The brain that changes itself
The brain that changes itself
The brain that changes itself
Норман Дойдж. Пластичность мозга. Потрясающие факты о том, как мысли способны менять структуру и функции нашего мозга
The Brain That Changes Itself:
Stories of Personal Triumph from the Frontiers of Brain Science
Ученые долго были убеждены в том, что мозг формируется к подростковому возрасту, а потом изменяется только в худшую сторону – стареет и деградирует. Как будто мы катимся по скользкой горке вниз – и уже ничто не может вернуть нас наверх.
Кроме того, врачи утверждали: любые повреждения мозга фатальны! Например, стоит лишь задеть речевой центр (зону Брока) во время операции – и пациент никогда не сможет нормально разговаривать. Поэтому врачи и физиологи не видели смысла в тренировке и обучении людей с врожденными или приобретенными аномалиями мозга.
Новейшие открытия нейрофизиологов доказали: мозг может изменяться в течение всей жизни. Более того, он способен к самоисцелению даже после тяжелой черепно-мозговой травмы или обширного инсульта! Эту способность назвали «нейропластичностью».
На самом деле нейропластичность могла быть открыта намного раньше. Способность мозга изменяться заметили еще в XVIII веке. Однако теорию нейропластичности долго не признавали в научном мире. Слишком невероятной казалась мысль о том, что развитие мозга зависит в первую очередь от усилий самого человека, а лишь во вторую – от природы.
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The Brain That Changes Itself
Stories of Personal Triumph from the Frontiers of Brain Science
by Norman Doidge, M.D.
Patrick Garnett, SMART Recovery ® Volunteer Facilitator & Regional Coordinator (IL)
If you are new to recovery you have probably wondered, is it really possible to change? In “The Brain That Changes Itself,” we learn the answer is a resounding yes. Dr. Doidge, a Canadian psychiatrist and award-winning science writer, recounts the accomplishments of neuroscientists involved in neuroplasticity by sharing with us eleven examples demonstrating how the human brain is extremely malleable, well into old age.
Doidge highlights how our brain is a system of processors that process data from our senses and how these processing centers change and adapt based upon the data that enters. We learn how certain brain exercises can offer radical improvement in cognitive functioning in how we learn, think, perceive and remember, and that these improvements are even possible in the elderly.
Changing our behaviors, unlearning a response and learning a new behavior is very possible, but it takes hard work and practice. The more we have repeated our bad habits, the more space in the brain they claim, thus making it harder for a new habit to find space. It is a process. The saying that you didn’t become addicted overnight, and that it will take practice and patience to unlearn your addictive habits and replace them with good habits, is proven true.
Neurons that fire together, wire together, which gives us insight into how and why certain stimuli or triggers can create an urge to use. You will learn that neurons that fire apart, wire apart, explaining why urges become less frequent, less intense and easier to resist the longer you abstain from using.
The author also covers how we can use our brain’s plasticity to stop worries, obsessions, compulsions and bad habits. We learn how we can shift our brain out of the obsessive thought patterns by focusing on a new, pleasurable activity. The key is to realize that the more you focus on the content of the obsession the worse the condition becomes. It is essential to DO something to “shift” the gear manually. This could even include doing meditation or deep-breathing.
There is not much difference, in our brain, between imagining an act and doing it. We learn that there is actually a materialistic change in the brain when we think. This is why it is of the utmost importance for us to not “play” with thoughts of using, such as remembering the “good old days,” and instead visualize what we are hoping to accomplish.
In another story, Doidge discusses how psychotherapy can actually help to reorganize the brain. So for those of you who may have passed on psychotherapy, thinking it was of no use, you may want to reconsider.
Doidge shows how physical exercise and learning are key to keeping the brain fluid and healthy. Exercise helps produce new brain stem cells and learning prolongs their survival. And when learning new skills, paying close attention and focusing is essential to long-term change. Doidge’s book is a fascinating read and reminds us that everything we think, feel and do matters. So for those of us in recovery, having a well-structured recovery plan is highly-advisable.
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The Brain: Malleable, Capable, Vulnerable
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By Abigail Zuger, M.D.
In bookstores, the science aisle generally lies well away from the self-help section, with hard reality on one set of shelves and wishful thinking on the other. But Norman Doidge’s fascinating synopsis of the current revolution in neuroscience straddles this gap: the age-old distinction between the brain and the mind is crumbling fast as the power of positive thinking finally gains scientific credibility.
