The Anatomy of Violence

by Adrian Raine

  Yet there is one piece missing. It is this juncture in our journey—what you see in the dynamic center part of the model—that we will now focus on. The lightning bolts represent striking out the biosocial pathway to adult violence. So what are the biosocial interventions that can block the development of conduct disorder and violence?

  IT’S NEVER TOO EARLY

  One approach to stopping violence—one that we see all too often today—is to wait until the child is already kicking down the doors and becoming unmanageable. Unfortunately, by then it’s often too late to effectively correct course. Why not intervene early in life to prevent future violence?

  That’s what David Olds did in a landmark study that won him the Stockholm Prize—criminology’s equivalent to the Nobel Prize. You’ll recall that mothers who smoke during pregnancy have offspring who are three times more likely to become adult violent offenders.5 Birth complications are another risk factor.6 We also discussed how poor nutrition during pregnancy doubles the rate of antisocial personality disorder in adulthood.7 We’ve noted the importance of early maternal care during the critical prenatal and postnatal periods of brain development.8 Alcohol during pregnancy is also associated with later adult crime and violence.9 These are the biosocial influences that David tackled.

  His sample consisted of 400 low-social-class pregnant women who were entered into a randomized controlled trial. The intervention group had nine home visits from nurse practitioners during pregnancy, with a further twenty-three follow-up visits in the first two years of the child’s life—a critical time window in child development. The nurses gave advice and counseling to the mothers on reducing smoking and alcohol use, improving their nutrition, and meeting the social, emotional, and physical needs of their infant. The control group received standard levels of prenatal and postnatal care. Follow-ups were made on the offspring for fifteen years.

  The results were dramatic. Compared with controls, the children whose mothers had nurse visitations showed a 52.8 percent reduction in arrests and a 63 percent reduction in convictions. They also showed a 56.2 percent reduction in alcohol use and a 40 percent reduction in smoking. Truancy and destruction of property were reduced by 91.3 percent. These effects were even stronger in mothers who were unmarried and particularly impoverished.10

  Why was this early intervention so effective? Clues come from other effects of the program. The babies of mothers visited by nurses were less likely to have low birth weight. When the children were age four, the mothers and children were more sensitive and responsive to each other. There was less domestic violence. More of these mothers enrolled their children into preschool programs. The homes became more supportive of early learning. The mothers’ executive functioning also improved, and they had better mental health. These improvements were especially true for mothers who were less intelligent and competent.11 When the children were age twelve, the mothers were less impaired from alcohol and drug use, their partnerships were lasting longer, and they continued to have a greater sense of mastery.12

  Providing those mothers most at risk for having wayward offspring with health information, education, and support can reverse later adolescent problems that are the harbingers of adult violence. David Olds was tackling not just the social risk factors we see in Figure 9.1, but also the biomedical health factors that join forces with social risk factors to create antisocial behavior. He was tackling the biosocial part of the equation in Figure 9.1, and that’s why it worked so well.

  The cost of the intervention per mother was $11,511 in 2006—but the government saved $12,300 in food stamps, Medicaid, and other financial aid to the families. The government actually spent less on the intervention group than they spent on the control group.13 And that’s not counting the savings brought about by reducing crime, and the incalculable benefits of improving people’s lives.

  IT’S NEVER TOO LATE

  You’ll remember Beauty and the Beast from Mauritius in chapter 4. Joëlle, who became Miss Mauritius, and Raj, the biker who became a career criminal. They were two of the three-year-old children in the study that my PhD supervisor Peter Venables set up—an environmental enrichment from ages three to five that tells us that while it’s never too early to start to prevent crime, it’s also never too late.

  What did our enrichment intervention consist of? It started at age three, had a duration of two years, and consisted of three main elements: nutrition, cognitive stimulation, and physical exercise. The enrichment was conducted in two specially constructed nursery schools. Staff members were brought up to speed on physical health—including nutrition, hygiene, and childhood disorders. They also received training on physical activities, including gymnastics and rhythm activities, outdoor activities, and physiotherapy. They were trained on multimodal cognitive stimulation with the use of toys, art, handicrafts, drama, and music.14 A structured nutrition program provided milk, fruit juice, a hot meal of fish or chicken or mutton, and a salad, each day. Physical-exercise sessions in the afternoons consisted of gym, structured outdoor games, and free play. The enrichment also included walking field trips, basic hygiene skills, and medical inspections.15 In fact, there was an average of two and a half hours of physical activity each day. Cognitive skills focused on verbal skills, visuospatial coordination, concept formation, memory, sensation, and perception.

  What happened to the control group? These kids underwent the usual Mauritian experience of attendance at petite écoles that focused on a traditional ABC curriculum.16 No lunch, milk, or structured exercise was provided. For lunch, children typically ate rice and bread.

  Stratified random sampling was conducted to select which 100 of the 1,795 would enter the environmental enrichment. From the remainder, 355 controls were selected who matched the enrichment group on ten cognitive, psychophysiological, and demographic measures. We then followed up on the children for eighteen years.

