Wired Magazine writer-psychiatrist Daniel Carlat came to our clinic for a scan. He was working on a negative article about how useless brain imaging is in clinical practice. He took on fMRI, SPECT and qEEG. He was not up front with his us about intent. You can read the article online this month at wired.com\wired. I wanted to post my response here and let you decide what you think. Feel free to post your thoughts here and at wired.com.
I am saddened that Dr. Carlat could actually write at the end of his article that “My journey through the land of functional neuroimaging has helped me to understand how spectacularly meaningless these images are likely to be.”
Maybe for someone like Danny who is not currently clinically depressed, the pictures have no meaning, but what about the patients with brain trauma, early dementia, toxic exposure, anoxia, or resistant psychiatric disorder that come through our offices that psychiatrists just missed because no one bothered to look at brain function.
Or what about the boy who I saw two weeks ago who spent 18 months in a residential treatment facility and 30 days in a drug treatment program at a cost of more than $100,000 who had a tennis ball sized cyst in the left side of his brain, who had a normal neurological exam? A neurosurgeon drained it at UCLA last week. Dr. Carlat would have diagnosed him as a character disorder after the boy threatened to kill his mom and dad. I was hoping for a much more thoughtful article.
I wonder why Dr. Carlat decided not to talk with many of the other people in my field who have been doing clinical brain imaging work for years, such as Ismael Mena, the grandfather of clinical imaging, or Mike Uszler at UCLA or Joe Wu at the University of California, Irvine or Jim Merikangas who used to be the president of the American Neuropsychiatric Association or Harold Bursztjan at Harvard who is director of the psychiatry and law program. Dr. Bursztjan correctly says that scans do not give you the answer, they teach you to ask better questions.
Psychiatrists make diagnoses today the same way they did in 1840 when Abraham Lincoln was depressed, through talking to patients and looking for symptom clusters. Psychiatrists are the only medical specialists that never look at the organ they treat. Isn’t that a scam”¦to make diagnoses of brain dysfunction without ever looking at the brain?
No question we have a long way to go and a lot more research to do, but to continue as most psychiatrists currently practice is not only backwards it is downright hurtful to people.
Dr. Rubin’s assessment of my work misses the mark completely. I am not interested in what your brain looks like as part of a group of depressed patients. I am looking at what your own brain specifically looks like. I am looking at an N of 1, your brain. Illnesses like depression will never have a singular finding on scans because they are not a singular disease. There are many different types that need an individual approach, that is where scans help”¦what does your brain look like, so that I can target treatment specifically to your brain.
Thomas Insel, Director of the National Institutes for Mental Health said in 2005 at the American Psychiatric Association that “Brain imaging in clinical practice is the next major advance in psychiatry”¦Trial and error diagnosis will move to an era where we understand the underlying biology of mental disorders”¦.We are going to have to use neuroimaging to begin to identify the systems pathology that is distributed in each of these disorders and think of imaging as a biomarker for mental illnesses”¦The DSM-IV has 100%reliability and 0% validity. We need to develop biomarkers, including brain imaging, to develop the validity of these disorders”¦.We need to develop treatments that go after the core pathology, understood by imaging”¦The end game is to get to an era of individualized care.“
Dr. Insel believed in 2005 that brain imaging in clinical practice would be a reality in 5 years. I think that brain imaging in clinical practice is long overdue. You can try to kill yourself in virtually every major city in the world, and no one will look at your brain!
One of the pieces of information that Dr. Carlat left out of his article is that he came to our clinic and refused to fill out our intake questionnaires. He wanted me to act like a palm reader and tell him what the scans said without much clinical information. That is not how we practice. That is not how any reputable physician operates. We want all of the information, clinical information and scan information, before we make a diagnosis and prescribe a treatment plan. Yet having said that, I was right! He admits that his scan did in fact fit his clinical presentation. He says it was because I am a good doctor (thanks Danny). I would say it is because I am a good doctor with more information. Don’t you want your doctor to have as much information before he goes about changing your brain?
Here are two responses that patients have posted on the Wired site.
