Here's what other people had to say about my book - Making a Good Brain Great: The Amen Clinic Program for Achieving and Sustaining Optimal Mental Performance.
"This book is wonderful. It gives the reader great understanding and hope that changes in oneself can be made. If you put these changes into action, a happy and healthy brain is yours."
— Bill Cosby
"Each of Daniel Amen’s books contains special nuggets that can be found nowhere else, as well as a wealth of useful, general information that he brings together under one roof. This book offers excellent advice as well as a great deal of new information. An extremely useful and easy-to-read book."
—Edward Hallowell, M.D., author of Delivered from Distraction and The Childhood Roots of Adult Happiness
“Making a Good Brain Great is the long-awaited synthesis of a true visionary’s work. I highly recommend it to anyone interested in self-improvement, and especially parents and other caregivers of children—this book is a gem for those of us who want to raise healthy kids.”
—Michael Gurian, author of The Minds of Boys and The Wonder of Girls
“The most important gift we have to share is wisdom. In this timely book, Dr. Amen shows us how to create a great brain so we can make the world a better place.”
—Dharma Singh Khalsa, M.D., president/medical director of the Alzheimer’s Prevention Foundation, and author of The Better Memory Kit and The End of Karma
“A must-read for those who live by their wits.”
— Dennis B. Alters, M.D., child, adolescent, and adult psychiatry, and author of Wizard’s Way
"Change means movement. Movement means friction. Only in the frictionless vacuum of a nonexistent abstract world can movement or change occur without that abrasive friction of conflict."
Saul Alinsky
Introduction
At the Amen Clinics we have been using brain SPECT imaging as an aide in making neuropsychiatric diagnoses and individualizing treatment plans since 1991. As I have said many times, SPECT does not give you the answer, it teaches us to ask better questions. It is an important piece of the clinical puzzle, but, by itself, it is never the answer.
In both medical school and during my psychiatric training at the Walter Reed Army Medical Center in Washington, DC I was taught to take a bio-psycho-social-spiritual approach to diagnosing and treating patients. Brain SPECT helps us gain a deeper understanding of the biological underpinnings of our patients’ problems and then helps us formulate the biological part of our patients’ treatment plans.
For example, SPECT helps us understand if an underlying head injury or toxic exposure may be contributing to our patients’ problems. If a patient has an overactive brain, SPECT helps us make recommendations to calm the brain, where if a patient has an underactive brain I am more likely to make recommendations to help stimulate it. Always, the SPECT data needs to be correlated with the clinical information. SPECT is not a doctor in a box and will never replace a competent physician. It helps him or her be a better doctor as he or she has more information.
I started ordering scans in 1991 for my patients after I attended a lecture on “brain SPECT imaging” at the psychiatric hospital where I worked in Fairfield, CA. The lecture was given by the chief of nuclear medicine at our local community hospital. Before that time I had been using neurofeedback and quantitative EEG in my clinical practice with patients, so I was prepared to understand the implications of this new technology for psychiatry.
SPECT looks at blood flow and activity patterns. SPECT is different than CAT scans and MRIs, those are anatomy scans. They show what the brain actually, physically looks like. SPECT looks at how the brain functions. SPECT stands for single photon emission computed tomography. It is a nuclear medicine study that uses radioisotopes as tracking devices to look at living brain tissue. The radiation exposure from one SPECT study is 1/3th the level of radiation from an abdominal CAT scans, a very common procedure in medicine.
SPECT gives a three dimensional view of brain activity. Basically, SPECT measures three things:
♦ areas of the brain that work well,
♦ areas of the brain that are low in activity and
♦ areas of the brain that are high in activity.
Initially, I found SPECT scans extremely useful, especially in complex cases. As I continued to use the technology in our very busy clinic I knew functional imaging would become part of the future of psychiatry.
Psychiatry is the only medical specialty that never looks at the organ it treats. Most psychiatrists today in 2008 make diagnoses the same way they did in 1840 when Abraham Lincoln was depressed, by looking for symptom clusters and talking with patients. You can try to kill yourself in every major city in the world and virtually no psychiatrist will look at how your brain functions.
By the early 1990s when I first started ordering scans there were already hundreds of functional imaging studies (SPECT and PET) on Alzheimer’s disease, head injuries, seizures, strokes, ADD, depression, substance abuse and schizophrenia.
Here is a review article from 1992: “Nuclear medicine has a place in the study of brain trauma, brain tumors, stroke, dementia epilepsy and depression. The development of new tracers labelled with widely available radionuclides, such as technetium-99m (99Tc) and iodine-123, has played a key role here. Practical methodology can now be implemented in the routine setting. Additional applications are reviewed in the context of brain death, encephalitis, post-viral fatigue syndrome, Parkinson's disease and schizophrenia.
