Nine Principles of the Amen Clinic
Daniel G. Amen, MD

The brain is the hardware of the soul. It is the vehicle that allows our soul, our very being, to function properly. Like the hardware of a computer, the brain must function at an optimal level in order for us to run the software programs of life (child rearing, education, going through adolescence, training for a career, marriage, navigating mid-life crises, for instance). When the brain is hurt or damaged (such as when a computer does not have enough RAM, speed, or storage space), we cannot run these software programs efficiently, and end up with a troubled life.

As with computers, you need more than hardware. 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, spiritual practice, positive relationships, opportunity, 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.

The latest brain imaging research has shown that thoughts, feelings, and social interactions all impact brain function, in potentially positive and negative ways. How we live our life matters. In addition, the condition of our soul and the spiritual connections we make have a strong impact on the physiology of the brain. It is a reciprocal relationship. I have seen that sin (doing things that you know are wrong) disrupts healthy brain function and leads to anxiety, fear, and depression; while living with integrity and having a positive relationship with God and others actually improves brain function. A number of research studies have demonstrated that people of faith suffer less from anxiety disorders and depression and they recover 70% faster from these illnesses than those without a strong religious faith. The suicide rate and even mortality rate is lower for religious people than the non-religious. The brain needs a healthy soul, and the soul needs a brain that works right.

In this article, I will show how the brain is involved in everything we do and how it must be considered in our day-to-day lives. The brain needs to be thought about when we try to explain the concepts of:

  • . good (it is likely that Mother Theresa had optimal brain function),
  • .evil (it is also likely that 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 experience many racists have abnormal brain patterns),
  • .drug abuse (you can actually see toxic effects of these substances on the brain),
  • .child abuse (often at the hands of people with brain problems), and
  • .school or work achievement and underachievement (people with full access to good brain function are much more likely to perform well in school, while people
  • .who struggle often have sluggish or hyperactive brain function).



Applying Brain Science in a Clinical Setting

Over the past 13 years the Amen Clinics have performed over 21,000 brain SPECT studies for psychiatric indications. Looking at the brain has been one of the most informative and stimulating adventures of my life. In the past few years I have been able to distill our work into 9 very simple principles. I share them here to try to encourage you to consider brain science in all you do with your clients.


Nine Amen Clinic Principles

1. Your brain is involved with everything you do. How you think, how you feel, how you act, and how well you get along with other people has to do with the moment-by-moment functioning of your brain. After looking at thousands of brain scans I have come to realize that how your brain functions influences the kind of therapist you are, the effectiveness of your mothering skill, and how well you do in business.

2. When the brain works right, you work right. When the brain is troubled, you generally experience trouble in your relationships, work, or within yourself. Since the brain is recognized as the organ of behavior, it makes sense that brain problems, such as Alzheimer's disease, attention deficit disorder, schizophrenia or brain trauma is likely to decrease a person's effectiveness in life. Your success in life is associated with how well your brain works.

This principle leads to an important paradigmatic shift: if you see someone who is "not right" then it may not be "his choice" or "his personality," it may not even be his upbringing or environment (directly) but a matter of his brain not working properly. WHY it's not working properly is a question not easily answered by saying he or she has a personality disorder, but the **big triumph** comes when we at least consider not "what's the matter with YOU?" but "What's the matter with your BRAIN?" when someone is behaving poorly.

3. The brain is the most complicated organ in the universe. There is nothing as complex as the human brain. Nothing. It is estimated that we have 100 billion neurons or nerve cells and trillions of supportive brain cells called glial cells. Each neuron is connected to other neurons by up to 40,000 individual connections between cells. You have more connections in your brain than there are stars in the universe. Also, even though your brain is only about two percent of your body's weight, it uses twenty five to thirty percent of the calories you consume. Your brain is the major energy consumer in the body. Of the breakfast, lunch, dinner and snacks you had today, almost a third went to feed your brain.

4. If you believe the first three principles, this next one is critical and often the undiagnosed cause of many "behavioral, learning or emotional" problems. Your brain is very soft, yet it is housed in a very hard skull that has many ridges. Mild traumatic brain injuries can change people's whole lives and virtually no one knows it, because mental health professionals never look at brain function. In fact, you do not have to lose consciousness to have a serious brain injury.

When we understand that brain injuries matter, we become much more cautious about letting children hit soccer balls with their heads; snowboard without helmets or play tackle football. As mental health professionals we need to take even mild traumatic brain injuries seriously. Clinically, I have found that I have to ask patient at least 5 times whether or not they have had a serious brain injury. Often they forget, and therapists give them the diagnoses of personality disorders, when, in fact, they have brain damage from injuries or accidents.

5. Certain parts of the brain tend to do certain things. For many years, neuropsychiatrists and neuropsychologists have known that certain brain systems are involved with certain behaviors. For example, the prefrontal cortex is involved with executive functions; the temporal lobes are involved with memory, auditory processing, word finding and emotional reactions; the anterior cingulate gyrus is involved with cognitive flexibility and shifting attention, etc. Understanding psychobiology is critical to taking a new view of psychiatric illness.

