Why Psychiatrists Must Look at Brains

Medical imaging as a calling

Dr. Amen's passion for medical imaging began during his 1972 army training as an X-ray technician, guided by the principle: 'How do you know, unless you look?' This philosophy later drove his adoption of brain SPECT imaging in psychiatry.

Why psychiatry mattered

After witnessing a family member's suicidal crisis resolved by psychiatric care in 1979, Amen realized psychiatry could change not just one person but entire generations—shaping children and grandchildren through a parent's improved stability.

The convergence: SPECT imaging meets psychiatry

In 1991, Amen attended his first SPECT imaging lecture, where his two professional loves—medical imaging and psychiatry—merged. SPECT (a nuclear medicine study measuring blood flow and brain activity) became the tool to help psychiatrists diagnose and treat patients more accurately.

Scale of the research effort

Over 22 years, Dr. Amen and colleagues built the world's largest database of brain scans related to behavior, scanning patients from 93 countries and accumulating 83,000 total scans.

83,000

brain scans analyzed over 22 years

Database spanning 93 countries

What SPECT scans reveal

SPECT imaging shows three states of brain activity: good activity, too little activity, or too much activity. A healthy brain displays full, even, symmetrical activity with high-activity areas typically in the back of the brain.

Visual patterns of brain disorders

SPECT scans reveal distinctive patterns: strokes show holes of activity; Alzheimer's shows deterioration in the back half of the brain; traumatic brain injury shows damage; obsessive-compulsive disorder shows overactivity in the front; and epilepsy shows areas of increased activity.

Alzheimer's begins decades before symptoms

Alzheimer's disease actually starts in the brain 30 to 50 years before any symptoms appear, making early detection through imaging potentially transformative for prevention.

Alzheimer's disease progression timeline

Psychiatry's unique diagnostic blindness

Psychiatrists are the only medical specialists who virtually never look at the organ they treat. Cardiologists examine hearts, neurologists examine nervous systems, orthopedic doctors examine bones—but psychiatrists diagnose by talking to patients and identifying symptom clusters, essentially guessing.

Medical specialists and their diagnostic approaches

Diagnosis unchanged since 1840

Without brain imaging, psychiatrists diagnose the same way they did in 1840 when Abraham Lincoln was depressed—by talking to patients and looking for symptom clusters, missing underlying brain pathology.

The danger of guessing

Before imaging, Amen felt like he was 'throwing darts in the dark' at patients, sometimes hurting them. Most psychiatric medications carry black box warnings because giving the wrong drug to the wrong person can precipitate a disaster.

Psychiatric illnesses have multiple brain types

Conditions like ADHD, anxiety, depression, and addictions are not single disorders but have multiple distinct brain patterns. Two patients with identical depression diagnoses can have radically different brain scans—one with low activity, one with high activity—requiring completely different treatments.

Same diagnosis, radically different brain patterns

Treatment must match individual brains

The critical lesson: treatment needs to be tailored to individual brain patterns, not to clusters of symptoms. Without imaging, psychiatrists cannot know which treatment will help which patient.

Traumatic brain injury as hidden psychiatric cause

Mild traumatic brain injury is a major cause of psychiatric illness that ruins lives but goes undiagnosed because psychiatrists never look. Patients present with temper problems, anxiety, depression, and insomnia, but without brain imaging, the underlying injury remains invisible.

The case of the 15-year-old with undiagnosed brain injury

A boy who fell down stairs at age three, unconscious for only minutes, had severe enduring brain damage. By age 15, he had been kicked out of three residential treatment programs for violence. He needed brain rehabilitation, not more medication or behavioral therapy—which is cruel when behavior is merely expressing an underlying brain problem.

Brain injuries drive homelessness and crime

Researchers have found that undiagnosed brain injuries are a major cause of homelessness, drug and alcohol abuse, depression, panic attacks, ADHD, and suicide. Hundreds of thousands of soldiers returning from Iraq and Afghanistan face this crisis with virtually no one examining their brain function.

Consequences of undiagnosed brain injuries

Scanned over 500 convicted felons

Dr. Amen's team scanned over 500 convicted felons, including 90 murderers, discovering that people who do bad things often have troubled brains—but surprisingly, many of these brains could be rehabilitated.

500+

convicted felons scanned, including 90 murderers

Finding: many troubled brains are rehabilitable

A radical alternative to warehousing

Instead of simply warehousing criminals in toxic, stressful environments, what if society evaluated and treated their troubled brains? This approach could save money by making people more functional so they could work, support families, and pay taxes upon release.

Judging society by how it treats criminals

Dostoyevsky said: 'A society should be judged not by how well it treats its outstanding citizens, but by how it treats its criminals.' The implication: crime evaluation and treatment, not just crime and punishment.

The core lesson: brains are not fixed

After 22 years and 83,000 scans, the single most important finding is that you can literally change people's brains. When you do, you change their life. People are not stuck with the brain they have—it can be made better, and this can be proven.

NFL players study: brain damage is real

Dr. Amen's team performed the first and largest study on active and retired NFL players, showing high levels of brain damage at a time when the NFL claimed not to know if football caused long-term damage. The NFL didn't want to know.

Brain-smart programs reverse damage

When 80% of NFL players were placed on a brain-smart program, they improved in blood flow, memory, and mood. This proves that brain damage is not permanent—people are not stuck with damaged brains; they can be made better.

80%

of NFL players improved in blood flow, memory, and mood on brain-smart program

Proof of reversible brain damage

Teenage girl with ADHD and self-harm

A teenage girl with ADHD who was cutting herself and failing in school (D's and F's) improved her brain function and went to A's and B's, becoming emotionally stable.

ADHD patient's academic and emotional transformation

Nancy: reversing dementia diagnosis

Nancy was diagnosed with dementia and her doctor told her husband to find a home for her because within a year she would not recognize him. On an intensive brain-rehabilitation program, Nancy's brain improved, and four years later, she still knows her husband's name.

Andrew: the case that changed everything

Andrew, a 9-year-old boy, was attacking other children and drawing pictures of himself hanging and shooting others—he was a mass shooting waiting to happen. His SPECT scan revealed a golf-ball-sized cyst in his left temporal lobe. After surgical removal, his behavior normalized completely. Now 18 years later, Andrew owns his home, is employed, pays taxes, and will be a better son, husband, father, and grandfather because someone bothered to look at his brain.

Changing brains changes generations

When you have the privilege of changing someone's brain, you not only change that person's life but have the opportunity to change generations to come. One person's brain rehabilitation ripples through families and society.