I first learned about the work of psychiatrist and brain expert Dr. Daniel Amen many years ago; personally, I have always been impressed with his approaches to the diagnosis and treatment of mental and brain health conditions. He was recently featured in the documentary movie, Quiet Explosions, directed by Emmy Award-winning director Jerri Sher and based on the incredible book Tales from the Blast Factory written by Adam and Andrew Marr. In my view, the movie is a game-changer for raising public awareness of brain injuries and empowering hope for recovery via better diagnosis and treatment.
I recently had the honor of an email interview with Dr. Amen about his thoughts on SPECT scans and paradigm changes within brain health diagnostics.
Understanding SPECT Scans
What is SPECT? The acronym SPECT stands for single-photon emission computerized tomography, which means it uses a radioactive substance and a special camera to create 3D pictures. According to the Mayo Clinic, while imaging tools such as X-rays show what the structures inside your body look like, SPECT produces images that show how your organs are working—how blood is flowing to your heart, for example, or what areas of your brain are more or less active. SPECT is currently thought to be most helpful in determining which parts of the brain are being affected by such conditions as traumatic head injury or dementia.
Dr. Amen goes further and reports that he's found SPECT scans to be a useful diagnostic tool in his psychiatric practice. He explained that SPECT is a nuclear medicine study that evaluates blood flow and activity. It looks at how the brain works and differs from structural CT or MRI scans that only show anatomy. SPECT looks at function and basically shows three things:
- Areas of the brain that work well
- Underactive areas of the brain
- Overactive areas
A picture is worth a thousand words, but a map is worth a thousand pictures. A map tells you where you are and gives direction on how to get to where you want to go. Amen claims that SPECT acts as a map for many psychiatric and neurological conditions.
If SPECT is so useful, why hasn't it become more widely accepted in psychiatry and neurology at this point in time? It's important to note that a significant number of psychologists and neurologists argue against the use of neuroimaging tools in psychiatric diagnosis, positing that they do not yet have widespread validity or usefulness. Some specifically disagree with Dr. Amen's use of SPECT scanning, and argue that it does not provide the diagnostic information he claims.
Dr. Amen, by contrast, says he believes that SPECT's low adoption rate is due to several factors, including lack of education and resistance of the established psychiatry and neurological communities. For one, he argues that psychiatrists are wed to the DSM symptom-based diagnostic approach—for example, if you have 6 of 9 specific symptoms, you are diagnosed with depression. Amen believes that this is short-sighted; he posits that SPECT shows there are many roads to depression which diminishes the DSM approach.
Beyond that disagreement, I wondered if the cost of the SPECT equipment could also be a factor in health professionals not adopting it. But according to Amen, SPECT cameras are actually cheaper than PET, MRI, and CT cameras. However, for neurologists to change to a SPECT-oriented practice could be costly, he notes. SPECT is currently widely used for cardiology.
How Scientific Paradigms Change
More broadly, Amen argues that SPECT scans may be caught in the midst of what's known as "a paradigm shift." He outlined the five-stage structure of scientific revolutions as delineated by the philosopher and scientific historian Thomas Kuhn in 1962 as it pertains to shifting a psychiatric paradigm.
Stage I: The Discrepancies Show
In the first stage, a "revolution" is started when the standard paradigm begins to fail. For example, in this case, Dr. Amen reports that when he would put patients diagnosed with major depression or ADHD (based on DSM criteria), on standard treatments such as fluoxetine or methylphenidate, some became suicidal or aggressive. He considered this a paradigm-based failure—one that occurred far too often, in his experience, and was often traumatic for patients and caregivers.
Stage II: The Disagreements Start
Once a paradigm begins to fail, experts begin to look for ways to fix their theories—but they often resist discarding their old models entirely and instead look for small fixes. Over time, the failing model can splinter into many competing schools of thought. Kuhn wrote that no matter how wrong their models become, the leaders maintain their beliefs and continue trying to tweak their ideas in order to preserve their power and influence.
Stage III: The Revolution
In stage three, a new paradigm that resolves many of the problems in the field emerges. The new thinking reinterprets existing knowledge—retaining the best of the old thinking and integrating the latest knowledge into a fresh model, resulting in a paradigm shift.
Stage IV: The Rejection
In the next stage, Kuhn asserts that the new paradigm will be rejected and ridiculed by the leaders in the field. This is considered one of the most reliable stages of a scientific revolution. The old guard becomes frustrated that the new idea did not come from them and they hold tightly to their own theories. The rejection period may last for decades until the old guard retires or die. Nobel Prize-winning physicist Max Planck wrote, “A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die, and a new generation grows up that is familiar with it.” Advances in science can sadly be said to advance through funerals.
Stage V: The Acceptance
The new theory is gradually adopted as younger, more open-minded scientists accept it early on in their careers and later become the leaders of the field. Kuhn also noted that new paradigms are often championed by professionals who are outsiders not wed to the status quo.
It is too often the case that advancing scientific theories lag behind potential beneficial treatment and diagnostic approaches for patients that are suffering. There is still so little we know about the brain; however, new brain health paradigms in the fields of psychiatry and neurology are crucial to provide hope and meet the needs of patients and their loved ones.
Tips for Managing TBIs
I also asked Dr. Amen's thoughts about TBIs, and whether he could give some tips for car crash survivors suffering from a brain injury. He believes that TBIs are a major cause of psychiatric illness that frequently go completely unrecognized unless they are classified as severe.
For TBI healing and recovery tips, Dr. Amen listed the following:
- A diet low in carbohydrates or processed foods. Diet is key, he says.
- Supplements such as omega-3s, ginkgo, B vitamins, or NAC (N-Acetyl Cysteine) may be helpful.
- HBOT (hyperbaric oxygen therapy) can help.
In Dr. Amen’s book, The End of Mental Illness, he also has a chapter on TBI healing and recovery.
In his latest book, Your Brain is Always Listening, Dr. Amen uses the image of an inner dragon breathing fire on the brain to show how habitual mental patterns can drive unhealthy behaviors that can sabotage happiness, relationships, and health. I was fascinated by his 12-step brain-based model for overcoming the effects of these long-established self-defeating patterns and his perspectives on ways to enhance biological brain health. He postulates that your brain is always listening, which is a potentially helpful heuristic that explains why positive affirmations are so powerful and transformative.
Daniel G. Amen, MD (2021). Your Brain is Always Listening: Tame the Hidden Dragons that Control Your Happiness, Habits, and Hang-ups. Carol Stream, Illinois: Tyndale.
Thomas S. Kuhn, PhD (1962). The Structure of Scientific Revolutions. Chicago: University of Chicago Press.
Adam Marr & Andrew Marr with Mark L. Gordon, MD (2018). Tales from the Blast Factory: A Brain Injured Special Forces Green Beret’s Journey Back from the Brink. New York: Morgan James.
Jerri Sher, director. (2020). Quiet Explosions: Healing the Brain. Amazon Prime (streaming).
James F. Zender, PhD (2020). Recovering from Your Car Accident: The Complete Guide to Reclaiming Your Life. New York: Rowman & Littlefield.