Treating Psychopathy with Therapy

A black man is wrongfully killed by police during an attempted arrest. First relatives and neighbors take to the streets, protesting the police’s use of undue force. Soon riots spread throughout the city and country as people loot, set fires, and destroy property. Eventually the chaos becomes less about “the cause” than the opportunism of anarchy. No, this was not Los Angeles of 1991; this was London of August 2011, and authorities are still trying to figure out what went wrong.

Police shootings are tragic but not particularly rare, and Mark Duggan was not savagely beaten to death by (later acquitted) police officers as was Rodney King. So why Duggan, why now, and why so much concern? According to “[a] government-funded study of the motivations of young people who took part in August’s rioting,” it had little to do with concern for Duggan at all. Rather, the study found that the youth who constituted the majority of the rioting factions “were driven by a combination of excitement, opportunism…and antipathy towards the police.” Most disturbingly, researchers found that bored youth viewed this mass rioting as “something to do,” and some participants even perceived the riots as a “party atmosphere,” a free alternative to a club with the bonus of looting while you party.

Since these unsettling findings, Britain has more than ever been interested in explaining and treating undesirable behavior through neuroscience, as explored by the new BBC Radio 4 series “Brain Culture: Neuroscience and Society.” In its premiere episode last Tuesday, “Brain Culture opens in a school in the South of England where staff are using the insights of neuroscience to help children who lack empathic reactions.” The headteacher explains that teachers once discouraged children with this so-called “‘callous and unemotional’ syndrome” by explaining to them how much harm they were doing to the other children. But rather than adjust their behavior, these children became even more inflammatory and hurtful. Now, the headteacher explains, they are working to “painstakingly” teach these children to learn how to feel emotion by having them “grade reactions like fear or happiness on a numerical scale” in order to learn how to respond to emotions.

In a country desperate to find a cure to youths’ apathy before more riots can break out, these “breakthroughs” are likely to inspire false hope. Although therapeutic methods such as emotion-gauging may prove effective among children who are merely bored opportunists when it comes to criminal behavior, for students with true psychopathy misdiagnosed as “callous and unemotional” syndrome, this therapy will do little. In fact, research has shown that introducing psychopaths to such group therapy in which they learn the harm that they inflict upon others “makes psychopaths worse” in the future because they better learn how to hurt and manipulate people’s emotions. As the school even observed, “the more they are told off, the angrier and more frustrated they become.” So although it would be nice to think that there is a cure-all emotion therapy to correct England’s disillusioned and apathetic youth, Brain Culture commentators and school therapists must acknowledge that such therapy used on psychopaths may do more harm than good.

Further Reading:

“Brain science and the law: should we understand more and condemn less?”

“Opportunism and dissatisfaction with police drove rioters, study finds”

Brain Culture: Neuroscience and Society

“Psychopaths Among Us”

Screening for Mental Disabilities in Juvenile Courts

Illuminating research is coming out of the U.K. concerning youths in the justice system. A report published this week by the Prison Reform Trust (PRT), Seen and Heard: supporting vulnerable children in the youth justice system, found that a disproportionate amount of children with mental/learning disabilities are sentenced to jail. The research team surveyed 208 youth offending team (YOT) staff over five years on the procedural details of handling juveniles. In England and Wales, a Youth Offending Team (YOT) is coordinated to deal with youth offenders. It is the responsibility of the YOT to provide counsel and rehabilitation for youth criminals.

The research team found widespread inconsistencies in how youths are treated by YOTs. Most YOTs did not have screening tools to identify learning disabilities, did not have mental health staff, and did not have procedures to deal with children with mental issues. However, youths with learning disabilities or mental health problems are over-represented in the youth justice system. The result of this is that “children with learning disabilities, communication difficulties, mental health problems, ADHD and low levels of literacy who come into contact with the criminal justice system are more likely than children without such impairments to receive a custodial sentence.”

