Tag Archives: violence

Can anosognosia help explain some public acts of violence?

Anosognosia has been traditionally discussed when explaining why patients with Alzheimer’s disease (Perrotin et al., 2005), Schizophrenia (Gerretsen et al., 2015), and various lesions (Moro et al., 2016) have resulted in the patient lacking awareness of the functional deficits associated with their disease or affliction. There are two competing models to explain anosognosia; a psychological model, which claims the individual is protecting themselves from the stress caused by their disease, and a neurological model, which posits that the lack of the patient’s insight into their own disorder is due to a failure of neurocognition (Lehrer & Lorenz, 2014). However, both models are in agreement that it is the disease that results in anosognosia: The disease results in the patient not recognizing they have the disease – or at least some symptoms of the disease.

Researchers are still vying for a comprehensive neurological profile of this lack of awareness, and even though the diseases and the injuries that are associated with anosognosia are diverse, there is overlap in the parts of the brain that are impacted. Patients with anosognosia have been found to have hypometabolism in the posterior cingulate cortex (PCC) (Perrotin et al., 2015; Therriault et al., 2018; Vannini et al., 2017), hypometabolism in the hippocampus (Vannini et al., 2016), and reduced gray matter in the anterior cingulate cortex (Spalletta et al., 2014). Some studies posit that reduced right hemispheric volume, which could occur through disease atrophy or injury, relative to the left hemisphere, particularly of the angular gyrus, the medial prefrontal cortex, the dorsolateral prefrontal cortex, insula, and anterior temporal lobe, lead to a lack of awareness in schizophrenic patients (Gerretsen et al., 2014).

To date, there appears to be little research on the prospect of anosognosia concomitantly occurring with an empathy or a moral deficit. This is surprising for two reasons. First, the aforementioned brain regions listed above, are also known to be involved in moral decision making (Baron-Cohen, 2012) and empathic responses (Alegria et al., 2016). Second, it is sometimes symptomatic of patients with Alzheimer’s Disease (Liljegren et al., 2016) and Schizophrenia (Del Bene et al., 2016) to behave violently towards others, which means that any anosognosia could extend to a patient’s unawareness of their own harmful behavior.


If an illness or a lesion results in both a loss of empathy or moral decision making, as well as the self-awareness of these, the behavioral intentions of the individual could change. This is extremely dangerous when the deficit is empathy, because empathy helps to inform humans about harmful behavior; if we observe another human in pain, most of us are able to recreate a sense or a feeling of that pain and thus feel that the behaviors and actions that have led to this are wrong. This mechanism can be behind our drive to prevent harmful behaviors and, and cause us to strive to ease the pain of others. If we stop or ease the pain of another individual, we prevent the need for an empathic response, and thus we stop or ease the empathic pain in ourselves.

The presence of an empathic response to seeing others in pain can thus lead to the stymieing of bad behaviors, not necessarily while they are being carried out, but even stopping them before they are carried out. The absence of an empathic response to pain could lead one to have the perception that some harmful behavior is okay, because this person is missing the internal response that would inform them otherwise. Our view of behaviors being right or wrong, due to our empathic response, will also shape our guiding philosophies and worldviews. If we feel that something is right or wrong, we tend to try and understand these feelings by providing a rationale, and this rationale contributes to our own moral code.


Anosognosia involving an empathy deficit could have a profound impact on the person’s life and their choices. Before the onset of anosognosia and the empathy deficit, the person might feel that certain behaviors are wrong, such as assault and violence; with empathy, these behaviors can be understood as deeply destructive, and function to prevent one engaging in them. The onset of anosognosia and an empathy deficit could lead to a person transitioning from feeling that a certain behavior is bad, to amoral or even good behavior.

