ENTERING A MAXIMUM-SECURITY prison is always daunting: after the extensive identity check at the gate, you have to hand over your keys, wallet, phone, and anything else that could possibly be stolen or used as a weapon. Everything that identifies you, except your clothing, is confiscated. One of the first locked doors you pass through is marked by a sign saying, in effect, that if you are taken hostage past this point, you’re on your own. The policy is ostensibly to prevent visitors from pretending to be held captive by prisoners and enabling their escape, but it also immediately instills an unsettling feeling. There are at least three or four double sets of thick metal doors, with many layers of human and electronic security between them, which slam solidly behind you before you can meet with the kind of prisoner I had been brought in to examine. Leon, at age sixteen, had sadistically murdered two teenage girls, and then raped their dead bodies.
Virginia and Laura demonstrated one way that neglect in early childhood can disrupt the development of the areas in the brain that control empathy and the ability to engage in healthy relationships—a loss that often leaves people awkward, lonely, and socially inept. Emotional deprivation in the first years of life, however, can also predispose people to malice or misanthropy. In the mother’s and the daughter’s cases, fortunately, despite their underdeveloped capacity for empathy, both became highly moral people; their early childhood experiences had left them emotionally crippled and often oblivious to social cues, but not filled with rage and hatred. Leon’s story illustrates a much more dangerous—and fortunately, less common—potential outcome. Leon would teach me more about how much damage parental neglect—even unintentional neglect—can inflict, and how modern Western culture can erode the extended family networks that have traditionally protected many children from it.
Leon had been convicted of a capital offense and faced the death penalty. His defense had hired me to testify during the sentencing phase of his trial. This hearing determines whether there are “mitigating” factors, such as a history of mental health problems or abuse, that should be weighed when sentencing decisions are made. My testimony would help the court decide between life without parole and the ultimate punishment.
I VISITED THE PRISON ON A PERFECT Spring day, the kind of clear day that makes most people happy to be alive. The cheery sound of chirping birds and the warmth of the sun seemed almost inappropriate as I stood in front of the massive gray building. It was five stories tall and made of cement block. It had too-few barred windows and a tiny green one-room guardhouse with a red door attached to one wall, which looked incongruously small compared to the imposing bulk of the prison. The grounds were surrounded by a twenty-foot wire fence with three coils of barbwire at the top. I was the only person outside. A few old cars were parked in the lot.
I approached the red door, my heart beating fast, my palms sweating. I had to tell myself to calm down. The whole place seemed fenced by tension. I walked in through a double door, passed through a metal detector, was summarily frisked and then taken into the compound by a guard who seemed as caged and resentful as a prisoner.
“You a psychologist?” disapprovingly she asked, looking me over.
“No. I’m a psychiatrist.”
“OK, whatever. You could spend a lifetime here.” She laughed disdainfully. I forced a smile. “Here’s the rules. You must read this.”
She handed me a one-page document and continued, “No contraband. No weapons. You may not bring gifts or take anything out of the prison.” Her tone and attitude told me she had no use for me. Maybe she was angry that she had to spend this perfect day in prison. Maybe she was resentful because she thought that mental health professionals working with the justice system mainly help criminals escape responsibility for their actions.
“OK,” I said, trying to be respectful. But I could tell she had already made up her mind about me. It’s no wonder that she was hostile, though. Our brains adapt to our environments, and this place wasn’t likely to elicit kindness or trust.
THE INTERVIEW ROOM WAS SMALL with a single metal table and two chairs. The floor was a tiled institutional gray with green speckles and the walls were painted cinderblock. Leon was brought in by two male guards. He looked small and childlike as he faced me, wearing an orange jumpsuit, his arms and legs shackled and chained to each other. He was thin and short for his age. He didn’t look lethal. Sure, his stance was aggressive, and I could see that he already had jailhouse tattoos, his forearm branded with a crooked “X.” But the toughness came across as phony and artificial, like an undersized tomcat with his hair on end, trying to appear larger than he actually was. It was almost impossible to believe that this now eighteen-year-old boy/man had brutally murdered two people.
He’d seen his two young victims in an elevator in the high-rise building where he lived. Although it was only three or four in the afternoon, he’d already been drinking beer. He had crudely propositioned the teenagers. When the girls—not surprisingly— rejected him, he’d followed them into an apartment and, apparently after a physical confrontation, stabbed both of them to death with a table knife. Cherise was twelve and her friend Lucy was thirteen.
Both were barely pubescent. The attack had happened so fast and Leon was so much larger than his victims that neither girl had been able to defend herself. He’d managed to quickly restrain Cherise with a belt. After that, while Lucy tried to fight him off, he killed her and then, either to avoid leaving a witness, or still in a rage, slaughtered the bound girl as well. He then raped both bodies. His anger still not sated, he’d kicked and stomped them.
Though he had often been in trouble with the law, Leon’s records didn’t indicate that he was capable of anything like this level of violence. His parents were hard-working, married legal immigrants, solid citizens without criminal histories. His family had never been involved with child protective services; there was no history of abuse, nor foster care placements, nor any other obvious red flags for attachment problems. Yet all of his records suggested that he was a master at manipulating people around him and, more ominously, that he was completely devoid of emotional connection to others. He was often described as having little to no empathy: remorseless, callous, indifferent to most of the “consequences” set up in school or in juvenile justice programs.
Seeing him now, looking so small in his shackles in this terrible prison, I almost felt sorry for him. But then we began to talk.
“You the doctor?” he asked, looking me over, clearly disappointed.
“Yep.”
“I told her I wanted a lady shrink,” he sneered. He pushed his chair away from the table and kicked it. I asked him whether he’d discussed my visit with his lawyer and understood its purpose.
He nodded, trying to act tough and indifferent, but I knew he had to be scared. He probably would never admit it or even understand it, but inside he was always on guard, always vigilant and always studying the people around him. Trying to work out who could help him and who could hurt him. What is this person’s weak point, what does he want, what does he fear? From the moment I came in I could see that he was studying me, too. Probing for weakness, seeking ways to manipulate me.
