As we met more and more of these children and their parents, our ability to evaluate them continued to improve, although some cases were easier than others. Perhaps our most clear-cut case was Jamie, a sandy-haired, button-nosed twelve-year-old boy who bounced in, visibly crackling with energy and trailed by his kindly but beleaguered-looking mother. We always started out our interview sessions by talking to the parent alone. We would interview the child alone next, a sequence that allowed us to spot when a child was lying or glossing over misbehaviors. With Jamie, there was little need for this sequence. He couldn’t have been prouder to detail his many, many exploits to us. His misbehaviors ran the gamut. Other than the items related to serious crimes and sexual offenses, he received top marks across the PCL:YV. He stole things. He set fires. He lied. He charmed and manipulated. He constructed elaborate cons to bilk his schoolmates of their money or possessions. Despite only being in middle school, he was running a successful loan shark operation out of his bedroom in a wealthy suburb of Richmond, Virginia. Interest payments ran to a dollar a day. When payments ran late, Jamie threatened to shoot fireworks at his clients. Many of these clients were high school boys who must have towered over him, but they took him seriously. Among Jamie’s more florid exploits was the time he somehow procured an artificial grenade and lobbed it into his local public library, “just to see how people would react.” Not surprisingly, people reacted by fleeing the building. Crying, screaming children and their parents poured out in a panic. While everyone else ran away from the building, Jamie and his friend ran toward it—carrying a video camera, no less, the better to record the terror and mayhem they had caused for posterity. Jamie’s pride in his caper was obvious. “It was,” he concluded with a crooked grin, “a total Kodak moment.”
Jamie wasn’t our highest-scoring subject, though. That would be fourteen-year-old Amber. Amber panthered into our interview room oozing charisma and sexuality that made me, a thirty-year-old woman at the time, feel unsettled. I can only imagine what her effect on young boys and men was. She was fully aware of this. Like many of the girls we worked with, Amber had figured out that it was often easier to get what she wanted using charm and allure than threats or violence. Like anyone else, children with psychopathic traits use the tools available to them to get what they want. They just care less than others about the collateral damage those tools may inflict. Amber liked expensive clothes, for example, and older boys and men were the ones with the means to buy them, so she seduced them. She didn’t much mind that they would end up branded as sex offenders for life if they slept with her.
Amber had the highest intelligence score of any of our study participants, and it showed. In typical kids, a higher IQ tends to be associated with fewer behavior problems, but in children with psychopathic traits the opposite seems to be true—a higher IQ coupled with a psychopathic personality seems to lead to more serious offenses, perhaps because the combination yields a sort of canniness that helps them get away with ever-ascending misdeeds without getting caught. Amber was certainly preternaturally perceptive for a young teenager. I could feel myself being sized up throughout our interview—she watched our faces keenly as she fed us stories about killing the family’s pet guinea pig or threatening to burn down her family’s home while they slept. Like Jamie, she wasn’t trying to hide anything. Quite the opposite. She was happy to describe what was going on in her head during these exploits. She explained, for example, how she sized up adults to avoid being punished. “Some adults are impressed when I use big words,” she said. “Others will let me off if I cry.” Her mother confirmed that Amber could produce effective crocodile tears. Once, her mother had found in Amber’s bag a printout from the Internet titled “A Guide to Shoplifting,” along with a pile of cosmetics and an expensive handbag from an upscale department store. When confronted, Amber had burst into tears, protesting that she was sorry and she would never do it again. Her mother admitted that she’d been mollified by similar displays in the past, but was so galled by the brazenness of this incident that she snapped, “Oh, get real.” And Amber’s tears, she said, stopped like a switch had been flipped, replaced by Amber’s usual level stare. Amber was the only one of the children we tested with whom I would have been unwilling to spend a night alone in a house.
Not every child we talked to was so frank about their motivations and behaviors. Heather was among our most difficult subjects to evaluate. According to her father, she was a terror. Like Dylan, she threw wild, violent tantrums that sometimes went on for hours and left her limp and spent. She also engaged in proactive forms of aggression that were just subtle enough that she could claim she hadn’t been doing anything wrong. Her father suffered frequent migraines, and Heather went out of her way to slam doors and flip on bright lights whenever one of his headaches came on, seemingly getting a visible kick out of the pain these sensory assaults caused. She was sometimes violent at school, once striking a schoolmate with a toy with such force that he required stitches. And like many of our other study participants, she manipulated, lied, stole things, and lied about stealing things.
