Amen was particularly anxious to try out this new brain-mind technique on kids with AD/HD. "Standard psychotherapy, as I'd been trained to do with AD/HD kids, made me crazy--they just never got any better," he recalls. Medications helped, but not nearly often enough, and there was no way to predict whether or not they would work. So Amen began using neurofeedback with his AD/HD patients to encourage more normal brain waves and reduce their symptoms. While not exactly the fast-track cure he'd have liked (it could take from one to two years to produce significant improvement), neurofeedback did work encouragingly well, with the side benefit of helping many kids avoid or lessen medications. In 1989, when he opened his private practice in northern California, he equipped it with his own biofeedback equipment.
Amen's clinic was an immediate success, no doubt partly because of the workaholic habits, business acumen, and marketing skills he says he inherited from his father; but also because he was the only child psychiatrist for 300,000 people in the county. During this period, he worked six- and seven-day weeks, building up his practice, directing the dual-diagnosis unit of a local hospital, lecturing in the local community, and writing a news column (he'd already published two self-help books on getting ahead in school and in work).
In March 1991, Amen attended a lecture on SPECT imaging at the hospital where he worked. If learning about neurofeedback had been a revelation to him, seeing SPECT scans was an epiphany. SPECT is the acronym for single photon emission computerized tomography, a nuclear-medicine imaging technique that measures an organ's blood flow or activity level--its function . An MRI, by contrast, looks at brain structure or anatomy, just as an ordinary X-ray does (but provides far more detailed images). A patient being SPECT-scanned is injected with a "radiopharmaceutical" and then lies on a table for about 15 minutes while a multiheaded camera rotates around his or her head picking up gamma rays (which are like pulses of light) from the radioactive material taken up by the brain cells. The data obtained by the camera are processed by a supercomputer to produce a series of two-dimensional cross sections of the brain. Different activity levels--relative blood flow--show up as shades of different colors or gray tones, depending on the color scale of the software program chosen by the imager.
These cross sections are then reconstructed into three-dimensional images. Notwithstanding Amen's suggestion that brain scans "aren't that hard to read," it's definitely not a simple process, requiring real skill and judgment to do well. To a lay viewer, the cross sections that first come out of the computer look like a meaningless kaleidoscope of colors and patterns. It takes an expert in reading, understanding, and manipulating the scans to tweak them into an accurate but elegant form--the dramatic, 3-D pictures of the kind Amen shows his audiences.