The Brain That Changes Itself
Stories of Personal Triumph from the Frontiers of Brain Science
NORMAN DOIDGE, M.D.
For Eugene L. Goldberg, M.D., because you said you might like to read it
Contents
1 A Woman Perpetually Falling . . .
Rescued by the Man Who Discovered the Plasticity of Our Senses
2 Building Herself a Better Brain
A Woman Labeled "Retarded" Discovers How to Heal Herself
3 Redesigning the Brain
A Scientist Changes Brains to Sharpen Perception and Memory, Increase
Speed of Thought, and Heal Learning Problems
4 Acquiring Tastes and Loves
What Neuroplasticity Teaches Us About Sexual Attraction and Love
5 Midnight Resurrections
Stroke Victims Learn to Move and Speak Again
6 Brain Lock Unlocked
Using Plasticity to Stop Worries, OPsessions, Compulsions, and Bad Habits
7 Pain
The Dark Side of Plasticity
8 Imagination
How Thinking Makes It So
9 Turning Our Ghosts into Ancestors
Psychoanalysis as a Neuroplastic Therapy
10 Rejuvenation
The Discovery of the Neuronal Stem Cell and Lessons for Preserving Our
Brains
11 More than the Sum of Her Parts
A Woman Shows Us How Radically Plastic the Brain Can Be
Appendix 1
The Culturally Modified Brain
Appendix 2
Plasticity and the Idea of Progress
Note to the Reader
All the names of people who have undergone neuroplastic transformations are
real, except in the few places indicated, and in the cases of children and their
families.
The Notes and References section at the end of the book includes comments on
both the chapters and the appendices.
Preface
This book is about the revolutionary discovery that the human brain can change
itself, as told through the stories of the scientists, doctors, and patients who have
together brought about these astonishing transformations. Without operations or
medications, they have made use of the brain's hitherto unknown ability to
change. Some were patients who had what were thought to be incurable brain
problems; others were people without specific problems who simply wanted to
improve the functioning of their brains or preserve them as they aged. For four
hundred years this venture would have been inconceivable because mainstream
medicine and science believed that brain anatomy was fixed.
The common wisdom was that after childhood the brain changed only when it
began the long process of decline; that when brain cells failed to develop properly,
or were injured, or died, they could not be replaced. Nor could the brain ever
alter its structure and find a new way to function if part of it was damaged. The
theory of the unchanging brain decreed that people who were born with brain or
mental limitations, or who sustained brain damage, would be limited or damaged
for life.
Scientists who wondered if the healthy brain might be improved or preserved
through activity or mental exercise were told not to waste their time, A
neurological nihilism — a sense that treatment for many brain problems was
ineffective or even unwarranted — had taken hold, and it spread through our
culture, even stunting our overall view of human nature. Since the brain could
not change, human nature, which emerges from it, seemed necessarily fixed and
unalterable as well.
The belief that the brain could not change had three major sources: the fact that
brain-damaged patients could so rarely make full recoveries; our inability to
observe the living brain's microscopic activities; and the idea — dating back to the
beginnings of modern science — that the brain is like a glorious machine. And
while machines do many extraordinary things, they don't change and grow.
I became interested in the idea of a changing brain because of my work as a
research psychiatrist and psychoanalyst. When patients did not progress
psychologically as much as hoped, often the conventional medical wisdom was
that their problems were deeply "hardwired" into an unchangeable brain.
"Hardwiring" was another machine metaphor coming from the idea of the brain
as computer hardware, with permanently connected circuits, each designed to
perform a specific, unchangeable function.
When I first heard news that the human brain might not be hardwired, I had to
investigate and weigh the evidence for myself. These investigations took me far
from my consulting room.
I began a series of travels, and in the process I met a band of brilliant scientists,
at the frontiers of brain science, who had, in the late 1960s or early 1970s, made a
series of unexpected discoveries. They showed that the brain changed its very
structure with each different activity it performed, perfecting its circuits so it was
better suited to the task at hand. If certain "parts" failed, then other parts could
sometimes take over. The machine metaphor, of the brain as an organ with
specialized parts, could not fully account for changes the scientists were seeing.
They began to call this fundamental brain property "neuroplasticity."
Neuro is for "neuron," the nerve cells in our brains and nervous systems.
Plastic is for "changeable, malleable, modifiable." At first many of the scientists
didn't dare use the word "neuroplasticity" in their publications, and their peers
belittled them for promoting a fanciful notion. Yet they persisted, slowly
overturning the doctrine of the unchanging brain. They showed that children are
not always stuck with the mental abilities they are born with; that the damaged
brain can often reorganize itself so that when one part fails, another can often
substitute; that if brain cells die, they can at times be replaced; that many
"circuits" and even basic reflexes that we think are hardwired are not. One of
these scientists even showed that thinking, learning, and acting can turn our
genes on or off, thus shaping our brain anatomy and our behavior — surely one of
the most extraordinary discoveries of the twentieth century.
In the course of my travels I met a scientist who enabled people who had been
blind since birth to begin to see, another who enabled the deaf to hear; I spoke
with people who had had strokes decades before and had been declared incurable,
who were helped to recover with neuroplastic treatments; I met people whose
learning disorders were cured and whose IQs were raised; I saw evidence that it is
possible for eighty-year-olds to sharpen their memories to function the way they
did when they were fifty-five. I saw people rewire their brains with their thoughts,
to cure previously incurable obsessions and traumas. I spoke with Nobel
laureates who were hotly debating how we must rethink our model of the brain
now that we know it is ever changing.
The idea that the brain can change its own structure and function through
thought and activity is, I believe, the most important alteration in our view of the
brain since we first sketched out its basic anatomy and the workings of its basic
component, the neuron. Like all revolutions, this one will have profound effects,
and this book, I hope, will begin to show some of them. The neuroplastic
revolution has implications for, among other things, our understanding of how
love, sex, grief, relationships, learning, addictions, culture, technology, and
psychotherapies change our brains. All of the humanities, social sciences, and
physical sciences, insofar as they deal with human nature, are affected, as are all
forms of training. All of these disciplines will have to come to terms with the fact
of the self-changing brain and with the realization that the architecture of the
brain differs from one person to the next and that it changes in the course of our
individual lives.
While the human brain has apparently underestimated itself, neuroplasticity isn't
all good news; it renders our brains not only more resourceful but also more
vulnerable to outside influences. Neuroplasticity has the power to produce more
flexible but also more rigid behaviors — a phenomenon I call "the plastic
paradox." Ironically, some of our most stubborn habits and disorders are
products of our plasticity. Once a particular plastic change occurs in the brain
and becomes well established, it can prevent other changes from occurring. It is
by understanding both the positive and negative effects of plasticity that we can
truly understand the extent of human possibilities.
Because a new word is useful for those who do a new thing, I call the practitioners
of this new science of changing brains "neuroplasticians." What follows is the
story of my encounters with them and the patients they have transformed.
Chapter 1
A Woman Perpetually Falling . . .
Rescued by the Man Who Discovered the Plasticity of Our Senses
And they saw the voices. Exodus 20:18
Cheryl Schiltz feels like she's perpetually falling. And because she feels like she's
falling, she falls.
When she stands up without support, she looks, within moments, as if she were
standing on a precipice, about to plummet. First her head wobbles and tilts to one
side, and her arms reach out to try to stabilize her stance. Soon her whole body is
moving chaotically back and forth, and she looks like a person walking a
tightrope in that frantic seesaw moment before losing his balance — except that
both her feet are firmly planted on the ground, wide apart. She doesn't look like
she is only afraid of falling, more like she's afraid of being pushed.
"You look like a person teetering on a bridge," I say, "Yeah, I feel I am going to
jump, even though I don't want to." Watching her more closely, I can see that as
she tries to stand still, she jerks, as though an invisible gang of hoodlums were
pushing and shoving her, first from one side, then from another, cruelly trying to
knock her over. Only this gang is actually inside her and has been doing this to
her for five years. When she tries to walk, she has to hold on to a wall, and still
she staggers like a drunk.
For Cheryl there is no peace, even after she's fallen to the floor, "What do you feel
when you've fallen?" I ask her. "Does the sense of falling go away once you've
landed?"
"There have been times," says Cheryl, "when I literally lose the sense of the
feeling of the floor ... and an imaginary trapdoor opens up and swallows me."
Even when she has fallen, she feels she is still falling, perpetually, into an infinite
abyss.
Cheryl's problem is that her vestibular apparatus, the sensory organ for the
balance system, isn't working. She is very tired, and her sense that she is in free
fall is driving her crazy because she can't think about anything else. She fears the
future. Soon after her problem began, she lost her job as an international sales
representative and now lives on a disability check of $1,000 a month. She has a
newfound fear of growing old. And she has a rare form of anxiety that has no
name.
An unspoken and yet profound aspect of our well-being is based on having a
normally functioning sense of balance. In the 1930s the psychiatrist Paul Schilder
studied how a healthy sense of being and a "stable" body image are related to the
vestibular sense. When we talk of "feeling settled" or "unsettled," "balanced" or
"unbalanced," "rooted" or "rootless," "grounded" or "ungrounded," we are
speaking a vestibular language, the truth of which is fully apparent only in people
like Cheryl. Not surprisingly, people with her disorder often fall to pieces
psychologically, and many have committed suicide.
We have senses we don't know we have — until we lose them; balance is one that
normally works so well, so seamlessly, that it is not listed among the five that
Aristotle described and was overlooked for centuries afterward.
The balance system gives us our sense of orientation in space. Its sense organ, the
vestibular apparatus, consists of three semicircular canals in the inner ear that
tell us when we are upright and how gravity is affecting our bodies by detecting
motion in three-dimensional space. One canal detects movement in the
horizontal plane, another in the vertical plane, and another when we are moving
forward or backward. The semicircular canals contain little hairs in a fluid bath.
When we move our head, the fluid stirs the hairs, which send a signal to our
brains telling us that we have increased our velocity in a particular direction.