6. Problems in certain brain areas are often associated with specific learning, behavioral or emotional problems. Understanding this principle allows clinicians to start listening for brain system problems, rather than just trying to fit people into DSM-IV diagnostic categories. For example, if there are prefrontal cortex issues one would expect there to be executive function problems, such as short attention span, disorganization, poor planning and impulse control issues. If there are temporal lobe problems it is likely people will exhibit struggles with memory, mood stability, word finding and temper control. If there are parietal lobe issues people may get lost easily. Knowing about brain pathology allows clinicians to target treatments to brain areas rather than nebulous psychiatric diagnoses. With this model, clinicians develop prefrontal cortex treatments, temporal lobe treatments, etc.

7. Most psychiatric illnesses are not single or simple disorders. Giving someone the diagnosis of major depression is akin to giving patients the diagnosis of chest pain. Why don't we give people the diagnosis of chest pain? Because chest pain is a symptom with many potential causes, such as heart or lung disease, musculoskeletal problems, abdominal or back problems, as well as grief or panic attacks. Unfortunately, in psychiatry we give people simple diagnoses, such as major depression, ADD, or bipolar disorder, that represent symptoms clusters without understanding the richness of the potential underlying causes. This leads to overly simplistic treatments that make some better and many worse. Our brain imaging work has classified 6 different types of ADD and 7 different types of anxiety and depression. Understanding the types helps us be better at targeting treatments to specific brain areas.

8. Imaging the brain helps mental health professionals be more effective, decreases stigma and increases compliance for patients. Imaging the brain teaches mental health professionals to ask more informed questions. Why are psychiatrists (and I would argue or mental health professionals) the only medical professionals that never look at the organ they treat? You can try to kill yourself today in Los Angeles and virtually no one outside of our clinics will look at the patient's brain. Cardiologists, orthopedists, gynecologist, gastroenterologists, and ophthalmologists all look at what they do before they do it. It would be considered malpractice in almost all areas of medicine to treat patients solely based on history and clinical examination. Yet, isn't that what we do in mental health?

9. The brain can change! This is the headline for mental health in the new millennium! When we do the right things for our clients, whether it is great psychotherapy, effective use of medication or supplements, or newer treatments such as transcranial magnetic stimulation or hyperbaric oxygen treatment we enhance brain function and enhance people's lives. My bestselling book, Change Your Brain, Change Your Life is centered on this principle. We have seen it work for more than 13 years. The brain is adaptive and influenced by what we do for it. The opposite is also true, the brain can change in a negative way when we do the wrong things. Yes, you can impair brain function with the wrong interventions. We must have great respect for our interventions. I argue that we need to look at the brain before we do things to it and also check ourselves periodically to see if we are making things better or worse.




Optimizing Brain Function

From our work as clinical neuroscientists, psychiatrists, and brain-imaging experts, our clinics have developed a simple 7 step program for optimizing brain function. Incorporate these steps into your own life and the lives of your clients to keep the brain healthy for as long as possible.

1. Protect Your Brain -- Protecting the brain from injury, pollution, sleep deprivation, and stress is the first step to optimizing its function. Wear your seatbelt when you're in a car, and wear a helmet when you ride a bicycle, motorcycle, or go snowboarding. Make sure children wear helmets. One head injury can ruin a life. Along the same lines, do not let children hit soccer balls with their heads. Soccer balls are heavy. Repeatedly slamming a child's head against a soccer ball may cause minor repetitive trauma to the brain. At this time there are not enough studies to say heading soccer balls is safe. I encourage my children to play golf, baseball, and tennis, rather than football, soccer, or hockey.

Current brain imaging research has shown that many chemicals are toxic to brain function. Alcohol, drugs of abuse, nicotine, much caffeine, and many medications decrease blood flow to the brain. When blood flow is decreased the brain cannot work efficiently. Avoid these toxic substances. In a similar way, sleep deprivation also decreases brain activity and limits access to learning, memory, and concentration. A recent brain imaging study showed that people who consistently slept less than 7 hours had overall less brain activity. Getting enough sleep is essential to brain function.

Scientists have only recently discovered how stress negatively affects brain function. Stress hormones have been shown in animals to be directly toxic to memory centers. Brain cells can die with prolonged stress. Managing stress effectively is essential to good brain function.

2. Feed Your Brain -- The fuel you feed the brain has a profound effect on how it functions. Lean protein, complex carbohydrates, and foods rich in omega 3 fatty acids (large cold water fish, such as tuna and salmon, walnuts, Brazil nuts, olive oil, and canola oil) are essential to brain function.

Balancing your diet is essential to brain health and longevity. I also recommend taking a 100% vitamin and mineral supplement, along with extra Vitamin E and C for brain longevity.

