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Archive for the ‘books’ Category

I finished reading William Fiennes, The Snow Geese, this morning, then as I looked out of my window I saw this sight

flying south

I followed them round to the other side of my house….

flying south

I don’t really know what to make of these “coincidences” in life, but they certainly heighten the sense of emerveillement in le quotidien……

I really enjoyed ‘The Snow Geese’. It’s one of those books I’ve had lying around for a long time, but only recently decided to read. It has that wonderful combination of beautiful writing and fascinating, thought provoking facts, which I love. The main themes of the book, based around the writer following snow geese as they head north to their breeding grounds, are about freedom, our connection with nature, and the strong instincts to head home (migratory birds have two homes really…..one for the summer and one for the winter).

What I didn’t expect to find were some references to homesickness from a medical perspective, and, given that I’m a doctor, it should be no surprise that those passages leaped out at me.

Baron Dominique Jean Larrey, Inspector of Health of the French armies under Napoleon [described nostalgia in the following terms] First, an exaggeration of the imaginative faculty: patients thought of their homes as enchanting and delightful, and expected to see relatives and friends advancing towards them. Second, the appearance of physical symptoms: fever, gastric disturbance, ‘wandering pains’. Finally, depression, listlessness, weeping, and sometimes suicide.

How fascinating to see this holistic description and understanding, beginning with an individual’s inner, subjective, mental processes, leading onto whole body dysfunction with specific disorders in certain organs and systems, then progressing to a life-threatening state of mind. What cures did such doctors suggest? Larrey recommended distraction – through “music, recreation and regular exercise”.

In 1858, James Copland, in his ‘Dictionary of Practical Medicine’, described nostalgia as a cause of disease, rather than as a disease itself (where does a disease begin? Can you really say where health gives way to disease?) However, he still considered it to be a serious problem.

The patient nurses his misery, augments it until it destroys his nightly repose and his daily peace, and ultimately devours, with more or less rapidity, his vital organs.

Fiennes quotes from a 1996 edition of Psychological Medicine ….

What strikes one most in the sparse literature on help for the homesick is that often only returning to the old home environment brings real relief.

Well, well, well…..how often is it the case that the solution to a problem is to deal with the problem?! I know that seems obvious, but if it’s so obvious why do we persist in using drugs which merely mask symptoms as first line treatments for so many problems?

I’m particularly struck by the holistic, contextually bound understanding of the nature of homesickness in these works. How have we allowed the practice of medicine to decline to its currently dehumanised, mechanistic form? A doctor must understand the narrative context of a patient’s illness to arrive at a correct “diagnosis”, not just hunt a lesion and divide illness into real or imaginary, organic or functional. A person can only be fully understood as a whole person, body, mind and spirit, inextricably embedded in their unique physical and semantic environments……and, so, “cures” should be based on this perspective rather than the diminished, reductionist one, shouldn’t they?

We are connected. Intimately, complexly connected. ‘The Snow Geese’ reminds us how connected all creatures are to their environments and to the rhythmic change of the seasons. Good to be reminded of that in this snow and ice bound December in Scotland.

How are you going to spend your wintering?

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Mary Midgley is an English philosopher whose latest book, The Solitary Self [978-1-84465-253-2], develops a case she has laid out in previous books. I first read Mary Midgley in her Science and Poetry, which was so clear, readable and thought-provoking. In that book, she argued that the concept of atomism when applied equally to the parts of a person and to individuals within society didn’t make sense. She develops that argument here in a brilliantly focused attack on neo-Darwinists such as Dawkins, who, she argues, have reduced Darwin’s thought to the principle of survival of the fittest. Dawkins’ Selfish Gene being a classic example of such a world view – the world view that competition and fighting for individual advantage is the way of Nature, the way of human beings, and the way society should be run. The values they promote are the values of selfishness. She elaborates in detail, quoting from Darwin’s own writings, how humans are actually intensely social creatures.

In fact, you can’t reduce Mary Midgley’s arguments to simple sound-bites in the way the neo-Darwinists like to promote their ideas. This is because she completely accepts the complexity of life, and the inescapable conflicts at the heart of every human being.

