Tag Archives: empathy

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

Humans are the only cruel species?

Since the dawn of cave graffiti, humans have polluted their stories with personal biases, usually because they have falsely labeled all other humans into erroneous categories. And this can be entertaining, seeing how an interesting and provocative character has noted differences in the behavior and appearance of other humans (the reason, incidentally, reality TV shows like to group together conflicting/strong personalities). However, if these perceived differences become more than anecdotal stories, have no factual basis, and become an integral part of ideology and worldviews, these ideas of difference can flourish into sinister prejudices. Within the human canon, this has led to horrific lies about women and those whose skin is not white.

But humans do it with non-humans, too. We have developed a species-ism, comparing all of the things we attribute with ourselves to the gamut of the animal kingdom, and we always find the other animals lacking. Clearly, humans have decided that it is their intelligence that is so superior to rest of the animals, after all, no donkey has built a skyscraper. As an interesting side note, it is only those humans on the far side of the intelligence bell curve that achieve the things that we boast about as a species.

Anyway, to pull myself back on track, it is often said that humans are the only species that are cruel for the sake of being cruel. Humans can be cruel because they like to be cruel. Ironically, I think this is another way we have decided that humans are superior to the rest of the animal kingdom. It’s the price of being so advanced that you have to deal with other humans indulging in abject cruelty. What a strange compliment we pay ourselves!

The question of why humans engage in cruel behaviors can be debated at length, although I think there are three main categories, and they can become interchangeable over time. First, humans are forced to be cruel to other humans. Second, ideology has convinced some humans that the lives of others (usually of a particular group) are not worth as much as their own, and while they might not *like* being cruel to these people, the conscience scarcely vibrates. Thirdly, some humans derive pleasure in being cruel to others. As cruelty typically implies intent, I am ruling out devastating behavior that results from accidents.

We think that all of these reasons are missing in the rest of the animal kingdom.

However, I think it would be a tall order to rule out all of them, even perhaps the most challenging – ideology that devalues the life of others (I refer to this as sociopathy). It has already been widely demonstrated that many other animals use language to communicate with others. Given that humans use language the most to understand their own thoughts, I don’t think this can be ruled out in other species, especially the neurologically complex species. If there are thoughts, there is the potential for worldview, and thus ideology. Couple that with all the ways that animals recognize difference, particularly the use of smell, and there is the potential for very strong and motivating thoughts about those others who are different, and that perhaps provoke thoughts of a threatening nature. These ‘thoughts’ then project necessary behaviors as a response, given the immediate context in relation to those an animal does not like, and this a basis for prejudice. Do other animals value their life and the life of those similar more than those that are different? Of course they do.

What about coercion into cruel behavior?

Within other species, can some members force others into being cruel to other members of the same species? In rat colonies, there is often an aggressive struggle for domination. Aggressive neck grooming, biting, and chasing is very common. In this environment, some rats become dominant, and others subordinate. There are two types of subordinate, those that stay close to the dominant rat (betas), and those that avoid the dominant rat (omegas). If the dominant rat is removed, it has been observed that the omega rats, over the betas, are more likely to become the new dominant rat. The experience of the omega, of being dominated (a history of stress and abuse), results here in the omega now acting dominant. This is somewhat an oversimplification, but it shows how members of the same species can “groom” others into behaving intentionally aggressively to others, no doubt resulting in distress (cruelty).

How about cruelty for pleasure?

This is usually what people mean when they say that humans can be cruel for the sake of cruelty. Nobody is cruel for the sake of being cruel. That’s like the outdated idea of people being evil for the sake of being evil. There are individuals that derive pleasure by doing things that cause another pain and distress, but this can also fall into three categories. First, the pain and distress of the other might be what causes the pleasure, such as the pleasure derived from watching another cry. Second, the action(s) that result in the pain and distress cause the pleasure, such as hunting another human for sport, and thirdly, a combination of both, such as a pathological rapist.

I am willing to grant that humans might be the only species that take pleasure in the expressions of suffering and pain in others, but it is worth noting that from a perspective of power and dominance, fear in the faces of others is affirmation and validation of one’s dominance, which is perhaps *enjoyable* in other species, too.

I am also willing to wager that where you find intellectual curiosity in other species, you will also find pleasure derived in actions that cause others distress. Cats, for example, do not seem all that interested in eating the things that they kill (and in some cases, literally torment to death), such as some of the larger bugs, mice, and birds. A mouse is entertainment, not dinner. And within species, there are other apes that will kill the young offspring of females to make them sexually viable for their own sexual coercion. This is obviously an immense distress for the aggrieved mother, and it was done to facilitate the drives and desires of the murderous male, leading to his own fulfillment.

