CHAPTER 4: GET YOUR BRAIN RIGHT AND YOUR MIND WILL FOLLOW: IT STARTS WITH FOUR CIRCLES AND PREVENTING OR TREATING 11 RISK FACTORS

She will be a star if you surround her with stars. She will go to jail if you surround her with people who go to jail.

MY COMMENT TO THE MOTHER OF ONE OF MY TEENAGE PATIENTS

To get your mind right, you must first have a healthy brain. Imagine going to a psychotherapist for depression, anxiety, bipolar disorder, or an addiction with a brain that has been physically traumatized; a brain that is inflamed, poisoned, infected, or low in neurohormones; or a brain that works too hard or not hard enough. You spend the time, invest the money, make the effort, and open up your emotional vulnerability trying to get the help you need, but it doesn’t work because you cannot focus, remember, or process the information. You are likely to quit therapy and feel demoralized and “less than others” who you assume are benefitting from similar techniques. You wonder why therapy seems to work for them but not for you. When this is the case, therapy can actually do more harm than good because of the failed expectations and wasted resources. Here is an example:

DAVE AND BONNIE

Dave and Bonnie were struggling in their marriage. Dave had a bad temper and many negative thoughts, and Bonnie was having a hard time dealing with his behavior. They decided to go to a psychologist for marital therapy and stuck with it for three years. But it was a frustrating endeavor. Try as they might to get closer, nothing seemed to work. The therapy sessions were filled with blaming, bickering, frequent explosions, and a general sense of unhappiness. The therapist, who was very experienced, tried and tried. She had diagnosed Dave with mixed personality disorder with narcissistic and antisocial features, along with intermittent explosive disorder, but none of the usual treatments, strategies, or relationship tools helped them make any progress. After considerable thought, the doctor decided to give the couple an F in marital therapy. She told Dave and Bonnie that, in her opinion, it was time for divorce. After spending years of effort and more than $25,000 trying to heal their marriage, the couple protested, and the therapist said there was one more option. She told them about Amen Clinics, where some of her most difficult clients had found help.

After an evaluation, our team performed brain SPECT scans on the couple. Bonnie’s scan was healthy. But Dave’s brain scan looked shriveled and full of holes, the same pattern that we see in drug or alcohol abusers. This was odd because Dave said he didn’t drink and never used drugs. To make sure, in front of Bonnie, I asked Dave if he was drinking heavily or using drugs, and he denied it.

I turned to Bonnie for more information, knowing that alcoholics are often in denial and drug abusers often lie. She said, “He’s right. He doesn’t drink and, as far as I know, has never used drugs. That is not his problem, Dr. Amen. He’s just a jerk.” As an aside, his therapist’s diagnosis of mixed personality disorder with narcissistic and antisocial features was her way of calling him a jerk, but “jerk” is not a billable diagnosis.

Dave’s Toxic SPECT Scan

DAVE’S TOXIC SPECT SCAN

Notice shriveled appearance and huge “holes” of decreased activity

I chuckled at Bonnie’s comment. But if Dave was really not a drinker or drug abuser, my mind started immediately looking for alternatives about why he had such a toxic-looking brain. My psychiatrist friend Harold Bursztajn, former codirector of the program in psychiatry and law at Harvard, often says that scans don’t always give you the answer; they teach you to ask better questions. I went through the different potential medical causes in my head —brain infections, a near-drowning episode, hypothyroidism, anemia, environmental toxins. My next question to Dave was, “Where do you work?”

He replied, “I work in a furniture factory.”

“What do you do there?” I asked.

“Finish furniture.”

“Is there good ventilation in the room?”

“No,” Dave said. “It’s often hot and reeks with fumes.”

Oh my goodness, I thought. Dave has a drug-affected brain from the solvents he is using at work. Even though he had never willfully used drugs, the chemicals were eating away at his brain. Dave thought he was going to work to support his family, but he was really being poisoned.

“Do you wear a mask?” I asked.

“No. They tell me I should, but I don’t think it’s important.”

“Ouch,” I said. “You really should.” My next question was to Bonnie: “When did he start becoming a jerk?”

She thought for a moment. “We weren’t always unhappy. We’ve been married for 15 years. It just seems that the last eight were hard. The first years were great. He was so different.” Then a look of “Aha” washed over Bonnie’s face. “Dave started to work at the furniture factory eight years ago. Do you think his personality change can be from his job?”

“You bet,” I answered. “Something is damaging his brain and damaging his ability to be the kind, thoughtful, empathic, and loving man you married.”

I urged Dave to take a six-month medical leave of absence and would only allow him to return to a nontoxic job at the plant. After seeing Dave’s brain scans, Bonnie developed empathy for her husband. She went from thinking he was a jerk to seeing him as someone who was in need of help and understanding. When a person’s behavior changes dramatically or does not make sense, like Dave’s, it is important to consider brain health issues as a potential cause of the trouble.

It was clear to me that Dave’s problem was not just psychiatric; it was biological. Numerous studies have shown that exposure to chemicals and solvents has negative effects on brain health, including mood, memory, and attention.[97] No amount of therapy and no amount of effort on Dave’s part was going to heal the damaging effects the solvents had on his brain. The problem is virtually no marital therapists, psychologists, or psychiatrists start by mapping the brain, so they have no idea if it is healthy or unhealthy and in need of repair. And most don’t look into a patient’s biology that might be contributing to the problem. We can and must do better.

AMEN CLINICS FOUR CIRCLES BRIGHT MINDS PROGRAM

To end mental illness in people like Dave —as well as in my nieces, Alizé and Amelie, whom I told you about at the beginning of the book —we need to stop looking at psychiatric problems through a singular lens as just a cluster of symptoms and start assessing and treating the whole person. The Amen Clinics Four Circles BRIGHT MINDS Program was developed to help you and your loved ones achieve long-term brain health/mental health. This program has three main components:

1. 1. Optimize the four circles of a whole life —biological, psychological, social, and spiritual (covered in this chapter).
2. 2. Prevent or treat the 11 major risk factors that damage the brain and steal your mind (covered in part 2).
3. 3. Target treatment to your specific needs, such as ADD/ADHD, anxiety, depression, psychosis, or insomnia (covered in part 3).

