La neurociencia de los monstruos de la vida real: psicópatas, directores ejecutivos y políticos

La neurociencia de los monstruos de la vida real: psicópatas, directores ejecutivos y políticos

Transcripción en inglés (active los subtítulos automaticos en español

good evening everyone my name is amanda thomas and i would love to welcome you to science on tap online as you know we are here to talk about the neuroscience of real life monsters psychopaths ceos and politicians with dr octavio choi who is a forensic psychiatrist and tavi has done this talk a couple of times in the

past and we asked him to repeat it here this evening and add some new things because we figured that um right before halloween and right before the election was a great time to be talking about this topic so welcome everyone thank you for being here um i noticed in the chat somebody was asking about whether or not

the the attendees would be recorded and no he will not be recorded it’s just me and tavi who will be on screen and recorded um so you don’t have to worry about you being on screen or having your your microphone on at all so just a quick note on that um so we will be uh we’re going

to start here in just a second i’m going to tell you a few things tavi is going to speak for around an hour maybe a little bit longer and then we’re going to have plenty of time for q a at the end so please write your questions in the chat if you’re watching on zoom you can write

um in the chat or the q a if you’re watching on facebook you can write it in the comments we have folks some of our volunteers who are watching all of those uh those chat channels and they will be sending those questions to me and i’ll be choosing which ones to ask tavi on screen once we get

to the q a section so we encourage you to write questions and are glad that you are are engaged and interested in the topic so thank you so i know that we have a lot of people here this evening and i know that there are probably a lot of new people here this evening as well so i

just wanted to give a quick brief intro to what science on tap is we are an event series that is based in portland oregon and we have been running events in person in theaters for around seven or eight years and we’ve been running mostly weekly events since uh online since april and tonight is actually our 32nd event

in the year 2020 so we’ve been we’ve done quite a lot of events and our goal is to make science accessible fun and meaningful particularly for adults because we think it’s important that adults understand how science works and uh and so we’re glad that you’re here and interested in science and also uh we record our events and

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some of the same author or same speakers but we have some other people that we interview and talk to as well so i encourage you to check that out this talk will be available on uh on our youtube channel in the next two or three days or so depending on how fast our uh video volunteer steve can

get things put together so thanks and also before we get started i just wanted to uh send out a quick um request we at science on tap need your help we are trying to get more science into the world which we think is really an important thing to do and as such we’ve been trying to make our

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or you can join our patreon also for make you think and it will go a long way to help keeping these programs available for the next year as well we will put the slide up again at the end but just wanted to put in a quick plug at the beginning okay with that i am going to stop

sharing my screen and invite our speaker this evening dr octavio choi welcome tavi hi thank you so much amanda thank you everyone of course i just put a fig bar in my mouth so i’m chewing and talking at the same time but i’m so happy to be here and um i see we have like 465 participants on

zoom i think we have a few hundred more um over facebook live so um i just so appreciate that we’re getting this many people um and paying attention to a science talk it’s kind of a miracle i’m really happy you’re here and um hope to make it worth your while so i’m gonna start sharing my screen great

uh so i am a forensic neuropsychiatrist with a background in neuroscience i have a phd in neuroscience i’m really interested in how neuroscience affects court proceedings and psychopathy and the neuroscience of psychopathy is um is related to that interest so uh happy halloween everyone um i’m probably dating myself but i grew up on these old campy horror

movies like halloween of course it’s freddy krueger nightmare on elm street all right pinhead right jason all these folks wonderful horror movies um but you know when i look back at them now they almost seem quaint to me they seem kind of almost charming and quaint i’ll tell you the the the monsters that that are in my

nightmares these days people like this guy definitely this guy what do you guys think about this guy um i bet a lot of people have feelings about this guy i certainly do and there’s president trump so when a psychiatrist talks about trump in a public arena ethical issues arise uh and uh specifically there’s something called the goldwater

rule which was established by the apa the american psychiatric association that basically said it’s unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement uh and this goldwater rule comes from the genesis of it is back in 1964 a magazine named

fact magazine sent out a question to thousands of psychiatrists with the question do you believe barry goldwater is psychologically fit to serve as president of the united states so 2400 psychiatrists responded and a bunch about half said that he was not fit and in the responses there were a lot of really embarrassing responses and as a psychiatrist

i read these responses and i really cringe so a bunch of people said you know i think goldwater’s suffering from a chronic psychosis another one said he’s basically a paranoid schizophrenic who decompensates from time to time and by the way i think since then it’s been clearly established goldwater was not a schizophrenic you know paranoid schizophrenic and

someone else said i believe gross water goldwater is grossly psychotic he has a serious thinking disorder he’s grandiose he’s suspicious he’s paranoid he’s impulsive suggesting that he has poor control over his feelings and that he acts on angry impulses this alone would make him an extremely psychologically unfit to serve as president a president must not act on

impulse but in addition he consciously wants to destroy the world of atomic bombs he’s a mass murderer at heart and a suicide he is amoral and immoral a dangerous lunatic exclamation point i find this uh quite embarrassing as a psychiatrist um but it also makes me a bit sober um you know i i you know i was

born in the 70s so i i did not know uh barry goldwater at all but reading the statement makes me think i should know a bit more about my history because it suggests to me that maybe people like trump are not a one you know a once in a century phenomena maybe people like trump pop up you

know on a regular basis in politics so the reason the goldwater rule was put in place was basically because of of abuse because a bunch of you know you know psychiatrists made these really childish kind of snap judgments with these definitive diagnoses and basically the goldwater rule stands because you know you know a proper psychiatric evaluation is

conducted with consent right so trump has not consented for me to conduct a psychiatric evaluation on him often your professional opinion requires careful medical history and a first-hand examination of a patient ideally so a face-to-face examination uh and uh you know when psychiatrists offer medical opinions about an individual they have not examined they have the potential to

stigmatize those of mental illness so i just wanted to apologize in advance to all the psychopaths in the audience that um you know if they feel insulted that i am implying that president trump is part of your crowd now trump you know is such an extreme case of um someone who seems quite dangerous in his role as

the most powerful person on the planet essentially that a lot of psychiatrists have objected that the goldwater rule is no longer valid basically because there’s a duty to warn people as psychiatrists in fact above a book was published in 2017 the dangerous case of donald trump by 37 psychiatrists essentially giving lots of opinions about his psychiatric condition

in response to this to this apa kind of clarified its goldwater rule and they said yeah it still halls you know you still don’t want to make an official diagnosis but it says the psychiatrist as a citizen may speak as any other citizen he or she may observe the behavior and work of a public figure in support

and support oppose or critique that public action but the psychiatrist may not assume a professional role in voicing that critique in the form of a professional opinion so um be assured that i will not offer any professional opinions tonight i will instead be offering many unprofessional opinions and many speculations nothing that you’d want to base a diagnosis

on and make a treatment plan and you know stuff like that but i will i do have a lot of expertise in psychopathy and i know what you know about trump i don’t have any access to special information but i read the press clippings and i read some of the books about him and i’m gonna juxtapose what

i seem to know about trump from from the uh from the press and from the public uh you know data and uh and my knowledge of psychopathy and i’ll leave it to you to make your own opinion about uh what trump is suffering from so the ap also said nothing in this opinion precludes a psychological profiling of

historical figures aimed at enhancing public and governmental understanding of these individuals uh don’t do don’t do a diagnosis and the in the profiling should be based in peer-reviewed scholarship that meets relevant standards of academic scholarship i feel pretty comfortable with this uh you know what i’ll present to you on psychopathy is um informed by a rigorous reading

of the literature and i might be do some psychological profiling but i will not offer any diagnoses so with that let’s let’s get proceed so i think the most fundamental question to start off with and it’s a question i’ll be coming back to you repeatedly is what is psychopathy there’s various answers to this question which is why

we’ll keep coming back to it so let me get start off with some examples so imagine it’s a slow thursday night you know you’re kind of you know you’re looking for a date and you’re swiping left and right on tinder and this guy shows up ted 32 psychology student swipe left or swipe right now most of you

probably know you don’t want to swipe like right on this guy this is ted bundy one of the most notorious serial killers in modern us history he uh has confirmed to have murdered 35 women all college students and and it’s thought that he may have murdered actually over 100 people he studied psychology in college and he actually

worked a peer counselor crisis hotline for a while no doubt getting lots of valuable insights about people’s vulnerabilities he’s described as charming and good looking and he actually does look quite good looking and he was very psychically psychologically minded you know he would for instance use crutches to kind of limp around uh to lure women and ask

for assistance they tried to help him to his car he put him in the car he drive them you know to a remote spot sexual assault followed by beating and killing and he did that over and over and over again uh and when the police finally arrested him he said i’m the most cold-blooded son of a that

you’ll ever meet so cold-blooded is kind of a core characteristics of psychopaths and when asked about whether he felt guilty about what he did he said guilt it’s this mechanism we use to control people it’s an illusion it’s a kind of social control mechanism and it’s very unhealthy it does terrible things to our bodies yes guilt does

do terrible things to our bodies um but sometimes we need to feel guilt right to guide us and to do the proper thing right but tekandi apparently does not feel guilt which is another characteristic of psychopaths when he was asked you deserve to die he said good question i think society deserves to be protected from me and

from people like me right so that’s a really reasonable rational answer so psychopaths don’t experience guilt and they’re very cold-blooded but they’re highly rational their cognitive functions are intact and he scored 39 out of 40 on the psychopathy checklist which we’ll talk about in a few minutes but that’s a very high score he is almost a perfect

psychopath now people often confuse psychopathy and psychosis so i just want to spend a few moments at differentiating the two so psychopathy is a personality disorder the people who suffer from it are rational meaning that they they’re not delusional they understand what’s happening around them and it’s not the basis so people psychopathy are not eligible for the

insanity defense should they have criminal charges although that might change in contrast people who are psychotic so psychosis is a symptom of a severe mental illness and you know the prototypical illness with psychotic illness is schizophrenia where you hear hallucinations and you have disordered thinking and really the core of psychosis is irrational so people who are psychotic

are irrational through no fault of their own so they cannot differentiate reality from from delusion and psychosis for example in the case of schizophrenia is an eligible condition for insanity so anyone recognize the woman on the left i know we have a lot of people from uh from oregon so um they might recognize this as diane downs

a notorious serial killer right she has had no psycho no history of a formal psychiatric illness she was not schizophrenic or anything like that and she shot three of her children killing one and then she shot herself and drove to the er and told the er doctor i was carjacked by a stranger and at first they believed

her but eventually one of the surviving children told people what had happened essentially um diana downs was having a an affair with a married man named rk and this married man told her that he didn’t want to be dating someone who have children so diane dowds thought that the most rational thing to do in that case because

