Psychopaths know right from wrong but don’t care
Another psychopath study for the database...
Social Cognitive and Affective Neuroscience Advance Access published January 6, 2010
Psychopaths know right from wrong but don’t care
This study was supported by a grant to MC from the Netherlands Organization for Scientific Research (NWO) grant number: 451-05-020, and to MH from the National Science Foundation-Human Social Dynamics. The authors declare they have no competing interests.
Note: DLPC = dorsolateral prefrontal cortex; VMPC = Ventromedial prefrontal cortex
Abstract
Adult psychopaths have deficits in emotional processing and inhibitory control, engage in morally inappropriate behavior, and generally fail to distinguish moral from conventional violations. These observations, together with a dominant tradition in the discipline which sees emotional processes as causally necessary for moral judgment, have led to the conclusion that psychopaths lack an understanding of moral rights and wrongs. We test an alternative explanation: psychopaths have normal understanding of right and wrong, but abnormal regulation of morally appropriate behavior. We presented psychopaths with moral dilemmas, contrasting their judgments with age- and sex-matched (i) healthy subjects and (ii) non-psychopathic, delinquents. Subjects in each group judged cases of personal harms (i.e. requiring physical contact) as less permissible than impersonal harms, even though both types of harms led to utilitarian gains. Importantly, however, psychopaths’ pattern of judgments on different dilemmas was the same as those of the other subjects. These results force a rejection of the strong hypothesis that emotional processes are causally necessary for judgments of moral dilemmas, suggesting instead that psychopaths understand the distinction between right and wrong, but do not care about such knowledge, or the consequences that ensue from their morally inappropriate behavior.
Subjects
Participants (all male adults) provided informed consent in accord with the policies of the Ethical Commission of the Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands. Healthy controls (n = 35; mean age = 30.29 years, SD = 9.99) were recruited from the south of the Netherlands. The psychopath (n = 14; mean age = 36.66 years; SD = 6.55) and non-psychopath (n = 23; mean age = 40.95 years; SD = 9.77) offenders were sampled from the Forensic Psychiatric Centre de Rooyse Wissel (FPCdRW) in Venray, the Netherlands.
Of the 37 delinquents, IQ scores were available for a subgroup of 20 (7 psychopaths and 13 non-psychopathic offenders) participants. Though mean IQ scores for the psychopaths (M = 81.6, SD = 8.66) was slightly lower than for the non-psychopathic offenders (M = 92.5; SD = 19.37), there was no group difference [t(18) = 1.41; P = 0.18; d = 0.66].
Clinical diagnosis
Psychopathy was assessed by a clinician presenting the Psychopathic Checklist-Revised [PCL-R (Hare, 1991)] test. The PCL-R is a reliable and valid instrument, designed to measure psychopathic traits such as antisocial behaviour, shallowness, impulsivity, callousness, criminal history, and lack of moral emotions, based on evidence obtained from medical and juridical records and documents, as well as extensive interviews with the forensic patients.
Based on a study of Grann et al. (1998), a PCL-R cutoff score of 26 was used to divide the current sample into psychopaths (PCL-R ≥ 26) and non-psychopaths (PCL-R < 26). Total PCL-R scores were available for all 37 offenders. However, of the 14 psychopaths, 2 were described in the crime record as having high PCL-R scores, without mentioning the exact scores. Therefore, the relationship within the psychopathic group between PCL-R scores and type of crime were only available for 12 psychopaths. Finally, regarding PCL-R factor scores, Factor 1 and Factor 2 scores were only available for 15 subjects.
The PCL-R has two main factors. The first factor comprises interpersonal and affective characteristics of psychopathy, including shallow affect, lack of remorse or guilt and glibness/superficial charm (Cooke and Michie, 2001; Hare, 2003). The second impulsive, antisocial and unstable lifestyle factor comprises the social deviance characteristics, and includes impulsivity, early behavioural problems, and parasitic lifestyle (Cooke and Michie, 2001; Hare, 2003).
All psychopathic offenders had a personality diagnosis. Most of them (57.1%) had a diagnosis of cluster B (narcissistic personality disorder or antisocial personality disorder), while the minority had a personality disorder not otherwise specified. Of the non-psychopathic offenders, the majority suffered a personality disorder not otherwise specified, 21.7% had a cluster B personality disorder, and 4.3% had a cluster C personality disorder.
Stimuli
We used the moral dilemmas of Greene et al. (2001, 2004), previously tested with the VMPC patients (Koenigs et al., 2007). Each dilemma was first translated into Dutch by FT, back-translated into English by a second bilingual Dutch-English speaker, and then checked by MH for accuracy.
We presented seven impersonal and 14 personal moral dilemmas (see Supplementary Information). Subjects then answered “yes” or “no” to the question “Would you X?”. A population of native Dutch speakers (adults, 324 females, 348 males) judged these cases on a Dutch version of the Moral Sense Test (_http://www.serve.com/∼harvardpcnl/MST/Dutch/), whereas the three test groups responded to these dilemmas with paper and pencil.
