HEAD CASE

12.14.12

Can Daniel Amen Read Your Mind?

Daniel Amen says he saves lives. His fellow psychiatrists say his brain-scan system is a sham. Eliza Shapiro checks into the superstar shrink’s new Manhattan clinic to see for herself.

My new psychiatrist just told me I have longstanding trauma I need to process and problems with hand-eye coordination, sports, and math. I should also think about having a protein shake with kale and spinach for breakfast every morning.

He told me this within a few minutes of shaking my hand. He didn’t need to know much more; he had already seen a part of me no one had ever seen before: my brain.

Daniel Amen is perhaps America’s most in-demand psychiatrist. He’s also one of the most reviled, at least among his peers. As the founder and medical director of Amen Clinics, a mini psychiatric empire with six clinics coast to coast, Amen sells a line of natural supplements with names like Neuro Memory and NeuroCalm. There’s also a line of books, like Use Your Brain to Change Your Age, and a series of cookbooks and workout regimens developed by Amen’s wife, Tana. He has made the New York Times bestseller list five times.

But the core of the Amen business revolves around his own controversial system called SPECT, or single-photon emission computed tomography, which tracks blood flow in the brain and shows areas of high and low activity. Amen says two scans, one taken at rest and one taken after a concentration test, along with a series of questionnaires and a clinical history, can paint a clearer diagnostic picture than decades and tens of thousands of dollars’ worth of talk therapy. He believes his brand of psychiatry gives hope to those who have tried and failed with everything else. He told me that by the time people come to him they have, on average, had 4.2 psychiatric diagnoses, have seen 3.3 psychiatric providers, and have been on 6 medications. “We see lovely people who have been suffering,” he says.

Amen’s services don’t come cheap: an hourlong consultation with him runs $350. And that’s only after the $3,575 initial evaluation, which includes two brain scans and a post-scan consultation. Amen’s six clinics employ a staff of 75, a third of whom are psychiatrists, and see about 1,600 patients a month. In 2011, Amen Clinics grossed about $15 million.

Amen says he changes lives. The American psychiatric establishment says his methods have no basis in science. Google his name, and the top two related searches come up as “Daniel Amen scam” and “Daniel Amen quack.”

Scam artist or savior? I figured the best way to find out would be to see Amen myself—as a patient. Over the course of two weeks this fall, I subjected myself to IV injections, pointed questions about my personal life, and what felt like hours (but were in fact many dark and lonely minutes) of being photographed as I lay perfectly still, wondering—fearing—what lay festering deep in the recesses of my innermost brain.

In the end, I was able to connect a few dots between my own mental faculties and my behavior, and it was cool to learn things I wasn’t able to grasp back in ninth-grade biology—like how important the cerebellum is and why murderers tend to have frontal-lobe problems. I learned that my own brain is processing a crazy amount of material that rarely occurs to me. But ultimately, the chance to peer into my own brain revealed surprisingly little about how my mind works.

* * *

A few weeks before my scans, Amen called to tell me a bit about what to expect. He spoke calmly about the logistics, but bubbled with excitement about peering into my brain:  “We get to look at the hardware of your soul,” he told me. 

He asked me a few questions about my psychiatric history. I told him I had been in talk therapy on and off for 15 years, since I was a child, and that I initially went for anxiety about a family illness, but then inevitably found other things to be anxious about and stuck around.

Scam artist or savior? I figured the best way to find out would be to see Amen myself—as a patient.

“Good,” he said, taking a swipe at my years of sitting on a therapist’s couch, “so we’re going to have a virgin brain.”

Amen’s newest clinic opened in October in New York City, a town that wasn’t exactly lacking in shrinks to begin with. It occupies a full city block in midtown Manhattan. Clinic director John Crepsac said there has already been an influx of patients from Japan and the United Arab Emirates.