she really wanted to date this person was to shoot and murder her own children down shot her children to be free of them so she can continue her affair with rk who didn’t want to have children in his life and she was convicted of murder rightfully so now many of you might also recognize this woman here right

and she has she has five children all of whom she killed unfortunately so this is andrea yates she had a long history of severe psychosis after um delivering her uh delivering each of her children she was hospitalized psychiatrically for that each time and sure enough after the birth of her fifth child hits this baby here um in

the 2000s she became severely psychotic and she drowned all five children in her bathtub and the expert that the defense expert that examined her phil resnick who’s one of the was one of the top forensic psychiatrists in the country if not the world said yates believed deeply that killing her children was was the right thing to do

she believed that satan had taken over her body and soul and was eyeing her children’s soul next she believed that if she killed her children while they were still innocent they would still be they would be sent to heaven and although she was initially convicted of murder that first trial was thrown out for various reasons that are

fascinating but i won’t go into and on her re-trial she was found insane which i think was the proper um adjudication okay so psychopaths are rational people who are psychotic are irrational they genuinely cannot it’s not that they will not differentiate reality from from fantasy that they cannot differentiate reality from fantasy so reading about people like ted

bundy and diane downs you might be feeling a mixture of emotions probably some negative emotions you might be angry you might be disgusted you might be just kind of horrified or angry right and you might be thinking how on earth can you do these things so i want you to kind of just check in with yourselves and

kind of just from a zero to 100 how outraged are you about ted bundy and diane downs and i want you to kind of remember that number because i’m going to ask you to check in on it as we go through the talk now psychopathy uh you know psychopaths have been described through the ages and it starts

with the bible right i mean probably even before the bible but the bible had cain who is thought to be one of the earliest psychopaths in the literature in the 1800s a french psychiatrist named philip philippe panel described it as maniac sounds delir insanity without delirium and his protege described it as la folie resonant or rational madness

benjamin rush was a very prominent psychiatrist in the 1800s in the us and he described it as psychopathy as a form of moral insanity and herbie klecky a famous psychopathy researcher in the 40s said wrote this book called the mask of sanity basically saying you know what they they’re rational they seem normal on the surface but underneath

their surf underneath the surface they actually have this moral insanity so it’s this combination of intact cognitive they’re rational but they’re morally deranged now this is robert hare robert here took psychopathy into the modern age so before robert hare you know psychopathy was just described with words like insanity without delirium or moral insanity and that kind of

makes sense and is understandable in an intuitive sense but really it gets kind of squishy and if you want to you know launch a research project it’s hard to you know you want to have a standardized set of criteria to define what a psychopath is robert harry is the man that did that he’s a canadian psycho psychologist

who um did his early work in the canadian prison system and interacted with lots of psychopaths and over time he said you know i want a way to quantify uh to describe psychopathy and quantify how psychopathic someone is so he developed a structured interview hundreds of questions to ask uh asked these folks and from these hundreds of

questions he you know the he developed this checklist um of 20 items and here are the here are the 20 items right and for each of these items you know based on the answers uh to the questions asked of them you kind of took each item and scored zero meaning you know it wasn’t relevant one meaning was

kind of relevant or two meaning that it was very relevant so take a look at these 20 uh 20 factors right now this is what the modern definition of a psychopath is it’s some combination of these 20 factors as described by robert hare and codified in what’s called the hair psychopathy checklist and i encourage you while you

do that to um summon up your knowledge of what you know about uh donald trump and just kind of see how well it matches up or doesn’t match up so you know hair divided these kind of these 20 items into four columns basically calling them facets so there’s an interpersonal column kind of describing the ways that uh

psychopaths are demon in their interpersonal relationships so they’re superficially charming they’re grandiose selfish egocentric they’re pathological liars they’re very cunning and manipulative con man the classic con man is a psychopath right and they also have these affective or emotional problems right the lack remorse famous as psychiatrists once called the psychopaths emptied souls so they lack remorse they

have a shallow affect meaning that they don’t have emotional depth right they seem to lack empathy and they constantly blame others um and then you know they have they live this kind of lifestyle where they constantly need stimulation they’re parasitic they kind of always live off others promiscuous they lack realistic long-term goals they’re impulsive and irresponsible and

then there’s just flagrant anti-social behaviors or criminal behaviors poor behavioral controls i think means like they get angry very easily and kind of fly off the handle the problems start early with early behavioral problems juvenile delinquency they’re um they’re in and out of prison a lot and they’re criminally versatile like they do lots of different kinds of

crimes and they’re engaged in many short-term relationships now um so you know you take these 20 items you know you score them zero one or two and you add them all up the total score would be 40. so someone who is super you know severe in every one of these facets or um parameters would score 40. remember

a ted bundy scored 39 out of 40. so he got pretty close uh and there was a check cut off harris said basically if you score over 30 you are a psychopath by my definition now when you define psychopathy like that it’s it’s nice because it’s it’s reproducible it’s standardized so then you can start running lots of

studies right and then compare one study to another you know if everyone before you know hair was using had a different definition of what a psychopath is then you can’t compare studies right so by standardizing what psychopathy meant uh you could start now run these rigorous studies and it turns out psycho psychopaths represent one percent of the

male population over 18 but they’re between 15 and 25 percent of male prisoners right so basically they’re a lot more this one percent makes up about a fifth of all prisoners in the united states at least and most of most of those uh prisoners are are in there for violent offenses they’re kind of sweet talking right so

they’re charming and glib so they have this facility with language so they’re they’re more likely to be early release they can sweet talk the parole board right but they’re also a lot more likely to recidivate right so basically then you know as soon as they’re released early they’ll often commit a crime immediately go right back into prison

so because of that there’s this three to one cycle compared to a non-psychopath in prison uh a psychopathic prisoner will be in and out three times for every one time a non-psychopathic prisoner goes in and out and because of this it’s estimated that they commit 50 of all violent crimes these i’m very impressed by these statistics i’m

going to show it to you visually so again psychopaths um represent 1 of the general male population but they are 20 of male prisoners and because there is um so much um uh cycling in and out because uh they get they leave the prison and they come right back because they just commit a new crime immediately they

go in and out three times more often than a non-psychopathic prisoner and because of that this one percent of the general male population is thought to commit half of all violent crimes that’s a truly staggering number right because the cost of crime is estimated in 2009 to cost society and just in the united states the total cost

of crime in the united states in 2009 it was estimated to be 2.3 trillion dollars and psychopaths are committing a significant fraction of those crimes it’s a staggering amount of money that psychopathy is costing society and just as a comparison the cost of health care in the united states for that year was 2.5 trillion so it’s roughly

the same amount we spend on health care is what psychopaths cost us or total crime costs as a society of which psychopaths might be up to half of that okay so here’s the psychopathy check uh you know checklist these are the things that robert here quantifies in his psychopaths and it describes kind of a well-formed psychopath right

but really kind of an interesting question is how did the psychopath become a psychopath how did they get to to be what how they were so if you turn back the clock you know maybe when they’re an adolescent were they like a little bit psychopathic and then you know when they were you know just a baby you

know are psychopaths born right or are are they made you know or you know this is this is my baby baby dean he’s actually three now but this is when he was a baby and i don’t think he’s a psychopath but uh he is a royalty-free image so i’m going to use my children as much as possible

um but you know can you you know are psychopaths basically do they start off as pretty intact babies but through a horrible environment maybe turn into a psychopath or a psychopath born with pre-born with inborn predispositions that make them into an adult psychopsychopath this is an interesting question that we will be exploring for much of this talk

so here’s the psychopathy checklist and um i’m going to rearrange things a bit to make it a bit more make to make it more sense from a neuroscience point of view okay so the categories i have that are kind of neuroscience informed are a bunch of these things about psychopaths have to do with impaired emotional processing lacking

empathy needing constant stimulation kind of not learning from their mistakes and making the same mistakes over and over again having a shallow affect and lacking remorse these are all can be described by uh certain brain uh impairments that affect emotional processing same with impulsivity impulsivity is quite well known um in terms of its neurobiology and still you

know if your brain is set up to be impulsive it’s gonna make you promiscuous and lacking long-term goals and you’re gonna have you know you’re going to fly off the handle really easily and you can be a lot in in and out lots of relationships uh deceit is also has also been well described from a neuroscience standpoint

and psychopaths have the equipment neurobiologically to be excellent liars and remember you know the thing about psychopaths is like they have these emotional problems and they’re highly impulsive and constantly live but they are still rational they have intact cognition right and then you know uh you know there’s an early onset right early behavioral problems juvenile delinquency right

and then all these things lead to the criminal behaviors that eventually follow so what i’m saying is these things that are blue right so the early onset you know that’s a clue that there might be something biological or genetic going on right because if it happens early then there’s less time for the environment to have influenced what

you’ve turned into right and this combination of emotional processing issues with an intact cognition i would argue is the core of what psychopathy means from a neurological basis so they’re rational but they’re morally deranged and because of that they uh are more likely to commit crimes now it turns out that psychopaths are also well equipped to be

well equipped neurobiologically to be very deceitful and we’ll talk about that and of course being very deceitful also predisposes you to criminal and antisocial behaviors and uh you know we’ll also talk about some of the affective machinery that makes people more impulsive and if people who are more impulsive tend to commit more crimes okay so um there

has been a lot of evidence that’s accumulated and what’s really interesting about the neuroscience of psychopathy is that it’s really under you know when you uncover the hood of what’s happening you know inside a psychopath’s head it turns out that a lot of it is quite biological and there’s a strong biological basis of psychopathy and some of

the evidence of this is that many psychopaths come from intact backgrounds backbones where there was no discernible neglect or abuse and in fact early studies by robert harris indicated that when you compare psychopaths the criminals to non-psychopathic criminals because there’s no consistent difference in family backgrounds the story is a bit more complicated though because later studies that

hair showed hair did show that actually there is some environmental influence that psychopaths that come from a low social economic status have a more a more severe form of psychopathy as adults so there is environmental influence twin studies are the strongest piece of evidence that there’s a strong biological basis of psychopathy the traits as we as we

described are apparently in early childhood and the brain you know the brain differences can be seen from an early age this all adds up to uh being highly um indicative that psychopathy has a strong biological slash genetic basis and so what i’m arguing is psychopaths in general tend to have genes that set up their brain in a

way to be more psychopathic and that brain as it grows up interacts with the environment and eventually turns you into a criminal psychopath and we’ll talk more about this so here’s the twin study from 2005 that basically showed that psychopathy is highly genetic so basically you the study compared to eternal twins with identical twins so you guys