The conclusion called for awareness to especially “vulnerable” children in the justice system, those with cognitive impairments and mental disabilities. This report, in conjunction with recent neuroscience evidence showing how tightly linked mental disorders are to behavior, helps elucidate the youth’s behavioral problems. It is precisely these disabilities that lead them to repeated trouble. And it is this realization and call to action that the US juvenile justice system can learn. Having careful and thorough measures in place to assess youth mental impairment is extremely important, especially with the recent trend toward rehabilitation. Rehabilitation is essentially conditioning of the mind. It is intimately linked with the participant’s neurobiology. Teaching someone to behave properly is inherently linked to his or her neurochemical pathways and different techniques may need to be used on someone with a learning disability. I would argue that establishing rigorous screening procedures for mental disabilities is the first and most important step toward designing efficient rehabilitation programs for youths in the justice system.

Further Reading:

http://www.guardian.co.uk/society/2010/nov/24/vulnerable-young-people-trapped-in-justice-system

http://www.theworkcontinues.com/news.asp?id=1590

The Relationship Between Juvenile and Adult Psychopathy

Psychopathy is one of the biggest problems that faces the legal system in our country today. Characterized as a basic lack of affect, psychopathy will cause those afflicted to engage in risky behavior designed to benefit their own personal needs, and have little or no concern for the wellbeing of others. As much as 25% of the prison population can be defined as psychopathic, with as much as 80% having the less severe but closely related antisocial personality disorder (ASPD). The number of cases processed by juvenile courts have increased by 75% in the last decade, so it makes sense to  look for similarities between this large number of juveniles and the prison population.

The relationship between psychopathy as a juvenile and the relevance in adults was mostly speculative until recently, when a study detailing the lives of approximately 1800 children from 1972 and 1973 came out with its results. 25 years later, follow-up work was able to be done on almost 400 of the original subjects, and the findings were along the lines of what had been expected- children who showed more psychopathic traits were more likely to be adult psychopaths. Low fear, stimulus-seeking behavior, and a reduced galvanic skin response to negative stimuli in children all were more pronounced in those who would later grow up to be the more psychopathic adults.

These findings are huge. If it can be shown that children who exhibit signs of psychopathy early on will in fact be psychopaths as adults, then that is a significant suggestion that they will commit crimes later on in life. While this is far from certainty, and just knowing this doesn’t necessarily mean we can prevent them from committing a particular crime, it is a great place to start. Perhaps, if children with these tendencies early on receive proper care and treatment then they will not develop psychopathic tendencies as adults, or at least not as severely. This is also huge in sentencing young adults; because if they have these tendencies, it is now clear that they do not go away and that they are at a very high risk to recidivate. These findings bring us one step closer to a more accurate sentencing process based on our knowledge of the brain and what it can make us do.

Juvenile Hall is the New Mental Asylum

It’s a terrible scenario that is playing out all across the country. As the need for child psychiatrists continues to grow, programs which were once able to treat a much smaller number of children are now having their budgets cut, causing the gap between who should receive treatment and who is being treated to widen. The number of psychiatrists has indeed increased, but still is not sufficient to meet the growing need of America’s youth. Now, mentally ill youth end up in state correctional facilities, only because they have nowhere else to go.

One main reason for this shortage is the closing of mental hospitals that occurred during the 1960s and 70s. Prescription medication had become a much simpler, more cost-effective method of “treating” psychiatric patients. As hospitals continued to close, more people, especially youth, were denied adequate mental care, and instead ended up in the state’s correctional systems.

The problem has become so bad that it is estimated that there are less than 9 psychiatrists for every 100,000 youths. In Texas, the state youth prison system has had to resort to telepsychiatry sessions, in which a mental health professional holds video conferences with youth thousands of miles away over the internet. It is even worse in rural areas and those who live in poverty. 80% of counties in Texas do not have a child or adolescent psychiatrist (CAP), and less than 4% of CAPs practice in rural counties. There are really only four areas with any significant number of CAPs, and they are exactly what one would expect: Dallas, Houston, San Antonio, and Austin. The rest of the state appears depressingly absent of CAPs.

