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 so this is of course the
Florida shooting that occurred last last
week 17 people killed that comes hot in
the heels of the Las Vegas shooting in
LA 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 the
deadliest shootings in the u.s. happened
that past five months if it seems like
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 spent 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
anti-social is a hardcore group of
anti-socials that we called 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
antisocial and Psychopaths typically
commit violent acts due to rational
reasons now ever after every mass
shooting there’s typically some sort of
scapegoating of a mentally ill and
that’s happened this time as well and I
want to explain to you why I think
that’s so misguided so the severely
mentally ill comprise 4 percent of the
adult population but they only commit 3
percent of overall violence so in other
words the people of 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 psycho
psychopaths comprise 1 percent of the
adult population they comprise 20% of
the prison population and because they
recidivate so frequently it’s thought
that they’re responsible for over half
of all violent crime
this is a group of people we’re studying
and worth trying to cure if possible so
psychopaths are labeled cold-blooded
killers and there’s a group of qualities
that that unites them so typically it
stucco paths or 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 violence they inflict typically as
planned aggression as opposed to
reactive impulsive aggression and very
curiously
many if not most come from intact
backgrounds and if you’re like me you’re
like really they come from intact
backgrounds yeah really
most of them come from intact
backgrounds and 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 so again there’s
no detectable differences in family
backgrounds between Psychopaths and non
Psychopaths we also know from twin
studies that is strongly heritable and
the traits are apparent from early
childhood and you can also see brain
differences from a very early age all of
this adds up to the fact to the 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 of art and
remarkably what parts of the brain are
required to have conscience so I want to
introduce you to a brain area called the
ventral medial prefrontal cortex or the
vmPFC which is a key brain area
necessary to have a conscience
so the ventral medial prefrontal cortex
it’s in between the middle halves of
both hemispheres and it’s a key area for
emotional intelligence and it
participates in three activities that I
would argue generates our conscience the
first is it creates it so it creates
emotional memories which form the basis
of social inhibitions the second is it
is a central brain area for imagination
and
imagination to have empathy the third
characteristic is it’s a place of 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 you
don’t do these things they don’t have a
conscience and you’re more likely to end
up like this guy so let’s take these one
at a time so emotional memories so I
have a toddler named Kyle and anyone
who’s raised toddler knows that toddlers
can be little savages they fight they
kick they scream and over time we
civilize them how do we civilize them
it’s all about negative feedback right
so every time you did something bad like
hit your brother your mom said don’t do
that it made you feel kind of bad in
your body this is the part of the brain
that stories had emotional linkage so
that 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 from
doing that violence an act and over time
this forms are the basis of our social
inhibitions against doing violent acts
the next part is the ventral medial
prefrontal cortex plays an essential
role in what I call the imagination
engine which 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 pro-social behavior and
there’s an obvious evolutionary benefit
if we act pro-social II you know to
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 so when you think about it 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 said hey that’s here that your
firstborn 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 with
imagining things in their few
with imagining various hypotheticals
asking your boss for a raise and when
you think about asking you boss for a
raise your imagination engine kicks into
gear and you can literally feel your
hearts are in a pound faster right so
it’s a really cool trick and the brain
accomplish assists with the imagination
engine which is a series of
interconnected brain area brain areas
that work in concert to create virtual
simulations simulations so he can replay
past events he can recreate it can
create future events you can create
hypotheticals it can also create you
know models of other people so we can
guess what other people are thinking and
feeling now the really cool thing is
different parts of the imagination
engine compute different parts of this
simulation so one important part is the
hippocampus which is an important area
from memory these memories feed the
imagination engine with past experiences
for which with which you can create new
experiences the dorsal medial prefrontal
cortex is essential area to that it
helps us figure out what other people
might be thinking so it gives us
cognitive understanding the ventral
medial prefrontal cortex helps us
imagine what other people might be
feeling not only do we know what other
people might be feeling this area helps
us to feel what they might be feeling
now the thing of psychopaths is that
their dorsal medial prefrontal cortex is
intact so they can perfectly well
imagine you know what what you might be
thinking right so that allows them to
lie and manipulate really well but they
have defects in the ventral medial
prefrontal cortex so they have trouble
feeling what other people are feeling in
other words they have impaired empathy
and if you have impaired empathy and you
can’t feel what other people are feeling
essentially other people are objects and
we treat objects really differently than
people right throwing out a hard drive
that’s no big deal right
so a famous psychopathy researchers put
it this way
psychopaths know the words but not the
music all right let’s go to the last
function that I want to talk about with
the ventromedial prefrontal cortex its
role in impulse control so we introduce
you to two areas of the brain you might
have heard of ready one is the amygdala
the other one is the nucleus accumbens
now the amygdala is our monster detector
these are ancient 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 so it’s
on the it’s on the lookout for things
that might be might constitute threats
to you and when it finds something that
might be a threat to you
it generates an emotion that makes you
want to watch you move away from that
object emotions like fear your nucleus
accumbens is your donut detector so it’s
constantly looking out on for things
that are pleasurable to you and when it
finds it finds those things it generates
an emotion that makes you want to
approach those things right things like
attraction or craving now the thing is
you know we don’t always run away from
everything that’s carrying we don’t run
to every donut that we come across well
most of us don’t right why is that and
the reason why is because 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 ventral medial prefrontal cortex is
