We need to talk about Kevin (and psychopathy)

We need to talk about Kevin has been described as masterful. But the film (or book) will probably leave you horrified. And perhaps you will be wondering about psychopathy afterwards. Psychopathy is characterized by “persistent antisocial behavior, impaired empathy and remorse, and bold, disinhibited, egotistical traits”, according to Wikipedia.

People with psychopathy make up 25% of the prison population and are responsible for a disproportionate amount of violent crime. In addition to the obvious and tragic human cost of violent crime, In the U.S., psychopathy has been estimated to come with an annual price tag of around $460 billion. By comparison, the cost of alcohol-abuse is “only” $329 billion, and smoking trails in at a comparatively paltry $172 billion.

We need to talk about psychopathy.

And indeed, we already have: In an earlier post we reported on a study that examined how individuals with greater or lesser psychopathic tendencies responded to watching other people’s pain—lack of empathy, or the inability to feel other people’s pain and suffering, is a psychopathic trait. Perhaps unsurprisingly that study found that people with higher affective-interpersonal psychopathic traits showed reduced neural responses to others’ pain. That is, people who revealed little “affective resonance” when filling in the questionnaire that examined their psychopathic traits showed little brain activity in those regions of the brain that are typically associated with empathy. (There were other nuances in the results, available here.)

A recent article in the Psychonomic Society’s journal Cognitive, Affective, & Behavioral Neuroscience shed further light on moral processing in psychopathy. Researcher Samantha Fede and colleagues examined a large sample of around 250 incarcerated adult males and observed their brain activation in an fMRI scanner during performance of a task that required a moral judgment.

This study targeted an important question that previous research has left unresolved: can psychopathic individuals correctly make moral judgments? The evidence on this is, perhaps surprisingly, quite mixed. Very often psychopathic individuals do not differ behaviorally from non-psychopaths on tasks that require stimuli to be classified as morally right or wrong (e.g., “theft” vs. “charity”).

Fede and colleagues investigated the neural correlates of processing of three types of moral stimuli: wrong (“theft”, “slavery”), not wrong (“charity”, “kindness”), and controversial (“euthanasia”, “prostitution”). Because the participants were incarcerated, the research took place in a mobile fMRI facility inside a prison.  Participants were presented with the stimuli one at a time, and indicated via button press whether they thought the word or phrase was morally wrong or not wrong. No information was provided to participants about what “morally wrong” meant, although they were told that there were no right or wrong answers.

In addition, participants’ psychopathy score was measured via questionnaire and structured interviews by skilled researchers. When those psychopathy scores were related to participants’ decisions, it was found that individuals with high psychopathy scores rated more stimuli overall as being not wrong than did individuals low on psychopathy. Thus, prostitution or theft does not appear as wrong to a psychopathic individual as it does to others.

Of even greater interest were the imaging data. Based on previous research, Fede and colleagues hypothesized that psychopathic traits would be inversely related to activity in regions that are known to be engaged in healthy moral processing. Specifically, Fede and colleagues expected activation in the amygdala, anterior cingulate cortex (ACC), posterior cingulate (PCC) and the temporal parietal junction (TPJ) to be depressed in psychopathic individuals, relative to non-psychopaths, during processing of wrong stimuli. Additionally, the ACC was also expected to be less engaged in psychopathic than non-psychopathic individuals during processing of not-wrong stimuli.

The hypotheses were partially supported. In confirmation of predictions, Fede and colleagues found a negative relationship between psychopathy score and activity in the ACC. Further inspection revealed this pattern to result from a reduction in the difference of brain engagement between the ‘wrong’ and ‘not wrong’ stimuli, suggesting that recognizing the distinction between right and wrong has a unique neural signature in the ACC that is attenuated in psychopathic individuals.

When Fede and colleagues examined the brains response to controversial stimuli, they again found a suppression of activity in the ACC, as well as in TPJ, in psychopathic individuals. Fede and colleagues conclude that “our study indicates that psychopaths do not recruit moral decision making or cognitive neural resources to the same extent that nonpsychopaths and healthy controls do during challenging moral dilemmas.”

Do these results imply that psychopathic individuals, and the society on which they impact, are doomed to remain psychopathic? Are their brains “wired differently” from non-psychopathic individuals?

Other research suggests that this need not be the case. For example, at one treatment center in Wisconsin, an intensive treatment program based on social skill acquisition and development of conventional social bonds has been found to be highly successful with juvenile offenders who score high on psychopathic traits. Specifically, whereas misconduct and security incidents at the outset of the treatment were predicted by individuals’ psychopathy scores—as one might expect in a prison population—at the end of treatment initial psychopathy scores no longer played a role. Instead, what mattered to predict behavior at the end of the treatment was only the duration of treatment: the longer the offenders had been treated, the better adjusted their behavior had become. Remarkably, violent recidivism during a 4-year follow-up period was also no longer predictable on the basis of initial psychopathy scores: instead, what mattered were the final behavioral scores in the institution.

In other words, it appears that the moral processing of psychopathic individuals has a distinct neural signature. However, an intensive prolonged treatment can reduce psychopathic behaviors and can reduce recidivism over considerable time spans. Neural signatures can help us identify what type of processing is impaired in psychopathic individuals, but that impairment by itself need not present an obstacle to successful treatment.

Article focused on in this post:

Fede, S. J. Schaich Borg, J., Nyalakanti, P. K., Harenski, C. L., Cope, L. M., Sinnott-Armstrong, W., Koenigs, M., Calhoun, V. D., & Kiehl, K. A. (2016). Distinct neuronal patterns of positive and negative moral processing in psychopathy. Cognitive, Affective, and Behavioral Neuroscience. DOI: 10.3758/s13415-016-0454-z.

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