Chapter One: The Brain Is the Soul's Fragile Dwelling Place
The Feedback Loop Between the Brain and the Soul Offers New Answers
The brain is the violin and the soul is the violinist. They both need to work together in order to make beautiful music.
-- FATHER CHARLES ARA, CATHOLIC PRIEST
Josey experienced a living hell. Not as a far-off place where people burn for unforgiven sins, but in her everyday life. Josey suffered from panic disorder, the most common psychiatric disorder in the United States. It began in her early twenties. She worried constantly, saw the future as negative and frightening, and endured many anxiety attacks. The attacks, which came on suddenly, were associated with crushing chest pain, her heart pounding hard against her chest wall; she also had trouble catching her breath, and she felt that something terrible was about to happen. The attacks made her hide from the world. They came in waves, eight to ten in a month, and then months with none at all. They were unpredictable. Her life started to revolve around the fear of attacks. She dropped out of college after her sophomore year, stopped driving, stopped seeing her boyfriend, and worked at home doing transcription so that she would not have to go out unaccompanied. She did not seek help for years for fear of being labeled crazy.
Josey prayed to God for deliverance from the anxiety attacks. As a child she had felt close to God and prayed every night before bed. Like many young adults, she had drifted away from her prayers but had still believed in a loving, present God, as her parents had taught her. When the attacks first occurred, she prayed many times a day that God would take this curse from her. Over time, as the anxiety attacks persisted, she prayed less and finally stopped. She became angry at God, and wondered why He was punishing her with the attacks. On several occasions the attacks were so bad that she contemplated suicide. When her parents heard about her suicidal ideas, they forced her to see me because I had helped her cousin with similar problems.
The day I met Josey I thought this young woman was in hell -- years of torture and torment from her anxiety disorder and disconnection from her friends, her work, her future, and even her God. Many theologians believe that hell is disconnection from God. The illness had caused Josey to lose herself, her relationship with God, and nearly her life.
As part of Josey's evaluation, I ordered a brain SPECT study -- an amazing test that examines how the brain works. Josey's scan showed a number of "hot spots," overactive areas, in the part of the brain that generates fear and anxiety. Seeing the physiological problem in her brain for herself was the first step in the healing process that would unfold over the next several months. Rather than thinking that she had a moral, character, or personality problem, she now accepted the fact that she had a medical illness needing treatment. The treatment involved medication, prayer and meditation, and targeted mental exercises. Over time, she successfully rebuilt her life. She was able to travel unaccompanied to work; she fell in love, married, had children, and made peace with God. Josey's brain, the hardware of her soul, all that she was inside, had been ill, a fact that caused everything else in her life to suffer. Helping her brain allowed her to once again have access to her soul, her real self, and even her God.
Josey's SPECT Study
The white color indicates the areas of greatest brain activity. A healthy scan shows white in the back of the brain only (cerebellum). Josey's brain shows white or hot areas in the emotional and anxiety centers of her brain.
The word "soul" as translated from Old Testament Hebrew means "all of your thoughts, feelings, personality characteristics, self, desires, and passions." The soul is who we are inside, from the top of our head to the bottom of our feet. The soul is felt and translated into action through the day-to-day function of the brain. William Shakespeare said, "The brain is the soul's fragile dwelling place." We can now see actual evidence of this brain-soul connection through the latest brain-imaging techniques. These studies have so clearly taught me that when the brain is healthy we are compassionate, thoughtful, loving, relaxed, and goal directed, and when the brain is sick or damaged we are unfeeling, impulsive, angry, tense, and unfocused, and it is very hard for our souls and our relationship with God to be at peace.
In my previous books Change Your Brain, Change Your Life and Healing ADD, I use my work with the latest brain-imaging science to teach readers about brain-behavioral problems like anxiety, depression, impulsiveness, obsession, anger, and attention deficit disorder. Through images of the brain the books show that behavioral problems are often related to brain dysfunction and are not the result of a weak will or a character defect. Healing the Hardware of the Soul builds upon these books by helping you understand and enhance the connection between brain function and your innermost being, your soul.
Brain-Soul Feedback Loop
This book will teach you how to harness the positive energy at work in the powerful feedback loop between brain function and the condition of your soul. A healthy soul actually enhances brain function, and a healthy brain is essential to a healthy soul.
Like the hardware of a computer, the brain must function at an optimal level in order to run the software programs of life (daily activities like child rearing, teaching and learning, going through adolescence, training for a career, intimate relationships, navigating midlife crises). When a computer does not have enough RAM (random-access memory), speed, or storage space, it cannot run its software programs efficiently. Similarly, a brain that isn't running at optimal efficiency will have trouble keeping a life and soul on track.