Juvenile corrections facilites are simply not equipped to deal with problems of this type and magnitude. While they may be doing the best they can, they are corrections facilities first, not mental hospitals or psychiatric wards, and the overcrowding is just amplifying an already desolate situation. Clearly, more funding needs to go toward these institutions, as possible help now could lead to a deterrence of crime later on in life. The chance to turn disadvantaged, struggling, mentally disturbed youth into functional adults in society is one that cannot be passed upon.

Brain Injury & Adolescent Crime

A group at the University of Exeter is assessing the prevalence of traumatic brain injury (TBI) in the criminal population. TBI is known to be associated with cognitive deficit and behavioral problems, especially if accompanied by a loss of consciousness for longer than 6 minutes. Previous studies have shown that TBI is much more prevalent in the male adult prison population (25-87%) than in the general male population (5-24%), establishing a possible link between brain injury and crime.

This group focused on TBI in the male, adolescent population, specifically in those who had prior criminal offenses. In order to further tease out the link between brain injury and criminal offenses, the group examined the rate of TBI in relation to convictions, violence, mental health problems, and drug use. They surveyed 186 male offenders between 11 and 19 years old. Each male had at least one conviction, but many were multiple offenders (the mean was ~7 conviction). The study participants were asked to self-report whether they had suffered one or more brain injuries, and if so, the length of time without consciousness and the cause of the injury. They also reported their convictions (these were not verifited with prison records) and whether or not and how often they used drugs. Additionally, they completed a general health questionnaire (GHQ-12) to assess psychological disorders.

Most of the participants (65%) had suffered some form of TBI. Those who had reported a TBI had on average 2 more convictions than those who did not report a TBI. The most common reasons for the injury were violence and falling while under the influence of drugs. Participants with 3 or more TBIs were more likely to have committed violent offenses. Further, the TBI group had more mental health symptoms and was more likely to have misused drugs.

It is hard to make sense of these results. It is possible that, as the authors suggest, TBI causes neurological problems that lead to violence, crime, and the inability to learn from past mistakes (because of the high incidence of multiple offenses). On the other hand, these offenders could have biological tendencies that make them more aggressive and more violent. They could have been more likely to put themselves into a situation that left them vulnerable for brain injury. There are a number of limitations to this study. The participants were to self-report all the answers and these answers were not verified with medical or court records. Additionally, there was no control group and there was no testing to actually assess if the TBI sufferers had reduced cognitive functioning. The authors did not dig into environmental factors that could have influenced the offending youths criminal history, such as family or social problems. Regardless, it is striking that the prevalence of TBI in the prison population is so high. As the authors suggest, these results, combined with the previous work with TBI, call for enhanced TBI screening procedures for offenders and also awareness of the potential vulnerability of the adolescent brain.

Further Reading:

http://www.bbc.co.uk/news/health-11718241

Williams, W. Huw; Cordan, Giray; Mewse, Avril J.; Tonks, James; Burgess, Crispin N. W. “Self-reported traumatic brain injury in male young offenders: A risk factor for re-offending, poor mental health and violence?” Neuropsychological Rehabilitation: An International Journal (2010). 15 Nov. 2010

Juveniles and Rehabilitation

Juveniles in the justice system have been receiving more and more press. Questions hover around how to treat juveniles in the courts. Should they be treated like adults or given more lenience? Is there room for rehabilitation or are they bad seeds who should be put away before they have the opportunity to cause even more problems? Some places, like Luzerne County, are focusing on rehabilitating young offenders. [1] The Children and Youth Services agency in the county has created a youth aid panel to deal with juvenile offenders. They will make juveniles write essays, apology letters, and work to dismiss their charges. The hope is that it “allows for juveniles to be accountable for their behavior without becoming part of the court system.” This mentality, however, will only apply to minor crimes.

