We're all psychopaths sometimes

A paper just published in the journal Brain reports that psychopathic individuals are less empathic than controls, but that empathy can be turned on on command.  The study is reported on the BBC website here. Researchers recorded fMRI images of 20 incarcerated males diagnosed as psychopaths and 26 non-prisoner controls as they watched video clips of hands interacting "in a loving, painful, neutral or rejecting way". The researchers report that the fMRI images are evidence that psychopathic individuals are less empathic than controls but that when they are encouraged to imagine what the actors in the videos were feeling, the active brain regions are more similar to those of the controls.

Experimental paradigm. (A) Three still frames from example videos of each condition. Each video included a receiving (1) and an approaching (2) hand. (B) Photo of hand interactions during the experience. (C) Design of the three experiments (always performed in this order). Source: Brain Vol 136, Issue 8, Pp 2550-2562

The researchers note that incarcerated psychopaths may not be representative of all psychopaths, and that the 20 subjects in their study were less educated and less wealthy than controls, and they can't be sure that these differences don't explain the differences observed between the two groups before the first were instructed to be empathetic.  And, the sample size is small.  Nonetheless they conclude that rather than having no empathy, as is apparently widely supposed, psychopaths simply have a 'reduced propensity' to empathize rather than an inability.  What 'reduced' means in other than some statistical value related to this particular study isn't clear, at least to us.

There are several interesting points here.  If it's true that people who have been thought to be unable to feel other people's pain actually can, this would mean that psychopathy is but a point on the spectrum of human affective behaviors, not to mention judgments we individually make about other people.  The ability to empathize is essentially distributed from none to total empathy, and as with blood pressure or height or blood glucose or many other traits, we (our culture or some assigned experts) define the extremes of the distributions, beyond some chosen value, as pathologies.

But it's not surprising that psychopaths, however defined, can switch on their empathy on command or under specific circumstances.  Few of us have equal amounts of empathy at all times -- we might identify more with someone we love than someone we dislike, or even cats more than dogs, if soldiers didn't turn off their empathy on the battlefield, they couldn't do their job, and we often listen to news about yet another war or famine in a far off place with no emotion.  Indeed, if the definition of psychopathy is lack of empathy, we're all psychopaths sometimes.

This study brings up many questions.  Can psychopathy be prevented?  Is it really a category?  Are psychopaths people who weren't taught empathy as children?  Will genes for psychopathy be sought, with the aim of identifying at-risk children and intervening (teaching empathy) before it's too late, and, disturbingly, where might that lead?  Is it ever too late, if even psychopaths who are hardened criminals can empathize on command?  Is the switchability something that we need to or will have studied for some assumed genetic basis?  If psychopaths can turn empathy on and off, what keeps them from turning it on more often? This seems to us to be the biggest challenge, no matter how clear it is that they can empathize.

We are not qualified to judge the degree to which fMRI is a modern form of phrenology with little in the way of rigorous underpinnings in circumstances like these, but there certainly are vocal skeptics about the usefulness of this new toy.  But it is likely that the much harder, if less glamorous slogging to work out the day-to-day behavior or behavior-changing approaches will take longer, and probably because they are more vague, the low-tech studies will struggle harder to get funding, and will get less news coverage.

The problem of understanding things like this, which we've said many times before, is that we don't know all of the potential triggers or vulnerabilities, inherent and environmental.  For that reason, even thinking of lifelong therapy, such as psychotropic drugging, is problematic.  Perhaps we just don't yet have the appropriate resesarch strategies, or even aren't asking the right kinds of questions.