Nine Common Questions As I was writing this book, the daytime television show The View did a program on the male brain. Elisabeth Ha.s.selbeck, Star Jones, Meredith Vieira, and Joy Behar wanted to know why men and women were so different. My segment was on after talk-show-host Donny Deutsch, whom the girls had just roasted. They asked him how many times he had been married (which was twice), and why his marriages had failed (he didn"t know), and whether or not he cheated on his wives (no), and what his problem was (he asked if they had a shrink"s couch nearby).

Thankfully, they were easier on me. My interview covered nine questions, which are included below (these are some of the most common questions women ask about men): 1. "Is there really a difference between a man"s and a woman"s brain?"

Gathering my composure, I said, "Huge differences, and we can prove it." Here I pointed to a set of brain scans that we did of a couple at my clinic. "Typically, the woman"s brain is very active. Thinking, thinking, thinking, especially in the emotional part of the brain. The man"s brain, by comparison, is relatively quiet. A woman"s brain is always working and a man"s brain needs stimulation."

Meredith Vieira chimed in, "Seems like little is happening in the male brain."

2. "Let"s get down to specifics. Why do men think about s.e.x all the time?"

"The part of the brain responsive to s.e.x hormones is two and a half times larger in men than women. Men are programmed to be more responsive to s.e.xual feelings. Plus, with the lower activity in the brain, men are looking for excitement and stimulation. What is more stimulating to think about than s.e.x?"

3. "You say there is a way you can tell which men have more testosterone than others. How?"

"According to University of Liverpool researcher John Manning, the size of your ring fingers and genitals are directly related to how much testosterone you received in the womb; the higher the testosterone level, the longer they are. In fact, looking at the length of ring fingers in comparison to index fingers will give an idea of the size of a man"s p.e.n.i.s. If the ring fingers are longer, it means that there were healthy testosterone levels; if they are the same size or smaller, it means that there were lowered levels. Women can estimate the length of a man"s p.e.n.i.s by saying, "Show me your hands." Those who have unusually long ring fingers (indicating very high testosterone levels) are at greater risk for autism, dyslexia, stuttering, and immune dysfunction. A large male member may not be all that great. On the other hand, a male with an unusually short ring finger is at higher risk for heart disease and infertility. Size matters, but it can go both ways."

4. "Why don"t men need foreplay like women do?"

"Men are always ready for excitement. With the lower activity levels in our brain, and higher testosterone levels, it takes little to get us going. Like Harrison Ford"s character Quinn Harris said in the movie Six Days, Seven Nights, "All women have to do is show up." We are always idling, waiting to be taken for a ride. Women, on the other hand, have so much going on in their brains that they need to be soothed, courted, and encouraged to be in the mood. They need a method to calm down their brains."

5. "Why don"t men ask for directions when they are lost?"

"Men do not know that they are lost, even if they have pa.s.sed the same gas station four times. Men have less access to the right hemisphere, which shows the big picture. The right hemisphere allows people to know when a problem exists. Since men have less access, they are often in the dark when something is wrong. It happens in many other situations besides driving, such as admitting that there is trouble in a relationship (75 percent of the time women are the ones who file for divorce or leave a relationship). Men are also singularly focused on finding their way. Admitting that you are lost is admitting failure, something men are very poor at doing."

6. "Why don"t men gossip?"

"Men do gossip, just not as much as women. Men have language exclusively on the left side of the brain, while women have language on both sides. Women have more to say because more areas of the brain are dedicated to language. Men are also more interested in sports than in emotional relationships. Sport talk shows are very popular sources of gossip for men. In conversations, men often get lost in the amount of words used by women. When it comes to parenting, using fewer words is actually helpful. As a child psychiatrist, I have seen that children usually listen to their fathers more often than their mothers. In large part, it is because men use fewer words than women and they are more serious about consequences to negative behavior. Mothers want children to understand, they want to be relational with them; fathers want children to comply, like listening to the coach during a ball game."

7. "Why can"t a man let go of the remote control?"

