The Anatomy of Violence

by Adrian Raine

  Let’s continue our travels to find a different cure to crime. La Pirogue is the jewel in the crown of the beautiful island of Mauritius. With its golden sands and tropical gardens surrounding traditional-style thatched rooms, it is a haven of peace and tranquillity. It is my favorite hotel in the world.

  Utoeya is also a utopian picturesque island, this one located in the Tyrifjorden fjord outside of Oslo in Norway. With its pretty little beaches it is similarly a summertime resort for young people. And it was here on the evening of July 22, 2011, that eighty-four people lost their lives while I unknowingly sat on the beach at La Pirogue in Mauritius, watching the sun set slowly over the coral reef.

  I had flown in just the day before on flight MK 647 from Singapore, where I had been working with my colleagues on our fish-oil study on conduct-disordered children. The biotech company Smartfish, whose headquarters are in the Oslo Innovation Center, supplied the Joint Child Health Project in Mauritius with an omega-3 drink. I had a connection with its cofounder Janne Sande Mathisen, as she had gone to Darlington Technical College, which was just a few blocks from 69 Abbey Road, the house I was brought up in as a child. I had an unexpected e-mail from her on that fateful day:

  Just 20 minutes ago there was an enormous explosion in central Oslo—affecting the governmental buildings. We could hear the explosion even though we live 20 minutes (by car) from the center. It is most likely a bomb and a terror attack. This has never happened before, and it will have strong impact here.

  What Janne had heard was a massive blast from a 2,000-pound fertilizer car bomb placed in the center of Oslo, which exploded at 3:17 p.m., damaging ministry buildings including the prime minister’s offices and killing eight people.

  A short while after, at about five p.m., an armed “policeman” took a ferry across the Tyrifjorden fjord just outside of Oslo to the island of Utoeya to “investigate” the bombing. Landing on the island, which was filled with teenagers taking part in a youth camp for the Labor Party, he called the students toward him. They dutifully came, whereupon he promptly shot them. Anders Behring Breivik continued his shooting spree for an hour, during which time he killed sixty-nine individuals, mostly teenagers, fifty-six of them shot in the head. Thirty-three more were shot but survived. It was the worst peacetime massacre in Norway’s modern history.

  Those victims had been drawn to that island for its charm and peace, to relax in the countryside and beaches just as I was doing in Mauritius. Yet as I sat in my paradise watching the sun setting over the Indian Ocean, their paradise was being invaded by a sandy-haired, blue-eyed devil. As I heard the crashing of the waves on the coral barrier reef outside my room at La Pirogue, there was the crushing of their young souls outside Oslo. Yet in the sea in both Norway and Mauritius there might just be a part-solution to this kind of mindless violence—fish.

  I first got the idea on a visit to Mauritius a decade ago. It was November 2002, and I had just revised our findings from our earlier study showing how early environmental enrichment particularly reduced conduct disorder in kids with poor nutrition—an enrichment that included more fish. I was in the airport in Mauritius, wanting to buy something to read on the plane going to Hong Kong. There is one, and only one, small book shop there, and it largely sells books in French. There were literally two short shelves with books in English. And there I saw it, Andrew Stoll’s The Omega-3 Connection,66 which had come out the previous year.

  Going through it on the flight, I read his summary on the early studies suggesting that omega-3 might help with depression, ADHD, and learning difficulties. There were no studies of aggression or antisocial behavior, but he speculated:

  We await the results of future studies in our nation’s schools and prisons, and hope that at least part of the answer may be as simple as an omega-3 fatty acid.67

  Perhaps he was right. The staff at the Joint Child Health Study in Mauritius tested the idea in a randomized, double-blind, placebo-controlled trial of omega-3 supplementation in children and adolescents. Participants were drawn from the Mauritius Child Health Project. One hundred children drank one pack of the Norwegian Smartfish Recharge juice per day. It’s only a 200-millileter drink (less than a cup), but packed into it is a whole gram of omega-3. They took that for six months. One hundred other children were randomized into the placebo control group and received the same juice drink, but lacking the omega-3. Parents then rated their children’s behavior problems at the beginning of the study, six months later (at the very end of the treatment), and for a third time six months after the treatment had ended.