probably noticed but an identical twin start from one fertilized egg that through a freak accident right so this fertilized egg splits into two and because of a freak accident then this fertilized egg kind of with two cells splits into two identical um two identical uh fertilized eggs essentially so identical twins share the exact same genetic material and

basically they found that if one uh one uh twin pair is uh has psychopathic traits it’s highly likely that the other twin will also have psychopathic traits and when you compare that with fraternal twins twins that often grow up in the same environment but only share half their genetic material the effect is mitigated so if one one

of the twin pair is a psychopath it’s only slightly more likely that the other twin the fraternal twin will be a psychopath so this study basically calculated that about 67 of psychopathic traits are heritable meaning like they’re meaning that they’re genetically encoded and there’s lots of case studies and you know case reports about very young children who

are highly emotionally disturbed and we don’t call these young children psychopaths because it’s quite pejorative and it can be a self-fulfilling prophecy prophecy so we call researchers call these young children used with callous unemotional traits so paul frick just who works with these children i described one word he used a knife to cut off the tail of

the family cat bit by bit over a period of weeks the boy was proud of the serial amputations which his parents initially failed to notice when we talked about it he was very straightforward trick recalls he said i want to be a scientist and i was i was experimenting i wanted to see how the cat would react

well that’s an admirable scientific attitude but how many among you could truly do that to your cat do you actually cut the tail off bit by bit and see the cat’s suffering and still continue because you just want to see how the cat would react right so if our crowd tonight is about 700 and about one percent

is our psychopathic there are seven of you that might be able to do this okay so um so this is the core problem of psychopathy from a neurobiological standpoint they have emotional processing problems with an intact cognition and so one of the earliest studies so let’s dive into this a bit more so one of the earliest studies

this is back in 1957 basically said you know psychopaths you’d be different than other people they seem less anxious they have a lower heart rate and when you stress them out by like giving them electrical shocks they respond they just have they don’t respond as much they seem to be more insensitive to pain and they just get

less stressed from those kind of painful stimuli they also have impaired learning so impaired fear conditioning things like you know most of us if we touch a hot stove we make that association immediately and we don’t touch that hot stove again but you know what psychopaths will touch a hot stove over and over again they seem like

to not get it at a kind of core neuro neurobiological circuit level and they have impaired punishment learning they don’t learn from punishment right you could you could punish a psychopath up the wazoo over and over again and for most people who are not psychopaths they get it they say i don’t want to feel pain i associate

doing this with feeling pain so i’m not going to do that thing anymore but psychopaths seem to not get that they have impaired punishment learning and because of this they’re more likely to recidivate right so if you if you don’t learn from your errors and you know going to prison is pretty painful i would imagine for most

people you don’t want most people would not want to do that thing again to go back to prison but psychopaths don’t learn from their mistakes all of this less anxious lower heart rate lower stress response all points to having an impaired amygdala so let’s talk about that most of you and this is probably a science savvy audience

know about the amygdala it’s like ground zero for emotions so let me tell you a story imagine you are sitting back on a nice you know spring day you’re just enjoying the sunshine in your face and you’re daydreaming you know about you know various fantasies maybe you’re kind of daydreaming about climbing up the corporate ladder maybe you’re

daydreaming about asking out that cute barista you know for a date and life is good and there’s a nice little kind of breeze on your arm and you’re feeling so relaxed and then you kind of notice the breeze isn’t all over your arm it’s just kind of in one spot on your arm and then like you know

actually the breeze doesn’t feel like a breeze it actually feels like little legs crawling on you you look down and you see this right so suddenly your brain snapped from a daydreaming state to a state of high alert that was caused because the amygdala in your brain sounded the alarm so the amygdala is this is your brain

this is the temporal lobe of your brain and the amygdala is right here it’s an almond-shaped nucleus amygdalin comes from the latin root almond and it’s right in front of the hippocampus which is a memory which is our main memory structure in our brain so you know and the amygdala you know is sort of our fear center

and that’s an oversimplification but it’s true to a first approximation that when you feel fear or kind of some sense of threat your immigrant gets highly active and it’s interesting that it’s right next to the memory center because fear right fear really helps you remember things doesn’t it right any any of you guys remember uh cramming for

finals week and right you remember stuff pretty well when you’re kind of really a bit scared right um so the amygdala you know we’ve known about the amiga for a long time we had these poor monkeys back in the 1930s where they did these experiments where they took out the temporal lobes and monkeys which include the amygdala

and basically you know they noticed profound personality changes in these monkeys to the point where they um they did not seem to feel fear so here’s a monkey approaching this is a rubber snake but it’s highly unusual for a monkey to reach out and grab a snake that’s highly unusual behavior this is because this monkey no longer

has a fear sentence in its brain right and we know from fmri studies look at brain activation that when you look at fearful faces your amygdala activate so one key thing to understand about the brain is that it’s hierarchically organized you’re not aware of most of the things your own brain is doing you’re only aware of a

tiny fraction of what your brain is doing things you’re paying attention to and things that you have access to so for instance your brain is constantly monitoring the uh the level of oxygen in your brain in your in your bloodstream right but you have no conscious access to what your oxygen level is in your bloodstream but you

know who does have access to um to that information you’re amygdala so i’ve i described the amygdala as a yappy chihuahua and i’ll get to that in a minute but you’re maybe less like this low-level employee who’s constantly working whether you’re paying attention or not it’s constantly expanding the entire environment things outside your world things inside your

body it’s scanning it all to um to to be able to know to detect things that might be threatening to your survival and then to pull the alarm so the amygdala is a highly connected structure everything basically this is a this is a diagram of brain connectivity and the amygdala is in the center and these are all

the different brain areas your medulla is connected to basically everything feeds into the amygdala and the amygdala in turn feeds into many brain areas so it senses a lot of information and then it can do a lot of things in your brain so the middle is like a yappy chihuahua that’s constantly scanning the environment so and it’s

getting signals from the visual system the auditory system tactile your skin right the olfactory system stuff inside your body the visceral system right and then it you know if it if it when something like a spider crawls in your arm right it says you know what this this is something that you really need to pay attention to

stop daydreaming right and so there’s this amazing thing with amygdala can then amplify the inputs that it thinks are the most salient right to really kind of hone in on so from that oh there’s a breeze in my arm oh there’s a kind of that feels like legs huh so suddenly your visual system and your tactile system

have really kicked into high drive so your medulla is behind that and what does your amygdala do it it sounds the alarms right it signals your your hypothalamus to for physiological arousal like to make your heart beat faster get more blood pumping to your muscles it uh it activates the the adrenaline and the cortisol endocrine system it

activates your hippocampus you start to start to remember things because if you know when you’re under threat that’s a really good thing to remember so that you can avoid situations like that in the future so your memory systems are activated right lots of cognitive arousal systems in your brain are also activated and it activates an aversive emotion

in your body all right it’s this thing that this aversive emotion that makes you want to move away from whatever the thing is that’s threatening so that’s what your amygdala does but um you know the thing about psychopaths is that they have smaller and less active amygdala so instead of having a yappy chihuahua they have some trouble

with it looks like this and when your amygdala’s not very active it’s sort of like there’s a dimmer switch on all this stuff it’s like an emotional dimmer switch where they’re just not sensing emotions or threats around it or pain things like that as um as vividly right so they’re less anxious and they have less fear right

uh and you know when you’re kind of when amygdala is very not very active you’re not really you know it’s not the alarm systems are very low right so you’re constantly bored right that’s why you know this need for stimulation is um is one of the one of the characteristics of psychopaths and it’s also why they use

drugs a lot because they’re looking for that sensation right and it also explains impaired punishment learning let’s get into that in a little let’s get into that now so key deficit for psychopathy is impaired punishment learning they don’t learn from painful mistakes so again here so here’s my baby dean right and uh you know dean um you

know he can be a very sweet baby and we love him very much and i i want to reiterate i don’t think he’s a psychopath but baby dean has a dark side right so when he was little you know he beat us on a regular basis and so what happens you know you know most of us who

raise kids understand that toddlers are like they’re like little savages they can kick and bite and scream and you know be quite violent with each other right but eventually we we kind of civilize them over time and how do we do that we do that with negative feedback right so uh you know some figure steps in says

don’t do that it makes you feel really bad in your body right so this is what’s happening in your brain right so here’s the amygdala right and here’s another part of the brain which i’m going to introduce called the ventromedial prefrontal cortex and these two structures are connected by um by a fiber bundle called the unsonic fasciculus

basically when uh inside the brain of let’s say you’re inside of this kid’s brain this kid just scratched the other kid and mama said don’t do that and said it in a harsh tone of voice that made the baby realize that was a bad thing to do the amygdala activates and registers an aversive emotion that diversity of

emotion right is then um is that so and then it’s the amygdala sends that signal to the vm pfc which understands the context i scratch my brother and so this combination of the reverse of emotion and this context is stored as an emotional memory so it’s mama in the pikachu you know the reason you don’t keep reaching

for the cookie jar is because the first few times you did it you got a slap on the wrist you registered in a reversive emotion associated with the context i reached i wrote you know i got cookies when i shouldn’t have right so you do that over and over again you store a bunch of these emotional memories

right or these emotional linkage linkages that build up over time and become the basis of what i call moral autopilot right so this kind of this database of things that you did that made you feel bad right and so the amazing thing is the vmpfc not only stores these kind of emotional linkages they can predict when a

bad thing is going to happen and start to play that emotion again so that you don’t do that thing again so you know most of you you know you know you can turn to the if you’re when i get this talk in the theater this is a lot easier but turn to the person next to you right

and imagine taking your hands and strangling the life out of them while you see the light go out in their eyes right now most of you could not do that under any circumstance because you have such strong training over time this with this kind of all these emotional linkages with violence that you know connected with this bad

feeling in your body that even contemplate when you contemplate doing stuff like that the vmpfc says oh wait wait there’s something you should know let me replay you this emotional memory that i think is relevant the situation and then you start to feel this bad feeling in your body again which makes you not want to do that

thing right so you can see how this kind of database of emotional linkages that can that get automatically replayed in the appropriate context can form the basis of this moral autopilot right this thing that makes you you know we don’t strangle people you don’t have to think to yourself should i strangle people or not you don’t have

to think about that it’s all kind of emotional and automatic that happens underneath the surface right and you know you know kind of storing these emotional linkages to to aversive experiences is the basis of punishment learning right the reason we don’t do things over and over again you know that that made us feel bad is because we

don’t want to feel bad again right now it’s interesting psychopaths have smaller amygdala and they’re more under active we talked about that right but their vm pfc is also less active and smaller so psychopaths are less able to store aversive emotional memory so they don’t learn from punishment and they don’t develop social inhibitions they don’t they don’t

