The Brain in Love Part 10

Obsessive-Compulsive Disorder (see Lesson Eight) Posttraumatic Stress Disorder Joanne, a thirty-four-year-old travel agent, was held up in her office at gunpoint by two men. Four or five times during the robbery, one of the men held a gun to her head and said he was going to kill her. She graphically imagined her brain being splattered with blood against the wall. Near the end of this fifteen-minute ordeal, they made her take off all her clothes. She pictured herself being brutally raped by them. They left without touching her, but locked her in a closet.

Since that time her life had been thrown into turmoil. She felt tense, and was plagued with flashbacks and nightmares of the robbery. Her stomach was in knots and she had a constant headache. Whenever she went out, she felt panicky. She was frustrated that she could not calm her body: her heart raced, she was short of breath, and her hands were constantly cold and sweaty. She hated how she felt and she was angry about how her nice life had turned into a nightmare. What was most upsetting to her were the ways that the robbery affected her marriage and her child. Her baby picked up the tension and was very fussy. Every time she tried to make love with her husband, she began to cry and get images of the men raping her. Joanne had posttraumatic stress disorder (PTSD), a brain reaction to severe traumatic events such as a robbery, rape, car accident, earthquake, tornado, or even a volcanic eruption. Her symptoms are cla.s.sic for PTSD, especially the flashbacks and nightmares of the event.

The worst symptoms came from the horrible thoughts about what never happened, such as seeing her brain splattered against the wall and being raped. These thoughts were registered in her subconscious as fact, and until she entered treatment she was not able to recognize how much damage they had been doing. For example, when she imagined that she was being raped, a part of her began to believe that she actually was raped. The first time she had her period after the robbery, she began to cry with relief that she was not impregnated by the robbers, even though they never touched her. A part of her even believed she was dead because she had so vividly pictured her own death. A significant portion of her treatment was geared to counteract these erroneous subconscious conclusions.

Without treatment, PTSD can literally ruin a person's life. The most effective treatment is usually psychotherapy. One type of psychotherapy that I think works especially well for PTSD is called eye movement desensitization and reprocessing (EMDR). You can learn more about this technique in my book Healing Anxiety and Depression or visiting www.emdria.org. Depending on the severity of PTSD, certain types of medications and supplements can also be helpful.

Performance Anxiety Feeling anxious or nervous before speaking or performing in front of a group is one of the most common fears of human beings. Many people hate feeling judged, scrutinized, or "on the spot." As anxiety levels go up in the brain, thoughtfulness usually goes down. This is particularly true with s.e.xual performance. It is very common for lovers, especially new lovers, to want to please their partners. They feel anxious and their nerves tend to get in the way of s.e.xual play and enjoyment. Often this type of anxiety is a.s.sociated with what I call Fortune Telling ANTs. ANT stands for automatic negative thoughts. These are the thoughts that go through your head automatically and ruin your day. Fortune-telling ANTs are the thoughts that predict a bad turnout, even though there is no evidence for the idea. Examples include, "He will not like my body." "She will think I have a small p.e.n.i.s." "I will come too quickly." "I have to fake an o.r.g.a.s.m, or he will not be happy with me." The problem with fortune-telling ANTs is that your brain makes happen what it sees. If you predict failure, you are more likely to fail. For example, when you see yourself not pleasing your partner, the subsequent anxiety will interfere with your feeling relaxed and present, in the moment; then you will not read his or her body language and end up missing important clues to making it a special s.e.xual time. Learning how to calm performance anxiety, through correcting negative thoughts, deep breathing, and meditation, is essential for great s.e.x.

Attention Deficit Disorder In my lectures I often ask, "How many people are married? Raise your hands." Usually, a good portion of the audience raises their hands. "Is it helpful," I ask next, "to say everything you think in your marriage?" Everyone laughs. "Of course not," I continue, "relationships require tact, they require thoughtfulness. Saying everything you think is usually a disaster in relationships." Unfortunately, you need healthy PFC activity to suppress the sneaky thoughts that just creep through your brain. Attention-deficit/hyperactivity disorder (ADHD) is usually a.s.sociated with low PFC activity and people are more likely to blurt out, without forethought.

Do you often feel restless? Have trouble concentrating? Have trouble with impulsiveness, either doing or saying things you wish you hadn't? Do you fail to finish many projects you start? Are you easily bored or quick to anger? If the answer to most of these questions is yes, you might have attention deficit disorder (ADD).

