When Zero Degrees of Empathy Is Negative - The Science of Evil: On Empathy and the Origins of Cruelty - Simon Baron-Cohen

The Science of Evil: On Empathy and the Origins of Cruelty - Simon Baron-Cohen (2011)

Chapter 3. When Zero Degrees of Empathy Is Negative

What is zero degrees of empathy like? What does it mean to have no empathy? And does this translate into what some people call “evil”?

Zero degrees of empathy means you have no awareness of how you come across to others, how to interact with others, or how to anticipate their feelings or reactions. Your Empathy Mechanism functions at Level 0. You feel mystified by why relationships don’t work out, and your lack of empathy creates a deep-seated self-centeredness. Other people’s thoughts and feelings are just off your radar. This leaves you doomed to do your own thing, in your own little bubble, not just oblivious to other people’s feelings and thoughts but also oblivious to the idea that there might even be other points of view. The consequence is that you believe 100 percent in the rightness of your own ideas and beliefs, and judge anyone who does not hold your beliefs as wrong or stupid.

Zero degrees of empathy is ultimately a lonely kind of existence, a life at best misunderstood, at worst condemned as selfish. It means you have no brakes on your behavior, leaving you free to pursue any object of your desires, or to express any thought in your mind, without considering the impact of your actions or words on any other person. In the extreme case your lack of empathy might lead you to commit murder or rape. In the less extreme case (close to zero, such as Level 1 or 2) it might lead you to be verbally abusive or just talk way too much or overstay your welcome. These are clearly different levels of empathy deficit because the person who is simply verbally insensitive may realize it’s not nice to physically hurt someone else. But even the verbally insensitive individual can be close to zero on the EQ. Zero degrees of empathy can lead one to commit acts of cruelty, it can leave one insensitive toward others, or, simply, socially isolated. We can see, then, that zero degrees of empathy does not equate to what some would call “evil.” But for those who come into the orbit of someone with such depleted empathy, it means the risk of being on the receiving end of verbal insults, physical attacks, or experiencing a lack of care or consideration—in short, at risk of getting hurt.

Zero degrees of empathy does not strike at random in the population. There are at least three well-defined routes to this end point. In this chapter I put forward a new view in which I take old categories from psychiatry and reconceptualize them as examples of zero degrees of empathy. I group these categories together as Zero-Negative because they have nothing positive to recommend them. They are unequivocally bad for the sufferer and for those around them. As we meet each of these types and look at their brains, we can see if it really is the case that however you lose empathy, if you are Zero-Negative, the same underlying empathy circuitry in the brain is affected.

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Figure 6: Three forms of Zero-Negative

We are slowly going to look into each of the three circles in Figure 6, but we need to go one step at a time. The first form of Zero-Negative is called borderline (or Type B).

Zero-Negative Type B

Carol is thirty-nine years old. I met her when she came to our diagnostic clinic in Cambridge. (I have disguised details of her life for reasons of confidentiality.) She is classed as borderline. To give it its full name, she has borderline personality disorder. For as long as she can remember, and certainly going back into early childhood, she has felt her life was “cursed.” As she looks back on her stormy childhood, her unstable teens, and her crisisridden adulthood, she contemplates her lifetime of depression. Her relationship with her parents has been punctuated by periods of years during which she did not speak to them at all.

She is aware that she has a huge reservoir of hatred toward her parents, who she feels maltreated her and who were never really parents toward her. However nice people are to her, she feels she can never quench this simmering rage, which even today can come out as hatred toward anyone she feels is disrespecting her. Often people she perceives as disrespecting her are simply people who disagree with her, and she senses that they are doing this in a confrontational way. In this way, there is a distortion or a bias in how she reacts to others, assuming they are treating her badly when they are not. If her children don’t do what she says, she screams and swears at them: “How dareyou treat me with such disrespect? You can just fuck off! I hate you. I never want to see you again. You can just look after yourselves. I’m through with the lot of you! You’re evil, selfish bastards! I hate you! I’m going to kill myself! And I hope you’re happy knowing you made me do it!”

She will then storm out, slamming the door behind her.

Minutes later she will drive to one of her friends and spend the evening having fun, leaving her children reeling with the impact of her hurtful words. When her hatred and anger bubble up, there is no chance of her stopping it coming out. It bursts forth with venom, designed to hurt whoever’s ears the words land on. Her own feelings are so strong that there is no space in her mind to consider how her children might feel being told by their mother that they are evil. The irony of Carol’s behavior is that in accusing others of selfishness (because their will does not accord with hers), she herself behaves with absolute selfishness.

If parenthood is defined by being able to put your own needs second to those of your child, she is totally ill equipped for parenthood. For Carol, her own needs are paramount and her children’s needs (or anyone else’s for that matter) never even feature on her radar. While her children are recovering from the bruising impact of her outburst, she is meantime laughing and partying with her friends in a café in town. When she comes back home, she either acts as if nothing has happened or refuses to talk to her children (or whoever provoked her rage) until they have apologized to her.

Hate and anger are not Carol’s only problems. She also has major difficulties in interpreting other people’s behavior and emotional expressions (in their faces, voices, or gestures). She thinks she knows exactly what others are thinking or feeling, but her empathy is twisted and distorted by a bias that leads her to assume other people are thinking hostile thoughts and harboring hostile intentions toward her. If someone is silent, even for a few minutes, she assumes they are being aggressive. If someone makes a joke, she assumes the other person is attacking her. If someone is caring, she assumes it is not meant. If someone apologizes, she assumes this, too, is not genuine. She will lash out with her accusations at other people’s insincerity so that, no matter how hard they try to persuade her that they care or are sorry for their apparently hurtful actions, she does not accept their well-intended approaches and pushes them away. That other people feel bullied and controlled by her tyrannical, self-centered behavior does not even occur to her.

Carol is extremely difficult because her behavior is so impulsive and explosive, but she also carves an extremely sad figure: At an age when she should feel confidence and a sense of achievement from her efforts, she has instead ended up feeling distrustful of close relationships, constantly disappointed by others, and believing she has been victimized by others. To those who know Carol, her emotions are like a roller coaster. She lurches from feeling lonely and depressed, to feeling totally happy, to feeling rage toward others. She goes out to clubs at night, dancing with strangers in the hope of finding a new close relationship. Some of these closer relationships develop into sexual relationships. She enjoys the idea that others find her attractive, and she wants to feel close to someone. However, as soon as she is in a new relationship, she starts to sabotage it by initiating conflict. She looks for problems in the relationship, constantly asking, “Why don’t you communicate?” and “Why don’t you care about me?”

Despite her new lover, John, trying to reassure her that he does care, or replying that he does communicate, Carol insists that he does not. When John gives her time to sit and talk, she argues that it is not “real” communication. If he tries to defend himself, she accuses him of being “switched off” or of “not really connecting with her pain.” She says that if he truly loves her, he would know how much she is hurting inside. She insists that he hates her, and she taunts him to hit her to prove that he hates her. After she has screamed and sworn at him, she will throw her arms around him and ask him to make love to her, begging him to “promise me you’ll never leave me!”

She frequently threatens to kill herself. On the last occasion she ran outside at 3:00 AM, claiming that John didn’t care enough about her and that “this time I am going to do it.” He spent hours that night searching the local public parks, desolate parking lots, wasteland, or other places where in the past she had run off to, trying to find her and console her and ask her to come back. Unsurprisingly, these unstable relationships tend not to last.

Within her marriage, she pours scorn on her husband, Mike, whom she accuses of making her feel insignificant, unimportant, and invisible, as if she does not exist. When he replies that she does matter, she says, “You’re just like everyone else. You’ll leave me in the end, just like everyone else does.” If Mike tries to comfort her by putting his arm around her, she pushes him away, saying he is suffocating her. She hates men touching her and does not want to be a wife, fearing it will take over her identity. She pushes away anyone who wants to get near her.