The role of nuclear medicine in neurology and psychiatry. REVIEW ARTICLE: 37 REFS. Costa DC: Institute of Nuclear Medicine, University College and Middlesex School of Medicine, London, UK: Curr Opin Neurol Neurosurg 1992 Dec;5(6):863-9
Many of our critics claim there is no scientific basis for what we do. I initially heard this criticism with disbelief and wondered if these people had actually read the vast scientific literature on brain imaging. Each year more and more studies have been added. Also, in 1992 Leonard Holman and Michael Devous wrote an article for the Journal of Nuclear Medicine titled “Functional brain SPECT: the emergence of a powerful clinical method.” In the paper they outlined the science for using SPECT with vascular disease, seizures, dementia and brain trauma and suggested that many other uses would be available soon.
Holman BL, Devous MD Sr. Functional brain SPECT: the emergence of a powerful clinical method. J Nucl Med. 1992 Oct;33(10):1888-904.
In 1992 and 1993 there were all day brain SPECT imaging in child and adult psychiatry courses presented at the American Psychiatric Association.
I continued to order SPECT studies because they helped me to be a better doctor with real patients. Here is one of my favorite examples from the first month of ordering scans:
Matilda was brought to the hospital by her family after she nearly burned down her house by forgetting something on the stove. Her family was at their wits end. At age 69 she had been diagnosed with Alzheimer’s disease and had been getting worse. She had also lost her driver’s license because she had been in four minor accidents. Five of her six children thought she should be in a care facility for her own safety. One of her daughters, however, had heard about me and brought her to the hospital for more testing. “One more try,” she told me. When I first met Matilda I thought she had Alzheimer's disease, but the results of her SPECT scan were very different. She had good activity in the areas usually affected by Alzheimer’s. Her scan was more consistent with depression. Sometimes in the elderly it can be difficult to distinguish Alzheimer's disease from depression, so I put Matilda on the antidepressant Wellbutrin. Within three weeks Matilda’s memory was better, she became more talkative and even started to help other patients on the ward. After a month I was ready to discharge her from the hospital. Everyone was so excited by her progress. Before she left she asked if I would write the DMV to help her get her driver's license back. I told her, “I drive on the same highways you drive. I need you to take your medicine, do the other things we discussed and if in 6 months you are still better and your scan is better than I will write the DMV. Six months later she remained improved. I repeated her SPECT study, which was now completely normal. I wrote the letter to the DMV and they gave her back her license! As a psychiatrist before I ordered SPECT scans I had virtually no experiences as powerful as this one. After I started ordering scans they started to happen regularly.
If you knew me personally you would know that I tend to be fairly anxious and I like people to like me. Stirring up this controversy was NOT fun. After 1993 when I received intense criticism from my colleagues for doing this work I limited talking about it public for the next two years.
Then Andrew came to my clinic. It was late one night in April 1995 when my sister-in-law Sherrie called me at home to tell me that my nine year old nephew Andrew had attacked a little girl on the baseball field that day, for no apparent reason, out of the blue. Stunned, I asked her what else was going on with Andrew?
“Danny,” she said, “he is different. He is mean and surly, and today I found two pictures in his room that he drew: in one picture he was shooting other children, in the other one he was hanging from a tree. I asked Sherrie to bring Andrew to see me the next day.
As I sat with him I said, “Buddy, what is going on?”
He said, “Uncle Danny, I don’t know. I am mad all the time.”
“Is anyone hurting you,” I asked?
He said NO.
“Is anyone teasing you?”
He said NO.
“Is anyone touching you in places they shouldn’t be touching you?”
He said NO. I don’t know why I feel this way.
As part of his evaluation I ordered a SPECT study. I had suspected he had a problem in his left temporal lobe. The temporal lobes, which are underneath our temples and behind our eyes are very important structures in the brain involved with language, memory and mood stability. By 1995 researchers had already correlated some types of violence to this part of the brain. I held Andrew’s hand while he had the scan. He held a teddy bear in his other hand. He was 9 years old.
On his scan Andrew was missing the function of his left temporal lobe. I had never seen anything like that before. He had a cyst the size of a golf ball occupying the space of his left temporal lobe. After Andrew’s surgery to drain the cyst I got two phone calls. One, from his mother who said Andrew did great with the surgery and that when he woke up from the anesthesia he smiled at her. “Danny,” she said, “he hadn’t smiled at me for a year.” The next call was from the neurosurgeon, Jorge Lazareff who said, “I am so glad you sent Andrew to me, the cyst had put so much pressure on Andrew’s brain that it had actually thinned the bone over his temporal lobe. If he would have been hit in the head by a baseball it would have killed him instantly. Either way, without the surgery he would have been dead within 6 months.”
Without the cyst pressing on Andrew’s brain he went back to being the sweet, loving boy he always wanted to be. Since Andrew’s surgery I knew I had to speak out about the need to do imaging in psychiatry. Most of my colleagues, and me before doing our brain imaging work, would have found a psychological explanation to make sense of Andrew’s behavior and completely miss the real cause of his trouble. That was no longer acceptable to me. Since Andrew, we have seen 15 other children and adults with temporal lobe cysts who had problems with aggression. Kip Kinkle, the school shooter in Oregon who murdered his mom and dad and then shot 25 people at his high school had severe problems in the same part of the brain.