  The results were intriguing. As you can see in Figure 9.3, both groups showed a reduction in aggression after six months of taking the drinks. That shows there was a placebo effect—that the fruit-juice drink without the omega-3 was doing just as good a job as the omega-3 drink. However, six months after the end of the treatment, the control group had returned almost to its pretreatment levels of aggression, whereas the omega-3 group continued to show even further reductions in aggression, delinquency, and attention problems. It was a significant interaction between treatment group and time, with the groups really diverging in outcome a full year after the study had begun.68 These results provide some initial support for the idea that omega-3 can help in the long term in reducing behavior problems in children, a significant precursor of adult crime and violence.

  Figure 9.3 The long-term effect of omega-3 in reducing aggression in children

  Why would we expect omega-3 to reduce aggression? In a way it’s surprisingly simple. We’ve seen throughout this book that there is a brain basis to violence. We discussed earlier how omega-3 enhances brain structure and function by increasing dendritic branching, enhancing synaptic functioning, boosting cell size, protecting the neuron from cell death, and regulating both neurotransmitter functioning and gene expression. So omega-3 might partly reverse the brain dysfunction that predisposes one to aggression.

  I was initially surprised that there would be a long-term change. Wouldn’t any initial results wash out after the Smartfish drink was discontinued? But Joe Hibbeln, a leading figure in the field, explained to me that the half-life of omega-3 in the body could be about two years—it stays in the body ready for re-uptake and it can make a lasting change in the brain.69 So it stands to reason, at least in theory, that by improving brain structure and function omega-3 could help reduce violence in the long term.

  The idea that nutrition could help is not new. In 1789, when the revolting French peasants in Versailles were baying for the blood of their queen, Marie Antoinette is reputed to have said, “If they have no bread, then let them eat cake.” Brioche—a rich form of bread that she was supposedly referring to, may not have helped much, but she wasn’t that far off the mark in thinking that nutrition could quell the violent rioting. And omega-3 is not just food for thought, it’s increasingly becoming food for court.70 The judiciary are becoming interested in the idea that omega-3 can cut crime.

  Skeptical? So far two randomized controlled trials have shown that omega-3 supplementation can reduce serious offending within a prison. The first study, by Bernard Gesch, at Oxford University, demonstrated that taking a combination of omega-3 and multivitamin supplements for five months led to a 35 percent reduction in serious offending in young adult prisoners.71 Fascinated by these initial findings, the Ministry of Justice in The Hague in the Netherlands conducted its own study on young-adult offenders and found that omega-3 and multivitamins for eleven weeks reduced serious offending within the prison by 34 percent—results almost identical to the British study.72

  Wherever you go around the world, it seems that omega-3 may make a difference. In Australia, six weeks of omega-3 supplementation reduced externalizing behavior problems in juveniles with bipolar disorder.73 In Italy, normal adults taking omega-3 for five weeks showed a significant reduction in aggression compared to controls.74 In Japan, a randomized controlled trial of omega-3 in adults reduced aggression.75 In Sweden, a randomized controlled trial found
that ADHD children with oppositional defiant disorder showed a 36 percent reduction in their oppositional behavior after fifteen weeks of omega-3.76 In Thailand, a randomized, double-blind trial of the omega-3 fatty acid DHA resulted in a significant reduction in aggression in adult university workers.77 In the United States, women with borderline personality disorder randomized into supplementation of the fatty acid EPA for two months showed a significant reduction in aggression.78 Another American study, this time a four-month randomized, double-blind, placebo-controlled trial of fatty-acid supplementation in fifty children, showed a significant 42.7 percent reduction in conduct-disorder problems.79

  It’s all too simple, you say. And strictly speaking you are right. Violence is complex. In omega-3 we are looking at only one ingredient of a much bigger nutritional package that can feed violence-intervention efforts. We saw earlier how eating candy is correlated with crime. Blood-sugar lows can blow the lid off containing aggression. Not eating enough can make one tough. Micronutrient supplementation of both zinc and iron helps accelerate recovery of hippocampal functioning following iron deficiency in rats.80 We also know that a lack of protein results in EFA (essential fatty acids) deficiency, while micronutrient deficiencies contribute to impaired EFA bioavailability and metabolism.81 You’re right, it’s not simple.

