Kent Kiehl: peering inside the psychopath's mind.
Antisocial personality disorder
Sociopathic personality (Analysis)
|Publication:||Name: The Forensic Examiner Publisher: American College of Forensic Examiners Audience: Professional Format: Magazine/Journal Subject: Health; Law; Science and technology Copyright: COPYRIGHT 2011 American College of Forensic Examiners ISSN: 1084-5569|
|Issue:||Date: Winter, 2011 Source Volume: 20 Source Issue: 3|
|Topic:||Event Code: 200 Management dynamics|
|Persons:||Named Person: Kiehl, Kent; Kiehl, Kent|
|Geographic:||Geographic Scope: United States Geographic Code: 1USA United States|
Dr. Kent Kiehl is at the forefront of the emerging neuroscience
research on psychopathy, and is considered one of its leading experts.
Mentored by the creator of the Psychopathy Checklist-Revised (PCL-R), he
is an associate professor of psychology at the University of New Mexico,
and Director of the Mobile Imaging Core and Clinical Cognitive
Neuroscience at the non-profit Mind Research Network in Albuquerque. His
primary focus is on groundbreaking research on the brains of
incarcerated psychopaths. Kiehl also consults for attorneys and judges
and testifies in the courtroom, hoping to educate the fact-finders about
the impact of neurological factors on culpability. Progress has been
made, he believes, but his field aims toward an even greater impact on
the future treatment of psychopathy. Kiehl will likely play a key role.
IT BEGAN WITH BUNDY
Kiehl grew up in Tacoma, Washington, where his father was a copy editor at the News Tribune. Kiehl was around eight when his father mentioned the killing spree of a man who had once lived down the street: Ted Bundy. Kiehl was intrigued. "I never met Ted Bundy," he says, "and I didn't need to grow up down the street from him to be fascinated about why someone could be like that, but my father was writing about it, and we were mystified how someone could grow up in our nice little neighborhood and end up as a killer. He had a relatively normal home. That was a point of fascination for me."
Despite his interest, Kiehl aimed toward a different career. With an athletic build and his father's enthusiastic support, he aspired to play professional football. But then a knee injury terminated his chances and he had to refocus. He enrolled as a pre-med student at the University of California at Davis, and he grew interested in the field of neuroscience, especially the brain's emotional centers. At the suggestion of his advisor to consider the research on psychopaths, Kiehl returned to the Bundy question: was the brain a significant factor in psychopathic behavior? He soon discovered the diagnostic Psychopathy Checklist-Revised (PCL-R), which led him to the work of Dr. Robert Hare.
During the 1980s, Hare and his colleagues had developed the PCL-R to focus their work with psychopaths in Canadian prisons. With demonstrated reliability and validity, this screening instrument has been adopted worldwide. With it, clinicians use interviews and archival data to assign points to specific traits and behaviors to derive a single score. High scorers are diagnosed as psychopaths. Seemingly free of remorse, they lie easily and manipulate with abandon, but are so inept with social cues that they often mimic others in order to pass as normal. They may be intellectually high functioning, and able to appreciate the difference between right and wrong, but they generally lack an ability to weigh risk or recognize quid pro quo. Parasitic and impulsive, rarely do they form a solid life plan. Given their propensity for aggression, social violation, and criminality, it can be difficult to view psychopaths as the victims of neurological impairment. It is just easier to say that they are evil.
Hare gave a presentation at UC-Davis and talked with Kiehl about his research. Afterward, Kiehl began a single-minded campaign to become one of Hare's proteges. He succeeded. "I'm the only American he'd ever taken as a student," says Kiehl. "I literally courted him for two years, because he's the grandfather of the field and I wanted to work with him. He was and is still, even in pseudo-retirement, a real facilitator for implementing new things."
When Kiehl arrived for graduate work at the University of British Columbia in Vancouver, Hare sent him to a new prison that housed "the worst of the worst" to screen inmates. "I worked with the psychiatrist Johann Brink," Kiehl says, "and he helped set the stage for me to work in the maximum-security facility where I spent seven years." He received a quick education when he interviewed offenders who described egregious crimes as easily and heartlessly as if recounting their daily schedules. Being in their presence, Kiehl says, can be "electrifying." He witnessed for himself the mind-boggling blend of charm, intelligence, and rational thought with poor planning, little insight, and a lack of empathy and remorse.
