Murderous Minds (16 page)

Based on his case studies, including his own, Fallon concluded that damage to the orbital prefrontal cortex and parts of the brain to which it is closely linked (including a neighboring part of the prefrontal cortex called the ventromedial prefrontal cortex and a fold of cortex found above and behind the orbital cortex called the ventral anterior cingulate) are clearly and unequivocally associated with psychopathic and even violent behavior. The list of neuroanatomical suspects also includes structures found beneath the brain’s outer cover, the cerebral cortex. These evolutionarily older, more “primitive” structures lie deeper in the brain, toward its center. They include the amygdala and parts of the basal ganglia connected to these limbic cortices (Figures 10 and 11).

Poor Test Results

Why do these parts of the brain get so much attention from scientists looking for neuroanatomical links to really bad behavior? Aside from the fact that they keep calling attention to themselves in neuroimaging studies—which by itself would be enough to generate a reputation for involvement in pathological behavior—they also affect a person’s ability to successfully interact in social settings. The orbitofrontal cortex, in collaboration with other structures such as the amygdala, helps regulate responses in psychological tests as well.

One test, for example, measures a person’s ability to learn to respond to a stimulus voluntarily when it is linked to a reward and to not respond when it will result in a punishment. For example, every time you press a key on a keyboard when you see something you should respond to, you get some money. Every time you do not hit a key when you see something you should not respond to, you also get some money. But every time you press a key when you should not, you lose some money. Both groups do equally well learning to press the key when they should. But psychopaths make significantly more errors by pressing the key when they should not.
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These and other results suggest that psychopaths don’t do well when it comes to learning to control their reward-seeking behavior, even if it costs them money.

Psychopaths also perform differently from non-psychopaths on tests that measure fear conditioning, startle reflexes, word and language processing, and responses to distressing cues. Multiple studies
show that psychopaths, compared to non-psychopaths, have trouble picking up emotional clues in facial expressions, voices, and words. When something grabs all of their attention, they don’t respond as much to threats with subtle increases in perspiration and heart rate as non-psychopaths do.

Other studies point to the involvement of brain regions that influence, control, or tone down impulsive behavior. They implicate parts of the brain responsible for influencing both actions and thoughts that reflect a sense of morality, ethics, guilt, regret, and reflection. They suggest with problems balancing the risks of punishment versus reward, and problems predicting likely future consequences of current actions. In short, they point to the involvement of neural pathways that include the orbital prefrontal cortex and associated brain regions capable of producing recklessness and manipulative behavior with shallow emotions and extreme callousness toward others.

Brian Dugan, whose story is told in detail in Chapter 11, is one individual whose test results strongly suggest that biology has influenced his fate—and, tragically, the fate of two young girls and one woman who were unlucky enough to have encountered him. He has the unenviable distinction of being in the Psychopath Top 1 Percent; he has more psychopathic traits than 99.5 percent of the population. He has scored between 37 and 38.5 out of a possible maximum of 40 on the Hare Psychopathy Checklist. His IQ is also exceptional; it is greater than 140, according to a profile that aired on National Public Radio in 2010.
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It is, to be sure, intelligence devoid of empathy or deep emotions, a deficiency he himself admits. But it is still intelligence intact enough to recognize and identify what psychologists call a “moral violation” in a psychological test.

In the test, subjects rate a picture on a scale of one to five, based on how much they think it represents a moral violation.
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The NPR profile used a picture of a racist group, the KKK, burning a cross as an example. To the surprise of some, psychopaths like Brian, who is serving three life terms for rape and murder, rate these images the same way non-psychopaths do. In other words, they can indicate that the photos are morally objectionable.

But whether or not they actually feel that moral objection, as most people do, is unlikely. This is where men like Brian diverge from the rest
of humankind. fMRI results show that the brain of a psychopath does not respond to the morally objectionable image the way the brain of a non-psychopath does. In psychopaths, parts of the brain involved in processing moral judgments, regions like the amygdala and posterior temporal cortex, show a different pattern of activation compared to non-psychopaths. You would not see, for example, increased activation in the amygdala and decreased activation in the temporal cortex in non-psychopaths, but that is exactly what you see in psychopaths.
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This may be an anatomical correlate of the psychopath’s inability to feel and process emotions like people without psychopathic traits.

