The Anatomy of Violence

by Adrian Raine

  Before the trial began I had been contacted by James Castle, Donta’s defense attorney, who had heard of my brain-imaging work on murderers. He believed that Page’s abominable social history would likely have consequences for brain functioning, and that this in turn would have consequences for behavioral control. I frequently get requests of this sort and usually turn them down, but after considering the details Jim Castle presented me with, I believed Page’s case deserved a closer look.

  We arranged to have Donta Page brought across state lines from Colorado to California, so he could be brain-scanned in the same PET scanner that I had used in our study of murderers—using the very same methodology. I presented Donta’s brain scan at his trial as an expert witness and compared it to fifty-six normal controls. I gave my opinion to the judge and jury: Donta Page showed clear evidence of reduced functioning in the medial and orbital regions of the prefrontal cortex, as well as the right temporal pole.

  You can see Donta’s brain scan alongside the normal controls in Figure 10.1, in the color-plate section. In the top half of the figure you are looking head-on and slightly up at the individual. Look at the normal controls on the right, and you can see a lot of warm red and yellow colors in the top half of the brain—the prefrontal cortex—indicating relatively normal prefrontal activity. If you look at the top left, at Donta Page’s brain, you can see those cooler green patches that indicate reduced glucose metabolism in the frontal poles.

  Now look at the lower half of the figure. You are looking down on the brain—a bird’s-eye view of a slice through the ventral part of the brain. At the top of the illustration you are looking at the frontal cortex. You can see that the controls are showing good activation in the medial region of the frontal cortex and at the two sides that make up the orbitofrontal cortex. In contrast, Donta Page demonstrates a distinct lack of medial and orbitofrontal functioning. It’s not far off being a black-and-white difference. Page clearly shows brain functioning that is quite different from that of normal people.

  By now you will have picked up on the significance of these brain regions. You’ll recall that the brain regions found to be impaired in Phineas Gage are critically important for cognitive, emotional, and behavioral control. The medial prefrontal cortex—especially the frontal pole—is involved in behavioral control, as well as moral decision-making, empathy, social judgment, and insight into oneself.6 The ventral prefrontal cortex, including the orbitofrontal cortex, is critically involved in emotion regulation and impulse control—as well as fear conditioning, the ability to switch behavioral response strategies, compassion and caring for others, and sensitivity to others’ emotional states.7 Neurological patients with damage to these regions show impulsivity, loss of self-control, immaturity, lack of tact, inability to modify and inhibit inappropriate behavior, poor social judgment, loss of intellectual flexibility, and poor reasoning and problem-solving skills, as well as psychopathic-like personalities and behavior.8 We’ve seen how these processes—when turned off—are important predispositions to violent and antisocial behavior. You will also recall that prefrontal dysfunction is especially characteristic of impulsive killers.9

  When you place this scientific knowledge in the context of Donta Page’s behavior, his actions become more explicable. He had not planned to rape and kill Peyton Tuthill—he just wanted to raid her house for any money he could get. It was not too dissimilar from the case of Antonio Bustamante, who impulsively burglarized a home for money and then battered an old man to death. As we saw in chapter 3, Bustamante’s PET scan similarly revealed orbitofrontal dysfunction. When Peyton surprised Page by unexpectedly coming back home, Donta acted impulsively. Once in full control of this beautiful young blond woman in the bedroom, his emotions and sexual instincts overcame him and he perpetrated on her the ugly act that had been perpetrated on him when he was young and vulnerable—rape.10 He lacked self-regulation and emotional control. He also lacked the ability to empathize with his victim or to be sensitive to her fear, and when she fought back, he stabbed her. He was angry at how his life, which had been at the brink of being turned around, had fallen back into old patterns. He was angry that he was being sent back to prison that very day, and he took that blazing anger and frustration out on his victim. Given his lifelong history of serious childhood abuse, it’s quite likely that either at a conscious or unconscious level, this was redirected aggression—dealing out to Peyton the abuse he had been on the receiving end of as a child.

  Nobody can deny that Page’s acts were abhorrent—and some would even say evil. But can you deny the predisposing factors that led him down the road to violence?

  A significant aspect of Page’s brain scan is that the most salient areas of damage included the orbitofrontal cortex and the temporal pole—the frontal tips of both brain regions. These are the areas that are most susceptible to head injury due to the way they sit in the brain. And this damage can result from events far less insidious than the shocking head injuries that resulted in Page being taken to the hospital in infancy and toddlerhood.

  We know from family members’ testimony that Page’s mother would vigorously and repeatedly shake baby Donta—simply because he cried too much. When that occurs, the brain of the baby rocks backward and forward inside the skull, with the orbitofrontal and frontal-temporal pole areas rubbing up against bony protuberances on the inner surfaces of the skull—and getting damaged. So the brain impairments that we saw in his PET scan are quite consistent with the social history of very significant and severe child abuse.

