Connecticut College Psychology Journal 2020

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Social Psychology of Free Will
Now that we have addressed the free will debate through neuroscientific experiments, it

may be helpful to consider some practical or pragmatic approaches for dealing with the debate
through the findings of social psychology experiments. There have been a few social psychology
experiments suggesting that it is more beneficial for humans to believe in free will than not. The
experiments themselves do not address whether we have free will or not, but they rather show
that belief in free will fosters a sense of thoughtful actions and reduces aggression and automatic
impulses (Baumeister, Masicampo, & DeWall, 2009).

Experiment 1:
Participants in this experiment were randomly assigned to three groups in a large
university classroom. They were given 15-page packets that had one sentence on each page. The
three groups had to read sentences in support of free will, determinism, or neutral control
sentences that were not relevant to free will or determinism. The three groups were instructed to
read their packets one page at a time and to move on to read the next page every time they heard
a tone, which happened once every minute. That gave the participants a total of 15 minutes to
read the full set of sentences, after which they were instructed to report how likely they would be
to offer help to people depicted in several hypothetical scenarios using a scale from 1 (not likely)
to 9 (very likely). Their responses were averaged to form the dependent measure of their
tendency to help others. The researchers reported that their choice of the neutral condition as a
control was based on the prediction that its effects should be intermediate between the two
manipulated belief conditions in free will or determinism. If the neutral condition differed from
only one of the other manipulated conditions, this would indicate that the other belief was
equivalent to what people normally believe. That means that the neutral condition would have

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similar results to the induced free will condition if humans generally believe in free will, and it
would have similar results to the induced determinism conditions if people normally disbelieve
in free will (Baumeister et al., 2009).

The results revealed significant variation among the three conditions in the likelihood of
participants to help others. Participants in the pro-determinism condition were found to be the
least willing to help others. There were no significant differences between the performance of
participants in the neutral control and the pro-free will conditions. There was no significant
variation in mood and arousal among participants. The researchers also conducted two validation
tests to confirm that the manipulation was effective in altering the participants’ beliefs in free
will and determinism while not conveying demands or expectations about their responses. The
tests also showed that the manipulation did not change feelings of personal accountability nor
lead participants to attempt to exert volition, which suggests that disbelief in free will serves only
as a subtle prime that leads people to respond spontaneously without exerting energy to have
self-control. The experiment concludes that disbelief in free will reduces prosocial tendencies, as
indicated by participants’ willingness to help others; nonetheless, promoting belief in free will
does not alter people’s attitudes from their normal state (Baumeister et al., 2009).

Experiment 2:
In the second experiment, the researchers investigated the effects of individual
differences of the chronic disbelief in free will on prosocial responses rather than manipulating
the beliefs of participants. Instead of relying on self-reported willingness to help others in
hypothetical scenarios, researchers measured participants’ behavioral commitment to help in a
more realistic situation. The researchers developed a scale to assess individual differences
between participants in belief in free will and determinism. The participants’ actual responses

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and tendencies to volunteer to help a college student, whose parents were killed recently, were
also analyzed. Although the college student case was hypothetical, the procedure involved asking
the participants to make a commitment to provide actual help as if the case were real. The
researchers reported that disbelief in free will was associated with a lower number of hours for
which participants volunteered to help the student. The relationship between chronic disbelief in
free will and reduced tendency to help was not due to positive or negative mode effects, leading
to the conclusion that belief in free will is positively associated with prosocial behaviors
(Baumeister et al., 2009).

Experiment 3:
In this experiment, researchers tested the hypothesis that disbelief in free will might lead
humans to be more aggressive toward seemingly innocent targets. Participants were told that
they were a part of an experiment about food preferences. They were also provided with
statements about free will and determinism which was like the manipulation in the first
experiment. They were then instructed to prepare food for a taste test by strangers, based on
responses from supposed preference questionnaires taken by the strangers. All the questionnaires
were set to indicate that the stranger liked all foods except spicy food. The participants were also
provided with a clearly labeled jar of hot sauce. The researchers took the tendency of participants
to put hot sauce into the food, which would be served to others who had explicitly expressed a
dislike for spicy food, as a sign of aggression. Participants whose beliefs were manipulated
towards disbelief in free will put much more of the unwelcome hot sauce in the food compared
to those whose beliefs were manipulated to think more in terms of free choice. The researchers
conclude that those findings confirm that encouraging disbelief in free will might result in higher
aggression than encouraging humans to believe that they have free will (Baumeister et al., 2009).

