Plastic Brains

To qualify as a licensed London taxi driver, trainees require comprehensive training and testing that typically takes three to four years. Drivers need to commit to memory and learn the mishmashed layout of approximately 25,000 streets, the location of thousands of landmarks, and the quickest way to navigate between any points in the city. In a landmark study, it was shown that this training physically changed the brain. Specifically, it was shown that the gray matter density of the posterior hippocampus was proportionately larger in qualified and more experienced drivers versus drivers that did not qualify or were less experienced. Additionally it was also shown that experienced taxi drivers not only had compensatory loss in the acquisition of new spatiotemporal information, but with the advent of GPS technology,  the posterior hippocampus has reverted back to its original size. 

This example of experience-dependent plasticity should not be surprising (at least in hindsight) as the evolutionary lineage (primate) which led to our species, has been characterized by the development of more flexible organisms that are able to adapt to widely different conditions and respond to rapidly changing circumstances.  Individual learning in tandem with social and technological innovations (next essay) has enabled our species to migrate, adapt, respond, and thrive to widely different conditions and changing circumstances. In effect, it has minimized the impact of environment-organism mismatches. Although not originated in the desert, the mountain, or the rainforest, we have the plasticity to learn the affordances (future essays) of each environment and can adapt at multiple interrelated levels – behaviors, institutions, and technologies – to respond to environmental  challenges.   

In my last essay, I wrote about the ecology of the emergency department and how it can impose a negative pressure on decision making by hindering metacognition, interoception, and mindreading. However, this downward pressure on decision making can be counteracted by utilizing the concepts of training and neuroplasticity to improve self-awareness, self-knowledge, and the knowledge of others. Generally, to improve self-knowledge and self-awareness, one must take a third-person perspective on ourselves. To step outside ourselves and look at oneself from “above.”  Mindful meditation is one such technique that can achieve that level of detachment. It has been suggested that mindful meditation improves appraisals of interoceptive states (self-awareness) and also increases the size of the interoceptive cortex. Mindful meditation also enables practitioners to tune empathy towards an emotionally neutral but cognitively detached state, thereby improving self-knowledge and mindreading.

Like most skill-building, however, compassion and meditation training requires deliberate repetition with error feedback and context-specificity. Thus, it would require time in conjunction with systemic and structural changes. Secondly, it is not entirely clear that context-independent training in metacognition, interoception, or mindreading would lead to gains in decision-making in the context of the emergency department. For example, brain training programs have neither been shown to be transferable outside of their context and the gains have not been durable . So, in a system that is forced into efficiency, that incentivizes productivity, and places extreme strains on interoception – reflecting on decisions and recognizing bodily states are often a luxury. Since plasticity is bidirectional and skills do not just augment but also atrophy, neuroplasticity must also be paired with social and technological solutions that not only augment the capacities of self-knowledge, other-knowledge, and interoception but also dispel the illusion of fluency (next essay) that prevails in the emergency department.

Recommended Reading:

  1. Know Thyself: The Science of Self Awareness

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