The Anatomy of Violence

by Adrian Raine

  If you think back at the neuroscience we looked at—the studies that document both the short-term and the long-term brain changes that occur with mindfulness—the effect of meditation begins to make some sense. Meditation enhances left frontal brain activity. That meshes with the fact that enhanced left frontal brain activation occurs when people experience positive emotions109 and is associated with reduced anxiety.110 It also increases frontal cortical thickness, and we know that this area is not just important in emotion regulation, but is also structurally and functionally impaired in offenders. Note also that meditation enhances brain areas important for moral decision-making as well as areas involved in attention, learning, and memory. We have seen that offenders have impairments in these cognitive functions. Meditation is improving brain areas involved in functions that are deficient in offenders, and that’s why it may help.

  Mind over brain matters. Brain over behavior matters. What matters to me is that hopefully in journeying through the anatomy of violence you have appreciated three important points. First, there is a basis to violence in the brain. Second, the biosocial jigsaw mix is critical. Third, we really can change the brain to change behavior.

  In that third point we have options that run the gamut from concrete surgical castration to almost spiritual mind-over-matter training. In between these extremes we have prenatal nursing interventions, early environmental enrichment, medication, and nutritional supplements that can all make a difference.

  Based on the biosocial model I’ve outlined here, we have promising techniques to block the foundational processes that result in the brain dysfunctions that in turn predispose an individual to violence. That has not been fully recognized within the traditional study of crime—and it really needs to be if we are to be sincere about stopping the suffering and pain associated with violence. We can wait until the milk is already spilled and we have to deal with the adult recidivistic offender who is so very hard to change. That’s where we are today. Or we can invest in broad-based prevention programs that start in infancy and can benefit everyone—a public-health approach to violence prevention.

  Ultimately, it is up to the public to make that decision. If you want my personal view—based on everything I have learned in my thirty-five-year career in research and practice—it would be this: the best investment that society can possibly make in stopping violence is to invest in the early years of the growing child—and that investment must be biosocial in nature. You cannot successfully intervene without addressing the brain.

  Don’t get me wrong. Biology is not the sole answer to stopping violence and never will be. Larry Sherman, a world-renowned experimental criminologist at Cambridge University, and others have marshaled systematic evidence from randomized controlled trials documenting that some traditional psychosocial and behavioral treatment programs can make a modest difference in offending.111 What I am arguing here does not negate the positive work done to date by experimental criminologists. What I am saying, however, is that we can go one better with biological interventions that take into account the anatomy of violence—and break the mold that is today giving birth to violent offenders in droves. We have much research ahead of us to develop new and innovative biosocial interventions, but we now have a base on which to build—if we are willing to.

  Imagine how society would change if for once we could cure crime. Can you picture a future where suddenly we crack the biological code to violence? How would that change how we think about violence? How would it affect our sense of culpability, punishment, and free will? Would it lead to changes in the law? We’ll see in the next chapter that this future isn’t so far away.

  10.

  THE BRAIN ON TRIAL

  Legal Implications

  Michael—or Mr. Oft, as we will refer to him here—was pretty much your everyday, run-of-the-mill middle-aged American guy. In his early career he worked as a correctional officer, later earning a master’s degree and becoming a schoolteacher in Charlottesville, Virginia. He liked teaching, and he liked kids. By all accounts he genuinely loved and cared for both his second wife, Anne, and his twelve-year-old stepdaughter, Christina, whom he had known since she was seven years old. He got on fabulously well with her. Oft had no prior psychiatric history, nor any history of deviant behavior. He was not much different from you or me—until the clock moved toward the turn of the century in late 1999.

  At the age of forty, his behavior slowly but surely changed. He’d never previously been interested in massages, but now he began to frequent massage parlors. He also began to avidly collect child pornography. Then the once-innocent act of putting his stepdaughter to bed changed in an unspeakable way.

  As Christina recollects, Mr. Oft used to sing her lullabies before he tucked her in. But after his wife took a part-time job that kept her out of the house until ten p.m. two evenings a week, the usual bedtime practices became a little more sultry and sordid. Oft began to get into bed with Christina, and began to touch and fondle her.

  Like many children suffering from abuse at the hands of a trusted relative, Christina was very confused. She knew that she loved her stepfather—but she also knew that what he was doing was wrong. She would argue with him over it, and it increasingly bothered her. But Michael’s changes were growing. Normally engaging and likeable, he was becoming more short-tempered. On Thanksgiving Day in 1999 he pulled out some of his wife’s hair in a fight. Oft was clearly a man in decline.

  Finally, the tearful Christina spoke to a counselor about her stepfather’s pedophilia. The counselor in turn spoke to her incredulous mother. Anne was shocked, horrified, and furious. She found “barely legal” child pornography in his possession—pictures of women supposedly of legal age but who looked thirteen or fourteen. She reported his behavior to the police.

  Mr. Oft was legally removed from the home and duly charged with sexual assault. Diagnosed as a pedophile, he was found guilty of child molestation and given the option of either completing a treatment program for pedophiles or going to prison.

