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Inside the
of a
Neuroscientists he word “psychopath” con- don’t feel particularly deeply about any-
jures up movie images of bru- thing at all.
are discovering tal, inexplicable violence: Jack So much of the way regular people

that some of the Nicholson chasing his family

with an ax in The Shining or
make sense of the world is through emo-
tion. It informs our “gut” decisions, our
most cold-blooded Anthony Hopkins as Hannibal Lecter, connections to people and places, our
his face locked into an armored mask to sense of belonging and purpose. It is al-
killers aren’t bad. keep him from biting people to death. most impossible to imagine life without

They suffer from a But real life offers another set of images,
that of killers making nice: Ted Bundy as
feelings — until you meet a psychopath.
But psychopaths often cover up their
brain abnormality law student and aide to the governor of deficiencies with a ready and engaging
Washington State, and John Wayne charm, so it can take time to realize
that sets them Gacy as the Junior Chamber of Com- what you are dealing with.

adrift in an merce’s “Man of the Year.” Psychopaths

are likable guys when they want to be.
One of us (Kiehl) used to ask inexpe-
rienced graduate students to interview a
emotionless world Between the two of us, we have in-
terviewed hundreds of prison inmates
particularly appealing inmate before ac-
quainting themselves with his criminal
to assess their mental health. We are history. These budding psychologists
By Kent A. Kiehl and trained in spotting psychopaths, but would emerge quite certain that such a
Joshua W. Buckholtz even so, coming face to face with the real well-spoken, trustworthy person must
article can be electrifying, if also unset- have been wrongly imprisoned. Until,
tling. One of the most striking peculiari- that is, they read his file — pimping, drug
ties of psychopaths is that they lack em- dealing, fraud, robbery, and on and on—

pathy; they are able to shake off as mere and went back to reinterview him, at
tinsel the most universal social obliga- which point he would say offhandedly,
tions. They lie and manipulate yet feel “Oh, yeah, I didn’t want to tell you
no compunction or regrets— in fact, they about all that stuff. That’s the old me.”

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are not merely
selfish. Their
brains process
differently from
those of other
people. It’s as if
they have a
Although they lack empathy, psychopaths fake normal emotions so convincingly that
they often come across as personable, even charming. They learn to compensate for their learning
emotional deficiencies, much the way an amputee manages without the use of a limb.
disability that
This appearance of normalcy— the langeta of the Yupi Eskimos and the impairs
so-called mask of sanity— has bedeviled arankan of Nigeria, nearly every culture
on earth has recorded the existence of emotional
the study of psychopaths. Though guilty
of the most erratic and irresponsible, individuals whose antisocial behavior
sometimes destructive and violent be- threatens community peace. But thanks
havior, they show none of the classic to technology that captures brain activ- psychiatrists have long written psycho-
signs of mental illness. They don’t have ity in real time, experts are no longer paths off as beyond help. But now that
hallucinations or hear voices. They aren’t limited to examining psychopaths’ aber- science is unraveling the mechanisms be-
confused, or anxious, or driven by over- rant behavior. We can investigate what hind the disorder, it’s time for that atti-
whelming compulsions. Nor do they is happening inside them as they think, tude to change. If specific physiological
tend to be socially awkward. They are make decisions and react to the world deficits prevent psychopaths from empa-
often of better-than-average intelligence. around them. And what we find is that thizing with others, forming stable rela-
Add that they do not express true re- far from being merely selfish, psycho- tionships and learning from their mis-
morse or a desire to change, and it has paths suffer from a serious biological de- takes, then elucidating them could lead
been easy to view psychopaths not as vic- fect. Their brains process information to new treatments: medications, per-
tims of a dire mental instability but sim- differently from those of other people. haps, or targeted behavioral strategies.
ply as opportunists. To paraphrase the It’s as if they have a learning disability Kiehl has launched an ambitious
dilemma: Are they mad or simply bad? that impairs emotional development. multimillion-dollar project — funded
From the biblical Cain to the kun- In a collective throwing up of hands, by the National Institutes of Mental
Health (NIMH) and Drug Abuse (NIDA)
and the John D. and Catherine T. Mac-
FAST FACTS Arthur Foundation — to gather genetic
Out of Tune with Life information, brain images and case his-
tories from 1,000 psychopaths and com-