"With the lower overall brain function, a man needs more stimulation. As he flips through channels, he is often looking for something new, something different, something exciting. A woman is often content watching a single program, with a relational story line where characters show emotions. She likes to predict what will happen next and needs the continuity to stay interested. The remote control allows a man to surf the wild looking for fair game. Men also have shorter attention spans than women. Men are diagnosed with attention-deficit/hyperactivity disorder (ADHD) five times more than women."

8. "A recent survey came out and it said that men lie more than women, but that women are actually better liars. Why is that?"

"Given the lower brain function, especially in the front part of the brain (also a.s.sociated with the higher incidence of ADHD), men tend to be more impulsive than women. They tend to have more affairs and tend to say things without fully thinking it through and often find themselves in hot water. Women also lie, but they get caught less. One reason, as I mentioned earlier, is that women have better access to the right hemisphere and thus read social cues better than men. They notice the small things, like looking away or down or clearing your throat, that are typical in people who are not telling the truth. Since men tend to be in denial a lot of the time, they do not see when their partner is lying."

9. "Why don"t men remember dates like birthdays and anniversaries?"

"Men are men. As such they are thinking about providing for their families, competing with other men, and s.e.x. Opposed to women, who are thinking, thinking, thinking about the relationship, men are busy doing. This does not mean they love less, they just love like men. This often causes them to forget important dates, even though they try hard not to."

Rules for Men on Women and for Women on Men Given the latest neuroscience research, here are eight rules to help men and women better understand and navigate the brain differences between the s.e.xes.

RULES FOR MEN ON WOMEN.

Recognize women are very different from you. Ask her what she needs to be happy and listen. Remember they leave the relationship 75 percent of the time.

Women typically need listening, not solutions (she is already competent).

Never ask a woman to get to the point.

She needs time, talking, and nons.e.xual touch for foreplay. (Her skin is ten times more sensitive. Find out how she likes to be touched. Her reality may be different from yours.) Just because she catches you ogling another woman does not mean she is not ogling another guy.

On a long trip do the night driving; usually your night vision is better than hers.

She thinks it is s.e.xy if you ask for directions. You win her heart by being willing to ask for help.

She has a keener sense of smell. Find out the smells she likes. Does she like it if you take a shower before bed, or does she like it if you don"t? Find out.

RULES FOR WOMEN ON MEN.

Recognize men are very different from you. Ask him what he needs to be happy.

He can do only one thing at a time. When you want to talk to him, wait until the game is over and ask for a specific time to talk.

Never try to get a man to admit to losing a fight.

If you want him to really listen, try to use fewer words.

He is programmed to compete and win. Make him think he wins a lot.

Just because you catch your guy ogling another woman does not mean you do not do it as well. It does not mean he finds you less attractive.

On a long trip do the day driving. Let him drive at night. His night vision is usually better. (And while you are sleeping, it won"t bother you as much when he is lost!) Many of his senses are not as keen as yours; tell him if odors or tastes bother you.

Lesson #4: Understanding the differences between the male and female brain helps prevent misunderstanding and pain and fosters communication and love.

LOOK CLOSELY.

Brain Imaging Secrets to Enhance Your Love Life "The brain is a tissue ... it is a complicated, intricately woven tissue, like nothing else we know of in the universe, but it is composed of cells, as any tissue is ... the connections that const.i.tute the brain"s woven feltwork can be mapped. In short, the brain can be studied, just as the kidney can."

-DAVID H. HUBEL (1981 n.o.bel Prize winner) In the winter of 2005, The New York Times Magazine did a story on my brain-imaging work. In it the writer quoted me as saying if you date one of my daughters for more than four months, you have to get a brain scan. After the article appeared, I received several pieces of angry mail from people around the country saying that I used imaging to discriminate against people with mental illness. One woman wrote that she hoped my daughter married someone with bipolar disorder. Ouch.

