Category Archives: Personality Disorders

Anosognosia, Psychopathy, and the Conscience

How people see and understand themselves is likely to have an impact on how they interpret interactions with others. Here, I briefly explore the brain areas implicated in anosognosia, how these areas are also relevant in psychopathy, and why anosognosia is important when considering the crime and the conscience.

ANOSOGNOSIA AND SELF BELIEF

Anosognosia is defined as the impaired ability of patients with neurological disorders to recognize the presence or adequately appreciate the severity of their deficits [1]. Torrey (2012) cites three examples of anosognosic patients; a stroke victim with a paralyzed arm claimed he couldn’t lift it because he had a shirt on; a woman with paralysis in her left arm was asked to raise it, and instead raised her left leg. When this was pointed out to her she responded that some people call it an arm, others a leg, and jokingly inquired as to the difference; the Supreme Court Justice, William Douglas, was paralyzed on his left side. He claimed this was a myth, and was still inviting people to go hiking [2].

NEUROLOGICAL FINDINGS IN ANOSOGNOSIC PATIENTS

Recent research on this phenomenon has identified deficits in the brain of the patients who in all honesty do not recognize that they are in some way impaired. By using fluorodeoxyglucose positron emission tomography (FDG-PET) and single photon emission computed Tomography (SPECT) Perrotin et al. (2015) found that anosognosic Alzheimer’s patients had a disruption in connectivity between the posterior cingulate cortex (PCC) and the orbitofrontal cortex (OFC) [1]. Ries et al. (2007) also implicated a compromised precuneus in anosognosic patients. These midline structures are susceptible to damage in those with Alzheimer’s Disease (AD) and stroke victims. Anosognosia is also experienced by schizophrenic patients; according to Gerretsen et al. (2015), 60% of schizophrenic patients experience moderate to severe illness awareness, and this can lead to medication non-adherence and poor treatment outcomes [4]; they found left hemispheric dominance in the left prefrontal cortex in anosognosic schizophrenic patients and cortical thinning in the temporoparietalocciptal junction (TPO).

There is still much work to be done to determine the mechanistic and functional basis of anosognosia, and to determine the subtleties between illnesses and disorders, but research is starting to identify suspect brain regions. This is useful if anosognosia is questioned in other disorders, because neurological studies exploring the disorder can be explored and legitimate avenues of scientific inquiry explored.

RESEARCH PARALLELS WITH PSYCHOPATHY

A failure to recognize a disorder is also present in those with psychopathy. While anosognosia is yet to be explored thoroughly in those with psychopathy, there are behavioral items on the Psychopathy Checklist (PCL-R) [5] that suggest anosognosia is present; grandiose sense of self-worth, lack of remorse, and failure to accept responsibility. The sense of self-worth and narcissistic traits of the psychopath clearly means that they think very highly of themselves. This negates the idea that the psychopath believes they suffer from a defect or a disorder; at the most they might recognize that most others are different, and perhaps inferior to themselves. If a lack of remorse is experienced, this is an explicit demonstration that they do recognize, at least on an emotional level, the consequences of their bad behavior as being wrong; if they do not believe their behavior is inappropriate, it stands to reason that they believe they behaved appropriately, and thus experience nothing ‘wrong’ about themselves. This aspect of self-belief and self-reflection is also seen in the psychopath’s failure to accept responsibility; if they are always good and right, there is little motivation to make amends.

Based upon this cursory examination of psychopathic behavior, it would seem reasonable to explore the neurological studies of psychopathy and see if there could be some overlap with previous studies on anosognosia, and in fact some of the same compromised brain areas are implicated. Many studies have demonstrated developmental differences in the PFC of the psychopath (for a review, see Umbach et al. (2015) [6]), and the white matter pathways, such as the uncinate fasciculus (UF) connecting to the PFC from the limbic regions [7]. Perrotin et al. [1] hypothesized that Anosognosia can result from a disruption in connectivity in the UF. When exploring connectivity in the frontoparietal network (FPN), Philippi et al. (2015) found reduced connectivity in those with higher scores on the PCL-R, which included the right precuneus. And to further the overlap, Glenn et al. (2009) [8] found that those with who scored high on the interpersonal factors of the PCL-R (manipulative, conning, deceitful), showed reduced activity in the PCC during an fMRI scan when having to make judgments during moral dilemma scenarios.

Anosognosia and psychopathy both demonstrate complex neurological constructs, and it is premature to conclude that the neurological basis for Anosognosia (itself still understood) would tuck neatly into the already known neurological research on the psychopath. However, given the neat juxtaposition of behavioral traits and neurological dysfunction, it is worth bringing psychopathy into discussions of Anosognosia for the following reason. The research on psychopathy is currently deeper and richer than the research on anosognosia, and behavior of the psychopath has been widely observed and studied. If we can reasonably conclude that psychopaths, particularly criminal psychopaths, are also anosognosics, their behavior can be assessed in light of what it means to recognize no disorder or defect within oneself. The parallel is further relevant with psychopathy when considering that a number of those with schizophrenia, and a minority of those with AD, have been known for antisocial, and sometimes criminal, behavior [9, 10].

ANOSOGNOSIA, ANTISOCIAL BEHAVIOR, AND THE CONSCIENCE

Those with schizophrenia and AD also suffer from abuse, but when they have been known to act violently, their behavior and motivations need to be understood. Torrey (2012) has documented extensively the violent acts of those with schizophrenia [2]. There is usually a history of progressively worse episodes of psychosis that can convince the patient that they are receiving supernatural or alien instructions to kill or harm individuals, and more often than not family members. Whether or not the auditory hallucinations slowly convince the patient over time of the necessity for deadly action, or whether the act is impulsive, after the event the patient often remains remorseless and attributes their behavior to necessary and mandated (often divine) reasons. This state of mind is similar to the violent psychopath, who also viewed his violent actions as necessary and fully justified. The problem is never attributed to the self; a disorder or defect is not recognized. While psychopaths are widely regarded as not having a conscience and experience only limited affect, more research is needed on the experience of conscience by schizophrenics, especially understanding the role that psychosis played in circumventing the conscience and providing them with permission to act. It is also crucial to discover how those events are remembered and felt post psychosis, perhaps when the patient has reconvened their medication.