From Lauralee:
I was referred to the Amen Clinic in Newport Beach, CA, by Dr. Earl Henslin for a SPECT scan 5 ½ years ago. At the time, I had to leave my job as Operations Manager with a company that I had been with for 23 years. I had no idea what was wrong with me other than I thought that I was losing my mind. In addition, I could not eat which caused my weight to drop to a very unhealthy level. I also became agoraphobic after having traveled the world. I had reached a point where it was more peaceful to be asleep than awake. I never thought that anything like this would ever happen to me. Thanks to Dr. Amen’s pioneering research and development of the SPECT scan, I learned that I was severely depressed which was a symptom completely on the other end of the spectrum for me as I was always happy (or so I thought). I had anxiety that was off the chart for which I was using large doses of Xanax in an attempt to unsuccessfully control. After the SPECT scan reading, the appropriate medications and dosages were prescribed along with psychotherapy. I can say that there is no way psychotherapy in and of itself would have ever helped me. SPECT scans and psychotherapy definitely go hand in hand. It only makes sense that psychiatrists and therapists would use a tool to help them “˜see’ the brain and make appropriate recommendations for treatment just as physicians have a myriad of tools to help them with a diagnosis elsewhere in the body. Are all tools used for medical diagnosis perfect? No. Are all methods of treatment perfect? No. Do we know everything that there is to know about the brain? No. Is the technology for this perfected? No. But, some information is better than none and SPECT scans do provide this. As with any cutting edge technology, the means of understanding the workings of the brain will evolve and become perfected. If we never took the chance of using new technology in the beginning, thousands of people would not be blessed with longer and healthier lives in so many arenas. SPECT scans take out some of the “˜guess work’ made by psychiatrists who have no concrete medical evidence on which to write prescriptions. I owe my life to Dr. Amen and Dr. Earl Henslin and cannot say whether I would be here if it were not for the two of them. I am now a happier person and look forward to the day ahead. My husband acknowledges how much happier I am and even says that I now have a great sense of humor. In addition, along the way I discovered my true passion in life which is photography for which I have won awards (and I never won anything in my life!). Thank you Dr. Amen and Dr. Henslin!!!
From Kirsten:
After reading your article about brain scans I found it necessary to comment from a consumers perspective. Two years ago I took my father to the Amen Clinic out of desperation. He had been diagnosed with early onset Alzheimer’s disease, severe clinical depression, and was living as a recluse in a single room. After a thorough assessment Dr. Amen explained that my father did not have Alzheimer’s disease and was on combination of medication that was essentially toxic. Today my father is working, volunteers at the local church and is once again living on his own and able to drive.Since then I have referred four friends to the Amen clinic. Three out four of those friends reported dramatic changes and improvement in the way they felt afterwards. One of those friends took her teenage son to the have a scan as a last resort after he was arrested and placed on probation for drugs. Upon seeing the effects that his drug use has had on his brain he decided he no longer wants to have a brain that looks like “swiss cheese” and has not done drugs since. Maybe a picture really is worth a thousand words.
Kirsten
Share this Article
Found this article useful or interesting? Share it with others!
It seems to me that perhaps Dr. Carhat doesn’t want to see his profession grow and change. I have seen employees resist the simplest changes in procedure. It is human nature. Applying science to psychiatry is foreign to most people.
Yet, doctors have no problem experimenting on young children with behavior issues, diagnosing them with ADD or ADHD; prescribing medication “to see if works” and “adjusting the dose” as needed. These adjustments are made based on anecdotal reports of behavior rather than blood tests.
It seems disingenuous for the Doctor to refuse to fully participate in the process. Clearly he has his own agenda.
Daniel,
Went over to Wired.com [may want to correct the URL on your blog so people can click right over there] and left a lengthy note there supporting your work, and roundly condemning his reductionistic and biased comments. Further, I indicated he wouldn’t be welcome in my office because his bias was so obvious it would likely interfere with good patient care!
