Zero Degrees of Empathy: A New Theory of Human Cruelty PDF

developed a model of anxiety he called the Behavioural Inhibition System (BIS), located in the septo-hippocampal brain network, the system that allows an animal to learn the emotional consequences (reward or punishment) of its actions. It was a bold model when he put it forward in 1982 156 and it in...

developed a model of anxiety he called the Behavioural Inhibition System (BIS), located in the septo-hippocampal brain network, the system that allows an animal to learn the emotional consequences (reward or punishment) of its actions. It was a bold model when he put it forward in 1982 156 and it inspired Joseph Newman at the University of Wisconsin- Madison to argue that psychopaths had an under-active BIS, while anxious people had an overactive BIS. xxx Newman’s interesting idea is that psychopaths basically have a problem in thinking about the consequences of their actions, since damage to the BIS leads an animal to repeat behaviours that elicit punishment. Newman argues this is the core problem in psychopaths – they do not learn to fear punishment. No wonder they do things that they know might get them into trouble. He argues this explains why psychopaths make errors on tasks where you have to learn which (otherwise neutral) numbers are rewarding and which ones are not, 157 and why they fail to change their behaviour even when an action is no longer rewarding and is leading to punishment. For example, given a deck of cards to play with, where each card leads to winning a reward, children with psychopathic traits continue playing even when the cards no longer lead to rewards. 158 Nowadays we recognize that there are many ‘fear pathways’ in the brain, and that the amygdala also plays a key role in the experience of fear. A problem for Joseph Newman’s account is that it emphasizes the importance of anxiety in how children are socialized, but many children are socialized not just through fear of punishment but through discussion about how the other person feels (empathy). 159 Nevertheless, the idea that psychopaths lack fear was an important insight. In The Mask of Sanity, Hervey Cleckley wrote, ‘Within himself he appears almost as incapable of anxiety as of profound remorse.’ appears to be true of the so-called ‘callous subgroup’, 161 160 This and behavioural geneticist David Lykken at the University of Minnesota tested this by using a ‘conditioning’ experiment: an electric shock paired with the sound of a buzzer. ‘Normal’ individuals developed ‘electrodermal fear’ (sweating) when hearing the buzzer (that is, the buzzer had become a ‘conditioned stimulus’). In contrast, psychopaths showed less electrodermal fear to the buzzer – they did not acquire the ‘conditioned response’ to the threat. They also show less of a startle reflex (an automatic jump) to a loud sound, or to an object looming towards them. 147 , 162 164 – All this suggests a very specific kind of learning difficulty involving lower fear of punishment. Clearly Type Ps differ in important ways to Type Bs, but they share the core feature of being Zero-Negative. This core represents a shared endpoint in development. Crucially, their zero degrees of empathy can result in them doing cruel things to others. When we come to look at their brain, we should expect to see the same underlying empathy circuitry to be affected. The Psychopathic Brain Scientists have managed to persuade psychopaths to climb into the fMRI scanner, to enable us to understand the neural basis of empathy and of its absence. Just as one might predict, abnormalities in the empathy circuit are seen: aggressive people show less ventromedial prefrontal cortex (vMPFC) activity, 165 and the higher a person scores on the Psychopathy Checklist- Revised (PCL-R), xxxi the less activity they showed in the orbitofrontal cortex(OFC)/ vMPFC and temporal regions. 166 These are squarely in the empathy circuit. Furthermore, when scientists map out the connections between the vMPFC/OFC and amygdala, they find the integrity of this tract is reduced in psychopaths and this predicts scores on the Psychopathy Checklist. 167 Males on average are also much more prone to anti-social behaviour. This sex difference is predominantly explained by sex differences in the size of the OFC. Males have a smaller OFC volume compared to females, and males who exhibited increasing anti-social behaviour have even smaller OFC. 168 One view of the psychopathic brain is that the primary problem is located in the frontal lobes, since these are meant to provide ‘executive’ control over action, stopping us from doing what could lead to punishment. Neuroanatomically, this is too simplistic for several reasons. First, the frontal lobe takes up at least a third of the brain, so as an explanation it is way too broad. Second, the frontal lobe can be segmented, and patients with damage in the OFC/vMPFC (but not in the dorsolateral segment) have increased levels of aggression. This shows the abnormality is occurring within the empathy circuitry within the frontal lobes, not the whole of the frontal lobes. Recall that patients with damage in the vMPFC show reduced heart rate arousal to emotionally distressing stimuli and also continue to gamble on tasks even when they are no longer winning (or being rewarded). 