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SPECT
(SPET)Change Your Brain Change Your Life:
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Introduction:
Change Your Brain Change Your Life, Daniel Amen, 1998 AD
The Breakthrough Program for Conquering Anxiety, Depression,
Obsessiveness, Anger, and Impulsiveness
Introduction to the Paperback Edition
Since Change Your Brain, Change Your Life was first published in January 1999, my clinic, the Amen Clinic for Behavioral Medicine, has had an overwhelming response from people in the United States, Canada, and even Europe. We have seen adults, teenagers, and children as young as three years old who suffered with depression, anxiety problems, aggression, attention deficit disorder, bipolar disorder, obsessive-compulsive disorder, and post-traumatic stress disorder. Using the new imaging technology, these patients and their families we're able to "see" the underlying brain problems that were driving their emotional and behavioral symptoms. Rather than blame themselves for having a weak character or a "mental illness," they were able to more clearly understand the origins of their struggles and get the right help with more targeted, more effective treatment.
All of us at the clinic have been so incredibly gratified to find that the book has had such a positive impact on people's lives. Three ex-periences from our clinic highlight how helpful this book has already been to many, many people, and how it might help you as well.
In early February 1999, I was sitting at my imaging computer screen reading brain scans when Dr. George Lewis, one of the psy-chiatrists in my clinic, brought in a patient who had flown in from the Midwest to meet me. The man, in his late fifties, introduced him-self to me with tears in his eyes. On January 14, he'd decided to kill himself. He'd been feeling very depressed, unable to get along with anyone, and hobbled by a terrible temper. And he had no hope that things would change, despite seeing a psychiatrist and taking med-ication. He was lying in bed contemplating the best way to commit suicide when by coincidence his girlfriend turned on the Today show while I happened to be on, discussing my book. He watched me ex-plain the brain scans of a person diagnosed with depression and anger. He heard me say that there was hope for people who suffered from these problems, that many "psychological problems" are in reality brain problems, and that through new imaging techniques we can see many of them and create more targeted and effective treatments. This patient went out and bought the book, did the checklists, and discovered that he probably had a left temporal lobe problem (which is where his anger came from), a deep limbic system problem (causing his depression), and a prefrontal cortex problem (which gave him attentional and impulse control problems).
He decided to come to my clinic on his own. As part of our evalu-ation we ordered a brain SPECT study. He had predicted his own scan perfectly. He had very poor activity in his left temporal lobe, too much activity in his deep limbic system, and poor prefrontal cortex activity. We often see this scan in patients who have clinical symp-toms of depression, anger, suicidal behavior, and attentional problems. Dr. Lewis put him on a combination of medications and followed him closely over the telephone. Within three weeks, this man had dramatically improved. He no longer had suicidal thoughts, his mood was more positive, and his mind felt sharper and more focused. He told Dr. Lewis that we had saved his life.
In early March we heard from an Israeli woman who had bought the book in the United States while on holiday. She'd suffered her whole life from angry outbursts, cyclic depression, and attention problems. After reading the book and completing the checklists, she predicted she had a left temporal lobe problem, a limbic problem, and a prefrontal cortex problem. Doctors in Israel had told her to get counseling, and she'd already spent vast amounts of money with no benefit. She came to our clinic and saw Dr. Brian Goldman, who ordered a SPECT study to evaluate her brain function. Her scan was very close to what she predicted. Dr. Goldman started her on a medication regimen, along with other brain-based strategies described in this book. He then communicated with her regularly on the telephone and through e-mail. Within weeks, she reported feeling calmer, in better control of her temper, and more focused. All the counseling in the world would do her little good until her brain worked right
.Several months later I was lecturing at a teachers conference in the Northwest. A woman came up to me after one of my sessions and told me how much she'd enjoyed my book. She said that before she'd read it, she hadn't really believed in mental illness. She thought that people who suffered from depression, anxiety, or obsessions were just weak-willed. The book allowed her to see people who suffer from these problems in a different light. Shortly after she finished the book, her daughter called home from college. The daughter said that she was feeling depressed and had suicidal thoughts. Before she had read the book, the mother told me, she would have told her daughter to snap out of it, to go to church and pray harder. Having read the book, she suspected that her daughter had a cingulate problem and helped her find a physician to evaluate her. Her daughter was diagnosed with obsessive-compulsive disorder, placed on medication, and made "a 180 degree" improvement. The mother told me she was grateful for the new information that helped her daughter heal and kept her from being mistreated out of ignorance.