1>> Aided by EEGs and brain scans, scientists have discovered that psy-
chopaths possess significant impairments that affect their ability to
feel emotions, read other people’s cues and learn from their mistakes.
pile it all into a searchable database. To
speed the work, Kiehl helped to design a
portable scanner— a functional MRI
machine housed in a trailer— that can be

2>> These deficiencies may be apparent in children who are as young brought inside prison walls, obviating
the need for high-level clearances to
peter sherrard Getty Images

as five years old.

bring dangerous prisoners off-site.

3>> When you tally trials, prison stays and inflicted damage, psycho-
paths cost us $250 billion to $400 billion a year.
We believe psychopaths are as de-
serving of treatment as anyone with a
mental illness, but you don’t have to feel

4>> Psychopaths have traditionally been considered untreatable, but

novel forms of therapy show promise.
sympathy to want to help them. Between
15 and 35 percent of U.S. prisoners are
psychopaths. Psychopaths offend earli-

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er, more frequently and more violently Hare of the University of British Colum-
than others, and they are four to eight bia, a pioneer in the field (and a mentor to
times more likely to commit new crimes Kiehl during graduate school), found that
on release. In fact, there is a direct cor- psychopaths miss the emotional nuances
relation between how high people score of language. The investigators flashed
on the 40-point screening test for psy- real and nonsense words in front of pris-
chopathy [see box on page 28] and how oners, some of whom were psychopaths,
likely they are to violate parole. Kiehl re- and asked them to press a button when
cently estimated that the expense of they saw a dictionary word. Psychopaths
prosecuting and incarcerating psycho- were as quick as nonpsychopaths to dif-
paths, combined with the costs of the ferentiate between real and fabricated
havoc they wreak in others’ lives, totals words. But the experiment went a level
$250 billion to $400 billion a year. No deeper, because among the real words
other mental health problem of this size some had positive or negative connota-
is being so willfully ignored. tions (“milk,” “scar”) whereas others
were neutral (“gate”). For the nonpsycho-
Level Heads, Empty Hearts paths, emotionally charged words leaped
A man we will call Brad was in prison off the screen; their automatic brain re-
for a particularly heinous crime. In an in- sponses, measured by electroencephalo-
terview he described how he had kid- Callousness or laserlike focus? Once some- grams, showed a distinctive electrical
thing has caught their interest, psychopaths
napped a young woman, tied her to a have trouble attending to their surroundings.
surge, and they pushed the button faster.
tree, raped her for two days, then slit her Psychopaths did not react faster to emo-
throat and left her for dead. He told the or joy, theirs remains a textbook under- tional words, and their brain waves did
story, then concluded with an unforget- standing — it has been said that they not change [see box on next page].
table non sequitur. “Do you have a girl?” “know the words but not the music.” Evidence is mounting that language
he asked. “Because I think it’s really im- Dozens of studies reveal that psycho- bedevils psychopaths in other ways. Psy-
portant to practice the three C’s— caring, paths experience the world differently chopaths have trouble understanding
communication and compassion. That’s from other people. They have trouble metaphors— for example, they are more
the secret to a good relationship. I try to making appropriate moral value judg- likely than others to judge as negative the
practice the three C’s in all my relation- ments and putting the brakes on their phrase “Love is an antidote for the
ships.” He spoke without hesitation, impulses. They are also hampered in world’s ills.” Additionally, Kiehl found
clearly unaware how bizarre this self- how they respond to emotions, language in a 1999 study that psychopaths make
help platitude sounded after his awful and distractions — a disconnect that is more errors when identifying abstract
confession. sometimes seen as early as age five. nouns — words such as “love,” “deceit,”
Charming as they may seem, psycho- Psychopaths are curiously oblivious “trust,” “dedication” and “curiosity.”
paths can also be tone-deaf because they to emotional cues. In 2002 James Blair of Yet another deficiency of psychopaths
lack access to their own feelings and the NIMH showed that they are not good has to do with how they pay attention. In
those of others. Imagine what it would at detecting emotions, especially fear, in an ingenious gambling experiment, Jo-
be like never to be depressed or anxious, another person’s voice. They also have seph P. Newman of the University of Wis-
never to have regrets or low self-esteem trouble identifying fearful facial expres- consin–Madison, with whom one of us
but also never to care deeply for anyone sions. And a classic experiment in 1991 (Buckholtz) has worked extensively,
or anything. Psychopaths’ emotions are co-authored by psychologist Robert D. showed that psychopaths have trouble
shallow: they feel irritated when they
don’t get their way and turn to risky be-
(The Authors)
R O B ERT DA LY a g e F o t o s t o c k

