1
12 Principles to Change Your Brain and Your Life
At Amen Clinics we have twelve core principles that provide the foundation for our work with patients suffering from a range of issues as well as those looking to optimize their brains. They are incredibly simple, but don’t let that fool you. They are also extremely powerful and will change everything in your life if you read, understand, and apply them.
1.Your brain is involved in everything you do and everything you are, including how you think, how you feel, how you act, and how well you get along with other people. Your brain is the organ behind your intelligence, character, personality, and every single decision you make. This is not a new idea. In about 400 BC, Hippocrates wrote, “And men ought to know that from the brain, and from the brain only, arise our pleasures, joy, laughter, and jests, as well as our sorrows, pains, despondency, and tears. And by this, in a special manner, we acquire wisdom and knowledge, and see and hear, and know what is foul and what is fair, what is bad and what is good, what is sweet, and what is unsavory . . . And by the same organ we become mad and delirious, where fears and terrors assail us . . . All these things we endure from the brain, when it is not healthy . . . In these ways I am of the opinion that the brain exercises the greatest power in the man. This is the interpreter to us of those things which emanate from the air, when the brain happens to be in a sound state.” (18)
It is your brain that decides whether you should get married and if you get divorced. It is your brain that manages your money and helps you be successful at work. And it is your brain that pushes you away from the table, telling you that you have had enough (or that gives you permission to have the third bowl of ice cream). Yet most people never really think about their brains, which is a huge mistake, because success in anything you do starts with a healthy brain.
2.When your brain works right, you work right. But when your brain is troubled, you are much more likely to have trouble in your life. With a healthy brain you are happier, physically healthier (because you make better decisions), wealthier (also because you make better decisions), and more successful in everything you do. When your brain is unhealthy, for whatever reason (brain injuries, drug abuse, obesity, sleep apnea, mold toxicity, etc.), you are sadder, sicker, poorer, and less successful. In all the books about success on the shelf at your local bookstore, virtually none of them talk about optimizing the physical health of your brain. Based on our work with tens of thousands of people, we believe it is always the first place to start.
Image 1:1
If you really understand principle number 2 it can be disturbing, because it directly challenges the notion of free will. Most people think of free will as black or white: you have it or you don’t. Our imaging work has taught me that free will is a gray concept. Some of us have great overall brain function and likely have a very high percentage of free will; while others, often through no fault of their own, such as having been in a car accident, have less healthy brains, leading to less free will and more troubled lives.
3.Your brain is the most amazing, energy-hungry organ in the universe. It is estimated that your brain has one hundred billion cells, with each one connected to other cells by up to ten thousand individual connections. It has also been estimated that you have more connections in your brain than there are stars in the universe. Let’s put this in binge- watching television terms: it’s been estimated that the brain has the storage capacity of three million hours of TV shows (19).
Even though your brain is only about 2 percent of your body’s weight (about three pounds), it uses 20 to 30 percent of the calories you consume and 20 percent of your body’s blood flow. Take a moment to consider that. Your brain is the most metabolically expensive real estate in your body. This is important to understand, because any form of oxygen deprivation state, from a scary event like a near-drowning episode to the seemingly commonplace, like having sleep apnea, can damage your brain.
4.Your brain is the consistency of soft butter and housed in a really hard skull with multiple sharp bony ridges, making it easily injured. Think of something that falls in between Jell-O and egg whites on the softness spectrum—that’s your brain. For extra credit, visit this link to watch a video of a newly autopsied brain, so you can see how soft it really is: https://m.youtube.com/watch?v=jHxyP-nUhUY. Now imagine it encased in a really hard skull with many sharp bony ridges (see Image 1:2). Jarring motions and head injuries can cause the brain to slam into the hard interior of the skull, causing brain injuries that can ruin lives.
Soft brain + hard skull with sharp ridges = trouble
Image 1:2: Inside the Skull
Notice the sharp bony ridges.
Traumatic brain injuries (TBIs) are a major cause of psychiatric illness and few people know this, because most psychiatrists never look at the brain. TBI has been linked to homelessness, drug and alcohol abuse, anxiety, panic attacks, depression, ADD/ADHD, learning problems, school failure, murder, suicide, domestic violence, job failure, and incarceration. In a study I did at Sierra Tucson, a psychiatric hospital in Arizona, 44 percent of new admissions had a significant history of brain injury. In another study of homeless people in Toronto, 58 percent of the men and 42 percent of the women had had a significant brain injury before becoming homeless.
At the time of this writing, more than three hundred thousand veterans have sustained a TBI since 2000 (8); the effects of such injuries can follow people for the rest of their lives, indicating that it’s likely those veterans and society will feel the consequences for many decades to come.
Two million new TBIs occur each year as a result of falls, accidents, and concussions. We have to do a much better job of preventing TBIs and repairing the brain once they occur. When President Barack Obama and LeBron James, both huge sports fans, said they would not let their children play tackle football, it was a sign that awareness about the effects of TBI are starting to become part of our cultural fabric.
5.Many things hurt the brain. Obviously, drugs, too much alcohol, infections, environmental toxins, and traumatic head injuries are bad for your brain. But research also tells us that obesity (20); sleep apnea (21); hypertension (22, 23), and even high normal blood pressure levels; diabetes (24, 25), prediabetes, and even high normal blood sugar levels; many medications, such as benzodiazepines (26, 27); the Standard American Diet (SAD), filled with processed foods, pesticides (28, 29), sugar, and artificial colors and sweeteners; unbalanced hormone levels; chronic stress (30, 31); negative thinking; even spending time with unhealthy people are all bad for the brain. Take a moment to think how many of these factors might be affecting you.
