The neuroplasticity bait-and-switch

As long as we're talking about brains this morning, here's another topic that irritates me: the abuse of the term neuroplasticity.

devneuro

Way, way back in the late 1970s, my first textbook in neuroscience was this one: Marcus Jacobson's Developmental Neurobiology. (That link is to a more recent edition; the picture is of the blue-and-black cover I remember very well, having read the whole thing). I came into the field by way of developmental biology, and that means we focused on all the changes that go on in the brain: everything from early tissue formation to senescence, with discussions of synaptogenesis, remodeling, metabolism, transport, and functional responses to activity or inactivity. This is all under the broad umbrella of neuroplasticity, a term that's at least a century old, and that is well-established as both a phenomenon and a science. That the brain modifies itself in response to experience is so thoroughly taken for granted that you can basically define neuroscience as the study of the responsiveness of neural tissue.

So I'm reading this interview with Norman Doidge, huckster of neuroplasticity, and I could not control my eyebrows, which started climbing up my forehead and felt like they were ascending the crown and considering a descent down to my neck. It's not just that Doidge is so full of shit that it's dribbling out his ears, it was the shamefully ignorant questions of the interviewer, Tim Adams. Look at this question:

One of the things that struck me, reading your books, is how entrenched our ideas of the brain’s essential fixed and unregenerative nature are. Why are those ideas so powerful?

Whoa right there. How could anyone have the idea that neuroscientists think the brain is essentially fixed and unregenerative? That's painfully counterfactual, the precise opposite of the actual position of the field of neurobiology. Conveniently, Adams has already answered how he came by such a bogus idea: by reading Doidge's books. That should tell you something about the worth of Doidge's stories.

Doidge’s first book, published seven years ago, described how the principle of such healing – of the plastic brain – was becoming established fact in the laboratory through a greater understanding of ways in which circuits of neurons functioned and were created by thought. “Equipped,” Doidge wrote, “for the first time, with the tools to observe the living brain’s microscopic activities, neuroplasticians showed that the brain changes as it works. In 2000, the Nobel prize for medicine was awarded for demonstrating that, as learning occurs, the connections among nerve cells increase. The scientist behind that discovery, Eric Kandel, also showed that learning can ‘switch on’ genes that change neural structure. Hundreds of studies went on to demonstrate that mental activity is not only the product of the brain but the shaper of it.”

Christ. Wrong.

I got my Ph.D. in 1985 for studies on changing spinal circuitry in the zebrafish spinal cord. I didn't get the Nobel for it because the idea that synapses form and change gradually and integrate new elements of the circuit was not new or revolutionary; I was filling in details on a specific organism, working within a model of neural function that basically everyone accepts. Kandel (and Carlsson and Greengard) won the Nobel prize for a large body of work on signal transduction in the nervous system. That the brain changes as it works isn't novel; working out the details, the specific molecules and pathways involved, was, especially since they had the potential to help address human disease. Doidge's "think yourself better" approach doesn't.

Here comes the bait-and-switch:

You suggest often that neuroplasticity is settled fact. That doesn’t seem to me to be the case in the medical profession and certainly not beyond it…

Within the lab, within science, within neurophysiology, neuroplasticity is established fact – nobody is challenging it.

So on the one hand, Doidge is claiming that the idea of the brain being this fixed and inflexible organ is entrenched; on the other, that neuroplasticity is an unchallenged fact. Which is it?

That the brain is capable of structural, molecular, chemical, and electrical changes in response to the environment is absolutely a fact, accepted without question by the field as a whole. That isn't a lump of phlegm in your cranium.

But what Doidge does is conflate the scientific understanding of neuroplasticity with his brand of quackery and hype. Doidge claims much more, using poorly sourced anecdotes of people curing themselves of Parkinson's or restoring their sight by thinking and carrying out various exercises.

The medical establishment has been well aware of the capacity of the brain to repair itself for years: you do know that there are all kinds of established therapies for stroke patients, right? There is no denial of the regenerative capacity of the brain, or that it rewires itself to meet circumstances. Quacks like Doidge rely on misrepresenting the known science to make standard treatments look like a miraculous consequence of his innovative and revolutionary thinking (they aren't), and to exaggerate the effects of his claims.

