[Paleopsych] Hartford Courant: The Mind of the Psychopath: Contours of Evil

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The Mind of the Psychopath: Contours of Evil
http://www.courant.com/news/health/hc-psychopathbrain1218.artdec18,0,209514.story?coll=hc-big-headlines-breaking

Researchers Study How The Mind Works When There's No  Remorse
By  WILLIAM HATHAWAY
Hartford Courant Staff Writer

December 18  2005

Dr. Kent A. Kiehl has interviewed dozens of psychopaths over  the past
their heinous acts he remains as astonished as he is  repulsed.

"I think, `I can't believe this guy is telling me he bashed in his mother's 
head with a propane tank,'" Kiehl says.

Kiehl and a team of researchers at Hartford Hospital's Institute of Living are 
using brain scans in an attempt to explain the inexplicable: What makes some 
people absolutely devoid of empathy and remorse?

Society needs answers because of the sheer havoc psychopaths create, the 
researchers say. Superficially charming, psychopaths lie, steal, rape, rob, 
embezzle, assault and abuse with no compunction, no conscience. But all 
psychopaths are notoriously impervious to rehabilitation.

Psychopaths account for a quarter of all prisoners in the United States - and 
for as much as 50 percent of all violent crime, the researchers estimate.

There are also hundreds of thousands of psychopaths in the United States who 
manage to stay out of prison, but nonetheless dole out immeasurable amounts of 
pain in homes, schools, even corporate boardrooms.

Within the pattern of bright blue and yellow blotches on the brain scans he has 
taken, Kiehl believes he has found the dark contours of the psychopathic mind. 
When psychopaths see or hear emotional words or pictures of misery, areas of 
their brains that should light up like a Christmas tree are dark and devoid of 
activity. Instead, their brains process information such as a picture of a 
bereaved mother holding her dead child in the same way they would react to a 
picture of a chair or shovel.

Psychopaths seem to know the words, but they can't hear the music, researchers 
often say.

In probing the abyss of the psychopathic mind, Kiehl and others are raising 
questions about our criminal justice system and our assumptions about human 
morality.

Beyond Bundy

Kiehl's own quest began with stories his father, a newspaper editor, told about 
serial killer Ted Bundy, who grew up in the same Tacoma, Wash., neighborhood as 
the Kiehls.

Bundy was the archetypal psychopath - handsome, disarmingly charming and 
utterly ruthless. His outwardly clean-cut appearance and his cunning - he 
volunteered for a suicide hot line and the Republican Party - made Bundy a 
virtuoso killer. He was known to use crutches as props and feign car trouble to 
induce young victims to give him a ride. He eventually confessed to more than 
two dozen murders, but he is thought to have killed dozens more during a spree 
in the mid- to late 1970s.

"The question has always been, `What makes people do something like that?'" 
Kiehl said.

Years later, while doing postgraduate studies in neurobiology at the University 
of California at Davis, Kiehl decided he would try to answer the question.

He launched a campaign to get hired in the lab of the guru of psychopathy: 
Robert D. Hare, now professor emeritus of psychology at the University of 
British Columbia.

Hare told him he "didn't hire Americans." But after a concerted sales pitch, 
which included a gift of baseball tickets to a Toronto Blue Jays game, Kiehl 
says Hare relented and hired the young researcher in 1994.

It was an auspicious time in psychopathy research. Hare's research had given 
the nascent field some terminology to use. And new imaging technology was just 
beginning to open a window onto the dark world of the psychopathic brain.

The personality type had been known for centuries. In the 18th century, 
Frenchman Philippe Pinel coined the term "insanity without delirium" to 
describe aberrant behavior accompanied by a complete lack of remorse. The study 
of psychopathy in the United States dates from 1941, when Hervey Cleckley 
published a book called "The Mask of Sanity" that described psychopaths as 
unusually intelligent people, characterized by a "poverty of emotions."

But it wasn't until Hare devised his psychopathy checklist in 1980 - which he 
revised in 1991 - that an easily identified set of personality characteristics 
defined the condition and opened up a field of research.

"There was a gut feeling that there was something different" about psychopaths, 
Hare said.

