it's just your OCD. And when people can do that and a lot of people can; demographically most people can, then you can get beyond just using exposure therapy or therapy where people only have to focus on the bad feeling and can start to focus on adaptive feeling.

Natasha Mitchell: Jeffrey Schwartz let's come to how you're exploiting neuroplasticity to do just that in a moment. You're with All in the Mind on

ABC Radio National, Radio Australia and in the digital ether across the world I'm Natasha Mitchell. Dr Norman Doidge you also have remarkable stories in your new book The Brain that Changes Itself. Introduce us to the brain of Michelle Mack because she's an example of just how differently a brain can be wired and still thrive, the mind can still thrive inside.

Norman Doidge: Well I went to visit Michelle Mack, she's a woman who was born with half a brain, she just had one hemisphere. If I told you that Michelle Mack had half a brain you might imagine that she was in some kind of intensive care unit with all sorts of things helping her breathe and machines keeping her alive. And if I told you that she was missing her left hemisphere, which is basically thought to process speech, you would think that she would be completely inarticulate. But in fact Michelle Mack for a number of years when she would go to the doctor they would sense something wasn't quite right but no one ever dreamed she was missing a hemisphere. She has a job, a part time job, it's fairly menial in some respects; she has a sense of humour, she loves, she votes in elections, she has feelings, she laughs at jokes. And what happened is her left

hemisphere never developed, no one knows exactly why not, it's possible that there was some kind of blood clot or something like that in the artery supplying that hemisphere.

    So she was left with a right hemisphere and yet her right hemisphere managed to take over the functions of the left. And so both left and the functions normally housed in the left and in the right are kind of crowded together in the right.

Natasha Mitchell: That's a lot of brain to fit into a limited amount of real estate.

Norman Doidge: Yes. Initially because she had a lot of trouble moving around but that right hemisphere was able to learn how to articulate

language and speak.

Natasha Mitchell: Which is unusual because of course the left hemisphere is what's most associated with language and verbal skills.

Norman Doidge: Yes.

Natasha Mitchell: And she didn't have one.

Norman Doidge: Yes, yes indeed and you know when the notion of the machine-like brain, again if the part isn't there the function isn't going to be there. But even in people who don't have problems like Michelle, these things move around so what we learned from Michelle is they move around, large departments move around, and also what gets there first tends to establish itself in the brain. Plasticity we've learned is competitive, so you learn a routine and that coalition of neurons that work on that routine get very good and efficient and fast. And it's like that keen kid in first grade who always has the answer to the questions...well when you learn a routine in your brain that coalition of neurons is volunteering to do things. It's as though there are squatter's rights in the brain and there's this ongoing war of nerves in the brain and a battle for cortical real estate. And so the things that got established early in Michelle came to be very dominant in her brain and other things that might, because she had a limited amount, has a limited amount of cortical real estate, some of the things that we might anticipate would come out later in development, came out but were not as well developed as they might otherwise be.

    So she's got a spectacular memory, she can remember events, she has savant-like skills and that ability to remember probably in normal development is something that precedes the ability to extract themes from all the events we experience, and she's a little weaker on that theme extraction, things like visual spatial skills, many people who know about left and right brain know that those tend to be housed in the right. But she didn't develop good visual spatial skills. Well you might say why not? Well this is because her left hemisphere was missing her movement was compromised so she couldn't move around a lot so she also had some problems seeing, so she wasn't seeing that much and she wasn't moving a lot through space so there wasn't the need in those early years when her mother was taking care of her to develop visual spatial skills. So isn't that an interesting lesson, it's just the resilience and the sheer practicality of human neuroplasticity and now she's using her awareness of what her strengths and limitations are to try and improve her life and that's having an affect too and she's regulating her emotions much better now that she understands more about how her brain works.

Jeffrey Schwartz: To me that's what the whole field really is about. When you understand how the brain works somewhat better you can use that information to literally enhance your own perspective, broaden your own sense of your capacities and, with that awareness, learn to, as Norman is saying, focus on other things knowing that if you focus on other things consistently you can change what's there. You can change the way that real estate is used.

Natasha Mitchell: Now Jeffrey you really unearthed the anatomy of obsessive compulsive disorder and called what was going on inside those brains, 'brain lock', which I think is very interesting in this conversation. What was going on in those brains, briefly?

Jeffrey Schwartz: There's a structure deep in the centre of the brain that's called the caudate nucleus and it actually does function a lot like the transmission in a car. And it's actually quite a useful analogy because it shifts circuits instead of gears. And what happens in obsessive compulsive disorder is you literally do get a stuck transmission and you get this error detection circuit coming in from another part of the brain in the front called the orbital frontal cortex locking, and you can't shift out of it and because you're locked in to an error detection circuit, you are bombarded with feelings that something is wrong, even though the rest of your brain and mind adequately can tell most of the time that even though this feels terrible it really doesn't make sense.

