When Your Brain Works Right, You Work Right

Excerpted from
Making a Good Brain Great : The Amen Clinic Program for Achieving and Sustaining Optimal Mental Performance
By Daniel G. Amen, M.D.

Your brain determines your effectiveness in life. Even though this principle is simple, it is also controversial and a bit unsettling. The basic idea is that since your brain is involved in everything you do, it has to work at an optimal level in order for you to be your best self. When your brain works right, it is easier for you to be an effective parent, child, friend, lover, manager, or community activist. When your brain works right, you have full access to your true nature. On the other hand, when your brain is troubled you are more likely to struggle at work, in relationships, within yourself, and in society. When your brain is troubled, you have trouble being your best self and often act outside your own values, morals, and desires.

This principle came to me after looking at hundreds of scans on my own patients. Not only do I read scans, I also work directly with patients and families, looking into the lives of the people behind the images. Early in my imaging work, it became clear to me that the quality of brain function represented by the scans was very often associated with the quality of the decisions, outcomes, and emotional connections in the lives of my patients. In analyzing the images, I started to think about the difference between will-driven behavior and brain-driven behavior. Will-driven behavior comes from a healthy brain. It allows you to exert conscious choice over a situation to work in your own best interest. Will-driven behavior is goal directed and productive; it helps you reach the goals you have set for your life. An example would be deciding to go to medical school, then working diligently over time to make that happen, despite all of the various obstacles that get in your way.

Before I explain brain-driven behavior, I want to take a short side trip to teach you a little about the scans we do at the clinics. It will help clarify the difference between will-driven and brain-driven behaviors. The imaging study we do is called brain SPECT imaging. SPECT stands for "single photon emission computed tomography." It is a nuclear medicine study that uses tiny doses of radioisotopes to look at blood flow and activity patterns in the brain. SPECT scans are different from standard MRI and CAT scans, which show brain anatomy or what the brain physically looks like. SPECT scans look at function or how the brain works. SPECT results are actually very easy to read and understand. We look at areas of the brain that work well, areas that work too hard, and areas that do not work hard enough. We compare individual patient scans against a large database of both healthy and abnormal scans.

The images in this book are all three-dimensional (3D) brain images, of two kinds. The first kind is a 3D surface image, which captures the top 45 percent of brain activity. It shows blood flow of the brain's cortical or outside surface. These images are helpful for visualizing areas of healthy blood flow and activity as well as those with diminished perfusion and activity. They assist us in looking at strokes, brain trauma, and the effects of drug abuse. A healthy 3D surface scan shows good, full, symmetrical activity across the brains cortical surface. A low level of activity shows up as a hole or a dent. The holes or dents usually represent not zero activity but low activity. To make these images, we ask the computer to look at the top 45 percent of brain activity; anything below that level shows up as a hole or a dent. We choose that number because it represents two standard deviations below normal, both from our own studies and from those of other scientific groups.

The second type of SPECT image we will look at is the 3D active image, which compares average brain activity to the hottest 15 percent of activity. Such images are helpful in visualizing overactive brain areas, as seen in active seizures, and many types of anxiety and depression, among other irregularities. A healthy 3D active scan reveals increased activity (shown by the light color) in the back of the brain, the cerebellum, and the visual or occipital cortex, and average activity everywhere else (shown by the background grid).