• Callous and unemotional violence

    Robin & Mani Aldridge. Robin is completing the Pittsburgh Half Marathon.

    Robin & Mani Aldridge. Robin is completing the Pittsburgh Half Marathon.

    I had a friend, Robin Aldridge, who taught elementary school. She’d adopted and raised a girl from a Ukrainian orphanage. Robin and her daughter lived in a house on a quiet street in Charlottesville, VA. Friday night, someone entered that house, beat Robin and Mani to death, and set their house on fire.

    After my daughter called me with this news, I felt like I had suddenly been transported to another planet: the planet of ISIS, Columbine, and Newtown.  There are questions that I cannot get out of my head. How could the killer do that? How is he different from (or similar to) me? What, if anything, can we do?

    How could the killer do that? James Blair, Ellen Leibenluft, and Daniel Pine have a valuable review of recent literature on conduct disorder (CD) in the current NEJM. Conduct disorder is a syndrome in which a young person engages recurrently in antisocial behavior. Please keep in mind that I have no idea what diagnosis, if any, the Aldridge killer might have. Moreover, there are many murderers without psychiatric diagnoses and most importantly, because some murderers are mentally ill doesn’t mean that we should infer that persons with mental illnesses are murderers.

    The most interesting part of Blair et al.’s review is a discussion of the neurology of persons with the callous-unemotional subtype of CD. ‘Callous and unemotional’ means that you have the personality traits of reduced guilt, callousness, uncaring behavior, lack of remorse, and reduced empathy.  The lack of empathy seems to be associated with unusual functioning in the amygdala.

    Functional magnetic resonance imaging (fMRI) studies have shown that adolescents with callous–unemotional traits, as compared with adolescents without such traits, have reduced amygdala responses to images of faces with fearful expressions; these weaker responses are presumably due to deficient empathy.

    There is an enormous and diverse literature here. David Hume and Adam Smith believed that the capacity for empathy — to feel what someone else feels — was essential for having a motivation to act in that other’s interest. If this account is right, these people have an impaired capacity for moral behavior associated with a neurological dysfunction.

    So is the killer different from or similar to me? If the capacity for committing horrible crimes is associated with brain dysfunctions, then that raises important questions. Peter Strawson wrote the classic modern discussion of moral responsibility. Someone might argue that a neurological impairment of empathy diminishes the killer’s moral responsibility. I — and I expect you — will resist this conclusion. Strawson argues that holding others responsible in these circumstances is built into who we are. It is an attitude that

    neither calls for nor permits, an external ‘rational’ justification.

    We experience responsibility for others’ lives as a moral fact, like gravity. Moreover, if we do not hold the killer responsible, then we are in effect treating him as being outside our moral community, the way we would a shark that killed a swimmer.

    We should, in my view, continue to view the killer as one of us — in our moral community — and therefore responsible. There are exceptions: perhaps the killer had a psychotic belief that he was defending himself against aliens. But a callous-unemotional killer’s brain is like mine in the following sense. My brain, like his, is weirdly heterogeneous, with many pockets of dysfunction. I have great difficulty in remembering the names that go with faces. That doesn’t exempt me, however, from the responsibility to learn and remember names. I just have to work harder at it than you do.

    So what, if anything, can we do? The Blair et al. review shows that we are making progress toward understanding callous-unemotional antisocial behavior. There are also some treatments with modest benefits. But we don’t yet have the treatments that we really need. We should therefore continue to pursue mental health research. We should also do more to deliver mental health treatments to those who need them. Finally, violence isn’t just the product of individual neurology. There is enormous variation across neighborhoods and social networks in the chance that one perpetrate or be the victim of a homicide. In my view, the most important thing we should do is to support programs to prevent youth violence and school dropout.

    @Bill_Gardner 

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