Our sense of what is normal also informs our moral code and how we should treat others. Most people tend to think of themselves as rational and fair minded (even though some are open to considering the views of others), and so what they think as right or wrong about the world (including behavior) feels true because it has come from a balanced place. If a person was unaware that they had an empathy deficit, they would still consider themselves rational and fair minded, as they don’t recognize a deficit to undermine this view of themselves. This could mean as their moral code is subtly changing due to an absence of empathy, the change feels true, and thus right, further validating their new view of certain behaviors. If they attribute a recently adopted ideology to this shift in their view, the ideology, too, would be further validated.

A cursory glance at any number of manifestos, penned by murderers before they acted, will inform you of how the way they saw the world changed, and finally how this change brought on their actions, which they felt were necessary. A deliberate act of murder is clearly a failure of empathy, and one cannot help wondering if the murderer was even aware of their empathy deficit.


If an empathy deficit is observed in a patient, or individual, it is therefore of the utmost importance to understand if they recognize this deficit. A person who could understand that they have an empathy deficit, even if it’s temporal, could perhaps take measures to ensure they behave in an innocuous manner, through counseling, or through supervision by friends, family, or healthcare professionals.

It is also crucial to know if a person was aware of an empathy deficit before they acted destructively towards others, because it introduces accountability when the suspect is tried. In some cases of homicide, if mental illness, disorder, or mental illness is suspected, the prosecution often has to argue against a defense that claims the defendant was not accountable due to temporary or permanent insanity, or the defendant acted in a way that was out of their control, because of a clinical difference in brain or mental functioning. If it can be shown that the defendant was aware of their empathy deficit, the legal system could hold them accountable for their actions.

Jack Pemment © 2018



Alegria, A. A., Radua, J., & Rubia, K. (2016). Meta-analysis of fMRI studies of disruptive behavior disorders. American Journal of Psychiatry, 173(11), 1119-1130.

Baron-Cohen, S. (2012). The science of evil: On empathy and the origins of cruelty. Basic books.

Del Bene, V. A., Foxe, J. J., Ross, L. A., Krakowski, M. I., Czobor, P., & De Sanctis, P. (2016). Neuroanatomical Abnormalities in Violent Individuals with and without a Diagnosis of Schizophrenia. PLoS one, 11(12), e0168100.

Gerretsen, P., Menon, M., Mamo, D. C., Fervaha, G., Remington, G., Pollock, B. G., & Graff-Guerrero, A. (2014). Impaired insight into illness and cognitive insight in schizophrenia spectrum disorders: resting state functional connectivity. Schizophrenia research, 160(1), 43-50.

Gerretsen, P., Menon, M., Chakravarty, M. M., Lerch, J. P., Mamo, D. C., Remington, G., … & Graff‐Guerrero, A. (2015). Illness denial in schizophrenia spectrum disorders. Human brain mapping, 36(1), 213-225.

Lehrer, D. S., & Lorenz, J. (2014). Anosognosia in schizophrenia: hidden in plain sight. Innovations in clinical neuroscience, 11(5-6), 10.

Liljegren, M., Naasan, G., Temlett, J., Perry, D. C., Rankin, K. P., Merrilees, J., … & Miller, B. L. (2015). Criminal behavior in frontotemporal dementia and Alzheimer disease. JAMA neurology, 72(3), 295-300.

Moro, V., Pernigo, S., Tsakiris, M., Avesani, R., Edelstyn, N. M., Jenkinson, P. M., & Fotopoulou, A. (2016). Motor versus body awareness: Voxel-based lesion analysis in anosognosia for hemiplegia and somatoparaphrenia following right hemisphere stroke. Cortex, 83, 62-77.

Perrotin, A., Desgranges, B., Landeau, B., Mézenge, F., La Joie, R., Egret, S., … & Chételat, G. (2015). Anosognosia in Alzheimer disease: Disconnection between memory and self‐related brain networks. Annals of neurology, 78(3), 477-486.