169 , 170 Recall that Phineas Gage suffered damage to his entire OFC and vMPFC, and began showing signs of callous, rude, irreverent and disinhibited behaviour. All of these are signals of difficulties in using emotions like embarrassment and guilt to regulate one’s own social behavior. 29, 30 , 171 Patients with damage to the OFC/vMPFC show changes in their moral judgements. For example, they would judge it morally acceptable to be personally involved in killing one person in order to save the lives of five others (a judgement that most people would deem to be unacceptable). 172 It turns out that such patients judge moral decisions in this way because they pay less attention to their own or others’ intentions. Thus, vMPFC-lesion patients judged attempted acts to harm another person as more morally permissible than did a control group. 173 In this way, as we saw earlier, patients with damage to this specific area of the prefrontal cortex resemble psychopaths. For this reason, Damasio’s vMPFC somatic marker theory (which we encountered in Chapter 2) could explain Type P. This has a lot of plausibility, though it is surrounded by debate since individuals without ‘autonomic’ arousal nevertheless perform normally on a classic gambling task. 174 , 175 It may be that abnormalities in the vMPFC/OFC lead to aggressive anti-social behaviour, but it may not necessarily be because these individuals have problems reading their own ‘somatic’ states. Another problem is that, while damage to the vMPFC can cause ‘reactive’ aggression (the hair-trigger anger reaction), it typically does not cause ‘instrumental’ aggression (the cold, calculated, premeditated type of cruelty). So, as a model of the Type P brain, it misses out a key aspect of their behaviour, since psychopaths can show an increase in both. Thirdly, patients with lesions in the vMPFC also show less autonomic arousal to other emotional stimuli (like images of nudity), whereas psychopaths tend to only show this reduction to threatening or distressing stimuli. This suggests the very particular form of zero degrees of empathy seen in psychopaths is not only simply a problem with the vMPFC. Adrian Raine and his colleagues have looked at the brains of murderers (those ‘pleading not guilty by reason of insanity’). They again found differences in the empathy circuit, in the vMPFC, the amygdala and superior temporal lobe (STS). 176 , 177 Reduced activity in the orbitofrontal cortex was also found in aggressive people in a novel study comparing people with different personality disorders. 178 The evidence of the empathy circuit being involved in aggression gets additional support from a remarkable study by neuroscientist Jean Decety and colleagues in the University of Chicago, of teenagers with Conduct Disorder who had all been involved in physical fights. As we mentioned earlier, a proportion of these kids grow up to be Type P. In this study the teenagers either watched films where someone got hurt accidently (e.g., something just happened to drop on their hand) or where someone got hurt deliberately (e.g., someone’s hand got stepped on). The aggressive teenagers showed more activity in both the amygdala and in the reward circuit (the ventral striatum) during the films showing deliberate infliction of pain on another person. Hypersensitivity of the reward circuitry 179 may be of key importance in anti-social behaviour/Type P. The implication is that they actually enjoy seeing another person suffer. That German word schadenfreude (experiencing pleasure at someone else’s pain) which we mentioned earlier comes to mind. The other difference in this study was that the aggressive teenagers did not show activity in parts of the empathy circuit like the temporoparietal junction (TPJ), an area of the brain normally used in understanding intentions when making moral judgements, 180 182 – or in the anterior insula (AI) and middle cingulate cortex (MCC) (recall that these are part of the ‘pain matrix’). And in Washington, working at the National Institutes of Health (NIH), James Blair has argued persuasively that in the psychopath the amygdala is not working normally. This claim is well supported by a neuroimaging study showing less amygdala activity in psychopaths while they are experiencing aversive conditioning. 