The Brain Is the Soul's Fragile Dwelling Place, Part 2

Healing the Hardware of the Soul
by Daniel G. Amen, M.D.

(Page 2 of 2)

ORU was an amazing place to attend medical school. We were taught solid medical science in an atmosphere of love, compassion, and prayer. It was different from every other medical school in the country. We were taught how to pray with patients, take spiritual histories, and consider the "mind, body, and spirit" in treating the whole person. In a number of classes we struggled with the issue of sin and sickness. Many fundamentalist Christians believe that physical or emotional sickness comes from a sick soul, and that you are more likely to be physically or emotionally sick if you have sin in your life. Others feel that we all get sick and die — it is part of the human condition. It only causes people to struggle with unnecessary guilt when you blame their illnesses on sin. It was a sticky and complex issue.

After medical school, I did my psychiatric internship and residency at Walter Reed Army Medical Center in Washington, D.C., the military's largest hospital. As a resident, I taught a class to physicians and chaplains on the connection between medicine and spirituality. I taught that 70 percent of the people in the United States have strong fundamental religious beliefs, and that health-care professionals, ministers, and rabbis needed to work together for the best interests of their patients. With each year of medical training and experience it became obvious to me that there were many missing pieces to the puzzle of spirituality and healing. During my residency I found that the more patients were connected to their religious faith, whether Catholic, Protestant, Jewish, Buddhist, or Muslim, the healthier they seemed to be as a whole. They tended to need fewer psychiatric visits than those who were not connected to a body of believers. Researchers at Harvard, Duke, and Johns Hopkins have found that people with deep religious faith show greater physical and emotional health. Of course, one could argue that healthier people are more likely better equipped to make and keep connections to others and subsequently are more likely to thrive in groups of people.

The second piece of the puzzle became clear to me while I was doing a fellowship in child and adolescent psychiatry at Tripler Army Medical Center in Honolulu, Hawaii. During this time I worked extensively with children, teenagers, and families. I consulted with schools, worked with medically ill kids, treated teens whose problems were so severe that they could not live at home, and ran therapy groups for kids and parents. I learned how important early development was to brain function. I saw how positive environments can enhance intellect and emotions, and more often, how negative environments can impair brain function and contribute to both psychiatric and learning disabilities. Any child psychiatrist knows that genetic vulnerability predisposes a person to problems, but the environment plays a large role in the expression of those problems.

The third major piece of the puzzle dropped into place in 1990. After military service, I set up a private psychiatric clinic in Fairfield, California, forty miles northeast of San Francisco. I saw patients in both outpatient and hospital settings, and directed a hospital unit that treated drug and alcohol abusers who also were diagnosed with psychiatric conditions. During one of the hospital's physician lectures I learned about brain SPECT imaging, a nuclear medicine study that uses very small amounts of a radioactive compound to view the inner workings of the living brain. Unlike standard magnetic resonance imaging (MRI) and computerized axial tomography (CAT) scanners, which show brain anatomy, SPECT — which stands for single photon emission computed tomography — evaluates brain physiology. I learned that SPECT was used to look at strokes, head trauma, and dementia. It was also being used by researchers to study depression, attention deficit disorder, schizophrenia, and obsessive-compulsive disorder. We could actually see brain patterns associated with "psychiatric" illness, meaning that many mental illnesses were actually visible brain illnesses. This idea would have made Sigmund Freud salivate — to see the inner workings of the brain as it related to behavior. As I learned more about SPECT and similar technologies, I believed they would change the face of psychiatry in my lifetime, although at the time I had no idea I would become a controversial part of it.

Controversy: To Look or Not to Look

Brain SPECT imaging gives us a visual picture of brain function, a window into the hardware of the soul, as we will see throughout this book. Seeing the initial SPECT studies of my own patients dramatically changed my perception of mental illness and the soul. I had only to look at the brains of people who did bad things to begin to understand that they had poorer access to their own brains, the organ that made them human. I was dumbfounded to find that many physicians strongly resisted the use of brain-imaging tools in clinical psychiatric practice to evaluate serious behavioral or emotional problems. These physicians claimed that you could not see tendencies toward specific psychiatric illness in brain scans, that the scans were overinterpreted, that it was too soon to use brain-imaging tools on patients, and that we needed much more research before it could become a clinical tool.

Over the past decade I have argued with many of my colleagues about the need to look at and evaluate the brain in psychiatry. Psychiatrists are the only medical specialists who rarely look at the organ they treat. In my opinion, the lack of brain imaging has kept psychiatry behind medicine's other specialties, decreasing our effectiveness with patients and helping to maintain stigma and noncompliance with needed treatment. Odds are if you are having serious problems with your feelings (depression or anxiety), thoughts (schizophrenia or bipolar disorder), or behavior (violence, pedophilia, or substance abuse), the psychiatrist treating you will never order a brain scan. He will prescribe psychotherapy or powerful medications without ever looking at how your specific brain works. He will not know which areas of your brain work well, which work too hard, or which do not work hard enough. Can you imagine the outcry if other medical specialists acted without looking? If orthopedists set broken bones without X rays? If cardiologists diagnosed coronary-artery blockages without angiograms or fast CAT scans? If internists diagnosed pneumonia without ordering chest X rays or sputum cultures? Or surgeons performed mastectomies without looking at breast tumors under the microscope to see if they were cancerous or not? Yet, the state of the art in psychiatry is not to look at the organ it treats.