You cannot cure Parkinson's by concentrating really hard while walking. You can learn to compensate for some of the effects of the disease. Eye exercises will not cure degenerative retinopathies. Let's not sell false hope.

And this just infuriates me:

Yes, well I didn’t set out to do that. When I finished my first book I had come to the conclusion that many of the claims that eastern medicine was making, which led to a lot of eye-rolling among western doctors, had at least to be re-examined in the light of neuroplasticity. By the time I had finished The Brain That Changes Itself, there were significant studies, which no one disputes, which show major changes in the structure of the brain of Tibetan monks, for example, brought about through the practice of meditation. I suppose it is not really a hard sell once you have grasped that the brain is plastic, that someone who has spent 30,000 hours meditating might actually have changed the structure of their brain. I mean, a London taxi driver can change his brain by studying routes through the city for a year or two.

Aaaaargh. That's right. No one disputes the idea that spending years doing something changes the brain. Tibetan monks get better at meditating, whatever that means; taxi drivers get familiar with travel routes; video game players get better at their games; surgeons get better at surgery with practice. It's kind of the whole sine qua non of learning.

Doidge didn't discover it, and it does have limitations. Don't fall for the neuroplasticity hype -- it's promoted by charlatans who inflate its significance far beyond the fundamental utility of the concept into vast magical realms of nonsense that verge on the Secret, the 'Law' of Attraction, and the Power of Positive Thinking. All bunk.

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One reviewer notes "while the (albeit tentative) credence Doidge lends to a link between vaccination and autism will, for some readers, underscore his open-mindedness, for others it will raise a red flag". Enough said.

Any review that resorts to name calling (huckster, quack) is not serious criticism in my view. Criticize the ideas. Leave the name calling to TV news.

