INTRODUCTION: YOUR BRAIN IS ALWAYS LISTENING
TO HIDDEN DRAGONS

It’s simply not an adventure worth telling if there aren’t any dragons.

J. R. R. TOLKIEN

In March 2020 as I was writing this book, I got a call from superstar Miley Cyrus. I could tell from the sound of her voice that she was freaking out. I’d been working with her since she was 18, when she first came to me filled with anxiety and fear. She used to worry nonstop that she would get sick or that her mom might get sick. She worried about the awful things that might happen if she didn’t have a boyfriend. She even thought she would die if she wasn’t in a relationship. As we worked together, Miley learned some powerful strategies to help her control these negative thoughts. But on this day, the anxiety had come roaring back, and I knew exactly why.

The coronavirus (COVID-19) outbreak, which had already killed thousands in China, was now spreading like wildfire around the globe, and it was starting to hit the US hard. On the phone, Miley rattled off so many questions about things that were terrifying her —like “How long does the virus live on packages?” —that I could hardly get a word in edgewise.

I finally managed to get Miley to take a few deep breaths with me to help her calm down. It was obvious to me that this new pandemic had unleashed Miley’s dragons from the past. These long-hidden dragons were now breathing fire on the fear centers of her brain, fueling her anxiety, worry, and negative thinking patterns. I let her know that in these unprecedented times, she needed to become a dragon tamer to soothe the savage beasts within.

As we worked through the dragon taming process —the same strategies I will share with you in this book —Miley went from feeling scared and helpless to feeling empowered and in control. She couldn’t wait to share what she’d learned in an Instagram Live series with her 105 million followers. She called the series Bright Minded, putting her own spin on my BRIGHT MINDS program for better brain health, which I wrote about in The End of Mental Illness. I was honored to be Miley’s first guest on the show, where we talked about ways to deal with the rampant stress, anxiety, depression, and loneliness, as well as the feelings of grief and loss, that were skyrocketing due to the COVID-19 pandemic.[1] From the comments her followers posted —such as “This is making me feel much better” and “Didn’t know how helpful this would be. THANK YOU!” —it was clear that Miley wasn’t the only one whose dragons from the past had been triggered as people were being forced to shelter at home and as the virus started crippling our economy and claiming American lives. It seemed as if everyone was feeling traumatized and mourning the loss of something —a job, a sense of security, a daily routine, a sport (playing or watching), a favorite restaurant, physical connections (no hugs!), or the death of a family member.

I had no idea at the time that COVID-19 was about to strike in my own family or that I would be suffering the devastating loss of a loved one just a few weeks later.

“She put on lipstick, wore sunglasses, packed a suitcase and, as the ambulance was arriving, she told some family members she was on her way to die.” That was the opening line from an April 16, 2020, article in the Orange County Register about my parents and their experience with the deadly coronavirus.[2] It fit my mother perfectly. In March, my mom (Dori Amen), who was 88 at the time, and my dad (Louis Amen), who was 90, both contracted pneumonia and tested positive for COVID-19. After getting the diagnosis, medical personnel wrapped my parents in yellow tarps, loaded them into separate ambulances, and whisked them away to the hospital. I thought the future was grim. According to the Centers for Disease Control (CDC), 10 to 27 percent of seniors over the age of 85 who develop the illness will die.[3] I was afraid my parents might be among them.

My parents’ doctor, also the hospital’s infectious disease director, admitted in the Register article that when my parents arrived at the hospital, he was petrified. But he had not met my mom and dad. Five days later, my parents left the hospital COVID-free and went home. It appeared they had beaten the illness. Over the next few weeks, my mom recovered quickly and really wanted to get back to playing golf, but my father continued to struggle. He had been suffering from a cough for weeks prior to testing positive for COVID-19, and he had recently been in the hospital for a gastrointestinal bleed that caused him to lose one-quarter of his blood.

On May 5, 2020, as I was getting ready to pick him up for a follow-up appointment, my mom called me in a panic saying he wasn’t breathing. I dialed 911 and raced over to their home. The paramedics did their best, but they couldn’t get him breathing again.

My dad joined the angels that day.

And suddenly the Grief and Loss Dragons that I had been helping so many of my patients and social media followers cope with during the pandemic unleashed a fireball in my brain. Fortunately, as a psychiatrist who has spent decades helping people deal with death and loss, I knew that I needed to start the healing process as soon as possible. Some people think you need to wallow in suffering following the death of a loved one, but I always ask, “If you broke your arm, would you wait six weeks to get the bone set?” One of the most important steps in healthy grieving —I’ll go over all of the steps in more detail in section 1 on the Death Dragons and the Grief and Loss Dragons —is to express your feelings rather than bottling them up. So I decided to share my pain with my followers on social media.

