The Controversy of Brain Imaging and Psychotherapy

Today’s cutting-edge therapists take pride in their growing knowledge of brain science. Mountains of books and endless hours of seminars teach us about our left, right, male, female, and reptilian brains—all exciting knowledge we eagerly apply in our clinical work. We now know more than ever about the brain. Yet, according to psychiatrist and eight-time New York Times bestselling author Daniel Amen, we’re still apprehensive about looking at it.

For nearly 20 years, Amen has led a controversial quest to make brain imaging common practice in the field. His prolific use of single-photon emission-computed tomography (SPECT) to detect various types of psychiatric disorders challenges the long-held belief that talk and observation are sufficient for diagnosis. Instead, he argues, we need to see the organ we treat.

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Ryan Howes: How did your interest in psychiatry turn into an interest in brain imaging?

Daniel Amen: In 1991, I was the director of a dual diagnosis unit at a psychiatric hospital in northern California, and heard a lecture on brain SPECT imaging, a computerized technology that looks at blood flow and activity in the brain. In that one lecture, my two professional loves—imagery and psychiatry—came together and revolutionized my life. Over the next 23 years, my colleagues and I built the world’s largest database of brain scans related to behavior, which is now about 87,000 scans. I mean, it was just so cool! Psychiatrists are the only medical doctors that never look at the organ that they treat. Neurologists look, cardiologists look, your orthopedic doctor looks, gastroenterologists look. Every other medical specialty looks—but psychiatrists guess.

Before imaging, people would come in with six out of the nine DSM-IV criteria for depression, and I’d put them on Prozac. Some people would get better, and some would get worse, but there was no way to predict which way it’d go. Once I had imaging, I became much better at predicting who’d get better and who’d get worse.

RH: SPECT is a diagnostic tool, so what treatments are you using to get these outcomes?

Amen: First, I create brain envy in my patients. When they see their brain image against a healthy brain, they generally want theirs to be better. Second, I teach them what to avoid: drugs, alcohol, brain injuries. But we get our best testimonials by far from planting the right diet in people’s lives. Food can be medicine or poison. A high-carbohydrate diet is associated with four times the risk of Alzheimer’s disease, while a high healthy-fat diet is associated with 42 percent less risk for Alzheimer’s disease. Most people don’t know that as your blood sugar goes up, the size of your brain goes down. So if you don’t exercise, if you’re not engaged in lifelong learning, if you eat poorly or are under chronic stress, if you have untreated ADD or depression---all those things increase your risk of dementia. There are 140 studies indicating that as your weight goes up, the size and function of your brain goes down. Given that two-thirds of us are overweight, it’s the biggest brain drain in the history of our country.

The third thing I tell patients is to engage in regular brain-healthy habits. There was a head-to-head study in Holland where they took ADHD kids, put them on an elimination diet versus doing nothing, and 73 percent of the kids had greater than 50 percent reduction in their symptoms after three months. So I could give you Ritalin---and I like Ritalin; it works---or I could change your diet. Healthy brain habits involve diet, exercise, new learning, and baseline supplements that are specifically targeted to what we see in the scans. We start with the least toxic, most effective thing, so we’ll often start with natural supplements because they work when they’re targeted effectively. If they don’t work, we’ll also use medication. But in contrast to what most people do, we target it to what your brain needs and not just a cluster of symptoms.

I tell the story of this boy, Jared, who was diagnosed with ADD when he was 3 years old. By the time we saw him at 14, he’d seen six different doctors and failed all the stimulants for ADD---in fact, they’d made him more aggressive. They were going to put him on an antipsychotic, but the mother said, “No I don’t think so. Let’s take a look at his brain.” It turns out that he had the pattern that absolutely responds badly to stimulants. We gave him a group of natural supplements, and he’s doing great. But they were targeted to his brain to calm it, not stimulate it. He’s been on the honor roll for the last two years. He never had friends, and now he has friends. You know, we changed the trajectory of his life.

Read Ryan's full interview with Daniel Amen in the May/June 2014 issue of Psychotherapy Networker magazine.