She is totally self-absorbed, talking unstoppably about herself and her thoughts, with no real interest in other people’s thoughts. If in bed her lover touches her, she removes his hand and tells him not to cross the midline of their bed. She tells him, “You think you’re so fucking important, just because you’re at the top of the tree.” She tells him that in his presence she feels she is “a nobody,” that he makes her feel like she is a “piece of shit,” and that the world would be better off if she was dead. She says she longs to be free of this life of pain and that one of these days she will “do it.” If John withdraws from her, she hurls abuse at him, saying, “There! I told you you didn’t care about me!” If he tries to get close to her, she tells him to “go away and leave me alone. You don’t really care about me.”

It is not hard to see why this is a clear case of Zero-Negative. Carol’s empathy is at ground zero, and there is nothing good about being in such a state. She has few friends, a situation not helped by the fact that she despises other women. When she is alone, she says she feels “abandoned,” and she experiences terrible levels of anxiety she can get rid of only through comfort eating, sex, alcohol, or aggression. She can act as a mature woman one minute, and the next she can curl up like a little girl. She can appear calm and reflective, and then the next minute be highly manipulative (“Do this or else I’ll take you to court! ...”). One minute she can slam her friend’s door, saying, “I’m never coming back,” only to return the next week as if nothing happened. She treats her few friends in the same hot-and-cold manner: One minute she tells them they are her best friend; the next minute she accuses them of disloyalty, claiming that the friendship is false and that they are evil.

This is a snapshot of Carol’s current behavior. The hallmark of borderlines is a constant fear of abandonment, emotional pain and loneliness, hatred (of others and of themselves), impulsivity, and self-destructive, highly inconsistent behavior. Jerold Kreisman and Hal Straus summarize borderlines in the title of their book I Hate You—Don’t Leave Me.93 This neatly sums up the contradictory behavior in borderlines.

So how did Carol end up as Zero-Negative? What is the route to becoming borderline? And does being borderline mean you inevitably treat other people cruelly?

Carol’s Development

When Carol was a baby, her mother used to ignore her. She thought it would just spoil children to give them attention, that to show them affection was to “make a rod for your back,” by which she meant that the child would then expect love and become clingy. She breastfed Carol for just one week after she was born and then passed the baby to a nanny to feed by bottle, saying she was too busy to look after the baby. She felt she had done her duty as a mother to have breastfed, but she got no maternal pleasure from such physical intimacy. She was proud of how Carol as a toddler showed independence, could be left alone for hours or even all day, and did not cry, and she prided herself in having trained Carol to learn that crying did not bring her mother or lead to being picked up and cuddled. “Children have to learn who is boss,” she would say.

Carol was hit constantly if she didn’t do what her mother ordered her to do. Carol can remember in her childhood frequently being sent from the table if her table manners were not to her mother’s standards, and her mother would then say, “Bread and water only, and stay in your room for a whole day.” If Carol cried at one of her punishments, she was threatened with being beaten with a belt, which her mother also used with the pet dog to control him. Carol recalls her mother showing no maternal affection; she would never hug or kiss Carol. And her mother constantly put Carol down, using criticism in public. She overtly favored Carol’s younger sister. At the age of eight Carol was sent to boarding school, where she felt lonely and was withdrawn and socially anxious. Her mother felt she had completed her maternal duty and that children needed to learn to stand on their own two feet. As a result, Carol grew up looking after herself from at least this age, if not before, knowing that her mother was never around to care for her. She taught herself to read and figured out how to use the washing machine and clean the house because her mother never did anything domestic. Carol would cook her own meals, clean the house, and cry herself to sleep every night.

Carol remembers her father being at times affectionate but also depressed, often away for long periods, his love unpredictable. She remembers the physical fights her parents had, while she would hide under her bed and block out the world with her fingers in her ears. Carol’s parents divorced when she was nine, and during her adolescence she hardly came home. When she wasn’t at boarding school, she would stay with friends or come home to an empty home, as her mother was always out. Carol started having sexual relationships early, at age fourteen, in a desperate attempt to be loved. She turned to drugs, initially cannabis, but later “acid,” to escape her depression, and she remembers how every day during her childhood she wished to die, feeling that life was a struggle from which she wanted to exit.

When Carol was sixteen, she was sitting in a café one day. She befriended a man in his forties who was sitting alone and started pouring out her life story to him. He in turn told her of his difficult marriage and his depression, and he asked her to be his friend. She identified with his sadness and was flattered at being wanted by him. He asked if she would come back to his apartment that evening to check a letter he was writing to his wife, and she willingly agreed. When she arrived later that evening, he locked the door behind her, said how beautiful she was, and asked her to go to bed with him. She was frightened and did not want to, but she said nothing while he had sex with her. After it was all over, she felt that she had been raped and that she had been treated “like dirt,” but she told no one. Carol felt as if this was what her life was destined to be—she described it as “her curse.”

At the age of eighteen she started cutting herself to escape her depression and drinking before going to clubs; she was surprised that she couldn’t remember how she had ended up in different men’s beds. During one such sexual encounter she became pregnant. She decided to keep the baby but developed postnatal depression when the baby was born. Her baby was put into foster care as she was unable to look after her. Four years later she married Mike, a man who offered to look after her, and had two children with him, though the relationship—if it was ever there—did not last beyond a few short years. She soon simply used Mike to pay the bills, look after the children, and look after her, while she went out most nights clubbing. Her friendships are short-lived and are based on what she can get out of them. She doesn’t want to hear about other people’s problems. All she cares about is herself.

Stepping Back from Carol

Carol had a terrible childhood and adolescence. More than a century of research into the effects of early deprivation has clearly established that such environmental factors affect brain development, probably irreversibly. We need to ask: What makes us say she is borderline (or Type B)? And what are the consequences for behavior in someone who is borderline?

According to psychiatrists, borderline is a highly specific form of personality disorder, different from other varieties. Borderlines, it turns out, are pretty common: In the general population they make up around 2 percent. Among those who turn up for counseling or psychiatric help, it is even more common: About 15 percent are borderline. Among people who commit suicide, about 33 percent are borderline. And in clinics for those with eating disorders, alcoholism, and/or drug abuse, Type B may be present in as many as 50 percent.94-96

The hallmarks of borderlines are self-destructive impulsivity, anger, and mood swings. (Appendix 2 contains a list of symptoms for borderlines.) Borderlines also tend to think in very black-and-white ways (so-called “splitting”), so that people are either “all good” or “all bad.” (This may be why borderlines can be particularly attracted to cults because the cult leader is seen by members as all good.) Borderlines are also very manipulative—for example, acting as if they are weak and helpless, or using sexual seduction, or threatening suicide to get attention. In terms of the two major components of empathy (recognition and response), it may be that Type Bs have difficulties in both—they are certainly failing to react to others with an appropriate emotion, and they may also have difficulty reading intentions and emotions in faces accurately.

Among borderlines in clinics, 70 percent have attempted suicide even before arriving at the clinic, and on average borderline patients attempt suicide at least three times in their lives. For this reason, borderlines are said to have “the most lethal psychiatric disorder.”97-101 Distinguishing between those who “merely” threaten suicide to get attention (but have no intention of carrying it out) and those who actually plan to carry it out can be tricky. About 10 percent of borderlines actually commit suicide, whereas the other 90 percent just threaten or attempt it. Threatening to commit suicide is clearly not an empathic thing to do to another person. Whether the 10 percent who succeed actually meant to succeed is also unclear because it could just have been an attention-seeking impulse that went disastrously wrong. But it leaves others in a quandary: If your partner or relative threatens suicide, do you just dismiss the threat as attention-seeking and ignore it? Or do you allow yourself to get swept up into the panic and the emergency of the situation just in case this time he or she really means it?102

Borderlines rage at those they love. When people say it is a thin line between love and hate, in borderlines that thin line becomes infinitesimal! Despite all this rage, they describe themselves as “empty” inside. They will say quite openly that the empty feelings cause a terrible emotional pain and depression. And they will tell you that the impulsive behaviors (the drinking, drugs, self-mutilation, sexual promiscuity, binge eating, gambling, or suicide attempts) are all just to get some brief relief in a desperate attempt to feel something, anything, rather than feel the emptiness.

