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PSYCH 158: Adult Antisocial Behavior, Criminality, and Violence · Clinical Deep Dives

0:00
SPEAKER_01: I want you to imagine two different individuals for a moment.
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SPEAKER_01: Just picture them in your head.
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SPEAKER_00: Okay.
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SPEAKER_00: I have got a blank canvas ready.
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SPEAKER_01: Right.
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SPEAKER_01: So the first is a man in a incredibly tailored, very expensive suit.
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SPEAKER_01: He is sitting at a mahogany desk and a high rise office.
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SPEAKER_01: And with just a single stroke of his pen,
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SPEAKER_01: he signs off on a corporate policy that he absolutely knows will expose thousands
0:23
SPEAKER_01: of workers to lethal toxins.
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SPEAKER_00: He knows it will happen as a statistical certainty.
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SPEAKER_01: Exactly.
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SPEAKER_01: He is fully aware that a certain percentage of them will die over the next decade.
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SPEAKER_01: Now, hold that image and imagine the second individual,
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SPEAKER_01: a man in a tracksuit standing in a dimly lit, damp alleyway.
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SPEAKER_01: He pulls a trigger and kills someone over a relatively minor financial debt.
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SPEAKER_00: It's a striking contrast, isn't it?
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SPEAKER_01: It is because when you read about these two men in the news,
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SPEAKER_01: society and honestly the legal system
0:56
SPEAKER_01: and our general moral intuition treats them entirely differently.
1:00
SPEAKER_00: Oh, completely differently.
1:01
SPEAKER_00: One is seen as a shrewd, perhaps slightly ruthless businessman who might face a regulatory fine.
1:07
SPEAKER_01: Right.
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SPEAKER_01: Maybe a slap on the wrist.
1:09
SPEAKER_00: Yeah.
1:09
SPEAKER_00: Whereas the other is a violent criminal facing a life sentence in prison.
1:13
SPEAKER_00: But if we strip away the expensive suits,
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SPEAKER_00: the gritty alleyways,
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SPEAKER_00: and all of that social conditioning,
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SPEAKER_00: we are left with the exact same fundamental question.
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SPEAKER_01: Which is,
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SPEAKER_01: how does the human brain authorize the infliction of profound harm
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SPEAKER_01: upon another human being?
1:29
SPEAKER_00: Spot on.
1:30
SPEAKER_01: That is the core of it.
1:31
SPEAKER_00: That is the core of it.
1:33
SPEAKER_01: Now, to explore that today, we are going to use a metaphor.
1:37
SPEAKER_01: If you are listening to this, I want you to imagine stepping into a vast sort of shadowy space.
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SPEAKER_01: We will call it the Chamber of Violence.
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SPEAKER_01: And walking into this chamber right alongside you is a conceptual detective.
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SPEAKER_01: We will call him Medlock Holmes.
1:52
SPEAKER_00: I like Medlock Holmes.
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SPEAKER_01: Brilliant, isn't it?
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SPEAKER_01: But Holmes isn't looking for muddy footprints,
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SPEAKER_01: and he certainly isn't dusting for fingerprints on a weapon.
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SPEAKER_00: Holmes is here for something much more elusive.
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SPEAKER_00: He is looking for the why.
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SPEAKER_00: Why do human beings become capable of harming others?
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SPEAKER_01: It is arguably the ultimate locked room mystery,
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SPEAKER_01: except in this case, the locked room is the human skull.
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SPEAKER_00: I love that.
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SPEAKER_01: And as Holmes walks through this chamber,
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SPEAKER_01: the sheer variety of what he finds is just completely jarring.
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SPEAKER_01: You have the highly organized criminal,
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SPEAKER_01: the corporate executive we mentioned,
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SPEAKER_01: and then the impulsively violent offender whose behavior appears entirely
2:29
SPEAKER_01: beyond their conscious control.
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SPEAKER_00: They do not look the same.
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SPEAKER_00: They certainly do not act the same.
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SPEAKER_00: And yet they all end up in this same conceptual space of antisocial behavior.
2:40
SPEAKER_01: Right.
2:41
SPEAKER_00: And that variety immediately shatters the illusion that violence is a single monolithic entity.
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SPEAKER_00: We are looking at clinical manifestations that vary so wildly,
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SPEAKER_00: it really defies any single neat categorization.
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SPEAKER_01: So it isn't just one disease or one type of broken brain.
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SPEAKER_00: Not at all.
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SPEAKER_00: Neither criminal behavior nor violence automatically indicates a psychiatric illness.
3:04
SPEAKER_00: And conversely, severe psychiatric illness does not automatically equate to violence.
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SPEAKER_01: And that nuance right there is our core mission for you today.
3:13
SPEAKER_01: Welcome to the Deep Dive.
3:14
SPEAKER_01: Today we are exploring a comprehensive conceptual synthesis of Chapter 28.2
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SPEAKER_01: from Kaplan and Sadoc's Comprehensive Textbook of Psychiatry.
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SPEAKER_00: Which focuses on adult antisocial behavior, criminality, and violence.
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SPEAKER_01: Yes, and if you are a psychiatry trainee,
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SPEAKER_01: a clinician,
3:31
SPEAKER_01: or just someone deeply fascinated by human behavior,
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SPEAKER_01: we want to anchor this entire conversation right here,
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SPEAKER_01: right now, with a core premise.
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SPEAKER_00: Which is that psychiatry is the study of how the brain, the mind, and experience interact.
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SPEAKER_01: Yes, and crucially, how that precise, delicate process can go horribly wrong.
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SPEAKER_00: That is a vital distinction to make right at the start,
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SPEAKER_00: because historically, the approach to understanding violence was...
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SPEAKER_00: Well, it was anything but clinical.
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SPEAKER_01: It was purely judgmental, wasn't it?
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SPEAKER_00: Absolutely.
4:01
SPEAKER_00: For decades,
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SPEAKER_00: perhaps centuries,
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SPEAKER_00: violent criminals and even nonviolent ones were simply deemed bad.
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SPEAKER_00: It was a strict binary.
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SPEAKER_00: If the crimes were particularly heinous, they were labeled evil.
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SPEAKER_01: It was essentially a moral judgment or a religious one.
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SPEAKER_01: It wasn't treated as a medical or neurobiological question at all.
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SPEAKER_01: You were just a rotten apple.
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SPEAKER_00: The overarching societal belief was that professional thieves,
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SPEAKER_00: racketeers,
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SPEAKER_00: or serial killers were just mentally healthy malefactors who had made a conscious,
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SPEAKER_00: albeit immoral, lifestyle choice.
4:35
SPEAKER_01: Right.
4:35
SPEAKER_01: The assumption was that there was absolutely nothing wrong with their brains.
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SPEAKER_01: They just woke up and chose to be wicked.
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SPEAKER_00: But that assumption rested on zero scientific evidence.
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SPEAKER_01: So let's unpack this.
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SPEAKER_01: Because modern science is telling us there is absolutely something wrong with
4:48
SPEAKER_01: the hardware and the software in many of these cases.
4:51
SPEAKER_01: But to understand the mechanisms, we really have to look at the manifestations first.
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SPEAKER_00: We need to see how criminality actually presents in the real world.
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SPEAKER_01: Exactly.
5:00
SPEAKER_01: So let's start with organized crime.
5:02
SPEAKER_01: Medlock Holmes is walking into the first room in this chamber.
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SPEAKER_00: Organized crime provides a fascinating psychological baseline.
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SPEAKER_00: If we look back to the 1970 definition in the United States,
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SPEAKER_00: it was described as structured racketeering by a highly organized,
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SPEAKER_00: disciplined association.
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SPEAKER_01: But what I find truly remarkable,
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SPEAKER_01: just from a sociological standpoint,
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SPEAKER_01: is how long authorities simply refused to see it as a structured entity.
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SPEAKER_00: You were talking about J. Edgar Hoover and the FBI.
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SPEAKER_01: Yes.
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SPEAKER_01: I find this historical blind spot incredible.
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SPEAKER_01: Until 1957,
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SPEAKER_01: Hoover effectively denied that the mafia,
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SPEAKER_01: or Cosa Nostra, Even existed as a national violent lucrative entity.
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SPEAKER_00: He dismissed them as disorganized local hoodlums, didn't he?
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SPEAKER_01: He did.
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SPEAKER_01: He was focusing all his resources on political dissidents or,
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SPEAKER_01: you know, high profile bank robbers.
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SPEAKER_00: He fundamentally misunderstood the structure of the phenomenon.
5:56
SPEAKER_01: Right.
5:57
SPEAKER_01: And it wasn't until a massive meeting in the autumn of 1957 at the Appalachian estate.
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SPEAKER_01: This was a 58 acre estate of a mobster named Joe Barbara in New York that
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SPEAKER_01: the illusion finally shattered.
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SPEAKER_00: The story of that raid is almost comical.
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SPEAKER_01: It really is.
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SPEAKER_01: Local police just happened to notice this massive fleet
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SPEAKER_01: of very expensive cars like Cadillacs and Lincolns parked at this rural,
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SPEAKER_01: quiet estate.
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SPEAKER_01: They went to investigate,
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SPEAKER_01: and suddenly you had dozens of the most powerful mob bosses in
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SPEAKER_01: the country literally running through muddy cornfields
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SPEAKER_01: in their tailored suits trying to escape.
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SPEAKER_00: The headlines the next day were brilliant.
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SPEAKER_00: Something like, police nab 67 mafia chiefs in backwoods.
6:36
SPEAKER_01: Exactly.
6:37
SPEAKER_01: The FBI finally had to acknowledge the structure.
6:40
SPEAKER_00: But, you know,
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SPEAKER_00: the structure of the organization isn't as interesting to us as the structure
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SPEAKER_00: of their minds.
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SPEAKER_00: From a psychiatric perspective, what is the psychology of a mobster?
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SPEAKER_01: Well, the lay assumption is that a crime syndicate is just a collection
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SPEAKER_01: of ruthless psychopaths who somehow managed to find each other.
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SPEAKER_00: But the data tells a completely different story.
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SPEAKER_00: There is a fascinating Italian study mentioned in the text
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SPEAKER_00: that compared mafia linked incarcerated criminals
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SPEAKER_00: with run-of-the-mill incarcerated non-mafiosi.
