What It’s Like to Spend 20 Years Listening to Psychopaths for Science

http://www.wired.com/2014/04/psychopath-brains-kiehl/

By Greg Miller
04.17.14

Kiehl [Kiehl] is a neuroscientist at the Mind Research Network and the University of New Mexico in Albuquerque, and he’s devoted his career to studying what’s different about the brains of psychopaths — people whose lack of compassion, empathy, and remorse has a tendency to get them into trouble with the law.

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Kiehl recounts the story in a new book about his research, The Psychopath Whisperer. He has been interviewing psychopaths for more than 20 years, and the book is filled with stories of these colorful (and occasionally off-color) encounters.

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WIRED: How do real life psychopaths differ from ones we see on TV or in movies?

Kent Kiehl: One of the biggest differences is that psychopaths are way more common than people believe. About one in 150 people will meet the stringent clinical criteria for the disorder. That means hundreds of thousands of them are out and about in the population. The majority of them don’t commit violent crimes, but they lead this sort of disorganized, nomadic life, and they tend to eventually end up in some sort of trouble. Hollywood hasn’t done a good job of portraying the average psychopath. For the most part, they’ve taken the extreme view, with the Hannibal Lecters and more sensationalized people like that. It’s actually far more common and banal.

WIRED: People also tend to confuse psychopathy and psychosis — what’s the difference?

Kiehl: Right. With psychopathy the main features are lack of empathy, guilt, and remorse — and impulsivity. Psychosis is a fragmentation of the mind where you have hallucinations and delusions. It’s a very different disorder. You almost never find someone who has psychotic delusions and even moderate levels of psychopathic traits.

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WIRED: What is known at this point about what’s different about their brains?

Kiehl: We’ve found that psychopaths have 5 to 10 percent reduced gray matter density in and around the limbic regions [a network deep in the brain that's important for emotional processing]. We’ve also found — and a group in Germany has published a similar finding — that the tissue that connects the limbic system to the frontal lobes is disrupted. There have also been lots of studies published showing reduced responsivity in those circuits during emotional processing and moral decision making.

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WIRED: Can psychopaths change?

Kiehl: I’m so encouraged by the pioneering work that’s occurring at places like the Mendota Juvenile Treatment Center in Wisconsin, where people are taking high risk youths [who show signs of developing psychopathic traits] and treating them with various intensive programs to try to reduce the odds that they’ll reoffend.

The treatments that seem to be making a big difference emphasize positive reinforcement rather than punishment. Yes, they’re incarcerated at the time and that’s their punishment for the crimes they’ve done, but the facilities instead of only punishing them when they do something bad actually reward them when they do something good. If they interact positively with staff they’re given a small reward, like maybe a video game in their cell for the weekend. Similarly, with this segment of the population, if you use positive reinforcement they’re much more likely to do what you want them to do.

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WIRED: Does it really make sense to devote the resources for intensive therapy to such a small minority?

Kiehl: If you look at just the published literature on the Mendota Juvenile Treatment Center, for every $10,000 the state of Wisconsin has invested on that program, it returned over $70,000 in reduced incarceration and criminal justice costs in the next four years. Boys that go through the treatment stop accumulating infractions that lengthen their sentence. When they get out, they stay out longer and they commit less violent crime, which is the most expensive kind of crime from a societal perspective.

WIRED: If we already have interventions that work, why do we need all the brain research?

Kiehl: The current programs aren’t perfect. They reduce violent recidivism by 50 percent. But 10 to 15 percent of kids still reoffended violently, despite the best psychological treatment. What the brain science might do is help inform the cognitive treatment process so maybe you could determine that the easy to treat kids might be ready for release after six months, but these other kids need a full year or more of treatment. You might be able to use the neuroscience to improve the decision making. That’s the sort of thing we’re hoping to do.

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