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Murderous Minds Exploring the Criminal Psychopathic Brain: Neurological Imaging and the Manifestation of Evil Dean A. Haycock, Ph.D. For Marie E. Culver Contents Preface Foreword by Charles C. Ouimet Ph.D., Professor and Faculty Scholar in Neuroscience, Florida State University College of Medicine Introduction Chapter One Who Would Do Something Like This? Chapter Two Kunlangeta, Psychopaths, and Sociopaths: Does the Label Matter? Chapter Three What Does Brain Imaging See? Chapter Four A Problem Just Behind the Forehead Chapter Five Troubling Developments and Genes Chapter Six Back Again? Predicting Bad Behavior Chapter Seven Missing Fear and Empathy Chapter Eight Successful, Unsuccessful, and Other Types of Psychopaths Chapter Nine Could You Become a Psychopath? Chapter Ten Could Your Child Be a Budding Psychopath? Chapter Eleven Why Do We Have to Deal with These People? Explaining Criminal Psychopaths to Juries and Darwinists Epilogue: A Little “Big Science” Further Reading Endnotes Figure Credits Acknowledgments Index About the Author Image Gallery Preface THE NEUROSCIENTISTS AND PSYCHOLOGISTS who are leading the way in the study of psychopathic personalities describe their fascinating research subjects by referring to the traits that distinguish them from 99 percent of the population. Some of these traits are related to emotional deficits such as lack of deep emotional attachments to other people and lack of empathy and guilt. Some traits like narcissism and superficial charm are related to how psychopaths interact with others. Their dishonesty, manipulativeness, recklessness and risk-taking activities are representative of their impulsive and antisocial behaviors. The members of the Society for the Scientific Study of Psychopathy caution that “Although psychopathy is a risk factor for physical aggression, it is by no means synonymous with it. In contrast to individuals with psychotic disorders, most psychopaths are in touch with reality and seemingly rational. Psychopathic individuals ar; e found at elevated rates in prisons and jails, but can be found in community settings as well.”1 The Society makes it clear that psychopathy is not the same thing as violence, serial killing, psychosis, mental illness, or what the American Psychiatric Association calls antisocial personality disorder. Murderous Minds is about a subgroup of psychopaths called criminal psychopaths. They share traits with non-criminal psychopaths, but they should not be equated with them. “Criminal psychopathy refers instead to a meaner, more aggressively disinhibited conception of psychopathy that explicitly entails persistent and sometimes serious criminal behavior,” psychologist Jennifer Skeem, Ph.D., and her co-authors declared in 2011.2 Criminal psychopaths are the only subgroup of psychopath for which there exists enough reproducible neurobiological data to begin to get a preliminary idea of how their brain structure and function relates to their antisocial behavior. This is in large part because many criminal psychopaths are currently in prison and thus researchers have had better access to this captive subgroup of the psychopathic population compared to non-criminal psychopaths, who are not incarcerated and therefore free citizens. Spread out geographically, many in this subgroup are more difficult to identify, test, and recruit or have no interest or desire to submit their brains to study. But when the brains of functional or successful psychopaths have been studied as extensively as the brains of their criminal counterparts, they, too, will deserve a book devoted to them. Foreword THE WORLD OF THE CRIMINAL psychopath is at once creepy and fascinating. You read about criminal psychopaths in the news, you see them portrayed in movies, you read about them in books. They do terrible things, horrific things. They are capable of murder, robbery, torture, and rape and they can do it all without a hint of remorse or a touch of empathy. And you wonder: how can these people be so evil? You hope you do not run across them, but could you recognize a psychopath if you met one? Given that an estimated 1 out of 100 adults is a psychopath, the chances are in fact quite good that you have met some of them without realizing who or what they were. You may even have married one (psychopaths can be incredibly charming when they want or need to be). Have you joked at work that your boss is a psychopath? That could actually be the case—many non-criminal psychopaths are not violent. They can control their antisocial impulses and even attain mixed success as business executives. They do not fret over making difficult decisions that have a severe negative impact on their employees. They simply do what is best for themselves. Does someone become a psychopath, or is one born a psychopath? Can psychopathy be treated or cured? Are the brains of psychopaths physically different from “normal” brains? If so, can society hold psychopaths to be morally responsible for what they have done? Can modern neuroscience identify psychopathic brains early on, before a psychopath has a chance to commit a crime? If so, should those thus identified be incarcerated before they have a chance to do something terrible? Neuroscientists can, in fact, use brain-imaging techniques to identify physical differences in the brains of psychopaths vs. “normal” people. Further, structural abnormalities seen in specific brain regions in psychopaths are thought to underlie the striking emotional abnormalities that can be measured by psychological testing. At first glance, the task—of understanding how abnormalities in specific brain areas arise, and how these abnormalities account for psychopathic behavior—is daunting. In this book, however, Dr. Dean Haycock has taken extremely complex material and rendered it readily digestible. One does not have to be a psychologist or a neuroscientist to understand this book. At the same time, the science has not been made more simple than necessary, and the topics covered have such breadth and depth that the book is also appropriate for professionals in the field. The information presented is evidence-based, and one cannot find a single example of information that is simply hearsay or otherwise unsubstantiated; the book is thoroughly documented with complete reference lists for each chapter. Moreover, Dr. Haycock has taken the extra steps of interviewing several of the major players in the field and accurately presenting their viewpoints. Finally, Dr. Haycock is a master at writing exciting prose to create a science-based book that is actually a “page-turner.” From psychopathic Eskimos to mass-murdering high school students, the true nature of the criminal psychopath is explored here. And that exploration is such that it leads us not only to a better understanding of the criminal psychopath, but to a better understanding of ourselves. —Charles C. Ouimet, Ph.D., Professor and Faculty Scholar in Neuroscience, Florida State University College of Medicine, Tallahassee, Florida Introduction HAVING A MURDEROUS MIND is not always the same thing as being a murderer or even having the intention of killing. A glance into the Merriam-Webster dictionary confirms it. The primary definition of murderous is indeed “having the purpose or capability of murder” and “characterized by or causing murder or bloodshed.” This accurately describes the psychopaths who fill the pages of true-crime books and are featured in news or infotainment stories. Criminals who lack a conscience, the sadistic psychopathic serial killers like Ted Bundy and John Wayne Gacy, the unfeeling psychopaths like Richard Kuklinsky who kill for personal gain, the school shooter Eric Harris, the rapist and murderer Brian Dugan, and the armed robber who kills without remorse to keep from being captured and then blames the victim, all have the purpose of murder. The secondary and, in this context, more relevant definition of murderous is “having the ability or power to overwhelm: devastating.” Without a conscience, and with a strong impulse to dominate and victimize, criminal psychopaths and some psychopaths who have avoided encounters with the law routinely leave their victims feeling overwhelmed and devastated. Consider the following synonyms of murderous. After marrying or being conned by a psychopath, many victims have gained firsthand experience with most of them: brutal, cruel, hard, harsh, oppressive, rough, searing, and, most intriguingly, inhuman. These offenses may involve more psychological than physical abuse, but by the dictionary definition they are murderous nonetheless. As victims know painfully well, their tormentors have the ability or power to overwhelm and devastate. The odds are that any encounter you have with a psychopath will not result in a murder. For every psychopathic serial killer, there are literally millions of psychopaths who don’t kill. It is certain, however, that any encounter you have with a criminal psychopath will be an encounter with a potentially murderous mind, in the sense of being capable, or having the ability or the power to overwhelm and devastate. The con man who serially seduces women and depletes their bank accounts, and the businessman who disappears with his partner’s assets and destroys their company, use their power to overwhelm and devastate their victims. If these individuals, it is important to stress, are strongly psychopathic, then they are still distinct from individuals who have some psychopathic traits. This is a distinction that confuses many readers and even some psychologists. It stems from the use and misuse of the word “psychopath” to describe everyone from the rare psychopathic serial killer to the ambitious co-worker who will befriend you and undermine you to get ahead at work. There is a range of psychopathy and psychopathic behavior. Some psychologists point out that many psychopaths or people with significant psychopathic features do not victimize others. “Most psychopaths are not violent, and most violent people are not psychopaths,” Scott Lilienfeld, Ph.D., and Hal Arkowitz, Ph.D., said in their 2007 essay “What ‘Psychopath’ Means.”1 Yet, in 2011, neuroscientist Kent Kiehl, Ph.D., and Judge Morris Hoffman estimated that “approximately 93% of adult male psychopaths in the United States are in prison, jail, parole, or probation.”2 Then, also in 2011, Lilienfeld and his co-authors stated that criminal psychopaths are widely regarded as meaner and “more aggressively disinhibited” than other psychopaths.3 It is hard to reconcile these claims. They stem, in large part, from the use of different tools used to measure psychopathy. Some researchers rely on newer self-report tests to identify psychopaths, while others rely on the Hare Psychopathy Checklist. This is a naming problem, and it is a serious one. Imagine using two pieces of string of slightly different lengths to measure out two standard units, each based on the length of one of the bits of string. Now call both standard units “inches.” You can see the problem. Two people using different “inches” will get different true lengths when measuring something. Until problems like this are resolved, the public will continue to be misinformed and confused by discussions of “psychopaths.” I have seen some scientists roll their eyes when the Press is mentioned because they are unimpressed with the sloppiness in some science-related stories. But sometimes members of the Press might be forgiven for rolling their eyes a bit when they discover that “inches” don’t measure up. In any case, we know even less about non-violent psychopaths than we know about criminal psychopaths. The only reason this book does not discuss non-criminal or “successful” psychopaths more than it does is because criminal psychopaths have provided the vast majority of data about the psychopathic brain, which, preliminary findings suggest, may be different in criminal and non-criminal psychopaths. The phenomenon of psychopathy is multifaceted and complex. It consists of a variety of personality and behavioral traits that vary in degree in different individuals. The frequency of the presence of these traits in individuals is normally distributed throughout members of our society. Some people score very low in psychopathic traits, some score in the middle, and some score very high. The chance that an abnormality in one part of the brain accounts for the presence of very high-scoring psychopaths is small. So too are the chances that psychopathic behavior can be traced to one or a few genes. Thinning of the brain’s cerebral cortex, sluggish amygdala, silent frontal lobes, or inheritance of genes linked to violent behavior by