THE BLOG
06/21/2011 02:17 pm ET Updated Aug 21, 2011

Weiner Makes Me Wonder: Do Bad Boys Really Have Bad Brains?

The recent flurry of sex scandals among politicians, from Arnold Schwarzenegger to Senator John Edwards and Congressman Anthony Weiner, has triggered a variety of commentary from political analysts to neuroscientists. We seek to understand the mental processes of the individuals involved: "What were they thinking?" They had it all, so why did they self-destruct? In a Huffington Post blog entitled "Why Men Cheat: A New Twist on an Old Question," Dr. Daniel Amen suggests that the bad decisions made by these politicians are due to impairment of the prefrontal cortex, the part of the brain involved in reasoning, judgment, planning, impulse control and organization.

As a neurologist, I agree that injury to the prefrontal cortex can impair judgment and impulse control. However, impaired judgment and impulse control due to prefrontal cortex dysfunction typically manifests in multiple arenas of one's life. The fact that all of the above-mentioned men have the necessary reasoning skills and self-discipline to succeed in politics indicates to me that their prefrontal cortexes are working just fine. After all, these men have exhibited supreme abilities to plan, organize and persevere to get elected to public office in the first place, not to mention the fact they also demonstrate marked skill planning their cover-up strategies and deceit, which further requires an intact prefrontal cortex.

In my practice, I care for many patients with bona fide prefrontal cortex dysfunction. Whether their brain dysfunction is congenital or caused by stroke, trauma or disease, their impairments affect every aspect of their lives. They perform poorly in school, their social interactions are impaired and they have difficulty holding down a job. A consistent pattern of failure can be traced over time.

Even in this population with clear disability, it may be difficult to detect visible changes in the prefrontal cortex despite using the most technologically advanced imaging studies. While Dr. Amen suggests that we can easily diagnose prefrontal cortex dysfunction by SPECT scanning, in truth, this is a gross oversimplification. It is very common for those with clear impairments of judgment and impulse control on neuropsychological testing to have completely normal brain scans. Complex human thought, motivation and behavior often cannot be explained by the most advanced brain imaging tools available today.

We also must consider the social implications of simply attributing bad behavior to a bad brain. Do we really want to encourage these men to explain their cheating with the easy excuse that "I have a bad brain," or, "Sorry, Honey, but I'm just wired this way"? This approach too conveniently sidesteps the issue of personal responsibility that we all have to develop and use our brain to its best potential.

One of the greatest breakthroughs in neuroscience is the realization that the way we use our brain ultimately determines its structure. Every experience we have and every thought we think physically changes our brain. Each time we think a specific thought or perform an action, a specific neural network fires, and structural changes occur along that pathway. The more we stimulate that neural pathway, the stronger it becomes over time. This is how learning occurs and how habits are formed. In this way, we truly are the architects of our brain. The choice is ours.

I would argue that these bad boys have made bad choices. Although these bad choices may have negatively altered their brain structure, this is very different from diagnosing them with an underlying brain disorder that is beyond their control. They alone are responsible for the self-destructive brain pathways they have allowed to flourish. Hopefully, through rehabilitation therapy, which essentially restructures brain circuits, they will overcome these behaviors and redesign a better brain for themselves and for society.