Each movement requires a corresponding adjustment of the rest of the body. If
we move our heads forward, our brains tell an appropriate segment of our bodies
to adjust, unconsciously, so that we can offset that change in our center of gravity
and maintain our balance. The signals from the vestibular apparatus go along a
nerve to a specialized clump of neurons in our brain, called the "vestibular
nuclei," which process them, then send commands to our muscles to adjust
themselves. A healthy vestibular apparatus also has a strong link to our visual
system. When you run after a bus, with your head bouncing up and down as you
race forward, you are able to keep that moving bus at the center of your gaze
because your vestibular apparatus sends messages to your brain, telling it the
speed and direction in which you are running. These signals allow your brain to
rotate and adjust the position of your eyeballs to keep them directed at your
target, the bus.
I am with Cheryl, and Paul Bach-y-Rita, one of the great pioneers in
understanding brain plasticity, and his team, in one of his labs. Cheryl is hopeful
about today's experiment and is stoical but open about her condition. Yuri
Danilov, the team biophysicist, does the calculations on the data they are
gathering on Cheryl's vestibular system. He is Russian, extremely smart, and has
a deep accent. He says, "Cheryl is patient who has lost vestibular system —
ninety-five to one hundred percent."
By any conventional standard, Cheryl's case is a hopeless one. The conventional
view sees the brain as made up of a group of specialized processing modules,
genetically hardwired to perform specific functions and those alone, each
developed and refined over millions of years of evolution. Once one of them is
this damaged, it can't be replaced. Now that her vestibular system is damaged,
Cheryl has as much chance of regaining her balance as a person whose retina has
been damaged has of seeing again.
But today all that is about to be challenged.
She is wearing a construction hat with holes in the side and a device inside it
called an accelerometer. Licking a thin plastic strip with small electrodes on it,
she places it on her tongue. The accelerometer in the hat sends signals to the strip,
and both are attached to a nearby computer. She laughs at the way she looks in
the hat, "because if I don't laugh I will cry."
This machine is one of Bach-y-Rita's bizarre-looking prototypes. It will replace
her vestibular apparatus and send balance signals to her brain from her tongue.
The hat may reverse Cheryl's current nightmare. In 1997 after a routine
hysterectomy, Cheryl, then thirty-nine years old, got a postoperative infection
and was given the antibiotic gentamicin. Excessive use of gentamicin is known to
poison the inner ear structures and can be responsible for hearing loss (which
Cheryl doesn't have), ringing in the ears (which she does), and devastation to the
balance system. But because gentamicin is cheap and effective, it is still
prescribed, though usually for only a brief period of time. Cheryl says she was
given the drug way beyond the limit. And so she became one of a small tribe of
gentamicin's casualties, known among themselves as Wobblers.
Suddenly one day she discovered she couldn't stand without falling. She'd turn
her head, and the whole room would move. She couldn't figure out if she or the
walls were causing the movement. Finally she got to her feet by hanging on to the
wall and reached for the phone to call her doctor.
When she arrived at the hospital, the doctors gave her various tests to see if her
vestibular function was working. They poured freezing-cold and warm water into
her ears and tilted her on a table. When they asked her to stand with her eyes
closed, she fell over. A doctor told her, "You have no vestibular function." The
tests showed she had about 2 percent of the function left.
"He was," she says, "so nonchalant. 'It looks like a side effect of the gentamicin.'"
Here Cheryl gets emotional. "Why in the world wasn't I told about that? 'It's
permanent,' he said. I was alone. My mother had taken me to the doctor, but she
went off to get the car and was waiting for me outside the hospital. My mother
asked, 'Is it going to be okay?' And I looked at her and said, 'It's permanent... this
is never going to go away'"
Because the link between Cheryl's vestibular apparatus and her visual system is
damaged, her eyes can't follow a moving target smoothly. "Everything I see
bounces like a bad amateur video," she says. "It's as though everything I look at
seems made of Jell-O, and with each step I take, everything wiggles."
Although she can't track moving objects with her eyes, her vision is all she has to
tell her that she is upright. Our eyes help us know where we are in space by fixing
on horizontal lines. Once when the lights went out, Cheryl immediately fell to the
floor. But vision proves an unreliable crutch for her, because any kind of
movement in front of her — even a person reaching out to her — exacerbates the
falling feeling. Even zigzags on a carpet can topple her, by initiating a burst of
false messages that make her think she's standing crookedly when she's not.
She suffers mental fatigue, as well, from being on constant high alert. It takes a
lot of brain power to maintain an upright position — brain power that is taken
away from such mental functions as memory and the ability to calculate and
reason.
While Yuri is readying the computer for Cheryl, I ask to try the machine. I put on
the construction worker's hat and slip into my mouth the plastic device with
electrodes on it, called a tongue display. It is flat, no thicker than a stick of
chewing gum.
The accelerometer, or sensor, in the hat detects movement in two planes. As I
nod my head, the movement is translated onto a map on the computer screen
that permits the team to monitor it.
The same map is projected onto a small array of 144 electrodes implanted in the
plastic strip on my tongue. As I tilt forward, electric shocks that feel like
champagne bubbles go off on the front of my tongue, telling me that I am
bending forward. On the computer screen I can see where my head is. As I tilt
back, I feel the champagne swirl in a gentle wave to the back of my tongue. The
same happens when I tilt to the sides. Then I close my eyes and experiment with
finding my way in space with my tongue. I soon forget that the sensory
information is coming from my tongue and can read where I am in space.
Cheryl takes the hat back; she keeps her balance by leaning against the table.
"Let's begin," says Yuri, adjusting the controls.
Cheryl puts on the hat and closes her eyes. She leans back from the table, keeping
two fingers on it for contact. She doesn't fall, though she has no indication
whatsoever of what is up and down except the swirling of the champagne bubbles
over her tongue. She lifts her fingers from the table. She's not wobbling anymore.
She starts to cry — the flood of tears that comes after a trauma; she can open up
now that she has the hat on and feels safe. The first time she put on the hat, the
sense of perpetual falling left her — for the first time in five years. Her goal today
is to stand, free, for twenty minutes, with the hat on, trying to keep centered. For
anyone — not to mention a Wobbler — to stand straight for twenty minutes
requires the training and skill of a guard at Buckingham Palace.
She looks peaceful. She makes minor corrections. The jerking has stopped, and
the mysterious demons that seemed to be inside her, pushing her, shoving her,
have vanished. Her brain is decoding signals from her artificial vestibular
apparatus. For her, these moments of peace are a miracle — a neuroplastic
miracle, because somehow these tingling sensations on her tongue, which
normally make then way to the part of the brain called the sensory cortex — the
thin layer on the surface of the brain that processes the sense of touch — are
making their way, through a novel pathway in the brain, to the brain area that
processes balance.
"We are now working on getting this device small enough so that it is hidden in
the mouth," says Bach-y-Rita, "like an orthodontist's mouth retainer. That's our
goal. Then she, and anyone with this problem, will have a normal life restored.
Someone like Cheryl should be able to wear the apparatus, talk, and eat without
anyone knowing she has it.
"But this isn't just going to affect people damaged by gentamicin," he continues.
"There was an article in The New York Times yesterday on falls in the elderly.
Old people are more frightened of falling than of being mugged, A third of the
elderly fall, and because they fear falling, they stay home, don't use their limbs,
and become more physically frail. But I think part of the problem is that the
vestibular sense — just like hearing, taste, eyesight, and our other senses — starts
to weaken as we age. This device will help them."
"It's time," says Yuri, turning off the machine.
Now comes the second neuroplastic marvel. Cheryl removes the tongue device
and takes off the hat. She gives a big grin, stands free with her eyes closed, and
doesn't fall. Then she opens her eyes and, still not touching the table, lifts one
foot off the ground, so she's balancing on the other.
"I love this guy," she says, and goes over and gives Bach-y-Rita a hug. She comes
over to me. She's overflowing with emotion, overwhelmed by feeling the world
under her feet again, and she gives me a hug too.
"I feel anchored and solid. I don't have to think where my muscles are. I can
actually think of other things." She returns to Yuri and gives him a kiss.
"I have to emphasize why this is a miracle," says Yuri, who considers himself a
data-driven skeptic. "She has almost no natural sensors. For the past twenty
minutes we provided her with an artificial sensor. But the real miracle is what is
happening now that we have removed the device, and she doesn't have either an
artificial or a natural vestibular apparatus. We are awakening some kind of force
inside her."
The first time they tried the hat, Cheryl wore it for only a minute. They noticed
that after she took it off, there was a "residual effect" that lasted about twenty
seconds, a third of the time she wore the device. Then Cheryl wore the hat for two
minutes and the residual effect lasted about forty seconds. Then they went up to
about twenty minutes, expecting a residual effect of just under seven minutes.
But instead of lasting a third of the time, it lasted triple the time, a full hour.
Today, Bach-y-Rita says, they are experimenting to see if twenty more minutes on
the device will lead to some kind of training effect, so that the residual effect will
last even longer.
Cheryl starts clowning and showing off. "I can walk like a woman again. That's
probably not important to most people, but it means a lot that I don't have to
walk with my feet wide apart now."
She gets up on a chair and jumps off. She bends down to pick things up off the
floor, to show she can right herself. "Last time I did this I was able to jump rope
in the residual time."
"What is amazing," says Yuri, "is that she doesn't just keep her posture. After
some time on the device, she behaves almost normally. Balancing on a beam.
Driving a car. It is the recovery of the vestibular function. When she moves her
head, she can keep her focus on her target — the link between the visual and
vestibular systems is also recovered."
I look up, and Cheryl is dancing with Bach-y-Rita. She leads.
