EXECUTIVE DYSFUNCTION
Peculiarities resulting from injuries or congenital differences in the area of the brain behind the forehead, especially in the orbitofrontal and ventromedial cortices near the eyes, seem to be the cause of the “executive dysfunction” often seen in antisocial children and adults.10 This means that antisocials often have trouble organizing their behavior. For example, a typical waitress job, which might involve fielding requests from a dozen different tables while interacting with the hostess, cooks, and busboys, would be difficult for someone with noticeable executive dysfunction. Orbitofrontal dysfunction in particular seems to release the normal brakes on aggressive and hostile impulses, while dorsolateral dysfunction contributes to an inability to learn from punishment.
Adrian Raine has conducted many studies that have done much to revolutionize our understanding of the neurological foundations of psychopathy. Raine has the seemingly mild-mannered look of an accountant—indeed, he was an accountant. His first two years in the workforce were as an airline accountant for British Airways. However, after receiving a doctorate in psychology, Raine gained a seasoned understanding of psychopathy by spending four years working as a prison psychologist in two top-security prisons in England. A key to the depth of Raine's research breakthroughs is not only his hardened “real-world” background, but also the way he combines knowledge from this background with an astonishing breadth of hard and soft science academic interests, which include brain imaging, psychophysiology, neurochemistry, antisocial behavior, schizotypal personality, and alcoholism.
Fig. 4.3. Damage or dysfunction in these three areas of the prefrontal cortex—the dorsolateral, orbitofrontal, and ventromedial cortices—appears to be strongly associated with antisocial behavior. All of the areas indicated are toward the front of the brain, near the eyes. The left picture is a side view, while the picture on the right shows a view looking up toward the brain from its bottom.
“Why doesn't everyone assault others or act violently?” asks Raine.
One reason is that most of us are good at fear conditioning and we've been punished in childhood for doing minor things like stealing or hitting friends. So we've learned the association between antisocial behavior and punishment and therefore feel fear when we even contemplate an antisocial act. But not everyone is able to form these conditioned responses with equal facility. While some people have biological systems that make it easy, others have biological systems that make it hard. If you are an individual whose right orbital cortex is not functioning well, you're biologically disadvantaged in developing a conscience.11
Oddly enough, one study has shown that murderers who have a normal family upbringing have even lower function in their right orbitofrontal cortical areas than murderers who were abused during childhood. Perhaps murderers “without a psychosocial ‘push’ toward violence require a greater neurobiological ‘push.’”12 In other words, children with less severe neurological problems may be helped by having a normal upbringing—but children with more severe neurological difficulties may not be.
Kind and conscientious people who suffer brain damage in ventromedial areas can suddenly have a complete change in personality and begin to act like psychopaths. Despite seemingly normal intelligence, these “pseudopsychopaths” are often found to have subtly impaired reasoning skills. For example, they may continue to make bad choices in rigged experimental card games even after they understand intellectually how the game is rigged and how they could easily play to win.13
EMOTIONAL CONTROL—AFFECTIVE AND PREDATORY MURDERERS
Imaging is not only allowing us to see into the brains of psychopaths, it is also providing clues about the neural circuitry that underlies their motives. For example, murderers have long been divided into two types: affective and predatory. Affective murderers murder under the influence of emotion. They show little planning to their passionate acts, which often take place in domestic settings. A typical example of an affective murderer is actor Marlon Brando's son Christian, who, while in a drunken rage, murdered the abusive boyfriend of his pregnant, mentally disturbed sister. Predatory murderers, on the other hand, are coldly unemotional, far more controlled, and are more likely to attack a stranger, often using a carefully planned setup. Richard Kuklinski, who “whacked” people for the Gambino crime family, is a good example of a predatory murderer. He perfunctorily explained his motives for killing nearly a hundred people on the HBO film The Iceman: “It was due to business.” (The first might be seen as committing a crime of passion, while the second is premeditated.)
The two very different sets of neural circuitry involved in affective versus predatory murderers are thought to be similar to the two different sets of circuitries seen in animals such as cats. The affective circuit, for example, is activated if Fluffy the cat is trapped by a barking dog—Fluffy's hackles are raised, her back is arched, and she hisses and spits loudly, pinning her ears back and displaying her teeth. If you are unwise enough to try to pick Fluffy up at this point, she is likely to mindlessly attack you. A completely different set of circuits is involved in predatory behavior, as when Fluffy is stalking a bird. She is snake-silent during this time, with ears and eyes focused; she moves slowly and close to the ground. You can safely pick up Fluffy when she's in this predatory mode, although her paws might pinwheel as she still tries to move toward her target.14
As expected, human imaging of affective and predatory murderers has revealed profound differences in how their brains operate—similar to the neural circuit differences known to operate in Fluffy the cat. The affective murderer shows lethargic activity in the prefrontal cortex, the area that normally reins in impulses.15 The predatory murderer, however, shows good functioning in the prefrontal cortex, which is, as Raine slyly notes, “consistent with the role of an intact prefrontal cortex in allowing him to regulate his behavior for nefarious ends.”16 In short, the predatory murderer is well aware of what he plans to do. Emotion-related areas of the brain (specifically, the midbrain, amygdala, hippocampus, and thalamus) in both sets of murderers were found to be metabolically turbocharged compared to normal people's.a. It's thought that the revved-up, party neural atmosphere predisposes both groups of murderers to an aggressive temperament. But only the predatory murderers are able to channel their aggressive impulses into slow-motion torture through bullying, manipulation, deceit—or carefully planned murder.