Natasha Mitchell: So this is for example if someone is stuck in a fixation that every time they touch a door handle that it's riddled with germs, they

get stuck in that belief.

Jeffrey Schwartz: That's an extremely good example and here's how we tie what Norman was just saying to this knowledge of neuroanatomy, which to me is the big take-home message. Once we now can say to someone with a genuinely good scientific grounding, you're saying to someone look, you know that that door knob just is not dirty the way you feel that it's dirty, but we're left with this terrible question, why does this keep bothering me so much, it doesn't make sense? When you can give people a genuinely cogent explanation having to do with the fact that their brain is stuck in gear, literally circuits that perceive the feeling of being dirty are locked in place in a way that is completely analogous to a false alarm. When people know that they can start to ignore the feeling and focus away from it and that actually changes the wiring of the alarm system.

Natasha Mitchell: You in fact have developed a program that exploits what you call self-directed neuroplasticity.

Jeffrey Schwartz: Well that's it, so I came up with this notion, pretty simple in certain ways, that yeah this is neuroplasticity in a way that had already been studied for a couple of decades but all the research on neuroplasticity that had been done previously was, as Norman pointed out earlier, based largely on changes of the brain in different environmental circumstances. But here we had a case that's uniquely human where people could direct their own inner environment through this enhanced understanding. So I said well you know what, this is self-directed neuroplasticity.

Natasha Mitchell: You got them to do a program and you actually directly proved that in fact getting people to change their thoughts strategically

about their obsessions and compulsions actually had an effect on the wiring of the brain. What did you see?

Jeffrey Schwartz: Yeah I mean the program, I mean it's a simple enough thing, I mean it's in a very simple book called Brain Lock—it's four little steps: re-label, call it OCD, re-attribute, realise that the reason it feels so bad is attributed to the fact that your brain is sending you a false message, refocus the critical step, that's where the action and the dynamic comes from. Because when you take advantage of knowing this is OCD and that it's their brain that is sending them a false message, then when they refocus their attention and by doing that wire in brain circuitry, that matches with adaptive behaviour and weakens the pathological circuitry.

Natasha Mitchell: So what did you see using scanning technology?

Jeffrey Schwartz: Oh we basically saw the connection, the intensity of the connection, the brain lock itself was weakened when people did this mind-based awareness therapy the activity in the cordate nucleus lessened and the intensity of the connection between the error circuit and the gearbox became weaker. Improved you might say.

Natasha Mitchell: In a sense you said that this awareness training was the wilful mind acting on the brain.

Jeffrey Schwartz: Absolutely, I take it as a paradigm of how focusing your attention differently changes how your brain actually works.

Natasha Mitchell: In a sense some would say that this is you perpetuating a bit of a dualistic myth here. saying that the mind and the brain are

somehow different beasts.

Jeffrey Schwartz: What I'm doing is debunking the materialist myth.

Natasha Mitchell: How can the mind act on the brain in the therapeutic context if the mind is the brain?

Jeffrey Schwartz: But the mind is not the brain, that's precisely the point that we're making. You see that's it, we're changing the frame, we're basically assertively making the claim that the statement the mind is the brain is false. What we're having is a paradigm shift.

Natasha Mitchell: I guess one of the things, Jeffrey Schwartz and Norman Doidge, is there's still a strong belief that there is a critical period of

plasticity in the developing brain, the child's brain—and all of us as we age, we actually want to try and reproduce that critical period of plasticity so

we never let it go. Norman is that possible and then Jeffrey.

Norman Doidge: There are many, Shakespeare has Seven Ages of Man, there are many epochs of human plasticity. I mean the first epoch is just after birth when we have very sketchy maps of the world and we go through this critical period where we can soak in everything without paying attention. The mechanism that regulates human plasticity is always turned on so you expose a baby to language and it learns it. After it's had sufficient exposure to that, that critical period ends and the only way to do changes as far as we know is by some kind of focused attention later in life. And couple that with appropriate rewards for that focused attention so you get good at it.

Natasha Mitchell: Jeffrey.

Jeffrey Schwartz: No question. It's easier to change it early on. Certain aspects of the change probably are limited just to the early developmental period. But the notion that the capacity to change stops at any point is now known to be false. So it really does become an issue of how much effort and how efficiently the change can take place. No we don't want to fall into the myth of perfectibility, but we do want people to know that with awareness, with focused attention and maybe even nowadays with some mechanical aids that might be on our horizon, even get the brain to change and work with your attention more effectively so the whole notion of critical period is shifting and changing and there's just no doubt at all that it's expanding later and later in life when change can occur even though we will absolutely assert that it's easier early on.

Norman Doidge: Now that we've learned so much more about the loss of neuroplasticity we don't actually need a critical period to do remarkable

things. You know there are language programs that are coming out that are real emersion programs. What real emersion language does it's an

ingenious way to activate brain plasticity.