I think this little book is terrific at putting the case for an understanding of the importance of collaboration, as much neglected in recent decades. She is also very strong on the irrationality of using reductionism to try to explain complex wholes –

One way and another, then, it emerges that, in general, the reductive thinking that theorizes about large-scale behaviour from analogy with the behaviour of small parts is not reliable or scientific.

Here’s one paragraph from her book, which I think, really does capture her most important argument.

All this later became part of a much wider campaign, conducted by thinkers such as Nietzsche and the existentialists, to exalt freedom above all other ideals, isolating modern individuals in pure and heroic independence. Like all such one-sided advice, this campaign ignores crucial aspects of our nature. It assumes that we are independent items, isolated brains, intelligent billiard balls that need no sustenance and could choose to live anywhere. But we are actually earthly organisms, framed to interact continually with the complex ecosystems of which we are a tiny part. For us, bonds, are not just awkward restraints. They are lifelines. Although we all need some solitude and some independence, total isolation is for us a desolate and meaningless state. In fact, it is about the worst thing that can happen to us.

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Tim Parks’ excellent “Teach Us to Sit Still: A Sceptic’s Search for Health and Healing” was recently reviewed by one of the British Medical Journal’s Associate Editors.

By now you must be as bored as I was. And we still haven’t reached the dénouement. I don’t think that I shall be spoiling anything for anyone if I say that eventually he found that learning to meditate brought an end to the pains, although he doesn’t say whether he can pee any better.
Obviously this book wasn’t written for doctors, and I’m doubtful whether they will enjoy it much. They will have heard versions of this story many times before from their own patients whom they tried hard, but failed, to help. Indeed at one level this particular narrative is little more than a long and self absorbed account of the inner journey of a man desperately seeking meaning in and relief from chronic (but not incapacitating) symptoms, who eventually manages to find both through visipanna meditation. Yet before dismissing it entirely it’s worth remembering that the author is a successful writer and academic—one of his novels was shortlisted for the Booker prize—and probably a lot cleverer than we are.

You can tell he didn’t like it.
Having just read the book myself and found it thoroughly engaging, and thought provoking, I thought the BMJ’s review showed just what’s gone wrong with medicine with these days – doctors shouldn’t find patients’ stories boring. They shouldn’t find them irrelevant, nor should they believe that their own take on illness or health is superior to that of the person they are trying to help. What happened to compassion? When did human beings become the boring part of medicine? Interestingly, there are clues in Parks’ own text. Consider these two statements –

What’s the point of speaking when you’ve arranged to do proper clinical tests? The tests will speak for you.

and

Without evidence of organic damage pains were perhaps unimportant. At least to doctors.

I’ve had junior doctors tell me they are being taught exactly these views – that only clinical tests show the “truth” and that patients’ stories don’t matter. This doesn’t bode well for the future practice of medicine.

In fact Parks predicts the BMJ editor’s response –

Doctors had never wanted to go into detail over this, as if afraid that an exhaustive description of symptoms would mean losing themselves in a labyrinth of highly nuanced but irrelevant sensation.

But the editor is right. This is not an uncommon story. That, however, certainly does not make it boring. This is a good read. It’s an engaging and thoroughly honest, open account of a chronic problem which the best of “evidence based medicine” could do nothing to help. That too, is not an uncommon story.

Given that Tim Parks describes himself as a “skeptic” (though I think that label is much misapplied these days….seems the average “skeptic” is actually someone arrogantly convinced of the rightness of their own personal view, only doubting everybody else’s!), it’s interesting to find him saying this (comparing his mother and father’s evangelical Christian fundamentalism to their belief in modern “scientific” medicine”) –

..like doctors’ syrups, divine healing required no effort or self-knowledge on the part of the sufferer; neither my father nor mother paid much attention to their bodies.

One of the most important points he makes is –

Wasn’t it weird, in fact, the way everybody imagined that when you were ill all you had to do was go to a doctor and get yourself prescribed a medicine? How did that happen?

He’s right. How did that happen? And isn’t it weird? Health isn’t about getting a pill, and doctors don’t always know best. Trust me. I’m a doctor.

Finally, referring to John Launer’s suggestion that “MUS” should mean “Medically Unexplored Stories”, instead of “Medically Unexplained Symptoms”, the reviewer concludes –

Perhaps he’s right. If so, the moral of the story told by Parks is that intelligent, educated, and apparently rational people may think about their health and illnesses in ways that hardly begin to overlap with ours.