How is it that Cheryl can dance and has returned to normal functioning without
the machine? Bach-y-Rita thinks there are several reasons. For one, her damaged
vestibular system is disorganized and "noisy," sending off random signals. Thus,
noise from the damaged tissue blocks any signals sent by healthy tissue. The
machine helps to reinforce the signals from her healthy tissues. He thinks the
machine also helps recruit other pathways, which is where plasticity comes in. A
brain system is made of many neuronal pathways, or neurons that are connected
to one another and working together. If certain key pathways are blocked, then
the brain uses older pathways to go around them. "I look at it this way," says
Bach-y-Rita. "If you are driving from here to Milwaukee, and the main bridge
goes out, first you are paralyzed. Then you take old secondary roads through the
farmland. Then, as you use these roads more, you find shorter paths to use to get
where you want to go, and you start to get there faster." These "secondary" neural
pathways are "unmasked," or exposed, and, with use, strengthened. This
"unmasking" is generally thought to be one of the main ways the plastic brain
reorganizes itself.
The fact that Cheryl is gradually lengthening the residual effect suggests that the
unmasked pathway is getting stronger. Bach-y-Rita hopes that Cheryl, with
training, will be able to continue extending the length of the residual effect.
A few days later an e-mail for Bach-y-Rita arrives from Cheryl, her report from
home about how long the residual time lasted. "Total residual time was: 3 hours,
20 minutes... The wobbling begins in my head — just like usual... I am having
trouble finding words ... Swimming feeling in my head. Tired, exhausted ...
Depressed."
A painful Cinderella story. Coming down from normalcy is very hard. When it
happens, she feels she has died, come to life, and then died again. On the other
hand, three hours and twenty minutes after only twenty minutes on the machine
is residual time ten times greater than the time on the device. She is the first
Wobbler ever to have been treated, and even if the residual time never grows
longer, she could now wear the device briefly four times a day and have a normal
life. But there is good reason to expect more, since each session seems to be
training her brain to extend the residual time. If this keeps up...
. . . It did keep up. Over the next year Cheryl wore the device more frequently to
get relief and build up her residual effect. Her residual effect progressed to
multiple hours, to days, and then to four months. Now she does not use the
device at all and no longer considers herself a Wobbler.
In 1969, Nature, Europe's premier science journal, published a short article that
had a distinctly sci-fi feel about it. Its lead author, Paul Bach-y-Rita, was both a
basic scientist and a rehabilitation physician — a rare combination. The article
described a device that enabled people who had been blind from birth to see. All
had damaged retinas and had been considered completely untreatable.
The Nature article was reported in The New York Times, Newsweek, and
Life, but perhaps because the claim seemed so implausible, the device and its
inventor soon slipped into relative obscurity.
Accompanying the article was a picture of a bizarre-looking machine — a large
old dentist's chair with a vibrating back, a tangle of wires, and bulky computers.
The whole contraption, made of castaway parts combined with 1960s electronics,
weighed four hundred pounds.
A congenitally blind person — someone who had never had any experience of
sight — sat in the chair, behind a large camera the size of those used in television
studios at the time. He "scanned" a scene in front of him by turning hand cranks
to move the camera, which sent electrical signals of the image to a computer that
processed them. Then the electrical signals were conveyed to four hundred
vibrating stimulators, arranged in rows on a metal plate attached to the inside of
the chair back, so the stimulators rested against the blind subject's skin. The
stimulators functioned like pixels vibrating for the dark part of a scene and
holding still for the brighter shades. This "tactile-vision device," as it was called,
enabled blind subjects to read, make out faces and shadows, and distinguish
which objects were closer and which farther away. It allowed them to discover
perspective and observe how objects seem to change shape depending upon the
angle from which they were viewed. The six subjects of the experiment learned to
recognize such objects as a telephone, even when it was partially obscured by a
vase. This being the 1960s, they even learned to recognize a picture of the
anorexic supermodel Twiggy.
Everyone who used the relatively clunky tactile-vision device had a remarkable
perceptual experience, as they went from having tactile sensations to "seeing"
people and objects.
With a little practice, the blind subjects began to experience the space in front of
them as three-dimensional, even though the information entered from the twodimensional array on their backs. If someone threw a ball toward the camera, the
subject would automatically jump back to duck it. If the plate of vibrating
stimulators was moved from their backs to their abdomens, subjects still
accurately perceived the scene as happening in front of the camera. If tickled near
the stimulators, they didn't confuse the tickle with a visual stimulus. Their mental
perceptual experience took place not on the skin surface but in the world. And
their perceptions were complex. With practice, subjects could move the camera
around and say things like "That is Betty; she is wearing her hair down today and
does not have her glasses on; her mouth is open, and she is moving her right
hand from her left side to the back of her head," True, the resolution was often
poor, but as Bach-y-Rita would explain, vision doesn't have to be perfect to be
vision. "When we walk down a foggy street and see the outline of a building," he
would ask, "are we seeing it any less for the lack of resolution? When we see
something in black and white, are we not seeing it for lack of color?"
This now-forgotten machine was one of the first and boldest applications of
neuroplasticity — an attempt to use one sense to replace another — and it worked.
Yet it was thought implausible and ignored because the scientific mind-set at the
time assumed that the brain's structure is fixed, and that our senses, the avenues
by which experience gets into our minds, are hardwired. This idea, which still has
many adherents, is called "localizationism." It's closely related to the idea that the
brain is like a complex machine, made up of parts, each of which performs a
specific mental function and exists in a genetically predetermined or hardwired
location — hence the name. A brain that is hardwired, and in which each mental
function has a strict location, leaves little room for plasticity.
The idea of the machinelike brain has inspired and guided neuro-science since it
was first proposed in the seventeenth century, replacing more mystical notions
about the soul and the body. Scientists, impressed by the discoveries of Galileo
(1564-1642), who showed that the planets could be understood as inanimate
bodies moved by mechanical forces, came to believe that all nature functioned as
a large cosmic clock, subject to the laws of physics, and they began to explain
individual living things, including our bodily organs, mechanistically, as though
they too were machines. This idea that all nature was like a vast mechanism, and
that our organs were machinelike, replaced the two-thousand-year-old Greek
idea that viewed all nature as a vast living organism, and our bodily organs as
anything but inanimate mechanisms. But the first great accomplishment of this
new "mechanistic biology" was a brilliant and original achievement.
William Harvey (1578-1657), who studied anatomy in Padua, Italy, where Galileo
lectured, discovered how our blood circulates through our bodies and
demonstrated that the heart functions like a pump, which is, of course, a simple
machine. It soon seemed to many scientists that for an explanation to be
scientific it had to be mechanistic — that is, subject to the mechanical laws of
motion.
Following Harvey, the French philosopher Rene Descartes (1596-1650) argued
that the brain and nervous system also functioned like a pump. Our nerves were
really tubes, he argued, that went from our limbs to the brain and back. He was
the first person to theorize how reflexes work, proposing that when a person is
touched on the skin, a fluidlike substance in the nerve tubes flows to the brain
and is mechanically "reflected" back down the nerves to move the muscles. As
crude as it sounds, he wasn't so far off. Scientists soon refined his primitive
picture, arguing that not some fluid but an electric current moved through the
nerves. Descartes's idea of the brain as a complex machine culminated in our
current idea of the brain as a computer and in localizationism. Like a machine,
the brain came to be seen as made of parts, each one in a preassigned location,
each performing a single function, so that if one of those parts was damaged,
nothing could be done to replace it; after all, machines don't grow new parts.
Localizationism was applied to the senses as well, theorizing that each of our
senses — sight, hearing, taste, touch, smell, balance — has a receptor cell that
specializes in detecting one of the various forms of energy around us. When
stimulated, these receptor cells send an electric signal along their nerve to a
specific brain area that processes that sense. Most scientists believed that these
brain areas were so specialized that one area could never do the work of another.
Almost in isolation from his colleagues, Paul Bach-y-Rita rejected these
localizationist claims. Our senses have an unexpectedly plastic nature, he
discovered, and if one is damaged, another can sometimes take over for it, a
process he calls "sensory substitution." He developed ways of triggering sensory
substitution and devices that give us "supersenses." By discovering that the
nervous system can adapt to seeing with cameras instead of retinas, Bach-y-Rita
laid the groundwork for the greatest hope for the blind: retinal implants, which
can be surgically inserted into the eye.
Unlike most scientists, who stick to one field, Bach-y-Rita has become an expert
in many — medicine, psychopharmacology, ocular neurophysiology (the study of
eye muscle), visuall neurophysiology (the study of sight and the nervous system),
and biomedical engineering. He follows ideas wherever they take him. He speaks
five languages and has lived for extended periods in Italy, Germany, France,
Mexico, Sweden, and throughout the United States. He has worked in the labs of
major scientists and Nobel Prize winners, but he has never much cared what
others thought and doesn't play the political games that many researchers do in
order to get ahead. After becoming a physician, he gave up medicine and
switched to basic research. He asked questions that seemed to defy common
sense, such as, "Are eyes necessary for vision, or ears for hearing, tongues for
tasting, noses for smelling?" And then, when he was forty-four years old, his
mind ever restless, he switched back to medicine and began a medical residency,
with its endless days and sleepless nights, in one of the dreariest specialties of all:
rehabilitation medicine. His ambition was to turn an intellectual backwater into a
science by applying to it what he had learned about plasticity.
Bach-y-Rita is a completely unassuming man. He is partial to five-dollar suits and
wears Salvation Army clothes whenever his wife lets him get away with it. He
drives a rusty twelve-year-old car, his wife a new model Passat.
He has a full head of thick, wavy gray hair, speaks softly and rapidly, has the
darkish skin of a Mediterranean man of Spanish and Jewish ancestry, and
appears a lot younger than his sixty-nine years. He's obviously cerebral but
radiates a boyish warmth toward his wife, Esther, a Mexican of Mayan descent.
He is used to being an outsider. He grew up in the Bronx, was four foot ten when
he entered high school because of a mysterious disease that stunted his growth
for eight years, and was twice given a preliminary diagnosis of leukemia. He was
beaten up by the larger students every day and during those years developed an
extraordinarily high pain threshold. When he was twelve, his appendix burst, and
the mysterious disease, a rare form of chronic appendicitis, was properly
diagnosed. He grew eight inches and won his first fight.
We are driving through Madison, Wisconsin, his home when he's not in Mexico.
He is devoid of pretension, and after many hours of our talking together, he lets
only one even remotely self-congratulatory remark leave his lips.