Hope all is well,
Chuck
An eloquent response, as usual, Dr. Amen, and from Dr. Parker on his blog, too. (I guess he is too modest to post the link, but here it is: http://www.corepsychblog.com)
But what I really want to know, Dr. A., is how Dr. C. looked. That’s how he starts off the story, so it must be important. Was it…. like a busboy in Milwaukee? A server in Kankakee? A valet parker in Atlanta? A sommelier in Acapulco?
Gina
yeah, why couldn’t he have said Dr. Amen dressed like steve jobs at Apple or Mike Myers German gameshow host character Maitre D is so gauche
I’m surprised by the hatchet job from Dr. Carlat , actually. His newsletter and blog seem on point most of the time. I’m glad you have the resolve to keep moving forward Dr. Amen- just remember the old saying
“the dogs bark, but the caravan moves on” .
There are so many people who lack empathy for people who suffer. They really believe that we’re all the same, and if they don’t have the problem, it must not exist. It is ignorance. Unfortunately for me, I am very sensitive, but fortunately for me, it has caused me to research a lot on health. When I read Change Your Brain, Change Your Life, it was so informative, and completely on target. So, if people don’t relate, I guess they will question, for for people who are hurting, Dr. Amen’s work is such a blessing. I read books by many types of doctors and I see what a puzzle it is that we’re solving, and I believe we’re getting there. Nature and nurture, common sense. Dr. Amen is helping us with the science. Thank you, Dr. Amen.
Dr. Amen: I have had a tremedous challenge w/my 16 year old son. He has a full scale WISC of 147. He can’t function in a typical school setting. His reasoning is ‘whack’ and he sometimes experiences hyper functioning of the senses – especially hearing. He also sometimes experiences heightened emotions which appear bi-polar or borderline. He was diagnosed ADHD in 3rd grade, but the research I’ve done on gifted children show great similarites in symtomology. He is a beautiful, sensitive, child…but emotionally confused and struggling during this period of identity formation. When he was little, he would often cry at night telling me he’s just tired of thinking – can’t stop. Would have trouble sleeping, etc. He writes poetry, is very mechanical, and loves to talk, talk, talk! I haven’t medicated him because I believe God has designed him this way for a purpose…but I don’t know what to do for him. I’ve always felt he was ‘wired’ differently and would love to see what’s going on inside his head. Any suggestions?
In March of 2006 my husband and I brought our 11 year old son to your clinic in Reston, Va. for a SPECT study and recommendations. Our Pediatric Psychiatrist was behind us 100% in an effort to find a solution to for his ADHD, bipolar and obsessive symptoms that we had been treating with medications since he was in 2nd grade with very poor results and many side effects. We were very excited at the prospect of having some definitive diagnostic testing done so that we could finally get the proper treatment for our son. We followed the recommendations of Dr. Barton Branscum and gave our son Neurolink and Omega-3s for nearly 2 months with absolutely no improvement. At that time we contacted Dr. Branscum and he recommended mediation that my son’s Dr. did no agree with. While we feel the diagnostic work confirmed our suspicions we have yet to find a treatment for our now 13 year old who is exhibiting bipolar symptoms that are worse than ever such as hitting himself in the head repeatedly when he is frustrated. His medication history is too long and involved to get into here but believe me we have tried just about everything. Our home life right now is verging on hell. Where do we go from here Dr. Amen?
all other doctorain from chiropatric ,dentist ,surgeon,have to take a view of the organ to be able to fix the health issue this is so eventent to the truth how else should this brain be treated only by guessing,this is history for a break threw of 21 century cures i’m just inspired to know i i can be a part of this healing,
Dr. Amen, isn’t it amazing that a professional like Dr. Carlat would condemn brain imaging when it is one of the most forward-looking areas of treatment and research?
I have schizophrenia and would not take my meds on and off for years. Then one day, I saw what a brain looks like with untreated schizophrenia — all holey and pitted. Then I compared it to the other picture that showed the schizophrenic brain after treatment. The holes were filled in and the pits smoothed over, and I could see it was definitely a more normal and likely more functional brain. This convinced me to commit to staying on an antipsychotic, probably for the rest of my life. Thank you so much.