themselves are still not enough to explain in detail the presence of this fascinating subpopulation of humans who live among us. People have been proposing biological causes of criminality for over a century, often citing physical features such as the shape of the skull, size of the ears and jaw, and other unsubstantiated “signs” and “evidence” that leaves us shaking our heads today. One of the remarkable achievements of modern neuroscience is its ability to routinely show us living brains at work. Functional magnetic resonance imaging, or fMRI, allows us to see the flow of blood to large clusters of brain cells as they deal with an increased workload in response to a specific mental challenge. The purpose of neuronal activity is to support communication between brain cells—which occurs at points of contact called synapses—and to establish neuronal circuits that underlie our behavior, both good and bad. “Neurological and mental disorders are going to be about synaptic function. We know this. They’re going to be about failure of communications between brain cells,”4 Baylor College of Medicine professor of neurology, molecular and human genetics, and pediatrics Huda Zoghbi, M.D., told Kayt Sukel of the Dana Foundation in 2013. Unfortunately, telling someone that their occipital frontal cortex or amygdala is sluggish compared to others when performing certain tasks does not yet provide an explanation of why someone has no conscience or otherwise behaves in an antisocial manner. We now know that personalities and personality disorders, like the majority of mental disorders, cannot be traced to one cause or factor, to bumps on the skull or to poor parenting. They are the result of complex processes that include genetics, brain development, and neurobiology, which are then influenced by experience and the environment. A person with brain-activity patterns identical to those seen in the brains of psychopaths may not be a psychopath. A person with genetic traits associated with violent behavior may not be a psychopath. A person who was abused as a child, or who was exposed to violence, may not turn into a psychopath. But when these factors are combined in one person, watch out. All the ingredients for creating a psychopath are then present. A secondary goal of this book is to provide readers with some background so they might answer a few questions they have about the psychopathic brain. But its major purpose is to prepare readers to be more critical of news stories and even scientific claims about psychopathy5 and other intriguing topics in neuroscience. Ideally, it will be a starting point for further exploration into neuroscience and the brain using a fascinating subject—people who lack a conscience and empathy—as an introduction. We are far from having a complete picture of how the brain works, or even how its parts are connected. “Most people really want to understand the mind, not the brain,” Allison Gopnik, Ph.D., pointed out in a Wall Street Journal column.6 The brain is the physical organ and the center of the nervous system, whereas the mind is the sum total of the brain’s product: awareness, perception, emotion, memory, reasoning, thought, and imagination. The University of California at Berkeley psychology professor describes the last twenty years of brain imaging studies as “an important first step.” But it is safe to add that this first step has brought the study of the brain and the study of the mind closer together than ever before, and nowhere is this truer than in the study of criminal psychopaths. Chapter One Who Would Do Something Like This? IT’S CLOSE TO TWO O’CLOCK in the morning on Saturday, January 8, 2011. In Tucson, Arizona, twenty-two-year-old Jared Lee Loughner calls Bryce Tierney, a friend he has known since middle school. Bryce doesn’t answer, so Jared leaves a message: “Hey, man, it’s Jared. Me and you had good times. Peace out. Later.”1 At six a.m., Jared leaves his parents’ home, driving his father’s green 1969 Chevrolet Nova. He returns in an hour, but minutes later he heads out again. He may be in a hurry because he has something important to do today. Perhaps thoughts are rushing through his head. Perhaps he is distracted by voices only he hears. He is under stress. Around 7:30 a.m., Alen Edward Forney, an officer with the Arizona Game and Fish Department, sees Jared run a red light.2 Lights flash and spin on Forney’s patrol vehicle. Jared pulls over. His license and registration are up-to-date and legal. Officer Forney admonishes him for speeding: “It’s bad for your health. You’re gonna kill somebody. You’re gonna kill yourself.” Jared gets off with a warning. And he starts to cry. “Are you okay?” Forney asks him. “Yeah,” Jared replies. “I’m okay, I’ve just had a rough time and I really thought I was gonna get a ticket and I’m really glad that you’re not [going to give me one].” Forney asks him again if he is okay. “I’m fine. I’m just heading home,” Jared answers. “It isn’t too far, and I’ll be okay.”3 By the time he returns to his parents’ house at 8:30 a.m., he has visited two Walmart stores to buy ammunition for his 9-millimeter Glock semiautomatic handgun. He had legally purchased the pistol from a local gun shop 39 days ago. The sporting-goods associate in the first Walmart Jared visits is wary. The associate finds Jared rude and impatient. Without thoroughly checking the inventory, he tells Jared the store is out of 9-millimeter ammunition.4 An associate at a second Walmart has no problem with Jared. Jared acts friendly as he asks if there is a limit on how many rounds of 9-millimeter cartridges he can buy. The sales associate checks Jared’s ID and finds nothing wrong. He double-bags six or seven boxes of ammunition for Jared.5 Around 8:30 a.m. at his parent’s home, Jared removes a backpack from the trunk of the car before he enters the house. His mother and father are concerned about their son’s behavior. They try to confront him. They want to know what’s in the backpack. What’s he going to do with it? Jared says nothing and flees, running down the street. His father drops his coffee and tries to catch up with him. But Jared is gone. His father goes back inside.6 By around 9:20 a.m., Jared is in a convenience store. His final destination is too far to walk in the Sketchers shoes he’s wearing today. He needs a ride to reach the site of a “Congress on Your Corner” event being held in the parking lot of the Safeway supermarket. He asks the clerk to call a cab company for him. Nervously waiting for his ride to arrive, Jared looks at the wall clock. “9:25,” he says, “I still got time.”7 He means he still has time to see United States Congresswoman Gabrielle Giffords in the parking lot in front of the supermarket where she is hosting the meet-and-greet event for her constituents. It’s been three to four years since Loughner fixated on Giffords. During one of the Congresswoman’s public appearances back then, he asked her a question. He was seriously, bitterly disappointed when he didn’t get an answer. He felt insulted by her lack of response. He had asked her: “What is government if words have no meaning?”8 Jared will see Giffords again soon. He gets into the cab and tells the driver to take him to the Safeway in Tucson. Like Jared’s parents, the cab driver has no idea Jared is carrying his 9-millimeter Glock. He drops Jared off in the parking lot in front of the supermarket. It is the most important address on Jared’s schedule today. For scores of people, it will be the most traumatic day of their lives. They have no idea Jared is coming, no hint of what he is about to do. Jared joins the people who have gathered near Giffords. Among them are U.S. District Court Chief Judge John M. Roll, Giffords’s aide Gabriel M. Zimmerman, her constituents Dorothy J. Morris, Phyllis C. Schneck, and Dorwan C. Stoddard, and nine-year-old Christina-Taylor Green. It’s close to 10:10 a.m. Jared has inserted peach-colored earplugs into his ears.9 Constituents write their names on a sign-up sheet offered by Giffords’s intern, Daniel Hernandez. Hernandez offers the sheet to a man wearing a black beanie and a black hooded sweatshirt. It’s Jared. “Gun!” someone yells.10 In an instant, Jared’s pistol changes from a concealed weapon into a murder weapon. He pulls the trigger of the sleek black pistol again and again. The semiautomatic handgun fires with each pull of the trigger—33 times. Bullet after bullet after bullet slide up the long ammunition clip into the pistol’s chamber and out the barrel. In twenty seconds, the gun is empty.11 People scream. And run. Jared tries to reload. He has two more ammo clips stuffed into the left front pocket of his khaki pants.12 He’s made sure he has plenty of bullets. Altogether, he has two long ammo clips and two short ones, plus a folded pocket knife. Congresswoman Giffords lies on the ground with a bullet in her brain. Her intern reassures her and tries to keep her from slipping into unconsciousness. Her eyes closed, she mumbles. Her breathing becomes shallow, but she survives with brain damage.13 She faces a long rehabilitation. Judge John Roll, Gabriel Zimmerman, Dorwan Stoddard, Dorothy Morris, Phyllis Schneck, and Christina-Taylor Green do not survive. They are now mortally wounded or already dead. A dozen others, in addition to Giffords, are injured.14 As Jared tries to reload, bystanders tackle and disarm him. They undoubtedly save many lives and prevent many injuries. Jared wants more victims, but the angry and brave bystanders hold him down until police arrive and arrest him. Now wearing handcuffs, Jared is driven away in a police car, accompanied by two deputies.15 “I just want you to know that I’m the only person that knew about this,” Loughner tells the police after his arrest. He leaves behind six dead, thirteen wounded, a bloody parking lot, and many questions. Most of the questions begin with “Why” or “How.” Before we look inside Jared’s brain to try to answer some of these questions, it will be useful to contrast Jared’s horrendous actions with those of a very different murderer, Eric Harris. Jared and Eric are both young, white males who carry guns to crowded places to shoot people they know and people they don’t. They both see their acts as nihilistic, but meaningful, while most people see them as deranged and pointless. Although Jared acts alone and Eric has a weak, depressed, and impressionable accomplice, both Jared and Eric are the driving forces behind their murderous plans. They both leave behind dead and wounded victims, confusion, blood—and the same questions. This Is Not Awesome Eric Harris doesn’t care that he is late for class today. He’s more concerned about falling behind his own schedule on this Tuesday morning, April 20, 1999.16 He and his friend Dylan Klebold have plans for their fellow students and for the teachers at Columbine High School in Littleton, Colorado.17 Today, just eleven days before Eric’s eighteenth birthday, his day planner reads: 10:30 set up 4 things 11: go to school 11:10 set up duffel bags 11:12 wait near cars, gear up 11:16 HAHAHA18 Sometime after 10:30 a.m., he drives to a spot near the intersection of Chatfield Avenue and Wadsworth Boulevard, three miles southwest of the high school. He drops off a couple of backpacks stuffed with propane tanks, aerosol containers, and pipe bombs. When they go off, he figures, local police and rescue services will be distracted by the size and surprise of the explosions. They will rush to this intersection far from the school, slowing their response to the awesome end-of-the-high-school-world apocalypse he has planned for over a year. At 11:10 a.m. Eric pulls his thirteen-year-old light gray Honda Civic into a parking space in the school’s south parking lot. His fellow high school senior and co-conspirator, 17½-year-old Dylan, drives his black 1982 BMW into the west parking lot across from, but within sight of, Eric’s parking spot. Dylan has coordinated his agenda with Eric’s. His “to do” list for this morning includes: Walk in, set bombs at 11:09, for 11:17 Leave, Drive to Clemete Park. Gear up. Get back by 11:15 Park cars. set car bombs for 11:18 get out, go to outside hill, wait. When first bombs go off, attack. have fun!19 Soon after Eric arrives, his off-and-on-again friend and fellow high school student Brooks Brown approaches him in the parking lot. Brooks excitedly tells Eric that he has missed a psychology test. Eric says it doesn’t matter now. “Brooks, I like you now. Get out of here. Go home,” Eric tells him.20 Of the 1,945 registered students and approximately 140 teachers and administrative staff at the school,21 Brooks will be the only one to get a warning and a break like this today. Eric and Dylan pull out duffel