Secret #5:

Brain Health Becomes Part of the Relationship

My imaging work has led me to want a better brain. I have personally been scanned ten times over fifteen years. As people age, the brain usually becomes less and less active. In my case, my brain has improved over time, because I have taken personal brain health seriously. In my relationships, whether with friends or potential partners, eventually everyone ends up being scanned. The imaging work generates intense interest. Most people want to know about themselves and how their own brain works. If one of my friends gets scanned, brain envy starts to invade his or her consciousness. She wants a better brain. She becomes more likely to eat in healthy ways, exercise, take supplements, wear her seat belt, and avoid too much alcohol or caffeine. As brain health enters her consciousness, it is easier for us to be together. We share a common goal, brain health. Ordering at restaurants becomes a collaborative effort and spending time together turns into more walks and word games than getting drinks at a bar.

Secret #6:

Scans Generate New Ideas

Scans generate new ideas and new ways of thinking about relationships. I recently saw a troubled couple. The husband was bipolar and his wife had gotten to the point where she couldn"t stand his behavior anymore. s.e.x was one of the areas of discontent. She came in for the first time on a joint visit to add some information about how he was doing. Within one minute of being with her, I felt very uncomfortable. Her tone of voice had frequencies in it that made me uneasy. I thought it needed to be recorded so we could study the brain reactions of others. Years ago, my colleague and coworker Dr. Leonti Thompson saw a number of men who had killed their infants in a fit of rage. His research brought up several cases where tests had shown that the frequencies of infant cries triggered seizurelike activity in the temporal lobes, arousing feelings of anger. If the wife and husband in this case were to be scanned when the wife was talking to him, I wondered if we would see his temporal lobes fire abnormally in response to her irritating frequency.

I once scanned a man who lit his ex-wife"s house on fire at Christmastime. He was on trial for arson. His initial scan showed mild trouble in his left temporal lobe (an area of the brain a.s.sociated with violence). Then, I scanned him while he listened to a message from his ex-wife. During this scan his mild left temporal lobe abnormality became severe, providing us with evidence that her voice triggered a negative reaction in his brain. Without the scans I would have never been able to see this connection.

The following story was contributed by my friend Barbara Wilson, a neurologist and pain specialist in Austin, Texas. The case ill.u.s.trates how brain imaging and changes in brain function alter behavior, which may be positive or negative.

"I had a very nice man who had a facial tic. It was just on one side. He smoked a lot of pot because it made his headaches not as bad. I initially trained as a movement-disorder doc-and one-sided tics must be scanned for tumors, even if the rest of the physical exam is okay. I got into trouble for ordering the MRI-the guy was in an HMO and they figured he had tics for at least three years so no immediate testing was necessary-but I stuck to my training and ordered the scan. The patient had a large frontal lobe tumor with a little spot of calcified brain. In neurology that little calcified spot upsets one greatly because it indicates that the tumor probably started out as benign, which would have been cured if it had been taken out earlier.

The really interesting part of the story: His girlfriend and I had a long talk. She spoke of how much fun he was-not inhibited like other guys. He was such a "unique spirit-free, wildly s.e.xual, and unreasonably happy with no rigid boundaries like most guys" she knew. ... Basically she was in love with the personality of someone without much of a frontal lobe. The girlfriend was devastated that this special wonderful man was diagnosed with a severely life-shortening tumor. Ironically, if he had not had the tumor, his personality would not have been attractive to the girlfriend. Consistent with the effects of some brain lesions; the guy wasn"t that bothered by his impending death. Actually it kind of clarified things: He could just spend all his money on drugs since he didn"t need to worry about long-term wealth acc.u.mulation. I worried more about the girlfriend, destined to go through life looking for another guy with a frontal lobe tumor.

This story ill.u.s.trates how our s.e.xual lives are tied to brain function. Whether we are outgoing, uninhibited, uptight, or afraid has to do with the moment-by-moment function of the brain. Looking closely at brain function opens a new world of possibilities for explanations about behavior and potential treatment enhancers.

Lesson #5: Looking at the brain can enhance your love life.