In a series of nightly live chats during the pandemic, I explained that during the mourning process —and at all times —your brain is always listening and responding to the hidden influences that act on it. This became even more evident in May 2020 when the heartbreaking and senseless death of George Floyd —a black man from Minneapolis who was killed when a white police officer kneeled on his neck for over eight minutes despite his cries of “I can’t breathe” —led to rage and destruction. This social injustice on top of the rampant stress of the pandemic triggered the release of Angry, Judgmental, and Ancestral Dragons (which you will learn more about in this book) that drove some people into the streets to protest peacefully while spurring others to loot, vandalize, and set fires. The powerful influences on your brain include:

Unless you recognize and redirect these influences, they can steal your happiness, damage your relationships, pilfer your health, rob your ability to cope with stress (like the coronavirus pandemic), and limit your destiny. The good news is that once you become aware and tame these dragons and eliminate the ANTs, you can break bad habits, shut down self-defeating thoughts, shore up your capacity to cope with uncertainty, reduce your vulnerability to schemers, and heal addictions. In fact, taming your dragons is essential for good mental health because when they control your brain, your entire life suffers.

JIMMY’S HIDDEN DRAGONS

The afternoon I met Jimmy, 39, a high-level business executive, he sat next to his wife on the soft burgundy leather sofa in my office. He had just been released from a psychiatric hospital that morning and looked anxious and worn-out. A week prior he’d told an emergency room doctor he had thought of killing himself to end the feelings of dread, panic, anxiety, and hopelessness that just wouldn’t go away. His Anxious Dragon, one of the 13 Dragons from the Past, was running rampant in his brain.

Jimmy had been seeing another psychiatrist for years to refill medication for anxiety and depression, which was explained as “working to fix a chemical imbalance.” The medication took the edge off his negative feelings, but it also took the edge off his positive feelings. While seeing the psychiatrist, he never learned any skills to deal with his Anxious Dragons or the 12 other ones that fueled his dark thoughts and mood swings.

The current “episode” that brought Jimmy to the ER started two weeks before when he found out he had to give a presentation to one of his company’s largest customers. It filled him with dread. He told me, “If I had to describe the fear, it’s like you’re on death row and the clock’s run out. The guard opens the door and you must take the first step —that kind of fear runs through my bones.” Jimmy had struggled with glossophobia (the fear of public speaking) since middle school. Through an exercise called Break the Bonds of the Past, which I will explain later, we learned that this fear started when he was 12, the day his grandmother made him give an “impact statement” at the Los Angeles County Superior Court about why his father, one of the leaders of a violent street gang, should not get the death penalty for a double homicide. Jimmy’s Anxious Dragons breathed fire on the fear centers in his young brain, and he was attacked by ANTs (automatic negative thoughts), including, What if I cannot speak in court and end up killing my father?

Even though Jimmy had repressed the memory, his Anxious Dragons haunted him throughout the rest of middle school, high school, and college, and into his adult life. He went to great lengths to avoid waking these dragons by dodging any presentations until about six years before when his supervisor asked him to give a brief talk at work about his role in the company. He loved his job but ruminated for days about how he would be unable to put his thoughts into words. Even after giving the presentation, the ANTs multiplied, stacked on top of one another, and attacked him, linking to many other catastrophic thoughts, such as:

A series of sentences contained in boxes, an arrow pointing from each box to the next. The sentences read, 'I can't speak in public. So I'm going to lose my job. I'm going to be afraid of interviewing. So I won't be able to get a new job. I'm a loser. My wife will divorce me. I'll end up on the streets. I should kill myself.'

That is when Jimmy started to see his original psychiatrist, went on medication, and made a conscious decision to overcome his fear, which worked for a while. He gave tours at work, traveled, and met with clients. He also gave his life to God and became an active member of his church, which he found incredibly helpful. However, the Anxious Dragons and other Dragons from the Past reappeared when he was given new responsibility at work, and once again his anxiety spiraled out of control.

Growing up, Jimmy had experienced intense, persistent psychological trauma (Wounded Dragons). He saw his father dealing drugs and beating up people. His father was incarcerated when Jimmy was a small child, and he went with his grandmother to visit his dad, who made him introduce himself to other gang leaders, which filled Jimmy with dread. He witnessed drive-by shootings and was in car chases before age nine. He was kidnapped twice by feuding family members, and he feared for his life on many occasions. Once a dozen SWAT officers crashed through his family’s front door with weapons drawn while Jimmy was lying on the couch in his father’s arms during a rare time when his father was home on parole. After his father’s rearrest, his mother sent Jimmy to live with his grandparents, even though she kept his two younger siblings. His Abandoned, Invisible, or Insignificant Dragons told his brain that he was alone and unloved. He also witnessed his grandmother being sexually assaulted, and the perpetrator asked Jimmy if he wanted to have sex with her too, which filled him with a sense of shame and hopelessness (Should and Shaming Dragons).

