The Psychopath Whisperer: The Science of Those Without Conscience (24 page)

Larry gave us all the nitty-gritty details of the Allegra system. He wowed us with the technical advantage, but he also told us about some of the problems. I could feel the Siemens sales rep cringe when Larry told us about the fact the system runs so fast it is hard to cool it down. I took notes in clear view of the Siemens sales rep. I planned to use these details to negotiate a fix on our system—and perhaps even lower the purchase price. Nevertheless, Siemens was on the top of the short list.

It was a great visit capped off with a lovely steak for Larry at Morton’s Steakhouse.

Now it was time for one more visit.

Hank and I went to visit GE. The company flew us to Wisconsin and showed us their plans for the next generation of research MRIs. We were wined and dined.

My friend Bryan Mock met us and he helped set up GE’s presentation in their lecture hall. A couple of other guys were running the show, and they told us all about the latest GE hardware and software.

I asked them about the software bug that allowed us to collect only 512 images in succession before stopping and restarting. They hadn’t fixed that problem yet. The salesmen then showed us a bunch of new options and data processing pipelines. I asked questions and pointed out limitations and potential flaws in their system and pipelines. The salesmen were clearly not technically oriented. I noticed Bryan crack a smile from his seat in the corner. Their design was geared toward a turnkey clinical system, and it was not research friendly.

I was probably a little hard on the salesmen, but I was trying to prove to Hank that I was the right person for the job and that I had done my homework.

As we left GE’s headquarters, I walked out with the vice president for MRI development. I told him that Bryan Mock knew how to fix all the problems that I raised during our visit. I suggested he promote Bryan to run the development unit—that Bryan would make GE competitive again in the functional brain imaging field.

But for me, GE was off the table. Their technology at the time was not competitive in functional neuroimaging.

Hank and I regrouped in his office the beginning of the following week. I presented my argument for purchasing a Siemens Allegra. I showed Hank the original list price and then the final negotiated price. I’d also gotten Siemens to guarantee the delivery date of the system to coincide with construction of our new research building. I’d also negotiated all the finer points—stability testing, up-time guarantee (with penalties for noncompliance), and service contract terms and price. All in all, I had tapped the expertise of nearly every director of an MRI program in the country. I had wanted to make sure we got a good system and a good deal.

Hank was pleased, and we ordered the Allegra. Hank mentioned that I had saved over one million dollars off the list price. A week later a very nice bonus showed up in my paycheck. I was going to like living in Connecticut.

One of the main donors to the Institute of Living had been the Olin family, a family who had had a number of children treated at the IOL. Dr. Hank Schwartz had decided to name our new research building in their honor. Remodeling the 1870s English Tudor–style building was my next job.

The preliminary plans had the building organized like a doctor’s office, with patient waiting rooms outside each office. I changed the design plan to include only one central waiting room near the first-floor front entrance. The reorganization added about five additional offices, for a total of fourteen offices on the second floor. Then I noticed there were no bathrooms on the second floor, so we fixed that. Patient rooms were added so we could conduct interviews and testing.

I worked with an acoustical engineer to make sure the MRI suite was soundproof. The design proved to be so quiet that visitors to the control room would often ask if the machine was working. The MRI techs were happy they didn’t have to listen to the constant beeping the MRI makes while it is collecting data.

During the process of buying the MRI and redesigning the research building, I also helped Dr. Schwartz recruit a center director. Dr. Schwartz wanted to hire a senior psychiatrist who had a breadth of experience but a focus on schizophrenia. After reviewing a number of candidates, we selected Dr. Godfrey Pearlson from Johns Hopkins University. Godfrey was known for his studies of brain structure in schizophrenia, and he wanted to expand into functional MRI and other brain connectivity measures.

Godfrey also asked us to interview Dr. Vince Calhoun, who would join the center as an assistant professor. Vince was the electrical engineer I had met via e-mail many years earlier when we were both trying to solve data collection problems we were having with our GE scanners. He was developing new ways to analyze brain networks using functional MRI data. Vince would be a fantastic hire.

I recommended to Hank that we hire them both, and we did. The core of the center was formed.

Godfrey was an experienced researcher, and he quickly filled the Olin Center with new staff and postdocs. We started writing grants emphasizing the unique and untapped clinical resources of the IOL. The inpatient wards at the IOL had more than three thousand psychiatric admissions per year. It was a clinical gold mine.

I formed my research team and started writing grants to be submitted to the National Institutes of Health to fund my research aims. For my psychopathy work, I planned to recruit psychopaths while they were on probation or parole in the community. In schizophrenia I was interested in one main goal. I wanted to know if brain imaging could be used to help diagnose the condition at early phases, perhaps even before the onset of serious symptoms. This advance might aid in the diagnosis of the condition, but critically, early treatment might minimize the tragic progression of the disease.

Dr. Peter Liddle, one of my graduate mentors, had hypothesized that functional brain activity could be used to help predict whether youth would develop the illness.

I brought the ideas Dr. Liddle had started to the Center and sought to develop new paradigms to address the problem of early diagnosis in schizophrenia. In addition to the new paradigms, I was also armed with Dr. Calhoun’s new algorithms for analyzing brain imaging data. Together we had created a powerful team of researchers, and we soon started to win grants from NIH to pursue our ideas.

In parallel to my grant writing, I continued to analyze the prison data from graduate school.

