by Adrian Raine
Is it just me who’s got a tile loose? Not really. We can measure schizotypal personality quite well using simple self-report questionnaires. I created a measure for it back in 1991 (yes, psychologists really do study the problems they have). It’s called the “Schizotypal Personality Questionnaire.”115 It includes questions like this one: “When you look at a person, or yourself in a mirror, have you ever seen the face change right before your eyes”? We found in Los Angeles that 18 percent of supposedly high-functioning undergraduates said yes to this item. “Have you had experiences with astrology, seeing the future, UFOs ESP, or a sixth sense?” Forty-nine percent say they have. “I feel I have to be on my guard, even with friends” has 21 percent endorsement, while 31 percent agreed that “some people think that I am a very bizarre person.” When we brought in the students whose total score was in the top 10 percent of the undergraduate population for a clinical interview, 55 percent of this group received a clinical diagnosis of schizotypal personality disorder—equivalent to 5.5 percent of the total undergraduate population, much higher than the 1 percent base rate for schizophrenia.
Now, you could put this all down to the fact that it’s L.A. that we’re talking about—a safe haven for loonies from other locations to migrate to so they can fit in with all the other nutters and not seem so obviously bananas. And there might just be a smidgen of truth to that West Coast stereotype. But at the same time, the reality is that psychosis has its manifestation at a dimensional level. There are shades of gray here, and there is a surprisingly large minority of people in the population with some characteristics similar to schizophrenia.
Are these individuals more likely to be violent and antisocial? Yes, they are. Whether we look at undergraduates at universities—the privileged offenders—or just individuals in the community, those with higher scores on the “Schizotypal Personality Questionnaire” have higher scores on self-reported measures of crime and violence.116 They parallel what many others find in clinical populations of schizophrenics. Put together those with schizotypal personality and those with outright schizophrenia and other psychoses, and you really do have a small but significant group at risk for crime and violence.
But why would schizophrenics be more likely to kill than others? One answer can be found at the surface level in the symptoms of schizophrenia. For one thing, one common manifestation of schizophrenia is paranoia. Paranoid schizophrenics are overly suspicious of other people’s intentions, and believe others are out to get them. If you believe that, then one reasonable defense is to get them before they get you. Other schizophrenics have delusions of grandeur, which can give them a righteous sense of power and control over others, or a religious grandiosity that may make them feel they have the right to override the sanctity of life. Other schizophrenics have a messianic vision—they are a prophet come to save the world from its debauchery and sins. One way of doing this, of course, is to kill as many prostitutes as you can, just as we saw with Peter Sutcliffe.
There are also features common to schizotypals and psychopaths. These two disorders may seem like chalk and cheese on the surface—the shy, retiring schizotypal versus the brash, confident psychopath. But there is a connection. Schizotypals have constricted affect—meaning that their emotions are blunted and reduced. We similarly see in the research literature on psychopaths repeated evidence of this emotional blunting. They just do not experience emotions in the same way that the rest of us do. Schizotypals also have no close friends outside of their family members, and in a similar fashion psychopaths form only very superficial, fleeting relationships, having an inability to form the deep and meaningful social affiliations that the rest of us do.
These superficial similarities partly explain why schizophrenics are more violent. In the same way that blunted emotions and a lack of social connectedness with other people nudge the psychopath into the perpetration of violence, social disconnection and a lack of feeling can tip the schizophrenic into violence. And if you can’t bring yourself to imagine some violent offenders as having schizophrenia-spectrum tendencies, then think again. How many serial killers or murderers have you heard of who at some level were extraordinarily bizarre and acted out strange behaviors? Or had a “had to get them before they got to me” paranoid rationalization for their assaults? Or had really odd beliefs about the world and the people in it? Yes, mad murderers are not uncommon. Recall Ted Kaczynski, the mail bomber, and Peter Sutcliffe, the prostitute killer. Crime connects with schizophrenia—at least part of the time.
Plummeting to a deeper level of analysis, another reason for schizophrenics’ being more likely to perpetrate violence lies in the brain. We have known since the 1970s, from the very first brain-imaging studies using CT scans, that schizophrenics have enlarged ventricles—large fluid-filled spaces in the deeper areas of the brain that likely reflect brain atrophy. Since then thousands of brain-imaging studies have documented functional and structural impairments to many brain regions in both schizophrenics and schizotypals, particularly the frontal and temporal lobes.117 These areas are particularly prevalent in violent offenders.118 Recall also in our prior discussion of brain imaging that schizophrenics who commit homicide are especially likely to have structural impairments to these brain areas. Consequently, one possible reason schizophrenics are more violent is that they have structural impairments to those brain areas that regulate aggression, as well as disturbances in the limbic system, where emotion is generated.119
For some schizophrenics, then, it can boil down to an inability to regulate emotion and acting on the spur of the moment. Things just get a bit out of control sometimes. It’s not so much that they meticulously plan an attack or homicide in a cold-hearted fashion. It’s more that their disorganized behavior and prefrontal dysfunction results in more reactive forms of aggression—acting impulsively on a provocative stimulus. Indeed, schizophrenics are more likely to kill their own family members than to kill strangers. As many of us know, the home setting can be a tinderbox where what starts as an off-the-cuff comment becomes an out-of-control, blazing argument. Add paranoia and delusions into the mix, and a spark can become a conflagration.