  What were the results? At age eleven we reassessed the children on a psychophysiological measure of attention—skin-conductance orienting. The bigger the sweat-rate response to the tones played over headphones, the greater the attention that is being paid. The two groups were matched very exactly on this measure at age three—before the intervention began.17 When they were retested eight years later, at age eleven, the enrichment group showed a 61 percent increase in orienting—a big jump in their ability to focus their attention and be alert to what was going on around them.18

  We also measured their EEG—brain-wave activity—at age eleven. Brain waves can be grouped into four basic frequency bands. Right now, as you are reading this, fast-wave beta activity predominates because your brain is aroused and activated, scanning this page, absorbing the text, and forming associations. When you are relaxed, alpha predominates. When you are asleep, however, slow-wave delta activity takes over. When you are awake but not very alert, you have more sluggish theta activity. Children in general have relatively more slow-wave theta activity because their brains are immature and still developing. We found that children from the environmentally enriched group showed significantly less theta activity than the controls six years after the intervention had finished.19 Their brains had matured more and become more aroused. In developmental terms their brains were 1.1 years older than those of the controls.20

  We then followed the children up for another six years, and behavior problems were assessed at age seventeen. The enriched children had significantly lower scores on ratings of conduct disorder and hyperactivity. They were less cruel to others, not so likely to pick fights, not so hot-tempered, and less likely to bully other children. In addition, they were less likely to be bouncing around the place and seeking out stimulation.21

  We continued to follow them. When they were aged twentythree we interviewed all the subjects on their perpetration of criminal offending using a structured interview to measure self-reported crime.22 Those who admitted to committing a criminal offense were categorized as an offender. In addition, we also scoured every single courthouse in Mauritius
and searched the records for registrations of offenses that included property damage, drug use, violence, and drunk driving—we excluded petty offenses like parking fines or a lack of vehicle registration. The enriched children showed a 34.6 percent reduction in self-reported offending compared with controls.23 For court convictions the enriched group had a much-reduced rate of offending, at 3.6 percent compared with 9.9 percent in the control group—but this difference just failed to reach statistical significance.24 The enrichment really did seem to make a difference—even twenty years later.

  That was interesting, but something else piqued our interest even more, which you can see in Figure 9.2. You’ll recall that pediatricians had assessed the children for signs of malnutrition at age three—before the intervention had begun. On the left-hand side of the figure, kids with normal levels of nutrition at age three who went into the enrichment showed only a small and statistically nonsignificant reduction in conduct disorder. In contrast, when we looked just at those kids who entered the study with poor nutrition, we found that the enrichment showed a 52.6 percent reduction in conduct disorder at age seventeen compared with controls.25 You can see that on the right-hand side of the figure. Early nutrition status moderates the relationship between the prevention program and the antisocial outcome. It works in one group—but not in another. Recall that the prevention program had a lot of ingredients. If nutrition was the active ingredient, you’d expect the program to work more in kids who had poor nutrition at the get-go—and that’s exactly what we found.

  Figure 9.2 Reductions in age seventeen conduct disorder are greater in children who had poor nutrition when they entered the enrichment

  It might be that better nutrition makes the difference—but could it be something else? This was the first study to show that early environmental enrichment increases physiological attention and arousal in the long term in humans. That gives us a clue to the mechanism of action—brain change. The prevention program had more physical exercise and outdoor play, and exercise by itself could account for some of the observed effects. Exercise in animals is known to have beneficial effects on brain structure and function.26 For example, we know that in mice environmental enrichment produces neurogenesis—new brain cells growing in the dentate gyrus of the hippocampus—that is entirely attributable to running.27 So it could be something as simple as the daily walks and running around in free play that the children in the enrichment group got that improved hippocampal functioning and reduced adult crime.

  Another hypothesis is that the increased social interaction with positive, educated preschool teachers in the experimental enrichment may in part account for the beneficial effects. On the other hand, it may be unreasonable to focus on any single component of the intervention. Instead, the multimodal nature of the prevention program, which combined social and cognitive components alongside nutrition and exercise, may have facilitated biosocial interactions that affected later development. Just as we saw in the model, the biosocial interaction is central to the explanation of crime. Similarly, with prevention it’s a question of covering all the bases to block bullying behavior in children and violence in adults.

  More intriguingly, perhaps the crime reduction can be chalked up to the young children eating fish. In Mauritius, I met with three of the original interventionists to reconstruct the typical week’s food intake for the enriched group, comparing it to that of the controls. The enriched group had more than two portions of fish extra per week. We’ve discussed in chapter 7 evidence that increased fish consumption is associated with reduced violent crime, and we’ll see later in this chapter more substantive evidence for this alternative explanation.

  It’s important to emphasize that our results could not be attributed to pre-prevention group differences in temperament, cognitive ability, nutritional status, autonomic reactivity, or social adversity, which were carefully controlled for.28 The fact that the prevention program reduced crime twenty years later using two different measures of outcome—both self-reporting and objective measures—indicates the robustness of the effects. It’s unusual in the field to get results that last. Something in the enrichment is really working to reduce adult crime and violence.