USE YOUR BRAIN BEFORE YOU GIVE AWAY YOUR HEART.

Warning Signs of Trouble "Know when to walk away, And know when to run."

-"The Gambler," KENNY ROGERS Have you ever made stupid decisions about love? I mean really inane, insane, unbelievably stupid decisions. I have, and some of those decisions have turned out to be very painful. I am never someone who feels as though I have it all together, but in the past I have felt as though I was smarter than I acted regarding some of my romantic decisions. And I have been curious about these less-than-stellar decisions for a long time. Can neuroscience help us understand the decisions we make about love? Can it help us know when to hold someone, when to walk away, and when to run? Decisions about love can help extend your life; as a group, people who are happily married live longer. Decisions about love can also ruin your life, through emotional pain and bankruptcy, and, in some cases, end it through suicide or murder. Decisions about love have potential life and death implications.

Warning Signs Around the Oasis of Love When we fall in love, many people experience what I call the Oasis Effect. Coming out of the desert of being alone and longing to be in a relationship that helps them feel more complete (as humans we are wired to be intimately connected to others), many people find that new love feels like an oasis of beauty and nourishment. When we fall in love, there is a large release of the bonding hormone oxytocin. This chemical has been found to increase our sense of trust, even in situations where perhaps we should be more cautious. Similar to the dusty, dirty, lonely, and thirsty desert traveler who is euphoric upon finding the oasis, falling in love feels unlike anything else, exciting, fulfilling, and satisfying. When first coming out of the desert, travelers are often so ecstatic to find the waters that they fail to see anything else. Their anxious state of euphoria causes them to overlook or ignore warning signs around the oasis, such as diseased animals. Those who have drunk from those same waters were sickened, evidence of the poison along the edges of the oasis. So, too, in love, when we come out of the desert of aloneness, we are often so happy, with love chemicals coursing through our brain, that we fail to see the trouble before our eyes, the metaphorical dead animals around the oasis of love. Here are two examples.

Eric Eric and Becky were in a tumultuous marriage for ten years. Eric had thought about getting divorced for the last five years they were together. They had seen eight different marital therapists without much help. One day, after going to a friend"s twenty-fifth wedding anniversary, Eric decided he had had enough and saw an attorney. There was no way he wanted to stay in a marriage filled with distance and pain for fifteen more years. Even though the divorce was painful, Eric knew it was the right decision. In dating Becky, Eric had ignored many warning signs of pending trouble. Nowhere in school are people taught to notice problematic signs in a relationship. Becky had been severely s.e.xually abused by an alcoholic father. When dating Eric, she failed to tell him of the tension, turmoil, and abuse at home. Without psychological help to process the pain of an abusive past, intimate relationships for an abused person are usually impaired; even with help, it can be a long road. In dating again, Eric vowed it would be different next time and he would make better choices for himself. Yet, his next two relationships were filled with turmoil and pain, prompting Eric to come and see me.

In describing his relationship with Becky, Eric said it was like living in a desert. Becky was not only volatile, she was almost always s.e.xually withholding. Eric said his s.e.xual advances were rebuffed nine times out of ten and he lived in a chronic state of frustration.

His first relationship after his divorce was with a beautiful, smart, highly s.e.xualized model, Monica. For the next eight months he felt happier than he had ever been, so he and Monica moved in together. Then the poison in the oasis started to make Eric sick. Eric and Monica started to fight. Monica spent money after agreeing not to, hiding it from Eric. s.e.x, which was free flowing in the beginning, was now being withheld. And Eric started to catch Monica in a series of lies. Even though there were several significant signs of trouble before they moved in together, the bliss of the s.e.x and the hope of finding a lasting, healthy love blinded Eric to the reality of the situation. He failed to see the warning signs: Monica had a young child who did not live with her, usually a sign of trouble.

One of Monica"s friends told Eric that she lied a lot and could not be trusted.

Monica"s oldest child told Eric that she had gone through six of her mother"s relationships and breakups, and that the last time she didn"t come home in order to avoid the fights.

Eric"s children always felt very uncomfortable around Monica.