The credo of this revolution is neuroplasticity — the discovery that the human brain is as malleable as a lump of wet clay not only in infancy, as scientists have long known, but well into hoary old age.
In classical neuroscience, the adult brain was considered an immutable machine, as wonderfully precise as a clock in a locked case. Every part had a specific purpose, none could be replaced or repaired, and the machine was destined to tick in unchanging rhythm until its gears corroded with age.
Now sophisticated experimental techniques suggest the brain is more like a Disney-esque animated sea creature. Constantly oozing in various directions, it is apparently able to respond to injury with striking functional reorganization, and can at times actually think itself into a new anatomic configuration, in a kind of word-made-flesh outcome far more characteristic of Lourdes than the National Institutes of Health.
So it is forgivable that Dr. Doidge, a Canadian psychiatrist and award-winning science writer, recounts the accomplishments of the “neuroplasticians,” as he calls the neuroscientists involved in these new studies, with breathless reverence. Their work is indeed mind-bending, miracle-making, reality-busting stuff, with implications, as Dr. Doidge notes, not only for individual patients with neurologic disease but for all human beings, not to mention human culture, human learning and human history.
And all this from the fact that the electronic circuits in a small lump of grayish tissue are perfectly accessible, it turns out, to any passing handyman with the right tools.
For patients with brain injury, the revolution brings only good news, as Dr. Doidge describes in numerous examples. A woman with damage to the inner ear’s vestibular system, where the sense of balance resides, feels as if she is in constant free fall, tumbling through space like an ocean bather pulled under by the surf. Sitting in a neuroscience lab, she puts a set of electrodes on the surface of her tongue, a wired-up hard hat on her head, and the feel of falling stops. The apparatus connects to a computer to create an external vestibular system, replacing her damaged one by sending the proper signals to her brain via her tongue.
But that’s not all. After a year of sessions with the device, she no longer needs it: her brain has rewired itself to bypass the damaged vestibular system with a new circuit.
A surgeon in his 50s suffers an incapacitating stroke. He is one of the first patients to enroll in a rehabilitation clinic guided by principles of neuroplasticity: his good arm and hand are immobilized, and he is set cleaning tables. At first the task is impossible, then slowly the bad arm remembers its skills. He learns to write again, he plays tennis again: the functions of the brain areas killed in the stroke have transferred themselves to healthy regions.
An amputee has a bizarre itch in his missing hand: unscratchable, it torments him. A neuroscientist finds that the brain cells that once received input from the hand are now devoted to the man’s face; a good scratch on the cheek relieves the itch. Another amputee has 10 years of excruciating “phantom” pain in his missing elbow. When he puts his good arm into a box lined with mirrors he seems to recognize his missing arm, and he can finally stretch the cramped elbow out. Within a month his brain reorganizes its damaged circuits, and the illusion of the arm and its pain vanish.
Research into the malleability of the normal brain has been no less amazing. Subjects who learn to play a sequence of notes on the piano develop characteristic changes in the brain’s electric activity; when other subjects sit in front of a piano and just think about playing the same notes, the same changes occur. It is the virtual made real, a solid quantification of the power of thought.
From this still relatively primitive experimental data, theories can be constructed for the entirety of human experience: creativity and love, addiction and obsession, anger and grief — all, presumably, are the products of distinct electrical associations that may be manipulated by the brain itself, and by the brains of others, for better or worse.
For neuroplasticity may prove a curse as well. The brain can think itself into ruts, with electrical habits as difficult to eradicate as if it were, in fact, the immutable machine of yore. Sometimes “roadblocks” can be created to help steer its activity back in the desired direction (like bandaging the stroke patient’s good arm). Sometimes rewiring the circuits requires hard cerebral work instead; Dr. Doidge cites the successful Freudian analysis of one of his patients.
And, of course, the implications for external re-engineering of the human brain are ominous, for if the brain is malleable it is also endlessly vulnerable, not only to its own mistakes but also to the ambitions and excesses of others, whether they are misguided parents, well-meaning cultural trendsetters or despotic national leaders.
The new science of the brain may still be in its infancy, but already, as Dr. Doidge makes quite clear, the scientific minds are leaping ahead.
Жить с одним полушарием: что такое пластичность мозга?