By Doug Garner (not verified) on 09 Feb 2015 #permalink

This advertorial is a major fail by the Guardian. They have taken Doidge's claim to be a "distinguished scientist" and neuroscience expert at face value, whereas it took me all of about 10 minutes to establish that he's not. I will append his full list of published papers (N = 22) from Web of Science. You will notice that they are mainly focused on psychoanalysis and contain nothing on neuroplasticity and no trials of any treatments. He leaves that stuff for his popular books, which are free from the scourge of peer review and can sell thousands of copies to hapless people who are given hope by a series of anecdotes about curing serious conditions.
Cameron, P. M., Leszcz, M., Bebchuk, W., Swinson, R. P., Antony, M. M., Azim, H. F., et al. (1999). The practice and roles of the psychotherapies: A discussion paper. Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie, 44, 18S-31S.
Doidge, N. (2001). Diagnosing The English Patient: Schizoid fantasies of being skinless and of being buried alive. Journal of the American Psychoanalytic Association, 49(1), 279-309, doi:10.1177/00030651010490010601.
Doidge, N. (2001). Introduction to Jeffery: Why psychoanalysts have low mortality rates. Journal of the American Psychoanalytic Association, 49(1), 97-102, doi:10.1177/00030651010490010701.
Doidge, N. (2002). Classics revisited: Freud's The Ego and the Id and "inhibitions, symptoms and anxiety". Journal of the American Psychoanalytic Association, 50(1), 281-294, doi:10.1177/00030651020500010401.
Doidge, N. (2007). Psychosis and near psychosis: Ego function, symbol structure, treatment' by Eric R. Marcus. Psychoanalytic Quarterly, 76(4), 1375-1388.
Doidge, N. (2015). Hypnosis, Neuroplasticity, and the Plastic Paradox. American Journal of Clinical Hypnosis, 57(3), 349-354.
Doidge, N., Simon, B., Brauer, L., Grant, D. C., First, M., Brunshaw, J., et al. (2002). Psychoanalytic patients in the US, Canada, and Australia: I. DSM-III-R disorders, indications, previous treatment medications, and length of treatment. Journal of the American Psychoanalytic Association, 50(2), 575-614, doi:10.1177/00030651020500021201.
Doidge, N., Simon, B., Lancee, W. J., First, M., Brunshaw, J., Brauer, L., et al. (2002). Psychoanalytic patients in the US, Canada, and Australia: II. A DSM-III-R validation study. Journal of the American Psychoanalytic Association, 50(2), 615-627, doi:10.1177/00030651020500021101.
Doidge, N. R. (2005). Dreams of animals. Cultural Zoo: Animals in the Human Mind and Its Sublimations, 45-91.
Fergusson, K., & Doidge, N. (2002). John Douglas Rodger - Obituary. British Medical Journal, 325(7372), 1118-1118.
Doidge, N. (1997). 'Many Tribes Have Come and Gone in the Book'. Judaism, 46(4), 472-472.
Doidge, N. (1997). 'Pillar of Salt'. Judaism, 46(4), 473-473.
Doidge, N. (1997). Psychodynamic treatment research: A handbook for clinical practice - Miller,NE, Luborsky,L, Barber,JP, Docherty,JP. Journal of the American Psychoanalytic Association, 45(1), 275-281, doi:10.1177/00030651970450011001.
Doidge, N. (1999). How to preserve psychoanalysis: Introduction to Gunderson and Gabbard. Journal of the American Psychoanalytic Association, 47(3), 673-677, doi:10.1177/00030651990470030801.
Doidge, N., Simon, B., Gillies, L. A., & Ruskin, R. (1994). CHARACTERISTICS OF PSYCHOANALYTIC PATIENTS UNDER A NATIONALIZED HEALTH PLAN - DSM-III-R DIAGNOSES, PREVIOUS TREATMENT, AND CHILDHOOD TRAUMA. American Journal of Psychiatry, 151(4), 586-590.
Gabbard, G. O., Doidge, N., & Lazar, S. (1997). Psychiatric outpatient services in the United States and Canada. New England Journal of Medicine, 337(3), 204-204.
Gabbard, G. O., Doidge, N., & Lazar, S. (1997). Psychiatric outpatient services in the United States and Canada. The New England journal of medicine, 337(3), 205-204; author reply 205.
Oldham, J. M., Skodol, A. E., Kellman, H. D., Hyler, S. E., Doidge, N., Rosnick, L., et al. (1995). COMORBIDITY OF AXIS-I AND AXIS-II DISORDERS. American Journal of Psychiatry, 152(4), 571-578.
Skodol, A. E., Oldham, J. M., Hyler, S. E., Kellman, H. D., Doidge, N., & Davies, M. (1993). COMORBIDITY OF DSM-III-R EATING DISORDERS AND PERSONALITY-DISORDERS. International Journal of Eating Disorders, 14(4), 403-416, doi:10.1002/1098-108x(199312)14:43.0.co;2-x.
Stevens, A., Doidge, N., Goldbloom, D., Voore, P., & Farewell, J. (1999). Pilot study of televideo psychiatric assessments in an underserviced community. American Journal of Psychiatry, 156(5), 783-785.
Doidge, N. H. (1987). RUBELLA IMMUNIZATION - WHAT HAPPENS IN OUR PRACTICE. Journal of the Royal College of General Practitioners, 37(298), 222-223.
Hyler, S. E., Skodol, A. E., Oldham, J. M., Kellman, H. D., & Doidge, N. (1992). VALIDITY OF THE PERSONALITY DIAGNOSTIC QUESTIONNAIRE REVISED - A REPLICATION IN AN OUTPATIENT SAMPLE. Comprehensive psychiatry, 33(2), 73-77, doi:10.1016/0010-440x(92)90001-7.

By Dorothy Bishop (not verified) on 09 Feb 2015 #permalink

This autistic (...myself, I mean) was officially finished with "The Brain That Changes Itself" as soon as Doidge started going on about "the mystery of a mind that cannot conceive of other minds" or some drivel in reference to autism -- which is ironic coming from someone who shows absolutely no evidence of being able to conceive of autistic minds.