ADD is the most common brain problem in children and adults, affecting 8 to 10 percent of the United States population. The main symptoms of ADD are a short attention span, distractibility, disorganization, procrastination, and poor internal supervision. It is often, but not always, a.s.sociated with impulsive behavior and hyperactivity or restlessness. Until recently, most people thought that children outgrew this disorder during their teenage years. For many, this is false. While it is true that the hyperactivity lessens over time, the other symptoms of impulsivity, distractibility, and a short attention span remain for most sufferers into adulthood. Current research shows that 60 to 80 percent of ADD children never fully outgrow this disorder.

Common symptoms of the adult form of ADD include poor organization and planning, procrastination, trouble listening carefully to directions, distractibility, short attention span, relationship problems, and excessive traffic violations. Additionally, people with adult ADD are often late for appointments, frequently misplace things, may be quick to anger, and have poor follow-through. There may also be frequent impulsive job or relationship changes and poor financial management. Substance abuse, especially alcohol or amphetamines and cocaine, and low self-esteem are also common.

Many people do not recognize the seriousness of this disorder and just pa.s.s off these kids and adults as lazy, defiant, or willful. Yet, ADD is a serious disorder. Left untreated, it affects a person's self-esteem, social relationships, and ability to learn and work. Several studies have shown that ADD children use twice as many medical services as non-ADD kids, up to 35 percent of untreated ADD teens never finish high school, 52 percent of untreated adults abuse substances, teens and adults with ADD have more traffic accidents, and adults with ADD move four times more than others.

Many adults tell me that when they were children, they were in trouble all the time and had a real sense that there was something very different about them. Even though many of the adults I treat with ADD are very bright, they are frequently frustrated by not living up to their potential.

From our research with SPECT scans, it is clear that ADD is a brain disorder, but not one simple disorder. I have described six different types of ADD. The most common feature of ADD is decreased activity in the prefrontal cortex with a concentration task. This means that the harder a person tries, the less brain activity they have to work with. Many people with ADD self-medicate with stimulants, such as caffeine, nicotine, cocaine, or methamphetamine, to increase activity in the PFC. They also tend to self-medicate with conflict-seeking behavior. If they can get someone upset, it helps to stimulate their brain. Of course, they have no idea they do this behavior. I call it unconscious, brain-driven behavior. But, if you are around ADD people long enough, you will see and feel the conflict-seeking behavior.

The best treatment for ADD depends on the type of ADD a person has. See my book Healing ADD for a complete description of types and treatments. In general, intense exercise helps, as does a higher protein, lower carbohydrate diet. Sometimes medications or supplements are helpful, but sometimes they can make things worse if they are not right. When correctly targeted, ADD is a highly treatable disorder.

Being a Jerk or a b.i.t.c.h I know "being a jerk" or "being a b.i.t.c.h" are not medical diagnostic terms. They are negative, name-calling phrases about someone's behavior. Yet, in my experience, it is possible that these behaviors are the result of poor brain function and not completely under conscious will. Sometimes, a head injury, toxic exposure, sleep deprivation, and personality disorders (see below) can interfere with someone's effectiveness in social and s.e.xual situations.

Our character can be defined in part by the way we interact with others. When the way in which we interact with others doesn't work, when we notice a pattern of multiple relationships and multiple disconnections, it may be that a personality disorder is at the root of the problem. The term personality disorder implies inflexible and long-standing patterns of experience and behavior (Diagnostic and Statistical Manual of Mental Disorders IV, or DSM-IV) that impair healthy functioning. They can be the source of great personal pain for the person suffering and those he or she loves. A personality disorder can sabotage relationships, prevent the realization of desired goals, and impede our moral development and our spiritual and s.e.xual health. When we are preoccupied, for example, with intrusive thoughts, deep fears of abandonment, or feelings of paranoia or superiority, it's hard to reach beyond the self to the expansive concerns of spirit and morality. It's hard to be our best selves. A person with a personality disorder may feel inexplicably apart from a sense of well-being, of closeness to others, and to G.o.d. It may be hard for someone with a personality disorder to feel empathy and thus to feel part of a reciprocally loving community. Feelings of isolation and disconnectedness can lead to the sense of life being meaningless and to devaluing one's own individual contributions. This sense of aloneness and lack of purpose can place people with personality disorders at higher risk for suicide. Personality is what we present to the outside world. It is not the true self, which is broader and deeper than the outward-appearance self. When we think of working on aspects of the personality, we think not of correcting flaws but of opening doors to greater joy and connectedness.

Personality disorders have been traditionally resistant to psychotherapy. Traditional psychiatric thought has focused on developmental causes of these disorders rather than brain abnormalities. It has been my experience that many people labeled as personality disordered are really brain disordered. The implications for treatment are immense-do we talk someone through their difficult behaviors or try to change their brain? Probably we need both.

