OPINION ARTICLE published: 05 March 2014 HUMAN doi: 10.3389/fnhum.2014.00124 Criminal minds: of the psychopathic brain

Sergio Canavero*

Turin Advanced Neuromodulation Group, Turin, Italy *Correspondence: [email protected] Edited by: Aron K. Barbey, University of Illinois at Urbana-Champaign, USA Reviewed by: Michael David Kruepke, University of Illinois at Urbana-Champaign, USA

Keywords: criminal mind, cortical stimulation, , psychosurgery, ethics, medical,

Although the definition of criminal behav- imaging data point to a difference between A report described limbic DBS for inter- ior is fraught with controversy, with sin- APD and psychopathy, in that the for- mittent explosive disorder (Maley et al., gle acts “criminalized” or “decriminal- mer have poor impulse control (DLPFC 2010) and others exist. Even for drug addic- ized” according to time and place, and dysfunction), whereas the latter have lack tion – which often leads to criminal behav- as such being observed in individuals of of empathy (non-underactive DLPFC) ior, both ablative and modulatory neu- all sorts, there seems to be an agreement (Greene, 2009; Baron-Cohen, 2011). rosurgery have been employed with ini- across the board that the truly danger- So-called ablative functional neuro- tial promising results (Stelten et al., 2008). ous subjects are psychopaths and the sub- surgery, whereby irreversible brain lesions Heath (1964) already experimented with jects affected by the Antisocial Personal- are achieved by various means, has been septal DBS in psychiatric subjects in order ity Disorder (Janowsky, 2008), often repeat employed mostly in the past to treat such to engage “pleasure” circuits with an eye offenders. Psychopaths exhibit callousness, patients. Sano and Mayanagi (1988) sub- to preemptive “mind control” of aberrant lack of empathy or emotional depth, and mitted to stereotactic posterior hypothal- behaviors. Unfortunately, DBS too carries a lack of genuine remorse for their anti- amotomy, a series of 60 children with small risk of mortality (roughly 0.4%) and social actions. Although distinct in many violent, aggressive behavior, and a history disabling morbidity (roughly 1%) (Arle regards, a subset of paraphilic subjects too of epileptic seizures and mental retarda- and Shils, 2011). can become dangerous, for instance those tion, with good long-term control in many. It is my contention that a strong suffering sexual sadism, which may involve Other authors reported similar results case can be made for the experimen- killing of the victim. in this group of patients (e.g., Rama- tal application of cortical neuromodula- Axis II personality disorder (APD) is murthi, 1988). Stereotactic amygdalotomy tion as applied to the control of psy- thought to be among the most treat- too has been applied since 1961 for chopaths and repeat offenders. This is a risk ment refractory of DSM APDs. Overall, the treatment of severe aggressive behav- free, zero-mortality, and zero-morbidity there is little evidence that drugs are reli- ior, with improvement varying between neuromodulatory technique (Canavero, ably effective, and the same conclusion 33 and 100%, many in the long term 2009). It modulates the excitability/activity applies to many psychotherapies (Glenn (Mpakopoulou et al., 2008). Dieckmann of cortical and related sub-cortical net- and Raine, 2013). Prognosis appears to be et al. (1988) reported excellent results for works involved in pathophysiological dis- poor, despite psychological, or drug ther- the control of aggressive sexual behav- orders, including those of psychiatric apy (Balon and Segraves, 2008). Although ior with hypothalamotomy, although the classification. hypnosis can manipulate moral judgments pedophilic character of such patients was (Whetley and Haidt, 2005), this modality retained (see also Roeder, 1966). PREMISE 1. The Scottish philosopher has proved too erratic in criminal behavior Unfortunately, stereotactic neuro- Hume (1739) referred to humans as reconditioning. surgery is associated with a mortality rate “slaves of the passions”,and this engen- The advent of in vivo neuroimaging which, according to the depth of penetra- dered “immoral” behavior, including allowed the dissection of brain regions tion of the surgical probes, is not trivial. . More than two centuries later, involved in such dysfunctions. A wide Thus, it cannot be offered on a routine Delgado (1969), the great neurologist, range of brain areas has been implicated, basis. wrote: “Some of our present problems including the frontal cortex [dorsolat- Deep brain stimulation (DBS), a derive from the lack of balance between eral prefrontal cortex (DLPFC), ventrome- reversible, stimulatory technique whereby material and mental evolution. We dial/orbitofrontal cortex (VMPFC/OFC), electrodes are inserted deep into the brain are civilized in our physical ecological and the amygdala]. Structural abnormali- in a targeted fashion, has emerged as a accomplishments but barbaric in our ties include reduced prefrontal gray matter viable option for the treatment of neuro- psychological responses. Within some in APD and psychopaths (e.g., Yang et al., logical and psychiatric disorders, including limits we can control atoms, trees, and 2005; Baron-Cohen, 2011). Importantly, aggressive behavior (Arle and Shils, 2011). animals, while we have not learned