3. Kill the ANTs That Invade Your Brain -- The thoughts that go through your mind, moment by moment, have a significant impact on how your brain works. Research by Mark George, MD and colleagues at the National Institutes of Health demonstrated that happy, hopeful thoughts had an overall calming effect on the brain, while negative thoughts inflamed brain areas often involved with depression and anxiety. Your thoughts matter. I often teach my patients how to metaphorically kill the ANTs that invade their minds. ANTs stand for Automatic Negative Thoughts. The ANTs are automatic. They just happen. But they can ruin your whole day, maybe even your life.

Whenever you feel sad, mad or nervous write out your automatic negative thoughts and talk back to them. You do not have to believe every thought that goes through your head. It's important to think about your thoughts to see if they help you or they hurt you. Develop an internal anteater to hunt down and devour the negative thoughts that are ruining your life.

4. Work Your Brain -- Your brain is like a muscle. The more you use it, the more you can use it. Every time you learn something new your brain makes a new connection. Learning enhances blood flow and activity in the brain. If you go for long periods without learning something new you start to lose some of the connections in the brain and you begin to struggle more with memory and learning. Strive to learn something new everyday, even if it is just for a short period of time. Einstein said that if a person studies a subject for just 15 minutes a day in a year he will be an expert, and in five years he may be a national expert. Learning is good for your brain.

5. Exercise For Your Brain - Regular physical exercise enhances brain function. People who exercise on a regular basis have better memories with age, they have better blood flow to the brain and many cerebral processes are enhanced. Physical exercise is the fountain of youth that many people seek. Exercise protects you from illnesses of aging. In a large study from Quebec, Canada, Dr. D. Laurin and colleagues explored the association between physical activity and the risk of cognitive impairment and dementia. They gathered information from a community sample of 9,008 randomly selected men and women 65 years or older, who were evaluated in the 1991-1992 Canadian Study of Health and Aging, a prospective group study of dementia. Compared with no exercise, physical activity was associated with lower risks of cognitive impairment, Alzheimer disease, and dementia of any type. High levels of physical activity were associated with even more reduced risks. They concluded that regular physical activity could represent an important and potent protective factor for cognitive decline and dementia in elderly people. The best kind of exercise improves the pump force of your heart (cardiovascular exercise) and strengthens the muscles of your body (resistive exercise).

6. Develop A "Concert State" For Your Brain -- Optimal performance is best achieved when a "concert state" exists in the brain. By "concert state" I mean "a relaxed body with a sharp, clear mind," much as you would experience at an exhilarating symphony. Achieving this state requires the ability to relax and focus. Deep breathing, prayer and meditation are excellent ways to achieve this state. Deep relaxation is easily achieved by most people through diaphragmatic breathing exercises (learning how to breathe with your belly). This is the most natural, efficient way to breathe. A quick way to learn belly breathing is to lay on the floor and put a book on your belly. As you breathe in make the book rise as you fill your lower lungs with air. As you breathe out make the book fall as you use your belly to exhale all the air out of your lungs. Take slow, deep breaths, less than 7 a minute. One of my patients told me that it was impossible for him to be anxious or mad when he breathed in this way.

Studies on prayer and meditation have also shown brain changes that help people block out the external world but focus internally. In Andrew Newberg's book, Why Won't God Go Away, he described a series of experiments with Tibetan Monks meditating and Catholic Nuns praying. Both states enhanced brain function. In the fall of 2003 I performed a study that demonstrated meditation had significant positive effects on brain function. Work to develop a "concert state" by relaxing your body and developing mental clarity.

7. Treat Brain Problems Early -- Many people sabotage themselves by denying they have brain problems until significant damage has been done to their lives. Most psychiatrists feel that there is a significant brain component to depression, anxiety problems, attention deficit disorder, obsessive compulsive disorder, substance abuse problems, and even violence. Unfortunately, the stigma associated with seeing a psychiatrist still prevents people from seeking help for obvious problems. Clearly, the earlier people seek help for these problems the less negative impact they will have on their lives. If you struggle with any of these problems you are not alone. According to the National Institutes of Health 49% of Americans will have a psychiatric illness (depression, anxiety, ADD, OCD, substance abuse problems, etc.) at some point in their lives. Successful people have problems, they are smart enough to seek help. The earlier the better.




Understanding our patients and clients through the lens of brain science helps us be more effective and less judgmental. It teaches us to focus on brain health as well as the psychodynamics that might be present. This is a very exciting time to be a mental health professional. We are on the verge of a radical new shift in our profession that will be more open to integrating the mind, body and the soul in mental health.

Daniel Amen, MD, is the director of Amen Clinics, Inc. He is the Assistant Clinical Professor of Psychiatry and Human Behavior
UC Irvine School of Medicine. Dr. Amen is the author many books including Making a Good Brain Great and NY Times bestseller, Change Your Brain, Change Your Life.