The Anatomy of Violence (51 page)

Can medications work too in quelling outbursts in adults? Surprisingly, there is much less research here, probably because once you become an adult and are violent, you are viewed as evil and we lock you up. We don’t want to help you anymore. A double-blind, placebo-controlled, randomized trial allocated impulsive aggressive male community volunteers to one of three
anticonvulsants.
⁶³
All three medications significantly reduced aggressive behavior.
⁶⁴
The same result has been found in several randomized controlled trials for treating impulsive forms of aggression in prisoners.
⁶⁵

Why
on earth
would anticonvulsants, normally used to stop
epileptic seizures, work with reducing aggression? We know these medications have a calming effect on the limbic regions of the brain—particularly the
amygdala and
hippocampus, where epileptic seizures begin. We saw earlier that impulsive, emotional murderers have excessive activation of these limbic subcortical regions, so anticonvulsants may help reduce their impulsive emotional rage attacks by calming their emotional
limbic system.

Let’s continue our travels to find a different cure to crime. La Pirogue is the jewel in the crown of the beautiful island of Mauritius. With its golden sands and tropical gardens surrounding traditional-style thatched rooms, it is a haven of peace and tranquillity. It is my favorite hotel in the world.

Utoeya is also a utopian picturesque island, this one located in the
Tyrifjorden fjord outside of
Oslo in Norway. With its pretty little beaches it is similarly a summertime resort for young people. And it was here on the evening of July 22, 2011, that eighty-four people lost their lives while I unknowingly sat on the beach at La Pirogue in Mauritius, watching the sun set slowly over the coral reef.

I had flown in just the day before on flight MK 647 from Singapore, where I had been working with my colleagues on our fish-oil study on
conduct-disordered children. The biotech company
Smartfish, whose headquarters are in the
Oslo Innovation Center, supplied the
Joint Child Health Project in Mauritius with an
omega-3 drink. I had a connection with its cofounder
Janne Sande Mathisen, as she had gone to Darlington Technical College, which was just a few blocks from 69 Abbey Road, the house I was brought up in as a child. I had an unexpected e-mail from her on that fateful day:

What Janne had heard was a massive blast from a 2,000-pound fertilizer car bomb placed in the center of Oslo, which exploded at 3:17 p.m., damaging ministry buildings including the prime minister’s offices and killing eight people.

A short while after, at about five p.m., an armed “policeman” took a ferry across the Tyrifjorden fjord just outside of Oslo to the island of Utoeya to “investigate” the bombing. Landing on the island, which was filled with teenagers taking part in a youth camp for the Labor Party, he called the students toward him. They dutifully came, whereupon he promptly shot them.
Anders Behring Breivik continued his shooting spree for an hour, during which time he killed sixty-nine individuals, mostly teenagers, fifty-six of them shot in the head. Thirty-three more were shot but survived. It was the worst peacetime massacre in Norway’s modern history.

Those victims had been drawn to that island for its charm and peace, to relax in the countryside and beaches just as I was doing in Mauritius. Yet as I sat in my paradise watching the sun setting over the Indian Ocean, their paradise was being invaded by a sandy-haired, blue-eyed devil. As I heard the crashing of the waves on the coral barrier reef outside my room at La Pirogue, there was the crushing of their young souls outside Oslo. Yet in the sea in both Norway and Mauritius there might just be a part-solution to this kind of mindless
violence—fish.

I first got the idea on a visit to Mauritius a decade ago. It was November 2002, and I had just revised our findings from our earlier
study showing how early environmental
enrichment particularly reduced conduct disorder in kids with poor nutrition—an enrichment that included more fish. I was in the airport in Mauritius, wanting to buy something to read on the plane going to
Hong Kong. There is one, and only one, small book shop there, and it largely sells books in French. There were literally two short shelves with books in English. And there I saw it,
Andrew Stoll’s
The
Omega-3 Connection
,
⁶⁶
which had come out the previous year.

Going through it on the flight, I read his summary on the early studies suggesting that omega-3 might help with
depression,
ADHD, and
learning difficulties. There were no studies of aggression or antisocial behavior, but he speculated:

Perhaps he was right. The staff at the
Joint Child Health Study in Mauritius tested the idea in a randomized, double-blind, placebo-controlled trial of omega-3 supplementation in children and adolescents. Participants were drawn from the
Mauritius Child Health Project. One hundred children drank one pack of the
Norwegian Smartfish Recharge juice per day. It’s only a 200-millileter drink (less than a cup), but packed into it is a whole gram of omega-3. They took that for six months. One hundred other children were randomized into the placebo control group and received the same juice drink, but lacking the omega-3. Parents then rated their children’s behavior problems at the beginning of the study, six months later (at the very end of the treatment), and for a third time six months after the treatment had ended.

The results were intriguing. As you can see in
Figure 9.3
, both groups showed a reduction in aggression after six months of taking the drinks. That shows there was a placebo effect—that the fruit-juice drink without the omega-3 was doing just as good a job as the omega-3 drink. However, six months after the end of the treatment, the control group had returned almost to its pretreatment levels of aggression, whereas the omega-3 group continued to show even further reductions in aggression,
delinquency, and attention problems. It was a significant interaction between treatment group and time, with the groups really
diverging in outcome a full year after the study had begun.
⁶⁸
These results provide some initial support for the idea that
omega-3 can help in the long term in reducing behavior problems in children, a significant precursor of adult crime
and
violence.

