Psychiatrist Daniel Amen is a trim, elfin figure with a puckish smile and the staccato delivery of a stand-up comic. The winner of a Distinguished Fellow Award from the American Psychiatric Association, a clinical professor of psychiatry and human behavior at the University of California, Irvine School of Medicine, the author of 20 books and as many peer-reviewed papers, and a hugely popular public lecturer and workshop leader. He cheerfully rails against the self-satisfied stuffed shirts from the worlds of academic psychiatry who, in defiance of reason and good sense, don't accept his view that a brain-imaging method called SPECT is an invaluable tool for understanding and treating psychiatric disorders.
"I just don't get it. Why are we the only medical specialists who never look at the organ we treat?" he asks, his voice rising in exasperation before a jam-packed audience of 500 therapists drawn to a full-day workshop on his work. "Why is it controversial to get more information on people who suffer? The images are really easy to understand. What's the problem with having more data?"
"All SPECT does is measure three things---areas of the brain that work well, areas that are underactive, and areas that work too hard,” he says. “Then you just gear the treatments to rebalance these areas."
So why not just take a look? What's the harm? His case is helped by the elegant, crisply articulated, brain images he shows that, in concert with his simple explanations, seem to luminously reveal what's actually going on upstairs.
To be sure, Amen has acquired a small, but growing, crowd of supporters and colleagues in psychiatry, psychology, and nuclear medicine---he says more than 1,000 professionals refer to him---who consider him a trailblazer and believe SPECT scans will revolutionize the practice of psychotherapy.
So what is it about Daniel Amen and his mission to get therapists to use brain imaging, and SPECT in particular, as an aid to diagnosis and treatment that makes him such a lightning rod?
The Man Behind the Cause
In March 1991, Amen attended a lecture on SPECT imaging at the hospital where he worked. 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.
The Society for Nuclear Imaging officially recognizes only four common indicators for the clinical use of SPECT: to detect and evaluate strokes, brain trauma, and suspected dementia (a recent article says that brain scans like SPECT can predict Alzheimer's disease nine years before people have symptoms), or to locate focal points of epileptic-seizure activity. But SPECT has been used in a huge and highly eclectic number of research studies on almost every conceivable psychiatric and neurological condition, as well as some nonpsychiatric studies, like measuring the impact of meditation and prayer on blood flow to different brain areas.
Amen and His Critics
Nevertheless, most of the research community and the psychiatric establishment remain deeply unimpressed. They argue that Amen isn't competent to use scans because he's not board certified in nuclear medicine, didn't train in radiology (his several hundred hours of imaging training don't count), and doesn't follow science-based methods of differential diagnosis (using appropriate tests to differentiate systematically between distinct diseases with similar symptoms). He counters that he has the proper licenses to do his studies, teaches SPECT at a major medical school, and has written or cowritten chapters about SPECT in three professional textbooks. “I have more experience with SPECT than anybody else in the world, and there are mountains of scientific literature backing up my clinical work---1,500 such studies are on my website alone.”
Brain and Soul
This peculiar, but almost universal, sleight of thought--"it's not me, it's my brain "---helps explain Amen's appeal and, for that matter, the appeal of all "biological psychiatry." Whether or not we're religious, spiritual seekers, or hard-nosed materialists, we feel intuitively that our real selves, our souls, if you will, aren't the same as the soft "hardware" of the brain. And unlike many drive-thru drug dispensers, as psychiatrists have too often become, Amen actually seems to care about the soul, perhaps even in some way believes he's doing his part to save souls, or at least free them from the malign influence of a sick brain.
It seems inevitable that Amen’s work, or some variant of it, represents a glimpse into the future. With the development of revolutionary new technologies permitting a direct look inside the brain, people will be increasingly dissatisfied with the clinical guesswork and serial medication trials that constitute so much of psychiatry today.
Whether one considers Amen a devil or a new messiah, his use of SPECT visionary or voodoo, it seems likely that time is on his side.
This blog is excerpted from “Visionary or Voodoo?". Read the full article here. >>
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