The Anatomy of Violence (32 page)

Environmental factors—especially in the form of
head injury—play a critical role in causing brain impairments. Yet we have also
borne witness to unusual brain abnormalities that implicate greater—not reduced—volume in areas that include the
corpus callosum,
striatum, and
hippocampus. Taken together with the presence of cavum septum pellucidum in offenders, these volume distortions give rise to the hypothesis that offending may be the result of an early
neurodevelopmental
brain abnormality. We have also seen that these brain abnormalities are not specific to serious violence but may characterize nonviolent antisocial behaviors even you may have been committing.

Criminals do have broken brains, brains that are physically different from those of the rest of us. The differences are substantial and can no longer be ignored. This may smack of the “born criminal” and genetics and destiny. Indeed, in many of the prior chapters I have given strong credence to biological and genetic predispositions to violence. Yet this chapter also highlights the critical importance of the
environment
in shaping the
structural brain deformations that we find in violent offenders.

But even acknowledging this, our model is still overly simplistic. It’s not some neurobiological influence added together with some environmental
influence in a simple way that causes violence. As we shall see later, these oppositional processes instead
interact
in complex ways to shape violence. But before reaching that point we need to address the question of what external forces act on the brain to distort its structure and function. And continuing the neurodevelopmental theory of offending I have been outlining here, the next chapter will again focus on very
early influences on the brain beyond the individual’s control. The seeds of sinful violence are sown early by the grim reaper, and not just at the time of conception. As we are about to see, those seeds are cultivated in utero, at the time of birth, and also in the early postnatal period to give rise to the framework for violence.

Peter Sutcliffe had such a difficult birth that doctors didn’t think he would survive the night. He arrived at ten p.m. on June 2, 1946, in the Bingley maternity hospital in West Yorkshire. It was just one year after the end of another long war for England and there was a high mortality rate for newborns. But little Peter was a five-pound fighter. In spite of the birth trauma he suffered, the premature baby was released from the hospital after a dramatic ten-day struggle for life.

Following that early biological hit, young Peter grew up in Bingley as a pretty normal kid. He was very much like me. We both were born with
birth complications. Both of us were shy lads brought up in the north of England in a typical northern working-class home. We were both small for our age. And both of us were in a big family and brought up Catholic. It seemed that Peter had escaped the clutches of death—but had he? It was when he was a grave digger in Bingley Cemetery in 1967 that he experienced the pivotal moment of his life. He was bent over his spade, digging away at a new grave when he heard it. A vague, echoing
voice coming directly from the cross of a nearby Polish grave. Sutcliffe later described the day:

But selected for what? Slowly, over time, Sutcliffe came to realize that he was the instrument of God’s wrath against evil and sexual sin. His mission was to rid the world of the sin of prostitutes.

It was a
pivotal psychotic experience. From that point on, despite a happy marriage to a Polish immigrant schoolteacher, Sutcliffe began to dig graves in a very different way. He went from being a
broken baby in his mother’s womb to becoming one of England’s most prolific serial killers, a schizophrenic murderer who ripped open the wombs of thirteen prostitutes in Yorkshire.
²

In this chapter we will see that for some, the predisposition to a violent life begins even before babies have drawn their first breath. That’s right—the birth of the individual may literally mark the birth of the violent offender. As early as the time of conception, health is a strong factor in the equation. And it’s health in the
public domain that shall be our point of departure in this area of the anatomy of
violence.

We have seen in the previous chapters that there is substantial evidence for a
biological basis to crime
and violence. Moving from evolution to genes to central nervous system functioning to autonomic functioning, we have been slowly working our way through the anatomy of violence to argue something that a reasonable social scientist can no longer deny. There is in part a biological basis to violence.

Indeed, the question of
whether
brain deficits in individuals contribute to violence is, frankly speaking, no longer a useful one.
³
Since there is no longer any doubt that brain deficits contribute in some way to antisocial and aggressive behavior, we should instead be asking the more important question, What’s happening very early on in life to cause the brain abnormalities that we find in adult violent offenders? Once we can identify these early processes, we are halfway toward new intervention and prevention studies that reshape a child’s trajectory away
from violent offending. With this knowledge we can begin to reel in the unacceptable level of violence we see not just in the United States, with its high
homicide
rate, but also everywhere else in the world.

In this and the next chapter I’m going to focus on violence as a public-health issue. While it may seem odd to think of violence in the same way we think about conditions like obesity, AIDS, and flu epidemics, it has become a useful—and increasingly popular—way of approaching the problem. Indeed, the United States’
Centers for Disease Control and Prevention (CDC)
⁴
now views violence as a
serious
public-health problem, and the
World Health Organization (WHO), in the first world report on violence, defines this condition as a global public-health problem. Right now we have an epidemic of violence that is the
leading
cause of death across the world for those aged fifteen to forty-four.
⁵
In the United States, violence is the second-leading cause of death. It’s an enormous drain on our health-care system. The CDC puts the
cost at $70
billion
per year,
⁶
while also acknowledging that this is an incomplete measure of the total cost. It’s much more like $105 billion when you add in medical losses, lost earnings, and public program costs related to victim assistance—and that is in 1993 dollars.
⁷
The actual costs are truly staggering. WHO estimates that
gunshot wounds alone currently cost the United States health-care system $126 billion a year, with cutting and stab wounds adding an extra $51 billion to the bill.
⁸
In England and Wales, the cost of violence is estimated at $63.8 billion every year.
⁹
Some countries, including
Colombia and El Salvador, spend a full 4 percent of their gross domestic product in dealing with
just
the health-related problems associated with violence, let alone legal and judicial costs. Convert that to the GDP of the United States, and it’s half a trillion dollars—and imagine how that chunk of change can be better spent.