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Disbelief of Free Will and Cheating
In two other experiments, Vohs and Schooler (2008) found that inducing disbelief in free

will was associated with increased cheating. In the first experiment, participants had a passive
cheating opportunity as they had to actively prevent the answer to an arithmetic problem from
appearing on the computer screen to avoid cheating. However, the second experiment measured
participants’ active cheating through monitoring how participants acted with integrity in paying
themselves some points for each correct answer on a difficult cognitive test. Reading messages
that supported disbelief in free will increased participants’ cheating on the task of answering
mathematical problems through passively allowing a flawed computer program to reveal the
answer. Moreover, the participants who read the deterministic messages cheated through
overpaying themselves for performance on the cognitive test, claiming to have more correct
answers than they actually did. Those results suggest that belief in free will leads individuals to
have increased levels of perceived autonomy that they freely and responsibly make choices.

Although the results of such social psychology experiments support the view that belief
in free will promotes prosocial behaviors, they cannot prove whether free will is an objective
reality or not since they can be valid even if free will is an illusion. The results only suggest that
supporting the common belief of free will can be socially beneficial through encouraging
humans to feel more responsible for their behaviors. Inducing belief in free will not only
stimulates conscious feelings of individuals leading them to be active, but it also encourages
them to have a sense of personal responsibility and accountability. This sense of responsibility
might make individuals feel that they ought to behave in a more socially desirable manner and to
restrain their selfish or antisocial impulses of aggression against others. The findings show how

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the debate over free will does not only have theoretical and scientific implications but also social
and societal impacts.

Other social psychology experiments have shown that belief in free will promotes
intolerance towards unethical behaviors and leads humans to support severe forms of criminal
punishment (Martin Rigoni, & Vohs, 2017). The research indicated that belief in free will is
associated with support for retributive criminal punishment, rather than restorative. This finding
might suggest that strong believers of free will tend to be less compassionate and hold people
accountable for their choices even when not sure about their freedom of choice. Although most
of the social psychology experiments might not acknowledge the role of individual variations
within a social setting, they suggest that beliefs in free will or determinism might have
significant implications on our moral judgments. It is also important to highlight the ethical
challenges of manipulating the beliefs of participants as happened in some of the mentioned
experiments. I believe that assessing the variations of belief in free will before an experiment is
more ethical than manipulating the beliefs of individuals just for the sake of it.
From a Philosophical Point of View

Although modern neuroscience is promising in advancing our understanding of
consciousness and decision-making processes, we are still far from having an ultimate answer to
the question of whether humans have free will or not. When philosophers refer to free will, it
implies making voluntary, conscious choices among a variety of options that could have moral
implications. However, most of the experiments that have been conducted to address the free will
debate only examine one defined action or choice that humans make in an experimental setting.
In addition, the debate of free will could be framed as “To what extent do humans have control
over their actions and decisions?” This question does not necessarily mean that it must be one

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way or the other; nonetheless, it is possible that humans can sometimes make free choices, but
not always.

Kahneman (2015) has argued that the human brain has two operating systems: fast and
slow. The fast system is characterized by being unconscious, spontaneous, and effortless, which
dictates about 98% of the cognitive processes. However, the slow system can be characterized by
being conscious, rational, and effortful, which dictates about 2% of our cognitive processes that
are related to integrating information and making some conscious decisions. In modern
terminology, we might frame the question around making a distinction between decisions that
are made consciously and the ones that are made subconsciously. The modern questions could
be: “To what extent do our subconscious minds control our actions and decisions?” and “Are we
responsible for actions that are made subconsciously?”

I think that we are far from finding ultimate answers or formulating absolute truths about
free will mainly because we are questioning our own decision-making. Even if scientific
experiments could prove that we have free will, someone could argue that we were programmed
to come to those conclusions and findings so we can continue to be deluded by the notion of free
will. In reply to this, it would be helpful to rely on the experiments and the observable facts to
overcome the inevitable skeptic argumentation that would not really further advance our
understanding of the debate. From a pragmatic point of view, I believe that it is better to assume
responsibility of humans for their actions even if we cannot find a definite answer for the free
will debate. This position is mainly because social psychology experiments show how the
disbelief in free will encourages aggression and cheating and discourages prosocial tendencies.
That is not to say that social psychology experiments prove the validity of free will, but they just
reflect the social benefits of believing in free will. It could be argued that, since researchers were

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able to manipulate human behaviors through convincing them with either side of the debate, that
could suggest that human actions and decisions are just a product of whatever the individuals
experience in their lives. Hence, even though we cannot find ultimate solutions for the free will
debate, it could be better to assume responsibility of humans over their actions from a pragmatic
approach. Still, those notions of skepticism and agnosticism about the free will debate could lead
us to be more forgiving and question our notions of capital punishment and justice, possibly
shifting towards restorative justice. Given that some of human actions might not be consciously
chosen, this should encourage us to reform reward and punishment systems that exist in human
societies to become more just. Knowing the distinction between conscious and subconscious
decisions might also help humans learn when they should hold themselves accountable for their
choices and when they should be kind to themselves and avoid unjustified feelings of shame and
guilt. Being aware of this distinction might also lead us to observe ourselves more and have
further control over our subconscious decisions. It is critical to investigate our responsibility for
controlling our subconscious thoughts and decisions. All the previously mentioned data shows
how the free will debate is critical to many different aspects of the human condition.
Possible Future Directions

It might be interesting to address to what extent belief in free will affect participants’
control over their visual attention by measuring their ability to locate specific targets and resist
visual distractions through eye-tracking experiments. This could help us understand if promoting
beliefs in free choice would lead humans to exert volition to inhibit their impulsive or
spontaneous actions.