  Omega-3 is certainly not the sole solution on the nutrition front—there are many more nutritional factors to consider. And nutrition itself is just one piece of the much bigger jigsaw puzzle. Not all omega-3 studies have come up trumps.82 Nevertheless, these international findings are initial appetizers that should tempt us to consider further how nutrition can nix crime and violence. A body of knowledge is being built up that gives us an alternative perspective to drugs as a solution. Societal distaste for any “Prozac for prisoners” proposition could be tempered by the more palatable alternative medical approach of “fish for felons.” It could potentially prevent future disasters.

  Anders Behring Breivik was initially argued to have a psychotic disorder—paranoid schizophrenia—that resulted in the Norwegian tragedy. We discussed earlier how schizophrenia is related to violence. Is it entirely a coincidence that the very first study to prevent the development of psychosis in adolescents and young adults was based on omega-3?83 Is it a coincidence that the early environmental enrichment in Mauritius that included an extra two and a half portions per week reduced not just adult crime, but also adult schizophrenia-spectrum personality traits, especially in those who had poor levels of nutrition before the enrichment?84 Future studies following the Norwegian Smartfish study on the island of Mauritius may ultimately provide prevention of slayings like the ones that took place on Utoeya island in Norway.

  MIND OVER BRAIN MATTER MATTERS

  Changing the brain to change violence may not necessarily require drugs or any invasive form of therapy—or even more benign biological interventions such as nutritional change. Let’s turn back to biofeedback and Danny. By feeding back to him his brain activity, he was able to learn how to increase activation of the prefrontal cortex. That gave him agency and the ability to better regulate his behavior. But can biofeedback like this really stop violence?

  Research on individuals with antisocial personality disorder claims to show that intensive EEG biofeedback involving from 80 to 120 sessions does improve their behavior.85 That is promising, but the clear limitation is that to date much of the evidence is based on case studies. Randomized controlled trials are needed to more conclusively demonstrate efficacy. We still have a long way to go with this particular biological intervention.

  But Buddha may help put us on the path to permanent brain change without drugs or invasive treatment. Mind over matter. Maybe meditation can change the brain for the better.

  The technique itself is fairly simple. You would have one training session for eight weeks, each one lasting about two hours. You would practice the technique one hour a day at home, six days a week.86 You would be taught to become more aware—or more mindful—of your internal mental and bodily state. Attention might, for example, be focused on breathing, becoming more aware of your present-moment experiences, and mindfully going through your whole body’s sensations and feelings. You are taught to take a compassionate, nonjudgmental stance to yourself—to not, for example, beat yourself up during training if your mind wanders from the task. Later on you would be taught to become aware of yourself in the here and now.87

  Doing all that will change your brain—permanently. In 2003, a leading neuroscientist, Richie Davidson, from the University of Wisconsin, Madison, performed a breakthrough meditation study. People were randomized into either a mindfulness training group or a control group that was put on a waiting list for training. Richie demonstrated that just eight weekly sessions of mindfulness training enhanced left frontal EEG activity.88 Manipulate the brain through mindfulness, and better mood and psychological functioning can result.

  One study from Davidson’s group showed how focusing on a mental state of compassion and loving kindness for others enhanced brain regions involved in empathy and mind-reading. Participants’ ability to process emotional stimuli was enhanced, bringing on line the amygdala and the temporal-parietal junction of the brain.89 Functional imaging research has also shown that expert meditators have greater activation in brain regions involved in attention and inhibition.90

  It’s not just that meditation changes the brain during the time of meditation. People who have practiced meditation over a long period later show that at rest—in a non-meditation state—their brain has shifted toward increased attention and alertness as measured by gamma activity—a form of high-frequency EEG activity involved in consciousness, attention, and learning.91 The more hours of practice, the greater the brain change taking place. Meditation is producing long-lasting positive effects on the brain.