Natasha Mitchell: So this is really tapping in to the fact that kids learn second languages really easily, adults find it damned hard.

Norman Doidge: The way I look at it is this, when we only knew about critical period plasticity, when we asked ourselves why is it so hard for adults to learn languages, we said well because their brains are rigid, the critical period has closed down now, the brain's too rigid to do it. But in a certain respect I say now it's because their brains are plastic that we have difficulty learning languages and that's because of the competitive nature of plasticity. What happens is, as you've spoken your language more you develop what I call the tyranny of the mother tongue, it takes over every nook and cranny of your linguistic map space. And the only way to sort of learn a second language is true emersion which basically means going somewhere, not thinking if you're an English speaker, not even thinking in English but having constant conversations in French and the other

language, so you can close it down. And I've spoken to many, many people who had many difficulties learning second languages who when they did true emersion all day long were amazed at how quickly they could pick up a language.

Natasha Mitchell: And yet you call immigration, the experience of immigration in effect a neuroplastic shock, don't you, an unending brutal work-out for the adult brain requiring massive rewiring of vast amounts of our cortical real estate—that's the way you put immigration.

Norman Doidge: Yes, I have a lot of thoughts about culture and plasticity. We've tended to think that the brain produces culture, but culture actually also reshapes our brains. And so if you move from culture A to culture B you have culture shock and culture shock is really brain shock at a deep level. That's why it's so difficult for instance these studies which show that people who come from China and related cultures, when they look at a still-life unconsciously, involuntarily their perceptual systems are wired to see the relationships between the apple and the orange and the pear. Whereas you show the same thing to people who come from civilisations descended from the ancient Greeks, you know Australians,

Canadians etc. and they always find the prominent object and this is actually a wiring in the brain issue, this is not just a kind of different opinion about what's important.

Natasha Mitchell: This is a sort of cultural imprint, plastic imprint.

Norman Doidge: It's a cultural imprint and then if someone moves from Japan for instance to the United States and we study them, over a period

of years they begin to unconsciously and voluntarily perceive it the way Americans do. This is incredibly important because what it means is that

many of the cultural differences that we think are simply differences of opinion turn out to be differences of wiring. Culture is rewiring brains. And no one has really begun to think through these problems and there implications for human beings. But just as we are able to show that children with learning disabilities can retrain their perceptual processes so that they can read better and make different kinds of visual observations etc, so too cultures change those same processors.

Natasha Mitchell: A point that I wanted to pick up on was this, I mean we're talking here about neuroplasticity and learning having a relationship, but you also talked of unlearning as well also being a plastic phenomenon and romantic love comes into play here.

Norman Doidge: Life's about two things in a way, it's about learning and it's about unlearning and they actually have different chemistries. And the different epochs of human plasticity include several epochs where there's a lot of pruning away of connections that we don't use. Now the most important relationships we have with people in our lives—and now we've been able to document this neuro scientifically—mothers literally mould the brains of their infants and lovers literally mould the brains of their beloved and so on, and people get into relationships and again, if they're good for them they change their brains for the better, and if they're bad they actually have an alternative effect.

Natasha Mitchell: A final question for you both, you're both at the Neuro Leadership Summit in Sydney this week; Jeffrey Schwartz what's neuro

leadership and what has it got to do with neuroplasticity?

Jeffrey Schwartz: Mainly what it means is really an application of this kind of four step method that I used for obsessive compulsive disorder much more broadly to regular problems. And you have the awareness that it's your brain that's making you do things in certain ways and the resistances that you have to change are caused by your brain and you have to overcome them by cognitively realising we have to train our brains to work differently. And the way you do that always does turn out to be by focusing your attention differently; so neuro leadership really does become a paradigm to enhance people in leadership positions to teach and practise refocusing attention effectively by knowing that that changes the

brain.

Natasha Mitchell: Norman Doidge.

Norman Doidge: It's inevitable that all sorts of groups of people are becoming educators—business people, military, I mean you name it—are becoming interested in the concept of neuroplasticity. Leaders in business realise that half of what they deal with is not simply the bottom line but human relations and organisations and organisational change. In capitalism there's a lot of change happening over time and to better understand change it's best to understand the organ which is changing and so plasticity has become something of interest to business people now.

Natasha Mitchell: Well Jeffrey Schwartz and Norman Doidge thank you for joining me on the program it's a vast area for people to consider.