In addition, Monica had posed nude for a famous photographer. Eric was fascinated by her ability to do this work without embarra.s.sment. One of the nude photos hung in their bedroom. However, Monica wanted to put her second nude photo in the living room. When Eric said no way (they both had children!), Monica had a huge fit.

s.e.x and hope for lasting love can cause blindness, even in very bright people.

After his breakup with Monica, Eric decided to take time off to discover what he really wanted in a relationship. He felt emotionally wrung out and had very good reason not to trust his own judgment. Then, through the Internet, Kate came into his life. He felt she was different. She was sweet, present, loving, and seemingly sincere. Even though the s.e.x was routine, it was ever present, and she seemed emotionally healthier than Monica. It felt like another oasis, where the water was cleaner and more refreshing. But the warning signs were again ignored.

Both of Kate"s parents struggled with alcoholism.

Kate resented her father, whom she said loved her brothers more than her. This father-daughter dynamic usually causes women to resent other men they start to trust.

Kate had left two husbands, blaming them for the problems in the relationship.

She said upfront that she cheated the IRS and never reported her cash income.

The first few months of the relationship were great; then Eric and Kate went through a series of breakups and getting back together, which was always Kate"s idea. When things didn"t go her way, she left again.

Now the warning signs became flashing-red-neon signs. Still Eric ignored them: Kate started pushing Eric to be more committed than he felt ready to be.

Kate never once said she was sorry or asked for forgiveness during any of their disagreements. It was always Eric"s fault.

Kate never seemed satisfied or happy with Eric. When they finally broke up for good, Eric felt as though he had fallen off a cliff. He was in such emotional pain that he felt as though his skin was being ripped from his body without any anesthesia. He couldn"t sleep for six months; he experienced crushing chest pain; felt obsessed with the thought of Kate; had suicidal thoughts for the first time in his life; and despaired of ever having a healthy relationship.

That"s where I came in for Eric. He needed to do a better job at seeing those dead animals around the oasis of love. Make no mistake; Eric was a big part of his own trouble. He was drawn to women whom, like his father, were distant and disapproving. Unconsciously, he found these women the most exciting. He tended to avoid women who were happy with him. His anxiety and actions subtly encouraged these women to take advantage of him, such as providing significant financial support without clear guidelines on what he expected in return. He also tended to set them up to be perceived as critical like his father by being excessively hurt by their criticisms rather than being able to hear them and try to improve. The work in therapy was about seeing his role in the demise of these relationships and helping him see the warning signs around any potential new love so he could be more cautious when he gave his heart away.

Jennifer Can you see the warning signs?

Through the Internet Jennifer met John for dinner on the day after Christmas. He was single, had never married, was forty-six years old, and had a history of short-term relationships. When he met Jennifer, he just melted. He said he could not even talk in her presence and did not want to be apart from her. That evening he invited Jennifer to go to Paris with him the next day, which she did not do. By New Year"s Eve they were talking up to eight hours a day, totally immersed in each other. From the moment he came back from Paris, ten days later, they were never apart for the next two months. Jennifer was totally taken with John. He was handsome, successful, highly intelligent, young minded, funny, charming, and independent. And, very important to Jennifer, he had the name John. For years, she was convinced that John was the name of her true soul mate. When they met, both of them dove right in without holding back. Jennifer loved that he wasn"t afraid to love her. Little did she know about the pain that awaited her.

John was the most generous man Jennifer had ever met. If he gave her flowers, he brought four bouquets, not just one. He never went shopping for himself without thinking of her and buying her something. He was abundantly generous with his words and affection. He constantly talked about how much he loved her, how much he loved holding her, retelling the story of their meeting over and over again and how special and new this "feeling" was. He asked her to marry him within two weeks. He told her that she was the woman he had been waiting for. He had been waiting for "this feeling" and now knew why he had never married. Whatever was good, he"d reinforce by talking about it all the time. They talked for hours about how great their relationship was.