In illnesses and disorders that can be associated with antisocial behavior or aggression, anosognosia could be a partial reason for the event of the behavior. Not recognizing any problems or defects, and thinking that one acted rightly or righteously, will affect personal judgments on the self-evaluation of behavior. This does not provide a fertile ground for remorse or responsibility, and if the behavior was aggressive, the patient could continue to remain dangerous, inflexible to a reasoned and peaceful behavioral change. This makes the search for the neural representation of anosognosia all the more crucial, treatment all the more pressing, and methods of identification all the more necessary.

© Jack Pemment, 2016

 

REFERENCES

  1. Perrotin, A. et al. (2015). Anosognosia in Alzheimer disease: Disconnection between memory and self‐related brain networks. Annals of neurology, 78(3), 477-486
  2. Torrey, E. F. (2012) The Insanity Offense, New York, W. W. Norton and Company
  3. Ries, M. L. et al. (2007). Anosognosia in mild cognitive impairment: relationship to activation of cortical midline structures involved in self-appraisal. Journal of the International Neuropsychological Society, 13(03), 450-461
  4. Gerretsen, P. et al. (2015). Illness denial in schizophrenia spectrum disorders. Human brain mapping, 36(1), 213-225
  5. Hare, R. D. et al. (1990). The revised Psychopathy Checklist: Reliability and factor structure. Psychological Assessment: A Journal of Consulting and Clinical Psychology, 2(3), 338-341
  6. Umbach, R. et al. (2015). Brain imaging research on psychopathy: Implications for punishment, prediction, and treatment in youth and adults. Journal of criminal justice, 43(4), 295-306
  7. Motzkin, J. C. et al. (2011). Reduced prefrontal connectivity in psychopathy. The Journal of Neuroscience, 31(48), 17348-17357
  8. Glenn, A. L. et al. (2009) The Neural Correlates of Moral Decision-Making in Psychopathy. Retrieved from http://repository.upenn.edu/neuroethics_pubs/55
  9. Fazel, S. et al. (2009). Schizophrenia and violence: systematic review and meta-analysis. PLoS Med, 6(8), e1000120
  10. Lopez, O. L. et al. (2003). Psychiatric symptoms vary with the severity of dementia in probable Alzheimer’s disease. The Journal of neuropsychiatry and clinical neurosciences, 15, 346–353

What’s in a name? The fickleness of sociopathy: Ideas, the suspension of the conscience, and why psychopathy is completely different

(For a PDF version, click here)

There is one question that can often haunt research on mental illness and mental disorders. Simple as it may seem, “What should we call it?” can often pose no end of obstacles, and result in long drawn out debates in the mental health and medical profession. One reason for this is that certain maladies often have numerous dimensions, and symptoms can present differently in those afflicted. Typically, through extensive research, diagnostic criteria are established under the banner of one name; pick up the DSM-V or the ICD-10 and you’ll see the names for all kinds of illness and disorder, with thorough lists of all the symptomatology that is now accompanied and unified under a common name. But these symptoms are often present in other conditions, and present in the patient to different extents. Rendering a diagnosis is indeed a tough challenge for any mental health professional.

 

Another reason that makes it difficult to name a particular mental health phenomenon, is that there is sometimes an inclination for the name to include the developmental origin. This struggle is perfectly captured in the history of psychopathy research. Cleckley, arguably the first psychiatrist to make strides in classifying psychopathy, writing in the 1940s devoted many chapters in his book, The Mask of Sanity, to discussing how the term and the individual were currently seen by the mental health establishment.

 

Every physician is familiar with the term psychopath, by which these people are most commonly designated. Despite the plain etymological inference of a ‘sick mind’ or of ‘mental sickness’, this term is ordinarily used to indicate those who are considered free from psychosis and even from psycho-neurosis.

Cleckley, The Mask of Sanity[i]

 

Clearly, in the mental health profession, a term denoting a ‘sick mind’ is not particularly useful in attempting to make a diagnosis, as it perhaps captures every possible mental malady that can afflict the human brain. However, the term does appear to capture those who are free from psychosis and psycho-neurosis, while still indicating that something is awry within these individuals. The truly psychopathic are renowned for behaving in socially pleasing ways, at least temporarily, before they are implicated in acts of antisocial behavior, sometimes even downright grotesque or horrendous behavior. This nature of the psychopath puzzled mental health experts and laypeople alike, as they pondered how one person could exhibit such extremes of behavior, sometimes in a short space of time.

 

Later, the term ‘psychopath’ clearly evolved and took on new meanings as research on this dangerous personality disorder progressed in the twentieth century. As the esteemed psychologist, Robert Hare, pointed out:

 

[Those] who feel that psychological, biological, and genetic factors also contribute to the development of the syndrome[,] generally use the term psychopath.

 Hare, Without Conscience[ii]

 

Hare stated this in contrast to those who were using the term ‘sociopath,’ who according to Hare were convinced that social factors and early experiences were responsible for the manifestation of this particular disorder, and subsequently this particular type of person, in society.

 

This appearance of two names for the same disorder (psychopathy/sociopathy), and the same person (psychopath/sociopath) becomes problematic. Not only is having two different names for the same condition a little redundant, but the developmental origins, the initial reason for having the two different terms, all belong together. Social factors, early childhood experience, psychological, biological, and genetic factors, all collapse into a uniform analysis of the one condition. Social factors and experience immediately become psychological and biological factors on the level of the brain, and these factors can have a direct impact on the level of gene expression. This is even more profound when the brain is still developing during the formative years, when certain kinds of abuse can result in neurological developmental errors.