  Naturally, Mr. Oft opted for the treatment program. But even during treatment Oft could not resist soliciting sexual favors from the female staff and other clients at the rehabilitation center. He was thrown out of the program. That was it. He now had to go to prison.

  The very night before he was due to start the prison sentence, Mr. Oft went to the University of Virginia’s hospital complaining of a headache. Unconvinced, the hospital turned him away, but as he was about to be discharged, he claimed he would kill himself if released, slipping in a threat to rape his landlady. The medical staff could not let someone go in those circumstances, so Mr. Oft was admitted to the hospital’s psychiatry ward under the medical diagnosis of pedophilia. Naturally, one of the first things he did was to come on to the female hospital staff and request carnal medical attention.

  That probably would have been his undoing if he had not also urinated on himself. The odd thing was that he did not seem concerned. He also began to walk a little unsteadily. A very astute neurologist—Dr. Russell Swerdlow—put two and two together and ordered a brain scan. The scan showed that Mr. Oft had a massive tumor growing at the base of his orbitofrontal cortex, compressing the right prefrontal region of his brain.1 Brain surgeons resected the tumor, and a most remarkable change came about. Mr. Oft’s emotion, cognition, and sexual activity returned to normal. The pangs of guilt and remorse at what he had done to his stepdaughter at last set in. He no longer sexually propositioned female staff members. He no longer felt the urge to rape his landlady or to commit suicide.

  Mr. Oft was a changed man.2 He was released from the hospital and went back to therapy. This time he successfully completed the twelve-step Sexaholics Anonymous program that he had previously failed so spectacularly. His behavior was now entirely appropriate. Seven months later he returned home to be reunited with his wife and stepdaughter to once more lead a normal life. It was a near-miraculous recovery—and it should have been a case of living happily ever after. But what
appeared to be a medical miracle was a mirage. The headaches came back.

  After several months of normal behavior, Mr. Oft again began to collect child pornography. Suspecting a relapse, one night his wife checked his computer and found the offending material—and once again Mr. Oft was in hot water. Yet thanks to a foresightful re-scan of his brain, his neurologist, Dr. Swerdlow, found that the tumor had grown back. In 2002 the tumor was resected for the second time.3 Once again Mr. Oft made a complete recovery, and this time for six years after the second resection of his tumor his sexual urges and general behavior have been totally appropriate.

  The case of Michael Oft is remarkable because it comes as close as one can get to demonstrating a causal link between brain dysfunction and deviant behavior. A double reversal of fortune over time. Going from normality to a growing tumor to the development of pedophilic urges then back to normality after the tumor is resected—with the pendulum swinging back yet again to repeat this tumor to pedophilia to resection to normality progression. The temporal ordering of events is very telling. But the powerful evidence suggesting that this man’s antisocial behavior was due to an uncontrollable growth in his skull also raises a profound legal question: Was Mr. Oft legally responsible for his deviant behavior?

  Some of the debates in life seem ancient and eternally fixed in time, like the frozen figures encircling a Grecian urn. Here we have such a debate. On one side of the urn we have Themis, the Greek goddess of law and justice. Themis wants no sob stories—she wants no excuses. Justice and retribution reign, and criminals have to be held responsible for their actions.

  On the other side of the urn, we have the pleading figure of Mr. Oft and others like him, victims, in ways we are still trying to understand, of complex biosocial forces—forces frequently beyond our control.

  In this penultimate chapter we will take a critical look at how research on the biology of violence is not just affecting the judicial system—but is also raising questions about core human values including free will. The new subdiscipline of “neurolaw” is playing a critical role in shaping our perspectives on this issue. Within this context we’ll take a focused look at criminal responsibility, and, as one would expect in a legal context, we’ll evaluate the cases for and against the relevance of neuroscience research on violence. Finally, we’ll return to the question of Mr. Oft’s responsibility—and examine the credibility of the current legal response.

  HOW FREE IS FREE WILL?

  We have been witnessing so far a myriad of biological, genetic, and brain factors that conspire together to create violence and crime. A number occur even before a child is born. A child does not ask to be born with birth complications or a shrunken amygdala, or to have the gene for low levels of MAOA. So if these factors predispose some innocent babies to a life of crime, can we really hold them responsible for what they eventually do—no matter how heinous the crime? Do they have free will in the strict sense of the word? That’s the key question we must address.

  At one extreme, many theologians, philosophers, social scientists—and likely yourself—would argue that barring exceptional circumstances such as severe mental illness, each and every one of us has full control over our actions. Theologians argue that we have a choice as to whether to let God into our soul, that we choose whether to commit sin or not, and consequently our criminal actions—our sins—are a product of a will that is under our full control.

  At the other extreme, some scientists eschew the idea of a disembodied soul that has its own free will and take a more reductionist approach. Francis Crick, who won the Nobel Prize for the discovery of the structure of DNA, for example, believed that free will is nothing more than a large assembly of neurons located in the anterior cingulate cortex, and that under a certain set of assumptions it would be possible to build a machine that would believe it has free will.4 Such a view harks back to our discussion of evolutionary perspectives. Perhaps we are indeed merely gene machines that con ourselves into believing we have choices in life.

