WEBVTT

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In this talk, I'm going to give you
the single most important lesson

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my colleagues and I have learned
from looking at 83,000 brain scans.

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But first, let me put
the lesson into context.

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I am in the middle of seven children.

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Growing up, my father called me a maverick

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which to him was not a good thing.

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(Laughter)

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In 1972, the army called my number,

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and I was trained as an infantry medic
where my love of medicine was born.

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But since I truly hated the idea
of being shot at or sleeping in the mud,

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I got myself retrained
as an X-ray technician

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and developed a passion
for medical imaging.

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As our professors used to say:
"How do you know, unless you look?"

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In 1979, when I was
a second-year medical student,

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someone in my family
became seriously suicidal,

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and I took her to see
a wonderful psychiatrist.

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Over time, I realized
if he helped her, which he did,

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it would not only save her life,

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but it would also help her children
and even her future grandchildren,

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as they would be shaped by someone
who is happier and more stable.

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I fell in love with psychiatry

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because I realized it had the potential
to change generations of people.

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In 1991, I went to my first lecture
on brain SPECT imaging.

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SPECT is a nuclear medicine study
that looks at the blood flow and activity,

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it looks at how your brain works.

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SPECT was presented
as a tool to help psychiatrists

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get more information
to help their patients.

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In that one lecture,
my two professional loves,

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medical imaging and psychiatry,

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came together, and quite honestly,
revolutionized my life.

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Over the next 22 years,
my colleagues and I would build

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the world's largest database
of brain scans related to behavior

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on patients from 93 countries.

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SPECT basically tells us
three things about the brain:

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good activity, too little, or too much.

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Here's a set of healthy SPECT scans.

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The image on the left shows
the outside surface of the brain,

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and a healthy scan shows full,
even, symmetrical activity.

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The color is not important,
it's the shape that matters.

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In the image on the right,
red equals the areas of high activity,

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and in a healthy brain, they're typically
in the back part of the brain.

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Here's a healthy scan compared
to someone who had two strokes.

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You can see the holes of activity.

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Here's what Alzheimer's looks like,

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where the back half
of the brain is deteriorating.

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Did you know that Alzheimer's disease
actually starts in the brain

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30 to 50 years before
you have any symptoms?

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Here's a scan
of a traumatic brain injury.

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Your brain is soft,
and your skull is really hard.

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Or drug abuse.

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The real reason not to use drugs -
they damage your brain.

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Obsessive–compulsive disorder

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where the front part of the brain
typically works too hard,

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so that people cannot
turn off their thoughts.

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An epilepsy where we frequently
see areas of increased activity.

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In 1992, I went to an all-day conference
on brain SPECT imaging,

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it was amazing and mirrored

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our own early experience
using SPECT in psychiatry.

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But at that same meeting,
researchers started to complain loudly

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that clinical psychiatrists like me
should not be doing scans,

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that they were only for their research.

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Being the maverick
and having clinical experience,

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I thought that was a really dumb idea.

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(Laughter)

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Without imaging,

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psychiatrists then and even now
make diagnosis like they did in 1840,

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when Abraham Lincoln was depressed,

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by talking to people and looking
for symptom clusters.

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Imaging was showing us
there was a better way.

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Did you know that psychiatrists
are the only medical specialists

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that virtually never look
at the organ they treat?

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Think about it!

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Cardiologists look, neurologists look,
orthopedic doctors look,

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virtually every other
medical specialties look -

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psychiatrists guess.

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Before imaging,

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I always felt like I was throwing
darts in the dark at my patients

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and had hurt some of them
which horrified me.

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There is a reason

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that most psychiatric medications
have black box warnings.

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Give them to the wrong person,
and you can precipitate a disaster.

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Early on, our imaging work
taught us many important lessons,

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such as illnesses, like ADHD,
anxiety, depression, and addictions,

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are not simple or single
disorders in the brain,

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they all have multiple types.

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For example, here are two patients

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who have been diagnosed
with major depression,

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that had virtually the same symptoms,
yet radically different brains.

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One had really low activity in the brain,
the other one had really high activity.

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How would you ever know what to do
for them, unless you actually looked?

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Treatment needs to be tailored

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to individual brains,
not clusters of symptoms.

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Our imaging work also taught us

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that mild traumatic brain injury
was a major cause of psychiatric illness

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that ruin people's lives,

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and virtually no one knew about it
because they would see psychiatrists

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for things like temper problems,
anxiety, depression, and insomnia,

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and they would never look,
so they would never know.

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Here's a scan of a 15-year-old boy

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who felt down a flight of stairs
at the age of three.

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Even though he was unconscious
for only a few minutes,

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there was nothing mild
about the enduring effect

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that injury had on this boy's life.

