Translator: Judy Klass
Reviewer: Theresa Ranft So, I usually begin this talk,
when I give it, by giving the latest slide
of a mass shooting; and depressingly,
I've had to update this slide every single time I've given this talk. This is, of course, the Florida shooting
that occurred last week - seventeen people killed. That comes hot on the heels
of the Las Vegas shooting, in last October, that killed 59 -
the deadliest mass shooting in America. And a month after that,
the Texas shooting that killed 26. So, we've had three
of the deadliest shootings in the US happen in the past five months. If it seems there's more and more
mass shootings these days, you're right. Every year, the number
of mass shootings goes up. So, violence is a problem. I'm a forensic psychiatrist
with a background in neuroscience, and I spend a lot of time thinking about these questions
which we'll be exploring in the talk. Why do people commit violence?
How can we reduce violence? And can neuroscience help? So when we look at the world
of repeat violent offenders and look underneath the hood,
we see basically three different groups: those with mental illness,
a group of people we call antisocial, and within that group of antisocials
a hardcore group of antisocials that we call psychopaths. One way to differentiate these groups is that generally people
with severe mental illness commit violent acts
for irrational reasons, whereas those who are anti-social
and psychopaths typically commit violent acts
due to rational reasons. Now, after every mass shooting, there's typically some sort
of scapegoating of a mentally ill. And it's happened this time as well. And I want to explain to you
why I think that's so misguided. The severely mentally ill
comprise 4% of the adult population, but they only commit 3%
of the overall violence. In other words,
people with severe mental illness are actually less violent
than the average person. And when you look at mass shootings,
less than 1% of mass shootings have to do with someone
with a severe mental illness. To contrast that,
the group of psychopaths ... So, psychopaths comprise 1%
of the adult population, they comprise 20%
of the prison population, and because they recidivate so frequently, it's thought that they are responsible
for over half of all violent crimes. This is a group of people we're studying
and we're trying to cure, if possible. So psychopaths are labeled
cold-blooded killers and there's a group of qualities
that unites them. So typically, psychopaths
are emotionally detached, they're said to lack empathy,
they lack remorse. So after committing horrible acts
that we would feel very guilty about, they feel no guilt at all. They have low levels of anxiety and fear, and the type of violent things
typically is planned aggression as opposed to reactive
impulsive aggression. And, very curiously, many if not most
come from intact backgrounds. If you're like me, you're like, "Really, they come
from intact backgrounds?" Yeah, really. Most of them
come from intact backgrounds. This is strong evidence
that psychopathy is a genetic condition, as opposed to something
that was created by a bad environment. If we look at the evidence
for the biological basis of psychopathy, it's strong. Again, there's no detectable differences
in family backgrounds between psychopaths and non-psychopaths. We also know from twin studies
that it's strongly heritable and the traits are apparent
from early childhood, and you can also see brain differences
from a very early age. All this adds up to the conclusion that psychopathy is essentially
a genetic condition, and the idea is that bad genes
lead to brain abnormalities, and those brain abnormalities
can help explain deviant behaviors. So psychopaths are said
to lack conscience, and actually the study of psychopathy has been a tremendous boon
to neuroscience. By studying the brains of psychopaths, neuroscientists have come
to a much better idea of what the conscience is,
and, most remarkably, what parts of the brain
are required to have a conscience. So I want to introduce you to a brain area
called the ventromedial prefrontal cortex, or the vmPFC, which is a key brain area
necessary to have a conscience. So the ventromedial prefrontal cortex sits in between the middle halves
of both hemispheres and it's a key area
for emotional intelligence. It participates in three activities that I would argue
generates our conscience. First, it creates emotional memories which form the basis
of social inhibitions. The second is it's an essential
brain area for imagination, and you need imagination to have empathy. The third characteristic is it plays
a major role in impulse control, which we need to have
to make wise decisions. These three qualities: to have social inhibitions,
to have empathy, and to have impulse control,
I would argue constitute the core of what we mean
by having a conscience. And psychopaths have defective
ventromedial prefrontal cortexes. So that means they don't do these things,
they don't have a conscience, and you more likely end up
like this guy. So let's take these one at a time. So emotional memories ... (Chuckling) I have a toddler named Kyle, and anyone who's raised a toddler
knows that toddlers can be little savages, Over time, we civilize them.
