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in this talk, i'm going to give youthe single most important lesson my colleagues and i have learnedfrom looking at 83,000 brain scans. but first, let me putthe lesson into context. i am in the middle of seven children. growing up, my father called me a maverick which to him was not a good thing. (laughter) in 1972, the army called my number, and i was trained as an infantry medicwhere my love of medicine was born.
but since i truly hated the ideaof being shot at or sleeping in the mud, i got myself retrainedas an x-ray technician and developed a passionfor medical imaging. as our professors used to say:"how do you know, unless you look?" in 1979, when i wasa second-year medical student, someone in my familybecame seriously suicidal, and i took her to seea wonderful psychiatrist. over time, i realizedif he helped her, which he did, it would not only save her life,
but it would also help her childrenand even her future grandchildren, as they would be shaped by someonewho is happier and more stable. i fell in love with psychiatry because i realized it had the potentialto change generations of people. in 1991, i went to my first lectureon brain spect imaging. spect is a nuclear medicine studythat looks at the blood flow and activity, it looks at how your brain works. spect was presentedas a tool to help psychiatrists get more informationto help their patients.
in that one lecture,my two professional loves, medical imaging and psychiatry, came together, and quite honestly,revolutionized my life. over the next 22 years,my colleagues and i would build the world's largest databaseof brain scans related to behavior on patients from 93 countries. spect basically tells usthree things about the brain: good activity, too little, or too much. here's a set of healthy spect scans.
the image on the left showsthe outside surface of the brain, and a healthy scan shows full,even, symmetrical activity. the color is not important,it's the shape that matters. in the image on the right,red equals the areas of high activity, and in a healthy brain, they're typicallyin the back part of the brain. here's a healthy scan comparedto someone who had two strokes. you can see the holes of activity. here's what alzheimer's looks like, where the back halfof the brain is deteriorating.
did you know that alzheimer's diseaseactually starts in the brain 30 to 50 years beforeyou have any symptoms? here's a scanof a traumatic brain injury. your brain is soft,and your skull is really hard. or drug abuse. the real reason not to use drugs -they damage your brain. obsessive–compulsive disorder where the front part of the braintypically works too hard, so that people cannotturn off their thoughts.
an epilepsy where we frequentlysee areas of increased activity. in 1992, i went to an all-day conferenceon brain spect imaging, it was amazing and mirrored our own early experienceusing spect in psychiatry. but at that same meeting,researchers started to complain loudly that clinical psychiatrists like meshould not be doing scans, that they were only for their research. being the maverickand having clinical experience, i thought that was a really dumb idea.
without imaging, psychiatrists then and even nowmake diagnosis like they did in 1840, when abraham lincoln was depressed, by talking to people and lookingfor symptom clusters. imaging was showing usthere was a better way. did you know that psychiatristsare the only medical specialists that virtually never lookat the organ they treat? think about it! cardiologists look, neurologists look,orthopedic doctors look,
virtually every othermedical specialties look - psychiatrists guess. before imaging, i always felt like i was throwingdarts in the dark at my patients and had hurt some of themwhich horrified me. there is a reason that most psychiatric medicationshave black box warnings. give them to the wrong person,and you can precipitate a disaster. early on, our imaging worktaught us many important lessons,
such as illnesses, like adhd,anxiety, depression, and addictions, are not simple or singledisorders in the brain, they all have multiple types. for example, here are two patients who have been diagnosedwith major depression, that had virtually the same symptoms,yet radically different brains. one had really low activity in the brain,the other one had really high activity. how would you ever know what to dofor them, unless you actually looked? treatment needs to be tailored
to individual brains,not clusters of symptoms. our imaging work also taught us that mild traumatic brain injurywas a major cause of psychiatric illness that ruin people's lives, and virtually no one knew about itbecause they would see psychiatrists for things like temper problems,anxiety, depression, and insomnia, and they would never look,so they would never know. here's a scan of a 15-year-old boy who felt down a flight of stairsat the age of three.