There was.

Grading Psychopaths

Psychopaths aren't crazy, at least in a traditional medical sense, but they are 
unfettered by any sense of shame or guilt. Symptoms can show up early in life. 
Psychopathic children have total disregard for rules and engage in unusually 
vicious assaults or torture animals. Kiehl has received a federal grant to see 
whether children diagnosed with "callous conduct disorder" might actually be 
budding psychopaths.

Researchers have come to the conclusion that while a hostile environment can 
contribute to the development of psychopathy, many psychopaths are born, not 
made. Studies of twins suggest that psychopathic tendencies can develop even in 
loving homes. Some studies suggest that male psychopaths outnumber females by 
about 3 to 1.  The general lack of social causes for the disorder is one reason 
why most experts no longer use the term "sociopath" to describe a psychopath.

Researchers say as many as 1 out of every 100 people in the United States may 
meet the classification of a psychopath; serial killers make up a tiny minority 
of them.

The revised psychopathy checklist, known as the PCL-R, lists 20 traits and 
behaviors common to the disorder. Experts who are trained in administering the 
test score subjects with a 0, 1 or 2 on each item on the checklist. Hare said 
most people might score a 4 on his PCL-R checklist. A person is not designated 
a psychopath unless he or she scores 30 or more on the scale of 40.

The higher the score, the more devastation a psychopath is likely to cause. 
Somebody who scores a 27 probably wouldn't be a great dinner guest.

Psychopaths are pathological liars who crave stimulation, are sexually 
promiscuous and unable to control their behavior. They typically lack realistic 
long-term goals.

They may be master manipulators, but psychopaths have a hard time concealing 
their nature from people trained to use the checklist, Kiehl said. Inevitably, 
they lie, boast or reveal their callousness.

"They can't help themselves," he said.

People who deal with psychopaths have observed another shared quality, one not 
on the checklist or easily measured. There is something different about their 
eyes. The gaze of the psychopath is disquieting, even frightening, and has been 
described as cold or penetrating, empty, reptilian, not quite human.

They lack any depth to their emotions and the ability to connect emotion to 
cognition

"They don't quite get it," Hare said. "There is something missing."

`I Never Hurt People'

In the mid-1990s, in Canadian prisons, Kiehl began to perfect the art of using 
the checklist to score prisoners, who were told their interviews would not be 
shared with law enforcement authorities. In training tapes he recorded, Kiehl, 
a burly former football player, maintains a steady voice as he peppers subjects 
with short questions. In one tape, a 30-something man with long sideburns and 
thinning hair, dressed in a green windbreaker, answers Kiehl's questions with 
an easy smile, a collegial, confiding, "just between us boys" air.

"Sideburns" confesses to bootlegging cigarettes, petty thefts.

"Do you have a temper?" asks Kiehl, who is off camera.

"Oh yes, explosive," Sideburns answers.

"Do you assault people?"

"Oh, I never physically hurt people."

"What happens when you lose your temper?"

"Oh, I can just lose it. Like the time I killed my girlfriend."

The blurted truth comes quick as a cobra strike. There is nothing in the man's 
face or voice to suggest he even recognizes he had told a lie about hurting 
people. When he relates how he held his girlfriend's head under water in a 
bathtub, there is no hesitation or pause in his voice, no change in tenor or 
inflection that hints he is aware the interview has shifted to a different 
moral ground.

"Police said she was already unconscious," he says, as if the statement 
absolves him of wrongdoing.

He changes the subject to all the stolen electronic equipment he gave the 
woman.

For the first time, Sideburns seems a bit worked up.

When you steal electronics, he asks, "Do you know how hard it is to find remote 
controls?"

Spotting The Predators

Warning the public about the dangers of such psychopaths is a passion for Hare, 
author of the book "Without Conscience."

Hare said zebras and other animals congregating around an African waterhole 
know to scatter when they see a lion.

"There you can identify a predator, but psychopaths don't wear bells around 
their necks," Hare said.

Psychopaths tend to thrive "where the rules are obscure, where there is chaotic 
upheaval,"  Hare said. "Countries such as Yugoslavia and the Soviet Union after 
their breakups were a warm niche for psychopaths, who simply moved in to take 
advantage of the chaos."