6. Many things help the brain. The exciting news is that many things are also good for your brain and can boost its function, such as learning new things; great nutrition; coordination exercises; meditation; loving relationships; and certain nutrients, including vitamins B6, B12, and D, methyltetrahydrofolate (MTHF), omega-3 fatty acids, and phosphatidylserine. In many ways, the best thing you can do for your brain is to spend time with healthy people. As we will see, they are contagious. I often say the fastest way to get healthy is to find the healthiest person you can stand and then spend as much time around him or her as possible. Chapters 19 and 20, give a detailed description of what you can do to enhance your brain.
7.Certain systems in the brain tend to do specific things, and problems in these systems tend to cause symptoms that can benefit from targeted treatments. Knowing about your brain can help you understand yourself and others. This is one of the main areas of focus for this book. You’ll learn about the five major brain systems involved with feelings, thinking, and behavior, including the limbic or emotional brain (mood and bonding), basal ganglia (motivation, pleasure, and anxiety), prefrontal cortex (the brain’s CEO—focus, forethought, and judgment), anterior cingulate gyrus (detects errors and helps shift attention), and the temporal lobes (memory, learning, and mood stability). Specifically, we will look at the latest research about what each system does, what happens when things go wrong, and how to help them.
8.Looking at the brain gives us the opportunity for many powerful insights not possible by just listening to symptoms alone. After looking at more than one hundred thousand brain scans we know that if you don’t look at how the brain functions in individual patients, you are really just guessing at what’s wrong with them. Without imaging an individual’s brain, physicians miss important causes of cognitive, emotional, or behavioral problems, such as brain injuries, toxic exposures, or infections. People end up misdiagnosed and mistreated.
Adrianna, age sixteen, went on a mountain vacation with her family. When they arrived at their cabin they were surrounded by six deer. It was a beautiful moment. Ten days later Adrianna became agitated and started having auditory hallucinations. Her parents sought help for Adrianna, who was admitted to a psychiatric hospital and prescribed antipsychotic medications, which didn’t help. The next three months were a torturous road of different doctors and multiple medications, at a cost of nearly $100,000. Adrianna had become a shadow of her former self. Desperate, her parents brought Adrianna in for a scan, which showed areas of unusually high activity. It caused us to look deeper at the potential causes of her symptoms, such as an infection or toxicity. It turned out Adrianna had Lyme disease, an infection, often caused by deer ticks. Treatment with antibiotics helped her get her life back.
Imaging immediately decreases stigma as people begin to see their problems as medical and not moral. We have nothing else in psychiatry that is this powerful or immediate. Imaging increases treatment compliance, because people want a better brain so they can have a better life.
Steve
After I gave a lecture to a group called the National Alliance for the Mentally Ill (NAMI), one of the NAMI officers brought her son, who had paranoid schizophrenia and addiction issues, to one of our clinics. Steve had been living on the streets of San Francisco and could not live at home because of his violent, erratic behavior and his refusal to get treatment. During his clinical interview, our historian knocked on my door and told me she didn’t feel comfortable seeing Steve alone; he scared her. As I introduced myself to Steve it was clear he was psychotic and was agitated being at the clinic. He told me in a loud voice that he would not take medication and I couldn’t make him. To settle the tension, I asked if I could get him a cup of water.
As we talked, I told him I didn’t want him to do anything he didn’t want to do, but wondered if it would be okay to scan his brain. Seeing the brain SPECT scans on the walls of the clinic, he was curious and agreed to be scanned. After his scan we looked at it together. It showed high levels of damage. When I showed him a healthy scan (Image 1.3) compared to his scan (Image 1.4), he just stared at them without saying a word.
After about five minutes Steve looked at me, which was the first time we actually had eye contact, and he asked if I could help him. The scans helped him make the shift from being angry and in denial to being open to working with me to get a better brain. This was a pivotal moment—one that the scans had given us with our patients thousands of times before. I told him we had better medications than the ones he had been on in the past and prescribed a low dose of a newer antipsychotic medication. I then gave him an appointment for three weeks later.
A week later I walked into my waiting room to get a new patient and saw Steve’s mother sitting there and wondered to myself why she was at the clinic without an appointment. All of a sudden she stood up, grabbed me, and kissed me on the cheek.
“Thank you,” I said, a little bewildered. “Why did you do that?”
“You can’t believe how much better Steve is,” she said. “He is not hallucinating, he’s not aggressive, and we can have him at home. I am so grateful.”
A few weeks later I saw Steve for his first follow‑up visit. He was remorseful for his prior behavior and grateful he was feeling better. We did a follow‑up scan, which was dramatically better. I put his original scan next to his new one and asked him, “Which brain do you want?”
He said, “I want the healthy one.”
“Then you have to take your medication,” I replied.
The scans made all the difference for Steve and those he loved. Imaging completely changes the discussion around mental health:
What If Mental Health Was Really Brain Health?
With the pervasive stigma around mental health issues, few people want to see a psychiatrist, but almost everyone wants a better brain! Imaging helps to create brain envy. When people see their own brains, they usually want it to be better, like Steve, so they treat it better. Know better, do better.
9.Psychiatric illnesses are not single or simple disorders in the brain. Each one has multiple types that require unique treatments. One treatment will never work for everyone. Based on our imaging work, it is very clear that giving someone the diagnosis of depression is exactly like giving them a diagnosis of chest pain. No doctor would do that, because it doesn’t tell you what is causing it or what to do for it. The same thing is true for psychiatric illnesses. Depression is a cluster of symptoms, not a disease. It has too many causes and each requires its own treatment. Rather than simply give you a diagnostic label based on symptoms, we need to understand why you are anxious or have attention problems or temper issues. Based on our imaging work, I’ve described seven types of anxiety and depression, seven types of ADD, six types of addicts and five types of overeaters.
Copyright © 2015 by Daniel G. Amen, M.D.. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
