A different version of this piece originally appeared in Big Think on January 9, 2023.
When neuroscientist Donalee Markus first meets with her clients, she asks them to reproduce an abstract image using colored pencils. Like this:
Every minute or so, they are asked to change pencils, from red to green to blue, and then other colors if necessary. The colors leave behind traces of their problem-solving strategies.
- Do they begin by drawing the square at the center of the image?
- Or moving from left to right?
- Or recreating the pointed figures on the outside?
- Or isolating the small details in the center of the image?
These puzzles are the basis of therapy and training for victims of traumatic injuries, people struggling with developmental and emotional problems like autism, and high-achieving processionals.
With these puzzles, clients work with a dizzying array of abstract images, drawn from a library of 18,000 images. They learn to compare images by isolating and analyzing their parts, one by one. Which parts got bigger or smaller, moved or changed angles, altered shapes or color or density?
It sounds simple, except that people have wired their brains to pay more attention to some elements than others. For patients with traumatic brain injury, the process can be physically and emotionally taxing.
These puzzles can be found on apps for devices and in books and printouts. Whether they’re higrdt h-tech or low, the process is the same: First, use the puzzles to identify which neural pathways people use to process the world and which grooves are underdeveloped. Then the clients can work with puzzles they find difficult in order to “rewire” the brain — or, form new neural pathways through neuroplasticity. With this process, clients increase their capacity to perform a wide range of tasks, from walking to organizing to high-level thinking.
Why puzzles work
Picture puzzles combine two powerful agents of brain change: images and challenges.
Vision dominates the sensory activities of the cerebral cortex, the so-called “executive” region of the brain. A 2002 study by David Van Essen of the Washington University School of Medicine found that “cortex that is predominantly visual in function occupies about 27% of the total extent of cerebral cortex [compared to] about 8% of cortex [that] is predominantly auditory, 7% somatosensory, and 7% motor.” The rest, about 51 percent, “includes major domains associated with cognition, emotion, and language.”
Images, as research shows, can trigger specific types of brain activity in a variety of ways. A 2001 study in Neurolmage, for example, found that viewing two similar sets of images lit up the brain in different ways. Artistic images lit up the parts of the brain processing value and reward, while more pedestrian images engaged the part of the brain for simple recognition.
The other element of brain change is the deliberate effort required to perform a task. Wordle and Soduku fans might be disappointed to learn that games themselves do not necessarily rewire the brain. “If you do Sudoku puzzles or crosswords, all that you get better at is Sudoku puzzles and crosswords,” neuroscientist Daniel Levitan notes.
Anders Ericsson, the Conradi Eminent Scholar of Psychology at Florida State University, coined the term “deliberate practice” to describe activity that requires intense effort, concentration, and strategy. Deliberate practice, he says, “entails considerable, specific, and sustained efforts to do something you can’t do well—or even at all.” Engaging in difficult tasks with focus and extended effort–like solving picture puzzles–can rewire the brain. But it’s not easy; it requires discipline and commitment.
The challenge lies in learning to solve problems in new ways. Over the years, Markus has identified eight basic approaches to processing information and solving problems:
- Bottom-liner: Starts at the bottom of the image and moves up.
- Left-to-righter: Starts on the left and moves right.
- Direction changer: Experiments with different approaches.
- Central shaper: Works from the inside out.
- Outliner: Works inside from the edges.
- Disconnector: Breaks up the image into pieces.
- Creator: Creates images from the given material.
- Random connector: Experiments, trying different approachs until something works.
Puzzlers vary according to whether they start with the familiar or explore openly, seek guarantees or embrace risk, are emotionally engaged or not, and are result-oriented or see possibilities.
Other researchers, doctors, and therapists have used pictures in their work. So what’s different?
“What I’ve done is create instruments, hierarchically organized, with multiple variables,” Markus says. “They get harder as you go and use different logic [and] analogies.”
Selected and sequenced well, these instruments may provide a useful treatment for a wide range of physical and mental ailments.