"I can connect anything to anything." He smiles.
"We see with our brains, not with our eyes," he says.
This claim runs counter to the commonsensical notion that we see with our eyes,
hear with our ears, taste with our tongues, smell with our noses, and feel with our
skin. Who would challenge such facts? But for Bach-y-Rita, our eyes merely sense
changes in light energy; it is our brains that perceive and hence see.
How a sensation enters the brain is not important to Bach-y-Rita. ''When a blind
man uses a cane, he sweeps it back and forth, and has only one point, the tip,
feeding him information through the skin receptors in the hand, Yet this
sweeping allows him to sort out where the doorjamb is, or the chair, or
distinguish a foot when he hits it, because it will give a little. Then he uses this
information to guide himself to the chair to sit down. Though his hand sensors
are where he gets the information and where the cane 'interfaces' with him, what
he subjectively perceives is not the cane's pressure on his hand but the layout
of the room: chairs, walls, feet, the three-dimensional space. The actual receptor
surface in the hand becomes merely a relay for information, a data port. The
receptor surface loses its identity in the process,"
Bach-y-Rita determined that skin and its touch receptors could substitute for a
retina, because both the skin and the retina are two-dimensional sheets, covered
with sensory receptors, that allow a "picture" to form on them.
It's one thing to find a new data port, or way of getting sensations to the brain.
But it's another for the brain to decode these skin sensations and turn them into
pictures. To do that, the brain has to learn something new, and the part of the
brain devoted to processing touch has to adapt to the new signals. This
adaptability implies that the brain is plastic in the sense that it can reorganize its
sensory-perceptual system.
If the brain can reorganize itself, simple localizationism cannot be a correct image
of the brain. At first even Bach-y-Rita was a localizationist, moved by its brilliant
accomplishments. Serious localizationism was first proposed in 1861, when Paul
Broca, a surgeon, had a stroke patient who lost the ability to speak and could
utter only one word. No matter what he was asked, the poor man responded,
"Tan, tan." When he died, Broca dissected his brain and found damaged tissue in
the left frontal lobe. Skeptics doubted that speech could be localized to a single
part of the brain until Broca showed them the injured tissue, then reported on
other patients who had lost the ability to speak and had damage in the same
location. That place came to be called "Broca's area" and was presumed to
coordinate the movements of the muscles of the lips and tongue. Soon afterward
another physician, Carl Wernicke, connected damage in another brain area
farther back to a different problem: the inability to understand language.
Wernicke proposed that the damaged area was responsible for the mental
representations of words and comprehension. It came to be known as
"Wernicke's area." Over the next hundred years localizationism became more
specific as new research refined the brain map.
Unfortunately, though, the case for localizationism was soon exaggerated. It went
from being a series of intriguing correlations (observations that damage to
specific brain areas led to the loss of specific mental functions) to a general theory
that declared that every brain function had only one hardwired location — an idea
summarized by the phrase "one function, one location," meaning that if a part
was damaged, the brain could not reorganize itself or recover that lost function.
A dark age for plasticity began, and any exceptions to the idea of "one function,
one location" were ignored. In 1868 Jules Cotard studied children who had early
massive brain disease, in which the left hemisphere (including Broca's area)
wasted away. Yet these children could still speak normally. This meant that even
if speech tended to be processed in the left hemisphere, as Broca claimed, the
brain might be plastic enough to reorganize itself, if necessary. In 1876 Otto
Soltmann removed the motor cortex from infant dogs and rabbits — the part of
the brain thought to be responsible for movement — yet found they were still able
to move. These findings were submerged in the wave of localizationist
enthusiasm.
Bach-y-Rita came to doubt localizationism while in Germany in the early 1960s.
He had joined a team that was studying how vision worked by measuring with
electrodes electrical discharge from the visual processing area of a cat's brain.
The team fully expected that when they showed the cat an image, the electrode in
its visual processing area would send off an electric spike, showing it was
processing that image. And it did. But when the cat's paw was accidentally
stroked, the visual area also fired, indicating that it was processing touch as well.
And they found that the visual area was also active when the cat heard sounds.
Bach-y-Rita began to think that the localizationist idea of "one function, one
location" couldn't be right. The "visual" part of the cat's brain was processing at
least two other functions, touch and sound. He began to conceive of much of the
brain as "polysensory" — that its sensory areas were able to process signals from
more than one sense.
This can happen because all our sense receptors translate different kinds of
energy from the external world, no matter what the source, into electrical
patterns that are sent down our nerves. These electrical patterns are the universal
language "spoken" inside the brain — there are no visual images, sounds, smells,
or feelings moving inside our neurons. Bach-y-Rita realized that the areas that
process these electrical impulses are far more homogeneous than neuroscientists
appreciated, a belief that was reinforced when the neuroscientist Vernon
Mountcastle discovered that the visual, auditory, and sensory cortices all have a
similar six-layer processing structure. To Bach-y-Rita, this meant that any part of
the cortex should be able to process whatever electrical signals were sent to it,
and that our brain modules were not so specialized after all.
Over the next few years Bach-y-Rita began to study all the exceptions to
localizationism. With his knowledge of languages, he delved into the untranslated,
older scientific literature and rediscovered scientific work done before the more
rigid versions of localizationism had taken hold. He discovered the work of
Marie-Jean-Pierre Flourens, who in the 1820s showed that the brain could
reorganize itself. And he read the oft-quoted but seldom translated work of Broca
in French and found that even Broca had not closed the door to plasticity as his
followers had.
The success of his tactile-vision machine further inspired Bach-y-Rita to reinvent
his picture of the human brain. After all, it was not his machine that was the
miracle, but the brain that was alive, changing, and adapting to new kinds of
artificial signals. As part of the reorganization, he guessed that signals from the
sense of touch (processed initially in the sensory cortex, near the top of the brain)
were rerouted to the visual cortex at the back of the brain for further processing,
which meant that any neuronal paths that ran from the skin to the visual cortex
were undergoing development.
Forty years ago, just when localization's empire had extended to its furthest
reaches, Bach-y-Rita began his protest. He praised localization's
accomplishments but argued that "a large body of evidence indicates that the
brain demonstrates both motor and sensory plasticity." One of his papers was
rejected for publication six times by journals, not because the evidence was
disputed but because he dared to put the word "plasticity" in the title. After his
Nature article came out, his beloved mentor, Ragnar Granit, who had received
the Nobel Prize in physiology in 1965 for his work on the retina, and who had
arranged for the publication of Bach-y-Rita's medical school thesis, invited him
over for tea. Granit asked his wife to leave the room and, after praising Bach-yRita's work on the eye muscles, asked him — for his own good — why he was
wasting his time with "that adult toy." Yet Bach-y-Rita persisted and began to lay
out, in a series of books and several hundred articles, the evidence for brain
plasticity and to develop a theory to explain how it might work.
Bach-y-Rita's deepest interest became explaining plasticity, but he continued to
invent sensory-substitution devices. He worked with engineers to shrink the
dentist-chair-computer-camera device for the blind. The clumsy, heavy plate of
vibrating stimulators that had been attached to the back has now been replaced
by a paper-thin strip of plastic covered with electrodes, the diameter of a silver
dollar, that is slipped onto the tongue, The tongue is what he calls the ideal
"brain-machine interface," an excellent entry point to the brain because it has no
insensitive layer of dead skin on it. The computer too has shrunk radically, and
the camera that was once the size of a suitcase now can be worn strapped to the
frame of eyeglasses.
He has been working on other sensory-substitution inventions as well. He
received NASA funding to develop an electronic "feeling" glove for astronauts in
space. Existing space gloves were so thick that it was hard for the astronauts to
feel small objects or perform delicate movements. So on the outside of the glove
he put electric sensors that relayed electrical signals to the hand. Then he took
what he learned making the glove and invented one to help people with leprosy,
whose illness mutilates the skin and destroys peripheral nerves so that the lepers
lose sensation in their hands. This glove, like the astronaut's glove, had sensors
on the outside, and it sent its signals to a healthy part of the skin — away from the
diseased hands — where the nerves were unaffected. That healthy skin became
the portal of entry for hand sensations. He then began work on a glove that would
allow blind people to read computer screens, and he even has a project for a
condom that he hopes will allow spinal cord injury victims who have no feeling in
their penises to have orgasms. It is based on the premise that sexual excitement,
like other sensory experiences, is "in the brain," so the sensations of sexual
movement, picked up by sensors on the condom, can be translated into electrical
impulses that can then be transmitted to the part of the brain that processes
sexual excitement. Other potential uses of his work include giving people
"supersenses," such as infrared or night vision. He has developed a device for the
Navy SEALs that helps them sense how their bodies are oriented underwater, and
another, successfully tested in France, that tells surgeons the exact position of a
scalpel by sending signals from an electronic sensor attached to the scalpel to a
small device attached to their tongues and to their brains.
The origin of Bach-y-Rita's understanding of brain rehabilitation lies in the
dramatic recovery of his own father, the Catalan poet and scholar Pedro Bach-yRita, after a disabling stroke. In 1959 Pedro, then a sixty-five-year-old widower,
had a stroke that paralyzed his face and half of his body and left him unable to
speak.
George, Paul's brother, now a psychiatrist in California, was told that his father
had no hope of recovery and would have to go into an institution. Instead, George,
then a medical student in Mexico, brought his paralyzed father from New York,
where he lived, back to Mexico to live with him. At first he tried to arrange
rehabilitation for his father at the American British Hospital, which offered only a
typical four-week rehab, as nobody believed the brain could benefit from
extended treatment. After four weeks his father was nowhere near better. He was
still helpless and needed to be lifted onto and off the toilet and showered, which
George did with the help of the gardener.
"Fortunately, he was a little man, a hundred and eighteen pounds, and we could
manage him," says George.
George knew nothing about rehabilitation, and his ignorance turned out to be a
godsend, because he succeeded by breaking all its current rules, unencumbered
by pessimistic theories.
