Transcript
Hide
Lynne Malcolm: Hello, welcome to All in the Mind, Lynne Malcolm with you, and it's great to be back for 2015. And what better way to start than to celebrate the brain's amazing ability to change and heal itself in response to mental experience.
Michael Merzenich: Because we know the brain is plastic we have a first level roadmap for understanding what we need to do to drive it back in an improving direction. And in many neurological conditions, many psychiatric conditions, we've been quite successful.
Barbara Arrowsmith Young: It is changing it at a physiological level, and what I see is all of the symptoms drop away, everything related to that cognitive deficit as it has improved through the exercise shifts.
Michael Merzenich: We are almost always worried about training the machinery of the brain that is controlling learning itself because that's plastic. We want to make you a powerful and effective learner again so you can acquire and get all the benefits of your brain plasticity.
Lynne Malcolm: Professor of neuroscience Michael Merzenich, and psychologist and educator Barbara Arrowsmith Young. They are from previous All in the Mind episodes.
The discovery of in neuroplasticity is thought to be one of the most important developments in our understanding of the brain. It's no longer considered to be fixed and unchangeable. It can create new neural pathways to adapt to its needs. This has led to an explosion of interest in the power of brain training to improve its performance. And now a new therapeutic potential is being explored. Today we hear some astonishing stories demonstrating that the brain has its own unique way of healing.
Norman Doidge: So many Western neuroscientists and clinicians have benefited and learned from things like yoga, meditation, visualisation, things that have been practised in the East for a long time. I think neuroplasticity is a subject that can bring together these two great medical traditions of humanity. The energy I talk about, it's not flaky, you can analyse it in terms of Western scientific equations.
Lynne Malcolm: Dr Norman Doidge is a psychiatrist and researcher from the University of Toronto in Canada, and author of the bestseller from 2007, The Brain That Changes Itself, which really put the concept of neuroplasticity in the spotlight. His at latest book, The Brain's Way of Healing, is a result of his world travels meeting doctors, and patients who are benefiting from neuroplasticity, healing the brain without medication or surgery. He explains what can go wrong in the brain and how neuroplastic healing works.
Norman Doidge: The first thing that I think it's best to attend to is the general neuronal and cellular health, and that goes awry in certain conditions. It goes awry to some degree in autism and in MS. It's probably going awry to some degree in Parkinson's. It's probably going awry in many children with ADD.
Then the next thing that happens is the cellular problems that are based on too much inflammation or toxins or maybe some genetically induced cellular abnormalities, give rise to wiring problems. And when the brain has wiring difficulties, the circuits don't work and they go dormant. It's not just the case that the brain cells are dead or that they are not firing at all, often the problem is that they are firing but at irrregular rates or at the wrong rate. And when that is happening they can't perform their function and they go dormant, but I call that the noisy brain. And so they need some kind of stimulation to pull them out of that dormancy.
And if the stimulation works properly, then the brain gets modulated, I call that neuromodulation, and lots of systems that weren't working well suddenly start to work together, and there's a balance of excitation and inhibition. An example might be think of people with traumatic brain injury. There are certain things they can't do anymore, and that's because circuits are dormant, but there are other circuits that seem to be hyperactive. So they are very, very sensitive to sounds and light and so on. That all has to be rebalanced. And then the brain goes through a period of rest and then it goes through learning.
Lynne Malcolm: In his travels, Norman Doidge met John Pepper who had been diagnosed with Parkinson's disease. Parkinson's is a result of damage to the dopamine producing cells in the brain which help us make automatic movements. This leads to difficulties with movement, balance and walking. John Pepper was prescribed standard Parkinson's medication, but his condition didn't improve. Around this time he decided to join his wife in a gentle get fit program which focused on walking.
Norman Doidge: And while he was there one of the instructors said, 'Pepper, you're not walking straight,' and she started to get him to pay attention to his gait. And I think that this was not intentional on his part but he started to break his walking down into individual movements. That's really interesting because take something like brushing your teeth or, I don't know, putting on a shirt, these are things that we have to learn how to do and we've forgotten that we had to learn how to do them by doing individual movements. Once they become automatic, the part of the brain, the substantia nigra and the basal ganglia that are involved in making things automatic, take over weaving those individual movements together.