Borderlines also report that that feeling of emptiness leaves them with a lack of core identity. Life feels like an act, as if they are continually pretending to be someone else. And in the same way that deep down they don’t know who they are, they also find it difficult to figure out who other people are. It is as if the problem they have in thinking about themselves mirrors the problem they have in thinking about others as whole people. Instead, they focus either on the good parts of others or the bad parts, but they cannot seem to see another person as both good and bad. They can switch, even in minutes, from perceiving those they love as perfect or as evil. People are either idolized or devalued. This “splitting” is sometimes thought of as a Freudian defense mechanism, though others see it as a sign of a mind that thinks in a very binary way—no shades of gray.

Marilyn Monroe

A well-known borderline was Marilyn Monroe (born Norma Jeane Mortenson). Despite her glamorous outward appearance, a volcano simmered within her. Elton John wrote his famous song “Candle in the Wind” to describe her, which succinctly summarizes how impulsively changeable she was. Norma was born in 1926, and her parents divorced in 1928. She always claimed she didn’t know who her real father was. Norma’s mother, Gladys, because of her mental health, gave her child away for fostering to the Bolenders, where she lived until she was seven. Norma believed the Bolenders were her real parents until she was told the truth at this age. Gladys came back to have her daughter live with her, but when Norma was nine, Gladys was taken to a psychiatric hospital. Gladys’s friend Grace became the young girl’s guardian. Grace married a man named Ervin Goddard when Norma was still just nine years old, so the young Norma was sent to the Los Angeles Orphan Home and then to a series of foster homes. Two years later she went back to live with Grace but was sexually molested by Goddard.

Marilyn was married three times, first to neighbor James Dougherty in 1942 when she was sixteen. He agreed to marry her to avoid her being returned to the orphanage. The marriage lasted only three years. She remarried in 1954, to baseball player Joe DiMaggio, but this marriage lasted less than a year. Very soon after, in 1956, she married playwright Arthur Miller, who described her as follows: “She was a whirling light to me then, all paradox and enticing mystery, street-tough one moment, then lifted by a lyrical and poetic sensitivity that few retain past early adolescence.”103 Throughout her life she hated being alone and was terrified of being abandoned. In adulthood she was in and out of psychiatric clinics and attempted suicide at least three times. She finally succeeded in killing herself (overdosing on barbiturates) on August 5, 1962.

What Causes Type B?

But let’s return to our main objective here: to understand this form of zero degrees of empathy. As we saw in both Carol’s case and Marilyn’s life, borderlines cannot tolerate being alone. For them, aloneness feels like abandonment, and to avoid that awful feeling the person will seek out other people, even relationships with strangers. But whoever they are with, borderlines either feel suffocated (by someone getting close to them) or abandoned (by someone being distant from them). They cannot find a calm, middle ground in which to enjoy a relationship comfortably. Instead, they live in an unhealthy alternating sequence of pushing others away (with angry hate) or clinging desperately to them (with extreme gratitude).

Borderlines were first described by Adolf Stern in 1938, who saw the condition as a borderline between psychosis and neurosis (a mild form of schizophrenia). We now know borderline personality disorder is really very different from schizophrenia, but what is known about its cause?

Blame the Parents

One of the earliest child psychological theories of borderlines was object relations theory. This argued that, if parents don’t respect their child’s needs or abuse or neglect their child, the child will become borderline. Object relations theory stems from four important psychodynamic ideas.

The first is that of the “significant other” (typically a parent), who is the “object” of a child’s feelings and to whom the child looks to meet his or her needs. The second is Sigmund Freud’s notion of the stages of development that a child has to successfully negotiate to establish a healthy personality. The third is the Freudian principle of the importance of the earliest relationship influencing all later ones. The fourth idea (deriving from Hungarian-born New York psychoanalyst Margaret Mahler) is that typical infants start in an “autistic phase” of development, in which they feel fused with their mother and then later separate and individuate. During this “separation-individuation phase,” the child establishes a sense of self, which is crucial for later mental health. This process balances the healthy needs for autonomy and for closeness on the one hand, with the unhealthy fear of engulfment and abandonment on the other.

Otto Kernberg developed these ideas into an explanation of borderlines. He is a professor of psychiatry at Weill Cornell Medical College and director of the Personality Disorders Institute at the college. Born in 1928 in Vienna,aKernberg, like Mahler, believed infants start off in an autistic state and have to build their first relationship, out of which comes a concept of self. During the phase of separating and individuating, the typical child uses a defense mechanism known as splitting. Good experiences are split off from bad ones. For Kernberg, the natural process of development involves integrating these splits, which means accepting the self as comprising good and bad parts and accepting the parent as having both good and bad parts.

In Kernberg’s account, a child who gets stuck at the splitting stage and who never achieves that integration enters into a “dissociative” state and is destined to become borderline. It could be because the mother frequently pushed her child away or provided no closeness. Or the mother may have made it hard for the child to explore the world by clinging too much to her infant, so that the child feared he would be abandoned (if she let go) or engulfed (by holding him too much). Or a dissociate state could arise from more extreme deprivation or maltreatment, such as child abuse. The result is a child who never achieves a sense of being an emotionally secure adult. Being stuck with the split, the good experiences and the good image the child has of the parent can be amplified or exaggerated into idealization of the other and into something idealized and construct a grandiose view of oneself, while the bad experiences are quarentined into a cesspool of negative feelings (anger and hate). The result is an intense need for attachment, an intense fear of abandonment, and a conflict-ridden relationship with their mother.

The Role of Abuse and Neglect

So much for object relations theory. It is a clever theory because it makes sense of some central characteristics of borderlines, such as the black-and-white thinking style and the switching that can occur from extreme love to extreme hate. However, many of its predictions about parenting are quite subtle for scientists to measure. How much is too much—or how little is too little—when it comes to hugging your toddler? And it suffers, like many theories of its day, from a bias toward “mother-blaming” that neglects other potential environmental factors (including abusive fathers, stepparents, or other caregivers).

An easier way to test object relations theory is to examine clear-cut cases of child physical abuse (when children are identified as having been battered, for example), child sexual abuse, or child neglect (when children are identified as having been left alone for unusually long periods). When you look at children who have had such experiences and follow them up, there is plenty of evidence for a link with becoming borderline in adulthood. 104,105Common within families of children who later grow up to become borderline are incest, child abuse, violence, and alcoholism. Obviously, the link between child abuse and borderline is not total: Not all who are abused go on to become borderline, and not all those who are borderline were abused. In fact, 80 percent of those with a history of sexual abuse are not borderline.106-113 Nevertheless, the link is strong. Between 40 and 70 percent of borderlines report a history of sex abuse.108 Sixty to 80 percent of borderlines also had a history of physical abuse, early separation through divorce, or emotional neglect, indifference, deprivation, and rejection.114 Thus, there is plenty of evidence for early developmental trauma causing a person to lose empathy in this uniquely borderline way (though this is not a necessary and sufficient cause).