haviors for the flimsiest of reasons. Be-

reft of loyalties and passions, they wan- KENT A. KIEHL is a neuroscientist at the University of New Mexico and a principal
der through life, often straying into crim- investigator at the Mind Research Network, a nonprofit dedicated to advancing the
inality on a whim — forgeries, thefts, treatment of mental illness. JOSHUA W. BUCKHOLTZ is a Ph.D. candidate in neuro-
assaults, even murders may be commit- science at Vanderbilt University, where he studies how genetic risk factors predis-
ted out of some trivial impulse. As for pose people to antisocial behavior and addiction problems.
complex emotions such as devotion, guilt

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shifting gears, even when their current
strategy for obtaining their goal is failing.
Although torture fest that appears almost aimless,
the work of two criminals who, having
Participants were given a computerized “half a begun the violence, are blind and deaf
deck of 100 cards that had been arranged teacupful” to information that might halt it (such
so that nine of the first 10 cards were face
cards, eight of the next 10 were face cards, of his as a victim’s pleas), unable to turn away
until it has been completed.
seven of the next 10 were face cards, and brain
so forth. They were told that each time
they turned over a card they would re-
leaked onto the An Altered Brain
In 1848 a handsome, dark-haired
ceive a point if it was a face card and lose floor, Phineas young man named Phineas Gage was
a point if it was not. They could end the Gage recovered. working as a construction foreman on
game at any time. Players earned easy
points at first, but as the odds worsened,
But there was a the Rutland & Burlington Railroad in
Vermont. He and his crew were clearing
nonpsychopaths noticed and stopped change in him. a rocky area when an accidental explo-
playing, usually after about 50 cards. Formerly savvy, sion blew Gage’s tamping iron— a heavy
Psychopaths, on the other hand, kept on
until the deck was almost fi nished and even-tempered metal rod more than three feet long—
through the left side of his face and out
their winnings had vanished. and responsible, the top of his head. Such an injury seemed
Newman believes that the apparent
he was now sure to kill or at the very least cripple
callousness of psychopaths is actually
the result of an attentional quirk: they churlish and him. But although “half a teacupful” of
his brain leaked onto the floor, as the at-
do not take in new information when unpredictable. tending doctor recalled, Gage apparently
their attention is otherwise engaged. never lost consciousness and on his re-
Previous research has suggested that covery remained relatively fit. His com-
psychopaths are unreactive: their palms their attention is directed elsewhere. patriots noticed a change in him, howev-

C O L L E C T I O N O F J AC K A N D B E V E R LY W I L G U S (P h i n e a s G a g e) ; “A B N O R M A L P R O C E S S I N G O F A F F E C T I V E W O R D S
do not sweat when they are exposed to Once fi xed on a goal, psychopaths pro- er— one that was more disturbing than if

