Tag Archives: aggression

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 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].


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.


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].


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



  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

The reappearing psychopath: Psychopathy’s stain on future generations

Aggression and Violent BehaviorI have finally gotten my third review paper published in Aggression and Violent Behavior. At a Science Direct near you!

(Click link) The reappearing psychopath: Psychopathy’s stain on future generations


The genesis of the psychopath has long been debated, typically within the framework of the long-held nature versus nature argument. Are psychopaths born psychopathic or are they molded by society? Like all personality disorders, the development of the psychopathic brain is dynamic, and as the psychopath remains a consistent, albeit small, part of the population, one has to wonder why psychopathy continues to reappear in generation after generation.

I explore the characteristics of psychopathic behavior, current theories on the adaptive qualities of this behavior, and psychopathy as it manifests in women. I argue that psychopathic behavior is not itself selecting for psychopathy. Psychopathy is a mental disorder that increases the likelihood of a set of behaviors, but these behaviors are not unique to the psychopath, and so will not favor the continued presence of psychopaths in the population. I also discuss the biological characteristics of the male brain that may make it more susceptible to psychopathy than the female brain.

Anger and Self Control

VolcanoAfter a recent experience in a place with abysmal customer service, I have found it healthy to re-evaluate my relationship with anger. Fortunately, I did not succumb to it, and many of the thoughts that flashed through my mind remained as fantasies, well behind the borders of imagination land. I was acutely aware throughout the whole episode how every thought I had as a response to somebody acting badly towards me was right and just. This in turn terrified me, because in these moments, life seems to become so clear, the required behavior so obvious, and there is a burning drive to act. The only problem is that anger induced responses are intimately linked to aggression; verbal, emotional, and physical, and even if you don’t express it immediately, these can manifest in passive aggressiveness or fostering a plan for vengeance.

Personally, I think these feelings are primitive survival instincts that do not have a place within contemporary standards of morality. There are very few circumstances where being aggressive against others is a permissible behavior. I would only defend physical aggression against others if you or your friends and family are being physically assaulted (or in the boxing ring, octagon, or on the mats). The obvious reason that aggression is never okay against others is because it can be seriously damaging and leave the victim forever changed with long lasting depression and misery.

I realize that there are degrees of aggression. Yelling at someone for cutting you off, making a sarcastic response, or even just refusing to talk to somebody are hardly in the same league as punching somebody in the face (although, in the times I’ve had people go behind my back, I would’ve preferred being punched in the face. Maybe there’s an important difference between honest aggression and cowardly aggression?) Still, if there’s one thing we know about aggression, is that it can quickly escalate. Remarks in passing when the other party leaves earshot or personal space can become viscerally incendiary if it turns into confrontation.

There are a number of philosophical directions you can take anger. We’re sometimes frustrated by the lack of action over particular issues, and anger leads one to act. Confrontation, although uncomfortable, can lead to closure, and despite the negativity, you at least know how the other party feels about you (honest aggression?); is this ‘healthier’ than angry remarks in passing with people you never see again? And finally, is it ever okay to defend one’s actions by stating that they were done out of anger?

What I have really taken away from my recent experience is that I don’t like feeling angry. If there’s anything I know about the world, it’s ridiculously complicated, and even the asshole that nearly sideswipes you, is somebody’s son/husband/father. If you’re experiencing a moment when the only conceivable right thing to do is to pick up a vase and smash it over somebody’s head, you are the one with the problem, and you are the one that has departed from reality. I wouldn’t mind betting that those who seem to strive on anger have become addicted to the sense of righteousness and power that comes with it. To somebody who suffers low esteem, these feelings could nourish them into a raging beast (bullied children gravitating towards careers of authority?)

During times of anger, especially in the absence of threat, it’s probably better to turn your attention on yourself, and do what is needed to come back down to earth. With all that is amazing in life, who has time to be angry? I’ll take blissful confusion any day.

The Role of Ring Girls at Professional Fighting Events

I am a boxing fan, and I do enjoy some of the promotional theatrics before professional sporting events between boxers. But what really sells the fight for me is the opportunity to watch two highly trained and highly skilled athletes box in the ring. Ring girls have always been there, and usually you just see an attractive and sometimes mostly-naked woman walking around in between rounds to let the crowd know which round is about to begin. It’s obviously all about sex appeal and something to press the deep evolutionary buttons within male audience members to give them a temporary buzz and make them feel like the event was worth the price of admission.

And that is the only point of ring girls. Carrying cards to indicate forthcoming-rounds is the epitome of a sinecure job. Obviously, ring girls are not the only example of using sex and naked women to enhance and promote events and products, and maybe there is an argument that being a ring girl helps to promote modeling careers of the women involved. While I am ashamedly on the fence with a number of these issues, what worries me is the presence of representations of sex and aggression in the same place.

Something that should strike us all as obvious, at least in the male, is that the brain can be warmed to sex and to aggression at the same time, meaning that they are not as conflicting emotions as one might think. This does not necessarily mean one is emphatically horny and dangerously aggressive at the same time, but the general buzz of both emotions can effortlessly sit in the slightly excited body of the spectator. Perhaps both of these feelings together represent a state of mind and brain that makes one feel like an alpha male – a firing of all the cylinders in the ‘machismo’ circuit, which helps boost the ego and makes one feel alive.