The Borderline Brain

Remarkably, despite the unstable behavior of Type Bs, scientists have managed to study their brains, which are definitely different in much of the empathy circuit. First, there is decreased binding of neurotransmitters to one of the serotonin receptors.b,115 Just as we might expect, these abnormalities occur in brain regions within the empathy circuit: the ventromedial prefrontal cortex (vMPFC), the middle cingulate cortex (MCC), and areas of temporal lobe, among other areas.115,116 Neuroimaging reveals abnormalities in the empathy circuit in the Type B brain as well, particularly underactivity in the orbital frontal cortex (OFC)/ vMPFC and in the temporal cortex. And when borderlines read a script about abandonment, there is less activity in empathy brain regions such as the amygdala, the vMPFC and the MCC, the inferior frontal gyrus (IFG), and the superior temporal sulcus (STS). Other studies have found increased amygdala activity on both sides of the brain during emotionally aversive slides. Similarly, while looking at emotional faces, borderlines show increased left amygdala activity.117-124 Finally, a recent study found that when Type B individuals played a “trust” game, they showed no signs of being able to maintain attempts or repair broken attempts to cooperate with other individuals. Neural markers related to cooperative and trusting gestures (the anterior insula [AI]), active in typical individuals, were completely absent in Type B individuals.125

A novel approach has been to follow up people who were abused as children and scan their brains. The approach is novel because it is prospective rather than retrospective: The emotional damage was done in childhood, and the scientific question is: What happened to their brain? Not all of them will turn out to be Type B, but a significant proportion will. Such people again have abnormalities in the empathy circuit, such as having a smaller amygdala. This is also true of women who were sexually abused, who later show less gray matter in their left medial temporal cortex compared to nonabused women. Smaller hippocampal volume is also found in people who experienced a trauma and went on to develop post-traumatic stress disorder (PTSD).126-132 One interpretation of all this evidence is that early negative experiences of abuse and neglect change how the brain turns out. But the key point is that the zero degrees of empathy in borderlines arises from abnormalities in the empathy circuit of the brain.

Zero-Negative Type P

Our next encounter with a form of zero degrees of empathy is the psychopath (or Type P). When we meet the psychopath, we see a person who shares that same total preoccupation with oneself as we saw in Type B. But in this case there is a willingness to do whatever it takes to satisfy their desires. This might take the form of a hair-trigger violent reaction to the smallest thing that thwarts the person. Or it might take the form of cold, calculated cruelty. Sometimes the mindless aggression is not triggered by a perceived threat but by a need to dominate, to get what one wants, a complete detachment from another person’s feelings, and possibly even some pleasure at seeing someone else suffer. (The Germans have a word for this pleasure: schadenfreude.)c

I think you’ll find it a small step to conceptualize Type P individuals as what some people call “evil,” but the questions we keep returning to in this book are whether this is the result of zero degrees of empathy, and if this is in turn the result of the empathy circuit not developing and functioning in the normal way. But first let’s look at the case of an actual psychopath.

Paul

Paul (not his real name) is twenty-eight years old and is currently detained in a secure prison after having been found guilty of murder. I was asked by his lawyer to conduct a diagnostic interview with Paul. Because of his violence, it could have been unsafe for him to come to our clinic, so I went to see him in prison. He told me how he had wound up in jail. He insisted he wasn’t guilty because the man he had stabbed had provoked him by looking at him from across the bar. Paul had gone over to the man and said, “Why were you staring at me?” The man had replied (I assume truthfully), “I wasn’t staring at you. I was simply looking around the bar.” Paul had felt incensed by the man’s answer, believing it to be disrespectful, and felt he needed to be taught a lesson. He picked up a beer bottle, smashed it on the table, and plunged the jagged end deep into the man’s face.

Like me, the attorney at Paul’s trial was shocked by the apparent lack of remorse and the self-righteousness of his plea of not guilty. In my questioning I probed further for some evidence of moral conscience. Paul was adamant that he had simply defended himself: “He humiliated me in public. I had to show him I wasn’t a doormat.”

I asked, “Do you believe you did anything wrong?”

Paul replied, “People have treated me like shit all my life. I’m not taking it from no one no more. If someone shows me disrespect, they deserve what they get.”

I probed further: “Are you sorry that he died?” I waited to hear Paul’s answer, holding my breath.

He replied with anger in his voice, “Were the kids at school sorry when they bullied me? Was my boss sorry when he fired me? Was my neighbor sorry when he deliberately hit my car? And you ask me if I’m sorry that that piece of shit died? Of course I’m not sorry. He had it coming to him. No one’s ever been sorry for how they’ve treated me. Why should I give a fuck about him?”

This wasn’t Paul’s first offense. He had been in prison six times since leaving school (at sixteen) for crimes that included shoplifting, drug dealing, rape, and violent assault. He left high school with no qualifications, and his career of criminal behavior had begun as young as thirteen when he had set fire to the school gym and sat in a tree from across a field to watch it burn. He was expelled and from there went to three more schools, each time being expelled for aggression—starting fights in the playground, attacking a teacher who asked him to be quiet, and even jumping on someone’s head when they wouldn’t let Paul onto the football team.

As a very young child, the warning signs had been there. At eight years old he was cruel to his cat, finding it amusing to tie a brick to her back leg and to film her trying to walk. For as long as his mother could remember, Paul had told lies, about both small things (saying he had done his homework when he hadn’t) and bigger things (saying he had gone to school when he hadn’t). Truanting led to staying out all night, even at twelve years old, without telling his parents or getting their permission.

Stepping Back from Paul

Paul is clearly not the kind of guy you want to live anywhere near. Many would not hesitate to describe him as “evil.” He is a psychopath—though to give him the proper diagnostic label, we should say he has antisocial personality disorder (see Appendix 2 for the list of symptoms required for this diagnosis). He earns this label because he shows “a pervasive pattern of disregard for and violation of the rights of others that begins in childhood or adolescence, and continues into adulthood.”134 Antisocial personality disorder is diagnosed if someone is older than eighteen and if they previously had a different diagnosis, conduct disorder, in childhood. In Paul’s case he clearly did. Not all cases of conduct disorder grow up into antisocial personality disorder, but many do (at least 40 percent).

In the general population, about 3 percent of males (but only 1 percent of females) have antisocial personality disorder. In prison samples, the rates are—perhaps unsurprisingly—much higher: About 50 percent of all male inmates and 25 percent of all female inmates would warrant this diagnosis.135 And some people with antisocial personality disorder—like Paul—are psychopaths.

Characteristics of Type P

The full name for Paul’s condition is psychopathic personality disorder or what I call Zero-Negative Type P. About 15 percent of prison samples are psychopaths and just less than 1 percent of males in the general population.136 The concept of the psychopath goes back to Hervey Cleckley’s 1941 book, The Mask of Sanity.137,d As its title suggests, Cleckley was concerned with how to recognize a psychopath if he or she were convincingly pretending to be normal. He argued that psychopaths exhibit these characteristics:

✵ superficial charm

✵ lack of anxiety or guilt

✵ undependability and dishonesty

✵ egocentricity

✵ inability to form lasting intimate relationships

✵ failure to learn from punishment

✵ poverty of emotions

✵ lack of insight into the impact of their behavior

✵ failure to plan ahead

Let’s look at the second of these characteristics a little more closely: lack of anxiety or guilt. To me, these two emotions are connected to Type P very differently. Clearly, someone who lacks guilt will be capable of doing bad things without worrying about how they themselves will feel later, let alone worrying about how someone else might feel. If you have empathy you will be capable of feeling guilt, whereas if you lack empathy, you won’t. This might make you think that guilt and empathy are one and the same thing. But this cannot be true because a person can feel guilt (e.g., that they went through a red traffic light) without necessarily feeling empathy. So empathy can give rise to guilt, but guilt is not proof of empathy. The relationship between anxiety and psychopathic behavior is also important because someone who lacks anxiety will be capable of doing bad things without worrying about being punished. But anxiety by itself is not part of empathy. It merely provides a rationale for why one person might not hurt another person.

