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James Fallon, The Psychopath Inside, A Neuroscientist's Personal Journey into the Dark Side of the Brain. H. H. A. Cooper

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Former President of Nuevevidas International, Inc., New Orleans, Louisiana Published online: 09 Oct 2014.

Click for updates To cite this article: H. H. A. Cooper (2014) James Fallon, The Psychopath Inside, A Neuroscientist's Personal Journey into the Dark Side of the Brain., Journal of Applied Security Research, 9:4, 517-526, DOI: 10.1080/19361610.2014.942830 To link to this article: http://dx.doi.org/10.1080/19361610.2014.942830

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Journal of Applied Security Research, 9:517–526, 2014 Copyright © Taylor & Francis Group, LLC ISSN: 1936-1610 print / 1936-1629 online DOI: 10.1080/19361610.2014.942830

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James Fallon, The Psychopath Inside, A Neuroscientist’s Personal Journey into the Dark Side of the Brain. New York, NY: Current (Penguin Group) (2013). 227 pages, plus 2 acknowledgements, 6 bibliography, $27.95 (hardcover). This is a curious, disturbing, provocative book. Although it is hardly to be regarded as an authoritative text on its principal line of enquiry, it contains many engaging observations on topics of interest to professional readers of this journal. The author, a recognized neuroscientist, is something of a polymath, who has engaged his many talents in a variety of fields, from bartending to truck driving to neuroscience. The book has an unusual genesis. Besides the range of his professional interests, Dr. Fallon seems to be something of a multitasker. While engaged in studying the brain scans of murderers for one project, he was at the same time frame engaged in a blind review of his family’s scans as a normal control group for an Alzheimer’s study, and his own scan, the last in the group, was included. The last scan was distinctively abnormal, registering the characteristics of the brain of a psychopath. Dr. Fallon writes, When I found out who the scan belonged to, I had to believe there was a mistake. In a fit of pique, I asked the technician to check the scanner and all the notes from the other imaging and database technicians. But there had been no mistake. The scan was mine. (pp. 2–3)

This is not stated unkindly, but readers of this book well versed in the literature on the controversial topic of psychopathy will, as they proceed through the personal disclosures in this text, assuming them to be reasonably truthful, something that should never be taken for granted in the case of any person registering psychopathic tendencies, would find abundant material to support a diagnosis of psychopathy. Not “psychopathy lite,” the author’s own characterization, to soften the blow. It is this reviewer’s contention, with more than 50 years of study of this disorder, that it is in the nature of a constitutional condition that does not admit of degrees. You can no more be a little bit of a psychopath than you can be a little bit pregnant: you either are or you are not. It is only in the consequences that their severity, from a forensic perspective, come into consideration, namely, what a particular psychopath does or does not do, his or her potential for harm. That potential for harm, “dangerousness,” is as controversial in terms of definition as opposed to mere description as the word psychopathy itself. That is a controversy well outside the scope of Dr. Fallon’s treatment in this 517