You know, it’s not about intelligence, education or rationalism, it’s the biotechnical doctors who have lost the plot. It’s their way of thinking which hardly begins to overlap with that of their patients, and as health is a personal and individual experience, the most important story is the patient’s one.

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The Other, by Ryszard Kapuciski (ISBN 978-1844674169) is a beautiful, thought provoking little book.

Here are a few quotes to whet your appetite.

[Herodotus] understood that to know ourselves we have to know others, who act as the mirror in which we see ourselves reflected; he knew that to understand ourselves better we have to understand others, to compare ourselves with them, to measure ourselves against them.

Xenophobia, Herodotus implied, is a sickness of people who are scared suffering an inferiority complex terrified at the prospect of seeing themselves in the mirror of the culture of others.

Conquer, colonise, master, make dependent – this reaction to others recurs constantly throughout the history of the world. The idea of equality with the other only occurs to the human mind very late on, many thousands of years after man first left traces of his presence on Earth.

All this seems increasingly relevant in the growing xenophobia around the world. Yesterday I read Rachida Dati’s impassioned plea, in Le Monde, to stop setting French people against each other.

Cessons donc d’opposer les Français les uns aux autres, au profit d’un meilleur vivre ensemble !

Today, I read in the Guardian, Mya Guarnieri’s piece about islamophobia, where she talks about her feelings and memories aroused by the newspiece about a pastor from her hometown of Gainsesville, Florida, who is intending to burn copies of the Qur’an to commemorate September 9th.

When I was a child, some of my evangelical Christian classmates urged me to convert. Because I was Jewish and didn’t accept Jesus Christ as my personal lord and saviour, they told me, I was going to hell…….In the past, there was antisemitism, roiling just below the surface. Now, there is Islamophobia. If Terry Jones burns copies of the Qur’an in Gainesville, he’ll leave a shameful scorch on us all.

We definitely need a more positive attitude to the Other – to whoever is different from us.

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Remember the X-files?

Well, the question about there being a truth “out there” is an interesting one. Out where, exactly? I’ve stumbled across an interesting couple of phrases recently which are getting me thinking about the nature of reality and how we experience it.

Our experience of the world helps to mould our brains, and our brains help to mould our experience of the world.

Iain McGilchrist, in The Master and His Emissary, uses a lovely word – “reverberative” – to capture the idea of reality being a dynamic interactive relationship between the subject and the object.

….right-hemisphere qualities of being a betweenness: a reverberative, “re-sonant”, “respons-ible” relationship, in which each party is altered by the other and by the relationship between the two..”

So, even if there is an “out there” it can only be known in the acting experiencing, a two-way, constantly changing experience.

Everything that we know can be known only from an individual point of view, or under one or another aspect of its existence, never in totality or perfection. Equally what we come to know consists not of things, but of relationships, each apparently separate entity qualifying the others to which it is related.

“…what we come to know consists not of things” – now that’s a thought-provoking phrase.

Then I came across an article by Professor Richard Conn Henry, from the Department of Physics and Astronomy at John Hopkins University. His article, published in Nature, is titled “The Mental Universe”, with the summary “The only reality is mind and observations, but observations are not of things. To see the universe as it really is, we must abandon our tendency to conceptualise observations as things”.

He quotes the physicists Sir James Jeans….

..the stream of knowledge is heading towards a non-mechanical reality; the Universe begins to look more like a great thought than like a great machine. Mind no longer appears to be an accidental intruder into the realm of matter….we ought rather hail it as the creator and governor of the realm of matter.

and Sir Arthur Eddington

It is difficult for the matter-of-fact physicist to accept the view that the substratum of everything is of mental character.

But, says Professor Henry, that’s exactly what quantum physics is showing us. In this article he says “The Universe is entirely mental…and we must learn to perceive it as such”, concluding with the following words –

The Universe is immaterial – mental and spiritual. Live, and enjoy

I have a feeling materialistic scientism is in its last days!