 

In early 1990, Hare and his team devised what became the psychopathy checklist, revised.[iii] This built upon earlier research that resulted in the psychopathy checklist,[iv] and has become the gold standard for diagnosing psychopathy. The list is composed of two sets of behavior, dividing them into antisocial traits and personality traits. This diagnostic tool generates a total possible score out of forty, and after a mental health professional has assessed the behavioral history of an individual, any score given in the high twenties and over thirty is indicative of a psychopath. Using this tool, many neuroscientists have created experimental groups of psychopathic individuals and have found unique brain differences between the psychopathic and the non-psychopathic. And so, despite ‘psychopath’ being a vague and somewhat empty term in Cleckley’s era, psychopath research today is incredibly rich from behavioral and neuroscientific input. This richness, coupled with the collapse of social factors in with the biological to describe the same condition, means that the term ‘sociopath’ should be extricated from discussions of the disorder.

 

The term ‘sociopathy’ does become useful again when considered in another context. Hare and Babiak described ‘sociopathy’ in their book, Snakes in Suits, thusly:

 

Sociopathy is not a formal psychiatric condition. It refers to patterns of attitudes and behaviors that are considered antisocial by society at large, but are seen as normal and necessary by the subculture or social environment in which they developed. Sociopaths may have a well-developed conscience and a normal capacity for empathy, guilt, and loyalty, but their sense of right and wrong is based upon the norms and the expectations of their subculture or group.

Hare & P. Babiak, Snakes in Suits[v]

 

This definition is really what sets the two terms apart. Psychopathy is understood as a mental disorder and has formal diagnostic criteria; sociopathy does not. Sociopaths have empathy, guilt, and remorse; psychopaths do not. It is this latter point that is the most profound, because neurological studies have shown us that the areas in the brain that are heavily implicated in moral decision-making are typically malformed and mal-developed in the psychopath. This means that the brain of the psychopath, physically and neurologically, will be significantly different from the brain of the sociopath.

 

With this new definition, sociopathy becomes so much more useful to us. We can now ask questions such as ‘How can someone commit devastating and destructive crimes if they have a conscience?’ and ‘If a sense of right and wrong is represented in a person’s personal ideology, what power do ideas have in influencing a person to commit crimes?’. Sociopathy presents us with the opportunity to study how those with a conscience can, at least temporarily, act unconscionably. It presents us with the opportunity to explore how those with strong moral codes can promote group solidarity, while treating those not in the group as subhuman; think gangs, or the Mafia, or paramilitaries. Exploring the ideas present in the manifestos of spree killers and hate groups also becomes relevant, as they usually purport a version of history where one or more groups in society present as a threat, and why action needs to be taken against this group. All of these people have a conscience, but over time it appears to have become punctured or torn. Sociopathy could help us to understand why this has happened.

 

If we explore perhaps the most antisocial of behaviors, taking the life of another, sociopathy as a study of the ideas that led up to the act adds to our wealth of knowledge of those with disorders or illnesses that can lead to murder. Not all psychopaths are killers, but it is easy to understand how they can kill. Not having a conscience and not feeling guilt or remorse, perhaps even coupled with the pleasure derived from killing or severely injuring others, could easily lead to the act being carried out. Others have suffered psychotic breaks, often over a period of time, and aggression has escalated to the point of lives being taken; this has been true in some with schizophrenia and related conditions. Visual and auditory hallucinations can convince them of the need to act, and when this is coupled with paranoia, something that is often present in the schizophrenic, patients are often compelled to act in a manner they consider appropriate and necessary. Now, it is arguable that as a psychopath does not have a conscience, then they are simply unable to develop a complex ideology of right and wrong behavior; but we could find that sociopathy is comorbid with schizophrenia. Auditory hallucinations become part of the schizophrenic’s experience, and thus represent to them a truth about the world. If, like has been documented elsewhere, the auditory hallucinations are believed to be voices from the supernatural, instructing the person to act, the patient could work those instructions into everything else they believe about the world. A patient with a religious faith could easily believe they are receiving divine instructions to end the lives of people who are secretly evil, for example, demons posing as family members. Their hallucinations make their belief system very real to them, and the drive to act comes from a strong sense of rightness, bolstered by the belief that they are perhaps an avenging angel with a divine mission.

 

There are other abnormalities with neurological correlates that could facilitate taking the life of another. Crimes of passion are quite common, where an individual experiences a heightened sexual or stressful state and lost, only temporarily, a state of rationality. Extreme emotions can sometimes dampen the ability to reason and think clearly, with catastrophic consequences. These can often be exacerbated with those susceptible to anger management issues, or serious stress disorders. Sociopathy could also be present here; a homophobic father who catches his child engaged in a homosexual act could prompt a loss of control due to stress and result in extreme violence. The father would have no doubt been exposed to homophobic ideology before witnessing his child in a same sex relationship, and used the component ideas to justify to him what is true about the world. The perceived infraction from the father’s moral code results in the stress and the loss of control. For the most part, the father has a conscience, and loves his child, but his beliefs about the world seemed to couple with witnessing this act, and worked together with poor stress control to temporarily suspend his conscience.

 

Brain tumors, physical damage to neurological tissue, as well as alcohol and drug use, are also all linked to violent behavior. Here, too, an overarching ideology of what is right and wrong about the world, could work in synchronization with these biological changes to motivate destructive behavior, and the compulsion to act aggressively could even further justify the truth value of the overarching belief system; it has to be true (and thus, right), because why would the desire to act be so strong, otherwise? But does something have to be wrong biologically for toxic ideologies to take root and influence behavior? This is also a question that merits further research. Experiencing the world negatively, either because of something biological, or maybe just suffering from intense psychological hurt and pain, would be enough to make a person crave understanding. During this time they will be receptive to any ideas that seem to explain the negativity, and perhaps claim to provide an answer to end or cure the suffering. This wouldn’t explain all sociopathic behavior, but it would go a long way to understanding its onset.

