Why can't psychopaths feel remorse?

Psychopaths learn to feel

There are shocking minutes in the courtroom in Verden, Lower Saxony. Stephan K. and his accomplice locked two women in a house for months. They kept their victims temporarily in a dog cage, raped them several times and forced them into prostitution. The nightmare didn't end until they captured a third woman who managed to escape. The criminals filmed their actions. The audience present at the trial can see excerpts from the videos.

But something else is also shocking: Stephan K. shows no signs of remorse. The fate of his victims seems to be indifferent to him. A reviewer certifies that he has a severe personality disorder with a tendency towards sadism and narcissism. He received a prison sentence of 14 years with subsequent preventive detention.

People like Stephan K. who show psychopathy - a severe personality disorder - are characterized by extreme coldness. They are impulsive, often feel no social responsibility, and they do not feel guilty. Often they are prone to criminal acts.

Lock up forever?

Most people agree: Serious criminal psychopaths should be locked up for life. This is backed up by the standard doctrine of many researchers that people with psychopathy cannot change. And that you can therefore not treat it successfully.

But the psychiatrist and brain researcher Niels Birbaumer from the University of Tübingen disagrees. "I have dealt with learning and changes in brain processes all my life as a researcher," he says. “I have doubts about the stability of such supposed character traits.” Niels Birbaumer helped children with ADHD to concentrate better and people with anxiety disorders to conquer their fear. He himself is a good example that people can change. In his youth he was impulsive and in a gang that rioted and cracked cars. When a member of another youth gang stole his breakfast, he rammed a pair of scissors into his foot.

Today Birbaumer is a recognized scientist who has devoted himself more and more to people with psychopathy in recent years. “Psychopaths have difficulty predicting the negative consequences of a particular act for themselves and for others,” he explains. They can cognitively assess the consequences. But they lack the physical-emotional aspect that is necessary to feel fear. They do not fear prison terms. All of this makes them prone to going the wrong way.

At the same time, psychopaths are true masters of deception who are excellent at concealing their lack of emotion (picture of science 2/2013, “Charming Beasts”). “Even the delinquent psychopaths I have met are often very charming,” explains the psychiatrist. "An aversion to them only arises when you find out what they have done."

Birbaumer sees the reasons for the cold feeling in abnormalities in the brain. As it turns out, some of these seem to play an important role in natural fear responses and empathy. When psychopaths are confronted with fear-inducing situations, their almond kernel remains completely calm in the brain. He usually takes care of the emotional coloring of what has been experienced and creates fear. In psychopaths, it is not only poorly supplied with blood, but also anatomically smaller.

"Because the circuits in the brain are anatomically changed, many researchers suspect that nothing can be done," says Birbaumer. Psychopaths have structural brain damage. “In my opinion, that is not the case. The affected areas can be reactivated and normalized through training. "

The Tübingen psychiatrist and his colleagues rely on so-called neurofeedback to get the affected circuits up to speed. The test subjects lie in magnetic resonance tomographs and receive feedback on the activity of their brain in real time. You can see the firing of your neurons on a monitor as a fever thermometer, whose "mercury column" you have to direct upwards. How they do that is up to them. Some remember emotional situations in their life like the death of their parents. Ultimately, they should learn to control their brain activity through trial and error.

Birbaumer and his colleagues trained their subjects to control the activity of the insula. As part of the temporal lobe, it is not only involved in processing emotions such as fear, but is also important for empathy. Usually the insula becomes more active when we share in the pain of others. A psychopath cannot do this.

Training for the temporal lobe

Thanks to the neurofeedback developed by the Tübingen researchers, healthy test subjects usually learn to activate their insula after just a few sessions. It takes a little longer with psychopaths. Afterwards, the hoped-for emotional effect can also be seen in them: "After training, psychopaths react to cruel images of accident victims and murdered people," says Birbaumer. Previously, these images only triggered completely neutral feelings in them.

In a small, as yet unpublished study with sex offenders, however, it was also shown that the higher the psychopathic scores of the test subjects, the more difficult it was for them to increase the activity of their insula. Despite financial incentives, most of them gave up quickly. "It was very difficult to keep the psychopathic test subjects engaged," says Birbaumer. Most of them got bored after two or three sessions.

The scientists also refer to a second, recently completed study with 14 serious criminal psychopaths. The researchers used neurofeedback again. However, this time they focused on the frontal lobe. Birbaumer's colleague Lilian Konicar explains: “The frontal lobe is the highest central point for controlling behavior, including aggressive and impulsive behavior. It is less active in psychopaths. ”The researchers had to carry out their examinations in forensic psychiatric clinics with high security requirements and were understandably not allowed to take the test subjects - murderers and multiple rapists - into their laboratory.

Through the neurofeedback, the serious criminals learned to control the activity in the frontal lobe. "After the training, the patient's aggression was also reduced," says Konicar. In addition, they were able to better control their behavior and more easily suppress impulsive behavior. The researchers found this out through tests in which the psychopaths were asked to press a key when they saw certain letters on a monitor, but had to suppress this spontaneous impulse for other letters.

"Psychopaths can very well change themselves and their brain activation in principle," Niels Birbaumer is convinced. However, it is still unclear whether the training has a lasting effect on social behavior. "So I'm not saying - at least not yet - that such people should be able to leave prison again," emphasizes Bierbaumer. You won't change psychopaths with just a little training. “Re-education is not that easy.” The results from the laboratory have to prove themselves in the everyday life of those affected.

Birbaumer is convinced that there will be some psychopaths who are completely the norm after such training. For others, on the other hand, training alone will not be enough. When they return from prison to their old surroundings, the old charms work and the old rewards beckon. “So you have to make sure with a psychopathic sex offender, for example, that if he sees a woman, he does not rape again.” You have to train him to cope with precisely such a situation in reality.

Fit for everyday life

Something similar is already being done successfully with anxiety patients today. You confront them with a situation they feared and make it clear to them that there are no dire consequences for them. In a similar way, one also has to train psychopaths for everyday life, says Birbaumer: “After all, that also works with anxiety patients. I'm quite sure that it will work. ”So far, nobody has tried that - neither the probation officers, who are often overwhelmed, nor the psychotherapists.

But Niels Birbaumer fears that the belief in a person's stable personality can hardly be eradicated from the minds of psychologists. Because ultimately we all rely on a certain consistency in the behavior and personality of other people. "But basically we usually don't change because we're in the same environment and don't learn anything new."

Christian Wolf is not yet convinced that empathy training will work. He is curious to see whether the neurofeedback therapy will also pass practical tests.

by Christian Wolf

November 18, 2014

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