So, the next time you find yourself wondering if humans are the cruelest species on the planet, just remember that there are plenty of bastards in the animal kingdom, too.

*I also wonder if the bite delivered to human swimmers by sharks is sometimes more than a ‘curiosity’ bite. It is widely known that sharks can hone in and become excited by such a tiny amount blood in the water, and so even though biting a human wouldn’t result in a satisfactory meal, the shark has to get something akin to a buzz from the mouthful of blood. Would it be a stretch to say that at least one shark, in some place and time, enjoyed it?

** Intellectual curiosity has an interesting dampening effect on empathy, with perhaps the best example being the behavior of Nazi scientists. After the war, the scientific research community sought to protect human research subjects, and a first step was in creating the Belmont Report.

Batman and psychopathy

Bat signalI have held off writing about my thoughts on this matter for a while, but the more I think about it, the more it seems to make sense. Clearly, Batman is a fictional character, and one that has appeared in many incarnations, but I believe his overall personality and history seems to make him a close candidate for a diagnosis of psychopath. I’m not a clinical psychologist or a psychiatrist, but here is my case.

Young Bruce Wayne witnessed both of his parents murdered together in cold blood. The emotional trauma of this event and the extreme misery to follow could very easily stymie brain development in profound ways. For a child witnessing their parents die in a grotesquely violent act at the hands of a killer, that killer has also just abused the child in a very serious and disturbing way. Child abuse is one of the primary suspects for the development of serious personality disorders, including those that result in a lack of empathy. Presumably, this act also made the young Bruce develop an obsession with criminals and instill in him the need to make sure they are brought to justice.

I don’t know much about the adolescent Bruce Wayne, perhaps someone who is more familiar with the canon can let me know if he was socially deviant, reckless, and callous.

There can be little doubt that Batman himself is extremely violent. Beating villains into a bloody mess seems second nature. Other than the apparent lack of empathy, it is worth noticing that the violence dished out by Batman is very personal; it is close quarter, bone crunching, skin ripping, joint popping, and back stomping violence. In other words, it’s a very intimate level of violence. This seems to point to him getting a thrill out of hurting people, which makes him a sadist. It is widely known that Batman does not use guns (an aversion that could perhaps be explained by his parents being gunned down), but guns are very impersonal. The irony here, which helps enrich the story, is that the Joker also likes to use personal forms of violence, such as knives, on his victims.

There is also an argument to be had that the adult Wayne (and Batman) lack emotion. Batman is usually very clear-minded, cold, and calculated in his behavior. One often hears it is bad to let “emotion” get in the way of making decisions, but perhaps here, Batman has very little to get in the way. Yet clearly, there is always an explosive rage ready burst out of Batman, usually in the form of fists, feet, and head butts. Arguably, he doesn’t have much of an emotional spectrum, which is perhaps one of the reasons he cannot seem to maintain a good relationship (with the exception of Alfred).

There is a parallel between Batman, and the fictional serial killer from Jeff Lindsay’s novels, Dexter. While Batman does typically withhold from killing, he still has a code that provides the parameters for his violence. These parameters help to keep him socially acceptable, as he’s only going after the bad guys. Although, Batman’s code, like all tyrannical codes, have an element of the greater good. Any philosophy that incorporates the greater good will result in the denial of human rights to at least one, but often many individuals. Depending on the group, one could argue that the temporary denial of their rights is necessary, as politicians often do (although not in these words), but nonetheless it places people on different levels of worth. In fact, prisoners, which were at one time criminals, are an incredibly vulnerable group of individuals because they are very much at the mercy of the state, and in scientific research, the use of prisoners is heavily regulated.

Much of these ideas have already been realized in the superhero comics, especially how morality is very often a slippery slope.

Still, if I was asked to write a Batman story, and part of the story included him being diagnosed using Hare’s Psychopathy Checklist, I don’t think it would be a stretch to convince people of a score of at least 25.

While the promise of thrill seeking is enough to excite your average psychopath, the Bat Signal clearly gives Batman a raging boner.

Emotion and Worldviews: The Deep Empathic Failing of Homophobia

Anchor and balloonLately, I have been trying to make sense of how our emotions and our sense of morality are related. Everyone has ideas about what is ‘right’ in the world, and these ideas are usually held as explanations for having certain feelings about particular events. For example, witnessing an assault or abuse can make us feel bad (if our brain is working). We then justify our bad feeling with ideas that explain why we feel bad, and we soon have a sense of morality.