183 So, we can say that the Type P brain shows lots of evidence of abnormalities in the empathy circuitry. The effects of early stress on the empathy circuit It begs the question as to how all these changes to the brain have come about. Given the role of the environment, especially the association with neglect and abuse in childhood, there is evidence that early stress affects 184 how well the hippocampus functions, and how active the neural systems are that respond to threat. Stress can also affect your hormonal response to threat. Prolonged exposure to stress isn’t good for your brain. The amygdala is one of the brain regions that respond to stress or threat. 185 When it does, it triggers the hypothalamus to trigger the pituitary gland to release a hormone called ACTH (adrenocorticotropic hormone). This is then carried by the blood from the brain down to the adrenal gland where it triggers the release of another hormone, cortisol. Cortisol is often called the ‘stress hormone’ because it is a good indicator of when an animal is under stress. There are receptors for cortisol in the hippocampus that allow the animal to regulate the stress response. Remarkably, too much stress can damage and shrink your hippocampus, irreversibly. amygdala, 186 xxxii , 187 Stress can also cause ‘aborization’ of one part of the in which nerve cells start branching more than normal, becoming over-reactive. 188 This is very relevant to what earlier we called ‘reactive aggression’, seen in both humans and other animals. It is part of the ‘fight or flight’ selfdefence system. A small threat usually leads an animal to freeze, to avoid getting any closer to the threat and enabling the animal to take stock of what to do next. Freezing can also minimize the risk of being attacked if the aggressor is responsive to your movement or is looking for a sign that you are submissive. If the threat gets a bit closer this typically leads to ‘escape’ behaviour. A bigger and closer threat, where escape is not an option, typically leads an animal to show reactive aggression. The signal to show reactive aggression comes both from the amygdala (since this region in the empathy circuit is highly active during the experience of fear) and from areas of the frontal cortex, which can either put the brakes on, to enable self-regulation and inhibition, or release the brakes to launch an attack against the perceived threat. So reactive aggression could be over-reactive because your amygdala is overactive (e.g., during periods of depression and anxiety, or for genetic reasons 189 190 or due to the prolonged exposure to early stress, ) and/or if your prefrontal cortex is under-active (such that you cannot inhibit your reactive aggression). 191 Once again, we see that abnormalities in key regions in the empathy circuit can produce reduced or even zero degrees of empathy. NIH cognitive neuroscientist James Blair has put forward an alternative model of what causes a person to become Type P. He worked at the Medical Research Council’s Cognitive Development Unit in London where I also did my early research. During his PhD work the young James Blair enthusiastically went to meet psychopaths who were locked up in maximum-security facilities such as Broadmoor Hospital. He developed a model that he called the Violence Inhibition Mechanism (VIM). Sounds relevant? He argued that when we (and this is true in many other animals too) see the distress of a conspecific (a member of the same species), we have an automatic reaction to reduce the other person/animal’s distress. Blair sees the VIM as a system that is automatically activated whenever you see sad or distressed facial expressions in others, or hear these emotions in their voice. It tells you ‘someone is upset’ and it leads to increased autonomic arousal (your heart starts beating faster, you start sweating more) and activation of the threat system in the brain, causing you to freeze. In other words, in the face of someone else’s distress, you inhibit what you are doing. Presumably this is highly adaptive in preventing one animal from inflicting violence on another. All they have to do is cry out or wince in pain for you to stop whatever you were doing, and this would include any actions of yours that might be causing their pain. According to Blair, psychopaths have an under-active VIM. Some evidence to support this is that psychopaths have reduced autonomic arousal to the distress of others. 