As with computers, you need more than hardware to live a full and authentic life. The hardware of a computer is powerless without an efficient operating system or proper software. So too in our lives, we need effective programming -- good parenting, optimal nutrition, positive relationships, freedom from chronic stress, clear goals, positive thoughts, and an attitude of gratefulness -- in order for the brain to work right. A dynamic feedback loop exists between the brain and the events of our lives. The brain impacts our behavior, and how we behave impacts actual brain function. Our latest research has shown that thoughts, feelings, and social interactions all impact brain function in potentially positive and negative ways.
The brain-soul connection is involved in everything we do. Understanding it will lead to a deeper knowledge of our most intimate selves and help us to explain human triumphs and failures. This connection will help us understand:
• good (it is likely that Mother Teresa and Mahatma Gandhi had optimal brain function),
• evil (it is also likely that Adolf Hitler and other brutal dictators had faulty brain wiring, despite being able to rise to power),
• sin (in the New Testament the Greek word for sin is hermatia, or quite simply, "missing the mark," which is quite easy to do with poor brain function),
• love (couples who thrive likely have more optimal brain patterns than those who struggle),
• hate (in my clinical experience, many racists have abnormal brain patterns), and
• child abuse (often at the hands of people with brain problems).
I have seen firsthand at the Amen Clinics how many people are searching desperately for a more fulfilling, meaningful, peaceful, hopeful, positive life, who want to live, love, and feel connected to something. Instead, many feel depressed, angry, lonely, unhappy, and disconnected. The clinically based brain-soul healing techniques included in this book will help you optimize your brain and improve your relationships, work, and spiritual connections in the deepest ways possible.
But what do I know about the soul? Isn't soul work off target for a brain scientist? Let me put these ideas into the context of my own life. I grew up in a very religious Roman Catholic Lebanese home, with five sisters and a brother. I attended Catholic school until the end of ninth grade, and was an altar boy for many years. I was taught very clear ideas of right and wrong, good and evil, heaven and hell, and the judgment day. These beliefs followed me into my adult life.
During the Vietnam War, I had a very low draft number and went into the U.S. Army, where I was trained to be a combat medic. I was fortunate enough to be sent to Germany rather than Vietnam. In Germany, as a lonely soldier, I met Christine, a pretty, petite company clerk. She asked me to go to a church service with her. It turned out to be an Assembly of God Pentecostal Church service, with shouting, praying in tongues, and long, intense healing sessions. At first I felt strange, especially with all of the noise in church. As a Roman Catholic, I was used to church being a quiet place. Not this church! There was a lot of intense emotional expression, but also a lot of fellowship and worship. I met some wonderful people and became actively involved with Teen Challenge, a Christian group that worked with drug addicts, which was one of the factors leading to my interest in psychiatry. Many of the addicts had failed traditional drug-treatment programs but were able to rid themselves of their addictions when they developed a deep faith and a connection with God. It was a fascinating process to watch.
After three years in Germany, I was discharged from the military and attended Orange Coast College for a year and then Vanguard University, an Assembly of God Bible college in Southern California. I studied biology and the Bible. I wanted to be a doctor, but I also wanted a solid spiritual foundation for my life. Nothing in the Bible dissuaded me from medicine, and nothing in my biological studies challenged my faith. In 1978, I had the good fortune to be accepted into the charter class of Oral Roberts University (ORU) School of Medicine. Minister and faith healer Oral Roberts had worked hard to bring together spiritual healing and medical healing, a concept that I felt could be extremely powerful. I was suspicious that they accepted me because of my last name: The first graduate from their medical school would be Dr. "Amen."
ORU was an amazing place to attend medical school. We were taught solid medical science in an atmosphere of love, compassion, and prayer. It was different from every other medical school in the country. We were taught how to pray with patients, take spiritual histories, and consider the "mind, body, and spirit" in treating the whole person. In a number of classes we struggled with the issue of sin and sickness. Many fundamentalist Christians believe that physical or emotional sickness comes from a sick soul, and that you are more likely to be physically or emotionally sick if you have sin in your life. Others feel that we all get sick and die -- it is part of the human condition. It only causes people to struggle with unnecessary guilt when you blame their illnesses on sin. It was a sticky and complex issue.