THE FOUR CIRCLES

When I started medical school in 1978, our dean, Dr. Sid Garrett, gave us one of our first lectures on how to help people of any age for any problem. He told us, “Always think of people as whole beings, never just as their symptoms.” He insisted that whenever we evaluated and treated anyone, we should take into consideration the four circles of health and illness:

• Biological: how your physical body and brain function (body)

• Psychological: developmental issues and how you think (mind)

• Social: social support and interactions, and your current life situation (connections)

• Spiritual: your connection to God, the planet, and past and future generations; and your deepest sense of meaning and purpose (spirit)[98]

At Amen Clinics, we use these four circles as part of a balanced, comprehensive approach to assessment and healing. I wrote about them in Change Your Brain, Change Your Life. Each of these four circles interacts with the 11 BRIGHT MINDS risk factors you will read about in part 2. The interplay of these four circles and 11 risk factors is our guide for alleviating mental illness. When you ignore the four circles, it allows your risk factors to get out of control, and they can then conspire against you to create mental illnesses. On the other hand, when you care for the four circles, it minimizes your risk factors. They begin to work in concert to help prevent or treat mental illness not only in yourself but also in the next generation, whether nieces (like Alizé and Amelie), nephews, children, or grandchildren.

In this chapter, you will see how each of the four circles affects brain health/mental health. You will also discover how modern society is attacking the four circles and contributing to the rise of mental health/brain health problems. To offset these attacks, I’ll offer simple strategies to optimize each of the four circles. It starts by knowing and caring about them, avoiding anything that hurts them, and engaging in simple habits to optimize them.

Four Circles BRIGHT MINDS Program

FOUR CIRCLES BRIGHT MINDS PROGRAM

I want you to imagine two rulers in rival kingdoms. One is an evil ruler whose top priority is to create and perpetuate mental illness as a way to diminish and control the kingdom’s subjects. How would he or she do it? The evil ruler would turn the four circles against us, creating policies and promoting behaviors guaranteed to increase the BRIGHT MINDS risk factors (part 2). The other one is a benevolent ruler, who is passionate about ending mental illness in order to create more effective, happier humans. What would he or she do to end mental illness? The good ruler would encourage people to use the four circles to enhance brain health and to advocate policies and behaviors that would help minimize their risk factors.

Throughout this chapter, you’ll find charts for each of the four circles, detailing the societal influences and the steps that will contribute to either creating mental illness and making future generations (like my nieces, Alizé and Amelie) suffer or to ending mental illness and keeping future generations healthy.

Biological Circle

The first circle of a whole life and a healthy brain is biology —how the physical aspects of your brain and body function together. In order for your biology to operate at peak efficiency, its machinery (cells, connections, chemicals, energy, blood flow, and waste processing) needs to work right. The brain is like a supercomputer, with both hardware and software. Think of the biological circle as the hardware. Within it are the BRIGHT MINDS factors (which will each be explored in subsequent chapters):

Blood Flow

Retirement/Aging

Inflammation

Genetics

Head Trauma

Toxins

Mind Storms (abnormal brain electrical activity)

Immunity/Infections

Neurohormone Issues

Diabesity

Sleep

When the brain’s biology is healthy, all these factors work together in a positive way to maximize your success and sense of well-being. When any of the BRIGHT MINDS risk factors are troubled, you are more likely to suffer with a wide variety of symptoms.

BIOLOGICAL CIRCLE

THE EVIL RULER WOULD . . .

Perpetuate the biological warfare in America by keeping 88 percent of the population metabolically unhealthy. (More biological evildoings in the BRIGHT MINDS chapters.)

THE BENEVOLENT RULER WOULD . . .

Counteract the biological warfare waged on society by creating a nationwide program that would help people fall in love with their brains. It would start in schools and go into churches, businesses, and senior centers —anywhere people gather.

Unfortunately, America’s population is being assaulted by biological warfare. Only 12 percent of the population is metabolically healthy.[99] According to a 2018 study, researchers reported that 88 percent of the population did not meet the following criteria for optimal health:

• Waist circumference —less than 45/35 inches for men/women
• Fasting glucose —less than 100mg/dL and hemoglobin A1c less than 5.7 percent
• Blood pressure —systolic less than 120 and diastolic less than 80mmHg
• Triglycerides —less than 150mg/dL
• High-density lipoprotein (HDL) cholesterol greater than 40/50mg/dL for men/women
• Not taking any related medication[100]

No wonder there is a high incidence of mental illness. Your brain is an organ linked to the rest of your body. When your body is unhealthy, so too is your brain. Singer Demi Lovato, who has talked openly about having bipolar disorder, has been publicly urging people to look at the biology behind mental disorders. In 2015, she told People magazine, “The problem with mental illness is people don’t look at it as a physical illness. When you think about it, the brain is actually the most complex organ in your body. We need to treat it like a physical illness and take it seriously.”[101]

---

In the biological circle, each one of the BRIGHT MINDS risk factors can create a mental illness.

 

---

 

BIOLOGICAL CIRCLE

STEPS TO CREATE MENTAL ILLNESS . . . AND MAKE MY NIECES, ALIZÉ AND AMELIE, SUFFER

1. 1. Don’t care about your brain.
2. 2. Engage in habits that hurt your brain and promote the BRIGHT MINDS risk factors (see part 2).
3. 3. Avoid regular brain-healthy habits.