Although initially overwhelmed at being thrown to the wolves, Kiehl rose to the challenge. Soon he was assisting with major projects, including an international conference in Portugal. "One of the first things that happened is that we won an award for a NATO ASI, Advanced Study Institute, that brought together scientists from fifty countries to talk about the current state of psychopathy. It was an amazing two-week, intensive experience."
During this time, Kiehl looked into the emerging technology of functional magnetic resonance imaging (fMRI). By mapping blood flow during neuronal activation, fMRI provides a way to chart real-time functioning in various areas of the brain during specific activities. Thus, the brains of diagnosed psychopaths could be studied while they were engaged in a task (looking at images or responding to questions) and compared with the brains of normal people who performed the same task. Kiehl added this to his research interests.
Once his graduate work in Canada was complete, Kiehl taught at Yale for seven years before the non-profit Mind Research Network, an association of scientists and research centers, lured him to Albuquerque in 2006. In his new position, and funded by the State of New Mexico, NIMH, NIDA, and the John D. and Catherine T. MacArthur Foundation, he took a portable MRI scanner into several correctional facilities. It is safe to say that Kiehl's team has now done more neurological assessments on psychopaths than anyone in the world.
"[As of March 2011], we've scanned over 1,700 offenders," says Kiehl, "and about seventeen percent would meet the criteria for psychopathy. Our plan is to look at all things related to the forensic population. I'm interested now in the policy and legal implications. If we do believe there are these brain differences, how will politicians get funding for treatment, and how will it help us with policy-related questions?"
Kiehl suspects that psychopathy arises from a brain deficit, and qualifies as a severe mental illness. In his mind, expecting psychopaths to understand and control their actions is like expecting someone with dyslexia to read Faulkner. "I liken it [psychopathy] to an emotional disorder with an adjunctive impulsivity problem. With those two facets, in conjunction with the right environment, psychopaths have an unstable lifestyle that often leads to criminal behavior. That's why we work with them in a forensic population, because they're potentially the most costly and self-defeating. We try to translate what we find into more effective therapies than are currently out there."
If they think differently, as they seem to do, Kiehl believes that they must have different brain structures or modes of processing. The research thus far seems to support this hypothesis. For one study, inmates were directed to respond to a series of images and morally provocative phrases, such as "sex with your mother." When the results were in, the psychopathic brain showed differences from a normal brain in the paralimbic system. This network of brain structures is associated with the regulation of attention, motivation, self-control, and emotion. The EEGs were consistent for diagnosed psychopaths, whether they were reading words with normally strong emotional tones or neutral words. For them, there was little, if any, difference.
In another study, the team asked subjects to perform an auditory task: respond to a target sound while ignoring standard and random non-target sounds. Compared to non-psychopathic inmates, psychopaths exhibited unusual brainwave patterns when detecting the target sound (a large, late N550, enlarged N2, and slightly decreased fronto-central P3), and were less distracted by non-target sounds. Kiehl finds this to be consistent with the hypothesis that psychopaths over-focus on items of immediate interest. They block other information, including risk cues, and proceed "as if they can't get off-the train until it reaches the station." Paired with impulsivity, this trait could account for apparently motiveless crimes.
Studies of college students were used in yet another study for comparison against both psychopathic and non-psychopathic inmates. All subjects evaluated three types of cause and effect rules. One set was descriptive ("If a person is from California, then that person will be patient"). A second type featured such "social contract" activities as borrowing items and keeping promises. The third type offered specific risks and precautions, such as, "If you work with tuberculosis patients, you must wear a surgical mask." On the descriptive logic, all participants performed at a similar level of functioning, but psychopaths fell behind on precautions and social contracts. These results suggest that their ability to cooperate with others in social situations, to weigh risks, and to think in moral terms is impaired.
Kiehl's work with incarcerated psychopaths has gained him notoriety. The idea of placing psychopathy on the list of mitigating conditions that might turn the tide for verdicts has stirred controversy.