It is true that if you date my children for more than four months, you get the opportunity of getting scanned. So far, everyone has taken me up on the offer. Inquisitive people want to know. I never use them to discriminate against people, rather as an opportunity to gather more information, like meeting someone"s parents or taking them on vacation.

Brain imaging teaches us many important lessons regarding s.e.xuality and relationships. In this chapter I will share six secrets I have learned from imaging to enhance your love life.

Secret #1:

There Is More to Love Than Most People Think

Looking at the brain has taught me that there is so much more to love than most people think. Biological brain influences are extremely important to how we feel, think, and act. Over the past sixteen years I have conducted brain-SPECT studies on more than three hundred couples who have had serious marital difficulties. I affectionately refer to this group as "the couples from h.e.l.l study." I have been fascinated, saddened, and enlightened by these images. I look at love and relationships in a whole new way (as compatible and incompatible brain patterns). I have come to realize that many relationships work or struggle because of healthy brain activity or brain misfires, and they have less to do with character, free will, or desire than most people think. Many marriages or relationships are sabotaged by factors beyond conscious or even unconscious control. Sometimes targeted brain help can make all the difference between love and hate, staying together or divorce, effective problem solving or prolonged litigation.

Many people, especially some cla.s.sically trained marital therapists, will see this idea as radical, premature, and even heretical. But how can we keep the brain out of the equation of love, s.e.x, and relationships? Frankly, I know of no marital therapy system or school of thought that seriously looks at the brain function of couples who struggle. But I wonder how you can develop paradigms and "schools of thought" about how couples function (or don"t function) without taking into account the organ that drives their behavior, namely the brain.

Brain-SPECT imaging is a powerful tool to evaluate brain function. It gives a sophisticated look into the function of living tissue. Simply put, the images give three pieces of information, showing areas of the brain that work well, areas of the brain that work too hard, and areas of the brain that do not work hard enough. This information then allows scientists to evaluate different brain systems.

One of the fundamental principles underlying our work at the Amen Clinics is that defined regions and circuits in the brain tend to perform certain tasks, and problems in these areas tend to give specific types of cognitive, behavioral, or emotional difficulties (see Lesson Two for a detailed look at brain systems). Balanced activity across the brain increases the chances for healthy behavior, while overactive or underactive areas of the brain can be involved in trouble.

Secret #2: Whenever There Is s.e.xual or Relationship Trouble, Think About the Brain The idea of scanning unhappy couples was born out of frustration and my internal critical voice. Bob and Betsy brought their two children to see me for school problems. As I worked with the kids, I came to believe that one of their major problems was the conflict between the parents. The chronic tension at home was having a negative impact on the children, causing anxiety, stress, and physical symptoms such as headaches, tummy aches, and problems concentrating. I suggested to the parents that they see me for marital counseling. They told me that they had seen four other therapists and it almost always made things worse for them. I was much younger then, more naive, and had the belief that I could help them. Maybe, I thought, they just hadn"t seen anyone really good (through the years I have learned that thoughts like this one are usually a sign of immaturity or narcissism on my part and often a predictor of trouble).

In my office in our Northern California clinic, where I saw them, I have two navy blue leather couches. On Bob and Betsy"s first visit, and every weekly appointment thereafter for the next nine months, they sat on opposite ends of each couch. That is a bad sign in marital therapy. After seeing this couple for three months, I started to hate them. Nothing I did with them seemed to make any difference. In my psychiatric training, my main supervisor said my biggest flaw was that I wanted patients to get better fast. I needed to be more patient. I dislike feeling ineffective. I thought to myself that Betsy had a PhD in grudge holding. She would go on and on, talk about the same things over and over, and be unable to let go of hurts from the past. Things from fifteen years ago still bothered her. I once thought that she would not only beat things to death, but also beat them into the afterlife as well. Betsy was married to a man I call "the sniper." He earned that nickname because he rarely seemed to be paying attention. Yet, whenever Betsy would settle down in her complaints, Bob would say things that were so evil, so nasty, just to get her going again. It seemed like he was purposefully revving her up. After six months of seeing this couple, I started to get physical stress symptoms on the day of their appointment. My stomach would hurt and my shoulders would get knotted. With no change in their marriage by the ninth month of therapy, all of us were feeling frustrated.