Наталия Киеня
Еще 30 лет назад человеческий мозг считался органом, который заканчивает свое развитие во взрослом возрасте. Однако наша нервная ткань эволюционирует всю жизнь, отвечая на движения интеллекта и изменения во внешней среде. Пластичность мозга позволяет человеку учиться, исследовать или даже жить с одним полушарием, если второе было повреждено. T&P рассказывают, что такое нейропластичность и как она работает на физиологическом и молекулярном уровне.
Развитие мозга не замирает, когда завершается его формирование. Сегодня мы знаем, что нейронные связи возникают, гаснут и восстанавливаются постоянно, так что процесс эволюции и оптимизации в нашей голове не прекращается никогда. Это явление носит название «нейрональная пластичность», или «нейропластичность». Именно она позволяет нашему разуму, сознанию и когнитивным навыкам адаптироваться к изменениям окружающей среды, и именно она является ключом к интеллектуальной эволюции вида. Между клетками нашего мозга постоянно возникают и поддерживаются триллионы связей, пронизанных электрическими импульсами и вспыхивающих, как маленькие молнии. Каждая клетка на своем месте. Каждый межклеточный мостик тщательно проверен с точки зрения необходимости его существования. Ничего случайного. И ничего предсказуемого: ведь пластичность мозга — это его способность приспосабливаться, улучшать себя и развиваться по обстоятельствам.
Пластичность позволяет мозгу переживать удивительные перемены. Например, одно полушарие может дополнительно взять на себя функции другого, если то не работает. Так произошло в случае Джоди Миллер — девочки, которой в возрасте трех лет из-за не поддававшей лечению эпилепсии почти целиком удалили кору правого полушария, заполнив освободившееся пространство спинномозговой жидкостью. Левое полушарие почти мгновенно стало адаптироваться к создавшимся условиям и взяло на себя управление левой половиной тела Джоди. Спустя всего десять дней после операции девочка покинула больницу: она уже могла ходить и пользоваться левой рукой. Несмотря на то что у Джоди осталась только половина коры, ее интеллектуальное, эмоциональное и физическое развитие идет без отклонений. Единственным напоминанием об операции остается легкий паралич левой части тела, который, однако, не помешал Миллер посещать занятия по хореографии. В 19 лет с отличными оценками она окончила школу.
Все это стало возможным благодаря способности нейронов создавать между собой новые связи и стирать старые, если они не нужны. В основе этого свойства мозга лежат сложные и малоизученные молекулярные события, которые опираются на экспрессию генов. Неожиданная мысль ведет к появлению нового синапса — зоны контакта между отростками нервных клеток. Освоение нового факта — к рождению новой клетки мозга в гипоталамусе. Сон дает возможность растить необходимые и удалять ненужные аксоны — длинные отростки нейронов, по которому нервные импульсы идут от тела клетки к ее соседкам.
Если ткань повреждена, мозг узнает об этом. Часть клеток, которые раньше анализировали свет, могут начать, к примеру, обрабатывать звук. Судя по данным исследований, в том, что касается информации, у наших нейронов просто зверский аппетит, так что они готовы анализировать все, что им только предложат. Любая клетка способна работать со сведениями любого типа. Ментальные события провоцируют лавину событий молекулярных, которые происходят в телах клеток. Тысячи импульсов регулируют производство молекул, необходимых для мгновенного ответа нейрона. Генетический пейзаж, на фоне которого разворачивается это действо, — физические изменения нервной клетки — выглядит невероятно многоплановым и сложным.
«Процесс развития мозга позволяет создавать миллионы нейронов в правильных местах, а потом «инструктирует» каждую клетку, помогая ей сформировать уникальные связи с другими клетками», — рассказывает Сьюзан МакКоннел, ученый-нейробиолог из Стэнфордского университета. «Можно сравнить это с театральной постановкой: она разворачивается по сценарию, написанному генетическим кодом, но у нее нет ни режиссера, ни продюсера, а актеры ни разу в жизни не разговаривали друг с другом до того, как выйти на сцену. И несмотря на все это, спектакль идет. Для меня это настоящее чудо».
Пластичность мозга проявляется не только в экстремальных случаях — после травмы или болезни. Само по себе развитие когнитивных способностей и памяти тоже является ее следствием. Исследования доказали, что освоение любых новых навыков, будь то изучение иностранного языка или привыкание к новой диете, усиливает синапсы. При этом декларативная память (например, запоминание фактов) и процедурная память (например, сохранение моторных навыков езды на велосипеде) связаны с двумя известными нам типами нейропластичности.