For ethical considerations, it may be better to pre-evaluate the beliefs of participants rather
than manipulating them. The experiment might involve two possible directions:

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- Assessing if the initial belief of participants on their ability to resist visual distractions
affects their performance.
Pre-evaluation in this case would involve simple questions like: To what extent do you
believe you have control over visual distractions?

- Assessing if the initial belief of participants on free will affects their ability to resist
visual distractions.
For this part, we might pre-evaluate participants through questions like: To what extent
do you believe that humans can freely choose to avoid or resist visual distractions? To
what extent do you think humans’ behaviors are driven by conscious, free decisions
versus subconscious, pre-determined decisions.

Following the evaluation, the participants would be asked to fixate at the center of a
screen, on which a serious of visual stimuli would be displayed (Moher et al., 2011). Those
stimuli would consist of six shapes that are arranged in a circular array surrounding the fixation
point: five circles or triangles with a sixth shape whichever was not used for the other five
shapes. The participants would be instructed to move their eyes to the unique shape in the
display, ignoring the uniquely colored shape, as quickly and accurately as they could. Then the
performance of the participants would be evaluated relative to their beliefs about their ability to
resist visual distraction or about free will. Based on the results from previous social psychology
experiments, it would be expected that individuals who believe that they have control over their
visual attention would be more likely to be successful in locating the target shape and avoiding
distractions. If the hypothesis is confirmed, this might suggest that personal beliefs about agency
and free will can affect our control of subconscious decisions. That means that if humans believe
in free will, their actions would be more controlled by their conscious rather than subconscious

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minds. This would present us with pragmatic approaches in addressing the free will debate on the
societal and community level.
Summary

The free will debate has been a central issue in the history of philosophy and science. For
centuries, attempts to address the free will debate were theoretical without empirical evidence.
However, in 1983, Benjamin Libet published a seminal experiment that investigated the
relationship between conscious intentions and their preceding neural activities. The experiment
laid the foundation for most of the modern empirical, neuroscientific attempts to examine human
free will and decision making. Additionally, some social psychology experiments have
considered practical approaches to the free will debate and how the belief in free will or
determinism affects behavior. Although all the mentioned research leaves the free will debate
open, it has paved the way for a new era of empirically examining human decision-making
through psychological and neuroscientific techniques. Addressing this debate is critical not only
for epistemology and ethics but also for having a deeper understanding of the human condition.

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References
Baumeister, R. F., Masicampo, E., & Dewall, C. N. (2009). Prosocial benefits of feeling free:

Disbelief in free will increases aggression and reduces helpfulness. Personality and Social
Psychology Bulletin, 35(2), 260-268. doi:10.1177/0146167208327217
Dennett, D. C., & Kinsbourne, M. (1992). Time and the observer: The where and when of
consciousness in the brain. Behavioral and Brain Sciences, 15(2), 183-247.
doi:10.1017/S0140525X00068229
Haggard, P., Filevich, E., & Kühn, S., (2013). There is no free won’t: Antecedent brain activity
predicts decisions to inhibit. PLoS ONE, 8(2): e53053. doi:10.1371/journal.pone.0053053
Kahneman, D. (2015). Thinking, fast and slow. New York: Farrar, Straus and Giroux.
Lavazza, A. (2016). Free will and neuroscience: From explaining freedom away to new ways of
operationalizing and measuring it. Frontiers in Human Neuroscience, 10, 262.
doi:10.3389/fnhum.2016.00262
Libet, B., Wright, E. W., & Gleason, C. A. (1983). Preparation- or intention-to-act, in relation to
pre-event potentials recorded at the vertex. Electroencephalography and clinical
Neurophysiology, 56(4), 367-72. doi:10.1016/0013-4694(83)90262-6.
Libet Experiments, Retrieved December, 4, 2019, from Information Philosopher
Website http://www.informationphilosopher.com/freedom/libet_experiments.html
Martin, N. D., Rigoni, D., & Vohs, K. D. (2017). Free will beliefs predict attitudes toward
unethical behavior and criminal punishment. Proceedings of the National Academy of
Sciences, 114(28), 7325–7330. doi:10.1073/pnas.1702119114
Martinez, P. I. C., Maggioni, E., Hornbæk, K., Obrist, M., & Subramanian, S. (2018). Beyond
the Libet clock: Modality variants for agency measurements., CHI Conference on Human