One day I was taking a shower getting ready to come to work and realized that they were on my schedule that morning. My stomach started to hurt. "d.a.m.n," I thought, "these people are in my shower with me. Today I am going to tell them to get divorced." I had actually been having that thought for several months. Research shows that it is better for children to be from divorced homes than from homes with chronic conflict. My problem with the thought about divorce, however, was that I grew up very Catholic. Not a little Catholic, but a lot! I attended Catholic school and was an altar boy for many years. We prayed the rosary every week on the way home from Grandpa"s house. Even though I was no longer a practicing Catholic, I still lived with the Catholic voice in my head, commenting on my thoughts and actions. After I had the thought "Today I am going to tell them to get divorced," the internal Catholic voice yelled, "What! Because you are not a good enough therapist, you are going to tell these people to get divorced and d.a.m.n their eternal souls to h.e.l.l!" I just started to stare at the water faucet wondering, "How much therapy does this take to get over?" I got out of the shower, dried off, and reached for the telephone. I called my friend who owned the imaging center and said, "Hey, Jack, will you give me two scans for the price of one?"

He asked why.

I said, "I have this couple I have been seeing and have no idea how to help them. I am hoping to get some clues from their scans."

"Couple? You want to scan a couple," he said at first with disbelief and then curiosity. "How interesting! You know I have been married twice and I cannot figure it out. Maybe we could even start an Internet dating service and call it brainmatch.com."

When I presented the idea of the brain imaging, the couple was very interested. They were obviously aware that things were not getting better. Plus they would not have gotten divorced if I had suggested it. They wanted to be married. After all, I was the fifth marital therapist they saw.

Their scans literally changed their lives and mine as well. The woman"s scan showed marked increased activity in a part of the brain called the anterior cingulate gyrus, which is the brain"s gear shifter, allowing the brain to go from idea to idea and task to task. When it is overactive, people tend to get stuck on negative thoughts and behaviors, such as worrying or holding grudges. Just by random chance, if you believe in random chance, the night before her scan I had read an article in the American Journal of Psychiatry that reported increased activity in the anterior cingulate gyrus is calmed by Prozac. I put Betsy on Prozac. Bob"s scan showed low activity in his prefrontal cortex when he performed a concentration task, a finding very consistent with attention-deficit/hyperactivity disorder (ADHD). At the time, in 1991, I was considered one of the experts in ADHD. I was very irritated that I had missed it in Bob. I put Bob on Ritalin. I told the couple to take a month off therapy to allow time for the medications to work (and for my stomach and the Catholic voices to settle down). When they came back a month later, for the first time they sat on the same couch. Betsy had her hand on Bob"s leg, which is a good sign in marital therapy. Now, fifteen years later, they are still married, have another child, and get along better than ever. I call this better marriage through biochemistry.

The work with this couple caused me to rethink my work with all of the couples I saw. How many of their problems were learned behavior? How much was brain? How would I know unless I looked? Obviously, because of costs and availability of imaging, I couldn"t scan everyone, but when I was struggling with complex cases, scans became invaluable. Over a decade ago, my friend and colleague psychologist Earl Henslin started sending many of the couples he saw to my clinic. He said of the first forty cases he sent to me, thirty-nine remained married years later.

Secret #3:

Something Completely Unexpected May Be Causing Trouble

Looking at the brain has taught me that there may be completely unexpected problems causing trouble for couples. The following story highlights this principle.

Dave and Bonnie saw a psychologist for marital therapy for three years. 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, yet nothing worked. 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. When the couple protested, as they had spent years of effort and over $25,000 trying to get better, the therapist said there was one more option. She told them about the work at Amen Clinics, where some of her most difficult clients had been helped.

