Murderous Minds (11 page)

In the lobby of the L’Enfant Plaza Hotel in Washington, D.C. on a Friday afternoon, Robert Hare wistfully mentioned that many of the young people attending the 2013 meeting of the Society for the Scientific Study of Psychopathy didn’t know who he was. This was a day after Chris Patrick began his acceptance speech upon receiving the 2013 R. D. Hare Lifetime Achievement Award by saying to Hare, who was seated in the audience:

“I want to thank you for keeping the field alive for so many years. I can only imagine what it must’ve been like to be starting out with no one else working in the area in the same way, to do the kind of work you did for all those years. And I think through the 1960s and ’70s and ’80s, you made the field what it was and opened up the opportunities for a lot of us.

I really want to thank you. I’m proud to be a recipient of an award named

for Robert D. Hare.”

Hare’s work in the 20th century is still exerting a significant influence in the 21st century. His development of the PCL–R marks the point when “the story of psychopathy becomes the science of psychopathy,” according to Feix. The concept will continue to evolve, but “psychopath” as described by Hare remains the most useful, practical description of the criminals who are the subjects of much of the neurobiological research being conducted today. Future challenges will involve incorporating insights from social-cognitive and neurosciences into a cohesive picture of this intriguing version of human nature in which empathy and conscience are absent.

On February 6, 1940, poet Ezra Pound wrote a letter to philosopher George Santayana in which he proposed they co-author, with poet T. S. Eliot, a book on education. In his attempt to persuade the philosopher, the poet included what he thought was a quote by Santayana: “It doesn’t matter what so long as they all read the same things.”
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The quote may not accurately reflect Santayana’s views, but it nevertheless makes some sense when adapted for any group that wants to educate itself. For mental health researchers who want to learn about a specific population, it doesn’t matter which population they study, so long as everyone in the field studies the same population.

Once they agree on what a psychopath is, they can begin gathering meaningful and interpretable information about whatever it is that makes a morally insane brain physically different from a morally sane one. The most direct way to do that is to look at living, functional brains using one of the neurosciences’ most popular tools: functional magnetic resonance imaging.

Chapter Three

What Does Brain Imaging See?

To the unaided eye, most brains look alike. Even brains that lack some of the honorable traits of humanity—a conscience and a sense of empathy—appear deceptively normal at first glance. Scientists have reported subtle differences in structure and function in the brains of psychopaths compared to the brains of psychologically healthy individuals, but detecting these differences requires millions of dollars’ worth of equipment, years of training, and months or years of work. Besides the basic cost of one to three million dollars for an fMRI machine, you can add on the expense of building special housing for the device as well as maintenance fees. The total can easily surpass five million dollars.

Researchers have turned to this expensive tool, however, because it allows them to see activity in living, working brains whose functioning results in what we call the mind and whose products include, if we are lucky, empathy, altruism, and a conscience. Brain scans, of course, cannot see human emotions or traits. There is a difference between what technology reveals in a brain scan and what we infer is taking place in the thought processes of the person being scanned. This chapter will review the technology behind fMRI brain scans, but it is still up to readers to ask themselves how much the technology does—and could—reveal about
psychopathic or other behavior and how this technology can complement insights from psychological tests and assessments.

Despite the general similarities between the brains of psychopaths and non-psychopaths, hints of differences may show up during a chat with a criminal psychopath, before the fMRI is turned on. These suggestions of abnormalities don’t require the multimillion-dollar equipment that is being used in the search for biological influences on psychopathic behavior. They do, however, partially explain why many researchers are willing to devote their careers and raise millions of dollars in research grants in the hope of tracking down the source of psychopathic behavior.

For example, some of the core emotional and interpersonal traits of psychopathy are suggested in an interview with “Brad,” as Joshua Buckholtz, Ph.D., refers to the criminal psychopath in an article he co-authored with Kent Kiehl for Scientific American Mind.
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During the exchange, Brad’s conversation suggested some of the textbook features of psychopathy: lack of empathy, lack of remorse, lack of guilt, impulsiveness, callousness, and superficial charm.

According to Buckholtz, who is now an Assistant Professor of Psychology at Harvard University, Brad recalled abducting a young woman and rendering her defenseless by tying her to a tree. He calmly told of sexually assaulting her over the course of two days. Then he described how he finally killed her by cutting her throat.

Without pausing, the kidnapper, rapist, torturer, and murderer finished his account by asking the interviewer: “Do you have a girl? 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 tried to practice the three C’s in all my relationships.”
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Surreal conversational twists that reveal a disconnection between empathy and action are not unusual in interviews with criminal psychopaths like Brad. Any brain incapable of grasping the incongruity of admitting to a heinous crime an instant before asserting a personal commitment to practicing “caring, communication, and compassion” in all relationships must, common sense would suggest, be very different on a fundamental level from most brains.

Robert Hare provides multiple examples in his book Without Conscience. In one, an armed robber counters a witness’s testimony placing him at the
scene of a crime by saying “He’s lying. I wasn’t there. I should have blown his fucking head off.”
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“Jack,” a petty thief and con man who scored the maximum 40 on the PCL–R, told an interviewer that his start in crime had to do with his mother: “… the most beautiful person in the world. She was strong, she worked hard to take care of four kids. A beautiful person. I started stealing her jewelry when I was in the fifth grade. You know, I never really knew the bitch—we went our separate ways.”
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“Willem Boerema” displayed slightly less odd contradictory speech when he expressed his opinion of the value of a brain-imaging study he took part in. “It was stupid, boring,” he told Nature magazine’s Senior European Correspondent Alison Abbott in 2007 before adding “if they say the study can help people then it’s good.”
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Abbott assigned Willem his pseudonym in 2001
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when she first encountered him in the course of her work. She later described him as “smart, articulate and multilingual.”
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Unlike Brad and Jack, Willem didn’t want to talk about his crimes. In return for not having to discuss his past history, Willem agreed to be featured in Abbott’s Nature articles as he took part in experiments in the Netherlands. He was part of a study comparing brain responses in people with empathy to those without. The latter group includes people with autism and, in Willem’s case, psychopathy.