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SPEAKER_01: And what did they find?
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SPEAKER_00: Because you would assume the mobsters are off the charts for psychopathy.
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SPEAKER_01: That is exactly what the researchers assumed.
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SPEAKER_01: They went in expecting sky-high rates of psychopathy among the mobsters,
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SPEAKER_01: given the calculated, often brutal nature of their crimes.
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SPEAKER_01: But instead,
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SPEAKER_01: they found that none of the mafia-linked criminals scored in the abnormal range
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SPEAKER_01: on standard psychopathy scales.
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SPEAKER_00: Wait, really?
7:34
SPEAKER_01: Yes.
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SPEAKER_00: The ordinary street criminals actually scored significantly higher on those scales.
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SPEAKER_01: So you were saying the people ordering hits
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SPEAKER_01: and running massive extortion rackets were actually less psychopathic than
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SPEAKER_01: the person holding up a corner off license?
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SPEAKER_01: How does that even make sense?
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SPEAKER_00: It makes sense when you look at the subscales of those diagnostic tests.
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SPEAKER_00: The mafiosi actually scored higher on interpersonal domains,
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SPEAKER_00: suggesting empathy and caring than their everyday criminal cellmates.
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SPEAKER_01: Empathy in a mafia boss.
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SPEAKER_00: Absolutely.
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SPEAKER_00: Many of them maintained highly stable marriages,
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SPEAKER_00: were deeply devoted to their children,
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SPEAKER_00: and exhibited incredibly strong loyalty to their friends.
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SPEAKER_01: Right.
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SPEAKER_01: So if you will forgive the analogy,
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SPEAKER_01: it sounds like a mob boss is essentially just a ruthless CEO in a tracksuit.
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SPEAKER_01: They are highly functional.
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SPEAKER_00: The clinical data strongly supports that analogy.
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SPEAKER_00: One expert in the text concluded that the exact personality traits
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SPEAKER_00: that predict leadership success in legitimate business,
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SPEAKER_00: things like extroversion,
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SPEAKER_00: controlled impulsiveness,
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SPEAKER_00: a sense of adventure,
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SPEAKER_00: megalomania,
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SPEAKER_00: and certain narcissistic traits,
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SPEAKER_00: apply equally well to a successful career in organized crime.
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SPEAKER_01: So they aren't inherently lacking in the neurobiological hardware for empathy?
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SPEAKER_00: No, their hardware is largely intact.
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SPEAKER_00: What they do is compartmentalize.
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SPEAKER_01: Oh, okay.
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SPEAKER_00: They selectively apply their empathy based on their structured in-group and out-group rules.
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SPEAKER_00: If you are in the family, you receive empathy.
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SPEAKER_00: If you are outside the family or you pose a threat to the business,
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SPEAKER_00: the empathy is cognitively switched off.
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SPEAKER_01: It is a social reinforcement of violence rather than a fundamental deficit in
9:13
SPEAKER_01: the brain's emotional centers.
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SPEAKER_00: Spot on.
9:16
SPEAKER_01: Which brings up a frankly terrifying question.
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SPEAKER_01: If empathy can be compartmentalized for an in-group, what happens when there is no in-group?
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SPEAKER_00: Or when the victim is entirely abstracted from the perpetrator.
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SPEAKER_01: Exactly.
9:30
SPEAKER_01: That brings us to a completely different manifestation of harm.
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SPEAKER_01: Room two, white collar crime.
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SPEAKER_01: And this is where the lines between business and violence get incredibly blurry.
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SPEAKER_00: The term white collar crime was coined by the sociologist Edwin Sutherland back in 1939.
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SPEAKER_00: He fundamentally challenged the prevailing theory of his day.
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SPEAKER_01: Which was what exactly?
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SPEAKER_00: The prevailing thought was that crime was primarily a result of poverty,
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SPEAKER_00: low intelligence, or societal disadvantage.
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SPEAKER_00: But Sutherland pointed his finger at the improper business practices of people in power.
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SPEAKER_01: And the sociological definition he created hinges on deceit,
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SPEAKER_01: concealment, or a violation of trust.
10:08
SPEAKER_01: But critically, it occurs without the application or threat of physical force.
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SPEAKER_00: That lack of physical force is the psychological key here.
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SPEAKER_00: When we look at the financial impact, the scale is almost unfathomable.
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SPEAKER_00: The sources estimate street crime costs society about $15 billion a year.
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SPEAKER_00: White collar crime?
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SPEAKER_00: Hundreds of billions.
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SPEAKER_01: But it is the psychological mechanism that allows this to happen that we
10:31
SPEAKER_01: as clinicians really need to focus on.
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SPEAKER_00: It comes down to one concept.
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SPEAKER_00: Distance.
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SPEAKER_01: Distance as an anesthetic for the conscience.
10:39
SPEAKER_00: Precisely.
10:41
SPEAKER_00: The human brain evolved to register the distress of people right in front of us.
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SPEAKER_00: If you hit someone, you see their face contort.
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SPEAKER_00: You hear them cry out in pain.
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SPEAKER_00: Your brain processes those signals and triggers an aversive emotional response.
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SPEAKER_01: It feels bad to hurt someone up close.
10:57
SPEAKER_00: Exactly.
10:58
SPEAKER_00: But as technology and corporate structures have evolved,
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SPEAKER_00: the distance between the perpetrator and the victim has expanded exponentially.
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SPEAKER_01: It's sort of like a drone warfare analogy.
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SPEAKER_01: It is psychologically vastly easier to push a button and drop a bomb from a drone on
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SPEAKER_01: a screen thousands of miles away than it is to look someone in the eye and use
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SPEAKER_01: a knife.
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SPEAKER_00: The victim becomes automated.
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SPEAKER_00: They are just digits on a spreadsheet.
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SPEAKER_00: The less human the target appears, the less troubled the conscience.
11:30
SPEAKER_01: A corporate officer can inflate stock prices,
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SPEAKER_01: or a fund manager can siphon retirement savings,
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SPEAKER_01: and they never have to actually look into the eyes of the pensioner
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SPEAKER_01: who now cannot afford to eat or heat their home.
11:41
SPEAKER_00: But this moral compromise isn't just about financial loss.
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SPEAKER_00: It is profoundly evident in the medical and pharmaceutical industries,
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SPEAKER_00: where corporate deceit translates directly into clinical physical harm.
11:53
SPEAKER_01: We have to talk about the Dalkin Shield here.
11:56
SPEAKER_01: For anyone listening who is unfamiliar,
11:57
SPEAKER_01: this is a textbook example of how the distance of white-collar crime results
12:02
SPEAKER_01: in literal bloodshed.
12:04
SPEAKER_00: The Dalkin Shield was an intrauterine contraceptive device,
12:07
SPEAKER_00: an IUD, aggressively marketed in the early 1970s.
12:12
SPEAKER_00: Early on, the corporation behind it knew there was a severe flaw in the design.
12:16
SPEAKER_00: The device had a multifilament string that essentially acted as a wick.
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SPEAKER_01: When I read this in the chapter, my jaw dropped.
12:22
SPEAKER_01: It was drawing bacteria-laden fluid from the vagina directly up into
12:27
SPEAKER_01: the normally sterile environment of the uterus.
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SPEAKER_00: It was a catastrophic biological failure.
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SPEAKER_00: It caused rampant pelvic inflammatory disease, ectopic pregnancies, and septic abortions.
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SPEAKER_00: Women were dying.
12:41
SPEAKER_00: Or losing their fertility permanently.
12:43
SPEAKER_01: And the corporate officials knew.
12:45
SPEAKER_00: Yes.
12:46
SPEAKER_00: Sitting in their boardrooms miles away from the emergency rooms,
12:49
SPEAKER_00: they went forward with the promotion and sales anyway.
12:52
SPEAKER_00: They left the product on the market for over three years while complaints
12:56
SPEAKER_00: and devastating medical reports poured in.
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SPEAKER_01: It ultimately resulted in hundreds of thousands of lawsuits.
13:02
SPEAKER_00: And we see the exact same pattern decades later with Purdue Pharma and OxyContin.
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SPEAKER_00: The internal documents showed they had clear indications of the drug's high abuse potential.
13:12
SPEAKER_01: Yep,
13:12
SPEAKER_01: they instructed their sales representatives to falsely assure doctors that the risk
13:15
SPEAKER_01: of addiction was less than 1%.
13:18
SPEAKER_00: They created a highly addictive product,
13:20
SPEAKER_00: aggressively marketed it,
13:22
SPEAKER_00: and directly fueled a crisis of addiction and death
13:25
SPEAKER_00: that is still ravaging communities globally today.
13:28
SPEAKER_00: Doctors themselves were reportedly paid to promote the drug,
13:31
SPEAKER_00: which is medical fraud on a devastating scale.
13:35
SPEAKER_01: This is why the concept of white collar violence is so vital for clinicians to grasp.
13:39
SPEAKER_01: We tend to artificially separate financial crimes from physical harm.
13:44
SPEAKER_01: But if you look at cases like the Ford Pinto.
13:46
SPEAKER_00: Oh, the Pinto case is chilling.
13:48
SPEAKER_01: Where the corporation notoriously calculated that paying out wrongful death lawsuits
13:52
SPEAKER_01: for people burning alive in rear end collisions was statistically cheaper
13:56
SPEAKER_01: than spending a few dollars per car for a safety recall or
14:00
SPEAKER_01: the upper big branch mine explosion.
14:02
SPEAKER_00: Exactly.
14:03
SPEAKER_00: An explosion that killed 29 miners after
14:06
SPEAKER_00: the corporate owners deliberately ignored hundreds of safety violations just
14:09
SPEAKER_00: to maximize coal production.
14:12
SPEAKER_00: The result is blood on their hands.
14:13
SPEAKER_01: The morbidity numbers in the text are staggering.
14:17
SPEAKER_01: In 2019, the fatal work injury rate in the U.S. was 3.5 per 100,000 full time workers.
14:24
SPEAKER_01: The deliberate homicide rate around that same time was 5.3 per 100,000.