  Mindfulness practice changes not just brain function but also brain structure. One study scanned subjects before and after an eight-week mindfulness course, with controls again being put on a waiting list. The mindfulness group showed a significant increase in the density of cortical gray matter after treatment—a tangible physical change.92 Enhanced areas included the posterior cingulate and the temporal-parietal junction, areas involved in moral decision-making. The hippocampus was also enhanced, an area critical for learning, memory, conditioning, and aggression regulation93 and that is impaired by extreme stress.94 So even though the hippocampus reaches full maturity early in life,95 its structure can still be enhanced through later environmental change. Another brain-imaging study documented that extensive meditators have increased cortical thickness in the prefrontal cortex compared to controls.96 Mindfulness remodels the brain—physically.

  Hold in your mind for a while the evidence that meditation can change your brain. Now let’s ask whether it changes crime and violence. Perhaps surprisingly, meditation training with prisoners has been going on for quite some time. Transcendental Meditation (TM)was made popular during the swinging ’60s by its founder, Maharishi Mahesh Yogi, a charismatic figure who was a guru to the Beatles. By the beginning of the 1970s it was already practiced in California prisons.97 Since then meditation studies have spread to Texas,98 Massachusetts,99 and India.100 Scientific reviews have argued that meditation in prisoners reduces their anxiety and stress levels, increases their psychological well-being, and reduces their anger and hostility. More important, one literature review on meditation in offenders has argued for not just a reduction in post-release drug and alcohol use, but also reduced recidivism.101 Even women arrested for domestic violence have shown reduced aggression, alcohol use, and drug use after twelve sessions of mindfulness training.102

  One large-scale study gave mindfulness training to 1,350 inmates and showed significant reductions in their hostility, aggression, and other negative moods. Interestingly, the improvements were stronger in women than in men. Among the men, improvements were stronger for minimum-security prisoners than for maximum-security prisoners—although all groups di
d improve. It seems that meditation most helps offenders who are not so severely criminal. One recent randomized controlled trial in normal adults, most of whom were female, showed that mindfulness significantly reduces anger expression and improves the ability to regulate emotions.103 It might be therefore that this intervention could particularly help female offenders.

  What are we to make of this? The claims are intriguing, but the reality is that we sorely need a randomized controlled trial to demonstrate that mindfulness training really can reduce violence. Unlike the studies by Davidson and others on brain change, no such study appears to have been conducted on offenders. Granted, Transcendental Meditation has a funky past, with its prior claims of levitation abilities and other supernormal powers. Mindfulness meditation, with its origins in Buddhism, might also seem quirky by association with the TM movement. Yet there is now unquestionably a strong body of scientific support—based on randomized controlled trials—documenting its efficacy in reducing anxiety and stress,104 substance use,105 depression, and smoking,106 and in increasing positive emotions.107 It’s a promising technique that is gaining in scientific credibility, and it cannot be ignored.

  Let’s suppose for a minute that it’s not all pie in the sky. Now put in your mind the hypothesis that mindfulness and other meditation techniques can really reduce violence. How might mindfulness and other meditation techniques work? What might be the mechanism of action? Recall that you are taught to become more aware of your own thinking.108 You become increasingly conscious of when you are beginning to feel angry over a disparaging comment someone makes to you. You become better able to regulate your thoughts before you boil over in a rage. You become more attuned to the very first moments when, say, your partner made that critical comment that cascaded into a steady stream of unpleasant thoughts and associations. You become aware of your heart racing and your face flushing, and how negative emotions then rear their ugly heads. You are taught to become more accepting of these feelings, to control the urge to act, and to step back from your first instinctive emotional reactions. Because you have become adept at experiencing the negative thoughts and emotions that you felt when the argument started, you have learned to habituate or acclimate to them. That means you can better control your urge to lash out. By being more mindful of your anger at an early stage, you are better able to control and regulate it—at a point in time when your anger is more manageable and has not yet reached its crescendo.