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The Master and His Emissary

Thank you, Iain McGilchrist. This is not only a brilliant and comprehensive work, not only utterly convincing and erudite, but it shines the bright light of understanding on so many aspects of life. I can’t remember a time I enjoyed a book more than this one. I can’t remember a time I felt so enthralled by a book as this one. I’ve been busy underlining, making notes, looking up references and reflecting since I opened up this immense text. I haven’t rushed it, but I’m still a bit sad I’ve finished it. I’d have read more!

Iain McGilchrist is trained in both the Arts and Science, having taught English at Oxford University and worked as a Consultant Psychiatrist. The Master and His Emissary begins with a review of the science of the brain. Why is our cerebral cortex split into two halves with only a thin connection between the parts? Do the two halves do the same job? And if so, why have two halves to do the same job? This is no simplistic idea of “right brain versus left brain” however. He does make the claim that the two halves are NOT the same. In fact we can see that in the gross anatomy, but we’re also seeing it in the functions revealed through clinical experience (what changes for a person who loses the function of a certain part of the brain?), and through both neuroscience experiments and imaging work.

Put simply, he claims that the two halves of the brain are used to engage with the world in two different, but essential, ways. While the right hemisphere has an open and wide focus on the world, noticing connections, or the “between-ness” of things, the left has a narrow focus, noticing the parts. Both of these forms of attention are important to us.

Things change according to the stance we adopt towards them, the type of attention we pay to them, the disposition we hold in relation to them. This is important because the most fundamental difference between the hemispheres lies in the type of attention they give to the world.

He postulates that the brain has evolved this way to allow us, first of all, using our right hemisphere, to be aware of life as it is, or in its wholeness, then the left hemisphere selects some of that information from the right in order to focus on part of life in order to exert power over it. In other words, the left has a focus on utility to allow us to interact with specific parts of reality. Having focused on part of reality, the left then sends this information back across to the right, for the right to incorporate it in its over all understanding. Drawing on an old tale of a Master and his Emissary, he identifies the right hemisphere as the Master, who sends out his Emissary (the left hemisphere) to do specific work for him.
He then goes on to show how dominance of either the right or left ways of engaging with the world create the culture of the time. Having done so, we come to the final part of his thesis. By describing the culture of different eras, examining everything from philosophy, art, music and writing of each time, he shows how there has been a progressive shift in power from the Master to his Emissary, so that by now we are experiencing a world created by the left hemisphere as if the right is either redundant, or doesn’t exist.

Let me be clear here. He is not simplistically saying right side good, left side bad. Rather he continually reminds us that we need a healthy integration of both of these ways of understanding and engaging with the world.

Ultimately we need to unite the ways of seeing that are yielded by both hemispheres. Above all the attention of the left hemisphere needs to be reintegrated with that of the right hemisphere if it is not to prove damaging.

He gives us plenty of evidence that the dis-integrated dominance of left hemisphere thinking is damaging ourselves and our planet.

Here’s one of his many summaries throughout the book of the differences between these two approaches.

The world of the left hemisphere, dependent on denotative language and abstraction, yields clarity and power to manipulate things that are known, fixed, static, isolated, decontextualised, explicit, disembodied, general in nature, but ultimately lifeless. The right hemisphere, by contrast, yields a world of individual, changing, evolving, interconnected, implicit, incarnate, living beings within the context of the lived world, but in the nature of things never fully graspable, always imperfectly known – and to this world it exists in a relationship of care.

I wish we had a course based on this book. A course which ALL health care professionals would complete. If we did, we’d counter the increasing objectification of patients as examples of diseases to be manipulated on the basis of abstracted and generalised research as if they are objects without individuality or context. We’d counter the increasing fruitless or delusional pursuit of certainty. We’d have a chance of increasing empathy, a respect for difference and individuality, of increasing our understanding of patients as people in a holistic and contextually embedded way. We’d move from agendae of “management” and “productivity” to ones of care and experience.

This book has taught me so much. The discussion of the relationship between music and language was a complete eye opener to me. I’m learning a lot about neuroscience just now as I’m taking Dr Dan Seigel’s “Mindsight” course, and his focus on “integration” fits right in with this thesis, as does Dan’s definition of mind – “an embodied, inter-relational, process of regulation of energy and information”. It connects to other books I’ve read, such as Daniel Pink’s “Whole New Mind”, Richard Ogle’s “Smart World”, Robert Solomon’s critique of the “thin-ness” of much philosophical thought in “The Joy of Philosophy“, and Lakoff and Johnson’s “Metaphors We live by”.
It helps me to make sense of both “scientism” and “scientific materialism” and gives me insights which clarify why I find those approaches to life to be so profoundly lacking and unsatisfying.