PROBLEMS WITH ABSTRACT REASONING
The latest imaging results are showing that psychopaths don't just have dysfunction in neural areas related to emotionally based traits such as aggression and impulsivity. They have trouble processing abstract concepts altogether. The next illustration shows the area of the brain where the hitch seems to occur. (For those who need a name, it's the right anterior superior temporal gyrus, which means the surface fold on the right, in the front, toward the upper part of the temples of the brain.) Here, neurons in normal individuals are more active than neurons in psychopaths when hearing abstract words such as justice. However, when concrete words such as table are heard, both normal and psychopathic brains function the same way.17 This agrees with evidence from other studies proposing that psychopathy is related to abnormalities in the right side of the brain—the artsy, abstract side that, among other tasks, synthesizes the big picture and understands nonverbal cues related to emotion.
Fig. 4.4. In the area shown, normal individuals showed much more activity than psychopaths in relation to processing abstract ideas.
The Disease of Too Much Trust—Williams Syndrome
Williams syndrome—what might be termed “antipsychopathy”—is perhaps the most endearing of all diseases. Those afflicted are very polite and sociable, show great empathy, and are completely unafraid of strangers. A trained geneticist can instantly pick out the upturned nose, wide mouth, full lips, and the long distance between the nose and the upper lip of a William's syndrome child. Such children often have heart or blood vessel problems, as well as dental and kidney abnormalities.
Fig. 4.5.
The disease is thought to be related to unusual functioning of a genetically controlled neural circuit that handles human social behavior. It is caused by the loss of a tiny snippet of roughly 21 genes on chromosome 7. In Williams syndrome patients, the amygdala, which sparks “fight-or-flight” responses, shows an unusually easygoing response to threatening faces. On the other hand, threatening scenes with no people, such as burning buildings or a plane crash, provoke overly powerful responses, meaning that Williams syndrome sufferers are uniquely “people persons” even as they are afflicted with unending phobias and worries about everything from spiders to heights. Another area, the medial prefrontal cortex, is perennially activated in Williams syndrome patients. This area, which is right behind the center of the forehead, has been associated with empathy and knowledge of how to interact socially, which may explain the heightened capabilities of Williams syndrome patients in these areas.18
It appears that the missing snippet is composed of “patterning genes” that tell the brain how to grow. Normally, as a baby's brain develops, there is a push-pull between the dorsal and ventral areas. The dorsal areas relate to mathematics, space, and recognizing the intentions of others; while the ventral areas relate to language, emotion, and social drive. Even in normal people, one area usually grows larger than the other—which is why people are often better at either math, or language, but not both. In Williams patients, however, the ventral area goes into overdrive. The excessive growth in this area directs these patients towards hyper-sociability and rich ability to process emotion, even as they are left struggling with concepts of number and space.19 It is possible that research on Williams syndrome may provide a better understanding of the overly trusting behavior of some individuals in the presence of Machiavellian and duplicitous behavior in others.
How might these and related abnormalities lead to psychopathic behavior? It may be that the difficulty psychopaths have with processing abstract concepts also means they have trouble processing complex and abstract social emotions such as love, empathy, guilt, and remorse. Therefore, it may be difficult for psychopaths to understand or control behavior involving these areas.
SEEING THE HUMAN CONSCIENCE
Modern medical imaging is showing that the human conscience, a sense of morality, and ethics—all the things psychopaths seem to be missing—aren't just the playthings of philosophers anymore. In fact, neurological regions related to morality itself have been imaged. In 2002, Brazilian researcher Jorge Moll and his colleagues published the results of a functional magnetic resonance study where people were shown pictures that normally evoke a sense of morality, such as abandoned children, physical assaults, and victims of war.b.20 Scanned images of their brains after viewing these scenes were compared to images produced after viewing benign scenes and scenes that triggered disgust rather than morality. Areas activated by moral rather than everyday conditions included critical regions for social behavior and perception. Morality, in other words, involves a tangible neurological process.