When I first started talking about our brain imaging work in scientific circles, we were severely criticized by many people. "What do you mean, you can see mental illness? You must be crazy if you think that a functional brain imaging study has anything to say about family dynamics!" Yet, the critics are being quieted. What I talk about in this book works. In 1998 I published five peer-reviewed professional medical articles on brain SPECT imaging in psychiatry. I was honored by being asked to coauthor the chapter on functional brain imaging in the Comprehensive Textbook of Psychiatry, one of the most respected psychiatric texts in the world. In the spring of 1999, I was invited by the nuclear medicine community to give lectures at their meetings. I felt very honored when Dr. Dennis Patton, the historian for the Society of Nuclear Medicine, introduced me at one of these meetings by saying that I was a pioneer in the brain imaging field and people would read my work for years to come.
There is no question in my mind that the most gratifying part of our research and clinical work is seeing people become more effec-tive, more loving, and more capable by gaining more access to their own brain function. Many people have called our work cutting edge. We have affectionately said to ourselves that we were "bleeding on the cutting edge." I'm deeply grateful for the increasing recognition of our work and I hope it continues to help others.
Introduction
Your brain is the hardware of your soul. It is the hardware of your very essence as a human being. You cannot be who you really want to be unless your brain works right. How your brain works determines how happy you are, how effective you feel, and how well you inter-act with others. Your brain patterns help you (or hurt you) with your marriage, parenting skills, work, and religious beliefs, along with your experiences of pleasure and pain. If you are anxious, depressed, obsessive-compulsive, prone to anger, or easily distracted, you probably believe these problems are "all in your head." In other words, you believe your problem is purely psychological. However, research that I and others have done shows that the problems are related to the physiology of the brain—and the good news is that we have proof that you can change that physiology. You can fix what's wrong for many problems.
Until very recently, scientists could only speculate about the brain's role in our personality and decision-making skills. We did not have advanced tools to look at the functioning of the brain and thus made many false assumptions about its impact on our lives. With the ad-vent of sophisticated brain-imaging techniques, we are now answer-ing questions about the brain's role in behavior at a phenomenal pace, questions that have practical applicability to your life, from re-lationships at home and at work to understanding what makes you a unique being.
I have been involved in brain-imaging research for the past ten years. I first began studying the brain with sophisticated quantitative EEG (brain wave) studies, and in the last eight years I've used a nuclear medicine brain study called SPECT (single photon emission computed tomography), which measures cerebral blood flow and metabolic activity patterns
. These last ten years have been both ex-I am one of only a handful of psychiatrists in the world who are licensed in nuclear brain imaging. Currently, I am the medical director of a large neuropsychiatric clinic in northern California, forty miles northeast of San Francisco. My clinic sees approximately eight hundred patients a month for evaluation and treatment
. We see pa-tients from around the globe, and we are recognized as experts in the fields of attention deficit disorder, learning disabilities, head trauma, violence, and obsessive-compulsive disorder. Even though I am a rarity among psychiatrists, I believe what I do will be more com-monplace in the years to come. It is just too helpful and too exciting to be confined to only a few clinics.FOCUS OF THE BOOK
The purpose of this book is to explain how the brain works, what happens when things go wrong, and how to optimize brain function. You will be introduced to five of the brain systems that are most intimately involved with our behavior and make up much of what is uniquely human.
You'll learn that the deep limbic system, at the center of the brain, is the bonding and mood control center. Being connected to others is essential to humanity, yet when this part of the brain is off kilter, people struggle with moodiness and negativity. You'll learn how certain smells and clear thinking soothe the activity in this part of the brain, and why spending time with positive people is essential to deep limbic health.