Antisocial Personality Disorder Antisocial personality disorder is characterized by a long-standing pattern of disregard for the rights of others and may be an extension of conduct disorder seen in adolescence. The likelihood of developing antisocial personality disorder seems increased in young children with conduct disorder and ADD. People with antisocial personality disorder frequently break rules, inhabit prisons, and have constant relationship and work problems. They often get into fights. With little or no empathy, they may steal, destroy property, manipulate or deceive others for their ends. They tend to be impulsive and lacking in forethought. Traditionally, these people are thought of as evil, bad, and sinful. The work of psychologist Adrienne Raine of the University of Southern California has seriously challenged this notion. Dr. Raine found that compared to a group of healthy men, the MRI scans of the men with antisocial personality disorder showed decreased PFC volume. They are likely dealing with less access to the brain part that controls conscience, free will, right and wrong, and good and evil. A fascinating additional finding of Dr. Raine's work was that people with antisocial personality disorder also had slower heart rates than the control group and decreased sweat gland activity. Lower heart rates and sweat gland activity are often a.s.sociated with low anxiety states (your hands sweat and your heart races when you are anxious). Could this mean that people with this type of difficult temperament do not have enough internal anxiety? Could the PFC be involved with appropriate anxiety? Intriguing questions. For example, most people feel anxious before they do something bad or risky. If I needed money, and got the thought in my head to rob the local grocery store, my next thoughts would be filled with anxiety: "I don't want to get caught."

"I don't like inst.i.tutional food."

"I don't want to be thought of as a criminal."

"I could lose my medical license."

The anxiety would prevent me from acting out on the bad thoughts. But, what if, as Dr. Raine's study suggests, I do not have enough anxiety and I get an evil thought in my head like, "Go rob the store"? With poor PFC activity (a lousy internal supervisor with little to no anxiety), I am likely to rob the store without considering all of the consequences to my behavior. There is an interesting treatment implication from this work. Typically, psychiatrists try to help lessen a person's anxiety. Maybe we have it backward for people with antisocial personality disorder; for them we should try to increase their anxiety.

Narcissistic Personality Disorder People with narcissistic personality disorder believe that they are special and more unique or gifted than other people. They require constant admiration and recognition for their achievements. A sense of ent.i.tlement derived from a bolstered sense of superiority may lead people with narcissistic personality disorder to place great demands on others, expecting their needs to be met immediately, regardless of the inconvenience. Although they may appear confident, they may in fact have very low self-esteem, which they attempt to boost by a.s.sociation with others they imagine being as gifted as they. They may seek connections exclusively with those whom they perceive to be as special and form alliances solely to advance their careers or other endeavors. While lacking empathy and ability to listen patiently to others' concerns, a person with narcissistic personality disorder may spend an inordinate amount of time thinking about what others think of her or him. People with narcissistic personality disorder may belittle or be envious of others' achievements and be unwilling to acknowledge contributions others make to their own successes. A person with narcissistic personality disorder may appear to be rude, condescending, and arrogant, criticizing others while being unable to tolerate criticism him- or herself. A person with NPD often seesaws between a depressed mood because of feelings of shame or humiliation and grandiosity. As with other personality disorders, a person with narcissistic personality disorder may suffer from additional problems such as anorexia, substance abuse, anxiety, and depression. People with narcissistic personality disorders may have overactive cingulate systems, disallowing them to see outside themselves and to take a broader perspective. Poor prefrontal lobe activity may cause the lack of empathy so p.r.o.nounced in this disorder.

A feeling of social connectedness is the basis of a healthy soul and character. Clinging to the notion that you might be better than others, somehow more privileged or ent.i.tled, erects barriers between you and the people to whom you want to get close and makes it impossible to empathize with others' needs. Protecting yourself with distancing tactics such as criticism, disinterest in others' problems, belittling others, or refusing to acknowledge their accomplishments makes it tough to develop a sense of security and companionship, of being loved. It's very hard to make moral decisions from this place, from the position of "What I need is most important." Persistent focus on yourself, your appearance, how others see you, and the neediness that accompanies these anxiety-provoking concerns takes you away from your true self, the self that can focus on what you really care about and what you want your life to be about. Because people with narcissistic personalities disorder may sometimes accomplish external goals, it can be hard to discern the reasons for a lack of connectedness and a hollow spiritual life. Identifying with others; being able to be humble, grateful, and kind; to listen; and to truly appreciate others' caring and contributions to your life readies you to receive spiritual learning.

