「The Brain That Changes Itself」是加拿大精神科醫師暨研究者Norman Doidge於2007年出版的暢銷科普書。本書深入探討神經可塑性（neuroplasticity）—即大腦具有重組與自我修復的能力，推翻了過去大腦「固定不變」的傳統觀點。Doidge 透過一系列引人入勝的個案故事與最新研究，描繪中風患者如何重學行走、學習障礙者改善讀寫、甚至強迫症患者重新訓練思考模式。他結合科學洞見與人性關懷，使本書兼具深度與可讀性，廣受醫學界與一般讀者推崇。
本書揭示神經科學的一大突破—大腦具有「可塑性」，能夠因學習、創傷或訓練而改變其結構與功能。作者透過科學家如Paul Bach-y-Rita的研究，說明視覺或運動功能受損的患者如何透過特定訓練恢復能力，顛覆「腦細胞死了就不能復原」的舊觀念。這些例子證明，大腦不是固定電路，而是一個充滿彈性的學習器官，具備重建自我的潛力。
透過觸動人心的真實故事，Doidge 展示神經可塑性如何改變個人命運—如一位中風婦女重新學會講話與行走、一名患有學習障礙的男孩透過新式訓練顯著進步，甚至有助於治療憂鬱、焦慮與性成癮。這些例子不僅提升對腦科學的認識，更鼓舞人心地指出人類潛能遠超想像。書中也提醒讀者，大腦的可塑性是雙面刃，若習慣或思維不良，也可能造成負面影響，須謹慎對待。以下摘要書中重點與您分享：
What makes neuroplasticity so exciting is that it completely upends how we look at the brain. It says that the brain, far from being a collection of specialized parts, each fixed in its location and function, is in fact a dynamic organ, one that can rewire and rearrange itself as the need arises. It is an insight from which all of us can benefit.
神經可塑性之所以令人興奮，在於它徹底顛覆了我們看待大腦的方式。它說明大腦並非由固定的專門部件組成，而是動態的器官，能根據需求重新接線和重新排列自身。這是我們所有人都能受益的見解。
神經可塑性顛覆傳統大腦固定不變的觀念，揭示大腦是能依需求重新接線與排列的動態器官。此見解對腦部受損或欲提升認知能力者均具深遠助益，展現大腦無限潛能。
We all have some weak brain functions, and such neuroplasticity-based techniques have great potential to help almost everyone. Our weak spots can have a profound effect on our professional success, since most careers require the use of multiple brain functions. Barbara used brain exercises to rescue a talented artist who had a first-rate drawing ability and sense of color but a weak ability to recognize the shape of objects.
我們每個人都有一些較弱的腦部功能，而這種以神經可塑性為基礎的技術具有很大的潛力，幾乎可以幫助每個人。我們的弱點可能會對我們的職業成功產生深遠的影響，因為大多數的職業都需要運用多種大腦功能。Barbara 利用腦部鍛鍊拯救了一位天才藝術家，他有一流的繪圖能力和色彩感，但辨認物體形狀的能力很弱。
以神經可塑性為基礎的腦部鍛鍊，能強化個人較弱的大腦功能，對於提升職業成就與個人能力具有廣泛潛力。透過特定練習，甚至能改善藝術家辨識形狀的缺陷，適用於廣泛人群。
Taub’s original studies showed that treatment works for virtually all stroke survivors who are left with some ability to move their fingers—about half of patients who have had chronic strokes. The Taub clinic has since learned how to train people to use completely paralyzed hands. Taub began by treating people who had had milder strokes, but he has now shown, using control studies, that 80 percent of stroke patients who have lost arm function can improve substantially. Many of these people have had severe chronic strokes and showed very large improvements. Even patients who had had their strokes, on average, more than four years before beginning CI therapy benefited significantly.