Spalletta, G., Piras, F., Piras, F., Sancesario, G., Iorio, M., Fratangeli, C., … & Orfei, M. D. (2014). Neuroanatomical correlates of awareness of illness in patients with amnestic mild cognitive impairment who will or will not convert to Alzheimer’s disease. cortex, 61, 183-195.

Therriault, J., Ng, K. P., Pascoal, T. A., Mathotaarachchi, S., Kang, M. S., Struyfs, H., … & Gauthier, S. (2018). Anosognosia predicts default mode network hypometabolism and clinical progression to dementia. Neurology, 90(11), e932-e939.

Vannini, P., Hanseeuw, B., Munro, C. E., Amariglio, R. E., Marshall, G. A., Rentz, D. M., … & Sperling, R. A. (2017). Anosognosia for memory deficits in mild cognitive impairment: Insight into the neural mechanism using functional and molecular imaging. NeuroImage: Clinical, 15, 408-414.


Manifesto: The relationship sociopaths have with themselves


Violent crime in the United States unfortunately remains a daily occurrence, and while domestic violence is undoubtedly the most common (and underreported), there now seems to be an increased interest in the role of ideology and murder. The recent shootings in San Bernadino, CA, and Philadelphia, PA, have been attributed to murderers who have been motivated by the ideology of the Islamic State of Iraq and the Levant (ISIL), and only in early October, 2015, Chris Harper Mercer killed nine people near Roseburg, Oregon, after penning his own manifesto that presumably explored his murderous inclinations. In 2014, Elliot Roger shot and killed six people and injured fourteen, after writing a manifesto entitled ‘My Twisted World: The Story of Elliot Roger.’

The motivations behind killing are complex and widely disputed, but it is time for some serious scholarship on the role that ideas play in dampening the conscience, at least temporarily, to provide an individual with a window of time where they have given themselves permission to kill. The role that ideology plays in the act of killing can be explained within the framework of sociopathy, but first this has to be distinguished from its estranged cousin, psychopathy.



Psychopathy is noted as a mental disorder that is characterized by an emotional deficit and antisocial behavior [1]. Neuroscientists have found some profound differences in the brains of psychopaths when compared to the non-psychopathic, and these differences seem to result from developmental errors [2, 3]. Two key features of the psychopathic is the lack of empathy and remorse, and while many psychopaths are killers, a significant proportion of killers are psychopaths [4]. Psychopathy is also a clinical diagnosis, and so for somebody to truly be called a psychopath, they have to have been assessed by a professional mental health expert.



When moving through our passage in life, we all develop a sense of what is right about the world, and figuring this out is probably one of the greatest sources of consternation many of us face on a daily basis. There seems to be a duality to this sense; feeling what is right, and then understanding conceptually what is right. When the two fit together, feeling right and being able to describe in words and ideas why we feel right, is an amazing and stable feeling, and the ideas are likely to become part of how we see the world. However, when our ideas and thoughts no longer feel right, or we feel right but do not know why, we are left feeling confused and perhaps even irritated.

Eventually, when we have had enough experiences and self-reflection, we start to develop a complex set of ideas that reflect what we think is true about the world.

During these pensive moments we suspend speculation and possibility surrounding the veracity of the idea, and it moves towards becoming a belief. This suspension could very well mark the difference between the scientific mind and the religious mind, as science only ever deals in probabilities, whereas the religious mind attributes absolute rightness to the core ideas, and this is known as faith (probabilities allow for‘wrongness’, a catalyst for the converse of faith, doubt). Indeed, always allowing a margin of error could mean that a person never has beliefs.

Regardless of how much truth currency we end up placing in our ideas, they become the mental lens that guides our behavior, gives us our sense of morality, and shapes how we will or will not understand the many more concepts and behaviors that will eventually cross our stream of consciousness. The new ideas and behaviors will be measured up against what we already have in our mental banks, and their acceptance into our worldviews will likely be a reflection of how well they agree with the rest of what we think is true about the world. Needless to say, this process can be excruciatingly hard work and can sometimes result in our peace of mind and sense of self being at stake.