Borderline Personality Disorder Instability in relationships, impulsivity, and low self-esteem characterize borderline personality disorder. People with borderline personality disorder may quickly switch att.i.tudes toward others, identifications, values, and goals. For example, someone with borderline personality disorder may worship a new friend or lover and then drop him or her quickly, complaining that their new friend wasn't caring enough. Professional goals and interests may change suddenly, as may moods. Highly reactive and impulsive, they may experience periods of extreme irritability, anger, or anxiety. They may engage in self-destructive behaviors such as drinking heavily, driving fast, overspending, bingeing on food, or having unsafe s.e.x. People with borderline personality disorder may feel periods of great emptiness and engage in suicidal or self-mutilating behaviors. Boredom may be intolerable to someone with this disorder, and consequently, he or she may perpetually seek stimulation. Childhood abuse or neglect or the early loss of a parent may be found in family histories of people with this disorder.

The biological underpinnings of borderline personality disorder are complex. People with borderline personalities may have a combination of prefrontal lobe problems, which accounts for impulsivity, conflict, and stimulation-seeking behaviors, and the tendency to intensely value or devalue individuals. Anterior cingulate problems may also exist, evidenced by the obsessive thinking, cognitive inflexibility, and a very strong tendency to hold onto grudges and past hurts. As well, there may be temporal lobe abnormalities. The left temporal lobe is involved with aggressive behaviors toward the self and others.

Consistency and control over impulsivity are necessary to developing and sticking to character goals. When you are controlled by your emotions, constantly reacting to outside events in the heat of the moment, you cannot develop an overall sense of who you are, what you want, and how you will get it. Contemplation is important to developing a sense of right and wrong, what is good and bad for you and for others. Likewise, being enslaved by impulses and reactions denies you the opportunity to build a strong sense of self-esteem. When you can control what you do, you can feel greater certainty about your ident.i.ty. It's rewarding to be able to clarify your personal values and to stick to them, to know that you and you alone are in charge of your life.

It's hard to build a sense of security and of being loved when you find yourself attaching unrealistic expectations to people to whom you're attracted and then ending friendships before they've had a chance to develop. Social connectedness takes work: It implies forgiving and flexibility. It's important for all of us to try to develop greater empathy for others by asking ourselves about another's point of view and not to automatically a.s.sume we know what others feel and think.

When Is It Time to See a Professional About My Brain?

This question is relatively easy to answer. People should seek professional help for themselves or a family member when their behaviors, feelings, thoughts, or memory (all brain functions) interfere with their ability to reach their potential in their relationships or work. If you are experiencing persistent relationship struggles (parent-child, sibling, friend, partner), it's time to get help. If you have ongoing work problems related to your memory, moods, actions, or thoughts, it is time to get professional help. If your impulsive behavior, poor choices, or anxiety are causing consistent monetary problems, it's time to get help. Many people think they cannot afford to get professional help. I think it is usually much more costly to live with brain problems than it is to get appropriate help.

Pride and denial can get in the way of seeking proper help. People want to be strong and rely on themselves, but I am constantly reminded of the strength it takes to make the decision to get help. Also, getting help should be looked at as a way to get your brain operating at its full capacity.

Angela came to see me for temper problems. Even though she was very competent at work, her behavior at home often caused problems with her husband. When her husband suggested she see me, she resisted. There was nothing wrong with her, she thought, it was everyone else. One day, after exploding at one of her children, she realized it was, at least partly, her fault and agreed to come for help. She resisted because she did not want to be seen as weak or defective. The brain-SPECT scan helped her to see that her brain needed to be balanced. With the appropriate help, she got better and didn't have to suffer from mood swings, and she and her family suffered less stress as a result of her better-balanced brain.

What to Do When a Loved One Is in Denial

About Needing Help

Unfortunately, the stigma a.s.sociated with a "mental illness" prevents many people from getting help. People do not want to be seen as crazy, stupid, or defective and do not seek help until they (or their loved one) can no longer tolerate the pain (at work, in their relationships, or within themselves). Most people do not see psychiatric problems as brain problems, but rather as weak character problems. Men are especially affected by denial.

Many men, when faced with obvious troubles in their marriages, their children, or even themselves, are often unable to really see problems. Their lack of awareness and strong tendency toward denial prevent them from seeking help until more damage than necessary has been done. Many men have to be threatened with divorce before they seek help. Some people may say it is unfair to pick on men. And, indeed, some men see problems long before some women. Overall, however, mothers see problems in children before fathers and are more willing to seek help, and many more wives call for marital counseling than do husbands. What is it in our society that causes men to overlook obvious problems, or to deny problems until it is too late to deal with them effectively or until more damage was done than necessary? Some of the answers may be found in how boys are raised in our society, the societal expectations we place on men, the overwhelming pace of many men's daily lives, and in the brain.