Guess what I’m going to do now? Yep, I’m going to start to read it again. I’m convinced this is an important and much needed book published just when the world needs it. We need to prioritise integrative approaches to life, and certainly to health care, and, I believe, we need to increase the amount of empathy and understanding in the world. Iain McGilchrist has shown us how to enrich life with the rewards which can come from a reactivated right hemispheric approach to reality.

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I recently read a great piece by Jonah Lehrer where he ponders about the way we pursue science. It’s worth reading the whole article, but here’s the paragraph which really grabbed my attention –

Karl Popper, the great philosopher of science, once divided the world into two categories: clocks and clouds. Clocks are neat, orderly systems that can be solved through reduction; clouds are an epistemic mess, “highly irregular, disorderly, and more or less unpredictable.” The mistake of modern science is to pretend that everything is a clock, which is why we get seduced again and again by the false promises of brain scanners and gene sequencers. We want to believe we will understand nature if we find the exact right tool to cut its joints. But that approach is doomed to failure. We live in a universe not of clocks but of clouds.

rain clouds

UFO clouds

sun through clouds

sun setting below clouds

I think clouds are beautiful, don’t you? Their variety, their constantly changing shape and colour and size…..their unpredictability. Astonishing. So, yes, I agree with Jonah, (and with Karl Popper), the mechanistic view of the universe has brought certain understandings and certain powers, but the networked, complex view of the universe will bring us a new understanding of reality, with quite a different concept of power. Jonah sums it up this way –

So how do we see the clouds? I think the answer returns us to the vintage approach of the Victorians. Right now, the life sciences follow a very deductive model, in which researchers begin with a testable hypothesis, and then find precisely the right set of tools to test their conjecture. Needless to say, this has been a fantastically successful approach. But I wonder if our most difficult questions will require a more inductive method, in which we first observe and stare and ponder, and only then theorize.

I think it’s about learning to use the whole brain again. Read Ian McGilchrist’s “The Master and his Emissary”. He explains more clearly than anyone else just what these two ways of seeing the world are about and how we might recapture our ability to use both halves of our brain!

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I like to read books which change my life. Lots of books do that for me. In fact, the books I enjoy most are those which do just that, the ones which open up new ways of thinking to me, new ways of seeing, expand my understanding, stimulate my creativity, books which, once I’ve read them, my world is not the same.
I’ve read a lot of books like that, and if you browse this blog reading the posts in the category “from the reading room” you’ll find reviews of several of them.
I’ve just read another. In fact, I can’t remember the last time I felt this excited reading a particular book. It’s Dan Siegel’s “The Mindful Therapist” [ISBN 978-0393706451]
Now, I haven’t come to this book cold. I’ve read, first of all, his “Mindsight” [ISBN 978-1851687619] (and if you’re inspired to explore this body of work I recommend you start with that), his “The Mindful Brain” [ISBN 978-0393704709], and “The Developing Mind” [ISBN 978-1572307407], before I got hold of this, his latest book, “The Mindful Therapist”.

I’m also well into his online course which I’m thoroughly enjoying.

So, a lot of the concepts in this “Mindful Therapist” were already familiar to me before I opened it up – the idea of the mind as “an embodied, relational process of regulation of energy and information flow”,  the idea of the triangle of wellness – mind, brain and relationships, the understandings from neuroscience of integrated function of differentiated parts, of the key roles of the midfrontal cortex, and of neuroplasticity,  and the practices of the wheel of awareness and other meditations
Despite my familiarity with all of that, and more, this particular book has blown me away. I’ve already begun to introduce patients to the idea of health as a flowing, adaptive, coherent, energised, stable river, with the opposite banks of chaos and rigidity which we end up on when we become unwell.