Our own personal worldviews and ideology tend to develop as we reflect on past experiences, contrast them with new ideas in the present, and then use ourworldview and ideology for perpetual self-reflection and interpreting new events as they arrive. From the case studies of psychopaths described by Cleckley [5] and Hare [4], psychopaths present as individuals who have little to no regard for their own future, let alone the futures of those they interact with. The psychopath appears stuck in the present, with an inability to make long term plans, and also has precious little regard for the past, and so it is questionable that a psychopath can develop a complex worldview.

Our worldview is also a reflection of our sense of morality. The ideas that we come to regard as good ways to live are built into how we see and interpret the world. Therefore, it stands to reason that if a psychopath has a limited sense of morality, any potential worldview or ideology is at an automatic deficit. When asked to justify their criminal behavior, many psychopaths will just admit that there was a rightness to it, mostly because they felt the dire urge to carry it out. The truth criteria behind their reasoning doesn’t fit into a complex philosophical framework, only that as
they felt they had to do it, it must have been the right thing to do.



The terms psychopath and sociopath are often used to describe the same type of person, that is an emotionless individual with a sense of grandeur and is prone to the manipulation of others, but the root words psycho and socio denote different developmental origins. As Hare notes [4], those who prefer the term sociopah tend to think that social forces and early experiences can explain this type of individual, whereas those preferring psychopath think that psychological, biological, and genetic factors offer the best explanation.

This polarized view of the etiology for psychopathy is terribly outdated, and falls victim to the old nature versus nurture discussion on the origin of behavior. Traditionally, a line seems to have been drawn at the skin of individuals, and everything on the inside reflects nature, anything on the outside is nurture, and they are mutually exclusive. While this framework perhaps provides a useful starting point for discussion, we now know that social influences and biology can interact together in very profound ways to influence the future path of an individual from the level of the cell all the way up to the organism. Our senses are lapping up so much information on a daily basis, and all of that information is creating changes in our biochemistry, especially in our nervous system. If a parent yells continually at their child, we may think, “Well, that’s terrible nurturing,” but it is also elevating the level of cortisol in the child’s circulatory system; soundwaves stimulating cells, sending signals that prompt tissues and organs to release molecules into the blood. All sensory stimulation leads to biological changes and activity, which is why this distinction between the two terms denoting etiological differences does not work.

Crucially, Hare and Babiak describe the sociopath as someone who has a sense of morality, but their sense of right and wrong has been informed by a subculture [6]. This
difference between the psychopath and the sociopath is profound, because unlike the psychopath, the conscience and the ability for rationalization in the sociopath are fully intact, which indicates an entirely different neurology. If sociopaths have an ideology, ideas of right and wrong, these ideas must be behind their eventual murderous behavior, and also goes a long way to explain the spree killer.

The term spree killer refers to an individual who is motivated, with varying extents of planning, to commit an act or acts of atrocity in a short space of time. One of the striking features about these types of events is that there is no attempt to hide or conceal the destruction or any associated fatalities or injuries. There is only the event, which must be completed, and often the only outcomes for the killer will be death by a shootout with law enforcement, death by suicide, death by sentence of the death penalty, or lifelong incarceration.

These outcomes provide some insight into the minds of these individuals leading up to and during the act of atrocity. It is inconceivable that at least the majority of these types of killers had no awareness of what would befall them after the event, which means at least one of two things. First, the act itself was valued by the killer more than their own life, and second, there was a physiological drive so powerful in their mind for completing the act that no other behavior was possible in the moment. The necessity of the act, which the killer could have justified to themselves many times, is heavily idea based, and because of this they were likely to have had a worldview containing ideas that devalued the lives of others.