Boys most often engage in active play (sports, war games, video games, etc.) that involves little dialogue or discussion. The games often involve dominance and submissiveness, winning and losing, and little interpersonal communication. Force, strength, or skill handles problems. Girls, on the other hand, often engage in more interpersonal or communicative types of play, such as dolls and storytelling. Fathers often take their sons to throw the ball around or shoot hoops, rather than to go for a walk and talk.

Many men retain the childhood notions of compet.i.tion and the idea that one must be better than others to be any good at all. To admit to a problem is to be less than other men. As a result, many men wait to seek help until their problem has become obvious to the whole world. Other men feel responsible for all that happens in their families, so admitting to a problem is the same as admitting that they have in some way failed.

Clearly, the pace of life prevents many people and particularly men from taking the time to look clearly at the important people in their lives and their relationships with them. When we spend time with fathers and husbands and help them slow down enough to see what is really important to them, more often than not they begin to see the problems and work toward helpful solutions. The issue is generally not one of being uncaring or uninterested; it is not seeing what is there. Men are wired differently than women. Men tend to be more left brained, which gives them better access to logical, detail-oriented thought patterns. Women tend to have greater access to both sides of their brains, with the right side being involved in understanding the gestalt or big picture of a situation. The right side of the brain also seems to be involved in being able to admit to a problem. Many men just don't see the problems a.s.sociated with anxiety or depression even though the symptoms may be very clear to others.

Here are several suggestions to help people who are unaware of or unwilling to get the help they need. Try the straightforward approach first (but with a new brain twist). Clearly tell the person what behaviors concern you, and explain that the problems may be due to underlying brain patterns that can be easily tuned up. Tell them help may be available-not help to cure a defect but rather help to optimize how their brain functions. Tell them you know they are trying to do their best, but their behavior, thoughts, or feelings may be getting in the way of their success (at work, in relationships, or within themselves). Emphasize better function, not defect.

Give them information. Books, videos, and articles on the subjects you are concerned about can be of tremendous help. Many people come to see us due to a book, video, or article. Good information can be very persuasive, especially if it is presented in a positive, life-enhancing way.

When a person remains resistant to help, even after you have been straightforward and given them good information, plant seeds. Plant ideas about getting help and then water them regularly. Drop an idea, article, or other information about the topic from time to time. If you talk too much about getting help, people become resentful and stubbornly won't get help, especially the overfocused types. Be careful not to go overboard.

Protect your relationship with the other person. People are more receptive to people they trust than to people who nag and belittle them. Work on gaining the person's trust over the long run. It will make them more receptive to your suggestions. Do not make getting help the only thing that you talk about. Make sure you are interested in their whole lives, not just their potential medical appointments.

Give them new hope. Many people with these problems have tried to get help and it did not work or it made them even worse. Educate them on new brain technology that helps professionals be more focused and more effective in treatment efforts.

There comes a time when you have to say enough is enough. If, over time, the other person refuses to get help, and his or her behavior has a negative impact on your life, you may have to separate yourself. Staying in a toxic relationship is harmful to your health, and it often enables the other person to remain sick as well. Actually, I have seen that the threat or act of leaving motivates people to change, whether it is about drinking, drug use, or treating ADD. Threatening to leave is not the first approach I would take, but after time it may be the best approach. Realize you cannot force a person into treatment unless they are dangerous to themselves, dangerous to others, or unable to care for themselves. You can only do what you can do. Fortunately, there is a lot more we can do today than even ten years ago.

Finding a Competent Professional Who Uses

This New Brain Science Thinking

The Amen Clinics get many calls, faxes, and e-mails each week from people all over the world looking for competent professionals who think in similar ways to the principles outlined in this book. Because this approach is on the edge of what is new in brain science, other professionals who know and practice this information may be hard to find. However, finding the right professional for evaluation and treatment is critical to the healing process. The right professional can have a very positive impact on your life. The wrong professional can make things worse.

There are a number of steps to take in finding the best person to a.s.sist you. The right help is not only cost effective but saves unnecessary pain and suffering, so don't rely on a person simply because they are on your managed care plan. That person may or may not be a good fit for you. Search for the best. If he or she is on your insurance plan, great, but don't let that be the primary criteria. Once you get the names of competent professionals, check their credentials. Very few patients ever check a professional's background. Board certification is a positive credential. To become board certified, physicians must pa.s.s additional written and verbal tests. They have had to discipline themselves to gain the skill and knowledge that was acceptable to their colleagues. Don't give too much weight to the medical school or graduate school the professional attended. I have worked with some doctors who went to Yale and Harvard who did not have a clue on how to appropriately treat patients, while other doctors from less prestigious schools were outstanding, forward thinking, and caring. Set up an interview with the professional to see whether or not you want to work with him or her. Generally you have to pay for their time, but it is worth spending the money to get to know the people you will rely on for help.