He was smart enough to know the stereotype of the liberal, bleeding-heart shrink. He had successfully read his lead attorney.
She felt sorry for him now; he had convinced her he was the one who’d been wronged. Those girls had invited him into the apartment. They promised to have sex with him. Things got rough and it was an accident. He tripped over their bodies; that’s how he got blood on his boots. He never intended to hurt them. And now he set out to persuade me, too, that he was a misunderstood victim of two teen vixens who had teased and tempted him.
“Tell me about yourself.” I started with open questions, trying to see where he would go.
“What do you mean? Is that some kind of shrink trick?” he asked, suspicious.
“No. I just figured you are the best person to tell me about you.
I’ve read a whole lot of other people’s opinions. Teachers, therapists, probation officers, the press. They all have opinions. So I want to know yours.”
“What do you want to know?”
“What do you want to tell me?” The dance continued. We circled around each other. It was a game I knew well. He was pretty good.
But I was used to this.
“Well. Let’s start with right now. What it is like living in prison?”
“It’s boring. It’s not so bad. Not too much to do.”
“Tell me your schedule.” And so it started. He slowly began to loosen up as he described the routines of the prison and his earlier experiences in the juvenile justice system. I let him talk and then after a few hours, we took a break so he could smoke a cigarette.
When I came back, it was time to get to the point. “Tell me what happened with those girls.”
“It was no big deal really. I was just hanging out and these two girls came by. We started talking and they invited me up to their apartment to fool around. Then when they got me up there, they changed their minds. It pissed me off.” This was different from his original statement and from other accounts he’d given. It seemed that the more time that passed since the crime, the less violent he made the story. Each time he told it, he was less and less responsible for what had happened; he, rather than the girls, increasingly became the victim.
“It was an accident. I just wanted to scare them. Stupid bitches wouldn’t shut up,” he went on. My stomach churned. Don’t react.
Be still. If he senses how horrified and disgusted you feel, he won’t be honest. He will edit. Stay calm. I nodded.
“They were loud?” I asked as neutrally as I could manage.
“Yes. I told them I wouldn’t hurt them if they would just shut up.”
He was giving me a short, sanitized version of the murders. He left out the rape. He left out how he’d brutally kicked the girls.
I asked whether their screams had enraged him, if that was why he’d kicked the bodies. The autopsy report showed that the thirteen-year-old had been kicked in the face and stomped on the neck and chest.
“Well, I didn’t really kick them. I just tripped. I had been drinking some. So, you know,” he said, hoping I would fill in the blanks. He looked up to see if I had bought his lies. There was little emotion on his face or in his voice. He described the murders as if he were giving a geography report in school. The only trace of emotion was the disdain he expressed that his victims had “made him” kill them, furious with them for fighting back, for resisting.
His coldness was breathtaking. This was a predator, someone whose only concern for other people was what he could get from them, what he could make them do, and how they could serve his selfish ends. He could not even put on a compassionate performance for a shrink hired by his defense, someone looking for the smallest glimmer of goodness or promise in him.
It wasn’t that he didn’t know that he should try to appear remorseful. He simply wasn’t capable of taking into account the feelings of others in any way other than to take advantage of them.
He could not feel compassion for others, so he couldn’t fake it very well, either. Leon was not unintelligent. In fact, his IQ was significantly above average in some ways. However, it was uneven. While his verbal IQ was in the low to normal range, his performance score, which measures things like the ability to properly sequence a series of pictures and manipulate objects in space, was quite high. He scored especially well in his ability to read social situations and understand other people’s intentions.
This split between verbal and performance scores is often seen in abused or traumatized children and can indicate that the developmental needs of certain brain regions, particularly those cortical areas involved in modulating the lower, more reactive regions have been not been met. In the general population about 5 percent of people show this pattern, but in prisons and juvenile treatment centers that proportion rises to over 35 percent. It reflects the use-dependent development of the brain: with more developmental chaos and threat the brain’s stress response systems and those areas of the brain responsible for reading threat-related social cues will grow, while less affection and nurturing will result in underdevelopment of the systems that code for compassion and self-control. These test results were the first clues that something had probably gone wrong in his early childhood.
I tried to figure out what might have happened from our interview, but didn’t get very far. Most people don’t remember much from the developmentally critical years of birth through kindergarten, anyway. There was evidence indicating he had been troubled from very early on, however. His records showed reports of aggressive behavior dating back to his preschool years. From our conversation I could also tell that he’d had few friends or lasting relationships with anyone outside his family. His charts showed a history of bullying and of petty crimes like shoplifting and other thefts, but he had never been to an adult prison before now.
His run-ins with the law as an adolescent had mainly resulted in probation; he hadn’t even spent much time in juvenile detention, despite having committed some serious assaults.
I did discover, however, that he’d committed, or been suspected of committing, several major offenses for which he had not been charged or convicted because there was not enough evidence to make the charges stick. For example, he’d once been found in possession of a stolen bicycle. The bike’s teenage owner had been beaten so severely that he’d wound up in the hospital with life- threatening injuries. But there were no witnesses to the assault—or none that would come forward—so Leon was only charged with possession of stolen property. Over the course of several evaluation visits he eventually bragged about previous sexual assaults to me, with the same cold disdain with which he’d discussed the murders.
Looking for any sign of remorse, I finally asked what should have been an easy question.
“Now that you look back on all this, what would you have done differently?” I said, expecting him to at least mouth some platitudes about controlling his anger, about not harming people. He seemed to think for a minute, then responded, “I don’t know.
Maybe throw away those boots?”
“Throw away the boots?”
“Yeah. It was the boot prints and the blood on the boots that got me.”
MANY PSYCHIATRISTS WOULD HAVE left the prison believing that Leon was the archetypal “bad seed,” a genetic freak of nature, a demonic child incapable of empathy. And there are genetic predispositions that appear to affect the brain’s systems involved in empathy. My research, however, has led me to believe that behavior as extreme as Leon’s is rare among people who have not suffered certain forms of early emotional and/or physical deprivation.