And I'll be picking up on next week's show with Norman Doidge to hear about how he as a psychoanalyst is drawing on these principles of brain plasticity to work with his clients and their various anxieties. And it turns out Freud may have been an early neuroplastician too, along with Rousseau the philosopher. Dr Norman Doidge's book The Brain that Changes Itself—Stories of Personal Triumph from the Frontiers of Brain Science is published in Australia by Scribe and if you are in balmy Brisbane this week on Thursday, Friday and Sunday you can catch him at the Brisbane Writers' Festival. And Professor Jeffrey Schwartz has penned a few books about his work too including Brain Lock—A Four Step Self Treatment Method to Change your Chemistry. You'll find the transcript, podcast and our email on the All in the Mind website along with my

blog—check it out, have your say all at abc.net.aurn/allinthemind. Many thanks today to producer Anita Barraud and studio engineer Angie Grant, I'm Natasha Mitchell feeling altogether neuroplastic.

All In The Mind - 20 September 2008 - Part 2 of 2

This second interview is with the Australian Broadcasting Corporation (ABC)’s Natasha Mitchell, on her show All in the Mind. Dr. Doidge discusses how thought,  imagination and therapy change the brain, in a discussion that ranges from the first intuitions of plasticity in the ancient Greeks, all the way up to the latest experiments and brain scans. The brain is more plastic than scientists once believed. Here, he discusses the plastic paradox, and sensory substitution, and treatment of strokes. But what does this mental malleability mean for humanity? More compelling stories from psychiatrist Dr Norman Doidge as he enters the labs and lives of the new 'neuroplasticians'. And, neuroplasticity on the couch - does psychotherapy physically change your brain?

Transcript

Natasha Mitchell: We're getting malleable with your mind today on All in the Mind here on ABC Radio National. Natasha Mitchell with

you—welcome.

Last week Canadian psychiatrist Dr Norman Doidge introduced us to his adventures into the labs and lives of the so-called 'neuroplasticians'.

Scientists fundamentally challenging the dogma that the brain is a rigid, unrenewable organ. As you'll hear in today's conversation, neuroplasticity

has a forgotten heritage. And we're putting the concept on the couch too. How might psychotherapy, that process of reassessing and restructuring your thoughts, physically change the brain?

Norman Doidge: People have often thought that you know real treatments are always biological and involve drugs etc. and that talk therapy is just

that, it's just talk, mere talk. But we now have really important work of psychoanalytical therapies, cognitive behaviour therapy, inter-personal therapy which of kind of grows out of psychoanalytical therapy that shows that patients come in with brains in certain states of wiring and after these interventions, their brains are rewired. So psychotherapy is every bit as biological as the use of medicines and I would say in a certain respect more precise at times.

Natasha Mitchell: Dr Norman Doidge is based at Columbia University's Center for Psychoanalytic Training and Research in New York and the

University of Toronto's Department of Psychiatry. And his book The Brain that Changes Itself: Stories of Personal Triumph from the Frontiers of

the Brain Science has landed him on the New York Times best seller list. Despite the dogma, the prehistory of neuroplasticity reaches as far back as the philosopher Jean Jacques Rousseau and before.

Norman Doidge: The ancient Greeks weren't in principle opposed to the idea, Socrates in The Republic says you can exercise the organ of thought that we exercise the way athletes exercise when they do gymnastics, and Jean Jacques Rousseau read the Greeks and he talked about exercising each of the senses. And out of that point of view certain experiments were done shortly after Rousseau died, in the early 1800s, where they took animals and they raised some of them in enriched environments with a lot of stimulation, and others in normal environments, and they found that those raised in the enriched environments had bigger brains. And there were many versions of this but they often got buried in the literature because people just questioned the reliability of the experiments, they questioned the integrity at times of the scientists—because there was this other notion that was so rigidly adhered to.

Natasha Mitchell: There are also moral concerns though about for example some of Rousseau's ideas, I mean he had this idea that our minds were plastic then humans had this sort of, were able to evolve and grow—and he had a concept of human perfectibility I gather.

Norman Doidge: Yes, he was very profound about this. You know, animals are plastic too to a degree but when he compared human beings to other species he noticed how much human beings changed in the course of their lives and he called this perfectibility and the French word “perfecter” came into fashion. Unfortunately these were, there were many Utopian ideas during the French Revolution that cottoned on to his notion and it was picked up by the Russian Revolution and you got to a point where progressive thought was very much dependent on this notion of human perfectibility. There was even an American stream that came through Count d'Orsay and Thomas Jefferson that led to the self help movement and many other things. But the problem was pointed at originally by Rousseau himself, the moral problem of it, and it and it was this—if you look at the ancients like Aristotle and Plato they often thought that for a human being to perfect himself or herself meant to cultivate your individual faculties as much as possible but that each of these faculties had a kind of limit and a certain essence about them. And what Rousseau had observed is that you could marry various different mental faculties and create new faculties and adjust senses and this meant that if human beings were truly perfectible and changeable in that sense, we didn't really know what a perfect human being looked like because each human being could develop in a very individual way. So he always used the word perfectibility in quotes which is just a brilliant, brilliant observation because in so far as the brain is more modifiable than we believed, we require even more wisdom not less to know what to do with this potential. A changeable brain is more resilient, yes indeed, but it's also much more vulnerable to the environment and the influences in what we do. And the other problem is that when it gets into the political realm and we start to accept that human beings' brains can change and improve themselves, is what happens when someone doesn't change and improve?

