|The Psychopath Whisperer: The Science of Those without Conscience
by Kent A Kiehl, narrated by Kevin Pariseau
In this fascinating scientific exploration into the biological differences between psychopaths and non-psychopathic people, Kiehl discusses his own dealings with psycopaths in prisons. Kiehl is known as the first person to use an MRI in a prison to study the differences between psychopaths and non-psychopathic prisoners.
Kiehl would determine psycopathy by interviewing prisoners and then rating them 1-3 on a list of 20 attributes. A score of 30 indicates a psychopath. Approximately 20% of inmates were psychopaths. A balanced number of people who rate high and low on the psychopathy scale would be chosen for the experiments.
Once the study subjects were put in the MRI, they would be shown pictures of three types: a morally neutral photo (perhaps an ice cream cone), a morally ambiguous photo (perhaps a wrestling match), and a immoral act (perhaps someone placing a bomb in a car). The prisoners would then rate one a 1-5 scale how immoral the picture was. When a person who scores low on the psychopathy scale sees an immoral picture, his limbic system lights up; but a psychopath’s limbic system remains eerily dark.
In his book, Kiehl also discusses findings other people have made about psychopaths – like the fact that they have no startle reflex. This mixture of scientific, psychological, and personal narrative make for a fantastic book.
I enjoyed this book quite a bit – especially the ethical implications of whether a psychopath deserves an insanity plea because their brains function differently than “normal” people and they are unable to physiologically respond the “right” way to the thought of immoral activity. Kiehl himself longs for a day when psychopathy will be caught earlier in childhood, so that they can receive treatment rather than incarceration. But the issue is quite an ethical dilemma. Where do you draw the line on the insanity plea?
I have previously discussed another ethical dilemma of the insanity plea: whether, in a patient with dissociative identity disorder, it is ethical to punish one personality for what another personality has done. Again, where’s the line? And then I wonder about what the neurodiversity movement would say about the whole thing? Things that make you go hmmmm.
One of the most difficult tasks for mental health workers is to clinically assess and diagnose mental illnesses – especially when comorbidity (having more than one mental illness) is so common. It usually begins with a psychological assessment through tests, observation, and interviews so the clinician can catalog the symptoms. Then the DSM-5 is consulted to give the diagnosis.
A clinician may focus the assessment in three ways – biological, psychodynamic, and behaviorally.
For the sake of appropriate treatment, it is very important to make sure that the symptoms are not due to a physical rather than a mental illness. In my experience, many doctors shrug off certain types of symptoms as those of a mentally ill patient. For instance, when I fainted at work a while back I was told it was “anxiety.” (And because it was diagnosed as a mental problem, my insurance didn’t pay – but that’s a problem to discuss on another day.) Granted, my fainting spell could have been anxiety-induced, but it could have been many things.
A more extreme example that I heard of from a doctor at a large university hospital was that a foreign patient (I can’t remember his origin) kept coming in complaining that there was a worm in his head. The doctors kept shunting him off to mental health. Eventually, the man came back and said “There’s a worm in my eye!” They looked, and sure enough there was a worm in his eye. (Possibly something like this?) Yeah. Sometimes the patient knows what he’s talking about.
Of course generally there aren’t really worms in people’s heads – but symptoms that seem mental could be due to head injuries, strokes, seizures, etc. There are a number of brain scans that can be performed to check for such problems.
One is computerized axial tomography (CAT) scan, which moves X-ray beam around the head to create a 2D image of the brain. CAT scans have become more rare because of the availability of magnetic resonance imaging (MRI). MRI quantifies magnetic fields affecting varying amounts of water content in tissue, thus giving a sharp image of different structures (or lesions / tumors) in the brain.
Another brain imaging technique is the positron emission tomography (PET) scan. PET scans measure the metabolic activity in the brain, thus allowing more clear-cut diagnoses to be made. PET can reveal problems that are not anatomically obvious. However, the images in PET images are low-fidelity and the scans are prohibitively expensive.
Functional MRI (fMRI) measures blood flow of specific areas of tissues, thus providing information about which areas of the brain are active. fMRI is the scan that helps researchers discover which parts of the brain are important for certain types of thoughts or activities. At the moment, it is more important in the research than in the clinical world, but there is some optimism that fMRI might eventually be used to map cognitive processes in mental disorders.
Sometimes, a lesion hasn’t developed enough to be recognizable by brain scans. In this case, neuropsychological tests can be performed to quantify a person’s cognitive, perceptual, and motor performance to determine what parts of the brain might be affected. The neuropsychological assessment usually involves a battery of tests such as the Halstead-Reitan assessment for adults. This assessment is composed of 5 tests.
1. Halstead Category Test: Measures learning, memory, judgement, and impulsivity. Patient hears a prompt and selects a number 1-4. A right choice gets a pleasent bell sound and a wrong choice gets a buzzer. Patient must determine the underlying pattern in prompt-number combinations.
2. Tactual Performance Test: Measures motor speed, response to the unfamiliar, and the ability to use tactile / kinesthetic cues. A blindfolded patient is asked to place blocks in the correct spaces on a board. Then she draws the board from memory, without ever seeing the board.
3. Rhythm Test: Measures attention and concentration. The patient listens to 30 pairs of rhythmic beats and must determine whether the pairs are the same or different.
4. Speech Sounds Perception Test: Determines whether patient can identify spoken words, and measures concentration, attention, and comprehension. Nonsense words are spoken, and the patient must choose the word from a list of four printed words.
5. Finger Oscillation Task: Measures the speed at which the patient can press a lever.