A corporation that is disorganized and growing quickly offers the same type of 
fertile environment, Hare said. In a book tentatively titled "Snakes in Suits" 
to be published next spring, Hare blames scandals such as the destruction of 
Enron at least partly on a category of psychopaths who typically know how to 
stay out of jail.

Hare's checklist today has provided a generally accepted definition of the 
psychopath, the "who" and the "what" that allows researchers from different 
disciplines to study the phenomenon.

Hare says his checklist has been both abused and underused. He railed against a 
judge in Texas, for instance, who has sentenced defendants to death because he 
has deemed them psychopaths, even though they were never examined by people 
trained to use his checklist.

But Hare also says many parole boards underutilize psychopathic evaluations 
when considering whether to release a prisoner.

How a prisoner scores on the 20 characteristics of Hare's checklist "is the 
best predictor of recidivism that we have," said Diana Fishbein, a researcher 
at RTI International of Research Triangle Park in North Carolina.

About half of prisoners released from jail wind up back there within three 
years, Kiehl said. The number skyrockets to at least 4 in 5 when the prisoner 
is a psychopath. And psychopaths seem to be immune to any sort of therapy that 
might better those odds.

One study explored whether group therapy might lower the recidivism rate of 
psychopaths. Sixty percent of untreated psychopaths in the study were back in 
jail after a year. But 80 percent of psychopaths who participated in group 
therapy were convicted of another offense in the same period.

"They used the sessions to learn how to exploit the emotions of others," Kiehl 
said.

Some people debate the value of using the checklist to determine sentences for 
individual killers. The recidivism rate is not 100 percent for psychopaths, 
noted Dr. Michael Norko, director of the Whiting Forensic Division of 
Connecticut Valley Hospital. And using the checklist is akin to doing a DNA 
analysis for an incurable disease. What are you going to do if you find it?

"It would be different if we had a pill for psychopathy," Norko said.

Devoid Of Emotion

Kiehl says he believes that brain imaging studies can pinpoint the biological 
cause of psychopathic behavior and possibly lead to a remedy, perhaps even a 
psychopathy pill.

"If we could develop a treatment for psychopaths, it would alleviate an 
enormous burden on society," said Kiehl, who is director of the clinical 
cognitive neuroscience laboratory at the institute's Olin Neuropsychiatry 
Research Center.

He has a theory of where in the brain to look. His previous work showed a 
peculiar pattern of brain activity in psychopaths when they were presented with 
different words or images.

Using both an electroencephalograph (EEG), which measures electrical activity 
in the brain, and functional magnetic resonance imaging scans, which measure 
oxygen use, Kiehl found striking differences between psychopaths and 
non-psychopaths in the activity of several regions of the brain. He is 
particularly intrigued by abnormalities in psychopaths' brains, in what he 
calls the paralimbic system, a loose organization of brain structures involved 
in processing emotion.

In most people, that picture of a distraught woman holding a dead child will 
trigger heightened activity in these brain areas, including a region called the 
amygdale. In contrast, the brains of criminal psychopaths respond much as they 
would to any inanimate object.

Kiehl and other scientists have also found heightened brain activity in the 
frontal cortex of psychopaths when they are presented with emotionally charged 
words or images. The frontal cortex helps govern reason and planning.

Some scientists have interpreted that as evidence that the root of psychopathic 
behavior lies in the frontal cortex. But Kiehl and others see it differently. 
People with injuries to the frontal cortex do not exhibit the goal-directed 
aggression or callousness often associated with psychopaths, Kiehl says.

Kiehl believes psychopaths enlist areas of the frontal cortex to process 
information that the brain usually processes in its emotional centers.

On his desk at the Institute of Living, Kiehl keeps a replica of a railroad 
spike, a memento of an 1848 accident that befell a Vermont construction foreman 
named Phineas Gage. An explosion drove a 3-foot-7-inch tamping iron through 
Gage's brain. The sheer improbability of his survival - the tamping iron 
entered under his cheekbone, exited the top of his skull and landed 25 feet 
away - assured Gage a place in the history of medical oddities. But the changes 
in his behavior made him famous. Gage, who had been a reliable worker and a 
sober, churchgoing, devoted family man, became an irresponsible cad, ignoring 
his wife, children and job.

