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Authors: Dean Haycock

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This is where LTK, a 25-year-old Norwegian man who impressed researchers as “somewhat grandiose” as well as manipulative, conning, and superficially charming in his social interactions, had his brain scanned. Like most individuals described in medical case reports, LTK is known to readers only by his initials.

It would be nice for his fellow Norwegians if LTK’s psychopathic profile were limited to the classic traits of manipulative conning behavior,
superficial charm, and the grandiose sense of self-worth his doctors saw in him. Sadly, his score of 36.8 out of 40 on the Hare Psychopathy Checklist (PCL–R) reflects some far more troubling traits—and convictions. The worst was for rape. Helge Hoff, who works at Haukeland University Hospital’s Center for Research and Education in Forensic Psychiatry, and his colleagues described LTK, who agreed to have his brain scanned while processing emotional information as part of an experiment, as a “prototypical criminal psychopath.”
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We know that a key way in which LTK and other criminal psychopaths differ from non-psychopaths is the way their brains deal with emotions. They don’t respond to emotional images or situations in the same way people who lack psychopathic features do. For the most part, they have impaired ability to process or personally relate to the emotional content of words or emotional experiences.

For example, consider the following scenarios or situations. You are waiting to be called into a dentist’s office for a procedure you fear. You discover that a creepy insect is under the bedcovers with you. You see a companion run down by an automobile. You hear sounds of a break-in when you are in the shower.

If your brain processes emotions like most people, seriously considering all of these scenarios is liable to produce some subtle but predictable and measurable effects. This ability to re-create or feel someone else’s discomfort is not “just in your head.” Your body responds as well. Your heart beats a little bit faster and you sweat more as you become more emotional. Even a small increase in moisture can be detected, because it makes it easier for an electric current to pass between sensors placed on your skin. Scientists measuring this skin conductance see it increase when a person with a conscience and a sense of empathy reads about, or views a disturbing picture of, a person experiencing fear, pain, or grief.

Attach the electrodes to men like Richard Kuklinski, Ted Bundy, or LTK and you will see that they are literally unmoved. And so is the recording device that’s measuring their skin conductance. They hardly respond emotionally to stimuli that make the rest of us uncomfortable and a little bit sweaty. These stress-and fear-inducing situations also affect brain and body so the heart beats two or three beats per minute faster than
normal. But in the one percent of the population with significant psychopathic features, these physiological responses are significantly toned down.

That is what Christopher Patrick and his fellow researchers found in 1994 when they presented 54 criminals, including some with psychopathic features like LTK’s, with imagined fearful and neutral scenarios.
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Regardless of their Psychopathy Checklist scores, all of the criminals rated themselves about equally capable of fear and equally capable of imagining themselves in described situations. But the physical responses of the criminal psychopaths in the group showed significantly decreased changes in heart rate and electrical skin conductance compared to the criminals who had lower psychopathy scores.

In fact, you can predict which criminals will have the least response to fearful images by looking for those who have the highest antisocial behavior factor scores on Hare’s psychopathy scale. These differences suggest that something is deficient or at least different—depending on how you regard psychopathy—in the brains of psychopaths.

These and other studies in the past twenty years suggest that there seems to be a disconnection between words and emotions in the brains of criminal psychopaths. Their brains do not process them the way non-psychopathic brains do. High psychopathic traits come with emotional disability. The oft-quoted, pithy characterization of this deficit made by psychologists John H. Johns and Herbert Quay more than a half century ago bears repeating: “Psychopaths know the words but not the music.”
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Hare expanded on this insight for Dick Carozza of Fraud magazine: “It means that psychopaths understand the denotative, dictionary meanings of words but do not fully appreciate their connotative, emotional meaning. Their language is only ‘word deep,’ lacking in emotional coloring. Saying ‘I love you’ or ‘I’m truly sorry’ has about as much emotional meaning as saying ‘have a nice day.’ This lack of emotional depth in language is part of their more general poverty of affect as described by clinicians and observed in neuroimaging studies.”
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People like LTK, however, often act as if they have emotional ability. They can often convincingly fake recognizing and experiencing emotions, for example, when they think the act will help them con others. But, in reality, it is fake. The quality of the acting differs among
individuals, but in some it can be very convincing. The practiced deceitfulness can routinely fool naïve victims. For a short period of time, skillful psychopaths can even fool experienced researchers upon first meeting, according to Robert Hare. But repeated studies over the past fifteen years indicate that psychopathy is harder to hide in the laboratory.

