The Psychopath Test

THERE’S A PART of the brain—the orbitofrontal cortex, just above the eye behind the ­forehead—that’s involved in decision-making and impulse control. Men show a reduction in volume there, Raine says: “And the lower the volume of that matter, the more antisocial and psychopathic a person is.” Men are also 10 times more likely to commit murder. “We try to explain that’s because we socialize differently—­we give girls dolls and we give boys sticks. That’s not entirely wrong, but it’s in addition to the biological differences.” (“I can only say this because I’m a man,” he adds.)

Any parent knows socialization can only account for some dissimilarities between kids. Raine has 10-year-old fraternal twin sons. At the time of our interview, his wife, Jianghong Liu, an associate professor at Penn’s School of Nursing, is in China for six weeks. “I’m home alone with the boys,” Raine says. “I’m giving them the same experiences, it seems to me. But they’re like chalk and cheese.”

Raine must be an … interesting parent. He barely reads newspapers. He doesn’t watch TV, except for what the boys watch. When I pose a question about Casey Anthony, he stares at me blankly: “Who?” “The woman in Florida accused of murdering her two-year-old?” I prompt. He shrugs: “Tell me about her.” I do. “Well, first off, I’d want a brain scan of this Casey Anthony,” he says, “to see if there’s a reduction in gray matter, a smaller amygdala. What’s her heart rate?” Not exactly fodder for Nancy Grace. Smaller amygdalas don’t tell a story; they don’t satisfy our thirst for heroes and villains, or our need to lay blame.

But maybe they should. As of now, at least seven genes associated with antisocial/aggressive behavior are thought to influence brain structure. Raine understands why this subject makes people edgy. Especially in America, we don’t like to think of biology as destiny. “You can become anything you want!” we exhort our children. How could a cherubic infant already be a bad seed?

Raine says we’re looking at it all wrong: “Everybody makes the mistake of saying, ‘If it’s biological, then throw away the key.’ But we can do things to change the brain for the better.” On Mauritius, his long-term studies have shown that improving kids’ diets and educational opportunities lessens future criminal behavior. Now he’s conducting a four-year randomized study of Philadelphia preteens who exhibit conduct disorder, aggression and psychopathy, using brain scans to see what helps more: omega-3 fatty acids, cognitive behavioral therapy, or both.

CBT is a touchy subject when it comes to psychopaths. Raine acknowledges its limits: “We can’t teach them to feel empathy, but we can teach them to behave as if they do.” Duke University ethicist and brain expert Walter Sinnott-Armstrong is dubious about the benefits. “There are very good studies that show psychopaths don’t respond to CBT,” he says, “and that it can be counterproductive.” Peter Woodcock told the BBC it had been helpful to him: “I did learn how to manipulate better.”

That’s a risk Raine is willing to live with, for a simple reason: America is failing in its war on crime. He’s proposing a new approach: screen all children for traits linked to psychopathy. He insists he’d want to know if his boys had them, though they haven’t been tested. “We’re not at that point yet,” he says. “But 20 to 30 years in the future”—when his kids are having kids—“we’re going to be able to predict criminal behavior early in life.”

It’s a radical idea, considering the New York Times recently ran a piece about the ethical hazards of testing kids for high cholesterol. But with such screening, Raine says, parents could be given a choice: “We could say, listen, your little Johnnie—all the boxes are checked. There’s an 80 percent chance he’s going to become a dangerous psychopath. We’ll take him away from you, work with him. He hasn’t done anything yet, but there’s an 80 percent chance he’ll ruin your life.”

The Dartmouth Institute’s H. Gilbert Welch researches problems created by medicine’s drive for ever-earlier identification of diseases. He’s skeptical about Raine’s idea. “If I want to predict criminal behavior,” he says, “give me social factors over genetics any day. Even if you have a reliably predictive test, there’s a lot of chance for mislabeling. You’re just going to end up with a whole bunch of worried parents when most of their kids are fine.”

Princeton bioethicist Peter Singer begs to differ. “If the tests become sufficiently reliable,” he says via email, “I think we should consider testing all children for psychopathy. I accept that there is a risk of stigmatization, but there is also a risk in not alerting parents and teachers to possible dangers … .”

I ask Liz Spikol, a local advocate for the mentally ill, what she thinks of such testing, expecting her to rise up in arms. She doesn’t. “This is going to sound harsh,” she says, “but other mental illnesses, like schizophrenia and bipolar disorder—you can take medication and then not re-offend. But psychopaths—they’re hardwired not to be empathetic.” She would favor such testing if the available interventions were proven to work, even as she sympathizes with those who have different sorts of mental wiring: “You always want to think that people can change, can be rehabilitated.” Her personal experience, though, has taught her: “Some people are just lost.”

Then she’s quick to add: “All that is about an adult. I wouldn’t say that about a child.”