Some of the earliest neurological studies performed on violent offenders occurred during the 1940s with electroencephalograms, which measured electrical activity in the brain. In a study that involved fifty-eight males and six females who had been implicated in murder, the EEG records were generally abnormal. The most dramatic readings came from offenders who had committed seemingly aimless crimes, yet were free of psychosis, i.e., psychopaths.
The CT scan came along in the 1970s, and was a prominent feature for the defense of John Hinckley, Jr., who had tried to assassinate President Ronald Reagan in 1981. He was acquitted by reason of insanity.
"The jury found Hinckley ill," Kiehl points out, "and he was clearly ill. It's just a matter of whether or not the information is helpful, but people are largely afraid of it."
Since then, other attorneys have hired experts to demonstrate that the brains of certain aggressors are structurally and/or functionally different from normal people. During the late 1980s, brain scans were used for analyzing the metabolic states of aggressively violent offenders, and by the next decade, scans were performed to look for evidence of structural differences or brain damage. Dr. Adriane Raine, at the University of Pennsylvania, used positron emission tomography (PET) to compare the brains of 41 murderers to 41 matched controls. He found deficits in several areas for violent individuals related to impulsivity, fearlessness, lack of response to aversive stimulation, and faulty processing of emotional information.
Other researchers have also concluded that there are visible structural and functional impairments in antisocial, psychopathic, and repeatedly violent individuals. The affected areas include the orbitofrontal and dorsolateral prefrontal cortex, as well as the superior temporal gyrus, amygdala-hippocampal complex, and the anterior cingulate cortex. The amygdala, linked through a complex network to brain regions that monitor all five senses, shares a communication channel with the prefrontal cortex. It assists in detecting danger and assessing reward by assigning values and adjusting according to context. If the amygdala is dysfunctional, the person can fixate on the reward or have a disturbed sense of emotional values. In psychopaths, if this brain region sent the wrong signals to the prefrontal cortex, it would result in an impaired ability to respond to the threat of punishment, make clear moral judgments, and grasp the emotional implications of any given behavior.
PENETRATING THE COURTROOM
Kiehl testified for the defense in the Brian Dugan trial in Illinois in 2009. Dugan had admitted grabbing a ten-year-old girl from her family's home in 1983 before raping and killing her. Having been convicted of two other murders, including that of a seven-year-old girl, he was clearly a dangerous predator. During sentencing, the jury had to decide whether he should get life in prison or a death sentence. Dugan's defense attorney invited Kiehl into the proceedings, hoping that a scan of Dugan's brain might reveal such abnormality that the jury would accept that, as a psychopath, his lack of empathy might have hindered his ability to control his aggressive compulsion. Kiehl found an abnormally low density of grey matter in areas that monitor emotion, which suggested that Dugan might not have chosen as freely as many believed. Kiehl testified about the development of psychopathy and what was known from neuroscience about the condition.
"They [the prosecution] couldn't find anything to countermand the science we presented," Kiehl points out, "except one point, which was that the imaging of Dugan's brain in 2009 didn't relate to a crime that happened twenty-five years before. But psychopathy is a lifelong disorder. It's like an IQ. It's reasonable to apply what we find today to what happened when someone was fifteen, because it's not like his IQ is going to change much."
Kiehl believes the jury heard him. "The Dugan jury was highly sensitive to what I said about what we know about psychopathy and what we don't know. They did come back originally with a signed life sentence verdict. But there was a lot of press, security, and crowds protesting at the trial. The jury apparently was nervous and asked the judge for guidance. Apparently the judge told them if they were uncomfortable, they should go back and deliberate more. It's not clear whether the judge read the verdict he was given then or waited until later. They came back two hours later with the death sentence." This was all under appeal until March 201 l, when Illinois abolished the death penalty and commuted Dugan's sentence. Dugan dropped his appeal, and he will serve the rest of his life in maximum security.