 

Sociopathic behavior could result if over time, exposure to negative ideas helped to diminish empathy towards other people, and is perhaps demonstrated best by considering the lives of spree killers. Elliot Rodger, Seung-Hoi Cho, Dylan Roof, Anders Breivik, and Christopher Dorner all wrote lengthy manifestos, and some maintained websites and made Youtube videos detailing their grievances at great length. There are various mental illnesses and disorders that have been implicated in the lives of some of those individuals, but it is sometimes hard to substantiate if a diagnosis was made or not. Regardless of conditions or disorders, the manifestos represent a detailed view of the world, as seen by these individuals, including what is wrong with it, and usually what in their view has to happen to fix these societal ills, perhaps taking the form of retribution and revenge. Constructing a manifesto takes a lot of time, and is a significant personal investment for the author; they have taken the time to create a reflection of the world that is accurate to them, built up of the ideas that they think represent the truth and depict reality. The tremendous effort and planning that goes into the manifesto begs the question of what role the manifesto played in bringing them up to their final act. Was it to help them understand why they needed to do what they felt was necessary, thus allowing their conscience to at least temporarily bend to murderous inclinations? Did it help to commit these acts, knowing that people could use the manifesto to understand why it took place, even though they no doubt accepted they would not be alive to witness this ‘understanding’? Finally, if hypothetically they were unable to put a manifesto together, or they believed nobody would ever understand their actions, would their final act still have taken place?

 

There is also the question of how ideology and determining what is true about the world can change after the experience of psychotic episodes. If auditory hallucinations convince a patient of imminent threats or inevitable actions, what the patient believes is true about the world could change; ideas that promote certain kinds of behavior are adopted to achieve goals that fit into an evolving ideological framework. When the psychotic episode has subsided, does the imminence and immediacy of these ideas decrease? Are the ideas eventually discarded as an inaccurate representation of the world? Psychotic episodes are no doubt traumatic because they force the patient to reassess how they are seeing and understanding the world around them, and the more they are forced to reassess, the more traumatic the experience. After a string of psychotic episodes, the patient could well still harbor ideas that became prominent during the last episode, and so certain inclinations that become mandatory are eventually expected. The entanglement of psychosis with ideas and conceptual representations of the world is clearly a crucial study, and could well illuminate the state of the patient’s conscience.

 

This study of sociopathy would also apply to soldiers, who have to be prepared to kill, and destroy infrastructure that could decrease the standing of living for civilians. Soldiers are trained to incapacitate or take the lives of enemy combatants, often by a bloody and violent means. For a soldier to be able to take this action, they have to at the very least temporarily suspend empathy towards other human life, and be comfortable after the carnage with the actions that were taken. Soldiers obviously go into the military with a conscience and do not join out of a love or desire to kill (there is certainly screening to catch this disposition). Ideology can assist with coming to terms with needing to kill, particularly those of nationalism and patriotism; believing that some war is unfortunate but necessary, the war was just, evil has been prevented, and the enemy is a direct threat upon one’s way of life (which is right and true).  When these ideas fail to resonate as true, perhaps based upon personal experiences, the life of soldiers can become a living Hell, especially if they are also suffering from stress-related disorders brought on by extended periods of combat.

 

If we take sociopathy to mean the use of ideology to at least temporarily suspend the conscience or diminish empathy towards others, the example of soldiers as sociopaths opens up an interesting dimension to the discussion. Regardless of political inclinations or personal worldviews, most people would reluctantly accept that sometimes it is necessary for soldiers to kill. Sometimes people have to kill other people. Most of us are fortunate in that we have people who do it in our stead, and we trust them to make those decisions and take all the necessary precautions to keep it as ethical as it can be. If one of the primary purposes of the soldier is to be prepared to kill, then within this framework of sociopathy, we condone the training of sociopaths to carry out this necessary and deadly behavior.  Here, it is crucial to keep this framework of sociopathy in mind, and not treat it as a synonym for psychopathy. Soldiers are not psychopaths. It would be a worthwhile study to track soldiers’ ideologies throughout their careers in the military, because exposure to extreme combat is likely to force the soldier to reassess how they see the world, in a similar manner to schizophrenics experiencing psychotic episodes (a severely agitated mental state, prompting a new understanding of reality). Any time that reality is re-assessed, values of right and wrong can be re-considered, and this will reflect in the overall conscience of the individual. Those forced to re-evaluate the world, due to agitation or trauma, will become open to new ideas and vulnerable to toxic ones, which is one of the reasons why these individuals need constant help and attention.

 

Connecting the dots between ideology and conscience is clearly of paramount importance if we hope to understand violence. This goal can be met with an open, honest, and concerted effort to study sociopathy on the level of the brain, the individual, and society.

© Jack Pemment, 2016

 

References

[i] Cleckley, H., The Mask of Sanity (3rd Edition), EPBM, Brattleboro (2015), p. 27

[ii] Hare, R. D., Without Conscience, Guilford, New York (1999), pp. 23-24

[iii] Hare, Robert D., Timothy J. Harpur, A. Ralph Hakstian, Adelle E. Forth, Stephen D. Hart, and Joseph P. Newman. “The revised Psychopathy Checklist: Reliability and factor structure.” Psychological Assessment: A Journal of Consulting and Clinical Psychology 2, no. 3 (1990): 338

[iv] Harpur, Timothy J., A. Ralph Hakstian, and Robert D. Hare. “Factor structure of the Psychopathy Checklist.” Journal of consulting and clinical psychology 56, no. 5 (1988): 741

[v] Hare, R. D.; Babiak, P., Snakes in Suits, Harper, New York (2007), p. 19

Hervey Cleckley and Psychopathy

Hervey Cleckley. Photo from Wikipedia.