    You saw this happen with the Russian Revolution, if people didn't move in the right direction then the state said they must be bad people and I've been concerned as I've tried to help articulate the importance of this new idea, which is very important and overall hopeful and good, that when people look to children who have learning disorders who don't change when they've had neuroplastic exercises—which I've seen with my own eyes really very remarkable results for many, many children—will they again be blamed. Because look, neuroplasticity is an incredibly important discovery but anyone with any degree of scientific maturity knows that you have to be very cautious even in the light of something like this and it doesn't mean we understand everything.

    Our task is to begin to understand how much plasticity there is inherent in the human brain, but also its limits, and articulate that for people. We are beginning to quantify a property that's always been there that we didn't recognise.

Natasha Mitchell: Norman Doidge, let's come to your therapeutic setting, you're a psychiatrist and psychoanalyst. What would Freud have thought

of all this, this idea that the brain is a profoundly plastic organ?

Norman Doidge: Well it's funny you should say that because in this certain sense Freud did think of all of this. In the 1880s he was one of the

very first people to propose that when we think and learn we change the connections between nerve cells. He was very, very prescient on this point and modern day neuroplasticians, which is a term I have for people who have helped further our understanding of neuroplasticity, often talk about a basic law of plasticity that states neurons that fire together, wire together and neurons that fire apart wire apart. This is a very monumental

discovery. This is how connections are formed in the brain. Sometimes they attributed that to a Canadian, a Canadian, Donald Hebb, and called it Hebbian plasticity. But in fact Freud proposed that idea in the 1880s and 90s and he called it the law of association by simultaneity—it's beautifully named and it just meant that when you put two things together in consciousness they get associated in the neuronal connections in the brain.

    And if you hear the word 'association' with respect to Freud you think of free association and you know saying everything that comes to mind and Freud's emphasis that you could find important links and in fact it was related to his work as a neurologist. You know he was never a psychiatrist, he was a neuroscience researcher before he turned to treating patients. Psychoanalysis grew out of these neuroplastic insights, and many of the other therapies that have grown out of psychoanalysis bear that heritage. And one of the most exciting and important things about this work is people have often thought that real treatments are always biological and involve drugs etc, and that talk therapy is just that—just talk, mere talk. But we now have really important work of psychoanalytic therapies, cognitive behaviour therapy, inter-personal therapy which kind of grows out of psychoanalytic therapy which shows that patients come in with brains in certain states of wiring and after these interventions their brains are rewired.

    So psychotherapy is every bit as biological as the use of medicines and I would say in a certain respect more precise at times. Now look I use medications from time to time, I never give medication without giving psychotherapy. The Canadian health care system allows me to do that but I think that's really, really important because medications basically bathe every cell in your brain at once. And in that sense, on that level they're a blunt instrument. Now there are times when they have very, very important results, I'm not saying that anyone should go off their medication and all that kind of thing, the reductionist approach... but one of the things we've learnt is that if you look at the letter A and then you close your eyes and think of the letter A, many of the same circuits are activated. And if you're hurting and talking with your therapist about that, those circuits are activated at that point and that provides a point of entry. And when therapy is working it's like a microsurgical intervention on precisely the circuits that have to be changed.

Natasha Mitchell: You've provocatively called psychoanalysis the new neuroplastic therapy. That's quite a claim given that I guess today

psychoanalysis is a bit on the nose in neuroscience circles.

Norman Doidge: Well actually at the heights of neuroscience it's actually treated with great respect. Eric Kandel who won the Nobel Prize in the year 2000 and is a great neuroplastician for actually showing how learning changes, turns on genes and changes structures, has written a whole book on psychoanalysis and neurobiology.

Natasha Mitchell: And his key field is of course memory which is the great example of plasticity.

Norman Doidge: He went into it actually, he was a Viennese person who went into psychiatry to become and analyst and wanted to understand

more about how learning works because learning is essential to psychotherapy. Gerald Edelman who won the Nobel Prize was interested in it, Antonio Damasio is. At the highest levels I think there is a tremendous amount of respect for the integrative work that Freud did, not for every little detail of what he did. No one is making that claim, he was always revising his work, but on this particular point about neuroplasticity,

psychoanalysis gave us a much more plastic understanding of how memory works, a much more plastic understanding of how emotion works, and that change was possible later in life.

Natasha Mitchell: So give us an example of how in a therapeutic setting you apply some of this thinking—and there are some lovely examples in

the book.