In the waiting room, which is decorated with a Persian rug and firm beige couches, a flat-screen TV was showing an Amen talk in which he said several recent presidents had brain issues that affected their decision-making ability. “Clinton had frontal-lobe problems,” he said, explaining that the poor judgment Bill Clinton displayed during the Monica Lewinsky scandal may have come from a brain problem that a SPECT scan could have detected. “Reagan clearly had Alzheimer’s,” he continued, smiling broadly.

I filled out dozens of pages of questionnaires about my psychiatric and medical history and went in for my two scans. First, however, I was injected with a radioactive tracer that allowed activity in my brain to show up on the scan. Next, cameras buzzed around my head for 25 minutes, during which time I was either resting or completing a concentration exercise.

A couple of days later, I met with Amen himself. He was waiting for me when I arrived at the clinic, wearing black jeans and a black sweater, and smiling. He is short and enthusiastic, with gray hair and the creaseless skin of a middle-aged Californian. 

We walked to the room where I’d had my scans taken—“this is where the magic happens,” he said—and started fiddling with images of my brain on a computer. His aim, he said, is to analyze the areas of high and low activity to tell his patients which parts of their brain seem to be functioning well and which are underperforming.

Amen said he was a psychiatrist for a decade before ever taking a SPECT scan, and now he’s been using the technology for 21 years. “We do what other psychiatrists do, we talk to you, but no one else looks at the brain,” he said. “It changed everything. Myself, my wife, my patients.” He has had 11 scans himself and insists on taking a scan of anyone his children are dating. He and his 9-year-old daughter, Chloe, play a game where she asks him, before making a decision (what to eat for breakfast, what to do after school), whether something is good or bad for her brain.

As for my brain, Amen called it “beautiful” as he examined slices of my prefrontal cortex and cerebellum. 

We sat down in an office with framed pictures reading “Imagine” and “Possibilities.” He asked me what I was like as a kid, how my boyfriend would describe me, and where I was on 9/11. 

He took out my scans and pointed out where the activity in my brain was highest and lowest. “Your concentration scan concerns me,” he said. Apparently, activity in my cerebellum—responsible for coordination, organization, and judgment—drops when I try to focus. This could explain some longstanding problems, he said, including my messy handwriting, my disastrous performance in sports (and related deep hatred of physical activity), my poor hand-eye coordination. A lightbulb goes off: years of misery in gym class, just sitting there in my scan!

I immediately started to panic. This is what Amen calls brain envy, when patients get self-conscious of their own scans and jealous of other people’s better scans. He thinks it is a good thing, encouraging people to “do good” (exercise, sleep) and “avoid bad” (drugs, negative thinking) for the health of their brain. Amen suggested that I try to take up table tennis to work on my coordination. “You would suck at it at first,” he said, “but the fountain of youth is exercise.” Dance classes could also do the trick, he added.  

We moved on to a diamond shape of heightened activity in my brain—connecting my anterior cingulate gyrus, basal ganglia, and thalamus—that Amen immediately recognized as evidence of trauma he’s seen in veterans and firefighters. We spent a few minutes talking about the possible causes—a serious family illness in my childhood, my time writing about the mass shooting in Aurora, Colo., over the summer. He suggests EMDR, a psychotherapy used for processing trauma, and I’m instantly intrigued by the trauma I didn’t even realize I was experiencing in the first place.

Amen also told me I looked pale and suggested I get blood work done for a possible vitamin D deficiency. He suggested I take melatonin, a natural supplement, instead of Ambien, for my occasional insomnia, along with Restful Sleep and Everyday Stress Relief, two of Amen’s brand of supplements. He asked me if I had any questions, then shook my hand and walked me out.

* * *

While I was intrigued by my experience with Amen, other New Yorkers—people with actual psychiatry degrees—aren’t rolling out the red carpet.

“I winced when I heard the news that he was opening a clinic in New York,” says Dr. Jeffrey Lieberman, the president of the American Psychiatric Association and psychiatrist in chief at Columbia University Medical Center. “Unsuspecting people could fall prey to this. This guy is a pretty slick operator—he leaves a patina of science into his talking points.”