Areas of the brain have been explored in men that become increasingly active during exposure to aversive/aggressive circumstances, and during exposure to sexual/erotic imagery. These tests are obviously controlled, so any activation is limited by precisely what the participant was exposed to, and the increased activation of certain brain regions must not be interpreted as these are the sole areas specifically involved in these activities. A point to note, however, is that a number of the same or similar areas are involved in both perceiving and feeling aggression, as perceiving and feeling arousal. Hopefully, one day we’ll see a study that monitors changes in activity from aggressive stimuli to arousing stimuli; my guess is that there might be one or two key differences, but the rest would remain subtle and barely noticeable. While this study would not tell you about the individual’s conscious experience through this shift, it might tell you just how lazy the brain can be when the context changes. This laziness could perhaps indicate how easy it is to shift from the aggressive state to the erotic state, and vice-versa.

But back to ring girls. While I am not going to argue for the complete removal of the girls from the sport of boxing, or indeed from other professional fighting events, I wholeheartedly argue that they be more clothed. One reason for this is that if ring girls are mostly naked, it creates the expectation that they be mostly naked all the time – the expected buzz attached to the price of admission. A model in an evening gown can still arouse the brain, but to the point of a subtle appreciation of her beauty, after all, spectators should be there to watch the boxing match. There are other places to go or websites to visit if anything else is desired.

There is a ‘ring girl’ culture growing in the United States, mainly in the Ultimate Fighting Championship (UFC) and other Mixed Martial Arts (MMA) events. Ring girls have televised try-outs and have to pose in outfits that would make normal underwear blush. In fact, it almost appears that MMA ring girls are vying to compete with Playboy (indeed some MMA ring girls have been in Playboy). This is no doubt a marketing ploy of MMA promoters in order for them to create a strong brand and maximize their franchising, on top of promoting their fights. The continual rise of MMA is going to be interesting to watch, because fighters are permitted to be fairly brutal to each other, showing maximal levels of aggression, and the associated ring girls are flaunting maximal levels of sex appeal.

In terms of appealing to the young male mind, the trap has been set.


Ferretti, A., Caulo, M., Del Gratta, C., Di Matteo, R., Merla, A., Montorsi, F., … & Romani, G. L. (2005). Dynamics of male sexual arousal: distinct components of brain activation revealed by fMRI. Neuroimage, 26(4), 1086-1096.

Lotze, M., Veit, R., Anders, S., & Birbaumer, N. (2007). Evidence for a different role of the ventral and dorsal medial prefrontal cortex for social reactive aggression: An interactive fMRI study. Neuroimage, 34(1), 470-478.

Head injuries, brain abnormalities, and violence

While there is incontrovertible evidence that brain damage can lead to an increase in violent behavior, I can easily see it becoming an excuse for defense attorneys to claim that their clients were not acting in their “right” state of mind.

Phineas GageFrontal lobe dementia and head injuries to the frontal lobe have resulted in aggressive outbursts, such as the famous case of Phineas Gage, who ended up with a metal rod through his posterior pre-frontal cortex. It was noted that after the accident Gage was no longer himself and his behavior was more antisocial than it had been before the accident. One of our most influential neuroscientists, Antonio Damasio, has examined this phenomenon in great deal and coined the term acquired sociopathy to analogize the frontal lobe damage in these patients to the developmental errors we see in psychopaths.

Antonio Damasio

Damasio has also worked with many patients with dementia brought on by various diseases, including Parkinson’s, Alzheimer’s, and Huntington’s Disease, and if the dementia is in the frontal lobe, the chances for antisocial behavior do indeed seem to be higher. It is my opinion that a healthy frontal lobe allows one to adhere to a ‘superego’ or cultural morality, and so damage here seems to sever that link, destroying a crucial layer to behavioral regulation.

Charles Whitman

The autopsy of Charles Whitman, a man who shot numerous people at the University of Texas in Austin in 1966, found a tumor in his hypothalamus, an area strongly involved in many of our basic drives – fighting, fleeing, reproducing, eating, and sleeping. It might just be coincidental, but the fact that a tumor was interfering in such a powerful and crucial area it seems unlikely that the tumor can be completely disregarded in an analysis of his behavior.

Astley (left) and Fujita (right)

Astley (left) and Fujita (right)
Click photo for Crimesider article

In the news today, there is a case involving the murder of an exgirlfriend, Lauren Astley, by a guy the same age, Nathanial Fujita. They were in high school together and the murder happened two years ago, whereby Fujita strangled and stabbed Astley. Fujita’s attorney is not disputing the murder, but he is claiming that Fujita was suffering a brief psychotic episode, something that if proven could diminish Fujita’s culpability.

A forensic psychiatrist, Wade Myers, has said that Fujita could have suffered traumatic brain injuries from football, and that he suffered from a number of mental problems. On top of this there is an apparent history in Fujita’s family of paranoia, schizophrenia, anxiety, and depression.