Taub 最初的研究顯示，幾乎所有中風倖存者（約有一半的慢性中風患者）在治療後都能活動手指。Taub 診所從此學會了如何訓練人們使用完全癱瘓的手。Taub 一開始是治療中風程度較輕的患者，但他現在已經利用對照研究顯示，80% 喪失手臂功能的中風患者都可以大幅改善。這些人當中有許多是嚴重的慢性中風患者，他們的改善幅度非常大。即使是平均在開始接受 CI 治療前已經中風超過四年的患者，也有顯著的改善。
Taub 的限制誘導療法對慢性中風患者效益顯著，即使是手臂功能完全喪失或中風多年者，80% 經訓練後皆大幅改善。此療法打破傳統復健限制，透過強制使用受損肢體，重塑運動能力。
Jeffrey M. Schwartz has developed an effective, plasticity-based treatment that helps not only those with obsessive-compulsive disorder but also those of us with more everyday worries, when we start stewing about something and can’t stop even though we know it’s pointless. It can help us when we get mentally “sticky” and hold on to worries or when we become compulsive and driven by such “nasty habits” as compulsive nail biting, hair pulling, shopping, gambling, and eating. Even some forms of obsessive jealousy, substance abuse, compulsive sexual behaviors, and excessive concern about what others think about us, self-image, the body, and self-esteem can be helped.
Jeffrey M. Schwartz 開發了一種有效的、基於可塑性的治療方法，不僅可以幫助那些患有強迫症的人，還可以幫助我們這些有更多日常憂慮的人。當我們精神上 「黏黏糊糊」，糾纏於煩惱不放時，或者當我們被強迫性咬指甲、拔頭髮、購物、賭博和進食等 「惡習 」驅使時，它可以幫助我們。即使是某些形式的強迫性嫉妒、藥物濫用、強迫性行為，以及過度在意他人對我們的看法、自我形象、身體和自尊，也都可以得到幫助。
Jeffrey M. Schwartz 發展出基於神經可塑性的療法，有效治療強迫症及日常憂慮。此法能協助人們擺脫重複性思緒或不良習慣，透過重塑大腦連結，廣泛應用於改善心理黏滯與多種強迫性行為。
Ramachandran thought he might be able to remedy “type 1 chronic pain,” experienced in a disorder called “reflex sympathetic dystrophy.” This occurs when a minor injury, a bruise, or an insect bite on the fingertip makes an entire limb so excruciatingly painful that “guarding” prevents the patient from moving it. The condition can last long after the original injury and often becomes chronic, accompanied by burning discomfort and agonizing pain in response to a light brushing or stroking of the skin. Ramachandran theorized that the brain’s plastic ability to rewire itself was leading to a pathological form of guarding.
Ramachandran 認為他或許能夠治療「第一型慢性疼痛」，這種疾病稱為「反射性交感神經營養失調」。當指尖受到輕傷、瘀青或昆蟲叮咬時，整個肢體就會疼痛難忍，以至於「防護」患者無法移動肢體。這種症狀可能會在原來的傷害之後持續很長的時間，而且通常會變成慢性，伴隨著灼熱的不適感，以及輕刷或輕撫皮膚時所產生的劇痛。Ramachandran 的理論認為，大腦重新接線的可塑性能力導致了病態形式的守護。
Ramachandran 提出慢性疼痛如「反射性交感神經營養失調」是因大腦可塑性錯誤接線，導致病態性「防護」。他探討利用此可塑性，透過鏡像療法等，矯正疼痛訊號，以期緩解甚至消除此類難治疼痛。
One reason we can change our brains simply by imagining is that, from a neuroscientific point of view, imagining an act and doing it are not as different as they sound. When people close their eyes and visualize a simple object, such as the letter a, the primary visual cortex lights up, just as it would if the subjects were actually looking at the letter a. Brain scans show that in action and imagination many of the same parts of the brain are activated. That is why visualizing can improve performance.
我們可以透過想像來改變我們的大腦，其中一個原因是，從神經科學的觀點來看，想像一個行為和做一個行為並不如聽起來那麼不同。當人們閉上眼睛想像一個簡單的物件，例如字母 a 時，主視皮層就會亮起，就像受試者真的在看字母 a 一樣。腦部掃描顯示，在行動和想像的過程中，大腦的許多相同部分都會被啟動。這就是為什麼視覺化能夠提高表現的原因。
神經科學顯示，想像與實際行動在大腦中激活相似區域。因此，透過視覺化練習能有效改變大腦結構並提升表現，例如增強肌肉力量或認知技能，因為其本質上是相同的神經程式。
We may, without knowing it, already be helping people get out of depression by using medications that foster brain plasticity. Since people who improve in psychotherapy also find that their memories improve, it may be that it also stimulates neuronal growth in their hippocampi.