The clients
At her fashionable home in Highland Park, Illinois, Markus and her team of eye specialists and psychologists work with children diagnosed with autism, victims of traumatic injuries, and others suffering for reasons they cannot pinpoint. The clients struggle with symptoms like dizziness, loss of balance, nausea, blurred vision, and headaches. Some have been driven to the edge of suicide by their conditions.
Her clients also include super achievers in business and science. For years Markus worked with NASA. She coaches athletes, performers, and business tycoons. The comprehensive guide to her approach, Restructuring Your Business Brain, is targeted at elite performers.
A puzzle can take one person a minute and another an hour — not because of intelligence, but because of wiring. “However accomplished they are, most people are missing something,” Markus says. But as they work on the puzzles, once-impossible tasks become easy — and they scale up and work on tougher and tougher puzzles.
For those who stay, improvement comes in life-changing bursts. By activating their whole brain, they not only think better and regain control of their body. They also become more present and empathetic. Families comment on their greater patience and problem-solving skills.
The computer scientist: Using pictures for therapy got a surge of attention in 2011 when a computer science professor named Clark Elliott published his memoir The Ghost in My Brain. For eight years after a 1999 car crash, Elliott met with dozens of specialists. Nothing alleviated his symptoms. A single father, he could not afford to stop working. Every day, he spent hours making a trip from the parking garage to his classroom at DePaul University. He shuttled along the concrete ground, holding the walls, inching forward as his head spun and nausea wracked his body. Finally, someone told him about Markus and her unusual form of picture therapy. Within 10 days of hard work, he started to get back to normal.
Elliott quotes Markus at length in his 2017 article in Functional Neurology, Rehabilitation, and Ergonomics: “When he had mastered the simplest shapes such as triangles and squares, we gradually added complexity: overlapping shapes, multiple instances of shapes on a page, 2D shapes, 3D shapes, symmetrical and asymmetrical shapes mixed together, and so on. Because Clark was a high-functioning individual we also had him rehearse complex images and rotations that overlapped.”
Elliott’s story is an inspiring tale of grit, striving, and overcoming. But his book also speaks to readers who wanted to activate brain processes that they had underused over the years. Markus calls her method “brain restructuring.” Back in the 1970s, few believed that the brain was plastic or malleable enough to be altered or improved. But the science has proven that almost anyone can engage in deliberate exercise to arouse the brain’s underused neural pathways.
The autistic child: When her four-year-old son was diagnosed with autism, Neha Pandey responded like the scientists she is. She tested a wide range of treatments: biomagnetism, photobiomodulation, homeopathy, grounding mats, and diet. When they met Markus, they noticed improvement—and motivation on her son’s part. “Treatment just started but his cognition has improved,” she said. He is devouring the puzzles—some used with NASA scientists. “I have to say, ‘That’s enough for now,’” Pandey says. “For the first time he became comfortable with someone else,” she said.
The pharma salesperson: Amy Roberts-Brubaker, a 50-year-old pharma salesperson, remembers her first visit. After Markus pulled out puzzles, Roberts-Brubaker resisted. “Oh, I don’t do geometry,” she said. Markus laughed and directed her to find angles. She couldn’t. “Sure, you can,” Markus said, as she showed how to isolate parts of the image. Roberts-Brubaker’s first homework puzzle took an hour. “I noticed quickly that I loved black-and-white but didn’t like color,” she said. She did not see yellow dots that were right under her nose. The experience “was making my ears ring.” These experiences helped Markus identify which picture puzzles could help activate dormant parts of her brain.
The super-achievers: Markus has also brought her system to the leadership training program at NASA. For Christine Williams, who coordinated the program, the process provided game-like feedback that transformed her work. “I can see my progress, how I first struggled and then I’m like, ‘OK, I’ve got that now. What’s the next level?’” As she worked with the puzzles, she says she developed a more sophisticated way of mapping organizational challenges and working with colleagues.
