Sunday, November 9, 2008

Evil Not Otherwise Specified



"And I looked, and behold a pale horse: and his name that sat on him was Death, and Hell followed with him."


Revelation



Enough for now with the rational exuberance of the election; let us be grimly realistic. The New Yorker this week has an intriguing look at the phenomenon of the psychopath, which, as the article reminds us, means "suffering soul." This brings up the obvious question of whether they themselves do in fact tend to suffer, as opposed to those who come in contact with them.

Those who, like me, do not work in forensic or correctional settings generally encounter antisocial types who are in distress of some kind (i.e. they present voluntarily for treatment). However, it seems to me that they are usually more perturbed by the social consequences of their actions than by those actions themselves. That is, they do, much like a severe substance abuser, seem to recognize at some level that they are not "right," at least not normal, but the distress comes about as a result of legal, financial, and social results of their behavior, which in itself they often find, of course, to be quite gratifying (or as we say in the business, ego-syntonic).

For instance, I saw a guy not long ago who was superficially quite pleasant and engaging but who professed to have committed a number of highly violent acts over the years, some of which had come to the attention of the legal system, some not. On one level, he seemed to exhibit remorse for this, but he was also at great pains (so to speak) to impress me with the magnitude of his potential for violence (he was affable with me and I did not feel directly threatened in any way). He said several times, "I don't want to hurt people," but at other times he acknowledged that hurting people sometimes gives him great pleasure, and he made a point of insisting that those whom he had victimized in the past had deserved it in some way.

This man did seem dysphoric, but I'm not sure that it was necessarily related to his antisocial style (he may have bipolar disorder as well). As the aforementioned article mentions, it is quite possible for psychopaths to function successfully and without obvious suffering. Psychopaths are not inevitably violent, and in settings such as business, law, or politics they may decide that it is in their best interests not to be, but the hallmark of the condition is that this decision is based purely on self-interest, not on true conscience.

A few decades ago, cultural explanations for the formation of antisocial individuals were dominant, reflected in the term "sociopath." The pendulum has very much swung back to neurobiological explanation. To be sure, many psychopaths have awful and abusive childhoods, but that may be due as much to genes shared with their parents as to any direct result of traumas endured (after all, most people abused as children do not become psychopaths).

Brain imaging is the reigning trend now for insight into behavior, but it's hard to know how this ultimately relates to whether we treat antisocial actions as freely willed or as imposed by psychopathology. After all, we know that all subjective experience and overt behavior originate in the brain in some fashion, and the precise location and nature of this--whether the amygdala or some other region lights up on functional MRI--is of questionable relevance to legal theories of responsibility. Of course, such theories ultimately reflect social consensus, and as brain imaging and other neurobiological techniques become more commonplace in the public eye, the trend over time may favor determinism over free will.

But there is a strong visceral resistance to viewing certain kinds of violent or predatory deeds as inevitable or merely biological. This may not be rational in a strictly scientific sense--as myriad philosophers have argued, from the point of view of the universe (or the ultimate functional MRI machine), all thoughts and behaviors are determined by the brain. However, our revulsion toward the psychopath is highly rational as itself a product of evolution.

One can imagine that genes favoring psychopathy may have survived over the eons because in some contexts they may confer survival advantage. In some situations ruthlessness and comparative lack of conscience, particularly when coupled with prudence, can be remarkably helpful. However, this has had to struggle against competing genes that have favored the social cooperation and trust that bound successful groups together over evolutionary time. Groups cannot function if more than a tiny fraction of its members are psychopaths.

A severely moralistic view of antisocial behavior has therefore, for both biological and social reasons, itself seemed inevitable so far. Whether psychopaths will continue to be "corrected" in the criminal justice system as they are now, or rather according to a mental health paradigm a la A Clockwork Orange (this remains science fiction, as no effective treatments for psychopathy currently exist), is based more upon social decree than upon science. It's for the voters to decide; the neurobiologists and the moralists will make their respective cases over time. The ultimate referendum: is the serial killer evil or sick?