Notice that several of the features in the preceding list also center on a lack of empathy: a lack of insight into the impact of his or her own behavior and egocentricity. As we saw in Chapter 2, intrinsic to poor empathy is lack of self-awareness, which is probably synonymous with “lack of insight” (a term of which psychiatrists are particularly fond). We can see the considerable overlap among these concepts. Take, for example, a person who hurts someone without meaning to (perhaps by saying the wrong thing). Here, the lack of insight is part and parcel of the lack of empathy. In terms of how willing we are to forgive an unempathic act, one might judge that if we hurt another person without realizing it, this is less bad than if we hurt someone else knowingly (i.e., in a “premeditated” way). From Cleckley’s definition, a psychopath might be capable of both kinds of unempathic acts. Lacking any guilt means one could hurt a person knowing they would indeed hurt, but lacking any insight into the impact of one’s behavior means that one also might hurt someone without realizing it.

Interestingly, Cleckley’s definition of a psychopath makes no mention of physical aggression or of breaking the law, which hints at how psychopaths may not come to the attention of the criminal justice system and may be at large in society. They may be the “snakes in suits” in any workplace.138 While this phrase has become somewhat clichéd, I know of no better way to convey the idea of how Type P might be camouflaged. Clearly, some psychopaths hurt others through physical aggression, but the breakthrough in Cleckley’s formulation was to extend this concept to those who are aggressive in more subtle, invisible ways. A milder form of Type P might be what is sometimes known as the “Machiavellian personality type,” or people who are what Richard Christie and Florence Geis call “high Machs:” individuals who use others for their own self-promotion. They will lie to get what they want.139

We saw that a major risk factor in becoming Type B is one’s experience of parental rejection in childhood. I want to dwell on this a bit longer, because how your mother (or father) treated you turns out to be very important, both for the development of healthy empathy and for the risk of becoming Zero-Negative Type P. Parental rejection can lead to a child growing up to become violent or a psychopath. It may not be the only factor, but it can be an important one. One reason that parental rejection might be linked to a child developing aggression in adulthood is that inside—emotionally—the child is quietly raging against the parental rejection and is developing high levels of hate. Such extreme, negative emotions are hard to regulate. The child has to vent their rage somewhere, and if as a child they were unable to express it toward the rejecting parent, it may build up—like steam in a pressure cooker—just waiting to be vented in adolescence and adulthood. The result can be explosive violence.

Parental rejection was famously studied by John Bowlby, a psychoanalyst and child psychiatrist at the Tavistock Clinic in London. It was here that he developed his remarkable attachment theory, which explored (on the negative side) the consequences of parental rejection and (on the positive side) the consequences of parental affection. I say remarkable because the theory made predictions that have been amply proved and are extremely important socially.

According to Bowlby, the infant uses the caregiver as a “secure base” from which to explore the world, feeling that when they move away from their parent, they can also return to him or her for “emotional refueling.” (The caregiver is often, but not necessarily, the child’s biological mother or father.) By giving praise, reassurance, and a feeling of safety, the caregiver’s affection helps the child manage his or her anxiety, develop self-confidence, and trust in the security of the relationship.

My paraphrase of Bowlby’s theory is this: What the caregiver gives their child in those first few critical years is like an internal pot of gold. The idea—which builds on Freud’s insight—is that what a parent can give his or her child by way of filling the child up with positive emotions is a gift more precious than anything material. That internal pot of gold is something the child can carry inside him or her throughout their life, even if they become a penniless refugee or a beset by other challenges. This internal pot of gold is what gives the individual the strength to deal with challenges, the ability to bounce back from setbacks, and the ability to show affection and enjoy intimacy with others, in other relationships.

Bringing this back to psychopaths (and other forms of antisocial personality disorder), if you trace backwards, such individuals typically have a higher rate of what Bowlby calls “insecure attachment.”141-143 Bowlby’s original study, published in 1944 and entitled Forty-Four Juvenile Thieves, was a careful look at adolescent delinquency. It was the impetus for his theory. What I find important in this work is that it argues that security of early attachment between an infant and his or her caregiver predicts not just how emotionally well-adjusted she turns out as an adult, but also predicts their moral development. (Moral development and empathy are not one and the same thing because it is possible to develop a strong moral code even in the absence of empathy. We will come back to this later.)

Bowlby’s forty-four thieves were—in his chilling words—“affectionless psychopaths.” They showed shallow relationships, having been in and out of children’s homes or institutions, forming superficial relationships with dozens—if not hundreds—of adults. In Bowlby’s view, deep, trusting relationships with just one or a small number of caregivers are vital. Such secure relationships promote both social development (popularity at school, good social skills, turn-taking, sharing) and language development (better communication). Even more, securely attached infants also later develop better empathy and “theory of mind” (being able to accurately infer others’ thoughts). Those with insecure attachments have a higher rate of social difficulties, including antisocial behavior, and, later in life, a higher risk of divorce in adulthood.

Bowlby studied psychology as part of medicine at my college (Trinity College) in Cambridge. He later forged close links with Cambridge ethologist Robert Hinde, who extended Harry Harlow’s seminal studies of monkeys reared without mothers to see the effects of maternal deprivation.144,145 This animal model—although ethically questionablee—has taught us a lot about how in social primates (whether humans or monkeys) a difficult attachment relationship increases the risk not only of a monkey developing aggression, mistakenly interpreting friendly approaches as aggressive, but also of a child growing up to become a parent who is harsh and abusive.

Now you can see why I describe Bowlby’s attachment theory as remarkable. It predicts transgenerational effects. Astonishingly, it also predicts effects outside the narrow realm of social development, in that securely attached infants grow up to become academically more successful at school. This may be because the internal pot of gold gives the child sufficient selfconfidence and self-esteem to have the courage to explore new areas of learning and to persist in the face of failure. It may also be that secure attachment makes the child a better mind reader, both of someone else’s and of their own mind, so that they can reflect on what they know and don’t know and therefore can learn how to learn. Following his important study of the forty-four thieves, Bowlby was commissioned by the World Health Organization in 1951 to write a report on Maternal Care and Mental Health,146 which transformed how we care for young children in both schools and hospitals, making such environments more child-friendly and parent-friendly.f What other psychological theory has had such far-reaching impact?147

Clearly insecure attachment is on a spectrum, and relevant to the development of a psychopath are the negative experiences at the most severe end that may accompany childhood separation, such as inconsistent parental discipline, parental alcoholism, lack of supervision, physical, sexual, or emotional abuse, or complete abandonment.148 The argument from the “internal pot of gold” is that insecure attachment of this more extreme form increases your risk of becoming Zero-Negative.149

My old friend Peter Fonagy is a professor of psychoanalysis at University College London and director of the Anna Freud Centre in Hampstead in London. He is one of those rare scientists who has taken interesting ideas from psychoanalysis and tried to test them empirically. He argues that during the attachment relationship the infant tries to “mentalize” the caregiver’s mind. The child’s relationship with his or her parents is the crucible for learning about other people. The child imagines not only what their mother is thinking or feeling about people and things in the immediate environment but also, more importantly, what their mother is thinking or feeling about them. Fonagy argues that the development of empathy proceeds well only if it is safe for the child to imagine another person’s thoughts and feelings.

But if, when you mentalize, you imagine that your mother hates you or wishes you didn’t exist, this could derail the development of empathy. It is certainly an interesting argument, and there is some evidence that fits the idea that parental behavior contributes to a child’s empathy. For example, parents who discipline their children by discussing the consequences of their actions produce children who have better moral development compared to children whose parents use authoritarian methods and punishment.150 And parents who use empathy to socialize their children also produce children who are less likely to commit offenses compared to the children of parents who use physical punishment.

