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The most important lesson from 83,000 brain scans | Daniel Amen | TEDxOrangeCoast

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Oct 16, 2013

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The most important lesson from 83,000 brain scans | Daniel Amen | TEDxOrangeCoast
The most important lesson from 83,000 brain scans | Daniel Amen | TEDxOrangeCoast thumb The most important lesson from 83,000 brain scans | Daniel Amen | TEDxOrangeCoast thumb The most important lesson from 83,000 brain scans | Daniel Amen | TEDxOrangeCoast thumb

Transcription

  • Translator: Ilze Garda Reviewer: Denise RQ
  • In this talk, I'm going to give you the single most important lesson
  • my colleagues and I have learned from looking at 83,000 brain scans.
  • But first, let me put the 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 medic where my love of medicine was born.
  • But since I truly hated the idea of being shot at or sleeping in the mud,
  • I got myself retrained as an X-ray technician
  • and developed a passion for medical imaging.
  • As our professors used to say: "How do you know, unless you look?"
  • In 1979, when I was a second-year medical student,
  • someone in my family became seriously suicidal,
  • and I took her to see a wonderful psychiatrist.
  • Over time, I realized if he helped her, which he did,
  • it would not only save her life,
  • but it would also help her children and even her future grandchildren,
  • as they would be shaped by someone who is happier and more stable.
  • I fell in love with psychiatry
  • because I realized it had the potential to change generations of people.
  • In 1991, I went to my first lecture on brain SPECT imaging.
  • SPECT is a nuclear medicine study that looks at the blood flow and activity,
  • it looks at how your brain works.
  • SPECT was presented as a tool to help psychiatrists
  • get more information to 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 database of brain scans related to behavior
  • on patients from 93 countries.
  • SPECT basically tells us three things about the brain:
  • good activity, too little, or too much.
  • Here's a set of healthy SPECT scans.
  • The image on the left shows the 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 typically in the back part of the brain.
  • Here's a healthy scan compared to someone who had two strokes.
  • You can see the holes of activity.
  • Here's what Alzheimer's looks like,
  • where the back half of the brain is deteriorating.
  • Did you know that Alzheimer's disease actually starts in the brain
  • 30 to 50 years before you have any symptoms?
  • Here's a scan of 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.
  • Obsessiveā€“compulsive disorder
  • where the front part of the brain typically works too hard,
  • so that people cannot turn off their thoughts.
  • An epilepsy where we frequently see areas of increased activity.
  • In 1992, I went to an all-day conference on brain SPECT imaging,
  • it was amazing and mirrored
  • our own early experience using SPECT in psychiatry.
  • But at that same meeting, researchers started to complain loudly
  • that clinical psychiatrists like me should not be doing scans,
  • that they were only for their research.
  • Being the maverick and having clinical experience,
  • I thought that was a really dumb idea.
  • (Laughter)
  • Without imaging,
  • psychiatrists then and even now make diagnosis like they did in 1840,
  • when Abraham Lincoln was depressed,
  • by talking to people and looking for symptom clusters.
  • Imaging was showing us there was a better way.
  • Did you know that psychiatrists are the only medical specialists
  • that virtually never look at the organ they treat?
  • Think about it!
  • Cardiologists look, neurologists look, orthopedic doctors look,
  • virtually every other medical specialties look -
  • psychiatrists guess.
  • Before imaging,
  • I always felt like I was throwing darts in the dark at my patients
  • and had hurt some of them which horrified me.
  • There is a reason
  • that most psychiatric medications have black box warnings.
  • Give them to the wrong person, and you can precipitate a disaster.
  • Early on, our imaging work taught us many important lessons,
  • such as illnesses, like ADHD, anxiety, depression, and addictions,
  • are not simple or single disorders in the brain,
  • they all have multiple types.
  • For example, here are two patients
  • who have been diagnosed with 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 do for 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 injury was a major cause of psychiatric illness
  • that ruin people's lives,
  • and virtually no one knew about it because 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 stairs at the age of three.
  • Even though he was unconscious for only a few minutes,
  • there was nothing mild about 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 residential treatment program for violence.
  • He needed a brain rehabilitation program,
  • not just more medication thrown 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 expression of the problem, it's not the problem.
  • Researchers have found that 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 hundreds and thousands of soldiers
  • coming back from Iraq and Afganistan,
  • and virtually no one is looking at 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 sought our help to understand criminal behavior.
  • Today, we have scanned over 500 convicted felons
  • including 90 murderers.
  • Our work taught us that people who do bad things
  • often have troubled brains.
  • That was not a surprise.
  • But what did surprise us
  • was that many of these brains could be rehabilitated.
  • So here's a radical idea.
  • What if we evaluated and treated troubled brains
  • rather than simply warehousing them in toxic, stressful environments?
  • In my experience, we could save tremendous 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 treats its outstanding citizens,
  • but by how it treats its criminals."
  • Instead of just crime and punishment,
  • we should be thinking about crime evaluation and treatment.
  • (Applause)
  • So after 22 years and 83,000 scans,
  • the single most important lesson my colleagues and I have learned
  • is that you can literally change 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 performed the first and largest study
  • on active and retired NFL players,
  • showing high levels of damage in these players at the time
  • when the NFL said they didn't know
  • if playing football caused long-term brain damage.
  • The fact was they didn't want to know.
  • That was not a surprise.
  • I think, if you get the most thoughtful 9-year-olds together,
  • and you talk about the brain is soft, about the consistency of soft butter,
  • it's housed in a really hard skull that has many sharp, bony ridges,
  • you know, 28 out of 30 nine-year-olds would go:
  • "Probably a bad idea for your life."
  • (Laughter)
  • But what really got us excited was the second part of the study
  • where we put players on a brain-smart program
  • and demonstrated that 80% of them could improve
  • in the areas of blood flow, memory, and mood,
  • that you are not stuck with the brain you have,
  • you can make it better on a brain-smart program.
  • How exciting is that?
  • I am so excited.
  • Reversing brain damage is a very exciting new frontier,
  • but the implications are really much wider.
  • Here is this scan of a teenage girl who has ADHD,
  • who was cutting herself, failing in 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 husband that 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 story to illustrate this point: Andrew,
  • a 9-year-old boy who attacked a little girl on the baseball field
  • for no particular reason,
  • and at the time, was drawing pictures of himself
  • hanging from a tree and shooting other children.
  • Andrew was Columbine, Aurora,
  • and Sandy Hook waiting to happen.
  • Most psychiatrists would have medicated Andrew,
  • as they did Eric Harris and the other mass shooters
  • before they committed their awful crimes,
  • but SPECT imaging taught me that I had to look at his brain
  • and not throw darts in the dark at him to understand what he needed.
  • His SPECT scan showed a cyst, the size of a golf ball,
  • occupying the space of his left temple lobe.
  • No amount of medication or therapy would have helped Andrew.
  • When the cyst was removed,
  • his behavior completely went back to normal,
  • and he became the sweet, loving boy he always wanted to be.
  • Now 18 years later, Andrew, who is my nephew,
  • owns his own home, is employed and pays taxes.
  • (Laughter)
  • Because someone bothered to look at his brain,
  • he has been a better son,
  • and will be a better husband, father, and grandfather.
  • When you have the privilege of changing someone's brain,
  • you not only change his or her life
  • but you have the opportunity to change generations to come.
  • I'm Dr. Daniel Amen. Thank you.
  • (Applause)

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