Murderous Minds (31 page)

At age eight, for instance, he repeatedly stole the milk set on his neighbors’ doorsteps before any of them could bring the daily deliveries indoors. He couldn’t drink all of it. He didn’t sell it or give it away. He threw it into the trash. He evidently just wanted to steal it and create mischief. Questioned about the thefts, he convinced his parents and his neighbors that a man who worked in the neighborhood, a janitor, was responsible for the thefts. The janitor was fired. Eventually, his victims discovered Rav’s deceitfulness, but not before Rav’s behavior produced more damage, anger, and hurt feelings.

At age nine, he falsely accused a pawnbroker of loaning him money for a cloak. This was bad news for the pawnbroker, because pawnbrokers were forbidden by law to loan money to a minor. The pawnbroker faced arrest and likely loss of his livelihood until Rav’s mother found the cloak stashed in the basement of their home.

A year later, Rav’s father became the target of the boy’s maliciousness and deceitfulness. Based on the boy’s accusations, his father was arrested for child abuse. The bruises on the child’s body looked convincing to the police until they learned that the boy was the source of the damage; the bruises were self-inflicted.

Lombroso’s records indicate that Rav’s family was law-abiding and honest. If we can believe them, their child was not raised among criminal role models; he didn’t grow up in an environment of abuse. Rav’s brothers and sisters did not impress their parents as abnormal. They did not display depravity like Rav and so did not inspire their parents to drag them to a renowned expert like Dr. Lombroso.

Today, Hollywood screenwriters might describe Rav as a “bad seed.” Like Eric Harris, he came from a good home which provided no indication, hints, or clues that might account for his antisocial attitude and behavior. Like Eric’s family, Rav’s family were blameless for his behavior. It appears that Rav and Eric were exceptional, rare individuals who very likely were born with genetic traits that placed them on the most extreme end of the spectrum of antisocial behavior. Their robust predispositions to the disorder or personality type did not require the push of damaging environmental factors like child abuse, bad role models, or neglect to drive them from a very early age, developing what psychiatrists call conduct disorder with callous, unemotional traits.

Dr. Lombroso had a different name for Rav’s condition. After hearing Rav’s parents describe the boy’s behavior, he decided the boy represented a typical case of “moral insanity.” A modern psychiatrist would substitute “conduct” for “moral” and “disorder” for “insanity,” but cases like Rav’s were as familiar to Lombroso as they are to modern-day child psychiatrists and psychologists.

From the Cradle

T
WO YEARS AFTER LOMBROSO’S
death in 1909, his daughter Gina recalled: “During many years of observation, my father was able to follow innumerable cases of moral insanity in which perversity was manifested literally from the cradle, and in which the victims of this disease grew up into delinquents in no wise distinguishable from born criminals.”
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In 2007, a group of contemporary researchers backed up Lombroso’s impression with an impressive study carried out in the island nation of the Republic of Mauritius in the Indian Ocean. Psychologist Andrea Glenn, then at the University of Southern California, and her fellow researchers reported the results of a twenty-five-year-long study that started with 1,795 three-year-old Mauritians in 1972–1973.
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The young children were observed and received a battery of tests, the results of which were carefully filed away.

Glenn and her co-authors managed to track down hundreds of these subjects 25 years after they were observed and tested. They persuaded 335 of these now-28-year-olds to answer the 60 questions on the self-report version of the Psychopathy Checklist-Revised. The results indicated that the kids who showed signs of being less inhibited, less afraid, and more inclined to seek out stimuli in a test of their startle response at age 3—a loud noise delivered through earphones—were more likely to score high on Hare’s Self-Report Psychopathy scale at age 28. The results suggest that a child’s ability to feel fear may be linked to the development of his or her moral sense. A child who feels fear is more likely to feel remorse after misbehaving. Not so with the subjects who weren’t as fearful at age three.

Many children can misbehave in many ways and still grow up to be psychologically healthy adults. Sadly, this outcome is less likely for one group
of troubled and troubling children in particular: those who lack a sense of guilt and a sense of empathy, and who demonstrate a callous disregard for, or use of, others for their own purposes. It sounds a lot like budding psychopathy. And in fact, kids with these features, which are known to child psychiatrists and researchers as callous-unemotional traits, have an increased risk of becoming adult psychopaths.

These children are a lot like Rav. They have temperaments that set them apart from their normally behaving and feeling siblings and peers. They seek thrills and may act without fear. Where other children who have trouble controlling their behavior may act violently in response to a disappointment or as a reaction to something that irritates them, callous-unemotional children engage in instrumental aggression, the cold-blooded kind that is very unnerving for adults to contemplate, let alone to witness.

The antisocial behavior of an impulsive, short-tempered child who does not obey, but who nevertheless can feel guilt and empathy, may be strongly influenced by his or her environment. Not so when there is a lack of guilt and empathy combined with a callous disregard for others. If one identical twin has callous-unemotional traits and shows antisocial behavior, the odds are excellent that the other twin will have these traits. Not surprisingly, callous-unemotional traits are highly heritable: twin studies suggest the figure is around 80 percent.
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And as with adult psychopathy, the genetic risk for developing callous-unemotional traits may be increased by exposure to stressful or unfavorable environments.
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Scanning Young Brains

Based on what scientists tell us about the abnormalities they find in the brains of adult psychopaths, you might think it would be a “no-brainer” to confirm their presence in children with callous-unemotional traits. But this reasoning includes an unstated assumption, the gremlin that scientists try hard to eliminate before devoting time and money to any experiment or study. The clue to the snag is in Chapter 5, “Troubling Developments and Genes.” Specifically, it is in the section about brain development.

