Norman Doidge tells about the amazing possibilities for healing by using neuroplasticity.

It was a fine, quiet morning early in January 1996. When I woke up, I noticed a high-pitched sound in my left ear. This wasn’t all that worrying — a couple of times every year, I would hear such a sound for five or ten seconds, and then it went away. This time was different. The sound continued indefinitely. It was a pure tone, continuous, and was there whenever I checked. Little did I know that checking to hear whether the sound was there was the worst thing I could do.

This was tinnitus, the term for ringing in the ears. Some people have multiple tones, or thumping or rumbling sounds. Some have it so bad their lives are ruined; a few commit suicide to escape the condition.

My case was minor by comparison, but still distressing. As an amateur musician, I value my hearing greatly. My doctor said I would just have to accept it, as nothing could be done.

A few weeks later, there was a new, additional sound, louder and lower pitched, in my right ear. I felt sick to my stomach. I believed the standard view that tinnitus is irreversible and potentially progressive, getting worse with time. Luckily the second sound went away after an hour.

Then, fortuitously, I heard an interview on the radio with a scientist who described a new treatment for tinnitus. I looked it up on the web: “tinnitus retraining therapy.” What I picked up was the idea that tinnitus is not a problem in the ear but rather in the brain. All the time there are signals going from the ear to the brain, for example from blood flowing through the eardrums, but normally the brain treats these signals as irrelevant, and does not bring them to conscious attention.

However, occasionally these routine signals are treated as a source of alarm and raised to consciousness. My brain was treating this high-pitched tone as something to be noticed — and I did. Tinnitus retraining therapy is based on changing the brain’s response.

Apparently if you are put in a soundproof room for an hour, there is a 90% chance you will develop tinnitus — the brain is constantly monitoring sound inputs, and when there are none externally, it starts to pay attention to internally generated signals. This helps explain why people with hearing impairment are more likely to suffer from tinnitus.

There are places to go for brain retraining, but I decided to apply the principles myself. I practised ignoring the high-pitched tone. When I noticed it, I would say to myself, “That’s boring” and turn my attention elsewhere. I became much more accepting of background sounds. Rather than craving silence, as before, I welcomed the capacity to hear naturally generated external sounds.

The high-pitched tone in my left ear gradually became less frequent and less noticeable and went away entirely after several months. My tinnitus was gone as a result of retraining my brain, and I did this by conscious efforts to change how I paid attention.

Neuroplasticity

With this experience, I was attuned to the idea of brain plasticity, which refers to the capacity of the brain to rewire itself. I read about therapies for stroke that seemed miraculous. The usual idea was that because stroke destroys part of the brain, disability was permanent: limbs would be useless, speech was impaired, and so on, depending on which parts of the brain were affected.

Constraint-induced movement therapy changed all this. Rather than using only the good arm and leaving the impaired one alone, this therapy in essence tied the good limb down and forced the patient to use the damaged limb intensively, up to hours per day, with gradually increasing challenges. For example, with your impaired limb, you repeatedly attempt to put a ball through a large hoop, then a somewhat smaller hoop, chalking up hours of forced effort.

The effect of this is not on the limb, which wasn’t directly damaged by the stroke – though it may weaken due to non-use – but on the brain, which was. The intensive training triggers major changes in the brain: to carry out the tasks, the brain uses unaffected parts of itself to carry out the limb function. The repetitive practice induces the brain to rewire itself. With this technique, in many cases normal or near-normal function can be regained.

In 2007, Norman Doidge’s book The Brain That Changes Itself was published. It describes constraint-induced limb therapy and many other wonders that can be achieved by taking advantage of neuroplasticity. Doidge, a psychiatrist, interviewed leading researchers in the field and wrote about their work in an engaging way, often using stories of individuals to motivate discussions of more technical matters.

Norman Doidge

Doidge was making accessible information from the frontiers of research and therapy that challenged long-established views about the brain, and offered hope where there had been little previously. I thought the book was highly important and wrote a comment about it. I could understand why it became a bestseller.

When I was young, my friends and I somehow learned that the brain was a static and degenerating organ. We would humorously remind each other that the brain loses 50,000 cells every day, a relentless downhill descent. Now I was learning that actually the brain creates new cells one’s whole life. Just as importantly, it is constantly changing its structure as well as its content. New experiences do not just add memories, but change the way connections are made in the brain. Furthermore, this can be achieved by simply thinking.