Furthermore, if Leon had the genetic makeup that increased the risk of sociopathic behavior—if such genes even exist—his family history should have revealed other relatives, such as a parent, a grandparent, maybe an uncle, with similar, even if less extreme, problems. Perhaps a history of multiple arrests, for example. But there was none. Also, Leon had been turned in to the police by his own brother, a brother who seemed to be everything that Leon was not.
Frank,* Leon’s brother, like his parents and other relatives, was gainfully employed. He was a successful plumber, married, a dutiful father of two who was respected in the community. The day of the crime, he’d come home to find Leon, still wearing his blood- encrusted boots, watching TV in his living room. On the news was an urgent bulletin about the recent discovery of the violated bodies of two young girls in Leon’s building. Sneaking occasional glances at the boots, Frank waited until Leon left, then called the police to report his suspicions about his brother’s connection to the crime.
Siblings share at least 50 percent of their genes. While Frank could have been genetically blessed with a far greater capacity for empathy than Leon, it was unlikely that this alone accounted for their very different temperaments and life paths. Yet as far as I knew, Leon and Frank had shared the same home and parents, so Leon’s environment didn’t appear to be a likely culprit either. I would only discover what I now believe to be at the root of Leon’s problems after I met with Frank and his parents, Maria* and Alan.* In our first meeting they were all in obvious distress over the situation.
MARIA WAS SMALL AND CONSERVATIVELY dressed, wearing a cardigan buttoned all the way up. She sat erect, knees together, with both hands on the handbag in her lap. Alan wore dark green work clothes; his name was sewn into a white oval over his pocket.
Frank was wearing a button-down, collared blue shirt and khaki pants. Maria looked sad and fragile, Alan seemed ashamed, and Frank seemed angry. I greeted each of them with a handshake and tried to establish eye contact.
“I’m sorry we have to meet under these circumstances,” I said, carefully watching them. I wanted to see how they related to others, whether they showed an ability to empathize, whether there were any hints of pathological or odd behavior that might not have shown up in Leon’s medical records and family history. But they responded appropriately. They were distressed, guilty, concerned, everything you would expect from family members who’d discovered that one of their own had committed an unspeakablecrime.
“As you know, your son’s attorney has asked me to evaluate him for the sentencing phase of the trial. I’ve met with Leon now twice.
I wanted to spend some time with you to get a better understanding of how he was when he was younger.” The parents listened, but neither would look me in the eye. Frank stared at me, however, defensive and protective of his parents. “We are all trying to understand why he did this,” I concluded. The parents looked at me and nodded; the father’s eyes filled with tears. Their grief filled the room; Frank finally looked away from me, blinking back tears of his own.
I could see that these parents had spent hours wracked with sadness, confusion, and guilt as they searched for the “why.” Why had our son done this? Why had he turned out this way? What did we do wrong? Are we bad parents? Was he born bad? They spoke with total bewilderment about Leon, telling me that they’d done their best, worked hard, given him what they could. They’d taken him to church, they told me, they’d done everything the teachers and schools and counselors had asked. I heard their recriminations: Maybe we should have been stricter. Maybe we should have been less strict. Maybe I should have sent him to live with my mother when he first got in trouble. They struggled to get through every day, tired from their grief, from sleepless nights, and from pretending that they didn’t see the stares and disapproving looks from their neighbors and coworkers.
“Let’s start at the beginning. Tell me about how you two met,” I said. Alan spoke first, beginning to smile slightly as he thought of his own childhood and his courtship. Alan and Maria had met as young children. They both lived in large extended families in the same small, rural community. They attended the same school, prayed in the same church, and lived in the same neighborhood.
They were economically poor, but wealthy in family. They grew up surrounded by cousins, aunties, uncles, and grandparents.
Everyone knew everyone else’s business, but that meant everyone cared, too. In Alan and Maria’s hometown children were never far from the watchful eyes of one relative or another.
Maria dropped out of high school at fifteen, becoming a maid at a local hotel. Alan stayed on until graduation, then started work at a nearby factory. They got married when he was twenty and she was eighteen. He did well at the factory and made a good living.
Soon Maria got pregnant.
This pregnancy was a joyous event for both extended families.
Maria was pampered, and she was able to quit work to stay home with their child. The young family lived in the basement apartment of a building owned by an uncle. Her parents lived next door; his family, one block over. As they discussed this time in their lives, they smiled at each other. Alan did most of the talking, while Maria nodded her agreement. Frank listened intently as if he had never heard about his parents’ early life. At moments the family almost seemed to forget what had brought them here.
As Alan dominated the conversation, I would occasionally try to direct a question to Maria, but most of the time she would just smile at me politely and then look to her husband who would then answer instead. In time it became clear that Maria, though kindhearted and polite, was mentally impaired. She didn’t seem to understand many of my questions. Finally, I asked her, “Did you like school?” Alan looked at me and said quietly, “She is not good at those things. She is maybe a little slow in that way.” She looked at me sheepishly and I nodded and smiled back. Both her husband and her son were clearly protective of her.
Alan went on, describing the birth of their first son, Frank. After Maria came home from the hospital, the grandmothers, aunties, and older cousins spent hours with the young mother and her new child. Both mother and baby were immersed in the attention and love of their extended families. When Maria felt overwhelmed by the responsibility of caring for this dependent little being, there was always an aunt or a cousin or her own mother around to help.
When his cries drove her crazy, she could always get a break by asking a family member to babysit. But then Alan lost his job. He looked diligently for new work, but the factory had closed and decent jobs for people without a college education became nearly impossible to find. After six months of unemployment he managed to get another factory job, but it was in a city, one hundred miles away. He felt he had no choice but to take it.
The family, with now three-year-old Frank, relocated to an apartment complex in the city. The only place they could afford was in a devastated inner-city neighborhood plagued with high rates of violent crime and drug use. Few people worked and few had roots in the area. As is often the case in this country, extended families were scattered, not living close together as they had back home.