Lieberman and many of his peers say there’s simply no proof that the blood-flow activity SPECT tracks can be useful for anything beyond identifying basic medical conditions. Mark Madsen, a professor of nuclear medicine at the University of Iowa, says SPECT scans can show how a brain works after epileptic seizures and strokes and can identify recurrent brain tumors more precisely than an MRI or a CT scan. “In terms of today’s technology, it’s a very unsophisticated mode of imaging,” says Lieberman. “It’s only useful for gross pathological lesions.”

In other words, SPECT might not be a useful tool for assessing more subtle physiological states, like anxiety and depression. Psychiatrists say there’s no proof that the activity Amen is measuring says much when it comes to distinguishing between natural psychiatric variations between people, even combined with questionnaires and assessments. “There’s no evidence at all to support it,” says Lieberman, “and beyond that, anyone who is currently trying to use neuroimaging technologies to diagnose or characterize mental disorders would not use SPECT.” 

To treat SPECT scans as an effective diagnostic tool, says Dr. Paul Appelbaum, the director of the Division of Law, Ethics, and Psychiatry at the Columbia University College of Physicians and Surgeons, “we would need to be able to say that, on the basis of the scan, we could reliably distinguish individual patients’ conditions from what is normal and from other psychiatric conditions.”

Dr. Fredric Busch, a psychiatrist in private practice in New York City, says the patients Amen sees often do get better, but that’s because after the scans and consultations, Amen will prescribe what any other psychiatrist might: a better diet, more exercise, and possibly a new or different supplement or medication, depending on the case. “The main thing that ends up happening is that his patients spend money and get exposure to radiation that they don’t necessarily need,” Busch says, “but the net effect is the same.”

In other words Amen may well be a perfectly decent therapist—he certainly asked me good questions and made me feel comfortable opening up to him—but the tool at the center of his practice might be useless at best, and harmful at worst.

Amen waves aside criticism by pointing to the people he has helped. “I’ve been trying to give this thing away forever,” he tells me, referring to his knowledge of SPECT and the tens of thousands of scans he’s conducted. “There are just too many who need help.” He says 75 percent of his patients are better six months after their evaluation across all measures, based on outcome studies conducted by the clinics. “The proof is in the outcome,” he says.

There’s plenty of proof in the science, too, he says. On his website, he points to nearly 2,800 scientific abstracts on the power of SPECT and its relationship to psychiatric problems (critics say these abstracts are incomplete, inconclusive, or published in unreliable journals). He also says that dozens of doctors around the country not affiliated with his clinics use SPECT for clinical purposes.  

I told Appelbaum, of Columbia University, what Amen had told me about my handwriting and trauma. “Good fortunetellers use similar techniques,” he said. “They deduce what kind of information you’re expecting to hear.” Besides, he pointed out, hadn’t I marked a box on one of my questionnaires that asked if I had messy handwriting? And hadn’t I mentioned different parts of my life that might connect with trauma?

My bigger concern was that much of what Amen told me about myself, I already knew. The coordination, the math problems, and the various possible causes of trauma were all familiar to me. Of course I should drink less. And I’m sure table tennis is fine once you get good at it. 

And sure, in my lifetime, I have spent far more than $3,575 on therapy, and yet I don’t really regret a penny—nor do I believe that had I only seen Amen from the beginning, I’d be any richer today. Moreover, does it matter that I’m bad at sports? Do I need to know about a hidden trauma if I’m not feeling traumatized? Did I need Amen’s prescriptions for issues I don’t experience as problems?

A few days after my assessment with Amen, I visited my therapist. I asked her if she’s heard of Amen, and she nodded politely. She maintained a perfectly professional poker face when I told her what Amen found and what he suggested.  

“So, how was your week otherwise?” she asked.

I stopped telling her what Amen found in my brain and told her what was on my mind instead.