The fact that he's now attempting to revive the long-discredited "link" between autism and vaccination fills me with fury and terror. I am immunocompromised. I can't receive the MMR vaccine. If I become another of the measles cases that are already emerging in my city because ignorant fools are refusing to vaccinate themselves and their children for fear of developing The Dreaded Autism or of "chemicals", I am likely to die.

"So full of shit that it's dribbling out his ears" doesn't cover half of Doidge's problems, but it's a fine start. Thank you for this.

I agree with Doug. There is no valid criticism in your critique here other than really agreeing with Norman that neuroplasticity is a thing. It is irrelevant how and when it got discovered.

Sorry to say but it sounds like someone is a little jealous for a better of a word that Norman has sold a million copies of his book and has gained more attention about his work on this topic.

I have interviewed Norman and he is a little pompous but ain't no snake oil salesman. Some genuinely eye brow raising stuff in his books and he has managed to connect the dots far better than anyone else. Stuff that is just beginning to make its way into the brain industry. There should be a place for people other than scientists such as this Guardian interviewer to enter into the debate of neuroplasticity. Just because we do not all have science degrees doesn't make us philistines.

Dorothy is correct in that he dips and slides from view of other scientists is probably correct. But that doesn't mean the case studies he exposes in his books should not be used as inspiration for medicine moving forward.

@Dave, When and how neuroplasticity was determined DOES matter, because it establishes the context of the idea and the data that support it. The scientifically established limits of it DO matter, because it protects people from being taken advantage. The only way such things DO NOT matter is if the truth of it is inconvenient to the oversimplification of it. There are a lot of fun and entertaining things that can be said about the brain generally, but as we've learned by the near constant need to refute brain myths like the 10% myth they ultimately do more harm than good.

I just want to say you should read Doidge's books before you criticize him. He is not talking about neuroplasticity generally, but about adult neuroplasticity. Mainstream medicine did not accept the concept till the 90s, and stroke patients were not expected to get better after a short window. A lot has been learned since then and ideas have genuinely changed.

As for the Parkinsons guy, again READ THE BOOK. I just read that chapter. He never says the guy cures his Parkinsons. He says he learns how to use his conscious mind to do stuff that his brain can't do automatically. And apparently his daily walks help him do this because when he can't walk for any period of time (post surgery for ex), he regresses and begins to look like any Parkinsons patient. Even when he is walking and doing all his work-arounds, he still has some symptoms.

So please read the book before saying anything more. I think you will find it interesting, if you set aside your resentments and read it with an open mind.

As a sufferer of a unilateral balance injury i am glad there is some common sense around the notion of plasticity. The brain cannot replicate the function of the eye in fact not a 1000 brains working together could replicate the speed of the vestibulo ocular reflex, that is why patients like me remain dizzy for the rest of their lives, "Do vestibular rehab therapy" they said,"it fixes you" they said. Bollix. The brain is a receiver and organizer with incredible ability but it cannot replace lost organs or extensive damage brought about through strokes and neurological disease. To say this is "over" sold to us as patients let alone readers is an "under" statement. Think of the ridiculous experiments that are funded when we could be instead filtering money into repairing the damaged tissue with cell therapy. A quick mention to Geoff Raisman who didn't listen to these plasticity quacks and now is on course to changing how medicine treats CNS disorders forever. Always look for the mechanism, if there is a mechanical injury then one needs a mechanical solution, The plasticity can stay in the counselling room. Thanks for nothing neuroscience.

Raisman stuff below
His panorama doc
http://www.dailymotion.com/video/x2cv8vk_bbc-panorama-special-to-walk-a…

Full Paper
https://www.stgeorges.nhs.uk/wp-content/uploads/2014/12/Functional-rege…

BBC interviews
2014
http://youtu.be/D0cMpLEflUw
http://youtu.be/_DFYxmuhX_Q

2006
with Chris Smith
http://youtu.be/g3-2Gc5LzrI

Stuff that is just beginning to make its way into the brain industry

Do you mean "stuff that's saleable"? Because that's exactly what the essay above is implying - that Doidge is taking liberties with the science to establish his expert credentials in "the brain industry", presumably for his own gain.

Just because we do not all have science degrees doesn’t make us philistines.

