I have not, however, abandoned my brain scanning research with children with serious behavior problems. All told, I have now spent over a decade on this work. And the research my students at Georgetown and I have conducted has expanded our initial findings about the role of the amygdala in understanding others’ fear. For example, my student Joana Vieira and others have now found that psychopathic adults and adolescents have amygdalas that are not only underactive but smaller than average as well. In one study by Adrian Raine, the amygdalas of psychopathic adults were found to be about 20 percent smaller than those of controls. Another recent study even found that young men with smaller amygdalas were more likely to have been psychopathic even as children and were more likely to engage in persistent violence in the future. Essi Viding’s studies of adolescents have found that the severity of psychopathic personality traits in this age group corresponds to how densely concentrated the gray matter in their amygdala is.
And in a 2014 study of amygdala activity, my student Leah Lozier found still more direct evidence that a lack of amygdala responsiveness to others’ fear drives psychopathic children’s antisocial behavior. For that study, we scanned the brains of over thirty children with serious conduct problems—children who frequently fought, stole, lied, and broke rules. Some of them had psychopathic traits, like low levels of traits like compassion, caring, and remorsefulness, and others didn’t. As I’ve described, it has long been suspected that antisocial behavior in children with versus without psychopathic traits is driven by distinct brain processes, and this study helped to confirm that. In children who had conduct problems in the absence of psychopathic traits, the amygdala responded more strongly to fearful expressions than it did in normal children. This is consistent with the idea that these children’s antisocial behavior is a by-product of overreactive emotionality, which may cause them to erupt in response to ambiguous or mild threats. Patterns like this are sometimes linked to anxiety, depression, or exposure to trauma. On the surface, however, it’s not always easy to tell these children apart from those who have psychopathic traits, as I had learned early on in my research at the NIH.
Liz and I had recruited a boy named Daniel toward the very beginning of our study—he was perhaps the third or fourth teenager we evaluated. Daniel was unlike most of our other participants in several ways. Nearly all the children I have described so far were white and living in intact, functional families in middle-class or even wealthy neighborhoods, and they went to good schools. Not all the children we studied fit this description, but a lot of them did, and the seeming ease and normalcy of their lives made their cruel and disruptive behavior much harder to explain than if they had led lives of real hardship, as Daniel had.
Daniel was the most outwardly alarming of all the subjects we brought in. Fifteen years old when we first met him, he was a rangy black boy who stood nearly six feet tall and walked with an unhurried saunter and a flat stare. Every time I saw him he was wearing his standard uniform of black sneakers, voluminously baggy black jeans, and a pristine white T-shirt. Some days he topped it off with a black bandanna tied around his head in such a way that his hair poofed out in perfect spheres on either side of his head like Mickey Mouse ears. He once told us about the protracted security screening he always received coming through the NIH gates, and I wasn’t remotely surprised. I saw how people responded to him just walking through the NIH corridors. Patients and physicians alike scuttled out of his way like shore crabs whose rock had been overturned, casting furtive sideways glances at him. Walking next to him was an odd experience—as a small woman, I’ve never personally experienced responses like that in my life. What must it feel like to send ripples of alarm through strangers around you wherever you go? I will never really know, of course, and I never thought to ask Daniel.
The security screeners and NIH personnel weren’t wrong to worry about Daniel. He had engaged in more theft, overt violence, and other criminal behavior than nearly any of our other subjects. He couldn’t count the number of fights he’d been in. He had been shot at and had shot at other people. He stole from neighbors and stores and restaurants and had tried a variety of drugs. In his telling, he felt neither fear nor remorse about any of it. We had only limited background information about him, unfortunately, because his mother’s own mental health problems were severe, so we stuck to a brief and not very informative interview with his aunt. On the basis of this and our interview with Daniel, he received a high enough psychopathy score to qualify for a brain scan.
