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Article

The Brain of a Killer


Group Members

Brittany Richardson
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Megan Telford
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Simon Deng
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Monika Milanovic
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1. Introduction


On the 20th of July 2012, James Holmes allegedly entered a cinema theatre in Aurora Colorado and proceeded to open fire indiscriminately on the people inside. As a result of his actions, 12 people were killed and 58 people were injured. When questioned by the authorities later, Holmes did not give any apparent motives for his actions (Gardner J, 2012).

Our article of interest “What Science can tell us about James Holmes’s Brain” was written by George Dvorsky and was posted online on io9.com on the 25th of July 2012, a mere 5 days after the attack. In this article Dvorsky explores plausible explanations for Holmes’s display of violence, the explanations included the possibility of psychopathy, schizophrenia, brain damage and brain tumour; but in our article we will be only discussing psychopathy and schizophrenia.

This article was chosen because psychopathy and schizophrenia, and their links with violence are very topical issues, and the media does much to shape the public’s perception of people with these mental disorders. In addition, it is human nature to look for an explanation in the face of such seemingly senseless violence.

Psychopathy and schizophrenia are among the mental illnesses which the public is most aware of, and which have been heavily sensationalised by the media. Movies such as “Psycho” (1960), “Silence of the Lambs” (1991), “Me, Myself and Irene” (2000) and “A Beautiful Mind” (2001) have done much to raise public awareness of these mental illnesses. However the common representation of people with schizophrenia and psychopathy as violent people, as well as the media’s fixation on violent crimes committed by offenders with these mental illnesses, have perpetuated the misconception that all schizophrenic and psychopathic people are violent. For example, one poll conducted in 2008 examined the general public’s knowledge of schizophrenia, and found that about 60% of the people polled believed that violence was a symptom of schizophrenia (Aron L., Carolla B. & Lehman C., 2008).

The main purpose of our article is to provide readers with a more informed understanding of the neuroscientific context and causes of psychopathy and schizophrenia, and the requirements to be clinically diagnosed with these mental disorders. We also aim to provide readers with a more educated appreciation of the link between each disorder and physical violence.


2. Neuroscientific Context


2.1. Psychopathy

2.1.1. Background

Psychopathy was the first personality disorder to be recognised in psychiatry (Millon, Simonsen & Birket-Smith et al 1998), and in the last two decades an increasing body of research has supported its validity (Hare & Neumann CS 2009a).

Psychopathy is a personality disorder, defined by a number of interpersonal, affective, lifestyle, and antisocial traits and behaviours. These include grandiosity, egocentricity, deceptiveness, shallow emotions, irresponsibility, impulsivity and a tendency to violate social norms. Psychopaths tend to be dominant, superficial and manipulative, and have a severe lack of empathy, guilt and/or remorse. Psychopaths by definition lead a socially deviant (not necessarily criminal) lifestyle (Millon et al 1998; Berrios 1996; Cleckley 1976; Hare 1991; Herve 2007). A common genetic factor accounts for substantial variance in these psychopathy domains (Larsson, Viding & Plomin 2008; Viding, Frick & Plomin 2007), which is evidence that they are constituents of the “superordinate construct of psychopathy” (Neumann, Hare & Newman 2007; Neumann, Vitacco, Hare et al 2007). In fact, 40% to 78% of the variation in callous-unemotional traits has been attributed to genetic influences (Bezdjian, Raine, Baker, & Lynam 2011).

Psychopathy is associated with a distinct pattern of cortical thinning and reduced functional connectivity.Relative to nonpsychopaths, psychopaths had significantly thinner cortex in a number of regions, including the left insula and dorsal anterior cingulate cortex, the left and right precentral gyri, the left and right anterior temporal cortices, and the right inferior frontal gyrus. (Ly M., Motzkin J.C. & Philippi C,L. 2012) (See Figure 1 and Table 1).

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Recent findings from the fields of behavioural genetics, developmental psychopathology and neurobiology indicate that the personality and behavioural propensities characterising psychopathy are firmly established and presumably difficult to change (Harris, Skilling & Rice 2001; Frick 2009; Gao, Glenn, Schug et al 2009; Harris & Rice 2006; Kiehl 2006; Wong & Hare 2005).