14:29
SPEAKER_00: Corporate malfeasance has a mortality rate strikingly similar to deliberate,
14:33
SPEAKER_00: street-level homicide.
14:35
SPEAKER_00: Yet because of that psychological and physical distance,
14:37
SPEAKER_00: society, and often the legal system, views the perpetrators entirely differently.
14:43
SPEAKER_01: They are seen as shrewd, perhaps greedy, but rarely as violent criminals.
14:48
SPEAKER_00: Their brains aren't malfunctioning.
14:50
SPEAKER_00: Their environment simply allows them to abstract their victims out of existence.
14:55
SPEAKER_01: Which forces us to ask the oldest philosophical question,
14:58
SPEAKER_01: transitioning us to room three, interpersonal violence.
15:02
SPEAKER_01: Are human beings naturally violent?
15:05
SPEAKER_00: It is the classic debate.
15:07
SPEAKER_01: Right.
15:07
SPEAKER_01: Thomas Hobbes argued in the 17th century that our natural state is a war of all against all.
15:13
SPEAKER_01: Life is nasty, brutish, and short.
15:15
SPEAKER_01: But then you have the romantic view like William Wordsworth
15:18
SPEAKER_01: or Jean-Jacques Rousseau arguing that we are born innocent and peaceful,
15:22
SPEAKER_01: the noble savage concept, only to be corrupted by modern society.
15:26
SPEAKER_00: Well, the clinical and anthropological evidence heavily leans away from Wordsworth.
15:30
SPEAKER_00: There's this enduring myth of the peaceful society.
15:35
SPEAKER_00: For a long time,
15:36
SPEAKER_00: anthropologists desperately searched for communities that were entirely devoid
15:40
SPEAKER_00: of interpersonal violence.
15:41
SPEAKER_01: Like Margaret Mead?
15:42
SPEAKER_00: Yes, Margaret Mead wrote famously about the peace-loving Samoan people,
15:46
SPEAKER_00: presenting them as a culture without teenage angst or violent conflict.
15:50
SPEAKER_01: But later research proved her generalizations were simply wrong.
15:54
SPEAKER_01: She was seeing what she wanted to see.
15:55
SPEAKER_00: She was.
15:56
SPEAKER_00: And the sources mention other tribes too,
15:59
SPEAKER_00: like the Pierroa in Venezuela or the Samai in Malaysia,
16:03
SPEAKER_00: who theoretically eschewed all violence and lived in perfect harmony.
16:07
SPEAKER_01: But when you actually dig into those societies, the picture is much darker.
16:11
SPEAKER_00: Upon closer inspection,
16:13
SPEAKER_00: even these allegedly peaceful societies are heavily defined by their fear
16:16
SPEAKER_00: of violence from others.
16:17
SPEAKER_00: They teach their children to be hypervigilant against unseen threats or malevolent spirits.
16:23
SPEAKER_00: There is virtually no evidence that idyllic,
16:25
SPEAKER_00: entirely non-aggressive human societies ever existed.
16:28
SPEAKER_01: Even Tibetan Buddhist societies,
16:29
SPEAKER_01: which are deeply philosophically rooted in non-violence, eventually took up arms.
16:34
SPEAKER_01: In 1958,
16:35
SPEAKER_01: a Tibetan army formed to fight Chinese domination,
16:38
SPEAKER_01: and even monks found themselves caught in the profound human dilemma
16:41
SPEAKER_01: of taking up weapons to defend their lives and culture.
16:44
SPEAKER_00: Violence, it seems, is a universal human capacity.
16:47
SPEAKER_00: It is baked into our species.
16:49
SPEAKER_01: The global epidemiology backs that up conclusively.
16:52
SPEAKER_01: We are looking
16:53
SPEAKER_01: at global homicide rates averaging around six per 100,000 people globally,
16:58
SPEAKER_01: though it is heavily concentrated in the Americas in Africa.
17:01
SPEAKER_00: And in the U.S.,
17:02
SPEAKER_00: where firearms are ubiquitous, they account for over three quarters of homicides.
17:07
SPEAKER_00: But the detail that clinicians must pay attention to is the phenomenon
17:10
SPEAKER_00: of post-war homicide rates.
17:13
SPEAKER_01: I found this incredibly counterintuitive.
17:15
SPEAKER_01: You would expect that after a major war ends, a society is exhausted and violence would drop.
17:21
SPEAKER_01: People are tired of fighting.
17:22
SPEAKER_00: But historically, homicide rates often spike within a nation after a major conflict concludes.
17:28
SPEAKER_00: And this happens regardless of whether the nation won or lost the war.
17:32
SPEAKER_01: Why does that happen?
17:33
SPEAKER_01: What is the mechanism there?
17:35
SPEAKER_00: It connects heavily to what we now understand as post-traumatic stress disorder,
17:38
SPEAKER_00: though on a societal scale.
17:41
SPEAKER_00: You have massive cohorts of traumatized individuals returning to civilian society.
17:45
SPEAKER_00: During the war, the threshold for violence has been normalized.
17:49
SPEAKER_01: And their brains have changed.
17:51
SPEAKER_00: More importantly,
17:51
SPEAKER_00: yes, their individual neurobiology has been altered by chronic exposure to threat.
17:57
SPEAKER_00: Their nervous systems are locked in a state of hyperarousal.
18:01
SPEAKER_00: The amygdala is constantly scanning for danger,
18:03
SPEAKER_00: and the prefrontal cortex, the breaking system, is fatigued.
18:07
SPEAKER_01: When you combine that traumatized hardware with the stresses
18:10
SPEAKER_01: of post-war civilian life, the violence spills over.
18:13
SPEAKER_00: Precisely.
18:15
SPEAKER_01: So we've looked at the manifestations in these three rooms.
18:18
SPEAKER_01: We've seen the compartmentalized empathy of the mobster,
18:21
SPEAKER_01: the distant corporate killer who abstracts their victim,
18:25
SPEAKER_01: and the traumatized street level offender.
18:27
SPEAKER_00: Right.
18:28
SPEAKER_01: Now Medlock Holmes steps into the absolute center of our metaphorical chamber
18:32
SPEAKER_01: and suspended there is an illuminated human brain.
18:35
SPEAKER_01: There are glowing brass wires connecting its deep ancient limbic circuits up to
18:39
SPEAKER_01: the highly evolved frontal lobes.
18:41
SPEAKER_00: This is where we transition from the sociology of crime to the true anatomy of violence.
18:46
SPEAKER_00: We are moving from the software to the hardware.
18:50
SPEAKER_01: Let's talk about morality.
18:52
SPEAKER_01: We like to think of morality as this high-minded,
18:54
SPEAKER_01: purely philosophical, learned behavior, a set of rules we memorize in childhood.
18:59
SPEAKER_01: But there is a literal, physical seat for it in the brain.
19:03
SPEAKER_00: To understand this, we should walk through the trolley problem.
19:06
SPEAKER_01: A classic thought experiment in ethics.
19:08
SPEAKER_01: Right.
19:09
SPEAKER_01: So imagine a runaway train is barreling down a track towards five workers
19:13
SPEAKER_01: who are tied to the rails.
19:15
SPEAKER_01: You are standing next to a lever.
19:17
SPEAKER_01: If you pull the lever, the train diverts to a sidetrack where only one worker is tied down.
19:23
SPEAKER_01: You kill one person, but you save five.
19:26
SPEAKER_00: And most people, when presented with this, say, yes, pull the lever.
19:29
SPEAKER_00: It's tragic, but utilitarianism wins.
19:32
SPEAKER_00: Save five, lose one.
19:34
SPEAKER_01: Correct.
19:35
SPEAKER_01: That is what we call an impersonal moral dilemma.
19:38
SPEAKER_01: You are interacting with a mechanism, a lever.
19:41
SPEAKER_00: But then the researchers switch the scenario to test something different.
19:45
SPEAKER_00: You are standing on a footbridge over the tracks.
19:48
SPEAKER_00: The train is coming toward the five workers.
19:50
SPEAKER_00: There is no lever.
19:51
SPEAKER_01: Okay, so what do you do?
19:53
SPEAKER_00: The only way to stop the train is to physically push a very large man
19:56
SPEAKER_00: who is standing next to you off the bridge and onto the tracks.
20:00
SPEAKER_00: His weight will stop the train.
20:02
SPEAKER_00: Save five, lose one.
20:04
SPEAKER_01: The mathematical outcome is exactly the same as the lever scenario.
20:08
SPEAKER_00: But almost everyone violently recoils and says, no, I couldn't push them.
20:11
SPEAKER_01: And that recoil is not just philosophy.
20:14
SPEAKER_01: It is neurobiology in action.
20:16
SPEAKER_01: Researchers like Joshua Green and Jean Desetti put subjects
20:20
SPEAKER_01: into functional MRI scanners, fMRIs, while presenting these exact dilemmas.
20:25
SPEAKER_00: They wanted to see what the brain is actually doing when we make these choices.
20:29
SPEAKER_01: And what did they find?
20:30
SPEAKER_00: When people contemplate the impersonal choice of pulling a lever,
20:34
SPEAKER_00: the brain's cognitive and calculation centers are active.
20:37
SPEAKER_00: But when they contemplate the up-close impersonal choice
20:39
SPEAKER_00: of physically pushing someone,
20:42
SPEAKER_00: specific emotional processing areas of the brain light up like a Christmas tree.
20:46
SPEAKER_00: Which areas specifically?
20:47
SPEAKER_01: If we are mapping this illuminated brain, where are we looking?
20:51
SPEAKER_00: We are looking primarily at the ventromedial prefrontal cortex,
20:54
SPEAKER_00: or VPFC,
20:56
SPEAKER_00: which sits right behind your eyes,
20:58
SPEAKER_00: and the amygdala, which is nestled deep in the brain's temporal lobe.
21:01
SPEAKER_01: Break those down for me.
21:03
SPEAKER_01: What are their specific jobs in this scenario?
21:05
SPEAKER_00: The amygdala is our ancient threat and fear processor.
21:09
SPEAKER_00: It is part of the limbic system.
21:11
SPEAKER_00: It provides raw, unfiltered emotional salience.
21:15
SPEAKER_00: It reacts instantly to faces, loud noises, and danger.