First, we might reason that the aggressor is wrong for behaving aggressively because we don’t like the way we feel when we witness what he is doing, or the way we feel when he is doing it to us. To make further sense of these feelings we start weaving together ideas, such as hitting people is wrong (it has to be, right, because it makes us feel bad?), and extend it to hitting smaller and weaker people is more wrong (because this change in context makes us feel worse). However, we might start to introduce caveats such as, hitting people is wrong, unless it’s to stop someone hitting someone else. And so as our emotional responses change throughout these different scenarios, our sense of morality and the way we understand the world evolves.

The key point to note here is that our emotions anchor our morality. It is also possible to have a cold and emotionless ‘code of ethics’, a system of rules that govern behavior, even though there is no emotional attachment to them. In fact, your emotion and the cold and emotionless ethical principles that you come into contact with probably duke it out to give you your sense of morality. Lacking an emotional attachment could cause a schism and internal conflict later, especially if we have (intellectually) accepted a moral position with no feeling, such as a stance on the death penalty or abortion. Should we experience for the first time a personal situation that involves these two issues, our emotions may go to war with our intellect.

But there’s no denying that the ideas about life that really stick, are the ones weighted down by a strong emotion, and this becomes problematic because our emotion, which is notoriously unreliable, becomes the first and often the most powerful truth criterion for understanding a moral action. If we feel strongly positive or negative towards something, that’s sometimes all the truth we need – our visceral experience.

I believe that it is this visceral failing that results in the most prejudice. For example, take homophobia. Sometimes it is touted that homophobes are really self-hating homosexuals. While I’m willing to merit that this is sometimes the case, I do not think it explains the majority of homophobia. What explains the majority of homophobia is a deep empathic failing – all justifications on top of this are all garbage, no matter what their brand. However, these justifications also form a culture that reinforces these deep empathic failings. Let me explain.

A heterosexual teenage male, with a new found and celebrated sexuality, will realize how awesome women can make him feel (this marks the beginning of personal growth and many political encounters with women, which will hopefully result in positive outcomes). Now, in an effort to understand homosexuality, there’ll be an attempt at empathy and he may fail miserably. In all likelihood he will recreate the experience of anal penetration, or imagine all of the sexual things he fantasizes about one day doing with a woman and supplanting the woman with a man. This will make him want to retreat into his shell like a turtle, and the bad feeling that results from this failed empathy could then easily be justified by bogus ideas of what it is to be gay. If the feeling is strong (or repulsive) enough, the quality of any further truth criteria doesn’t matter – the repulsion is his experience – his truth (I haven’t been to church in ages, but let me throw out Leviticus, and then show you this sour expression on my face).

There was a deep empathic failing here for the following reason.

The great feeling arising from the heterosexual sexuality will hinder attempts at homosexual empathy, and to a large extent, a heterosexual male will never know how awesome it feels to fall in love with another man. But this doesn’t matter. What the heterosexual person can empathize with is what it is to love somebody and be attracted to somebody. How great it is to curl up on the couch after a long and trying day with their significant other. If the empathic focus shifts from physical sex to the emotional satisfaction (or turmoil) of being in a relationship, empathy can prevail. Given time and maturity, the awkwardness elicited by thoughts of homosexual sex can also be diminished.

The problem is that homophobic ideas do focus on sex and encourage negative feelings, which in turn reinforces homophobic morality. It’s a particular problem with sex because the emotional experiences that result from our sexuality are often so powerful that there is no neutral ground – something is either very wrong or it’s very right. This is why sex is usually a major part of religion – the strong feelings of guilt (or in some cases empowerment) strengthens the underlying creed, which may force some to disband and others to cling even tighter.

I believe that a failure to empathize on this crucial issue could be addressed by mentioning sexuality in school. Firstly, it’s crucial that homosexual children can learn that there is nothing wrong with them, which is vital for their development, and secondly children/teenagers can learn some theory surrounding relationships. Obviously, there is much to be learned from experience, but some good foot holds from the beginning could be beneficial. It is perhaps time that children are shown how to empathize, because their morality depends on it.

Recent crime and the need for mental healthcare reform

Alexis Carey Lanza

Aaron Alexis (left), Miriam Carey (center), Adam Lanza (right)

After a string of violent incidents that clearly indicate the presence of an unhealthy mental state, it is still shocking that a Congressional debate on improving mental healthcare in this nation has not been mentioned. Clearly, with the government shutdown, hands are probably tied right now, but it is not even getting suggested. Stop me if you have evidence of impending mental healthcare reform with the inclusion of ongoing care and assistance of the mentally ill once they have left hospital.

When yet another violent attack by an individual happens, everyone gets bogged down in motives and intentions, which are important, but secondary to the mental health of the individual. Poor mental health can only serve to exacerbate or create dangerous motives and intentions, and a discussion of the motives and intentions of mentally ill people cannot happen if mental health is excluded.