After two months, Jennifer decided she needed some s.p.a.ce and would not sleep over at his house. John became irate. The relationship quickly started to unravel. He liked Jennifer when she was a sweet, soft, loving girl, but when she acted like the a.s.sertive woman she really was, he became angry and controlling. Their fights about their troubles went on and on. He had a challenged relationship with his own depressed mother, who often did not talk to him, which may have been why he needed to talk about problems for a long time. Initially, the relationship was so thrilling that Jennifer jumped in the water without hesitation. When the warning signs flared, she ignored them because she did not want to lose the hope of this new love.

Jennifer started to realize that everything had to be on his turf and his way or there was a huge power struggle. He was overly sensitive to her every move, gesture, tone, and mode of communication. If there was something Jennifer did that he didn"t like, she would hear about it for hours ... basically until she recognized the error in her ways and repented. One night, after another fight, she went home. A few hours later John came over, violently banging on the door until Jennifer opened it. Then he got furious at her because she wasn"t excited to see him. They went into therapy, but after a few sessions the therapist saw it as hopeless.

The hope of love often blinds us to the reality of the situation. Losing hope is painful. Living in a mismatched relationship is usually much more painful than being alone.

Look Before You Drink Before you give away your heart, use your brain. Notice the warning signs and any evidence that there will be potential trouble at the oasis of love. Never expect perfection, as there are very few perfect people in the world. But look for toxic symptoms. All of us have some trouble in our past; but how much and how severe is a score worth noticing. Here is a list of questions about potential new relationships to help you see any warnings.

Do you often feel in trouble when you are with the other person?

Is he or she disappointed in you a lot?

Are you pushed to go faster than you are comfortable?

Are your friends or family concerned about the relationship?

Do you have a nagging, internal voice saying that there is trouble brewing?

Are you ambivalent?

Is there a past history of many short relationships? This indicates trouble committing or the constant need for someone new and exciting in his/her life.

Is his/her behavior inconsistent?

Does he/she blame everyone else for his/her problems?

Does he/she have trouble telling the truth?

Does he/she never apologize?

Do his/her own children say negative things about him/her?

Do your kids feel uncomfortable around him/her?

Is there any drug abuse?

Does he/she cheat the IRS?

Are there temper problems?

Does he/she act in a demeaning or belittling manner?

Is there evidence of alcohol abuse?

Do you lose yourself in his/her presence?

Do you find yourself trying to mold yourself more and more to make him/her happy?

Does he/she come forth with interest and then suddenly withdraw and become unavailable?

Taking a Brain Science History When evaluating whether or not a person is a suitable partner for you, a.s.sess how his or her brain and psyche work. Can you really do this without a scan? Yes. Through the questions we ask ahead of time at the Amen Clinics, our historians are uncannily accurate in predicting what the brain scans of our patients are likely to look like. We a.s.sess brain function by asking the right questions. You can, too. I believe it is essential in dating to obtain extensive information on a potential mate before you give away your heart. Think about using your head to protect your heart.

What kind of questions should you ask? What follows is the outline of the major sections of the Amen Clinic Adult Intake Questionnaire that we use to take the histories of patients who come to our office for help. I will give you tips on how to gather this information and how to ask insightful questions. None of these questions need to feel intrusive. Do not ask them in rapid-fire succession, but rather weave them into the give-and-take of many conversations. Ask them over the first month of dating someone new. Write down their answers in private to obtain a detailed history and fill in the gaps as needed. Anyone who objects to this type of probing likely has something to hide.

ACI Adult Intake Topics 1. Why Are You Here?

In this section we ask people why they came to the clinic. What is the problem? For daters, you need to know what the real purpose of the date is. What does the person really want? This is a critical question to answer. Is the person looking for a one-night stand, a friend, a long-term relationship? Do his or her goals match your desires?

2. What Have You Done in the Past to Fix the Problem?

In this section of the questionnaire we ask patients about past attempts to fix the problem for which they are seeking help. For daters, you want to learn about their past dating experiences. How have they attempted to meet people? What has worked and what hasn"t?