Norman Doidge: There are examples in strokes where people have had strokes and their brain goes into shock after the stroke, they try to use their affected arm, it doesn't work so they kind of learn it doesn't work and that is what we call learned non use, that's a treatment by Dr Edward Taub, and then we start to rely on our good arm and it's a use it or lose it brain, the good arm gets better and the weak arm, if there was anything left in the area gets weaker. And what he did is he literally put a sling on the good arm and forced people to incrementally use their bad arms and what we find in brain scans is that areas around the harmed area, areas around the injured area of the stroke take over for those cells.

Natasha Mitchell: Interestingly from a psychoanalytic perspective you point to the presence and persistence of childhood conflicts as being explainable in terms of plasticity and you talk about unmasking some of those older experiences.

Norman Doidge: Right, people often say what's the use of talking about the past. Well sometimes it can be counter-productive but often it's

productive because when we've had an early childhood trauma development doesn't stop, it proceeds at a pace but in a slightly distorted way. And those old damaged networks are still there, I describe in detail a case of a man who came to me in his late 50s who couldn't form any relationships and he had trouble with alcohol, he couldn't be faithful to people he cared about. And we traced it back to the death of his mother when he was I think about 26 months old. Well it turned out all of those events were registered in his brain but they were kind of obscured by later development.

    Unmasking basically means there were pathways laid down earlier on that are no longer used as extensively but they are still there. The way to think about it is this. One of the ways we can create plastic change is rediscovering old pathways, so for instance if there is a road from Melbourne to Sydney and for some reason or other the bridge is washed out, what the commuters are going to begin to do is to find old pathways, they are not as efficient, they take you a bit out of their way and those old buried pathways can often give rise in patients to neurotic symptoms, but they can also be retraced and revivified and then changed when revivified.

    One of the things we know, and this is a very important point, in general about neuroplastic change, we've discovered that when you remembered something you revivify a particular network and it enters a state—it goes from being kind of consolidated and difficult to change to once remembered a more plastic state again. And so we now understand why it's important to remember, we know that we know the chemical pathways that are involved, and this is in some ways very promising because there are new treatments, many treatments now where we treat post-traumatic stress disorder which is a great example of a disorder that teaches us about plasticity. Someone is doing fine then they get in a car accident or someone holds them up and they have a kind of nervous breakdown, to use a very old fashioned term, which actually I think makes a lot of sense.They can't function well nervously and they can't separate past from present and so on and so forth. And we get them in a very safe condition and in all sorts of different ways we then try to get them to remember the aspects of the accident piece by piece and while they are remembering in a safe place they can begin to rewire their brains and put it behind them.

Natasha Mitchell: Talking about evidence, though, you're using some of these principles in your own therapeutic work with patients and clients asa psychoanalyst, is it too early to be translating some of these ideas into working with the neuroses that people have about their own lives, pasts, presence and futures?

Norman Doidge: Well I think these are early days but already I think I've certainly—look one of the most important things it's not too early to do is

really to change the attitude. Again it used to be thought that development is really child development or an adolescent development, when they talked about adult development it was usually something like we enter a stage where we accept we're going to die and we want to pass on what we know to other people. It was to a degree the counsel of despair and the idea was that as you develop you start to lose brain cells but hopefully you can be wise and recognise important patterns. But there really is such a thing as adult development, it is really much more possible than we ever believed. And that has major implications for psychotherapy including changing longstanding habits.

    I've learned a lot from people who do rehab as to how to practise psychotherapy, how to sort of set up road blocks so that they don't develop certain kinds of grooves and behaviour which get worse and worse and the role of new behaviours.

Natasha Mitchell: There's always the risk of neurobabble though entering the clinic. And there is a lot of neurobabble out there. Neuro has become a prefix for everything—that's risky, isn't it because people are really prone to believing neurobabble? If neuroscience says this is the right way to go about things then it must be right.

Norman Doidge: Yeah, but it's not just neurobabble, I mean just as you shop around carefully for when you're buying a stereo, when you're looking for a good book on neuroscience, or when you're looking for a good clinic, you've got to really try to educate yourself. But the fact is

anybody who has a brain who does anything that is involved in the brain could lay claim to being a practitioner of neuroplasticity. I reserve that

term for people who have extended our knowledge of the field. But sure, people will be climbing on this band wagon and it'll be abused and simplified and misunderstood but that much being said I think I owed it to people to say look, we've been too negative about this and understand the limits of plasticity and what's possible and you can probably do a lot more than you thought you could.

Natasha Mitchell: An optimistic view of your malleable mind with psychiatrist Dr Norman Doidge author of The Brain That Changes Itself. He's my guest today on All in the Mind on ABC Radio National. I'm Natasha Mitchell going global on Radio Australia, online and as podcast

You suggest that even though our brain is very plastic, in fact we're getting into plastic traps, and also interestingly there is a great plastic paradox that you name which has some therapeutic consequences.