Well, he was paying really close attention to his gait. You know, it would be something like; shift your weight to your left leg, raise your right leg at your hip, swing the foot forward from the knee, go into a controlled fall forward onto your right heel, and so on. He broke it down like that. And what he found was that he could do movements with that level of awareness, by breaking it down, because that's not broken in the Parkinson's brain, if you will. So he was actually using another part of his brain, in the frontal lobes, to kind of work around the Parkinson's. And he was just such an earnest, conscientious person that he got to the point where he was walking quite briskly with this technique, and he called it the conscious walking technique and he applied it to other movements as well.
Some of his Parkinson's symptoms were starting to improve. He just wasn't quite as rigid as he used to be. And so he did some research. And there was an extensive research that was just coming out that showed that walking actually triggers brain growth factors of two kinds, one that consolidates connections between the neurons and another one that supports what are called the glial cells. The glial cells were originally thought to be the infrastructure of the brain that support the neurons, but we now know they are also communicative. And so he tapped into this literature and he was able to teach other people to do this.
Here was a man with advanced…you know, had had Parkinson's for years, and he still has Parkinson's, but he learned how to diminish the symptoms by triggering growth factors with this work-around. What we realised was that the person with Parkinson's is caught in a noose. They increasingly can't move, and yet one of the things that would actually help their brain deal with the Parkinson's would be walking, because walking triggers these growth factors.
So what was he doing in terms of what I was talking about? He was actually using activity, thought and movement to stimulate the dormant circuitry in the brain. So this was a neuronal stimulation intervention, but I think it was also because it was stimulating the glial cells, which again provide infrastructure and support for the neurons which are the nerve cells which carry electrical and chemical signals in the brain. It was also to some degree addressing normal cellular and neuronal health. So it's the first two stages.
Of course the thing that is so beautiful about this is it's something that anyone has access to. And the interesting thing is that people with Parkinson's are very prone to certain kinds of setbacks. They have trouble swallowing, they are prone to get pneumonia and things like that, and sometimes he was laid up, once for an operation, once because he got pneumonia, and he couldn't walk. And what happened was he regressed, so that his movement symptoms returned much more intensely when he couldn't walk, and it would take him about six weeks of learning how to walk, just as he originally had, and then building up to his hour and 15 minute walking every other day for him to get control of the movement symptoms again.
Lynne Malcolm: So a couple of things strike me about that story, one is that you were talking about close attention, he was paying very close attention to walking, and that's an aspect of mindfulness that we hear about, that attention is very important. And the other thing is that the brain found a way around a shortfall, so it found another part of the brain to get around the problem. Also I guess it draws attention to the very simple act of walking and how valuable a movement in the body can be for the brain.
Norman Doidge: Absolutely, and, you know, just over a year ago there was a study, the biggest study ever done of exercise and dementia risk, and it was done in Wales by the Cochrane Institute. This is part of a study that was designed by Archibald Cochrane who was said to be the father of evidence-based medicine. And they followed over 2,200 men for 30 years in Wales, and they did five healthy behaviours; exercise, not smoking, not drinking more than a glass of wine a day, eating about four servings of fruits and vegetables a day, and being a normal weight. And they found if the men did four of those five activities, they reduced the risk of developing dementia by a staggering 60%.
Now, if any drug did that it would be the most talked about drug in the world probably, and the most powerful factor was exercise, and exercise wasn't brutal cross-fitness, it was the men walking a mile to work and a mile home five days a week, so that's about half an hour a day I think, or riding their bikes 10 miles a day, five days a week, or regular vigorous exercise.