In short, he acted like a psychopath. Kiehl notes that the tamping iron damaged 
the paralimbic system in Gage's brain, the same areas that seem abnormal in the 
brain's of psychopaths.

Kiehl's theory explains, for instance, why psychopaths seldom seem to 
experience anxiety or fear in the same way normal people do and why they do not 
fully comprehend the meaning of emotions such as love or compassion.

"For a psychopath, it is all cognition," Kiehl said.

His lab has received federal grants totaling $6 million for the study of 
psychopathy. In one study, he is investigating whether one reason that drug 
abuse treatment programs have a high failure rate in prisoners is because so 
many psychopaths are enrolled. Psychopaths do not respond to traditional 
treatment and Kiehl suspects that, while psychopaths are heavy drug and alcohol 
abusers, they do not develop the same sort of dependency on drugs as 
non-psychopaths.

To test his hypothesis, he hopes to persuade Connecticut correctional officials 
to allow his team to study teen and adult inmates.

If Kiehl's ideas are borne out by research, they may suggest ways to change 
psychopathic behavior. For now, Hare believes that any therapeutic approach 
must appeal to the psychopath's own self-interest because treatments based on 
an appreciation of somebody else's feelings are bound to fail.

Understanding the underlying physiology of the disorder could lead to a drug 
that might actually restore emotional responses and cure psychopaths, said Dr. 
James Blair, an expert in psychopathy and a researcher at the National 
Institute of Mental Health, part of the National Institutes of Health.

Blair points out that the symptoms of psychopathy are almost exactly the 
opposite of symptoms of people who suffer from post-traumatic stress and 
anxiety disorders - conditions for which treatments now exist.

Roots Of Morality

Kiehl hopes that by explaining how psychopaths' minds work, he can help arm 
society with the tools to deal with them. One of his research associates, Jana 
Schaich-Borg, also wants to answer a more fundamental question: Why are most 
humans moral in the first place?

If Kiehl is correct that a failure of the emotional processing centers of the 
brain is at the root of psychopathy, then it follows that moral behavior might 
arise in those same areas. If a pill could create emotional responses in a 
psychopath, could such a drug also give him a moral core?

Schaich-Borg plans to investigate whether psychopaths feel disgust - or the 
deeply ingrained reaction that people in most cultures have about, say, 
handling feces or having sex with a sibling. She speculates that the areas of 
the brain that govern disgust in a normal person may also play a role in the 
formation of more sophisticated moral beliefs, which are absent in psychopaths.

For years, the link between instincts and moral decision-making has been 
inferred from fictional ethical scenarios. Schaich-Borg offers one example:

Five people are tied up on a railroad track and a locomotive barrels toward 
them. You can save them, but only by pulling a lever and switching the 
locomotive to a different track, where two other people are tied.

Do you pull the lever?

People answer instinctively, and study after study shows that they are split 
right down the middle and argue their positions passionately.

"Some people say they won't play God under any circumstance," said 
Schaich-Borg, who said she personally would pull the lever.

But what if you could save the people on both sides of the railway spur by 
shoving a single man in front of the train?

"Nearly everybody says no," she said.

But, she said, a psychopath wouldn't care a whit whether the lever was pulled 
or not. She wants to compare what happens in people's brains when the question 
is asked.

In the pattern of neural activity, she believes she may see the outline of 
human morality. And those imaging scans may illustrate why predators such as 
Ted Bundy are a rarity, rather than a rule in society.

Kiehl says most people probably make moral choices using both rational and 
emotional parts of their brain. But he and Hare both say much more research 
needs to be done to shed light into the abyss of the psychopathic mind.

"Unless we understand what makes these people tick," Hare says, "we are all 
going to suffer."

A discussion of this story with Courant Staff Writer William Hathaway is 
scheduled to be shown on New England Cable News each hour Monday between 9 a.m. 
and noon.