bags—one orange and one blue—from their cars and carry them into the cafeteria. Unnoticed, they set them on the floor near some tables in the crowded cafeteria before returning to their cars. The bags conceal homemade bombs amateurishly constructed with 20-pound propane tanks, flammable liquid, timers, and detonators. The homemade devices are set to explode at 11:17 a.m. But it is already 11:14 a.m. Eric and Dylan are leaving themselves dangerously little time to drop off the bombs and get out. They needn’t worry. They sit in their cars now, waiting for the explosions. They expect the twin blasts to bring part of the second floor crashing down into the cafeteria, killing hundreds. When the propane tanks explode, the blasts alone could directly kill many of the estimated 500 students in the dining area. When the survivors flee from the cafeteria, Eric and Dylan plan on gunning them down. This is the goal, and it makes sense only to them. Fortunately, they are incompetent bomb makers. Neither knows how to wire these compound bombs or set their fuses properly.22 The duffel bags lie, unexploded and unnoticed, among hundreds of other backpacks and bags belonging to students filling the cafeteria. With no explosion in the cafeteria, Eric and Dylan’s master plan has begun to falter. They continue with the next stage of their attack by setting the timers on two additional bombs in their cars. The car bombs are timed to go off after the police cars, fire trucks, ambulances and journalists arrive. They are meant to boost the body count. Just before 11:20 a.m., road crew workers toss aside the bags which Eric left as a diversion miles from the school. Some pipe bombs and an aerosol container explode. But like those now in the cafeteria and in their cars, these devices are poorly constructed; the propane tanks included to make the explosion really noticeable remain intact. Some grass catches fire. Appropriately, the local Littleton Fire Department and the Sheriff ’s office are alerted, but there is no mass response by area police racing to the grass fire. Now the two young men are on the move. They claim the campus’s high ground. They stand atop the west stairs outside the school. They are armed with sawed-off shotguns, a 9-mm rifle, and a TEC-9 semi-automatic handgun. This weapon is a civilian version of a military submachine gun. It is sometimes referred to as the cheap man’s Uzi, a submachine gun once used by Israel’s military. Realizing their big bombs have fizzled, their supplementary shooting plan becomes their only option for creating mayhem. As journalist Dave Cullen writes in his excellent account of the attack, Columbine, for Eric and Dylan “There was no Plan B.”23 The two are wearing long black coats called dusters,24 which are often associated with cowboys and horseback riding. On this and subsequent days, the coats are frequently misidentified as trench coats. Both are good for hiding long-barreled rifles and shotguns. Trench coats, once associated with spies, private eyes, and investigative journalists, soon will become linked to murderous, socially outcast students who kill to avenge the ill treatment they receive from their peers. But as Cullen points out in his account of the massacre, and as forensic psychiatrists and psychologists later conclude after studying the writings and videotapes left behind by Eric, this motivation does not apply to, or explain, the actions of these two murderous friends, as we will discover. “Go! Go!” one of the soon-to-be killers shouts.25 It is probably Eric, the dominant member of the lethal team. Eric and Dylan pull out their shotguns and 9-mm weapons and begin by firing at students who are seated on the grass, eating lunch. They wound Richard Castaldo and shoot Rachel Scott in the head and chest, killing her. Three more students are moving up the stairs toward them. Eric fires his carbine again and again, killing Danny Rohrbough instantly and wounding Lance Kirkland in four places from his chest down to his foot. Sean Graves runs but falls wounded before he can get away from the shooters. From time to time throughout the massacre, the attackers pause to light pipe bombs, the most reliable of their homemade explosives. Now they are throwing them high onto the roof and down onto the lawn. Later they will throw them, to their amusement, throughout the school. More students run across the grass, trying to get away. One, Mark Taylor, falls seriously wounded. Although shot, Michael Johnson manages to reach a storage shed and joins several others already using it for cover.26 The gunmen are moving again. One reaches Lance, who lies wounded on the ground. Lance, weak and disoriented from his wounds, grabs a pant leg of the figure standing over him and asks for help. “Sure, I’ll help,” the owner of the pant leg says, and shoots Lance in the face.27 Lance, despite multiple wounds, survives. Eric, the leader and by far the more murderous of the two killers, climbs the stairs. He laughs. From his elevated vantage point, he sees Anne Marie Hochhalter running. He fires. She falls, shot multiple times. It’s been less than five minutes since the carnage began. “This is what we always wanted to do. This is awesome!” one of the killers yells.28 Seeing hall monitor Patti Nielson and student Brian Anderson inside the school behind a westward-facing exit, one of the shooters fires. The bullets drive metal and glass shrapnel into Patti’s arm, shoulder and knee, and into Brian’s chest. Eric looks toward the south parking lot. He easily spots Sheriff ’s Deputy Neil Gardner. The deputy is wearing a hard-to-miss bright yellow School Community Service Officer’s shirt. Deputy Gardner is getting out of his patrol car about 180 feet away. Eric shoots at him repeatedly. Bullets fly into parked cars behind Deputy Gardner. None of the ten or so shots he manages to get off hits the deputy. Then Eric’s rifle jams. As Eric tries to clear his weapon, Gardner fires four shots at him, but misses. Eric clears his jammed weapon. He fires and misses the deputy again before he retreats into the school through the shattered west doors. It’s now around 11:26 a.m. From inside the entrance, Eric exchanges more fire with Gardner and another deputy, who has joined the shootout. The gunmen disappear into the school. The deputies, following orders, do not go after the gunmen. Together, Eric and Dylan walk back and forth along the library hallway, throwing pipe bombs, shooting at nothing in particular, and laughing. A couple of minutes later, they enter the library where 56 classmates hide or cower. Immediately, Eric points his shotgun at the top of the front counter and pulls the trigger. Wood splinters fly into the air and into a student crouched behind a copying machine at the end of the counter. As they move across the room toward the library windows, the coldblooded pair nonchalantly shoot and kill another student. Windows shatter as they fire outside at students fleeing the killing field Eric and Dylan have created out of the once-familiar campus. Police and deputies fire back through the windows at the killers. Before retreating across the library, away from the windows, the killers shoot eight more students. Four of them die. They walk back toward the library entrance, where Dylan blasts a display case. Then they shoot eight more kids. Three of them die. Surrounded by dead, dying, wounded, and cowering victims—one of the killers shouts “Yahoo!” Eric and Dylan move to the center of the large room. It’s approximately 11:34 a.m. They reload their weapons and turn them on nearby students. Four are hit. Two of them die. In just seven minutes and thirty seconds, Eric and Dylan execute ten people and wound half a dozen others in the library. A few minutes later, they leave the library and walk through the halls near the science classrooms and laboratories. They look through the windows of locked classroom doors. They see students hiding inside, but they pass by. Like medieval figures of Death, carrying firearms instead of scythes, they randomly and opportunistically choose their victims. They shoot up the school, even firing into empty rooms. And they throw some more pipe bombs, creating several explosions. About twelve minutes before noon, they wander down to the cafeteria. Eric kneels on the stairs. He raises his carbine and fires repeatedly at one of the duffel bags containing one of the homemade, 20-pound propane bombs he and Dylan had left there before the shooting began. The gas tank does not explode. Eric and Dylan look at the abandoned lunch tables. They grab a couple of abandoned bottles of water, raise them to their lips, and drink. “Today,” one of them announces grandly at some point during this visit to the cafeteria, “the world’s going to come to an end. Today is the day we die.”29 The pair succeeds in setting off an explosion in the cafeteria that ignites a container of flammable liquid. The fire sprinklers in the ceiling spray water. The large propane bombs never explode. Eric and Dylan go back to wandering the hallways, briefly visiting the office area and the kitchen before ending up back in the library on the second floor. Now they have killed all they are going to kill: thirteen students and one teacher. Twenty-one others are wounded. It is far fewer than they had hoped to slaughter; they wanted to kill hundreds. Had either of them known how to connect a fuse, had either understood bomb construction, their homemade propane bombs could have killed most of the 500 students eating lunch on this day. Eric and Dylan walk back to the library for the last time. Around 12:08 p.m., they take some final shots at paramedics and law-enforcement officers from the windows on the library’s second floor. They move toward the end bookshelves in the southwest corner of the library. One of them lights a cloth stuck into a glass bottle filled with flammable liquid and sets it on a library table. This becomes their next-to-last violent act. Their final violent act is suicide. They shoot themselves. Each dies from a single self-inflicted gunshot wound to the head. The Molotov cocktail starts a small fire on the tabletop. The fire alarm is screaming so loudly, it drowns out speech. “Not Used Technically” Despite the similarities of the atrocities Jared and Eric committed, the brains of these two particular killers most certainly malfunctioned in very different ways. Their murderous intentions differed, as did their mental states before and during their crimes. One had lost touch with reality. The other had no delusions and clearly understood the difference between right and wrong. One suffers from a mental illness; the other has what the American Psychiatric Association calls a “personality disorder.” Most neuroscientists and research psychologists call it psychopathy. Eric left behind very convincing evidence that he had highly psychopathic traits. Although he understood the difference between right and wrong, he appeared to lack a conscience. Combined with a disdain for nearly everyone, a lack of conscience can be a very dangerous thing, as we have seen. Jared was legally insane when he killed. Eric was legally sane when he committed the same acts. But sane and insane are legal, not scientific or medical, definitions. As neuroscientists find more indications that the brains of killers differ from those of non-killers, some scientists are joining defense attorneys in claiming that the violence committed by legally sane killers, like psychopaths, can be traced to their abnormal brain structure and function. In fact, the editors of the magazine Scientific American Mind prefaced a 2010 article titled “Inside the Mind of a Psychopath” with the teaser “Neuroscientists are discovering that some of the most cold-blooded killers aren’t bad”30 [emphasis added]. Aren’t bad? “They suffer,” the preview continues, “from a brain abnormality that sets them adrift in an emotionless world.” “Poor babies,” some cynics might comment on reading this. Skeptics might wonder if this means we will see descriptions of the not-bad serial killer Ted Bundy, the not-bad serial killer John Wayne Gacy, the not-bad killer Richard Kuklinski, and the not-bad mass murderer Eric Harris—all of whom displayed traits strongly indicative of psychopathy—in future accounts of their crimes. The provocative lead-in to Kent A. Kiehl’s and Joshua W. Buckholtz’s article Inside the Mind of a Psychopath succeeds in drawing the reader’s attention with what many would consider an outrageous statement. But in their defense, scientists are reporting more and more evidence that points to links between brain abnormalities and violent behavior. But does it make them evil? And what is the correlation between such abnormalities