It doesn’t matter how these brain abnormalities occur. There are many ways people can suffer damage to their brain’s emotional circuitry: stroke, head trauma, or genetics combined with a damaging environment. In the case of born or developmental psychopaths, bad luck with regard to genetics and upbringing can impair function in the key brain regions.

In the case of acquired sociopathy or “pseudopsychopathy,” we know stroke and impact injuries, infections such as herpes simplex and rabies encephalitis, and organic brain diseases such as temporal lobe epilepsy and fronto-temporal dementia can transform a pleasant personality into a seriously unpleasant personality in a very short period of time.

Although there are significant differences between developmental psychopathy and the pseudopsychopathy induced by injury or disease, the similarities are impressive enough to support a link between parts of the brain implicated in psychopathy and regions damaged in patients who develop antisocial traits.

In 1995, Dominique LaPierre and his co-authors from the University of Québec in Montréal described a seemingly inconsequential trait psychopaths share with patients who suffered orbitofrontal brain damage: people who have damaged frontal cortices have trouble naming odors. A comparison of thirty psychopathic and thirty non-psychopathic criminals revealed that the psychopaths had the same problem.
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This finding regarding odor-labeling skills is especially important, they explained, “in the sense that it cannot readily be explained socioculturally, thus presenting a new and convincing argument for brain-based etiology of this disorder.” In other words, here is a subtle deficiency that psychopaths
share with brain-damaged individuals. And the brain damage is in two different regions of the prefrontal cortex, the orbitofrontal and the ventromedial subdivisions. LaPierre and colleagues note that their findings are not surprising in light of the striking similarities between psychopaths and patients with prefrontal cortex damage.

Since it is possible to induce antisocial behavior in previously nice people by directly altering their brain tissue, it is less likely that a disorder like psychopathy can be traced solely to society’s influence. Skeptics critical of this view may point to good people turned bad as a result of abuse. They cannot, however, dismiss the evidence that brain abnormalities caused by either brain injuries or developmental abnormalities can strongly influence and even determine antisocial behavior. Impaired function of the orbitofrontal or ventromedial regions due to injury or psychopathy may result in poor planning, poor judgment regarding social and ethical matters, impulsivity, preoccupation with sex, and promiscuity. One interesting case involved a previously sexually normal and law-abiding forty-year-old man who developed an uncharacteristic interest in pedophilia. Although he knew his interest was morally wrong, he felt helpless trying to control it. Eventually his behavior was traced to an egg-sized tumor in the right orbitofrontal cortex of his brain.
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His sexual attraction to children vanished when the tumor was removed and reappeared when it grew back. A second operation succeeded in removing the entire tumor, together with his sexual interest in children once and for all. It is possible that the removal of the tumor allowed his frontal cortex to reassert its role inhibiting darker urges springing up from deeper brain regions.

Could similar “dark urges” be lurking in all of us? The answer, which depends on your interpretation of “dark urges,” is probably yes. The patient with the tumor-induced pedophilia also exhibited an overall greater, uncontrollable interest in sex in general. It is possible his extraordinary and certainly abnormal interest in children was part of an aberrant, out-of-control preoccupation with sex itself. Limbic system activity, signals from the deeper brain regions, looks out for our basic individual survival needs—fear, food, aggression—as well as our species survival needs: sex. Perhaps, without the overseeing controls exerted by the frontal lobes, the checks are removed, like a car with a stuck gas pedal and no brakes. Symptoms may
vary in individuals, however. Brain wiring varies somewhat. They follow a general plan, but brains are not constructed like identical integrated circuit boards. A tumor in the same location in a different person might not result in the exact same symptoms seen in the patient who developed a sexual interest in children.

