Brain Stimulation Therapies And Psychopathic Criminals

Question 1

How is Antisocial Personality Disorder defined in the DSM5?

Answer 1

Three or more of the following diagnostic characteristics:

1) failure to conform to social norms with respect to lawful behaviours
2) deceitfulness
3) impulsivity
4) aggressiveness in the form of physical fights or assaults
5) reckless disregard for safety of self or others
6) consistent socioeconomic irresponsibility
7) lack of remorse

Question 2

What is the Triarchic Model of Psychopathy developed by Patrick, Fowler, and Krueger to summarize the psychopathic personality?

Answer 2

1) Disinhibition (eg difficulties with emotion regulation and impulse control)
2) Boldness (eg need for social dominance, risk-seeking)
3) Meanness (eg lack of remorse, callousness)

Question 3

What is the difference between antisocial personality disorder and psychopathy?

Answer 3

The diagnostic criterion that an individual with ASPD must have displayed conduct disordered behaviour as a child

Also, psychopathy exists on a spectrum in which certain personality traits are associated with anti-social and/or criminal behaviour (Hare’s Psychopathy Checklist-Revised [PCL-R] is considered the gold standard of assessing psychopathy - 20 item, semi-structured interview)

Question 4

What brain structures connected to the PFC are involved in psychopathic behaviour?

Answer 4

1) Ventromedial prefrontal cortex: diminished capacity for operant learning (reward and punishment less likely to guide behaviour)
2) Dorsolateral prefrontal cortex: cortical inhibition is deficient which impairs executive functioning in the brain and diminishes self-regulation (heightens impulsivity and predatory behaviour)
3) Orbitofrontal cortex: dysfunction diminishes ability to process others’ emotions and subsequent ability to to use such information to guide social behaviour
4) Amygdala: decreased amygdala volume is linked to higher levels of aggression, violence, and psychopathic traits

Question 5

What is Dr. Sergio Canavero position on neuromodulating interventions (specifically with regard to cortical stimulation)?

Answer 5

1) It is a “risk free” procedure for treating people with criminal psychopathy (certainly compared to stereotactic posterior hypothalamotomy, which is associated with a high mortality rate; and DBS which has a risk of mortality or disability morbidity)
2) It has the potential to increase behavioural inhibition, boost neuroplasticity, and retire moral circuitry in the psychopathic brain
3) Benefits of the procedures outweigh legal and ethical concerns

Question 6

What are the ethical objections to the treatment of psychopaths in general?

Answer 6

1) Because they know the difference between right and wrong and simply aren’t bothered by wrong, this lack of moral motivation might not allow them to assent to interventions; furthermore, any consent given would be from external motivation (bribery or coercion) rather than internal motivation
2) Because there is effectively no suffering, it is unlikely that a psychopath would pursue treatment; or that treatment would be ethical because there would be no individual medical benefit to the procedure
3) Treatment itself might be unethical because the purpose of treatment is to return someone to “normal” by psychopathy is the psychopath’s normal

Question 7

What are some negative side effects to DBS?

Answer 7

1) Insertion of devices can cause bleeding in the brain
2) Stimulation can cause seizures
3) If the equipment breaks or malfunctions then additional surgery - and risks - will be required
4) Documented side effects following surgery: depression, apathy, hypomania, euphoria, mirth, hypersexuality, and loss of attention or memory

Question 8

What are the differences between the treatment of psychopaths and treatment for sexual offenders? How is it the same as treatment for homosexuality?

Answer 8

1) a sex offender may experience suffering as a result of behaviour, whereas a psychopath cannot
2) homosexuals are not relieved from suffering when treated, but only from social sanctions (same for psychopaths) -> the benefit is social and not medical and therefore precludes the use of experimental treatments on prisoners

Question 9

What are the differences between “first-order desires” and “second-order desires” (Harry Frankfurt) and how does it relate to psychopathy?

Answer 9

1) First-order desires: directed at possible actions (will)
2) Second-order desires: targeted at just first-order desires (volition)

DBS would propose to bring bad first-order desires in line with desired second order desires (volition); but psychopaths do not have a moral motivation for this to work -> psychopaths approve of their behaviours and shun social consequences