and violent behavior? Do certain brain abnormalities guarantee violent behavior? Can understanding what is going on in the brains of psychopaths and cold-blooded killers really justify a claim that they are “not bad?” Goodness and badness are moral judgments with sometimes tenuous links to the law. The debate about whether or not someone is bad or evil is not a scientific one. But the scientific findings, if they hold up, have serious legal implications. Some people might shake their heads and dismiss murderous behavior as incomprehensible. And they may be content to look no further for explanations or for greater understanding. Others, when they hear about Jared, Eric, Sandy Hook Elementary School gunman Adam Lanza, and other mass murderers, quickly dismiss them as “psychos” or, more descriptively, “psycho killers.” A “psycho” is a person “who behaves in a frightening or violent way,” according to the primary definition offered by the Macmillan Dictionary. That could be a useful definition if it were limited to that meaning. In the minds of many, however, it merges with the second definition: “an offensive word for someone who has a mental illness.” For readers of the Merriam-Webster Dictionary, a psycho is “a deranged or psychopathic person—not used technically.” With a popular diagnosis like this brought out every time there is a mass shooting or other despicable act of violence, it’s not surprising the media asks over and over again in the wake of violent attacks: “How and why does this happen?” “Who’s responsible?” And it’s no wonder many people have little or no understanding of what motivates or drives the killers. The senselessness of such acts is so great, and so defies the logic of most people, that clumping them all together and dismissing them as the acts of “psychos” seems to make sense. In an easy way, it helps the public to make some sense of seemingly senseless crimes. A major problem is that people frequently confuse psychotic with psychopathic. Psychopathic and psychotic are two different terms used by professionals to describe people with very different mentalities. Psychotic refers to psychosis, a key feature of serious mental illnesses like the one that afflicts Jared Loughner: schizophrenia. During and before his shooting spree, he displayed classic symptoms of psychosis. They included mental derangement with a loss of contact with reality, hallucinations, delusions, and disorganized thought, speech, and behavior. In popular culture, the word “psycho” is thus an inaccurate and confusing mixture of an offensive word for someone with a mental illness and/or someone who is a psychopath. Psychopathy is not madness. People with undeniable and striking psychopathic traits, people like Eric Harris, remain sane in the eyes of the law. They appear quite sane too, even to experts who know they are different from you and me, because of their complete lack of empathy and conscience. They can easily fool family, friends, court officials, strangers, and even mental health professionals who haven’t had a chance to examine them closely. Part of the confusion stems from the fact that, as we have seen in the cases of Jared and Eric, people with psychosis sometimes commit the same kinds of crimes that some criminal psychopaths commit. The difference is that a psychopath on a killing spree knows what he (the killer is usually a male) is doing and he knows it is wrong. He is in touch with reality and very likely enjoying what he is doing. Witnesses heard Eric laughing during his shooting spree and appearing to have a great time. A psychotic person, by contrast, acts in response to delusional, often paranoid thoughts, as when Jared became obsessed with Giffords because he perceived a personal slight after she failed to respond to his question: “What is government if words have no meaning?” A psychotic person is out of touch with reality. He or she cannot distinguish between what is going on in the outside world and what is going on inside their heads. Theoretically, in a legal sense, psychotic individuals should not be held accountable for their actions. Medically, they are mentally ill and suffering from a brain disorder. In the real world, violent psychotic individuals are often convicted as if they were in touch with reality and aware they were committing crimes society agrees are abhorrent. In courtrooms in the real world, mentally ill killers are often treated like psychopaths, who actually know better but don’t care. If we ever hope to prevent such tragedies in the future, we will have to intercept the Erics and Jareds and Adam Lanzas of the world before they make their murderous plans. To do that, educators and mental health professionals will have to make better use of mental-illness screening programs. And neuroscientists will have to find out more about brain abnormalities that are present before the killing starts if they are to make a contribution to deterring criminal behavior in society. Jared’s violent behavior started with his pulling out a 9-mm pistol and emptying its ammunition clip into a group of people gathered in front of a grocery store in Tucson, Arizona. The reason he did it lies somewhere in, or perhaps throughout much of, his brain, which was deranged by paranoid schizophrenia. We know where and when Loughner obtained his murder weapon. He legally purchased it from a gun store near Tucson on Tuesday, November 30, 2010. We are not so sure where or how he acquired his mental illness. We do know it developed long before the day he used his semiautomatic handgun to shoot nineteen people, killing six of them. Jared’s mental disorder may have developed more than twenty-two years earlier as his fetal brain grew and developed. By the time he was in his late teens and early twenties, the overt symptoms of paranoid schizophrenia began to become obvious. However the disorder developed in his brain, it was there long before he became violent. In the months before the attack, his behavior and thought processes became erratic, his anger troubling. “My concern was like, meth or something … because his behavior and his, was, um, odd,” his mother said later.31 He was disruptive in his college classes and eventually expelled. His behavior led his father to confiscate his shotgun and at times to prevent him from using the family car. But when he tried to talk to Jared on the day of the attack, his son walked out. “Sometimes you’d hear him in his room, like, having conversations,” his mother recalled. “And sometimes he would look like he was having a conversation with someone right there, be talking to someone. I don’t know how to explain it.”32 The explanation is, of course, that Jared was hallucinating because he had a brain disease. The illness that twisted Loughner’s thought processes is a very familiar, poorly understood, complex disease which typically begins to show in the late teens or young adulthood. His illness was there that Tuesday in 2010 when he purchased his Glock handgun. It was certainly there a little over a year and a month later, on January 8, 2011, when he took a cab to the parking lot in front of the Safeway grocery store in Tucson. It was there when he inserted earplugs, to protect his ears from what he was about to do. It was there at 10:10 a.m. that Saturday when he opened fire, shooting U.S. Representative Gabrielle Giffords in the head before turning the gun on the crowd. It is possible that it had been developing a long time before it became apparent to his friends and family. Many things Jared and his mother possibly were exposed to—for example, flus and other viruses—could have interacted with the genes he inherited to result in paranoid schizophrenia. The possible factors that might have transformed Jared’s predisposition to schizophrenia into the tragic, crippling reality of severe mental illness range from exposure to maternal infections and stress before birth to exposure to stress during childhood. While the cause of schizophrenia is unknown, many researchers believe it is a neurodevelopmental disorder, which could be one reason its symptoms become apparent in late adolescence or young adulthood. Interactions between some of the genes people like Jared are born with and things they are exposed to in the environment are suspected of producing abnormalities in brain function and structure. For example, in 2013 when Jong H. Yoon and his colleagues at the University of California-Davis used functional magnetic resonance imaging (fMRI) to measure activity in the brains of 18 individuals with, and 19 without, schizophrenia, they saw decreased activity in the prefrontal cortices of those with the mental disease.33 The cells in this part of the brain, located behind the forehead, are closely associated with higher mental functions. They influence your ability to set priorities, make plans, figure out strategies, and predict the consequences of your actions. Brain scientists call these “executive functions.” It is a part of the brain, as we will see, that is also implicated in psychopathy and other disorders. At the same time that the prefrontal cortices of people with schizophrenia appear to have decreased activity, another part of the brain appears to have increased activity. This is the substantia nigra and it is located deep in the brain, in a subdivision called the midbrain. The researchers found that communication between the prefrontal cortex and the substantia nigra was weaker in the group of people with schizophrenia. Latin speakers can readily figure out that brain cells in the substantia nigra are pigmented; the translation is “black substance” or “black body.” The color comes from melanin, a pigment produced when the neurons make dopamine, a neurotransmitter closely associated with schizophrenia. Antipsychotic medications prescribed to treat schizophrenia interact with dopamine-signaling mechanisms in the brain. Another condition linked to the substantia nigra is Parkinson’s disease, in which these pigmented neurons are lost. The loss of dopamine-producing neurons in the substantia nigra affects a neighboring part of the brain called the striatum, whose cells depend on dopamine to function properly. The connection between the striatum and the substantia nigra may also play a role in schizophrenia. The results suggest that communication between these regions is “out of sync”34 in the people with schizophrenia. Furthermore, the research turned up evidence of a correlation between how psychotic a person was and how closely connected his or her substantia nigra was to the nearby striatum. The study needs to be reproduced with more subjects before we can be sure the results represent a general finding in schizophrenia. But they raise the possibility that the communication pathway, or neuronal circuit, that connects the prefrontal cortex with the basal ganglia may be a route through which psychoses are linked to the disordered thought patterns that characterize schizophrenia. Distinct pathways that connect the same brain structures but which follow different routes are being implicated in other mental illnesses and with personality disorders like psychopathy. Our society’s routine failure to examine people like Jared is a wasted opportunity to increase our insights into abnormal behavior. No one knows if Jared’s prefrontal cortex would have looked less active while his basal ganglia looked more active compared to healthy individuals. We don’t know if, like some people with schizophrenia, he has slightly less gray matter in parts of his cerebral cortex or if he has slightly larger-than-normal, fluid-filled spaces called ventricles in the middle of his brain, as some people with schizophrenia do. He and other prisoners can’t be forced to volunteer for scientific study. At first thought, you might suppose that smaller brain volume must be due to loss of brain cells. But it might be due to neurons being smaller in these brains. Decreased volume in the cerebral cortex also might be due to decreased density in the mass of intertwined contacts and connections among brain cells.35 The projections of neurons, which receive and send signals to other brain cells, are called axons and dendrites. Together with a second type of brain cell called neuroglial cells or glia, these projections form an intricate and very complex network of interwoven processes in your brain called the neuropil. It is in this meshwork that much of the cell-to-cell communication that underlies thinking and feeling is somehow realized. It’s easy to imagine how reducing this crucial area of brain cell interaction and communication could severely compromise thought processes. Jared had never been treated with antipsychotic medications before he attacked. One