_http://www.scientificamerican.com/sciammind/
Cover Story
September-October issue of Scientific American – MIND Magazine
By Kent A. Kiehl and Joshua W. Buckholtz
Kent Kiehl is a neuroscientist at the University of New Mexico and a principal investigator at the Mind Research Network, a nonprofit dedicated to advancing the treatment of mental illness.
Joshua Buckholtz is a Ph.D. candidate in neuroscience at Vanderbilt University, where he studies how genetic risk factors predispose people to antisocial behavior and addiction problems.
The Making Of A Psychopath. Why They Don’t Care: They Can’t
…From the biblical Cain to the kunlangeta of the Yupi Eskimos and the arankan of Nigeria, nearly every culture on earth has recorded the existence of individuals whose antisocial behavior threatens community peace. But thanks to technology that captures brain activity in real time, experts are no longer limited to examining psychopaths' aberrant behavior. We can investigate what is happening inside them as they think, make decisions and react to the world around them. And what we find is that far from being merely selfish, psychopaths suffer from a serious biological defect. Their brains process information differently from those of other people. It's as if they have a learning disability that impairs emotional development.
…psychiatrists have long written psychopaths off as beyond help. But now that science is unraveling the mechanisms behind the disorder, it's time for that attitude to change. If specific physiological deficits prevent psychopaths from empathizing with others, forming stable relationships and learning from their mistakes, then elucidating them could lead to new treatments.
…Kiehl has launched an ambitious multimillion-dollar project-funded by the National Institutes of Mental Health (NIMH) and Drug Abuse (NIDA) and the John D. and Catherine T. MacArthur Foundation to gather genetic information, brain images and case histories from 1,000 psychopaths and compile it all into a searchable database. To speed the work, Kiehl helped to design a portable scanner-a functional MRI machine housed in a trailer-that can be brought inside prison walls, obviating the need for high-level clearances to bring dangerous prisoners off-site. [Next stop for that portable scanner should be Washington DC!]
…You don’t have to feel sympathy to want to help them. Between 15 and 35 percent of U.S. prisoners are psychopaths. Kiehl recently estimated that the expense of prosecuting and incarcerating psychopaths, combined with the costs of the havoc they wreak in others' lives, totals $250 billion to $400 billion a year. No other mental health problem of this size is being so willfully ignored.
Level Heads, Empty Hearts
…A man we will call Brad was in prison for a particularly heinous crime. In an interview he described how he had kidnapped a young woman, tied her to a tree, raped her for two days, then slit her throat and left her for dead. He told the story, then concluded with an unforgettable non sequitur. "Do you have a girl?" he asked. "Because I think it's really important to practice the three C's-caring, communication and compassion. That's the secret to a good relationship. I try to practice the three C's in all my relationships." He spoke without hesitation, clearly unaware how bizarre this self-help platitude sounded after his awful confession.
…a classic experiment in 1991 co-authored by psychologist Robert D. Hare, who was Kiehl’s mentor during graduate school, found that psychopaths miss the emotional nuances of language. The investigators flashed real and nonsense words in front of prisoners, some of whom were psychopaths, and asked them to press a button when they saw a dictionary word. Psychopaths were as quick as non-psychopaths to differentiate between real and fabricated words. But the experiment went a level deeper, because among the real words some had positive or negative connotations (“milk”, "scar") whereas others were neutral ("gate"). For the non-psychopaths, emotionally charged words leaped off the screen; their automatic brain responses, measured by electroencephalograms, showed a distinctive electrical surge, and they pushed the button faster. Psychopaths did not react faster to emotional words, and their brain waves did not change
…Newman believes that the apparent callousness of psychopaths is actually the result of an attentional quirk: they do not take in new information when their attention is otherwise engaged. Previous research has suggested that psychopaths are unreactive: their palms do not sweat when they are exposed to foul odors or shown images of mutilated faces. But Newman and his colleagues recently demonstrated that psychopaths actually have normal physiological responses to unpleasant stimuli, like the threat of an electric shock-except when their attention is directed elsewhere.
…Once fixed on a goal, psychopaths proceed as if they can't get off the train until it reaches the station. This narrowly focused, full-speed-ahead tendency, paired with the psychopath's impulsivity, may produce the kind of horror describe in In Cold Blood…[or in a global pathocracy bent on world domination] in which the criminals, having begun the violence, are blind and deaf to information that might halt it (such as a victim's pleas), unable to turn away until it has been completed.