I have been in therapy for 34 years. I have not worked a regular job in 30 years
I have had a major blunt trauma to the back of my brain from a car accident at the age of 13. I was raised in an alcoholic family. I hit my head maybe 10 times in my life. Mostly needing stitches for small lacerations. I have been sexually abused as a child.
And the diagnosis I received at 18 years old was that I am bi-polar and that it manifested itself in my late teans. Everything else was ignored. Psychiatrists can be so myopic in their view of a patients illness. I would love to be able to afford a scan. I am sure it would show something that has been overlooked.
Mike S
I had brain scans done in mid-June 2007 at the Amen Clinic in Reston, VA. As a result, I now have photographic evidence of my brain’s SUPER-activity (over-activity) when hypomanic. I was diagnosed with dysthymia (depression) at age 40. Per doctor’s orders, I dutifully took Paxil, an SSRI anti-depressant for the next 5 years. This was a BIG mistake for me. During my 5 years on Paxil, I suffered severe mood swings (from hypomania to depression), without knowing or realizing what was happening to me, of course. I lost multiple jobs and multiple fair-weather “friends” in the process. In November 2003, while still on Paxil, I experienced yet another in a string of annual employment conflicts. As a result, I experienced my first-ever full-blown mania. In March 2004, at age 45, I was diagnosed with bipolar II disorder.
Sadly, I have found that an Amen Clinic diagnosis of bipolar disorder, ADHD and closed head injury with brain trauma (from a concussion), means nothing, practically-speaking, to those closest to me, e.g., to my mom and siblings. Without exception, my family members expect me — despite my brain chemisty — to change to suit them and their preferences, in ALL cases, and in ALL situations. I am blamed for everything that has happened to me. I am blamed for having made “bad” choices. My employment history is entirely my fault, according to them. My employers and the blatant injustices they attempted to perpetrate against me are “innocent,” of course, justified, according to my family members, I imagine. My economic situation is my fault. I should have made other more economically-advantageous choices, according to my family members, no doubt. I have never received empathy, sympathy, kindness, compassion or appropriate expressions of care from my family members. They do not have disabilities. Their economic situations are fine, more than fine, in fact. They have families, spouses, children, busy lives. I am single. I have never been married. I live alone, because I have found this to be the safest option for me. As a result of my consistently low income and inconsistent employment, I am routinely forced to survive on my good credit, constantly in debt. None of them care, of course. Why should they? They are not suffering, so… what is there to care about? After all, I am only a HUMAN BEING?! Why care about me when not caring is so much easier?
Even after being given an Amen Clinic binder of photographs of my SUPER-active (while hypomanic) brain, I am expected to act as my family members want me to act. I am expected to please them with my behavior, to do what they want me to do, to do what is convenient and comfortable for them in all instances, no matter how or why or if I am negatively impacted in the process. My family members make no allowances for my brain chemisty, in spite of brain scan photos which give evidence of my extraordinary brain chemistry. They are not at all interested in real physical evidence of my extraordinary brain chemistry. They are not interested in being kind to me either. They are not interested in abstaining from the life-long emotional abuse and emotional cruelty that they have committed against me. Abusing a family member with a brain chemistry disorder is very easily accomplished, after all, especially when the suffering family member is laid low by depression for the first 40 years of her life. My family members are not interested in abstaining from the emotional abuse and emotional cruelty that trigger my hypomanias. They are callous, insensitive, completely clueless.
I have brain scan evidence of my brain’s SUPER-activity during hypomanias. But people like Dr. Daniel Carlat (pseudo-psychiatrist, that he is in my opinion) and my family members don’t give a damn. Why? Because they have their own agendas, agendas which have nothing to do with providing appropriately sensitive and compassionate care to those with brain chemistry disorders. Shame on them. May they be blessed with a brain chemistry disorder of their very own, so that they can finally, at long last, walk in shoes that will lead them — if at all possible, in light of their stoney hearts — to a more enlightened state of mind re: brain chemistry disorders and those who are psychiatrically challenged by such disorders. May God have mercy on their souls, for they surely need it. And may God bless Dr. Daniel Amen for what he has done to advance compassionate and enlightened care for those who suffer from brain chemistry disorders, among other things.