B Y P S YC H O PAT H S ,” B Y S H E R R I E W I L L I A M S O N E T A L . , I N P S Y C H O P H Y S I O LO GY, V O L . 2 8 , N O . 3 ; 1 9 91 (E E G)
foul odors or shown images of mutilated ceed as if they can’t get off the train un- he had lost the use of his limbs. Formerly
faces. But Newman and his colleagues til it reaches the station. This narrowly savvy, even-tempered and responsible,
recently demonstrated that psychopaths focused, full-speed-ahead tendency, Gage was now churlish and unpredict-
actually have normal physiological re- paired with the psychopath’s impulsiv- able, driven by his immediate passions.
sponses to unpleasant stimuli, like the ity, may produce the kind of horror de- Gage’s story became a classic of neuro-
threat of an electric shock— except when scribed in In Cold Blood: an all-night science because it revealed that behavior,
which seems a matter of personal will, is
fundamentally biological.
On a Different Wavelength Gage lost the use of a part of the brain
called the ventromedial prefrontal cor-

hen shown both real Nonpsychopaths Psychopaths tex. Located behind the eyes, this area is
and nonsense words structurally similar to its neighbor, the
and asked to distin- orbitofrontal cortex—which many scien-
guish between the two, most tists believe malfunctions in psychopaths.
people are quicker to recognize The orbitofrontal cortex is involved in so-
real words that also happen to Neutral words phisticated decision-making tasks that in-
Emotional words
be emotionally sug gestive, volve sensitivity to risk, reward and pun-
such as “blood.” Psychopaths, on the other hand, do not press the button any ishment. People whose brains are dam-
faster for “blood” than for a neutral word such as “house.” Not only that, their aged in this area develop problems with
EEG readings tend to be consistent no matter what kind of word they are viewing, impulsivity and insight and lash out in re-
whereas other people’s EEGs change distinctively when they spot an emotional sponse to perceived affronts — much like
word. Moreover, no matter what kind of word they are viewing, psychopaths have Gage. In fact, such patients are often said
unusually shaped brain waves (above). These findings suggest that psychopaths’ to suffer from “acquired psychopathy.”
brains fire differently from those of other people. But transformed as Gage was by his
accident, he did not show all the charac-

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A Brain Gone Wrong

horseshoe-shaped band of tissue nestled in the deep- experiences. These brain regions also handle decision making,
est recesses of the brain may be the area that malfunc- high-level reasoning, and impulse control. People with brain
tions in psychopaths. Known as the paralimbic system, damage in these areas tend to develop psychopathic traits and
it includes several interconnected brain regions that register behaviors. And imaging studies reveal that in psychopaths, the
feelings and other sensations and assign emotional value to paralimbic areas tend to be underdeveloped.

Anterior cingulate
Empathy, affect, decision
making, cognitive control

Orbitofrontal cortex Learning

from rewards and punishments, Posterior cingulate
behavioral flexibility, impulse Emotional memory,
control, emotional and social emotion processing
decision making
Insula Awareness of body
states, pain perception

Amygdala Evaluation of Temporal pole Integration

B Y K ENT A . K IE H L , IN P S Y C H I AT R Y R E S E A R C H , V O L . 1 4 2 ; 2 0 0 6 (b r a i n) ; B al d u r B r agas o n N o r d i c p h o t o s /C o r b i s (f i n g e r )

sensory stimuli; generation of of emotion and perception,

emotional responses social processing

teristics of psychopathy, such as lack of this part of the brain is underdeveloped, under certain conditions, they are strik-
empathy. This fact suggests that other like a weak muscle. ingly unfazed by the threat of pain; they
brain structures are also involved. One In addition to the orbitofrontal cor- also have trouble noticing their errors
likely candidate is the almond-shaped tex and amygdala, the paralimbic system and adjusting their behavior accordingly
amygdala, which generates emotions includes the anterior cingulate cortex (which helps to explain the self-defeat-
such as fear. Monkeys with amygdala and the insula. The anterior cingulate ing way that psychopaths land in jail
damage walk right up to people. Psycho- regulates emotional states and helps peo- repeatedly, unable to learn from past
paths, too, are notable for their fearless- ple control their impulses and monitor mistakes).
ness: when confronted with images such their behavior for mistakes. Are psychopaths made or born? The
as a looming attacker or a weapon aimed The insula plays a key role in recog- answer is probably both. If, as investiga-
their way, they literally don’t blink. nizing violations of social norms, as well tors believe, genes account for 50 percent
But evidence suggests that one or two as in experiencing anger, fear, empathy of the variability among those who ex-
brain areas are not enough to produce and disgust. Psychopathic behavior is by hibit adult antisocial traits, that means
the profound impairments of psycho- definition insensitive to social ex- life circumstances are just as impor-
paths. Kiehl recently proposed that psy- pectations, and as described ear- tant as biological inheritance. Some
chopathy emanates from the paralimbic lier, psychopaths can have un- psychopaths are scarred by rough
system, a group of interconnected brain usually high disgust thresholds, childhoods, but others are the “black
structures that are involved in emotion tolerating repellent smells and sheep” of stable families. Regardless
processing, goal seeking, motivation and images with equanimity. of whether genes or environment has
self-control [see box above]. Supporting The insula is also involved in the greater influence,
this hypothesis are fMRI images of psy- pain perception. Stud-
Not only are psycho-
chopaths’ brains made by Kiehl and oth- ies of psychopaths —
paths blithe about
ers, which show a pronounced thinning including one in which subjects in­flict­ing pain, they
of the paralimbic tissue — indicating that got electric shocks — find that, often don’t fear it.