A couple of the studies I conducted before leaving Canada had their roots from insights I gleaned through my clinical experiences with the inmates. After I had finished my master’s thesis, I was asked by the director of the psychology clinic at the Regional Health Centre Prison, Dr. Carson Smiley, to sit in on group treatment classes for the violent offenders and sex offenders. The Canadian Department of Corrections allows master’s-level psychologists to serve as clinicians. Dr. Smiley wanted me to learn more about the
group therapy they were conducting so that I might be able to contribute to improving it. He also wanted to know if the neuroscience I was conducting might give them some insights into the deficits psychopaths experience. The goal was to use my neuroscience findings to help develop better treatments for psychopaths.

At the time, I really didn’t know much about treatment for violent offenders or sex offenders, but I figured it would be a good experience, so I agreed to help. The psychiatric nurse ran the therapy sessions, and I sat in the room and observed.

The therapy sessions employed cognitive behavioral therapy, or CBT. CBT is a type of talk therapy that tries to get people to look at problems from a different perspective, using a goal-oriented, systematic approach. With violent offenders and sex offenders, CBT is used to challenge individuals on their maladaptive thinking patterns and beliefs. The goal is to replace these maladaptive errors in thinking with more constructive patterns that will reduce future antisocial behavior.

I noticed in these group therapy sessions that psychopaths could not grasp abstract concepts. For example, the nurse would often use metaphors to emphasize her points. In more than a few cases, the psychopath she was speaking to just stared back at her with a blank expression.

I had seen that expression on the faces of psychopaths before. It was a
tell
—just like in poker. The facial
tell
was apparent when I would ask psychopaths about whether they worried about things. The classic example of the type of worry I am referring to is the kind that occurs in individuals who suffer from obsessive-compulsive disorder (OCD). Individuals with OCD worry all the time about things; for example, being concerned that they have left the stove on every time they leave the house. Eventually, it can escalate to the point where people with OCD won’t leave the house because they are so worried they left the stove on and they have to constantly go back and forth to make sure that it is off.

If you ask a psychopath if he or she has ever worried about leaving the stove on after leaving the house, you will get this blank expression I am referring to. Psychopaths have no concept of what worrying like this is like. Psychopathy and OCD are at opposite ends
of the spectrum. I’ve never met a psychopath with OCD—I don’t believe one has ever existed.

I was fascinated to see that psychopaths were unable to appreciate metaphors. It seemed that psychopaths were able to understand concepts only if they were presented in concrete terms. I quickly designed a series of studies to examine whether the psychopaths’ inability to process abstract concepts generalized to more simple stimuli. My first study examined how psychopaths process abstract and concrete words.

Psychologists break down words in a number of different ways. They can be broken down by their frequency of usage in the population. For example, a low-frequency word would be
aardvark
and a high-frequency word would be
deer
. It turns out your brain processes common words differently than uncommon words.

The brain also differentiates abstract words from concrete words. Abstract words are ones that don’t have any physical meaning. For example,
finite
is an abstract word, while
table
is a concrete word. I developed a database of concrete and abstract words that were matched on things like frequency of usage, word length, and number of vowels. I wanted to know whether psychopaths differentiated concrete from abstract words under different conditions. I made sure that all the concrete and abstract words were neutral in affect. I didn’t want my studies of abstractness to be confounded by the emotional processing deficits in psychopaths.

But I also wondered if the psychopaths’ emotional abnormalities might be due to deficits in processing abstract information. After all, emotional words are often abstract. “Love” for example, is a highly abstract word. It means many different things to people, and it doesn’t necessarily have a concrete meaning. People use poems, musicals, and theater to describe the abstract aspects of love—but what does love really
feel
like?

I always ask psychopaths during interviews, “What does love mean to you?” The most common answer is “sex.” That answer is often followed by the psychopath describing his favorite sexual escapades. Psychopaths get stuck on the physical, the concrete, and they fail to describe the abstract connections that love provides.

In my first studies, I used brain waves to examine the neural
response in psychopaths to abstract words. I found that psychopaths did not show the same brain wave differences between concrete and abstract words as nonpsychopaths and healthy individuals did.
²

The brain is truly amazing at differentiating different word types. One hundred and seventy-five milliseconds after the word is presented, the brain has started to put abstract words on a different processing path than concrete words.
³
But for psychopaths, brain waves show that all words were processed in the same way, going down the same path. Their brains did not respond differently to abstract and concrete words.

It seemed pretty clear from these brain wave studies that psychopaths were impaired in processing abstract words; something was wrong in the neurocircuitry of their brains that prevented the two types of words from being processed differently.

Next I used the fMRI technique to find out
where
in the brain things were going wrong in psychopaths while they processed abstract words. In nonpsychopaths, the right anterior temporal pole is the critical node for differentiating abstract representations of speech, including the difference between abstract and concrete words (see
Figure 5
). As predicted by my research, psychopaths showed huge deficits in this region of the brain when processing abstract words.
⁴

The temporal pole is the area that integrates information from our senses: like integrating video and sound together to make a movie. One way to think about the deficits in psychopaths is that they have problems putting the abstract content in the story line.

The research suggested that the reason psychopaths failed so badly in treatments that emphasized abstract concepts was that their brains were unable to process them. If psychopaths were going to benefit from treatment, the neuroscience data were telling us that the treatment must be presented in simple, concrete terms.

My graduate research studies from Canada had indicated a number of brain regions were impaired in psychopaths: the amygdala, hippocampus, anterior and posterior cingulate cortex, and the temporal pole. Other scientists had shown that the orbital frontal cortex was also impaired.

A summary of the regions believed by the start of the twenty-first century to be implicated in psychopathy is outlined in
Figure 6
.