The Psychopath Whisperer: The Science of Those Without Conscience (22 page)

Ideally, we would like the different assessment procedures to converge on very similar answers. This would help to develop a more coherent set of research findings and move the field forward more quickly. Nevertheless, the diversity and explosion of research in this area has led to a number of very important discoveries.

Among them, studies have shown that CU traits are fairly stable from childhood into adolescence and into early adulthood.
¹⁰
Indeed, CU traits appear to be more stable than conduct disorder traits (i.e., impulsivity, acting out) over time. More important, CU traits predict pretty well which children will go on to be convicted of crimes as adults.
¹¹

Research has even shown that CU traits assessed in boys between the ages of seven and twelve predict their psychopathy score when they reach age nineteen.
¹²
And Lyman and colleagues (2007) reported measures of CU traits at age thirteen that predicted adult measures of psychopathy at age twenty-four.
¹³

The implications of this research have led psychologists to propose that
DSM-5
includes a child conduct disorder subtype that carefully assesses and includes CU traits.
DSM-5
, which was released in May 2013, has added a new conduct disorder subtype:
limited prosocial emotions
.

The new specifier of conduct disorder with
limited prosocial emotions
is the first attempt of the
DSM
to capture the relative importance of CU traits in the assessment of high-risk youth. Hopefully, this new subtype will capture these latter traits better than previous
iterations of the
DSM
, but at the time of the writing of this book there was little research completed on this new
DSM-5
subtype.

In summary, research over the last twenty years has led to great advances in our understanding of how CU traits manifest themselves in children. We are moving rapidly toward being able to identify children who are at the highest risk for developing lifelong personality disorders. By getting the diagnosis correct, we can avoid incorrectly labeling such kids as having ADHD or childhood bipolar disorder or some other malady. As this research continues, we may be able to find ways to manage and perhaps even treat these children.

In addition to using scales or instruments to measure CU traits, psychologists and neuropsychologists have developed tasks or games to try to examine the systems of the brain associated with these symptoms. One game or task that researchers employ is called the
emotional lexical decision task
. A lexical decision is like a spelling test. Strings of letters are briefly flashed on a computer screen, and the participant has to decide if the letters form a real word or whether it is a nonsense or misspelled word. When the letter string forms an emotional word (“hate,” “kill,” “die”), people are faster to respond than if the word formed by the letter string is a neutral word (“table,” “chair,” “arm”). Processing emotional words taps into a brain system that makes us recognize the word very quickly. It turns out that the brain system believed to be giving the “boost” is the amygdala—the amplifier in the brain that helps us pay attention to important salient events.
¹⁴

The emotional lexical decision task was first used to study adult male psychopaths in prison. In a paper published in 1991, graduate students Sherrie Williamson and Tim Harpur, along with their mentor, Dr. Robert Hare, found that, unlike normal people, criminal psychopaths failed to show faster responses to emotional words than to neutral words. This was seen as evidence that psychopaths
“know the words but not the music.” In other words, psychopaths know what “love,” “hate,” and “kill” mean, but they don’t
feel
the affective impact these words convey.

As an undergraduate at the University of California, Davis, I had a mentor who was a professor who studied how the brain processes language, Dr. Debra Long. When I told Dr. Long about the emotional lexical decision finding in adult psychopaths, she became interested in using this task to study whether college undergraduates would show deficits. So we used the Levenson Self-Report Psychopathy Scale (LSRP)
¹⁵
to examine whether self-report psychopathy scores would correlate with response times on the emotional lexical decision task in UC Davis undergraduates. We found that they did. The higher the college undergraduates scored on psychopathy, the worse they were at processing emotional words. We also found that high LSRP scores predicted which students would cheat on tests and encounter other student problems on campus.

Subsequent to these findings, researchers have shown that youth with CU traits show impairments in emotional lexical decision and related tasks.
¹⁶
In other words, CU traits in youth (and in adults) are linked to abnormalities in how the brain processes these affective stimuli.

A number of additional studies and tasks that have been developed over the last decade or so show that youth with CU traits and adults with psychopathy have deficits in processing emotional stimuli. These results are consistent with letters from the parents of such kids who ask if their children have an emotional learning disorder.

But as good as these tests are at teaching us what’s wrong in these children, they are at best proxies for what is really happening in the brains of these children. To continue to examine in more detail how CU traits are manifest in the brain, researchers need to study the brain itself.

As I discussed in
Chapter 4
, the latest advances in MRI techniques permit scientists to study the brain in action. The functional MRI procedure is completely noninvasive and can be used to study children and adolescents. For example, we can put youth in an MRI scanner and show them pictures depicting emotional situations (i.e., results of a car crash) or pictures of neutral scenes (i.e., a car parked in front of a building). By mapping the brain’s response to these pictures, we can show that it engages very differently for emotional pictures than it does for neutral pictures. In this way we can probe how the emotional systems of the brain are working. Indeed, scientists now can map out pretty much any process in the brain with this technology. Reading ability, mathematics, decision making, even moral decision making, are but a few of the kinds of processes in the brain that can be studied with fMRI. This technique has caused a revolution in the field of neuroscience in general, and the field of psychopathy in particular.

Children, however, present with some unique difficulties when you try to measure their brain function in an MRI. First, they need to lie still for about an hour, something that many children have difficulty doing. Children who are impulsive and agitated are even more likely to move around in the MRI scanner. And moving around in an MRI scanner while we are trying to collect data effectively blurs out the pictures of the brain and prevents usable data from being collected.

