The Anatomy of Violence

by Adrian Raine

  At the University of Pennsylvania, I was fortunate to rub shoulders with William Laufer, a professor of legal studies and business ethics at the Wharton School. Bill brought me up to speed on this neglected area of crime. We had assessed self-reported criminal offending in our community volunteers, and a bunch of them had owned up to white-collar crimes. They had done such things as cheating or conning a business or government agency for financial benefit, using computers illegally to gain money, stealing from work, or telling lies to obtain sickness benefits. It’s not as if Bill and I had a nice group of Bernie Madoffs to work with. Clearly, this is pretty run-of-the-mill stuff, but all of these offenses met the criteria of white-collar crime.122 And for Bill and me it was an initial entry into virgin territory.

  We matched twenty-one white-collar criminals with twenty-one individuals who admitted to criminal offending, but who had not perpetrated white-collar crimes. This was important, as our white-collar criminals had also committed offenses outside of the work context, and we needed to control for such offending. This is true of white-collar crime in general.123 So both groups had the same level of criminal offending. We also matched the groups on age, gender, and ethnicity; the only difference between them was the perpetration of white-collar crime. Working with Yaling Yang, we then compared the two groups on our neurobiological measures, and obtained some interesting group differences.124

  First—perhaps appropriately for the nature of the white-collar criminal—these offenders had better “executive functioning” as assessed by the Wisconsin card-sorting task. This neurocognitive task measures concentration, planning, organization, flexibility in shifting strategies to achieve a goal, working memory, and the ability to inhibit impulsive responding.125 Our white-collar offenders did appear to have skills that would normally make for quite a successful business executive.

  Second, they gave larger skin-conductance responses to both neutral auditory stimuli and “speech-like” stimuli. They not only gave bigger responses to the initial presentation of these stimuli—indicating greater attention—but they kept on responding to repeated presentations of these stimuli. They were able to sustain their attention. This greater orienting, or “What is it?” response reflects better functioning of the ventromedial prefrontal cortex, the medial temporal cortex, and the temporal-parietal junction,126 areas that we have seen previously to be dysfunctional in offenders.127

  Third—and perhaps most interestingly of all—the brains of the white-collar criminals were physically different from those of the controls. They showed greater cortical thickness in several regions of interest. They show greater thickness of gray matter in the ventromedial prefrontal cortex (BA 11), which is the lower part of the prefrontal cortex. They also showed increased thickness in a band of cortex that stretches across the lateral, outer surface of the right hemisphere of the brain. This includes part of the right prefrontal cortex (the inferior frontal gyrus—BA 44), the right motor cortex (precentral gyrus—BA 6), the right somatosensory cortex (postcentral gyrus—BAs 1, 2, 3), the right posterior superior temporal gyrus that forms part of the temporal-parietal junction (BAs 22, 41, 42), and the inferior parietal region of the right temporal-parietal junction (BAs 39, 40, 43).

  What can we make of these structural brain superiorities in the white-collar criminals? They are interesting for several reasons. First, the inferior frontal gyrus is involved in executive functions. This includes the ability to coordinate thoughts and actions in relation to internally generated goals, to respond to changes in task demands, the ability to inhibit a wrong response, to switch from one task to another, and to decide between conflicting reasoning.128 This is especially true of the right hemisphere, where we found the biggest group differences.129 Taken together with findings of better executive functioning, increased cortical thickness of this area is consistent with increased cognitive flexibility and regulatory control in white-collar criminals.

  Second, the ventromedial region has been associated with good decision-making, sensitivity to the future consequences of one’s actions, and the generation of skin-conductance responses.130 This structural advantage is again broadly consistent with the better executive functioning, skin-conductance orienting, arousal, and attention observed in white-collar criminals. But of even greater interest, this ventromedial region is involved in the monitoring of the reward value of stimuli, and also learning and remembering what things in life are rewarding.131 Intriguingly, we see the anterior, front region of this ventromedial area enhanced in white-collar criminals. Functional imaging studies have shown that this anterior area is specifically associated with abstract rewarding stimuli, particularly money.132 In contrast, less abstract and more fundamental rewards such as taste are processed in the more posterior region of the ventromedial area, a region that did not differ between the two groups.133 So, increased thickness specifically in this anterior region of the ventromedial prefrontal cortex suggests that white-collar criminals are particularly driven by abstract monetary rewards like money, as opposed to less abstract rewards.

  Third, the premotor area of the precentral gyrus is involved in your ability to monitor your performance, to make decisions, to plan, to program your actions, and to inhibit motor actions depending on the situation.134 It is also involved in the ability to understand the intentions of others’ actions135 and in social perception.136 So this structural enhancement is again broadly consistent with adept executive functioning and social cognition in white-collar criminals.

  Fourth, enhancement of the somatosensory cortex would be broadly consistent with better somatic marker functioning. Somatic markers are predicated on good functioning of both the somatosensory cortex, where these bodily markers are stored,137 and the ventral prefrontal cortex, where the somatic markers are processed.138 We’ve already seen that this latter area was enhanced in white-collar criminals. Unlike conventional criminals, who have somatic-marker deficits and poor decision-making skills, white-collar criminals may be characterized by relatively better decision-making skills.

  Fifth, the right temporal-parietal junction is important for social cognition and orienting.139 Social cognition involves the ability to process social information and to understand others’ perspectives.140 The temporal-parietal junction is also involved in orienting—directing attention to external events—and facilitating responses to these events.141 Because Brodmann areas 41 and 42 also make up the primary auditory cortex, increased cortical thickness of these areas may help account for the better orienting to auditory stimuli we found in white-collar criminals. This supports the hypothesis that they have better social perspective-taking and the ability to read others, which in turn may place them at an advantage in an occupational context to perpetrate white-collar crimes.

  Let’s put this all together to grasp the underlying neurobiology of what on the surface was barely considered a crime at all. White-collar criminals have relatively better executive functions and at times are more capable of making good decisions. They are more attentive to what’s going on around them and to what people say, as well as being better able to maintain their attention over time. They have a good social sense and know how to read others. They value rewards, particularly abstract rewards like money, and are both motivated and driven by them. They know when to act and when not to act, depending on the social circumstance. They can carefully calculate both the costs and benefits of acting or not acting, depending on the situation. There may indeed be a neurobiological, brain bias to white-collar crime.

  In chapter 3 we documented a software failure in the functioning of the brains of violent offenders. Now in this chapter—beginning with Herbert Weinstein—we have seen signs of a fundamental hardware failure in the brains of offenders that could underlie their functional brain impairments, a hard-drive failure that can trip the circuit on violence. This hard-drive defect lies in the frontal cortex and affects behavioral inhibition. It also lies in the amygdala at the level of emotion.

  Environmental factors—es
pecially 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.

  6.

  NATURAL-BORN KILLERS

  Early Health Influences

  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:

  The mumbling voice had a strange effect. Felt I was privileged to hear it. It had started to rain and I remember looking from the top of the slope over the valley and feeling I’d just experienced something fantastic. I looked across the valley, and all around, and thought of Heaven and Earth and how insignificant we all were. But I felt so important at that moment. I had been selected.1

  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.

  VIOLENCE AS A PUBLIC-HEALTH PROBLEM

  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?

  BORN BAD

  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.