After medical school, I did my psychiatric internship and residency at Walter Reed Army Medical Center in Washington, D.C., the military's largest hospital. As a resident, I taught a class to physicians and chaplains on the connection between medicine and spirituality. I taught that 70 percent of the people in the United States have strong fundamental religious beliefs, and that health-care professionals, ministers, and rabbis needed to work together for the best interests of their patients. With each year of medical training and experience it became obvious to me that there were many missing pieces to the puzzle of spirituality and healing. During my residency I found that the more patients were connected to their religious faith, whether Catholic, Protestant, Jewish, Buddhist, or Muslim, the healthier they seemed to be as a whole. They tended to need fewer psychiatric visits than those who were not connected to a body of believers. Researchers at Harvard, Duke, and Johns Hopkins have found that people with deep religious faith show greater physical and emotional health. Of course, one could argue that healthier people are more likely better equipped to make and keep connections to others and subsequently are more likely to thrive in groups of people.
The second piece of the puzzle became clear to me while I was doing a fellowship in child and adolescent psychiatry at Tripler Army Medical Center in Honolulu, Hawaii. During this time I worked extensively with children, teenagers, and families. I consulted with schools, worked with medically ill kids, treated teens whose problems were so severe that they could not live at home, and ran therapy groups for kids and parents. I learned how important early development was to brain function. I saw how positive environments can enhance intellect and emotions, and more often, how negative environments can impair brain function and contribute to both psychiatric and learning disabilities. Any child psychiatrist knows that genetic vulnerability predisposes a person to problems, but the environment plays a large role in the expression of those problems.
The third major piece of the puzzle dropped into place in 1990. After military service, I set up a private psychiatric clinic in Fairfield, California, forty miles northeast of San Francisco. I saw patients in both outpatient and hospital settings, and directed a hospital unit that treated drug and alcohol abusers who also were diagnosed with psychiatric conditions. During one of the hospital's physician lectures I learned about brain SPECT imaging, a nuclear medicine study that uses very small amounts of a radioactive compound to view the inner workings of the living brain. Unlike standard magnetic resonance imaging (MRI) and computerized axial tomography (CAT) scanners, which show brain anatomy, SPECT -- which stands for single photon emission computed tomography -- evaluates brain physiology. I learned that SPECT was used to look at strokes, head trauma, and dementia. It was also being used by researchers to study depression, attention deficit disorder, schizophrenia, and obsessive-compulsive disorder. We could actually see brain patterns associated with "psychiatric" illness, meaning that many mental illnesses were actually visible brain illnesses. This idea would have made Sigmund Freud salivate -- to see the inner workings of the brain as it related to behavior. As I learned more about SPECT and similar technologies, I believed they would change the face of psychiatry in my lifetime, although at the time I had no idea I would become a controversial part of it.
Controversy: To Look or Not to Look
Brain SPECT imaging gives us a visual picture of brain function, a window into the hardware of the soul, as we will see throughout this book. Seeing the initial SPECT studies of my own patients dramatically changed my perception of mental illness and the soul. I had only to look at the brains of people who did bad things to begin to understand that they had poorer access to their own brains, the organ that made them human. I was dumbfounded to find that many physicians strongly resisted the use of brain-imaging tools in clinical psychiatric practice to evaluate serious behavioral or emotional problems. These physicians claimed that you could not see tendencies toward specific psychiatric illness in brain scans, that the scans were overinterpreted, that it was too soon to use brain-imaging tools on patients, and that we needed much more research before it could become a clinical tool.
Over the past decade I have argued with many of my colleagues about the need to look at and evaluate the brain in psychiatry. Psychiatrists are the only medical specialists who rarely look at the organ they treat. In my opinion, the lack of brain imaging has kept psychiatry behind medicine's other specialties, decreasing our effectiveness with patients and helping to maintain stigma and noncompliance with needed treatment. Odds are if you are having serious problems with your feelings (depression or anxiety), thoughts (schizophrenia or bipolar disorder), or behavior (violence, pedophilia, or substance abuse), the psychiatrist treating you will never order a brain scan. He will prescribe psychotherapy or powerful medications without ever looking at how your specific brain works. He will not know which areas of your brain work well, which work too hard, or which do not work hard enough. Can you imagine the outcry if other medical specialists acted without looking? If orthopedists set broken bones without X rays? If cardiologists diagnosed coronary-artery blockages without angiograms or fast CAT scans? If internists diagnosed pneumonia without ordering chest X rays or sputum cultures? Or surgeons performed mastectomies without looking at breast tumors under the microscope to see if they were cancerous or not? Yet, the state of the art in psychiatry is not to look at the organ it treats.