His MRI session started like any other, with my explaining how the brain scan would work and what he’d need to do while we sat in the cramped control room, which looked like a shabby sort of mission control, with tangles of wires and monitors and knob-and button-bedecked consoles cluttering every surface. As I talked, I noticed that his eyes kept darting toward the control room window, through which the gray, humming hulk of the scanner could be seen. “Something wrong, Daniel?” I eventually asked. “Any questions I can answer for you?”
“What’s this going to feel like? Is it… it gonna hurt?”
“Oh my gosh, no, definitely not, Daniel! We wouldn’t ask you to do something that hurt. It’s really just a big camera. Does it hurt to get your picture taken?”
He shook his head.
“Well, this is just the same. It doesn’t feel like anything.”
He nodded. But I glanced past his head at Liz, who raised her eyebrows at me. The fact that he even asked the question was odd. No other kids with psychopathic traits had asked anything like this. Before the scan, they only ever seemed either mildly curious or bored. Even our healthy controls rarely asked for reassurance.
As the scanning preparations went on, Daniel kept asking more questions. How long would it last? Could we stop the scan if he wanted to come out early? How many other people had we scanned? Could his cousin (who was in the waiting room) come in the scanning room with him? He didn’t want to be in the scanner alone. No, we couldn’t bring his cousin in the scanning room, but we could bring him into the control room, which we did.
“How you doing, man?” asked his cousin, surveying the scene.
“I’m good,” said Daniel. But he didn’t look good. He looked nervous.
I opened the door to the magnet. We were ready to start. “Okay, Daniel. We’re all set. Think you’re ready to go in?”
But Daniel didn’t get up. He just stared through the door at the magnet.
Finally, he shook his head. I was astonished to see his eyes welling up. “I can’t do it. I can’t do it. I want to go. I want my mom.”
He wanted his mom? He was too nervous to go in the MRI? This hardened teenage veteran of gun battles and drug deals was too scared to do something that several sweet ten-year-olds had already sailed through? But it was what happened next that really floored me: he apologized.
“I’m really sorry, guys,” he said. “I can’t do it. I wanted to do it, though. I thought I could do it.”
Then he stood up and grabbed me. He pulled me into a big bear hug.
From inside a nest of skinny teenage arms I managed a muffled “It’s totally okay, Daniel. Of course it’s okay. Thank you for trying. I’m glad you came in today anyhow.”
Daniel had totally fooled us. He was a boy who had been forced to adopt the trappings of a hardened adult, and had done so convincingly. But he was not a child with a broken VIM—he was a child whose broken life had pushed him to engage in the same sorts of behaviors that an actually callous, remorseless child would. Underneath, Daniel was, I believe now, probably an ordinary boy in the very best sense, one capable of affection and compassion and remorse who deserved (as do so many children) a much better shake in life than he had gotten. By now he would be about twenty-six years old. I still think of him and his sweet, fierce hug and hope he somehow managed to overcome all the obstacles life had thrown in his path.
What my student Leah’s study found is that the brains of violent but emotionally sensitive children like Daniel
(at least, the ones who are willing to be scanned) can, on average, be distinguished from those of children who are violent but callous. The Daniels of the world are actually highly emotionally reactive (no matter how well they try to conceal it) and show elevated amygdala responses to others’ fear. In contrast, children who are legitimately callous and remorseless show very little amygdala response to others’ fear. More, the degree to which actually callous children’s amygdalas are nonresponsive to fear seems to be a biomarker of sorts for aggression—particularly the goal-directed, proactive kind of aggression that is notoriously linked to psychopathy. In our study, the relationship between the severity of a child’s psychopathic traits and the severity of their proactive aggression could be accounted for, statistically speaking, by how underreactive the child’s amygdala was to fearful expressions.
It was powerful support for the idea that the way our brains respond to others’ distress is intrinsic to our capacity to experience caring and concern for others.