21:19
SPEAKER_01: In the VPFC?
21:21
SPEAKER_00: The prefrontal cortex, specifically the ventral medial part, is the executive brake system.
21:28
SPEAKER_00: It integrates those raw emotions with our complex understanding of social rules
21:33
SPEAKER_00: and consequences.
21:34
SPEAKER_00: De Setti found that when a healthy subject imagines harming someone else,
21:38
SPEAKER_00: like pushing that man off the bridge, there's a complex interaction.
21:42
SPEAKER_01: A strong signal decrease in the VPFC?
21:45
SPEAKER_00: Yes, and intense activation in the amygdala.
21:49
SPEAKER_01: Okay, so translate that fMRI scan into clinical reasoning for me.
21:53
SPEAKER_01: What does it actually feel like for the person?
21:56
SPEAKER_00: It feels bad.
21:57
SPEAKER_00: A healthy prefrontal cortex generates an aversive response to harming another human being.
22:02
SPEAKER_00: It is the physical sensation of a troubled conscience.
22:05
SPEAKER_00: You feel sick to your stomach, your heart races, you feel a sense of dread.
22:10
SPEAKER_01: So it is a very physical reaction.
22:12
SPEAKER_00: Very physical.
22:13
SPEAKER_00: Investigators have argued
22:14
SPEAKER_00: that what we colloquially call psychopathic behavior often results from dysfunction
22:19
SPEAKER_00: or physical damage to this exact prefrontal cortex circuitry.
22:24
SPEAKER_00: The person literally lacks the physical hardware to develop
22:27
SPEAKER_00: that physiological aversion to doing something immoral.
22:30
SPEAKER_01: They don't feel the recoil.
22:31
SPEAKER_00: Exactly.
22:32
SPEAKER_00: They do not feel the recoil.
22:34
SPEAKER_01: And here is a crucial clinical nuance from the sources that just blew me away.
22:38
SPEAKER_01: The Tabard Thomas study.
22:40
SPEAKER_01: It proves that the timing of when that hardware gets damaged matters incredibly.
22:44
SPEAKER_00: This is a vital concept for any psychiatric evaluation.
22:48
SPEAKER_00: Tabra Thomas and colleagues looked at patients who had suffered damage
22:51
SPEAKER_00: to their VPFC, but they separated them into two groups.
22:55
SPEAKER_01: Right.
22:55
SPEAKER_01: Those who suffered the brain damage in adulthood,
22:58
SPEAKER_01: say from a car accident or a tumor,
23:00
SPEAKER_01: and those who suffered the exact same damage in early childhood.
23:04
SPEAKER_00: So the hardware is broken in both groups, just at different times in their lives.
23:07
SPEAKER_01: Precisely.
23:08
SPEAKER_01: They then presented these subjects with scenarios testing self-interest versus morality.
23:13
SPEAKER_01: Questions like,
23:14
SPEAKER_01: would you kill your boss for a million dollars if you knew you wouldn't get caught?
23:17
SPEAKER_00: And there was a stark, fascinating difference between the two groups.
23:21
SPEAKER_01: The ones with the childhood damage didn't care.
23:23
SPEAKER_01: They were completely utilitarian about it.
23:25
SPEAKER_00: Exactly.
23:26
SPEAKER_00: The adults who had early childhood damage were far less likely to condemn
23:30
SPEAKER_00: the self-interested harmful act.
23:32
SPEAKER_00: They would happily take the million dollars.
23:35
SPEAKER_01: Why?
23:36
SPEAKER_00: Because learning morality starts early.
23:38
SPEAKER_00: The brain requires an intact VPFC during early childhood development to learn
23:43
SPEAKER_00: and lay down those aversive affective responses.
23:46
SPEAKER_00: You have to learn the physical feeling of morality.
23:49
SPEAKER_00: If the hardware is damaged early, the person never requires that physical feeling.
23:53
SPEAKER_01: But if the damage happens in adulthood?
23:56
SPEAKER_00: If the damage happens in adulthood, the person retains the moral compass they already built.
24:00
SPEAKER_00: Their impulse control might be slightly compromised.
24:03
SPEAKER_00: They might act out more.
24:05
SPEAKER_00: But they still know and feel that harming someone is wrong.
24:09
SPEAKER_01: Because the software was successfully installed before the hardware broke.
24:12
SPEAKER_00: Exactly that.
24:14
SPEAKER_01: That is profound.
24:17
SPEAKER_01: If you don't build the hardware early, you can't install the software later.
24:21
SPEAKER_01: Morality is fundamentally developmental.
24:24
SPEAKER_01: Now, we have to transition from the structure of the brain to the chemicals that bathe it.
24:28
SPEAKER_01: We have to address a darker, undeniable reality in the epidemiology of violence.
24:33
SPEAKER_00: You mean the gender disparity?
24:35
SPEAKER_01: Yes.
24:36
SPEAKER_01: 90% of homicides globally are committed by men.
24:38
SPEAKER_00: And 80% of the victims of homicide are also men.
24:42
SPEAKER_00: This is a staggering statistical reality.
24:44
SPEAKER_00: Whether you were looking at rough and tumble play in toddlers on a playground
24:48
SPEAKER_00: or adult violent crime statistics in a metropolis,
24:51
SPEAKER_00: human males behave demonstrably more aggressively than females
24:55
SPEAKER_00: across virtually all cultures and all recorded history.
24:59
SPEAKER_01: And I know a lot of sociologists want to attribute this entirely
25:02
SPEAKER_01: to patriarchal human culture, toxic masculinity and social conditioning.
25:08
SPEAKER_01: But we know it isn't just human culture because Jane Goodall found
25:11
SPEAKER_01: the exact same thing in our closest genetic relatives in the wild.
25:16
SPEAKER_00: Yes, chimpanzees.
25:18
SPEAKER_00: Goodall's early observations were shocking to the scientific community
25:21
SPEAKER_00: because they shatter the idea of the peaceful ape.
25:25
SPEAKER_00: In a five-decade study of chimpanzee communities in Africa,
25:29
SPEAKER_00: researchers documented coordinated lethal raiding parties.
25:33
SPEAKER_01: Groups of chimps deliberately patrolling their borders,
25:36
SPEAKER_01: hunting down, and brutally killing members of neighboring groups.
25:40
SPEAKER_00: And the statistics are telling.
25:42
SPEAKER_00: 92% of the attackers in those lethal raids were male.
25:46
SPEAKER_01: So it's evolutionary.
25:48
SPEAKER_01: It predates human society.
25:49
SPEAKER_00: It is deeply rooted in our biology.
25:52
SPEAKER_00: From an evolutionary perspective, Homo sapiens are great apes.
25:57
SPEAKER_00: We share an extraordinary amount of DNA with chimpanzees.
26:00
SPEAKER_00: And the biological driver behind this sexually dimorphic aggression,
26:04
SPEAKER_00: meaning the difference in aggression between the sexes, is heavily hormonal.
26:08
SPEAKER_01: We are talking about testosterone.
26:11
SPEAKER_01: But not just the testosterone in a teenage boy or an adult man.
26:14
SPEAKER_01: We are talking about fetal testosterone.
26:18
SPEAKER_00: Long before birth, while the infant is still in utero, the dye is cast.
26:23
SPEAKER_00: Mammalian males possess an X and a Y chromosome.
26:27
SPEAKER_00: The Y chromosome contains the SRY gene.
26:30
SPEAKER_00: Around the eighth week of gestation,
26:32
SPEAKER_00: this gene triggers the developing testes to release a massive flood of androgens,
26:36
SPEAKER_00: primarily testosterone.
26:38
SPEAKER_01: And this fetal testosterone doesn't just develop the male body?
26:42
SPEAKER_00: No.
26:43
SPEAKER_00: It physically alters the density of neurons and the circuitry in the developing brain.
26:47
SPEAKER_01: It masculinizes the brain's hardware?
26:50
SPEAKER_00: It does.
26:51
SPEAKER_00: And there is a fascinating paradoxical mechanism at play here.
26:55
SPEAKER_00: It is often the conversion of that testosterone into estrogens right inside
26:59
SPEAKER_00: the brain,
27:00
SPEAKER_00: facilitated by an enzyme called cytochrome P450 aromatase,
27:04
SPEAKER_00: that cements this structural differentiation.
27:07
SPEAKER_01: Wait, estrogen masculinizes the male brain?
27:11
SPEAKER_00: In a neurodevelopmental sense, yes.
27:14
SPEAKER_00: Think of cytochrome P450 aromatase as a chemical translator.
27:18
SPEAKER_00: It takes the circulating testosterone,
27:20
SPEAKER_00: converts it locally in the brain cells,
27:23
SPEAKER_00: and that local estrogen signal is what triggers the specific wiring of
27:27
SPEAKER_00: the male neural circuitry.
27:28
SPEAKER_01: So the end result is that males and females are born with sexually dimorphic brains.
27:33
SPEAKER_01: There are subtle yet critical structural differences in areas like
27:36
SPEAKER_01: the orbitofrontal cortex, the amygdala, and the hypothalamus.
27:41
SPEAKER_00: And mentioning the hypothalamus leads us to what I consider one of
27:43
SPEAKER_00: the most mind-bending, slightly terrifying studies in the entire textbook.
27:49
SPEAKER_01: You mean the optogenetics breakthrough by David J. Anderson?
27:52
SPEAKER_00: Yes.
27:53
SPEAKER_01: For the listeners who aren't familiar with the cutting edge of neuroscience,
27:57
SPEAKER_01: optogenetics is a technique where scientists genetically modify specific neurons in
28:01
SPEAKER_01: an animal's brain so they become sensitive to light.
28:04
SPEAKER_01: The scientists can then insert a tiny fiber optic cable into the brain
28:08
SPEAKER_01: and literally turn specific behaviors on or off with bursts of light.
28:13
SPEAKER_00: It allows for pinpoint accuracy in mapping behavior to exact brain cells.
28:19
SPEAKER_01: It's science fiction, basically.
28:20
SPEAKER_00: It really is.
28:21
SPEAKER_00: Anderson's team was studying mice,
28:23
SPEAKER_00: and they focused on a tiny,
28:25
SPEAKER_00: incredibly specific sub-region of the ventromedial hypothalamus known as the VMHVL.
