By Carey Goldberg, Globe Staff,7/15/2003
Scientists may slowly be closing in on thepsychopath.
New research tools, from brain scans topsychological tests, are yielding more sophisticated insights intowhat makes psychopaths such cold-blooded predators, raising theprospect of improved tests to identify them and possibly eventreatment.
''We can treat most other emotional disorderspretty successfully, and we will be able to treat this one soon,''said Dr. James Blair, a researcher at the National Institute ofMental Health.
Psychologists estimate that one in every 100people is unfeeling enough to qualify as a psychopath, with anespecially heavy concentration among criminals. The ranks includeserial killers such as Ted Bundy, who charmed and killed dozens ofyoung women in the 1970s, and cannibal-murderer Jeffrey Dahmer, whofatally seduced 17 men and boys before he was caught in 1991, as wellas a great many other people who never commit a crime punishable bylaw, but go through life heartlessly using and manipulating otherswithout remorse.
Blair is an admitted optimist, but evenskeptical scientists say that the last few years have broughtprogress, as researchers have largely reached agreement on how todefine a psychopath and have begun pinpointing what happens in theirbrains.
Even the last few weeks have brought intriguingnew findings. Among them: A psychological test designed to detectunconscious or frowned-upon attitudes picked up a decided tendencyamong psychopathic murderers to have abnormally positive attitudestoward violence, British researchers reported in the May 29 editionof the journal Nature.
No one has ever pinned down that attitude amongpsychopaths before, said Nicola Gray, coauthor of the Nature paper,because they relied on explicit questions, and psychopaths lie alot.
Spinal taps on more than 50 imprisonedcriminals in Sweden produced new evidence that psychopaths may havean imbalance of the brain chemicals serotonin and dopamine, accordingto a paper in last month's Journal of Neurology, Neurosurgery andPsychiatry.
Experiments using brain scanners whilepsychopaths perform various tasks also have beenaccumulating.
They suggest that ''the psychopath finds itdifficult to process, handle, or use emotional material in the sameway the rest of us do,'' said Robert D. Hare, professor emeritus ofpsychology at the University of British Columbia and widelyconsidered the world's foremost authority on psychopaths.
Of course, that is the obvious problem, thevery definition of a psychopath: They lack normal feelings, likeempathy and remorse. And researchers have known for decades thatpsychopaths also tend to show some unusual physical responses: Theysweat less and generally exhibit less distress when exposed tofrightening or threatening stimuli, for example.
But research is now focusing on the brainabnormalities in psychopaths, said Dr. Bruce Price, chief ofneurology at McLean Hospital in Belmont.
And, he said, ''the seismic shift is that, upuntil a decade or so ago, this was the realm of psychologists andsociologists. We now are at the point where biological science cantry to make sense of this.''
That point has been reached partly thanks tonew tools like brain scanners, researchers say, but also partlythanks to Hare's development of a broadly accepted clinical standardfor who is a psychopath, a test called the PCL-R, or psychopathychecklist-revised.
The PCL-R allows psychologists to rate asubject's level of psychopathic behavior and emotional makeup byextensive interviewing and examination of his or her record. (It isalmost always a man.) It measures how callously the subject has usedothers, for example, and how antisocial and unstable the subject'slife has been.
The development and broad acceptance of thePCL-R gave researchers a basis for making sure they compared applesto apples across studies. Research on psychopaths has ''skyrocketed''in recent years, Hare said, with particular interest in Scandinavia,Germany, the United States and Canada. It was, he said, ''a ruler notmade out of rubber.''
Among all those researchers, those examiningbrain activity have tended to find abnormal activity in the amygdala,a part of the brain seen as the seat of basic emotions like fear, andthe orbito-frontal cortex, which is involved in helping people adjusttheir behavior in response to reward or punishment.
Some studies also indicate problems in theconnection between the deep, emotional brain and the thinking part ofthe brain.
That anatomical finding combined withpsychological tests show with new precision that psychopaths haveproblems processing emotional information, particularly things thatmake normal people afraid or sad, Blair said.
And consider, he said, that ''the best way ofteaching a child to feel guilt about harming another individual is tofocus the child's attention on the victim's sadness. But that sort ofsocialization technique doesn't work well with individuals withpsychopathy,'' because they tend to be unable to feel empathy and torespond poorly to cues associated with negative emotions.
In essence, Hare said, it appears that''emotion for the psychopath is like a second language,'' one he orshe must struggle to speak and never master deep down. Emotions forpsychopaths are abstractions, much as they are for Data or Mr. Spockon ''Star Trek,'' he said.
Even their murders tend to be dispassionate: Astudy of 125 Canadian murderers found that among those with highpsychopath scores on the PCL-R, 93 percent of their killings were''instrumental,'' practical, rather than crimes committed in the heatof high emotion. That cold-blooded quality makes them particularlydangerous, experts say.
So, with all this research, how about adefinitive test to catch the potential serial killers before theystart killing?
It is conceivable, researchers say, but not yetdoable: ''The false positive rate would be horrific,'' Hare said.But, eventually, it should be possible to combine the telltale signsin psychopaths' brains -- once it becomes much more clear what thoseare -- with a clinical tool like the PCL-R and get an excellentpredictor of future danger, he said.
But to get there would require large-scale,expensive studies, he added.
The psychological test of attitudes towardviolence published in Nature may be usable to predict how violent apsychopath is likely to be, but more research is needed, according toGray. A similar test shows promise in revealing attitudes towardpedophilia, she said.
But a Harvard expert on the test used in theNature study, which is called an Implicit Association Test, expressedconcern: ''The IAT is not, and never will be a test like a DNAtest,'' said Mahzarin Banaji. ''It is meant for research, notdiagnosis,'' she said.
As for treatment, past research has shown thatmost conventional treatment, like group therapy, only makespsychopaths worse; it seems to train them in manipulating people andfaking emotions.
But Blair and some others believe that, withina few years, a drug may be developed to treat psychopaths. Peoplewith depression and anxiety problems can be helped by adjustments oftheir brain chemicals, he said, and psychopaths effectively have theopposite problem in that they feel too little.
''You would be able to help the systems thataren't working particularly well by using a drug, so long as weunderstand what's not working well,'' he said. So, perhaps ''we cangive emotions to people who lack them.''
Carey Goldberg may be contacted atgoldberg@globe.com.
This story ran on page C1 of the Boston Globeon 7/15/2003.
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