For kids, that spark may come at school. Together with Annis Fung and Bess Lam at City University in Hong Kong, we found that children with high scores on the child version of the Schizotypal Personality Questionnaire had high scores on reactive aggression.120 In this sample of 3,608 schoolchildren we also found that victimization mediated—or explained—this relationship. Schizotypal kids are picked on because they are odd, shy, and different, and because of that, they reacted by lashing out in anger at others.
The spark igniting the violence tinderbox need not be physical in nature—it might be ideological. Recall from chapter 4 that Ted Kaczynski’s bombings were a reaction to industrialization and perceived scientific control over society. In other cases, homicide can be in reaction to social rejection and a sense of hopelessness. That might have been partly true for Kip Kinkel, who was expelled from Thurston High School and on the same day shot his parents before embarking on a mass school killing. Might social isolation have partly triggered Adam Lanza’s shooting his mother and then later killing schoolchildren at Sandy Hook Elementary School?
Thus, poor mental health is a risk factor for violence in part because it reflects the type of brain dysfunction that can predispose people to violence. We certainly see a lot of evidence of mental-health disturbances in violent offenders. Not just in disorganized murderers overcome by florid symptoms of psychosis, but also in organized serial killers who can exhibit more muted forms of schizophrenia, as well as overt psychotic symptoms. Here’s an example of that muted form and the mix of schizotypal symptoms that include odd beliefs, bizarre behavior, delusional thinking, paranoid ideation, blunted affect, and no close friends.
THE MADNESS OF LEONARD LAKE
I doubt any of you have ever heard of Leonard Lake. Though he killed at least twelve—and as many as twenty-five—men, women, and babies, he is still cons
idered a small fry in the bigger sea of serial killers. People like him slip from public attention, where there are so many other killers basking in an eerie limelight. Yet Lake’s case illustrates a mental-health point that is relatively underreported in the literature and needs to be recognized.
Lake had been diagnosed with schizoid personality disorder when he was discharged from the Marine Corps after service in Vietnam. Although he went into psychotherapy, there is no known effective treatment for this personality disorder, one of the schizophrenia-spectrum disorders. Lake was an odd man in many ways. He was fascinated by medieval legends, paganism, and the Vikings. He was once observed to have a large pot on his stove in which he was cooking the head of a goat for soup.121
Odd beliefs and behavior like this are characteristic of those with schizotypal personality disorder. One schizotypal I heard being described at a clinical case conference at UCLA wanted to sleep with a goat. Lake’s behavior and beliefs were no less bizarre. He had delusions of grandeur and developed a vision of running a survivalist compound in which only the strongest and bravest individuals would survive the apocalypse that was about to come. He believed the world would be destroyed in a nuclear war, but that he would rebuild the human race with his collection of young female sex slaves.122
Bizarre beliefs in those with schizophrenia-spectrum disorders don’t pop up from random neural misfiring in the brain. Instead, they have some foundation in the social environment. Lake’s delusions eerily mimic the main theme in Stanley Kubrick’s classic film Dr. Strangelove, which was released in 1964. In the movie, the nuclear-arms race is getting out of control and paranoia is running rampant. Brigadier General Jack Ripper initiates a B-52 nuclear attack against the Russians under the belief that a communist conspiracy lies behind the water fluoridation that is sapping his “precious bodily fluids.” The Russians have, unbeknownst to the West, developed a doomsday device that is programmed to wipe out the world in the event of an attack on Russia. The U.S. president, under the advice of Dr. Strangelove (a former Nazi weapons expert), develops a plan to occupy deep mine shafts. Selected men—who of course would include the president, Dr. Strangelove, and senior officials—will cohabit with many young women selected for their reproductive fitness and attractiveness so that the men may perform prodigious acts of unselfish reproduction to help repopulate the world.
Did Lake once watch Dr. Strangelove, or some similar apocalyptic narrative, and take on board some of these bizarre belief systems? Or were his violent fantasies shaped in part by his tours of duty in the Marine Corps in Vietnam? Or both? Lake certainly had paranoid ideation and believed the wider world was under imminent attack, that it would be wiped out, and that he would need to repopulate the world. He began to act on his beliefs with callous disregard for the suffering of others. He had the cognitive, emotional, and behavioral features of schizotypal personality disorder.
Lake put his vision into operation by setting up a compound in Wilseyville in the rural area of Calaveras County123 in California. There, in his bunker, he stockpiled arms and food to survive the nuclear fallout, complete with all the necessary shackles, chains, and sexual devices to help him repopulate the post-nuclear world. With a partner, Charles Ng, he lured both men and women using classified ads in which he advertised the sale and exchange of video equipment. Men who replied were immediately killed for their possessions. Women were imprisoned in an underground bunker, where Lake and Ng would make them perform sex-slave rituals in snuff videos, begging for mercy as they were tortured and raped.
