Why is therapy useless for psychopaths
The so-called evil
Anyone who believes that they can explain violence, murder and manslaughter neurobiologically better than the humanities, philosophy, social sciences, psychology and “common sense” have tried for centuries is wrong. Brain research and criminology need each other. I'll come back to that.
Anyone who believes that violence, guilt and remorse are exclusively determined by the brain and that free will is therefore an illusion is wrong. I will come back to that too.
Anyone who believes, as I am often accused of and sometimes forced to believe myself, that my own adolescent crime has motivated interest in our topic, is wrong. I won't come back to that.
Neurobiological research into the causes of the perennial orgies of violence of the human race (especially men) does not provide any fundamentally new, but causes-uncovering contributions to previous efforts to educate people. They add some important determinants to the known social and genetic factors.
Suffering violence, being a victim is obviously emotionally and physiologically stressful, often lifelong traumatizing, but often not easy to document because death or severe pathology (e.g. brain damage) makes the victim impossible. But the brain states and psychology of the perpetrator, which usually survive. However, scientific data are only available after, rarely or never during the crime. An exception are posed socio-psychological experiments such as that by Stanley Milgram from the 1960s, but even in these groundbreaking investigations the victims were not systematically observed because they were initiated employees of the experimenter.
We simulated the Milgram experiment in a magnetic resonance scanner and examined the “victims” and “perpetrators”. As a reminder, Stanley Milgram allowed his test subjects to punish an unknown person who could only be observed through a pane of glass for incorrect answers in various puzzles with increasingly painful and ultimately fatal electric shocks. If the subjects hesitated, the experimenter simply said, “Carry on.” Sixty to seventy percent of the subjects in every nation where this experiment was repeated, from Harvard (Stanley Milgram's home university) to Germany to India, killed the persons for their own sake Alleged mistake, stimulated by the relatively little pressure exerting authority of an experimenter who asks to “continue”. All healthy, inconspicuous citizens. Male and female test participants the same, no personality differences between refusers and “perpetrators”, no differences in intelligence, no psychological disorders in the perpetrators. No psychological experiment on violence, repeated over and over again with identical results, has ever been more revealing than this.
The Milgram experiment raises tremendous questions and questions many of the truisms about violence. First of all, men and women: physical violence and crime seem to be men's business, and especially young men with high androgen levels. Male sex hormones are transported in significantly smaller quantities into the brain of women, but in the male brain they lead to anatomically and neurochemically distinguishable reorganizations of the brain regions responsible for aggressive behavior. So is it the (young) straight man after puberty with high androgen levels who is primarily the source of violence? Milgram found no difference between the sexes. Both kill the same and for the same motives: submission, belief in authority, obedience. The fact is that psychopathic men in particular prefer to kill women, an above-average number of these men were neglected by their mothers or suffered brain damage before and during birth, which was accompanied by physical and psychological neglect of the fetus and small child.
Let me leave the bleak gender struggle and return to the reality of our experiment. Could the “superiority” of young men as criminals and perpetrators be a cultural phenomenon? We have left the privilege of murder based on the tradition of superior muscular strength to the young man for thousands of years. Does it have to stay that way? Those brains that reported feelings of guilt and remorse after the experiment, and those brains that said they had only followed the experimenter's request to continue to punish the victim intensively, differed significantly in their activities. Guilt and remorse activated a brain region in the so-called medial prefrontal cortex (mPFC). Exactly this region is not activated in psychopathic violent offenders or is damaged during or shortly after birth. Those violent offenders who had suffered diagnosable damage to the mPFC became violent even if they had not experienced neglect in their youth and came from “good” families. In this case the brain triumphs over social circumstances.
The psychological examination of the “repentant” vis-à-vis the perpetrators revealed another interesting difference. The shameless - with little prefrontal activation - were more psychopathic. What is psychopathy and how to measure it and what does this have to do with violence? The term “psychopathy” is burdened because it used to be used as a general collective term for all types of behavioral disorders. In the behavioral and neurosciences, this is a relatively clear and defined profile of behaviors and brain reactions, at the center of which is the lack of emotional anticipatory fear: Our results are now among the "classics" of the neurobiology of psychopathy. Serious criminals were examined.
However, these were not "ordinary" felons, but men who, according to a reliable psychological measuring instrument, had very high scores for psychopathy. This means: no emotional fear, ie no feeling of fear of the negative consequences of one's own actions, in spite of a completely clear cognitive and intellectual insight into the consequences for the person himself and the victim; frequent relapses into the same reckless or criminal behavior; learn poorly from negative emotional experiences; are therefore often daring, are often experienced as cold-blooded or, in a positive sense, as "courageous"; don't tolerate boredom and monotony and are therefore often on the lookout for excessive irritation and “sensational” experiences. Robert Musil described the prostitute murderer Moosbrugger in inimitable precision in “Man without Qualities” and also identified the lack of emotion with “otherwise clear mind” as a central defect.
At the unsuccessful end of the psychopathy scales are prison inmates, at the successful end are successful executives with exactly the same characteristics. Whether someone becomes a criminal or a successful manager with the same degree of psychopathy is decided by their parents, early experience and nutrition, intelligence, economic resources at home, the extent of extreme income differences and schooling and the more relaxed (measured by the heart rate at rest) a psychopath is. But the better its autonomous system, for example the heart, can be activated, the more likely it will be successful. Women are just as likely to be psychopathic, but - as already mentioned above - they are significantly less likely to be criminal and physically violent.