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Factors in Computing Systems, April 2018, Montreal QC, Canada, Paper No.: 541, 1-14.
doi:10.1145/3173574.3174115
Mele, A. R., Brass, M., & Furstenberg, A., (2019). Why neuroscience does not disprove free
will. Neuroscience & Biobehavioral Reviews, 102, 251-263.
doi:10.1016/j.neubiorev.2019.04.024
Mele, A. R. (2010). Effective intentions: The power of conscious will. New York: Oxford
University Press.
Moher, J., Abrams, J., Egeth, H. E., Yantis, S., &Stuphorn, V. (2011). Trial-by-trial adjustments
of top-down set modulate oculomotor capture. Psychonomic Bulletin & Review, 18(5), 897–
903. doi:10.3758/s13423-011-0118-5
Schurger, A., Sitt, J. D., & Dehaene, S. (2012). An accumulator model for spontaneous neural
activity prior to self-initiated movement. Proceedings of the National Academy of
Sciences, 109(42) E2904-E2913. doi:10.1073/pnas.1210467109
Soon, C. S., Brass, M., Heinze, H.-J., & Haynes, J.-D. (2008). Unconscious determinants of free
decisions in the human brain. Nature Neuroscience, 11(5), 543–545. doi:10.1038/nn.2112
Trevena, J., & Miller, J. (2010). Brain preparation before a voluntary action: evidence against
unconscious movement initiation. Consciousness and Cognition, 19(1), 447–456.
doi:10.1016/j.concog.2009.08.006
Vohs, K. D., & Schooler, J. W. (2008). The value of believing in free will. Psychological
Science, 19(1), 49–54. doi:10.1111/j.1467-9280.2008.02045.x

Running head: MENTAL HEALTH SYSTEM REVIEW 162

Planning a Community-Based Mental Health System from the Perspective of a Family Member:
A Review

Tashayla Borden

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Dan E. Weisburd’s Perspective of a Family Member depicts the effects that mental
illness, in this case, schizophrenia, has on family members. Weisburd puts forth the image of
his son, a Harvard-level scholar who was dissuaded from furthering his education by the
school staff and whose family was burdened by the associated costs attached to treating his
mental illness. The father exposes the many difficulties of navigating the mental illness of a
family member. Weisburd writes how his son, “after a couple of years in this unwanted and
demanding experience, that [he] was so angry and so depleted emotionally and financially
that [he] had to make a conscious change in [his] own behavior that [he] may survive”
(Weisburd, 1990, p. 1245). He criticizes how the current mental health field, specifically
within systems of “care,” aren’t easily accessible to all who aren’t insured or simply cannot
afford it. He alludes to the cumulative trauma the family shared as a result of other health
issues occurring at the same time. He recalls how his son was punished for having his mental
illness and how he suffered more hardship due to the criminalization and heavy burden
relating to his son’s mental illness. Weisburd then discussed how the prescribed drugs had
tumultuous side-effects that made it even more difficult for his son to live with. After
discussing the differing themes of how we as a society aren’t equipped to handle mental
illnesses with care and how our health systems are skewed to that of private interest
corporations, he goes on to explain his findings and political activism through his proposition
of a new law and policy changes to the California healthcare system. When looking at
Weisburd’s theme of how there is a lack of care within the healthcare system, it is imperative
to look at how the system failed as a whole. He urges the reader to:

Watch as I have watched very ill people strain to communicate through an
endless procession of meaningless days with underpaid, undertrained staff whose

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heavy Afghani, Egyptian, Filipino, Pakistani, Salvadoran and Thai accents give a
wonderful, melodic whimsicality to a totally incredulous reality from which death is
often a blessed escape. (Weisburd, 1990, p. 1246)
To state that there isn’t a solid foundation for care work to begin is plausible, however, it
would make more sense, which he does later, not to look at the individuals in the systems, but
rather to look at the systems as a whole. To point to the immediate images of workers, who are
statistically overrepresented to be workers of color (Bureau of Labor Statistics, 2019) would be
bad faith, but pointing to a broader system that also perpetuates racial disparities of economic
contribution would be most beneficial.
When Weisburd then discusses how his son David was punished for his affliction, he
reasoned there was an inherent criminalization of mental illness. He writes that:
David’s schizophrenia went on also. And he started to be punished for having it. He
was jailed for being a nuisance in the community. He was waitlisted for programs that
purportedly could help him otherwise. He was dismissed by doctors because they had
tried all they knew and were embarrassed to take more money for more of what hadn’t
worked. (Weisburd, 1990, p. 1246)
Controversially, this statement is true when observing individuals with mental health
illnesses within prisons, and also the rates in which they are denied housing and other forms of
care, when quite contrary to the outcome, they need such supports to ease stressors that may
trigger mental health episode outbursts. It is true that this portion of the research, Weisburd
maintains, is missing from discourse when discussing how to help and assist those with
schizophrenia and other energy-consuming illnesses. There is also the added effect race and
socioeconomic status have on the criminalization and negative treatment of individuals with

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schizophrenia that was also missing from the paper, which limited the true effect on what
criminality has on, especially, Black and Brown bodies.

