Tag Archives: Neuroscience

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

Diversity within psychopathy

diversityMuch of medical science today is about further understanding disease, disorder, and treatment. By manipulating context, we hope to tease the unknowns out of the chaotic vacuum of human ignorance into the controlled environment of categorization and understanding. There is nothing more satisfying in research to draw a statistically probable connection between concept x and concept y. The mind revels in these successes and after years of research, shedding blood, sweat, and tears, it can feel like the beast has been tamed.

However, as is the nature of scientific knowledge, there are never absolutes, only probabilities. And so once we have our category, it soon becomes apparent that sub-categories are needed. In the world of psychology, humans are forever providing exceptions  to what we thought we knew (who would’ve thought that with billions of neurons and trillions of synapses, humans would ever throw continual curve balls?).

In psychopathy research, there have been some tremendous strides in identifying those with the disorder. The PCL-R and the CAPP are both powerful tools, but it is also important to remember that just as all people are different, the list of behaviors that make up these tests can be exhibited very differently, depending on the individual. This is partly why it takes a trained mental health expert, with a thorough understanding of the subject’s history, to determine whether or not the criteria is met.

Psychopathy, for many years now, is still being explored within different sub categories; along gender lines, within prison populations, in children and adolescents, and in those whose behavior never resulted in incarceration. The latter of this group have previously been termed ‘successful’ psychopaths, and researchers have pushed to see if there are any brain differences that could explain this phenomenon; for example, do psychopaths who have never been incarcerated have better impulse control? Does the way they express their ‘psychopathic’ behavior never quite fall foul of the law? Are they simply more intelligent and better at covering their criminal tracks?

Cleckley seems to recognize the problem of varying degrees of psychopathy in a variety of different individuals. In The Mask of Sanity, he lists six types of individual and attempts to explain how psychopathy manifests in all of them: These are psychopaths as business man, man of the world, gentleman, scientist, physician, and psychiatrist.* This list is clearly indicative of his time, and one has to wonder what the few pages on psychopath as customer service representative, rap star, or cable guy would look like. However, it is an interesting debate to see if there is anything remotely formulaic about how a psychopath’s career could influence and be influenced by all of the behaviors they are known to exhibit (in varying frequency), that is if they are a psychopath that can maintain a career for any length of time.

Psychopathy remains a very dynamic disorder, and there is clearly a profound amount of difference between those afflicted. There are many areas in the brain that have been implicated in the disorder, and it is when these areas have failed to develop that the disorder could start to make an appearance. One has to wonder that in the symphony of brain development, how much of x has to fail to develop, in light of the failures of y and z to reach maturation? What are the ratios in terms of tissue development and cellular activity that will increase the probability of psychopathic behavior to the point where the disorder is there to stay?

How much can psychopathy be parceled up, before it splits into independent diagnostic components?

 

*Despite having listed two female case studies, when theorizing Cleckley tends to default to psychopaths as male.

 

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.

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

Source

Crimesider

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…