"I decided that instead of teaching my father to walk, I was going to teach him
first to crawl. I said, 'You started off crawling, you are going to have to crawl
again for a while.' We got kneepads for him. At first we held him on all fours, but
his arms and legs didn't hold him very well, so it was a struggle." As soon as
Pedro could support himself somewhat, George then got him to crawl with his
weak shoulder and arm supported by a wall. "That crawling beside the wall went
on for months. After that I even had him practicing in the garden, which led to
problems with the neighbors, who were saying it wasn't nice, it was unseemly, to
be making the professor crawl like a dog. The only model I had was how babies
learn. So we played games on the floor, with me rolling marbles, and him having
to catch them. Or we'd throw coins on the floor, and he'd have to try and pick
them up with his weak right hand. Everything we tried involved turning normal
life experiences into exercises. We turned washing pots into an exercise. He'd
hold the pot with his good hand and make his weak hand — it had little control
and made spastic jerking movements — go round and round, fifteen minutes
clockwise, fifteen minutes counterclockwise. The circumference of the pot kept
his hand contained.
There were steps, each one overlapping with the one before, and little by little he
got better. After a while he helped to design the steps. He wanted to get to the
point where he could sit down and eat with me and the other medical students."
The regime took many hours every day, but gradually Pedro went from crawling,
to moving on his knees, to standing, to walking,
Pedro struggled with his speech on his own, and after about three months there
were signs it too was coming back. After a number of months he wanted to
resume his writing. He would sit in front of the typewriter, his middle finger over
the desired key, then drop his whole arm to strike it. When he had mastered that,
he would drop just the wrist, and finally the fingers, one at a time. Eventually he
learned to type normally again.
At the end of a year his recovery was complete enough for Pedro, now sixty-eight,
to start full-time teaching again at City College in New York. He loved it and
worked until he retired at seventy. Then he got another teaching job at San
Francisco State, remarried, and kept working, hiking, and traveling. He was
active for seven more years after his stroke. On a visit to friends in Bogota,
Colombia, he went climbing high in the mountains. At nine thousand feet he had
a heart attack and died shortly thereafter. He was seventy-two.
I asked George if he understood how unusual this recovery was so long after his
father's stroke and whether he thought at the time that the recovery might have
been the result of brain plasticity.
"I just saw it in terms of taking care of Papa. But Paul, in subsequent years, talked
about it in terms of neuroplasticity. Not right away, though. It wasn't until after
our father died."
Pedro's body was brought to San Francisco, where Paul was working. It was 1965,
and in those days, before brain scans, autopsies were routine because they were
one way doctors could learn about brain diseases, and about why a patient died.
Paul asked Dr. Mary Jane Aguilar to perform the autopsy.
"A few days later Mary Jane called me and said, 'Paul, come down. I've got
something to show you.' When I got to the old Stanford Hospital, there, spread
out on the table, were slices of my father's brain on slides."
He was speechless.
"I was feeling revulsion, but I could also see Mary Jane's excitement, because
what the slides showed was that my father had had a huge lesion from his stroke
and that it had never healed, even though he recovered all those functions. I
freaked out. I got numb. I was thinking, 'Look at all this damage he has.' And she
said, 'How can you recover with all this damage?'"
When he looked closely, Paul saw that his father's seven-year-old lesion was
mainly in the brain stem — the part of the brain closest to the spinal cord — and
that other major brain centers in the cortex that control movement had been
destroyed by the stroke as well. Ninety-seven percent of the nerves that run from
the cerebral cortex to the spine were destroyed — catastrophic damage that had
caused his paralysis.
"I knew that meant that somehow his brain had totally reorganized itself with the
work he did with George. We didn't know how remarkable his recovery was until
that moment, because we had no idea of the extent of his lesion, since there were
no brain scans in those days. When people did recover, we tended to assume that
there really hadn't been much damage in the first place. She wanted me to be a
coauthor on the paper she wrote about his case. I couldn't."
His father's story was firsthand evidence that a "late" recovery could occur even
with a massive lesion in an elderly person. But after examining that lesion and
reviewing the literature, Paul found more evidence that the brain can reorganize
itself to recover functions after devastating strokes, discovering that in 1915 an
American psychologist, Shepherd Ivory Franz, had shown that patients who had
been paralyzed for twenty years were capable of making late recoveries with
brain-stimulating exercises.
His father's "late recovery" triggered a career change for Bach-y-Rita. At fortyfour, he went back to practicing medicine and did residencies in neurology and
rehabilitation medicine. He understood that for patients to recover they needed
to be motivated, as his father had been, with exercises that closely approximated
real-life activities. He turned his attention to treating strokes, focusing on "late
rehabilitation)" helping people overcome major neurological problems years after
they'd begun, and developing computer video games to train stroke patients to
move their arms again. And he began to integrate what he knew about plasticity
into exercise design. Traditional rehabilitation exercises typically ended after a
few weeks, when a patient stopped improving, or plateaued, and doctors lost the
motivation to continue. But Bach-y-Rita, based on his knowledge of nerve growth,
began to argue that these learning plateaus were temporary — part of a plasticitybased learning cycle — in which stages of learning are followed by periods of
consolidation. Though there was no apparent progress in the consolidation
stage, biological changes were happening internally, as new skills became more
automatic and refined.
Bach-y-Rita developed a program for people with damaged facial motor nerves,
who could not move their facial muscles and so couldn't close their eyes, speak
properly, or express emotion, making them look like monstrous automatons.
Bach-y-Rita had one of the "extra" nerves that normally goes to the tongue
surgically attached to a patient's facial muscles. Then he developed a program of
brain exercises to train the "tongue nerve" (and particularly the part of the brain
that controls it) to act like a facial nerve. These patients learned to express
normal facial emotions, speak, and close their eyes — one more instance of Bachy-Rita's ability to "connect anything to anything."
Thirty-three years after Bach-y-Rita's Nature article, scientists using the small
modern version of his tactile-vision machine have put patients under brain scans
and confirmed that the tactile images that enter patients through their tongues
are indeed processed in their brains' visual cortex.
All reasonable doubt that the senses can be rewired was recently put to rest in
one of the most amazing plasticity experiments of our time. It involved rewiring
not touch and vision pathways, as Bach-y-Rita had done, but those for hearing
and vision — literally.
Mriganka Sur, a neuroscientist, surgically rewired the brain of a very young ferret.
Normally the optic nerves run from the eyes to the visual cortex, but Sur
surgically redirected the optic nerves from the ferret's visual to its auditory
(hearing) cortex and discovered that the ferret learned to see. Using electrodes
inserted into the ferret's brain, Sur proved that when the ferret was seeing, the
neurons in its auditory cortex were firing and doing the visual processing. The
auditory cortex, as plastic as Bach-y-Rita had always imagined, had reorganized
itself, so that it had the structure of the visual cortex. Though the ferrets that had
this surgery did not have 20/20 vision, they had about a third of that, or 20/60 —
no worse than some people who wear eyeglasses.
Till recently, such transformations would have seemed utterly inexplicable. But
Bach-y-Rita, by showing that our brains are more flexible than localizationism
admits, has helped to invent a more accurate view of the brain that allows for
such changes. Before he did this work, it was acceptable to say, as most
neuroscientists do, that we have a "visual cortex" in our occipital lobe that
processes vision, and an "auditory cortex" in our temporal lobe that processes
hearing.
From Bach-y-Rita we have learned that the matter is more complicated and that
these areas of the brain are plastic processors, connected to each other and
capable of processing an unexpected variety of input.
Cheryl has not been the only one to benefit from Bach-y-Rita's strange hat. The
team has since used the device to train fifty more patients to improve their
balance and walking. Some had the same damage Cheryl had; others have had
brain trauma, stroke, or Parkinson's disease.
Paul Bach-y-Rita's importance lies in his being the first of his generation of
neuroscientists both to understand that the brain is plastic and to apply this
knowledge in a practical way to ease human suffering. Implicit in all his work is
the idea that we are all born with a far more adaptable, all-purpose, opportunistic
brain than we have understood.
When Cheryl's brain developed a renewed vestibular sense — or blind subjects'
brains developed new paths as they learned to recognize objects, perspective, or
movement — these changes were not the mysterious exception to the rule but the
rule: the sensory cortex is plastic and adaptable.
When Cheryl's brain learned to respond to the artificial receptor that replaced her
damaged one, it was not doing anything out of the ordinary. Recently Bach-yRita's work has inspired cognitive scientist Andy Clark to wittily argue that we are
"natural-born cyborgs," meaning that brain plasticity allows us to attach
ourselves to machines, such as computers and electronic tools, quite naturally.
But our brains also restructure themselves in response to input from the simplest
tools too, such as a blind man's cane. Plasticity has been, after all, a property
inherent in the brain since prehistoric times. The brain is a far more open system
than we ever imagined, and nature has gone very far to help us perceive and take
in the world around us. It has given us a brain that survives in a changing world
by changing itself.
Chapter 2
Building Herself a Better Brain
A Woman Labeled "Retarded" Discovers How to Heal Herself
The scientists who make important discoveries about the brain are often those
whose own brains are extraordinary, working on those whose brains are damaged.
It is rare that the person who makes an important discovery is the one with the
defect, but there are some exceptions. Barbara Arrowsmith Young is one of these.
"Asymmetry" is the word that best describes her mind when she was a schoolgirl.
Born in Toronto in 1951 and raised in Peterborough, Ontario, Barbara had areas
of brilliance as a child — her auditory and visual memory both tested in the
ninety-ninth percentile. Her frontal lobes were remarkably developed, giving her
a driven, dogged quality. But her brain was "asymmetrical," meaning that these
exceptional abilities coexisted with areas of retardation.
This asymmetry left its chaotic handwriting on her body as well. Her mother
made a joke of it. "The obstetrician must have yanked you out by your right leg,"
which was longer than her left, causing her pelvis to shift. Her right arm never
straightened, her right side was larger than her left, her left eye less alert, Her
spine was asymmetrical and twisted with scoliosis.
She had a confusing assortment of serious learning disabilities.