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When I met him at the age of 15,
he had just been kicked out

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of his third residential
treatment program for violence.

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He needed a brain rehabilitation program,

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not just more medication
thrown at him in the dark,

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or behavioral therapy which,
if you think about it, is really cruel.

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To put him on a behavioral therapy program

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when behavior is really an expression
of the problem, it's not the problem.

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Researchers have found
that undiagnosed brain injuries

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are a major cause of homelessness,
drug and alcohol abuse, depression,

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panic attacks, ADHD, and suicide.

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We are in for a pending disaster

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with the hundreds
and thousands of soldiers

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coming back from Iraq and Afganistan,

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and virtually no one is looking
at the function of their brain.

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As we continued our work with SPECT,

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the criticism grew louder,
but so did the lessons.

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Judges and defense attorneys sought
our help to understand criminal behavior.

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Today, we have scanned
over 500 convicted felons

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including 90 murderers.

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Our work taught us
that people who do bad things

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often have troubled brains.

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That was not a surprise.

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But what did surprise us

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was that many of these brains
could be rehabilitated.

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So here's a radical idea.

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What if we evaluated
and treated troubled brains

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rather than simply warehousing them
in toxic, stressful environments?

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In my experience, we could save
tremendous amounts of money

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by making these people more functional,

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so when they left prison, they could work,

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support their families and pay taxes.

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Dostoyevsky once said:
"A society should be judged

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not by how well it treats
its outstanding citizens,

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but by how it treats its criminals."

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Instead of just crime and punishment,

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we should be thinking
about crime evaluation and treatment.

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(Applause)

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So after 22 years and 83,000 scans,

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the single most important lesson
my colleagues and I have learned

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is that you can literally
change people's brains.

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And when you do, you change their life.

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You are not stuck with the brain you have,

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you can make it better,
and we can prove it.

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My colleagues and I performed
the first and largest study

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on active and retired NFL players,

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showing high levels of damage
in these players at the time

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when the NFL said they didn't know

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if playing football caused
long-term brain damage.

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The fact was they didn't want to know.

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That was not a surprise.

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I think, if you get the most thoughtful
9-year-olds together,

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and you talk about the brain is soft,
about the consistency of soft butter,

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it's housed in a really hard skull
that has many sharp, bony ridges,

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you know, 28 out of 30
nine-year-olds would go:

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"Probably a bad idea for your life."

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(Laughter)

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But what really got us excited
was the second part of the study

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where we put players
on a brain-smart program

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and demonstrated
that 80% of them could improve

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in the areas of blood flow,
memory, and mood,

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that you are not stuck
with the brain you have,

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you can make it better
on a brain-smart program.

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How exciting is that?

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I am so excited.

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Reversing brain damage
is a very exciting new frontier,

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but the implications
are really much wider.

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Here is this scan
of a teenage girl who has ADHD,

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who was cutting herself, failing
in school, and fighting with her parents.

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When we improved her brain,

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she went from D's and F's to A's and B's,

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and was much more emotionally stable.

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Here is the scan of Nancy.

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Nancy had been diagnosed with dementia,

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and her doctor told her husband
that he should find a home for her

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because within a year,
she would not know his name.

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But on an intensive,
brain-rehabilitation program,

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Nancy's brain was better,
as was her memory,

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and four years later,
Nancy still knows her husband's name.

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Or my favorite story
to illustrate this point: Andrew,

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a 9-year-old boy who attacked
a little girl on the baseball field

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for no particular reason,

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and at the time,
was drawing pictures of himself

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hanging from a tree
and shooting other children.

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Andrew was Columbine, Aurora,

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and Sandy Hook waiting to happen.

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Most psychiatrists
would have medicated Andrew,

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as they did Eric Harris
and the other mass shooters

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before they committed their awful crimes,

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but SPECT imaging taught me
that I had to look at his brain

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and not throw darts in the dark at him
to understand what he needed.

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His SPECT scan showed
a cyst, the size of a golf ball,

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occupying the space
of his left temple lobe.

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No amount of medication or therapy
would have helped Andrew.

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When the cyst was removed,

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his behavior completely
went back to normal,

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and he became the sweet, loving boy
he always wanted to be.

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Now 18 years later,
Andrew, who is my nephew,

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owns his own home,
is employed and pays taxes.

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(Laughter)

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Because someone bothered
to look at his brain,

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he has been a better son,

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and will be a better husband,
father, and grandfather.

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When you have the privilege
of changing someone's brain,

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you not only change his or her life

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but you have the opportunity
to change generations to come.

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I'm Dr. Daniel Amen. Thank you.

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(Applause)