The idea of the ‘greater good’ is intriguing because when it is placed within an ideological framework that is supposed to promote the good or health of a group as a whole, it inevitably leads to the denial of the rights or even life of an individual or a subgroup of individuals. When the rights of people are often trampled upon for the greater good, the justification for this treatment is often seen as a necessary sacrifice, or once the new ideas or policies are in place, everyone will benefit (legislating common sense).

In order to implement a social or political system that is predicated upon greater good ideas, those with power have to be convinced, legitimately through debate or tacitly through violence. The style of the fight employed for the realization of these ideas is indicative of how well these ideas are to be received and the immediacy with which the advocate needs them to be realized. A potentially receptive audience and a debate reflect an advocate that is patient and willing to modify or compromise. A perceived unreceptive audience and violence reflect an advocate that feels compelled to act and is not willing to compromise. We can spot instances of these behaviors throughout history, particularly in terms of governmental behavior, but the desire for self-expression and the acceptance of ideas also operates on a much smaller scale.

For many, seeking acceptance among peers, or perhaps more potently in school, is a natural, but often painful, part of life. Finding a personal happy medium between what friends think is right and what you think is right is a daunting experience. To add to this, teenagers, by virtue of being young, do not have many other experiences with which to compare their immediate experience in school; this lack of experience in determining what is right for them results in grief and anxiety, and often puts them at the mercy of going along with a group that has met with their approval, even though there is sometimes respect for those who have the confidence to be different and not be influenced by the group, perhaps because it is such a huge pressure to overcome. The acceptance of ideas and behavior in these environments is similar to political expression at a higher social level, and could even be all the worse because of the huge emotional price tag of group acceptance. The perceived receptivity of the group and the compulsion for ideas and behaviors to be accepted could determine a change in tact of how an individual will later confront the group.

Even though many spree killers have no doubt accepted their own demise before they act, it is this notion that fuels their drive to act. They feel that their expression has been permanently blocked by those that need to validate these ideas (and related behavior), and so the only conceivable route of expression becomes violence to those who are blocking. This creates a fertile ground for accepting ideologies that dehumanize these ‘blockers.’ With resentment already in place towards those preventing self-expression, dehumanizing ideology towards these individuals will become palatable and sticky. This ideology, if unchecked, becomes the greater good for the individual in question.

Indeed, it could be useful to look at prejudicial worldviews in light of barriers to self-expression and a person’s right to the pursuit of happiness. Misogyny from men could result if men believe that women, by virtue of being women, will prevent their self-expression, especially sexual expression and subsequent gratification and acceptance. Likewise, Anti-Semitism results when an individual believes that Jews, by virtue of being Jewish, will always seek to prevent the self-expression and pursuit of happiness of non-Jews. At the heart of prejudice, there is always a lazy mind that is unwilling to evaluate people on an individual basis, as sweeping blanket condemnations seek to address painful and confused emotions. A lack of worldly experience, perhaps, would also prevent the person from having the cognitive maturity to make these individual assessments. It is worth asking, therefore, what is the object of the hatred preventing the subject from experiencing? When we have an answer to that question, it tells us all about how the subject thinks they should be able to exist in the world; behaviors they should be allowed to express, and ridding behaviors and ideas that muddy the waters of their idealized life. Knowing this could lead to methods of prevention or even intervention.



When reading a sociopath’s manifesto there are a few important points to note about the writing. The sociopath is usually presenting a history that supports the necessary action that will arrive by the end of the manuscript. As the sociopath’s mindset is heavily ruled by a guiding ideology, their main points or perceived milestones in their own development are likely to be heavily skewed or even fabricated.

However, much insight can be gained into their mind by realizing that the manuscript reflects back to them how they would like to be seen, perhaps not just by their community or the population after they carry out the devastating act, but also to themselves; the manuscript is how the sociopath would like to be seen in the mirror. Once the reflection pleases them, they are free to act.