Before LTK entered the lab to have his brain scanned to see how he responded to emotion-related stimuli, Hoff and his colleagues needed to find out more about their volunteer. The history they gathered about his family background uncovered little that would have predicted his future career as a psychopathic rapist. While there is evidence that psychopathy has a genetic component, it wasn’t an obvious factor in LTK’s case.

According to his parents, his mother had an unremarkable pregnancy and an unremarkable birth. LTK seemed like a normal baby: he seemed to respond to people as any baby does. He was born too soon to take part in an experiment that tested skin conductance activity in 1-year-old infants exposed to a fear challenge. Skin conductance, as described earlier, reflects the body’s automatic response to fear or stress by increasing perspiration. The study found that infants who showed low levels of skin conductance activity at age one year were more likely to act aggressively at age three years.
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LTK wasn’t a particularly fussy infant either, a trait that has been linked to later conduct problems in boys.
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When conduct problems lead to a formal diagnosis of conduct disorder during childhood or adolescence, it may precede a diagnosis of psychopathy in adulthood. Reportedly, LTK’s family was not much different from other families that did not produce a psychopathic son. There were no signs that LTK had been abused or subjected to extreme stress as a child. In this regard, LTK differed from many criminal psychopaths who claim, or are known, to have been abused early in life.

The Homicidal Triad

He also had no history of setting fires or abusing animals. Arson and animal abuse, together with bed-wetting, are known as the “Homicidal Triad,” “Hellman and Blackman Triad,” or the “Macdonald Triad”
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among forensic psychologists and psychiatrists, criminal profilers, and many readers of true-crime books. Because they are frequently associated with psychopathic behavior in the public’s mind, it makes sense to ask: why didn’t
they appear in LTK’s medical history? They are, after all, frequently said to predict a child’s future as a psychopath. According to forensic psychologist Karen Franklin, Ph.D., a careful examination of the evidence indicates a weaker connection between the Homicidal Triad and future violence than the original FBI profilers who made the link assumed.
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More likely, with the exception of bed-wetting, they are indications of severe stress or abuse. In other words, future violent individuals, psychopaths, or serial killers who have suffered childhood abuse may indeed include the Homicidal Triad in their list of youthful experiences, yet other abused children who show the same set of behaviors do not grow up to be violent or to become serial killers.

It is every caring parent’s nightmare if her child displays the Homicidal Triad by any of its names. But the presence of the Triad by itself doesn’t guarantee that the child will follow in the footsteps of Ted Bundy or John Wayne Gacy, who have become the twin faces of psychopathic serial killing in popular culture. Nor does its absence, as illustrated by LTK, guarantee the absence of psychopathy.

Who Are You Calling a Psychopath?

The Homicidal Triad is often linked to serial killers in popular culture. There is an interesting, uncertain, and somewhat controversial relationship between serial killers and psychopaths. We know that not all psychopaths are serial killers and that not all serial killers are psychopaths. Of the estimated one to two million criminal and non-criminal psychopaths in the U.S., a minuscule number are serial killers: estimates range from 35 to 100.

U.S. federal law makes no mention of psychopathy in its definition of serial killers: “The term ‘serial killings’ means a series of three or more killings, not less than one of which was committed within the United States, having common characteristics such as to suggest the reasonable possibility that the crimes were committed by the same actor or actors.”
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The FBI recognized the complexity of serial killer motivations and their relationship to psychopathy when it declared that “psychopathy alone does not explain the motivations of a serial killer.”
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Christopher Patrick questions what many people assume is obvious: that all serial killers are psychopaths. He used Jeffrey Dahmer as an example.