Most of the households with children were headed by single mothers.
Soon Maria became pregnant with Leon. This pregnancy, however, was very different from her first one. Maria was now alone all day long in a small apartment with a toddler as her only companion. She was bewildered by her new life—and lonely. She didn’t know anyone and didn’t know how to reach out to her neighbors. Alan worked long hours, and when he came home he was exhausted. Maria’s three-year-old son became her best friend.
They spent hours together. They would walk to a nearby park, take the bus to the free museums in the city, and participate in a mother’s drop-in program at a church. Maria developed a routine in which she would leave the apartment early in the morning and stay out all day, picking up groceries just before she returned home.
The routine was comforting. She created a repetitive pattern of activity and the familiar faces she saw each day were some tiny connection to others, reminding her of the familiarity of the world she left behind. Still, she missed her family. She missed her neighborhood. She missed the group of experienced women who had helped her raise her first baby.
Then, Leon was born. Maria was now overwhelmed by the inevitable neediness of a newborn. She never had to raise a baby alone before. It became clear to me that the family had understood Maria’s limitations and, when needed, had stepped in to provide a loving, predictable, and safe environment for Frank. But when Leon was born this relational safety net was absent. I was starting to see why Leon and Frank had turned out so differently.
“He was such a fussy baby. He cried,” Maria told me, describing Leon.
She smiled. I smiled back.
“And how would you calm him down?”
“I tried to feed him. Sometimes he would take the bottle and stop.”
“Anything else?”“Sometimes he would not stop. So we would go on our walk.”
“We?”
“Me and Frank.”
“Ah.”
“Did anyone ever come to help you take care of Leon?”
“No. We would wake up and feed him and then go for our walk.”
“Was this like the walks you took before Leon was born?”
“Yes. We go to the park. Play for a while. Take the bus to the church and have lunch. Then go to the children’s museum. Take the bus to the market to buy food for dinner. And then go home.”
“So you were gone most of the day.”
“Yes.”
Little by little it became clear that from the time Leon was four weeks old, the mother had resumed her “walks” with her oldest son, by then a four-year-old. She left baby Leon alone in a dark apartment. My heart sank as I listened to the mother—innocent, yet ignorant of the crucial needs of an infant—describe her systematic neglect of her youngest son. It was hard to be critical: she had given her four-year-old loving and attentive care. But at the same time she had deprived her newborn of the experiences necessary for him to form and maintain healthy relationships.
“He stopped crying so much,” she said, indicating that she thought that her solution to the problem had worked.
But as he grew older, both parents related, Leon never responded to their parenting the same way that Frank did. Whenever they reprimanded Frank, he felt bad that he had disappointed his parents and he corrected his behaviors. When Frank was told that he’d done well, he smiled and it was easy to see that he found pleasing his parents to be rewarding. The little boy was always hugging someone, running up to Mom or Dad and wrapping his little arms around them.
When Leon was scolded or punished, however, he showed no emotion. He didn’t seem to care that he’d let his parents down or hurt someone else emotionally or physically. He didn’t correct his behavior. When his parents or teachers were pleased with him and gave him positive attention, he seemed equally unaffected. He actively avoided being touched, or touching others.
Over time he learned to use flattery, flirtation, and other forms of manipulation to get what he wanted. If that did not work, he did what he wanted when he wanted anyway, and if he wasn’t given what he asked for, then he took it. If he got caught doing something wrong, he would lie, and if he got caught in a lie, he was indifferent to lectures and punishment. All he seemed to learn from punishment was how to improve his deception and better hide his bad behavior. Teachers, counselors, youth ministers, and coaches all said the same thing: Leon didn’t seem to care about anyone or anything but himself. The normal relational rewards and consequences—making your parents proud, making a friend happy, feeling upset if you hurt a loved one—did not matter to him.
So he started to get in trouble, first at preschool, then kindergarten, then elementary school. At first it was little things: stealing candy, minor bullying, poking classmates with pencils, talking back to teachers, ignoring the rules. But by third grade he had been referred for mental health services. By fifth grade he was a regular in the juvenile justice system, brought up on charges of truancy, theft, and vandalism. This callous and criminal behavior qualified him for the diagnosis of “conduct disorder” by age ten.
When Maria had taken Frank out for walks, Leon had wailed in his crib at first. But he’d soon learned that crying would bring no aid, so he stopped. He lay there, alone and uncared for, with no one to talk to him and no one to praise him for learning to turn over or crawl (and not much room to explore anyway). For most of the day he heard no language, saw no new sights, and received no attention.
Like Laura and Virginia, Leon had been deprived of the critical stimuli necessary to develop the brain areas that modulate stress and link pleasure and comfort with human company. His cries had gone unanswered, his early need for warmth and touch unmet. At least Virginia had known consistent care in her foster homes, even though she was moved from one to another repeatedly, and at least Laura had known the constant presence of her mother, even if she hadn’t received enough physical affection from her. But Leon’s early life was maddeningly inconstant. Sometimes Maria would pay attention to him, others times she would leave him home alone for the whole day. Occasionally Alan was home and would play with him, but more often he was out working or too exhausted from his long days to cope with a baby. An environment of such intermittent care punctuated by total abandonment may be the worst of all worlds for a child. The brain needs patterned, repetitive stimuli to develop properly. Spastic, unpredictable relief from fear, loneliness, discomfort, and hunger keeps a baby’s stress system on high alert. Receiving no consistent, loving response to his fears and needs, Leon never developed the normal association between human contact and relief from stress. What he learned instead was that the only person he could rely on was himself.
When he did interact with others, his neediness made him seem alternately demanding, aggressive, and cold. In vain attempts to get the love and attention he desperately required, Leon would lash out, hit people, take things, and destroy them. Receiving only punishment, his rage grew. And the “worse” he behaved, the more he confirmed to those around him that he was “bad” and didn’t deserve their affection. It was a vicious cycle, and as Leon got older his misbehavior escalated from bullying into crime.