caveat of research on people with schizophrenia is that many of them, unlike Jared, have received antipsychotic drugs before and during the time they are examined by scientists. Could long or short-term exposure to these powerful medications be responsible for the brain changes we see in people with schizophrenia? Researchers in this field, like Yoon and his collaborators, acknowledge the possibility that such drugs could make a difference and that their work should be extended to include people who have not yet received medication. Yet we also know that in the past four decades, more than 120 studies have reported neurobiological abnormalities in the brains of people with schizophrenia who have never received a single dose of antipsychotic medication.36 There seems, therefore, to be strong evidence that the brains of people with schizophrenia are physically different from the brains of people without schizophrenia. But it’s not quite that simple. It turns out that the brain abnormalities associated with schizophrenia are not really limited to schizophrenia. We are more likely to find them in people with schizophrenia, but you can also find them in people with other brain diseases, such as Parkinson’s disease, and even in people with no brain disease at all.37 Later we will see that some of the differences associated with the brains of psychopaths can sometimes be found in the brains of people with few psychopathic traits. Biological results often fall short of being completely black or white. However Jared’s brain differs from that of an average healthy person, we do know that it does respond to antipsychotic medication, the only means we now have for treating the delusional thought processes that led to six deaths, thirteen disrupted lives and intense suffering for family and friends of the victims. Jared’s apprehension eventually led to his being forced, under court order, to take antipsychotic medication. Only under its influence would he begin to get a sense of the horror he had perpetrated. Jared was charged with murder, attempted murder, and the attempted assassination of a member of Congress. A psychiatrist and a psychologist diagnosed paranoid schizophrenia following a total of sixteen hours of interviews. Loughner, they reported, was delusional and hallucinated. His thoughts were disorganized, random and bizarre. In August 2012, he pled guilty to nineteen charges to avoid the death penalty. Given a life sentence, he is now receiving court-ordered antipsychotic medication at the U.S. Medical Center for Federal Prisoners in Springfield, Missouri.38 Forensic psychologist J. Reid Meloy has studied the crimes of people like Jared and other mass murderers, both adolescents and adults, which have occurred over the past half-century. “The majority of adult mass murderers typically are individuals who have a psychiatric history and typically a majority is psychotic at the time that they’re actually carrying out the killing,” Meloy said in a 2007 interview on NPR.39 The minority who are not psychotic include rare depressive individuals like Dylan Klebold who want to take others with them on their suicidal journey. Another minority are individuals with many psychopathic traits, like Eric. It is commonly assumed that people with schizophrenia like Jared are more likely to be violent than people without schizophrenia. Criminologist Adrian Raine, for example, cites studies from around the world showing that people with schizophrenia are more likely to have a criminal and violent history than healthy people.40 He concludes in his book, The Anatomy of Violence, that the “relationship between violence and schizophrenia is not weak.” Later he softens his assertion by noting that “It’s true that most schizophrenics are not dangerous, and neither kill nor perpetuate violence.” It is true that studies show that only a small number of people with mental illnesses do become violent. The threat in the public’s imagination, however, is exaggerated by the publicity that acts such as Jared’s receive and by the public’s general lack of understanding of the disease schizophrenia. “The challenge for medical practitioners is to remain aware that some of their psychiatric patients do in fact pose a small risk of violence, while not losing sight of the larger perspective—that most people who are violent are not mentally ill, and most people who are mentally ill are not violent,” Richard A. Friedman, M.D., wrote in The New England Journal of Medicine.41 It is worth reiterating that most violent people are not mentally ill—as countless acts of violence are committed every day by sane people with decidedly obvious motives: frustration, desperation, jealousy, greed, or anger. Crimes like Jared’s are “extraordinarily rare events,” according to Meloy. And that, the clinical professor of psychiatry at the University of California in San Diego says, is the reason they get so much publicity. The media coverage of such events skews the public perception of the threat posed by the mentally ill. A look back at nearly thirty years of research reveals that there is indeed an association between schizophrenia and violence—homicide, in particular. But most of this violence can be attributed to drug and alcohol abuse. In fact, people with schizophrenia who abuse drugs are about as violent as people without schizophrenia who abuse drugs,42 so the corollary to violence could arguably be the drug use versus the schizophrenia itself. Jared’s friends reported that he had used drugs extensively in the years before he was arrested, although he had reportedly stopped using them in the last few months before he was arrested. His past history included abuse of alcohol, marijuana, and hallucinogens.43 The confounding issue of drug abuse and violence illustrates the difficulty of sorting out a complex issue like violence and its multiple causes. Robert Hare and his co-workers, for example, suggested in 1994 that drug use by psychopaths, which is hardly rare, could probably be linked more to their unstable and antisocial lifestyles than to the characteristic features of psychopathy.44 There are superficial similarities between brain abnormalities reported in schizophrenia and abnormalities found in psychopaths. For example, they both are believed to involve dysfunction in the frontal lobes. But schizophrenia and psychopathy are distinct disorders. The uninformed diagnosis of “psycho killer” doesn’t begin to capture the mysteries behind either condition. Of the two, psychopathy may be the more puzzling, and even the scarier, because when it involves violence, the violence springs from someone who on the surface appears as normal as the rest of us. “No I Am Not Crazy …” —Eric Harris45 Eric Harris left us thousands of words in his notebooks and on his web pages, words that tell us a lot about him: “My belief is that if I say something, it goes,” he ranted. “I am the law, and if you don’t like it, you die. If I don’t like you or I don’t like what you want me to do, you die… . I’ll just go to some downtown area in some big ass city and blow up and shoot everything I can. Feel no remorse, no sense of shame.”46 There are indeed no indications of remorse or shame in Eric’s personal manifestos and ranting announcements. But he had no problem feigning those feelings when it would help him, as Dave Cullen pointed out in his 2004 Slate article, “The Depressive and the Psychopath: At Last We Know Why the Columbine Killers Did It.” Frank Ochberg, M.D., a Clinical Professor of Psychiatry at Michigan State University, said he believes Eric lacked a conscience.47 Based on his history and writings, Eric impressed Ochberg and other experts as someone who was good at reading and manipulating people and ingratiating himself to them when it would benefit him.48 For example, the FBI agent perhaps most familiar with the motivations of the Columbine killers, clinical psychologist Dr. Dwayne Fuselier, told Cullen that Eric wrote “an ingratiating letter” to a person he had robbed.49 Eric wrote it when he was participating in a community service program that allowed him to avoid prosecution for breaking into a man’s van. The letter offered not just apologies, but went so far as to express empathy. Fuselier said Eric’s letter “was packed with statements like Jeez, I understand now how you feel and I understand what this did to you.”50 Eric added: “My parents and everyone else that knew me was shocked that I did something like that. My parents lost almost all their trust in me and I was grounded for two months … I am truly sorry for what I have done.”51 That is the mask of contrition and human decency Eric brought out and wore when it suited him. Eric and other criminal psychopaths may be able to express empathy, but it is not part of their emotional repertoire. Behind the mask, in private, he revealed how he really felt: “Isn’t America supposed to be the land of the free? How come, if I’m free, I can’t deprive a stupid fucking dumbshit from his possessions if he leaves them sitting in the front seat of his fucking van out in plain sight and in the middle of fucking nowhere on a Frifuckingday night. NATURAL SELECTION. Fucker should be shot.”52 This is the type of rationalization for immoral, unethical, or criminal behavior typical of many criminals whose psychopathy has been established by psychological testing: if someone is dumb enough to become a victim, they deserve it. “I’ll never forget talking to the head counselor, who counseled both boys before all this [the shooting] happened. He described how different they were. Harris would just tell you what you needed to know to satisfy your needs so he could get what he wanted,” psychiatrist Ochberg remembered fourteen years after the events at Columbine. Dylan, on the other hand, was depressive and emotional, Ochberg recalls. Eric’s writings provide a fascinating and revealing look into the mind of a non-psychotic person who would not just dream about—but actually take the extraordinary step of—planning and executing a cold-blooded massacre. There is no record that a formal “psychological autopsy” had been performed on either Eric or Dylan, and no evidence of an official document describing their psychological state. Former FBI Special Agent and criminal profiler Mary Ellen O’Toole, Ph.D., an expert on psychopathy with firsthand knowledge of the behavior of the Columbine shooters, confirms that no formal evaluation analysis was issued. Cullen’s Slate magazine article describing the opinions of Drs. Ochberg and Fuselier is still the main source of information for most people about the killers’ psychological states. O’Toole, who worked for over fourteen years as a profiler in the FBI’s Behavioral Analysis Unit, recalled the crime scene this way: “Based on the behavior at the crime scene: it was predatory, it was preplanned, and it was extremely callous.” As the killers moved through the school picking out victims and shooting them, they displayed a calm cold-bloodedness, according to O’Toole. Experts call this eerily calm style of execution hypo-emotionality, and it is characteristic of other campus and school shooters. They moved through the school, O’Toole said, “in a very tempered and controlled way. When I saw his [Eric’s] videotapes in which he talked about his plans, there was a sense of thrill and excitement. It was [a] very risk-taking kind of behavior. I would say, based on the behavior at the crime scene, that would be a manifestation of some of the traits of psychopathy.”53 O’Toole’s FBI colleague Fuselier and Ochberg, a former Associate Director of the National Institute of Mental Health, go a bit further in discussing Eric’s psychopathic traits. Fuselier, a clinical psychologist, spent months studying Eric and Dylan before he arrived at his opinion. In the summer of 1999, according to Cullen’s book Columbine, Fuselier was in Leesburg, Virginia attending a meeting organized by the FBI to discuss school shootings.54 He reviewed his findings about Eric’s personality by concluding that Eric was a “budding young psychopath.” A prominent psychiatrist at the meeting, however, disagreed with Fuselier, according to Cullen’s account: “‘I don’t think he was a budding young psychopath,’ the psychiatrist said. “‘What’s your objection?’ “‘I think he was a full-blown psychopath.’ “His colleagues agreed. Eric Harris was textbook.”55 Like Fuselier, Ochberg saw a budding psychopath in Eric. Ochberg traveled to Columbine repeatedly in the year following the tragedy to help victims and members of the community recover from the trauma. And he read Eric’s writings and reviewed his history. “I did reach a conclusion that Eric Harris appeared on his way to becoming psychopathic, that he was very good at imitating caring,” Ochberg recalled in an interview for this book. Few mental health professionals are willing to call someone a psychopath before they reach the age of eighteen. Eric would have been eighteen years old a mere eleven days after he calmly shot his classmates and teachers. “You don’t call someone a psychopath until they have given a lot of evidence and they have grown up… . After age eighteen and in the adult range, they have a series of behaviors that can be observed,” Ochberg said in a short film produced by Joyce Boaz, What Is a Psychopath? 56 While Eric’s crimes prevented him from graduating from high school, they were also evidence that he appeared to have graduated into adult psychopathy before his eighteenth birthday. “Some psychopaths become sadists,” Ochberg continued. “Being sadistic means you enjoy hurting another person. Not every psychopath becomes a sadist but if they stumble into sadism, they have absolutely no regret, no empathy, no remorse as a product of their being a psychopath. And they practice and they get better. “The worst are the serial killers who are not only psychopaths and sadists, but they have learned to enjoy their own grandiosity. They’re narcissist. They care about themselves. They want to outwit the police. They want to humiliate logical, decent people. They hold us in contempt. They are ‘the worst of bad.’” Eric was not a serial killer, but his personal history and his status as a mass murderer suggest he had the traits Ochberg describes. Mass murderers kill multiple people during a single violent event, while serial killers commit a series of murders over an extended period of time. Between murders, they often do not attract attention. Spree killers murder multiple people in a series of violent, related events. Eric’s parents have since come to accept that their son was a psychopath. He had fooled them, as he had fooled a psychiatrist he had once been sent to visit.57 But being fooled by a psychopath is nothing to be ashamed of. Experts who have spent their careers working with psychopaths, experts like Dr. Robert Hare, attest to the fact that even they, for a time anyway, have been fooled by the appearance of normality that psychopaths can convincingly present.58 It can take time to see behind what psychiatrist Hervey Cleckley referred to as “the mask of sanity.” It is fair to document a person’s psychopathic characteristics or traits, but it is up to the reader to realize that psychopathy requires documentation of more than a few such traits before the label “psychopath” can be authoritatively applied to an individual. One nasty comment, spiteful act, fist fight, theft, lawsuit, or self-serving action doesn’t amount to psychopathy. A lifetime pattern of antisocial behavior, such as Eric was well on his way to establishing just before his eighteenth birthday, may—providing the determination is made by a professional trained to evaluate a person’s behavior as well as his or her legal and medical history. Eric’s personal history, his journals and videos, combined with his many traits characteristic of psychopathy, convinced the experts who examined his writings and life that he was either well on his way to being a psychopath or had already become one, a “textbook psychopath.” “I am higher than you people,” he announced. “If you disagree I would shoot you … some people go through life begging to be shot.” And some people go through life without a conscience. Scientists are accepting the difficult challenge of trying to figure out why an estimated one out of every hundred adults share this deficit with Eric. Not all of them are killers, but so many are criminals that they make up an estimated 15 to 25 percent of the prison population in the United States. And criminal psychopaths, by one estimate, commit half again as many crimes as non-psychopathic criminals.59 Criminal or unsuccessful psychopaths may be a subgroup in the heterogeneous population of all psychopaths that includes non-criminal or successful psychopaths. It is the record they leave and often their confinement that make criminal psychopaths the best scientific subjects for anyone who wants to see into the psychopathic brain. If you hope to come away with useful insights by studying human beings, you have to know what kind of human beings you are studying. We have already seen that similar violent actions do not reflect the functioning of similar brains. You have to know who you have invited into your laboratory and who you have slid into your brain-imaging machine as you watch their brains in action. It’s important to know their background, gender, age, weight, medical history, ethnicity, and drinking and drug use habits, for a start, because many factors can influence behavior, behavioral responses, and even the structure of the brain. And it is most important that you have a way to identify who is a psychopath and who is not. You have to know, as best as you can determine, where on the spectrum of psychopathy the person you are studying lies. Chapter Two Kunlangeta, Psychopaths, and Sociopaths: Does the Label Matter? “… the definition of psychopathy itself—what it is, what it is not—is one of the most fundamental questions for psychological science.” —Jennifer Skeem, et al.1 THERE IS NO RECORD OF HIS REAL NAME, but we do know he was a Siberian Yup’ik Eskimo2 who lived on the remote island of Seevookuk between 1940 and 1955. We’ll call him Kopanuk. An Eskimo elder who was familiar with nearly five hundred of his fellow Eskimo said Kopanuk’s behavior made him stand out.3 Seevookuk is only about fifty miles from Siberia, so it is not surprising that one of the first Europeans to reach it was a Russian explorer. Vitus Bering stepped onto the island in 1728. He called it St. Lawrence Island, and that is how it is labeled on maps showing its location near the Bering Strait in the Bering Sea. In isolated lands with long winters, cutting wind chill, and subzero temperatures, cooperation in traditional, self-sufficient Eskimo and Inuit societies was valued and essential for survival. Meat was shared in Kopanuk’s day, as it is today. Laws were not codified. Instead, responses to social transgressions were adjusted by members of the tribe and, for more serious offenses by tribal leaders, to suit the individual circumstances of the offense.4 The communities, ranging in population from twenty to two hundred people, depended on social pressure to guide the behavior of their members.5 Kopanuk’s personality was clearly different from others in his group of self-sufficient hunters and gatherers. He didn’t seem to feel social pressure or worry about social guidelines. He knew what was expected of him as a member of a tight-knit community living in a very harsh environment, but he didn’t seem to care. Even as an adolescent, he stole, lied, and cheated. He avoided the work of fishing for salmon, a mainstay of the Yup’ik diet. He made excuses to avoid hunting the caribou, whale, seal, walrus, and polar bear that his people needed to survive. If he came across birds’ eggs, he rarely shared them, or anything else he found. When he did share, he usually wanted something in return. This was unusual behavior in the typically cooperative community, which had had limited exposure to outsiders who had little opportunity to introduce Kopanuk to a more selfish outlook. His antisocial behavior persisted into adulthood, despite all the times his peers dragged Kopanuk to stand before the elders. The elders spoke to him. They reprimanded him. They told him to make amends to those he had taken advantage of and harmed. But none of it changed his behavior for long. He always returned to being Kopanuk. Some of the Eskimo asked their shaman if he could help, if he could influence or change Kopanuk’s behavior. But, as they feared, the shaman said he had no power to help. There was nothing he could do, because Kopanuk was not the victim of a harmful spirit, or anything else the shaman could influence. Rather, Kopanuk was a kunlangeta, a person whose “mind knows what to do but he does not do it.”6 As in modern North America, being a kunlangeta among the Eskimo was not the same as being psychotic, or nuthkavihak in the Yup’ik language. The Yup’ik translation of nuthkavihak is “being crazy.”7 Kopanuk, his fellow Eskimo agreed, was not nuthkavihak, so they didn’t think his behavior could be excused when he did things like taking advantage of women. The traditional Eskimo and Inuit had a lenient attitude about sexual activity among adults, but Kopanuk’s behavior went too far. Avoiding another challenging hunting and fishing expedition, Kopanuk stayed behind with the women and children. When the hunters returned, they learned that Kopanuk had visited most of the Yup’ik dwellings, half a dozen or so, and had sex with most of the women. What happened to people like Kopanuk before Eskimo and Inuit societies were transformed by Western culture, technology, and law? During the first field trip of her career in 1954–55, a young anthropologist named Jane M. Murphy visited Seevookuk to conduct a pilot study. She wanted to learn how people on the island viewed physical and mental illness.8 When she asked her source, an elder, how people like Kopanuk were dealt with in traditional Yup’ik society, he told her that someone like Kopanuk probably would have been taken on a hunting trip. Then, she learned, “somebody would have pushed him off the ice when nobody else was looking.”9 It’s possible the interviewee gave the young anthropologist a flippant answer. But in a challenging environment like Seevookuk where cooperation and sharing is essential for survival, it would not be surprising if the anthropologist got a straight answer. If Kopanuk avoided the fateful hunting trip that may have awaited other kunlangeta, he would have had more time to observe Yup’ik girls play with yaaruin, story knives. They used them like pencils to draw in the snow or sand as they told stories. Sometimes the stories were told for fun. Sometimes they were about their families. And sometimes the stories had a moral message. It would be interesting to know if Kopanuk was ever featured in the girls’ illustrated stories, if his lack of conscience and empathy was ever explained with an image in the sand. Traditional Eskimo experiences with, and treatments of, extremely antisocial individuals have parallels to modern North American experiences with such people. According to Murphy, who went on to become the Director of Massachusetts General Hospital’s Psychiatric Epidemiology Unit, professor of psychiatry at the Harvard Medical School, and professor of epidemiology at the Harvard School of Public Health, the kunlangeta parallel our concept of the psychopath. It’s easy to compare the Eskimo elders with our court system, and their shaman with our psychologists and psychiatrists. A socially tolerated act like pushing a kunlangeta “off the ice” could be seen as a vigilante version of pushing a psychopath into the execution chamber or, for less severe crimes, pushing one into a prison cell or forensic psychiatric hospital. People like Kopanuk turn up in cultures all over the world. Murphy reports that the Yoruba people of West Africa, whom she studied during field trips in 1961 and 1963, describe them as arankan. Arankan refers to “a person who always goes his own way regardless of others, who is uncooperative, full of malice, and bullheaded.”10 Interestingly, Murphy reported that the Yoruba do not consider an arankan to be ill. Just as psychopaths are not considered insane in modern Western society and kunlangeta are not regarded as insane in Yup’ik Eskimo society, arankan are not considered insane in Yoruba society, but they are considered uniquely different. Today, while many people would refer to Kopanuk as a psychopath, others would call him a sociopath. And there are those, particularly psychiatrists and psychologists who follow the lead of the American Psychiatric Association, who would say he suffered from antisocial personality disorder. But what exactly do those labels mean for the individuals encountering such people and the societies they live in? No Matter What You Call It, Something Is Not Right The labeling situation sounds confusing because it is confusing. Over time, the labels have accumulated. Sociopathy, psychopathy, antisocial personality disorder, and dyssocial personality disorder are sometimes confused and often used synonymously. Experts and amateurs declare with conviction that a sociopath differs from, or is identical to, a psychopath who is essentially the same as, or different in significant ways from, someone with antisocial personality disorder. Psychiatrists, psychologists, and neuroscientists have yet