The author discusses the expensive costs under the controlling insurance and health care
companies of paying for services. He goes on to write how families pay extensive amounts of
money for pills that cost too much and for insurance that won’t work “because the rate structures
don’t make any sense” (Weisburd, 1990, p. 1247). There were also the complexities of taking
drugs with severe side effects. When the writer’s son’s white blood count was low, regarded as
the second-lowest blood count to keep someone alive, he felt the relief of his symptoms. Yet
another controversial idea is having to choose between living with the symptoms and having
serious potential consequences, such as death, or facing one’s mental illness burden. It was
shown to be difficult for his family to choose between two life choices and continues to be a
choice within the broader society, thanks to companies, of having an expensive drug with many
hidden costs as well. The author may have alluded to the big pharmacy complex we have as a
nation and does well to note their ties with the drugs people use and the high insurance people
cannot afford.

Finally, another controversial aspect of his paper would be what he suggested at the end,
turning health care from the benefits of the private sector insurance goals to what the patient and
families want. This controversial report, called Integrated Service Systems (ISS), would force
insurance companies to barter with “the public sector for mental health funds” (Weisburd, 1990,
p. 1248). Weisburd ascertains the following: “I have dedicated a major portion of my energies to
work with other families who know the pain and disillusionment of having a mentally ill loved
one who needs help that is not out there. Families know which professionals in their
communities really do care…Families know when programs for the mentally ill are willing to

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abandon practices that haven’t worked”; therein lie some challenges (Weisburd, 1990, p. 1247).
Some potential problems that could leave out a rather significant portion of individuals with this
mental illness, are the potential lack of conversation regarding race and lower-income disparities.
To have spoken with the families he mentions here, there may be other communities with other
families who do not have the resources in their community to have good health care or know
what that means to communicate to Weisburd. Truthfully, many families may not know if there
are even professionals in their communities, let alone if there is true care involved. There also
exists the potentiality that many individuals with schizophrenia may not have immediate family
members to connect with them, or to care. It is also revolutionizing to have a task force of many
influential individuals with “several” past patients, but a question while reading was how many
were from or around the poverty level? How many represented cultural communities, which are
at a higher disadvantage when it comes to the lack of schizophrenia treatment?

To conclude, from what I gathered from the article, there is added trauma to the family
when considering how mental illness, especially in the United States, is stigmatized and
expensive to treat. While there were limitations to what the author proposed, having a board with
differing experiences and power relating to mental illness is transformative. The controversial
attitude of putting the cost in the hand of the one with the mental illness is also what can
dramatically change the way the United States views taking care of someone. To reduce the cost
and ultimately give the individuals struggling with the illness autonomy to choose and maintain
healthy relationships with their families and emotional connections is ideal and the beginning of
a new path of humanistic health care support. With that, it is crucial to look at intersecting
disparities to see a much broader structure that could be afflicting many more.

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References
Bureau of Labor Statistics. (2019). Labor Force Statistics from the Current Population SURVEY.

United States Department of Labor. Washington DC: Division of Labor Force Statistics.
Horvitz-Lennon, M., Volya, R., Garfield, R., Donohue, J. M., Lave, J. R., & Normand, S. L.

(2015). Where you live matters: Quality and racial/ethnic disparities in schizophrenia
care in four state Medicaid programs. Health Services Research, 50(5), 1710–
1729. https://doi.org/10.1111/1475-6773.12296.
Weisburd, D. E. (1990). Planning a community-based mental health system: Perspective of a
family member. American Psychologist, 45(11), 1245-1248.
https://moodle.conncoll.edu/moodle1920/pluginfile.php/26477/mod_resource/content/1/P
lanning%20a%20community%20based%20mental%20health%20program%20Parents%2
0perspective.pdf . doi:10.1037/0003-066X.45.11.1245

Running head: BIOLOGICAL EFFECTS OF TRAUMA 168

The Biological Effects of Trauma
Daphne Michie

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Introduction
Over the years, our knowledge of the impact of trauma has increased monumentally. Trauma is
the root of a significant amount of psychological disorders. We now know that trauma does not
only lead to psychological distress, it has numerous biological and physiological effects as well.
These impacts can be neurobiological, genetic, and physical. In addition to impacting cognition
and overall psychological well being, trauma has the ability to alter one’s biology. Trauma does
not only lead to Post-traumatic Stress Disorder, it can lead to things like heart disease, substance
dependence, and psychosis. Trauma and its impacts are incredibly multifaceted and vast. In this
paper, I will offer several examples of the biological impacts of trauma to demonstrate how far
trauma can reach and how many areas of life it can impact.