2.1.2. Diagnosis

The Psychopathy Checklist-Revised (PCL-R) is a 20-item clinical construct rating scale that uses case history information, a semi-structured interview, and very detailed scoring criteria to rate each item on a 3-point scale (0,1,2) according to the degree to which it applies to the specified person (Hare 2003; Book, Clark, Forth et al 2006; Hare & Neumann CN 2008; Hare & Neumann CS 2008; Hare & Neumann CS 2009b). In some cases, this conventional procedure (interview and file information) is replaced by a nonstandard approach, in which only file information is used to score the items. Total scores on the PCL-R can range from 0 to 40 and indicate the extent to which the person matches the “prototypical” psychopathic person, in accordance with the recent evidence that the construct underlying the PCL-R (and derivatives) is dimensional in nature rather than taxonomic. (Edens, Marcus, Lilienfeld et al 2006; Guay, Ruscio, Knight et al 2007; Walters, Gray, Jackson et al 2007). A PCL-


R cut-off score of 30 has been found useful for classifying people as psychopathic for research and applied purposes, although some studies have used other cut-off scores for psychopathy (e.g. 25 in some european studies). 30 is an extreme score, and is obtained by approximately 15% of male offenders and 10% of female offenders, described by Hare (2003).

2.1.3. Link with Violence

Many traits which inhibit antisocial and violent behaviour- empathy, close emotional bonds, fear of punishment, guilt- are lacking or severely defective in psychopathic people. In addition, their “egocentricity, grandiosity, sense of entitlement, impulsivity, general lack of behavioural inhibitions, and need for power and control” essentially constitute what could be called a prescription for the perpetration of antisocial and criminal acts (Hare 2003; Porter & Porter 2007). This explains why psychopathic offenders are disproportionately represented in the criminal justice system, and why psychopaths are at ease victimising the vulnerable. Psychopaths enjoy using intimidation and violence as tools to achieve power and control over others. Their impulsivity and poor behavioural controls may lead to reactive forms of aggression and/or violence, but their other characteristics (e.g. lack of empathy and shallow emotions) also make it comparatively easy to engage in more predatory, premeditated and/or cold-blooded violence and aggression (Hare 2003; Cornell, Warren, Hawk et al 1996; Meloy 2002; Porter & Woodworth 2006; Williamson, Hare & Wong 1987; Woodworth & Porter 2002).


2.2. Schizophrenia

2.2.1. Background

Schizophrenia is a complicated and severe mental illness characterized by a distortion of one’s reality, with sources stating that it affects 1% of the global population (Lewis & Levit 2002; Mueser & McGurk 2004). Due to varied experiences of how schizophrenia can manifest itself, and the differing range of symptoms, both neurological and behavioural, that may be present in someone suffering schizophrenia, it is difficult to define and classify the illness (Keshavan, Nasrallah & Tandon 2011). It is even challenging to establish whether schizophrenia is simply just one disease (Bear, Connors & Paradiso 2007).

Schizophrenia can be defined by several characteristics, or symptoms, which are classified into positive or negative categories. Positive symptoms, behaviours and thoughts considered abnormal (Bear, Connors & Paradiso 2007), may include hallucinating, including auditory hallucinations, and suffering from incoherent speech, delusions and disorganised or catatonic behaviour (Bear, Connors & Paradiso 2007; Rolls & Deco 2011). Negative symptoms, when normal behaviours are absent (Bear, Connors & Paradiso 2007), may include poor language processing and production, reduced expression, impairment of short-term memory and a proneness to being easily distracted (Bear, Connors & Paradiso 2007; Rolls & Deco 2011; Cohen & Servan-Schreiber 1992).

As a result of the varied symptoms and manifestations, both behavioural and neurological, of schizophrenia, there has been a lot of difficulty classifying, and indeed, understanding the possible causes of the mental illness. Genetics and environment both play an important role in the development of the condition, however research into the neurological component of schizophrenia reveals that several neurotransmitters may also be involved (Bear, Connors & Paradiso 2007; Wong & Van Tol 2003).


2.2.2. Diagnosis

The neurological symptoms relating to schizophrenia, such as enlarged lateral ventricles (Wong & Van Tol 2003; van Os & Kapur 2009; Bear, Connors & Paradiso 2007), are not apparent in all schizophrenics and hence, diagnosis cannot rely on these characteristics of the disease (van Os & Kapur 2009). Consequently, diagnosis of schizophrenia relies largely on psychological methods that examine the behavioural symptoms present, ensuring at first that other causes of such symptoms are eliminated (van Os & Kapur 2009). Such diagnosis methods include criteria presented in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and the International Classification of Disease (ICD-10) (Wong & Van Tol 2003; van Os & Kapur 2009). These sets of criteria have several requirements that, in order to be classified as schizophrenic, one must meet. These include factors such as symptoms, duration of the symptoms, and exclusion of other explanations of symptoms (Wong & Van Tol 2003). Evidently there are issues when diagnosing schizophrenia, however these sets of diagnostic criteria seek to overcome these through a strict set of criteria detailing symptoms, and through continuous revision.