The area of her brain devoted to speech, Broca's area, was not working properly,
so she had trouble pronouncing words. She also lacked the capacity for spatial
reasoning. When we wish to move our bodies in space, we use spatial reasoning
to construct an imaginary pathway in our heads before executing our movements.
Spatial reasoning is important for a baby crawling, a dentist drilling a tooth, a
hockey player planning his moves. One day when Barbara was three she decided
to play matador and bull. She was the bull, and the car in the driveway was the
matador's cape. She charged, thinking she would swerve and avoid it, but she
misjudged the space and ran into the car, ripping her head open. Her mother
declared she would be surprised if Barbara lived another year.
Spatial reasoning is also necessary for forming a mental map of where things are.
We use this kind of reasoning to organize our desks or remember where we have
left our keys. Barbara lost everything all the time. With no mental map of things
in space, out of sight was literally out of mind, so she became a "pile person" and
had to keep everything she was playing with or working on in front of her in piles,
and her closets and dressers open. Outdoors she was always getting lost.
She also had a "kinesthetic" problem. Kinesthetic perception allows us to be
aware of where our body or limbs are in space, enabling us to control and
coordinate our movements. It also helps us recognize objects by touch. But
Barbara could never tell how far her arms or legs had moved on her left side.
Though a tomboy in spirit, she was clumsy. She couldn't hold a cup of juice in her
left hand without spilling it. She frequently tripped or stumbled. Stairs were
treacherous. She also had a decreased sense of touch on her left and was always
bruising herself on that side. When she eventually learned to drive, she kept
denting the left side of the car. She had a visual disability as well. Her span of
vision was so narrow that when she looked at a page of writing, she could take in
only a few letters at a time.
But these were not her most debilitating problems. Because the part of her brain
that helps to understand the relationships between symbols wasn't functioning
normally, she had trouble understanding grammar, math concepts, logic, and
cause and effect. She couldn't distinguish between "the father's brother" and "the
brother's father." The double negative was impossible for her to decipher. She
couldn't read a clock because she couldn't understand the relationship between
the hands. She literally couldn't tell her left hand from her right, not only because
she lacked a spatial map but because she couldn't understand the relationship
between "left" and "right." Only with extraordinary mental effort and constant
repetition could she learn to relate symbols to one another.
She reversed b, d, q, and p, read "was" as "saw," and read and wrote from right
to left, a disability called mirror writing. She was right-handed, but because she
wrote from right to left, she smeared all her work. Her teachers thought she was
being obstreperous. Because she was dyslexic, she made reading errors that cost
her dearly. Her brothers kept sulfuric acid for experiments in her old nose-drops
bottle.
Once when she decided to treat herself for sniffles, Barbara misread the new label
they had written. Lying in bed with acid running into her sinuses, she was too
ashamed to tell her mother of yet another mishap.
Unable to understand cause and effect, she did odd things socially because she
couldn't connect behavior with its consequences. In kindergarten she couldn't
understand why, if her brothers were in the same school, she couldn't leave her
class and visit them in theirs whenever she wanted. She could memorize math
procedures but couldn't understand math concepts. She could recall that five
times five equals twenty-five but couldn't understand why. Her teachers
responded by giving her extra drills, and her father spent hours tutoring her, to
no avail. Her mother held up flash cards with simple math problems on them.
Because Barbara couldn't figure them out, she found a place to sit where the sun
made the paper translucent, so she could read the answers on the back. But the
attempts at remediation didn't get at the root of the problem; they just made it
more agonizing.
Wanting desperately to do well, she got through elementary school by
memorizing during lunch hours and after school. In high school her performance
was extremely erratic. She learned to use her memory to cover her deficits and
with practice could remember pages of facts. Before tests she prayed they would
be fact-based, knowing she could score 100; if they were based on understanding
relationships, she would probably score in the low teens.
Barbara understood nothing in real time, only after the fact, in lag time. Because
she did not understand what was happening around her while it was occurring,
she spent hours reviewing the past, to make its confusing fragments come
together and become comprehensible. She had to replay simple conversations,
movie dialogue, and song lyrics twenty times over in her head because by the
time she got to the end of a sentence, she could not recall what the beginning
meant.
Her emotional development suffered. Because she had trouble with logic, she
could not pick up inconsistencies when listening to smooth talkers and so she was
never sure whom to trust. Friendships were difficult, and she could not have
more than one relationship at a time.
But what plagued her most was the chronic doubt and uncertainty that she felt
about everything. She sensed meaning everywhere but could never verify it. Her
motto was "I don't get it." She told herself, "I live in a fog, and the world is no
more solid than cotton candy." Like many children with serious learning
disabilities, she began to think she might be crazy.
Barbara grew up in a time when little help was available.
"In the 1950s, in a small town like Peterborough, you didn't talk about these
things," she says. "The attitude was, you either make it or you don't. There were
no specialized teachers, no visits to medical specialists or psychologists. The term
'learning disabilities' wouldn't be widely used for another two decades. My gradeone teacher told my parents I had 'a mental block' and I wouldn't ever learn the
way others did. That was as specific as it got. You were either bright, average,
slow, or mentally retarded."
If you were mentally retarded, you were placed in "opportunity classes." But that
was not the place for a girl with a brilliant memory who could ace vocabulary
tests. Barbara's childhood friend Donald Frost, now a sculptor, says, "She was
under incredible academic pressure. The whole Young family were high achievers.
Her father, Jack, was an electrical engineer and inventor with thirty-four patents
for Canadian General Electric. If you could pull Jack from a book for dinner, it
was a miracle. Her mother, Mary, had the attitude: 'You will succeed; there is no
doubt,' and 'If you have a problem, fix it.' Barbara was always incredibly sensitive,
warm, and caring," Frost continues, "but she hid her problems well. It was hushhush. In the postwar years there was a sense of integrity that meant you didn't
draw attention to your disabilities any more than you would to your pimples."
Barbara gravitated toward the study of child development, hop-ins somehow to
sort things out for herself. As an undergraduate at the University of Guelph, her
great mental disparities were again apparent. But fortunately her teachers saw
that she had a remarkable ability to pick up nonverbal cues in the childobservation laboratory, and she was asked to teach the course. She felt there must
have been some mistake. Then she was accepted into graduate school at the
Ontario Institute for Studies in Education (OISE). Most students read a research
paper once or twice, but typically Barbara had to read one twenty times as well as
many of its sources to get even a fleeting sense of its meaning, She survived on
four hours of sleep a night.
Because Barbara was brilliant in so many ways, and so adept at child observation,
her teachers in graduate school had trouble believing she was disabled. It was
Joshua Cohen, another gifted but learning-disabled student at OISE, who first
understood. He ran a small clinic for learning-disabled kids that used the
standard treatment, "compensations," based on the accepted theory of the time;
once brain cells die or fail to develop, they cannot be restored. Compensations
work around the problem. People with trouble reading listen to audiotapes.
Those who are "slow" are given more time on tests. Those who have trouble
following an argument are told to color-code the main points. Joshua designed a
compensation program for Barbara, but she found it too time-consuming.
Moreover, her thesis, a study of learning-disabled children treated with
compensations at the OISE clinic, showed that most of them were not really
improving. And she herself had so many deficits that it was sometimes hard to
find healthy functions that could work around her deficits. Because she had had
such success developing her memory, she told Joshua she thought there must be
a better way.
One day Joshua suggested she look into some books by Aleksandr Luria that he'd
been reading. She tackled them, going over the difficult passages countless times,
especially a section in Luria's Basic Problems of Neurolinguistics about
people with strokes or wounds who had trouble with grammar, logic, and reading
clocks. Luria, born in 1902, came of age in revolutionary Russia. He was deeply
interested in psychoanalysis, corresponded with Freud, and wrote papers on the
psychoanalytic technique of "free association," in which patients say everything
that comes to mind. His goal was to develop objective methods to assess Freudian
ideas. While still in his twenties, he invented the prototype of the lie detector.
When the Great Purges of the Stalin era began, psychoanalysis became
scientianon grata, and Luria was denounced. He delivered a public
recantation, admitting to having made certain "ideological mistakes." Then, to
remove himself from view, he went to medical school.
But he had not totally finished with psychoanalysis. Without calling attention to
his work, he integrated aspects of the psycho-analytic method and of psychology
into neurology, becoming the founder of neuropsychology. His case histories,
instead of being brief vignettes focused on symptoms, described his patients at
length. As Oliver Sacks wrote, "Luria's case histories, indeed, can only be
compared to Freud's in their precision, their vitality, their wealth and depth of
detail." One of Luria's books, The Man with a Shattered World, was the
summary of, and commentary on, the diary of a patient with a very peculiar
condition.
At the end of May 1943 Comrade Lyova Zazetsky, a man who seemed like a boy,
came to Luria's office in the rehabilitation hospital where he was working.
Zazetsky was a young Russian lieutenant who had just been injured in the battle
of Smolensk, where poorly equipped Russians had been thrown against the
invading Nazi war machine. He had sustained a bullet wound to the head, with
massive damage on the left side, deep inside his brain. For a long time he lay in a
coma. When Zazetsky awoke, his symptoms were very odd. The shrapnel had
lodged in the part of the brain that helped him understand relationships between
symbols. He could no longer understand logic, cause and effect, or spatial
relationships. He couldn't distinguish his left from his right. He couldn't
understand the elements of grammar dealing with relationships. Prepositions
such as "in," "out," "before," "after," "with," and 'without" had become
meaningless to him. He couldn't comprehend a whole word, understand a whole
sentence, or recall a complete memory because doing any of those things would
require relating symbols. He could grasp only fleeting fragments. Yet his frontal
lobes — which allowed him to seek out what is relevant and to plan, strategize,
form intentions, and pursue them — were spared, so he had the capacity to
recognize his defects, and the wish to overcome them, Though he could not read,
which is largely a perceptual activity, he could write, because it is an intentional
one. He began a fragmentary diary he called I'll Fight On that swelled to three
thousand pages. "I was killed March 2, 1943," he wrote, "but because of some
vital power of my organism, I miraculously remained alive."