Norman Doidge: One of the most important things I learned when I stood back from all the research was what I call the plastic paradox, and it's this in a sentence—that the same brain that gives rise to so many flexible behaviours also gives rise to our rigid ones, many of our bad habits etc. and that's because plasticity is competitive and you establish a network, it gets efficient and then it kind of bullies out the other networks. And its plasticity is like snow on a hill in winter, if we're going to ski down that hill because the snow is plastic and pliable we can take many different paths down that hill, not an infinite number, there are rocks here and trees over there. And if we had a good pass down the first time, being human we will tend to favour a path close to that the second and third times and then because the snow is pliable and plastic we'll develop tracks which become ruts and we can get stuck in them, brain lock. And they get worse and many of the neuroplastic treatments basically find ways of setting up road blocks, so that you can get out of those ruts and learn about new pathways and grow new pathways etc.

Natasha Mitchell: Is there any one story, in fact you did a world tour, didn't you of neuroplasticians as you called them, people who were working

to research on and reveal the dimensions of our plastic brain. Is there any one story that is sort of emblematic of how exciting this all this?

Norman Doidge: I'm very moved by the work of Paul Bach-y-Rita. Paul Bach-y-Rita because he really was the first of his generation to argue for

plasticity and he had a very, very personal kind of story and then he did just amazing work showing that our senses are plastic. His father, Pedro

Bach-y-Rita was a cattle importer and a very independent man and when he was in his late 60s he had a devastating stroke and he went for the

usual rehab and at the end of it he basically couldn't move and the doctors called his son, George Bach-y-Rita, who was a medical student at the time to find a place for him to spend the rest of his life as an invalid. George, his son, had no preconceived notions of rehabilitation so he just took him down to where he was studying medicine to Mexico and he basically got him on the ground and said Papa, you learn to walk by first learning

to crawl as a baby, we're going to get you to do that. He got him down to do that and once he could do that he got him to do it against a wall outside with lifting one hand on the wall so that he was now just on three limbs and the neighbours looked in and said it was unseemly what the boy was doing to his Papa. And gradually he got him standing up and then using the same kinds of incremental principals Pedro Bach-y-Rita taught himself to type by lifting his arm and smashing it down on the typewriter, then smashing just the wrist and then one finger at a time. By the end of about a year of this he was actually functioning, he'd been a widower, he'd remarried, he started teaching again, and seven years later was climbing a mountain in Bogot·, Columbia, and he collapsed with a heart attack. And he was brought back and at this point it was now Paul Bach-y-Rita's turn to take over and he ordered an autopsy on his father. And this is where it really gets interesting because a couple of days later he was called down to the pathology lab and there on the table spread before him were slices of his father's brain.

Natasha Mitchell: Amazing.

Norman Doidge: And he was of course numb and shocked, but he saw something in those slices. What he saw was the original lesion caused by the stroke, 97% to 98% of parts of the brain and the tracks of the parts of the brain involved in movement were still obviously damaged and this meant one thing to Paul Bach-y-Rita, it meant that the work Papa had done with his brother so many years before had recruited new areas to take over these movements. So Paul Bach-y-Rita was then launched as a champion of what he called late brain plasticity. And late brain is important not just because it can help elderly people who have had strokes but it means that plasticity exists from cradle to grave and he invented these utterly unique inventions which allowed people who had had loss of sensory capacities to rewire them.

    And I open the book with this remarkable story of a women who is perpetually falling cause her balance system was wiped out by a drug and an

atherogenic problem or just a bad side effect, and he learned how to rewire her brain so that she could get the balance input, it sounds bizarre,

through her tongue. And she was able to be completely recovered. And he used similar mechanisms teaching people who had been blind since birth to see for the first time—it's really, really remarkable.

Natasha Mitchell: Seeing through sensations in their skin, effectively their skin becomes their seeing organ not the damaged bit of their visual

brain, which is remarkable.

Norman Doidge: Yes, it's quite remarkable to go and see a man who's completely blind take a basketball and sink it, getting this input through a

camera which is then going through the part of the brain that is involved in touch which we now know then the brain finds a way to connect up

more to the visual cortex. So unfortunately Paul Bach-y-Rita recently passed away just as all of his prophetic work was beginning to be believed.

Natasha Mitchell: Because he was a maverick for so long, wasn't he?

Norman Doidge: He was a great creative visionary, and so I have a special place in my heart for him.

Natasha Mitchell: Have you been, in documenting all these stories of people with stroke recovering, of people with half a brain living a complete life, by no means with not half a mind with a full mind in half a brain. Have you been flooded with letters and emails from people whose brains have been possibly compromised and they therefore had a sort of compromised experience, they want solutions, they want cures?

