Murderous Minds (26 page)

Asked if fMRI allowed him to tell what someone is thinking, the expert explained, accurately, that it did not. Instead, it allowed him to tell how someone is feeling “and specifically, we can identify responses associated with sociopathic tendencies. Here we determined the defendant was racist” because his amygdala lit up during the test. Furthermore, the expert swore he could measure it “with extreme accuracy.”

Like Batman’s opponent, “Amygdala” Helzinger, the case brought by the Boston Legal prosecutor is a good example of bad neuroscience. Many popular cultural and infotainment accounts of neuroscience are oversimplified. The fictional jury in the television show and their creators, the show’s writers David Kelly and Craig Kurt, clearly knew this. Perhaps they were up on the scientific literature, because they seemed to know that there is no credible evidence showing that fMRI can be used in this way to “tell how someone is feeling.” It shows blood flow patterns in the brain, which reflect brain-cell activity. Neuronal activity in an isolated part of the brain is not the same thing as a feeling or an emotion. It is an indication of activity in one component of an emotion system, as LeDoux points out. It is an indication that a specific part of the brain appears to be involved in the perception, recognition, analysis, or other cognitive function related to viewing an image.

It’s true that this cluster of nerve cells in the temporal lobe is activated when someone is afraid. But few amygdala stories also mention that this brain region is also activated when you look at pleasant pictures that interest
you. It is possible that the police officer on Boston Legal accused of racism was attracted to African-Americans. His amygdalae might have responded the same way if he looked at a happy face.

Find Your Amygdala

Joseph LeDoux provides easy directions for locating your amygdala.
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Point a finger at your ear. Point another finger at your eye, on the same side of your head. If both fingers projected a beam of light that could pass through flesh, bone and brain, then the two beams would intersect at one of your amygdalae. You have another one in the same relative position on the other side of your brain.

If you could illuminate all of the cells in the amygdala with the beam of light, part of the structure might remind you of an almond, amygdala in Latin. That is what early anatomists thought it looked like. Neuroanatomists have since decided that there is more to the amygdala than first recognized. More subsections, a dozen or so subnuclei, are included in the structure so, on the whole, it has lost its almond shape but, thanks to its Latin name, it has retained its almond identity. “Its actual shape resembles more a strap carrying an old style dumbbell,” according to neuroanatomist Jim Fallon, whose own brain we’ve already discussed as an interesting example of a brain that looks like it belongs to a psychopathic murderer but has never produced criminal behavior.

Like Batman and the
Boston Legal
district attorney, many people connect the amygdala exclusively with fear, and it definitely plays a key role in this important emotion. This small group of brain cells has a role in the processes that allow people to recognize fear and initiate aggression, among other emotional responses. But, like its size and shape, its role in other functions has expanded as neurobiologists have learned more about it. It appears to help integrate emotional processing, behavior, and motivation. All of the senses communicate with the amygdala. This is something to at least keep in the back of your mind when you consider that the amygdala has been reported to be less active and smaller in the brains of criminal psychopaths.

If the amygdalae are damaged in a person, that person may have trouble recognizing fear in facial expressions,
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a trait seen in psychopaths.

Multiple studies indicate that high psychopathy scores are associated with an impaired ability to recognize emotional expressions in faces and to link clues to fearful situations. Psychopaths just don’t process fear the way most people do. Harvard Medical School associate professor of psychiatry Jordan Smoller points out in his book, The Other Side of Normal,
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that a few unfortunate individuals born without psychopathic traits show the same response after their amygdalae are damaged.

Yaling Yang, Adrian Raine, and their collaborators tapped five temporary employment agencies to find subjects for their study which measured the volume of the amygdalae in 27 people with PCL–R psychopathy scores ranging between 23 and 40. They compared them to 32 controls with psychopathy scores ranging from 5 to 14.
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Their finding that the amygdalae of higher-scoring psychopaths are around 18 percent smaller in volume than they are in low-scoring or non-psychopaths, suggests that the amygdala has a role in the brain processes that work differently or are defective in psychopaths.

The amygdala, as discussed in Chapter 6, is connected to another brain region that has been linked to an impaired ability to identify emotional states and lack of empathy, the ventromedial prefrontal cortex (vmPFC) in the frontal lobe. James Blair, Ph.D., of the U. S. National Institute of Mental Health proposed that a deficit or deficits in the function and interaction of the vmPFC and the amygdala provides an explanation for the development of psychopathy.
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His suggestion is based on brain scanning and psychological testing results of psychopathic individuals that researchers have been gathering for at least two decades. It is supported by observations that the vmPFC plays a highly influential role in decision-making processes. It is also supported by the knowledge that the amygdala’s role goes beyond processing fear and driving aggression. In addition to processing emotional expressions, the amygdala plays an important role in forming associations between a stimulus and a reward, and between a stimulus and a punishment.

Rounding Up the Usual Suspects

But brain-imaging studies have suggested that associations appear to exist between multiple brain regions and psychopathy. In addition to the
amygdala and the vmPFC, other regions of the frontal lobes as well as the hippocampus, thalamus, basal ganglia, cingulate cortex, insula, and parts of the temporal lobe all appear to function differently in psychopaths. This has led Kent Kiehl to propose a paralimbic dysfunction model to explain the development of psychopathy.
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It proposes that decreased activity in, and underdevelopment of, a group of closely interconnected brain structures that form a ring around the inside, center of the brain (see Figure 10) can account for the characteristic features of psychopathy. He calls it the paralimbic model because it includes structures that formally belong to the limbic system and some that are closely associated with it.