Childhood is also a time of rapid neuronal development, which can complicate scientists’ ability to understand or interpret differences between two groups of children. Sometimes it might not be possible to know if an abnormality is just a delay in development or a true deficit that might last a lifetime.

At the time of the writing of this book, only about a half-dozen brain imaging studies have been published on children with elevated CU traits. But interestingly, these studies are finding pretty similar results. In one study, researchers found that the children
with CU traits failed to activate the amygdala while viewing fearful faces.
¹⁷
The failure of the amygdala—an important part of the brain’s emotional system—to engage when processing fearful faces may be part of the reason why children with CU traits are so aggressive. If two children are fighting, and one displays a petrified, fearful face, it is likely the fight will stop. But if the child with CU traits gets no signal or input from his or her amygdala when viewing the other child’s fearful face, the fight may continue, and even escalate, with more severe injury as a result. The child with amygdala deficits might also get into more fights than other children.

Another area of the brain that appears to be abnormal in children with callous conduct disorder is the bit of the brain right above the eyes, the orbital frontal cortex. This very important part of the brain is responsible for determining a lot of our personality. Several studies have shown that callous conduct disordered children show impairments in the engagement of the orbital frontal cortex during learning tasks.
¹⁸
Among the implications from this research is that children with CU traits do not learn from punishment in the same way as other children. In other words, punishment, or even the fear of punishment, is not restraining the behavior of these children in the same way it does for other children. The children with CU traits simply do not learn from punishment.

This work may have profound implications for how children with CU traits are managed. It also may have major implications for how parents raise these children.

The year was 2000, and my time in British Columbia was
coming to an end. My main thesis adviser, the father of modern research in psychopathy, Dr. Robert Hare, had retired from the University of British Columbia, and my postdoctoral supervisor, Dr. Peter Liddle, had decided to move his family to Nottingham, England. I was on the job market. I’d sent out a dozen applications for academic positions. I prepped and practiced my job talk for upcoming interviews. At the time I was unclear whether I was going to do another postdoc or whether I should try to go straight for a faculty position. I was just testing the water to see what was out there.

Over the next few months, I interviewed at the University of Wisconsin, the University of Florida, Yale University, and the University of Connecticut Health Science Center. All expressed interest in hiring me. At Yale the faculty had wanted me to take a position conducting brain imaging studies of posttraumatic stress disorder (PTSD). Yale was committed to researching and developing a better understanding of the brain processes involved in that condition.

Interestingly, the brain systems involved in PTSD are nearly the same as those involved in psychopathy, only in the opposite direction. Individuals with PTSD show exaggerated brain activity in the
amygdala and anterior cingulate in response to salient stimuli. Psychopaths show the opposite—reduced activity. I thought it might be a good match at Yale. I could do a few years studying PTSD and then see if I could create opportunities to continue my psychopathy research. The forensic psychiatry program at Yale was top-notch, and the professors expressed a great deal of interest in my brain imaging findings on psychopaths.

The University of Connecticut Health Science interview was for a postdoc with Dr. Vince Clark. I’d met Vince years earlier when I showed him my weird psychopath brain waves at a scientific conference. Vince had studied brain waves for years and he found my results fascinating. Vince had just received a new grant from the National Institute on Drug Abuse (NIDA) examining the P3 brain wave and fMRI activity in substance abusers. With his collaborators at UConn, he found that the amplitude of the P3 brain wave predicted which individuals with substance abuse would relapse to drugs. It was a fascinating finding—the smaller the P3, the more likely the individual was to relapse to substance abuse. I wondered whether the P3 would predict which convicted felons would go on to commit other crimes.

Vince and I had a great interview. But as we were wrapping up, he told me that as much as he wanted me to come do a postdoctoral fellowship with him, I was doing extremely well so far in my career and I should take a permanent faculty position if I could get one.

Then he asked me to give another lecture while I was in Connecticut. There was a group forming a new research center and while I was in town I might as well go talk with them. The lecture was to take place at an organization I’d never heard of before, the Institute of Living.

In my hotel room I went online and found out that the Institute of Living (IOL) was the third-oldest asylum in the United States. It was located on a large campus in the middle of Hartford, the state capital.

The next day Vince picked me up at my hotel and drove me over to the IOL for my noon talk. The grounds of the IOL were immaculate.
The trees were blooming in all their fall glory, and the brick hospital buildings provided the perfect backdrop. Vince told me that the grounds were designed by Frederick Law Olmsted, the landscape architect who designed Central Park in New York City. Rumor had it that Olmsted designed the grounds while he was a patient at the IOL.

The IOL has a rich and long history in psychiatry. The famous psychiatric patient HM (H.M. were the patient’s initials) had been treated here. HM had suffered from intractable epilepsy, and surgeons had performed a radical bilateral resection of his temporal lobes to try to treat his seizures. The surgery removed the left and right sides of HM’s brain that controlled memory; it helped to alleviate his seizures, but HM developed a unique memory problem. He could no longer encode new events. If you met him, talked to him, and then left and came back fifteen minutes later, he would not recall having met you. HM never recovered the ability to encode new memories. Apparently, he lived just around the corner from the IOL in a West Hartford retirement community.

After using the bathroom, I entered the auditorium to find four people eating their lunches—Vince and three very senior-looking men.

Vince introduced me to them: Drs. John Goethe, Les Silverstein, and Harold Schwartz. All were in their mid to late fifties and seemed far more interested in their lunches than in my lecture.