Psychiatrists diagnose and treat patients based on symptom clusters, not underling brain dysfunction. Imagine taking your car to the mechanic because it is smoking, using too much gasoline, or stalling in the middle of intersections. The mechanic listens to the symptoms and decides to change the car's fuel pump, without ever looking under the hood. How would you feel? Probably like going somewhere else. It's silly. We must look at the brain if we are to really understand the problems we face.

One of the criticisms of using brain imaging in clinical practice is that there is not enough published literature to verify that it will be helpful. Yet, there is a very large body of literature on brain imaging for behavioral problems. On my web site, www.brainplace.com, you can see over four hundred abstracts on brain imaging for neuropsychiatric reasons. We should image the brain in people who struggle with thoughts, feelings, or behaviors because the brain is complex and needs to be better understood. We need better diagnostic tools. We need more targeted treatments, based on the areas of the brain involved in illness.

Being ahead of your time can be painful. Many people have told me that my brain research and clinical work have been on the cutting edge of brain science. I often respond that I have been "bleeding on the cutting edge" for many years. Applying brain-imaging science to everyday practice seemed natural to me, and most important, it seemed like the right thing to do. When the brain works right, you can work right. When the brain doesn't work right, it is very hard for you to be your best. Yet, when you go up against established psychiatric practice and try to change the ways things are done, bad things can happen.

In October 1996, I was asked to give the State-of-the-Art Lecture in Medicine to the Society of Developmental Pediatrics. I shared my work with brain SPECT imaging with hundreds of physicians. One physician in attendance complained to the California Medical Board about my use of SPECT technology in medical practice. Psychiatrists are not supposed to do brain scans, he said; that is not the standard of care in the medical community. In California, if you do anything outside of the standard of care, you can lose your license. For over a year I attended meetings with investigators and medical board physicians, hired an attorney, worried, and didn't sleep much. My life's love and work were threatened. It was perhaps the most painful time in my life. In the end, my work was labeled by one of the physicians who reviewed it as exciting and good medicine. One is often labeled a heretic for trying to change religious beliefs. I was (am) trying to change the mind-set of a profession steeped in religion. The religion of psychoanalysis and psychodynamic psychotherapy, interestingly enough, was started by a neurologist, Freud.

One of the sustaining factors in my work has been my own personal faith. From the first month that I started to order these scans, I felt that they had a special place in science and that I was led by God to pursue this work. Some of my critics would scoff, saying that religion and science do not mix. Yet, patient after patient benefited from what we were learning, including many of my own family members. My nine-year-old nephew Andrew had an episode of violent behavior accompanied by suicidal and homicidal thoughts. When we uncovered and removed a temporal-lobe cyst, his behavior normalized. Without our work he would have likely died. One of my own children was diagnosed with a learning problem based on the imaging work, and the treatment gave her dramatic benefit in school. There are literally hundreds of stories that have filled my own soul with joy and determination about this work. Despite the trials, I feel incredibly blessed to be able to do this work and to help others. Now, twelve years after we began the imaging work, my clinics have been credited by many as pioneering the use of functional brain imaging in day-to-day psychiatric practice. The Amen Clinics, in Newport Beach and Fairfield, are the most active brain-imaging centers in the world, and we have the world's largest database of brain scans related to behavioral and learning problems.

The imaging work affected every part of my life. I started to dream in brain pictures. When I watched the news, I thought of the brains of people who did bad things and the brains of people who were victimized. I thought of the brains of people who were compassionate and thoughtful and the brains of people who were mean or evil. There has not been a day over the past twelve years when I have not thought about the brain and its relationship to everyday life and to our souls. Some people, like my children, might say I am obsessed with the brain. I think of it as a wonderful personal journey that I love to share.

The Brain Is Involved in Everything You Do

Despite advances in medical science, many people don't seem to realize how important the brain is to everyday life. It is the organ that guides and directs nearly everything we do. How we think, how we feel, how we act, how well we get along with others, and even our faith are influenced by the physical functioning of the brain. When I meet a person whose brain works right, I am likely to see someone with a prosperous, fulfilled, loving, and connected life. When I treat someone whose brain does not work right, more often than not the history I take reveals a life that is associated with struggle, pain, isolation, and failure. The soul's health and the physical functioning of the brain work together to help us be happy, giving, and loving or they are discordant and cause serious emotional or behavioral problems. Here's a very sad example of a sick soul, stemming from an injured brain.

