Tag Archives: violence

Anosognosia, Psychopathy, and the Conscience

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


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


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

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


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

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

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


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

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

© Jack Pemment, 2016



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

The reappearing psychopath: Psychopathy’s stain on future generations

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

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


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

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

Anger and Self Control

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

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

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

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

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

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

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.

Evolution and the Psychopath


Since I began studying psychopathy, I have often wondered about an evolutionary basis for this dangerous disorder. Psychopathy is considered to be a developmental disorder (Blair, 2006), which means that through its normal course of development the brain experiences stresses or biochemical changes that are not conducive to proper neurological development. This idea is supported by suppositions from both behavioral psychology and neuroscience; firstly, in behavioral psychology, it is suspected that serious child abuse could be an underlying factor behind psychopathy (Kunitz et al., 1998), and secondly, in neuroscience, it has been noted that many with psychopathy show a significant underdevelopment of a number of regions in their brain (for a review see Pemment, 2012).

Read more at Psychology Today…

Copyright Jack Pemment, 2012

An interview with Bundy, the day before his execution

Bundy is surprisingly forthcoming in his attempts to explain and understand how he came to be a monster. There are a number of responses that seem decidedly un-psychopathic. He has no problem taking full responsibility for the murders and he realizes that he is very different from other people.

Bundy claims that he was from a good home and was never abused, and that it was his exposure from soft to violent pornography that made his fantasies become more and more violent; one could raise the argument that it was simply stumbling across violent pornography as a child that constituted the abuse necessary to traumatize and stymie the development of his brain.

He speaks of the need to murder (which included necrophilia) as an addiction. Keppel, one of the detectives who helped to apprehend Bundy explained that Bundy experienced the desire for necrophilia as a chemical tidal wave, like an addiction to a narcotic. It certainly seems like his frontal lobe, and the connections between it and the limbic system, failed to control and inhibit his desires.

The interview does not strike me as a manipulation or an attempt to spread lies, but of course that can’t be ruled out. He does, however, appear to respect his interviewer.

This is a good interview with Bundy, which anyone interested in the development of extreme human behaviors should watch.