The brains of children are actively changing and developing. We still don’t know as much as we would like about the normal development of the brain, although researchers have begun systematic studies to learn more about this important topic.
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We don’t know the full extent of variations in brain structure and function in the population as a whole.
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As challenging as it is to interpret the meaning and significance of brain scans of adults with psychopathy, it is even more challenging to draw firm conclusions from scans of children with callous-unemotional traits whose brains are growing and changing.

Despite this caution, can we learn anything useful by scanning young brains that might some day develop into the brains of old psychopaths? Some studies published so far suggest that we can. For example, a study by researchers at the National Institute of Mental Health compared brain scans of children with callous-unemotional features to those with attention deficit hyperactivity disorder and to children without behavior problems.
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Each group consisted of a dozen children between the ages of 10 and 17. The children were asked to look at and process information about fearful, angry, or neutral facial expressions. Activity in the amygdalae in all three groups looked pretty much the same when the children considered angry or neutral expressions. When the youths with callous-unemotional traits dealt with fearful expressions, however, their amygdalae showed reduced levels of activation compared to the other two groups. The association of callous and unemotional personality traits with reduced amygdala activation to fearful faces is not inconsistent with what we see in the brains of adult psychopaths, who appear to have deficiencies processing emotional information.

A year after that study was published, researchers at King’s College London confirmed the finding in seventeen boys with callous-unemotional traits compared to thirteen well-adjusted controls. The decreased activity in the amygdala suggested to the researchers that the neuronal basis of the emotional deficits seen in children with callous-unemotional traits “are already present in childhood.”
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A second study published in 2009 by the same group in the United Kingdom presented a finding that seemed to highlight differences between childhood conduct disorder with callous and unemotional traits and adult psychopathy. A comparison of around two dozen boys with callous-unemotional conduct problems and a similar number of controls detected increased gray matter in some parts of the brain: the medial orbitofrontal
cortex, the anterior cingulate (which has been implicated in recidivism; see Chapter 6), and the temporal lobes.
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Yet, as we’ve learned, adult psychopaths have been found to have cortical thinning in several regions, including portions of the temporal lobes, the insula, and the prefrontal cortex, among others. Why don’t children who give the impression they are developing psychopathy show the same pattern of cortical thinning? The answer probably lies in the way the brain develops. During childhood, unneeded gray matter is trimmed as the brain matures. Perhaps, as the authors suggest, youths with callous-unemotional traits experience delayed maturation of their cerebral cortices, if they ever do mature completely. If conduct disorder with callous-unemotional traits is a precursor to adult psychopathy, the flaw or flaws in brain development that affect key regions of cortex involved in empathy and morality somehow lead to less gray matter later in life.

Treating Youth and Psycho(path)therapy

Despite some similarities (and some differences that might be explained based on what we know about brain development) among fMRI studies of children with callous-unemotional traits and adult psychopaths, it would be irresponsible to equate these children with the adults they seem to resemble. Sadly, as of 2014 there were no well controlled long-term studies that showed that adult psychopaths can be effectively treated. This is not to say there will never be such a study, or that mental healthcare professionals should not try to develop therapies—but it will be a challenge. Due to the nature of criminal psychopathy, dealing with manipulative patients or prisoners who are often capable of mimicking true emotions and feelings presents challenges. In other words, therapists will have to demonstrate true change in their patients. That will require extended periods of follow-up.

Despite these challenges posed by the nature of psychopathy, Kent Kiehl is optimistic. “It is, I think, a manageable condition in the adult, and I think it is a treatable condition in youth with the current state of knowledge,” Kiehl said when interviewed for Miller-McCune magazine.
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Anyone familiar with the state of psychiatry before the mid-1950s and the discovery of antipsychotic or psychotropic medications will recall that psychiatric hospitals were filled with untreatable patients, many condemned to life locked in the back wards. These hospitals virtually emptied out after
the introduction of psychiatric medication, which improved the lives of many previously untreatable patients. A treatment for psychopathy could have as revolutionary an effect on forensic and clinical psychiatry. We just don’t have that treatment yet, and we don’t know when we will find it. Perhaps insights gained from study of the brains of psychopaths will speed progress toward this distant goal.

Children who display psychopathic traits may have an advantage over adult psychopaths. Their brains may still be plastic enough to respond to therapy more readily than adults. Treating schizophrenia as soon as its symptoms appear generally produces better results than starting treatment years after the disease has developed. We should assume that the same applies to conduct disorder with callous-unemotional traits and to psychopathy. Intensive therapy for youth might help “rewire” the brain or strengthen weak neural circuits associated with feelings of empathy, morality, and effective decision-making.

For example, Michael Caldwell at the University of Wisconsin-Madison’s Mendota Juvenile Treatment Center and his collaborators followed up on potentially psychopathic youths who took part in an intensive treatment program involving very close monitoring and access to a psychiatrist, a psychologist, a social worker, and a psychiatric nurse. The program was designed to replace the young offenders’ antagonistic outlooks and relationships with more conventional ones. During a two-year follow-up period, a control group of similar youths confined to a conventional juvenile correctional institution had double the risk of returning to detention for committing violent acts compared to the young people who received treatment.
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Such encouraging results represent good progress, but, of course, there is much room for more. Paul Frick, Ph.D., a psychologist at the University of New Orleans and a pioneer in this field, told the New York Times Magazine in 2012 that he is not sure what the best way is to intervene in the lives of such youth. “Before you can develop effective treatments, you need several decades of basic research just to figure out what these kids are like, and what they respond to. That’s what we’re doing now—but it will take a while to get real traction.”
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