develop that kind of database of emotional linkages right they just that that memory says emotional memory system is just defective so they don’t have this moral autopilot which is why direct deterrence doesn’t work and they don’t learn from their painful mistakes and they recidivate frequently now you know with regards to trump what if you never got punished

so you know i don’t know what trump’s amygdala is like maybe his amygdala is working just fine but maybe the reason he doesn’t have emotional linkages to uh you know to things that most of us would feel shameful about is because maybe he just wasn’t punished when he uh when he you know on a regular basis when

he was growing up you know so you know one of the books i read uh you know in preparing for this talk is this book by mary trump who is a niece of donald trump uh and i you know i found her accounts very relevant because she has a first-hand accounts she has first-hand knowledge of what this

family was like growing up right so she wrote you know you know at an early age donald began to realize there was nothing he could do wrong so he stopped trying to do anything right he became bolder and more aggressive because he was rarely challenged or held to account by the only person in the world who mattered

his father fred liked his killer attitude so his father actually encouraged kind of this aggression in donald um because he liked his killer attitude even if it manifested as bad behavior every one of donald’s transgressions became an audition for his father’s favor as if he was saying see dad i’m the tough one i’m the killer now again

i’m not offering a professional opinion i’m not offering a diagnosis that donald trump is a psychopath but you know and i don’t know whether mary trump’s account is true i think she’s credible right why would she lie but you know that’s a diagnosis would can depend on all these things but if this account is true and donald

trump was not punished on a regular basis of being highly aggressive you could see why he would continue to be highly aggressive as an adult right it’s not rocket science so robert hare described this kind of 20 factors that make up a psychopath but if you could describe it in one phrase it’s basically and he wrote this

book called without conscience you know so what is a psychopath it’s this complicated set of 20 factors or stated simply you can say a psychopath is someone who who is without conscience but what is the conscience right now the the fascinating thing is we are we know a lot about how the conscious conscience is um is instantiated

by brain activity because of this wonderful machine called an mri that can with the fmri we can scan brain activity and so there are actually four different literatures that all point to this structure the ventral medial prefrontal cortex so here’s the brain and the medial you know the brain has two halves and so there’s a medial surface

to the brain so ventral means underneath and medial means in the middle right so this ventral medial prefrontal cortex here’s another view of it right is really um ground central for the conscience without eventual medial prefrontal cortex you cannot have a conscience and the literature is that all point in separate literatures all point to the structure as

being a critical brain structure for the conscience there’s a whole literature about moral reasoning so when you kind of solve moral dilemmas this part of your brain is highly active and we’ll talk about that the psychopathic literature um you know ken kiel and rjr blair um i had to kind of have really um fleshed out that this

is a structure that’s highly defective and psychopaths and i recently had the pleasure of meeting rgr blair and i invited him to his talk so he might be out there listening to this talk um and uh if he is i’m honored to have you the traumatic brain injury literature people who have had this part of their being

damaged very uh you know so phineas gage many of you guys know phineas gage the railroad foreman who had a tamping iron kind of that went through his brain and damaged this area which basically turns people into instant psychopaths and then there’s a dementia literature there’s um slowly demanding conditions like frontal temporal dementia which affects the sprain

area and people become immoral over time so let’s talk a little bit about the neuroscience of moral decision making and the main person is who does this is josh green who basically sticks people in scanners and gives them moral dilemmas and then he looks at their brain activity to figure out which parts of the brain are important

to solve moral dilemmas so let me pose a few moral dilemmas to you so i’m going to pose a dilemma i’m going to say is it appropriate to appropriate two um and i’m gonna finish the phrase and then you know basically you know i want you to to really decide whether it’s appropriate to do whatever i’m asking

you to do okay so let’s start with an easy one is it appropriate for you to destroy the sculpture in order to save this work man’s life there’s a sculpture over a bridge and there’s a trolley coming about to kill this person so is it appropriate for you to destroy the to push the sculpture over to save

the workman’s life now let’s make the same situation but instead of having to push a sculpture you have to push a person so you kill one person but you do it in order to save five people is it appropriate for you to push the stranger onto the tracks in order to save the five workmen crying baby so

let’s say you’re a jewish family hiding in the basement from nazi soldiers who are over ahead right and you all have to be super quiet or else the nazi soldiers will find you and kill you all and your baby starts to cry and you cannot shut this baby up right so and if the baby is hurt by

the nazi soldiers the baby will be killed including and all the other people will be killed so is it appropriate for you to smother your child in order to save yourself and the other town’s people so note that you know if you don’t smother your child your baby’s gonna cry and the baby and everyone’s gonna die including

the baby but if you do smother your child you have a chance of saving everyone else at this point you’re probably wondering boy this is science on tap i’m supposed to be drinking a beer and having having fun what the heck am i doing here it gets better i promise you so some of these moral dilemmas were

harder than others and there’s some that i didn’t mention here if you had to rank which ones were harder and easier you know i would imagine most of you found it pretty easy to decide whether to push the sculpture off that’s a no-brainer right push the sculpture off save a person probably many people find it harder to

push a person off right to save five people and then the hardest thing would be to smother your own baby to solve for for a good cause to save everyone else but how many of you could really do that could really smother your own baby um even if it meant you could save everyone else including you know

so you know the the harder moral dilemma is elicit the sense of horror right the kind of the sense that you’re going to harm someone and we have this automatic feeling of horror in contemplating that most of us who are non-psychopaths have that but psychopaths do not have that sense of horror and why is that well okay

so you know these moral dilemmas were difficult the crying baby pushing the person right because there’s a conflict in your brain there’s a conflict between the reasoning part of your brain that says you know what um you know the the math works out you kill one person you save five but then there’s this heart this horror part

of your brain says you know what i don’t know if i could do it i don’t know if i could really push that person over the bridge right something’s stopping you right and that conflict is played out in your brain so josh green by sticking people in scanners while solving moral dilemmas like the crying baby dilemma basically

found that there are two separate systems in the brain one system is uh is anchored by the dlpfc which is a brain area that is involved in abstract reasoning and the brain you know they’re always brain circuits that that do abs there’s a whole circuit uh that um does abstract reasoning but the dlpfc is a critical area

that uh it anchors that whole that whole rational reasoning circuit and then in contrast there’s another circuit that does emotional reasoning right and that’s anchored by the vmpfc that can process the social context and say and then generate an aversive emotion the sense of horror right so you know in these kind of you know the crying baby

example right the math works out the abstract reasoning part of your brain says you know what i kill one baby but i save everyone else right otherwise everyone dies right so the math works out to go ahead and smother that baby so the the reasoning part of your brain right saying go but the social emotion part of

your brain right saying no i don’t think i can do that that just feels too horrible right and then every time there’s a conflict between two two competing goals the acc snaps into place the ecc is sort of like a hot like a ceo in your brain a very high level executive in your brain that gets consulted

when they’re when the lower levels of the brain are having a conflict and the acc tries to solve that conflict by saying either do it or don’t do it so it’s reasons versus emotions right um and you know for a lot of us no matter how strong the reasons are our emotions stop us so even if there

were 100 people in that basement right so and if you killed your own baby you could sell save 100 people right most of us still probably couldn’t do it because the sense of horror is such a strong stop signal uh but you know psychopaths it’s interesting have defective vm pfcs right so you know this area of the

brain isn’t quite as active so they feel less of a sense of horror right meaning that the stop signal is less intense meaning that for psychopaths if you ask a psychopath what they’re going to do in that situation they’re going to say i’m going to smother the baby and why is everyone so upset at me it just

makes sense so the vmpfc is a key area for the conscience and i would argue that the conscious is composed of three different functions that the vm pfc are participates in one is social inhibitions which we’ve talked about already right kind of uh kind of like this you know the story of emotional aversive languages linkages mama mama

in the cookie jar right but the other components are empathy and impulse control so let’s talk about that a little bit so the vmpfc is a key area for empathy and what is empathy empathy is a kind of imagination right it’s the ability to understand and share the feelings of another person it’s the foundation of pro-social behavior

and it’s thought to be an evolutionary benefit because you know it turns out that when we’re out on the african savannah it made sense to team up with other people that helped us survive and having empathy was sort of like a social glue that helped people live in large groups and empathy is actually a kind of imagination

so think about what imagination is and you know i was an avid reader when i was young i still read when i can but you know i just love picking up a book and you know from a from a one-dimensional stream of text that entering my brain it ignited this whole universe a whole world right a world

full of sounds and images and thoughts and feelings right and the thing is you know we all have this imagination engine in our head right so this imagination engine you know when you look at it neurobiologically it’s a set of interconnected brain areas that all kind of participate in a circuit to create virtual simulations so all of

us can think back to an emotional day in our lives you know the day we got married the day our first you know child was born maybe the day we got divorced any kind of emotionally significant experience you know you could really close your eyes and relive that entire experience right with sights and sounds thoughts and feelings

and and you know we can also stimulate how other people might feel right so you know what are these brain areas so you know there’s the hippocampus right which is uh you know important for memory and memory forms the building block blocks for imagination right and then there’s a part of the brain called the dmpfc or the

dorsal medial prefrontal cortex that helps us understand what other people might be thinking right so you know when we you know when you think about like you know the prospect of going to your boss and asking for a raise you can have that entire conversation in your head you know what your boss is gonna you know what

you’re gonna say then you can predict what your boss is gonna say that’s your dmpfc kind of calculating what other people might be thinking it’s just it’s this a skill called mentalization that psychologists are very familiar with right so the vm pfc on the other hand right the structure we’ve been talking about so much uh helps helps

us to understand what other people might be feeling right it’s the basis for empathy so when the you know when someone is feeling something right we automatically can feel what they’re feeling right so the vmpfc helps us kind of attune to other people’s feelings now psychopaths have intact dmpfcs so they’re able to mentalize just fine right so

they’re really good at lying in manipulation but their vm pfc’s in-app is uh less active right and defective so they have imperial empathy for them other people are like just like objects they’re not people right so a famous psychopathy researcher said psychopaths know the words but not the music now empathy is also the basis for vicarious learning

so i’m gonna date myself again but many of you probably you know some of you if you’re over 40 you recognize who this person is right and you recognize what movie this comes from this is glenn close from fatal attraction right and what’s the moral of this story basically don’t cheat on your wife do not cheat on

your life right and uh you know and how did it teach you not to cheat on your wife did it show you an excel spreadsheet showing you like all the reasons you shouldn’t cheat on your wife no right it’s it you you learn that lesson by feeling horrible right because michael douglas was feeling the sense of horror

as this woman kind of stalked him and kind of killed his rabbit and all did all these horrible things and you just felt like oh my god i feel horrible you empathize with michael douglas and you said you know what i don’t want to be like michael douglas so i’m not gonna cheat on my wife and i