Leon could see that other people liked to be hugged and touched, but since his own needs for that had been neglected, he began to find it repellent. He could see that other people enjoyed interacting with each other, but because he’d been denied early attention, it now mostly left him cold. He just didn’t understand relationships.
Leon could enjoy food, could enjoy material pleasures like toys and television, and could relish physical sensations, including those associated with his developing sexuality. But because he’d been neglected when key social circuitry of the brain was developing he couldn’t really appreciate the pleasure of pleasing someone else or receiving their praise, nor did he suffer particularly from the rejection that followed if his behavior displeased teachers or peers. Having failed to develop an association between people and pleasure, he saw no need to do as they wished, felt no joy in making them happy, and didn’t care whether or not they got hurt.
When he was two-and-a-half, Leon’s behavioral problems qualified him for an early intervention preschool program, which could have been a great opportunity, but in fact only worsened his problems. Now his mother no longer left him alone during the day, and he was exposed to enough cognitive stimulation to learn to talk and to intellectually understand what was expected of him. But this didn’t make up for what he’d missed. While well intentioned, the program had only one caregiver to handle five or six severely troubled toddlers, a child to adult ratio that may not be enough to give appropriate attention to normal children that age, let alone those with emotional disorders.
The cognitive development of his cortex did, however, allow Leon to take note of how other people behaved. Over time he became able to mimic appropriate behavior when he wanted to.
This allowed him to manipulate others into getting what he wanted, though his underdeveloped limbic and relational neural systems limited him to shallow, superficial relationships. For him people were just objects that either stood in his way or acceded to his needs. He was a classic sociopath (the psychiatric diagnosis is antisocial personality disorder, or ASPD), and one I think who was almost entirely a product of his environment, not his genes. I believe that if he had been raised the way his brother Frank had been, he probably would have grown up to have a normal life, and would almost certainly have never become a murderer and rapist.
Even the steps taken to help him—for example the preschool intervention program that placed him in a group of other disturbed children—only worsened his condition. Research has repeatedly found that surrounding a child with other troubled peers only tends to escalate bad behavior. This pattern of backfiring interventions would continue through his childhood and adolescence as he was shunted into “special ed” and other programs. There, he also found other antisocial peers who reinforced each other’s impulsivity. They became partners in crime, egging each other on and modeling for each other the idea that violence is the best way to solve problems. Furthermore, through what he saw in his neighborhood, at the movies, and on the TV that was always on in most of the places where he spent his time, he also got the message that violence solves problems and that there was pleasure to be had in wielding physical power over others. Leon learned to copy the worst of human behavior, but remained unable to understand why he should imitate the best.
There are other brain disorders that affect the ability to empathize that provide insight on sociopathy like Leon’s. Most notable are autism spectrum disorders (ASDs), including what was previously known as Asperger’s syndrome, the less severe form of autism. ASDs appear to be strongly genetically influenced and range widely in their link to disability. About one-third of autistic children never learn to speak and all of them tend to isolate themselves from others, frequently focusing more on objects than on people. Autistic boys don’t usually engage in imaginative play— and although many people on the spectrum desperately want to connect with others, they have great difficulty in forming and understanding relationships.
ASDs are almost always accompanied by sensory integration problems and differences in sensitivity, such as being unable to tolerate “itchy” fabrics and being overwhelmed by loud noises or bright lights. Autistic children also have repetitive behaviors like rocking and odd obsessions, typically with moving objects—for example, trains or the wheels on toy cars. Some autistic people are highly talented at understanding complex systems like math, music, and computer science, and most develop focused interests in particular objects or ideas.
People with Asperger’s are better at connecting with others and functioning in society than those with more severe forms of autism, but their obsessions and inability to read social cues often keep them isolated. Their poor social skills can also make it hard for them to get or keep a job, although in some cases their mathematical and engineering abilities more than compensate for their awkwardness. Many children tagged as “geeks” or “nerds” because of their inability to relate to their peers may have an ASD or come close to meeting the criteria for one.
In order to function socially, people need to develop what is known as a “theory of mind.” They need to know, in other words, that other people are distinct from them, have different knowledge about the world and have different desires and interests. In autism this distinction is blurred. One reason some autistic children may not talk is that they don’t recognize the need to communicate; they aren’t aware that other people don’t know what they know. In one famous experiment, researchers put a pencil in a tube that ordinarily held candy and asked autistic children what someone outside the room would expect to find in it. Normal and even Down syndrome preschoolers said candy. But the autistic children insisted that others would expect the pencil, not realizing that people who hadn’t seen the candy removed would think it was still there. The children knew the candy was gone, so their logical assumption was that everyone else must know, too. (The brain regions involved in coding “theory of mind” are believed to be in the left medial frontal cortex, just over the eyes.) Unlike sociopaths like Leon, however, autistic people, although odd, do not tend toward violence or crime despite their problems with perspective taking and with recognizing, for example, that ignoring someone might be hurtful to him. Their problem with empathy is conceptual. Autistic people can be insensitive to the feelings and needs of others, but this usually occurs when they cannot fully perceive these feelings, not because they wish to cause harm or to be unkind. They have every capacity to love and feel emotional pain, but not the wiring that allows them to easily understand how to interact and have relationships. They may have difficulty imagining what it’s like to be in someone else’s shoes— sometimes called “mind-blindness”—but they do not lack sympathy for those people’s experiences when they become aware of them.
Sociopaths like Leon are different. Their inability to empathize is a difficulty with mirroring the feelings of others coupled with a lack of compassion for them. In other words, they not only don’t completely recognize what other people feel, but they don’t care if they hurt them or they even actively desire to do so. They can imagine walking in someone else’s shoes, and they can predict how other people will behave based upon this ability to put themselves in someone else’s place, but they don’t care what it’s like there. Their only concern is how others will affect them.
In essence, they have a “theory of mind,” but it is twisted. Not being able to fully experience love, they see it as something you promise in order to get sex, for example, not as a genuine feeling.