146 However, the VIM model can’t easily account for the results showing that psychopaths continue to play card gambling games even when they are no longer rewarding – since in these games there are presumably no distress cues. Nor can his model readily explain why affectionate parenting (of the kind Bowlby argued promoted secure attachment) also leads to better socialization, since in the lives of such children there are presumably few if any cues of distress. So, there is more than ample evidence that in Type P there are abnormalities in the empathy circuit of the brain. This is one more piece of evidence for the argument that instead of using the term ‘evil’ we should talk about reduced (or even absent) empathy. But there is just one more Zero-Negative type we have yet to meet, if you’re still willing to pursue this journey with me: Type N (or the narcissist). JAMES: ZERO-NEGATIVE TYPE N James is sixty-four years old. Like Carol, James came to our diagnostic clinic. He feels angry at the world. He feels he has only done good things all his life, and that others have not reciprocated. As a result, he feels he has been badly treated by society. ‘I have tried to live a good life, always helping others, supporting my family, visiting sick friends and relatives in hospital, helping others. And guess what? Other people are shits. They don’t bother helping me. They don’t visit, they don’t call, they even cross the road when they see me coming. I eat alone everyday. You wouldn’t treat a dog the way people treat me. I’m entitled to friendship just like everyone else, so why do they offer it to others and not to me?’ The key word here is ‘entitled’. James feels he has an automatic right to be treated well, irrespective of how he treats others. When you talk to James it becomes apparent after a few minutes that all he talks about is himself and his family, his needs and desires. If you believed his account, his children are more talented than anyone else’s, he is superior to other people, he is more attractive than anyone else, and in his mind his social status is above others. It’s as if nothing or no one of any importance exists outside himself and his children. He is oblivious to how other people listening to him might feel. It is as if they are there to be his audience, listening to how great he is, and their role is to agree with him and admire him. When people murmur politely he takes this as confirmation of his own specialness, and he is elated for a while. But soon his mood plummets, and he reverts to sounding depressed, negative and complaining. If you ask James why he is so negative he says: ‘People should treat me better. Since my wife died I live alone. No one bothers to cook for me, phone me, or even knock on my door. It’s as if I’m some kind of social leper. Anyone would think I had some kind of disease.’ When James goes to a restaurant, he demands the best table. He assumes he can go straight to the front of the queue, and he becomes abusive to the waiter when his food does not arrive quickly. If he goes to hospital, he harasses the receptionist, demanding to be seen before other patients. ‘If I don’t see the doctor immediately I’m putting in a complaint!’ When he phones up for an engineer to fix an appliance at home, he demands they come immediately. He constantly complains his children are bad because they don’t phone him or visit him enough. When they do, he verbally abuses them, telling them they are selfish for not giving him any attention. They know that, however much attention they give him, his needs are so great that whatever they do is never enough. When he feels important, for example when he flies business class, he temporarily feels elated. When he feels people aren’t giving him enough attention, if for example he is seated at the end of a table during a family gathering, he feels badly treated, and will look angry and be critical. He has no idea that his behaviour only drives others further away, and when they avoid him he takes this as confirmation that they are bad people, that the problem is with them rather than him. If he meets people who are in a position of influence and could be of some help to him, he turns on his charm and is fun and humorous, storing up information on how they might be of value to him in the future. But, if someone cannot give him anything that he needs, they suddenly become unimportant. ‘They are of no value to me,’ he will say. He is unaware how this reflects his pattern of using people shamelessly, taking as much as he can from them, discarding them when they are of no use to him. When he goes to the local church community centre and people ask him how he is, he vents his criticisms: nothing works properly, people have let him down, services are under par. His diatribe is so negative that it leaves some people wanting to walk away. He has no idea what others might find rude and he often makes offensive remarks. In answer to the question ‘How are you?’ he often replies sarcastically: ‘Thanks for the invitation to dinner’, leaving the questioner in an awkward silence. If people ask James what he has been doing he usually mentions he is writing his autobiography, which he alone thinks is interesting. If women show an interest in him, he