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to control ourselves. New solutions are instance, Blair and Cipolotti(2000) ineffective, but interventions that seek needed in order to civilize our psyche, reported a patient (J.S.) who, follow- to improve behavior regulation capa- consciously to organize our efforts to ing trauma to the right frontal region, bilities (DLPFC function) might be develop a future psychocivilized society including the orbitofrontal cortex, effective in at least reducing the ... why after several thousand years of presented with “acquired sociopathy”. behavioral expression of bias (Ito civilization are human beings continu- His behavior was notably aberrant and Bartholow, 2009). On the other ing to torture and kill each other? ... the and marked by high levels of aggres- hand, non-utilitarian intuitive emo- direction of the colossal forces discov- sion and a callous disregard for oth- tional response is processed by BA9/10 ered by man requires the development ers (see also Burns and Swerdlow, plus the posterior cingulate cortex of mental qualities able to apply intel- 2003). Moral reasoning is most use- and posterior superior temporal sul- ligence not only to the domination of fully thought of as an attempt to cus/temporoparietal junction (BA39). nature but also to the civilization of the explain the cause and effect of our human psyche”. moral intuitions that draws upon all HYPOTHESIS available explicit information about a The first attempt at non-invasive thera- His solution was the electrical stimulation given situation. This attempt is car- peutic cortical stimulation (CS) was at the of the brain. In a much advertised feat, he ried out by the so-called left hemi- hands of Giovanni Aldini, Luigi Galvani’s stopped a raging bull hurtling toward him spheric interpreter, a specialized mod- nephew, at the end of the 1790s, who stim- by simply activating an electrode implanted ule that tries to make sense of uncon- ulated a depressed subject with the forerun- in the animal’s caudate nucleus by a radio sciously determined behaviors (Funk ner of modern transcranial direct current signal. Similarly, he demonstrated the fea- and Gazzaniga, 2009). Differences in stimulation (tDCS) (Canavero, 2011). sibility of controlling human behavior opinion on moral topics may be based Cortical neuromodulation can be via radio-controlled implanted stimula- on the sensitivities of specific neural achieved both invasively and non- tory apparatuses. Unfortunately, these first circuits that process various moral invasively. The first involves the positioning “mind control”attempts required the inser- dimensions (Haidt, 2007). of one or more stimulating paddles (ca. tion of electrodes inside or in contact with 5 cm × 1 cm × 2 mm) below the skull the brains, casting a pall on the whole PREMISE 3. The choice of target bone overlying the dura mater (which undertaking. The unfolding of the psy- appears to be the most relevant issue. obviates any risk of intracerebral hemor- chosurgery saga in the 1960–1970s accel- I hypothesize that one way to bring rhage/infection) with a minimally invasive erated the demise of such developments. the psychopathic brain under control approach (simple burr holes, no craniec- PREMISE 2. Free will is a mere illu- is to engage “moral/compassion cir- tomy) under neuronavigation conditions. sion: a large body of evidence points cuits”.Several theories concerning the A connecting wire is tunneled to a subcu- to the unescapable conclusion that the neural basis of human morality have taneously installed subclavear pacemaker pursuit of goals that we consciously been put forth (Moll et al., 2005). One (which can be recharged from an external set and adopt is prepared uncon- which has particular appeal is Greene source). Non-invasive stimulation – which sciously (Wegner, 2002). Goals them- (2009)’s dual-process theory of moral can also be employed for preoperative selves can arise and operate uncon- judgement. Accordingly, both intu- assessment of possible cortical targets for sciously (Custers and Aarts, 2010), itive emotional responses and more implanted electrodes – exploits transcra- with the brain easily deceived and controlled cognitive responses play nial magnetic stimulation (TMS), which manipulated by external factors (Fine, crucial, and in some cases, mutu- is more cumbersome and expensive, but 2006), including subliminal stimuli ally competitive roles. This theory more accurate, or tDCS, which is much (Custers and Aarts, 2010). This fact associates controlled cognitive pro- less expensive, but coarser in its modula- is still being downplayed or even cessing with utilitarian moral judge- tory capacity. TMS is FDA-approved for ignored by many, as this casts a pall on ment aimed at promoting the “greater the treatment of depression, and both are how we should judge criminal behav- good”; in contrast, this theory asso- currently being evaluated for other psychi- ior (“He did it, but is not responsible”). ciates intuitive emotional processing atric conditions. No mortality or disabling, On the other hand, this opens the with deontological judgement aimed permanent morbidity has been reported way to neurosurgical modulation of at respecting rights, duties, and oblig- for CS (Canavero, 2009, 2011). Recently, behavior (presently pursued for other ations that may trump the greater a tDCS study showed that stimulating psychiatric indications: Arle and Shils, good. Here, the DLPFC plays a major the right DLPFC increases compliance 2011) in the criminal subject. The role both in utilitarian moral rea- to social norms enforced by punishment goal is redirecting the action course soning (BA46) and cognitive control (Ruff et al., 2013). This point is important: of the criminal behavior by “rewrit- (BA10); BA10 may be particularly psychopaths may believe to act appro- ing” the original priming signal to engaged by high-conflict personal priately, and it is imperative to “switch” commit an antisocial act. This should dilemmas. Incidentally, the DLPFC their right/wrong circuitry to a socially not come as a surprise. Psychopathic also plays a role in racial bias, and non-disruptive mode. This also means that behavior is a purely biological epiphe- studies show that attempts to get peo- CS will be applied simultaneously to psy- nomenon and can be induced. For ple to not “see” race will be relatively chological reconditioning: this is similar

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This is an open-access arti- chopaths in this century and should be pur- Reprint 1978. cle distributed under the terms of the Creative Commons sued actively despite the legal and ethical Ito, T. A., and Bartholow, B. D. (2009). The neural cor- Attribution License (CC BY). The use, distribution or dilemmas. relates of race. Trends Cogn. Sci. (Regul. Ed.) 13, reproduction in other forums is permitted, provided the 524–531. doi:10.1016/j.tics.2009.10.002 original author(s) or licensor are credited and that the ACKNOWLEDGMENTS Janowsky, D. (2008). “Personality disorders,” in Cur- original publication in this journal is cited, in accordance rent Diagnosis and Treatment. Psychiatry, eds M. H. with accepted academic practice. No use, distribution or The author wishes to express his grat- Ebert, P.T. Loosen, B. Nurcombe, and J. F. Leckman reproduction is permitted which does not comply with itude to the reviewer for the insightful (New York: McGraw-Hill Medical), 521–523. these terms.

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