Though we recognize that studies of moral judgment and responses to artificial dilemmas in particular, represent only one of several valid approaches to understanding our moral psychology, we used this approach to provide the most direct comparison with VMPC patients, as well as other recent studies of intuitive moral judgments.
To control the possibility that psychopaths simply lie about their responses to our moral dilemmas, we also administered a questionnaire [Socio-Moral Reflection; SRM-SF (Gibbs et al., 1992)], asking straightforward and explicitly whether certain familiar transgressions would be morally permissible. For instance, “How important is it to keep a promise to your friend?”; “How important is it not to steal?”. Answers could be given on a 5-point scale, ranging from very unimportant to very important. Scores on the SRM-SF questionnaire result in a total score and a score of moral standing, indicating the level of moral development.
DISCUSSION
Philosophers, legal scholars, and scientists agree that our moral judgments are influenced by processes of reasoning, intuition and emotion (Damasio, 1994; Dwyer, 2004; Greene, 2003; Haidt, 2001; Hauser, 2006; Mikhail, 2007, 2009; Posner, 1999), where controversy emerges in deciding which of these processes alone or in combination provide the source of our moral judgments. For example, though we often reflect upon moral problems, weighing the pros and cons of particular actions and outcomes, using our knowledge of similar cases to deliberate, several recent studies indicate that such rational and reasoned contemplation often arises after an intuitive system has fired off a judgment of moral permissibility.
Commonly, this intuitive process has been aligned with the emotions, and more specifically, the source of our moral judgments lie in our feelings about particular actions and outcomes (Blair et al., 2005; Haidt, 2001; Moll et al. 2007; Nichols, 2004; Prinz, 2008).
Support for this position comes from three lines of evidence:
(i) subjects are dumb-founded by their judgments, unable to provide a coherent explanation for why a particular action is morally forbidden (Haidt, 1993, 2001);
(ii) emotional priming influences moral judgment (Schnall et al., 2008; Valdesolo and DeSteno, 2006; Wheatley and Haidt, 2006);
(iii) when healthy subjects process moral scenarios, classic emotional areas activate (Greene et al., 2001, 2004; Moll et al., 2002a, b, 2005); in contrast, patients with diminished emotional processing (i.e., FTD, VMPC, and psychopaths) show different patterns of moral judgments than healthy subjects, at least for a particular set of moral problems (Anderson et al., 1999; Blair, 1995, 1997; Koenigs et al., 2007; Mendez et al., 2005).
The present work was aimed at both the general thesis that proper emotional processing is necessary for moral understanding, and the more specific thesis that the compromised emotional processes of psychopaths accounts for their abnormal moral psychology, including most specifically, their heinous violence and disregard for others.
Our results license two conclusions.
First, like healthy subjects and non-psychopath delinquents, psychopaths judged impersonal moral actions as more permissible than personal moral actions. As previously noted (Greene et al., 2001, 2004), this distinction is anchored on an emotional gradient, with impersonal cases considered less emotionally intense than personal cases. Thus, even though psychopaths show diminished emotional processing, either a sufficient level or type of emotion is preserved or non-emotional processes can carry out the relevant computation required to evaluate these particular moral scenarios.
Second, though psychopaths showed diminished emotional processing relative to both control groups, and even though both delinquent groups differed from healthy subjects in their morally inappropriate behaviors (e.g., paedophilia, murder), there were no group differences in moral judgments for either impersonal or personal scenarios. Furthermore, though there was variation among our psychopathic participants in terms of their PCL-R scores, as well as the nature of their criminal convictions, there was no relationship between these factors and their moral judgments.
At one level, these results could be perceived as conflicting with both previous studies of psychopaths as well as those with VMPC patients. In particular, adult psychopaths generally make less distinction between conventional and moral transgressions, whereas VMPC patients tend to provide a higher proportion of utilitarian judgments for a subclass of personal moral dilemmas.
These data have been used to argue among the critical and causal role of emotion in generating normal moral judgments. However, it is difficult to provide firm evidence for a causal link between emotion and moral judgments, since both the theoretical arguments and empirical evidence to date are unclear about how specific types of emotion, impact upon moral judgment with moral concerns.
Consider, for example, the Koenigs et al. (2007) paper, though it is generally agreed that patients with damage to VMPC have emotional deficits, and in particular, show difficulty with social emotions such as empathy, embarrassment, and guilt, it is not clear how the absence of these emotions, or the reduction in their manifestation would cause subjects to provide more utilitarian judgments for the narrow range of other-serving dilemmas.
That is, why would the aversiveness of harming one person be diminished because one feels less embarrassment, empathy, or guilt? And even if one could provide a coherent account, including the possibility in the absence of guilt, one is simply less affected by harming one person, then why would not the same argument go through for other cases of harm that were present but that showed no group differences?