Psychiatrists diagnose and treat patients based on symptom clusters, not underling brain dysfunction. Imagine taking your car to the mechanic because it is smoking, using too much gasoline, or stalling in the middle of intersections. The mechanic listens to the symptoms and decides to change the car's fuel pump, without ever looking under the hood. How would you feel? Probably like going somewhere else. It's silly. We must look at the brain if we are to really understand the problems we face.
One of the criticisms of using brain imaging in clinical practice is that there is not enough published literature to verify that it will be helpful. Yet, there is a very large body of literature on brain imaging for behavioral problems. On my web site, www.brainplace.com, you can see over four hundred abstracts on brain imaging for neuropsychiatric reasons. We should image the brain in people who struggle with thoughts, feelings, or behaviors because the brain is complex and needs to be better understood. We need better diagnostic tools. We need more targeted treatments, based on the areas of the brain involved in illness.
Being ahead of your time can be painful. Many people have told me that my brain research and clinical work have been on the cutting edge of brain science. I often respond that I have been "bleeding on the cutting edge" for many years. Applying brain-imaging science to everyday practice seemed natural to me, and most important, it seemed like the right thing to do. When the brain works right, you can work right. When the brain doesn't work right, it is very hard for you to be your best. Yet, when you go up against established psychiatric practice and try to change the ways things are done, bad things can happen.
In October 1996, I was asked to give the State-of-the-Art Lecture in Medicine to the Society of Developmental Pediatrics. I shared my work with brain SPECT imaging with hundreds of physicians. One physician in attendance complained to the California Medical Board about my use of SPECT technology in medical practice. Psychiatrists are not supposed to do brain scans, he said; that is not the standard of care in the medical community. In California, if you do anything outside of the standard of care, you can lose your license. For over a year I attended meetings with investigators and medical board physicians, hired an attorney, worried, and didn't sleep much. My life's love and work were threatened. It was perhaps the most painful time in my life. In the end, my work was labeled by one of the physicians who reviewed it as exciting and good medicine. One is often labeled a heretic for trying to change religious beliefs. I was (am) trying to change the mind-set of a profession steeped in religion. The religion of psychoanalysis and psychodynamic psychotherapy, interestingly enough, was started by a neurologist, Freud.
One of the sustaining factors in my work has been my own personal faith. From the first month that I started to order these scans, I felt that they had a special place in science and that I was led by God to pursue this work. Some of my critics would scoff, saying that religion and science do not mix. Yet, patient after patient benefited from what we were learning, including many of my own family members. My nine-year-old nephew Andrew had an episode of violent behavior accompanied by suicidal and homicidal thoughts. When we uncovered and removed a temporal-lobe cyst, his behavior normalized. Without our work he would have likely died. One of my own children was diagnosed with a learning problem based on the imaging work, and the treatment gave her dramatic benefit in school. There are literally hundreds of stories that have filled my own soul with joy and determination about this work. Despite the trials, I feel incredibly blessed to be able to do this work and to help others. Now, twelve years after we began the imaging work, my clinics have been credited by many as pioneering the use of functional brain imaging in day-to-day psychiatric practice. The Amen Clinics, in Newport Beach and Fairfield, are the most active brain-imaging centers in the world, and we have the world's largest database of brain scans related to behavioral and learning problems.
The imaging work affected every part of my life. I started to dream in brain pictures. When I watched the news, I thought of the brains of people who did bad things and the brains of people who were victimized. I thought of the brains of people who were compassionate and thoughtful and the brains of people who were mean or evil. There has not been a day over the past twelve years when I have not thought about the brain and its relationship to everyday life and to our souls. Some people, like my children, might say I am obsessed with the brain. I think of it as a wonderful personal journey that I love to share.
The Brain Is Involved in Everything You Do
Despite advances in medical science, many people don't seem to realize how important the brain is to everyday life. It is the organ that guides and directs nearly everything we do. How we think, how we feel, how we act, how well we get along with others, and even our faith are influenced by the physical functioning of the brain. When I meet a person whose brain works right, I am likely to see someone with a prosperous, fulfilled, loving, and connected life. When I treat someone whose brain does not work right, more often than not the history I take reveals a life that is associated with struggle, pain, isolation, and failure. The soul's health and the physical functioning of the brain work together to help us be happy, giving, and loving or they are discordant and cause serious emotional or behavioral problems. Here's a very sad example of a sick soul, stemming from an injured brain.
