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    1.
Burns, J. M. & Swerdlow, R. H. (2003). Right orbitofrontal tumor with pedophilia symptom and constructional apraxia sign.
Archives of Neurology
60, 437–40.

    2.
The pseudonym “Mr. Oft” was coined by my good friend and colleague
Dr. Stephen Morse, a professor of law at the University of Pennsylvania. Stephen first introduced me to the case. “Oft” is an acronym for “orbitofrontal tumor.”

    3.
Burns & Swerdlow, Right orbitofrontal tumor with pedophilia symptom and constructional apraxia sign.

    4.
Crick, F. (1994).
The Astonishing Hypothesis: The Scientific Search for the Soul.
New York: Touchstone.

    5.
Documents obtained by the defense team from Children’s National Medical Center in Washington, D.C., were at trial to prove how brutal his childhood beatings were.

    6.
Gusnard, D. A. et al. (2001). Medial prefrontal cortex and self-referential mental activity: Relation to a default mode of brain function.
Proceedings of the National Academy of Sciences of the United States of America
98, 4259–64; Antonucci, A. S. et al. (2006). Orbitofrontal correlates of aggression and impulsivity in psychiatric patients.
Psychiatry Research
147, 213–20.

    7.
Freedman, M. et al. (1998). Orbitofrontal function, object alternation and perseveration.
Cerebral Cortex
8, 18–27; Shamay-Tsoory, S. G. et al. (2005). Impaired “affective theory of mind” is associated with right ventromedial prefrontal damage.
Cognitive Behavioral Neurology
18, 55–67.

    8.
Bechara, A., Damasio, H., Tranel, D. & Damasio, A. R. (1997). Deciding advantageously before knowing the advantageous strategy.
Science
275, 1293–94; Damasio, A. R., Tranel, D. & Damasio, H. (1990). Individuals with sociopathic behavior caused by frontal damage fail to respond autonomically to social stimuli.
Behavioural Brain Research
41, 81–94.

    9.
Raine, A., Meloy, J. R., Bihrle, S., Stoddard, J., LaCasse, L., et al. (1998). Reduced prefrontal and increased subcortical brain functioning assessed using positron emission tomography in predatory and affective murderers.
Behavioral Sciences & the Law
16, 319–32.

  10.
It also has to be recognized that Donta Page could have left the house after going outside to take money from the car. The fact that he came back into the house instead of leaving the scene of the burglary suggests some degree of premeditation. This admixture of lack of planning combined with some degree of regulatory control is not uncommon in murderers, and it is a difficult task to clearly divide murders into “impulsive” versus “planned.”

  11.
Centers for Disease Control and Prevention. Sexually transmitted diseases (STDs).
http://www.cdc.gov/std/pregnancy/STDFact-Pregnancy.htm
.

  12.
Raine, A., Brennan, P. & Mednick, S. A. (1994). Birth complications combined with early maternal rejection at age 1 year predispose to violent crime at age 18 years.
Archives of General Psychiatry
51, 984–88.

  13.
Farrington, D. P. (2005). Childhood origins of antisocial behavior.
Clinical
Psychology & Psychotherapy
12, 177–90; Loeber, R. & Farrington, D. P. (2000). Young children who commit crime: Epidemiology, developmental origins, risk factors, early interventions, and policy implications.
Development & Psychopathology
12, 737–62.