The Psychopathic Mind

Moving from the early family environment, we can go a little deeper to probe what is going on within the mind of a psychopath. It will come as no surprise that on questionnaire measures of empathy, psychopaths score lower than others. This can be seen, for example, on the Interpersonal Reactivity Index.151 However, self-report is notoriously unreliable with psychopaths because they typically lie to hide their true nature. To avoid this, researchers have resorted to physiological measures of autonomic arousal—how stirred up you become when you hear or see emotional material.152,153 Typically, what is measured is galvanic skin response (GSR)—how much you sweat on the palms of your hands when shown emotionally charged material. GSR measures reveal that psychopaths have reduced autonomic responsiveness (they are less aroused) while looking at pictures of individuals in distress.

Psychopaths are also worse at naming fearful emotional expressions.154,155 This suggests that people who are Type P have difficulty with both of the two major components of empathy (recognition and response). Another clue that psychopaths are not processing emotional material in the normal way is that, whereas most people are faster to judge “is this a word?” when they are shown emotional words (relative to their speed at judging neutral words), psychopaths do not show a difference between emotional and neutral words. A method to measure how aroused an individual is by emotional material is to use event-related potentials (ERP). These show electrical activity in the brain measured by placing electrodes on the scalp. Psychopaths do not show the usual increase in brain activity over the central and parietal regions of the brain in response to emotion words.156,157 As we saw with Paul, one other difference in those who are aggressive is the tendency to interpret ambiguous situations as if the other person has a hostile intent. This has been found in children with conduct disorder, some of whom go on to become psychopaths, and is referred to as an “attributional bias,”158 a clear example of the cognitive aspect of empathy not working accurately.

One view of the psychopathic mind is that they are simply amoral. The classic test of morality was developed by Lawrence Kohlberg; in it you are asked to read a story and judge the morality of the story character’s action. The famous example is of a husband who breaks into a drugstore to steal an anticancer drug for his wife who is dying of cancer because the pharmacist refuses to sell the drug for less than $2,000 (even though it cost the pharmacist only $200 to make). You are asked to judge if the husband was wrong or not. The more complex your ability to reason about such moral dilemmas, the more advanced your moral reasoning is judged to be. If you can see that there are two sides to this argument, or that the context might change the rights and wrongs of an act, this is taken as a sign of a subtler mind than someone who simply reasons on the basis of rules. Contrary to what we might expect, psychopaths do not necessarily score lower on such tests.159 This may be because psychopaths can say one thing, even though in their day-to-day life they will do another.

Kohlberg’s method of measuring moral reasoning is not the only approach. On Elliot Turiel’s tests of moral reasoning, the stories describe not only moral transgressions (acts that violate human rights, such as hurting another person) but also conventional transgressions (acts that violate social conventions, such as talking in a library). You are asked to judge how bad an action was and whether it would still be wrong if there were no rule banning it. By four years old most children can tell the difference between these two types of transgressions and recognize that while you can change the rules for conventional transgressions so that the act is no longer a transgression (you can announce that in this particular library talking is allowed), if you modify the rule for a moral transgression (announcing it is now legal to hurt others), it doesn’t make an act any less bad than before. 160 Psychopaths have trouble with this kind of distinction, as do children with antisocial behavior.154,161

So this tells us that, as well as not showing emotional reactions to others’ distress in the normal way, psychopaths are also blunted in their moral development. But is this simply because psychopaths are less intelligent? There is a clear link among low IQ, low socioeconomic status (SES), and antisocial behavior. The link between low IQ and low SES could be because in poorer neighborhoods there is a greater likelihood of poorer education. But why should low IQ and low SES increase your risk of developing antisocial behavior? One reason could be because without educational qualifications or a job, crime may be a way to make a living. Low IQ may also make it harder for someone to imagine the consequences of getting caught. But the fact that intelligent psychopaths exist shows that low intelligence cannot explain everyone who becomes a psychopath, and the fact that empathic individuals with low IQ also exist proves that empathy and IQ must be independent.

Jeffrey Gray was a professor of psychology at London’s Institute of Psychiatry who I had the pleasure of working with in the early 1990s. He developed a model of anxiety he called the Behavioural Inhibition System (BIS, located in the septo-hippocampal brain network), the system that allows an animal to learn the emotional consequences (reward or punishment) of its actions.g It was a bold model when he put it forward in 1982,162 and it inspired Joseph Newman at the University of Wisconsin-Madison to argue that psychopaths have an underactive BIS, whereas anxious people have an overactive BIS. Newman’s interesting idea is that psychopaths basically have a problem in thinking about the consequences of their actions because damage to the BIS leads an animal to repeat behaviors that elicit punishment.

Newman argues this is the core problem in psychopaths—they do not learn to fear punishment. No wonder they do things that they know might get them into trouble. He argues this explains why psychopaths make errors on tasks where they have to learn which (otherwise neutral) numbers are rewarding and which ones are not, and why they fail to change their behavior even when an action is no longer rewarding and is leading to punishment.163 For example, given a deck of cards to play with in which each card leads to winning a reward, children with psychopathic traits continue playing even when the cards no longer lead to rewards.164 Nowadays we recognize that there are many “fear pathways” in the brain, and that the amygdala also plays a key role in the experience of fear. A problem for Newman’s account is that it emphasizes the importance of anxiety in how children are socialized, but many children are socialized not just through fear of punishment but also through discussion about how the other person feels (empathy).165

Nevertheless, the idea that psychopaths lack fear was an important insight. In his book The Mask of Sanity, Hervey Cleckley wrote, “Within himself he appears almost as incapable of anxiety as of profound remorse.”137 This appears to be true of the so-called callous subgroup,166 and behavioral geneticist David Lykken at the University of Minnesota tested this by using a “conditioning” experiment in which an electric shock was paired with the sound of a buzzer. “Normal” individuals developed “electrodermal fear” (sweating) when hearing the buzzer (that is, the buzzer had become a conditioned stimulus). In contrast, psychopaths showed less electrodermal fear to the buzzer—they did not acquire the “conditioned response” to the threat. They also showed less of a startle reflex (an automatic jump) to a loud sound or to an object looming toward them.153,167-169 All this suggests a very specific kind of learning difficulty involving a lower fear of punishment.

Clearly, Type P differs in important ways from Type B, but they share the core feature of being Zero-Negative. This core represents a shared end point in development. Crucially, their zero degrees of empathy can result in their doing cruel things to others. When we come to look at their brains, we should expect to see the same underlying empathy circuitry affected.

The Psychopathic Brain

Scientists have managed to persuade psychopaths to climb into the scanner, so that we can understand the neural basis of empathy and of its absence. Just as we might predict, abnormalities in the empathy circuit are seen: Aggressive people show less vMPFC activity,170 and the higher a person scores on the Psychopathy Checklist-Revised (PCL-R),h the less activity they show in the OFC/vMPFC and temporal regions.171 These are squarely in the empathy circuit. Furthermore, when scientists map out the connections between the vMPFC/OFC and the amygdala, they find the integrity of this tract is reduced in psychopaths, and this reduction predicts scores on the PCL-R.172Males on average are also much more prone to antisocial behavior. This sex difference is predominantly explained by sex differences in the size of the OFC. Males have a smaller OFC volume compared to females, and males exhibiting increasing antisocial behavior have even smaller OFC.173

One view of the psychopathic brain is that the primary problem is a problem in the frontal lobes because these are meant to provide “executive control” over action, stopping us from doing what could lead to punishment. But this is too simplistic an explanation neuroanatomically for several reasons. First, the frontal lobe takes up at least one-third of the brain, so as an explanation it is way too broad. Second, the frontal lobe can be segmented, and patients with damage in the OFC/vMPFC (but not in the dorsolateral segment) have increased levels of aggression. This shows the abnormality is occurring within the empathy circuitry in the frontal lobes, not in the whole of the frontal lobes. Recall that patients with damage in the vMPFC show reduced heart rate arousal to emotionally distressing stimuli and also continue to gamble on tasks even when they are no longer winning (or being rewarded).174,175 Recall also that Phineas Gage suffered damage to his entire OFC and vMPFC and began showing signs of callous, rude, irreverent, and disinhibited behavior. All of these are signals of difficulties in using emotions like embarrassment and guilt to regulate one’s own social behavior. 31,32,176 Patients with damage to the OFC/vMPFC show changes in their moral judgments. For example, they would judge it morally acceptable to be personally involved in killing one person in order to save the lives of five others (a judgment that most people would deem unacceptable).177 It turns out that such patients judge moral decisions in this way because they pay less attention to their own or other’s intentions. Thus, vMPFC lesion patients judged attempted acts to harm another person as more morally permissible than did a control group.178 In this way, as we saw earlier, patients with damage to this specific area of the prefrontal cortex resemble psychopaths.