Hervey Cleckley. Photo from Wikipedia.

Hervey Cleckley is arguably one of the first mental health researchers to make sense of psychopathy. He worked as a psychiatrist in the Department of Psychiatry at the University of Georgia School of Medicine. In 1941 he published The Mask of Sanity: An Attempt to Clarify Some Issues About the So-Called Psychopathic Personality. As you can guess by the latter part of the title, in the 1940s there was a lot of confusion about what psychopathy was and how it should be addressed – not just how the public saw it, but how it was treated in legal and psychological/medical circles. In fact, at the end of an article Cleckley wrote for Federal Probation in 1946, he admits, “Psychiatry has not yet been able to prove or demonstrate precisely what is wrong with the psychopath.”

There were a least a couple of reasons for this confusion. First, psychopathic individuals appeared to commit crimes impulsively, even knowing that what they were doing was legally wrong. Cleckley wrote, “While on parole for stealing something [the psychopath] did not need, he will steal again, often taking an object he does not particularly want, and under circumstances that he knows may result in his being discovered as the thief.” This behavior was deeply puzzling, and it must have appeared that the psychopath was acting self-destructively. Now we of course can easily distinguish between knowledge of the law and feeling what is morally right. And we have also hypothesized that psychopaths often get their psycho-physiological kicks from acting recklessly and abusing other people, kicks that are far more important than any legal consequence.

The second reason for this confusion was that the psychopath appeared to act perfectly normal, right up until the very moment that they didn’t. This made it hard to determine whether or not the psychopath knew what was morally acceptable and whether or not they met the legal definition for insanity. The psychopathic offender wasn’t hallucinating. They didn’t display any evidence of brain damage as measured by instruments and tests of the day. The psychopathic behaviors of pathological lying and manipulation made it increasingly difficult to gauge the sincerity of the individual, and that still poses a problem for people today, including trained psychologists.

The writing of Cleckley is actually very amusing. It certainly betrays a stereotypical male attitude from the 1940s. For example, when describing the behavior of the psychopath, Cleckley writes, “Not rarely the records will show that [the psychopath] has won the chancellor’s prize at college for an essay on the Renaissance, or graduated from high school summa cum laude, or outstripped 20 rival salesmen over a period of 6 months, or married the most desirable girl in town.” I think Cleckley overestimates the intelligence of psychopaths to the point where he thought psychopathy and intelligence were naturally entwined, but writing about the Renaissance? To Cleckley, perhaps that is the epitome of scholarly brilliance. But marrying ‘the most desirable girl in town’ is surely a reflection of male chauvinism, even though psychopaths might enjoy the status of being with a beautiful woman.

Another example of Cleckley’s 1940s attitude comes through with, “If [the psychopath] escapes detection [for theft] he will repeat his stealing or perhaps forge a check or noisily entertain a prostitute in the apartment of his respectable and devoted aunt who is away on a week’s vacation.” I feel like this quote speaks for itself.

I have yet to come across any evidence that Cleckley believed women to be psychopathic. If anyone knows different, I would appreciate a reference. The psychopath is always addressed in third person male, which while is a writing bias, I’m sure it also reflects that many (if not all) of the psychopaths Cleckley studied were male. Even now it does seem like most psychopaths are male, but it has been suggested that the diagnostic criteria for determining psychopathy has come from male-dominated research. It is possible that the behaviors of the psychopathic are expressed differently in men and women. In fact, some believe that women are more likely to be diagnosed with Borderline Personality Disorder (BPD) than Antisocial Personality Disorder (APD – this is fairly closely related to psychopathy), because BPD reflects an emotional instability that is strongly associated with women. This bias could naturally lead to the wrong diagnosis.

Source

Cleckley, H. (1946) The Psychopath: A Problem for Society, 10 Federal Probation 22 (22-25)

Q&A With Dr. Robert Hanlon (Survived By One)

Survived by OneI recently reviewed Dr. Robert Hanlon‘s book, Survived By One. The book describes Hanlon’s relationship with Tom Odle, a killer serving life in prison in Illinois for murdering his entire family. This was the first time that I had really gained any insight into the topics of familicide and parricide – the killing of one’s family, and the killing of one’s parents, respectively. Anyone who has explored the question of why people kill (especially as it seems to relate to a loop hole or simply a hole in their conscience) knows that there is no easy answer, and it is easy to get lost in the dynamics of a person’s brain or their mind. With regards to the motivations and experience of Tom Odle, I believe Dr. Hanlon has done a fantastic job in laying it out there for us so that we can comfortably approach the question under the guidance of a professional.

I had the good fortune to be able to ask Dr. Hanlon a number of questions regarding the book, and about the life of Tom Odle and his family.

 

Q&A With Dr. R. Hanlon

Q1: Dr. Hanlon, would you mind explaining the job of a neuropsychologist? For example, when you are evaluating patients or clients, are you seeking to determine cellular and tissue health as well as to approach a diagnosis from a behavioral point of view?

Neuropsychological evaluations are typically conducted to objectively determine the presence, type, extent, and severity of neurocognitive dysfunction and neurobehavioral abnormalities.  As such, the objective of neuropsychological evaluations is usually to determine the psychological effects of brain disorders and brain damage.  Additionally, a neuropsychological evaluation of a criminal defendant may also involve other forensic questions, such as fitness to stand trial, sanity, and capacity to make a knowing and intelligent waiver of Miranda rights.