Figure 9.3
   The long-term effect of omega-3 in reducing aggression in children

Why would we expect omega-3 to reduce aggression? In a way it’s surprisingly simple. We’ve seen throughout this book that there is a
brain basis to violence. We discussed earlier how omega-3 enhances brain structure and function by increasing dendritic branching, enhancing synaptic functioning, boosting cell size, protecting the neuron from cell death, and regulating both neurotransmitter functioning and gene expression. So omega-3 might partly reverse the brain dysfunction that predisposes one to aggression.

I was initially surprised that there would be a long-term change. Wouldn’t any initial results wash out after the Smartfish drink was discontinued? But
Joe Hibbeln, a leading figure in the field, explained to me that the half-life of omega-3 in the body could be about two years—it stays in the body ready for re-uptake and it can make a lasting change in the brain.
⁶⁹
So it stands to reason, at least in theory, that by improving brain structure and function omega-3 could help reduce violence in the long term.

The idea that nutrition could help is not new. In 1789, when the revolting
French peasants in Versailles were baying for the blood of their queen,
Marie Antoinette is reputed to have said, “If they have no bread, then let them eat cake.”
Brioche—a rich form of bread that she was supposedly referring to, may not have helped much, but she
wasn’t that far off the mark in thinking that
nutrition could quell the violent rioting. And
omega-3 is not just food for thought, it’s increasingly becoming food for court.
⁷⁰
The judiciary are becoming interested in the idea that omega-3 can cut crime.

Skeptical? So far two randomized controlled trials have shown that omega-3 supplementation can reduce serious offending within a prison. The first study, by
Bernard Gesch, at
Oxford University, demonstrated that taking a combination of omega-3 and multivitamin supplements for five months led to a 35 percent reduction in serious offending in young adult prisoners.
⁷¹
Fascinated by these initial findings, the Ministry of
Justice in The Hague in the Netherlands
conducted its own study on young-adult offenders and found that omega-3 and multivitamins for eleven weeks reduced serious offending within the prison by 34 percent—results almost identical to the British study.
⁷²

Wherever you go around the world, it seems that omega-3 may make a difference. In
Australia, six weeks of omega-3 supplementation reduced externalizing behavior problems in juveniles with bipolar disorder.
⁷³
In Italy, normal adults taking omega-3 for five weeks showed a significant reduction in aggression compared to controls.
⁷⁴
In Japan, a randomized controlled trial of omega-3 in adults reduced aggression.
⁷⁵
In
Sweden, a randomized controlled trial found that
ADHD children with
oppositional defiant disorder showed a 36 percent reduction in their oppositional behavior after fifteen weeks of omega-3.
⁷⁶
In Thailand, a randomized, double-blind trial of the omega-3 fatty acid DHA resulted in a significant reduction in aggression in adult university workers.
⁷⁷
In the United States, women with
borderline personality disorder randomized into supplementation of the fatty acid
EPA for two months showed a significant reduction in aggression.
⁷⁸
Another American study, this time a four-month randomized, double-blind, placebo-controlled trial of fatty-acid supplementation in fifty children, showed a significant 42.7 percent reduction in conduct-disorder problems.
⁷⁹

It’s all too simple, you say. And strictly speaking you are right. Violence is complex. In omega-3 we are looking at only one ingredient of a much bigger nutritional package that can feed violence-intervention efforts. We saw earlier how eating candy is correlated with crime.
Blood-
sugar lows can blow the lid off containing aggression. Not eating enough can make one tough.
Micronutrient supplementation of both
zinc and iron helps accelerate recovery of
hippocampal functioning following
iron deficiency in rats.
⁸⁰
We also know that a lack of protein
results in EFA (essential fatty acids) deficiency, while micronutrient deficiencies contribute to impaired EFA bioavailability and metabolism.
⁸¹
You’re right, it’s not simple.

Omega-3 is certainly not the sole solution on the nutrition front—there are many more nutritional factors to consider. And nutrition itself is just one piece of the much bigger jigsaw puzzle. Not all omega-3 studies have come up trumps.
⁸²
Nevertheless, these international findings are initial appetizers that should tempt us to consider further how nutrition can nix crime and violence. A body of knowledge is being built up that gives us an alternative perspective to drugs as a solution. Societal distaste for any “Prozac for prisoners” proposition could be tempered by the more palatable alternative medical approach of “fish for felons.” It could potentially prevent future disasters.

Anders Behring Breivik was initially argued to have a psychotic disorder—
paranoid
schizophrenia—that resulted in the
Norwegian tragedy. We discussed earlier how schizophrenia is related to violence. Is it entirely a coincidence that the very first study to prevent the development of psychosis in adolescents and young adults was based on omega-3?
⁸³
Is it a coincidence that the early environmental
enrichment in Mauritius that included an extra two and a half portions per week reduced not just adult crime, but also adult schizophrenia-spectrum personality traits, especially in those who had poor levels of nutrition before the enrichment?
⁸⁴
Future studies following the Norwegian Smartfish study on the island of Mauritius may ultimately provide prevention of slayings like the ones that took place on
Utoeya island in Norway.