Williams marvels at Markus’s ability to observe and direct clients. “She’s watching everything about you—where you hold your breath, how you move your eyes, where you’re having difficulty,” she said. “She has a phenomenal sense of everything that’s going on in this moment. She’s able to pick up on all those little nuances.”
The mentor
Donalee Markus’s journey began in the 1970s. Working on her Ph.D. in Education Administration and Policy Studies at Northwestern University, she worked with Reuven Feuerstein, a protégé of the developmental psychologist Jean Piaget who ran a program for psychological services for immigrant children in Israel. Many children tested low on intelligence tests but showed remarkable gains when they got individual attention.
Feuerstein worked one-on-one with students to identify their strengths and weaknesses. By guiding learners “through the backwaters of their own subconscious thought processes,” Feuerstein could discover students’ familiar, comfortable grooves. Then he could redirect their learning activities.
Then came the breakthrough: Markus’s personal contribution to the learning experience: creating abstract pictures that could also arouse the underused parts of the brain.
Working with Markus does not come cheap: She charges $375 an hour (the fee includes 200 to 250 pages of pencil-and-paper exercises), which isn’t covered by insurance. Using her other learning tools, individuals can work through the same exercises. “It’s the same experience, it’s just not intensified,” she said. Without mediation—the expert’s guidance—the process could take longer and hit some dead ends. But it still rewires the brain.
Is the mediation of an expert like Markus necessary? For treating serious injuries and ailments, yes. Other learners—people who simply want to use all of their brain and get out of familiar grooves—might only need access to the puzzles and a guide to using those puzzles strategically.
Like other pioneers, Markus remains outside the fraternity of specialists and technocrats. Despite a healthy collection of case studies attesting to the effectiveness of her approach, she has never had a classic double-blind, longitudinal study. So, even though the case studies are impressive, it’s hard to pin down the exact efficacy of the approach. She works mostly outside the normal channels of care for traumatic injuries, autism, and other brain-related dysfunction.
At 78, Markus resists the idea that she should work more with the medical establishment. Pointing to her 2007 article in Physical Medicine and Rehabilitation Clinics of North America, she asks, “How many letters and comments do you think I got for that? None, that’s how many.” Working with the establishment, she said, is like getting on a treadmill to nowhere. “If someone wants to get a grant, that would be great,” she says. “But I have apps to write and people to work with. I don’t have time.”
If people want to rewire their brains with pictures, might there be a midpoint between her hands-on work and the individual use of puzzles in books and apps? What about small-group work? Markus can imagine groups getting together to apply her methods without her direct oversight. She applauds the “spark groups” formed after Harvard neuroscientist John Ratey showed how play improves the brain’s capacity to learn. Years ago, her program was used at Encyclopedia Britannica’s after-school centers in Highland Park. “But they said they couldn’t get someone for $15 an hour to run the program,” she said.
Picture this
Pictures work because the brain experiences the world more visually than any other way. Even blind people experience the world through their mental images, maps, and models. When working one-on-one, Markus works with an eye expert named Deborah Zelinsky of the Mind-Eye Institute. Patients are fitted with glasses that reorient what and how they see. That experience can be as painful and disorienting as doing puzzles. But it is critical in reshaping the brain.
“As a species we are primarily visual/spatial entities to the very core of our being,” Clarke Elliott noted in an email. “The symbols of human thought itself are constructed and manipulated through this kind of processing, and of course such processing drives language, emotion, planning, balance coordination, motor coordination, [and] our sense of ourselves in the world.” In fact, as Elliott notes, “retinas are actually brain matter that happens to be hanging out the front of our face.” How better to reshape the brain than by manipulating its external piece?
Some day, Markus will retire. Then what happens? If she stopped work now, she would leave behind 18,000 instruments. Those pictures and puzzles could provide a simple but powerful strategy for helping everyone—from a 7-year-old autistic child to a victim of brain trauma to a NASA astronaut—to discover their brain grooves and create new grooves.