Many professionals write articles or books or speak at meetings or local groups. Read the work of or hear the professional speak, if possible. By doing so, you may be able to get a feel for the person and his or her ability to help you. Look for a person who is open-minded, up-to-date, and willing to try new things. Look for a person who treats you with respect, who listens to your questions, and responds to your needs. Look for a relationship that is collaborative and respectful. I know it is hard to find a professional who meets all of these criteria who also has the right training in brain physiology, but these people can be found. Be persistent. The caregiver is essential to healing.

Do not let pride get in the way of getting the help you need. In order to make a good brain great, you have to admit when you need help.

Lesson #11: Fix the issues that get in the way of great s.e.x.

A HEALTHIER BRAIN.

EQUALS A s.e.xIER YOU.

Strategies to Improve Your Brain and Life You know you've got to exercise your brain just like your muscles.

-WILL ROGERS I am a sucker for a beautiful brain. Usually one needs to be attracted physically to a potential romantic partner, but my brain-imaging work has taught me that it is also a good idea to be attracted to the appearance of a person's physical brain as well. Ugly brains usually make for ugly relationships. "Beauty and brains" is more than just a cliche. In 2001, CNN International aired a story on my imaging work. News anchor Marina Kolbe spent several days in our clinic watching us work and filming the imaging process; she was even scanned herself as part of our healthy-brain study. Besides being a smart, attractive woman, she also had one of the prettiest brains I had ever seen. Now, to a neuroscientist, that is ever so s.e.xy. She and I have been friends ever since. Her behavior is consistent with her lovely brain. Beauty is much more than skin deep.

Roseanne has been a friend of mine for many years. She is an attractive woman, but not attractive to me. I saw her as anxious, worried, and fretful. One day her doctor put her on the antidepressant Zoloft to calm her anxiety. Several weeks later I found myself being more interested in her. Something about her was different. Even though she looked the same, she was more appealing. She had an air of confidence that had been missing before the medication. Her smile was brighter and she seemed to have a more genuinely positive internal state. Her eyes had a new, more intense sparkle. Her brain was more relaxed, one of the effects of Zoloft. A healthier brain is a.s.sociated with a healthier, s.e.xier you.

Since your brain is involved in everything you do, including everything s.e.xual, it follows that a healthy brain is more likely to be a.s.sociated with more effective behavior, at work, at home, and even in the bedroom. A healthy brain will give you more consistently loving behavior, help you read social cues, and allow you to be a better lover. As in Roseanne's case, it can even increase your s.e.x appeal. Working to keep your brain healthy increases your chances for loving relationships and great s.e.x.

In my work I have seen many things that hurt how the brain functions, ruining your chances for love; and many things that help brain function, improving your chances for love. In this chapter I will explore behaviors that make your brain look old, ugly, shriveled, and damaged as well as those things that enhance and beautify the brain. Once you know what helps and hurts the brain, you will have a clearer choice on how healthy you want your brain to be, and subsequently how effective you will be.

Hurtful Brain Behaviors Brain Trauma One of the most important lessons I have learned from looking at 35,000 scans these last sixteen years is that mild traumatic brain injuries change people's whole lives and virtually n.o.body knows about it. Virtually no marital counselor on the planet thinks about evaluating brain trauma as part of why people struggle in their relationships. Even what many professionals would consider mild trauma can be harmful. The brain is the consistency of soft b.u.t.ter or tofu, somewhere between egg whites and Jell-O. It is housed in a really hard skull that has many ridges.

I recently scanned a nineteen-year-old man who had a skateboarding accident which caused him to be unconscious for about half an hour. Most physicians would consider that a mild traumatic brain injury. Yet on his scan it literally wiped out 25 percent of the front part of his brain; so the part of his brain that is involved with judgment, forethought, impulse control, organization, and planning is dead, from what professionals consider a minor brain injury. Protecting the brains of our children, our loved ones, and ourselves should be a top priority because brain damage affects us in a very serious way. A high percentage of people in prison have had brain injuries. There is a higher incident of children who struggle in school after a brain injury. There is a higher incident of depression and substance abuse after brain injuries.

I treat a couple in which the woman had a diving accident when she was eighteen years old, again something that was considered a mild traumatic brain injury as she was unconscious for only a short period of time. She was dating her soon-to-be husband at the time, and he noticed a big change in her behavior over the next six months. She went from being loving, attentive, sweet, consistent, and reliable to someone who was more emotional, depressed, disorganized, and temperamental. He felt committed to her and hoped she would change back to the person she used to be. Unfortunately, she struggled with her mood and her temper for thirty years, until she came to see me. When I scanned her, she was missing the function of about 30 percent of her left prefrontal cortex, which is the happy side of the brain. The left side of the brain has been reported by researchers to be the happy side, while the right side is a.s.sociated with more anxiety and negativity. When you hurt the happy side of the brain, the more anxious, negative right side has more dominance in your life. This injury seriously affected this couple's happiness.

