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  • In this talk, I'm going to give you the single most important lesson

  • my colleagues and I have learned from looking at 83,000 brain scans.

  • But first, let me put the lesson into context.

  • I am in the middle of seven children.

  • Growing up, my father called me a maverick

  • which to him was not a good thing.

  • (Laughter)

  • In 1972, the army called my number,

  • and I was trained as an infantry medic where my love of medicine was born.

  • But since I truly hated the idea of being shot at or sleeping in the mud,

  • I got myself retrained as an X-ray technician

  • and developed a passion for medical imaging.

  • As our professors used to say: "How do you know, unless you look?"

  • In 1979, when I was a second-year medical student,

  • someone in my family became seriously suicidal,

  • and I took her to see a wonderful psychiatrist.

  • Over time, I realized if he helped her, which he did,

  • it would not only save her life,

  • but it would also help her children and even her future grandchildren,

  • as they would be shaped by someone who is happier and more stable.

  • I fell in love with psychiatry

  • because I realized it had the potential to change generations of people.

  • In 1991, I went to my first lecture on brain SPECT imaging.

  • SPECT is a nuclear medicine study that looks at the blood flow and activity,

  • it looks at how your brain works.

  • SPECT was presented as a tool to help psychiatrists

  • get more information to help their patients.

  • In that one lecture, my two professional loves,

  • medical imaging and psychiatry,

  • came together, and quite honestly, revolutionized my life.

  • Over the next 22 years, my colleagues and I would build

  • the world's largest database of brain scans related to behavior

  • on patients from 93 countries.

  • SPECT basically tells us three things about the brain:

  • good activity, too little, or too much.

  • Here's a set of healthy SPECT scans.

  • The image on the left shows the outside surface of the brain,

  • and a healthy scan shows full, even, symmetrical activity.

  • The color is not important, it's the shape that matters.

  • In the image on the right, red equals the areas of high activity,

  • and in a healthy brain, they're typically in the back part of the brain.

  • Here's a healthy scan compared to someone who had two strokes.

  • You can see the holes of activity.

  • Here's what Alzheimer's looks like,

  • where the back half of the brain is deteriorating.

  • Did you know that Alzheimer's disease actually starts in the brain

  • 30 to 50 years before you have any symptoms?

  • Here's a scan of a traumatic brain injury.

  • Your brain is soft, and your skull is really hard.

  • Or drug abuse.

  • The real reason not to use drugs - they damage your brain.

  • Obsessivecompulsive disorder

  • where the front part of the brain typically works too hard,

  • so that people cannot turn off their thoughts.

  • An epilepsy where we frequently see areas of increased activity.

  • In 1992, I went to an all-day conference on brain SPECT imaging,

  • it was amazing and mirrored

  • our own early experience using SPECT in psychiatry.

  • But at that same meeting, researchers started to complain loudly

  • that clinical psychiatrists like me should not be doing scans,

  • that they were only for their research.

  • Being the maverick and having clinical experience,

  • I thought that was a really dumb idea.

  • (Laughter)

  • Without imaging,

  • psychiatrists then and even now make diagnosis like they did in 1840,

  • when Abraham Lincoln was depressed,

  • by talking to people and looking for symptom clusters.

  • Imaging was showing us there was a better way.

  • Did you know that psychiatrists are the only medical specialists

  • that virtually never look at the organ they treat?

  • Think about it!

  • Cardiologists look, neurologists look, orthopedic doctors look,

  • virtually every other medical specialties look -

  • psychiatrists guess.

  • Before imaging,

  • I always felt like I was throwing darts in the dark at my patients

  • and had hurt some of them which horrified me.

  • There is a reason

  • that most psychiatric medications have black box warnings.

  • Give them to the wrong person, and you can precipitate a disaster.

  • Early on, our imaging work taught us many important lessons,

  • such as illnesses, like ADHD, anxiety, depression, and addictions,

  • are not simple or single disorders in the brain,

  • they all have multiple types.

  • For example, here are two patients

  • who have been diagnosed with major depression,

  • that had virtually the same symptoms, yet radically different brains.

  • One had really low activity in the brain, the other one had really high activity.

  • How would you ever know what to do for them, unless you actually looked?

  • Treatment needs to be tailored

  • to individual brains, not clusters of symptoms.

  • Our imaging work also taught us

  • that mild traumatic brain injury was a major cause of psychiatric illness

  • that ruin people's lives,

  • and virtually no one knew about it because they would see psychiatrists

  • for things like temper problems, anxiety, depression, and insomnia,

  • and they would never look, so they would never know.

  • Here's a scan of a 15-year-old boy

  • who felt down a flight of stairs at the age of three.

  • Even though he was unconscious for only a few minutes,

  • there was nothing mild about the enduring effect

  • that injury had on this boy's life.

  • When I met him at the age of 15, he had just been kicked out

  • of his third residential treatment program for violence.