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book. What he tells of himself is very revealing and what he does not tell, one might fairly speculate, is possibly more revealing. Psychopath, a term as abused as terrorist, is not a label worn with pride—even one might aver by those forensically so adjudged. It is thus understandable why Dr. Fallon should have wished to diminish, as he does, the significance of his discovery. He writes: “Many people wear masks so that they can just get on with life and be liked, accepted, and loved. Few want to be shunned by society.” Dr. Fallon need hardly be concerned by this, nor does he seem to be. He made assiduous attempts following his biological discovery to find out what friends and acquaintances really thought of him before and after he “came out.” He became, as a scientist, especially interested in the way he connected with people, (pp. 150–151) and was obviously disconcerted by the results. A 50 page report he commissioned, substantially of what had been revealed to him informally (pp. 180–181), though hardly flattering, was not radically different from the professional perspective (pp. 181–184). His observations at p. 184 are telling: “I didn’t disagree with the findings but laughed off the negative aspects, as I do with everything.” The real significance of this book lies in its forensic implications. Psychopathy finds no place in the Diagnostic and Statistical Manual of Mental Disorders in any of its iterations as a mental disease, much to the chagrin of Big Pharma. The emphasis psychiatrically has always been on diagnosis, not treatment. There has been a tendency, among practitioners, especially those in the field of penology, to regard psychopathy as something of a self-limiting condition, like influenza or the common cold. There existed a belief at least among some that it was possible to envisage a “growing out of it,” at least with regard to its most dangerous potential; ages 15 to 45 were often regarded as beginning and end points. This book offers a number of useful corrections to that position both from the biologic standpoint and the personal correlations provided by the author in his own case. The most significant characteristics seem to have become more pronounced even as Dr. Fallon has made and announced his unwelcome discovery. This bears out other significant instances such as the Kansas cases of Robinson and BTK, Dennis Rader, two psychopathic serial killers, poster persons for the condition. Clearly, however unconcernedly he might pose, Dr. Fallon is understandably troubled, at probably a deeper level by what people might think about him, and particularly the validity of his work, since his disclosures, in the restricted ambit of their relevance. Worth citing in full, here is what he writes as he widens the impact to a larger audience: None of the psychological tests I took prior to 2006 addressed the issue of psychopathy directly. And since there is no formal definition of a psychopath, no formal test was going to be able to determine whether I was one. In retrospect, however, the assessments did point out several traits that are common to psychopaths—grandiosity, narcissism,

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ego-centricity, thrill-seeking, dependency, a potential for poor selfassessment, and superficiality in relationships—a point I had never considered in the context of psychopathy. These somewhat egotistical, blowhard, devil-may-care traits were of no real matter to me because I wasn’t anti-social. (p. 194)

It surely all depends on how one defines “anti-social.” What he writes on p. 207, whether completely honest or not, is most revealing, especially the throw-away observation on the antecedent “. . . because I like getting away with it.” Forensically, the real significance of psychopathy lies, despite the heroic efforts of a few great defense lawyers, in the fact that it finds no place in the law of insanity as an excuse for criminal conduct. From McNaughton onwards, psychopathy has been ruled out as such a disease of the mind that the actor could be said not to know what he or she was doing or that it was wrong. However horrendous the crime, commonsense (a supposed petit jury quality) tells us that the psychopath knew very well what he or she was doing; you cannot dump your pregnant wife of nearly 9 months in the cold waters of San Francisco Bay and plead that you just thought she might enjoy the swim. The problem is only complicated by knowing the controversial socially mediated distinction between what is right and what is wrong. There is the real issue for the clever advocate. The psychopath hews fiercely to his or her own notion of what is right and what is wrong. This is what is meant by antisocial behavior rather than by any measure of the degree of the consequences. This is the point on which Dr. Fallon is experiencing his considerable difficulties in ameliorating the effects of his disclosures. His real contribution in this book is when he confines himself to the implications of his own specialty, namely the structure and workings of the brain. To this end, Chapter 3: The Brain of a Killer, should command the special attention of the readers of this journal who are professionally concerned with psychiatry and its place in the pantheon of excuses or rationales for criminal behavior, especially in cases of homicide. This is really quite a technical exposition and it needs to be read very carefully by those unfamiliar with the neuroscience terms so familiar to scientists in this field. This is but a small challenge for lawyers who must, if they are able to practice at all, familiarize themselves in-depth with the jargon of other disciplines. Dr. Fallon writes:

One day in 1995, my colleague in psychiatry Anthony rang me up and said, “Hey, Jim, I’ve got a job for you. These lawyers I’m consulting have a guy who murdered some people, and we did a scan to see if there was something wrong with his brain. Could you take a look and tell us what you see.” I said sure and reviewed his PET scan. (pp. 43–44)