Another study, by neuroscientist Scott Huettel of Duke University Medical Center, showed that more naturally altruistic people have ramped-up activity in the posterior superior temporal cortex.21 This is the area that is related to perceiving others’ intentions and actions. Altruism, it seems, may be founded on our understanding that others have motivations and actions that are similar to our own. Huettel explains: “Perhaps altruism did not grow out of a warm-glow feeling of doing good for others, but out of the simple recognition that that thing over there is a person that has intentions and goals. And therefore, I might want to treat them like I might want them to treat myself.”22 Yet another study showed that the emotions of guilt and shame, like feelings of altruism, activate specific areas of the brain. Shame differs from guilt by a dash of stronger activation in a few additional areas.23 Even the processes of resentment and forgiveness appear to be related to specific sets of neural circuitry—circuitry that can go awry as psychopathology increases.24
Fig. 4.6. This image, by neuroscientist Adrian Raine and his colleague Yaling Yang, highlights the overlapping areas of moral reasoning and psychopathic dysfunction.
It seems that many of the areas that are activated when a person is involved in moral reasoning overlap those that are dysfunctional in psychopaths, as shown in the preceding figure. Impairments to these areas produce impairments in the emotions that comprise the feeling of what is moral. Indeed, psychopaths know intellectually what is immoral—they just don't have a feeling of immorality about it.25
WHY DOES PSYCHOPATHY DEVELOP?
There are dazzling numbers of theories about how and why psychopathy develops, but most of them involve the idea that children with psychopathic traits have neurological glitches that reduce their moral reasoning and empathic concern for others—the emotional building blocks of conscience. Children with the callous, unemotional traits of psychopathy, along with youth who show the chronic misbehavior of conduct disorder (which has been linked to the development of antisocial personality disorder as the child grows into adulthood), often show additional traits of impulsiveness and narcissism. Such children aren't bothered by the hurtful and even shocking effects of their behavior on others and are less able to recognize expressions of sadness on the faces and in the voices of other children.26 Forensic psychologist J. Reid Meloy relays the heartbreaking story of a mother of a psychopath that captures the early onset of the disorder's essence:
“At 18 months [said the mother], it was as if a switch had gone off in him. He started showing tremendous rage, complete lack of remorse and an almost complete lack of empathy. His first reaction, when he would see an animal, would be to kill it. He became extremely hateful and vicious.” This mother went on to describe his affective and predatory behavior toward her, including starting fires in the house, threatening her with a knife, and sticking straight pins out of the carpeting in front of her dresser, out of her pillow, and into her clothes so they would scratch her when she put them on…. As her child has grown older, sadistic behavior is more evident. Once he hanged a cat in the backyard and waited for his mother to come home to watch her reaction. She remembers seeing his pleasure at her horror, and then imitating her horror back to her.27
One particularly important theory about the cause of psychopathy has been developed by Joseph Newman, a University of Wisconsin psychologist who has spent the last twenty-five years investigating the wheres and whys of psychopathy. Where many researchers have focused on the lack of fear and other emotions present in psychopaths—hypothesizing that this leads to a psychopath's indifference to the feelings of others—Newman has pursued a very different idea. He believes that “psychopathy is essentially a type of learning disability or ‘informational processing deficit’ that makes individuals oblivious to the implications of their actions when focused on tasks that promise instant reward.”28 Newman's work is also important in that it is helping us to better understand the different types of psychopathy. One fascinating implication is that psychopathy may not necessarily be related to violence. Forensic psychologists working with violent psychopaths in high-security prisons might be incensed by these ideas, but Newman points out that if you are looking at psychopaths in high-security environments, of course those psychopaths show violent characteristics. (It's a bit like the old story of looking for the keys under the streetlight because that's where the light is.) But there are also psychopaths in minimum-security prisons—these individuals show less violent characteristics. “The essence of psychopathy,” Newman notes, “is not the violence, or the forgery, or the sex crime, or the many miscellaneous minor crimes, it is the psychobiological process that diminishes regulation and behavior change.”29
Overall then, rather like intelligence itself, it appears that moral reasoning is controlled by various neurological features of the brain—features that develop differently, if at all, in children with a genotype that predisposes them toward psychopathy. Just as a child needs the neurol
ogical structure of the eye to process information from the electromagnetic fields that shimmer through the air around him, a child also needs the structure of the orbitofrontal cortex and related neurological features to have a feeling of compassion. Psychopaths, it appears, may be born preprogrammed with a tendency to grow up “morally blind.”
EMPATHY AND MIRROR NEURONS
Empathy—identifying with and understanding another person—appears to be related to a distributed complex of neural units that are primed in part by mirror neurons. These neurons, believed by many to be the greatest neurological discovery of the 1990s, are triggered not only when humans perform an action but also when a person witnesses another person performing the same activity. Thus far, mirror neurons have been found in the premotor cortex and the inferior parietal cortex, and it is thought they may be located in additional areas of the human brain. It may be that these types of neurons have evolved to allow animals to understand what another animal is doing or to recognize another's action. It appears, however, that human mirror neurons are far more flexible and highly evolved than neurons found in any other animal. Dr. Marco Iacoboni, a neuroscientist who specializes in researching mirror neurons, notes:
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