Структурная нейропластичность: постоянная развития
С декларативной памятью связана структурная нейропластичность. Каждый раз, когда мы обращаемся к знакомой информации, синапсы между нашими нервными клетками меняются: стабилизируются, усиливаются или стираются. Это происходит в мозжечке, миндалинах, гиппокампе и коре больших полушарий каждого человека каждую секунду. «Приемники» информации на поверхности нейронов — так называемые дендритные шипики — растут, чтобы усваивать больше сведений. Причем если процесс роста запускается в одном шипике, соседние тут же охотно следуют его примеру. В постсинаптических уплотнениях — плотной зоне, которая есть в некоторых синапсах, — вырабатывается больше 1000 белков, которые помогают отрегулировать обмен информацией на химическом уровне. По синапсам курсируют множество различных молекул, действие которых позволяет им не распасться. Все эти процессы идут постоянно, так что с точки зрения химии наша голова выглядит как пронизанный транспортными сетями мегаполис, который всегда находится в движении.
Нейропластичность обучения: вспышки в мозжечке
Нейропластичность обучения, в отличие от структурной, возникает вспышками. Она связана с процедурной памятью, отвечающей за чувство равновесия и моторику. Когда мы садимся на велосипед после долгого перерыва или учимся плавать кролем, в нашем мозжечке восстанавливаются или возникают впервые так называемые лазящие и моховидные волокна: первые — между крупными клетками Пуркинье в одном слое ткани, вторые — между гранулярными клетками в другом. Множество клеток меняется вместе, «хором», в один и тот же момент, — так что мы, ничего специально не вспоминая, оказываемся способны сдвинуть с места самокат или удержаться на плаву.
Моторная нейропластичность тесно связана с явлением долговременной потенциации — усилением синаптической передачи между нейронами, которое позволяет надолго сохранить проводящий путь. Сегодня ученые полагают, что долговременная потенциация лежит в основе клеточных механизмов обучения и памяти. Это она на протяжении всего процесса эволюции различных видов обеспечивала их способность приспосабливаться к изменениям окружающей среды: не падать с ветки во сне, копать подмерзшую почву, замечать тени хищных птиц в солнечный день.
Очевидно, однако, что два типа нейропластичности позволяют описать далеко не все изменения, которые происходят в нервных клетках и между ними на протяжении жизни. Картина мозга, похоже, так же сложна, как картина генетического кода: чем больше мы о нем узнаем, тем лучше понимаем, как мало нам в действительности известно. Пластичность позволяет мозгу приспосабливаться и развиваться, менять свою структуру, улучшать свои функции в любом возрасте и справляться с последствиями болезней и травм. Это результат одновременной совместной работы самых разных механизмов, законы которой нам еще только предстоит изучить.
The Brain That Changes Itself: Stories of Personal Triumph From the Frontiers of Science (Book Review)
Author: Doidge, Norman
Publisher: Viking Press
Reviewed By: Jane Hall, Vol. XXVII, No. 4, pp. 38-40
Psychiatrist, psychoanalyst, writer, and researcher Norman Doidge delivers a revolutionary message in The Brain That Changes Itself, a very important and informative book that should be read by all. Dr. Doidge takes the reader by the hand and carefully explains that the brain can and does change throughout life. Contrary to the original belief that after childhood the brain begins a long process of decline, he shows us that our brains have the remarkable power to grow, change, overcome disabilities, learn, recover, and alter the very culture that has the potential to deeply affect human nature.
Clear, fascinating, and gripping is how I would describe this invitation to understand how the brain can work. I say “can work” because Dr. Doidge gives new hope to everyone from the youngest to the oldest among us; from the stroke victim to the person born with brain abnormality; from those who can not seem to learn to those whose neurotic suffering has stunted growth through denial and other defenses; and from those who cannot feel to those who feel too much.
The long-held theory that brain functions were localized and specialized has now evolved to embrace the recognition that the brain is plastic and can actually change itself with exercise and understanding. In my mind this is a huge leap in the history of mankind – far greater than landing on the moon – and it is of vital interest for the practice of psychoanalysis among other equally important things.