bet if you could i bet if you graphed like infidelity levels for six weeks after this movie i bet you there was a sharp drop in infidelity for at least for a while after this movie so this is what’s called indirect deterrence or vicarious experience we can learn from other people’s mistakes we don’t have to experience those

mistakes but again if psychopaths have defects in experiencing these emotions and learning from other people’s emotions right again they’re not going to learn from other people’s mistakes so again this is another factor that makes them recidivate this is why they don’t learn they don’t want it from their own mistakes that’s the direct deterrence and they don’t learn

from other people’s mistakes that’s indirect deterrence uh and with regards for empathy i thought this was a um you know trump has made quite clear that empathy is for suckers right and i thought this passage for mary trump’s book was quite interesting so she describes basically you know when she was younger her dad donald trump’s older older

brother uh you know was hospitalized after a very significant heart attack uh and basically you know the family was gathered in the house and uh you know everyone knew that that the father’s situation was grave right um and you know what did donald trump do that night he went to the movies all right um and later that

night um you know the the the hospital called uh you know called call the family saying that the per that uh the dad was dead so you know you know i think this is an interesting anecdote you know your older brother your oldest brother is in the hospital almost certain to die and what you choose to do

is not go to the hospital and visit him but instead go to the movies so you can draw your own conclusions about trump and empathy okay so let’s talk about impulse control right so um we talked about the amygdala right so the amygdala is like this yappy little chihuahua that’s constantly you know scanning the environment for things

that might threaten you right so it’s your monster detector right but then there’s another part of the brain called the nucleus accumbens that is sort of like the opposite of the amygdala there your nucleus comes is like a it’s a happy little puppy that’s constantly looking for things that might bring you pleasure right and uh it’s your

donut detector so when your amygdala finds things that are threatening it activates and it generates an aversive emotion that makes you want to move away from that thing when your nucleus accumbens activates it generates this attraction uh this kind of feeling like you want to move towards that object right so the amygdala is your monster detector your

nucleus confidence is your donut detector right now the thing is though that you know we don’t you know we don’t run away from every monster and we don’t you know go for every donut that we see why is that because these uh the activity of these low-level brain areas which comprise your kind of your low-level impulses your

drives we don’t we don’t like we don’t follow through in every drive that we have right and why is that it’s because the both these structures are connected to the vmpfc which is kind of like the dog walker in this case or the executive so the vm pfc is an intelligent part of your brain that provides contextual

understanding right so your michelin might say oh my gosh oh my gosh i see a snake i see a snake i’m going to activate you know it tells the vmpfc right and the vmpfc is always okay thank you amygdala thank you for telling me that the snake there but you know what i have additional information i know

i’m in a zoo and i see that that snake is behind behind glass in a cage so you know what amygdala you need to chill out right so the vmpfc interprets the data coming from the amygdala and nucleus accumbens right and determines whether to follow through on and follow through on it or not and the reason the

vmpfc is so intelligent is because it’s connected to other brain areas it’s connected to the hippocampus and all the memories you might have about certain things it’s connected to the reasoning part of your brains it’s connected to this whole database of emotional uh linkages that you made growing up so it can make wise decisions it doesn’t have

to just follow everything that your amygdala and your nucleus accumbens is telling it to do now um you know one interesting thing that we’ve learned uh is that you know your breed maturation takes a really long time so we used to think that the brain was mature at an early age and so this is a famous graph

from age 5 to age 20 blue means mature and red means immature and you can see the videos here of how can the the back areas of your brain mature first and then that maturity kind of the frontal lobes actually mature alas so actually this vm pfc which is located in the front of your brain is one

of the last areas to mature so take a baby babies have very immature vmpfc’s right so you know they you know they run away from every monster and they you know they can’t keep away from every donut right so they’re highly impulsive they’re basically slaves to their drives because they don’t have a well-formed executive yet right they

just kind of do whatever their amygdalar nucleus accumbens the same now as teenagers are a little bit better right they’re but they’re still impulsive right because this area of the brain is still not quite developed right and interestingly when you look at psychopaths what we said about the amygdala is that they’re instead of a yappy chihuahua it’s

kind of like they’re kind of like their child was asleep at the wheel right so basically their monster detector is not working very well right so that’s why they’re fearless right on the other hand you know and i know rjr blair if you’re out there he’s uh he’s done a lot of research that shows that the contradictions

but so the literature is complicated but there is at least some literature that shows that people who are psychopathic have very act over overly active nucleus accumbens so donuts look super good to them right so they’re highly hedonic meaning that they’re really go for immediate gratification so when you consider that you know psychopaths have an underdeveloped vmtfc

and they have a underactive amygdala so they’re fearless and an overactive nucleus accumbens that is a that’s a bad combination right if you’re fearless hedonic and have a poorly formed executive then you’re a highly impulsive person and i’ll just let you judge for yourself where you think trump fits on the spectrum of impulsivity okay so let’s talk

about um so we talked about you know the core deficit i believe in psychopathy from a neurobiological standpoint is that they have a deranged emotional processing but an intact cognition right so their emotional processing is drained in various ways their amygdala right is less active their vm pfc is less active and atrophied so they’re less able to

do punishment learning the vm50 is also involved in empathy and in psychopaths their vmpc does not work very well so they have less empathy and finally the event the mpfc is um involved in impulse control right so they have less impulse control also they’re fearless and they’re highly hedonic right so that explains a lot of the of

what’s on the psychopathy checklist right and they have intact cognition right so they can still manipulate and con people really well i want to talk uh briefly about this and i know i’m going this is about a little bit over i’m just if you can indulge me this is such a fascinating thing about psychopaths and being pathological

liars you guys remember this at trump’s inauguration january 20th 2010 these are kind of crowd sizes of obama and trump and the next day sean spicer no doubt at the direction of donald trump said that was the largest audience to witness an inauguration period and this is just the start of i mean this seems like a million

years ago for most of us this was like what the hell is going on here like why would trump lie about something so objectively verifiably false right it was just puzzling right and since then and so um you know i just want to say this anecdote too you know so one thing about psychopaths is they’re kind of

superficially um charming and and so it takes a little bit while you know when you first meet a psychopath you might be really taken by them you think oh that’s a really great person but you know who knows psychopaths really well are there people who i mean so the people closest to the psychopath right if you spend

time with a psychopath it eventually becomes obvious that oh this is all an act they’re actually this kind of cold-blooded person inside and so you know i thought it was interesting that mary trump’s reaction to election night you know um was basically you know um at five o’clock the next morning you know when there was when trump

was announced the winner you know i was wandering around my house as traumatized as many other people but in a more personal way it felt as though 62 million voters had chosen had chosen to turn this country into a macro version of my malignantly dysfunctional family so that this kind of inauguration claim was you know for most

of us it was like wow i’ve never thought like a president would lie so blatantly so verify will be false too it’s bizarre right um but you know these poor people who check who keep track of how many lies trump has told right the washington post had an article july 13th 2020 that’s 1270 days since inauguration at

that point he had told 20 000 false or misleading claims and they’ve accelerated the first ten thousand false mix lean claims took 827 days but the next 10 000 took only 400 days this is interesting this is a speech from one of his recent rallies that was fact checked by the new york times and everything he read

was basically a lie right so in 90 minutes president trump made 131 false or inaccurate statements there is this phenomenon called pseudologia fantastica which is not officially a psychiatric diagnosis yet it’s more a collection of fascinating cases of people who lie apparently for no reason right so um pseudological pseudological fantasy describe patients who tell complex tales where

delusions seem to co-exist with lies and these are the key characteristics chronic lying and you know i encourage you to think about donald trump and see how well he matches this chronic lying or storytelling that is unrelated to or out of proportion to any clear benefit these people lie for apparently no reason right the lie when they

don’t need to lie when it’s objectively false qualitatively the stories are dramatic detailed complicated colorful and fantastic the stories typically feature the suitalog as the hero or a victim and seem geared to achieve acceptance admiration and sympathy right in terms of insight the the key is these people are not psychotic they are not totally delusional in the

psychotic sense of they cannot differentiate really reality from um uh from uh from delusion it’s more like they believe what they’re saying so much that they seem like outs i’ll call it pseudo-delusional right they can fact-check themselves and they can’t step back and say oh that’s not true but they seem to believe their their lives so convincingly

that they almost convinced themselves so let’s talk a little bit about the neurobiology neurobiology of deception you know here’s old school lie detection in ancient china it was common practice to have an accused person shoot a handful of dry rice and then attempt to spit it out if the rice became wet and therefore easy to spit out

the person was considered truthful if the gods made the rice dry and stuck and stuck to the suspect’s mouth when he tried to spit it out then he was thought to be lying does this make sense at all or is this a total bs it kind of makes sense right because most people when they lie they feel

nervous right when you feel nervous your sympathetic nervous system is active and your mouth becomes more dry right so uh this is basically you know this kind of dry rice test is basically a test to see how anxious you are right and what is exact how is anxiety encoded in the brain what’s ground central for anxiety you

got it the amygdala right so we can already see if a psychopath has an underactive and atrophy amygdala and they don’t experience fear the same way other people do right they’re not going to be anxious when they lie so they’re going to be better liars and it gets more it gets more complicated than that you know when

you think about what happens inside someone’s head when they’re lying right so there’s an emotional aspect like most people not everyone psychopaths don’t but most people feel anxious right or they feel guilty or they feel excited right and then they just there’s this cognitive component where it’s like you know what dude lie effectively you have to inhibit

telling the truth you have to generate a story you have to keep track of things with your memory it’s pretty hard and then you have to act right you have to suppress whatever emotions you might be showing you have to generate honest behaviors like looking into someone’s eyes right so it’s all the stuff needs to happen in

your brain right which is why it’s hard to do which is why you know one of the oldest truth compelling technologies is to get someone drunk because then your cortex goes offline and it’s harder to do all these things right to make a long story short so neuroscientists understand lying quite well right at this point because they

stick people in scanners right and they make them lie and they look under they figure out what parts of their brain are active and i’m not gonna go you know there’s not enough time um but this is like you know kind of one diagram that shows areas that are active when you’re lying and this is the front

of the brain i just want you to notice that a lot of what’s happening is in the front of the brain so um you know when you people have studied pathological lives and found actually you know there’s more stuff at the front of their brain they have more white matter pathological liars have more white matter in the

front of the brain and that what in subsequent study that white matter was shown to be in areas that are that are highly active and lying right so the idea is people who lie all the time are practicing lying all the time they’re building up the circuit of lying um right and that’s what they’re building up is

their myelins the myelin connects different brain areas right as you practice the circuit over and over again your the myelin gets thicker and that surface surface comes more robust stronger more efficiently activated so um you know one of the reasons that um that psychopaths can lie so well is because they have little amygdala activity so they don’t