"What you hear from prosecutors' offices, mostly," Kiehl explains, "is that if you raise the brain imaging issue, they often will try to do a plea. It's usually relevant right now only for people with psychiatric problems. It helps to confirm those conditions. I think the mentally ill are terribly underserved in the criminal justice system, and if neuroscience can help move us towards a better understanding, and especially towards a more treatment-oriented philosophy, those are good steps for the individual and for society."
Judges have overturned some verdicts in cases where brain scans were not done, and in recent years, the U. S. Supreme Court has recognized the contributions of neuroscience. In Graham v. Florida, the Court outlawed life without parole sentencing for juveniles convicted of non-homicide crimes. The decision was based in part on research that demonstrated that adolescents are more impulsive and more susceptible to negative influences than adults. Mentally and emotionally, their brains are immature. Similarly, in Roper v. Simmons, the Court struck down the death penalty in 2005 for offenders who had committed extreme crimes when they were juveniles.
"Graham v. Florida was the first time the Supreme Court cited neuroscience of adolescents as central to their decision," Kiehl states. "In Roper, they didn't cite it, but it was presented and they talked about it in oral arguments."
It is hardly a surprise, then, that Kiehl receives numerous phone calls from prosecutors about brain imaging, and from defense attorneys who seek help for their clients. "I've been involved in a dozen other cases," he says, "I get phone calls literally weekly from attorneys who would like to know whether or not neuroscience could potentially benefit or not benefit their clients. More and more judges are referring me to attorneys who work for them, because I do a lot of judicial education, and this resonates with judges. We're on the cusp of this exploding in the legal system, but I'm extremely careful. The interesting thing to me is not a diagnostic approach, like radiology locating a tumor. Functional imaging is just one tool that can help make an argument. Some psychiatrists have said we shouldn't put brain imaging in the courtroom until it's diagnostic, but I say that they're holding it to a high standard. You should hold it to the standards of any other forensic testing, like neuropsychological testing."
When diagnoses are in conflict, which often occurs with dueling experts, a brain scan can make the difference. "Typically, if your client has a history of head trauma or knocking himself unconscious," Kiehl explains, "or has had any hypoxic events or anything that might have led to disruptive problems and orbital-frontal damage, and he's in a capital case situation, then it's warranted to have at least a structural MRI done."
Neuroscience appears to be on track to demonstrate that psychopaths cannot experience remorse, not because they are "bad," but because their brains are different from those of normal people. They might be unable to fully appreciate their behavior, and would thus have reduced incentive to control it in prosocial ways. Like other mental illnesses once thought to arise from poor choices or maladjustment (i.e., schizophrenia), the primary cause of psychopathy might be identified one day as organic. However, an important question would then emerge: if something in their brain caused their criminal behavior, how can they be held accountable? As the results from neuroscience show up in more cases, the legal system will have to deal with some of its fundamental assumptions.
The shrinkage of moral accountability for the worst of the worst could upset the entire justice system. Without free choice, according to a long tradition of Western philosophy since Aristotle, there is no responsibility. The law, based on these concepts, holds that people are rational actors who understand that actions have consequences. Breaking rules is a choice and should be punished. If neuroscience upsets this formula, much could change for our correctional system.
Critics have already pointed out that brain scan results are not definitive, and within this uncertainty lies the possibility that, even with a brain disorder, psychopaths can appreciate the wrongfulness of murder. They could also have controlled themselves, and could thus be punitively responsible. At the very least, they understand that there are consequences for certain behavior. Even Hinckley didn't get to just walk out of the courtroom a free man.
"I have colleagues on both sides," Kiehl admits. "If you have someone who comes up before a prosecutor and a judge, and that person has a severe but treatable mental illness that contributed to their criminal behavior, then you should remediate it and then bring them back for trial. Like everything, there's a gradient. Some individuals are more contemplative, and able to weigh the risks and benefits of their behavior. I would again draw the analogy to the IQ. Everyone understands that an individual who suffers from a low IQ is not fully responsible, and doesn't have the same amount of free will as the rest of us. What we're showing is that psychopaths have a low emotional IQ, and they are suffering from a similar type of thing. If this argument holds weight with jurors, hopefully it will help us to prevent future violence."