Over thirty years Luria observed him and reflected on the way Zazetsky's wound
affected his mental activities, He would witness Zazetsky's relentless fight "to live,
not merely exist."
Reading Zazetsky's diary, Barbara thought "He is describing my life."
"I knew what the word? 'mother' and 'daughter' meant but not the expression
'mother's daughter,'" Zazetsky wrote. "The expressions 'mother's daughter' and
'daughter's mother' sounded just the same to me. I also had trouble with
expressions like 'Is an elephant bigger than a fly?' All I could figure out was that a
fly was small and an elephant is big, but I didn't understand the words 'bigger'
and 'smaller.'"
While watching a film, Zazetsky wrote, "before I've had a chance to figure out
what the actors are saying, a new scene begins."
Luria began to make sense of the problem. Zazetsky's bullet had lodged in the left
hemisphere, at the junction of three major perceptual areas where the temporal
lobe (which normally processes sound and language), the occipital lobe (which
normally processes visual images), and the parietal lobe (which normally
processes spatial relationships and integrates information from different senses)
meet. At this junction perceptual input from those three areas is brought together
and associated. While Zazetsky could perceive properly, Luria realized he could
not relate his different perceptions, or parts of things to wholes. Most important,
he had great difficulty relating a number of symbols to one another, as we
normally do when we think with words. Thus Zazetsky often spoke in
malapropisms. It was as though he didn't have a large enough net to catch and
hold words and their meanings, and he often could not relate words to their
meanings or definitions. He lived with fragments and wrote, 'I'm in a fog all the
time ... All that flashes through my mind are images . . hazy visions that suddenly
appear and just as suddenly disappear ... I simply can't understand or remember
what these mean."
For the first time, Barbara understood that her main brain deficit had an address.
But Luria did not provide the one thing she needed: a treatment. When she
realized how impaired she really was, she found herself more exhausted and
depressed and thought she could not go on this way. On subway platforms she
looked for a spot from which to jump for maximum impact.
It was at this point in her life, while she was twenty-eight and still in graduate
school, that a paper came across her desk. Mark Roseneig of the University of
California at Berkeley had studied rats in stimulating and nonstimulating
environments, and in postmortem exams he found that the brains of the
stimulated rats had more neurotransmitters, were heavier, and had better blood
supply than those from the less stimulating environments. He was one of the first
scientists to demonstrate neuroplasticity by showing that activity could produce
changes in the structure of the brain.
For Barbara, lightning struck. Rosenzweig had shown that the brain could be
modified. Though many doubted it, to her this meant that compensation might
not be the only answer. Her own breakthrough would be to link Rosenzweig's and
Luria's research.
She isolated herself and began toiling to the point of exhaustion, week after week
— with only brief breaks for sleep — at mental exercises she designed, though she
had no guarantee they would lead anywhere. Instead of practicing compensation,
she exercised her most weakened function — relating a number of symbols to
each other, One exercise involved reading hundreds of cards picturing clock faces
showing different times. She had Joshua Cohen write the correct time on the
backs. She shuffled the cards so she couldn't memorize the answers. She turned
up a card, attempted to tell the time, checked the answer, then moved on to the
next card as fast as she could. When she couldn't get the time right, she'd spend
hours with a real clock, turning the hands slowly, trying to understand why, at
2:45, the hour hand was three-quarters of the way toward the three.
When she finally started to get the answers, she added hands for
seconds and sixtieths of a second. At the end of many exhausting weeks, not only
could she read clocks faster than normal people, but she noticed improvements in
her other difficulties relating to symbols and began for the first time to grasp
grammar, math, and logic. Most important, she could understand what people
were saying as they said it. For the first time in her life, she began to live in real
time. Spurred on by her initial success, she designed exercises for her other
disabilities — her difficulties with space, her trouble with knowing where her
limbs were, and her visual disabilities — and brought them up to average level.
Barbara and Joshua Cohen married, and in 1980 they opened the Arrowsmith
School in Toronto. They did research together, and Barbara continued to develop
brain exercises and to run the school from day to day. Eventually they parted, and
Joshua died in 2000.
Because so few others knew about or accepted neuroplasticity or believed that the
brain might be exercised as though it were a muscle, there was seldom any
context in which to understand her work. She was viewed by some critics as
making claims — that learning disabilities were treatable — that couldn't be
substantiated. But far from being plagued by uncertainty, she continued to design
exercises for the brain areas and functions most commonly weakened in those
with learning disabilities. In these years before high-tech brain scans were
available, she relied on Luria's work to understand which areas or the brain
commonly processed which mental functions. Luria had formed his own map of
the brain by working with patients like Zazetsky. He observed where a soldier's
wound had occurred and related this location to the mental functions lost.
Barbara found that learning disorders were often milder versions of the thinking
deficits seen in Luria's patients. Applicants to the Arrowsmith School — children
and adults alike — undergo up to forty hours of assessments, designed to
determine precisely which brain functions are weak and whether they might be
helped. Accepted students, many of whom were distracted in regular schools, sit
quietly working at their computers. Some, diagnosed with attention-deficit as
well as learning disorders, were on Ritalin when they entered the school. As their
exercises progress, some can come off medication, because their attention
problems are secondary to their underlying learning disorders.
At the school, children who, like Barbara, had been unable to read a clock now
work at computer exercises reading mind-numbingly complex ten-handed clocks
(with hands not only for minutes, hours, and seconds but also for other time
divisions, such as days, months, years) in mere seconds. They sit quietly, with
intense concentration,
until they get enough answers right to progress to the nest level, when they shriek
out a loud "Yes!" and their computer screen lights up to congratulate them. By
the time they finish, they can read clocks far more complex than those any
"normal" person can read.
At other tables children are studying Urdu and Persian letters to strengthen their
visual memories. The shapes of these letters are unfamiliar, and the brain
exercise requires the students to learn to recognize these alien shapes quickly.
Other children, like little pirates, wear eye patches on their left eyes and diligently
trace intricate lines, squiggles, and Chinese letters with pens. The eye patch
forces visual input into the right eye, then to the side of the brain where they have
a problem. These children are not simply learning to write better. Most of them
come with three related problems: trouble speaking in a smooth, flowing way,
writing neatly, and reading. Barbara, following Luria, believes that all three
difficulties are caused by a weakness in the brain function that normally helps us
to coordinate and string together a number of movements when we perform
these tasks.
When we speak, our brain converts a sequence of symbols — the letters and
words of the thought — into a sequence of movements made by our tongue and
lip muscles. Barbara believes, again following Luria, that the part of the brain
that strings these movements together is the left premotor cortex of the brain. I
referred several people with a weakness in this brain function to the school. One
boy with this problem was always frustrated, because his thoughts came faster
than he could turn them into speech, and he would often leave out chunks of
information, have trouble finding words, and ramble. He was a very social person
yet could not express himself and so remained silent much of the time. When he
was asked a question in class, he often knew the answer but took such a painfully
long time to get it out that he appeared much less intelligent than he was, and he
began to doubt himself.
When we write a thought, our brain converts the words — which are symbols —
into movements of the fingers and hands. The same boy had very jerky writing
because his processing capacity for converting symbols into movements was
easily overloaded, so he had to write with many separate, small movements
instead of long, flowing ones. Even though he had been taught cursive writing, he
preferred to print. (As adults, people with this problem can often be identified
because they prefer to print or type. When we print, we make each letter
separately, with just a few pen movements, which is less demanding on the brain.
In cursive we write several letters at a time, and the brain must process more
complex movements.) Writing was especially painful for the boy, since he often
knew the right answers on tests but wrote so slowly that he couldn't get them all
down. Or he would think of one word, letter, or number but write another. These
children are often accused of being careless, but actually their over-loaded brains
fire the wrong motor movements.
Students with this disability also have reading problems. Normally when we read,
the brain reads part of a sentence, then directs the eyes to move the right distance
across the page to take in the next part of the sentence, requiring an ongoing
sequence of precise eye movements.
The boy's reading was very slow because he skipped words, lost his place, and
then lost his concentration. Reading was overwhelming and exhausting. On
exams he would often misread the question, and when he tried to proofread his
answers, he'd skip whole sections.
At the Arrowsmith School this boy's brain exercises involved tracing complex
lines to stimulate his neurons in the weakened pre-motor area. Barbara has
found that tracing exercises improve children in all three areas — speaking,
writing, and reading. By the time the boy graduated, he read above grade level
and could read for pleasure for the first time. He spoke more spontaneously in
longer, fuller sentences, and his writing improved.
At the school some students listen to CDs and memorize poems to improve their
weak auditory memories. Such children often forget instructions and are thought
to be irresponsible or lazy, when in fact they have a brain difficulty. Whereas the
average person can remember seven unrelated items (such as a seven-digit phone
number), these people can remember only two or three. Some take notes
compulsively, so they won t forget. In severe cases, they can't follow a song lyric
from beginning to end, and they get so overloaded they just tune out. Some have
difficulty remembering not only spoken language but even their own thoughts,
because thinking with language is slow. This deficit can be treated with exercises
in rote memorizing.
Barbara has also developed brain exercises for children who are socially clumsy
because they have a weakness in the brain function that would allow them to read
nonverbal cues. Other exercises are for those who have frontal lobe deficits and
who are impulsive or have problems planning, developing strategies, sorting out
what is relevant, forming goals, and sticking to them, They often appear
disorganized, flighty, and unable to learn from their mistakes. Barbara believes
that many people labeled "hysterical" or "antisocial" have weaknesses in this area.
The brain exercises are life-transforming. One American graduate told me that
when he came to the school at thirteen, his math and reading skills were still at a
third-grade level. He had been told after neuropsychological testing at Tufts
University that he would never improve. His mother had tried him in ten
different schools for students with learning disabilities, but none had helped.
After three years at Arrowsmith, he was reading and doing math at a tenth-grade
level. Now he has graduated from college and works in venture capital. Another
student came to Arrowsmith at sixteen reading at a first-grade level. His parents,
both teachers, had tried all the standard compensation techniques. After fourteen
months at Arrowsmith he is reading at a seventh-grade level.