  14.
Jackson, S. (2001). Dead reckoning.
Denver Westward News
. June 28.

  15.
Ibid.

  16.
Federal Bureau of Investigation (2011).
Uniform Crime Reports
.
http://www.fbi.gov/about-us/cjis/ucr/ucr#ucr_cius
.

  17.
Jenkins, A. C. & Mitchell, J. P. (2011). Medial prefrontal cortex subserves diverse forms of self-reflection.
Social Neuroscience
6, 211–18. While the medial prefrontal cortex is the area most robustly associated with self-reflection and self-referential thinking, other brain areas have been implicated as well, including the anterior cingulate and the posterior cingulate, areas also found to be dysfunctional in offenders. In particular, the medial prefrontal cortex and the anterior cingulate cortex appear to underlie thinking about aspirations and hopes, while the posterior cingulate is particularly activated when reflecting on one’s duties and obligations. It has been hypothesized that the medial prefrontal cortex is more linked to an inward-directed focus, whereas the posterior cingulate is more associated with an outward-directed, social, or contextual focus. See also Johnson, M. K., Raye, C. L., Mitchell, K. J., et al. (2006). Dissociating medial frontal and posterior cingulate activity during self-reflection.
Social, Cognitive, and Affective Neuroscience
1, 56–64.

  18.
You will recall that Mr. Oft did indeed tell the hospital authorities that he felt that if released he would rape his landlady. Bear in mind, however, that he was about to go to prison, and this could be construed as a simple con to remain in the more benign environment of a psychiatric hospital.

  19.
Gorman-Smith, D., Henry, D. B. & Tolan, P. H. (2004). Exposure to community violence and violence perpetration: The protective effects of family functioning.
Journal of Clinical and Adolescent Psychology
33, 439–49.

  20.
Raine, A., Venables, P. H. & Williams, M. (1996). Better autonomic conditioning and faster electrodermal half-recovery time at age 15 years as possible protective factors against crime at age 29 years.
Developmental Psychology
32, 624–30.

  21.
Raine, A., Venables, P. H. & Williams, M. (1995). High autonomic arousal and electrodermal orienting at age 15 years as protective factors against criminal behavior at age 29 years.
American Journal of Psychiatry
152, 1595–1600.

  22.
It is ironic that the stimulus that led Page to slitting Peyton Tuthill’s throat was the fact that he could not stand her screaming. It was his own screaming as a baby that caused his mother to shake him vigorously and repeatedly. This shaking is one cause of prefrontal dysfunction, the risk factor
we documented in Page and that we believe was instrumental in his killing of Peyton Tuthill.

  23.
Kershaw, I. (2008).
Hitler: A Biography
. New York: W. W. Norton & Company.

  24.
Ibid.

  25.
Fulda, B. (2009).
Press and Politics in the Weimar Republic
. Oxford University Press.

  26.
CNN (2007). Amish grandfather: “We must not think evil of this man.” December 10.

  27.
Gottlieb, D. (2006). Not Always Divine.
Cross-Currents
. October 17.
http://www.cross-currents.com/archives/2006/10/17/not-always-divine/
.

  28.
Jacoby, J. (2006). Undeserved forgiveness.
Boston Globe
. October 8.

  29.
This seminar series was conducted by AAAS in collaboration with the Federal Judicial Center and the National Center for State Courts, with funding from the Dana Foundation. It has been ongoing since 2006, and there are concerted efforts to bring the judiciary up to speed on the latest advances in neuroscience, how new techniques and knowledge may inform legal decision making, and what their limitations are.

  30.
Pedophilia is indeed viewed by the medical profession as a clinical disorder, and is a condition outlined in detail in
DSM-4
.

  31.
Morse, S. J. (2011). Mental disorder and the criminal law.
Journal of Criminal Law and Criminology
101, 885–968.

  32.
Such affirmative defenses are not restricted to mental illness. Another example is acting in self-defense. You may have the “mens rea,” or guilty mind—you may know what you are doing—but you are acting in self-defense against a deadly aggressor. In this case, you are not a “responsible agent.”

  33.
You would also not be held responsible if you were sufficiently coerced or compelled to commit a criminal act. For example, if somebody holds a gun to your head and threatens to kill you unless you perform a sex act on a third party.

  34.
Mindshock: Sex on the Brain
. (2006). Channel Four. Tiger Aspect Productions.

  35.
Ibid.

  36.
Ibid.

  37.
Damasio, A. R. (2000). A neural basis for sociopathy.
Archives of General Psychiatry
57, 128–29.

  38.
Morse, S. J. (2008). Psychopathy and criminal responsibility.
Neuroethics
1, 205–12.