The sociopath is likely to have spent months, maybe years, carefully crafting the manuscript and gone to painstaking detail to get it just right, and so this helps to combat the idea that they have intentionally gone out of their way to fabricate in order to trick readers. While this is still a possibility, the manuscript is usually a testament to what the sociopath believes is right about the world, after all, it provided them with the justification to act. While the history they present might not be objectively accurate, or perhaps even stunningly ignorant, the sociopath sees themselves ultimately as truthful and righteous, and no doubt want others to see them that way, too.



While not all manifestos are written, it is worth taking a long hard look at the ones that are. There is a very intimate relationship between an author and their writing, after all, writing is a way from them to organize and catalogue their own thoughts. The linguist, Noam Chomsky, is famous for noting that the majority of our language use is internal, and far exceeds our use of language in dialogue. Just take a moment to realize how frequently your thoughts are rolling through your mind, and how most of them drift in and out of a language, usually your primary one. Writing is the art of taking these ticker-tape thoughts and stabilizing them on the page, and the words can then be further manipulated until they meet with the satisfaction of the author, i.e. capturing (almost) perfectly the author’s intent.

For the confused or troubled mind, where thoughts and feelings are whizzing around like delocalized electrons, writing helps to pull them together into one place and provides the writer with focus. When an individual is experiencing emotional pain and confusion, therefore, this focus provides stability and a platform from which they can move forward. This is far from unique to the sociopath, and is most likely one of the main reasons that people keep diaries or write blogs. Writing facilitates clear thought, and clear thoughts, among other things, help to calm the mind and allow one to plan and project their future; goals can be determined and decisions made over the required behavior to meet those goals.

At some point in the life of the sociopath, the idea for committing an act of atrocity must enter their mind. The ease with which this idea is entertained will depend upon what they think is an accurate worldview (the right and wrong of the act), how necessary the action has become, and how compelled they feel to carry it through. This toxic idea will be stuck in their mind while they seek every justification for accepting it as more than just a good idea, but as something that they are compelled to act upon. During this time, there will likely be a high level of fantasizing and imagining, and an increased exposure to materials and ideas that facilitates the potential action in the mind of the sociopath; the act, slowly but surely, becomes inevitable.

The manifesto is a large part of making the act inevitable. It is worth bearing in mind that these acts are not a part of most people’s daily repertoire, including the soon-to-be-killer, and involve marathon amounts of planning and self-reflection. The sociopath needs to be able to see themselves actually doing the act, and there is very little room for doubt or uncertainty. This is why the manifesto is so important, because it allows the person to review and re-create their life history as if their life was always leading up to the deadly and devastating moment that they have decided is necessary. By cataloguing their history through the lens of their contemporary perturbed mind, therefore, right up until the present day, they are providing themselves with the consent and conviction that they need to go through with their plan.

This manufacturing of consent could also be why it is a good reason to stem the release of the manifesto after an act or at least hide many of the details surrounding the killer for as long as possible. If the manifesto was used as a tool to provide the author with consent to act, there is every chance it could be used by another individual with a similar history as a tool to act. If a like-mind is exposed to the manifesto soon after its author has acted, it could prompt the feeling of the immediacy to act again, perhaps resulting in a copy-cat killing. Silencing the thoughts and ideas of a killer after they have acted can only be effective for so long, but is still worth doing as a precautionary measure.


1. Hare, R.D.; Harpur, T.J.; Hakstian, A.R.; Forth, A.E.; Hart, S.D.; Newman, J.P. (1990) The revised Psychopathy Checklist: Reliability and factor structure, Psychological Assessment: A Journal of Consulting and Clinical Psychology, 2(3), 338-341

2. Raine, A.; Lencz, T.; Taylor, K.; Hellige, J. B.; Bihrle, S.; Lacasse, L.; Colletti, P. (2003). Corpus callosum abnormalities in psychopathic antisocial individuals, Archives of General Psychiatry, 60(11), 1134-1142

