Daniel Amen on The Most Important Lesson From 83,000 Brain Scans (Transcript)

The Most Important Lesson From 83,000 Brain Scans by Daniel Amen at TEDxOrangeCoast – Transcript

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Dr. Daniel Amen – Psychiatrist

In this talk, I’m going to give you the single most important lesson my colleagues and I have learned from looking at 83,000 brain scans.

But first, let me put the lesson into context. I am in the middle of seven children. Growing up, my father called me a maverick which to him was not a good thing.

In 1972, the army called my number, and I was trained as an infantry medic where my love of medicine was born. But since I truly hated the idea of being shot at or sleeping in the mud, I got myself retrained as an X-ray technician and developed a passion for medical imaging. As our professors used to say: “How do you know, unless you look?”

In 1979, when I was a second-year medical student, someone in my family became seriously suicidal, and I took her to see a wonderful psychiatrist.

Over time, I realized that if he helped her, which he did, it would not only save her life, but it would also help her children and even her future grandchildren, as they would be shaped by someone who is happier and more stable. I fell in love with psychiatry because I realized it had the potential to change generations of people.

In 1991, I went to my first lecture on brain SPECT imaging. SPECT is a nuclear medicine study that looks at blood flow and activity, it looks at how your brain works. SPECT was presented as a tool to help psychiatrists get more information to help their patients.

In that one lecture, my two professional loves, medical imaging and psychiatry, came together, and quite honestly, revolutionized my life.

Over the next 22 years, my colleagues and I would build the world’s largest database of brain scans related to behavior on patients from 93 countries.

SPECT basically tells us three things about the brain: good activity, too little, or too much.

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Here’s a set of healthy SPECT scans. The image on the left shows the outside surface of the brain, and a healthy scan shows full, even, symmetrical activity. The color is not important, it’s the shape that matters.

In the image on the right, red equals the areas of high activity, and in a healthy brain, they’re typically in the back part of the brain.

Here’s a healthy scan compared to someone who had two strokes. You can see the holes of activity.

Here’s what Alzheimer’s looks like, where the back half of the brain is deteriorating.

Did you know that Alzheimer’s disease actually starts in the brain 30 to 50 years before you have any symptoms?

Here’s a scan of a traumatic brain injury. Your brain is soft, and your skull is really hard.

Or drug abuse. The real reason not to use drugs – they damage your brain.

Obsessive compulsive disorder where the front part of the brain typically works too hard, so that people cannot turn off their thoughts.

An epilepsy where we frequently see areas of increased activity.

In 1992, I went to an all-day conference on brain SPECT imaging, it was amazing and mirrored our own early experience using SPECT in psychiatry. But at that same meeting, researchers started to complain loudly that clinical psychiatrists like me should not be doing scans, that they were only for their research.

Being the maverick and having clinical experience, I thought that was a really dumb idea.

Without imaging, psychiatrists then and even now make diagnosis like they did in 1840, when Abraham Lincoln was depressed, by talking to people and looking for symptom clusters. Imaging was showing us there was a better way.

Did you know that psychiatrists are the only medical specialists that virtually never look at the organ they treat? Think about it. Cardiologists look, neurologists look, orthopedic doctors look, virtually every other medical specialties look — psychiatrists guess.

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Before imaging, I always felt like I was throwing darts in the dark at my patients and had hurt some of them which horrified me. There is a reason that most psychiatric medications have black box warnings. Give them to the wrong person, and you can precipitate a disaster.

Early on, our imaging work taught us many important lessons, such as illnesses, like ADHD, anxiety, depression, and addictions, are not simple or single disorders in the brain, they all have multiple types. For example, here are two patients who have been diagnosed with major depression, that had virtually the same symptoms, yet radically different brains. One had really low activity in the brain, the other one had really high activity.

How would you ever know what to do for them, unless you actually looked? Treatment needs to be tailored to individual brains, not clusters of symptoms.

Our imaging work also taught us that mild traumatic brain injury was a major cause of psychiatric illness that ruin people’s lives, and virtually no one knew about it because they would see psychiatrists for things like temper problems, anxiety, depression, and insomnia, and they would never look, so they would never know.

Here’s a scan of a 15-year-old boy who fell down a flight of stairs at the age of three. Even though he was unconscious for only a few minutes, there was nothing mild about the enduring effect that injury had on this boy’s life. When I met him at the age of 15, he had just been kicked out of his third residential treatment program for violence. He needed a brain rehabilitation program, not just more medication thrown at him in the dark, or behavioral therapy which, if you think about it, is really cruel. To put him on a behavioral therapy program when behavior is really an expression of the problem, it’s not the problem.

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