And I think it goes back to what I said; we have had a very disembodied view of the brain, I call it the imperial brain. There has been a tendency to think about the brain as separate from the body, for all sorts of reasons, and to think that if a person has a brain problem the only way to fix it is cracking open the skull and getting into the brain or giving a person a medication to get into the brain. But all the interventions I describe in this book for Parkinson's, MS, traumatic brain injury, chronic pain, attention deficit, autism, learning disorders, dyslexia, sensory processing disorders, they are all non-invasive, and they all use the senses or movement of the body to access the brain.
Lynne Malcolm: I wonder if we could move now to pain. It's a human experience which we've always accepted has a strong mind component. What have you learned about the nature of pain and therefore how it can be better managed?
Norman Doidge: I've learned several things with respect to pain and neuroplasticity. There's two kinds of pain. There's acute pain, and acute pain is basically a warning not to move a body part because you could cause further damage to it. So we need our acute pain. But sometimes it's not only the body part that's injured when we hurt ourselves, sometimes over time we also injure the body part and the pain system itself. And this typically happens because the pain system is being chronically stimulated over time.
Now, the brain is neuroplastic and the nervous system is neuroplastic, which means that it changes its structure and function in response to activity and mental experience, that's what it does. It's a blessing when you are trying to learn how to paint or enjoy music and you go to the opera and you find as you get better at it you can hear many voices in the choir and distinguish those voices. You can develop differentiation of your sound maps in that case.
It's a curse when the sense that is being stimulated over time and getting better is the pain sense. Then what happens is even a small movement of the injured body part can lead to a jolt of pain that lasts very, very long and spreads out over the body. I can tell this best by telling the story I tell in this book of Michael Moskowitz who was a pain physician and a psychiatrist, and he had had several experiences that taught him important lessons.
The first one was on 4 July many years ago, he went with a friend just outside the San Rafael dump where they were storing some tanks for the 4 July parade, military tanks. And he climbed up on one and he jumped off, and as he was going down, his corduroys were caught on a piece of metal, and he heard three pops, and that was the sound of the longest bone in the body, the femur, cracking in three spots. And as he lay there on the ground he was actually bleeding to death and he was experiencing what pain physicians call a 10 out of 10 pain, and realising that he could tolerate it.
He also noticed as he was waiting for the ambulance that if he didn't move at all for an entire minute, the pain stopped completely. And he thought to himself, you know, I've been teaching my medical residents about this for a long time, that there are these switches or gates in the brain, that was the main theory of pain, but now I've lived it, I realise it's really real, the brain can turn off pain. My God, there is a switch in there. And that was an important lesson for him.
And he had another lesson, and that is he was doing a kind of waterskiing with his daughters, he was on an inflatable tube going at a high speed. He flipped over and injured his neck. And originally there was just one part of his neck that was hurting. But as time passed, that nerve kept getting pressed on, that neuroplastic system started to grow, and it became a chronic pain. So that instead of having pain in one point of his neck it was now spread out over all of his neck, his shoulders, his head, and it was disabling.
And at that point neuroplasticity was starting to be a word that was being used, and he read 15,000 pages of the scientific literature on plasticity. He was a pain physician who came at it from psychiatry, he was also a psychiatrist, so he was very attuned to the mind-body connection. And as a pain physician he knew that there is not just a one pain centre in the brain but there's about a dozen centres in the brain that process pain. And interestingly, almost all of them don't just process pain, they process something else. So you may have noticed when you are in pain you get cranky, and that's because there is an area of the brain that processes pain and emotional regulation. Or that you can't do higher maths and you can't visualise certain things, and believe it or not there are two areas of the brain that process both visual imagery and pain.
He also knew one other thing. When the brain is not in pain, that map for imagery and pain isn't really firing. When it's in acute pain there is a certain amount of firing that you can see on an fMRI. And when it is in chronic pain, about 15% of that map that would normally be used to process imagery gets hijacked to process more pain.
So he had the following thought; every time I'm in pain I will force myself to have visual imagery, to try to take back that combined pain imagery map for imagery. Because he knew from studies and he'd also read my first book, that plasticity is competitive. So it's a 'use it or lose it' brain. When you use a brain processing area for a particular activity, the part of that processing area that is devoted for that activity actually expands. And when you use it for something else, that other activity kind of invades it and takes it over. So we would use the competitive nature of plasticity.
