Jeremy Jones is an example of an already psychopathic person whose propensity to violence was aggravated by methamphetamine. A delinquent of the "childhood-persistent" type, he was at high risk for future poor adult adjustment.43 Conduct disorder was apparent by age eight. As an adolescent he had assaulted a boy-and then the boy's mother when she came to her son's defense. At eighteen he killed the bride of a neighbor and erstwhile friend. Charged with rape at twenty-one and again at twenty-two, he was by then heavily addicted to methamphetamine. Unfortunatelybecause of poor communication between police in different locales-he was only put on probation for these crimes, making it easier for him to flee to another state and assume an alias. His use of crystal meth spiked both the noradrenaline and dopamine systems in his brain, rendering him hypersexual as well as increasingly violent. A psychopath of the charmer/con man type, he always had girlfriends who swore by him, even while he was committing one rape-murder after another, often burning down the homes of his victims so as to eliminate evidence. Utterly without remorse and contemptuous of the law or of ordinary human feelings, he boasted he could talk the panties off a nun, and that one day he would be free again (from the death row in Alabama where he now sits) to write a book and "laugh my ass off."44 A serial killer in Category 18 on the Gradation scale, he is known to have raped and killed eight women but is suspected of having killed a dozen or more besides. He killed a married couple in Oklahoma and then murdered their sixteen-year-old daughter and her friend as well, throwing their bodies down a mine shaft. He later confessed to this, but for which they would never have been found.
The recreational drug phencyclidine (angel dust or PCP) was developed originally as an anesthetic of the ketamine family of anesthetics but was discontinued for medical purposes because of its potentially dangerous side effects. Phencyclidine has direct effects on dopamine D2 and serotonin 5HT2 receptors in the brain and is capable of producing symptoms suggestive of schizophrenia: hallucinations, loss of ego boundaries-and in some people-outbursts of rage and violence.45 A common method of using the drug is to spray it on leafy material like marijuana or oregano leaves and then smoke it.
Sometimes the PCP is mixed with cocaine, resulting in a substance known on the street as "tragic magic." Tragic magic was the mixture smoked by the man mentioned in the introduction-the man who had killed one man and blinded another. The marijuana joint, laced with PCP/cocaine, had induced a state of rage and persecutory hallucinations that had precipitated the attack. It would be only fair to state that in his childhood he had been choked to unconsciousness and then sodomized by his father, and repeatedly whipped with an electrical cord by his mother for minor disobedience. This left him with a residue of vengeful feelings for the abuse he had suffered. The drug abuse with marijuana, PCP, and cocaine in his early twenties may have sufficed to provoke the violence unleashed in the murder and attempted murder. Whether he was additionally vulnerable because of adverse genetic peculiarities (to be discussed below) we do not know; the appropriate tests had not been developed at the time and are not commercially available even today. As a psychopathic man with poorly controlled rage and poor social skills, he belongs in Category 13 on the Gradations scale.
In the same way that schizophrenia, mania, and the other hereditary psychoses can occasionally spur outbreaks of violence, illicit drugs whose effects mimic these conditions can do the same in persons who have no prior history of violence or even of antisocial (or psychopathic) personality. That they may have been primed to violence by violence done to them earlier is another matter. This seems to have been the case with a man admitted to a forensic hospital after killing his mother. The mother had been diagnosed as a schizophrenic, though with what accuracy is not known. She had been alternatingly abusive and neglectful toward her son. In his twenties he began to use LSD with some regularity, which caused him to hallucinate both sounds and colors. During one of his visits with his mother, she became verbally abusive with greater than usual intensity. Still in his LSD-induced mental haze, he picked up a scissors and stabbed his mother to death, then eviscerated her-removing her heart and liver, parts of which he ate. His T-shirt soaked with blood, he then wandered in the street, where he was soon apprehended by the police, found to be "crazy," and remanded to the forensic hospital. Once the LSD was mostly cleared from his brain (a lengthy process, in the case of LSD), his behavior and personality returned to acceptable, nearly normal, levels. A gifted artist, he spent most of his days drawing and painting. He had no record of other violent acts. Eventually he was allowed to go to an ordinary psychiatric hospital, from which he was released back into the community a few years later. When I traced him, fifteen years after the murder, an art gallery was staging a one-man show of his artwork. The former patient was living a peaceful life, supporting himself through his art. The man had been psychotic because of the drugs, but was not psychopathic. He belongs in Category 6 or 8 on the Gradations scale.