is instantly flirtatious. As soon as they turn their attention away, or express an alternative view to his, he denigrates and criticizes them. Stepping back from James The narcissist (Type N) is recognizably different from the psychopath (Type P) and the borderline (Type B) we met earlier. In one way, their zero degrees of empathy renders them deeply self-centred, but while they may say and do things that offend others, they may not commit cruel acts. Rather, narcissists think they are much better than other people, as if they have special gifts that others lack, in the absence of any humility. Indeed, the continuous boastfulness and self-promotion is partly what others find offensive, not because of jealousy but as indicators of the narcissist’s total selfpreoccupation. The narcissist, like the other Zero-Negative forms, fails to recognize the importance of relationships being two-way. For those who have zero degrees of empathy, relationships are not really relationships because they are one way. This is even evident in how much the narcissist talks. There is no attempt to make space in the conversation for the other person, or to find out about the other person. The narcissist simply lectures, holding forth about him or herself, and they decide when to end the conversation. They have monologues, not dialogues. Some psychodynamic thinkers would regard a modicum of narcissism as both necessary, normative and healthy, the opposite being someone who does not like themselves. 192 , 193 This implies narcissism itself lies on a spectrum of traits, and becomes ‘pathological’ only in the extreme case of someone who only cares about him or herself and cares about others only if they are useful to him or her. Expressed differently, other people are exploited for their usefulness to the narcissist. In that sense, they are being used as objects (in the jargon, as ‘self-objects’). Narcissism can take different forms in different people. (See Appendix 2 for the list of their ‘diagnostic symptoms’.) Some are very outgoing, wanting to steal the limelight, being the boss of a company or the leader of a group. Others appear socially withdrawn as if shy, but they still have the sense of entitlement, angry that others are not doing more for them, and expecting others to run to then, rather than expecting to meet others half way. Yet others may become dangerous, and this personality type has sometimes been thought to underlie the serial killer. 194 Narcissists are about 1 per cent of the general population, though much more common (making up to 16 per cent) in those attending clinics for mental health issues. Unlike Type B, at least half to three-quarters are male. Like Types P or B, early emotional abuse has been suggested as a possible cause of Type N, again reminding us of the importance of that internal pot of gold. But unlike the other ZeroNegative types, it is speculated that excessive admiration, excessive praise for their good looks or talents, over-indulgence, and being over-valued in the absence of realistic feedback (by parents) may also contribute to why someone ends up as Type N. By comparison to Types P or B, there is very little research into Type N, a gap that needs to be filled. My own view is that, of these three forms of Zero-Negative personalities, Type N may be no less easy for others but may be less likely to lead to acts of cruelty. This is precisely the kind of question we need more information about though. Psychiatry groups these three ways of becoming Zero-Negative under the heading of ‘personality disorders’, which of course they all are. But for me the blindingly obvious characteristic they all share is they are all at zero degrees of empathy. My prediction was that they should all show abnormalities in the empathy circuitry in the brain. What we have seen is that, whether someone loses their empathy by becoming Type B or Type P, the same neural circuitry is affected. We can predict similar abnormalities in the empathy circuit in Type N will be found, though these studies have yet to be done. All this is building a more complete picture of empathy and how someone becomes Zero-Negative. This of course raises the question as to why one individual is Type P and another is Type B or Type N. Here we must assume the routes to the common endpoint are different, either in terms of different genes or different environmental factors, or both. We will return to this in Chapter 5. The distinction between transient or permanent under-activity of the empathy circuit echoes the distinction in personality psychology of ‘states’ vs. ‘traits’. ‘States’ are fluctuations in a psychological or neural system, induced by a particular context, and are reversible. We all know the kinds of short-term states we can enter which can compromise our empathy. These include being