3. Medical History Here we ask about a patient"s physical health. We ask about general health, current and past medications, surgeries or hospitalizations, past head injuries, s.e.xually transmitted diseases, and allergies. In dating, you want to know the specifics about the health of a person. A good way to ask these questions is by starting off with your own health history and then asking about theirs. The health of someone"s brain usually influences the potential health of their relationships. Be curious. Past head injuries may help explain impulsive or erratic behavior. None of the information gathered needs to be the final decision on ruling someone in or out, but it can help you make a more informed decision in the context of the whole relationship.

4. Past Psychiatric History Has the person ever been diagnosed or treated with a psychiatric illness, such as ADD, anxiety, or depression? According to the National Inst.i.tutes of Mental Health, 49 percent of the United States population at some point in their lives will meet the criteria for a mental disorder. It is almost more normal to have a problem than to not have a problem. I never think this should rule someone in or out. But you need to know. If someone has a condition, you absolutely want to know as much as possible about it.

5. Current Life Stresses In this section we ask about the current stresses in a person"s life, such as financial, health, work, or family issues. It helps us to understand the whole person and perhaps why they are having problems at this time. The current stresses in a person"s life are something worth knowing for potential daters. What is stressful or difficult in the person"s life at the moment? A friend of mine once dated a woman who had serious financial problems. She was still being supported by an ex-boyfriend who continued to have s.e.x with her as an exchange. It was important information for my friend to know. This can also be a place to ask potential partners about financial stability. Even though this is an uncomfortable topic, it is critical nonetheless. Financial issues are one of the most common sources of stress for couples. Truly understanding a person"s att.i.tude and behavior toward money can tell you a lot of information about a person"s judgment and how he or she deals with responsibilities.

6. Sleep Behavior Sleep issues are explored in this section, including nightmares, recurrent dreams, insomnia, and any current problems in getting up or going to bed. In s.e.xual relationships sleep is a very important issue. Is the person a light sleeper, so any snoring might bother him or her? Is there chronic insomnia, so partners cannot sleep together, which is a very common problem?

7. School History We want to know all about school. It is such an important part of someone"s life. Here are some questions to ask. What did you like and not like about school? What did your teachers say about you? What were your best and worst subjects? What were your biggest frustrations and joys in school? How far in school did you go? Do you have further educational goals?

8. Employment History Likewise, we want to know all about a person"s work history. Work says a lot about a person. Some questions to consider asking include: What were your favorite jobs? Worst jobs? What would past employers say about you? What is your dream job? What are your work goals?

9. Legal History This section explores any legal or criminal issues. For a potential partner it is a good idea to know if there are any ghosts in the legal past, such as bankruptcies, divorce proceedings, child-custody issues, arrests, criminal charges, and convictions. Even though it seems obvious to ask, sometimes we are blinded by the light of the oasis and fail to do so. If you are in doubt, check their background, which can be done easily on the Internet.

10. s.e.xual History This is often an uncomfortable subject, even for psychiatrists. But it is essential to understanding a person"s life and psyche. It is crucial to know the s.e.xual history of your potential mate. Here are some potential questions to consider. Age of first s.e.xual experience? Number of s.e.xual partners? Any history of s.e.xually transmitted disease? Any abortions? Any history of molestation, s.e.xual abuse, or rape? Any current s.e.xual problems? Any fetishes or particular behaviors I should know about? What is your att.i.tude toward p.o.r.nography?

11. Drug and Alcohol History This is a critical part of our intake process. Even with us, many patients lie about their drug and alcohol usage. Of all the issues that damage relationships, drug and alcohol abuse are near the top of the list. Moderate to heavy use of drugs or alcohol likely predicts trouble in the future because they damage brain function. Whatever damages brain function damages life function as well. Ask candid questions, listen to the answers, and observe the person"s behavior when you are together. Questions we ask about drug and alcohol usage include: How much alcohol do you drink? What other drugs have you used? What is your current usage? Has anyone ever been concerned about your drug or alcohol usage? Have you ever felt guilty about your drug or alcohol use? Have you ever felt annoyed when someone talked to you about your drug or alcohol use? Have you ever used drugs or alcohol first thing in the morning?