3. Raine, A.; Ishikawa, S. S.; Arce, E., Lencz; T.; Knuth, K. H.; Bihrle, S.; Colletti, P. (2004). Hippocampal structural asymmetry in unsuccessful psychopaths. Biological psychiatry, 55(2), 185-191

4. Hare, R.D. (1999) Without Conscience, New York, Guilford Press

5. Cleckley, H. (2015) The Mask of Sanity (3rd Ed.), Brattleboro, Echo Point Books and Media, LLC.

6. Hare, R.D. & Babiak, P. (2006) Snakes in Suits, New York, Harper Collins

Anosognosia, Psychopathy, and the Conscience

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


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


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

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


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

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

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


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

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

© Jack Pemment, 2016



  1. Perrotin, A. et al. (2015). Anosognosia in Alzheimer disease: Disconnection between memory and self‐related brain networks. Annals of neurology, 78(3), 477-486
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  9. Fazel, S. et al. (2009). Schizophrenia and violence: systematic review and meta-analysis. PLoS Med, 6(8), e1000120
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The reappearing psychopath: Psychopathy’s stain on future generations

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

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


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

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

Anger and Self Control

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

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

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

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

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

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

Guest spot on Sportshour: Mayweather: Boxing, Money & Domestic Violence – BBC World Service

SportshourI recently had the honor of a small spot on the Sportshour podcast with the BBC World Service, entitled Mayweather: Boxing, Money & Domestic Violence. The podcast was put together in light of the mega fight taking place tonight (May 2nd) in Las Vegas, between two of the most seasoned fighters in the boxing world – Floyd Mayweather, Jr., and Manny Pacquiao.

Floyd Mayweather has a few domestic violence accounts on his rap sheet, but most recently against Josie Harris, whom he beat in front of their children. Floyd did serve some time for this, had to pay a fine, and was also sentenced to community service, but if you look into these penalties on a comparative basis, you’ll immediately start to wonder if he was treated leniently.

If you consider Mayweather’s upbringing in Grand Rapids, MI, and note the poverty and squalor that he fought to escape, you can start to put some theories to his current personality and behavior. To make it clear from the outset, there is no excuse for domestic violence, but Floyd has clearly suffered a lot during his formative years, which seems to show yet another example of the cycle of violence, and helps to explain why Floyd has become such a polarizing figure.

I have included my previous post on boxing and domestic violence below, written back in 2013, and here is a more recent rebuttal of blaming boxing for domestic abuse.

Boxers and Domestic Abuse

About a month ago, I was discussing that the American heavyweight boxer, Deontay Wilder, could be one of the potential candidates to finally dethrone the Klitschkos. The Ukrainian brothers, Vitali and Wladimir, have held most of the important belts in the heavyweight division for some time now.

As I am an avid boxing fan, and respect the fighters as athletes, I was disheartened to find out that Deontay Wilder was arrested recently for domestic battery by strangulation. He was bailed for $15,000.

Dereck-Chisora-006While I’m sure that most professional boxers have never laid a finger on their partners, domestic battery has become an issue in boxing. British heavyweight, Dereck Chisora, who was recently slated to fight Deontay Wilder, was also convicted of beating his girlfriend. However, Wilder may not be able to go to the UK to fight Chisora, because of his recent arrest.

Mayweather going to jailAnd of course, boxing favorite, Floyd Mayweather Jr., was alsosent to prison for 3 months (only served 2) for domestic abuse. To add insult to injury, Mayweather’s sentence was actually postponed so that he could fight in Vegas. The argument given to the judge was that the fight would be a huge financial stimulus to Las Vegas, and so would benefit the economy. Mayweather, of course, also made millions from the fight. There were also children present when Mayweather hit Josie Harris, which can have terribly adverse consequences (Holt, Buckley, & Whelan, 2008). Indeed, watching the assault on their mother, by their father, made these children victims of the assault, too.