We all have some weak brain functions, and such neuroplasticity-based
techniques have great potential to help almost everyone. Our weak spots can have
a profound effect on our professional success, since most careers require the use
of multiple brain functions. Barbara used brain exercises to rescue a talented
artist who had a first-rate drawing ability and sense of color but a weak ability to
recognize the shape of objects. (The ability to recognize shapes depends on a
brain function quite different from those functions required for drawing or seeing
color; it is the same skill that allows some people to excel at games like Where's
Waldo? Women are often better at it at than men, which is why men seem to have
more difficulty finding things in the refrigerator.)
Barbara also helped a lawyer, a promising litigator who, because of a Broca's area
pronunciation deficit, spoke poorly in court. Since expending the extra mental
effort to support a weak area seems to divert resources from strong areas, a
person with a Broca's problem may also find it harder to think while talking.
After practicing brain exercises focused on Broca's area, the lawyer went on to a
successful courtroom career.
The Arrowsmith approach, and the use of brain exercises generally, has major
implications for education. Clearly many children would benefit from a brainarea-based assessment to identify their weakened functions and a program to
strengthen them — a far more productive approach than tutoring that simply
repeats a lesson and leads to endless frustration. When "weak links in the chain"
are strengthened, people gain access to skills whose development was formerly
blocked, and they feel enormously liberated. A patient of mine, before he did the
brain exercises, had a sense that he was very bright but could not make full use of
his intelligence. For a long time I mistakenly thought his problems were based
primarily on psychological conflicts, such as a fear of competition, and buried
conflicts about surpassing his parents and siblings. Such conflicts did exist and
did hold him back. But I came to see that his conflict about learning — his wish to
avoid it — was based mostly on years of frustration and on a very legitimate fear
of failure based on his brain's limits. Once he was liberated from his difficulties
by Arrowsmith's exercises, his innate love of learning emerged full force.
The irony of this new discovery is that for hundreds of years educators did seem
to sense that children's brains had to be built up through exercises of increasing
difficulty that strengthened brain functions. Up through the nineteenth and early
twentieth centuries a classical education often included rote memorization of
long poems in foreign languages, which strengthened the auditory memory
(hence thinking in language) and an almost fanatical attention to handwriting,
which probably helped strengthen motor capacities and thus not only helped
handwriting but added speed and fluency to reading and speaking. Often a great
deal of attention was paid to exact elocution and to perfecting the pronunciation
of words. Then in the 1960s educators dropped such traditional exercises from
the curriculum, because they were too rigid, boring, and "not relevant." But the
loss of these drills has been costly; they may have been the only opportunity that
many students had to systematically exercise the brain function that gives us
fluency and grace with symbols, For the rest of us, their disappearance may have
contributed to the general decline of eloquence, which requires memory and a
level of auditory brainpower unfamiliar to us now. In the Lincoln-Douglas
debates of 1858 the debaters would comfortably speak for an hour or more
without notes, in extended memorized paragraphs; today many of the most
learned among us, raised in our most elite schools since the 1960s, prefer the
omnipresent PowerPoint presentation — the ultimate compensation for a weak
premotor cortex.
Barbara Arrowsmith Young's work compels us to imagine how much good might
be accomplished if every child had a brain-based assessment and, if problems
were found, a tailor-made program created to strengthen essential areas in the
early years, when neuroplasticity is greatest. It is far better to nip brain problems
in the bud than to allow the child to wire into his brain the idea that he is
"stupid," begin to hate school and learning, and stop work in the weakened area,
losing whatever strength he may have. Younger children often progress more
quickly through brain exercises than do adolescents, perhaps because in an
immature brain the number of connections among neurons, or synapses, is 50
percent greater than in the adult brain. When we reach adolescence, a massive
"pruning back" operation begins in the brain, and synaptic connections and
neurons that have not been used extensively suddenly die off — a classic case of
"use it or lose it." It is probably best to strengthen weakened areas while all this
extra cortical real estate is available. Still, brain-based assessments can be helpful
all through school and even in college and university, when many students who
did well in high school fail because their weak brain functions are overloaded by
the increased demand. Even apart from these crises, every adult could benefit
from a brain-based cognitive assessment, a cognitive fitness test, to help them
better understand their own brain.
It's been years since Mark Rosenzweig first did the rat experiments that inspired
Barbara and showed her that enriched environments and stimulation lead the
brain to grow. Over the years his labs and others have shown that stimulating the
brain makes it grow in almost every conceivable way. Animals raised in enriched
environments — surrounded by other animals, objects to explore, toys to roll,
ladders to climb, and running wheels — learn better than genetically identical
animals that have been reared in impoverished environments. Acetylcholine, a
brain chemical essential for learning, is higher in rats trained on difficult spatial
problems than in rats trained on simpler problems. Mental training or life in
enriched environments increases brain weight by 5 percent in the cerebral cortex
of animals and up to 9 percent in areas that the training directly stimulates.
Trained or stimulated neurons develop 25 percent more branches and increase
their size, the number of connections per neuron, and their blood supply. These
changes can occur late in life, though they do not develop as rapidly in older
animals as in younger ones. Similar effects of training and enrichment on brain
anatomy have been seen in all types of animals tested to date.
For people, postmortem examinations have shown that education increases the
number of branches among neurons. An increased number of branches drives the
neurons farther apart, leading to an increase in the volume and thickness of the
brain. The idea that the brain is like a muscle that grows with exercise is not just
a metaphor.
Some things can never be put together again. Lyova Zazetsky's diaries remained
mostly a series of fragmented thoughts till the end. Aleksandr Luria, who figured
out the meaning of those fragments, could not really help him. But Zazetsky's life
story made it possible for Barbara Arrowsmith Young to heal herself and now
others.
Today Barbara Arrowsmith Young is sharp and funny, with no noticeable
bottlenecks in her mental processes. She flows from one activity to the next, from
one child to the next, a master of many skills.
She has shown that children with learning disabilities can often go beyond
compensations and correct their underlying problem. Like all brain exercise
programs, hers work best and most quickly for people with only a few areas of
difficulty, But because she has developed exercises for so many brain
dysfunctions, she is often able to help children with multiple learning disabilities
— children like herself, before she built herself a better brain.
Chapter 3
Redesigning the Brain
A Scientist Changes Brains to Sharpen Perception and Memory, Increase Speed
of Thought, and Heal Learning Problems
Michael Merzenich is a driving force behind scores of neuroplastic innovations
and practical inventions, and I am on the road to Santa Rosa, California, to find
him. His is the name most frequently praised by other neuroplasticians, and he's
by far the hardest to track down. Only when I found out that he would be at a
conference in Texas, went there, and sat myself down beside him, was I finally
able to set up a meeting in San Francisco. "Use this e-mail address," he says.
"And if you don't respond again?" "Be persistent."At the last minute, he switches
our meeting to his villa in Santa Rosa. Merzenich is worth the search.
The Irish neuroscientist Ian Robertson has described him as "the world's leading
researcher on brain plasticity." Merzenich's specialty is improving people's ability
to think and perceive by redesigning the brain by training specific processing
areas, called brain maps, so that they do more mental work. He has also, perhaps
more than any other scientist, shown in rich scientific detail how our brainprocessing areas change.
This villa in the Santa Rosa hills is where Merzenich slows down and regenerates
himself. This air, these trees, these vineyards, seem like a piece of Tuscany
transplanted into North America. I spend the night here with him and his family,
and then in the morning we are off to his lab in San Francisco.
Those who work with him call him "Merz," to rhyme with "whirs" and "stirs." As
he drives his small convertible to meetings — he's been double-booked much of
the afternoon — his gray hair flies in the wind, and he tells me that many of his
most vivid memories, in this, the second half of his life — he's sixty-one — are of
conversations about scientific ideas. I hear him pour them into his cell phone, in
his crackling voice. As we pass over one of San Francisco's glorious bridges, he
pays a toll he doesn't have to because he's so involved with the concepts we are
discussing. He has dozens of collaborations and experiments all going on at once
and has started several companies. He describes himself as "just this side of
crazy." He is not, but he is an interesting mix of intensity and informality. He was
born in Lebanon, Oregon, of German stock, and though his name is Teutonic and
his work ethic unrelenting, his speech is West Coast, easygoing, down-to-earth.
Of neuroplasticians with solid hard-science credentials, it is Merzenich who has
made the most ambitious claims for the field: that brain exercises may be as
useful as drugs to treat diseases as severe as schizophrenia; that
plasticity exists from the cradle to the grave; and that radical
improvements in cognitive functioning — how we learn, think,
perceive, and remember — are possible even in the elderly. His latest
patents are for techniques that show promise in allowing adults to learn language
skills, without effortful memorization. Merzenich argues that practicing a new
skill, under the right conditions, can change hundreds of millions and possibly
billions of the connections between the nerve cells in our brain maps.
If you are skeptical of such spectacular claims, keep in mind that they come from
a man who has already helped cure some disorders that were once thought
intractable. Early in his career Merzenich developed, along with his group, the
most commonly used design for the cochlear implant, which allows congenitally
deaf children to hear. His current plasticity work helps learning-disabled
students improve their cognition and perception. These techniques — his series
of plasticity-based computer programs, Fast ForWord — have already helped
hundreds of thousands. Fast ForWord is disguised as a children's game. What
is amazing about it is how quickly the change occurs. In some cases people who
have had a lifetime of cognitive difficulties get better after only thirty to sixty
hours of treatment. Unexpectedly, the program has also helped a number of
autistic children.
Merzenich claims that when learning occurs in a way consistent with the laws
that govern brain plasticity, the mental "machinery" of the brain can be improved
so that we learn and perceive with greater precision, speed, and retention.
Clearly when we learn, we increase what we know. But Merzenich's claim is that
we can also change the very structure of the brain itself and increase its capacity
to learn. Unlike a computer, the brain is constantly adapting itself.
"The cerebral cortex," he says of the thin outer layer of the brain, "is actually
selectively refining its processing capacities to fit each task at hand." It doesn't
simply learn; it i...
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