On Wednesday, May 20, 1998, in Springfield, Oregon, Kip Kinkel, fifteen, was caught with a stolen gun on campus and suspended from school, pending possible expulsion. Police booked him on criminal charges and sent him home with his parents. Authorities said that Kip shot his father and mother to death sometime between Wednesday afternoon and Wednesday evening. Dressed in a trench coat, he drove a family car the next morning to a spot near Thurston High School and parked it. Carrying a rifle and two handguns, Kip walked into the school, where he fired fifty-one rounds. Two students died and twenty-five others were injured.
A New Look at Difficult Behavior
By all outward evidence Kip Kinkel is an evil boy who destroyed the lives of many people. Because I had the opportunity to read a scan of Kip's brain, I have another perspective. I do not think that Kip is evil. I know that he is sick. He has one of the most damaged brains that I have ever seen. He has serious decreased activity in his left temporal lobe (an area commonly associated with violence), prefrontal cortex (the part of his brain that supervises behavior and is responsible for conscience, or lack of it, decision making, impulse control, and the ability to focus), and occipital cortex (the visual area of the brain indicating the possibility of past brain trauma). Without proper medical help his damaged brain could only produce an ineffective, broken, and tragic life. The right medication to stabilize and enhance his left temporal lobe and prefrontal cortex likely would have prevented this terrible tragedy.
Challenging Our Basic Beliefs
After many clinical experiences with patients who had serious behavioral problems not unlike Kip's, it became clear to me that the people who struggled with difficult behavior almost always had abnormal brain SPECT studies. Shortly after I started ordering these scans, I felt that my beliefs about good and evil, heaven and hell, and judgment needed to be challenged. How could we judge someone like Kip as bad when the organ that controls his behavior doesn't work right? The judgmental waters seemed murky to me. I trusted that God knew everything that I was discovering and that He had the judgment issue figured out. But what about man? We had been operating under erroneous assumptions. We assumed that we are all equal and we have an equal ability to choose right or wrong, good or evil, and heaven or hell. The brain-imaging work taught me that we are not all equal, and not everyone has the same power to choose.
In my clinics, where staff psychiatrists and neurologists see over twelve hundred patients a month, we have been able to get an intimate look at the inner workings of the brains of people with depression, obsessive-compulsive disorder, schizophrenia, alcohol and drug problems, attention deficit disorders, premenstrual syndrome, spousal abuse, and suicidal behavior. We have seen how the brain works (or doesn't work) in murderers, rapists, armed robbers, arsonists, stalkers, and pedophiles. In addition, we have been able to look at the brains of people who were healthy, motivated, loving, and organized. Living with a healthy brain gives people the opportunity to be and act healthy; living with a damaged brain often causes great struggle.
New Thinking and Hope
The exciting news is that you are not stuck with the brain that you have; brain problems can be improved and even healed. The brain itself, like a computer, can be optimized to produce better results.
Healing the Hardware of the Soul is a book about hope and healing. It departs radically from traditional thinking and gives you a completely new look at yourself and those you love (or hate). Specifically, it looks at how we need an effectively working supervisor (the brain's prefrontal cortex) to have a healthy conscience. It looks at how religious experience often stems from temporal-lobe and limbic system function, and how obsessions (religious and others) stem from too much activity in the anterior cingulate gyrus and basal ganglia (which allows us to shift gears). In addition, the book looks at the concepts of good and evil, thoughtfulness, and caring as brain functions. For the first time, it discusses our relationship to faith, sin, evil, hatred, love, compassion, judgment, healing, and forgiveness through the lens of brain science. This is not a collection of high-technology excuses for bad behavior. Ultimately, we as individuals have to be responsible for our own behavior. It is, however, a book about understanding behavior that offers new solutions to help us be more effective as a society in dealing with ourselves, our neighbors, and extreme people like Kip, based on and informed by the relatively new science of brain imaging.
This is not a book about a specific religion, although the fact that I grew up in a Roman Catholic family will not be lost on the reader. The principles for healing discussed in it are universal. These healing-soul principles (forgiveness, connection, giving to others, focused thoughts, and leaving judgment to the Almighty) are similar across most world religions. Healing the Hardware of the Soul highlights studies that demonstrate how faith and religious connection have a healing impact on brain function. The purpose is to help you understand how important the brain is in everyday life and how through physical, emotional, and spiritual strategies you can optimize the brain and heal the hardware of your soul.
Copyright © 2002 by Daniel G. Amen, M.D.