For this reason, Antonio Damasio’s vMPFC somatic marker theory (which we encountered in Chapter 2) could explain Type P. This theory has a lot of plausibility, although it is surrounded by debate because individuals without “autonomic” arousal nevertheless perform normally on a classic gambling task.179,28 It may be that abnormalities in the vMPFC/OFC lead to aggressive antisocial behavior, but it may not necessarily be because these individuals have problems reading their own “somatic” states. Another problem is that, even though damage to the vMPFC can cause “reactive” aggression (the hair-trigger anger reaction), it typically does not cause “instrumental” aggression (the cold, calculated, premeditated type of cruelty). So as a model of the Type P brain, the somatic marker theory misses a key aspect of their behavior because psychopaths can show an increase in both kinds of aggression. In addition, patients with lesions in the vMPFC show less autonomic arousal to other emotional stimuli (such as images of nudity), whereas psychopaths tend to show this reduction only to threatening or distressing stimuli. This suggests the very particular form of zero degrees of empathy seen in psychopaths is not simply a problem with the vMPFC.

Adrian Raine and his colleagues looked at the brains of murderers (“pleading not guilty by reason of insanity”). They again found differences in the empathy circuit, the vMPFC, the amygdala, and the STS.180,181 Reduced activity in the OFC was also found in aggressive people in a novel study comparing people with different personality disorders.182

The evidence of the empathy circuit being involved in aggression gets additional support from a remarkable study by neuroscientist Jean Decety and colleagues at the University of Chicago of teenagers with conduct disorder who had all been involved in physical fights. As mentioned earlier, a proportion of these kids grow up to be Type P. In this study the teenagers either watched films in which someone got hurt accidently (e.g., something just happened to drop on their hand) or in which someone got hurt deliberately (e.g., someone got stepped on). The aggressive teenagers showed more activity in both the amygdala and the reward circuit (the ventral striatum) during the films showing deliberate infliction of pain on another person. Hypersensitivity of reward circuitry may be of key importance in antisocial behavior/Type P.183 The implication is that they actually enjoy seeing other people suffer. That German word schadenfreude (experiencing pleasure at someone else’s pain) that we mentioned earlier comes to mind.

The other difference in this study was that the aggressive teenagers did not show activity in parts of the empathy circuit such as the temporoparietal junction (TPJ), an area of the brain normally used in understanding intentions when making moral judgments,184-186 or in the AI and MCC (recall these are part of the pain matrix). And in Washington, working at the National Institutes of Health, James Blair has argued persuasively that in the psychopath the amygdala is not working normally. This claim is well supported by a neuroimaging study showing less amygdala activity in psychopaths while they are experiencing aversive conditioning.187 So we can say that the Type P brain shows lots of evidence of abnormalities in the empathy circuitry.

The Effects of Early Stress on the Empathy Circuit

But how do all these changes to the brain come about? Given the association between Type B and neglect and abuse in childhood, there is evidence that early stress affects how well the hippocampus functions and how active the neural systems are that respond to threat.188 Stress can also affect the hormonal response to threat. Prolonged exposure to stress isn’t good for your brain. The amygdala is one of the brain regions that respond to stress or threat.189When it does, it triggers the hypothalamus to trigger the pituitary gland to release a hormone called ACTH (adrenocorticotropic hormone). This is then carried by the blood from the brain down to the adrenal gland, where it triggers the release of another hormone, cortisol.

Cortisol is often called the “stress hormone” because it is a good indicator of when an animal is under stress. There are receptors for cortisol in the hippocampus that allow the animal to regulate the stress response. Remarkably, too much stress can damage and shrink the hippocampus irreversibly.190,191 Stress can also cause “arborization” in one part of the amygdala (the basolateral nucleus) in which nerve cells start branching more than normal—becoming overreactive.192

This is very relevant to what we earlier called “reactive aggression” seen in both humans and other animals. This aggression is part of the “fight-or-flight” self-defense system. A small threat usually leads an animal to freeze in order to avoid getting any closer to the threat and to take stock of what to do next. Freezing can also minimize an attack if the aggressor is responsive to your movement or is looking for a sign that you are submissive. If the threat gets a bit closer, this typically leads to “escape” behavior. A bigger and closer threat, where escape is not an option, typically leads an animal to show reactive aggression.

The signal to show reactive aggression comes both from the amygdala (because this region in the empathy circuit is highly active during the experience of fear) and from areas of the frontal cortex which can either put the brakes on, to enable self-regulation and inhibition, or release the brakes to launch an attack against the perceived threat. So reactive aggression could be overreactive because your amygdala is overactive (e.g., because of depression and anxiety, or due to prolonged exposure to early stress, or for genetic reasons) and/or if your prefrontal cortex is underactive (such that a person cannot inhibit reactive aggression). 193-195 Once again, we see that abnormalities in key regions in the empathy circuit can produce reduced or even zero degrees of empathy.

James Blair has put forward an alternative model of what causes a person to become Type P. He worked at the MRC Cognitive Development Unit in London, where I also did my early research. During his PhD studies the young Blair enthusiastically went to meet psychopaths who were locked up in maximumsecurity prisons such as Broadmoor. He developed a model that he called the Violence Inhibition Mechanism (VIM). Sounds relevant? He argued that when we (and this is true in many other animals too) see the distress of a conspecific (a member of the same species), we have an automatic reaction to reduce the other person/animal’s distress.

Blair sees the VIM as a system that is automatically activated whenever you see sad or distressed facial expressions in others or hear these emotions in their voice. It tells you “someone is upset” and leads to increased autonomic arousal (your heart starts beating faster, and you start sweating more) and activation of the threat system in the brain, causing you to freeze. In other words, in the face of someone else’s distress, you inhibit what you are doing. Presumably, this is highly adaptive in preventing one animal from inflicting violence on another. All they have to do is cry out or wince in pain for you to stop whatever you were doing, and this would include any actions of yours that might be causing their pain. According to Blair, psychopaths have an underactive VIM.

Some evidence to support this is that psychopaths have reduced autonomic arousal to the distress of others.152 However, the VIM model can’t easily account for the results showing that psychopaths continue to play card gambling games even when they are no longer rewarding—because in these games there are presumably no distress cues. Nor can his model readily explain why affectionate parenting (of the kind Bowlby argued promoted secure attachment) also leads to better socialization because in the lives of such children there are presumably few, if any, cues of distress.

So there is more than ample evidence that in Type P there are abnormalities in the empathy circuit of the brain. This is one more piece of evidence for the argument that instead of using the term “evil,” we should talk about reduced (or even absent) empathy. But there is just one more Zero-Negative type we have yet to meet, if you are still willing to pursue this journey with me: Type N (or the narcissist).