28:32
SPEAKER_01: What happened when they turned on the light?
28:34
SPEAKER_00: When they used a strong pulse of light
28:36
SPEAKER_00: to optogenetically stimulate these exact neurons in a male mouse,
28:40
SPEAKER_00: the mouse would instantly,
28:42
SPEAKER_00: aggressively launch into a violent attack against any other mouse in the cage.
28:46
SPEAKER_00: It was like flipping a switch for lethal violence.
28:50
SPEAKER_01: But here is the terrifying overlap.
28:52
SPEAKER_01: What happens when you tweak the light?
28:56
SPEAKER_00: When the researchers applied a weaker,
28:58
SPEAKER_00: lower frequency optogenetic stimulation to those exact same neurons,
29:03
SPEAKER_00: the mouse didn't attack.
29:05
SPEAKER_00: Instead, it initiated mounting, sexual behavior.
29:09
SPEAKER_01: The exact same neural pathway.
29:12
SPEAKER_00: The exact same cluster of cells.
29:14
SPEAKER_00: At low stimulation, it triggers sex.
29:17
SPEAKER_00: At high stimulation, it triggers lethal violence.
29:20
SPEAKER_01: That is just chilling.
29:23
SPEAKER_00: It is.
29:24
SPEAKER_00: Because if we pull back and connect this to the bigger picture
29:26
SPEAKER_00: of clinical psychiatry,
29:28
SPEAKER_00: this biological reality begins to explain the clinical manifestation of rape
29:32
SPEAKER_00: in humans.
29:33
SPEAKER_00: Sociologically, we debate whether rape is a crime of violence or a crime of sex.
29:37
SPEAKER_01: But the neurobiology suggests that in some individuals,
29:40
SPEAKER_01: those circuits are terrifyingly physically intertwined.
29:44
SPEAKER_00: It is.
29:46
SPEAKER_00: An aggressive and sexual behavior.
29:49
SPEAKER_00: Governed by overlapping neural networks.
29:51
SPEAKER_01: That brings a really heavy clinical reality into focus.
29:55
SPEAKER_01: Now, I want to play devil's advocate here and push back on this biological framing for a moment.
29:59
SPEAKER_00: Go on.
30:00
SPEAKER_01: If we are sitting here saying violence is linked to the Y chromosome,
30:04
SPEAKER_01: fetal testosterone,
30:05
SPEAKER_01: evolution,
30:06
SPEAKER_01: and specific neuronal clusters,
30:08
SPEAKER_01: and if we know criminality runs in families,
30:12
SPEAKER_01: aren't we just saying violence is genetic destiny?
30:15
SPEAKER_01: What about the so-called warrior gene I read about in the news?
30:19
SPEAKER_01: If it's genetic, do we just give up on trying to change these people?
30:22
SPEAKER_00: It is so tempting to fall into that trap of biological determinism.
30:27
SPEAKER_00: It offers a neat, simple explanation for terrible things.
30:30
SPEAKER_00: But we must resist it because it is clinically and scientifically inaccurate.
30:35
SPEAKER_01: So genetics don't tell the whole story?
30:37
SPEAKER_00: No.
30:38
SPEAKER_00: Yes, genetics absolutely matter.
30:41
SPEAKER_00: We look closely at genes regulating neurotransmitters like dopamine and serotonin.
30:45
SPEAKER_01: You're referring to the Brunner study from the 90s.
30:47
SPEAKER_00: Yes, a famous 1993 study in the Netherlands by H.G.
30:51
SPEAKER_00: Brunner.
30:52
SPEAKER_00: He identified a large family with a severe inherited defect in the MAOA gene.
30:59
SPEAKER_00: The MAOA enzyme breaks down neurotransmitters.
31:02
SPEAKER_01: And because these men had a defective gene...
31:04
SPEAKER_00: They had abnormally high levels of neurotransmitters
31:08
SPEAKER_00: and displayed terrible impulsive violence,
31:11
SPEAKER_00: arson, and rape across multiple generations.
31:15
SPEAKER_00: This is where the media eagerly coined the term warrior gene.
31:19
SPEAKER_01: But it's not that simple, is it?
31:21
SPEAKER_01: You don't just have a gene and automatically become a killer.
31:24
SPEAKER_00: Not at all.
31:24
SPEAKER_00: Genes do not operate in a vacuum.
31:27
SPEAKER_00: How and when a gene is expressed,
31:29
SPEAKER_00: whether it is turned on or off,
31:31
SPEAKER_00: a field known as epigenetics, depends heavily on environmental stimuli.
31:37
SPEAKER_01: Which means the environment has to pull the trigger.
31:40
SPEAKER_00: Exactly.
31:41
SPEAKER_00: A massive subsequent study looking at over 400 genetic variants found that
31:46
SPEAKER_00: the genetic risk for violence only really manifested in youths
31:51
SPEAKER_00: who experienced what sociologists call low social control.
31:55
SPEAKER_01: Meaning their environment activated the genetic vulnerability.
31:58
SPEAKER_00: Exactly.
32:00
SPEAKER_00: If the youth had poor parental attachment,
32:02
SPEAKER_00: loose discipline,
32:03
SPEAKER_00: or lived in impoverished,
32:05
SPEAKER_00: high-stress, dangerous neighborhoods, the genetic vulnerability was triggered.
32:09
SPEAKER_00: The gun was loaded by genetics, but the environment pulled the trigger.
32:13
SPEAKER_01: Conversely,
32:14
SPEAKER_01: if children with those exact same genetic variants were raised in nurturing,
32:18
SPEAKER_01: stable, supportive environments, the genetic risk was largely silenced.
32:23
SPEAKER_01: They didn't become violent.
32:24
SPEAKER_00: Precisely.
32:25
SPEAKER_01: You have a great analogy
32:27
SPEAKER_01: for how epidemiological researchers sometimes get this wrong when they are looking
32:31
SPEAKER_01: at family histories of criminality.
32:34
SPEAKER_01: The Walmart versus Tiffany analogy.
32:35
SPEAKER_01: Can you walk us through that?
32:37
SPEAKER_00: Gladly.
32:38
SPEAKER_00: Many large epidemiological studies rely on massive impersonal databases,
32:43
SPEAKER_00: national arrest records, birth registries, tax data.
32:47
SPEAKER_00: They buy this data in bulk,
32:49
SPEAKER_00: which I compare to shopping at a massive warehouse store like Walmart.
32:52
SPEAKER_01: You get huge volume, but no detail.
32:54
SPEAKER_00: Right.
32:55
SPEAKER_00: You get thousands,
32:56
SPEAKER_00: maybe millions of subjects,
32:58
SPEAKER_00: and you can run beautiful statistical regressions on a computer that say,
33:01
SPEAKER_00: look, criminality is inherited.
33:03
SPEAKER_00: The father was a criminal.
33:04
SPEAKER_00: The son is a criminal.
33:06
SPEAKER_00: But they miss all the texture of the actual human lives.
33:09
SPEAKER_00: And the Tiffany approach?
33:11
SPEAKER_00: The Tiffany approach is what clinicians actually do.
33:14
SPEAKER_00: It is deep, painstaking individual investigation.
33:17
SPEAKER_00: You take a jeweler's loop, a magnifying glass to the facets of a single individual's history.
33:22
SPEAKER_01: And what do you see when you do that?
33:24
SPEAKER_00: When you do that,
33:24
SPEAKER_00: you find that what looked like a clean,
33:26
SPEAKER_00: simple genetic transmission of a violence gene is actually a transmission
33:30
SPEAKER_00: of untreated severe mental illness,
33:33
SPEAKER_00: chaotic living conditions, physical abuse, and intergenerational trauma.
33:37
SPEAKER_01: The case of Jeffrey Landrigan perfectly illustrates this difference between
33:40
SPEAKER_01: the Walmart view and the Tiffany view.
33:42
SPEAKER_01: He was an inmate on death row in Arizona.
33:45
SPEAKER_01: From a Walmart perspective, he was a perfect case study for genetic evil.
33:50
SPEAKER_00: He was adopted at birth, wasn't he?
33:52
SPEAKER_01: Yes, adopted at birth into a lovely middle class, highly supportive family.
33:56
SPEAKER_01: Yet from age two, he had uncontrollable violent tantrums.
34:00
SPEAKER_01: By 10, he was abusing alcohol.
34:02
SPEAKER_01: By his 20s, he had committed murder.
34:05
SPEAKER_00: And people pointed to him and said, look, a bad seed.
34:08
SPEAKER_00: He had perfect adoptive parents, but his genetics of violence overrode a good environment.
34:14
SPEAKER_01: But that was a lazy analysis.
34:16
SPEAKER_01: When clinical researchers,
34:17
SPEAKER_01: specifically mitigation specialists,
34:19
SPEAKER_01: actually dug into his biological history with a Tiffany-level lens,
34:23
SPEAKER_01: they found he wasn't just a bad seed.
34:26
SPEAKER_00: First, they ordered brain imaging, which revealed severe frontal lobe abnormalities.
34:31
SPEAKER_00: Then they looked at his biological mother, who drank heavily during pregnancy.
34:35
SPEAKER_00: Landrigan likely suffered from undiagnosed fetal alcohol syndrome,
34:38
SPEAKER_00: which destroys impulse control.
34:40
SPEAKER_01: And his biological family tree was a mess, right?
34:43
SPEAKER_00: It was tragic.
34:44
SPEAKER_00: When you look at his biological lineage, it wasn't just a genetic propensity for being evil.
34:49
SPEAKER_00: It was a lineage plagued by severe untreated psychiatric illness,
34:53
SPEAKER_00: rampant substance abuse, and repeated head trauma passed down through generations.
34:57
SPEAKER_01: Violence was just the end symptom.
34:59
SPEAKER_00: Exactly.
34:59
SPEAKER_00: It was the final common pathway of a massive multi-generational clinical failure.
35:04
SPEAKER_01: Which means we have to pivot and look at the environment.
35:07
SPEAKER_01: Medlock Holmes is leaving the illuminated brain and walking over to open the dusty,
35:11
SPEAKER_01: heartbreaking archives of early childhood adversity.
