Murderous Minds (30 page)

Such personality changes can result from damage caused by injury, as well as by tumors and strokes. Hundreds of soldiers who had received head wounds during the Vietnam War were surveyed two decades after the troops of the Vietnamese People’s Army captured the city of Saigon in 1975 and claimed victory. Those with damage in the frontal ventromedial region consistently scored far higher in aggression and violence than soldiers with damage in other parts of their brains. In these soldiers, the aggressive behavior was more often verbal than physical, but the results support the association between vmPFC lesions and antisocial behavior.
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It doesn’t seem to matter when the damage occurs, either. Prefrontal-lobe injuries in two children less than 16 months of age did not impair their intelligence, memory, school work, language, or visual perception as they grew to young adulthood. The injuries did, however, affect their ability to make good decisions, control their behavior, and act acceptably in social situations. Despite their normal intellectual abilities, the early damage affecting the function of their prefrontal lobes left them with lifelong severe social behavioral problems.
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Some of these traits are characteristic of many developmental, successful, or unsuccessful psychopaths. Other features of pseudopsychopathy, however, distinguish it from developmental psychopathy. When violent, for example, these patients seem to act more out of frustration than in pursuit of a goal. They are more likely to strike an inanimate object than they are to hit a person during one of their sporadic violent outbursts.
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When they use violence, developmental criminal psychopaths tend to engage in instrumental or goal-oriented aggression more than reactive aggression.

The first convincing hint that the part of the brain that houses the vmPFC, the frontal lobes, plays a significant role regulating this kind of behavior and moral decision-making processes came not from tests of moral dilemmas or fMRI scans but from 19th century medicine and a horrible workplace accident.

Neuroscience’s Most Famous Patient

On Wednesday, September 13, 1848, 26-year-old Phineas Gage was at work as a railroad foreman in the Green Mountains near Cavendish, Vermont. He was a good-looking single fellow, five feet, six inches tall and
respected by his men and bosses for his reliability. In addition to supervising his crew, he prepared explosive charges to blast apart the granite bedrock that stood in the way of the expanding Rutland and Burlington Railroad.

Phineas routinely used a forged metal tool called a tamping iron to pack down sand which had been poured on top of gunpowder at the bottom of narrow holes drilled into the bedrock. The compressed gunpowder was usually ignited from a safe distance, using a fuse which set off the rock-shattering blast. But around 4:30 p.m. on his last day on the job, Phineas had a horrendous workplace accident.
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This is what was supposed to have happened that afternoon: After an assistant poured gunpowder into the hole, Phineas would have used the narrow end of his custom-forged tamping iron to carefully poke a depression in the gunpowder to hold a fuse in place. Then the assistant would have poured sand over the gunpowder, leaving the fuse extending out of the hole. Phineas would have then used the thick end of his tamping iron to pack the sand down over the gunpowder. This helps direct more of the explosive force of the gunpowder into the rock rather than out of the hole. But for some reason on that fall day, there was no sand over the gunpowder in one hole.
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Phineas tamped, either intentionally or accidentally. A spark sparked. The gunpowder exploded.

The tamping iron shot out of the hole. It blew through Phineas’s left cheek and through the back portion of his left eye socket. It soared through the top of his head like a missile fired from a submarine. The missile was three feet, seven inches long with a diameter ranging from ¼ inch at one end to 1¼ inches at the other end.
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The 13¾-pound iron rod-turned-missile landed about 30 feet away from where Phineas was knocked flat on his back. He never lost consciousness. After being transported in an oxcart to the Cavendish hotel where he had a room, Dr. Edward Williams arrived from a nearby village, to find a horrifically wounded Phineas, who greeted him with the words: “Well, here’s work enough for you, Doctor.”

Besides taking the sight from Phineas’s left eye, the tamping iron took much of his left prefrontal lobe. The injury was as gruesome as it sounds. While cleaning bone fragments from the wound, Cavendish town physician John Harlow, who took over from Dr. Williams, explored the extent of the injury. He inserted one of his fingers down into the wound on the top
of Phineas’s skull and one of his fingers up into the wound in the cheek.

His fingers touched.
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But to everyone’s surprise, including the doctor’s, the patient did not die that day, or for many days after. He lived for more than a decade and made neuroscience history doing it.

It is close to impossible to get away from his story if you study neuroscience or read many “brain” books like this one, partly because it is so graphic, but more because of what it revealed about the neurobiological basis of decent and respectable human behavior and the contributions of the frontal lobes to our better natures. It demonstrated clearly and graphically to many who read about the case, from the second half of the 19th century until today, that behavior and personality are influenced by particular regions of the brain.

Although the exact details of the brain injury Phineas suffered are still debated, the path of the missile certainly led to the destruction of his left frontal lobe. He recovered with his intellect, memory, speech, perception, and motor function intact enough to survive another 11½ years. Sadly, he never recovered his pre-injury easy-going, likable personality. Instead, he became disrespectful, unpleasant, moody, and impatient. Phineas’s personality changed dramatically and he became socially impaired, according to contemporary accounts.

Although Malcolm Macmillan, D.Sc., an authority on the case, claims Gage’s post-injury life has sometimes been misrepresented to bolster the argument that he is a good example of pseudopsychopathy, Macmillan does acknowledge that Gage was “profoundly changed by the accident and was irreverent… .”
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And we have the word of the physician who treated Phineas:

“The equilibrium or balance, so to speak, between his intellectual faculty and animal propensities, seemed to have been destroyed,” physician John Harlow wrote. “He is fitful, irreverent, indulging at times in the greatest profanity (which was not previously his custom), manifesting but little deference for his fellows, impatient of restraint of advice when it conflicts with his desires, at times pertinaciously obstinate, yet capricious and vacillating, devising many plans of operation, which are no sooner arranged than they are abandoned in turn for others appearing more feasible. A child in his intellectual capacity and manifestations, he has the animal passions of a strong man.”
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The changes in Phineas’s personality prevented him from keeping his old job. He became a different person unqualified to supervise others. He died from epilepsy on Monday, May 21, 1860. The accident claimed his life in the end.