I have discovered that you have to ask people five to ten times whether or not they have had brain trauma. People just forget, even serious injuries. I have a friend who has financial problems that have affected his marriage. His ability to have s.e.x suffers due to his financial problems. His wife is anxious about money and she feels insecure about their future. He is an amazing, sweet man, but struggles to make good financial decisions. Before I scanned him, I asked him seven or eight times whether or not he had had a head injury, which is common in people who struggle with finances. He said no, no, no, no, no, no. When I scanned him, I saw a large dent in the function of the front part of his brain. The only thing that I could figure is that he had a head injury that he forgot. So I asked him again and he said no. I asked him again and was very specific, "Have you ever been in a car accident?"

"No," he said.

And then, and it always happens this way, his faced changed, he got this "Aha" look on his face, and said, "I am so sorry. I lied to you. When I was fifteen years old I was in the front pa.s.senger seat of a car when we got in a head-on collision. I wasn't wearing my seat belt and my head broke the windshield. I lost my eyesight for four days. I can't believe I forgot that incident." He hurt a significant portion of the judgment center in his brain. He's still a wonderful, sweet, loving man, but when it comes to money, he would make bad decisions that increased his wife's anxiety and decreased her libido.

Having a head injury can really ruin your chances for great s.e.x. Protect your brain. I work with many couples who have experienced domestic violence. The incidence of head injuries in violent individuals is rampant and very few people know it. If you have serious problems with your temper and the police come to your house, the first thing the courts and mental health professionals recommend is anger-management cla.s.ses. If a head injury is part of the cause of the trouble, anger-management cla.s.ses are like trying software programs to fix hardware problems. Not very effective.

I once treated a man from Normal, Illinois, who was referred to me by his psychologist after I gave a lecture at the university there. What a fun visit for this California boy. I went to the Normal grocery store, was interviewed on the Normal radio station, and even had the opportunity to meet Normal women-not many normal women in California. ... The patient had been arrested for felony domestic violence. He had broken his wife's arm. When I met this man, he truly hated himself. He hated his temper and his inability to control the rage he felt inside. He was suicidal at our first visit. His SPECT scan showed a dent in the left-front side of his brain and he had very poor function in the part of his brain called the left temporal lobe, an area that we have a.s.sociated with violence. I had already asked him six times if he had had a head injury, to which he replied no, but when I had evidence on the scan of a head injury and asked if he had ever fallen out of a tree, fallen off a fence, or dived into a shallow pool, an "Aha" look came over his face and he said, "When I was six years old I was standing on top of the railing on our porch, it was raining, and I slipped and fell six feet head first into a pile of bricks. My parents told me I was only unconscious for a little bit. Do you think that could cause this problem?" I said it could and asked when the temper problems began. He said he had always had them. I then asked him to ask his mom if he had them before he was in kindergarten. It turned out that his temper problems started when he was in first grade. He had problems nearly his whole life, probably secondary to a brain injury n.o.body knew about. He and his wife had been to multiple relationship counselors with no benefit. If you never look at the brain, you may miss very important pieces of information. The combination of the right medication changed his life. The other interesting thing is that it changed his wife's life as well because rather than seeing him as a bad person, she saw him as somebody who was sick, that potentially with the right treatment could get much better.

Emotional Trauma In a similar way, emotional trauma can change the brain negatively and make it harder for you to get the love that you want. Whenever people have been physically, emotionally, or s.e.xually abused, brain changes take place. Being in a fire, car accident, earthquake, or flood can also change the brain. In our imaging work we have seen specific scan patterns a.s.sociated with emotional trauma. The limbic or emotional centers of the brain tend to become overactive, making people vulnerable to obsessions, anxiety, and depression, all things that interfere with our ability to connect with others in a loving way. It has been well doc.u.mented that adverse childhood events affect people throughout their life. These experiences disrupt the child's ability to form secure attachments to their parents. This may lead to their inability to form secure attachments later in life. These people have multiple partners and are promiscuous in their s.e.xuality.

As with brain injuries, many people forget they have had emotional trauma. When we see the scan pattern a.s.sociated with trauma, we ask about it multiple times. I have been surprised many times by people who said they never had trauma, later to remember being s.e.xually molested, in a fire, robbed at knife point, raped, or even attacked by animals.