12. Significant Developmental Events In this section we want to know about the events that help shape a person"s character. Here we want to know about marriages, separations, divorces, deaths, traumatic events, losses, abuse, and also biggest joys, greatest moments, and successes. Listen to the events that highlight your potential mate"s past.

13. History of Past Marriages and Romantic Relationships This section helps us understand how people connect to past intimate lovers and partners. It is important to know about a person"s history in relationships. Do they blame others for all the problems or have they learned from their own mistakes? What have been the issues, patterns, joys, and sorrows in past relationships? The best predictor of future behavior is past behavior. How people have been in the past is likely how they will be. This is not always true, but true enough that you want to know past patterns.

14. Family History (Parents, Siblings, and Children) Family history is one of the most important sections of our intake process. Many brain problems, such as ADD, depression, alcoholism, or bipolar disorder, are genetic and tend to run in families. Understanding a person"s family usually gives you good insight into their own character and vulnerabilities. Listen to family stories. Specifically, try to understand the relationship between a potential partner and his or her mother and father.

15. Spirituality How did he or she get along with his or her mother (which is usually the primary bonding relationship)? This relationship usually sets the tone for all other relationships for males and females. A positive maternal-child bond helps the brain feel more settled as it develops; a strained maternal-child bond causes stress hormones to disrupt development. How did he or she get along with his or her father (another crucial relationship)? What about the relationship with siblings, and children? Meet his/her family and watch the interactions between them.

It is unusual for many psychiatrists to ask about a person"s relationship with G.o.d or his sense of meaning and purpose in life. Yet, I feel these are very important topics to discuss. This is certainly a critical issue in relationships. When people are matched in their sense of meaning and purpose, with their beliefs in G.o.d or a higher power, their relationships tend to be happier and more mutual. Ask your potential mate about current beliefs in G.o.d and religion. What was he or she taught growing up? What does he or she believe are the influences of these beliefs on other aspects of life? What is his or her overall sense of meaning and purpose in life? Why does life matter? These questions often stimulate great discussions. If not, that is more information for you to have in evaluating the relationship.

BrainMatch.com and Internet Dating Internet dating is the rage, and rightly so. Bars are definitely not the best place to meet someone, especially if you are into brain health. Workplace romances are often trouble from the start. And friends and family can only set you up so much. The Internet works because you are meeting people who want to be met-people who are ready, willing, and available (if they are not lying). People on dating sites help you sift through important information. They tell you what they like, don"t like, their habits and interests. You can see how they write, how they think, and how creative or not they are. I have many friends and patients who have made great use of Internet dating.

Of course, there are dangers to Internet dating as well. One of my eighteen-year-old patients from Northern California met a man from West Virginia on the Web. They talked for hours, got engaged, and he sent her a train ticket to be with him. When she told me all of this in a therapy session, the father in me freaked, and the psychiatrist part of me called a family meeting. I had the mother and father come into our session and we discussed the pros and cons of the pending move. When the girl broke off the trip and the engagement, the man threatened to kill her. We later found out he had just been released from jail. Children, teenagers, and some young adults need to be protected from the seedy side of the Internet. As s.e.x and gambling can become addictive, so can Internet dating. I have known people who spend hours a day searching for the perfect date. They can"t stop and it affects every aspect of their lives, including their jobs and relationships with their children.

From a neuroscience perspective, here are a few tips for safer Internet dating: Really look at the photos posted. If they contain pictures of motorcycles, fast cars, or skydiving, it is likely the person is excitement seeking (perhaps low in PFC activity). If more than one of the pictures has alcohol in it, be concerned about drinking.

Look for the truth. Many people lie on Internet dating. If they lie in that situation, they are likely to lie in others. Lying breeds mistrust. If a person lies about his age, income, desire for children, be concerned. Lying is a deal-breaker.

Talk to them on the telephone and by e-mail at least three times. Be patient. Get to know someone before you let them know where you live. Remember the movie Fatal Attraction?

As in all dating, be careful about moving too fast. Dopamine chemicals are being pumped out fast and furious in the first few months of a relationship.