How do we civilize them? It's all about negative feedback, right? So every time you do something bad
like hit your brother, your mom said, "Don't do that." It made you feel bad in your body. This part of the brain
stores that emotional linkage, so the next time you contemplate
hitting little Billy, it replays that emotion
so you feel bad in your body and hopefully that guides you away
from doing that violent act. And over time, this forms the basis of our social inhibitions
against doing violent acts. The next part is the ventromedial
prefrontal cortex plays an essential role in what I call the imagination engine,
which is essential to have empathy. So what do we mean by empathy? Empathy is the ability to understand
and share the feelings of another. It's the foundation
for prosocial behavior and there's an obvious
evolutionary benefit. If we act socially toward others,
it means we can live in large groups, and those large groups help protect
from predators and help us get resources. And the key thing about empathy
is that it requires imagination, it requires that you put yourself
in the shoes of another person. Now, having an imagination is one of the coolest things
your brain pulls off. You can close your eyes and think back
to a really significant day in your life - maybe it's the day you got married,
maybe it's the day you got divorced, maybe it's the day
that your first child was born. The thing is you can close your eyes
and replay those events with sounds and visuals
and thoughts and feelings. You can literally refeel the feelings
that you had with that event. We can do the same thing
imagining things in the future, imagining various hypotheticals,
asking your boss for a raise. When you think about
asking your boss for a raise, your imagination kicks into gear, and you can literally feel your heart
starting to pound faster. So it's a really cool trick. And the brain accomplishes this
with the imagination engine which is a series
of interconnected brain areas that work in concert
to create virtual simulations. Simulations so it can replay past events,
it can create future events, it can create hypotheticals. It can also create models of other people so we can guess what other people
are thinking and feeling. The really cool thing is different parts
of the imagination engine compute different parts of the simulation. So one important part is the hippocampus
which is an important area for memory. These memories feed the imagination engine
with past experiences with which it can create new experiences. The dorsomedial prefrontal cortex
is an essential area too that helps us figure out
what other people might be thinking. It gives us cognitive understanding, The ventromedial prefrontal cortex helps us imagine
what other people might feel. Not only do we know what they might feel, this area helps us to feel
what they might be feeling. The thing with psychopaths is that their dorsomedial
prefrontal cortex is intact so they can perfectly well imagine
what you might be thinking - that allows them to lie
and manipulate really well. But they have defects
in the ventromedial prefrontal cortex so they have trouble feeling
what other people feel. In other words,
they have impaired empathy. If you have impaired empathy
and can't feel what other people feel, essentially other people are objects. We treat objects really differently
than people, right? Throwing out a hard drive,
that's no big deal right? A famous psychopathy researcher
put it this way: "Psychopaths know the words,
but not the music." The last function
that I want to talk about with the ventromedial prefrontal cortex -
its role in impulse control. So, I'll introduce you
to two areas of the brain you might have heard of - one is the amygdala and the other one
is the nucleus accumbens. The amygdala is our monster detector. Both of these
are ancient parts of the brain that constantly scan the environment
for things that help you survive. The amygdala is our monster detector. It's on the lookout for things
that might constitute threats to you. When it finds one, it generates an emotion that makes
you want to move away from that object, emotions like fear. Your nucleus accumbens
is your doughnut detector. It constantly looks out
for pleasurable things for you. When it finds those things,
it generates an emotion that makes you want
to approach those things, things like attraction or craving. We don't always run away
from everything that's scary, we don't run to every doughnut
we come across - most of us don't, right. Why is that? The reason is the amygdala
and the nucleus accumbens are not decision-making areas
of the brain. They feed information to other brain areas
which do make decisions, brain areas like the ventromedial
prefrontal cortex. So the ventromedial prefrontal cortex is like a wise teacher
that sits in your brain, receives information from these impulses about the scary monsters
and doughnuts and says, "OK. I hear you, amygdala.