Because they use other people’s feelings as a way to manipulate them, sociopaths assume that’s what everyone else does, too. Not feeling pleasure from relationships, they don’t believe others genuinely feel it, either. Since they are selfish, they believe others act only in their own self-interest as well. As a result, they dismiss appeals for attention or mercy as manipulative attempts to take power, not as genuine emotional pleas. They are emotionally frozen, in an ice that distorts not only their own feelings, but also how they see the feelings of others and then respond to them.
UNSURPRISINGLY RESEARCH HAS now identified that some of the chemical correlates of sociopathy can be found in some of the same neurotransmitter systems that compose our stress response systems: alterations in serotonin, norepinephrine, and dopamine systems have been implicated in aggressive, violent, or antisocial behavior. Young people exhibiting antisocial traits and callous behavior tend to have abnormal levels of the stress hormone cortisol (which can be measured in a saliva test). Sociopaths are notorious for being able to fool lie detector tests, which actually measure physical responses related to anxiety and stress, not deception. It appears that their stress systems—either because they were placed on overdrive due to early trauma or because of genetic vulnerability or, most likely, some combination of both—are dysregulated, no longer responsive to anything except extreme stimulation. This makes them appear “cold” and unemotional and allows them to lie with impunity, as they do not show the signs of fear of detection that tend to give others away. It may also mean that far higher levels of painful or pleasurable stimulation are necessary in order for them to feel anything at all. Unlike people whose response to trauma is to get stuck in a highly sensitized state in which any stress at all triggers a massive response, sociopaths’ systems appear to have gotten stuck at the other end of the spectrum, in deadening—and sometimes deadly— numbness.While preparing my testimony, I thought hard about what I would say about Leon and what I believed about his own responsibility for his actions. Why did he kill? Why does anyone kill? Are these even the right questions? Maybe, I thought, I should try to understand what keeps the rest of us from killing, what didn’t put the brakes on Leon’s behavior. How exactly had things gone so wrong for this boy? How had he forged his misfortune, neglect, and trauma into hate—or did those things forge him entirely? He was unquestionably guilty and did not meet the legal definition of insanity, which requires that a person be unable to tell right from wrong. Leon knew that murder was against the law and that it was reprehensible; he’d admitted it and he did not have any diagnosable mental illness that would impair his moral reasoning.
He met criteria for attention deficit disorder and conduct disorder during most of his childhood and youth. As an adult, Leon certainly fit the profile for both ADHD and ASPD, but those diagnoses, which simply describe symptoms like defiance, callous behavior, and an inability to focus attention, do not imply mental clouding that would overwhelm one’s ability to know that killing and raping people is not acceptable. These disorders involve decreased impulse control, but impaired impulse control does not mean complete lack of free will.
But what about Leon’s inability to give and receive love? Can we blame him for having a childhood that wilted the part of his brain that allows him to feel the greatest joys most of us have in life: the pain and pleasure of human connection? Of course not. He is responsible, I believe, for his reactions to his vulnerabilities.
Virginia and Laura struggled with similar problems, but they did not become violent people, let alone murderers. One might argue that this difference in outcome is due to gender and, indeed, male gender is the biggest predictor of violent behavior. Male murderers outnumber females by at least nine to one, though it appears that very recently, women have begun to close the gap. Nonetheless, throughout history, in every culture and even in most species, male violence predominates. Among our closest evolutionary cousins, the chimps, it is the males who make war on others, the males who are prone to use force. Yet I’d treated other adolescent boys with far worse histories of neglect, abuse and abandonment, and far fewer opportunities for love and affection than Leon had. Some had literally been raised in cages with no loving family at all, unlike Leon who had two parents and a brother, and who was neglected out of ignorance, not malice. Most of these boys who I’d treated grew up awkward and lonely, many were severely mentally ill, but the vast majority was not malign.
What about genetics? Could that explain Leon’s behavior? Disadvantageous genetics combined with a less-than-ideal environment was likely a factor in how he was raised and who he became. If Leon had had an easier temperament, for example,
Maria might not have been so overwhelmed by his needs; if Maria had been more intelligent, she might have discovered better ways to cope with her challenging baby.
But what I think happened in Leon’s life was an escalation of small, in-themselves-inconsequential negative decisions made by him and for him that gradually led to a horrendous outcome for his victims, his family and himself. You may have heard of the “butterfly effect”: the idea that complex systems—most famously, that which determines the earth’s weather—are extraordinarily sensitive to minor fluctuations at certain critical points. Such systems are so responsive to tiny perturbations that, as the example goes, if a butterfly flutters its wings at the wrong instant in Brazil, it can trigger a series of events that may ultimately result in a tornado that devastates a small Texas town. The human brain, the ultimate complex system—in fact, the most complicated object in the known universe—is equally vulnerable to a version of the butterfly effect.
This might also be called a “snowball effect”: when things go right early on, they will tend to continue to go right and even to self- correct if there are minor problems. But when they go wrong at first, they will tend to continue to go wrong.
This effect is literally built into the architecture of our brains and bodies. For example, it is a tiny chemical gradient that determines which of our early cells will become skin, which will become brain, and which will become bone, heart, and bowel. Other extremely tiny differences tell one neuron to become part of the cerebellum, another to become cerebrum, and similar slight differences in position and in concentration of certain chemicals determine which cells live and which will die.
We don’t have nearly enough genes to begin to determine the location or even the type of every cell: there are just 30,000 for the whole body and yet the brain alone has 86 billion nerve cells (and supporting glial cells for each of those). Each one of those billions of neurons makes between 5,000 and 10,000 connections, producing extraordinarily complex networks. Our bodies and especially our brains are built to magnify practically imperceptible initial incongruities into massively differentiated results. And this, in turn, allows us to respond to the complicated social and physical environment that we face. So, while for most babies, being born colicky does little more than frustrate their parents, for Leon it overwhelmed his mother’s already limited emotional resources. Without the presence of her extended family, there was no one to hand him off to when she was at her wit’s end, as there had been with Frank. Abandoning her infant during the day, she left him without the critical input he needed to soothe and, ultimately, organize his already slightly dysregulated stress response systems, making them even more chaotic and disorganized.