Even better, if the work of Kiehl and his colleagues can assist those who treat emerging psychopaths in the juvenile population, perhaps they can redirect them before they become habitual offenders. "The goal of my lab is this," Kiehl says, "that we can identify these kids early. We know they're derailed from an emotional track, and we have penal treatment programs that are showing great success. If we applied programs like that at the Mendota Juvenile Treatment Center (MJTC) in Madison, Wisconsin, nationwide, we could reduce youth violence by fifty percent. MJTC studies have shown that for every $10,000 the Department of Corrections invested in treatment, you save $70,000 in the next four-year period. Over the life of that offender, it's millions of dollars. Serious cognitive behavioral therapy helps them to reduce their impulsivity, and to understand their limitations in terms of thinking and planning."
The clinical community might assist. The working group for the fifth edition of the Diagnostic and Statistical Manual (DSM-V) has recommended that the current diagnosis for antisocial personality disorder (ASPD), which many psychopathy researchers think is too generic to be useful, be reformulated as "Antisocial/Psychopathic Type." It will include a mix of traits and behaviors found on the PCL-R. When asked if he could predict what might result from this debate, Kiehl said, "There are thousands of papers confirming the psychometric validity and neuroscience correlates of the construct we call psychopathy. So, no matter what the DSM does, we'll continue to use the measure we're using. It's going to take five to ten years of research on the DSM-V criteria before we can develop a neuroscience correlate in forensic populations."
Whenever Kiehl describes the current DSM criteria to juries, he states that ASPD is nothing more than a general assessment that labels about eighty percent of inmates. "I say that the DSM is like a field book," Kiehl adds. "It helps psychiatrists and psychologists understand that they might be dealing with someone who has a more severe illness. It's like someone who has schizophrenia: they'll do an assessment with the DSM, but they'll also use a more rigorous assessment to try to quantify the type and degree and level of the symptoms. Psychopathy is an extreme form of ASPD, and we use the PCL-R rather than the DSM to identify it."
Kiehl hopes to amass a searchable database of 10,000 psychopaths of all ages and ethnicities, including females. Since each brain scan requires a significant amount of biographical data for proper interpretation, not to mention time-consuming analysis, this project could take many years. Thus, the bottom line is the bottom line: what's the benefit to society, and at what cost? Kiehl has calculated that when we tally the cost of trials, prison sentences, recidivism, and damage to property and victims, we're looking at an annual economic burden from psychopathy of $250 billion to $400 billon. In light of this, although the intensive analysis and treatment of psychopaths might seem costly upfront, in the long run it will save us money. More importantly, it will protect us from crimes that deterred criminal psychopaths would otherwise commit.
Interview with author, February 201 I.
Ermer, E. & Kiehl, K. (2010). Psychopaths are impaired in social exchange and precautionary reasoning. Psychological Science.
Haederle, M. (2010, February 23). A mind of crime. Miller-McCune. http://www.miller-mccune.com/ legal-affairs.
Hare, R. (1993). Without conscience: Inside the world of the psychopath. New York, NY: Pocket.
Kichl, K. A. & Buckholtz, J.W. (2010). Inside the mind of a psychopath. Scientific American Mind. September/October.
Kiehl, K. A., Laurens, K, Bartes, A, Hare, R, & Liddle, 12. (2006). Brain potentials implicate temporal lobe abnormalities in criminal psychopaths. Journal of Abnormal Psychology, 115(3), 443-453.
Kiehl, K. A., Smith, A. M., & Hare, R. D. (2001). Limbic abnormalities in affective processing by criminal psychopaths as revealed by functional magnetic resonance imaging, Biological Psychiatry, 50, 677-684.
Raine, A. (1999, April 1). Murderous minds: Can we see the mark of Cain? The Dana Foundation, dana.org.
Seabrook, J. (2008, November 10). Suffering souls. The New Yorker, 75-82.
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KATHERINE RAMSLAND, PhD, CMI-V has published over 1,000 articles and 39 books, including The Mind of a Murderer: Privileged Access to the Demons that Drive Extreme Violence. Dr. Ramsland is an associate professor of forensic psychology and criminal justice at DeSales University in Pennsylvania and has been a member of the American College of Forensic Examiners International since 1998.
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