 

Q: Tom Odle contacted you while in prison to help gain some life perspective. Is it unusual for prisoners to contact you in this way?

Yes.  No other inmate or criminal defendant has ever contacted me before or after a neuropsychological evaluation.

 

Q: Odle murdered his entire family on Nov 8th, 1985 (both of his parents, his two younger brothers, and his younger sister). It’s purely speculative, but how likely do you think it is that Odle would have killed more people if not apprehended?

It is very unlikely that he would have murdered anyone else.  Murdering his mother was the driving force behind the family mass murder and killing his mother was his primary objective.   Unfortunately, his worsening depression, increasing sense of desperation, and acute feeling of abandonment escalated into a homicidal rage that resulted in a nihilistic, drug-fueled termination of the family.  He would have likely committed suicide if he had not been arrested.

 

Q: I really enjoyed the way you worked through Tom’s young life and discussed a number of life events that no doubt had a very profound effect on his mind (and brain). Clearly, he suffered a lot of psychological and physical abuse from his mother. Do you think she would have met the diagnostic criteria for Antisocial Personality Disorder?

No.  Although I believe she possessed some antisocial traits, she also possessed borderline personality traits and sadistic personality traits.

 

Q: The dynamic of Tom’s parents, Carolyn and Robert Odle, would strike many as odd. You mentioned that perhaps Carolyn was hard on her children because she was exercising control that she never had when she had been abused as a child. But why do you suppose Robert did little to stop the abuse carried out by Carolyn?

The family dynamics in abusive households are often complex.  However, it is not uncommon for one parent to be the primary abuser and the other parent to be aware of the abuse, but do nothing to stop it.

 

Q: Tom was the eldest child, and you mentioned that his younger brothers, Scott and Sean, were also abused. Do you think Scott and Sean would have met the criteria for Conduct Disorder, like Tom, and perhaps eventually followed a similar path to killing?

Sean was also abused by his mother.  In fact, Sean likely sustained worse abuse than Tom.  Sean was deprived of food by his mother, whereas Tom was never deprived of food.  Sean was also abused by Tom and Carolyn likely encouraged Tom to abuse Sean.  To my knowledge, Scott was never abused.  In my opinion, neither Sean nor Scott would have met criteria for conduct disorder.

 

Q: I once attended a conference about psychopathic serial killers, and one of the speakers, Dr. Lawrence J. Simon, had worked as a psychologist on Death Row in Florida for many years. He explained that a reoccurring theme in the lives of male killers was an abusive mother and an emotionally or physically absent father. In your experience, does this also seem to be the case?

A history of abuse is a common thread.  In many cases, the mother was the abuser, but in many other cases, the father was the abuser.  In some cases, both parents were abusive.

 

Q: Does Odle fit the profile of a serial killer? The F.B.I., I think, now describes a serial murderer as somebody who has killed two or more people with a cooling off period in between murders. The murders on Nov 8th, 1985, were spaced out over a few hours. Serial murder is often premeditated, too, but Odle’s decision to kill his family seemed very last minute. How closely do you think Odle meets the profile of a serial killer?

He is not a serial killer.  Although the murders of the Odle family members occurred over a period of several hours, all murders occurred in the Odle home and all victims were family members.

 

Q: There has been a lot of research over the last decade that has used brain scanning technology to examine physical and functional differences in the brains of those with serious personality disorders and criminals who have been found guilty of murder and rape. Did Odle ever have a brain scan?

The only neuroimaging that he underwent was a CT scan of his brain shortly before the first pretrial forensic evaluations were conducted.  Not surprisingly, the CT scan of his brain was negative (i.e., normal).

 

Q: One thing that seemed abundantly obvious was that Odle had problems understanding emotions. For example, he mentions that music was full of emotion that he was unable to express, and later he admits that he had trouble understanding lyrics. It is often observed that those with antisocial or psychopathic traits are unable to understand emotion. Do you think Tom’s experience with music was already evidence that his brain had not developed as it should?

No. 

 

Q: Odle spent two weeks in the Army. Do you know if he received a psychological examination?

I am not aware of a psychological evaluation while he was in the military.  He was discharged due to physical issues (i.e., knee injury).

 

Q: It was only two weeks, but do you think the Army had any lasting impact on Tom, such entertaining any ideas about killing?

I think the Army was one of the best opportunities he ever had.  If he had stayed in the Army, it is very unlikely that he would have murdered his family.

 

Q: Odle’s account of the murders is chilling. He claimed that there was a voice, his own voice, in his head, instructing him to end his family. There are numerous ways to interpret this, but to me it seems like his past was so painful and it had basically shaped him in such a way that he could not successfully approach any kind of future. So the killing was a means of ending all of this pain and exorcizing many past and personal demons. Do you think the house where he grew up and ultimately committed the murders, played a role in the killings? Would he have killed the family outside of the family home?

It is very unlikely that he would have killed any family members outside of the home.  In the home, they were captive and concealed. 

 

Q: Odle spoke of being very depressed and even felt suicidal at times. In fact, he had wanted to end his own life after he took the lives of his family. This also seems to set him apart from serial killers, who have no intention of committing suicide while they are still free kill others. However, a number of killers, especially spree killers and suicide bombers, seem to have no regard for their own life. Do you think having a ‘sense of future’ would help to prevent certain kinds of murders?

It is important to note that Tom Odle is not a serial killer and does not have the mentality of a serial killer.  At the time of the murders, he had the mentality of a mass murderer, specifically a family mass murderer.  Like many family mass murderers, the motive was to terminate the family unit and subsequently commit suicide.  However, he delayed his suicide and was arrested in the interim.  Yes, having a realistic sense of future is important in preventing domestic homicides of this type. 

