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
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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
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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.