Some states, like Florida, are very harsh on juveniles. Florida has sentenced more juveniles to life in prison for non-murder crimes than any other state. [2] Currently, there are 116 juveniles in Florida prisons for life without the opportunity for parole. In hopes to curb this behavior, the U.S. Supreme court recently ruled that it was unconstitutional for juveniles to be sentenced to life in prison for non-murder crimes in Florida. The Court stated that it violates the right to not be subjected to cruel and unusual punishment, protected by the Eighth Amendment. In essence, the Supreme Court is saying that juveniles are different than adults, and do not deserve to be treated the same.

However, these juveniles in Florida are now receiving “effective” life in prison sentences: 50 – 90 years. Bryan Gowdy, a lawyer in Jacksonville, has been arguing on behalf of these juveniles. He is pushing for juveniles to have access to rehabilitation programs once they reach a mature age. There is a movement to develop a system to handle these youths who commit especially heinous crimes – armed robbery, rape, and assault and battery. The current idea is to still allow life in prison sentences, but require the offender to meet a series of criteria in order to gain parole. The criteria would include education programs and good behavior. The hopes are that meeting the criteria would indicate that the youth is on his/her way to rehabilitation.

The effectiveness of rehabilitation on juveniles still remains to be seen, however. Certainly, adolescence is a time of large-scale changes in the body, and in the brain as well. There is a certain amount of plasticity in neural connections, but whether these can be shaped and formed to reach the desired outcome is another question. Last week, I wrote about traumatic brain injuries in young offenders. Research has linked trauma at a young age to adverse behavior. With this same idea, it seems possible that enough conditioning may be able to potentiate positive behavior. It still remains to be determined if there is a certain window at which the brain is more plastic, and if this window disappears at a certain age.

Further Reading:

[1] http://citizensvoice.com/news/youth-aid-panels-to-focus-on-rehabilitating-offenders-1.1067173

[2]http://www.heraldtribune.com/article/20101121/ARTICLE/11211086/2055/NEWS?p=all&tc=pgall

A loophole that can be filled by neuroscience

A recent article in the Houston Chronicle highlights a possible loophole in the Texas law system for treating mentally ill youth. It turns out that hundreds of juveniles who have committed crimes are being released by the Texas Youth Commission, because they are mentally ill and the commission just doesn’t have the resources to treat them. This raises an issue relating to the intended purpose of the criminal justice system.

While the teens are referred to mental health centers when they are released, many go on entirely without treatment. Many of these are individuals who have committed serious crimes. Last year, a 16-year-old who stabbed a high school teacher to death using a butcher knife, and a teen who killed a roofer during a shopping spree, were both released on grounds of mental illness. There are countless other cases such as these.

Releasing these sorts of individuals, without any plan for treatment, seems to be a severe mishandling of the situation. After all, it is in some sense the duty of a criminal rehabilitation system to rehabilitate when possible, and there certainly seems to be a shot at doing this.

It certainly seems that advances in neuroscience can be used to remedy this situation. Currently, there seems to be an uncertainty about how to approach these cases, because mental illness and mental retardation are considered mitigating circumstances, and allow the Texas Youth Commission to drop charges on the individual. However, the next step is perhaps hazy because there might be a question as to whether these teens can even be rehabilitated in the first place. In comes neuroscience. If we advance current studies, we might find that there is definite reason to believe in the power of rehabilitation. Brain scans and trustworthy longitudinal studies might be used in court or in proceedings to demonstrate that the 16-year-old murderer has a strong chance of developing positively, and treating his mental illness, if a course of action demanding rehabilitation is pursued.

At present moment, too many questions that can easily be answered by neuroscience are simply being dismissed because they are too nebulous to approach other ones. The question of treating mentally ill individuals should not be one of them. Too many mentally ill youth, with a true chance for treatment and improvement, are being released on unclear grounds. This is the ideal situation to make a strong case for neuroscience.

Sources:

“Loophole lets mentally ill Texas juveniles go free”. Houston Chronicle. 20 Dec 2009. Web. 1 Oct 2010. <http://www.chron.com/disp/story.mpl/metropolitan/6779716.html>