After an evaluation we performed brain-SPECT scans on the couple. Dave"s brain scans looked shriveled and full of holes, the same pattern that we see in drug or alcohol abusers. The scan was odd, because in his history 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. He said no, and repeated that he didn"t drink and never used drugs.

I turned to Bonnie for more information, knowing that alcoholics are often in denial and drug abusers often lie. She said, "He is right. He doesn"t drink and as far as I know has never used drugs. That is not his problem, Dr. Amen. He is just an a.s.shole."

I chuckled at her comment. But internally my mind started to race. If he was not a drinker or drug abuser, then why did he have such a toxic-looking brain? I went through the different potential medical causes in my head: brain infections, near-drowning episode, hypothyroidism, anemia, and environmental toxins. My friend psychiatrist Harold Bursztajn, co-director of the Psychiatry and Law Program at Harvard, often says that scans are usually not the answer, they teach you to ask better questions. 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?" Oh my goodness, I thought, Dave has a drug-affected brain from the solvents he was using at work; even though he has never willfully used drugs, they are eating away his brain. Dave just thinks he is being a good provider to his family, while his brain is being poisoned.

"No," Dave said, "it is often hot and reeks with fumes."

"Do you wear a mask?" I asked.

"No, they tell me I should but I don"t think it is important."

"Ouch," I said. "You really should."

My next question was to Bonnie: "When did he start becoming an a.s.shole?"

She thought for a moment. "We were not always unhappy. We have been married for fifteen years. It just seems that the last eight were hard. The first years were great. He was so different."

Then Bonnie had a look of "Aha" wash over her 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 eating away his brain, and eating away his ability to be kind, thoughtful, empathic, and to love you."

Working with this couple has been an amazing lesson in the brain-love connection. I took Dave out of work for six months and would only allow him to return to a nontoxic job at the plant. Bonnie developed empathy for her husband, who before in her mind was just an a.s.shole but who had become someone in need of help and understanding. When behavior does not make sense, it is important to consider brain health issues as a potential cause of the trouble. When people have issues concerning their behavior, the brain is an important place to look. Research done on brain-injured patients revealed that over one-third of them suffer from depression. In addition, of those people suffering from depression, three-quarters also had anxiety issues and exhibited aggressive behavior.

Secret #4:

Think About Scanning Potential Partners or Taking Their Brain Science History

When I was single, whenever I dated someone new, I tacitly took a brain science history. I wanted to know as much about how her brain worked as I wanted to know how her body felt next to mine. If I thought the relationship had the potential of going further, I asked her to get a scan. Most women had no problem with the idea. In fact, when women really understood my work, most were curious and wanted to know more about themselves. The idea of scanning someone was never to rule them in or out; it was to gain a better understanding of the issues that might face us in a serious relationship.

One of my close friends, Will, had been dating a new woman he met on Match.com. He really liked her and felt they had great chemistry but he was concerned about a number of issues. She tended to run late, was disorganized, lived on the edge by riding motorcycles, and was p.r.o.ne to starting fights between them. As much as he liked her, she was not easy for him to be around. She suspected herself that she had attention-deficit disorder. Her scan showed very low activity in the PFC when she tried to concentrate, which is a common scan finding of ADD. The deeper understanding of his potential mate allowed Will to make a more informed decision about what he wanted to do with the relationship.

Another friend, Katie, started dating a man, Ben, she had met through her professional circle of colleagues. Again, the chemistry was powerful, but she was concerned with his tendency to argue and be oppositional. It never felt easy being with him. She felt on guard a lot and she was often chastised by her new boyfriend for what seemed to her like minor offenses. After first refusing to get scanned, he later agreed. His scan showed excessive activity in his anterior cingulate gyrus. His brain tended to get stuck in the loop of negative thoughts and behaviors. Recognizing the problem after seeing his scan, and admitting it had been a problem in other relationships, Ben took a supplement (5-HTP) to calm this part of the brain. Subsequently, the couple got along much better.

Since most people do not have access to scans, taking a brain science history can be of great value. I"ll discuss this more in the next chapter.