Norman Doidge: Yes I have. And some people can be helped, but I'm just one guy and so I encourage people to go to the book as I've put what I know about plasticity into the book, and those people can you know generally be contacted. Yeah, it's been remarkable. One of the noble things about being a physician is sometimes you're willing to tell people, you're willing to say the thing that no one else wants to say. If you really truly think a person is dying, or you really truly think that they have a deficit that can't be dealt with, doctors say so and it's not because they are just gloomy figures, but if they are not going to tell the truth who is? You know people have to sometimes get their affairs in order, they have to know what they are dealing with to mobilize themselves, deal with it, grieve and go on. But the problem is of course we have to be very well informed about what isn't possible, and because of our theory and our model of the brain underestimated , its capacities, many mistakes have been made. And because we didn't know enough about plasticity we didn't know how to conduct rehab as effectively as we are now learning how to do.

    You know when I started out in medicine, rehab and I mean to insult nobody, but rehab was a very, very depressing thing and in some ways it

seemed like an intellectual backwater because people are working with a brain that can't change and so on and so forth. You can imagine that that

becomes a self fulfilling prophecy and indeed it did. But now with the work of the neuroplasticians I think rehab is one of the most exciting parts of medicine and that is as it should be.

Natasha Mitchell: Norman Doidge where does this leave all those 'just so' stories that are still subscribed to by many, that we possess a

hunter/gatherer brain, a brain whose essential form and function evolved millennia ago?

Norman Doidge: Well that's interesting. It's true that we possess a brain that evolved in the Serengeti and has hunter/gatherer components. But one of the things that our hunter/gatherer forebears evolved to be was particularly plastic, and that means that there is not just Darwinian evolution thatwe have to think about, but we have to think about our own individual neuroplastic evolution. Each of us as individuals have changing brains over the course of our lives You know, the map of your face in your brain, if we were to remap it three weeks from now is different than it is today. And your brain's maps are going to be determined by what you do in a day to day way. So the great gift of our hunter/gatherer forebears was a gift that gives us an extraordinary ability to become individuals in many ways.

    And so it's not all genetically determined in that sense, or another way to put it would be the human genetic inheritance includes plasticity. Our

genes have two kind of fundamental properties, one of them is something that is not easily in our control—well it's not in our control—which is

that they replicate themselves and so we're born with a certain set of genes. Nothing much at this point that we can do about that but the other aspect of...

Natasha Mitchell: We can switch them on and off though according to how we live our life.

Norman Doidge: Yes, that's right. The other aspect of genes is they're turned on and off all the time. When you go to sleep some are turned on and others are turned off and when you wake in the morning other switches are thrown. But it turns out that thoughts also throw these switches and this gives us a lot more control. So against the genetic determinism I would say the following: it turns out that neuroplasticity by showing that consciousness changes brain structure leaves an important place for free will in human functioning. Look it's never, it's never with the rarest of exceptions either nature or nurture. We evolved to be nurtured, it's always how much nature and how much nurture and neuroplasticity in a way is about self-nurture.

Natasha Mitchell: Norman Doidge, congratulations on the book and thank you for joining me on the program.

Norman Doidge: Thank you so much.

Natasha Mitchell: And a reminder that Dr Norman Doidge's book The Brain That Changes Itself is published in Australia by Scribe. More info

on the All in the Mindwebsite along with our email and the downloadable audio of the last two shows on matters plastic, and by midweek a

transcript. Check out the All in the Mind blog too—read it, post to it and participate, all at abc.net.au/rn/allinthemind. My thanks to producer Anita Barraud, I'm Natasha Mitchell. Next week, sceptical thinking.

Guests

Dr Norman Doidge

Psychiatrist

Center for Psychoanalytic Training and Research

Columbia University, New York.

& Department of Psychiatry

University of Toronto, Canada

http://www.normandoidge.com/

Publications

Title: The Brain that Changes Itself: Stories of Personal Triumph from Frontiers of Brain Science

Author: Norman Doidge, M.D

Publisher: Scribe, 2007

ISBN: 978192125827

Jeffrey Schwartz

Associate Research Professor of Psychiatry

School of Medicine

University of California Los Angeles

Los Angeles

http://www.psychiatry.ucla.edu/

Title: The Mind and the Brain: Neuroplasticity & the power of mental force

Author: Jeffrey Schwartz and Sharon Begley

Publisher: Regan Books, 2002

ISBN 0-06-039355

Title: Quantum Physics in neuroscience & psychology : A neurophysical model of mind-brain interaction

Author: Schwartz J.M, Stapp H.P, Beauregard M.

Publisher: Philos Trans R Soc Lond B Biol Sci. 2005 Jun 29;360(1458):1309-27

URL: http://www.ncbi.nlm.nih.gov/pubmed/16147524

All In The Mind - 13 September 2008 - Part 1 of 2: The Power of Plasticity http://www.abc.net.au/rn/allinthemind/stories/2008/2359328.htm#transcript