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Time English Language 2 Action
00:00
Transcriber: Ilze Garda Reviewer: Denise RQ
00:07
In this talk, I'm going to give you the single most important lesson
00:13
my colleagues and I have learned from looking at 83,000 brain scans.
00:19
But first, let me put the lesson into context.
00:23
I am in the middle of seven children.
00:25
Growing up, my father called me a maverick
00:29
which to him was not a good thing.
00:32
(Laughter)
00:33
In 1972, the army called my number,
00:37
and I was trained as an infantry medic where my love of medicine was born.
00:43
But since I truly hated the idea of being shot at or sleeping in the mud,
00:50
I got myself retrained as an X-ray technician
00:53
and developed a passion for medical imaging.
00:57
As our professors used to say: "How do you know, unless you look?"
01:03
In 1979, when I was a second-year medical student,
01:07
someone in my family became seriously suicidal,
01:12
and I took her to see a wonderful psychiatrist.
01:15
Over time, I realized if he helped her, which he did,
01:20
it would not only save her life,
01:24
but it would also help her children and even her future grandchildren,
01:29
as they would be shaped by someone who is happier and more stable.
01:36
I fell in love with psychiatry
01:38
because I realized it had the potential to change generations of people.
01:47
In 1991, I went to my first lecture on brain SPECT imaging.
01:51
SPECT is a nuclear medicine study that looks at the blood flow and activity,
01:56
it looks at how your brain works.
02:00
SPECT was presented as a tool to help psychiatrists
02:04
get more information to help their patients.
02:09
In that one lecture, my two professional loves,
02:13
medical imaging and psychiatry,
02:15
came together, and quite honestly, revolutionized my life.
02:21
Over the next 22 years, my colleagues and I would build
02:24
the world's largest database of brain scans related to behavior
02:29
on patients from 93 countries.
02:33
SPECT basically tells us three things about the brain:
02:37
good activity, too little, or too much.
02:41
Here's a set of healthy SPECT scans.
02:43
The image on the left shows the outside surface of the brain,
02:48
and a healthy scan shows full, even, symmetrical activity.
02:53
The color is not important, it's the shape that matters.
02:58
In the image on the right, red equals the areas of high activity,
03:03
and in a healthy brain, they're typically in the back part of the brain.
03:10
Here's a healthy scan compared to someone who had two strokes.
03:14
You can see the holes of activity.
03:17
Here's what Alzheimer's looks like,
03:19
where the back half of the brain is deteriorating.
03:23
Did you know that Alzheimer's disease actually starts in the brain
03:28
30 to 50 years before you have any symptoms?
03:34
Here's a scan of a traumatic brain injury.
03:36
Your brain is soft, and your skull is really hard.
03:41
Or drug abuse.
03:42
The real reason not to use drugs - they damage your brain.
03:48
Obsessive–compulsive disorder
03:49
where the front part of the brain typically works too hard,
03:53
so that people cannot turn off their thoughts.
03:57
An epilepsy where we frequently see areas of increased activity.
04:04
In 1992, I went to an all-day conference on brain SPECT imaging,
04:08
it was amazing and mirrored
04:11
our own early experience using SPECT in psychiatry.
04:17
But at that same meeting, researchers started to complain loudly
04:23
that clinical psychiatrists like me should not be doing scans,
04:27
that they were only for their research.
04:32
Being the maverick and having clinical experience,
04:37
I thought that was a really dumb idea.
04:40
(Laughter)
04:42
Without imaging,
04:44
psychiatrists then and even now make diagnosis like they did in 1840,
04:49
when Abraham Lincoln was depressed,
04:52
by talking to people and looking for symptom clusters.
04:58
Imaging was showing us there was a better way.
05:01
Did you know that psychiatrists are the only medical specialists
05:06
that virtually never look at the organ they treat?
05:10
Think about it!
05:11
Cardiologists look, neurologists look, orthopedic doctors look,
05:17
virtually every other medical specialties look -
05:21
psychiatrists guess.
05:24
Before imaging,
05:25
I always felt like I was throwing darts in the dark at my patients
05:31
and had hurt some of them which horrified me.
05:37
There is a reason
05:39
that most psychiatric medications have black box warnings.
05:43
Give them to the wrong person, and you can precipitate a disaster.
05:51
Early on, our imaging work taught us many important lessons,
05:56
such as illnesses, like ADHD, anxiety, depression, and addictions,
06:00
are not simple or single disorders in the brain,
06:04
they all have multiple types.
06:07
For example, here are two patients
06:09
who have been diagnosed with major depression,
06:12
that had virtually the same symptoms, yet radically different brains.
06:18
One had really low activity in the brain, the other one had really high activity.
06:25
How would you ever know what to do for them, unless you actually looked?
06:31
Treatment needs to be tailored
06:34
to individual brains, not clusters of symptoms.
06:40
Our imaging work also taught us
06:42
that mild traumatic brain injury was a major cause of psychiatric illness
06:48
that ruin people's lives,
06:50
and virtually no one knew about it because they would see psychiatrists
06:55
for things like temper problems, anxiety, depression, and insomnia,
07:00
and they would never look, so they would never know.
07:04
Here's a scan of a 15-year-old boy
07:07
who felt down a flight of stairs at the age of three.
07:12
Even though he was unconscious for only a few minutes,
07:18
there was nothing mild about the enduring effect
07:24
that injury had on this boy's life.
07:27
When I met him at the age of 15, he had just been kicked out
07:32
of his third residential treatment program for violence.
07:36
He needed a brain rehabilitation program,
07:40
not just more medication thrown at him in the dark,
07:45
or behavioral therapy which, if you think about it, is really cruel.
07:50
To put him on a behavioral therapy program
07:52
when behavior is really an expression of the problem, it's not the problem.
07:59
Researchers have found that undiagnosed brain injuries
08:02
are a major cause of homelessness, drug and alcohol abuse, depression,
08:08
panic attacks, ADHD, and suicide.
08:12
We are in for a pending disaster
08:15
with the hundreds and thousands of soldiers
08:18
coming back from Iraq and Afganistan,
08:20
and virtually no one is looking at the function of their brain.
08:26
As we continued our work with SPECT,
08:30
the criticism grew louder, but so did the lessons.