For the first couple of weeks, every moment he detected any pain, he visualised. And he got no results. But after several weeks he started to get some results, and by several months he could go 15, 20 minutes or whatever without pain. At the end of the year he had no pain. And I want to emphasise that when he started doing this, he had been tried on all the known pain medications, nerve blocks, things that we use in mainstream medicine, and he had tried all the complementary and alternative things, and at the end of the year he was off all pain meds and he was basically pain free. So he beat back his chronic pain with this neuroplastic mental intervention, if you will.
Lynne Malcolm: Norman Doidge, author of The Brain's Way of Healing.
You're with All in the Mind on RN, Radio Australia, and perhaps on your ABC mobile app. I'm Lynne Malcolm, today with some remarkable stories of recovery from pain and brain injury through neuroplastic healing.
It sounds almost miraculous. What can people who are listening to this who may be dealing with pain draw from it? Do people have to actually believe in the power of neuroplasticity, for example, for it to work?
Norman Doidge: No. This isn't a belief-based thing, it's not a placebo thing either. Placebo, which is a very, very interesting and important thing to understand, is when people are expecting a good response to something, a medication, and then something about the mind switches on part of the brain so that they get that response. And there are placebo responses in pain and depression. Placebo responses vary by illness. But in general what happens with the placebo response is over time it wanes. And of course you will always have to be doing the technique.
The opposite pattern was seen with Moskowitz. Over time the pain relief got stronger and he had to use the technique less and less. So he was training up new circuitry. So you don't have to believe this, you just have to be willing to do it. And the other thing I want to emphasise about plasticity and pain is that many, many people get hooked on our medications for pain, and that's also a plasticity story. Our body produces…the term is 'endogenous' but it just means its own pain relieving substances, these are the endorphins and so on that we produce that can block out our pain.
But when people have profound pain problems we supplement these endogenous endorphins with chemicals that are very much like them. But over time people need more and more of these drugs because they develop tolerance to them, and that's because the brain is neuroplastic. And so if you start loading the receptors for the neurons up with these drugs, it's not as though the brain stays still, the braid always responds to activity and it says, boy, there is too much of this (whatever the drug is, you know, if it's a narcotic or whatever it is) around, so I'm going to become less sensitive to it. Therefore the person is not only going to need more of the exogenous medication to get the same bang for their buck, but because their own receptors are becoming less sensitive to these drugs, they are even less sensitive to their own endogenous pain endorphins and so on.
So many, many people with chronic pain syndromes, they start off with these medications, and in the acute situation they work beautifully to eliminate pain. But if they are used chronically over time you need more and more of them, and then they have some pretty bad side-effects. But what's great about the Moskowitz approach and the neuroplastic approach is you can in many cases eliminate the pain altogether, and in some cases you can't go that far but you can lower the amount of medication the person needs, so they get far fewer side effects.
Lynne Malcolm: You've also written about neuroplastic interventions that work for children with autism, and the key to that lies in the connection between music and the brain. Can you describe an example of what you've seen in that area?
Norman Doidge: Sure. When we studied people who are listening to music we find that their neurons are firing at the dominant frequency of the music that they are listening to. And not only that, you take two jazz musicians, put them in a room and hook them up to an EEG, an electroencephalogram, and their brain waves start to synchronise. This is called entrainment. That's very cool. They say they are in the groove. They are capturing something that's going on in the brain.
Okay, now autism. You may have noticed that many autistic children are often covering their ears and showing great signs of distress. What it turns out is going on in their brains is the following. A person who doesn't have this autism will walk into a noisy room, think of a party. At first you just hear booming, buzzing confusion, and then very quickly your perceptual experience is transformed and you can start to make out conversations, you know, one is about politics and one is about religion and one is about sports. The frequencies of human speech are actually fairly high in the spectrum of the things that we can hear. We can hone in on that, because in the ear-brain circuit for listening there is what a person I describe in the book, Alfred Tomatis, he was an MD, an ENT doctor, described as the auditory zoom. Just as a camera has a zoom that allows you to focus in on certain things, a healthy ear-brain circuit has an auditory zoom, and that is not working in autistic kids.