STEPS TO END MENTAL ILLNESS . . . AND KEEP MY NIECES, ALIZÉ AND AMELIE, HEALTHY

1. 1. Love your brain.
2. 2. Avoid anything that hurts your brain (such as the BRIGHT MINDS risk factors, see part 2).
3. 3. Engage in regular brain-healthy habits (explored throughout the rest of the book).

Here is my favorite tiny habit that relates not only to the biological circle but to all four circles.

---

When you come to a decision point in your day, ask, “Is the decision I’m about to make good for my brain or bad for it?” It takes three seconds, and if you consistently make good decisions, your brain and mental health will begin to improve immediately.

---

 

Psychological Circle

The psychological circle includes how we think and talk to ourselves —the running dialogue in our minds —as well as our self-concept, body image, past emotional traumas, upbringing, and significant developmental events.[102] This circle helps us decide if we are enough —good enough, smart enough, pretty enough, strong enough, rich enough, and so on. When we feel as if we are enough, we are happier and more successful in our relationships and work. When we feel less than enough, it drives a sense of sadness, anxiety, and failure.

I keep fighting voices in my head that say I’m not enough.

LAUREN DAIGLE, “YOU SAY”

Growing up in a reasonably happy home, receiving positive messages, and feeling confident and comfortable with our abilities and our bodies all contribute to good psychological health and the feeling of being enough. When we struggle in any of these areas, we are less likely to be “psychologically healthy.” If we perceive ourselves as unattractive or somehow inferior to our peers, trouble starts to accumulate. If our thoughts are excessively harsh or critical —I call these automatic negative thoughts (ANTs) —it will have a negative impact on our moods, anxiety levels, and ultimately on our biology.

Developmental issues, such as adoption, neglect or abuse, or surviving a significant loss or trauma as a child, are also important. Children often believe that they are the center of the universe and if something bad happens, such as a child’s dad having a heart attack, the child may think it’s his fault and be racked with guilt. Successes and failures, hope, a sense of worth, and personal power or control are a part of the psychological circle.

---

In the psychological circle, past emotional trauma, undisciplined thinking, ANTs, excessive social media and screen time, and shame can create a mental illness.

 

---

 

PSYCHOLOGICAL CIRCLE

THE EVIL RULER WOULD . . .

1. 1. Use psychological warfare to hurt subjects. This includes ignoring past emotional trauma created by alcoholic or drug-abusing parents and not addressing current or past traumas from earthquakes, fires, floods, immigration, and criminal behaviors.
2. 2. Model undisciplined, negative thinking patterns and never teach people how to eliminate the ANTs that infest their minds.
3. 3. Perpetuate shame, one of the most powerful psychological weapons. Shame is a painful emotion that results from negatively comparing yourself to others or not living up to your own standards. Social media outlets are masterful at creating shame as they invite nonstop comparisons to other people who may or may not even be real. Because of this, the evil ruler would use social media to shame others and would give people free rein to spout hateful ideas without consequences.

THE BENEVOLENT RULER WOULD . . .

1. 1. Make psychotherapy readily available for those who want or need it, especially if they’ve had past emotional trauma, after they have worked to optimize their brains.
2. 2. Teach subjects how to deal with current or past emotional traumas.
3. 3. Make rational thinking skills (eliminating the ANTs) part of the educational curriculum, along with ways to help people self-regulate their bodies and emotions with guided imagery, meditation, and hypnosis.
4. 4. Limit social media so people cannot endlessly compare themselves to others, never feeling enough.
5. 5. Require all therapists to have brain health modules as part of their education programs.
6. 6. Incorporate more green space into urban planning to promote better moods and reduce the incidence of mental illness.[103]

I find Eckhart Tolle’s concept of the “painbody” to be a very helpful psychological concept. He writes, “There is such a thing as old emotional pain living inside you. It is an accumulation of painful life experience that was not fully faced and accepted in the moment it arose. It leaves behind an energy form of emotional pain. It comes together with other energy forms from other instances, and so after some years you have a ‘painbody,’ an energy entity consisting of old emotion.”[104] When your painbody bumps up against the painbodies of others, it can cause intense relational disturbances, where each painbody feeds off the others. Tolle teaches us:

Recognize the painbody when it shifts from dormant to active, when something triggers a very strong emotional reaction. At that moment, when it does take over your mind, the internal dialogue, which is dysfunctional at the best of times, now becomes the voice of the painbody talking to you internally. Everything it says is deeply colored by the old, painful emotion of the painbody. Every interpretation, everything it says, every judgment about your life, about other people, about a situation you are in, will be totally distorted by the old emotional pain.[105]

If you are present by being “in the moment,” the painbody cannot feed anymore on your thoughts or on other people’s reactions. The antidote to the painbody is to recognize it by asking, “Could this be my painbody talking? Am I reacting from the present moment or from pain in the past?” Tolle writes, “You can simply observe it, and be the witness, be the space for it. Then gradually, its energy will decrease.”[106]

To optimize your psychological circle, it is important to train your mind to help you rather than hurt you. In a recent public television special, my 16-year-old daughter, Chloe, shared some of her own anxieties about school, the way she looked, and her future. She knows these are common worries for teens, but that doesn’t mean they’re not painful. For many years, she thought she was the only person who felt that way. Many adults still carry the ANTs they collected during adolescence . . . which can continue to infest them for the rest of their lives unless they learn how to eliminate them.

---

To optimize the psychological circle, it is critical to train your mind to help you by eliminating the ANTs and soothing any painbodies.

 

---

You can train your mind to help you, but left undisciplined it can spin out of control. Unfortunately, most people are never taught how to train their minds. Chloe shared the following examples of the thoughts that used to torture her.

• I’m not good enough.
• I’m not smart enough.
• Why do I have to work harder than other people?
• Why am I the only person who feels this way?
• I don’t fit in.