Zero-Negative Type N

James is sixty-four years old. Like Carol, James also came to our diagnostic clinic. He feels angry at the world. He feels that he has done only good things all his life and that others have not reciprocated. As a result, he feels he has been badly treated by society.

“I have tried to live a good life, always helping others, supporting my family, visiting sick friends and relatives in the hospital, helping others. And guess what? Other people are shits. They don’t bother helping me. They don’t visit, they don’t call, they even cross the road when they see me coming. I eat alone every day. You wouldn’t treat a dog the way people treat me. I’m entitled to friendship just like everyone else, so why do they offer it to others and not to me?”

The key notion here is “entitlement.” James feels he has an automatic right to be treated well, regardless of how he treats others. When you talk to James, it becomes apparent after a few minutes that all he talks about is himself and his family, his needs and his desires. If you believed his account, his children are more talented than anyone else’s, he is superior to other people, he is more attractive than anyone else, and in his mind his social status is above that of others. It’s as if nothing or no one of any importance exists outside of himself and his children. He is oblivious to how other people listening to him might feel. It is as if they are there to be his audience, listening to how great he is, and their role is to agree with him and admire him. When people murmur politely, he takes this as confirmation of his own specialness, and he is elated for a while. But soon his mood plummets, and he reverts to sounding depressed, negative, and complaining. If you ask James why he is so negative, he replies, “People should treat me better. Since my wife died I live alone. No one bothers to cook for me, phone me, or even knock on my door. It’s as if I’m some kind of social leper. Anyone would think I had some kind of disease.”

When James goes to a restaurant, he demands the best table. He assumes he can go straight to the front of the line, and he becomes abusive to the waiter when his food does not arrive quickly. If he goes to the doctor’s office, he harasses the receptionist, demanding to be seen before other patients. “If I don’t see the doctor immediately, I’m putting in a complaint!” When he phones for someone to fix an appliance at home, he demands the repairperson comes immediately. He constantly complains his children are bad because they don’t phone him or visit him enough. When they do, he verbally abuses them, telling them they are selfish for not giving him any attention. They know that however much attention they give him, his needs are so great that whatever they do is never enough. When he feels important, for example, when he flies business class, he temporarily feels elated. When he feels people aren’t giving him enough attention if, for example, he is seated at the end of a table during a family gathering, he feels badly treated and will look angry and critical. He has no idea that his behavior only drives others farther away, and when they avoid him, he takes this as confirmation that they are bad people, that the problem is with them rather than him.

If he meets people who are in a position of influence and could help him, he turns on his charm and is fun and humorous, storing up information on how they might be of value to him in the future. But if they cannot give him anything he needs, they suddenly become unimportant. “They are of no value to me,” he says. He is unaware of how this reflects his pattern of using people shamelessly, taking as much as he can from them, and discarding them when they are no longer of any use to him. When he goes to the local church community center and people ask him how he is, he vents his criticisms: Nothing works properly, people have let him down, and services are poor. His diatribe is so negative that it leaves some people wanting to walk away. He has no idea what others might find rude, and he often makes offensive remarks. In answer to the question “How are you?” he often replies sarcastically, “Thanks for the invitation to dinner,” leaving the questioner in an awkward silence. If people ask James what he has been doing, he usually mentions he is writing his autobiography, which he alone thinks is interesting. If women show an interest in him, he is instantly flirtatious. As soon as they turn their attention away, or express an alternative view to his, he denigrates and criticizes them.

Stepping Back from James

Narcissists (Type N) are recognizably different from the psychopaths (Type P) and borderlines (Type B) we met earlier. In one way their zero degrees of empathy renders them deeply self-centered, and even though they may say and do things that offend others, they may not commit cruel acts. Rather, in the absence of any humility, narcissists think they are much better than other people, as if they have special gifts that others lack. Indeed, the continuous boastfulness and self-promotion are partly what others find offensive, not because they are jealous, but because they see these as indicators of the narcissist’s total self-preoccupation. Narcissists, like the other Zero-Negative forms, fail to recognize the importance of relationships being two way. For those who have zero degrees of empathy, relationships are not really relationships because they are one way. This is even evident in how much narcissists talk. There is no attempt to make space in the conversation for the other person or to find out about the other person. Narcissists simply lecture, holding forth about him or herself, and they decide when to end the conversation. They have monologues, not dialogues.

Some psychodynamic thinkers regard a modicum of narcissism as necessary, normative, and healthy, the opposite being someone who does not like themselves.196,197 This implies narcissism lies on a spectrum of traits and becomes “pathological” only in the extreme case of someone who cares only about him or herself and cares about others only if they are useful to him or her. Expressed differently, other people are exploited for their use to the narcissist. In that sense they are being used as objects (in the jargon, as “self-objects”).

Narcissism can take different forms in different people. (See Appendix 2 for the list of diagnostic symptoms.) Some are very outgoing, wanting to steal center stage, being the boss of a company or the leader of a group. Others appear socially withdrawn as if shy, but they still have a sense of entitlement, expecting others to come to them rather than expecting to meet others half way, and angry that others are not doing more for them. Yet other types of narcissists may become dangerous, and this personality type has sometimes been thought to underlie the serial killer.198

Narcissists are about 1 percent of the general population, though they are much more common (up to 16 percent) among those attending clinics for mental health issues. Unlike Type B, at least 50 to 75 percent are male. Like Types P and B, early emotional abuse has been suggested as a possible cause of Type N, again reminding us of the importance of that internal pot of gold. But unlike the other Zero-Negative types, it is speculated that Type N may also derive from excessive admiration, excessive praise for their good looks or talents, overindulgence, and being over-valued in the absence of realistic feedback (by parents). By comparison to Type P or B, there is very little research into Type N, a gap that needs to be filled. My own view is that of these three forms of Zero-Negative, Type N may be no less easy for others but may be less likely to commit acts of cruelty. This is, however, precisely the kind of question we need more information about though.

Psychiatry groups these three ways of becoming Zero-Negative under the heading of “personality disorders,” which they all are. But for me the blindingly obvious characteristic they all share is zero degrees of empathy. My prediction was that they should all show abnormalities in the empathy circuitry in the brain. What we have seen is that, regardless of whether the loss leads to Type B or Type P, the same neural circuitry is affected. We can predict similar abnormalities in the empathy circuit in Type N will be found, though these studies have yet to be done. All this is building a more complete picture of empathy and how someone becomes Zero-Negative.

This raises the question as to why one individual is Type P and another is Type B or Type N. Here we must assume the routes to the common end point are different, either in terms of different genes or different environmental factors, or both. We return to this in Chapter 5.

The distinction between transient or permanent underactivity of the empathy circuit echoes the distinction in personality psychology of “states” versus “traits.” States are fluctuations in a psychological or neural system, induced by a particular context, and they are reversible. We all know the kinds of short-term states we can enter that can compromise our empathy. These include being drunk, tired, impatient, or stressed, during which we might say or do the wrong thing to someone else and later regret it. The feeling of regret is a sign of our empathy circuit coming back on, but the fact that we say or do the wrong thing is nevertheless—at that moment—a fluctuation in our empathy circuit. In contrast, traits are permanent, crystallized configurations of a psychological or neural system, enduring across different contexts, and they are irreversible.

In personality psychology, clusters of traits constitute personality types (such as introverts or extroverts), and Types B, P, and N are clear examples of “personality disorders.” In this chapter I have recast the traditional concept of personality disorders as examples of permanent underactivity of the empathy circuit. It is impossible to establish if permanent really means permanent because to test this would entail following individuals throughout their lives. Traits could instead be thought of as longer term and certainly more long lasting than short-term changes in states.

But we have spent more than enough time probing the negative forms of zero degrees of empathy. Now I want to turn to the question of whether all forms of zero degrees of empathy are necessarily negative and to the controversial idea that there is at least one way in which zero degrees can be positive.