I have to give kudos to Ann Welldaugh and what she wrote. I feel sorry that she does not have a supportive family as I do, but instead of getting angry with family or the world (which does absolutely no good) those of us who suffer need to be grateful that at least one psychiatrist out there seems to “get it” . After reading Dr. Amen’s books, I was set free from the bondage of suffering from major depression (which is especially difficult when you are a Christian). There is such a stigma that comes along with mental illness’. I doubt that will ever change, but I have hope that it might before I am dead. The greatest thing I can recommend for someone suffering with major depression is to have an intimate relationship with the Lord. After all, He created us and understands exactly what we are going through. Yes, we have a disease that you can’t see, but He can. He has given Dr. Amen a divine insight into our illness, so we must praise God for that. God has kept me alive through the power of His Son Jesus Christ through so much tragedy and a major head trauma for His purpose. Although it doesn’t make much sense to me and I don’t understand it, I just know He will uses it in some way for His glory. Knowing the “Finished work of Jesus Christ” and Gods Grace (His unmerited favor towards all born again believers), gives me hope. There will come a day for me, Dr. Amen and others that know the One who controls it all, that this will all end. God has already blessed Dr. Amen with wisdom and knowledge regarding the human brain. Dr. Amen makes me think of the story of Solomon in the bible. We just need to follow the Lords ways and God will give us the peace that He promised us. We just need to make sure that we don’t mess it up like Solomon did, even though I am a sinner saved by the grace of God and mess up enough, we can never out sin the Grace of God. Jesus Christ already paid the price for our mental illness’. We just need to live for Him, stay in the present, and realize that our past was paid for by the blood of Jesus Christ. The Lord has given Dr. Amen the tools and the wisdom, but it is up to us to make the choice to use them to the best of our ability with the finances the Lord provides us with.
I don’t know for sure if Dr. Amen’s SPECT treatment actually works or not. Based on my personal readings from lots of sites including Dr. Amen’s own book, Change your brain, change your life, I’m a bit skeptical. There are indeed quite a few valuable suggestions in the book like – having a personal goals statement, listening to Mozart, exercise etc. but I don’t understand why ppl should pay $3000+ for the scans. Maybe they are useful in very specific cases, but for a poor student like myself I’d rather concentrate on taking self positive actions to improve the outcomes in my life. It’s too easy to blame everything on biology. Maybe there are valid cases like brain injury or Bipolar disorder. But after reading a book that is marketed to general public isn’t there a case that normal ppl or those who are a little different, will start obsessing on treatment, instead of taking care of their responsibilities in life? I think a lot of people can learn to channel their differences in useful ways instead of paying $3,000 for scans.
It saddens me that some doctors are so crass and fearful. I understand questioning things; I believe this is a key element to bettering oneself and devising better treatments. But to write in an insulting manner, seems to me that the person writing may be scared of the new ideas, much like racism etcetera. I have been going through different diagnosis since I was fifteen and am still unstable. I have been treated for manic depression in the traditional manner and was even advised to have electoral shock therapy, which in my humble opinion is frightening. Reminds me of earlier methods, when the medical profession believed in drilling a small whole in the skull would let the evil demons out and you would be cured. That said, though I have many questions about the SPECT procedure, I am going to try to have it done. If you have ever been mentally ill to the point of which you are frozen, disabled, and tried suicide many times, you may understand why patients are willing to try anything to get better. I have had very bad experiences on FDA approved medicines, those of which have been studied extensively. My question is why does the SPECT imaging frighten or worry some doctors? Why are they not worried about FDA approved drugs, some of which had very adverse effects on me. (I ended up hospitalized, as the drug intensified negative traits.) Is it just because one is FDA approved or studied more often on rats? I truly believe that when it comes to mental illness I am just as much of an experimental guinea pig with FDA approved and studied approaches as I am with the SPECT imaging. The brain is still so misunderstood and so many things are unknown about it that I really can’t see why someone talking to me for an hour could honestly believe that they knew what illness I had. Even if it had been a year observing me, the doctor only sees you for an hour and has not once looked at how you, inside, are working. I here so much talk about chemical imbalance, nutritional imbalance, etcetera. Seriously, I don’t think Dr. Amen or Dr. Carlat KNOW what is going on with mental illness because absolutely no one does in the medical field otherwise there would not be so many mentally ill roaming around. I do however, appreciate and respect Dr. Amen because he is trying to understand in what I believe to be a very honest manner. He right out says that the SPECT does not give a diagnosis it just helps to confirm, observe and enlighten the doctors, patient and perhaps the patients family. I for one would like to have something tangible to show my family, that I have a problem that is not only “in my head” that it is uneducated to ask me to snap out of it. It would be just as uneducated to ask a diabetic to snap out of it. But with diabetes there is a test that one may show there family and the subject does not have as much stigma attached to it. My only hope is that there are individuals like Dr. Amen who continue to explore possibilities for those with brain injuries, mental illnesses and other brain related illnesses. The only two things that worry me about the SPECT imaging would be the cost and radiation effects. The cost, is rather high for some one with a mental illness to afford. I have been on disability for seven years and can in no way pay 4,000 plus for treatment. I am also unclear about how much radiation you are exposed to? Never the less, these are very interesting discoveries being made by Dr. Amen’s clinics.
