THE BRAIN'S WAY OF HEALING
by Dr. Norman Doidge
A REMARKABLE BOOK THAT SHOULD BE REQUIRED READING FOR ALL ENTERING THE MEDICAL PROFESSION - Keith Hunt
Learning Disorders, Social Engagement, and Depression
One of Tomatis's students was a physician who was skeptical that sound could correct learning problems. That attitude changed when his own daughter s life was hanging in the balance. Ron Minson had been chief of psychiatry at Presbyterian Medical Center in Denver and head of the Behavioral Sciences Center at Mercy Medical Center, where he taught before he went into private practice.
After losing a child to crib death, he and his wife, Nancy, adopted a delightful infant, Erica. A happy toddler, in grade one she had trouble sounding out letters, reversed them, and couldn't spell or do math. Her voice was flat, she struggled to understand others, and she couldn't tell if they were joking, angry, or being insistent. She failed first grade, and as each school year passed, she experienced a steady diet of failure.
An astute colleague of Ron's thought she might have dyslexia, so they tried all the conventional approaches—private tutors, speech and language pathologists, and special education—but to no avail. Ritalin-like stimulants for her poor attention just made her feel "hyped up." Erica became a sullen, depressed, rebellious adolescent warrior. Psychological testing concluded that "she lived in a fantasy world, much of the time, characterized by magical thinking." Antidepressants gave her side effects that made her feel worse than being depressed. In high school, her reading was still at fifth-grade level, and she fought every attempt her parents made to help her. Her school gave up on her, and by the time she reached eleventh grade, she was so filled with despair, she dropped out and worked as a chambermaid, at a car wash, and at a fast-food restaurant, but was routinely fired for a bad attitude or for not showing up. At eighteen, when her peers were talking about their GPAs and heading to college, she was looking at her future and couldn't see her life working out. Like so many young people with learning disorders, she gave up on herself. She became suicidal. Ron was an adept psychiatrist, and yet with the person he wanted to help most, it seemed he could do nothing.
One day when she was nineteen, she slipped into a warm bath with a razor blade to slit her wrists. Just then, her cat came into the room, jumped up on the bath ledge, and licked her shoulder. Erica changed her mind.
Around this time, another colleague of Ron's went to a conference and heard Paul Madaule tell how Tomatis had helped him. Ron says he "blew it off" because it sounded too weird. But as Erica's depression worsened, he did a literature search on Tomatis and discovered the one paper on the subject in English, Paul Madaule's "The Dyslexified World."
"I read it and I cried," said Ron. "I realized that I finally had an idea of what it was to be caught in that world."
"The Dyslexified World" (or "Uunivers dyslexie," as Paul originally called it) was written when he was only twenty-eight years old, yet remains one of the more remarkable papers on a clinical subject that I have read. It is an understated clinical masterpiece. Psychiatry gives learning disorders short shrift. The Diagnostic and Statistical Manual of Psychiatry (DSM-IV-TR) offers only impoverished categories with titles such as "reading disorder." To meet the criteria, you must be unable to read, as measured on standardized tests, implying that dyslexia is only an academic problem.
Paul's paper blasted this idea apart. It begins:
In the eyes of many, dyslexia might appear to exist only in the classroom, since it is the label which designates the child with reading problems. Here my purpose is to focus on the dyslexic youngster himself, on the person hidden behind the phenomenon known as "dyslexia" precisely because the dyslexic child lives with his dyslexia all of the time: at recess, at home, with his friends, alone, asleep and in his dreams. The dyslexic is dyslexic every second of his life. The dyslexic child is difficult to grasp because he does not have a grip on himself. He disorients others because he himself is disoriented. In fact, he projects onto others his own inner world, which we will describe as "dyslexified."
Paul then describes how psychotherapists often feel helpless with adolescent dyslexics, unable to handle them, and how dyslexics themselves seemed to be "playing a role with no clear idea of what they wanted," and how "a direct and open relationship with them was often impossible." Here was an explanation of how a teacher and a school system, otherwise helpful, could write a child off; how parents were so often at a loss; how a diagnostic system could, through the hollowness of its description of dyslexia, practically ignore this condition. Dyslexia was disorienting to everyone concerned.
Even conscientious teachers got "dyslexified" by these youngsters, becoming "disoriented" and "battle-weary" and ascribing to dyslexic youngsters all manner of vices, labeling them "idle, lazy, stupid, rude, inattentive, 'out of it,' having a bad influence." And "because these students transmit their inner malaise to those around them, they often serve as scapegoats for their peers."
Paul compared being dyslexic to visiting a foreign country, where the language is always unfamiliar:
The foreigner knows what he wants to say, but is able to express it only in an incomplete or imperfect way. The inadequate vocabulary and poorly constructed sentences he uses to express his thoughts are only approximations. Nuance is impossible [He] acts on his partial comprehension rather than the actual meaning of the other persons words [T]he effort of searching for the right words and trying to understand what the others are saying requires so much concentration that the foreigner soon loses the thread of his ideas and quickly feels tired and worn-out.
His self-confidence is shattered; he dreads new surroundings; he feels chronically homesick for he knows not what and finally withdraws.