35:15
SPEAKER_01: Because if biology is the primer, the environment is the spark.
35:18
SPEAKER_00: We can crystallize this interaction into a clinical formulation.
35:22
SPEAKER_00: It is an equation of interacting risks that every clinician should keep in mind.
35:27
SPEAKER_00: Neurobiology multiplied by development multiplied by trauma multiplied
35:32
SPEAKER_00: by social context leads to violence vulnerability.
35:36
SPEAKER_01: Neurobiology times development times trauma times social context.
35:41
SPEAKER_01: Let's focus heavily on the trauma variable in that equation because there is
35:45
SPEAKER_01: a common misconception that severe child abuse is just a bad psychological memory,
35:49
SPEAKER_01: something you talk out in therapy.
35:51
SPEAKER_00: But the textbook is clear.
35:53
SPEAKER_00: It literally physically alters the machine.
35:56
SPEAKER_01: Walk me through that.
35:57
SPEAKER_01: How does abuse break the brain?
35:59
SPEAKER_00: It causes direct central nervous system injury.
36:02
SPEAKER_00: When a child is chronically, brutally abused, their brain adapts in order to survive a war zone.
36:08
SPEAKER_00: It creates a state of physiological hypervigilance.
36:12
SPEAKER_00: Their amygdala becomes enlarged and hypersensitive,
36:15
SPEAKER_00: constantly scanning the environment for threats.
36:17
SPEAKER_01: And clinically, how does that look day to day?
36:20
SPEAKER_00: Clinically, this manifests as paranoid misperceptions.
36:23
SPEAKER_00: They perceive a neutral glance from a stranger or an accidental bump in a hallway as
36:28
SPEAKER_00: an intentional, aggressive challenge that must be met with force.
36:33
SPEAKER_01: It also damages their ability to speak, doesn't it?
36:36
SPEAKER_01: Which sounds strange, but the mechanism makes sense.
36:39
SPEAKER_00: Yes.
36:40
SPEAKER_00: Severe trauma impairs verbalization,
36:41
SPEAKER_00: particularly the connection between emotional centers and language centers.
36:46
SPEAKER_00: Abused toddlers are less able to use words to describe their inner emotional states.
36:51
SPEAKER_01: When you cannot articulate anger,
36:53
SPEAKER_01: frustration, or sadness with language, that emotion doesn't just disappear.
36:57
SPEAKER_00: It bypasses the language centers entirely and goes straight into motor action.
37:02
SPEAKER_00: Anger becomes a punch, not a sentence.
37:05
SPEAKER_00: Furthermore,
37:05
SPEAKER_00: the chronic stress hormones like cortisol and the actual physical trauma
37:09
SPEAKER_00: from being hit in the head often directly damage the prefrontal cortex,
37:13
SPEAKER_00: the exact breaking mechanism they desperately need
37:16
SPEAKER_00: to control those violent impulses.
37:18
SPEAKER_01: So if we connect this to the bigger picture of public health and psychiatry...
37:22
SPEAKER_00: Early, ongoing,
37:23
SPEAKER_00: severe child abuse is arguably the most potent known generator of violence
37:27
SPEAKER_00: in adolescents and adults.
37:29
SPEAKER_00: It provides a violent role model,
37:31
SPEAKER_00: it inflicts chronic physical pain,
37:32
SPEAKER_00: which naturally stimulates an aggressive response,
37:35
SPEAKER_00: and it structurally,
37:36
SPEAKER_00: neurologically breaks the developing brain's ability to self-regulate.
37:40
SPEAKER_01: And yet,
37:41
SPEAKER_01: as a society,
37:42
SPEAKER_01: and shockingly even in the medical and educational fields,
37:45
SPEAKER_01: We constantly miss the signals.
37:47
SPEAKER_01: The textbook details two chilling clinical evaluations of 16-year-old mass shooters.
37:53
SPEAKER_01: They are heartbreaking studies in missed psychiatric emergencies.
37:57
SPEAKER_01: Let's look at the first case, the boy.
37:59
SPEAKER_01: I want to walk through how many times the system failed him.
38:02
SPEAKER_00: This was a highly intelligent 16-year-old boy who had a documented history
38:06
SPEAKER_00: of hearing voices dating back to age 12.
38:08
SPEAKER_00: He became increasingly obsessed with war,
38:10
SPEAKER_00: destruction, and guns, coming to his high school dressed in full camouflage.
38:14
SPEAKER_01: Eventually,
38:15
SPEAKER_01: a psychiatrist evaluated him,
38:17
SPEAKER_01: diagnosed him with depression, and put him on antidepressant medication.
38:21
SPEAKER_00: And while on the medication and in therapy, he actually stabilized and did quite well.
38:25
SPEAKER_01: But then the parents, seeing he was doing better, decided he was cured.
38:30
SPEAKER_01: They unilaterally stopped the therapy and abruptly took him off the medication.
38:34
SPEAKER_00: And he rapidly, catastrophically decompensated.
38:39
SPEAKER_00: He started writing essays exclusively about murder, blood, and war.
38:43
SPEAKER_00: His psychosis returned with a vengeance.
38:45
SPEAKER_00: In the middle of a class,
38:46
SPEAKER_00: he grabbed his head in agony and screamed out loud,
38:49
SPEAKER_00: God damn these voices in my head.
38:52
SPEAKER_01: A literal desperate cry for psychiatric help.
38:56
SPEAKER_01: And what was the response from the school authorities?
38:58
SPEAKER_01: Did they call a hospital?
39:00
SPEAKER_00: No.
39:01
SPEAKER_00: Unbelievable.
39:02
SPEAKER_00: And the tragic coda to this story...
39:27
SPEAKER_00: The state psychiatrist who evaluated him for trial found no psychosis,
39:32
SPEAKER_00: and he was sentenced to life in prison.
39:34
SPEAKER_01: They missed the hardware failure entirely.
39:36
SPEAKER_01: In the second case, the 16-year-old girl is just as infuriating from a clinical perspective.
39:41
SPEAKER_00: She lived with a male relative who actively gifted her firearms.
39:46
SPEAKER_00: A school counselor actually noticed her severe deepening depression, and
39:50
SPEAKER_00: a consulting psychiatrist strongly recommended immediate inpatient hospitalization.
39:54
SPEAKER_01: But the male relative refused to allow it.
39:56
SPEAKER_01: Why?
39:56
SPEAKER_01: Why?
39:57
SPEAKER_00: Because it was highly suspected and later confirmed that he was actively sexually abusing her.
40:02
SPEAKER_00: And he didn't want the medical system uncovering his crimes.
40:06
SPEAKER_01: But beyond the trauma, there is a massive neurological component here too that was ignored.
40:11
SPEAKER_00: Right.
40:11
SPEAKER_00: She had suffered a severe bicycle accident a few years prior.
40:15
SPEAKER_00: She has sustained serious blunt force trauma to the left temporal parietal area of her skull.
40:20
SPEAKER_00: Following that injury, she exhibited classic symptoms consistent with complex partial seizures.
40:25
SPEAKER_01: Can you explain complex partial seizures for the non-medical listener?
40:29
SPEAKER_01: What do they look like?
40:30
SPEAKER_00: These are the dramatic fall to the floor shaking seizures you see on television.
40:35
SPEAKER_00: They are localized electrical storms in the brain that might just look like
40:39
SPEAKER_00: a person zoning out, staring blankly or doing something repetitive.
40:42
SPEAKER_01: But what is happening internally?
40:44
SPEAKER_00: They completely wipe out memory and conscious control for that brief window.
40:48
SPEAKER_00: She had episodes where she had absolutely no memory of her actions.
40:52
SPEAKER_00: Yet prior to her trial for eventually taking a gun and shooting up a school yard,
40:57
SPEAKER_00: she never received a proper neurological or neuropsychological evaluation.
41:01
SPEAKER_00: She literally warned her schoolmates days before that she was going to do something big.
41:06
SPEAKER_01: And everyone ignored it.
41:08
SPEAKER_00: They dismissed it as an angsty teenager looking for attention.
41:11
SPEAKER_01: Exactly.
41:12
SPEAKER_00: Society consistently dismisses these declarations as dramatic ploys for attention,
41:17
SPEAKER_00: completely missing the profound psychiatric
41:20
SPEAKER_00: and neurological emergencies boiling underneath.
41:23
SPEAKER_00: We punish the swearing,
41:24
SPEAKER_00: we ignore the brain injury,
41:25
SPEAKER_00: we ignore the trauma,
41:27
SPEAKER_00: and then we act universally shocked when the violence inevitably occurs.
41:31
SPEAKER_01: So what does this all mean when a person like this actually ends up in the legal system?
41:35
SPEAKER_01: Holmes is leaving the dusty archives of childhood trauma and walking into
41:39
SPEAKER_01: the final room, a courtroom of responsibility.
41:43
SPEAKER_00: This is where things get legally and medically very complicated.
41:46
SPEAKER_01: Right.
41:47
SPEAKER_01: How does a forensic psychiatrist apply this complex web of biology, trauma,
41:51
SPEAKER_01: and missed signals when a person's life is on the line in front of a judge and jury?
41:56
SPEAKER_00: The first most critical thing a clinician must do in a forensic setting is avoid lazy labels.
42:02
SPEAKER_00: And this brings us to a highly controversial topic within the field, the concept of psychopathy.
42:08
SPEAKER_00: Specifically as defined by Robert Hare's widely used psychopathy checklist, or the PCLR.
42:13
SPEAKER_01: The authors of this chapter issue a very strong warning against relying on this checklist.
42:18
SPEAKER_01: Why is it considered dangerous in a clinical setting?
42:20
SPEAKER_00: Because it takes a mishmash of diverse behaviors,
42:23
SPEAKER_00: impulsivity,
42:24
SPEAKER_00: grandiosity,
42:25
SPEAKER_00: sexual promiscuity,
42:27
SPEAKER_00: lack of realistic long-term goals,
42:29
SPEAKER_00: shallow affect,
42:30
SPEAKER_00: and lumps them all together under the umbrella of an untreatable,
42:33
SPEAKER_00: inherently evil personality construct.