It would be foolish to suggest that there is some kind of causal connection between boxing and domestic abuse, but anyone who assaults another individual should be held accountable, and I am of the opinion that fighters and martial artists should be held to a higher standard – they should know better. There have been instances where judges have ruled that the hands and feet of martial artists should be counted as ‘deadly weapons’. Clearly, boxers have been trained to hit powerfully and hard, and this should be taken into account during any kind of assault.

As boxing remains popular and Mixed Martial Arts is rapidly gaining many viewers, we need more studies on the relationship between boxing and fighting to domestic abuse. Studies on domestic violence committed by fighters are surprisingly scarce. Here are some good research questions we need to address:

Are physically violent people naturally drawn into boxing?

–          While it is a stretch to connect learning boxing with becoming violent, there is a chance that people who like to engage in violence become boxers to enable and promote their violent desires. If this is the case, can a gym really discipline these individuals to keep them out of trouble? A number of boxing gyms have been opened to specifically discipline young people and keep them out of trouble with law enforcement and to prevent them from joining gangs.

Does fame lead to leniency and an increase in the likelihood for domestic abuse?

–          Floyd Mayweather, Jr. had his prison sentence postponed so that he could fight in Vegas, and he only served two months of a three month sentence. The maximum penalty in Nevada for a first offense of domestic violence is 6 months in prison. To some, it might seem that Mayweather got off lightly. It is certainly questionable that an amateur boxer, who committed the crime, would be treated as leniently. Only a handful of boxers make it to the professional ranks and even fewer start to get notoriety and world title shots, but once a boxer does achieve this they start to have fame on their side and become considerable cash cows. I fear that these aspects start to shield these boxers from holding them accountable for their indiscretions. The legal immunity of celebrities, however, is not limited to boxers.

What role does stress play in turning a boxer violent?

–          Boxing is very athletic and physically demanding sport. The sport also calls for a strong mindset, which inevitably leads to a certain degree of “smack talk” even if it is just to promote the fight. The need to train hard and prepare for going twelve rounds in the ring is very stressful for a boxer, meaning that stress-related disorders, some of which are intimately connected with violence, could creep in.

Would a change in boxing promotional strategies deter acts of aggression?

–          David Haye and Dereck Chisora got into an infamous scrap at a post-fight press conference in Munich. Both fighters lost their British licenses for this, but ended up getting sanctioned through the Luxembourg Board of Boxing so they could have a ‘grudge’ match in the ring. In other words, they were rewarded for assaulting each other in public, and the fight had a remarkable effect of convincing everyone that because they’d just fought each other in a ring (with rules), we could all now forget about it. The accountability of each fighter during the incident in Munich is still very disputable and should have been determined in a courtroom.

Many boxers are not guilty of domestic violence, in fact some, such as Sergio Martinez, actively campaign against it. However, the popularity of boxing and fighting, as well as the destructive potential of those involved, mandates that we shed some light on this important issue.

Jack Pemment, 2013


Holt, S., Buckley, H., & Whelan, S. (2008). The impact of exposure to domestic violence on children and young people: A review of the literature. Child abuse & neglect, 32(8), 797-810.

John Gottman’s work on aggression

John Gottman

I was pleased to find a link to John Gottman’s 1995 study on domestic violence that did not require access from a university electronic library. Please click on the link below to take a look.

The Relationship Between Heart Rate Reactivity, Emotionally Aggressive Behavior, and General Violence in Batterers

The study is very interesting, for numerous reasons, particularly because the research team found two types of men when exploring domestic violence. Low and behold, one type is the psychopath, and the other type is the reactively aggressive individual. The study explores the physiology of both types of men, and finds a number of differences – such as low resting heart rate in the psychopathic, and that the psychopathic levels of aggression always seem to exceed the reactively aggressive.

One of the most chilling points the research team found was that when they followed up about a year later to look at how many of the couples had broken up, NONE of the couples with the psychopath had split up. This just goes to show how good these people can become at keeping others under their heel.

Well worth a look.