At least, according to her father all this was true. But when Liz and I sat down to talk to Heather, we were stunned by how differently she came across in person. Heather had the limpid brown eyes and long limbs of a doe, a sweet, shy smile, and a soft voice in which she told us stories that would begin in the same place as her father’s stories, but always ended up somewhere completely different—inevitably a place in which Heather had committed no wrongdoing. It was her father who had the terrible temper and was forever taking out his unhappiness on Heather (said Heather). And when the interview ended, I watched in amazement as Heather carefully cleaned up the wrappers and crumbs from the food she had been eating while we spoke. Liz and I emerged from the interview stumped. It was by far the biggest mismatch between a parent’s and a child’s stories we’d encountered. Even knowing how genuinely winning many of the children we met could be, it was hard to understand how Heather fit into our study. We ended up calling a referee—in this case, one of Heather’s teachers. We asked for details on several of the stories we’d heard two versions of that the teacher had personally witnessed, and in every case the teacher’s stories echoed those of Heather’s father. Heather was just an incredibly skilled deceiver—the best we ever encountered. If we had used just her interview, we would never have pegged her for one of the children we were studying. I could easily imagine having offered her a research assistantship or a babysitting position based on her interview. But when we tallied her up, she scored well above our cutoff. Yet another lesson learned.
I can guess what you’re thinking at this point. I have talked to many people about these children and their families over the years and tend to hear the same comments over and over. In some recess of your mind, the thought These kids must have really terrible parents may be bouncing around. The belief that badly behaved children are the product of bad parenting is so deeply rooted in our culture that it is difficult to dispel. But let me try. First of all, we acquired a lot of information about these families during the course of our screening and interviews, and while they varied in many ways, a common thread was that the parents had tried literally every possible option to help their children before coming to see us—counselors, medication, special schools, social workers. These were caring parents with resources who really were trying, but none of it helped. I’m not saying they all were the best parents in the world (they varied, naturally), but they were definitely not so bad that their parenting alone could have produced such children.
As evidence, nearly all of these parents had other children, most of whom we met, and none of whom were also psychopathic—much like Gary Ridgway’s normal siblings. If unusually terribly behaved children are the product of unusually terrible parents, then the children of such parents should uniformly be a mess, right? But they’re not. It’s not that poor parenting can’t result in badly behaved children—of course it can. But it doesn’t make children psycho
pathic. Parents who are overly permissive or simply unskilled may end up with ill-mannered or entitled or bratty children, but these problems can often be solved with a little coaching on setting clear limits and not rewarding misbehavior. And parents in highly dysfunctional households marked by domestic violence or neglect or abuse may produce children with significant behavior problems. But again, most of these children’s aggression tends to be of the emotional, reactive variety, and they often present with depression or anxiety as well.
When the misbehaviors are of the purposefully cruel, manipulative, deceitful, or remorseless variety, it’s a different story. Engaging in these kinds of behaviors seems to be much more strongly driven by inherited factors, as we know from adoption and twin studies. Recall that these studies consistently show that parenting and other environmental factors explain only a small fraction of the variation in the proactive aggression that psychopathic children engage in.
I should note that some recent studies examining the relationship between child psychopathy and parenting find that children with higher levels of psychopathic traits have parents who are colder or more neglectful than average. The urge to assume that the arrow of causation runs in a straight line from cold and neglectful parents to callous and remorseless children is a powerful one. But there are several alternatives. One is that cold and uncaring parents end up with cold and uncaring children because they share similar genes that predispose them toward this personality profile. More than one adoption study suggests this is true. Another alternative is that a child who is difficult from the get-go causes his parents to become colder, less attentive, quicker to punish, and harsher when they do, a dynamic also backed up by research. These various causal pathways may of course interact as well, such that different styles of parenting may buffer or exacerbate the expression of psychopathic traits. For example, some recent research suggests that very high levels of parental warmth may lessen the severity of inherited psychopathic traits. So although cold parenting does not cause children to become psychopathic, interventions focusing on increasing the warmth of parents’ interactions with their children may help to reduce symptoms, particularly in younger children.
The parents of the psychopathic children we studied, however, had never had any of these nuances explained to them. Instead, everyone from pediatricians to school principals to neighbors had placed the blame squarely on them and their putatively rotten parenting. They often blamed themselves as well, being subject to the same cultural forces as the rest of us. More than one parent became teary when we asked if they thought their son or daughter ever felt remorse for any of the things they’d done. When I asked Michael’s mother this question, her face crumpled. After a long silence, she responded, “I want to think he does, but…,” then trailed off.
What could I say? She was right. He didn’t care. Many days my heart ached for these children’s parents long after I left the interview room.
So what was going wrong with these children? Our goal was to find out using the (at the time) fairly new technology called functional magnetic resonance imaging (or fMRI for short) to peek inside the active brains of these children. The emergence of fMRI in the 1990s revolutionized the field of cognitive neuroscience, which aims to identify biological mechanisms that undergird mental processes like attention, memory, and emotion. Before the emergence of fMRI, researchers who wanted to identify a malfunctioning brain area in a clinical population had only a few choices. One was to use positron emission tomography (PET), which requires injecting study volunteers with a radioactive sugar solution, then hustling them into a PET scanner before the radioactive isotopes decay. The end result is fairly fuzzy images of energy consumption levels inside the brain. Or, if researchers suspected that the problem lay in some dysfunction in the brain’s cortex, right underneath the skull, they could use electroencephalography (EEG) to measure electrical potentials across the scalp. But, like PET, the readings produced by EEG are spatially fuzzy, making it hard to tell exactly what part of the brain is generating the signal.