I taught Chloe the following principles to train her mind:

1. 1. Whenever you have a sad thought, a mad thought, or a hopeless thought, such as “I don’t fit in,” your brain releases chemicals that make you feel bad. Your hands get colder, they start to sweat, your breathing changes, your muscles tense, you can’t think, and these changes happen immediately. But the opposite is also true.
2. 2. Every time you have a happy thought, a hopeful thought, or an empowering thought, such as “I don’t fit in, which may be a good thing,” your brain releases a different set of chemicals that make you feel good . . . immediately. Your hands become warmer and drier, your breathing rate slows down, your muscles become more relaxed, and you feel happier.
3. 3. Thoughts are powerful, and they can help you feel wonderful or miserable.
4. 4. Thoughts are automatic; they just happen.
5. 5. Unfortunately, thoughts lie. They lie a lot, and it is these bad thoughts that steal our happiness. We call them ANTs, but you can learn to kill the ANTs and be happier.
6. 6. To kill ANTs, write down what you’re thinking whenever you feel mad, sad, nervous, or out of control. Then ask yourself if the thoughts are factually true or whether you are jumping to a conclusion or making an assumption. Often ANTs are simply interpretations that you cannot prove as true. Can you absolutely know if they’re true? Challenging the ANTs helps to take away their power. (For a more in-depth look at how to kill the ANTs, see my book Feel Better Fast and Make It Last.)

Many of my patients wear rubber bands around their wrists and snap them whenever they notice bad thoughts to remind themselves to eliminate the ANTs. You don’t have to believe every thought you have. Killing the ANTs made a big difference for Chloe, and normally it only takes a few minutes. Plus, the more you do it, the easier it gets. If teenagers can do it, I think you can do it too.

Also, it is critical to program your mind to look for what is right, rather than just thinking about what is wrong. Where you bring your attention determines how you feel. I start every day with the phrase, “Today is going to be a great day.” It’s a simple way to begin training your brain to look for what’s right rather than what’s wrong, and it sets a positive tone for the rest of the day. Ending each day by journaling or meditating on what went well that day sets up your dreams to be much more positive. This simple technique will take about three minutes and can decrease depression in just 30 days. Do this as a household or family. Start every day by saying to each other, “Today is going to be a great day.” End each day by asking “What went well today?” It will completely change your relational dynamics in just a few days.

Practicing gratitude is also incredibly powerful. It increases happiness, self-esteem, self-control, you live longer, and your relationships are better. Gratitude should be written at the top of every prescription your doctor gives you, and journaling gratitude doesn’t have to take more than three minutes a day. It really helped Sarah, a 16-year-old who came to our clinic in Chicago in search of help for crushing depression.

Sarah Discovers the Power of Gratitude Journaling

February 2017 is when my story of mental illness began. What started out as frequent feelings of sadness slowly intensified into a numb depression. As time went on, the depression overcame and muted any feelings of happiness I had, making it seemingly impossible for me to enjoy the things I once loved. Thankfully, I hadn’t lost hope yet, and I found the strength to reach out and get professional help.

In the beginning, I tried therapy. I went to many appointments with several therapists, but I left each one feeling no better than when I went in. To me, it was simple. I didn’t have anything wrong with my life; I didn’t have anything to talk about or “fix.” When therapy didn’t help, I tried medication. I spent month after month trying what seemed like randomly selected cocktails of medications. Unfortunately, this was a dead end as well. Each time a medication didn’t help, I lost a little more hope.

Throughout these months my depression only continued to consume me, and anxiety decided to join the party. After tirelessly trying to feel better for months with my symptoms only declining, I settled at my lowest point yet. I had lost all hope of recovering, there was no more light to hold on to, and I felt as if there was no reason to keep trying. I gave up.

It was at this point that my grandma discovered Amen Clinics. Instead of randomly selecting medications to put me on, they would use brain scans to see exactly what I needed, my grandma explained to me. Seeing how much hope my mom and my grandma had in this, I went along with it.

In February 2018 my mom, my grandma, and I drove to the Chicago location of Amen Clinics. The first two days I was there I got both my brain scans done and completed a computer test. On the third day, I got my evaluation. From the test results, Dr. Michelle Flowers determined what the best treatment option would be for me. First, I would begin taking deliberately selected vitamins and supplements. I would also continue on the medication I was still on from my last doctor because with the help of these new supplements my body could use the medication to its full advantage. Secondly, I would begin trying a new type of therapy, and unlike the form [of] therapy I previously tried, this new therapy would be used to retrain my brain, not pick at it. And the third major piece of the puzzle was gratitude journaling.

In the beginning, it was challenging to think of pleasant moments to write about, but over time my brain learned to find these moments without thought. Before long, my brain was noticing moments to be grateful for all throughout the day.

I left knowing we had physical evidence and facts to back up the treatment plan. We had a plan that we knew would help. It wasn’t just some doctor telling me it would be okay, it was a doctor showing me what was wrong and how we could fix it. I still have a way to go in my recovery, but I have exactly what I need to keep growing, healing, and taking on what life throws at me.

 —Sarah, 16

It is important to recognize the psychological warfare being perpetuated by our society with the excessive use of social media, where teenagers and young adults are endlessly comparing themselves to others, never feeling enough. I talk about this with my nieces, Alizé and Amelie, on a regular basis to help them maintain a healthy perspective about social media. In a study of more than a million teens since 1991, researchers found that when the teens limited social media, spent time with their friends in person, exercised, played sports, attended religious services, read, and even did homework, they were happier than those who spent time on the internet and social media, playing computer games, texting, using video chat, or watching TV.[107]

PSYCHOLOGICAL CIRCLE

STEPS TO CREATE MENTAL ILLNESS . . . AND MAKE MY NIECES, ALIZÉ AND AMELIE, SUFFER

1. 1. Don’t think or care about your psychological health.
2. 2. Engage in habits that hurt your mind, including:
   • Comparing yourself to others (the seeds of shame)
   • Telling yourself you are not enough
   • Believing the ANTs
   • Not recognizing the painbody or getting help for your past emotional traumas
   • Focusing primarily on what’s wrong with you and others
3. 3. Avoid any education or habits on how to help your mind.

