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The Brain is not Bad or Mad
Meg Perkins 11August 2011
definition of mad - 1843
Legal definition of insanity
such a defect of reason, from disease of the mind, as not to
know the nature and quality of the act he was doing;
or, if he did know it, that he did not know he was doing what
was wrong
1843
Not guilty!
medical definitions
Bipolar affective disorder/Schizophrenia
Drug induced psychosis
Many people with these disorders are in prison
28% of Indigenous women prisoners have been
psychotic in the previous 12 months (Qld 2008)
10% male and 15% female reception psychosis
(Butler & Allnutt in New South Wales 2003)
3% in the general population
Trauma and PTSD
Overwhelming fear
Overactive limbic system
Red alert switch is faulty or ON
Outbursts of anger, survival mode
Numb and detached from others
May be “paranoid” or hallucinate
More severe if trauma ongoing
25% of prisoners have PTSD (at least)
Intellectual disability/impairment
Head injuries or...
80 different medical conditions
Affect development of the brain
Cared for by parents and (over)protected
If parents/relatives are unable or unwilling to care
Many people with these conditions are in prison
60-80% head injuries, 8-9% gen pop (Perros 2010)
45% borderline or full ID (British study Hayes 2007)
definition of bad – 1941/1993
Psychopath
Hervey Cleckley/Robert Hare
Without conscience
No respect for the rights of others
This person does as s/he likes and is dangerous
history of an idea
Psychopathology is disease of the mind or soul
Possession by demons or born without a soul
Hervey Cleckley 1941 interviewed men in prison
Psychopathic personality (psychoanalysis)
Lack of internal personality structure
Freud’s Id Ego and Superego – no superego
70 years ago – brilliant and persuasive
Robert Hare’s idea
PCL-R developed in the 1980s
Did not report the knife that his first client Ray showed him.
This man made many demands on him and he says that “Ray
made my eight month stint at the prison miserable”.
Hare refused to get Ray a job when he applied for parole.
Ray knew that Hare’s father was a roofing contractor.
Hare’s car was tampered with in the prison auto shop.
He decided later that Ray was a psychopath.
Dangerous people
There are dangerous people
A few who enjoy violent crimes
Not always a Hare psychopath
There is no such thing as a psychopath
except as defined by Robert Hare
Robert Hare
It appears that psychopaths are unable or
unwilling to process or use the deep semantic
and affective meanings of language...
Hare PCL-R 2nd Edition Technical Manual p112
But the research says that Hare psychopaths have
difficulty using language to tell stories and
difficulty expressing abstract or affective
(emotional) concepts...
Kent Kiehl and Joshua Buckholtz
“Inside the Mind of a Psychopath” Scientific American Mind
Kiehl has helped design a portable functional MRI scanner
that can be taken inside a prison
Studying psychopaths to prevent the offending behaviour and
develop effective treatments
“not monsters but people whose emotional disabilities may
cause them to act monstrously”
Research by Robert Hare and associates*
Have difficulty feeling emotions
Struggle to “read between the lines” and read social cues
Often of better-than-average intelligence
Suffer from a serious biological deficit
Learning disability that impairs emotional development
Specific physiological deficits prevent empathizing, stable
relationships and learning from mistakes
*Scientific American Mind: September/October 2010
Research continued
Lack access to feelings, body sensations
Oblivious to emotional cues, can’t hear fear in voice
Can’t see fear in someone’s face
Miss the emotional nuances of language
Trouble understanding metaphors
Difficulty in shifting attention
Fearless in dangerous situations
Paralimbic system underdeveloped on fMRI scans
Paralimbic system
Orbitofrontal cortex – sensitivity to risk, reward and
punishment, damage causes impulsivity and lack of insight
Amygdala malfunction may result in fearlessness
Anterior cingulate cortex – reward anticipation, decision
making, empathy and emotion
Insula – recognizing violations of social norms, as well as
experiencing anger, fear, empathy and disgust
Also pain perception
the insula
According to neuroscientists who study it, the insula is a
long-neglected brain region that has emerged as crucial to
understanding what it feels like to be human.
They say it is the wellspring of social emotions, things like
lust and disgust, pride and humiliation, guilt and atonement.
It helps give rise to moral intuition, empathy and the capacity
to respond emotionally to music.
(Recognising the violation of social norms)
A Small Part of the Brain and its Profound Effects
Sandra Blakeslee ,The New York Times
Mental Health and Behaviour Feb 6, 2007
uncinate fasciculus
Dr Michael Craig 2009
Kings College London using DT MRI
Abnormalities in the white matter connecting
The amygdala and the orbitofrontal cortex
More extreme scores on PCL-R more
dysfunction in the uncinate fasciculus
Understanding and treatment
DTI Tractography of the Arcuate, Inferior
Longitudinal, and Uncinate Fasciculus.
Relevant publications from our lab
Phillips OR, Nuechterlein KH, Clark KA, Hamilton LS,
Asarnow RF, Hageman NS, Toga AW, Narr KL. (2008)
Fiber Tractography Reveals Disruption of Temporal Lobe
White Matter Tracts in Schizophrenia. Schizophrenia
Research, (2008)
Schizophrenia and Psychopathy
This study examined three major white matter tracts
connecting lateral and medial temporal lobe regions with
neocortical association regions widely implicated in systemslevel functional and structural disturbances in schizophrenia.
Disruptions of connectivity within these pathways may
potentially contribute to the disturbances of memory,
language, and social cognitive processing.
www.loni.ucla.edu/~narr/project.php?q=sztract
higher level language skills
speech and language pathologist
Making inferences
Difficulties
Sequencing
Not see consequences
Negative questions
Problem solving
Predicting
Determining causes
Not link behaviour to
result/not understanding
why he is punished
Not link emotion to events
Can’t read between the
lines/see implications
Not learn from mistakes
Pamela Snow and Martine Powell
Oral Language Competence, Social Skills
and High-risk Boys: What are Juvenile
Offenders Trying to Tell us? Children and Society 2008
Oral language
competency
Basis for
relationships and
literacy
skills/education
Young people
In Custody
61% language
impaired
Autism and Asperger’s syndrome
Autistische Psychopathen (1930s)
Autistic Psychopath (in German not “evil”)
Difficulty making friends
Impaired non-verbal communication
Impaired communication of emotion
Impaired empathy
PDD NOS
A severe and pervasive impairment in the
development of reciprocal social interaction
associated with impairment of either verbal
or non-verbal communication skills
or stereotyped behaviour
Pervasive developmental disorder not
otherwise specified (autistic spectrum)
PDA
pathological demand avoidance syndrome
Socially manipulative, disruptive
Imitate inappropriate behaviour
Need to dominate and control due to social
anxiety, resist demands of everyday life
Cognitive deficits, neurological pathologies
Punishment is ineffective with these
children and behavioural techniques fail
www.pdacontact.org.uk
In prison for disability
Mental illness
Intellectual or learning disability
Psychopath OR
Posttraumatic Stress Disorder?
Communication problem?
Neuro-behavioural disability?
alternatives
Therapeutic jurisprudence.“One of the things therapeutic
jurisprudence tries to do is to look carefully at promising
literature from psychology, psychiatry, clinical behavioral
sciences, criminology and social work to see whether those
insights can be incorporated or brought into the legal system”
(Wexler 1999).
Restorative justice “actively involves both offenders and
victims in reparation and rehabilitation”. (Van Ness 1997)
Early intervention and prevention. “ Crime and delinquency
are in large measure responses to frustration and inequality”.
(Palmer 1973). School assessments of mental health and
cognitive skills, psychotherapy and skills training.