The Wisdom of Psychopaths, by Kevin Dutton.
The psychopath's fearlessness and focus has traditionally been attributed to deficits in emotional processing, more specifically to amygdala dysfunction. Until recently, this has led researchers to believe that in addition to not "doing" fear, they don't "do" empathy, either. But a 2008 study, by Shirley Fecteau and her colleagues at the Beth Israel Deaconess Medical Center in Boston, has thrown a completely different light on the matter, suggesting that psychopaths not only have the capacity to recognize emotions – they are, in fact, actually better at it than we are.
Fecteau and her co-workers used transcranial magnetic stimulation (TMS) to stimulate the somatosensory cortex (the part of the brain that processes and regulates physical sensations) in the brains of volunteers scoring high on the Psychopathic Personality Inventory (PPI). Previous research has shown that observing something painful happening to someone else results in a temporary slowdown in neural excitation in response to TMS, in the area of the somatosensory cortex corresponding to the region afflicted by the pain: the work of highly specialized, and aptly named, brain structures called mirror neurons.
If psychopaths lack the ability to empathize, Fecteau surmised, then such attenuation in neural response should be reduced in those individuals scoring high on the PPI, compared to those with low to average scores – in exactly the same way that psychopaths might well, in comparison with most normal members of the population, display reduced yawn contagion. The researchers, however, were in for quite a surprise.
Much to their amazement, Fecteau and her team actually turned up the opposite of what they were expecting. High PPI scorers – specifically, those who scored high on the "Coldheartedness" subscale of the questionnaire, the subscale that most directly taps into empathy – in fact showed greater attenuation of the TMS response than low scorers, suggesting that psychopaths, rather than having an impairment in recognizing the emotions of others, indeed have a talent for it. And that the problem lies not in emotional recognition per se, but in the dissociation between its sensory and affective components: in the disconnect between knowing what an emotion is and feeling what it's like.
Psychologist Abigail Baird has discovered something similar. In an emotion recognition task using functional magnetic resonance imaging (fMRI), she found that while volunteers scoring high on the PPI showed reduced amygdala activity compared to low scorers when matching faces with similar emotional expressions (consonant with a deficit in emotional processing), they also displayed increased activity in both the visual and dorsolateral prefrontal cortices – indicative, as Baird and her team point out, of "high-scoring participants relying on regions associated with perception and cognition to do the emotion recognition task."
One psychopath I spoke to put it like this. "Even the colour-blind," he said, "know when to stop at a traffic light. You'd be surprised. I've got hidden shallows." Not caring and not understanding are two different things entirely.
Of course, psychopaths' enhanced ability to recognize emotion in others might go some way toward explaining their superior persuasion and manipulation skills – as, needless to say, does their enhanced ability to fake emotion, a phenomenon we touched upon earlier in the chapter. But the capacity to decouple "cold" sensory empathy from "hot" emotional empathy has other advantages too – most notably in arenas where a degree of affective detachment must be preserved between practitioner and practice. Like the medical profession, for instance.
Here's one of the U.K.'s top neurosurgeons on how he feels prior to going into the [operating] theatre: "Do I get nervous before a big operation? No, I wouldn't say so. But I guess it's like any performance. You have to get yourself psyched up. And you need to remain concentrated and focused on the job at hand, not get distracted. You have to get it right.
"You know, you mentioned Special Forces a few moments ago. And actually, the mentality of a surgeon and, say, that of an elite soldier about to storm a building or an airliner are possibly quite similar. In both cases, the job is referred to as an 'operation.' In both cases, you 'tool up' and don a mask. And in both cases, all the years of practice and training can never fully prepare you for that element of uncertainty as you make the first incision; that exhilarating split second of 'explosive entry,' when you fold back the skin and suddenly realize … you're in.
"What's the difference between a millimetre's margin of error when it comes to taking a head shot and a millimetre's margin of error when it comes to navigating your way between two crucial blood vessels? In both of those cases, you hold life and death in your hands, must make a death-or-glory decision. In surgery, quite literally, on a knife edge."
This guy scored well above average on the PPI. And if that surprises you coming from one of the world's top neurosurgeons, then think again. Yawei Cheng, at the National Yang Ming University in Taiwan, and her co-workers took a group of medical doctors with at least two years' experience in acupuncture and a group of non-medical professionals, and, using fMRI, peered into their brains to see what happened as they viewed needles being inserted into mouths, hands and feet. What they observed was rather interesting.
When the control volunteers watched the videos of the needles being inserted, those areas of their somatosensory cortices corresponding to the relevant body regions lit up like Christmas trees, as did other brain areas such as the periaqueductal gray (the co-ordinator of the panic response) and the anterior cingulate cortex (which codes for error, anomaly, and pain processing).
In contrast, there was barely a flicker of pain-related activity in the brains of the experts. Instead, they exhibited increased activation of the medial and superior prefrontal cortices, as well as of the temporoparietal junction: brain regions involved in emotion regulation and theory of mind (the ability to see, in both a cognitive and emotional sense, where others are "coming from").
Moreover, the experts rated the acupuncture displays as significantly less unpleasant than the controls did – reminiscent of numerous laboratory findings showing attenuated physiological responses in psychopaths on presentation of fearful, disgusting, or erotic stimuli, and in the face of arduous social stress tests.
What the expert acquires through experience, psychopaths have from the start.
Excerpted from The Wisdom of Psychopaths. Copyright © 2012 Kevin Dutton. Published by Doubleday Canada, an imprint of the Doubleday Canada Publishing Group, which is a division of Random House of Canada Limited. Reproduced by arrangement with the Publisher. All rights reserved.