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secondary psychopathyMost of us find the behavior of the true psychopath frightening enough that we have few issues with locking them up and throwing away the key. They seem so very different from us and hearing the facts of their behavior is frightening and leaves us feeling unsafe. If you are not afraid of the psychopath, read a few of our posts on psychopathy and watch your mind change.

Now that you have accepted the reality that all psychopaths are cold, callous and untreatable, here’s something to ponder. A new study tells us that contrary to popular belief, there are some psychopaths who have feelings and might be amenable to treatment—especially if they have intervention while they are young [and that by itself might challenge their being categorized as a psychopath].

Researchers examined 150 male and female juveniles ages 11 to 17 (60% male; 85% White, 5% Hispanic, 3% African-American, and 6% multiracial or other; average age of 15.2 years) who had been classified as “callous and unemotional” and had severe anti-social behaviors that put them at risk of developing psychopathic traits as adults. What they found was that many of these juveniles did fit the classic definition of psychopathy—but others did not. Instead, say the researchers, some of the budding psychopaths had feelings. They call this group with higher internal emotionality “secondary psychopaths”.

“They appear callous and unemotional to others but are actually very distressed, have high levels of anxiety, higher levels of depression, higher levels of emotion.”

Rather than callous and unemotional, the researchers say these secondary psychopaths are actually callous and emotional. That is, the secondary psychopaths do have high psychopathic traits, but they also have higher anxiety and depression. The researchers believe that those who can be identified as secondary psychopaths experience higher levels of negative emotion, more intense negative emotion, and more intense positive emotion than those in the primary (stereotypical) group of psychopaths. In short, they believe the high psychopathy scores of the callous and emotional secondary psychopaths makes them appear unfeeling to the observer, but internally they are in turmoil.

To identify the subgroup of youths with higher levels of internal emotionality, the researchers used comprehensive diagnostic tests (the Inventory of Callous-Unemotional Traits, Impulsivity Conduct Problems and trait Narcissism subscales from the Antisocial Process Screening device, teacher report scores on screening measures, Behavioral Inhibition Scale, Behavioral Activation Scale, Sensation Seeking Scale, Interpersonal Reactivity Index, Revised Child Anxiety and Depression Scale, Positive and Negative Affect Schedule) and sophisticated statistical analysis to differentiate between those with classic psychopathic traits (i.e., low empathy and insensitivity to the pain of others) and those with a “surplus of unregulated emotion”.

This is the first study to identify girls as especially likely to fall within the high internal emotionality group. In fact, there were more females in the secondary psychopathy group than in the primary psychopathy group. The researchers believe that if we offer treatments such as cognitive behavioral therapy and dialectical behavior therapy that offer strategies for managing emotions—we can actually change the incidence of unwanted behaviors. This would save, according to the authors, as much as $3M across the lifetime of a single young adult.

This is an important first effort and we hope to see more intensive work along these lines. What the article says is not to make assumptions and we would agree. Do not make assumptions that all psychopaths have no internal emotionality. On the other hand, do not make assumptions that all psychopaths have (deep down inside) internal emotionality that makes them amenable to treatment.

Remain curious. And remain wary.

Gill AD, & Stickle TR (2015). Affective Differences Between Psychopathy Variants and Genders in Adjudicated Youth. Journal of Abnormal Child Psychology PMID: 25727716

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millennial tattooWe’ve written a lot about tattoos here and this writeup is going to be a little different from most of our posts. Rather than spending time on the research findings, we want to cite some of the more unusual and surprising findings the author reviews as a prelude to her results.

So, to be brief, the researcher found that Millennials are growing up and yes, they do know tattoos may be frowned upon in some parts of the business world. Further, many of them say that they will consider how able they will be to conceal a new tattoo in business attire as they approach the job market. That isn’t that surprising to us at all. What was surprising was some of the literature the author cited as she reviewed (oh the many) reasons someone should talk to Millennials and make sure they realize tattoos are permanent and may keep them from getting hired.

Here are just a few of the findings she cites in her review of the literature:

There is a Facebook page called “Tattoo Acceptance in the Workplace” which has over 2 million “likes”! (It seems to be more a place to show your art than to talk about the issues related to having tattoos in the workplace.)

A 2012 study showed that customers who have tattoos are more likely to trust salespeople who also have tattoos and that people associate more positive traits to salespeople with “feminine tattoos”.

Another survey completed in 2012 in a rural hospital showed patients did not view male health care professionals with tattoos positively. Caregivers with tattoos are seen as “unsanitary” or “dirty”. It is imagined that the judges of the tattoos are not, themselves, owners of tattoos. No ink-bonding there. Another 2010 health care setting survey resulted in concerns about infection control since tattoo cover ups could hamper good washing of the hands. We imagine that there is concern that some people who cover up tattoos don’t realize that they need to be uncovered for the sake of cleaning skin. An odd concern, we think.