Willem’s criminal history was less important than his rating of 35 out of 40 on the PCL–R. In North America, a score of 30 generally is the cutoff for a diagnosis of psychopathy. In much of Europe, it is 25. With a score of 35, Willem readily exceeded the entry requirements. His high score was more than enough to earn him a break from his daily routine so he could enjoy the novelty of taking part in a neuroscience experiment. It was also a significant factor in his involuntary commitment to the high-security Dutch Forensic Psychiatric Clinic, where he had been confined since 1996.

The type of brain-scanning experiment Willem volunteered for depends on a relatively new technology. fMRI has only been around for a couple of decades, but it has quickly become a preeminent tool in cognitive neuroscience. Its popularity with neuroscientists can be traced directly to the conviction that mental phenomena such as a lack of empathy and other deficits that make up the defining personality
traits of criminal psychopaths can be traced to the function of interacting clusters of brain cells. In other words, according to this point of view, products of the mind like empathy, remorse, compassion, cruelty, and violent tendencies are products of physical brain tissue.

Some fundamental questions—Is the mind a product of the brain? Is the mind distinct from the brain?—must be addressed because they linger in—or, in some cases, haunt the thoughts of—many people whenever scientists discuss or investigate mental activity. Unanswerable (and sometimes tedious) discussions of free will versus determinism have been known to crop up even when neuroscientists discuss psychopathy. The philosophical topic arose very briefly during Adrian Raine’s audience-participation session at the 5th Biennial Meeting of the Society for the Scientific Study of Psychopathy.

Philosophizing Before Scanning

Many philosophers, theologians, and people of other walks of life insist that the mind is more than the brain. They rely largely on verbal arguments to defend this viewpoint. They may be correct; no one can say for sure. It is not possible to disprove the existence of an intangible entity that many people assume or believe exists. But their arguments lie outside the boundaries and limitations of science because they can’t be tested convincingly and reproducibly in a laboratory. Consequently, many neuroscientists with a quantitative bent are not dualist: they don’t recognize a separation between mind and brain.

Instead, they point to experimental results to support the argument that there is no reason or need to postulate a mind distinct from the brain. Changes in the brain are closely associated with changes in behavior, outlook, and emotional state. Drugs, surgery, injury, and stroke—all of which alter or change the structure and function of the brain, can also alter or change personality and behavior, two concepts closely associated with the mind. In the view of modern science, there is no reason to believe that the mind and brain exist or function separately. Mind and brain can be thought of as being on different levels of
analysis
, but not on different levels of
existence
.

Property dualism is the label philosophers use to describe the belief that mind and brain are separate properties of a single tangible substance:
for example, lots and lots of neurons and their complex interconnections.

Property dualists, however, might not agree that the mind can be reduced to the brain, even though both owe their existence to the same substance.

That belief belongs to the opposing side in this age-old battle in the arena of the philosophy of mind. It is called monism. The subcategory of monism that comes closest to what neuroscientists are up to when they peek into the brains of psychopaths and other volunteers is called physicalism. Anyone who believes that the mind can be reduced to what happens in the brain is a physicalist in the eyes of philosophers. And anyone who believes that mental states and brain states are the same thing is a type physicalist.

If the physicalists are correct, then key underlying elements of psychopathy can be found ultimately somewhere in the structures that make up the brain and in the interconnections of its different regions. Somewhere in the neural circuits of the brains of psychopaths we’ll discuss like Brad, Willem, and Jack are answers that explain their aberrant outlook, behavior, and crimes.

Their brains, like the brains of non-psychopaths, have billions of brain cells, although no one knows precisely how many lie beneath the glistening, pink-tinted surface of the neocortex. The cerebral cortex is divided into neocortex and allocortex. They differ based on their cellular organization and how they develop in a fetus. Neocortex represents about 85 percent of the cerebral cortex and is prominent in large areas of the brain implicated in psychopathy including the frontal and temporal lobes (Figures 8 and 9).

Some studies have found that the brains of psychopaths may be a little light in cortical density or thickness in these regions, but not so much that you could see the difference with your naked eye. The highlighted region in Figure 9, for example, marks one area which reportedly contains less gray matter in psychopaths than in non-psychopaths.
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This part of the brain—it is the temporal pole in the temporal lobe—is involved, along with other brain regions, in processing and recognizing emotions.

Back in 2000, Adrian Raine and his co-workers reported an 11 percent decrease in prefrontal gray matter in the brains of 21 men with average Hare psychopathy scores of 29 (plus or minus 6) out of 40. In their view, the prefrontal lobe deficit they found with structural MRI imagining “may underlie the low arousal, poor fear conditioning, lack of conscience, and decision-making deficits” that characterize psychopathic behavior.
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Another region that may come up short in psychopaths is located at the tip of the front part of the brain (Figure 3).
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Although sometimes called the anterior rostral prefrontal cortex, a more precise address is Brodmann area 10, a portion of the anteroventral prefrontal cortex. Brodmann areas are discrete regions of the cerebral cortex made up of neurons with similar features and organization. In the early 20th century, the German neurologist Korbinian Brodmann surveyed the brain’s cortex on a microscopic level and divided it into 52 Brodmann areas. His impressive painstaking efforts of 115 years ago are still helping neuroanatomists, neuroscientists, and psychologists find their way around the cortex.