…But evidence suggests that one or two brain areas are not enough to produce the profound impairments of psychopaths. Kiehl recently proposed that psychopathy emanates from the paralimbic system, a group of interconnected brain structures that are involved in emotion processing, goal seeking, motivation and self-control. Supporting this hypothesis are fMRI images of psychopaths' brains made by Kiehl and others, which show a pronounced thinning of the paralimbic tissue-indicating that this part of the brain is underdeveloped, like a weak muscle.
…One likely candidate is the almond-shaped amygdala, which generates emotions such as fear. Monkeys with amygdala damage walk right up to people. Psychopaths, too, are notable for their fearlessness: when confronted with images such as a looming attacker or a weapon aimed their way, they literally don't blink.
…In addition to the orbitofrontal cortex and amygdala, the paralimbic system includes the anterior cingulate cortex and the insula. The anterior cingulate regulates emotional states and helps people control their impulses and monitor their behavior for mistakes… The insula plays a key role in recognizing violations of social norms, as well as in experiencing anger, fear, empathy and disgust. Psychopathic behavior is by definition insensitive to social expectations, and as described earlier, psychopaths can have unusually high disgust thresholds, tolerating repellent smells and images with equanimity.
…The insula is also involved in pain perception. Studies of psychopaths--including one in which subjects got electric shocks--find that under certain conditions, they are strikingly unfazed by the threat of pain; they also have trouble noticing their errors and adjusting their behavior accordingly (which helps to explain the self-defeating way that psychopaths land in jail repeatedly, unable to learn from past mistakes) [this fact serves as disinformation by reinforcing the belief that psychopaths are in jail vs. in boardrooms, or elected offices]
Ignore at Our Peril
…Psychopaths are misunderstood. This fact may not tug at the heartstrings, but it is a problem for all of us. Some researchers have estimated that as many as 500,000 psychopaths inhabit the U.S. prison system, and there may be another 250,000 more living freely-perhaps not committing serious crimes but still taking advantage of those around them [further reinforcement of the belief that most dangerous psychopaths are in jail and not committing serious crimes in boardrooms or elected offices]. Helping them manage their impulsivity and aggression could protect many innocents. Until now, though, few efforts have been made in that direction. Billions of research dollars have been spent on depression; probably less than a million has been spent to find treatments for psychopathy [big surprise].
…But there is room for optimism: a new treatment for intractable juvenile offenders with psychopathic tendencies has had tremendous success. Michael Caldwell, a psychologist at the Mendota Juvenile Treatment Center in Madison, Wis., uses intensive one-on-one therapy known as decompression aimed at ending the vicious cycle in which punishment for bad behavior inspires more bad behavior, which is in turn punished. Over time, the incarcerated youths in Caldwell's program act out less frequently and become able to participate in standard rehabilitation services [but does their “acting out less frequently” simply mean “defective psychopaths” are actually learning to “act” normal—to be “successful psychopaths”?]
…A group of more than 150 youths treated by Caldwell were 50 percent less likely to engage in violent crime afterward than a comparable group who were treated at regular juvenile corrections facilities. The young people in the regular system killed 16 people [i.e. 10% of young psychopaths commit murder!?] in the first four years after their release; those in Caldwell’s program killed no one.
Further Reading:
Mask of Sanity. Hervey Cleckley. C. V. Mosby Co., 1941.
Without Conscience: The Disturbing World of the Psychopaths among Us. Robert D. Hare. Guilford Press, 1993.
Are Violent Delinquents Worth Treating? A Cost-Benefit Analysis. Michael F. Caldwell, Michael Vitacco and Gregory J. Van Rybroek in Journal of Research in Crime and Delinquency, Vol. 43, No.2, pages 148-168; May 2006.
A Cognitive Neuroscience Perspective on Psychopathy: Evidence for Paralimblc System Dysfunction. Kent A. Kiehl in Psychiatry Research, Vol. 142, Nos. 2-3, pages 107-128: June 15, 2006.
Suffering Souls: The Search for the Roots of Psychopathy. John Seabrook in New Yorker, pages 64-73; November 10, 2008.