STEPS TO END MENTAL ILLNESS . . . AND KEEP MY NIECES, ALIZÉ AND AMELIE, HEALTHY

1. 1. Care deeply about your psychological health.
2. 2. Engage in regular healthy psychological habits, including:
   • Telling yourself you are enough
   • Challenging and eliminating the ANTs
   • Noticing what’s right about yourself more than what is wrong
   • Saying, “Today is going to be a great day.”
   • At the end of the day, journaling what went well that day
   • Practicing gratitude
   • Recognizing a painbody and focusing on being present to calm it down
   • Seeking brain-informed psychotherapy, when needed
3. 3. Avoid excessive social media use and bad psychological habits, such as believing every thought you have or not dealing with past emotional trauma.

Here are three of my favorite psychological circle tiny habits.

---

• Whenever you feel sad, mad, nervous, or out of control, write down your ANTs and ask yourself if they are assumptions, conclusions, interpretations, or truth. Can you absolutely know if they are true? Questioning your thoughts helps to take away their power.
• Every day when your feet hit the floor in the morning, say to yourself, “Today is going to be a great day!” That way your subconscious mind will find why it will be a great day. This helps to train your mind to look for what is right rather than what is wrong.
• Every night before bed, write down what went well that day. Research suggests it can improve your happiness after just one month.[108]

---

Social Circle

In a computer analogy, the biological circle is the hardware, the psychological circle is the software, and the social circle is the network connections. The social circle includes the quality of your relationships and any current stresses —think problems with your spouse or kids, crazy deadlines at work, a family member’s health crisis, or mounting credit card debt. When we have great relationships, healthy families, a job we love, and enough money, our brains tend to do much better than when any of these areas are troubled. Dealing with difficult life circumstances —such as a divorce, moving, a job change, or the death of a close family member —elevates stress hormone levels and makes us more vulnerable to many illnesses, including depression, anxiety disorders, and more.

---

You become like the people with whom you spend the most time. Relationship health is critical to the health of your brain and mind.

 

---

Stress occurs when a person perceives excessive demands on his or her emotional or physical resources. Stress increases to toxic levels when we feel things are out of control. In 1967, US psychiatrists Thomas Holmes and Richard Rahe studied the effects of stress on health, surveying more than 5,000 medical patients. They asked them to say whether they had any of a series of life events in the previous two years. The more events someone had, the more likely they were to become physically or emotionally sick.[109] Toxic stress has been associated with obesity, heart disease, cancer, ADD/ADHD, learning disabilities, social anxiety, depression, alcohol and drug abuse, PTSD, being arrested, and an unhealthy “fight or flight” aggressive tendency in the brain. Decreasing everyday stress (relationships, work, finances, and health) lowers inflammation and improves immune system function.[110]

SOCIAL CIRCLE

THE EVIL RULER WOULD . . .

1. 1. Cause strife among the people, subjecting them to chronic stress that separates them from each other, so that the ruler could retain more power.
2. 2. Bombard people with negative news cycles, creating an us-versus-them mentality and pitting political, racial, and other groups against each other.
3. 3. Create a society where recreational marijuana dispensaries are on every corner and alcohol is promoted as a health food. (In an example of evil-ruler entrepreneurial genius, Girl Scouts are now setting up outside marijuana dispensaries. In 2014, a 13-year-old Girl Scout sold 177 boxes of Samoas, Tagalongs, and Thin Mints outside a San Francisco pot dispensary. After being there just a short time, she had to call for help to be restocked. In 2018, a nine-year-old Girl Scout sold 300 boxes of the tasty treats outside a San Diego pot dispensary in about six hours.[111] Smarter still, inside the pot dispensaries they are offering cookies with THC in them and a strain of marijuana called Girl Scout Cookies.)
4. 4. Increase the social pressure to stay connected to your phone and social media for work and relationships, not allowing enough time for sleep and self-care.

THE BENEVOLENT RULER WOULD . . .

1. 1. Make job training, healthcare, parent training, and financial assistance readily available to those who need it.
2. 2. Advocate for stress-management classes in schools and businesses.
3. 3. Provide classes on decision-making skills so people would make better life decisions and be less stressed. Decisions are better when you have clear goals, sleep more than seven hours, avoid low-blood-sugar states (have protein and healthy fat at every meal), and eliminate the ANTs when they attack.

Social warfare —that’s when our society wages an attack on our well-being —is one of the most common causes of mental illness. Negative news cycles create an us-versus-them mentality, pitting political, racial, and other groups against each other. Just 14 minutes of negative news has been found to increase both anxious and sad moods.[112] Such chronic stress and relational separation damages brains. In addition, bad relationships, health problems, and financial stress all contribute to the social causes of mental illnesses. That’s why all four circles of health matter so much.

Loneliness is also a concern in the social circle. Baby boomers are aging alone more than any generation in US history. About 10 percent of Americans who are 50 and older do not have a spouse, partner, or living child. This group has the highest rate of suicide and an increasing problem of drug addiction.[113] Loneliness is a recognized risk factor for Alzheimer’s disease.[114]

We’re increasingly spending more time on the internet, with social media rapidly replacing in-person connections. But social media doesn’t provide us with the same benefits as socializing face-to-face. In fact, in a new study, there was a clear, causal link between Facebook, Snapchat, and Instagram and depression and loneliness, especially in teenage girls.[115] These sites also made vulnerable people feel worse about their bodies.[116] In addition, new research shows that using screens for long periods changes children’s brains in a negative way. Researchers at the National Institutes of Health performed brain scans of 4,500 children. Those who had daily screen time usage of more than seven hours showed premature thinning of the cortex, the outermost brain layer responsible for processing information from the physical world.[117]

Even more frightening is the reported emergence of seemingly innocent online videos directed at children that encourage them to engage in challenges involving self-harm. For example, reports have surfaced of deadly suicide games aimed at teens called the “Momo” (a scary-looking doll-like figure) challenge and the Blue Whale challenge.[118] Even if these games don’t actually exist, the social media buzz surrounding them can spread quickly among vulnerable children and teens who think they are real and who may act on them.