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early intervention— perhaps even in pre- oping the social and cognitive skills that it is a problem for all of us. Some re-
school— could be critical. Just as there is underlie what we call “conscience.” searchers have estimated that as many as
a moment in childhood when the brain is 500,000 psychopaths inhabit the U.S.
primed to learn language, a task that be- Ignored at Our Peril prison system, and there may be another
comes much harder later on, we suspect Psychopaths are misunderstood. This 250,000 more living freely— perhaps not
there may be an early window for devel- fact may not tug at the heartstrings, but committing serious crimes but still tak-
ing advantage of those around them.
Helping them manage their impulsivity

Do You Know a Psychopath? and aggression could protect many in-

nocents. Until now, though, few efforts

hances are, you have met a psychopath. People with the disorder make up have been made in that direction. Bil-
0.5 to 1 percent of the general population. When you discount children, lions of research dollars have been spent
women (for reasons that remain a puzzle, few women are afflicted), and on depression; probably less than a mil-
those who are already locked up, that translates to approximately 250,000 psy- lion has been spent to find treatments for
chopaths living freely in the U.S. psychopathy. In part, psychologists have
How can you recognize a psychopath? The test that experts use, known as been turned off by evidence that psycho-
the Hare Psychopathy Checklist–Revised, consists of 20 criteria, each of which paths are untreatable. For example,
is scored as a 0, 1 or 2. The criteria include behaviors and traits such as patho- some studies show that after receiving
logical lying, proneness to boredom and sexual promiscuity (below), which are group therapy in prison, psychopaths
assessed during an interview as well as by consulting prison and police reports are more likely to commit new crimes
and other official records. The highest possible score is 40 (a score of 2 on all than if they had received no treatment at
20 criteria), but anyone who gets 30 or higher is considered a psychopath. all. Listening to others bare their soul is
The thing is, everyone falls somewhere on the psychopathy continuum. The aver- clearly not a good strategy: psychopaths
age person scores about a 4, but there are plenty who rank in the teens and 20s — are notoriously good at learning and ex-
not high enough to receive an official diagnosis yet possessing significant (and often ploiting the weaknesses of others. They
noticeable) psychopathic tendencies — the bullying boss, the drifter, the irrespon- also have trouble absorbing abstract
sible guy who is always milking the generosity of friends and lovers. ideas, so lectures about personal respon-
sibility are unlikely to penetrate.
Antisocial Behavior But there is room for optimism: a
new treatment for intractable juvenile
>> N eed for stimulation and >> I mpulsivity offenders with psychopathic tendencies
proneness to boredom >> I rresponsibility has had tremendous success. Michael
>> P arasitic lifestyle >> E arly behavior problems Caldwell, a psychologist at the Mendota
>> P oor behavioral ­control >> J uvenile delinquency Juvenile Treatment Center in Madison,
>> S exual promiscuity >> P arole or probation violations
Wis., uses intensive one-on-one therapy
known as decompression aimed at end-
>> L ack of realistic long-term goals
ing the vicious cycle in which punish-
ment for bad behavior inspires more bad
Emotional/Interpersonal Traits
behavior, which is in turn punished.
>> G libness and superficial charm >> S hallow affect Over time, the incarcerated youths in
>> G randiose sense of self-worth >> C allousness and lack of empathy Caldwell’s program act out less frequent-
ly and become able to participate in stan-
>> P athological lying >> F ailure to accept responsibility
for own actions dard rehabilitation services.
>> C onning and manipulativeness A group of more than 150 youths
>> L ack of remorse or guilt treated by Caldwell were 50 percent less
likely to engage in violent crime after-
Other Factors ward than a comparable group who were
treated at regular juvenile corrections
>> C ommitting a wide variety >> H aving many short-term marital ­facilities. The young people in the regu-
of crimes relationships
lar system killed 16 people in the first
four years after their release; those in