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No review can do, in summary, justice to the substance of this chapter and the interested reader will need, as recommended here, to read it most carefully for it is really the heart of the book and its most substantive value. It would be impertinent of this reviewer to comment on its accuracy; only another neuroscientist could be expected to do that. But it is nevertheless comprehensible as written to the nonspecialist and is replete with useful illustrations. What Dr. Fallon saw from his intensive studies of the brains of criminals he studied over a decade were patterns associated with certain parts of the brain that were abnormal in the cases referred to him by concerned members of the legal profession. He writes of the excitement in his discoveries, : “When a neuroanatomist sees a pattern, he goes crazy. I could have been studying butterflies and I still would have gotten excited. Patterns are where we get our baggage. And that’s when I really became interested in psychopathy” (p. 58). It is here that the true genesis of the enquiry in this book begins to take hold. At p. 64, we find: My first reaction: “you’ve got to be kidding me” It blew me away. Then I just laughed. I said to myself, “Oh, I get the joke.” If you were asked over the years to look at killers brains and found a pattern to them, and then found out you had the same pattern, that’s funny. If I’d thought for a moment that I really was a psychopath, I may have reacted more soberly. But I didn’t.

Here, a serious defect of reasoning reveals itself, one which like a powerful undercurrent runs throughout this otherwise well-reasoned work and which distorts its value as a truly useful treatise on the subject of the workings of the psychopathic mind. There are those who are unquestionably diagnosed as psychopaths, who have never killed another human being nor for a valid variety of reasons have ever seriously entertained a thought of doing so. There are, too, those who have killed and are not, on other grounds, susceptible of being diagnosed as psychopathic. Killing is simply not a necessary element in the definition of psychopathy. It is largely, if not solely, on the absence of this element in Dr. Fallon’s life trajectory, so far, that he relies for mitigation of the inevitable conclusion that certain aspects of his brain would cause him to fit the pattern he was so excited to discover. As the next chapter begins, he writes: Although I wasn’t worried I was a psychopath, the revelation that my own scan fit perfectly with the pattern of the scans of the psychopathic killers did give me reason to pause. I’d been so sure I’d discovered something profound that would help us better understand what makes a psychopath a psychopath, but the disconnect between my brain pattern and my behavior might imply that my theory of the psychopath brain was wrong or, at the very least, incomplete.

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At p. 11, Dr. Fallon offers a professional caution to which he himself should have paid greater attention: “Despite advances in our understanding of how the brain works, the organ is still largely a mystery to us.” Chapter 4 on Bloodlines is clearly intended to supply the missing element that might supply a rational answer to the seeming anomaly suggested by the absence of the homicidal instinct. It must be stated here as a caution that much of what is written by Dr. Fallon of his ancestry hardly rises to the level of serious scientific debate, but it is necessary to introduce his theory of genetics. It does somewhat to the professional critic detract from an otherwise reasoned thesis; Dr. Fallon claims Lizzie Borden as something of a cousin, but even her worst detractors would hardly have called her a psychopath. At most she is said to have perhaps acted in a state of temporal epilepsy (see the connectivity with psychopathy suggested on p. 184). Otherwise, the genetic argument deserves to be taken seriously. This is especially the case with what the author calls the “Warrior gene,” which forms one leg of his “three-legged stool” thesis. (See, in particular, the deduction at p. 106.) The “Warrior gene” theory, as related to psychopathy, would require a great deal of specialized examination for any kind of responsible acceptance in a forensic setting. What is difficult to overcome in many familial situations is how certain members may embark upon a career of violent crime, while others show not the slightest inclination to do so. See, for example, Gary Gilmore and his brother Mikal. Gary, like Ted Bundy, was a poster boy for psychopathy. Chapter 6 offers another interesting technical discussion design to expand and explain some of the earlier seeming genetic contradictions that again appear to be necessary as a kind of apologia for explaining away the anomaly in his own case—that is, he fits the pattern, but something is missing, what is it? This chapter is rather like Dr. Fallon taking on a serious discussion with himself and not being wholly satisfied with the outcome.