I have found in life that whenever someone offers a revolutionary answer to an old problem there will always be those that choose to stay in the past. Many thought Henry Ford’s invention was just a fad and they refused to give up the horse and buggy. It took the Catholic Church hundreds of years to officially admit Galileo was right about the earth not being the center of the universe and to officially concede that the Earth was not stationary. My own dad at the age of 87 told me in 2004 he would be the last person on the planet to use a computer. So in field of success science, we know change comes slow, many have difficulty accepting change and there will always be those that will doubt and discredit the new. I anticipate the same challenge when I publish my new book “Copenology-The New Science of Success” which will apply cutting edge brain science from neuroimaging to helping people achieve more success in their lives. Dr. Amen’s response was right on point. I just hope Dr. Carlat moves into the 21st century before we get to the 22nd century.
So, popular media equals peer review? All hail the commercial, I mean, scientific, method.
I’ve had depression and anxiety for over 12 years. I’ve seen over 10 (at least) psychiatrists and quite a few psychologists.
I am grateful to maybe two of those psychiatrists and one of those psychologists.
They did not help much w/ my problem….but they honestly TRIED!! This is huge for folks going through any mental health issues.
This is a completely trial and error field. There are no real blood tests. Any, I mean ANY, technique that sounds feasible, and can potentially be positively life-altering should be explored.
I have a good deal of respect for Dr. Amen for pioneering this technology. What have his detractors done? What have they accomplished and how many lives have they positively impacted? What a pack of highly-educated imbeciles.
You want people considering suicide to wait for a double-blind placebo controlled study to come out on a vitamin or herb? Are you kidding?? Does anyone realize how long that takes? Testosterone has been available since the 1930’s. We are still doing studies on it. That’s a good thing….but what if many men going through andropause w/ clinacally low levels of testorone had to wait another decade to be treated and be relieved of many of the ailments many experience due to lack of testosterone?
The PDF still says it doesn’t enhance athletic peformance. Ehh…it does. That’s why it’s tested for in every major sport at multiple levels. Archaic ill-informed docs still pushing this non-sense and refusing any chance at enlightenment…yet they demonize any possible advances in medicine. Kindly stay in your think-tanks and out of the practice of medicine! You are likely creating or exacerbating serious problems. If you want to be well you have to take responsibility for your OWN health…do all the research you possibly can and seek appropriate treatment.
Yes i would like to know why you do not take medicare(or at least that is what i was told by email at your VA. center)when that is the way alot of people have to pay for medical treatment!Dr.amen said in Ask the questions section of your web site that insurance probably would pay you just have to word it right!and i know what he means because my doctor said the same thing for me to get a MRI of my brain,one doctor was having trouble but she didn’t have any trouble at all!!I mean you would think Dr A men would help you in any way he could he seems like that kind of man!! Thank you, tony-Louisville,Ky. They say i have severe OCD-ADD and depression and i have for years but i am doing no good!!!