Schizotypals score lower on empathy than normal individuals,124 and Lake’s level of empathy was decidedly low. He is recorded telling one of his victims, Kathy Allen, “If you don’t do what we tell you, we will tie you to the bed, rape you, shoot you in the head, and take you out and bury you.”125 The reality was to be even worse. Indifferent to the pain he was causing by torturing and raping the women in his bunker, Lake took away the baby of one of his victims, Brenda O’Connor, claiming it was for now in the safe hands of another family. Terrified and hysterical at what might happen to her baby and deluded into believing she could save it, Brenda went along with Lake and Ng’s perverted wishes in their snuff videos. The reality was that her baby had already been cut up and buried outside the bunker, and Brenda was to follow after slow torture with sadomasochistic devices.
As was mentioned above, schizotypals have no close genuine friendships outside of their own families, and while they may have superficial associates, these relationships are not deep and meaningful relationships. Lake’s social connectedness did not even extend as far as his own family. He killed his brother and also killed one of his few associates for his money and possessions, just as he had killed strangers.
A significant number of schizotypals have obsessive-compulsive personality features.126 Lake too had his obsessive-compulsive features, taking several showers a day and repeatedly washing his hands—he was compulsively clean as a child. He also made his victims shower before sex.
Another symptom of schizotypal personality is bizarre behavior. Lake would dissect his victims after murdering them, boil the skin off their bones, and place their remains in plastic bags, which he buried in shallow graves around his bunker. Individuals with schizophrenia-spectrum disorders are at risk for suicide,127 and so it’s not entirely surprising that after being captured Lake swallowed a cyanide pill that he had carefully hidden under the lapel of his shirt. He died four days later.
Leonard Lake was not a schizophrenic hearing voices like Peter Sutcliffe or Ron Kray or Henry Lee Lucas. He did not stand out on the street looking disheveled or talking to himself. Instead, he had the kind of symptoms that are not too obvious or noticeable in isolation, but in unison can be clear signs of someone at risk for violent behavior. Clearly not all people with schizotypal personality are killers—far from it—and there were certainly additional factors that made Lake the monster he evolved into. But I suspect that features of schizotypal personality are far more common in violent offenders than today’s criminal justice system recognizes, largely because these features are not in and of themselves very striking, pathological, or “abnormal.”
After all, did anyone think that Adam Lanza might kill his mother and twenty-six children and adults at Sandy Hook Elementary School in Connecticut in December 2012? At the time of writing—just nineteen days after this tragic event—little definitive is known about his mental condition. Yet to me, he very likely had at the least four of the seven symptoms of schizoid personality disorder: lack of close friends, chooses solitary activities, emotional detachment, and does not desire close relationships or being part of a family. This is the very same diagnosis Leonard Lake was given after his discharge from the Marine Corps. Four out of seven signs are sufficient for a clinical diagnosis. Lanza might also have had the remaining three: takes pleasure in few activities, indifferent to praise or criticism, little interest in sexual experiences. Like Lake, he may also have had additional features of schizotypal personality disorder, including odd appearance/behavior, constricted affect, social anxiety, and odd speech.
I have selected schizophrenia-spectrum disorders from a much wider number of psychological disorders to illustrate that health considerations do not end with physical health. Psychosis and subliminal forms of psychosis—like schizotypal personality—have a strong neurobiological basis and are also clearly related to crime and violence.128
There are two very important caveats to repeat, however. First, most schizophrenics neither kill nor are dangerous to others. We should take care not to stigmatize patients with schizophrenia or schizoid personality as both “mad and bad.” At the same time, we need to recognize the raised rates of violence in schizophrenics so that they can receive treatment to reduce the likelihood of violence, and thus reduce the stigma.129 Second, there are many other mental disorders—including depression, bipolar disorder, ADHD, and borderline personality disorder—that are also significant mental-health risk factors for violence. It
does not stop with schizophrenia, and of course alcohol and drug use are also major mental-health disorders that increase the risk of violence.
I believe that taken together, the physical- and mental-health risk factors that we have scrutinized in this chapter are convincing components of the anatomy of violence. We’ll see later that these constituent pieces are not unalterable. Indeed, we have continued the theme seen in the past two chapters, on broken brains and natural-born killers, that the environment has a role in shaping the biological infrastructure of the violent offender. We’ll now move further forward with this recipe for violence to understand how all the different ingredients that we have discussed so far blend together to form a lethal brew.
8.
THE BIOSOCIAL JIGSAW PUZZLE
Putting the Pieces Together
Henry Lee Lucas never really had a chance in life. Right from the beginning he was damaged goods. His father, an alcoholic hobo named Anderson Lucas, who lost both of his legs after falling off a freight train, whiled away his time drinking, selling pencils, and making illegal liquor. Henry himself became addicted to alcohol by the tender age of ten. Drunk most hours of the day, Anderson had no time for Henry—or anyone else, for that matter.