And so it seems that they are hearing lower frequencies. Lower frequencies, for evolutionary reasons, tend to be very threatening to human beings. In general, the sounds made by our predators turn on our survival fight-flight reaction and get us very, very tense. So, for instance, if I suddenly started talking like this [low voice] you would think that an alien had come into Norman Doidge's body and brain, or if you go and see the movie Jaws and the shark comes on…filmmakers always have low predatory rumbling sounds going on when the monster arrives on the scene. Well, the autistic kids are hearing this all the time.
So in the techniques I describe in the book, the brain is neuroplasticly trained with modified music, or in autistic kids we use the mother's voice modified. And we very, very gently introduce the frequencies of human speech but very, very slowly, just the frequencies and the modified music, and then go back to what they are accustomed to hearing. And slowly and incrementally we train up that auditory zoom.
And in the book I describe the case of Timothy who at 18 months underwent an autistic regression. His language just got fixated, he just said, 'Doh, doh, doh, doh.' He lost eye contact with his parents, he had constant temperature tantrums, and many typical signs of autism. And his parents felt that he was no longer relating to them as people. He went to this place in Toronto called the Listening Centre that used these techniques. After the second day on the way home his grandmother said, 'There's something different about Timothy.' On the third day he spontaneously hugged his father for the first time in his life.
Timothy was supposed to be institutionalised, that's what his parents were told would happen to him. And he had moderate severe autism. Today it's almost the end of the school year, he got As in English, he has had some friends, but most importantly his parents said, you know, we got our relationship back with him. Here's a boy who was on track to being in an institution and he will probably be living independently.
I describe another boy, Jordan Rosen, that's his real name. Jordan Rosen too was supposed to be institutionalised, having temper tantrums, biting people all the time, and today if you met him you simply would not be able to tell that he was once autistic. He is socially attuned, he's got a job, lots of friends, graduated from university. I'm not saying that usually happens with this treatment. The more common result is the Timothy result where he went from moderate severe autism to mild. But this helped him to rewire his brain in a very positive direction.
Lynne Malcolm: I wonder what you see in the future regarding this concept of neuroplasticity. In the best of all possible worlds, what changes would you like to see in the medical world in its approaches to healing, bearing neuroplasticity in mind?
Norman Doidge: Well, I'd like to see some of these treatments more widely distributed so that neurologists, for instance, start recommending activity very early on for a number of these diseases, and particularly neurologists becoming aware of them so people don't have to find them by themselves. A lot of it is an attitudinal change. Because people believed that the brain was fixed, it gave rise to this neurological nihilism where people kind of reflexly just sort of talk about a number of conditions as though nothing can be done. It's a self-fulfilling prophecy; if you believe nothing can be done then when you hear about these kinds of conditions you immediately soon that it's false hope. I really wish people would look into these things before they declared that just because they don't fit with the existing paradigm, that they are not possible. I think the scientific attitude is a systematic mature scepticism, which is sceptical of itself as well. And so if it encounters something that it hasn't met before, the idea is not to roll your eyes away from it and not look at it, but to actually look at it more intensively. So we need more studies of these things as well.
Lynne Malcolm: Norman Doidge, thank you very much, it's been a pleasure to speak with you.
Norman Doidge: Thank you so much.
Lynne Malcolm: And details of Norman Doidge's books, including The Brain's Way of Healing, are on our webpage. And next month Norman Doidge will be appearing at the Sydney Writers Festival.
While you are on our webpage, leave a comment about this topic, we'd love to hear from you. And you can sign up to the All in the Mind podcast there too.
Thanks to producer Diane Dean and sound engineer Mark Don. I'm Lynne Malcolm, bringing you All in the Mind each week this year, same time, same station.
kosa701