Dahmer sexually abused and killed seventeen young men and adults over a thirteen-year period ending in 1991. He also ate some of their body parts.

“On some level,” Patrick said, “Dahmer’s compulsive behavior may have been driven by probably dopaminergic reward tendencies in a way that addicts are driven. The impulse is so strong that it almost engulfs them. Jeffrey Dahmer’s case is way over the top; you’ve got a typical case [of addiction] dressed in alcohol, and you’ve got Jeffrey Dahmer’s dressed in blood.”
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Park Dietz, who examined Dahmer, agrees that he was not a psychopath, although, he pointed out, many serial killers are indeed psychopaths. He doesn’t, however, agree with the suggestion that Dahmer’s problem could be traced to compulsive behavior.

“Dahmer had several mental disorders, diagnosed by nearly all forensic evaluators who saw him,” Dietz wrote. “His inability to find a sexual partner who shared his interest in prolonged cuddling was a function of his personality disorder, which I believe I diagnosed as Schizotypal Personality Disorder.”
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Features of this disorder include social isolation and superstitious, odd beliefs. Dahmer’s sexual tastes reflected paraphilias, which, Dietz explained, “included necrophilia, what was once called ‘Pygmalionism’ (a taste for dolls and mannequins), and what I named ‘splanchnophlia’ (an attraction to the shiny membranes covering the viscera); for him, cannibalism was never erotic.” [Paraphilic behaviors entail extreme, dangerous, and abnormal sexual desires.]

Dahmer was an alcoholic, a problem that impaired his judgment and made it more difficult for him to avoid getting caught. Of Dahmer’s disorders, Dietz regards only alcoholism as an addiction. “There are those who want to view paraphilias as an addiction, but I do not share their view. Paraphilias are more or less stable configurations of erotically arousing imagery and activities, probably learned in late childhood by the time of puberty,” the psychiatrist explained.

In fact, apart from drinking, there is little in Dahmer’s behavior that qualifies as compulsive behavior, in Dietz’s view. “He did not regard his sexual desires, preferences, or behavior as senseless activities that he sought to stop or that relieved anxiety (which is the psychiatric concept of
compulsion). Nor was I impressed with anything about his behavior—apart from drinking—that could be called impulsive or reflective of impulses any stronger than the sex drive of normal men his age.”

“Did he seek rewards? Of course! Don’t we all?” Dietz summed up. “He found it rewarding to lie next to a man with nice biceps all night long, and he wanted one who wouldn’t leave him and wouldn’t rob him. If that’s dopamine at work, okay, but this doesn’t mean there was anything pathological about his dopaminergic system.”
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Psychiatrist Michael Stone is also skeptical of a link between serial killing and addiction. He points out that addiction is associated with physical withdrawal. He believes it is more likely that most serial killers have sexual urges combined with psychopathic traits, both of which are responsible for their behavior.
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What’s Left Behind

At the Society for the Scientific Study of Psychopathy meeting in Washington, D.C. in 2013, a young graduate student approached former FBI special agent and criminal profiler Mary Ellen O’Toole and told her very adamantly that many serial killers are not psychopaths. “Really?” O’Toole replied. “Interesting, because I worked on hundreds of these cases.”
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The young student had not visited the scene of a single case, but she was nevertheless very certain that she was correct.

O’Toole explained what it looks like in the trenches: “When we analyze a crime scene, we look at the pre-offense behavior, the crime scene behavior, and the post offense behavior. In my research, I was looking at manifestations of behavior that could be indicative of the 20 traits [which are part of the Hare Psychopathy Checklist]. We are looking for predatory behavior. We are looking for the hunting behavior, which is associated with psychopathy. We are looking for instrumental violence, which has a very strong presence in these kinds of cases. [Instrumental violence is goal-oriented, premeditated, and “cold-blooded.” Reactive violence is impulsive and “hot-blooded”]. We are looking for a lack of empathy for the victim. We are looking for callousness.”

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