  Let’s also be careful about the claim. The early enrichment did not eradicate crime. It reduced it by about 35 percent—so that leaves a lot. Obviously, we need more than two years of intensive enrichment to abolish adult crime. And maybe the Mauritius miracle crime cure would not apply to other countries that have a different culture and standard of living. Yet many kids don’t get good nutrition, even in the affluent United States, and we think our findings from Mauritius may be particularly relevant to poor rural areas of the United States such as the Mississippi delta region and also to inner cities, where rates of both malnutrition and behavioral problems in children are relatively high.29

  We were pleased with what was achieved and how early efforts paid off in reducing crime. At the time the study began there were no government preschools on the island at all. One lasting infrastructure contribution made by the research team, which included Peter Venables, Sarnoff Mednick, Cyril Dalais, and staff at the Mauritius Child Health Project, was embodied in the 1984 Pre-School Trust Fund Act, which established government preschools based on the two model nursery schools the group had set up in 1972.30 Currently, 183 such schools are running in five educational zones in Mauritius—and making a difference in turning Mauritius into a model African country.

  OFF WITH THEIR HEADS!

  The authoritarian Queen of Hearts in Lewis Carroll’s Alice’s Adventures in Wonderland was a wayward woman with a radical way of dealing with even the smallest of difficulties. “Off with their heads” was her simple solution to every misdemeanor.31 Although quite heartless, the Queen of Hearts was on the anatomical road to addressing one of the most difficult to treat classes of violent criminals—pedophiles and sex offenders. Surgical castration is the simple, radical, and highly controversial solution some authorities resorted to in order to reduce recidivism rates of sex offenders. Is this a mindless and unethical policy that should be halted? Or does it get to the heart of the matter and provide a workable solution to an intractable problem?

  Surgical castration still continues in Germany, ever since a law was passed in 1970 allowing it. It’s a voluntary procedure, and only a few are performed every year. Because it sounds barbaric and is so easy to condemn, the German government has put several safeguards in place to regulate it. The offender has to be over twenty-five, and approval is needed from a panel of experts.32 Nevertheless, it remains a controversial practice in Europe. The Council of Europe’s anti-torture committee in Strasbourg, for instance, views it as a degrading treatment that should be halted. But let’s reserve judgment until we hear all sides.

  It’s not only Germany that conducts castration. The Czech Republic has put over ninety inmates under the knife in the past ten years. Pavel is a case in hand. He was imprisoned at the age of eighteen after he gave in to uncontrollable sexual desires for a twelve-year-old that resulted in the boy’s death. But even before the crime he knew he had a serious problem. After waking up in the middle of the night in a sweat just two days before the murder, he sought help from his doctor. He was told that the urges would go away. But they didn’t, and apparently they became magnified as he watched a Bruce Lee movie, which stimulated his compulsion to use violence to heighten his sexual appetite. He took a knife to the boy and killed him.

  After eleven years in prison and psychiatric institutions in the Czech Republic, and just one year before he was due to be released, Pavel asked to be surgically castrated. “I can finally live knowing that I am no harm to anybody,” he reported after the procedure. “I am living a productive life. I want to tell people that there is help.”33 Pavel now loves his life in Prague, working as a gardener for a Catholic charity.

  For Pavel, removal of his testicles was the price he paid for peace of mind, even if it meant being alone, with neither sex nor romance. It’s a tough lif
e, but nevertheless a life that gives him meaning and some degree of dignity. Isn’t that better than rotting away in prison, or living every day being torn apart by the wild horses inside that are urging you to desecrate the body of an innocent child?

  Debates over the ethics of castration are heated and inevitably revolve around prisoners’ rights and the benefits to the individual and society. Let’s leave aside the ethics for now, which can be debated at length. Here we’ll take a cold, calculated look at the empirical evidence for and against the efficacy of this drastic intervention. Does it work? If it does not make a difference, that would be a compelling argument for eradication of this drastic—and some would say draconian—form of treatment.

  We saw earlier how high levels of testosterone are associated with increased aggression, yet these data are correlational, not causal. The etiological assumption behind castration is that lowering testosterone and thus sex drive would lower reconviction rates in sex offenders. But does it?

  Good studies of the effects of castration in human prisoners are few and far between. Ethically, you cannot randomly assign one sex offender to castration and one to an alternative treatment. The study that comes the closest to the impossibly ideal experiment was conducted by the medical researchers Reinhard Wille and Klaus M. Beier in Germany in the 1980s.34 Wille and Beier followed up ninety-nine castrated sex offenders and thirty-five non-castrated sex offenders for, on average, eleven years after release from prison. Such a sample covers about 25 percent of all castrations in the period from 1970 to 1980, and is therefore reasonably representative of this population. Subjects could not be randomly assigned to experimental and control conditions as would be demanded by a rigorous randomized controlled trial. Nevertheless, the thirty-five controls had all requested castration—but ended up changing their minds. As such they constitute as close a control group as can be ethically achieved.