In addition, the health habits of the people with whom you spend time have a dramatic impact on your own health and habits. If you spend time with unhealthy people, you are much more likely to be unhealthy yourself. Brazilian supermodel Gisele Bündchen discovered this in her twenties when, despite her multimillion-dollar career and romantic involvement with Hollywood heartthrob Leonardo DiCaprio, she sank into depression and began to experience panic attacks. Not surprisingly, a doctor suggested she take Xanax. But the supermodel chose to make some lifestyle changes instead. The jet setter who had basically been living on wine, coffee, and cigarettes cut back on those bad habits, reduced her work schedule, and integrated yoga, meditation, and family time into her daily life.

“I’ve learned that our thoughts, words, and actions are all connected, and why we need to be careful with them. I began nourishing my body, mind, and spirit through meditation, healing foods, and a positive outlook, and as a result was able to experience a deeper clarity and greater sense of purpose,” she wrote in her book Lessons: My Path to a Meaningful Life.[119] That’s when she came to realize her boyfriend was not quite right for her, and the pair split. Getting healthy means avoiding people who encourage habits that contribute to illness and, instead, surrounding yourself with those who support brain-healthy choices.

Social connections are also essential to mental health. German Emperor Frederick II conducted a barbaric 13th-century experiment because he wanted to know what language and words children would speak if they were raised without hearing any words at all. He took a number of infants from their homes and put them with people who fed them but had strict instructions not to touch, cuddle, or talk to them. The babies never spoke a word. They all died before they could speak. Salimbene, a historian of the time, wrote of the experiment in 1248, “They could not live without petting.”[120] This powerful finding has been rediscovered over and over. In the early 1990s, thousands of Romanian infants were orphaned and warehoused without touch sometimes for years at a time. PET studies (similar to SPECT studies) of a number of these deprived children have shown marked overall decreased activity across the whole brain.[121]

---

In the social circle, an us-versus-them mentality, chronic stress, social pressure that encourages bad habits and illness, loneliness, and a lack of affection and touch can create a mental illness.

 

---

 

SOCIAL CIRCLE

STEPS TO CREATE MENTAL ILLNESS . . . AND MAKE MY NIECES, ALIZÉ AND AMELIE, SUFFER

1. 1. Don’t think about your social connections or how you manage stress.
2. 2. Engage in things that damage your social connections and generate stress, including:
   • Loneliness, social isolation
   • Poor or disconnected relationships
   • Us-versus-them mentality, pitting social or political groups against each other
   • Excessive health, school, job, financial, relational, or legal stress
   • Toxic societal stress; constant negative news cycles
   • Associating with people with negative health habits
   • Being in easy proximity to illness temptations, such as fast food restaurants, marijuana dispensaries, happy hour, decadent holiday parties, etc.
   • Staying connected to your phone and other devices at all times
   • Choosing social media connections over in-person relationships
3. 3. Avoid any education or habits on how to strengthen your social connections or lower stress.

STEPS TO END MENTAL ILLNESS . . . AND KEEP MY NIECES, ALIZÉ AND AMELIE, HEALTHY

1. 1. Care about your social connections and how you manage stress.
2. 2. Avoid anything that hurts your relationships or increases stress, such as:
   • Unhealthy people
   • Us-versus-them mentality
   • Negative news cycles
   • Unnecessary stress
   • Excessive screen time and social media
3. 3. Engage in habits that strengthen your relationships and lower unnecessary stress, such as:
   • Positive relationship habits (responsibility, empathy, time, listening, assertiveness, noticing what you like more than what you don’t, forgiveness)
   • Volunteering to help others in need
   • Looking for ways to bring your social connections together
   • Cultivating stress management and decision-making skills
   • Surrounding yourself with positive, healthy people —the fastest way to get healthy is to find the healthiest people you can stand and spend as much time around them as possible.
   • Keeping your distance from fast food restaurants, marijuana dispensaries, happy hour, decadent holiday parties, etc.

Here are three of my favorite social circle tiny habits.

---

• After I’ve had a fight with a loved one, I will take responsibility for my part and quickly apologize.
• When I feel overwhelmed or stressed, I will take five deep breaths, taking twice as long to exhale to settle and center myself.
• If I have children, I’ll spend at least 20 minutes a day fully present with them, doing something they want to do. I will make no commands, ask no questions, and give no directions. It is just a time to be together. (This dramatically improves bonding.)

---

Spiritual Circle

Beyond the biological, psychological, and social aspects of our lives, we are also spiritual beings. To fully heal and be your best, it is important to recognize that we are more than just our cells, thoughts, and connections. We are all spiritual beings created with divine purpose, whether or not we believe in God. Having a sense of purpose and a moral code, as well as connections to God, the planet, past generations (my grandfather, as an example: I was named after him, and he was my best friend growing up), and future generations (my grandchildren and great-grandchildren) reminds us that our lives matter; we have a role to play and a calling to fulfill. Without this spiritual connection, many people experience a sense of despair or meaninglessness, which can lead to depression.

SPIRITUAL CIRCLE

THE EVIL RULER WOULD . . .

1. 1. Lead people to live meaningless lives, devoid of values and connection to a life beyond themselves.
2. 2. Model an amoral life, making it seem normal, even desirable.