We meet the patients, scientists and researchers who have pioneered this voyage from brain localization theory (localizationism) to the understanding of brain plasticity. Too numerous to mention, what Dr. Doidge does is introduce these scientists and their work with an ease and grace that brings the reader into their world and work.
In chapter 1, we meet Cheryl, a woman who has completely lost her sense of balance. She must hold on to the wall to walk, but even that does not steady her. And when she does fall, there is no relief for she still feels like she is falling perpetually into an abyss. This excruciating disorder due to total loss of vestibular apparatus makes her life a living hell. Such people are called “wobblers” because that is what they do. They behave and look like they are walking a tight rope. It is not surprising that many “wobblers” have committed suicide.
According to localization theory Cheryl’s case is hopeless. The genetically hardwired processing molecules necessary to feel balance cannot be replaced and there is no cure. Enter Paul Bach-y-Rita and his team who have invented a hat. This hat/helmet, with its tongue display and electrodes, acts as a sensor of movement in two planes thus giving Cheryl the ability to orient herself in space, thereby losing the terrible vertigo that led to wobbling. Cheryl and those like her who wear this seemingly magical hat can experience through the tongue connecting to the brain what is needed to maintain balance by finding new pathways in the brain that process balance.
The broader implications of this discovery are mind-boggling. The elderly, in fear of losing balance due to the weakening of the vestibular sense, often curtail their activities. This device will help them feel secure enough to keep fit. It can also help blind people orient themselves in space thereby giving them a way to see. But the most amazing finding is the residual effect. The longer Cheryl wore the hat, the longer she could keep her balance after she took it off. Over the course of a year Cheryl built her residual effect to four months and now does not use the device at all. She has been cured by her own brain with the help of the device that showed her brain a new road to achieve balance.
Paul Bach-y-Rita’s work has been used with brain trauma, stroke, and Parkinson’s disease showing that the brain is indeed plastic. Such knowledge can ease suffering in many ways. The lesson is that the sensory cortex is plastic and adaptable.
Another hero in the plasticity movement is Michael Merzenich, one of the world’s leading researchers on the subject. Based on his belief in practicing a new skill under the right conditions, he claims that brain exercises can compete with drugs to treat schizophrenia and that cognitive function can improve radically in the elderly. Learning itself increases the capacity to learn by changing the structure of the brain which he likens to a living creature with an appetite needing nourishment and exercise.
Working with a monkey he showed how brain maps are dynamic and work by the ‘use it or lose it’ principle. When a monkey’s middle finger was amputated two other fingers took over the middle finger’s original space, using it themselves. He found that plasticity is a normal phenomenon and by micro-mapping the brain he saw that normal body parts change naturally on the map every few weeks. His biggest opposition came from Nobel Prize winner Torsten Wiesel who believed plasticity existed only in critical periods and never in adults. Wiesel has since recanted, admitting that he was wrong.
Two phrases associated with Merzenich are ‘use it or lose it’ (as with any muscle) and “neurons that fire together wire together” meaning that throwing a ball, for instance, many times in the same way creates a brain map where the thumb map is next to the index finger map, and then the middle finger. So, brain maps work by spatially grouping together events that happen together. Practice makes perfect with minimal effort because fewer neurons are required to perform a task. Proficiency implies a more efficient use of neurons leaving more room on the map for adding skills and executing them more quickly. Paying close attention was found to be essential to long-term plastic change. I would add here that enthusiasm, often involving falling in love with a person, teacher, or game, is an important ingredient in paying close attention. Multi-tasking or divided attention does not lead to lasting change in brain maps.
Fast-ForWord is a training program developed by Mezernich and his colleagues for language-impaired and learning disabled children. Chapter 3, Redesigning the Brain explains how the program was developed and what it does. Raising IQ levels, helping children conquer their disabilities and even changing the lives of the autistic, this chapter is the heart of the book and of great import to the aging population (all of us). Merzenich explains that the reason it becomes hard to find words as we age is that attentional systems become atrophied and have to be engaged for plastic change to occur. He says that ‘fuzzy engrams’ (unsharp) are being fired slowly and are not passed down stream quickly causing muddy streams or noisy brains. “OK,” Merzenich seems to say, “everything is going to hell progressively, but on top of that the brain gets noisier due to lack of exercise.” Acetylochine, a chemical which allows neurons to communicate with each other thus helping the brain tune in and form sharp memories is not even measurable in most elderly people. This is because after middle age a sense of relaxation about who we are and what we do lulls us into repeating skills and favorite activities instead of learning new ones which allows the brain to atrophy. By age seventy a person may not have focused on something new for years thus losing plasticity. Learning new things such as language, doing challenging puzzles, even learning new dance steps revive plasticity. The message is clear. Do something new and challenging and have fun doing it. Then you may remember where you put your keys or why you walked into the kitchen. Turn your senior moments into junior ones! Merzerlich claims that 20 to 30 years of reversal in cognitive ability can occur. As soon as I finish writing this review I am going out to cyberspace to hunt down the Posit Science web site he and his colleagues founded. Last week I started dancing lessons. Maybe next week I’ll start learning Spanish. I am sold.
