Murderous Minds (29 page)

Based on the available neurobiological evidence, Yu Gao and Adrian Raine suggest that successful psychopaths have brains that function as well as or better than most people.
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This explains how they are able to avoid prison and violence and still get what they want. Unsuccessful psychopaths appear to be hindered by abnormal brain structure and function. Their autonomic nervous systems, the neural wiring that influences their bodies’ response to stress, are also abnormal. These differences could account for the deficits in thinking and emotional responsiveness that lead to more overt and ultimately self-harming, violent, and other antisocial acts. These hypotheses are consistent with what we have learned about the psychopathic brain, but all we know for certain is that success in the realm of psychopathy is defined by lack of a criminal record. And despite the charm and charisma and take-charge attitude of many successful psychopaths, they share a key feature with their criminal cousins: they are never concerned about your best interests.

Chapter Nine

Could You Become a Psychopath?

C
HANCES ARE THAT NEARLY EVERYONE
with a healthy conscience and a sense of empathy will keep them. There is no need to worry about becoming a successful or unsuccessful psychopath, the prototypical type of personality associated with high scores on psychopathy inventories or evaluation tools. There is, however, a “but.” Anyone can become a “pseudopsychopath.” It is not the same thing as a developmental psychopath, but this neurological condition—a result of injury or disease—is just as troubling and often more tragic.

Injury to some of the same parts of the brain that are implicated in developmental psychopathy can change the way anyone views moral choices. To see how a specific brain injury can affect a person’s moral judgments, test yourself with a few of the same personal moral scenarios Michael Koenigs, Ph.D., now at University of Wisconsin Department of Psychiatry, and his fellow researchers presented to some patients they worked with.
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What Would You Do?

Scenario 1
. Imagine you are a waiter who overhears a customer you know very well declare that he is going to infect as many people with HIV as he can before he goes to prison in two days. You know
he is serious and he intends to act on his threat with the many people he knows. But … he is highly allergic to poppy seeds. Just one will make him convulse and send him to the hospital for two days at least, and from there he would go right on to prison. Would you slip him some poppy seeds to stop him from infecting innocent people?

Scenario 2
. While driving your expensive car in the country, you come across a man lying by the side of the road. His leg is severely injured and bloody, the result of a hiking accident, he explains. He asks you to help him by driving him to the local hospital. Since it is clear he might lose his leg if he doesn’t receive timely medical treatment, your first impulse is to help. You realize, however, that the blood which is sure to get on your leather seats will ruin them. Would you drive off without helping the man to prevent ruining your automobile’s upholstery?

Scenario 3
. Using a video-and-audio satellite connection, you are negotiating with a dangerous terrorist. You know he is capable of setting off an explosion that could kill thousands of innocent people. But … you have his teenaged son in your custody. You can stop the terrorist act by breaking one of his son’s arms and then threatening to break the other if the terrorist does not surrender. Do you save thousands of potential victims by breaking the teenager’s arm?

Scenario 4
. Your cruise-ship vacation is interrupted by a fire. You and the other passengers abandon ship. The lifeboat you manage to board, like all the others, is overcrowded and close to sinking from too much weight. Rough seas begin filling the already-low-in-the-water boat with water. Inaction will result in the lifeboat sinking long before rescue is expected. If that happens, everyone will drown. But … one of the passengers is seriously injured and can’t survive in any case, even after the rescue boats finally arrive. Throwing the mortally wounded person over the side will lighten the boat enough to prevent it sinking and save the lives of the other passengers. Would you throw the injured person out of the boat to save the others?

Three of these scenarios are classified as “high-conflict.” One, Scenario 2 (about an injured leg and a potentially ruined car seat), is classified as “low-conflict.” Koenigs and his colleagues presented scenarios like these to six patients whose prefrontal lobes had been damaged by tumors or
aneurysms. Specifically, the patients had lesions in their ventromedial prefrontal cortices (vmPFC) (Figure 10). These lesions changed the way the patients dealt with some of the moral challenges or dilemmas Koenigs and fellow scientists presented to them.

It is important to note that the six patients had normal intellects and baseline moods. The way they made moral decisions was not influenced by an overall impairment of their ability to think or reason. The localized brain damage they experienced nevertheless severely impaired their capacity for empathy, embarrassment, and guilt. Damage to the vmPFC typically leaves patients with reduced social emotions like these, as well as with diminished compassion, all of which are linked to moral values. Patients with these lesions can have trouble controlling frustration and anger as well.

These deficits, however, do not affect how patients respond to low-conflict moral challenges like that presented in Scenario 2. They respond in the same way people without brain damage do. And they respond the same way a second control group—patients with brain damage that does not involve the vmPFC—do. Like the two control groups, patients with damaged vmPFCs reject harming anyone if no lives are at stake and they choose not to harm anyone if the stakes are petty, like damaging leather car seats. You only see a difference in their moral decision-making process when they have to get their hands dirty to save lives, such as when it is necessary to harm or kill one person to prevent more deaths. That is where the patients with damaged vmPFCs stand apart from the control groups.

Making It Personal: Two More Scenarios

Scenario 5.
The trolley you are driving is out of control as it speeds toward a point where the track splits into two paths. Five workers standing with their backs toward you are on the left fork. One worker standing with his back toward you is on the right track. If you hit a switch you will divert your trolley to the right and kill the single workman there. If you do nothing, your trolley will follow the left-hand track and kill the five workers there. Would you hit the switch?