I am often asked if doing this kind of research is depressing. Sometimes it is, of course. I feel tremendous sympathy and sorrow for the parents of the children we meet, who are worried and anxious and frustrated, understandably, about their children. I wish I could do more to help them. And I worry for their children’s futures. But I really enjoy working with the children themselves. Children who are callous and remorseless are rarely terribly anxious or unhappy themselves—quite the contrary.
To get an overall sense of their mental well-being we sometimes ask children to rate themselves on a scale from 1 to 10, with 1 meaning that they are very unhappy with themselves and 10 meaning that they think they are terrific. A typical child will usually respond with a 7 or 8. But I have heard children with psychopathic traits shout out “Ten!” “Eleven!” even “Twenty!” And remember, these are children who may have been kicked out of multiple schools, who have been arrested, who have no real friends, and whose parents live in fear of them. It’s a great reminder of the vast gulf that can separate perception from reality.
The children are often impish and funny and interesting, just like any other teenagers, only more so. Sometimes they can be exasperating—like the psychopathic boy who was getting bored toward the end of his MRI scan here at Georgetown and tried to convince my graduate students to let him come out early because, he said, somehow as he was lying immobile inside the MRI and pushing buttons, his leg had broken. My students had trouble keeping a straight face in response to that one. Other children have caused various kinds of trouble on testing day. One boy locked his mother out of their house when it was time to leave for their scanning session, then refused to let her back in. Another stole food from a cafeteria right outside the scanner. He ate it, unconcerned, in the waiting room. A couple of the girls peed all over their pregnancy testing kits, clearly not bothered that I would be handling them afterward. An enormous number of the boys seem to rarely bathe, judging from the way their feet smelled when they took their shoes off before their scan. But their confidence was untarnished. One memorable teenage boy flirted so incessantly with my flustered twenty-six-year-old graduate student that his mother asked, only half-jokingly, if he was going to invite her to his prom.
But usually by the time they made it all the way into the MRI, the children were motivated to complete their testing and get on to the part where they got some money and a picture of the inside of their brain (the printout of which they could flap in their mother’s face, crowing, “See, look, I really have one!”).
Unexpectedly, one aspect of this line of research has been downright uplifting, and that is the stark contrast it has revealed between the highly psychopathic adolescents and young adults we have studied and everyone else.
Individuals who are considered “highly psychopathic” make up maybe 1 or 2 percent of the population. This small minority is not categorically different from everyone else, though, as far as we can tell. Rather, they have a larger agglomeration of traits that are present in smaller amounts in much of the rest of the population. One study found that perhaps 30 percent of the population registers as at least a little psychopathic on a variant of the PCL used for screening adults in the general community, the Psychopathy Checklist—Screening Version (PCL-SV). Interestingly, that’s about the same percentage of volunteers who were unwilling to take any shocks to help “Elaine.” It’s also about the same percentage of people found by my colleague David Rand to behave uniformly selfishly toward strangers in an online study he conducted. Subjects in that study had the option to share a small stake of money with a stranger they would never meet, for no reason except sheer generosity. Some 39 percent of the subjects never shared the money. But the remaining 61 percent were generous at least some of the time. Likewise, about 70 percent of people would score a big fat zero on a standard measure of psychopathy. That is an incredibly reassuring number.
It’s an all-too-common perception that human nature is “fundamentally selfish”—egotistical, Machiavellian, callous. Philosophers have been fretting over this issue for millennia, at least as far back as Aristotle, who concluded that, “All the friendly feelings are derived to others from those that have the Self primarily for their object.” Even a person’s apparently selfless deeds are, according to Aristotle, ultimately performed to accrue “honor and praise on himself.” This line of thinking dictates that even when people appear to be acting in caring ways toward others, their behavior always somehow can be traced back to concern for themselves. Did someone give money to charity? A tax write-off! Volunteer to help the homeless? Trying to feel better about his own life! Rescue a woman from a fiery inferno, Cory Booker style, and risk getting burned to death? Well—there must be some self-serving reason buried in there! “Honor and praise,” perhaps.