2.2.3. Possible Neurological Explanations

Research suggests that there may be several possible explanations for schizophrenia on a neurological level. Research into genetics as one of the main causes of schizophrenia exposes that the genes thought to be responsible seem to have “important roles in synaptic transmission, its plasticity, or the growth of synapses” (Bear, Connors & Paradiso 2007). Environmental factors, such as issues with prenatal development (Bear, Connors & Paradiso 2007; Wong & van Tol 2003), could be responsible for the expressions of such genes (Wong & van Tol 2003). Furthermore, research has provided evidence that some schizophrenics exhibit structural changes in their brains (Wong & van Tol 2003, Bear, Connors & Paradiso 2007). Such structural changes have included: enlarged lateral ventricles and decrease in cortical volume (See Figure 2) (Wong & van Tol 2003; van Os & Kapur 2009; Bear, Connors & Paradiso 2007); myelin sheath defects in the cerebral cortex (Bear, Connors & Paradiso 2007); and a decrease in the size of the cortical and hippocampal neurons (Wong & van Tol 2003). Such neurological structural changes however, do not completely explain schizophrenia at a neurological level and hence, hypotheses involving neurotransmitters have been proposed.

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2.2.3.1.The Glutamate Hypothesis
The glutamate hypothesis is just one possible explanation of schizophrenia at a neurotransmitter level, and involves glutamate and one of its main receptors, NMDA receptors (Keshavan, Nasrallah & Tandon, 2011; Bear, Connors & Paradiso 2007). This model proposes that the inhibition of these receptors causes some symptoms characteristic of schizophrenia, and this was initially discovered through work with phencyclidine (PCP), a drug that blocked NMDA receptors and consequently caused some schizophrenic-like behaviours (See Figure 3) (Keshavan, Nasrallah & Tandon, 2011; Bear, Connors & Paradiso 2007).

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2.2.3.2. The Dopamine Hypothesis
Another, more developed, possible neurological explanation of schizophrenia is the dopamine hypothesis. The dopamine model suggests that when dopamine receptors are overly activated, positive symptoms of schizophrenia can occur (See Figure 4) (Bear, Connors & Paradiso 2007). As Wong and Van Tol (2003, p.276) state, this hypothesis “posits that hyperactivity of the (dopamine) system is responsible for the psychotic symptoms”. Hence, the model suggests that abnormal dopamine concentrations or regulations could be an explanation for the psychotic schizophrenia symptoms (van Os & Kapur 2009).

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2.2.4. Link with Violence

Further research and investigation is looking into whether violence is linked to schizophrenia. Walsh, Bauchanan and Fahy (2002) report that there is, in fact, an increased tendency towards violence if one suffers from schizophrenia, but that this link has only been recognized in the past thirty years or so. The authors highlight, however, the important distinction between investigating how many people who have committed violent acts are schizophrenic, versus how many people who are schizophrenic have committed violent acts (Walsh, Bauchanan & Fahy 2002). Furthermore, articles link schizophrenia to violence through psychosis and empathy (Taylor 2008; Bragado-Jimenez & Taylor 2012). Taylor (2008, p.656) proposes that for individuals suffering from schizophrenia “psychotic symptoms seem to drive that violence”, but that we know little about this on a neurological level currently. Other research also looks at the relationship between violence, schizophrenia and empathy impairments, but there is no conclusive research as of yet (Bragado-Jimenez & Taylor 2012).



3. Analysis


3.1. Target Audience

The media item was published on the online website, Io9, on the 25th of July, 2012 within the week of the fatal shootings committed by James Holmes in Aurora, Colorado. Io9 is an informative website focusing on science, science fiction and the future for the general populous. The target audience for this article would be the generalised audience of English speaking individuals between the ages of 18-50 years old that may have some or little knowledge of neuroscience and an interest of the possible neuroscientific causes underlying Holmes’s deadly actions.


3.2. Pitch

The Colorado shooting has attracted widespread media attention, with many outlets providing speculative articles focused on deducing the reason behind the mass murder. The intention of this media article was therefore to provide a generalized overview on the three possible theories to account for this tragedy from a scientific, or ‘neurological’ perspective. In an attempt to provide a scientific explanation for this event, author George Dvorsky aims to account for a causal link between a neurological disorder and the behaviour of Holmes. The article itself is presented in a biased manner by the author with particular focus on psychopathy and/or schizophrenia as being the probable explanation rather than brain damage. Dvorskys’ relatively subjective stance towards psychopathy as the reason does influence the audiences view and intentionally or not, discredits the two alternate explanations.