One example is a study of strengthening a little-used muscle, the one that moves your little finger away from the ring finger. One group exercised this muscle by moving the little finger against resistance. The other group simply imagined doing this without moving the little finger. Amazingly, just imagining exerting muscles in your little finger can make it stronger. Actually, the muscle may not be stronger, but the mental circuits that activate the muscle become better developed, a process that also occurs in conventional weight training. Mental rehearsals of physical actions can be effective in many fields.

The Brain’s Way of Healing

Because of the popularity of The Brain that Changes Itself, numerous people contacted Doidge, introducing him to other work on neuroplasticity. His new book, The Brain’s Way of Healing, examines various techniques and therapies that utilise neuroplasticity. Doidge again uses personal stories by healers, scientists and individuals dealing with their own health problems to motivate his descriptions of approaches to healing. Many of the stories are remarkable.

John Pepper first developed symptoms of Parkinson’s disease in his 30s. After many years with declining capacities, he started a programme of moderate “conscious” walking, using his powers of concentration to force his body to move in the conventional way, rather than in the usual habitual pattern. With this approach, he was able to keep his Parkinson’s symptoms under control. What seems to have occurred is that he forced parts of his brain to consciously take over functions that are normally controlled unconsciously by brain areas that were degenerating.

Another route to healing via neuroplasticity is to shine low-intensity lasers on parts of the body, even the brain itself. This somehow causes the body to reorganise scrambled nerve systems, that send unwarranted signals, and eliminate the problem. The treatments Doidge describes seem miraculous.

Doidge is willing to examine approaches to healing that are dismissed by mainstream medicine, though always putting these in the context of the science of neuroplasticity. Doidge devotes a chapter to Moshe Feldenkrais and his methods. The Feldenkrais method is normally thought of as in the same context as the Alexander technique or Pilates, namely as some sort of alternative health modality. Doidge, however, presents Feldenkrais as a pioneer in using neuroplasticity as a tool for recovery of normal body functions, decades ahead of the laboratory studies that would explain how his methods worked.

Moshe Feldenkrais

Other tools for healing that Doidge discusses include listening to manipulated sounds and an electronic device placed on the tongue to stimulate neuromodulation. The picture that comes across is that the brain can be stimulated to rewire itself and to function more normally by using a variety of techniques, involving virtually any way of sending signals, including using the mind to do this.

Paying attention

The key to several of the methods of healing Doidge describes is focused attention. Sustained concentration is a powerful way of creating long-term brain change. The brain is like a muscle: physical activity strengthens the components that are exercised, and paying attention is a way of doing this.

The problem is when bad mental habits take over: unlearning these habits is difficult and requires sustained effort. Doidge tells about psychiatrist Michael Moskowitz who developed chronic pain and studied research in the area until he came up with a new approach.

Moskowitz’s inspiration was simple: what if he could use competitive plasticity in his favor? What if, when his pain started – instead of allowing those areas to be pirated and “taken over” by pain processing – he “took them back” for their original main activities, by forcing himself to perform those activities, no matter how intense the pain was?

What if, when he was in pain, he could try to override the natural tendency to retreat, lie down, rest, stop thinking, and nurse himself? Moskowitz decided the brain needed a counterstimulation. He would force those brain areas to process anything-but-pain, to weaken his chronic pain circuits. (p. 13)

Moskowitz went on to conquer his own severe pain and became a pain medicine specialist, helping many others. In this case, as with other therapies, focused attention becomes a way to reprogramme the brain.

Pay attention!

Focused attention is also a powerful tool in other contexts. In the form of deliberate practice, it is the key to expert performance in many domains, such as chess, golf, writing and playing the violin. In the form of meditation or mindfulness, it is one of the most potent tools for achieving increased happiness. In these and other areas, the capacity to focus attention needs to be combined with knowledge about what to focus on and how. Research and practice are opening up new avenues, all of which exploit brain plasticity.

Conclusion

Doidge tells many stories of recovery from seemingly hopeless conditions, including chronic pain, Parkinson’s disease, brain damage and autism. The overall message is that there is hope where previously there was none. However, the treatments are not sitting on a shelf to be purchased and applied. Quite a few of them are in the early stages of development, many involve specialised equipment, and all require practitioners to have advanced skills to obtain good results. Furthermore, not every technique will work for every sufferer. And not everyone can afford to travel to specialised treatment units or to provide the intense therapy required.

If you or someone close to you has any of the conditions addressed by Doidge, it may be worthwhile to read his books as a starting point, check out his website, and decide whether to investigate further. If doctors say you will never regain a function, they might be right, but invoking the power of neuroplasticity is making some of their predictions out of date.

Brian Martin
bmartin@uow.edu.au

Thanks to Chris Barker for valuable comments on a draft.