There are other ways Phineas could have acquired unpleasant personality changes. He could have experienced similar changes if his right, instead of his left, prefrontal cortex had been damaged, for example. That is what happened to a patient in the United Kingdom identified as “J. S.” The trauma that destroyed his right prefrontal region including his orbitofrontal cortex left him with “acquired sociopathy,” according to the researchers who examined him. “His behavior was notably aberrant and marked by high levels of aggression and a callous disregard for others.”
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Like others with similar injuries, he found it very difficult to recognize emotional expressions and to control his socially inappropriate behavior.

Damage to other brain regions implicated in psychopathy has also been linked to pseudopsychopathy or acquired sociopathy. For example, the anterior cingulate cortex, a component of the paralimbic model of psychopathy, is the region that Kent Kiehl and his colleagues say is linked to the likelihood of a criminal’s reoffending. Damage to this structure resulting in epilepsy is often accompanied by psychopathic behaviors.
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Brain damage-induced pseudopsychopathy, or acquired sociopathy, has similarities to developmental psychopathy, but it never duplicates the condition entirely. As we’ve seen, the cold-blooded, goal-oriented instrumental aggression seen in some criminal psychopaths is not a characteristic of the acquired version of the disorder. Andrea Glenn and her co-authors point out that differences between the two conditions might be expected, because one presumably develops early in life and one is acquired later in life.
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Criminal psychopathy, or a predisposition to it, may get its start during conception and develop as the brain develops before and after birth. Acquired psychopathy is the result of a lesion inserted into an otherwise normally developed, healthy brain. Even a child who receives prefrontal-lobe damage before the age of one and a half still has a brain that developed normally in the womb and during infancy, before the injury. The criminal psychopath, by contrast, may have a brain that developed abnormally as a
fetus and infant, leaving it with impaired connections and multiple sites of dysfunction.

The features of the criminal psychopath’s brain that produce psychopathic behavior cannot be reproduced exactly by damaging specific, limited regions of the brain, as happens following brain damage. Psychopathy is much too complex for that to happen, but looking at unusual injuries like those suffered by Phineas and J.M. reinforces the importance of the frontal lobes in understanding the minds of psychopaths. Abnormal functioning in this and associated brain regions may be present in some people even before adulthood. In some cases, it may explain the behavior of children at risk of growing into full-fledged psychopaths.

Chapter Ten

Could Your Child Be a Budding Psychopath?

Rav’s parents knew that something serious was wrong with their son.

Based on his appearance (Figure 2), there was no way to tell what Rav was capable of doing, but we know he was capable of doing some very unsettling things, if we can trust the doctor his worried and exasperated parents took him to see. It is not surprising they sought the best help they could find for their eight-year-old boy; Rav’s mother and father were good people, “well-to-do,” according to the respected 19th century psychiatrist they consulted, Cesare Lombroso.
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His parents had raised Rav in Romagna, the region in northern Italy where he was born. The region, which is located between the Apennine Mountains and the Adriatic Sea, includes the cities of Rimini, Imola, and Ravenna. Rav’s home town, like other northern Italian regions was, in general, considerably better off than those in southern Italy. The rich nobles who owned much of the land in the south preferred living in Rav’s birthplace and in other regions of northern Italy.
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These rich absentee landowners hired overseers to make sure they made money from their southern property holdings. Profit interested them more than the welfare of their
employees, tenants, or even the land itself. They failed to maintain the quality of the soil which, like the quality of the southerners’ lives, eroded. The southern Italians suffered terribly from the neglect and exploitation, like any group of sharecroppers or unvalued tenants who worked poorly maintained land they did not own in a class-conscious culture. It wouldn’t be surprising if the exploitative landowners, were they around today, would be candidates for inclusion in some corporate psychopathy surveys.

The political unification of Italy in 1871, and the new taxes that followed did nothing to ease the poverty, unemployment, poor living conditions, lack of opportunity, and lack of hope in the south. That same year, a mass migration began. In forty years, it would see four million Italians move to South and North America.

But, as far as we can determine, Rav experienced none of the hardships his fellow countrymen experienced. He was well fed and appeared healthy with thick, close-cropped hair, protruding ears, and a blithely unconcerned, perhaps slightly bemused, expression. He slouched just a bit as he sat motionless in a wooden straightback chair, hands on knees, wearing a striped shirt and a dark jacket, waiting for the photographer to tell him he could move. We don’t know what he was feeling or thinking as he waited for the film to be exposed; but if he had a conscience, he would have had a lot to think about.

His expulsion from school for “the bad influence he exercised over his schoolfellows”
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was certainly troubling but hardly an indication of criminality by itself. And his spiteful behavior toward his younger brothers and sisters might be dismissed as typical behavior of one child toward his siblings—until you hear about his attempts on more than one occasion to strangle several of them. That crossed the line from “it’s just roughhousing” to “it’s scary.” It was also scary when the staggeringly underhanded nature of his antisocial behavior became clear.

He seemed to take pleasure in robbing nearly everyone he came into contact with and then trying to blame others for the thefts. He stole from his parents, his neighbors, and the people he did jobs for. He lied well enough to convince them for some time that others were guilty of his crimes.