This kind of defense worries me, because it seems like the psychiatrist is throwing out every reason under the Sun in the hopes that one of these issues played a causal role in Fujita’s “disconnection” from reality as he murdered his exgirlfriend. I personally think the history of paranoia, schizophrenia, anxiety, and depression is irrelevant, albeit there are no doubt genetic predispositions and susceptibilities to those conditions. Connecting causal violence to all of those conditions, in this context, is tantamount to fishing with no hook.

The idea that football caused this departure from reality is also troubling to me. I think it’s far more plausible that a continued battering to the head could lead to abnormalities in behavior, but violent behavior? It’s possible, I suppose. But this happens to so many football players. Are we going to accept that when these athletes act violently towards loved ones, it’s because of their sport? Do we need to re-examine the safety and long term effects of these games?

Myers might be bang on the mark, but I suspect that in order to really know what’s going on, there might not be the knowledge or the time to figure it out, thus the avalanche of excuses.

Copyright Jack Pemment, 2013



Not at a deficit, just different

deficit or differenceThere has been a big push in the field of clinical psychology to recognize and celebrate difference, pushing us away from behavioral explanations that might use words such as retarded or deficit. The motive for this is obvious; using these kinds of words with negative connotations can hugely undermine all of the great qualities of the patient in question. I support this kind of thinking, but have the following reservations.

Firstly, I have no problem with the word retarded going into the dustbin of history. That word is no use to anyone.

But I would like to maintain that deficit does have a place. Those in developmental neuroscience are becoming very familiar with neurogenesis (the creation and proliferation of neurons) and brain development. The biochemical environment in the brain tissue during development is crucial for proper neurological maturation and for the brain to function. If the environment in the brain changes, because of high levels of stress hormones or the presence of harmful drugs, the outcome will be a neurological deficit. Depending on where this deficit is will have serious implications on the afflicted’s lifestyle.

You could refer to this hindered development as a difference, not a deficit, but that undermines the fact that given different circumstances (environmental or genetic), there was no reason for the lack of neuronal growth to occur. Academically, it’s critical to recognize the factors that hinder potential growth and the resulting behavioral consequences. To refer to hindered development as just a difference undermines the pursuit of preventing developmental disorders.

Behaviorally, everyone is at a deficit! There are millions of things I will never be able to do, and things that somebody else will always be able to do better than me. But there are nasty diseases that can result in the break down of once healthy systems, and there are nasty diseases that can prevent one from having the healthy system in the first place – such as motor movement and coordination, our propensity for empathy and an intuitive understanding of others, and one’s ability to memorize, intellectualize, and think critically. While these things may not have developed or may have started to deteriorate, as humans we usually learn to compensate for these growing deficits by adopting new skills or techniques that we never used previously. There is nothing wrong with acknowledging the deficits, because that allows us to deal successfully with reality.

This issue of deficits is clearly about respect and a fear that by focusing on deficits we will fail to give people the dignity that they deserve.

Which brings me to my second reservation. There are some disorders that are now synonymous with neurological and behavioral deficits that we would not want to celebrate as just different. The main disorder in question here is a developmental disorder known as psychopathy. Neurologically, we know that those with psychopathy have deficits in their amydalas and in the posterior prefrontal lobe. Behaviorally, psychopaths do not have a conscience, cannot understand emotion, and often engage in very risky behaviors that can seriously harm the wellbeing of others. Here, the term deficit appears perfectly valid, and I think part of the reason is because we despise the behavior of these people and recognize that as their brain failed to develop correctly they are at a deficit, both personally and socially. Psychopathy is not a difference to be celebrated.

I think there is also an element of our willingness to accept a ‘greater good’ mentality over those with neurological deficits to this argument. Autistic individuals are known to have a poor understanding of the feelings and emotions of others. The same is true of psychopaths. Culturally, (for the most part) we accept autism and marvel at the analytical and descriptive talents that are present in some autistic individuals, and those with autism never really go out of their way to harm others. Therefore, we have no problem allowing those with autism to be fully integrated into society, albeit in their fastidious and calculating bubbles; those with autism are just different from us.

But psychopaths? Yes, they have neurological and sociological deficits, but they are harmful to others. So in this case we do need to exercise a ‘greater good’ mentality to keep them out of society and prevent them from continuing to hurt people. This isn’t a difference we can accept. A psychopath’s deficits can make them deadly, and as it is the recognition and comprehension of these deficits that help us to identify these people, talk of deficits is just fine.

Copyright Jack Pemment, 2013

What would we find wrong in the brain of a serial killer?

You do not have be enlightened to realize that there is something different about serial killers. Clearly, the horror stories from victims and police reports will soon have you believing that something has to be very different about these people for them to do what they do, and whatever that something is has to be encoded in the brain somewhere, somehow. I would like to talk through some of the psychological disorders that could be behind the possibility for serial killing, but firstly, I would like to clarify what I mean by ‘encoded in the brain.’ I simply mean that at any one moment in time our brains have developed in one particular way and that way controls the statistical likelihood of certain behaviors occurring under certain circumstances, in this case, serial killing.

Read more at Psychology Today…