Of particular relevance to our story here is that both the central orbital/amygdala circuits in the dualistic circuit on the bottom, and the midline circuit above, are underactive in psychopaths. This is clear in psychopath brains in general and in my own brain. (p. 125)

Chapter 6 concludes on a very interesting note. It is really the only time Dr. Fallon enters into a serious consideration of the forensic implications of his work: “In 2011, I did another Discovery Channel show, an episode of curiosity titled ‘How Evil are you?’ For this show Ed Roth asked me to scan his brain and test his genes, but didn’t tell me why” (p. 128). Dr. Fallon goes on to explain what he did and how he did it, together with its impact on the subject of the experiment, Roth. He concludes,

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I got a buzz out of that show, predicting Ed’s behavior. In some cases you can really nail down what someone’s thinking and what’s driving him in different circumstances. But this could be dangerous in a courtroom. Going from a useful clinical tool and a nice parlor game to determining someone’s life or death, that’s a big jump. I’ve consulted on cases during the penalty phases, but using this stuff when deciding guilt would be jumping the gun. I have nothing against it ethically, but scientifically we’re not ready. For instance, Ed’s got a wild brain, but he’s not a criminal. He’s just a talented and different sort of guy. Sounds like someone I know. Or, maybe if I get it wrong I’ll be irrevocably blamed and my reputation will go down the drain. This is rather like providing evidence without the fear and inconvenience of having to be cross examined on it. (pp. 128–129)

Chapter 7, Love and Other Abstractions, is a mixed bag of recollections and musings, much of which is not directly on the point for the serious student of psychopathy. Indeed, this chapter has almost an hiatus quality about it—except for the telling of one event which, for psychopathy and its relation to the peculiar brain pattern of Dr. Fallon, has greater significance than almost anything else of a personal nature recounted in the book. Love, like charm is easier to describe than to define. It is often more noticeable in its absence than when it is, supposedly, present. Both can so easily be confused by their counterfeit cousins. Dr. Fallon has a difficult time finding suitable points of reference for his own feelings in this murky area. He is more evocative in his descriptions of his other less favorable psychopathic emanations. Yet challenged, he would probably insist that he has known much love throughout his life and, shallow and superficial though he would be to admit to it, he would claim he has given his share in return. Is this but the manifest action of a now familiar defense mechanism, “I can’t really be a psychopath, I love and I am appropriately empathetic”? But to the telling issue. Recall this is no curious ignoramus, but a neuroanatomical scientist who has taught medical students and is not wholly unlearned in the ways of the law. He may not have engaged the critical niceties of mens rea, but, from his writings, he must surely have an adequate sense of the distinction between malice aforethought and the grossest of negligence. The troubling matter is somewhat innocently recounted on pp. 154–158. The introduction at least merits recounting in his own words. In that first year of my sabbatical, two physicians at the Nairobi hospital told me about a man who, in 1989, had been brought in from a remote mountain site, bleeding from most of his bodily orifices. Within a week he was dead. It was quickly determined that he had visited the Kitum Caves in Mount Elgon in the west of Kenya near the Ugandan border. I recognized the name of the caves for thousands of years matriarch elephants led the herd deep inside them under the cover of darkness to

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scrape at the walls to get at the salts and other minerals they need to thrive. This is a place I had always wanted to visit, but the story put a bit of caution into me. The man had contracted Marburg hemorrhagic fever, caused by the Marburg virus, a close cousin of the Ebola virus with similar deadly results. There are daredevils and risk-takers of all kinds. That is why we have extreme sports. One can only marvel, or stand aghast at one who crosses Niagara Falls on a tightrope, but should he invite a companion to ride along on his shoulder, at least there is no deceit, no concealment of the risk involved. When my brother visited me that December, we went on a safari to the west and northern sectors of Kenya. I decided to finally visit the Kitum Caves. I wanted the sense of danger, but told Tom only about the elephants.