Physical Illness as a Result of Childhood Trauma
Physical punishment of children can lead to physical health issues in adult life. Hyland, Alkhalaf,
and Whalley (2012) did a cross-sectional study of forty to sixty-year-old men and women from
Saudi Arabia where the use of physical punishment is an acceptable form of parenting. Hyland et
al. (2012) found that more frequent beating (once or more per month) and verbal insults
correlated with a significantly increased risk of developing cancer, cardiac disease, and asthma.
The researchers explain that these health problems that coincide with experiencing abuse as a
child likely occur because stress-inducing parenting has shown a correlation with adverse health
consequences in a significant amount of previous research. This study highlights the fact that not
only can child abuse lead to behavioral and psychological issues, it can impact one’s physical
health later in life. Hyland et al. (2012) state that most research on physical punishment of young
children tends to focus on the behavioral and psychological outcomes as opposed to the physical
outcomes. However, the researchers explain that child abuse creates a stressful environment, and

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experiencing continuous stress during childhood can cause epigenetic changes that predispose
people to disease. This study highlights the detrimental impact of physical punishment on
children as a stress-inducing form of parenting. Hyland et al. (2012) point to other types of
stress-inducing parenting such as neglect, family dysfunction, and low socio-economic status.
The researchers also highlight the importance of biological predisposition for physical health
problems such as cancer and cardiac disease and the interaction with the environment. When a
biological predisposition for a physical health problem such as cardiac disease exists, child abuse
can prompt the development of serious physical illness in adult life. Physical punishment is not
the only type of stress-inducing parenting. There are multiple factors that could lead to a stressful
environment for children, but when those factors are exacerbated by physical abuse, neglect, and
familial dysfunction, the risk for developing physical illness in adult life is much greater.

Sex Differences in Response to Trauma
Research has found that there are sex differences in the physical response to trauma. Tiwari and
Gonzalez (2018) state that adult mental health consequences of trauma are well documented, but
the differences between men and women in terms of biological circuitry and physical response to
trauma are quite different. There is a growing emphasis on the differences between sexes of the
biological circuitry that can contribute to risk following early childhood trauma. Tiwari and
Gonzalez (2018) state that physiological sex differences influence biological development and
functioning, which can impact sex-specific biological functioning in response to early childhood
trauma. In this article, Tiwari and Gonzalez (2018) define trauma as any kind of childhood abuse
or neglect. The researchers explain that the hypothalamic-pituitary-adrenal axis, or HPA axis, is
responsible for controlling the stress response. If the HPA axis is constantly active due to chronic
stress, this can disrupt cortisol regulation, which is the hormone that regulates stress. Tiwari and

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Gonzalez (2018) describe a study wherein men with major depressive disorder were discovered
to display heightened levels of cortisol whereas women displayed lower levels of cortisol in
response to stressful situations.
Previous research has shown sex differences in biological stress regulation. For example, Tiwari
and Gonzalez (2018) state that research has shown women to be more likely to develop PTSD
and major depressive disorder in response to early childhood trauma, and the way these disorders
present themselves are biologically different in males and females. Research has shown men to
exhibit greater right amygdala activation and women exhibit greater left amygdala activation in
response to negative stimuli (Tiwari and Gonzalez, 2018). The amygdala is the area of the brain
responsible for regulating fear and anger. The researchers also state that research has shown that
men and women exhibit different neural responses when they experience stress-induced anxiety.
This means that men and women likely experience anxiety differently. Tiwari and Gonzalez
(2018) explain that childhood abuse is linked to smaller hippocampal volume, which is the area
of the brain that is heavily responsible for memory, and that males experience greater reduction
of hippocampal volume in comparison to females. The fact that ther are genetic differences in
response to trauma highlights the importance of gene-environment interaction. The idea that men
and women experience anxiety differently due to biological changes as a result of trauma could
impact how therapists approach clinical treatment of anxiety.

HPA Axis Dysregulation
Trauma can have a devastating impact on the functioning of the HPA axis. Kuhlman, Vargas,
Geiss, Nestor, and Lopez-Duran (2015) explain that the HPA axis is sensitive to stress through
development and the time of exposure to trauma causes differences in HPA axis functioning. To
explore this phenomenon, Kuhlman et al. (2015) conducted a study using 97 young people that

BIOLOGICAL EFFECTS OF TRAUMA 172

evaluates the relationship of time of exposure to trauma and HPA axis functioning. The
researchers found that the HPA axis is susceptible to developing stress dysregulation when
exposed to trauma during infancy. Kuhlman et al. (2015) state that the HPA axis is especially
sensitive before one year of age and that exposure to trauma during infancy makes the HPA axis
hypersensitive to future stressors, which has long-term health implications. This study highlights
the idea that the timing of trauma exposure can impact neurobiological systems differently. The
HPA axis is extremely important in physiological stress regulation, and early exposure to trauma
causes HPA axis dysregulation that can lead the development of lifelong physical health
problems.