我們可能在不知不覺間，已經透過使用促進大腦可塑性的藥物，幫助人們走出憂鬱症。由於接受心理治療的人記憶力也有所改善，這可能也是因為心理治療刺激了他們海馬區的神經元生長。
研究顯示，促進大腦可塑性的藥物有助於治療憂鬱症。同時，心理治療亦能改善記憶，可能透過刺激海馬區的神經元生長來實現，揭示心理治療不僅是心理層面，更具有神經生物學基礎。
Merzenich told me, “Everything that you can see happen in a young brain can happen in an older brain.” The only requirement is that the person must have enough of a reward, or punishment, to keep paying attention through what might otherwise be a boring training session. If so, he says, “the changes can be every bit as great as the changes in a newborn.”
Merzenich 告訴我：「你能在年輕人的大腦中看到的一切，都能在年長人的大腦中發生」。唯一的條件是，這個人必須有足夠的獎勵或懲罰，才能在原本可能很無聊的訓練課程中保持注意力。如果是這樣的話，他說：「這種改變可能和新生兒的改變一樣大。」
Merzenich 強調，只要保持高度專注並有足夠動機，老年人的大腦也能像年輕人一樣展現驚人的可塑性與變化。透過特定訓練，認知功能可大幅逆轉，其潛力如同新生兒般無限。
She can do all this because her right hemisphere took over for her left, and such essential mental functions as speech and language moved to her right. Her development makes it clear that neuroplasticity is no minor phenomenon operating at the margins; it has the potential to allow whole brain areas that process one kind of input to process another.
她能做這一切，是因為她的右半腦接管了左半腦的功能，語音和語言等基本心智功能都轉移到她的右半腦。她的發展清楚表明，神經可塑性並非僅限於邊緣的微小現象；它有潛力讓整個大腦區域處理不同類型的輸入。
Michelle Mack 僅靠右半腦便能正常生活，因其右腦接管了左腦功能，展現了神經可塑性的非凡潛力。此案例證明大腦能將處理一種輸入的區域重塑為處理另一種輸入，顯示其適應性遠超預期。
It is not just “highly cultured” activities that rewire the brain. Brain scans of London taxi drivers show that the more years a cabbie spends navigating London streets, the larger the volume of his hippocampus, that part of the brain that stores spatial representations.
這不僅僅是『高度文化』活動才能重塑大腦。倫敦計程車司機的大腦掃描顯示，司機在倫敦街頭導航的時間越長，其海馬體的體積就越大，這是大腦中儲存空間表徵的部分。
倫敦計程車司機的大腦掃描顯示，長期在複雜街道導航會使海馬體積增大。這證明不僅是高雅文化活動，連日常職業活動也能透過神經可塑性改變大腦結構，適應環境需求。
結語
神經可塑性顛覆了「大腦固定不變」的舊觀點，指出大腦如同鍛鍊肌肉般，能隨需求重組迴路、強化功能。透過專門設計的腦部運動或視覺化練習，不但能幫助中風患者恢復肢體活動，也能改善學習障礙與認知衰退，進而提升日常生活品質。持續運用這些可塑性技術，可促進神經元更新，增強腦部健康，為長壽打下穩固基礎，達到「養生」與「延年益壽」的雙重效益。
神經可塑性同樣在心理層面帶來革新：從強迫症、憂鬱、成癮行為到慢性疼痛，都能透過重塑大腦連結獲得改善。定期進行意象訓練、鏡像療法或專注冥想，能重整負面思維路徑，增強情緒韌性，減少壓力傷害。這些做法如同全方位「腦部養生法」，不僅維護精神健康，更激發內在活力，助我們擁有更長久、充滿活力的生命。