The paralimbic model is similar to the model Jim Fallon proposed based on his unpublished research. He believes the deficits seen in psychopaths: imperfect communication between the amygdala, orbital/ventromedial prefrontal cortex, and mostly anterior cingulate cortex are intimately involved in psychopathic behavior. Fallon’s work, he said, “was based on case studies. Some [of the subjects] were impulsive murderers. Some were psychopaths. It was kind of a mixed bag. I was just putting together what I thought might be true. Kent really did the scientific study. I took a guess that turned out to be pretty good.”
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If it was a guess, it certainly was not a wild guess. His model is consistent with others that imply psychopathy is a developmental disorder.

It is possible, of course, that there is more than one way to develop a psychopath. Problems during development may result in different flaws or physical deficits in different individuals but still produce behaviors we call psychopathic. While it is still not possible to establish a cause-and-effect relationship between brain abnormalities and psychopathic behavior,
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the correlations that have been established so far—combined with what we know about the psychological effects of brain injuries in patients—strongly suggest that the answers do indeed hide in the dark regions of the brain that appear on fMRI scans.

Chapter Eight

Successful, Unsuccessful, and Other Types of Psychopaths

T
HE NEW JOB AND THE NEW LIFE
start today. It’s the beginning of a career that will present new experiences and new challenges. And it will involve face-to-face encounters with people like you have never faced before. Last month you left San Francisco and drove 225 miles south to Atascadero, California, where you signed a lease for your new apartment. The next day, you unpacked. The day after that, you drove over to the Atascadero State Hospital to have a look. This is where you’ll work in exchange for a $40,700 annual stipend and necessary experience in preparation for your budding career in forensic psychology.

Although it was established sixty years ago, this maximum-security forensic hospital looks nothing like the snake pits people associated with psychiatric hospitals in the first half of the 20th century. In daylight, the pinkish façade seems to lighten the image of the 1,275-bed hospital, which has around sixty doctoral psychologists on staff. At night, however, when the exterior spotlights cut through the darkness and illuminate the security perimeter fencing, it is unmistakably a maximum-security facility. Inside the main building you find, as NPR reporter Ina Jaffe did, that “the
hospital appears more blandly institutional than dangerous,” and “the halls seem endlessly long.”
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You are one of four interns selected from 48 applicants. Today, having completed a three-week orientation, you will begin your rotations. You’ll start in the admissions unit, where you’ll pick up experience in the psychological assessment of mentally ill criminals. After 3½ months, you’ll begin spending time in the treatment units. Before you are done, you will have completed sixteen psychological evaluations of your patients, including forensic evaluations, psychological testing batteries, behavioral analysis, and the PCL–R, the Hare psychopathy checklist, evaluation.

All of your patients are male, all are dressed in khaki pants and khaki shirts, and none of them is here voluntarily. Some are clearly mentally ill. Some are here because they have been found not guilty by reason of insanity or being incompetent to stand trial. And others are classified as mentally disordered offenders. They are being confined after their scheduled parole date because they are believed to still pose a threat. And many do pose a threat. In March of 2013, a dozen employees of the hospital were injured by aggressive patients, according to a local newspaper account.
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All varieties of mental illness are present in the inmate population. Those with high psychopathy scores are always noted. In 2011, hospital director Jon De Morales told Ina Jaffe that the inmate population of his institution seemed to consist of two groups. “There are criminals who happen to exhibit symptoms of a mental disorder,” he said, and then “there are mentally ill people who happen to have committed crimes. They all end up in the same place.”
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Those with high psychopathy scores tend to cluster in the first group. And the longer you observe and interact with them, the more you notice distinct differences that suggest they are not all the same. This is despite the fact that popular references to criminal psychopaths often suggest that the only difference between them is their address: in or out of prison.

So how can you explain the big differences in behaviors among psychopaths you observe in the hospital? It seems to you that at Atascadero, the patient/inmates with PCL–R scores in the psychopathy range fall into one of four distinct subtypes. When describing your new job to your friends and family, and to preserve confidentiality, you create four composite
hypothetical patients whose behaviors capture what you see on the job five days a week. Call them Lawrence, Barry, Zach, and Andy.

Lawrence impresses you as insufferably stuck-up. His attitude, body language, and behavior announce that he considers himself to be privileged by the nature of his existence. He has no problem insulting anyone on the staff or any of his fellow inmates, as long as they pose no physical threat to him. You have even seen him insulting another patient with a high psychopathy score, Barry.

Barry tends to whine and alternate easily between agitation and depression. He frequently complains to the staff about slights and petty injustices he feels he has suffered. Barry, as well as many non-psychopathic inmates, has been the target of another inmate who, like the others, easily meets the cutoff score for a diagnosis of psychopathy: Zach.

Zach will lean against a wall, savoring the conflicts or discomfort he observes in a common room. His amusement at the agitation and the trouble he sometimes instigates is clear. It reveals the pleasure he gets from observing and causing the discomfort of others. His file includes testimony that Zach once pulled a sleeping handicapped man from his wheelchair and set him gently on the floor in an empty classroom. He offered to help the man back into his wheelchair if he would pull himself halfway across the room to reach the spot where Zach had moved the empty chair. When the man reached his chair, Zach chuckled and walked away. He watched from the hallway as a teacher eventually arrived to help after hearing the man call for assistance.

Yet even Zach is leery and tries to steer clear of Andy. Charged with assault, robbery, rape, and attempted murder, Andy showed intermittent signs of mental illness in the past including hallucinations, but claims to be “in remission” now. The last time he claimed he heard voices, he blamed them for urging him to severely beat up a weaker fellow inmate. Andy claimed his victim owed him his dessert after losing a bet which his victim denied making. Andy’s gaze reminds you of an animal watching prey. Far too often, it is.