The belief that human nature is fundamentally selfish remains a cornerstone of much modern economic, biological, and psychological research. It’s the basis, for example, of the economic assumption of so-called rational self-interest, according to which all human motivation can be reduced to a little internal ledger that calculates the benefits and costs of any potential decision or course of action and strives to pick the option that maximizes benefits for the self—the option that, very simply, is the most selfish. Belief in this view of human nature is pervasive. In 1988, when a representative sample of over 2,000 Americans was asked, “Is the tendency of people to look out for their own interests a serious problem in the United States?” 80 percent agreed that it was. In 1999, a New York Times/CBS poll of nearly 1,200 Americans similarly found that 60 percent believed that most people are overly concerned with themselves and not concerned enough about other people, and 63 percent believed that most people cannot be trusted. (A nearly identical percentage of people polled by the 2014 General Social Survey [GSS] agreed that most people cannot be trusted.) Forty-three percent agreed that most people are just looking out for themselves.
But the studies of Milgram, Batson, Blair, and many others, including myself, raise a problem with this view of human nature: people vary. There is no one “human nature.” To take one obvious example, some people are psychopathic. And if you want to know what a person who is genuinely, fundamentally selfish looks like, just look at a psychopath. They are the Aristotelean ideal of a person whose apparently friendly or helpful actions always really do have the self primarily for their object. They are genuinely unmoved by others’ suffering and unmotivated to relieve or prevent it. Their apparently good deeds really are aimed at achieving some self-benefit. Take Brent, for instance, a psychopathic boy we studied at NIMH, who fashioned himself as a middle school Robin Hood and sought out bullies to beat up after school—but only to increase his own status and keep others afraid of him and in his debt. The whole point of studying people like Brent—of singling them out and evaluating them with clinical measures—is that they are different from other people. Their callousness and indifference toward others’ suffering, their willingness to manipulate and exploit others for their own benefit, are not no
rmal. Studying people with psychopathic traits is a great way to gain a renewed appreciation for the fact that most people are not like them at all but instead seem to be genuinely capable of caring about the needs of other people.
Now, saying that most people aren’t psychopaths isn’t exactly a ringing endorsement of their characters. But the fact that psychopathy is continuously distributed implies something more interesting than just the fact that psychopaths lie at the far end of the callousness spectrum, with most other people bunched up toward the “zero” end. Most human physiological and personality traits aren’t distributed in this uneven way. Most traits, from height to cholesterol levels to intelligence to personality traits like extraversion, are distributed in a bell-shaped curve across the population, with most people clustered in the middle of the scale and fewer people residing at either the low or high end. So, for example, the average height of an American woman is about five-four, and the height of about two-thirds of all the women in the country is within a couple inches of that. Only a small number of women are, like me, shorter than five-one; a similarly small percentage are taller than five-seven. Most other variable traits are distributed the same way. This pattern of distribution is so common that it is literally called the normal curve.
Psychopathic traits as measured by the Psychopathy Checklist don’t fit this distribution. Instead, as one recent study found, they are distributed in what is called a half normal curve—it looks like a typical bell-shaped curve that has been sliced in half down the middle, leaving only the right-hand side. What this odd distribution suggests is that psychopathy measures like this are not capturing all of the available variance in traits related to psychopathy, like empathic concern and compassion. Instead, the “half normal” distribution may indeed represent only half of what is actually a symmetrical bell-shaped distribution, which ranges from people with unusually low levels of concern for others at one end (the psychopaths) to a clump of ordinary people in the middle, and then, perhaps, moving past that group, to another, smallish group of individuals on the opposite end of the curve from psychopaths whose capacity for caring and compassion is even higher than average—the “anti-psychopaths,” you might call them. If this is true—if the small population of truly psychopathic people among us is really balanced out by another small population of anti-psychopaths—it would be compelling evidence that selflessness is just as fundamental to human nature as selfishness.
The Fear Factor Page 11