  I might argue for a middle ground between these two extremes. Free will likely lies on a continuum, with some people having almost complete choice in their actions, while others have relatively less. Rather than viewing intent in black-and-white, all-or-nothing terms, as the law does, with a few exceptions, I see shades of gray. Most of us lie between these extremes. Think of the free-will concept like IQ, extraversion, or temperature, which are dimensional in nature. There are degrees of free will, and we all differ on that dimension of agency.

  What determines the extent of free will? Early biological and genetic mechanisms alongside social and environmental factors play substantial roles. For some, free will is significantly constrained early in life by forces far beyond their control. Let’s look into the life history of one murderer and rapist I worked with to illustrate my argument. I’ll first present his life circumstances that his defense team argued constrained his free will—but I’ll return to his case later to offer a more retributive perspective from the prosecution.

  Donta Page was born on March 28, 1976. His mother, Patricia Page, was only sixteen years old at the time of his birth. She had gonorrhea during her pregnancy. Her own mother was fourteen when she gave birth to Patricia, so Donta’s mother was raised by her aunt and uncle, both of whom physically abused her, forcing her into an eight-year-long incestuous sexual relationship with the uncle that started when Patricia was four. Donta himself did not have a father at home, but he did inherit a family history from his father’s side of crime, drug abuse, and mental illness.

  Throughout his early childhood, Donta was a frequent visitor to the local emergency room. He had five recorded admissions before the age of two. When he was just nine months old he was taken there after he supposedly “fell” out of a car window—but in all likelihood the unwanted child was thrown out. A scar on his head as an adult is the only external sign of what likely resulted in a very significant closed-head injury. Due to lack of close parental supervision, he was also knocked unconscious by a swing, and when six months old he fell out of the top of a bunk bed. So before he was even two years old he had a substantial history of head injury—and very likely brain impairment.

  When Donta was three he was moved into one of the worst neighborhoods in Washington, D.C. His defense attorney reported that as he walked in the area where Donta grew up, he could see that every fourth or fifth house was burned or abandoned. During this time Donta was bounced around from his mother to his great-aunt and back again, experiencing sustained instability in bonding and a normal family life. Frequently he was left at home alone to fend for himself for the whole day. Things were so bad with his abusive mother that by the time he was ten, Donta often preferred to sleep in an abandoned building rather than face the abuse at home.

  Given how Donta’s mother had herself been raised, it was not surprising that she physically abused him. His grandmother testified that as an infant he was vigorously shaken on repeated occasions for crying. At the age of three, he was punched in the head by his mother so hard that it caused him headaches. At six he was being beaten with an electrical cord that caused bleeding. He was beaten for wetting himself. He was beaten for getting bad grades. He was beaten for any minor misbehavior. When his teacher told his mother that she suspected Donta had ADHD, his mother went home to beat him because he had a childhood disorder. It was documented that by age ten he was being hit by his mother with a closed fist. Donta was also burned with cigarettes, leaving him with dark black spots on his arm that remain in adulthood—alongside scars on his thighs, back, flanks, arm, and chest that bear testimony to the bombardment of abuse.

  That abuse was dealt out not just by his mother but also by neighboring predators. When he was ten he was violently raped by a next-door neighbor. Back in the local emergency room, it was documented that he had rectal bleeding. It was further suspected that he was also bleeding internally. Despite all the physical evidence of rape, the hospital never referred the matter to child protection agencies.
Donta was sent back to live in the same house, across the way from the same rapist, likely to be raped again. He was given neither counseling nor one ounce of understanding. Neither the family nor the hospital cared about the safety of a small, unsupervised boy from predatory neighborhood rapists.

  The abuse escalated. By age thirteen, he was yet again back in the ER because his mother had hit him very hard on the side of his head with an iron. The attending physician documented welts on his arm where his mother had struck him with an electrical cord and the swelling to his temple where he had been hit with the iron. This was clear documentation of child abuse,5 but no action was taken, and Donta was ultimately returned back home to his mother.

  As one might have predicted, Donta was committing property crimes by the age of sixteen and was duly sent to a juvenile detention center. When he was later on trial as an adult for homicide, his attorney carefully pointed out that by the age of eighteen, Donta had been referred by teachers and probation officers for psychological treatment an amazing nineteen times. Astonishingly, he never received even one treatment session. Eight of these attempted referrals were before he had committed a single criminal act.

  Given the complete absence of any form of intervention, it is unsurprising that Donta quickly fell into a criminal lifestyle, committing robberies and burglaries that when he was eighteen resulted in a sentence of twenty years in prison and ten suspended sentences. He’d only served four years, however, before being let out on parole and sent to a halfway house on Stout Street in Denver, Colorado, in October 1998. The respite from prison did not last long. He assaulted one of the other residents, and on February 23, 1999, he was told he would be sent back to Maryland to serve the rest of his sentence. It was on the following day, when he was due to be returned to prison, that he robbed and killed Peyton Tuthill in Denver.