It is not yet possible to prove a direct, one-to-one association of brain abnormalities to psychopathy in the same way that a blocked artery is recognized as the direct cause of a heart attack or stroke. It is possible to say, however, that brain abnormalities, and not just sociocultural influences, can play a major role in psychopathy.

It’s important to keep in mind, however, that it is easy to over-emphasize the role of the particular brain region one is reading about or studying. The frontal lobes’ executive function applies to executive brain functions, not just to executive psychopathy functions. It plays crucial roles in healthy brains capable of empathy as well as in unhealthy brains incapable of empathy. The orbitofrontal cortex, for example, also figures prominently in a condition that plagued writer, lecturer, and radio personality David Sedaris, who suffered from obsessive compulsive disorder (OCD). Consider the difference between the manifestation of orbitofrontal cortex involvement in OCD and in psychopathy. Sedaris’s obsessive compulsive behavior during his childhood compelled him to repeatedly touch, count, and even lick objects. There was nothing psychopathic about his behavior, even though OCD involves a part of the brain also implicated in psychopathy.

“It started off with touching things and then I would have to touch things with my nose,” he told an interviewer in 1998 on the Palm Springs show More Than a Mouthful.
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“It would take me forever to get anywhere. Then I would go home and go to bed. Then I would have to get out of bed to go lick the light bulb in the refrigerator. So I’d lick the light bulb in the refrigerator and I [would] go back to bed and I would think I probably didn’t lick that in the right place. So I have to get out of bed again and do it again, and go back to bed. And then I would think: how many peppercorns are in that spice jar? So I would have to get out of bed—this is like at 3 o’clock in the morning—count all the peppercorns and go back to bed. Then I was sure I had miscounted. So I had to get up again. It was exhausting.” Compulsive head movements, tics, and beeping vocalizations followed.

Then Sedaris went through a phase during which, he says, “I had to take my shoe off and hit myself over the head with a shoe.” Doing all of these things, things he “had” to do, left him a complete wreck. “If I was sitting in class, I had to lick the light switch that was beside the door.” And he would do just that as he returned to his seat when called to the blackboard.
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“It lasted until I was twenty. Then I started smoking and it went away,” he told an interviewer. (Jim Fallon’s OCD also waned dramatically when he started smoking at age eighteen. Many people with schizophrenia take to smoking too; they are two to three times more likely to pick up the habit than the rest of the population. This might be an instance of self-medication, since nicotine causes an increase in an inhibitory neurotransmitter known as GABA.
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GABA tones down neural activity and so could dampen brain circuits that are overactive in some mental disorders.)

If Sedaris indeed suffered from OCD as a child and young adult, there is a good chance that his symptoms could be traced to greater-than-normal activity in the orbitofrontal cortex of his brain. This is not just because the orbitofrontal cortex is a crucial piece of neural real estate involved in making decisions and linking rewards and learning. When an unmedicated Sedaris was in the thrall of his compulsions, there is a good chance that his orbitofrontal cortex, in a sense, had too strong a connection to a part of the brain that is intimately involved in movement, including movements involved in touching and licking things.

This is what Jan Beucke and his colleagues found when they scanned the brains of 92 subjects when researching OCD.
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People who had not taken antidepressants to help them suppress their compulsions appeared to have brains that were hyper-connected between the orbitofrontal cortex and the basal ganglia, located deep in the center of the brain (Figure 11). This is the same region that is implicated in Parkinson’s disease, which produces major symptoms of movement disorder. The researchers found that medication might even reduce the degree of connectedness between the brain region most associated with executive function, the orbitofrontal cortex, and one closely linked to movement, the basal ganglia. It is possible that it is the degree and specificity of the interactions between the prefrontal region and other parts of the brain that may account for symptoms of multiple neurological or mental disorders, including Alzheimer’s disease, schizophrenia,
OCD, and psychopathy. However, Sedaris’s prefrontal cortex issues clearly have nothing to do with psychopathy. It’s not clear if Jim Fallon’s childhood OCD, along with his childhood hyper-religiosity, were related to his psychopathic traits. Now, he says, they are just tendencies.
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