 

Dr Edward HanlonDr. Robert E. Hanlon is a board-certified Clinical Neuropsychologist with a specialization in forensic neuropsychology and is an Associate Professor of Clinical Psychiatry and Clinical Neurology at Northwestern University’s Feinberg School of Medicine in Chicago.  He has more than a quarter-century of experience as a forensic expert, having evaluated hundreds of murder defendants and death-row inmates, and testifying in many trials.  For the past 17 years, he has served as the director of the Inpatient Neuropsychology Service at Northwestern Memorial Hospital in Chicago.  He is also the director of Neuropsychological Associates of Chicago, involved in clinical assessment, consultation, forensic neuropsychology, teaching, and research. His degrees include the following: Ph.D., M.Phil., M.S. and B.S.

Survived By One – A Review

Survived by OneSurvived By One tells the devastatingly sad story of Thomas V. Odle, who was still a teenager in 1985 when he murdered all of his close family members – his parents, two brothers, and his sister. Dr. Hanlon, the author of the book and forensic neuropsychologist, traces young Tom’s life from his childhood to his teens, and then from his arrest through to his prison sentence. Odle had been on Death Row in Illinois, but this was eventually changed to life in prison after a series of landmark court cases. While in prison, Odle reached out to Dr. Hanlon to help put his life in perspective. With Odle’s assistance and permission, Hanlon has expertly put together this life story of a killer.

Apart from being very accessible, one of the best things about this book is how Odle’s story is told. Hanlon describes the life of Odle, which includes his expert psychological analysis of events in Tom’s life, as well as the historical and legal context of the story, and splices in Odle’s own personal narratives. This allows the reader to build up a rich idea of how Tom’s mind and life perspective developed throughout his childhood. For those seeking to understand how a person could commit familicide, Hanlon’s telling of the story is genius.

The story also reminds us that nothing is black and white when it comes to understanding human behavior. Even though Tom was physically and psychologically abused as a child, many abused children do not go on to murder anyone, let alone their entire family. Odle displayed Conduct Disorder as a teenager and developed the habit of taking numerous drugs on a relatively frequent basis. But Odle considered taking his own life before he even thought about taking the lives of his family, and when he did eventually take their lives, he explained it as an out of body experience that he just watched happen.

I highly recommend this book to anyone, not just students of psychology or criminology, who are interested in the question of what makes a killer.

Dissecting Empathy: How Do Killers Experience Other People?

Dissecting empathyThe stereotype of a killer, especially a serial killer, is well known – a cold and remorseless man who usually plans and calculates his abductions and assaults, and has absolutely no empathy with his victims. The victim is not a person. They do not have hopes, dreams, and desires. They do not have family or friends who are going to miss them. They do not feel pain or suffering. They are a thing to fulfill the self-serving desires of the monster.

The topic of empathy in all humans (not just criminals) has been studied extensively, usually by taking ‘normal’ people and contrasting their biology and behavior with people we know have killed or committed cruel acts against another. In psychology, this line of questioning has led to diagnostic categories that are used to indicate a variety of disorders. For example, it is widely held that a lack of empathy is characteristic of a number of personality disorders – such as Antisocial Personality Disorder (APD), Narcissistic Personality Disorder (NPD), Borderline Personality Disorder (BPD). However, it must be noted that the lack of empathy experienced is not necessarily permanent, and may even be for only brief periods of time in very specific circumstances. Out of all three of the above mentioned personality disorders, APD is by far the most associated with serious crime.

Because of neuroscience, we now know that there are numerous ‘mirror’ neurons in the brain that become active in an individual when they both watch a task and perform the same task. This suggests that witnessing the behavior of others causes activation in our own brains similar to if we were doing the behavior ourselves. The argument is that perhaps we can ‘recreate’ the experience of others, which points to the presence of a neurological tool kit geared for this very purpose.

A recent study by Meffert et al. (2013) looked at brain activation in psychopaths when they were deliberately asked to empathize with individuals they saw in videos. One of the videos involved slapping another person’s hand with a ruler. When psychopaths observed this action there was low activation in the dorsal anterior cingulate cortex (dACC) (an area associated with pain), but when asked to empathize, the activity in the area increased when viewing the same video. Another aspect of the experiment involved the psychopaths actually getting hit in the hand with a ruler, similar to the video, and there was no difference in activation between the psychopaths and the non-psychopaths. This means that the dACC was active in the psychopaths when experiencing the slap. The study suggests that the mere act of asking the psychopaths to empathize, literally did ‘flick on’ their ability to empathize with pain.

Could a victim of a psychopathic killer or rapist simply ask their attacker to empathize with their pain? Probably not. Passively watching a video of a non-sexual and relatively innocuous act seems to be necessary for it to work, and we have to remember that empathy with no action does not stop criminal behavior. This is not to undermine the above study, because showing that empathy can exist in psychopaths is a major finding. I would also like to know what would happen if the normal group in this study were asked to not empathize or at least fabricate irrational reasons why they hate the person getting hit by the ruler. Would we see something as devastating as the Stanford Prison Experiment?

So, empathizing with victims is clearly compromised in the mind of a killer, but what about empathizing with partners in crime? I bring this up because I think it adds another layer of complexity as to why people kill. Most serial killers act alone (Bundy, Dahmer, Gacy, Sowell, Keyes, etc.), but there are some infamous partnerships and groups who are also responsible for multiple murders. The D.C. Sniper (John Allen Mohammed), who terrorized Washington D.C. in early October 2002, had an accomplice – Lee Boyd Malvo. Mohammed had become a father-figure to Malvo after they met, and despite being separated numerous times, Malvo always sought out Mohammed. Malvo had only been fifteen when the two met the first time. After the two were arrested, Malvo did later testify that Mohammed had pulled the trigger ten times, and himself three times (Censer, 2010).

