Why The Grey Matter Matters

The Age

Saturday April 26, 2008

Gordon Farrer

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

By Norman Doidge

Scribe, $35

Life in His Hands: The True Story of a Neurosurgeon and a Pianist

By Susan Wyndham

Picador, $32.95

Two writers give different insights into our most vital organ, writes Gordon Farrer.

IT TURNS OUT THAT YOU can teach old dogs new tricks after all. That's the most important and exciting lesson to take from Norman Doidge's foray into the revolution that has shaken neuroscience in the past few decades.

It is no exaggeration to call what has happened a revolution. Old ways of thinking about the brain have been swept aside, replaced by a new understanding of our most complex organ, which has implications for brain repair and healing, for childhood development and for accelerated learning at all ages.

Gone is the notion that the brain is hard-wired to perform certain functions in specific ways - that brain anatomy is fixed from youth and the only change from that point is decline into the fragility of old age. Gone, too, are the ideas that brain cells cannot be replaced; that the brain cannot change its structure to compensate for severe damage and continue to perform lost functions; and that mental activity to improve and preserve the brain is a waste of time.

The buzzword of the revolution is neuroplasticity, the idea that the brain not only can but constantly does rewire itself and regenerate when damaged. Doidge, a research psychiatrist and psychoanalyst at Columbia University and the University of Toronto, is clearly excited by the potential of neuroplasticity and inspired by the scientists at the vanguard of research in the field.

Much of his book is taken up by accounts of meetings with them and the seemingly miraculous stories of their patients. The researchers and doctors he visits include Paul Bach-y-Rita , Michael Merzenich, Edward Taub and V. S. Ramachandran - all brilliant, all visionary and all stars in the neuroplasticity firmament.

The cases Doidge recounts are no less remarkable than the scientists who treat them. Michelle Mack was born with half a brain - only one hemisphere developed when she was a foetus - yet it performs nearly all the functions of a normal brain. Barbara Arrowsmith Young was born with major retardation that caused disabilities in speech, spatial reasoning and affected her ability to comprehend logic and relationships between symbols. Yet she taught herself to function normally, studied child development, designed exercises to correct her disabilities and eventually opened a school to teach them to others.

The most astonishing case Doidge recounts is that of Cheryl Schiltz. In her late 30s, Schiltz lost her sense of balance when an antibiotic she was prescribed destroyed her vestibular apparatus. Her brain could no longer receive balance signals through the normal channels and she constantly felt as though she was falling, even when lying on the ground. She was unable to walk and was going mad with frustration and mental fatigue.

Dr Bach-y-Rita invented a helmet that gave her a sense of balance using a connection to her brain via her tongue. Schiltz found she could walk for brief periods while wearing the helmet in the laboratory but - here's the astonishing part - she found that her balance continued for a period after she took it off. After wearing the helmet for extended periods her balance lasted longer each time and eventually returned completely. Schlitz's brain, through her tongue, had rewired itself and found a new way to perform a lost function.

The cases sound miraculous but, as Doidge points out, they seem miraculous only because the old, flawed understanding of brain function did not credit as normal its ability to change.

This is not the reason for his enthusiasm about neuroplasticity. What really excites Doidge - in addition to neuroplasticity's potential for neurological repair, advances in psychotherapy, child development and late-life learning - is the discovery that certain thinking activities can turn genes on and off and that the effects are lasting.

The very act of thinking about an activity, it turns out, can be almost as effective as doing the activity; visualisation and imagination become as important as action: "Everything your 'immaterial' mind imagines leaves material traces," he writes. "Each thought alters the physical state of your brain synapses at a microscopic level. Each time you imagine moving your fingers across the keys to play the piano, you alter the tendrils in your living brain."

This, says Doidge, finally destroys the mechanistic view of the brain and the Cartesian notion that mind is separate from body, with significant implications for human intellectual potential, relationships and culture.

Doidge writes well, with insight and a clarity that makes a complex field accessible to the general reader. His enthusiasm is palpable, yet the subject is not without a dark side. With understanding of how the mind works comes the potential danger of manipulation and, more ominously, social engineering. Doidge hints at such issues without delving more deeply. But that is forgivable. Doidge writes as a keen clinician; it will take a philosopher, perhaps, to fully appreciate and speculate more generally on the full impact of neuroplasticity for society.

If The Brain that Changes Itself is a somewhat dispassionate window into an exciting future for brain science, Susan Wyndham has provided a personal, more emotional counterpoint.

In Life in His Hands, Wyndham tells of gifted pianist Aaron McMillan and "rogue" Sydney neurosurgeon Charlie Teo.

In 2001, McMillan was diagnosed with a rare type of malignant brain tumour and Dr Teo took on his case. McMillan's battle with the cancer featured in an episode of the ABC's Australian Story and Wyndham wrote about both men for The Sydney Morning Herald and Good Weekend. At the time McMillan's story seemed to be an uplifting one of victory against great odds. But, after initial success in the operating theatre, the cancer returned and McMillan, aged 30, died in mid-2007. A second Australian Story bookended the tale. Life in His Hands is a kind of coda.

Wyndham's job as storyteller is made easier by the high-achieving nature of her subjects. Both were driven men: Dr Teo a highly skilled surgeon who demanded perfection from everyone in his life and whose obsessiveness about his profession and willingness to take risks put him offside with colleagues; McMillan obsessed with music, compelled to spend every moment composing, recording, practising or furthering his career. There is constant motion in everything they did, every course they followed. The result is a natural energy ready for the author to harness.

That's not to say Wyndham had a free ride. She has seamlessly woven the narratives of the men's lives to create a compelling and compassionate read. Her research, attention to detail and ability to evoke mood and place are first-rate. She especially excels at thematic clustering and contrast, in seeing the things that link or separate.

Noting similarities of character in the men, she writes that "both were mavericks in their fields . . . pungent, eloquent, inspiring, funny and stubborn characters who had confronted death - one of them his own and the other on most days on the operating theatre". Yet, in other ways, she says, they represented the coming together of opposites; of science and art, of the ethereal and the physical, of blond and dark good looks.

Wyndham's voice is strong in the story, but this is understandable and forgivable. When she began the book - and still, she says, even halfway through writing - she thought it was a story of medical triumph aided by the strength of spirit in doctor and patient. That theme changed when McMillan's illness returned, becoming one about how to live in the face of death. The author's personal investment in her subject naturally turned to one of her own loss - though she never lets her responses overwhelm the major players' stories.

Watching Dr Teo operate, Wyndham says, gave her greater understanding of and appreciation for the human brain, "the most challenging organ for surgeons, scientists and philosophers". McMillan gave her insight into what it means to face the end of life with equanimity and courage.

They are different insights from those Doidge offers in his account of neuroplasticity, yet all are bound by a common thread: they remind us that our brains make us who we are in more ways than we can imagine.

© 2008 The Age

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