Human-Egg-Hatching

Mentally ill people hatching from their egg in the forest

These violent events often re-ignite quarrels about gun control. Regardless of whether or not you think all law-abiding U.S. citizens are entitled to own a gun, I think we can all agree that a gun in the hand of a mentally ill person is a recipe for disaster. What I think many fail to understand is that mental illness is not necessarily something you are born with and it can manifest itself at any point during a person’s life. It’s perfectly possible for a gun owner, who has safely owned and kept their gun for many years, to suffer mental illness. This does not automatically mean they will become a killer, but owning a gun might not be a good idea for this person any longer. Currently, in light of gun debates and commentary on mass shootings, the mentally ill seem to be treated like they are those ‘other’ people who hatch from eggs in the forest, and have nothing to do with us normal people.

Mental health is often excluded from initial discussions of these events, because as a nation we want immediate accountability. To say that a shooter killed a number of people was a schizophrenic who was off their medication is not a satisfying answer – it almost makes the event kind of pointless, meaning that lives were lost for nothing. To say that a killer was evil, had a hatred for a certain group of people, or was deranged as I’ve heard it explained, seems to give our rage and indignation of the event a focus or a purpose – after all, after a tragedy we need to stick our blame to something if we are to help our feet back to the ground.

Wanting to attach accountability to Aaron Alexis, the shooter at the Naval Yard in DC, in my opinion, is the easy and natural thing to do, especially for the victims and the victims’ families. But politicians and elected officials cannot allow themselves to fall back on this. President Obama referred to the intentions of Alexis as ‘cowardly’. This kind of comment is of no use to anyone – how is it useful to discuss the behavior of a man suffering psychotic symptoms, who had a shotgun in his possession and who killed 12 people, as acting cowardly? This attitude means that nothing gets done, and we’re almost guaranteed that a similar event is going to happen again. If the reason for a shooting is that the shooter was a schizophrenic off their medication, we should turn our indignation towards an inadequate mental healthcare system, and the absence of mental health education. We should also demand to know why so many red flags are often missed. Aaron Alexis had a ten year history of mental illness, was involved in three crimes, and yet he was still able to buy a gun and get a pass to work at the navy yard – this is the failure, and this should be the target of our national indignation.

In light of the shooting at the navy yard, a number of pundits were also quick to jump on Obama’s comment that if he had a son he would look like Trayvon Martin, and quipped, “If Obama had a son, he would look like Aaron Alexis.” This is no doubt supposed to be humorous because a number of conservatives and Zimmerman supporters were irked by Obama’s comment about Martin, because in their opinion Martin had been a threat. Alexis was a threat, and this is not something that is divided by opinion. Therefore, this recent comment serves to ridicule Obama’s original statement about Martin. This snide attempt to ridicule Obama is appalling, because it serves to undermine Alexis and his history of mental illness. Alexis “could’ve” been Obama’s son, because even people with schizophrenia have parents, and threat or not, Martin is now dead, after having only a very brief life. This kind of commentary only serves to obfuscate the real issues.

Whenever these type of tragedies come to pass, as they do all too frequently, there’s always mental illness or a mental disorder. Miriam Carey, the lady recently shot by police for driving her car into security barriers in DC, had suffered post-partum depression and psychosis. Adam Lanza, the teenager responsible for the Sandy Hook tragedy was diagnosed with Asperger’s and Sensory Integration Disorder (SID), and also had many articles about Anders Breivik, the Norwegian mass killer who shot dead many people, including children, on the island of Utoya  in 2011. Figuring out how the disorder could have resulted in these acts is not always straight forward, but poor mental health is always there. Even with pathological serial killers, the brain is different from everybody else. In fact, I’m going to go out on a limb and say that anytime a person’s natural in-built capacity for empathy fails completely, there is probably a disorder or the potential for a disorder present. This does not necessarily mean that an act of violence will result, but the chances have certainly increased.

One last thing I would like to comment upon is the term ‘isolated event’. Often after a mass shooting or an event that included the dangerous behavior of a citizen, you often see police officials or the media saying that it was an isolated event. I think this serves at least two purposes. Firstly, it lets us know that it wasn’t the result of terrorism, and there aren’t going to be similar acts to follow. And secondly, it bolsters the idea that the person responsible has been neutralized and will not commit further atrocities. I would like to contend that none of these events are isolated. They may not be the result of terrorism, but the issue of mental illness is behind all of them. Together, these events suggest that there is a tremendous ignorance and ineptitude regarding the mentally ill, and as mental illness can impact any of us at any time (either personally or by the actions of others), we need to stop looking at it as some weird anomaly that happens to other people, and start treating it as a human, national problem.

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)

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