even though he was unconsciousfor only a few minutes, there was nothing mildabout the enduring effect that injury had on this boy's life. when i met him at the age of 15,he had just been kicked out of his third residentialtreatment program for violence. he needed a brain rehabilitation program, not just more medicationthrown at him in the dark, or behavioral therapy which,if you think about it, is really cruel. to put him on a behavioral therapy program
when behavior is really an expressionof the problem, it's not the problem. researchers have foundthat undiagnosed brain injuries are a major cause of homelessness,drug and alcohol abuse, depression, panic attacks, adhd, and suicide. we are in for a pending disaster with the hundredsand thousands of soldiers coming back from iraq and afganistan, and virtually no one is lookingat the function of their brain. as we continued our work with spect,
the criticism grew louder,but so did the lessons. judges and defense attorneys soughtour help to understand criminal behavior. today, we have scannedover 500 convicted felons including 90 murderers. our work taught usthat people who do bad things often have troubled brains. that was not a surprise. but what did surprise us was that many of these brainscould be rehabilitated.
so here's a radical idea. what if we evaluatedand treated troubled brains rather than simply warehousing themin toxic, stressful environments? in my experience, we could savetremendous amounts of money by making these people more functional, so when they left prison, they could work, support their families and pay taxes. dostoyevsky once said:"a society should be judged not by how well it treatsits outstanding citizens,
but by how it treats its criminals." instead of just crime and punishment, we should be thinkingabout crime evaluation and treatment. (applause) so after 22 years and 83,000 scans, the single most important lessonmy colleagues and i have learned is that you can literallychange people's brains. and when you do, you change their life. you are not stuck with the brain you have,
you can make it better,and we can prove it. my colleagues and i performedthe first and largest study on active and retired nfl players, showing high levels of damagein these players at the time when the nfl said they didn't know if playing football causedlong-term brain damage. the fact was they didn't want to know. i think, if you get the most thoughtful9-year-olds together, and you talk about the brain is soft,about the consistency of soft butter,
it's housed in a really hard skullthat has many sharp, bony ridges, you know, 28 out of 30nine-year-olds would go: "probably a bad idea for your life." but what really got us excitedwas the second part of the study where we put playerson a brain-smart program and demonstratedthat 80% of them could improve in the areas of blood flow,memory, and mood, that you are not stuckwith the brain you have, you can make it betteron a brain-smart program.
how exciting is that? i am so excited. reversing brain damageis a very exciting new frontier, but the implicationsare really much wider. here is this scanof a teenage girl who has adhd, who was cutting herself, failingin school, and fighting with her parents. when we improved her brain, she went from d's and f's to a's and b's, and was much more emotionally stable.
here is the scan of nancy. nancy had been diagnosed with dementia, and her doctor told her husbandthat he should find a home for her because within a year,she would not know his name. but on an intensive,brain-rehabilitation program, nancy's brain was better,as was her memory, and four years later,nancy still knows her husband's name. or my favorite storyto illustrate this point: andrew, a 9-year-old boy who attackeda little girl on the baseball field
for no particular reason, and at the time,was drawing pictures of himself hanging from a treeand shooting other children. andrew was columbine, aurora, and sandy hook waiting to happen. most psychiatristswould have medicated andrew, as they did eric harrisand the other mass shooters before they committed their awful crimes, but spect imaging taught methat i had to look at his brain
and not throw darts in the dark at himto understand what he needed. his spect scan showeda cyst, the size of a golf ball, occupying the spaceof his left temple lobe. no amount of medication or therapywould have helped andrew. when the cyst was removed, his behavior completelywent back to normal, and he became the sweet, loving boyhe always wanted to be. now 18 years later,andrew, who is my nephew, owns his own home,is employed and pays taxes.
because someone botheredto look at his brain, he has been a better son, and will be a better husband,father, and grandfather. when you have the privilegeof changing someone's brain, you not only change his or her life but you have the opportunityto change generations to come. i'm dr. daniel amen. thank you.
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