  There were more elements of Page’s history that struck me. He was enuretic and encopretic until he was ten—he could not control his bladder and bowels in bed. For that he was beaten by his mother. You might see this in children at age three or four years, but the fact that it went on till the age of ten illustrates the anxiety, fear, and tension that the young Donta Page must have experienced in his unbearably traumatic upbringing. He clearly had a very disturbed and harrowing childhood.

  At a neuropsychological level, Page performed poorly on the Wisconsin card-sorting task, a classic measure of executive functions—what we’d expect given the results from the PET scan that showed a lack of regulatory prefrontal functioning. Donta also flunked three grades as a child, a clear indication of learning disability.

  At a psychophysiological level, his resting heart rate was 60 beats per minute. I compared that to a demographically matched sample of males his age, and this would place him in the bottom 3 percent of the distribution. We’ve seen earlier that low resting heart rate is one of the best-replicated biological correlates of antisocial behavior—a marker of fearlessness and an indicator of low arousal that can give rise to stimulation-seeking behavior.

  At a cognitive level there was a striking difference between his verbal and spatial IQ scores—a gap of 17 IQ points, with the spatial “right hemisphere” score being much lower than the left, suggesting relatively more impairment to the “emotional” right hemisphere. Neuropsychological testing also revealed memory impairments in both auditory and visual modalities, consistent with his history of head injury to the temporal region of the brain.

  Three experts documented that Donta suffered from some form of mental illness, likely organic in nature. Given also a familial history of mental illness on his father’s side, to say nothing of the aberrant social family history on his mother’s side, it is likely that genetic factors also played some role in predisposing him to a dysregulated and impulsive lifestyle, including violence.

  Let us not forget that the social environment can have profound “biosocial” effects on the brain, and the fact that Donta as a young baby had a rejecting, uncaring, and callous mother who severely neglected her son. In chapter 8 we talked about interaction effects between biological and social factors. We have few details of Donta’s birth, but we do know that his mother had gonorrhea at the time of pregnancy. This can result in obstetric complications, including premature rupture of the membrane that surrounds the baby
in the uterus, infection of the amniotic sac and fluid, and early onset of labor. Donta himself could have even contracted a sexually transmitted disease when he passed through the birth canal at the time of delivery.11 We have seen earlier that maternal rejection of the child, when combined with obstetric complications, triples the likelihood of adult violence.12 Given the abject poverty in which he lived, the growing Donta was very likely undernourished as a baby and young infant, another important factor that can negatively influence the developing brain.

  We’ve seen how the term “biosocial” can also be viewed in a different light—social factors giving rise to biological risk factors for violence. At the level of environmental toxins, Donta’s great-aunt reported that he ate paint debris in the house as a toddler. The old housing in which Donta lived had lead-based paint, and we’ve seen how lead is neurotoxic, resulting in brain damage. Donta had little in the way of food, and children at any age when hungry will try to eat whatever comes their way—including paint chips—as they crawl around and put their fingers in their mouth. We’ve seen that poor nutrition is associated with later antisocial behavior—a social risk factor that impairs brain functioning. So at both levels, the social adversity that Donta experienced likely produced brain deficits that in turn contributed to his evolution into a violent offender.

  All of these processes—social and biological—can shape further risk factors for violence. His first-grade teacher documented “emotional disturbances” when Donta was six and a half years old. She clearly saw that the young Donta was completely out of it, and that something was profoundly wrong with him. Similarly, his grandmother viewed him as seriously troubled and depressed at ages five and six, and also as being distractible, impulsive, and hyperactive. These clinical behavior problems are again well-documented risk factors for later antisocial and violent behavior.13

  Let’s summarize the case of Donta Page here. Teenage pregnancy. Potential birth complications combined with uncaring, callous mother. Total absence of father. Impoverished neighborhood. Vigorous shaking as an infant that likely resulted in a disconnection between the frontal cortex and the limbic system. Sustained and severe physical and sexual abuse, including rape resulting in scarring and rectal bleeding. Total neglect. Early head injuries and multiple visits to the emergency hospital in the first two years of life. Neurotoxic lead exposure. Poor nutrition. A complete lack of supervision. Learning disability. A family history of mental illness and signs of depression, ADHD, and conduct disorder as early as elementary school. Impaired executive functioning and memory. Low physiological arousal. Poor functioning of the orbitofrontal and medial prefrontal cortex in addition to reduced temporal-pole functioning.

  This shopping list of risk factors looks as if it was freshly plucked from a neurocriminological recipe book for creating a recidivistic violent criminal. Donta Page was a walking time bomb waiting to go off. He was totally unloved and uncared for right from the moment he popped out of his gonorrhea-infected mother’s womb. It was Peyton Tuthill’s dreadful bad luck to be in the wrong place at the wrong time when Page blew up in her face.