42:36
SPEAKER_01: It essentially says this person is a psychopath, lock them up and throw away the key.
42:40
SPEAKER_00: Precisely.
42:41
SPEAKER_00: But clinically,
42:43
SPEAKER_00: those exact same symptoms on the checklist can be caused by a multitude
42:46
SPEAKER_00: of highly treatable or legally mitigating conditions.
42:50
SPEAKER_01: Give me a specific clinical example of how that goes wrong in practice.
42:53
SPEAKER_00: Consider a prisoner evaluated by the authors of the text.
42:57
SPEAKER_00: He was jittery, jumpy, impulsive, and he had shot and killed a policeman during a confrontation.
43:04
SPEAKER_00: His initial cursory evaluation suggested he might have some frontal lobe
43:08
SPEAKER_00: dysfunction,
43:09
SPEAKER_00: but the legal system found it much easier and cleaner to just label him
43:13
SPEAKER_00: a cold-blooded psychopath using the checklist.
43:15
SPEAKER_01: He was advised by his own lawyers to plead guilty, and he was sentenced to death.
43:20
SPEAKER_00: The garbage can label of psychopathy almost threw his life away.
43:24
SPEAKER_01: Almost.
43:25
SPEAKER_01: Decades later...
43:26
SPEAKER_01: As his execution approached, a new, more diligent attorney took the case.
43:31
SPEAKER_01: They brought in a true clinical team again,
43:34
SPEAKER_01: and this time they got an fMRI of the inmate's brain.
43:38
SPEAKER_01: The scan was undeniable.
43:40
SPEAKER_01: It showed massive diffuse cortical atrophy, specifically severe orbitofrontal thinning.
43:46
SPEAKER_00: The VPFC braking system we talked about earlier.
43:49
SPEAKER_01: Exactly.
43:50
SPEAKER_01: The man had literal physical brain damage that decimated his impulse control.
43:55
SPEAKER_01: He wasn't a calculated, cold-blooded psychopath.
43:59
SPEAKER_01: His brain was physically,
44:00
SPEAKER_01: structurally incapable of breaking his impulses when he felt threatened.
44:05
SPEAKER_00: There is another case study in this section that is even more complex,
44:08
SPEAKER_00: and it really highlights the danger of first impressions.
44:11
SPEAKER_00: The case of the upstanding cop.
44:14
SPEAKER_00: I want to walk through this because it blew my mind.
44:17
SPEAKER_01: It is a profound study in the necessity of deep clinical digging.
44:21
SPEAKER_01: This was a police officer with an impeccable decorated record,
44:25
SPEAKER_01: a beloved member of the community.
44:27
SPEAKER_01: One day, he snaps.
44:29
SPEAKER_00: And what does he do?
44:31
SPEAKER_01: He stops a woman for a minor traffic violation, drags her into a field, and rapes her.
44:36
SPEAKER_01: Bizarrely, he gives her his official police business card afterward.
44:40
SPEAKER_01: He then drives to a department store where his estranged wife works,
44:43
SPEAKER_01: brandishes his gun,
44:45
SPEAKER_01: accidentally shoots and kills a clerk,
44:47
SPEAKER_01: takes multiple women hostage,
44:49
SPEAKER_01: forces them into sexual acts,
44:50
SPEAKER_01: and then amidst this horrific violence,
44:53
SPEAKER_01: when they get hungry,
44:55
SPEAKER_01: he raids the cash register to buy candy from a vending machine for everyone.
44:58
SPEAKER_00: If you are sitting on a jury from the outside,
45:01
SPEAKER_00: that looks like pure, unadulterated, sadistic, psychopathic evil.
45:06
SPEAKER_01: And that was the initial reaction of the public, the press, and the legal system.
45:11
SPEAKER_01: But when the clinical defense team did a true Tiffany-level deep dive
45:15
SPEAKER_01: into his background, a completely different medically terrifying picture emerged.
45:20
SPEAKER_00: What did they find?
45:22
SPEAKER_01: First, they uncovered a strong hidden family history of bipolar disorder.
45:26
SPEAKER_01: Second, they found a suppressed history of severe,
45:29
SPEAKER_01: early, ongoing childhood sexual abuse that he had never dealt with.
45:33
SPEAKER_00: But what was the immediate trigger for the violence?
45:36
SPEAKER_00: There had to be a spark.
45:37
SPEAKER_01: The trigger was what he was putting in his body to survive his long shifts.
45:41
SPEAKER_01: To work double shifts and manage his undiagnosed mood swings,
45:45
SPEAKER_01: he was consuming massive toxic amounts of over-the-counter bodybuilding vitamins.
45:49
SPEAKER_01: He was taking ripped fuel, high doses of ephedrine, excessive caffeine, and chromium picolinate.
45:55
SPEAKER_01: He was severely sleep deprived for days and chemically wired.
45:59
SPEAKER_00: So he wasn't displaying psychopathy.
46:01
SPEAKER_01: No, he was in the middle of a chemically induced, floridly manic psychotic episode.
46:06
SPEAKER_01: He was a man with a genetic predisposition to bipolar disorder
46:09
SPEAKER_01: whose brain had been primed by horrific childhood sexual trauma and who threw
46:14
SPEAKER_01: a chemical match into that powder keg.
46:16
SPEAKER_01: He had absolutely no idea he was susceptible to mania or
46:19
SPEAKER_01: that these seemingly harmless supplements could trigger psychosis.
46:22
SPEAKER_00: But his behavior in the courtroom alienated his own defense team, right?
46:25
SPEAKER_00: Because he was still manic?
46:26
SPEAKER_01: Tragically, yes.
46:28
SPEAKER_01: During his trial,
46:29
SPEAKER_01: he was grandiose,
46:30
SPEAKER_01: he bragged, he made inappropriate jokes, classic symptoms of severe mania.
46:34
SPEAKER_01: But his lawyers didn't recognize the psychiatry.
46:37
SPEAKER_01: They were so personally disgusted by his demeanor that they told him to plead guilty.
46:41
SPEAKER_01: He was sentenced to death.
46:43
SPEAKER_00: That is just awful.
46:45
SPEAKER_01: It took 10 long years for a new appellate lawyer to find
46:47
SPEAKER_01: the original psychiatric report buried in the files and appeal his sentence based
46:52
SPEAKER_01: on his deeply compromised state of mind at the time of the crime.
46:55
SPEAKER_01: It proves how easily the legal system misinterprets psychiatric emergencies
46:58
SPEAKER_01: as malicious calculated intent.
47:00
SPEAKER_00: Which brings up a very delicate intersection.
47:03
SPEAKER_00: Severe psychiatric disorders and violence.
47:06
SPEAKER_00: We have to tread very carefully here, and I want to be explicit.
47:10
SPEAKER_00: The vast majority of people living with mental illness are not violent.
47:14
SPEAKER_01: In fact,
47:14
SPEAKER_01: they are statistically much more likely to be the victims of violence than
47:18
SPEAKER_01: the perpetrators.
47:19
SPEAKER_00: That must be stated unequivocally.
47:21
SPEAKER_00: Mental illness does not equal violence.
47:24
SPEAKER_00: However, as clinicians, we cannot let political correctness blind us to clinical reality.
47:29
SPEAKER_00: The textbook is highly critical of certain sociological studies,
47:33
SPEAKER_00: like the 1998 MacArthur Foundation study.
47:36
SPEAKER_01: What did that study claim?
47:37
SPEAKER_00: It attempted to claim
47:38
SPEAKER_00: that discharge psychiatric patients were essentially no more dangerous than
47:42
SPEAKER_00: the general public in their neighborhoods.
47:45
SPEAKER_00: The textbook authors argue that it's statistically and clinically false.
47:49
SPEAKER_01: When does the risk actually increase?
47:51
SPEAKER_01: What is the specific clinical profile?
47:54
SPEAKER_00: The risk of violence skyrockets when you combine a severe,
47:57
SPEAKER_00: untreated Axis-1 disorder,
47:59
SPEAKER_00: and by Axis-1 we mean major clinical syndromes like schizophrenia
48:03
SPEAKER_00: or acute bipolar mania,
48:05
SPEAKER_00: with active substance abuse,
48:07
SPEAKER_00: especially when the person is living in an impoverished, high-stress environment.
48:11
SPEAKER_01: And the psychological driver of that violence is rarely malice or a desire to dominate, is it?
48:16
SPEAKER_00: No, it is paranoia.
48:18
SPEAKER_01: Paranoia as a frantic need for self-defense.
48:21
SPEAKER_00: Exactly.
48:21
SPEAKER_00: When the brain is malfunctioning,
48:23
SPEAKER_00: When reality is severely distorted by psychosis and the amygdala is screaming
48:28
SPEAKER_00: that you are in mortal danger from the people around you,
48:31
SPEAKER_00: violence becomes a desperate, preemptive strike for survival.
48:36
SPEAKER_00: They aren't attacking out of cruelty.
48:38
SPEAKER_00: They're lashing out because they genuinely,
48:40
SPEAKER_00: psychotically believe their own life is in imminent danger.
48:43
SPEAKER_01: Now, speaking of the clinical profession, we have to look at our own house.
48:46
SPEAKER_01: The outline of this chapter forces us to confront the ethical implications
48:50
SPEAKER_01: of psychiatry itself and the dark side of the medical profession.
48:54
SPEAKER_01: Because if we understand exactly how the brain works,
48:56
SPEAKER_01: how to break it, and how to manipulate it, that knowledge can be weaponized.
49:01
SPEAKER_00: It is a dark chapter, but necessary to discuss.
49:04
SPEAKER_00: The text highlights instances where psychologists
49:07
SPEAKER_00: and medical doctors have used their deep understanding of neurobiology and trauma
49:11
SPEAKER_00: to intentionally inflict harm.
49:13
SPEAKER_01: We are talking about the involvement of health professionals in CIA torture programs
49:18
SPEAKER_01: and coercive interrogation techniques.
49:20
SPEAKER_00: Why does a healer become a torture?
49:22
SPEAKER_00: How does a doctor justify waterboarding or sleep deprivation?
49:26
SPEAKER_01: It comes back to the same mechanisms we discussed with white collar crime.
