Under the skin: coloured scan of the human brain Photo: Alamy
Excerpted from The Telegraph | Author: Paul Broks
Norman Doidge is not shy of hyperbole. His previous book, he tells us, bore tidings of “the most important breakthrough in understanding the brain and its relationship to the mind since the beginning of modern science”. This, apparently, is the discovery that the brain is “neuroplastic” – in other words, is capable of changing its own structure and function in response to experience. The Brain’s Way of Healing continues the story with extraordinary tales of recovery from the symptoms of hitherto incurable conditions such as Parkinson’s disease, multiple sclerosis and autism, and there are lengthy excursions into brain science to back up the case stories.
Take, for example, John Pepper, an energetic octogenarian, who was diagnosed with Parkinson’s 40-odd years ago but who has apparently managed to stave off the usually debilitating movement-related symptoms of the disease – shuffling gait, tremor and so on – through a highly systematic, self-designed program of “conscious walking” therapy. This involves paying meticulous attention to the fine details of locomotion that are usually under unconscious brain control: the lift of the back leg, the bending of the knee, launching from the toe and so forth. It’s an arduous and unnatural process, but, suggests Doidge, cases like this show that it’s possible to train the brain to circumvent diseased circuits. There is also evidence that vigorous exercise increases the production of chemicals that promote the survival and connectivity of brain cells, so Pepper’s regime may confer therapeutic benefits at more than one level of brain function.
If the Pepper story is true then it is indeed remarkable, but I was not surprised to learn that some neurologists had raised doubts about the diagnosis. Perhaps he has a more benign, non-progressive form of “Parkinsonism” rather than true Parkinson’s disease. The author, to his credit, meets the objections head on, and does so quite persuasively. But still there are doubts.
Doidge points to evidence that exercise can also delay the onset of Huntington’s disease, another devastating movement disorder, and that it protects against mental decline in Alzheimer’s. “If there’s a panacea in medicine,” he says, “it’s walking.” But there are other therapeutic strings to the “neuroplastician’s” bow (the “dawn of neuroplasticity” brings with it some hideous jargon) and Doidge describes a variety of techniques, mental and physical, for modifying brain function. These include visualisation exercises for the control of chronic pain, and the use of light therapy for the treatment of traumatic brain injury, stroke and depression.
But just how revolutionary is the idea of neuroplasticity? Is it really the biggest breakthrough in neuropsychology since the dawn of modern science? That’s a bold claim. At one level the notion of the “plastic brain” is utterly trite. How else would we acquire knowledge and new skills? Everything we learn and remember involves a subtle “rewiring” of the brain. Nor is plasticity a particularly novel concept in clinical neurology. The influential Russian neuropsychologist A R Luria, among others, was developing the idea of “functional reorganisation” following brain injury in the middle of the last century and the basic idea had been around for decades before that. In Luria’s wake, the past several decades have witnessed steady and significant advances in neuro-rehabilitation therapies, which directly exploit the brain’s plasticity.
One reviewer of Doidge’s first book, a highly regarded neuropsychologist, called it “intriguing, infuriating, fascinating, absurd, credulous, wrong and misleading in parts”. I’m guessing he would say the same about this book. But despite the gripes, among which is the significant risk of raising false hopes of a miracle cure in vulnerable sufferers of brain disorder, I think it’s an impressive piece of work.
Doidge is a gifted storyteller and summariser of brain science. Get past the hyperbole and, here and there, one can see glimpses of real, and perhaps revolutionary, progress. Time will tell.
There’s little danger of Allan Ropper and B D Burrell’s Reaching Down the Rabbit Hole: A Renowned Neurologist Explains the Mystery and Drama of Brain Disease raising false hopes. It tells it like it is on the front line of clinical neurology. Engagingly written, informative, often funny, it also manages to be moving without slipping into the sentimentality that too often infests medical writing. Ropper is a Harvard professor and a clinical neurologist at the Brigham and Women’s Hospital in Boston, “a place where the strangest and most challenging cases are sent to be sorted out”.
Strange and challenging the cases may be, but the underlying strokes, tumours and degenerative diseases he encounters are the bread and butter of neurological practice. Following Ropper on his rounds, you get a vivid insight into the routines and rituals of neurology, “the queen of the medical specialities”. It’s queen rather than king because of its elegance. The “systematic, logical, deductive method that was in the past applicable to all branches of medicine” now resides mainly in neurology and, more than any branch of medicine, neurology is person-centred.
“How do you begin to understand a sick brain?… by engaging the person inside, and you do it on a case-by-case basis.”
Ropper knows his stuff and he does not hide his light under a bushel – “I am an authority on what the brain does right and wrong.” In this, and in his evident genius for diagnostic detective work, there are undeniable shades of the doctor Gregory House in the American television drama. But you trust him, and there’s warmth behind the white coat.
In contrast to the relentless, horizon-scanning optimism of Doidge’s book, this is a work of the clinical here-and-now, which, on the whole, is lacking in miracle cures. It reflects the human realities of brain disease, which can be awful and incurable. But I came away from this humane book with a sense of uplift. If ever anything goes wrong with my brain, I’d like a doctor like Ropper to help sort me out.
Paul Broks is the author of Into the Silent Land: Travels in Neuropsychology (Atlantic)
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