  • He needed a brain rehabilitation program,

  • not just more medication thrown at him in the dark,

  • or behavioral therapy which, if you think about it, is really cruel.

  • To put him on a behavioral therapy program

  • when behavior is really an expression of the problem, it's not the problem.

  • Researchers have found that undiagnosed brain injuries

  • are a major cause of homelessness, drug and alcohol abuse, depression,

  • panic attacks, ADHD, and suicide.

  • We are in for a pending disaster

  • with the hundreds and thousands of soldiers

  • coming back from Iraq and Afganistan,

  • and virtually no one is looking at the function of their brain.

  • As we continued our work with SPECT,

  • the criticism grew louder, but so did the lessons.

  • Judges and defense attorneys sought our help to understand criminal behavior.

  • Today, we have scanned over 500 convicted felons

  • including 90 murderers.

  • Our work taught us that people who do bad things

  • often have troubled brains.

  • That was not a surprise.

  • But what did surprise us

  • was that many of these brains could be rehabilitated.

  • So here's a radical idea.

  • What if we evaluated and treated troubled brains

  • rather than simply warehousing them in toxic, stressful environments?

  • In my experience, we could save tremendous amounts of money

  • by making these people more functional,

  • so when they left prison, they could work,

  • support their families and pay taxes.

  • Dostoyevsky once said: "A society should be judged

  • not by how well it treats its outstanding citizens,

  • but by how it treats its criminals."

  • Instead of just crime and punishment,

  • we should be thinking about crime evaluation and treatment.

  • (Applause)

  • So after 22 years and 83,000 scans,

  • the single most important lesson my colleagues and I have learned

  • is that you can literally change people's brains.

  • And when you do, you change their life.

  • You are not stuck with the brain you have,

  • you can make it better, and we can prove it.

  • My colleagues and I performed the first and largest study

  • on active and retired NFL players,

  • showing high levels of damage in these players at the time

  • when the NFL said they didn't know

  • if playing football caused long-term brain damage.

  • The fact was they didn't want to know.

  • That was not a surprise.

  • I think, if you get the most thoughtful 9-year-olds together,

  • and you talk about the brain is soft, about the consistency of soft butter,

  • it's housed in a really hard skull that has many sharp, bony ridges,

  • you know, 28 out of 30 nine-year-olds would go:

  • "Probably a bad idea for your life."

  • (Laughter)

  • But what really got us excited was the second part of the study

  • were we put players on a brain-smart program

  • and demonstrated that 80% of them could improve

  • in the areas of blood flow, memory, and mood,

  • that you are not stuck with the brain you have,

  • you can make it better on a brain-smart program.

  • How exciting is that?

  • I am so excited.

  • Reversing brain damage is a very exciting new frontier,

  • but the implications are really much wider.

  • Here is this scan of a teenage girl who has ADHD,

  • who was cutting herself, failing in school, and fighting with her parents.

  • When we improved her brain,

  • she went from D's and F's to A's and B's,

  • and was much more emotionally stable.

  • Here is the scan of Nancy.

  • Nancy had been diagnosed with dementia,

  • and her doctor told her husband that he should find a home for her

  • because within a year, she would not know his name.

  • But on an intensive, brain-rehabilitation program,

  • Nancy's brain was better, as was her memory,

  • and four years later, Nancy still knows her husband's name.

  • Or my favorite story to illustrate this point: Andrew,

  • a 9-year-old boy who attacked a little girl on the baseball field

  • for no particular reason,

  • and at the time, was drawing pictures of himself

  • hanging from a tree and shooting other children.

  • Andrew was Columbine, Aurora,

  • and Sandy Hook waiting to happen.

  • Most psychiatrists would have medicated Andrew,

  • as they did Eric Harris and the other mass shooters

  • before they committed their awful crimes,

  • but SPECT imaging taught me that I had to look at his brain

  • and not throw darts in the dark at him to understand what he needed.

  • His SPECT scan showed a cyst, the size of a golf ball,

  • occupying the space of his left temple lobe.

  • No amount of medication or therapy would have helped Andrew.

  • When the cyst was removed,

  • his behavior completely went back to normal,

  • and he became the sweet, loving boy he always wanted to be.

  • Now 18 years later, Andrew, who is my nephew,

  • owns his own home, is employed and pays taxes.

  • (Laughter)

  • Because someone bothered to look at his brain,

  • he has been a better son,

  • and will be a better husband, father, and grandfather.

  • When you have the privilege of changing someone's brain,

  • you not only change his or her life

  • but you have the opportunity to change generations to come.

  • I'm Dr. Daniel Amen. Thank you.

  • (Applause)

In this talk, I'm going to give you the single most important lesson

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TEDx】8万3000人の脳スキャンから得た最も重要な教訓|ダニエル・アーメン|TEDxOrangeCoast (【TEDx】The most important lesson from 83,000 brain scans | Daniel Amen | TEDxOrangeCoast)

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    wxg19900627 に公開 2021 年 01 月 14 日
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