49:30
SPEAKER_01: Money, rationalization, and distancing.
49:33
SPEAKER_01: The professionals involved were highly paid,
49:36
SPEAKER_01: but psychologically they distanced themselves by claiming they were there
49:39
SPEAKER_01: to quote-unquote monitor for safety, ensuring the subject didn't die.
49:43
SPEAKER_00: They used clinical language to sterilize torture.
49:46
SPEAKER_00: It is a profound failure of ethical oversight and a warning that medical knowledge
49:51
SPEAKER_00: without rigid moral boundaries can be devastating.
49:54
SPEAKER_01: Which brings us back to how society judges a broken mind.
49:58
SPEAKER_01: If we understand exactly how the brain breaks,
50:01
SPEAKER_01: how trauma,
50:02
SPEAKER_01: genetics,
50:02
SPEAKER_01: chemicals,
50:03
SPEAKER_01: and even state-sponsored torture can dismantle a person's free will,
50:07
SPEAKER_01: What does that mean for how the law judges them?
50:09
SPEAKER_01: Because right now, the legal system relies heavily on the McNaughton Rule.
50:13
SPEAKER_00: Yes, the McNaughton Rule, established way back in the 19th century.
50:17
SPEAKER_00: It is the foundation of the insanity defense in many jurisdictions.
50:22
SPEAKER_00: It essentially asks two cognitive questions.
50:24
SPEAKER_00: Did the defendant know the nature and quality of the act they were doing?
50:28
SPEAKER_00: And if they did, did they know that what they were doing was wrong?
50:32
SPEAKER_01: So it's purely a test of knowledge.
50:35
SPEAKER_00: Purely cognitive.
50:37
SPEAKER_00: It assumes the brain is a simple logic engine.
50:39
SPEAKER_01: But based on everything we've discussed today, that is fundamentally flawed.
50:44
SPEAKER_01: The law assumes that if you know X is bad, you simply won't do X.
50:48
SPEAKER_01: But we just spent the last hour proving that the brain doesn't work that way.
50:51
SPEAKER_00: If your frontal lobe is damaged by fetal alcohol syndrome or a bicycle accident
50:56
SPEAKER_00: or severe childhood abuse, you might cognitively know that a stove burner is hot.
51:01
SPEAKER_00: You might cognitively know that murder is illegal.
51:04
SPEAKER_01: But when the amygdala fires,
51:05
SPEAKER_01: your brain physically lacks the breaking mechanism to stop your hand from touching
51:09
SPEAKER_01: the burner or pulling the trigger.
51:12
SPEAKER_00: This is where the authors look back to Aristotle's classical concept of virtue.
51:16
SPEAKER_00: Aristotle argued that virtue isn't just knowing what is good.
51:19
SPEAKER_00: It requires the physical and psychological capacity to regulate your impulses
51:24
SPEAKER_00: and actually choose the good action over the bad one.
51:27
SPEAKER_01: But what if you lost what bioethicists call the natural lottery?
51:31
SPEAKER_01: What if you were born with a vulnerable VPFC,
51:34
SPEAKER_01: inherited a severe mental illness,
51:36
SPEAKER_01: were brutally abused as a toddler and suffered traumatic brain injuries?
51:40
SPEAKER_01: Do you actually possess the biological autonomy to act virtuously?
51:43
SPEAKER_00: There's a quote from one of the subjects in the book that haunts me.
51:47
SPEAKER_00: He said, ain't no thinking anymore.
51:49
SPEAKER_00: It's a reaction.
51:51
SPEAKER_00: That captures the neurobiology perfectly.
51:53
SPEAKER_01: The clinical data overwhelmingly calls for the neuropsychiatric profession
51:57
SPEAKER_01: to step up and help the judiciary redefine the criteria for legal mitigation
52:02
SPEAKER_01: and insanity.
52:03
SPEAKER_01: We must move past these outdated 19th century cognitive tests and start accounting
52:08
SPEAKER_01: for the actual neurobiology of impulse control and emotional regulation.
52:13
SPEAKER_00: It's time to consolidate what we've learned.
52:15
SPEAKER_00: Our key takeaways for today.
52:17
SPEAKER_00: Violence is not a single evil entity.
52:21
SPEAKER_00: It is the final common pathway
52:23
SPEAKER_00: of incredibly diverse neurophysiological vulnerabilities intersecting
52:27
SPEAKER_00: with brutal environmental stressors.
52:30
SPEAKER_01: And proper psychiatric evaluation demands
52:33
SPEAKER_01: that we abandon lazy catch-all labels like psychopathy.
52:36
SPEAKER_01: We must dig deep,
52:37
SPEAKER_01: using that Tiffany approach,
52:39
SPEAKER_01: to uncover the actual neurological,
52:41
SPEAKER_01: genetic,
52:42
SPEAKER_01: and psychiatric deficits driving the behavior,
52:44
SPEAKER_01: because many of those deficits are treatable.
52:47
SPEAKER_00: Right.
52:48
SPEAKER_00: I reckon it is time for our quick pop quiz for our medical listeners,
52:51
SPEAKER_00: trainees, and students to reinforce these mental models.
52:55
SPEAKER_01: Yes, this is single best answer style.
52:57
SPEAKER_01: I will read the question.
52:58
SPEAKER_01: I'll pause so you can think about it,
52:59
SPEAKER_01: and then our expert will break down the answer and the mechanism.
53:02
SPEAKER_01: Ready?
53:03
SPEAKER_00: Let's do it.
53:04
SPEAKER_01: Question one.
53:05
SPEAKER_01: What region of the brain,
53:07
SPEAKER_01: when damaged in childhood rather than in adulthood,
53:10
SPEAKER_01: leads to a profound inability to develop an aversive response to harmful actions?
53:15
SPEAKER_00: The answer is the ventromedial prefrontal cortex, or VPFC.
53:19
SPEAKER_00: The Tabor-Thomas study demonstrated that early childhood damage prevents
53:22
SPEAKER_00: the individual from ever learning or experiencing the physiological feeling
53:27
SPEAKER_00: of moral aversion.
53:28
SPEAKER_00: In contrast,
53:29
SPEAKER_00: if the damage occurs in adulthood,
53:31
SPEAKER_00: the previously learned moral feelings remain largely intact even
53:34
SPEAKER_00: if impulse control drops.
53:36
SPEAKER_00: Question two.
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SPEAKER_01: According to sociological definitions pioneered by Edwin Sutherland,
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SPEAKER_01: what fundamentally distinguishes white-collar crime from street crime?
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SPEAKER_00: The defining characteristic is the reliance on deceit,
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SPEAKER_00: concealment,
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SPEAKER_00: or a violation of trust strictly without the application or threat
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SPEAKER_00: of physical force.
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SPEAKER_00: This allows the perpetrator to maintain psychological distance from the harm they cause.
53:59
SPEAKER_01: Question 3.
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SPEAKER_01: In evaluating a violent offender,
54:02
SPEAKER_01: what is a primary clinical danger of relying strictly on
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SPEAKER_01: the hair psychopathy checklist, the PCLR?
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SPEAKER_00: The primary danger is that the PCLR acts as a lazy diagnosis.
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SPEAKER_00: It frequently miscategorizes highly treatable
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SPEAKER_00: or legally mitigating medical conditions such as bipolar mania,
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SPEAKER_00: complex partial seizures,
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SPEAKER_00: or frontal lobe dysfunction as untreatable,
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SPEAKER_00: inherently evil personality deficits,
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SPEAKER_00: which can result in devastating legal outcomes for the patient.
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SPEAKER_01: Question four.
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SPEAKER_01: Based on large cohort studies,
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SPEAKER_01: what combination of factors presents the highest statistical risk for violence
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SPEAKER_01: in adults?
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SPEAKER_00: The highest statistical risk is seen when a severe,
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SPEAKER_00: untreated AXIS-1 mental illness,
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SPEAKER_00: like schizophrenia or bipolar disorder,
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SPEAKER_00: is combined with active substance abuse and a history
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SPEAKER_00: of early childhood maltreatment or trauma,
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SPEAKER_00: often leading to paranoia-driven preemptive violence.
54:55
SPEAKER_01: Final question, question five.
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SPEAKER_01: Why is the 19th century McNaughton rule considered hopelessly inadequate
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SPEAKER_01: by modern neuropsychiatrists for evaluating criminal culpability?
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SPEAKER_00: Because the McNaughton Rule focuses exclusively on the cognitive understanding
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SPEAKER_00: of right and wrong.
55:10
SPEAKER_00: It completely ignores modern neuroscience,
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SPEAKER_00: which proves that the frontal lobe and limbic system govern emotional regulation
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SPEAKER_00: and impulse control.
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SPEAKER_00: You can cognitively know and act as wrong,
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SPEAKER_00: but entirely lack the neurobiological capacity to stop yourself from doing it.
55:26
SPEAKER_01: Which brings us back to Medlock Holmes,
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SPEAKER_01: standing in the center of that chamber of violence,
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SPEAKER_01: staring at the illuminated brain.
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SPEAKER_01: The mystery of why is slowly being decoded by optogenetics,
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SPEAKER_01: fMRIs, and trauma-informed psychiatry.
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SPEAKER_01: But it leaves us with a lingering, deeply provocative thought to mull over.
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SPEAKER_00: What is that?
55:45
SPEAKER_01: If we can now map the exact neurobiological and environmental ingredients
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SPEAKER_01: that create a violent mind, well,
55:53
SPEAKER_01: at what point does society transition from punishing the end result to treating
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SPEAKER_01: the underlying brain long before the crime is ever committed?
56:02
SPEAKER_01: And if we eventually develop the medical technology to safely medicate or alter
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SPEAKER_01: the brain to suppress aggression entirely,
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SPEAKER_01: who exactly gets to decide what the right level of compliance is?
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SPEAKER_00: A chilling question for the future of neuroethics
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SPEAKER_00: and one every clinician will eventually have to face.
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SPEAKER_01: Something to think about.
56:21
SPEAKER_01: We highly encourage you to go back and read chapter 28.2 of Kaplan
56:24
SPEAKER_01: and Sadek alongside these new mental models.
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SPEAKER_01: Until next time, keep diving deep.