As written, whatever the motivation, this can only be seen as a deliberate deception. But there is more to come lest some enterprising advocate should feel able with Darrow-like eloquence to put a benign coloring on this. Fallon writes, “We reached the only place we could make camp. I did not want to tell my brother that this was the same small campsite clearing the ill-fated man had stayed at just a few weeks before he died.” It is material to recall that at this time, Dr. Fallon was no thrill-seeking juvenile nor a bored, restless graduate student. He was already 43 years of age at the time. Whatever the peculiar motive ascribed to the act might have been, the intentionality accompanying the act, the mens rea is unmistakably clear. Had he survived and his brother died of the incredibly cruel Marburg fever, there would have been few prosecutors doubtful of the propriety of seeking an indictment for murder. The tale concludes with a poignant coda. Two years later, back in the safer arms and approved odors of Orange County, I received a rather animated call from Tom. Apparently someone had given him a copy of Richard Preston’s New Yorker article “Crises in the Hot Zone” and the 1996 book The Hot Zone (later adapted into the film Outbreak starring Dustin Hoffman) and he was furious. He had correctly guessed that I purposely had taken him on the exact trail from the campsite to the caves where the man had contracted Marburg and died. Suffice it to say, he was livid at me for putting him in harm’s way. “It was a great experience”; he told me, “but I can’t forgive you for bringing me to that place.”

Lest our author only advocate that this was a unique, irresistible adventure, a once-in-a-lifetime chance to realize a long harbored desire, let us close this with his own words. This was not the first or the last time I would put the lives of people close to me in danger. Had Lizzie Borden actually done that which was imputed to her (and of which she was acquitted by the good people of Fall River, MA) she could at least have been said, even on the worst

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view, to have had a rational motive, albeit sudden, in defense of what she conceived to be her own interests.

All Dr. Fallon can offer is a plea of mitigation:

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“I do good work, I give a lot to charity.” Moreover, “There are others who have cared more about larger causes than the people next to them.” “So, am I a psychopath? The categorical answer is no. But a better answer is that I’m a pro social psychopath.” (p. 225)

This really does little more than confuse further an already confusing issue. In Chapter 9, A Party in My Brain, Dr. Fallon thought he had found a scientific route out of that awkward confusion. There was no hiding his tell-tale brain scan. It was already, by his own doing, out in plain sight. It was available for any competent professional to interpret. That was the biological fact of such inconvenience. But, he also exhibited many of the cardinal characteristics of the psychopath on the PCL-R of Dr. Robert Hare. Characteristically, he went into denial. Then he was invited to Oslo, Norway to present a paper on depression before a very distinguished gathering of mental health professionals. And, there, mirabile dictu—a solution of the most unexpected kind presented itself. The brain scan still could not be explained away, but now there was no urgent need for it to be so. Thanks to the prestigious attendees at the conference, he discovered that he was suffering from a different mental illness altogether, one which offered a plausible explanation for all those inconvenient and embarrassing psychopathic traits that accompanied his unpleasant discovery about his own brain. In his own words, “The revelation that I may have had bipolar disorder most of my life without realizing it floored me.” The rest of this chapter is largely devoted to an exposition of bipolar disorders and what this revelation meant for him personally and professionally. Again, it is accompanied by useful, cogently explained illustrations. For those interested, Dr. Fallon gives the National Institutes of Health definition of bipolar disorders at p. 177. The impact of this discovery on Dr. Fallon is set down on the preceding page: “In the six years of personal discovery I had experienced since my brain scan, this was the first time I was really stunned. I realized I had never had a clue about the deeper ground waters that had shaped me” (p. 176). Dr. Fallon waxes exultant about this discovery, “. . . who in their right mind would ever want to cure hypomania? It feels great, even if one does appear to be, as an eloquent neurologist friend put it, ‘a fart on a skillet’—volatile and unpredictable!” (p. 179). A mental health professional might find something rather strange about this, but as a way out of a most inconvenient professional dilemma it offered greater relief and coping possibilities than simple denial. What Dr. Fallon does most usefully introduce as a necessary part of his explanation is something of considerable importance from a forensic