Jimmy’s brain was always listening to his Ancestral Dragons from his family history and genetics. His mother took medication for anxiety, and there was a family history of anxiety and alcohol abuse. His father’s side of the family had rampant psychiatric issues, including panic attacks, depression, and drug abuse, and his siblings had similar problems.

Jimmy’s brain was also always listening to his Bad Habit Dragons that had formed from listening to the other dragons in his life. One of Jimmy’s bad habits particularly disturbed his wife. He loved to watch violent movies, boxing and UFC matches, animal attacks, and execution documentaries, which he had watched with his father. Being exposed to intense, life-threatening violence as a young child had set his “arousal template” (what gave him the most powerful emotional rush) to these disturbing images, but they only perpetuated the stress inside his brain and body.

Not only was Jimmy’s brain run by these dragons, he’d also had a number of head injuries from playing football (he was a high school all-conference linebacker), boxing until he was 18, and being involved in a number of bar fights. When he was 15, he fell eight feet onto his head; he convulsed, lost consciousness for about 10 minutes, and lost the hearing in his right ear. He was hospitalized for four days, and that whole summer he had to relearn how to walk. To quiet his Anxious and Wounded Dragons, Jimmy used drugs and alcohol as a teenager and young adult, but they gave him only temporary relief.

Jimmy had no idea that dragons were running his brain and his life. The only messages his brain could hear were that he was hopeless, messed up, and a failure. Jimmy’s dragons told him many stories —such as You were abandoned, You are unlovable, The world is dangerous, and You can’t speak in public —which eventually caused his downward spiral and his belief that he’d be better off dead. Most of us did not have trauma as intense as Jimmy’s growing up, but unless we are consciously taught how to identify the voices of our dragons, we may still create horror stories based on erroneous or incomplete inputs that can cause us to feel or act in self-defeating ways.

As part of our evaluation of Jimmy, we took a detailed history to understand the story of his life, reviewed the records from his prior doctor and the hospital, ran a complete set of laboratory tests, and did a sophisticated 3D brain imaging study called SPECT (single photon emission computed tomography), which is a nuclear medicine study that evaluates brain blood flow and activity. SPECT is different from the structural CT or MRI scans, which both assess brain anatomy. SPECT looks at how the brain functions and basically tells us three things about brain activity: whether it is healthy, underactive, or overactive. At Amen Clinics we have been performing SPECT scans for 30 years and have built the world’s largest database of brain scans related to mental health issues, totaling more than 175,000 scans on patients from 155 countries.

The images on the following page represent a healthy SPECT scan. The image on the left looks at the outside surface of the brain, which shows full, even, symmetrical activity. It’s called a surface scan. In the image on the right, white shows the most active areas. In a healthy scan these are typically in the cerebellum (the back, bottom part of the brain), which contains half the brain’s neurons. The image on the right is called an active scan.

Jimmy’s SPECT scan showed two significant findings:

  1. Low activity in his left temporal lobe on the surface scan, in a pattern consistent with past brain trauma. This part of the brain is involved with mood stability, irritability, expressive language difficulties (finding the right words), memory issues, anxiety, and dark thoughts. When hurt, this area can send interruption signals to the rest of the brain.
  2. Increased activity in a diamond pattern in the limbic or emotional part of the brain, consistent with past emotional trauma that became stuck in his brain, so it is always listening to painful inputs from the past.

By diligently using the strategies in this book, by understanding and taming the hidden dragons and eliminating the ANTs, and by getting his diet, nutrients, and brain healthy, Jimmy thrived. Over the next six months, his mood stabilized and his anxiety lessened. He was able to become an even more important part of his team at work and a happier and more loving husband and father. In addition, he lost 37 pounds, felt stronger, and had more energy than he’d had in years. He also started to help others in his family get well. Continuing to use these strategies during the pandemic helped him and his family cope in healthy ways that kept them emotionally strong in spite of the added stress.

This book will explore the many reasons —some hidden and some obvious (like the pandemic) —that dragons and ANTs are constantly talking to your brain, making you feel sad, anxious, worried, depressed, mad, or out of control. With practical strategies to tame your dragons, you will take control of your brain and be able to choose what it listens to. You’ll no longer give in to negative thinking or let bad habits derail your health and relationships even in times of trauma, extreme stress, or grief. You’ll be able to recognize what’s true, build your self-confidence, discipline your mind, and feel happier, calmer, and in more control of your own destiny. In order to get and stay well, once you understand and use this information, share it with loved ones; that way you are also creating your own support group, making it more likely you will keep these new habits for the rest of your life.