Clearly violence costs us. But is it really a public-health problem? Do we really need to think of violence in medical terms like this? Yes we do, and that’s the change in thinking that is occurring right now. Let me explain. Public health is part of
medicine
. It asks four questions. One, how often and in what situations does violence happen? Two, what are the causes? Three, what are the cures? Four, how can we apply treatments across the board in the general population? It is radically different from sociological perspectives, which view violence as a nonmedical issue. It is different from a clinical perspective that focuses on specific individuals rather than on the broader population. Medical practitioners
are right now becoming more and more involved in the treatment and
prevention of violence. Even
dentists
are taking this seriously.

Jonathan Shepherd is a professor of oral and maxillofacial surgery in the
School of
Dentistry at
Cardiff University. After moving to Cardiff in 1991 he was shocked not only to see so many victims of violence with facial injuries, but also to find that the vast majority of
bar fights that produced these injuries were not reported. Working in unison with law-enforcement agencies, he shared information that allowed the police to get a true picture of where the violent hot spots were in Cardiff. He worked with beer-glass manufacturers, persuading them to replace standard beer glasses with toughened glasses that were much more difficult to break and use as a weapon. The result of these public-health initiatives? A substantial reduction in injuries and a major contribution to making Cardiff not just a much safer city in Wales, but an exciting city to live in.
¹⁰
If someone in dentistry can make a difference, surely knowledge from other health fields can also make a contribution to the goal of violence reduction.

For this reason, we will now shift our attention from the dark chambers of our inner biological functioning to the outside, to shed light on how early
environmental
factors contribute to the disruptions we saw in brain and biological processing that were laid out in the previous chapters. What better way to begin this journey than as we began with Peter Sutcliffe, with the
birth of the child?

I found the
Rigshospitalet hospital in Copenhagen to be a truly imposing institution on my visit in 1991. Founded on March 30, 1757, and originally named for King
Frederick V, it’s the national hospital of Denmark. It’s a bustling institution with 8,000 personnel and nearly half a million patients to deal with every year.
Mary, the crown princess of Denmark, gave birth to her two children, Prince Christian and Princess Isabella, there. Prince Christian’s birth, on October 15, 2005, went very smoothly and was marked by a twenty-one-gun salute at noon, with beacons lit all over Denmark in national rejoicing. But for other boys born in the very same Rigshospitalet, birth is not so smooth and regal, and the outcome not quite as glorious.

In 1994 I published our findings on 4,269 live male births occurring
at the Rigshospitalet in 1959.
¹¹
Birth complications were assessed by obstetricians assisted by midwives. Examples of delivery complications included things like forceps extraction, breech delivery, umbilical-cord prolapse, preeclampsia,
¹²
and long birth duration. One year later, social workers went around to all the homes of the
mothers and conducted interviews. Had she wanted the pregnancy? Did she ever make an attempt to abort the fetus during pregnancy? Was her child placed in a public institution for any reason for at least four months in the first year of life? These three indicators of
maternal rejection of the child were duly noted. When these babies were eighteen years old, we conducted a national search of all court records in Denmark to find out which of the baby boys had been arrested for a violent crime.
¹³
We then classified them into four groups. Those with neither birth complications nor maternal rejection of the child in the first year of life were the normal controls. Some had birth complications, but had not been rejected by their mothers. Some were rejected, but had a normal birth. And the fourth group had the double whammy—
birth complications and rejection by their mothers in the first year of life.

The results were striking. As you can see in the top half of
Figure 6.1
, the first three groups did not differ significantly from each other, with rates of
violence at about 3 percent. It was the fourth biosocial group—the one with both the biological and the social hits—that had the highest rates of violence. This group had three times the average of the other three groups—9 percent of them became violent offenders. Furthermore, although only 4.5 percent of the population had both birth complications and
early child rejection, this small group accounted for 18 percent of all violent crimes perpetrated by the entire sample of 4,269—four times higher.
¹⁴
It’s a classic case of early biological factors interacting with social factors very early in life to shape adult violence.

A lot of violence is committed after the age of eighteen. Would this biosocial interaction also explain this later violence, or is it especially important in explaining early violence? We reassessed the entire birth cohort at age thirty-four for arrests for violent crimes. This resulted in a tripling of the sample size of violent offenders, allowing us to conduct more detailed analyses.
¹⁵
The results indicated that the biosocial interaction was specific to violent crime with an early onset. It did not explain violence that started later in life. In addition, we found the interaction to be specific to violent offending—it did not explain nonviolent
criminal offending. It seems that a violent
birth makes for violent behavior in particular.

Looking back at the three components of “maternal rejection,” were there any that were particularly important? Two of them were. First, rearing in a public-
care institution in the first year of life was critical. Second, an
attempt to abort the fetus also came up trumps. These were the two elements of maternal rejection that interacted with birth complications in producing later violence. In contrast, if the mother simply did not want the pregnancy but took no action, it did not seem to affect long-term outcome.
¹⁶
Furthermore, the interaction was found to be specific to more serious forms of violence like
robbery,
rape, and murder—but not for less serious forms like
threats of violence. It seems, then, that birth complications conspire with more severe forms of maternal rejection to launch particularly violent criminal careers.