Undergraduate accounting students in 2011 thought accounting professionals should not have visible tattoos (even though 26% of the survey participants had their own tattoos!). Further, those students had less confidence in the tattooed accountant and were less likely to recommend the services of a tattooed accountant.

A man in Pennsylvania sought employment as a “Liquor Enforcement Officer” in 2012 and was told in order to be hired he would have to remove his tattoos. He filed a lawsuit alleging multiple violations and the US Court of Appeals for the Third Circuit upheld the lower court ruling (for the Defendant) saying “having a tattoo is not a fundamental right”.

Another ruling in 2006 involved lawsuit by several police officers who claimed their police chief did not have the authority to force employees to cover up tattoos because they were “offensive” or “unprofessional”. The court said that public employees may expect to have their first amendment rights more curtailed in order to “promote effective government”.

It is intriguing that self-expression tends to lose in court. Even more so, it is a testament to the power of the tattoo to divide even those with tattoos. Tattoos are going to be judged and they are almost always going to be judged negatively (even by those who also have tattoos)—so if you are a tattooed attorney or have a tattooed client, you may want to cover your own and have your client cover theirs as well while in court.

Foltz, KA (2015). The Millennial’s perception of tattoos: Self expression or business faux pas? College Student Journal

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murdered black maleIn December of last year, we wrote about investigative case files in Shreveport, Louisiana. One of the findings in the analysis of those investigative files was this:

Overall, say the researchers, cases with White female victims resulted in the highest number of case file pages (i.e., the most investigative work) and the most severe sentences. In contrast, Black male homicide victims received the least investigative attention and the least severe sentences.

Now, data from the Capital Jury Project has been used to see whether there was a “White female victim effect”. The “female victim effect” describes the tendency for longer sentences or the death penalty when the victim was a female and especially when the victim was a White female who was killed by a Black male.

The Capital Jury Project study involved examining 249 cases of which 57.4% resulted in the death penalty and 42.6% resulted in a life sentence. A little over half (58.2%) of the capital trials took place in a southern jurisdiction. 56.2% of the cases had White male defendants and 43.8% had Black male defendants.

In 41% of the cases, the victim was a White female and of those cases, 61.8% resulted in a death sentence and 38.2% resulted in life sentences.

37.8% of the cases involved White male victims, and of those cases, 59.6% resulted in a death sentence and 40.4% resulted in life sentences.

12% of the cases involved Black male victims, and of those cases, only 38.7% resulted in a death sentence and 61.3% resulted in life sentences.

8.8% of the cases involved Black female victims and in those 22 cases, 54.5% resulted in a death sentence and 45.5% resulted in a life sentence.

Even just reading those numbers, it is apparent that if you are a White victim, your killer is more likely to receive a death penalty sentence and if you are a Black male victim, the opposite is true. The researchers say that the difference is “not as pronounced in Black female victim cases” but for Black males, the difference is statistically significant and sobering.

If that isn’t disturbing enough, comments from the jurors seem to indicate they don’t see the Black male homicide victim as having “suffered” as much as other victims. That is, they perceived suffering for the victim in 76.8% of the White female victim cases but only in 31% of the Black male victim cases. “Nearly 79% of Black male victim cases are perceived by jurors not to involve brutality and another 69% of the cases are perceived by jurors not to involve suffering.”

Here’s a representative comment from a male juror: “you shoot somebody and they die right there and then I don’t think there is any suffering to happen”.

And a representative comment from a female juror: “I don’t know if you’d call it brutal or not. He [the defendant] just got it over with…if there was torture involved then I would call it brutal…but there was no torture involved. He just shot him.”

The researchers conclude that “victim race, not victim gender, appears to be driving juror decision-making in capital cases”. They focus on what they say is a “black male victim effect”: and define it this way:

“It appears that defendants who kill Black male victims are significantly less likely to receive a death sentence compared to defendants convicted of killing White female and White male victims”.

Ultimately, this research finds (through involved archival work and juror interviews) what they found in Louisiana by just measuring the thickness of the investigative files.

Black male victims do not get justice at either the investigative stage or the criminal trial stage. The investigations are far shorter and less thorough than for White victims.

This disparity at the investigative stage appears to be an artifact of what prosecutors deem to be most worthy of effort in homicide investigations, but it is offensively unfair to those murder victims who are Black males, and arguably, to a justice-minded populace.

For all of us, it is a sad statement when a measure like simply counting pages in a prosecutorial file shows us what the system values and then when presented in court, decisions are made that reflect what the system says is valuable.

Girgenti, A. (2015). The Intersection of Victim Race and Gender: The “Black Male Victim Effect” and the Death Penalty Race and Justice DOI: 10.1177/2153368715570060

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evil psychopathsCriminal psychopaths are a common topic we write about here. They are notoriously difficult to treat, but are so disturbing they make for fascinating study (and hopefully reading). Some say they are not treatable. They are highly likely to reoffend after incarceration and prison is neither a deterrent nor a punishment for many of them. So to see a research article on an actual treatment for the adult psychopath is noteworthy.