experience fear right which is what gives away lying for a lot of people another reason is because they practice so much that the lying circus in their brain are super well developed and that can be discerned by these structural studies that have looked at how much white matters in people’s in the brains of pathological liars i thought

that was quite fascinating um i’m just gonna spend a few minutes on legal implications basically she will be punished psychopaths uh and the question basically is like are psychopaths insane and insanity basically is you know different from state to state but basically it’s you have a qualifying mental assaulter and because of that you lack a successful capacity

to appreciate right or wrong right from wrong or you control your behaviors interesting about psychopathy is most i think every state has a specific psychopathy exclusion basically saying like you know what psychopathy is not a qualifying mental disorder but you know what you know over time you know we thought a lot of different kinds of mental disorders

used to be you’re just a bad person right so epilepsy used to be like you’re possessed by a demon you’re a bad person but now we know it’s a disease it’s an electrical storm in the brain so as we you know as society progresses as scientific knowledge progresses we often ship a lot of diseases like epilepsy major

depression addiction somewhat on this pathway too instead of just seeing like if you’re a bad person for having this illness it’s it’s seen more as disease so people become more sympathetic and basically i’m one of my predictions is as we know more about psychopathy we tend to feel a bit more sympathetic like maybe it’s not all their

fault in quite the same way as we thought before and this is where i want you to check in right think about diane downs think about ted bundy even think about donald trump you know just knowing about but some of these neurobiological derangements make you a bit more sympathetic when judges were presented cases of psychopaths with and

without uh basically biological data the sentence that they handed down was about a year or less so you know when you said when you when they were sentencing and this is all mock trial when they were sentencing people who appeared to be psychopaths they got a 14-year sentence when biological evidence was uh was shown the judge shaved

about a year off so it was a small effect but it was a but it was a noticeable effect in being mitigating essentially now i’m going to spend the last few minutes about like what you do of psychopaths right so can psychopathy be treated and again again the model was psychopaths have these bad genes that sets up

their brain with psychopathic tendencies that brain interacts with society right environmental influences and somehow in that that soup of environmental influences in the brain sometimes a criminal psychopath is created so let’s just take this one by one so if psychopathy is essentially a genetic condition can we fix their genes and we’re getting better at gene therapy taking

out bad genes and sticking in good genes but the problem is with psychopathy that there are dozens of genes involved and we simply do not have the technical we are nowhere near the technical know-how to simultaneously snip out dozens of bad genes and snip them back in we don’t even know what the genes are there’s some candidate

genes that have been identified but most of it is just a big mystery so genetic approach as well can offer a complete cure at the root of the problem but it’s we’re nowhere near the technical capacities to do it now how about things that can influence the brain right so we are in the golden age of neuroscience

we’re getting better and better at looking at brain structure 100 years ago if you wanted to look at the brain you couldn’t you had to inject air into people’s ventricles and see the air bubbles now you know 100 years later we have these wonderful mri images of the brain we’re also getting better better better with pet and

fmri at looking at brain activity and finally the latest wave is we’re getting it better and better intervening and actually changing brain activity right so we are in the era of precision psychiatry where you know this is helen miebert she is pioneered the use of deep brain electrodes stimulating electrodes that insert into the brain and she has

to do very methodical and rigorous work found a spot in the brain uh we’re using very fancy techniques the exact right spot in people’s brains who suffer from major depression just sticking an electrode when you turn the electrode on it’s virtually instant cure for their depression obviously sticking people’s uh taking needles into people’s brains is highly invasive

so it’s going to be this is going to be limited right to how many people can do it i’m fortunate enough to be part of the interventional team at stanford which are using non-invasive methods to modulate brain activity and i think some of my colleagues are out there in the audience and wanted to give a shout out

to them so transcranial magnetic stimulation if you’ve not heard of it is a breakthrough technology that can change brain activity and we use it currently to treat depression it’s one of the most uh effective treatments for depression and if you learn nothing else from this uh from the talk other than if you know someone who’s depressed and

hasn’t responded to medications you should look into tms it’s an office procedure it’s 30 sessions but each session is only three to ten minutes long there’s no cognitive impairment there’s virtually no side effects except for a one in thirty thousand risk of seizure so it’s super duper rare and uh in our clinic about two-thirds of people who

have failed medications get a lot better in terms of their depression and when you look at research studies that use high-dose uh high-dose tms people like nolan williams at stanford nolan is able to induce a 90 remission rate in the most treatment-resistant depressive population that we have people who failed ect so um it’s a remarkable remarkable technology

and you know because tms can be applied to different parts of the brain and we know that different parts of the brain are responsible for empathy we can turn up and down people’s empathy with tms non-invasively and the next thing beyond tms is focus ultrasound where you can beam ultrasound beams into someone’s brain and at high doses

it can actually ablate tissue it can actually remove tissue but low doses you can actually stimulate brain tissue out of in a very very precise way this is not in clinical use yet for in terms of brain stimulation it is being used by neurosurgeons to vaporize tiny bits of tissue instead of having to come to people’s skull

uh but it’s not quite there for brain stimulation but this is the future focus ultrasound uh we’ve gotten so good at modulating people’s brains uh kind of in a very focused way that you know raises lots of lots of ethical questions right and so you know do we want to go mucking on people’s brains right um and

um you know really i think the thing that’s going to you know really limit using brain neuromodulation to change behaviors like psychopathy it’s kind of this kind of this what i call the yuck factor where people just feel really uncomfortable about doctors mucking around with their brain activity and changing their behaviors with the technology okay let’s go

to the last thing can we change the psychopath himself um you know with training so can you train them to be more empathetic and the bottom line is yes empathy is a skill you just kind of you know practice empathy over over and over again you get better at it that’s been shown lots of ways but the

problem is practice requires motivation and why would psychopaths want to be more empathetic because to a psychopath this is what the world looks like right they’re the wolf and everyone else are suckers right so they viewed lack of empathy as an advantage right so uh you know it’s really hard to make them practice more empathy when they

don’t think when they think that’s going to harm them right so finally so we talked about genetic approaches we talked about modifying the brain we talked about empathy training right those all have the limitations i’ve described so the really the last thing to think about is can we somehow change society to make psychopathic individuals less likely to

occur and the answer i believe is yes so let’s say this is my other baby baby kyle he’s five years old now but let’s say and he’s not a psychopath but let’s say he let’s say he was born with psychopathic traits of being fearless having low levels of empathy right so one path is he can become a

criminal psychopath but another path is maybe he can be a surgeon right there are careers where a low empathy levels of empathy may be an advantage like being a surgeon or a ceo or a lawyer right these are careers that in which low empathy these are pro-social careers that can take advantage of low levels of empathy so

a person who is born with the psychopathic traits doesn’t necessarily have to become a criminal maybe they can become a functional member of society right and how do we ensure that how do we make it more likely to make more brain surgeons and fewer criminals right biology is not destiny i think the key is that psychopaths are

rational so we if we set up a world in which the rational choice is to help others they will do it because they want to they want to do you know whatever gets them the most stuff right now we help other people for two reasons one is it helps it feels good right and the other reason is

because it helps us get ahead actually helping others is actually kind of selfish in that it makes me feel good and it helps me get ahead right but psychopaths don’t feel good by helping others right because they have that deficient emotional processing so basically they’re going to be motivated to help other people if it helps them get

ahead right so how do we create a world where helping others helps them get ahead a long time ago abraham maslow a psychologist had this the self-actualization pyramid that basically said you know what you know these lower needs have to be met before these higher needs are met and so there’s a line beneath like so your most

basic need are physiological like food water and then the next ones are safety if these needs if you’re living in underneath this line where these needs are not met then this is a zero-sum world where if like if you have more food and then i have less food right so self and other you know acting selfishly does

not help the other person but if we can create a society where these basic needs are met then suddenly helping others right social needs esteem needs helping other people have actually helped get our own needs met right so basically if we create a society where basic needs are met the rules are fair and the culture rewards altruism

then the rational choice will be to act socially right so think about the cultures created by these two different presidents which culture rewards psychopathy essentially and what culture rewards altruism let me just i know i’m going way over and i know and i’ll stay longer for questions but uh i just wanna if psychopathy is a genetic condition

and we are getting near the end why hasn’t evolution weeded it out right so um you know there’s a book the wisdom of psychopaths that you know they kind of list a bunch of careers that are enriched in psychopathy there’s a study that says one of the five ceos are psychopaths so there are careers where they’re they’re

kind of pro social in a sense where low empathy could be helpful right and psychopathy exists in this spectrum so some you know it’s not like it’s not like some people are so some people are highly so this is just basically showing you you know there’s some people and this is a sample from england where some people

are highly psychopathic and then some people are less psychopathic and there’s everything in between so in our population we have some people who are very psychopathic and maybe that’s not an evolutionary advantage right but some people are less psychopathic and so think about the crying baby right you know i doubt that any of us maybe except for

the psychopaths out there could smother your own baby even if it meant saving a hundred other people right um but you know when you think about it you kind of wish there was a psychopath in that room because someone needs to kill that baby just because if you don’t kill that baby the baby still dies but everyone

else dies so there’s some cases where a psychopath can be really helpful right so in a weird sense we might need so having a few psychopaths right maybe not the full-on super psychopathic people that kill people maybe like the moderate psychopaths that can be evolutionary adapted as a species because sometimes we need to do bad things to

get good things done now this is the final few slides uh and so you know the question is and i don’t want me to imply so if donald trump is a psychopath is he the psychopath that we need because sometimes sometimes you could use a psychopath right and versus you know the the president of china’s uh xi

jinping right you know if he’s a psychopath you know compare these two people right they’re both very cruel right um and but you know one could argue that the president of china is cruel but effective and one could argue that trump is cruel but ineffective right and kovat has really brought a lot of this to the fore

right so you know here’s kova here’s china’s covet curve right they started off with 7000 cases right there and over time this is their covet curve over time they’ve had eighty five thousand cases four thousand six hundred deaths this is our covert curve and notice the graph is this goes up to a hundred thousand so eight thousand

on this graph is here right so we’re just way off the charts we’ve had nine million cases and over two hundred thousand deaths right and i’m not suggesting we should turn to china china does many awful things xi jinping is a highly cruel person you do horrible things to ethnic minorities and to the tibetans um right but

um but that but we could still learn from china right we can learn and you know one of the things that really drives me crazy about trump’s reaction or response to the copic crisis is that he’s made this false dichotomy between public safety and saving the environment right china shows that those things are linked right so you

know if trump’s shouting hey open everything up as quickly as possible because we need the economy to rebound right the thing is it’s not going to rebound until people feel safe right and if you’re not doing the things to drive the coveted cases down the economy is not going to rebound just telling yelling at people to open