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For every
$10,000 spent
on decompression
therapy, a
treatment for
youths with
tendencies, we
save $70,000
that would have
been required to
keep them
in jail.
chopath. Yet time and again at trial, ex-
perts wrongfully attest that when a de-
fendant has antisocial personality disor-
der, it means he is a psychopath, which
Psychopaths typically get worse, not better, after standard treatments like group therapy. in turn means he is likely to reoffend and
Insights into others’ vulnerabilities become opportunities to hone their manipulation skills.
should not be paroled.
Caldwell’s program killed no one. The after all, psychopaths are sure to lie con- As scientists continue to describe the
economic benefits are also huge: for ev- vincingly during the interview. brain dysfunctions of psychopaths, the
ery $10,000 society spends on treatment, Whatever the reasons, many psychi- revelations promise not only to aid dis-
we save $70,000 that would have been atrists are left with the false impression turbed individuals but to bring sanity to
required to keep those people in jail. that psychopathy and antisocial person- society. For it is senseless to ignore psy-
The ongoing brain and genetic studies ality disorder are the same. They are not. chopaths when they pose such a threat.
are likely to further improve Cald­well’s Antisocial personality disorder is a help- When lawyers, jailers, psychiatrists and
results: perhaps, as with depression, a ful diagnosis when the question is wheth- others begin to see psychopaths for what
combination of therapy and medication er a person is likely to behave badly, but they are— not monsters but people whose
will prove especially potent. But such ad- it does nothing to discriminate among emotional disabilities may cause them to
vances are slowed by the fact that psy- criminals. Only one in five people with act monstrously— we will all be on the
chopathy is often overlooked by the men- antisocial personality disorder is a psy- path to a safer future. M
tal health mainstream. It isn’t even in-
cluded in the Diagnostic and Statistical (Further Reading)
Manual of Mental Disorders— the DSM—
◆ ◆ The Mask of Sanity. Hervey Cleckley. C. V. Mosby Co., 1941.
an exhaustive catalogue of more than 300
◆ ◆ Without Conscience: The Disturbing World of the Psychopaths among Us.
known psychiatric conditions that serves Robert D. Hare. Guilford Press, 1993.
as the clinician’s bible. The DSM’s ­framers ◆ ◆ Are Violent Delinquents Worth Treating? A Cost-Benefit Analysis. Michael F.
instead created a catchall diagnosis for the Caldwell, Michael Vitacco and Gregory J. Van Rybroek in Journal of Research
criminally inclined, known as antisocial in Crime and Delinquency, Vol. 43, No. 2, pages 148–168; May 2006.
◆ ◆ A Cognitive Neuroscience Perspective on Psychopathy: Evidence for Paralimbic
personality disorder, and left it at that.
System Dysfunction. Kent A. Kiehl in Psychiatry Research, Vol. 142, Nos. 2–3,
Why was psychopathy excluded? The pages 107–128; June 15, 2006.
creators of the DSM may have felt that it ◆ ◆ Suffering Souls: The Search for the Roots of Psychopathy. John Seabrook in

would be too difficult for the average New Yorker, pages 64–73; November 10, 2008.
therapist to make an accurate diagnosis:

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