  Page himself wrote lucidly on his life and the perspective of the jury in a letter read out to the court before sentencing:

  All they see is a black man that killed a white woman. Nobody took the time to ask why but rather who. I’ve been asking for help for years. Nobody cares until I hurt someone, then they wanted to give me medicine, but when I went home nothing until I got in trouble again.… I don’t see what I really have to live for. I’m 24 years old. I never had a chance to live. Now it’s over.14

  “I never had a chance to live.”15 He was a 300-pound African-American who had raped and killed a pretty young blond woman. This interracial rape and homicide is rare. Most violence—about 90 percent—is intra-racial.16 The racial dynamic must surely have ratcheted up the retribution factor in the minds of the jurors. When they returned after three days, they found him guilty of first-degree deliberate murder and rape—and a prime candidate for the death penalty.

  The jury took time to answer the question of “who?” but spent much less time to answer Page’s own more pertinent question of “why?,” a question so childishly simple that it is almost impertinent. Yet we sometimes need to ask an impertinent question to find our way to the pertinent answer. We need to understand the “why”—the causal factors that explain the crime—if we are ever going to prevent horrific crimes like the one poor Peyton Tuthill had to suffer.

  Page is also essentially correct on the remainder of his letter. Very early behavioral signs of disturbance flagged him immediately. He was crying out for intervention. Eight documented referrals for treatment before he had even committed a single crime—and heaven knows how many undocumented referrals. He desperately needed an expert to defuse the toxic mix of risk factors that was thrust upon him so early in life. These were life circumstances he had no control over whatsoever.

  Looking at the free-will continuum as a totem pole, Donta is down at the bottom, where destiny lies. He was always in the red zone. Anyone could have seen that; indeed, they did see it. If you want to lay the blame on someone, blame his psychopathic-like mother for the wretched life she knowingly and uncaringly thrust on her son. Blame the indolent bystanders who witnessed what was going on and did nothing to intervene. Blame the social services for a complete and abject failure to act in a case that was crying out for intervention. Blame society for not doing more to protect once-innocent lives.

  But don’t blame Cain. Donta’s case shows that free will is not as free as law and society would like to believe.

  MERCY OR JUSTICE—SHOULD PAGE BE EXECUTED?

  Should we execute Page? He was eventually found guilty and was facing the death penalty. We strongly suspect that brain damage made him significantly more likely to commit violent acts. We have also ascertained that the likely cause of damage occurred early in life for reasons beyond his control. Of course we have to protect society, and unless we can treat this brain dysfunction we may need to keep him in secure conditions for the rest of his life. But does Page deserve more punishment? Should he lose his life, given the early constraints on his free will?

  One argument rests on the belief that we all have free will and agency even in the face of risk factors. It’s almost a religious belief. Surely we all have a choice? If I were to ask you to explain why you are reading this book right now, you’d say something like, “Well, I wanted something to read today and decided to pick up your book. I’ve always been fascinated by violence, and these days we’re hearing a lot more about the brain and biology. So here I am now.”

  Sounds reasonable, doesn’t it? You can choose. You have free will. I was not standing beside you with a gun to your head coercing you to buy it, was I? Surely this has to be full-bodied proof of free will? No, it’s not.

  You did not choose to read this book. Your brain made you do it. You likely had “risk factors” for buying this book, whether you are conscious of them or not. You may have been a victim of crime. You may have yourself bordered on committing a crime—and always wondered where the line between offenders and good citizens lay. Alternatively you were born good, giving you the fascination for the bad seed that you are not. You may have been exposed to domestic violence and abuse. If you are a woman, we know you are more attracted to books on crime than men—likely because you have a greater fear of being a victim. These factors produce a causal chain of events that predisposed you to read this book. You saw the bold title and colorful cover. In milliseconds it triggered a chain of past emotional memories and associations that made you pick up the book and start reading its contents.

  You want so desperately to believe that you determine things in your life, yet that belief has no true substance. It floats like a ghost in a mind machine forged by ancient evolutionary forces. You were as helpless in deciding to buy this book as I was in writing it.

  Even if you decide to put this book down right now to prove me wrong, it wasn’t you that
chose to close it. It was your Bolshie brain that was programmed to be oppositional and defiant when challenged. Free will is sadly an illusion—a mirage. I wish it were not, because I too find this perspective unsettling. But there we have it.

  Here’s another example. We know that alcoholism is a disease state that has a substantial genetic component. If we sit an alcoholic and a nonalcoholic in front of a glass of beer and tell them not to drink it—then yes, in some sense they do indeed “choose” to drink it or not. But in a probabilistic sense we also know that the alcoholic is going to be less able to resist drinking from the glass. In this situation, the alcoholic’s freedom of will has been constrained in large part by genetic, biological, and, to be sure, environmental forces beyond his control. Offenders like Donta Page are no different.

  Okay, you say, so Page has a whole bunch of risk factors for violence. Sure, he got a rough deal in life. But he’s still as responsible as anyone. If an individual possesses characteristics that make him disproportionately more likely to commit violence, then he has to take responsibility for those predisposing factors. Just as an alcoholic knows he has a drinking problem and must seek out treatment, so the person at risk for violence needs to recognize those risk factors and take preventive steps to ensure that he doesn’t harm others. He has a choice, and he needs to act. He is responsible.