On Wednesday, May 20, 1998, in Springfield, Oregon, Kip Kinkel, fifteen, was caught with a stolen gun on campus and suspended from school, pending possible expulsion. Police booked him on criminal charges and sent him home with his parents. Authorities said that Kip shot his father and mother to death sometime between Wednesday afternoon and Wednesday evening. Dressed in a trench coat, he drove a family car the next morning to a spot near Thurston High School and parked it. Carrying a rifle and two handguns, Kip walked into the school, where he fired fifty-one rounds. Two students died and twenty-five others were injured.

A New Look at Difficult Behavior

By all outward evidence Kip Kinkel is an evil boy who destroyed the lives of many people. Because I had the opportunity to read a scan of Kip's brain, I have another perspective. I do not think that Kip is evil. I know that he is sick. He has one of the most damaged brains that I have ever seen. He has serious decreased activity in his left temporal lobe (an area commonly associated with violence), prefrontal cortex (the part of his brain that supervises behavior and is responsible for conscience, or lack of it, decision making, impulse control, and the ability to focus), and occipital cortex (the visual area of the brain indicating the possibility of past brain trauma). Without proper medical help his damaged brain could only produce an ineffective, broken, and tragic life. The right medication to stabilize and enhance his left temporal lobe and prefrontal cortex likely would have prevented this terrible tragedy.

Challenging Our Basic Beliefs

After many clinical experiences with patients who had serious behavioral problems not unlike Kip's, it became clear to me that the people who struggled with difficult behavior almost always had abnormal brain SPECT studies. Shortly after I started ordering these scans, I felt that my beliefs about good and evil, heaven and hell, and judgment needed to be challenged. How could we judge someone like Kip as bad when the organ that controls his behavior doesn't work right? The judgmental waters seemed murky to me. I trusted that God knew everything that I was discovering and that He had the judgment issue figured out. But what about man? We had been operating under erroneous assumptions. We assumed that we are all equal and we have an equal ability to choose right or wrong, good or evil, and heaven or hell. The brain-imaging work taught me that we are not all equal, and not everyone has the same power to choose.

In my clinics, where staff psychiatrists and neurologists see over twelve hundred patients a month, we have been able to get an intimate look at the inner workings of the brains of people with depression, obsessive-compulsive disorder, schizophrenia, alcohol and drug problems, attention deficit disorders, premenstrual syndrome, spousal abuse, and suicidal behavior. We have seen how the brain works (or doesn't work) in murderers, rapists, armed robbers, arsonists, stalkers, and pedophiles. In addition, we have been able to look at the brains of people who were healthy, motivated, loving, and organized. Living with a healthy brain gives people the opportunity to be and act healthy; living with a damaged brain often causes great struggle.

New Thinking and Hope

The exciting news is that you are not stuck with the brain that you have; brain problems can be improved and even healed. The brain itself, like a computer, can be optimized to produce better results.

Healing the Hardware of the Soul is a book about hope and healing. It departs radically from traditional thinking and gives you a completely new look at yourself and those you love (or hate). Specifically, it looks at how we need an effectively working supervisor (the brain's prefrontal cortex) to have a healthy conscience. It looks at how religious experience often stems from temporal-lobe and limbic system function, and how obsessions (religious and others) stem from too much activity in the anterior cingulate gyrus and basal ganglia (which allows us to shift gears). In addition, the book looks at the concepts of good and evil, thoughtfulness, and caring as brain functions. For the first time, it discusses our relationship to faith, sin, evil, hatred, love, compassion, judgment, healing, and forgiveness through the lens of brain science. This is not a collection of high-technology excuses for bad behavior. Ultimately, we as individuals have to be responsible for our own behavior. It is, however, a book about understanding behavior that offers new solutions to help us be more effective as a society in dealing with ourselves, our neighbors, and extreme people like Kip, based on and informed by the relatively new science of brain imaging.

This is not a book about a specific religion, although the fact that I grew up in a Roman Catholic family will not be lost on the reader. The principles for healing discussed in it are universal. These healing-soul principles (forgiveness, connection, giving to others, focused thoughts, and leaving judgment to the Almighty) are similar across most world religions. Healing the Hardware of the Soul highlights studies that demonstrate how faith and religious connection have a healing impact on brain function. The purpose is to help you understand how important the brain is in everyday life and how through physical, emotional, and spiritual strategies you can optimize the brain and heal the hardware of your soul.

Copyright © 2002 by Daniel G. Amen, M.D.

About the Author

Daniel G. Amen, M.D., is a clinical neuroscientist, psychiatrist, and brain-imaging expert who heads up the world-renowned Amen Clinics. He is a Distinguished Fellow of the American Psychiatric Association and has won numerous writing and research awards. He writes a monthly column in Men's Health called "Head Check" and has published nineteen books, numerous professional and popular articles, and a number of audio and video programs. His books include Preventing Alzheimer's, Healing Anxiety and Depression, Healing the Hardware of the Soul, Healing ADD, and the New York Times bestseller Change Your Brain, Change Your Life. He is an internationally renowned keynote speaker and a popular guest expert for the media, with appearances on CNN, the Today show, The View, and other venues.