4 comments:

Anonymous said...

Does having a biological predisposition to something necessarily negate free will?

You reported feeling comfortable talking with the patient who wanted to impress you with his capacity for violence, because his demeanor was affable. Do you think he chose to present that way, or did you just get lucky that he wasn't short-circuiting during the appointment?

I am not a psychiatrist, but was raised by a father who would, by most accounts, be considered antisocial (if not actually psychopathic), yet who managed to function well in certain environments. He had a successful business career but also had a capacity for cruelty and violence. It was apparent to me that he chose when to express those traits, which means outside the public eye. He also chose how far to carry his violence, in that he was able to stop before anyone was seriously injured or killed.

The fact that he had that much control over his behavior suggests that he exercised free will, that he knew certain behaviors would be considered immoral and/or illegal, and that he understood the consequences of engaging in those behaviors should he get caught. He may have been sadistic, and may have lacked empathy, but you would be hard-pressed to convince me that he didn't act with deliberate intent.

I imagine there exists a continuum of organic dysfunctionality that helps determine how much impulsivity vs. control a person exercises, as well as what degree of psychopathy is present.

Like the nature vs nurture argument, I think its possible both evil and illness play a role in a serial killer's behavior, not merely one or the other.

Cheryl Fuller, Ph.D. said...

Two things come to my mind --

1. I once worked for a short time with a man who came to therapy because he was depressed -- depressed because he was lonely. And then he told me he was obsessed by a woman he couldn't have and whom he stalked and in a by the way comment on the way out one day said he had been charged with murder in another state. He seemed not all disturbed by the impact of his stalking on the woman he was then obsessed with nor did he seem to have any concern about the murder charge which was still open. He was pleasant, well-educated, and his demeanor did suggest depression. All against a background of violence and remarkable lack of concern for others.

2. I think of Tony Soprano. And I wonder about cultural context. If a person is a member of a sub-culture or culture in which violence, even murder, is common and seen as inevitable, then is an individual who is successful in that culture sociopathic or is he normal in his culture? And how do we deal with these kinds of differences in culture? Gangs would be another instance in which repugnant behavior can be normal in that context yet pathological outside of it.

Novalis said...

I think that biology and free will must coexist, but only for pragmatic reasons--even someone consciously committed to a deterministic point of view would still have to make a lot of "choices" simply due to ignorance of what the "determined" outcome might be.

The cultural question is an interesting one, and brings to mind other extreme, if morbid, behaviors that can become normative in isolated sub-cultures. For instance, is suicide terrorism primarily a political or a clinical phenomenon? Can entire groups or sub-cultures be pathological? The news tonight mentioned the 30th anniversary of the Jonestown mass suicide.

Anonymous said...

It's impossible to untangle the complicated constellation of psychopathic neurobiological determinants and the extent to which they are externally induced/modified/potentiated/negated etc.

On a macro scale, the brain architecture and physiology of psychopathic brains may be similar; but it could be the microscopic permutations and combinations of biological influences and their dynamic interplay with environment that govern the degree to which the pathology is contained or exuberantly embraced in all its bloody glory.

Thus, regardless of the minutiae that produces an individual's unique psychopathy profile, it's all determined by this genetic and random external dynamism; and whether a psychopath is able to exert 'self-will' on his/her tendency is dependent on the degree to which the impulse control parameter is expressed in relation to all the other ingredients in the formula--which is beyond the psychopath's control.

So where does this leave moral culpability?-- as an illusion that society will fiercely defend and uphold as the hallmark of its civil evolution until that pale horse comes galloping.

Moral responsibility is a societal construct; it is the tenuous glue that binds order out of the loose ends of chaos.

If all is random then we have no control; and if all is pre-determined, we're still stuffed!

What to do? Use brain scans to mitigate psychopaths' culpability so we all win...not.

Crime must be punished whoever/whatever the hell is responsible so 'justice' is served.
It keeps our consciences pretty and well manicured like fake front yards coloured and cut into aesthetically pleasing shapes by celebrity gardeners.