I’ve begun to share with some patients the deceptively simple wheel of awareness meditation. But now, I’ve got a whole new level of insight.
Into this familiar mix, which Dan expands and reinforces throughout “The Mindful Therapist”, he gives exercises in self-discovery, and models of personality and behaviour which I’ve never seen described elsewhere. I’ve said before I’ve got a synthetic brain – always making links, seeing patterns, associations, expanding through increasing connections – well, I’m pretty sure that’s how Dan’s brain works too. He draws on insights from a multiplicity of disciplines and together, (in a “consilient” way), they create a whole which is way greater than its parts.
If you’re a health professional of any kind, I urge you to read this book. You practice, your life, won’t be the same again. You’ll find new depths as well as new horizons.

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Connected, by Nicholas Christakis and James Fowler, (ISBN 978-0-00-734743-8) is a fascinating study of social networks. In the Preface they write

To know who we are, we must understand how we are connected.

This is what Clay Shirky says in Here Comes Everybody, it’s what Johansson says in The Medici Effect, Andy Clark says in Smart World, and, for me, most powerfully what Barabasi says in Linked. So what does this book add?

The clear focus of Connected is social networks – you’ll be familiar with the idea of “six degrees of separation” where it’s been discovered there are an average of only six steps between any two human beings on the planet. Christakis and Fowler take this finding a step further by highlighting and explaining “three degrees of influence”. In social networks, you influence your friend, who influences their friend, who influences their friend (and the influences flow both ways), but after that, the power of the effect tails off or disappears. The power of the effect seems related to two things – how many connections a person has, and how many of those people to whom they are connected are connected to each other (in other words how many of your friends know each other?)

These simple characteristics create very complex webs and patterns of influence and can explain a wide range of events, from the spread of a viral infection in a community, to the collapse of the financial system, to the spread of obesity, a wide range of disorders, and both cultural and political changes.

It’s a bizarre thought to learn that obesity in a community is distributed the same way as an infection. If your friend’s friend becomes obese, you’re more likely to become obese (and vice versa)! Obesity seems to be contagious.

The book is packed full of interesting and mind-boggling examples. A couple that really struck me were the spread of back pain in Germany – before the wall came down East Germany had a very, very low incidence of back pain, and in the West it was one of the highest rates in the world. After the wall came down, the incidence in the East rose to match that in the West. A study of epidemic control showed that you needed to vaccinate 90% of the population to stop the infection, but if, instead you asked a random selection of individuals who their acquaintances were, then calculated which individuals were most connected, and vaccinated only them, you could control the infection by vaccinating only 30% of the population. I could go on…..but read it yourself, it’s truly mind expanding. Really the idea that we are all separate free-thinking individuals is at best a simplistic delusion. We are who we are because of the way we connect.

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The Brain That Changes Itself. Norman Doidge (ISBN 978-0141038872)

Read this book. It’s a long time since I read such an inspiring book. Norman Doidge is a great storyteller and in this book he weaves together a number of individual stories of pioneering clinicians and researchers and remarkable people who overcame enormous difficulties. One of the most remarkable elements of the stories of the researchers is contemporary rediscoveries of decades old findings which were totally dismissed by orthodox science of the time, and which met equally harsh criticism when re-presented and developed. There’s something about scientific orthodoxy which slows up progress as entrenched authorities dismiss new discoveries. Whilst scepticism is a healthy scientific stance, there are lessons to be learned about the negative impact of closed minds.
The stories told in this book show how careful observation of, and listening to, individuals, the ability to imagine what nobody else has considered so far, and the courage to break new ground by thinking differently, all combine to break through limits, deepen understanding and show what’s really possible.
The dominant model of the brain for centuries has been a mechanical one. In particular, we’ve had (and, amazingly, many still have) a model of the brain as being a machine of many parts, with fixed areas responsible for specific functions. The discovery of brain plasticity – the capacity of the brain to physically change – has blown this old model out of the water.
In chapter after chapter of this book, Norman Doidge shows that the potential for the brain to recover from serious damage is astonishingly greater than you’d ever have imagined. He also shows how the relationships between the brain and the mind, between the brain and the body, and between the brain and other people, is completely bi-directional. Our brains physically change with our thoughts – thought patterns create and reinforce physical connections of neurons – and those connections set up thought patterns. Our brains change our relationships with others, and our relationships with others actually change our brains.
This is an immensely convincing and satisfying alternative explanation to mechanistic reductionism.
Ultimately this is an exciting read, an inspiring read, a book that will change your idea of the limits of human potential.

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