3.3. Quality of Information

The chosen media article does provide a rational, albeit evidently simplistic account of the possible neurological deficits providing an explanation for the actions and behaviour of James Holmes. Dvorsky approaches the target audience successfully in an appropriate manner giving simplified accounts of three possible neurological explanations with relative depth and avoiding excessive use of scientific jargon. To analyze the quality of information it is also relevant to note that the writer is not an expert within the field of neuroscience, therefore questioning the reliability of the information provided. The interpretation of current scientific knowledge within the article is fairly accurate, well researched with dense coverage concerning psychopathy and schizophrenia and to a lesser extent, brain damage. For example, in terms of psychopathy, the author mentions the Hare Psychopathy Checklist Revised PCL-R (Hare, 2003), accurately describing its use to classify individuals as psychopaths and provides a rationale in the classification of Holmes. The same can be said about the description of deficits related to schizophrenia and brain damage as a possible explanation for James Holmes’ actions. The author provides accurate information similar to the neuroscientific context mentioned above, but in a simple, and rather subjective manner. Continuing with the psychopathy example, Dvorsky further assumes that Holmes would rate highly in the severe category on the PCL-R scale being “a good bet”. Statements such as these were evident within the article but presented with no substantiated evidence and subsequently overshadowed the quality of the information presented.

In an attempt to further engage with the audience, the article published on an online platform allowed for the inclusion of hyperlinks towards relevant resources for topics raised in the article. The links were broad and included information from other media outlets and published scientific resources, such as journal articles that overall were credible sources of information. One could argue that the article in a way sensationalized the neuroscientific content demonstrated in the hyperlink in the statement, “3-5% of CEO’s are psychopaths”. Instead of linking to the research paper that the conclusion made by Board and Fritzon (2005), it links to a Forbes interview piece on an author discussing his comedic book about the findings. Overall, the content and information discussed within the article was relevant and likely to be engaged with the target audience.

The author concludes that whilst psychopathy, schizophrenia or brain damage accounts may possibly be true, these factors in combination, or a myriad of other reasons may be behind Holmes’ behaviour. These proposed neurological perspectives are completely reasonable in this case, but if depicted more objectively to demonstrate no particular bias would provide greater scientific credibility. The speculative nature of the article also casts a shadow over the information presented. Despite all that is mentioned above, the simplified analysis of neuroscientific information within the article provides substantiated insight into the science of James Holme’s brain and therefore achieves the intention of informing the targeted general population.


4. Appendix


The group was formed in class on the 27th of July, and the first meeting was organised for the 5th of August. During this meeting various topics were proposed, and topics were searched for through various online media channels, including Google and YouTube searches. The chosen online media article was located when researching recent news stories linked to neuroscience.

Dvorsky’s article appealed to the group immensely due to the issue of James Holmes’ recent extremely violent outburst in Colorado being so prevalent in the media currently, as well as the intriguing propositions in the article that linked James Holmes’ actions to a neurological cause, such as brain damage, schizophrenia or psychopathy. The interesting neuroscientific concepts the article touched on, and the relevancy of the article to current news events, made the article an ideal choice for our group.

After further research, the decision was made to focus on the psychopathy and schizophrenia aspects in the article, and we were each assigned different aspects of the assignment to focus on.

Research for each section was conducted by consulting books, online peer-reviewed journal resources located through means such as the UNSW library website, and linked journal articles within Dvorsky’s article. Our references were checked for reliability and validity, and we consulted their citations to ensure that they were all sound sources of information.

The group regularly communicated through discussion boards, face-to-face meetings, shared online documents and the Facebook group. Communication was vital in order to effectively convey ideas, thoughts and feedback within the group.

Once feedback was received from the peer reviewing process, members sought to incorporate the feedback appropriately into their sections. A significant portion of feedback in all sections consisted of grammar corrections and spelling errors which had been overlooked in the initial draft submission. These were all taken into consideration, and amended for the final draft. Furthermore, the comments suggested adding more figures/tables to support the neuroscientific context section, and hence, these were incorporated.

Regarding the information itself, most feedback comments were positive. However, comments from the peer review suggested that the introduction required some further amending, and hence, more information was added and the wording slightly changed. Additionally, in neuroscientific context, the psychopathy section required the diagnosis section to be minimized and more neuro-specific information to be added, and these changes were made through rereading references and changing the information included. Furthermore, in neuroscientific context, one peer reviewer suggested adding much more detailed information regarding the neuroscience of schizophrenia. However, considering a limited word count which had already been reached, an evaluation that the information already included was of significance, and the other positive comments regarding the quality and relevancy of the included information in all sections, this feedback was considered but this amendment was not made.

Overall, the peer review feedback received was highly valued and ensured that the final wiki presented was of the highest quality that we could produce within the boundaries of the guidelines and requirements. Our group worked well, communicated effectively, and learnt a lot regarding our focused neuroscientific topics, our article, and the quality of the article.


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5. References



Reference List