This, in turn, left Leon alternately clingy and aggressive, hampering his social skills, which could potentially have allowed him to elicit the warmth and care he needed from elsewhere. It also further alienated him from his parents and created a cycle of misbehavior, punishment and increasing rage and distress. Then he was placed with a negative peer group, from preschool onwards, which further magnified the harm.
Surrounded by normal peers, he might have found people who could reach out to him, who might have offered him healthy friendships that could have led him away from antisocial behavior.
But in the company of other angry, distressed, and needy children, and additionally stigmatized by the labels applied to them, he instead became more distressed and out of control, leading him to react with escalating impulsivity and aggression.
At no one point did Leon make a conscious decision to become malevolent, but each small choice he or his family made pushed him further toward sociopathy, and each consequence of those choices made further negative choices increasingly likely. There were numerous forks in the road where different circumstances might have led Leon to become a better person, where better choices could have led to the start of a virtuous—not vicious— cycle. But unfortunately, he rejected every opportunity to turn away from his rage and impulsivity, and at none of those crossroads did he receive the appropriate help and support he needed from other people to pull him from the rut in which he’d become stuck.
The brain is built—our selves are built—from millions of tiny decisions—some conscious, most not. Seemingly irrelevant choices can result in tremendously different later outcomes. Timing is everything. We don’t know when the smallest choice, or “stimuli,” will push a developing brain onto the path of genius, or onto the highway to hell. I want to stress that this doesn’t mean that parents have to be perfect. But it’s important to know that young children are extraordinarily susceptible to the spiraling consequences of the choices we—and later they—make, for good and for ill.
Fortunately, the virtuous cycle is every bit as cascading and self- amplifying as the vicious cycle. A word of praise at just the right time, for example, can lead a child with a moderate interest in art to become more passionate about it. That intensity can escalate, leading him to develop greater skill, receive more praise, and, ultimately, build into his brain artistic genius, where once there may only have been modest potential.
Some recent research emphasizes the power of this effect in sports. Half of England’s elite young soccer players on the teams that feed their professional leagues are born in the first three months of the year. The rest are equally distributed among the other months. Why should this be? Well, all youth teams have age cutoffs; if you are born earlier in the year, you are likely to be more physically mature, more skilled, and receive more rewards for your competence than those who are born later in that group. The pleasure of reward leads to more practice; we gravitate toward our competence. And, in the positive feedback cycle within the virtuous cycle, practice creates skill, skill attracts reward, and reward fuels practice. This small difference, enhanced over time by practice, leads to a huge difference, giving the earlier-born players a far better chance of making the cut by the time they reach the pros.
These positive spirals are hard to predict, however. We just don’t know when the butterfly will billow its tiny breeze into a hurricane.
So what could I tell the court about Leon, and what did I believe about his chances for rehabilitation? I would testify that the development of his brain had been skewed by what had happened to him as an infant. And I would confirm the diagnoses of attention deficit disorder and conduct disorder, which are mitigating factors, even if they do not absolve him of responsibility for his actions.
I would tell the court that his emotional, social, and cognitive problems and neuropsychiatric diagnoses were related to his mother’s unintentional neglect. His stress response systems had certainly received aberrant input: being left alone as an infant amped them up, and there was no one around at that critical time to teach him how to calm them down. And at the same time that these lower systems of the brain became overdeveloped, the higher, cortical regions surrounding them, the areas that modulate our responses to the world, our focus, and our self-control, were left underdeveloped.
I would also have to take into consideration the fact that Leon had been drinking when he committed his crime. Alcohol is disinhibiting; it reduces self-control and increases impulsiveness.
Leon was already prone to acting without thinking; alcohol only exacerbated this tendency, with deadly consequences for his victims. Would he have committed the crime had he not been drinking first? I suspect not. The alcohol released the already- overwhelmed and improperly developed brakes on his behavior, allowing his rage and lust to take over. Had he not been drunk, he might have stopped himself long before he killed or even assaulted the girls.
I ultimately testified about Leon’s early childhood and its effects on his ability to maintain relationships, his impulse control, and his attentiveness. I discussed how early neglect can predispose children to reduced empathy and violence. I included all the mitigating factors that I had found. It was all I could do: there was no case to be made that he was not legally responsible for his actions, and I could not deny that he was an ongoing danger to those around him.
During a break I happened to be near the defendant as he watched the victims’ families cry and try to soothe each other. They were despondent, tears running down their cheeks, clinging to each other like survivors on a life raft. Leon said to me, “Why are they crying? I’m the one who’s going to jail.” Again, his emptiness was chilling. He was emotionally blind.
Afterwards, when Leon had been removed as the jury retired to deliberate, Cherise’s mother approached me. Her pain was visible in every step, in the slow movement of her hands, in her expression. “Doctor! Doctor!” she called to me, with great urgency, afraid I might leave before she could talk to me. I stopped, turned, and watched her slowly approach. Almost pleading, she asked,
“Why did he do it? You talked to him. Why did he kill my baby? Please tell me. Why? ”I shook my head, acknowledging that, even with my expertise, I couldn’t give her a satisfactory answer. Crying and holding my arm, she asked again. “You know about these things. Why did he kill my baby?”
“Honestly, I just don’t know for sure,” I said, feeling embarrassed at the inadequacy of my words. I sought out something to help this grieving mother. “I think his heart is cold. Something in him is broken. He’s not able to love like you can—like your daughter could. You hurt so much because you loved her so much. He doesn’t feel things like you do—good things or bad.”
She was quiet for a moment. I could see her bring her daughter’s image to mind with a fleeting smile, then more tears.