Well, except that YOU are asking us to set aside the science because YOU agree with Norman Doidge. What does that say about your relationship with the facts? Further, saying "I'm not a scientist" is a dumb move in any argument, unless it's followed by "...and I don't know what I'm talking about." Otherwise there's a good possibility that you really are a Philistine.

Anyone who is familiar with D.O. Hebb's "The Organization of Behavior," which has influenced generations of behavioral and cognitive neuroscientists, physiological psychologists, and the like since it was published in 1949 have been familiar with adult neuroplasticity, without which, no one could learn or remember anything new after puberty. Neuroplasticity is not a new idea.

I agree with those who have commented that you should actually read Doidg'e work before you call him a huckster, but the comment I would like to make is that as a practicing physician I have first hand knowledge of how little the discovery of brain plasticity has penetrated clinical medicine. Most stroke patients are still being told that they won't gain more recovery after about 3 months despite the well-documented success of Dr. Edward Taub's Constraint-Induced Movement Therapy, which by the way is NOT considered quackery!
It is true that some of the treatments described in Doidge's new book are fringe by current standards, he has clearly done his homework.
With regards to "curing Parkinson's by walking," if you had actually read the book you would know that no claim for cure was made. The biggest problem with that approach is not that it is unscientific or doesn't work, but the fact that it requires intense effort that most patients are unlikely to be willing or able to do.
In fact, one of the things that stands out about the treatments that Doidge describes is that none of them are passive. Even those that use what you would consider suspicious because they use energy (such as sound or low level lasers) require active participation by the patients. This is in harmony with what we know about the science of brain plasticity.
I agree that there is no shortage of hucksters in the brain plasticity space, but Norman Doidge is not among them.

By Ginger Campbell, MD (not verified) on 16 Feb 2015 #permalink

If what you say is true, Dr. Campbell, that there are health care professionals that tell post-CVA patients recovery stops after three months, it's pretty infuriating. I'm a clinical psychologist, and some of my work is with post-TBI/mTBI individuals. Cognitive Rehabilitation is a basic element of TBI treatment, and is premised on the idea that the brain heals, adapts, self-reorganizes. I honestly can't imagine anyone working with TBI patients who thought these processes stop while a person is still alive, even when suffering a degenerative disease like Parkinson's.

Can symptom progression be slowed through CR? Clearly. Can some lost functioning be restored? Indeed, it can. Is this a cure for neurodegenerative disease? Of course not, but none of the professionals I work with would say so, and frankly neither would the patients or their families, any more than a physical therapist would claim PT 'cures' a torn ACL.

Maybe the term neuroplasticity gets bandied around too casually, and the existence of poorly-informed people making exaggerated claims for products and techniques is nothing new or unique to this issue, but applying a term like 'snake-oil' strikes me as too broadly dismissive, too loaded with the implication of deliberate deception by Doidge. Might someone critically evaluate specific treatments described by Doidge, and point out where data is lacking to support a claim? Please do, that would be a great service. But placing him in the same category as 'energized health bracelets' and rhinoceros horn supplements is using the term 'snake oil' much too loosely.

By Ian Douglas Ru… (not verified) on 19 Feb 2015 #permalink

A suicide attempt left me with a serious serious brain injury, encephalopathy, in 2007. After reading Doidge's "The Brain That Changes Itself" and using it as my guide, I performed activities daily for years to encourage directed neuroplasticity to recover. I did completely beyond predictions of doctors. The medical establishment had nothing to offer me and was of NO help. It doesn't matter what research Norman Doidge has done or what requirements you would like to see him, his books, and his work have. His books changes lives for the better. It changed mine. No one knows what the limits are for any particular brain. The "medical experts" with all their facts and tests do a person a HUGE disservice by predicting what they CAN't do based on "the science." No one knows what an individual brain is capable of until they try. Is neuroplasticity going to solve every brain issue? No. BUT, it can remedy many and should be at least considered as an option before pills, surgery, or hopeless resignation is pushed on someone which is all too common.

By debbie hampton (not verified) on 19 Feb 2015 #permalink