Unlike alcohol, which contributes to violence largely through disinhibition (interfering with the brain's "top-down" ability to suppress violent behavior) '46 or cocaine and methamphetamine that intensify the ("bottom-up") drive toward violent "solutions," the effects of marijuana are less clear-cut and usually not so strong as promoters of violence. Some have suggested that marijuana may even reduce violence41 or else that persons in a state of low-dose marijuana are more violence-prone than those in a higher-dose state.48 But this is not true in a general way. The man mentioned in chapter 2, for example, who bludgeoned his mother to death, had abused marijuana extremely heavily every day for months on end-to the point where he developed a paranoid (persecutory type) psychosis that lasted long after he was hospitalized and no longer had access to the drug.
In my experience at a forensic hospital it was common to see men (and a few women) who had begun heavy marijuana use around age twelve or thirteen, sometimes as the only drug of abuse, more often admixed with alcohol or cocaine. They then went on to develop a psychosis mimicking schizophrenia. This was true of many of the patients who were remanded to a hospital because of murder (more often of a family member or sexual partner than of a stranger). Since these patients behave in ways very sim ilar to the genuine "hereditary" schizophrenics, there is good reason to suspect that the drug has, over time, actually altered the genome, creating brain changes that are permanent-as though they came about via inheritance. Such changes are called epigenetic, and concern chemical "switches" that can turn certain genes on or off, thereby altering their expression. Environment, as we are now learning, can affect genes, as well as the other way around (though environmentally induced changes are not inherited). Genes and environment are a two-way street. Chronic cocaine use, for example, can cause more branching of the dendrite nerve endings in the nucleus accumbens, creating stronger connections to other neurons and, in this way, heightening the impact of subsequently used cocaine on the brain's reward system.49
In all these varieties of drug abuse, one has to take into consideration the brain's general state of maturity. Adolescent brains, less well myelinated in the frontal lobes than they will be a few years hence, are more vulnerable. This leaves adolescents (and young adults) more prone to violence than they might be later on-witness the fact that crimes of violence peak between the ages of eighteen and thirty.50 In more than half of violent crimes (irrespective of the age of the attacker) alcohol has been a factor.51 Examples are innumerable, but here is just one: In the summer of 1993, five high school dropouts in Houston, Texas, all age seventeen or eighteen and all with many prior arrests for violence (including assaults against teachers, for which they were expelled) formed a loose gang. One evening, after they had been drinking beer all day long, they first got into fistfights with each other by way of proving who was "macho" enough to belong to the group. They turned their attention a little later to two young girls walking home through the park where the boys were. All five boys raped, tortured, and stomped to death the two girls. All were quickly captured and ultimately given the d
eath penalty. Alcohol was the catalyst to the crime (the only one in Texas history where five men were given the death penalty for the same crime), obviously not the sole cause. Some of the teenagers had been seriously neglected by their mothers, one-who had abused alcohol since he was five-had a father who was in prison for murder, three had murdered a man before they joined in the rape-murders of the girls, all had come from chaotically disorganized families. Most had conduct disorders present from an early age. All had committed previous violent crimes when under the influence of alcohols" The torture of the girls was prolonged; the sexual attack preceded their being stomped to death. On the Gradations scale, the appropriate category is 22.