to agree on the nature of this disorder—or, it may be more accurate to say, on the nature of the subtypes of personalities with psychopathic traits. Until there is an agreed-upon common language to describe the spectrum of antisocial behavior identified by these different labels, it is unlikely we will be able to claim we have a good understanding of behavior included under the heading “psychopathy.” In part because we lack so much information about this type of human behavior, academic researchers are engaged in a sometimes bitter controversy concerning the nature of psychopathy and how it should be measured and defined. It is not unusual for a researcher submitting a paper to a peer-reviewed scientific journal to ask the editor to avoid sending the manuscript to certain competing or antagonistic fellow scientists. This happens in other fields of research as well. Sometimes this request is made to prevent a competing research group from rushing their own findings into print and “scooping” their competitors. Sometimes it is made to prevent competitors from using the reported data to correct or further their own research and so gain an advantage. But another reason such requests are made can be traced to ill feelings between researchers. Competition can be vicious in scientific research. Egos can be strong. Feelings are hurt. On occasion, sending your paper for review to a competitor, someone who dislikes you or whom you may have slighted, can result in rejection or delay, no matter how good your data is. Such pettiness seems at odds with the ideals of Science, but scientific research is a career, a competitive one, which at times is heavily influenced by ambitions and emotions that in some cases would be interesting subjects for research in themselves. There is nothing unique about the field of psychopathy research in this regard; the same thing has happened in various departments of prestigious universities around the country. The co-discoverer of the chemical structure of DNA, Nobel laureate James D. Watson, once said that scientists are not like many people think they are. In his view “a lot of us are more like Michael Douglas—slightly evil, highly competitive [in his movie roles].”11 But anyone on the receiving end of an unfair review or an inexplicably rejected grant application might wonder if it was Gordon Gekko, Douglas’s character in the movie Wall Street, writing the evaluation. Woodrow Wilson observed that the ferociousness of the academic infighting he witnessed while he was president of Princeton University was related to the triviality of the issues at stake.12 Over time, the quote has become a version of “academic politics are so vicious because the stakes are so small.” Many people who have spent a few semesters among the faculty in an academic setting can relate to this sentiment. Positions at universities open up rarely, while many people in the same field are competing for a portion of a limited supply of grant money. In the case of the controversy surrounding the definition of psychopathy, however, the stakes are by no means small. The magnitude of the problem posed by psychopathic behavior is at least as great as that posed by schizophrenia. The National Institute of Mental Health estimates that around 2.4 million American adults 18 years of age or older have schizophrenia.13 That is approximately 1 in 100 people in this age group. Experts generally believe that around 1 in 100 non-institutionalized adult males 18 years and older are psychopaths, meaning there could be between 2 and 3 million psychopaths in North America alone. Approximately 1 million psychopaths are locked up, on parole, or on probation.14 These people may be responsible for half of all serious crime.15 Their crimes, trials, and confinement have been estimated to cost between $250 and $400 billion each year.16 In 2002, the cost of schizophrenia in the United States was an estimated $63 billion.17 Furthermore, one out of two serial rapists may be psychopaths.18 Classifying someone as a psychopath, even as an adult, is a very serious step that can follow a person for life and play an important role in determining how he or she is treated by the courts. This issue clearly troubled NPR correspondent Alix Spiegel when she prepared a piece called “Can a Test Really Tell Who’s a Psychopath?” in May 2011. Her subject was Robert Dixon, a convicted felon coming up for parole.19 Thirty years ago, a surprised Dixon asked “What happened?” when he saw the dead body of the robbery victim his accomplice had shot. Because he acted as the lookout for the robbery-turned-murder, Dixon was sentenced to 15 years to life with the possibility of parole. Coming up for parole after 26 years of confinement, Dixon agreed to be evaluated using the Psychopathy Checklist–Revised (PCL–R), which has repeatedly been called the “Gold Standard” of psychopathy measures.20 Versions of the Checklist have dominated psychopathy research since it was first developed by Canadian psychologist and psychopathy expert Dr. Robert Hare in the 1970s. Even some academics who are highly critical of this method for measuring psychopathy and how it has come to be associated with the definition of the disorder consider it “the most widely used and extensively validated measure of psychopathy.”21 The PCL–R rates each of 20 antisocial behaviors and emotional and interpersonal traits on a three-point scale. The criteria range from need for stimulation and proneness to boredom to sexual promiscuity, from glibness and superficial charm to callousness and lack of empathy. Among academics, a big part of the controversy surrounding psychopathy centers on the influence this test still has on researchers’ views about the nature of psychopathy and the influence it has on the fate of criminal psychopaths. As Spiegel reported it: “And so Dixon found himself sitting across a table from a no-nonsense female psychologist, answering a series of questions about his family and troubled youth. “The woman, Dixon says, didn’t look at him. Instead, she stared at the computer, methodically entering his answers, her face dimly lit by the screen. “They talked for over an hour. Then the psychologist thanked him, closed her computer and went away.” The report doesn’t mention that the evaluation, to be valid, should have included a review of his criminal record and past history. Diagnosing someone as a psychopath using the full PCL–R requires more than a pencil (or a computer) and a list of 20 items. (Some writers like Jon Ronson, the author of The Psychopath Test, journalists, and bloggers oversimplify the process of identifying a psychopath to a misleading degree when they lightheartedly, and at times without a clue, do exactly this and with far fewer than 20 items.) Competent, qualified professionals are trained to administer the PCL–R interview and taught to observe the subject. They should review court and other institutional records as well. Ideally, they should interview people who know the subject and can provide evidence of his or her behavior. In addition, the subject’s home life and upbringing, as well as behavior during childhood, adolescence, and adulthood, in school, at work, and toward friends and lovers, should be considered. Even someone’s hobbies and how they spend their “off ” time may factor into the final diagnosis. All this information should then be integrated into the total psychological assessment before assigning a score. 22 More than one interview may be necessary to accumulate all the information, and the process may take as little as two hours or as many as six to complete.23 But this, of course, is the ideal. It takes time and costs money to conduct a series of interviews, if that is required. There is always concern that unqualified examiners might cut corners. Although it would be unconscionable to skimp when administering a test that has such significant implications for a person facing sentencing or parole, the quality control lies with the test administrator, who should be certified. While this tool for measuring psychopathy was developed for research purposes, it has become highly influential in court systems in many parts of the world, including North America and Europe. Incompetent administration of the PCL–R or other tests of psychopathy is as serious as incompetent medical care or failure to follow legal due process. Improper application or administration of the test by unqualified personnel has raised concerns, like those expressed in Spiegel’s report, that the test could be used improperly. “I feel ambivalent about it,” Hare told Spiegel on air, referring to how the test may be used in the judicial system.24 Spiegel may have wanted more from Hare. He formed the impression over the two days Spiegel interviewed him that the NPR correspondent had an agenda to get him to repudiate the use of the test in the judicial system. Spiegel denied she had an agenda but, according to Hare, “It turns out she was trying to get me to say that I was really concerned about how the PCL–R is being used and misused in criminal justice. Now, I am; I’m very concerned about it. But the way it was presented somehow indicated that it should not be used at all, which is clearly inappropriate. The real gist of the program was to take up the case of the California lifers [prisoners serving life terms in California prisons]. These are people who are very unlikely to get out for a very long period of time. They are in for murder and other serious crimes.”25 Hare concluded that Spiegel was trying to make the point that these convicts are never going to get out of prison because of their high PCL–R test results. “Well, in fact, the PCL–R is never, ever the sole instrument used for parole purposes,” Hare said. “In fact, it is not a risk assessment tool at all. It just measures a personality condition or disorder, as most people would say, although I don’t think it is a disorder.” (Hare later explained that “Disorder in psychiatry has several meanings, and does not necessarily imply deficit or malfunction.”26 After more than half a century studying psychopaths, he believes that they “have an intellectual understanding of the rules of society and the conventional meanings of right and wrong, and know enough about what they are doing to be held accountable for their actions.”)27 Forensic psychologist Stephen Porter, Ph.D., of the University of British Columbia also questions the widely held view that high PCL–R scores routinely condemn criminals to serve their prison time with little chance of parole. Porter and his collaborator found “that when given the opportunity to speak to a parole board, high PCL–R scores were associated with likelihood of release.28 I think the finding relates specifically to this context in which an offender has been granted the opportunity to speak (and perhaps put on an acting job) in front of observers. Yes, the [Canadian] parole board would have been fully aware of the offenders’ PCL–R scores prior to the hearing. In a more recent study we found that psychopathy was associated with the ability to effectively simulate/fake facial expressions.”29 “I wonder,” Porter continued, “if there is good evidence that high PCL– Rs actually keep people in prison longer in the U.S. It is possible that U.S. courts are more punitive and/or their parole boards are less liberal, such that people get longer sentences and then have stricter criteria to be eligible for parole in the U.S. than Canada.”30 “Because high PCL–R scorers are such effective actors and manipulators,” he added, “I would predict you’d find the same pattern in the U.S., such that IF provided the opportunity to speak to a parole board and express remorse, high PCL–R scorers would have an advantage over low scorers.” Dixon’s lawyer, Charles Carbone, doesn’t agree. After reading the psychologist’s conclusion that “Mr. Dixon obtained a total score on the PCL–R which placed him in the high range of the clinical construct of psychopathy,” he told Spiegel, “I remember reading the report and feeling heartbroken because I knew no matter how hard I worked from that day forward, that when I brought him back to the board, we were going to get denied.” One example of the fallout following Spiegel’s broadcast was that psychologists in California became concerned that the report gave the impression that the PCL–R is unfairly keeping people in prison. Hare’s concern is that unqualified people may be administering and interpreting the test results. Anytime a tool or instrument is misused, whether it is a screwdriver or a test of personality traits, damage can occur. The rhetoric surrounding the use of the test can become strong inside, and outside, academia. “One of my former students, Stephen