the country up and go to start to go to bars again isn’t going to make it happen people have to be safe public safety and economic rebound are intricately linked and you can see that in china’s response they drove the coven epidemic pandemic down very quickly and their gdp has rebounded right almost back to their pre-gdp level

so i’m going to close of this the new england general journal of medicine broke from a 208 year history so new england journal medicine is the most prestigious most prestigious medical journal uh in the world and they broke from their 208 year tradition of not being political by by publishing the first political editorial in 208 years and

it was unanimously signed by all 34 editors that’s only happened four times in the history of that journal i’ve been to enough meetings with doctors to know that to get 34 doctors especially egotistical doctors at the top of the game to agree that’s somewhat of a miracle i’m just going to leave you with some of the words

they said covet 19 has created a crisis throughout the world this crisis has produced a test of leadership here in the united states our leaders have failed that test they have taken a crisis and turned it into a tragedy the magnitude of this failure is astonishing these are not joe schmo saying this these are 34 of the

top scientists in the world all unanimously agreeing about the magnitude of the failure of the trump administration’s response to coven reasonable people will certainly disagree about the many political positions taken by candidates but truth is neither liberal nor conservative when it comes to the response to the largest public health crisis of our time our current political leaders

have demonstrated that they are dangerously incompetent we should not abet them and enable the deaths of thousands more americans by allowing them to keep their jobs thank you that’s ended my talk thank you tommy i’m sorry that went so long but i just want to cram that all in as much as possible you’re getting a lot of

applause so we’re good um and yeah we’ll we’ll stick around for a little bit longer for excuse me for questions because there are a lot of questions however i have the microphone so i’m gonna make a quick announce announcement maybe um and tavi you don’t know this but i had have a major depressive disorder and i had

tms earlier this year and it changed my life and it is amazing and if any of you are out there with with depression um i had it for more than a decade i still probably do but i’m feeling great even in this climate um please honestly get in touch with me send a message to science on tap

on facebook or send me an email or something because it it’s amazing and the only reason i knew about it was because somebody who i follow online talked about it and that’s where i found out about it so i’m telling you please get in touch with me i would be glad to tell you about my experience with

tms so that’s so great to hear that is so great to hear tms is the greatest uh you know treatment for depression that no one’s heard of including doctors most doctors haven’t heard of it so as many people as possible need to know about it yeah that i did not anticipate talking about that tonight but you know

what i learned about tms because i was a doctor i didn’t know about tms from watching neil brennan three mikes brilliant stand-up show on netflix i recommend everyone to watch it but he spends a lot of that show talking about his own depression and the treatments he sought for it tms being one of those treatments and at

the end of that show i thought like what is tms i don’t haven’t even heard of this thing before yeah um you and i can talk about it a little bit more later sure lots of questions i’m sure to get you but again to any of you who are suffering from long-term depression please get in touch with

me and please investigate tms because it i sound like an evangelist but it’s really been life-changing so now onto your questions uh the questions from the talk um have a lot of people curious about um the difference between psychopath and sociopath and antisocial personality disorder and narcissist can you talk a little bit about those terms yeah um

boy that’s that’s a whole lot of different questions i think the easiest thing to say is social sociopathy or sociopaths um you know the the research literature does not distinguish between psychopathy and sociopathy they’re basically identical but i’ve noticed in late in kind of layman’s terms the way you know lay people use it sociopathy seems to refer

to kind of a milder condition of psychopathy where maybe you have some of those core things of low empathy but you’re not necessarily of the full-blown criminal psychopath um so again that goes back to the psychopathy spectrum right of like some people have a mild version some people have a more severe version and so the bottom line

is i think sociopathy essentially the way we use it in the lay public refers to a milder version of psychopathy that may not necessarily have the criminal behaviors associated with it anti-social personality disorder is a personality disorder in the dsm interestingly psychopathy is not a diagnosis in the dsm and that has to do with a turf battle

between the psychologists like robert hare and the psychiatrist who control the dsm so there’s a fascinating backstory to that but basically anti-social personality story describes two different mutually exclusive populations one is psychopaths but it also describes a whole bunch of other people who don’t have that core core emotional defect of being callous and non-apathetic but they engage

in a lot of criminal behaviors so and anti-social personal disorder is a bit of a garbage bucket that conflates a lot of different categories together which is why i don’t really talk about it much but basically you can be anti-social engage in a lot of criminal behaviors but not be not be a psychopath you know so you

can engage in criminal behaviors just because you’re poor and you’ve been traumatized and you need you need money and food or if someone you know you have a history of trauma and someone taps you on the shoulder and you overreact you act violently that can that that’s an anti-social person who acts anti-socially but for way different reasons

than psychopaths which are driven by the core of low empathy the let’s see brit asks the questions are psychopaths immune to getting ptsd that is such a good question and i you know i’ve never read a paper that said that but i have thought the same thing essentially i believe psychopathy and ptsd are mutually exclusive conditions the

ptsd is essentially an overreaction to uh uh to a aversive stimulus like a trauma right that just gets really amplified and when you look at the neurobiology of people with ptsd their amygdalas are overactive and kind of they get they get you know triggered by the littlest thing right versus psychopathy it’s like the opposite end of that

spectrum where they have really underactive amygdalis so i think psychopathy is a protective factor for trauma in a related question i guess soraya asks do psychopaths suffer i think you’d have to ask a psychopath but really you know um you know think about that ted bundy slide where someone asked me if he felt guilt right i mean

he they don’t feel guilt the same way i mean you know and again it’s a spectrum so some people might feel a little guilt some people in the severe psychopaths probably feel no guilt so they don’t suffer in terms of that they don’t suffer from anxiety generally um but uh you know psychopaths still don’t get fly off

the handle very easily they have they get angry very easily so if you consider that a form of suffering but they don’t um they don’t they’re not the most reflective people right they have a shallow affect they don’t they don’t have a rich psychological life because you know that rich psychological life you know you develop that amount

they’re probably from watching lots of movies and talking to lots of people and you kind of really develop this rich model of what other people are like if you don’t have that then it’s hard to be reflective and so i don’t think they suffer nearly as much as people without psychopathy you you touched on this a little

bit um towards the end but brooke asked a question kind of in the beginning and i’d like for you to reiterate a little bit about this can you have psychopaths who don’t commit crimes at least nothing major but still meet the criteria absolutely yeah so you know when you look at those 20 criteria right i mean each

one of those is worth two points and you just have to get over 30 right that’s the official definition of a clinical psychopath as defined by the psychopathy checklist so you can get to that score without any of those antisocial behaviors any of those criminal you know criminal recidivism all those antisocial factors you can still get to

30 just by meeting all the other factors so there’s different kinds of psychopaths i mean i glossed over but there’s different ways to get to 30 points basically and people have described different kind of subsets of psychopaths but yeah you can get there without without acting criminally we’ve had a couple of questions about autism and connection with

psychopathy and and one of our anonymous attendees asks can masking in autism sometimes look like psychopathy can you be autistic and psychopathic assuming at the same time or is that an error yeah um you know it’s interesting uh i think having autism does increase your risk of committing crimes i’ve been you know involved in several cases of

people of autism who um you know the problem with autism and there’s many different kind of problems of autism but one of one of the core deficits in autism is this inability to mentalize to understand what someone else might be thinking or feeling right um so psychopaths can understand what other people might might be thinking right which

allows them to really lie really well and manipulate other people they have difficulty understanding what other people are feeling though right so with autism they’re both those problems they have deficits in empathy like a feeling what other people are feeling right so you might think that might predispose them a bit more to committing crimes but the problem

is they also have difficulty understanding what other people are thinking so that you know i haven’t come across an up person of autism who’s a good liar right to lie well you need to be able to manipulate someone else’s mind really well and so they’re almo they’re helped by that impairment they they’re less able to commit crimes

because they’re less able to manipulate other people if that makes sense but you know they do commit more crimes that require like understanding of intent so the cases i’ve been involved with autistic defendants have been sexual assault crimes where really the the person of autism had no id i had very little idea the other person didn’t want

their sexual advances right and that’s that’s because of this problem with mentalization you talked about twins and how if if uh identical twins are if one is a psychopath then both probably are whereas fraternal twins maybe maybe not um leah asked about the epigenetic influences or considerations with psychopathy can you talk about that a little yeah um

i so i i have not felt i haven’t read any papers regarding epigenetics and um psychopathy so for people who don’t know basically epigenetics is a mechanism it’s a type of cellular memory it’s a way that the body can store certain kinds of memories like traumatic memories not in the neural circuits in our brain but actually in

the genetic code by um kind of chemical modifications of the dna which then affect how much how much different genes are expressed um so i don’t know much about that um i don’t you know so a lot of the epigenetic work it looks at trauma so people who have experienced a lot of trauma have a lot of

epigenetic changes to their dna and it’s thought that is one way that trauma is passed down from generation to generation actually um but um outside of epigenetics for trauma you know i’m not i’m not aware of like a lot of other epigenetic research and maybe you know if you’re knowledgeable please reach out to me and teach me

i’m suitably humble about the how much data is out there but really the epigenetic data is about trauma and psychopathy it’s not about trauma most of these people who are psychopaths did not have a traumatic background speaking of background this question fits into that gabrielle was asking about she would also be interested if there are neurological differences

between sexes given that most research is done on men do women just present differently any research she can have would be appreciated yeah you know i’m kind of a dummy on female psychopaths they do exist so diane downes is one of them that you know i discussed and one of the most famous psychopaths in history is lizzie

borden this kind of famous serial killer the turn of the 18th century um who murdered lots of people um so there are not nearly as many studies on women than men um and you know when you do kind of look at those studies it’s basically a lot more rare and so the number is thrown out there’s a

five to one proportion for every female psychopath there’s five male cycle paths uh and i really i don’t think i i know the literature well enough to give an expert opinion on why that difference occurs um one thing comes to mind is you know i didn’t discuss this but you know um many of the criminal psychopaths are

highly aggressive right like you know there’s little kids that just want to mutilate little animals for instance they’re they’re not just lacking in empathy they actually have this kind of foot on the grass pedal of like being highly aggressive we know aggression is genetically encoded so um you know i would imag and you know a lot of

aggression is is mediated by testosterone so i i would imagine testosterone has a lot to do with the levels of aggression that then convert a low empathy person to an aggressive violent you know um criminal psychopath that’s why would happen more in men related to that what should parents of probable psychopaths do yeah so um that’s a

very very relevant question you know and there’s someone you know uh some there’s someone in my family that you know the the parents are worried about you know um that you know this is this kid you know he seems very aggressive not does not learn from punishment seems to have a low level of empathy and so you