Brain Injury Related to Violence
Injury to the brain can come about in many ways. One common way is blunt trauma that, besides causing unconsciousness right after the blow, damages specific areas of the brain. Depending on which areas of the brain are involved, the effects on personality and behavior may be negligible or at least nondangerous. Or the damage may have profound effects on personality and behavior: there may be weakening of self-control and loss of inhibition. Brain tumors affecting certain areas may have similar effects. In addition, fetal distress at the time of birth may result from birth complications that interfere with proper oxygenation; the inadequate oxygenation, in turn, can damage key areas of the brain involved in behavior. These complications can occur toward the end of pregnancy or shortly after birth, and for this reason are often called perinatal, meaning "around the time of birth." The results can span the whole spectrum of possibilities, from docility to irritability to violence.
An important clue about such changes in behavior after brain injury came in the wake of a most unusual incident. A twenty-five-year-old Vermont construction foreman, Phineas Gage, was using a tamping iron to pack explosives into a rock. He inadvertently triggered an explosion that sent the iron bar, more than a yard long, through his left cheek and head. Unconscious only for a few minutes, Gage miraculously survived. But he underwent a profound change of personality. Having been a shrewd, energetic, industrious, and trustworthy worker before the accident, he was then described by the doctor who followed his case in these terms: "fitful, irreverent, indulging at times in the grossest profanity ... impatient of restraint or advice when it conflicts with his desires ... capricious and vacillating."53 Gage also became alcoholic and grandiose.
Gage died some twelve years later, having taken on many traits of the psychopath-as a result of his brain injury. His skull has been preserved and studied extensively by Drs. Antonio and Hannah Damasio. They demonstrated that, besides his having been blinded in the left eye, Gage experienced selective damage to the prefrontal cortex on both sides.14 Recently, Gage's skull has been examined by other observers who concluded that the damage was limited to the left prefrontal cortex. 55 Specifically, it was the ventromedial prefrontal cortex region that was damaged in Gage; we now understand that this region plays an important role in normal decision making. Gage's inability, after the accident, to plan meaningfully for the future and to obey the social rules he adhered to when he was brought up, were the consequences of the bar passing through his brain in that area. Why, we may ask, did Gage not go on to become a violent criminal? Perhaps the answer to this question may be resolved by looking back to his childhood, which seems to have been fairly normal and nontraumatic.sb
This scenario contrasts with that of the Texas Tower mass murderer, Charles Whitman (chapter 5), who at autopsy was found to have a tumor that impinged on the amygdala-irritation of which may lead to aggressive behavior.57 But in his formative years, Whitman had been the object of punitive physical abuse by his father.58 In Whitman's case the combination of the early environmental trauma coupled with the brain damage affecting the amygdala may have unleashed in him an explosion of murderous rage. As for the detonator to this rage, Whitman had experienced a number of recent stresses just before that fatal August day in 1966: strains at work and at school, and the impending divorce of his parents.
Given the "right" amount of damage to the brain, especially in the top-down areas (such as the ventromedial prefrontal cortex) that ordinarily put the brakes on socially inappropriate behavior, violence can be the outcome, even in the absence of known environmental traumata. This is a topic where research and forensic experience often pass each other by, because fMRT data before death and autopsy findings afterwards are seldom available in the cases of greatest interest to us. We wish we knew such details in the "Mr. Goodbar Murder" in 1973 about which a movie was made. Joe "Willie" Simpson, twenty-four at the time, sustained a brain injury and had become unconsciousness during a car accident when he was thirteen. He had been raised in a working-class family in Peoria, Illinois, by parents who, as far as we know, were not abusive. After the accident, Simpson underwent a drastic change in personality. He began to have headaches and nightmares. He ran away from home, became a thief and a vagrant; he conned people and lived a parasitic life as a male prostitute kept by a wealthy gay lover. Willie also had sex with women-including a girl of sixteen he married (and then abandoned), by whom he had a child. Simpson could swing quickly between being sociable and charming-and explosively angry. He abused alcohol, LSD, and marijuana. Alcohol was in his system the night of New Year's Eve 1973 when he met a teacher, Kathy Cleary, in a bar in New York City. She invited him back to her apartment. He tried to have sex but was unable; he became enraged, strangled her to death, and had sex with the corpse. Once in prison for the murder, he hanged himself.59 So we don't really know which parts of his brain were affected by the car accident; we can only make shrewd guesses based on what we know from cases where pertinent examinations had been carried out. Perhaps, judging from his impulsive lifestyle after the accident, the bottom-up drive centers, including the amygdala, had been damaged, though the blunt force of a car plowing into one most likely caused more widespread damage to the decision-making centers as well.
