The Brain That Changes Itself: What the Evidence Supports

In 2007, Viking published in the United States a book by a Canadian psychiatrist that told readers the adult brain is not a fixed machine. Norman Doidge's The Brain That Changes Itself made neuroplasticity a household word. What did it claim, and how much has held up?

Who wrote it

According to his official biography, Doidge is a psychiatrist and psychoanalyst who spent thirty years on the faculty of the University of Toronto's Department of Psychiatry and was research faculty at Columbia University's Center for Psychoanalytic Training and Research in New York. His site says the book has sold over 1 million copies and is available in over 100 countries and 27 languages.

The thesis: the end of the hardwired brain

In the preface, Doidge argues that for four hundred years mainstream medicine treated adult brain anatomy as fixed. The book follows researchers who, from the late 1960s on, showed that the brain reorganizes itself with use. It also warns of what Doidge calls "the plastic paradox": the same flexibility that allows recovery can lock in rigid habits.

The cases at the heart of the book

Cheryl Schiltz and Paul Bach-y-Rita. In 1997, the antibiotic gentamicin destroyed nearly all of Schiltz's balance function; tests showed about 2 percent remaining. Bach-y-Rita, who had described a touch based vision aid for the blind in Nature in 1969, fitted her with a hat whose accelerometer fed a strip of 144 electrodes on her tongue. In Doidge's account, her balance lasted longer after each session until she no longer needed the device. A 2003 paper by the team reported that this tongue display restored postural control for a time after removal.

Michael Merzenich and cortical maps. In a 1984 study of adult owl monkeys that had lost one or two fingers, Merzenich's team found that the neighboring fingers had expanded into most or all of the brain territory once devoted to the missing ones.

Edward Taub and constraint induced therapy. Taub's team restrained the healthy arm of chronic stroke patients for 14 days and gave them intensive practice with the weak arm. In a 1993 paper, patients improved markedly from a plateau that had lasted years, with gains maintained over two years of follow up.

V.S. Ramachandran and the mirror box. In a 1996 study of ten amputees, a vertical mirror made the reflection of the intact hand appear where the phantom limb was felt. In four of five patients with painful clenching spasms in the phantom hand, the mirror relieved them.

Michelle Mack. Mack was born missing nearly all of her left hemisphere, likely after a stroke before birth. Her NIH doctor told CNN in 2009 that about 95 percent of that side's cortex was gone, yet her right hemisphere had taken over language, at some cost to spatial skills.

Reading the book today

The core claim, that experience reshapes the brain, is no longer controversial. The open question is scope: which changes are large and reliable enough to help patients beyond a single case? Constraint induced therapy shows the path: a mechanism, small studies, then a multisite randomized trial. The 2014 statement makes the reverse point about brain games: practice changes the brain, but gains on a practiced task do not prove a general benefit. See also our reading of the ACTIVE trial and dementia and our guide to reading a health study in five minutes.

For any striking recovery, readers can ask: was there a comparison group, how many people were tested, and who was selling what? This article describes published research and is not medical advice.