Hart, said the PCL–R kills people,” Hare recalled with traces of disappointment, resentment, and pain in his voice. Hart is the lead author of the short version of the PCL–R, The Hare Psychopathy Checklist: Screening Version (PCL: SV).31 “Well, I don’t know where it kills people,” Hare said. “I don’t know of anyone who’s ever been condemned to death because of the PCL–R.” The short version of the test, which Hart developed with David Cox and Hare, takes about half as much time to complete as the full version. It allows a screener to determine if someone has a score high enough to justify spending the time and money to administer the full version. If Dixon was evaluated by a qualified examiner using the most recent, full version of the PCL–R, he would have provided information concerning 20 different items, each rated 0, 1, or 2 during a semi-structured interview. The evaluation also would have included a review of his written records. He would have received a rating of “0” for any trait he lacked, a “1” when there was some indication he had the trait, and a “2” if there was abundant evidence he had it. His potential maximum score was thus 40, but a score of 30 and above in North America was sufficient to get him a diagnosis of psychopathy. In Europe, a score of 25 or higher would have secured him the same diagnosis.32 Most of the items—18 out of the 20—included among the PCL–R measures fall into one of four related categories or clusters.33 Psychologists often refer to them as Factors. It is not possible to measure a concept like psychopathy directly any more than it is possible to measure directly a concept such as intelligence. You can’t heft it in your hand, weigh it on a scale, or set it next to a ruler. One of the reasons psychology is such a challenging field is because it deals with intangibles, concepts like personality, emotions, mental states, etc. We know they are real because we experience them and observe their effects, but they are impossible to measure physically. This is why some scientists in fields like physics and chemistry, and later biology, once referred to psychology and social science as “soft sciences” while they, with a bit of snobbishness and feeling of superiority, regarded their fields of study as “hard sciences.” Psychopathy research has entered the interesting in-between realm of social psychology and neuroscience. Neuroscience is bringing aspects of “hard science” to the field—for example, as we’ll see, measurement of brain activity, volume, and structure—but at the same time psychologists are still arguing over what psychopathy is, who is a psychopath, and—as one can see with the debate surrounding the PCL–R—how this knowledge should be used in our society. Many researchers devoted to studying the neurobiological basis—the “hard science” aspect—of psychopathy still rely on the PCL–R, as they have for decades. It is a proven, reliable indicator of something that distinguishes the criminal psychopath who lacks a conscience from a person who has a conscience. Because they can’t measure psychopathy directly, psychologists use a statistical method called factor analysis to evaluate the features of psychopathy. It indicates to them whether or not a collection of variables, such as the behaviors or traits we associate with psychopathy, are in fact actually related to a smaller number of unknown factors. Smaller is better; it gets you closer to the source and eliminates false leads. Factor analysis in the past has yielded two-factor, three-factor, and four-factor models of psychopathy based on PCL scores. Some statisticians are fans of factor analysis, and others think it can be used to show whatever a user wants it to show. The generally accepted view is that, like many statistical techniques, it can be used or misused. Used properly, it can identify useful patterns hidden in large, messy piles of data. Used properly, it can reduce the number of variables researchers have to deal with as they struggle to better understand complicated human behaviors. Used improperly, it could mislead. Questions in the PCL–R34 designed to detect Glibness and Superficial Charm, Grandiose Sense of Self-Worth, Pathological Lying, and Conning/Manipulative Behavior fall into the category of Interpersonal factors. Some people with considerable psychopathic traits are good at manipulating others with smooth talk. They often are good at persuading others and talking their way out of trouble, as Eric Harris did on many occasions while growing up. The glibness and confidence make these people effective persuaders and sometimes come across as overconfidence or arrogance. As with the other factors or dimensions of psychopathy, these traits are not obvious or apparent in all psychopaths all the time. Some show stronger traits in some of these areas than in others. It’s possible these differences may reflect different subtypes of psychopaths, although that remains unresolved. A second category of factors, Affective, includes features related to feelings or emotions: Lack of Remorse or Guilt, Shallow Affect, and Callous Lack of Empathy. Psychopaths do not feel the way other people do, and these differences show up in the laboratory. They do not respond physiologically to images that make most people cringe, even other criminals. Show most folks a picture of someone crushing their fingers in a car door, for example, and they will react almost as if they feel the pain. This is not so with psychopaths. They also differ in the way they process and use language. For example, words that have emotional connotations for most people—slaughter, rape, death—subtly grab people’s attentions more than neutral words—air, float, walk. Robert Hare and his colleagues saw this back in 1991 when they compared the time it took psychopaths and non-psychopaths to decide if a group of letters represented a word or not.35 They also used EEG (electroencephalography) to measure the subjects’ brain waves (called event-related potentials) during the task. They found that non-psychopaths identified emotion-laden words faster than psychopaths and they showed greater brain wave changes while doing so. People with high psychopathy scores respond to the two sets of words as if they were the same. These deficits may be related to the inability of people who score high on the psychopathy checklist to relate to, care about, or appreciate others’ emotions. A third category on the PCL–R concerns the psychopathic lifestyle: Parasitic Lifestyle, Lack of Realistic Long-Term Goals, Impulsivity, and Irresponsibility. Many criminal psychopaths have trouble sticking with long-term projects or commitments, including jobs and relationships. Perhaps because they lack much of the ability to feel the way others do, they seek stimulation by dropping what is boring and looking for new experiences. Sometimes this means a regular job is too boring and they may find someone to exploit instead, a strategy that evokes no feelings of guilt; it is simply a means to an end. The fourth category concerns Antisocial factors: Poor Behavioral Controls, Early Behavioral Problems, Juvenile Delinquency, Revocation of Conditional Release, and Criminal Versatility. This dimension, David Kosson and Robert Hare maintain, “is associated not with criminal behavior per se, but with early, versatile, and persistent antisocial behavior that often is extremely distressing and frustrating for others.”36 The final two topics look like they should fall into one or more of the above categories, but statistical analysis doesn’t support this: Failure to Accept Responsibility and Many Marital Relationships. Dixon scored high enough on the test of the above items to be considered a psychopath in the eyes of the legal system. Spiegel’s NPR piece made it clear she believed Dixon’s test result would condemn him, perhaps unfairly, to prison for life despite the change for the better his family and friends had seen in him in recent years. His evaluation should have considered the fact that as a youth he had threatened to kill his father and commit suicide, and that he had been convicted of assaulting a woman and raping another during a date. It’s not unusual for people with high psychopathy scores to mellow with age, to turn down the antisocial behavior, if not the attitudes associated with it. It’s also not unusual for them to manipulate the system and act however they need to act to get what they want. In some cases, it is possible that the perception of “mellowing with age” is simply an act. From 1956 to 1957, Peter Woodcock, for example, killed three children in Toronto, Canada. He was seventeen years old at the time and had endured a tragic childhood, although he impressed his high school teachers as being intelligent and charming. After thirty-four years of treatment in a psychiatric institution, and now aged fifty-one, he managed to convince the staff that he should receive his first day pass. Within hours, he killed a fellow inmate, twenty-seven-year-old Dennis Kerr, on the perimeter of the hospital grounds by beating him with a pipe wrench. He said he would have killed another man too, but was too tired.37 There is no scientific way to balance forgiveness and wariness. Many researchers remain convinced that high-scoring individuals can never be treated, trusted, or changed, while others say that change is possible. But no parole board or judge wants to risk taking the blame if someone they release commits a heinous crime. They don’t want to have critics point at them and say “You released a psychopath?! What were you thinking?” When Hare, a pioneer of modern psychopathy research, began to study psychopathy in the late 1960s, there was no reliable—or even generally accepted—way to measure the degree of psychopathy in a person. The best measurement systems then available were “inventories” like the Minnesota Multiphasic Personality Inventory, which had been developed in the 1930s. These have the drawback of depending on the word of the subject; that is, they are self-report inventories. Needless to say, people with strong psychopathic traits are not the most reliable sources of insight into their thoughts and motivations, since deception and lying are often prominent features of psychopathy. Many people with this type of personality—or, in the opinion of some, personality disorder—can and have figured out what is being tested and adjusted their answers to sway the results.38 A better way to measure a person’s degree of psychopathic traits was necessary if scientists were ever going to understand the subjects they wanted to study. During the development of his groundbreaking measurement instrument, Hare was influenced39 by psychiatrist Hervey Cleckley’s 1941 book, The Mask of Sanity: An Attempt to Clarify Some Issues About the So-Called Psychopathic Personality.40 The anonymous, mostly favorable review of the book in the Journal of the American Medical Association (JAMA) began: “As a psychiatrist in the United States Veterans Administration, the author became interested in that nosological [disease classification] wastebasket known as ‘psychopathic inferiority’ and its diagnostic variations [emphasis added].”41 Now a classic in the field, the book included 15 detailed case histories and descriptions of patients with psychopathic traits, whom Cleckley—then a professor of neuropsychiatry at the University of Georgia School of Medicine—had encountered during his career. In gathering together these case histories and describing the personality disorder of psychopathy in 1941, Cleckley took a fresh look at a subject to which scattered references had been made for hundreds of years, and which had been described in various ways since the end of the 19th century.42 French physician Philippe Pinel, a key figure in the history of psychiatry, used the phrase manie sans délire in 1801 to describe people he recognized as having “insanity without delirium.” People lacking consciences came to the attention of at least one eminent physician in North America too: just a year before he died in 1813, Dr. Benjamin Rush, a pioneer of American psychiatry and signer of the Declaration of Independence, described them as people with a “moral derangement.” You can spot familiar aspects of the psychopathic personality in people who were later described as suffering from “psychopathic inferiority,” “psychopathic personality,” and one now-quaint but descriptive phrase: “moral insanity.”43 English psychiatrist James Pritchard introduced the term in 1835 to describe individuals whose moral judgment was absent or flawed but whose intellectual judgment was intact. Moral insanity captures the unique and troubling blend of seemingly rational thought processes—free of halluci