Clearly, there was a relationship between Mohammed and Malvo.  I do not think it is a stretch to say that Malvo loved Mohammed, as evidenced by his willingness to imprint on the former U.S. soldier. Mohammed had very strong anti-U.S. views and even went so far as to say that the U.S. deserved the terrorist attack on 11th September, 2001 (Censer, 2010). Mohammed’s views no doubt rubbed off on Malvo, who was receptive to them because he loved his father-figure. In a child-parent bond, it is love that helps provide our truth criterion for the world. Parents are imitated by their children, in part because the child loves them (they would be less inclined to imitate people they have taken an active dislike to). The activities of the parent are therefore recreated and performed in the brains of the children – this means that the child can and will now empathize with the parent. Malvo imprinted on a killer.

Mohammed may have loved Malvo as a son or a protégé, but Malvo is not the reason he became a killer. Mohammed had killed in the army, felt betrayed by the U.S., and developed strong radical Islamic beliefs that preached the U.S. to be the enemy. The choice to kill civilians is lost within those facts and we do not know if he had any pathology that led him down the road to murder (i.e. psychopathy).

Linda Kasabian, Patrica Krenwinkel, and Susan Atkins also imprinted on a dangerous man. Through the use of drugs, role playing and open sex, Charles Manson slowly but surely began to control the minds of these young women when he met up with them in California in the 1960s. Manson was eventually able to talk these women into the mindset of murder. He had become their leader and they would do anything for him. Like Mohammed, Manson had very strong beliefs about the world, particularly that a war between black people and white people was inevitable. Through the relationship that these women established with Manson, he was able to persuade them to share a similar outlook.

I have argued elsewhere that we need to treat the terms ‘psychopathy’ and ‘sociopathy’ differently (Pemment, 2013). One reason I give for this is that sociopaths do have a sense of morality (Hare & Babiek, 2010) and as such their brains are likely to function differently than the psychopath. The need for this distinction can also be seen in the light of these examples. A strong relationship with a criminal mind can facilitate the acceptance of criminal behaviors and the adherence to dangerous ideas. This happens because of empathy. A sense of morality is still present, only it allows for circumstances that devalue life. A sociopath, therefore, must be capable of empathy for a cause or an ideology (or a person who represents them), so they can ironically prevent themselves from empathizing with those this ideology devalues. A psychopath, as we have seen, has a diminished capacity for empathy that results from their brain not developing correctly. Psychopaths, by extension, do not tend to have a sense of morality.

In law, when considering murder, the concept of guilty mind (mens rea) and guilty body (actus reus) are often considered, and I also think these concepts can be used to discuss psychopathic and sociopathic killers. Dahmer was a psychopath and tortured and killed animals as a teenager and later had uncontrollable urges to drug and kidnap other men, rape them, and carryout unspeakable acts with the bodies. In an interview with Stone Phillips, Dahmer discussed how he wanted complete sexual control over the men he abducted, and this was not explainable, other than he just felt the compulsion to commit these acts. The detective (Keppel) who helped bring the psychopath Ted Bundy to justice, once interviewed Bundy, and Bundy explained his need for necrophilia like a chemical tidal wave – like the sudden need for a narcotic. These needs do not reflect a morality or a worldview consisting of many interlocking and self-supporting ideas.  Mohammed’s anti-US Islamic ideas, Manson’s race wars, and I would argue Anders Breivik’s National Socialism, do.

There has been a lot of debate surrounding psychopathic serial killers and whether or not they can be held accountable, especially if they have a unique brain. If we consider the mind as the part of the brain responsible for our intellectual life and our worldview, then this is not the part of the brain that motivates psychopathic killers to kill – therefore they would have actus reus, but not mens rea. Sociopathic killers, by contrast, would have at least mens rea, and possibly actus reus. Psychopathic killers have to have a guilty body because the physical interaction with their victim is everything to them – and this interaction usually results in their victim’s death. But to have a guilty mind in the context of murder, one must have a capacity for empathy.

© Jack Pemment, 2013

Sources

Censer, J. R. (2010) On the Trail of the D.C. Sniper: Fear and the Media, University of Virginia Press

Hare, R; Babiak, P. (2006) Snakes in Suits, Harper, New York

Meffert, H.; Gazzola, V.; den Boer, J. A.; Bartels, A. A.; Keysers, C. (2013) Reduced Spontaneous But Relatively Normal Deliberate Vicarious Representations in Psychopathy, Brain, 136, 2250-2562

Pemment, J. (2013) Psychopathy Versus Sociopathy: Why the Distinction Has Become Crucial, Aggression and Violent Behavior (in press)

Psychopathy vs. Sociopathy

Psycho SocioI was happy to land my second review paper in the journal Aggression and Violent Behavior. Quibbling over terminology is not uncommon in any field, but I make the case that these two terms have to be treated separately. Robert Hare, the designer of the the Psychopathy Checklist (PCL), and Paul Babiak, state in their book Snakes in Suits that sociopaths differ from psychopaths in that they do have a sense of morality, although it’s a sense derived from a subculture (rather than the over-arching parent culture). The presence of a sense of morality means that the brain of the sociopath is likely to be different from the brain of the psychopath, or the characteristics that define both represent different brain systems – perhaps with some overlap.

Pemment, J. (2013) Psychopathy versus Sociopathy: Why the distinction has become crucial, Aggression and Violent Behavior (In press)

Abstract

The terms psychopath and sociopath are often used interchangeably, but there appears to be some hesitance by researchers in the many disciplines comprising criminology to continue this trend. The problem seems to be that as research has advanced in studies of psychopathy, which is the more common of the two terms, psychopathy now commands a much more specific definition, and this is what alienates it from its estranged cousin, sociopathy. As language can serve to hinder or confound research, it is crucial that these terms take their proper place in brain science. Here, I present how the two terms are currently used in neuroscience and psychology, and suggest how research in sociopathy should progress.