Furthermore, even if there is a coherent account for this aspect of process, it doesn’t necessarily show that emotions dictate how we decide whether an action is morally right or wrong. For example, it could be some other set of processes that makes this decision, but emotions titrate the severity of judgment.
Thus, for example, when the social emotions are diminished with respect to their impact on decision making, we see harming one as less bad when there is a greater good, i.e. both VMPC patients and normals see harming one for some greater good as bad, but VMPC patients simply see the harm as less bad. On this view, emotions are like a gain function, moving our judgments up and down a scale from very bad or forbidden to obligatory or required (see Huebner et al. 2008, for further development of this argument).
There are at least two reasons why the psychopathy data on the moral-conventional distinction leave many questions unanswered, especially in terms of the specific role of emotions:
1) since both adults and juveniles received scenarios that were designed for children, it is unclear how adult psychopaths would fare on adult versions;
2) the adult and juvenile psychopaths appear to have opposite judgment biases, with adults judging most cases to be forbidden whereas juveniles consider most to be permissible; why differences in emotion would lead to this developmental flip-flop is unclear.
Though VMPC patients show some of the same kinds of emotional deficits as do psychopaths, no one has yet established how specific kinds of emotion are causally linked to specific kinds of moral problems. For example, though VMPC patients generate normal judgments for most moral dilemmas tested so far, it is not clear why diminished capacity to experience empathy, embarrassment and loyalty should lead to a selective deficit for other-serving moral dilemmas in which a highly aversive action is pitted against a significant utilitarian outcome.
Given these uncertainties, it is perhaps less surprising, and at odds with the existing data, psychopaths show normal patterns of moral judgments for moral dilemmas. More specifically, though psychopaths show some of the same emotional deficits as patients with damage to VMPC, other aspects of their emotions may be relatively preserved, and these may be the most important with respect to moral understanding.
At present, however, this literature is unclear, with some studies reporting normal recognition and judgments by psychopaths of basic emotions such as anger, fear, sadness and disgust, whereas other studies show differences, including evidence of abnormalities in brain activation during imaging studies of emotional processing (Blair et al., 2002; Fullam and Dolan, 2006; Muller et al., 2003; Pham et al., 2000).
Furthermore, though psychopaths may show deficits in distinguishing conventional from moral cases, whatever cognitive function is necessary for this distinction is apparently unnecessary with respect to judging moral dilemmas, and especially, for perceiving the difference between personal and impersonal cases.
This conclusion is reinforced by a recent imaging study of psychopaths in which individuals evaluated the same set of dilemmas presented here, showed reduced activation in the amygdala relative to controls (Glenn et al., 2009), but no difference in judgments (Glenn, Raine, Schrug, Young, and Hauser, in press).
Moreover, Glenn et al. (in press) show that non-prison convicted psychopaths (classified based on the PCL-R) evidence significantly lower amygdala activation relative to controls, and significantly higher DLPC activation. Amygdala is associated with processing predominant negative emotions, and especially fear. In contrast, the DLPC plays a critical role in conscious reasoning and decision making. Despite these neural differences, population of non-prison convicted psychopaths showed no differences in moral judgment from a control group.
Lastly, it is possible that the emotional deficits of psychopaths only show up, or show up most intensely, under pressure to respond quickly, or feel compelled to do so, thereby triggering their more impulsive character (Kiehl, 2007). Here, there was no such pressure, perhaps resulting in normal patterns of judgment.
We conclude that psychopaths make the same kind of moral distinctions as healthy individuals when it comes to evaluating the permissibility of an action embedded in a moral dilemma. Consequently, these results support the hypothesis that normal social emotional processing does not appear necessary for making these kinds of moral judgments.
Normal emotional processing is likely to be most important in generating an appreciation of these distinctions and in guiding actions (Huebner et al., 2008).
Psychopaths know what is right or wrong, but simply don’t care.
Given that legal distinctions often turn on whether crimes are committed knowingly (e.g., Model Penal Code), these results could have bearing on court decisions concerning the nature of moral knowledge – i.e. instead of strictly focusing on criminal actions carried out knowingly, we should also focus on whether such knowingly immoral and illegal actions are carried out caringly. Equally important, these results may shed light on treatment, pushing clinicians to distinguish between the sources of deficit regarding morally relevant decisions and actions.
Full Text includes the Figures, Tables and their images:
_http://scan.oxfordjournals.org/content/early/2010/01/06/scan.nsp051.full
PDF:
_http://scan.oxfordjournals.org/content/early/2010/01/06/scan.nsp051.full.pdf+html
The moral dilemmas that were administered:
_http://scan.oxfordjournals.org/content/suppl/2010/01/06/nsp051.DC1/scan-09-089-File002.doc
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