Clinician's Digest - Page 6

Brain-Scan Battles

Since the 1990s Decade of the Brain, there's been growing interest in how the emerging neuroscientific technology can improve psychotherapy's diagnostic and treatment effectiveness. No one has addressed the challenge of using the advances in brain imaging more directly than psychiatrist Daniel Amen, who's developed a method for using SPECT scans (a nuclear medicine tomographic imaging technique using gamma rays) to guide diagnosis and treatment, not just for difficult brain-injury cases, but for common clinical issues like depression, aggression, AD/HD, eating disorders, obesity, and addictions. An effective and popular presenter, Amen has brought his work to a broad audience through his workshops, books, public lectures, and PBS appearances.

In contrast to Amen, however, most neuroscientists have remained cautious about the direct applications of neuroimaging in psychotherapy, and during the last year, Amen's work has been widely attacked, most recently in two strongly worded critiques from neuroscientists in the normally staid American Journal of Psychiatry (AJP).

The dispute began in the May 2009 AJP when UCLA neuropsychiatrist Andrew Leuchter reviewed Amen's book Healing the Hardware of the Soul. Leuchter referred to the author as a "self-described clinical neuroscientist, psychiatrist, and brain-imaging specialist [italics added]," and stated that Amen's "science" was based not on solid research, but upon "anecdotal evidence, post-hoc rationalizations for his preferred approaches, and his own strongly held religious beliefs." (Amen, who earned his degree at Oral Roberts University, has been open about the importance of his Christian faith.) Claiming that Amen has failed to make the case that SPECT scans provide any better treatment information than ordinary clinical judgment—which spares patients the added expense and radiation—Leuchter added the caustic aside that, "Dr. Amen does practice what he preaches: he states that he benefited from his own self-help approach, most notably to manage the stress of an investigation by the Medical Board of California for his unorthodox diagnostic and treatment approaches (an investigation that he says vindicated him)."

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