Then the paper added something else new: that even though dyslexia is supposedly about a problem with words,
[m]any dyslexics live with a virtually constant feeling of uneasiness within their body, this instrument they can neither control nor master…Dyslexics are dyslexified throughout their entire body. The are often awkward in their physical movements and seem hampered or constricted by their bodies….They do not know what to do with their legs and arms, and particularly their hands. Their posture, whether it is slumped or tense, lacks flexibility and naturalness.
The psychological effect of it all is a wish to escape to a place "where language is not necessary." But "for the dyslexic, however, there is no native land to return to." With classmates, he cannot keep up with the repartee. On vacation, the dyslexic cannot enjoy socializing with other children, games, or sports. To escape reality, he withdraws into an imaginary world of dreams, reveries, fantasy, and absentmindedness. He is immature and in adolescence becomes vulnerable to alcohol and drugs. He can fall into fringe movements, into the hands of dream merchants, con artists, and manipulators. With all these problems, the dyslexic soon becomes neurotic or deeply depressed and suicidal. Psychotherapists, Paul explained, are at a loss with dyslexics because the principal tool of psychotherapists is verbal communication. The dyslexic cannot translate his disability into language; introspection, without a way of fixing the problem, only opens up old wounds.
In 1989 Ron told Erica that he had heard of a program, involving music, that might help her, and he told her he would do the entire program with her. He took her to the Sound Listening and Learning Center in Phoenix, run by Billie Thompson, a center Paul had often visited, to help guide its development. Though Erica was acutely suicidal, a psychiatrist decided she didn't have to be hospitalized if her father was constantly with her. "So we stayed together," Ron says, "in the hotel, for the next three weeks, for the fifteen listening sessions. My hope was that she would learn how to read and overcome her dyslexia, and then eventually her depression would lift."
To his surprise, her dark depression lifted almost immediately. Her all-day sleeping disappeared. Her mental and physical energy began to blossom within four or five days, and she brightened. The biggest difference was that she immediately became able to express what she was thinking and feeling. (In my terms, neurostimulation of the centers that energize the brain, the reticular activating system, led to a neuromodm lation of her sleep-wake cycle, and to neurorelaxation, which resulted in her being reenergized.) Now she could regulate her mood, learn, and differentiate. The neurorelaxation stage also involved the activation of her parasympathetic system, which turned on social engagement. Now she could relate to others. Ron observed how articulate Erica was; he had never heard her speak so directly. Stunned and delighted at the speed of her changes and her new openness, he asked, one night in the hotel, why she had resisted her parents' previous attempts to help her. She answered, "'Everything you did with the therapies showed me what I couldn't do. So I shut down. I felt I was supposed to be on another planet, and I didn't belong here. I was waiting to die.'"
"Hearing her talk about the anguish," Ron told me, "and not feeling any hope, I said, 'Erica, I'm so sorry. I'm so sorry. I just didn't know.' And she said, 'That's okay, Pop, you didn't understand.'"
Telling me about that conversation from so many years ago, Ron wept. "I still feel it. I had wanted so much to help my daughter, and I was helpless and scared and angry at her for not trying. I just didn't get it. When I learned how miserable she was inside and how my best attempts td help her just made it worse, we bonded as never before."
ErIca is as frank as her father. "I was a very angry child. When I hurt myself, I didn't cry, I got angry. I felt I didn't fit anywhere." She told me how close she was to killing herself. But now her once-atonal voice is rich, warm, energetic, engaging, and expressive. She remembers those transformative days when she first put on the headphones and heard the screechy music. "A couple of days into it, I was able to sit down in the hotel and talk to Pop about what I was feeling." She told her father she felt listened to and truly heard for the first time, and that never, in her life, had she felt so connected to a human being.
It might be tempting to describe Erica's breakthrough as triggered by her realizing how much her father loved her, as demonstrated by his willingness to go through the therapy with her. But that wouldn't do justice to what happened. Erica told me she always remembered "feeling 100 percent loved by my parents," even during the worst periods. She and her father had tried and failed to connect many times before: "Before I felt like he was talking at me, not with me, because my brain was not registering sound as others did. I just didn't understand. After Tomatis, I understood what he was saying. Within three to four days in Phoenix, I woke feeling happier, bouncier, with more energy. One day I was able to add up the bill for lunch, while it was upside down. And math had always been hardest, along with spelling."
After the active phase, her confidence shot up. She got her first steady job as a receptionist at a hair salon and soon worked her way up to manager. She got her high school diploma through correspondence. Eventually she got a job at a bank, where she stayed for fifteen years, managing millions of dollars daily. She's held steady jobs for years. She reads voraciously now, and the only remnant of her dyslexia is that she sometimes reverses letters when tired.
Totally unanticipated for Ron was a change in his own sleep patterns. Now he could be wide awake after only four or five hours' sleep and feel refreshed. He was more relaxed and more in touch with his emotions. He found he could release pent-up hurts. A knot of tension that had been lodged in his stomach for thirty years vanished. It could be argued that this surge in well-being was the relief of a father who had seen his daughter's suffering end, but it was more than relief, because the changes have lasted decades. Everything he saw with Erica, he would later write, "flew in the face of all my clinical experience as a psychiatrist. What's more, it was happening without medications." Ron Minson began studying French and left for Europe to study with Tomatis.