In a similar fashion, we don't know precisely which brain regions were damaged in Richard Starrett (chapter 7) after his episodes of head injury and unconsciousness, though we do know that he became hypersexual and preoccupied with pornography in his early teens, following the injuries. Whether these were signs of damage to the lateral prefrontal cortex (that may be associated with such symptoms) is unclear; Starrett has not to my knowledge been studied with MRI during his years in prison.
Hormones
On average, men are more apt to be aggressive than women, and tend to be less empathic than women. From the perspective of evolution, there are solid reasons for this. Men behave in ways similar to male lions (another social animal group), where the males guard the perimeter from would-be invading male lions who might be eager to take over the pride. Leaving his urine scent on trees and other objects in the pride's perimeter, the male lion signals that all within is his turf. Intruders trespass at their own peril.60 Pissing contests of this sort are part of the repertoire of males in our species also-carried out sometimes just as crudely, though more often on a more symbolic level. Businessmen are fond of saying that their new product or new CEO is going to "kill the competition," by which is meant not murder (not usually, anyway) but rather an eagerness to prevail in the struggle for supremacy and for all the perquisites that go with beating the competition. Since ancestral times, before and after humans left the African savannahs fifty thousand years ago to try their luck in other parts of the world, men have guarded the perimeter of a social group. The women gathered in an inner circle, taking care of the children and preparing the food that their men, with any luck, dragged back from beyond the outer circle. Our tools, language, and dress have changed considerably since then; our brains have not.
Since testosterone in the fetus with the XY chromosome plays a crucial role in making that baby a boy, and in shaping his brain along lines associated with maleness, there has been a tendency to assume that males with higher testosterone plasma levels will be more aggressive than those with more modest levels. Taking th
is a step further, we often assume that murderers, who are far more likely to be men than women-by a factor of about 9 to 161-would have particularly "off the chart" levels of male hormone. For a time it seemed as if violent criminals did tend to have higher testosterone levels,62 but subsequent studies did not bear out such a neat relationship.
Because circulating testosterone levels increase in boys in lockstep with their advance into puberty-a period when antisocial behaviors increase markedly, as well-it seemed worthwhile to look at the hormone picture in boys between the ages of nine and fifteen. The expected increase in testosterone during those years turned out to have more to do with nonphysical aggression and social dominance (in the hightestosterone adolescents), and did not seem to relate to aggression.63 Under certain circumstances there did seem to be a connection between high testosterone and aggression-but this occurred when, simultaneously, the brain serotonin level was low.64 Severe aggression was related to the low serotonin level, not the high testosterone.
There are genes in the body cells that allow male hormone to become attached at the appropriate site: "androgen receptor" genes. Now that the human genome has been worked out in extensive detail, variations in the structure of different genes have been discovered. Some variations have fewer components (making for shorter alleles that one inherits from each parent); other variations have longer components. A person can inherit a "long" variant (i.e., allele) from both parents (cre ating an L-L, or long-long situation), or one long and one short (L-s), or a short allele from both (s-s). In a recent study in India, it turns out that rapists who went on to murder their victims were much more likely to have the s-s (double short) alleles for a particular sequence on the androgen-receptor gene, when compared with the men who only raped or the men who only murdered.15
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