Neurocounseling
Proper counseling after experiencing trauma is critical. Lorelle and Michel (2017) explain the
importance of professional counselors understanding the physiological and neurological factors
that impact human development across the life span. Lorelle and Michel (2017) define
neurocounseling as “the integration of neuroscience into counseling to treat behavioral and
psychological challenges” (106). There has been an increased emphasis on integrating
neuroscience into counseling, but there is not enough discussion of how professional counselors
can increase their knowledge in relation to neurocounseling.
Lorelle and Michel (2017) additionally describe the role of neurobiology in forming attachment
as children. They explain that children with stronger attachment to caregivers have shown a
correlation to more effective emotional regulation. In the case of trauma, children would not be
able to attach to caregivers, or the process would be significantly complicated, which would
impact the neurobiological pathways in the brain that regulate emotion. Lorelle and Michel
(2017) articulate the importance of neuroeducation, which is designed to help clinicians

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understand the neurological processes underlying mental functioning and resulting behavior.
Experiencing childhood trauma changes how the brain responds to stressors in the environment
because the brainstem, which regulates things like heartbeat and blood pressure, has developed
to be in a constant state of alarm (Lorelle and Michel, 2017). This distorts the body’s ability to
regulate stress. Additionally, childhood trauma impacts the memory systems of the brain,
specifically the hippocampus. This impairs the encoding of explicit memory, or the memory of
factual information and events. Lorelle and Michel (2017) advocate for clinicians to learn about
how trauma impacts the stress response and memory. If clinicians do not know that trauma has
the ability to change one’s biology in relation to the stress response and memory, their treatment
will be ineffective if they attempt to treat the cognition and behavior that are symptomatic of the
neurological pathways that were harmed by trauma. Individual’s experiences will differ
depending on where they are developmentally due to this idea that neurobiology changes
throughout the lifespan. Lorelle and Michel (2017) argue that by providing information about
biological aspects of the client’s experience to both the client and clinician, this will help to
normalize the client’s experience and provide the groundwork for trust between client and
clinician.

Salivary Cortisol and Evaluating Stress
Early separation from caregivers can be extremely stressful for children. Van Andel, Jansen,
Grietens, Knorth, and van der Gaag (2014) describe the biological implications of early
separation from caregivers for young foster children, and they examine studies evaluating the
role of salivary cortisol in the stress levels of children aged 0-6 that were placed in foster care or
adoptive families. Van Andel et al. (2014) explain that stress, in addition to neglect, loss of a
caregiver, younger age at placement, and a higher number of placements are all associated with

BIOLOGICAL EFFECTS OF TRAUMA 174

an altered HPA axis, which is responsible for regulating the stress response. Each of the studies
showed salivary cortisol to fluctuate when a stressful event for a child occurred. These studies
demonstrate that the cortisol levels in children that were adopted seemed to normalize as
opposed to children that remained in foster care. Van Andel et al. (2014) explain that the stress
system does adapt over time, but cortisol fluctuates more when children continue to undergo
traumatic experiences, such as being separated from a caregiver. Van Andel et al. (2014) state
that researchers need to reach a consensus on how to measure salivary cortisol in foster care
research and that there are multiple variables including age, time of placement, duration of time
in foster care, and severity of abuse that could impact results. This study highlights the
importance and clinical implications of hormonal changes as a result of childhood trauma.

PTSD in Children Exposed to Partner Violence

Early exposure to trauma can lead to PTSD later in life. Horn, Miller-Graff, Galano, and
Graham-Bermann (2017) describe the development of Post-traumatic Stress Disorder in children
under the age of six who have been exposed to chronic trauma such as intimate partner violence.
There is a wide variability in the presentation of symptoms of PTSD in children because many of
these symptoms are internal such as heart rate (Horn et al., 2017). The researchers conducted a
study that examined the physiological symptoms of 56 young children who have been exposed to
intimate partner violence. The results showed that children who had been exposed to intimate
partner violence were more likely to exhibit emotional dysregulation, mood swings, behavioral
outbursts, and temper tantrums when physiologically aroused. During the study, the children’s
therapists would assess whether or not the child exhibited physiological arousal trauma
symptoms. The children who had been exposed to intimate partner violence became more
biologically worked up during the study as opposed to the children who had not been exposed to

BIOLOGICAL EFFECTS OF TRAUMA 175

intimate partner violence. This implies that children who are not necessarily the physical target
of abuse can still be traumatized, which can change their physiological responses to stressors in
the environment. In children with PTSD, the physiological responses are even more amplified.
Being aware of these physiological arousal symptoms can help clinicians treat PTSD in young
children who cannot clearly express what they are experiencing.