One of our patients, who saw a colleague of mine at the clinic, had the scan pattern of emotional trauma. She initially denied any past trauma. When given more specific examples, such as being in a fire, robbed, or raped, she said no, no, no. Then after a long hesitation she said that there was this one time when she was ten years old and went to a friend's house in the high desert of California. Her friend's father was an actor who collected unusual animals. They had a lion at home and the day she was at her friend's house, the lion got loose and chased her, pinned her, and actually had her head in his mouth before they got him off of her.

Emotional trauma can impact the brain and wreak havoc in your love life. Getting the emotional trauma treated can actually rebalance the brain and improve your chances for love. Many researchers have seen that early abuse survivors have overlapping psychiatric disorders. Therefore, they may suffer from major depressive disorder, generalized anxiety disorder, and panic disorder. Emotional trauma, like abuse or exposure to domestic violence, at early ages has been studied extensively and has shown that negative behaviors have resulted later in life. Depression, suicide, and drug abuse in later life are often a.s.sociated with trauma early in life.

Drug and Alcohol Abuse Drugs and alcohol clearly damage the brain. They prematurely age and lower overall function in the brain. Alcohol is toxic to the brain if you drink more than a couple of drinks a week. A study from Johns Hopkins University reported that people who drink every day have smaller brains. When it comes to the brain, size really does matter. Alcohol kills cells in the cerebellum, the back bottom part of the brain that is involved with coordination, learning, and o.r.g.a.s.mic pleasure.

Many people drink and use drugs as a way to medicate negative feelings. If you have experienced emotional trauma, you are more likely to drink. In fact, up to 30 percent of people with alcohol abuse or drug abuse have emotional trauma in their backgrounds. As many as 60 percent of women who are substance abusers have posttraumatic stress disorder (PTSD), which is a.s.sociated with nightmares, flashbacks, emotional numbing, anxiety, insomnia. When they stop their drug or alcohol abuse, their PTSD often gets worse. People also medicate social anxiety with marijuana, painkillers, or alcohol. They feel better in social situations, less inhibited. The problem with using substances for self-medication is that they actually damage brain function and subsequently damage the parts of the brain involved in forethought, judgment, impulse control, organization, and planning-all things important for healthy s.e.xual behavior.

I once saw a woman from Maine who had problems with obsession and anxiety. Her husband came along and got scanned, in his mind, just to support his wife. I looked at her brain and saw the trouble we expected and prescribed a course of treatment. When I looked at his fifty-six-year-old brain, his brain looked like he was eighty. I asked him what he was doing to hurt his brain.

"Nothing, Dr. Amen," he said.

I said, "Really? How much do you drink?"

"Oh, not very much," he replied.

"What's not very much?"

"Oh, maybe I have three or four drinks a day."

"Every day?" I said.

"Yeah, every day. But it's never a problem. I never get drunk. I have never gotten into trouble with it," he said with anxiety.

I said, "Why do you drink every day?"

"Since my son went off to college, I have this empty-nest thing going on. I just get great enjoyment out of going to the bar, seeing my friends. It's a social time, kind of like the show Cheers."

I said, "Well, you are poisoning yourself. You're fifty-six and you're brain looks like it's eighty. If you keep this up, pretty soon a lot of your brain is going to be dead."

It shocked him that his brain looked as bad as it did. Then he developed this concept I call brain envy. After learning about the brain, he wanted a better one. I helped him develop a brain-healthy plan that included abstinence from alcohol, regular exercise, mental exercise, vitamins, and fish oil. Four months later he wrote me back saying that he mentally felt like he was twenty. His energy and memory were better, he felt smarter, more articulate. His work as a writer had also improved.

Lisa, forty-two, drank three to four gla.s.ses of wine nearly every day. She rarely got drunk, but felt uncomfortable when she didn't drink. Her husband noticed over the past few years that she was not herself. She was more forgetful and more irritable. She started to have high blood pressure and was much less s.e.xual and less s.e.xually responsive. I saw her out of concern for her memory problems. Her SPECT scan showed overall decreased activity. She had a toxic brain. The alcohol was damaging her brain, affecting her memory and moods, and even her s.e.xuality. High blood pressure is a common side effect of too much alcohol. With high blood pressure, blood flow to vital organs, such as the brain and genitals, is impaired, so there will be trouble having an o.r.g.a.s.m and trouble thinking, a bad combination.

Sometimes small amounts of alcohol can calm anxiety and help people be more receptive to social and s.e.xual interactions. Small amounts of alcohol have been found useful for a number of issues, including heart health. But small amounts mean one or two gla.s.ses a week, not a day as most people think. A little bit of alcohol is not my concern in this section.