drunk, tired, impatient, or stressed, where we might say or do the wrong thing to someone else, and later regret it. The feeling of regret is a sign of our empathy circuit coming back on, but the fact that we say or do the wrong thing is nevertheless – at that moment – a fluctuation in our empathy circuit. In contrast, ‘traits’ are permanent, crystallized configurations of a psychological or neural system, enduring across different contexts, and are irreversible. In personality psychology, clusters of traits constitute personality types (such as introverts or extraverts), and Types B, P and N are clear examples of ‘personality disorders’. In this chapter I have re-cast the traditional concept of ‘personality disorders’ as examples of permanent under-activity of the empathy circuit. It is impossible to establish if permanent really means permanent, since to test this would entail following individuals throughout their lives. Traits could instead be thought of as longer-term, and certainly more long-lasting, than short-term changes in states. But we have spent more than enough time probing the negative forms of zero degrees of empathy. Now I want to turn to the question of whether all forms of zero degrees of empathy are necessarily negative, and to the controversial idea that there is at least one way in which zero degrees of empathy can be positive. 4 When Zero Degrees of Empathy is Positive The three types of people whom we have met so far not only have zero degrees of empathy but are Zero-Negative. This is because there is nothing desirable about the state they have ended up in. If a cure came along for forms of Zero-Negative, this would be very welcome. In addition, so far I think one can replace the terms ‘evil’ and ‘cruelty’ with the term ‘empathy’ in relation to the Zero-Negative forms. But in this chapter we discover that having zero degrees of empathy does not invariably lead someone to do awful things to others. Having empathy difficulties may be socially disabling but having empathy is not the sole route to developing a moral code and a moral conscience that leads the person to behave ethically. This is where we meet people who have zero degrees of empathy but who are Zero-Positive. It seems unthinkable, but bear with me. Being Zero-Positive means that, alongside their difficulties with empathy, those affected have a remarkably precise, exact mind. They have Asperger Syndrome, a condition on the autistic spectrum. People with Asperger Syndrome are Zero-Positive for two reasons. First, in their case, their empathy difficulties are associated with having a brain that processes information in ways that can lead to talent. And, second, the way their brain processes information paradoxically leads them not to be immoral, but super-moral. Let me make this more concrete by introducing you to Michael. MICHAEL: ASPERGER SYNDROME Michael is fifty-two years old. He has tried working in different jobs but keeps getting fired because he offends people by saying hurtful things. He claims he doesn’t understand why people take offence at his remarks because all he does is speak the truth. If he thinks someone’s haircut is ugly, he tells them. If he finds a conversation boring, he says so. If he thinks someone is wrong, he says so, in no uncertain terms. He confesses he doesn’t really understand people, and he avoids social gatherings like parties where one is expected to make idle chitchat, as he can’t see the point of such flighty, aimless conversation. To his mind, it leads nowhere and he has no idea how to do it. Conversations based around an issue where evidence can be marshalled in favour of a position are fine. Then he knows where the conversation is heading. Other people often tell him that when he is trying to persuade them of the rightness of his position, he lectures at them rather having a sensitive dialogue. They often feel they are being pinned against the wall in such discussions, since he will not let go of a point until the other person concedes that he is right. But he finds other kinds of conversation stressful because it is so unpredictable. He has a long-suffering mother who can’t get him to understand that there are other points of view besides his own. He asserts that he is right on everything he says because if he does not know about a topic, he remains silent on it. All facts for him are checked and double-checked. He insists on everything being in its own place at home, with nothing being allowed to move to a new position unless he moves it there. His life operates by a system of rules that he imposes on his parents, rules designed to suit him. They complain that he has no idea how they feel, having to live within his rules. If his mother moves something small in the house, like an ornament from the mantelpiece to a bookshelf, he moves it back to its