The basal ganglia, large structures deep within the brain, control the body's idling speed. When this part of the brain works too hard, anxiety, panic, fearfulness, and conflict avoidance are often the result. As I describe in the book, I inherited overactive basal ganglia, which leave me vulnerable to anxiety and nervousness. I know personally that anxiety is no fun and will give you plenty of ideas on how to set-tle down this part of the brain. When it is underactive, people often struggle with concentration and fine motor control problems.
The prefrontal cortex, at the front tip of the brain, is your supervi-sor, the part of the brain that helps you stay focused, make plans, con-trol impulses, and make good (or bad) decisions. When this part of the brain is underactive, people have problems supervising them-selves and also have significant problems with attention span, focus, organization, and follow-through. Learning how to activate the pre-frontal cortex in a positive way leads to better internal supervision.
The cingulate (pronounced sing-u -lat), a part of the brain that runs
longitudinally through the middle part of the frontal lobes, is the part of the brain I call your "gear shifter." It allows you to shift at-tention from thought to thought and between behaviors. When this part of the brain is overactive, people have problems getting stuck in certain loops of thoughts or behaviors. Understanding its function will help you deal with repetitive worries. Dealing with worry, rigid-ity, and "overfocused" behavior in yourself or others will be easier after reading this book.
Lastly, the temporal lobes, underneath the temples and behind the eyes, are involved with memory, understanding language, facial recognition, and temper control. When there are problems, especially in the left temporal lobe, people are more prone to temper flare-ups, rapid mood shifts, and memory and learning problems. Optimizing this part of the brain may help you experience inner peace for the first time in your life.
It is important to note that none of these brain systems exists in a vacuum. They are intricately interconnected. Whenever you affect one system, you're likely to affect the others as well. Also, some brain researchers would separate the systems differently than I lay them out in this book, placing the cingulate system and deep temporal lobes within the limbic system. I am presenting the system we use in my clinic, which has worked so well for our patients
.Presenting and defining these five terms—prefrontal cortex, cingulate system, deep limbic system, basal ganglia, and temporal lobes—is about as technical as the book gets. Mastering these systems will give you a whole new view about why you do what you do and what you can do about it.
After I describe each brain system, I'll offer targeted behavioral, cognitive, medicinal, and nutritional prescriptions to optimize its function. These prescriptions are practical, simple, and effective. They are based on my experience with more than sixty thousand patient visits to my clinic over the past ten years, as well as the experiences and research of my colleagues
.It is important to note that having an abnormal SPECT scan is not an excuse for "bad behavior." SPECT adds to our knowledge about and understanding of behavior, but it does not provide all the answers
. Many people who have difficulties in their brains never do anything harmful or destructive to others. These scans need to be interpreted in the context of each clinical situation.Not all scientists will agree with every finding in this book. The information here is based largely on extensive clinical experience and research. The Brain Imaging Division of the Amen Clinic for Be-havioral Medicine has done more brain SPECT studies for psychi-atric reasons than any other clinic I know of in the world. Experience is one of the best teachers in medicine. Second, I have had the privi-lege of working closely with a nuclear medicine physician, Jack Paldi, who has a passion for applying his knowledge to psychiatry. Third, we have had the use of one of the best SPECT cameras avail-able, which provides more and better information than older cam-eras.
The purpose of this book is not to encourage readers to go out and get their brains scanned
. You don't need a SPECT scan to benefit from this book. In fact, if you go to a medical center that has little ex-perience with SPECT, the results are not likely to mean much to your doctor. My goal is to help explain a wide variety of human be-haviors, both aberrant and normal, by showing the images of the brain that SPECT provides. These images make it plain that many problems long thought of as psychiatric in nature—depression, panic disorders, attention deficit disorders—are actually medical problems that can be treated using a medical model, along with the traditional psychological and sociological models. I hope that by providing new insights into how the brain works, you'll gain a deeper understand-ing of your own feelings and behavior and the feelings and behaviors of others. And I hope you'll use the specific brain-based "prescrip-tions" to optimize the patterns in the brain to help you be more ef-fective in your day-to-day life.
By Steve Rudd: Contact the author for comments, input or corrections.
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