I hear you, nucleus accumbens, but I'm not so sure we should act
on those impulses." It consults other areas of the brain to give it access
to past experiences and to reasons. So it's able to compute
and integrate a decision based on experiences, reasons,
and the impulses to make wise decisions. In contrast, if you look
at a psychopathic brain, there are several brain differences. One is their amygdala
is less active and smaller, so they truly are less fearful
of things in general. Their nucleus accumbens,
on the other hand, is overactive, so doughnuts look super tasty to them. They definitely shouldn't move
to Portland. (Laughter) As I said before, the ventromedial prefrontal cortex
doesn't function so hot. Instead of having
this wise guru in your brain, you have something like this guy. And so you're less able to compute
these integrated wise decisions and you're more a slave of your impulses. When you talk about a psychopathic brain, this is a brain
that is not set up for fear and super set up
for immediate gratification. That makes you an impulsive person. So, moving on
to the last part of the talk, can psychopathy be cured? Well, yes, in theory. If we know
the biological causes of psychopathy, we should be able to design rational
biological solutions to psychopathy. We should be able to come up
with therapies at each of these levels: at the gene, at the brain,
and with behavior. So let's take these one at a time. Most of you have probably heard
of gene therapy. Modern medicine gets better and better at snipping out bad sections of genes
and putting in good genes. In fact, two months ago, the FDA approved the very first
gene therapy treatment in the US. The problem with psychopathy
is we don't yet know - we know it's a genetic condition, but we don't yet know
what those genes are. And we know from indirect evidence
there are many genes that are involved. To get to the point
where we can identify all those genes and then fix
all those genes simultaneously, it will require a lot
of technical advancement. So gene therapy will be a cure one day,
but that day is quite far off. What about at the level of the brain? Can we change brain activity in a way
to make psychopaths more empathetic? We live in a golden age of neuroscience and there are so many modalities
I'd love to tell you about that we can now use
to influence brain activity. One of the most promising
is on the right here. It's called "transcranial
magnetic stimulation." You basically put a magnetic coil
on top of the head and it generates magnetic pulses
that can pass through the skull and either stimulate
or inhibit the brain underneath it. So this is a way
we can safely and reversibly either increase or decrease
the activity of brain areas. Lots of studies show
that if you do the TMS at the right spots in the brain, you can actually increase empathy. Now, there are many technical barriers
until this technology can be perfected. But really I think the main barrier
is not a technical but a social barrier. When I look at technology, it's like planting electrodes
in your brain or pulsing your brain by magnetic waves - I think that's super cool. But many of you might think
more like this, "Yuck, that's a little creepy." The mind's a sacred space, we don't like the idea of people
messing with our minds, especially if it's against our will
like we'd have to do with psychopaths. So I think the main barrier here
to fully implement brain technologies to cure psychopathy are societal barriers. What about behaviors?