Although both PET and EEG are valuable, fMRI opened up new worlds to cognitive neuroscientists, permitting direct and spatially precise measurement of activity deep inside the brains of living, behaving humans. An MRI scanner is just a giant, doughnut-shaped magnet; fMRI is the use of such a magnet to detect small increases in the flow of blood to brain areas that are active and clamoring hungrily for the fuel that blood carries. Unlike a PET scan, an MRI scan uses no radiation, although it does have other limitations, which mainly stem from the fact that fMRI measures blood flow rather than activity in neurons themselves. Measuring blood flow limits the temporal precision of fMRI because the ebbing and flowing of blood in the brain (termed the hemodynamic response) takes a few seconds, whereas changes in actual neural activity take place in milliseconds. On the other hand, fMRI’s spatial precision is good and getting continually better as stronger magnets and more advanced software are rolled out. The MRI machine we initially used at NIMH in 2004 was a 1.5-Tesla magnet, which is about 50 percent stronger than the magnets that lift cars in scrapyards. Later we switched to a 3-Tesla magnet, which is standard today. Recently, the NIMH acquired a 7-Tesla magnet, which is so powerful that it can measure changes in brain activity with a spatial resolution of one cubic millimeter—although it wreaks such havoc on charged particles in the inner ear that volunteers must be rolled into its bore very slowly to avoid getting vertigo or vomiting. I had the occasional bout of dizziness working next to the 3-Tesla magnets, but the sensation wasn’t unpleasant, just strange (and not nearly as distracting as its sly tugs on the metal hooks and rings of my bra).
We would be using fMRI to measure activity in parts of the brains of psychopathic teenagers that are hard to assess using any other approach, in particular the underside of the prefrontal cortex, which sits right above the eyes, and a region called the amygdala. The amygdala (Latin for “almond”) is a lump of fat and fiber about half an inch in diameter that is buried beneath layers of cortex under each temple. The structure is so small and lies so far beneath the scalp that neither PET nor EEG can reliably measure its activity. But its small size belies its importance. Among other things, it plays a critical role in recognizing fearful facial expressions.
This had first been discovered in 1994, prior to the advent of fMRI, through neurological studies of a patient with a very rare kind of brain damage: total obliteration of both the left and the right amygdala, and nothing else. No accident or stroke can do such precisely localized damage; instead, the culprit is a rare genetic illness called Urbach-Wiethe, which can cause the amygdala to gradually calcify over the first decade or two of a person’s life. In the late 1980s, a group of researchers, led by Daniel Tranel at the University of Iowa, was approached by a woman with this condition, whom they called S.M. to protect her privacy. S.M. was twenty at the time, with a pleasant, open face, a breathy voice, and a flirtatious, disinhibited demeanor. She liked to stand about twelve inches away from the person she was talking to, and the researchers’ first published description of her drily described her “tendency to become somewhat coquettish” during her testing sessions. A CAT scan of her brain confirmed that her amygdalae were totally destroyed. Intrigued, the researchers ran S.M. through dozens of cognitive tests to see what else she’d lost along with this structure.
Many of her mental abilities remained intact, including her intelligence and memory, but among the deficits the researchers uncovered was S.M.’s inability to recognize others’ fear. The researchers presented her with a series of emotional facial expressions, including some of the same ones I’d used in my research, and asked her to provide a label for each. She had no trouble with faces that expressed anger or disgust or happiness or sadness; her performance corresponded very well to that of other adults, including adults with damage to other parts of their brains. But when she was shown photographs of people who looked frightened, she bottomed out, describing the expressions alternately as sad, disgusted, angry—nearly anythi
ng but fearful.
The researchers wondered what S.M. thought fear did look like, so they asked her to try to draw a frightened face, along with faces expressing other emotions, a request that revealed her knack for portraiture. Her depictions of anger, sadness, and disgust were vivid and easily recognizable. The angry face glowered fiercely, looking a bit like a bearded Fidel Castro in his prime. Tears dripped from each eye of the sad face, the eyebrows of which were perfectly oblique. But when asked to draw a fearful face, S.M. literally drew a blank. She protested that she had no idea what it would look like—no image at all came to her mind. She tried several times to create drawings that she ended up scrapping. Finally, she produced an image that looked nothing like the others. It was not a portrait, but a small, round figure shown in profile on its hands and knees. Its expression was hard to read, but it did not look frightened. Its mouth was closed, and its brows sat low and straight over its eyes.
Subsequent tests of other individuals with localized damage to the amygdala have consistently revealed similar patterns—their ability to recognize fearful facial expressions is reliably impaired. The most recent such study found fear recognition deficits nearly identical to S.M.’s in a teenage Urbach-Wiethe patient in Iran. Such patients sometimes have trouble recognizing fear from other cues as well, including vocal utterances, body postures, even emotionally stirring music. Damage to no other brain structure results in this specific pattern. These data make clear that the amygdala must play some important role in our ability to recognize expressions of fear.
Strikingly, they also point to the conclusion that psychopathic children’s struggle to recognize others’ fear may similarly stem from dysfunction in their amygdala.
The Fear Factor Page 9