like a wise teacher that sits in your
brain and receives information from
these impulses about the scary monsters
and the donuts and says well okay
I got I hear you amygdala I hear your
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 an
integrated decision based on experiences
reasons and the impulses to make wise
decisions now in contrast so if you’re
so if you look at a psychopathic brain
there are several brain differences one
is your amygdala is less active and
smaller so they truly are less fearful
of things in general there are nucleus
accumbens on the other hand is
overactive so don’t us look super tasty
to them
this definitely shouldn’t move to
Portland and like as I said before the
ventral medial prefrontal cortex doesn’t
function so hot so instead of having
this wise guru in your brain you have
something like this guy right and so you
know you’re less able to compute these
integrated wise decisions and you’re
more a slave of your impulses so 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 scan psych and
psychopathy be cured well yes in theory
so if we know the biological causes of
psychopathy we should be able to design
rational biological solutions to
psychopathy and we should be able to
come up with with therapy is that each
of these levels at the gene at the brain
and with
behavior so let’s take these one at a
time so most of you is popular of gene
therapy modern medicine is getting
better and better it’s nipping out bad
sections of genes and putting in good
genes and in fact two months ago the FDA
approved the very first gene therapy
treatment in the US but the problem with
psychopathy is that we don’t yet know we
know that it’s a genetic condition but
we don’t yet know what those genes are
and we know from indirect evidence that
there are many genes that are involved
so they get to the point where we can
identify all those genes and then fix
all those genes simultaneously it’s
gonna require a lot of technical
advancements so gene therapy would 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 would
love to tell you about that we can now
use to influence brain activity what are
the most promising is on the right here
it’s called transcranial magnetic
stimulation you basically put a magnetic
coil on on top of the head and it it it
generates magnetic pulses that can
generate that can pass through the skull
and and either stimulate or inhibit the
brain underneath it so this is a way we
can safely and reversibly either
increase the activity brain areas or
decrease the activity of brain areas and
there been lots of studies that show
that if you do the TMS it’s just the
right spots in the brain you can
actually increase empathy now you know
there are many technical barriers until
this this technology can be perfected
but really I think that the main barrier
is not technical but it’s a social
barrier so when I look at technology is
like implanting electrodes in your brain
or you know pulsing your brain a
magnetic waves I think that’s super cool
but many of you might think more like
this you know like yuck that’s a little
that’s a little creepy
you know the minds of sacred space and
we don’t like the idea of people messing
with our minds especially if it’s
against our will like we would have to
do a Psychopaths right so I think the
main barriers here to really fully
implementing brain technologies to cure
psychopathy are societal barriers
well what about behaviors can we change
psychopathic behaviors and so there’s
been lots of studies on empathy training
so I you know I’ve argued through the
brain the genes in 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
shown to increase empathy
if you actually apply them you know the
problem is practice requires motivation
and when you think about it why would
Psychopaths want to be more empathetic
you know from the point of view of a
psychopath you know we’re all suckers
waiting to be conned right and for a lot
of Psychopaths they might think that the
lack of empathy is an advantage right
they’re not like encumbered by morality
right so then the question becomes how
do we create a world where Psychopaths
make pro-social choices see the idea is
that biology is not destiny I’ve argued
that placa paths are biologically
different they have less empathy for
instance but just just happen the mere
fact that you have less empathy than
average doesn’t make you automatically
make you a serial murderer right so you
know let’s say you have a baby and this
happens to be my baby baby Dean who is
not a psychopath
but let’s say there is a baby that has
low levels of empathy it doesn’t
automatically follow that they become a
serial murderer right maybe they should
they can become a surgeon right the
plots of studies that show that surgeons
on average are less empathetic than the
average person and that might be a good
thing right because if you’re doing
surgery right you kind of want to be
able shut off your emotions and focus on
the super complicated cognitive task at
hand right 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 irrational
and some would say they are hyper
rational because they’re not like
encumbering or you know they’re not like
encumbered by emotions and they can play
by the rules beautifully when it suits
them and so we can view a lot of their
criminal behavior is 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 an offer rational altruistic
at alternatives maybe they’ll do that
instead of crime right 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 you know what humans need to to
survive and thrive and this is the
famous pyramid of needs right and so the
lowest level of needs are physiological
needs like food and water the next level
where safety needs it’s only when those
needs are met can you start the thing
about societal needs right
so if you live below this line right
sort of like you’re living in a war zone
where the resources are scarce since
like it’s a zero-sum game the more you
have the less I have right so altruistic
and selfish interests 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 and 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 responsively ronson
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’s universal access
to basic needs things like food safety
and shelter it’s only after those basic
needs are met that that there is a
potential to thank altruistic Lee once
those needs are met we still need to
work on creating a fairer world you know
most of you in this room who are not
criminals you know had lots of
opportunities right – not lots of
non-criminal alternatives to get the
things that you want to have a good job
and resources and stuff like that so we
need to make sure that 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 we’re you know it’s things where
kindness is reward is recognized and
rewarded and encouraged I’m thinking
about the think about the worst
workplace you ever worked at like some
corporate law firm or whatever I think
about the best workplace you ever worked
at those cultures are super different
because they value different things if
we create a world that values kindness
will 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 the selfish choice is the
altruistic choice and we’ll we should
have more surgeons and fewer murderers I
leave I let leave you with the words the
dilemma my religion is very simple my
religion is kindness thank you
[Music] [Applause]