Reviewing: The Psychopath Inside by James Fallon

The Motive:

Throughout this series of blogs we’ve found ourselves unraveling a thread on psychopathy: we’ve been guided by a scientist who assesses psychopaths, a criminal profiler who helped incarcerate them and even a comedic journalist investigating the checklist that defined the condition. Will our final word on this topic come from one of the few psychopaths who ever decided to write about it?

The Evidence:

That much knowledge of psychopathy derives from research on convicted violent offenders introduces some interesting biases. Based on such material it is entirely natural to presume that psychopaths are a uniform group, and that if a test for psychopathy is positive, you are inevitably dealing with a highly dangerous criminal. But is this always true? James Fallon’s book is the story of a scientist, who, much like Kent Kiehl, learned to diagnose psychopathy from the activation patterns shown in brain scans. Then one day he scanned himself.

Some say every book is a unique product of the author, and that is certainly true in this case. After all, only a tiny fraction of people will ever be brain scanned for research purposes, and only a tiny fraction of those will have the skills and desire to write a book about the experience. By the time we discover our subject was a professor of psychiatry and neuroscience and that his scan exhibited psychopathic markers, we’ve reached such an apex of improbability that the whole thing sounds like a setup. And yet, it isn’t.

As an experienced scientist with research interests in neuroanatomy and brain chemistry, Fallon tripped over criminality by assisting the research work of colleagues. From a blinded trial of brain scans he identified a group that shared a common set of damage. When he found out those scans were all from psychopathic killers his interest grew and he became an occasional public commentator on the underpinnings of psychopathy, and sometime expert consultant in legal trials.

The book describes Fallon’s reaction to discovering his own brain scan (taken as a control for an Alzheimer’s project) matched the most extreme case-studies taken from murderers. And that reaction? He wasn’t especially worried. When he subsequently learned his family-tree featured a long line of murderers, including the first American matricide and Lizzie Borden, he remained unperturbed. When genetic tests scored him highly for aggression-related genes, still he found it unconcerning. Then friends and psychiatric colleagues described his some of his behaviours using the word “sociopath“, and he realised his continuing lack of anxiety was simply part of the way his brain worked: long on what he calls cold cognition, the domain of hard rationality and logic, but woefully short on hot cognition, emotional understanding and empathy. But why, he asked himself, wasn’t he a killer?

His research concluded that the formation of this type of offender required three components: first, genetics, specifically the presence of high-risk aggression-related genes such as the so-called Warrior Gene; second, reduced function or damage in specific areas of the brain; finally, abuse in childhood, something that crops up time and again in interviews with killers. These elements formed what Fallon called the three-legged stool necessary for the development of a psychopathic murderer, and he possessed two from three. His own saving grace, he decided, was an idyllic childhood, leaving him a prosocial psychopath: one who wants to be part of society, doesn’t want to be violent towards anyone, but who doesn’t view the world the same way as more neurotypical people and never will.

The importance of youth experiences had cropped up for Fallon previously as an adviser to the US Department of Defense on the impact of warfare on the brain. He describes sending kids to war at eighteen, while they are still in an active state of frontal-lobe development as “ridiculous”, pointing out the known links between extreme-stress response and schizophrenia, bipolar, OCD and personality disorders. Given his background and knowledge, it is hard to disagree with his assessment that protection of the young is an investment in a safer society.

The book includes a discussion of why psychopathy exists – why, essentially, psychopaths have not been so shunned and ostracised as to have left the gene pool, and why they remain a stable minority in all of our societies. He proposes that it represents a survival advantage for a population to contain people strong in traits that would otherwise score highly on the Hare Checklist. Do we want our surgeons riven with empathic concerns as they wield the scalpel? Our military personnel stricken by remorse on the battlefield? And might we find a surplus of sociopaths in some boardrooms because our economic system occasionally values executives who can act without care for the impact on the workforce? Fallon essentially believes psychopathic traits remain to save our species from stagnation. Without those genes and traits, he concludes, the human race would be doomed by its own passivity.

The Verdict:

This is a fascinating book that demystifies the psychopathic condition from someone who knows it both inside and out. And Fallon’s three-legged stool theory not only overturned his own previous certainties of the dominance of nature over nurture, but poses a challenge we would all be wise to consider: how can we better protect more of our children, so fewer grow into monsters under the bed?