know if if if you’re just moderately you know psychopathic or calisthenic emotionals what we call them kids then you can do empathy training you can get that person into intensive specialized psychotherapy to kind of help boost up their you know every skill that we have is a combination of some genetic predisposition how good you are to it

and level of practice so one can practice empathy with specific kinds of therapy if you have a high level of psychopathy you know as a youth that’s a really tough population and um you know there is promising studies though and these these kind of treatments are not widespread but you know rgr blair the one of the psychopathy

researchers i’ve mentioned recently left his post at the at the nimh to fight to to go to the boys town which is the center for troubled jews so he runs a very highly funded uh center that does intensive specialized uh therapy on uh use that are highly psychopathic and he’s getting good results so basically you need high

intensity training and specialized training if you just do the regular kind of therapy with psychopaths often you know there’s just famous studies that shows that psychopaths it’s an old study but psychopaths who were exposed to group therapy actually turned out they turned out worse they did worse they became more psychopathic and once psychopath who was involved in

this study said yeah that group therapy was great it was like a finishing school for other people’s vulnerabilities like they learned how to manipulate other people by being in this group therapy session so one does have to be careful with the kind of therapy that’s provided question about more adult folks with uh psychopathy how does alcohol affect

psychopaths um with respect to truth or lying do they tend to avoid alcohol to be to uh avoid being caught in their lives indeed are they at all concerned about being found out about lying and being a psychopath well you know anecdotally um you know when psychopaths are caught in a lie they are extremely cavalier they’re like

they’re kind of laughing after whatever i mean it doesn’t seem to affect them at all that they were caught in a line no matter how big the lie was so that’s really you know that’s abnormal compared to a non-psychopath um so um yeah what was the first part of the question amanda about alcohol does it oh right

yeah yeah so i don’t know specifically about alcohol but in general psychopaths do abuse substances at a higher rate than non-psychopaths and part of that’s because they have this need for stimulation their amygdalas are really underactive so they’re constantly looking for ways to get sensation right to feel something right um so i would just speculate that they

use alcohol at a higher rate as well uh and i would imagine it would affect their lying ability the way it affects everyone else which is you know once your frontal lobes are taken offline you have less inability to inhibit other things right and it’s you’re less able to solve this puzzle of generating a plausible lie and

keeping track of the lies you told before to be consistent and all that stuff so i would predict alcohol would work in a similar fashion with lies a question that just popped up a minute ago is uh can a psychopath fall in love [Laughter] um i think a psychopath can have a mutually beneficial transactional relationship with other

people but love uh you know requires empathy it requires really understanding what someone else is experiencing right and being attuned to that person so again psychopathy is a spectrum right so i mean if you’re mildly psychopathic you can experience some level of love if you’re highly psychopathic you probably experience a lot less level of love love is

based on empathy they can certainly make you feel like they love you though they’re highly manipulative and they’re glib in the superficially charming so ted bundy i mean he got 100 women you know in his little car and i’m i i think i mentioned this but i’m not sure you you touched on it exactly what is a

narcissist and how does a narcissist fit into this yeah so yeah so certainly um psychopaths are narcissistic and that has to you know their psychopathy checklist there’s you know being having a grandiose sense of self-worth right being egocentric so that is part of narcissism separately there is a personality disorder in the dsm called narcissistic personality disorder which

basically you know basically privileges your own kind of experience over other people’s and so um you know again there’s this kind of uncomfortable tension between psychopathy which is a psycholo a term from psychology and the dsm which is in the world of psychiatry and so things don’t mesh quite well but i would say that narcissism and narcissists

disorder is incorporated as part as part of the checklist of psychopathy but one can also be purely narcissist narcissistic and not a psychopath you know i i did my residency training at ucla tons of narcissists lots of like agents right talent agents out there they’re super narcissistic but they’re not psychopaths right they don’t want they don’t enjoy

hurting other people they’re just they’re just full of themselves right so a narcissist the definition would be somebody who’s just totally self-focused is that yeah someone who privileges their own experiences and um over other people’s and so again narcissism is its own thing psychopathy is narcissism plus a whole lot of other things we had a bunch of

people asking about that so i just wanted to drill down a little bit um so let’s do just one or two more questions eric asks if the punishment mechanism is diminished in a psychopath isn’t the reward mechanism diminished too and and you talked about the amygdala maybe not letting the pleasure center work as well talk about that

yeah no it’s actually so um it’s so the reward center so nucleus accumbens is commonly thought of as the reward center and so actually although the literature is controversial there are at least some studies that show that psychopaths have overactive reward centers nucleus accumbens is overactive so they’re actually super sensitive to immediate reward that’s that’s what makes

them highly hedonic right kind of like they’re really into like immediate gratification because it’s like those donuts look super good to them right so actually when you look at the specialized therapy that’s offered to um psychopathic use in these facilities that do this high intensity training they’re not punishment based at all they’re highly reward based and those

rewards aren’t immediate but there’s this there’s this kind of like a point system that you can start gathering points immediately right because you can’t psychopaths can’t wait right so you give them immediate rewards and eventually you kind of build up that reward system over time so they can look forward to more distant rewards you kind of build

that skill of delayed gratification a question about the legal system you you touched on that a little bit at the end and i know that that you are an expert witness in in situations um question jordy has a question about has our understanding of psychopathy affected the court slash prison system for example could someone be denied parole

because of it yes they can um so you know um psychopathy so any kind of when you when you claim a broken brain is responsible for someone’s bad behaviors that’s a double-edged sword because you know in one sense it can be it can be uh aggravating that you have this broken brain because you have this broken brain

can’t be fixed and you’re gonna it makes you more dangerous on the other hand if a broken brain cause bad behaviors it makes you less culpable right it makes you kind of less responsible for your bad behaviors if you have a broken brain so you know the the legal concept of a broken brain can actually be either

aggravating or mitigating a uh you know condition and really has to do with the skill of the lawyer that presents the condition uh it’s either aggravating or so prosecutors will say psychopathy it’s a biological condition that’s an aggravated condition defense lawyers will um argue exactly the opposite and so when you that judges studies i showed you there’s

this tension it could be aggravating could be mitigating but on the whole it’s slightly mitigating that’s what we found so i know that there are a lot of questions we haven’t gotten to but i i want to respect everyone’s time and finish up but i have one more question um from myself and that question is why do

you tavi why do you feel it’s important for people to learn about science it’s never been more important to learn about science and one of the reasons i’m speaking out against trump and just like in new england junior medicine for the first time just like the scientific american editorial for the very first time it’s because science is

under assault and that is seriously up you know science is our best way to help us understand the physical world and objective truths and i’m not saying that science knows every truth there are different kinds of truth there’s spiritual truths there are personal truths there’s the soul there’s so much richness that is outside of science yet science

is the best way we can discern what is objectively true about the universe and if we have an administration that actively denies objective truth then you’re living in delusion is impossible to make wise decisions when those decisions are predicated on delusions right so we need to know science we have to value science science is what’s beaming these

electrons and bouncing them off of satellites and beaming them into your living room from my living room it’s amazing right and it actually works not to say the science knows everything not to say that times doesn’t make errors and we’re getting better and better at certain things but in general science is the best way to discern what

is objectively true and that is the best foundation to make wise decisions the other thing i would say about science is that for me personally it’s a source of hope the world is so messed up right now and there’s so many problems there’s global warming there’s the pandemic but you know when i think about science it’s my

happy place science you know moves forward there’s brilliant people all around the world constantly pushing forward you know particle physics and with biology and with neuroscience and you know with engineers you know there’s so much so many brilliant people collectively working to discern these objective objective of truths and in a very tangible way making the world better

uh you know when you look at the graph of how humans have done technology it’s like this right the last hundred years of technological progress is equal to like the previous five thousand years so science is hopeful and it’s accelerating too right so um i’m highly hopeful that the next ten years the next 50 years is going

to bring forth all sorts of breakthroughs all sorts of unknown unknowns of things that we should be happy about that we just don’t know about yet that is an amazing answer so thank you for that um and i i too see science as hope and i hope that the the folks that are still online watching with us

can take that to hope uh or take that hope as well and um vote please everyone vote and thank you dr octavio choi for joining us here this evening i’m sorry we didn’t get to everyone’s questions but there were a lot of questions and hopefully we we got a lot of information for you um i’m gonna share

oh go ahead thank you and thank the entire support team that’s kind of your invisible helper elves being behind the scenes you guys are doing a great job science is so important getting science out to the people in different venues i can’t wait to go back to portland and start doing these things in bars again uh tends

to be a really good experience but it’s so important science education is so important so everyone out there donate a few bucks donate five bucks to the organization it makes a difference uh and just thank you so much for the opportunity to talk well thank you and uh thank you to everyone who has joined us here this

evening i’m going to share my screen just real quick and mention a couple of quick things as tavi mentioned we could use your help science on tap we need donations that’s the only way we’re making money these days so if you found tonight’s talk valuable tavi has generously donated his time but we have to pay for zoom

and we have to pay for lots of things um and we’ve got a whole staff of people behind the scenes um and it’s it’s really important for you our attendees to help us out if you are available or able to i know that a lot of people are struggling right now and i want to keep these free

for as long as possible so that we can have as many people view our events and our podcasts as we can because as we’ve said science education is very important so there’s two ways to donate you can make a one-time donation um through make you think.org support or you can do an ongoing donation through our patreon at

patreon.com make you think and wanted to let you know what is coming up next our next event we’re taking next week off because i couldn’t deal with doing an event the same week as the election so we’re taking next week off but the following week on november 12th at 7 p.m we will be talking about a good

time to be born how science and public health gave children a future with uh author and pediatrician dr perry class and perry will be joined by david oshinski who’s also a doctor and a pulitzer prize winning author professor at nyu grossman school of medicine so again that will be on tuesday i’m sorry thursday november 12 at 7

p.m pacific and just a quick shout out to our what now 116 actually i think 117 patreon supporters i saw somebody come through during the talk um these are the folks who are donating 10 or more per month you are hugely i was so grateful to all of you for joining us um it really genuinely makes a

difference and if any of you are waiting for pint glasses or stickers i figured i would wait until after the usps was dealing with all the uh the political or the the voting situation so i’m going to wait until next week to mail all of that stuff out so if you’re waiting um keep an eye out after

the election and also wanted to say a quick thank you um to a special thank you to one of our patreon supporters carol stewart thank you carol and coming back to this slide if you are able to donate we greatly appreciate it thank you all so much for coming if again if anybody has questions about tms please

contact me i’ve already gotten two names that i will be writing to you very shortly after and thank you tavi for joining us this evening and um everyone have a great evening and please please go vote word thank you you

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