Scenario 6
. This time you and a very large stranger are standing on a footbridge above a straight, single track on which an out-of-control trolley is speeding toward five workers who will soon be killed unless the trolley is
stopped. You and the stranger are positioned above the tracks between the oncoming trolley and the workers. If you push the oversized stranger onto the tracks, he will die, but his body will stop the trolley before it runs down and kills the five workers. Would you save the five workers by pushing the stranger off the footbridge to his certain death?
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Sometimes the dilemma is not hypothetical. During World War II, Winston Churchill and members of the British Cabinet faced a moral dilemma very much like that presented by the out-of-control-trolley challenge. On September 8, 1944, the first V2 rocket, launched from Nazi-occupied Europe, struck London. Travelling faster than sound, more than 1,300 of the rockets rained down on the British capital in the following months, killing more than 2,500 Londoners. British intelligence services had the ability to feed false information to the Germans about the accuracy of the missile strikes by using captured German agents under their control. The British fed the German military inaccurate information about where the V2s were falling. The misinformation caused the German commanders to alter the paths of subsequent missile launches in hopes of improving their accuracy, not knowing that they were in fact sending their rockets off course to land outside London. This subterfuge would spare Londoners but not those living in less densely populated regions of Great Britain where the misguided missiles would fall silently from the sky, without warning, until the blasts brought destruction and death. Some cabinet members wondered “Did they have the right to play God? Did they have a right to spare Londoners by killing those in less populated regions of the country?” In the end, they went ahead with the plan. The German military was deceived by the inaccurate feedback reports, and misdirected rockets fell farther from London.
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Far from wartime Britain, in the laboratory, people without brain damage, patients with brain damage not affecting the vmPFC, and patients with damage to the vmPFC all tended to say they would take remote action, such as flipping the switch, which would result in one death but save the lives of five others. Patients with damaged vmPFCs, however, were nearly twice as likely to say they would push the stranger off the footbridge, to engage in hands-on killing of one person, to save five others.

This and similar studies show that patients with vmPFC damage were much more likely to make utilitarian choices when presented with moral dilemmas like that presented in Scenario 6. Such dilemmas typically make many people without brain damage squirm with discomfort, but the patients more readily decided to personally sacrifice one person to save others when presented with the hypothetical scenarios. In some cases, people with damaged vmPFCs more readily say they would kill their own infant or child in order to save the lives of other family members, other persons and themselves, compared to control groups.

We don’t know how these six patients, or others with similar lesions, would behave if they were presented with the scenarios outside the laboratory, on real footbridges, above real out-of-control trolleys. We do know, however, that the vmPFC in the frontal lobes plays a role in mediating our discomfort at the prospect of harming others and in making such moral choices.

Koenigs told the New York Times that one patient with vmPFC damage who repeatedly indicated he would kill when faced with high-conflict decisions like that presented in Scenario 6 said “Jeez, I’ve turned into a killer.”
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But the hypothetical scenarios did not cause this patient to turn into an indiscriminate hypothetical killer. He was only more likely to kill when direct action was required to save lives. Developmental psychopaths also see the decision to push the oversized man off the footbridge if they wanted to save five lives as a “no-brainer” decision. One life for five; what is the problem? One shove and the situation is resolved.

Harvard psychologist Joshua Green told the New York Times that “I think it’s very convincing now [with the publication of this study] that there are at least two systems working when we make moral judgments. There’s an emotional system that depends on this specific part of the brain [the vmPFC], and another system that performs more utilitarian cost–benefit analyses which, in these people, is clearly intact.”
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Patients with this kind of brain injury “don’t sweat” the process of making moral decisions as control subjects do. Or, more accurately, they don’t show the variations in skin conductance—which reflect increased autonomic nervous system activity—the way people with intact vmPFCs
do. Remember that emotion-laden challenges like deciding if you will allow five people to die or save them by personally pushing one person off a bridge, results in small increases in perspiration, which increases skin conductance. These consequences of vmPFC damage suggest that this part of the brain plays a big role in modulating moral judgments and in expecting or predicting emotional fallout from such difficult decisions.
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After reviewing the results of over 171 studies published over 32 years starting in 1980, Donatella Marazziti and her collaborators agree that the vmPFC might be a key processing center for the nerve circuits that produce what we interpret as a moral sense.
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This is not the place in the brain where a little white angel sits next to a little red devil arguing about how you should act. There is no sign of angels in the vmPFC shown in Figure 10 in its ventral (toward the bottom), medial (toward the middle) position in the frontal lobe. But as you can see in Figure 7, this part of the brain is closely interconnected to all or nearly all of the brain regions that have been implicated in psychopathic behavior.
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Psychopathy-like

The term
pseudopsychopathy
was first used in 1975
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to describe the personality features that appeared in some patients with damaged frontal lobes. The phrase
acquired sociopathy
was used about 10 years later to describe a patient identified as E.V.R.
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Before he developed a tumor in the orbitofrontal region of his prefrontal cortex, E.V.R. was a successful, happily married businessman. After surgery, his personality changed. The changes severely affected his ability to successfully navigate social situations and plan for the future. Consequently, he was divorced, remarried, and divorced a second time. His poor business decisions resulted in his bankruptcy.

Other patients with similar brain damage also lost their social graces and inhibitions. They became tactless and unrestrained in their comments and showed little concern for future consequences of their actions. Prior to their frontal-lobe injuries, they showed no sign of conduct disorder in their youth or developmental psychopathy as adults.
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But after experiencing brain damage, they could no longer plan effectively for the future. They began to behave recklessly and sometimes dangerously. They also lacked a sense of remorse.
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They became indiscreet and impulsive.