These researchers recruited 14 criminal psychopaths with long and very violent histories who were serving long-term sentences in forensic psychiatric institutions with high security regulations in Germany to take part in a neurofeedback training program. Neurofeedback involves hooking a person up to an EEG machine to monitor brain activity. The brain activity is displayed on a computer screen as a graphical object and the person involved attempts to move the graphical display by controlling their brain activity—and they are rewarded for so doing, as in a video game.

So the psychopaths had 25 training sessions (each about an hour-long) in neurofeedback spread out over about 3 months and afterwards, they demonstrated “improved control” over their brain activity and reported (in questionnaire completion) having “reduced levels of impulsivity and aggression”. Those with the most “improved control” reported larger reductions in their aggression.

The researchers say that they will need to do more research but these criminal psychopaths were able to improve their brain activity control and reported a decrease in the impulsivity and aggression that varied depending on how much they improved in their ability to control brain activity. I guess it’s comforting that they report lower aggression, but I’m not sure I’d accept the word of a psychopath on that. The researchers think it would be good to have outcome measures that were not reliant on self-reports from severely violent psychopaths and we would agree. Very, very strongly…

Let’s consider the life of the severe criminal psychopath serving a “long term sentence in forensic psychiatric institutions with high security regulations”. They must get very bored and this research presents an opportunity to have 25 hours over the course of three months away from their highly restricted routine. The sample is very small (only 14) and while they did improve in their ability to control their brain activity on an EEG monitor, that makes them completely unremarkable. It isn’t a terribly hard thing to do, it simply requires an effort. And they really have little else to do.

It’s an interesting line of inquiry though and we’ll watch for more on this one. At this point though, it is likely interesting but meaningless in the overall question of what we do with the severely violent criminal psychopath.

Konicar L, Veit R, Eisenbarth H, Barth B, Tonin P, Strehl U, & Birbaumer N (2015). Brain self-regulation in criminal psychopaths. Scientific reports, 5 PMID: 25800672

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Non-Surgical SideI grew up in a family where multiple siblings got confused about which way was right and which way was left. When I began to drive, I would make a capital R in the air with my right index finger to be sure I was turning the right way. Unbeknownst to me, my siblings had developed similar coping mechanisms.

Back in the early 2000s we began to see pictures of people writing on their non-surgical side in black magic marker (“not this leg!”) to avoid medical mistakes. And I remember wondering how any surgeon could make that sort of error. Well. It comes from right-left confusion and the many distractions prior to surgery. And yes. It is good neither I nor my siblings are surgeons.

Researchers from today’s article talk about distractions like phone calls, bleeping monitors, and questions from patients, their relatives and colleagues all while attempting to begin a surgery. In the midst of all these distractions, the researchers measured the ability of 234 undergraduate medical students in Belfast, Ireland (55% female; 88.8% right-handed; 62.8% were between 18 and 20 years old and the remainder were 21 or older;) to make right-left judgments. Even the background noise of the facility was enough to impair some students’ decisions. When the researchers asked the students questions while also asking them to make right-left decisions, the errors increased and the researchers called it “the distraction effect”.

Here are some of their findings:

Participants were asked to rate their ability to distinguish between right and left and most of them though they were much better at the task than they actually were (as measured later in the experiment).

Females were more prone to distraction (and increased errors) than were males [F(3,211) = 3.53, p < 0.05, partial η2 = 0.05]. This apparently is a commonly found gender difference in right-left discrimination and is not specific to these Belfast medical students.

Older participants were more distractible than younger participants (but let’s remember these are undergraduate pre-med students and almost all quite young).

Cognitive distraction (as compared to the audible distraction of noise in the area) resulted in more errors in discriminating between left and right.

When the only distraction is background noise, it seems to have little impact on the ability to distinguish between right and left.

The researchers suggest constant awareness of the complexity of right-left discrimination and ongoing assessment of the ability to accurately discriminate. This makes sense from an awareness perspective but, in this research, most participants did not think they had any difficulty with right-left discrimination. Thankfully, many medical centers have multiple checks and balances to avoid medical mistakes like removing the wrong kidney, operating on the wrong arm, or even amputating the wrong leg.

From a litigation advocacy perspective, this study shows us that basic distraction can result in errors that, if unchecked, could have disastrous results. This study is about right-left confusion, but it seems obvious the issue applies to other behaviors just as well. It highlights the importance of ongoing self-assessment and self-awareness as well as policy and procedure updates for medical training programs, hospitals, and other facilities where people are being cared for or having surgeries. And in the event you wish to check your own right-left discrimination ability, here’s an online test on which I did very poorly.

McKinley, J, Dempster, M, & Gormley, GJ (2015). ‘Sorry, I meant the patient’s left side’: Impact of distraction on left-right discrimination. Medical Education, 49, 427-435

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