The story of Mr. L in Chapter 9 illustrates exactly how psychoanalysis changed his character defenses by helping him access his deepest feelings about loss. Mr. L learned that it was safe to give up the denial that protected him for over 40 years from the pain of early loss. He exposed the memories and emotional pain that he had hidden, permitting psychological reorganization. Mr. L changed from an isolated, depressed man unable to commit to anyone, to a man able to experience profound love, marry, and have children. We psychoanalysts see exactly how Mr. L’s analysis worked using the theory of brain plasticity.
In chapter 11, «More Than the Sum of Her Parts,» we meet Michelle, born with half a brain. The fact that her right hemisphere took over from her left hemisphere the functions of speech and language, while performing its own functions speaks clearly for neuroplasticity. Michelle leads a comfortable, though somewhat impaired life, enjoys movies, a job, and her family. The story of how one half of her brain took on functions of the missing half is an adventure.
My favorite parts of the book have to do with stroke victims (those who lose feeling, in chapter 5; and those who have too much feeling and are in pain, chapter 7). Earlier in the book (page 20) we meet Paul Bach-y-Rita’s father, Pedro, who suffered a severe stroke at age 65 paralyzing his face, half of his body and leaving him unable to walk or speak. He was pronounced incurable after the usual rehabilitation course and an institution was recommended. Instead, his son, George, took his poet father Pedro home to Mexico where, with the help of the gardener, they rehabilitated him by starting him crawling, then playing children’s games, and turning everyday life experiences such as washing pots into exercises in order to strengthen his arm. Pedro eventually began typing and speaking and after a year of this unconventional therapy (which included much love I think) he was back teaching full time. He remarried, traveled, hiked in the mountains, and led a full life for seven more years. After he died from a heart attack while climbing a mountain, an autopsy revealed catastrophic damage from the cerebral cortex to the spine which had caused the paralysis and had never healed. There were no brain scans in those days but the autopsy proved that the brain was indeed plastic and could reorganize its functioning completely after long periods of inactivity in an elderly person. This is important because when a patient recovers from a stroke so completely doctors think there was not much damage in the first place. The autopsy showed the vast destruction. A longer discussion of stroke recovery is in chapter 5, “Midnight Ressurections” – a chapter that defies synopsis – and must be read to be thoroughly appreciated.
The theory from the time of Descartes, that pain receptors send a one way signal to the passive brain, has been refuted. Neurologists Wall and Melzack assert that the pain system is spread throughout the brain and spinal cord making the brain, far from passive receiver, the controller of pain. These men proposed the “gate control theory of pain” and their findings must be read by anyone who has or does experience acute or chronic pain. Therapists who work with such patients will benefit as well.
Dr. Doidge is in the position to use the implications of brain plasticity to explore many psychoanalytic theories, diagnoses, and treatment techniques and I hope he will focus on these issues in his next book. Such phenomena as splitting, hysteria, obsessions and compulsions, and especially addictions must be explored from the theory of brain plasticity. I would venture to say that such concepts as changes in one’s representational world, identification, internalization, and the analyst as new object looked at in terms of brain plasticity is imminent if not already here. If you link Pedro Bach-y-Rita’s remarkable recovery to regression, revisiting an early developmental stage, the regression in psychoanalysis seems explainable in terms of new development and new compromise formations. Although cognitive behavioral therapy would seem viable with all this learning involved, it misses the most important ingredient for change and that is the connection over time with the analyst and the empathy and love experienced.
The Brain That Changes Itself leaves me with one major question: Why isn’t this book on the top of the bestseller list for all time? Gift shopping will no longer be a problem for me!
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