Can we change psychopathic behaviors? So there's been lots of studies
on empathy training. I've argued that the brain -
the genes and the brain, that empathy is an inborn ability,
but it's also a skill and skills improve with practice. There are literally dozens of programs
that have been validated and have shown to increase empathy
if you actually apply them. The problem is practice
requires motivation. When you think about it, why would psychopaths
want to be more empathetic? From the point of view of a psychopath,
we're all suckers waiting to be conned. For a lot of psychopaths, they might think the lack
of empathy is an advantage. They're not encumbered by morality. Then the question becomes,
how do we create a world where psychopaths make prosocial choices? See, the idea is that biology
is not destiny. I've argued that psychopaths
are biologically different - they have less empathy, for instance. But just the mere fact
that you have less empathy than average doesn't automatically
make you a serial murderer. So let's say you have a baby. This happens to be my baby, Jean,
who is not a psychopath. Let's say there is a baby
that has low levels of empathy. It doesn't automatically follow
that they become a serial murderer; maybe they can become a surgeon. Lots of studies show
that surgeons, on average, are less empathetic
than the average person. And that might be a good thing,
because if you're doing surgery, you want to shut off your emotions and focus on the super complicated
cognitive task ahead. So the question becomes - how do we nudge this baby away
from being a serial murderer and to become a surgeon? I think the key is to realize that although psychopaths
have defects with their emotions, that they are rational. Some would say they are hyper rational because they're not encumbered
by emotions and they can play
by the rules beautifully when it suits them. So we can view a lot of their criminal
behavior as actually selfish but rational choices to get the things
that they want: resources, respect, power, whatever it is. The idea is that
if we can create and offer rational altruistic alternatives, maybe they'll do that instead of crime. So, how do we create a world
where altruism is a way to get ahead? I believe there are three conditions
we have to meet. Basic needs have to be met. The rules have to be fair and the culture
has to support cooperation. So Abraham Maslow studied
what humans need to survive and thrive. This is the famous pyramid of needs. The lowest level of needs are physiological needs
like food and water. Next level are safety needs. It's only when those needs are met then you start to think
about the societal needs. So if you live below this line, it's like you're living in a war zone
where the resources are scarce and it's like a zero sum game: the more you have, the less I have. So altruistic and self interest
do not align in that kind of world. It's only when these basic needs are met
that we can have the possibility that selfish and altruistic acts
can coincide. But the rules have to be fair
and the culture has to be supportive. So, the bottom line is
we are all responsible. I've said that psychopaths
are the 1% of the population that's responsible
for 50% of all violent acts. But ending violence
isn't just about fixing psychopaths, we also need to fix the world around them. And this is what our responsibility is,
this is what we need to do, everyone in this room needs to do
if we want to reduce violence. We have to make sure that there is universal access
to basic needs, things like food, safety, and shelter. It's only after those basic needs are met that there is a potential
to think altruistically. Once those needs are met, we still need to work
on creating a fair world. Most of you in this room
who are not criminals had lots of opportunities, lots of non-criminal alternatives
to get the things that you want to have a good job and resources
and stuff like that. We need to make sure those opportunities
are available to everyone so we can give potential psychopaths
non-criminal alternatives. We also have to work
on creating a kind world, a world where kindness is recognized
and rewarded and encouraged. Think about the worst workplace
you ever worked at, like some corporate law firm. Think of the best place
you ever worked at. Those cultures are super different
because they value different things. If we create a world that values kindness,
we'll have more kind people in it. So if we do these three things:
give universal access to basic needs, create a fair world,
and create a kind world, we're essentially creating a world where the rational and selfish choice
is the altruistic choice, and we should have more surgeons
and fewer murderers. I leave you with the words
of the Dalai Lama: "My religion is very simple.
My religion is kindness." Thank you. (Applause)
He is a forensic psychiatrist...and he still believes that psychopaths are only in prisons. His definition is correct on many points. It applies to so many scientists, politicians, bankers . It is mostly agreed among new psychological studies that psychopathy is a post traumatic condition as are all other mental illnesses. That guy is scary . Psychopath have a form of empathy but it’s cold empathy : they use it. Empathy is not feeling what other people are feeling. It is more like : I am quoting Pr Vaknin here : Empathy relates to external objects (Others) but the subjects communicate and reach an agreement regarding the way THEY would have felt had they BEEN the object. What is it that we feel in empathy? Do we feel OUR emotions/sensations, provoked by an external trigger (classic intersubjectivity) or do we experience a TRANSFER of the object's feelings/sensations to us ? Such a transfer being physically impossible (as far as we know) - we are forced to adopt the former model. Empathy is the set of reactions - emotional and cognitive - to being triggered by an external object (the Other). It is the equivalent of resonance in the physical sciences. But we have NO WAY of ascertaining that the "wavelength" of such resonance is identical in both subjects.
...because we all know that it was simply a lack of kindness that created Trump, right?
Is it too psychopathic to just cut the bullshit and shoot psychopaths? Maybe we need a less tolerant society, rather than a more tolerant one?