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perspective that may be somewhat unfamiliar to many defense attorneys. Psychopathy offers no defense in the insanity spectrum and its very introduction in a death penalty case may aggravate the condition of the accused rather than ameliorate it. Here, Dr. Fallon opens up an interesting possibility: Psychiatric conditions often carry with them a phenomenon called comorbidity. This refers to the presence of other disorders in addition to the primary one in question. So a patient diagnosed, for example, with bipolar disorder or schizophrenia will often have other diagnoses, too, such as borderline personality disorder. I don’t know anyone who is just a psychopath and nothing else. There’s a wide overlap between disorders in the symptoms displayed, the brain areas responsible, and the transmitters involved. And my psychopathic traits can’t be discussed in isolation because other problems shape how they are expressed. I’m attractive to people in part because I’m boring and glib and I can bullshit my way around. Well, that energy and fluidity comes from my hypomania. So all my behaviors are tied together. (p. 181)

This certainly does open up interesting new avenues of defense for those diagnosed as psychopaths. Chapter 9, Can You Change a Psychopath, deals mainly with Dr. Fallon’s own designs to change his inappropriate, some would say self-destructive, behavior patterns. These are hardly of general application, but there are more than a few pointers for those still hopefully engaged in the treatment of psychopathy. It is a long held tenet in the mental health field that there is no cure for this disorder and now some doubt as to whether a person afflicted with it might grow out of it and, if so, at what age. Dr. Fallon recognizes the fragility and the latent hypocrisy of his own efforts at reform. Most telling, in general, with respect to psychopathy, is what he sets forth emphatically on p. 197 after giving serious thought to all the bad things his behavior occasioned: “I admitted to myself, ‘I don’t care.’ That’s right, ‘I DON’T CARE.”’ All efforts at reform, changes in behavior, considerateness towards others, and so forth, are superficial at best and effect little by way of permanent change. If this disappointing result is the work of a dedicated professional, well advised, with ample resources attempting to change these negative factors in his own life, can anything better be expected of the worthy efforts of those trying to treat and change psychopathic others? The psychopath is quick to discern the fundamental flaws in these efforts that are dealt with by his manipulative skills to turn them to his best advantage as circumstances suggest. Chapter 10, effectively the conclusion of this book, bears the somewhat unusual title, Why Do Psychopaths Exist? Most of it is simply speculative and really does very little to support Dr. Fallon’s principal contentions. It would be not unfair to opine that this final chapter is the least scientific of

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this work. Indeed, to some extent what is advanced in this chapter tends to contradict some of the more sound propositions proclaimed elsewhere in the book. He now asserts at p. 213:

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Psychopaths are present in all human societies. The cultural reality of psychopathy, at a rate of about 2 percent, suggests that psychopathy, or at least the traits and associated alleles found in psychopaths, is somehow “desirable” in humanity. Otherwise evolution should have wiped them out or at least diminished their numbers ages ago.

Earlier the author had correctly shown that there is little professional agreement on the definition of psychopathy and, accordingly, there can be even less on its quantification in any society. Taken as a whole, this appears to be an understandable, but somewhat unfamiliar, effort to extol the virtues of at least some psychopaths whose brain scans might be thought to resemble that of the author. Indeed, the very last words in the book are redolent with what is suggested here. I don’t think we should remove the psychopathy-related traits and genes from society. It would lead to passivity and wipe us out. We just need to identify those people with the traits early in their lives and keep them out of trouble. Individuals with low empathy and high aggression, if they’re treated well, can have a positive impact. Of course, they put stress on their families and friends as I do, but on a macro level they’re beneficial to society. Maybe this is my own narcissism speaking, but I believe there’s a sweet spot on the psychopathy spectrum. People who are twenty-five or thirty on the Hare scale are dangerous, but we need a lot of twenties around—people with the chutzpah and brio and outrageousness to keep humanity vibrant and adaptable—and alive. People like me.

This reviewer wondered whether Dr. Robert Hare, who has spent a lifetime studying psychopathy and teaching so many others about his findings and how to employ them professionally, would agree. H. H. A. Cooper Former President of Nuevevidas International Inc. New Orleans, Louisiana