She sighed and nodded. “Yes. He must be broken inside to kill such a beautiful child. She never hurt anyone.” I awkwardly hugged her for a moment and then she walked out toward the rest of her family. I thought of Maria and Alan and Frank. Our research is beginning to unlock the secrets of the brain and the causes of tragedies such as this one, but in that moment I was painfully aware of how much we still don’t know.
Commentary
Looking back at this chapter, I laughed—and blushed—at the arrogance of our last sentence. We are still nowhere near unlocking the secrets of the brain, and, if anything, advances in the developmental and social neurosciences have added complexities that we didn’t even know about ten years ago. It’s that “the more we learn, the less we know” thing. We are still far from understanding complex cases of sociopathy like Leon’s.
In addition, we are learning that the quality of the genetics, neurochemistry, and neuroimaging studies that have examined human psychiatric conditions like sociopathy are woefully inadequate and may be essentially uninterpretable: too often, they have inadequate sample sizes, poor characterizations of the population studied—and of course, they use DSM labels, which, as we’ve seen, are deeply problematic.
As a field, we have spent a lot of time and money getting, well, not too far, in understanding the complexities of brain development and its effect on behavior. With all of that said, we are still actually making progress.
As we slowly increase our understanding of development, the brain, and humankind, there will always be a gap between what we are learning and what we can actually apply. Right now, that chasm seems especially large—but it is often darkest just before dawn.
Sometimes, of course, we create practices, programs, and policy based on “what we know” only to learn later that this “understanding” was immature or even wrong. Psychiatry has far too many examples of this: the frontal lobotomy, ice-cold baths, and insulin-induced shock are only the low lights. The area of what is now known as “translational medicine” is intended to take what is being discovered in basic sciences and develop practical applications of those discoveries. The concept is good; the application part has been challenging, and this occurs at least in part both because of the “innovation gap” and the tendency of those who benefit from the existing approaches to push back when “translational” innovations emerge.
Our working group has always been at the interface between discovery and application; we have attempted to bring advances in the neurosciences—and related disciplines—into clinical practice, education, and caregiving. This requires “translating” complex facts, principles, and concepts into a language that is clear and understandable. A key problem is that things really do get lost in translation. Due to the abundance of facts in the neurosciences, we often choose to teach concepts or general principles when we communicate to non-neuroscientists; we use shorthand and teaching devices to illustrate the key concepts, such as the images and tables included in the Appendix.
But for each principle, there are often important exceptions to the rule.
And simplification often includes hidden distortions that can lead to false conclusions when people try to generalize from it. An attempt to teach about the explosive rate of development in utero and in the first years of life, for example, can get turned into “Dr.
Perry says it’s too late to change the brain after age three. ”Another example of this over the last ten years has been seen in the emerging “trauma-informed” world. The phrases “the amygdala hijacks the brain” and “an amygdala storm” have become common language amongst the “trauma-informed.” The attempt to teach a little about the neurobiology of threat interpretation and how fear alters the way we process and act on information gets turned into a distorting buzz phrase.
Unfortunately, people like simple explanations such as “The amygdala is the ‘fear center’” and a child’s meltdown is an “amygdala hijacking.” Misunderstandings and distortion about the complex functioning of the amygdala in processing and interpreting fear-related cues became so pervasive that Joseph LeDoux, the pioneer in study of the amygdala and fear, and the person typically cited when the “amygdala storm” language is used, finally wrote a blog entry about it. It was titled “The Amygdala Is NOT the Brain’s Fear Center.” Indeed, this region is involved in many different emotions and the complexity of the brain means that phrases like “hijacking” often incorrectly reduce complex human behaviors into the actions of will-less zombies.
Translational work has implications for policy and practice outside of clinical settings. The legal system, for example, has been using neuroscience and developmental trauma research in a variety of ways. Cognitive impairment and obvious mental illnesses —both neurobiological conditions—have always been taken into consideration in determining guilt and sentencing. In recent landmark cases, including two Supreme Court cases, the role of the “immature adolescent cortex” in judgment and impulsivity has been cited in modifying sentencing guidelines related to the death penalty and life without parole; neither sentence can now be used with adolescents. The ChildTrauma Academy has been involved in educating the courts and the juvenile justice system about the neurobiology of trauma, the role of trauma in the development of violent behaviors, the impact of seclusion and solitary confinement, the effects of indiscriminate use of shackles on youth in court, and especially, the creation of trauma-aware and trauma-sensitive practices in juvenile justice settings.
Unfortunately, the legal system is also vulnerable to the “mistranslations” or distorted interpretations of work on trauma and development. On numerous occasions, I have been asked to become an expert witness to give testimony about the impact that a given experience has had on a person; this is a significant area in civil (not criminal) litigation, seeking to prove “damages” following some event or injury. Sometimes the event is clearly traumatic. For example, an employee is seriously injured in an explosion at a factory that also kills several co-workers and the effects are obvious: sleep problems, anxiety, cue-specific panic, avoidant behaviors.
In other cases, the legal team will try to convince me that an adolescent living in a household with documented history of domestic violence was instead “traumatized” by a hostile teacher and that his impulsive and aggressive behaviors all stem from this teacher’s “abusive” practices, such as giving him a “0” on a homework assignment that he forgot to bring in.
I don’t do very much forensic work, and when I do, I try to pick cases where I think I can learn something—and Leon’s case was, in fact, one of these. Over the last ten years, research has confirmed that people convicted of violent crimes, like Leon, have astoundingly high rates of early life attachment disruption and chronic developmental trauma, especially exposure to violence.
These findings have lead to efforts to create a “trauma-aware” judiciary and “trauma-informed” juvenile justice and criminal justice programs—in prisons and probation. True rehabilitation will not be possible without awareness of the multiple complex effects of trauma, neglect, poverty, racism, and other developmental adversities. Addressing recidivism and successful re-entry to the community is impossible without a respectful, humane, and developmentally-informed, trauma-aware perspective.
“Translation” matters. It does help the people in these systems better understand these children, youth, and families, and this can truly help improve our systems. And, no matter how often our efforts at translation get twisted, we can’t give up. Connect, correct, clarify, and carry on.
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