THE BENEVOLENT RULER WOULD . . .

1. 1. Model a purposeful life and encourage everyone else to do the same.
2. 2. Encourage spiritual beliefs and practices without dictating them, such as prayer, meditation, worship, and service.
3. 3. Foster a deep connection to the past, the future, and the planet.

Purposeful people, defined as having “the psychological tendency to derive meaning from life’s experiences and to possess a sense of intentionality and goal directedness that guides behavior,” live longer and are healthier overall.[122] In a large study, purposeful people were found to have better mental health, less depression, greater happiness and satisfaction, more personal growth and self-acceptance, and better sleep. Over time, higher scores on this scale were also associated with a reduced risk of Alzheimer’s disease, less cognitive impairment, and a slower rate of cognitive decline in old age.[123]

Research shows that having a strong “purpose in life” also reduces the chances that your self-esteem will fluctuate with the number of likes you get on social media.[124] Ultimately, feeling as if your life matters and living purposefully helps protect you from the social warfare you now understand is behind so much mental illness. On the flip side, a lack of purpose has been linked to higher levels of the stress hormone cortisol, more abdominal fat, and other negative health markers. It’s easy to see how increased stress, a bigger belly, and poorer health can contribute to negative feelings that, when combined with low brain reserve, can create mental illness. Think of how easily that can be passed on to younger people, such as my nieces, who are vulnerable.

In our society, the media constantly highlights people —such as politicians, religious and business leaders, and celebrities —who model amoral lives. In addition, on a day-to-day basis, we often come into contact with people —including our own parents, teachers, or bosses —whose lives are devoid of meaning and purpose. With so much confusion about the spiritual circle in our society, how can we find our purpose in life?

Dr. Viktor Frankl, a psychiatrist, World War II concentration camp survivor, and author of Man’s Search for Meaning, believed there were three ways to create meaning:

1. 1. Purposeful work or being productive —asking questions such as, “Why is the world a better place because I am here?” or “What do I contribute?”
2. 2. Love for the people who are central to our lives.
3. 3. Courage in the face of difficulty —shouldering whatever difficult fate we have and helping others shoulder theirs.

I suggest engaging in spiritual practices, such as prayer, meditation, worship, and service. I stay connected to God and my Christian faith through daily prayers, meditation, and attending church with my family. Think of your church or other places of worship, as well as any nurturing environment, as a space that fosters all four circles of health. I also have my patients ask themselves:

• What does your life mean?
• What is your purpose?
• Why are you here?
• What are your values?
• Do you believe in God or a higher power?
• How does that affect your life?
• What is your connection to past generations, future generations, and the planet?[125]

---

In the spiritual circle, a lack of purpose or connections to something larger than yourself and not living up to your own moral code can create a mental illness.

 

---

Here are two of my favorite spiritual circle tiny habits.

---

• In the morning, I will ask myself, What one purposeful thing will I do today?
• When I start getting upset about something happening in my day, I’ll ask myself, Does this have eternal value?

---

SPIRITUAL CIRCLE

STEPS TO CREATE MENTAL ILLNESS . . . AND MAKE MY NIECES, ALIZÉ AND AMELIE, SUFFER

1. 1. Don’t care or think about your spiritual well-being or purpose in life.
2. 2. Live a meaningless existence, focused solely on yourself and the pleasures of the moment.
3. 3. Behave in opposition to a moral code (anger, gluttony, addictions, affairs, pornography, etc.).
4. 4. Look up to people who live amoral lives.
5. 5. Avoid a sense of passion or purpose.
6. 6. Avoid connections to the past, future, and planet.
7. 7. Avoid role models who are living spiritual lives.

STEPS TO END MENTAL ILLNESS . . . AND KEEP MY NIECES, ALIZÉ AND AMELIE, HEALTHY

1. 1. Care about your deepest sense of meaning and purpose. You are more than just your cells, thoughts, and connections.
2. 2. Stop engaging in habits that hurt your spiritual circle.
3. 3. Live by a moral code.
4. 4. Engage in regular positive spiritual habits, including:
   • Living with intentionality, being goal oriented toward a higher purpose.
   • Building or rediscovering connections with God, the church, the past, the future, and/or the planet.
   • Engaging in meaningful work, such as volunteering at your church or place of worship.
   • Engaging in meaningful relationships with people who share your values and faith.
   • Having courage and faith in the face of challenges.
   • Living with the end in mind —what does God want you to accomplish while you are alive?

THE POWER OF PURPOSE AND THE SPIRITUAL CIRCLE

I met Byron Katie in 2005, and we immediately became friends. She is the author of one of my favorite books Loving What Is and was helpful to me personally during a difficult time of grief. She worked with people I loved to help discipline their minds, and I worked with people she loved to help balance their brains. Eventually, I scanned Katie’s brain. It was not healthy and looked like the scan of someone who was suffering. Yet she was at peace. Her spiritual practice overrode her brain issues.

Likewise, a number of years ago, I scanned Sam, who had been practicing loving-kindness meditation for 20 years. Of note, his SPECT scan looked quite terrible, with decreased activity to his left frontal and temporal lobes. He told me he’d had a motorcycle accident 20 years earlier, and he started the meditation practice to deal with the depression he experienced after the trauma. In the last 15 years, he had started his own chiropractic office, had been very successful, and had not experienced any more depression, although he admitted he was quite disorganized and relied on his wonderful wife and practice manager to keep him on track.

---

Psychological health, positive social connections, and spiritual practices can help stabilize troubled brains.

 

---

Both Byron Katie’s story and Sam’s story point to how psychological health, positive social connections, and spiritual practices can help override brains that are in trouble. Getting and staying well involves all four circles. In part 2, you’ll see how the four circles intersect with and influence the 11 BRIGHT MINDS risk factors. And I’ll introduce you to some simple strategies using each of the four circles that you can use to prevent or heal those risk factors to enhance your brain health and end mental illness.