In prisons with felons, their percentage fluctuates between 25 and 50 percent of the inmates, with recidivists and particularly violent offenders in many cases exhibiting a high psychopathic value. Further risk factors for unsuccessful psychopaths are: birth trauma, no reward and attention for non-aggressive behavior in development, poor parents with a young, single mother, malnutrition or malnutrition, chaotic upbringing, sexual and physical abuse as children and adolescents, no role models for self-control, low intelligence, poor schooling, attention disorder, excessive use of aggressive games and videos, sensationalism and boredom, alcohol and drug abuse.
The causes of psychopathy and crime are manifold. As with all relatively stable behavioral traits, an approx. 50 percent genetic component exists, but many of the genes involved and their metabolites are unknown. However, risk factors and protective factors for aggressive criminal behavior are known and probably also largely apply to the successful end of the scale.
In psychopaths, protective reflexes start weakly, as if “everything was fine”. Your vegetative system is particularly balanced, the activating fluctuations of the sweat glands under stress and also at rest are significantly lower. The body signals of fear and stress occur less and / or do not reach the brain and / or are not processed there as "emotional" signs. In successful psychopaths, physical signals reach the brain when they are under stress and warn them of dangers.
We come back to our starting point, the Milgram experiment: we kill and torture almost everyone when it is ordered by the authority and takes place in a seemingly everyday but criminal context like National Socialism. The psychopathic minority of around five percent of the population feels neither fear nor regret nor shame and is probably characterized by a particular continuity of repulsive violence and often joy in it. In the context of a democratic environment such as the European one at the moment, social pressure and obedience mostly cease to exist, and psychopaths dominate the negative social extremes, both the unsuccessful with criminal behavior and the successful ones, for example in the banking and stock market crisis of recent years, completely Disregard for the catastrophic economic consequences, focused on the near-win - as is characteristic of psychopathy.
Properties such as psychopathy, but also such as impulsiveness and instrumental aggression in serious criminals and the associated reckless behavior are considered to be stable for life; they are already present and measurable before puberty, have a considerable genetic component and often result in damage to the frontal brain and of the limbic fear areas and thus fulfill the expectation of the majority that they are unchangeable. Neurobiology also seems to confirm this.
However, we were suspicious of immutability and stability because the brain regions we identified responsible for controlling fear expectation and anticipation are among the best-studied and particularly neuroplastic brain regions that are closely connected to learning and memory processes. The cell areas of the amygdala and the closely related hippocampus are among the most important “learning machines” in our brain. The front island region, its connections, must be active with every new negative emotional state, with every new confrontation and learning to perceive the physical changes, especially in fear - otherwise we consciously do not feel fear. The perception of physical changes can be modified through learning and unconsciously controls our emotional behavior even without the involvement of consciousness. So how can the psychopath's brain be unimpressive? Fear is learned very easily and quickly, and the successful exposure behavioral therapies demonstrate how easily it can be unlearned again.
The significantly reduced recidivism rates and the falling serious crime rate in all democratic countries with “humane” penal systems (not the United States, for example) correlate with the effectiveness of learning, training and rehabilitation measures in the penal system. Unfortunately, this does not apply to the successful psychopaths in freedom at the center of society, who are usually continuously materially and socially rewarded for their behavior.
Without changing the brain activities in the fear system in those social situations that control an adapted socialization and avoidance behavior (“don't do that, otherwise…”), psychopathic behavior and violence and recklessness cannot be permanently influenced. Previous attempts to achieve this through psychotropic drugs or brain stimulation or classic psychotherapy have largely failed. However, prevention studies, for example on the island of Mauritius, have shown that the early selection (here in the third year of life) of the risk group with low skin conductivity and heart rate and intensive social care and an omega-3 (fish) diet both the crime rate and the The likelihood of severe mental illness (e.g. schizophrenia) is dramatically reduced.
How can it be proven that the critical brain regions involved can be permanently changed through learning? That was the question we asked ourselves together with the prison system. Attempts to examine even successful psychopaths almost never work. The "suffering" (from the deprivation of liberty) is missing, and the intentions of the researchers can be seen through. Even large sums of money cannot induce successful psychopaths to cooperate. You usually have enough of it.
In several therapeutic examinations at our institute, serious criminals trained in high-security prisons to reinforce those regions of the brain that are responsible for self-regulation and control of aggression and the development of fear, and / or to suppress those regions that convey instrumental aggression. For this purpose, neurofeedback of the cerebral blood flow and neurofeedback of so-called frontal slow brain potentials were used. The criminals observe their own brain activity from those disturbed brain regions on a screen in the form of, for example, a stronger or weaker glowing thermometer, and they have the task of amplifying or weakening this feedback signal from their brain. They do not receive any help whatsoever as to which mental or other strategies they use to control the signal, since each person develops their own, individual strategy of self-control and is immediately rewarded by the computer for the "correct" brain change. All, even the most severe cases, learned brain control over the course of 10 to 25 hours of training, and their behavior changed depending on the learning success: anxiety increased as intended, cognitive-mental self-control of aggressiveness decreased.
Whether this is sufficient for the confrontation with freedom and its “temptations” after the end of the sentence must be checked and cannot be decided in prison on the basis of this result alone. These brain training results clearly confirm the neuroplastic changeability of the brain changes of psychopathic criminals. We assume that the learned change in brain activation through neurofeedback, in combination with intensive anti-aggression training, contributes to a significant reduction in the risk of relapse and criminal offenses. Particularly promising are preventive measures such as early social care and prosocial training, balanced nutrition, removal from a chaotic psychopathic milieu, but also early genetic risk identification and subsequent therapy.
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