[97] Erika L. Sabbath et al., “Time May Not Fully Attenuate Solvent-Associated Cognitive Deficits in Highly Exposed Workers,” Neurology 82, no. 19 (May 13, 2014): 1716–23.

Samuel Keer et al., “Neuropsychological Performance in Solvent-Exposed Vehicle Collision Repair Workers in New Zealand,” PLOSOne 12, no. 12 (December 13, 2017): e0189108.

[98] Daniel G. Amen et al., Change Your Brain, Change Your Life (New York: Harmony Books, 2015), 49.

[99] J. Araújo et al., “Prevalence of Optimal Metabolic Health in American Adults: National Health and Nutrition Examination Survey 2009–2016,” Metabolic Syndrome and Related Disorders 17, no. 1 (February 2019): 46–52.

[100] Ibid.

[101] Michele Corriston, “Demi Lovato Fights for Mental Health Reform on Capitol Hill: ‘I Went through Several Years of Pain and Suffering,’” People, October 5, 2015, people.com/celebrity/demi-lovato-fights-for-mental-health-awareness-in-washington-dc/.

[102] Amen, Change Your Brain, Change Your Life, 51.

[103] Kristine Engemann et al., “Residential Green Space in Childhood Is Associated with Lower Risk of Psychiatric Disorders from Adolescence into Adulthood,” Proceedings of the National Academy of Sciences of the United States of America 116, no. 11 (March 12, 2019): 5188–93.

[104] Eckhart Tolle, “Living in Presence with Your Emotional Pain Body,” HuffPost The Blog, October 6, 2010, www.huffingtonpost.com/eckhart-tolle/living-in-presence-with-y_b_753114.html.

[105] Ibid.

[106] Ibid.

[107] Jean Twenge, “What Might Explain the Current Unhappiness Epidemic?” Ladders.com, (December 7, 2018), www.theladders.com/career-advice/what-might-explain-the-current-unhappiness-epidemic.

[108] M. E. Seligman et al., “Positive Psychology Progress: Empirical Validation of Interventions,” American Psychologist 60, no. 5 (July–August 2005): 410–21.

[109] Thomas H. Holmes and Richard H. Rahe, “The Social Readjustment Rating Scale,” Journal of Psychosomatic Research 11, no. 2 (August 1967): 213–18.

[110] Emily J. Jones et al., “Chronic Family Stress and Adolescent Health: The Moderating Role of Emotion Regulation,” Psychosomatic Medicine 80, no. 8 (2018): 764–73.

[111] Scott Stump, “Girl Scout Sells 300 Boxes of Cookies outside Marijuana Dispensary in 6 Hours,” Today.com, February 7, 2018, www.today.com/parents/girl-scout-sells-300-boxes-cookies-outside-marijuana-dispensary-6-t122455.

[112] Wendy M. Johnston and Graham C. L. Davey, “The Psychological Impact of Negative TV News Bulletins: The Catastrophizing of Personal Worries,” British Journal of Psychology 88, pt. 1 (February 1997): 85–91.

[113] Janet Adamy and Paul Overberg, “The Loneliest Generation: Americans, More Than Ever, Are Aging Alone,” Wall Street Journal, December 11, 2018, www.wsj.com/articles/the-loneliest-generation-americans-more-than-ever-are-aging-alone-11544541134.

[114] “Loneliness and Alzheimer’s,” Rush University Medical Center, www.rush.edu/health-wellness/discover-health/loneliness-and-alzheimers.

[115] Melissa G. Hunt et al., “No More FOMO: Limiting Social Media Decreases Loneliness and Depression,” Journal of Social and Clinical Psychology 37, no. 10 (2018): 751–68.

Denis Campbell, “Depression in Girls Linked to Higher Use of Social Media,” Guardian, January 3, 2019, www.theguardian.com/society/2019/jan/04/depression-in-girls-linked-to-higher-use-of-social-media?CMP=Share_iOSApp_Other.

[116] Jacqueline V. Hogue and Jennifer S. Mills, “The Effects of Active Social Media Engagement with Peers on Body Image in Young Women,” Body Image 28 (March 2019): 1–5.

[117] Lisa Lee, “NIH Study Probes Impact of Heavy Screen Time on Young Brains,” Bloomberg Quint, December 9, 2018, www.bloombergquint.com/technology/screen-time-changes-structure-of-kids-brains-60-minutes-says#gs.ddq1FHk.

[118] Larry Magid, “Dire Warnings about Children Dying because of Apps and Games Are a Form of ‘Juvenoia,’” ConnectSafely.org, August 27, 2018, www.connectsafely.org/dire-warnings-about-children-dying-because-of-apps-and-games-are-a-form-of-juvenoia/.

[119] Gisele Bündchen, Lessons: My Path to a Meaningful Life (New York: Avery, 2018).

[120] “Frederick’s Experiment,” Digma.com, https://www.digma.com/digma-images/video-scripts/fredericks_experiment.pdf.

[121] Harry T. Chugani et al., “Local Brain Functional Activity Following Early Deprivation: A Study of Postinstitutionalized Romanian Orphans,” NeuroImage 14, no. 6 (December 2001): 1290–301.

[122] Patricia A. Boyle et al., “Effect of Purpose in Life on Risk of Incident Alzheimer’s Disease and Mild Cognitive Impairment in Community-Dwelling Older Persons,” Archives of General Psychiatry 67, no. 3 (March 2010): 304–10.

[123] Ibid.

[124] Anthony L. Burrow and Nicolette Rainone, “How Many Likes Did I Get?: Purpose Moderates Links between Positive Social Media Feedback and Self-Esteem,” Journal of Experimental Social Psychology 69 (March 2017): 232–36.

[125] Daniel G. Amen, Change Your Brain, Change Your Life, 53–54.