Intergenerational Trauma
Trauma does not only impact the individual, but its physiological markers can become inherited
biologically. Jovanovic, Smith, Kamkwalala, Poole, Samples, Norrholm, Ressler, and Bradley
(2011) explain that African American men and women living in urban environments are at high
risk for trauma exposure, which can have intergenerational effects. Jovanovic et al. (2011)
conducted a study wherein 36 mother-child pairs from a highly traumatized urban population
were assessed for childhood abuse, PTSD, and depression. The children of the mothers were
measured for startle responses and heart rate variability. The researchers found that children had
a higher startle response in the sympathetic nervous system when their mothers had high levels
of childhood abuse as opposed to the mothers who had low levels of childhood abuse. The same
trend of high startle responses in children held true for mothers who experienced PTSD and
depression. These results demonstrate that children of mothers who have experienced trauma
have higher activity of the sympathetic nervous system, which means that trauma can become
inherited biologically. This implies that marginalized communities that experience chronic stress
likely experience deeper, more complicated biological impacts of trauma than non-marginalized
communities.

Trauma History and Obstetric Outcomes

BIOLOGICAL EFFECTS OF TRAUMA 176

Trauma also has implications on obstetric outcomes in women who experience trauma.
Blackmore, Putnam, Pressman, Rubinow, Putnam, Matthieu, Gilchrist, Jones, and O’Connor
(2016) explain how prenatal maternal mood can impact obstetric outcomes in disadvantaged
populations. Blackmore et al. (2016) conducted a study of the impact of trauma exposure and
mood symptoms on obstetric outcomes in 358 women. The researchers explain that women who
had experienced trauma were more likely to experience depression, anxiety, were younger at
their first pregnancy, and had a higher number of pregnancies in comparison to women who had
not experienced trauma. The researchers also explain that women who experience childhood
trauma and prenatal anxiety as a result of trauma are more likely to have underweight babies.
Low birthweight or premature birth in mothers who have experienced trauma may be a result of
using substances, or it may be due to traumatized women entering pregnancy with dysregulation
of the HPA axis as a result of childhood trauma (Blackmore et al., 2016). There is not yet enough
research done on pregnant mothers who have experienced trauma to say what exactly is the
cause of low birthweight. But either way, the researchers observed a correlation between mothers
experiencing trauma and low birthweight or premature birth. Babies who are born underweight
can experience life-threatening obstacles right after they are born. Some of these effects can
impact people the rest of their lives. The fact that trauma experienced by the mother can impact a
fetus highlights the incredibly complex and multifaceted nature of trauma.

Childhood Trauma and Psychosis
Symptoms of schizophrenia are strongly correlated with childhood abuse. Read, van Os,
Morrison, and Ross (2005) describe the connection between childhood trauma, psychosis, and
schizophrenia. Examining child abuse as a causal factor of schizophrenia is a radical idea that
changes the conception of the typically accepted causal factors of various psychological

BIOLOGICAL EFFECTS OF TRAUMA 177

disorders. Schizophrenia is typically associated heavily with biology, but the interaction between
biology and trauma is an area that could lead to development in our conceptualization of the
causal factors of many other psychological disorders. Read et al. (2005) pay particular attention
to hallucinations because hallucinations are also symptomatic of PTSD, which can be the result
of childhood abuse. Previous research has shown a strong correlation between childhood abuse
and psychosis (Read et al., 2005). Most of the research shows a stronger predisposition to
auditory hallucinations rather than visual hallucinations in people who have experienced
childhood trauma. Additionally, sexual delusions are common in people who have experienced
childhood sexual abuse. The negative symptoms of schizophrenia, including apathy, poverty of
speech and thought, and lack of social drive, additionally appear in people who have experienced
childhood trauma. It makes sense that childhood trauma would create horrific memories or
flashbacks to the sensory experience of abuse that might appear to be hallucinations typical of
schizophrenia. It also makes sense that people who were traumatized as children may experience
lack of social drive and apathy in adult life. If someone has enough of these symptoms, and for
the right amount of time, this could warrant a diagnosis of schizophrenia. Read et al. (2005)
explain that most of the research on schizophrenia as a result of childhood trauma focuses mainly
on the psychological components as opposed to the biological components. However, the
researchers state that the biological causes of schizophrenia in people who have experienced
childhood trauma could stem from an overactive HPA axis. Stress exposure does not only
increase the release of cortisol, it also increases the release of dopamine, which plays an integral
role in schizophrenia (Read et al., 2005). Structural damage to areas of the brain such as the
hippocampus and cerebral cortex can additionally play a role in the development of
schizophrenia. It is important to recognize the prevalence of biological predispositions and the

BIOLOGICAL EFFECTS OF TRAUMA 178

interaction between genetics and the environment. In this case, if one has a biological
predisposition for schizophrenia, an abusive environment could prompt it to manifest.

Epigenetics and War Trauma
Survivors of war trauma are at an increased risk for PTSD. Traumatic stress has shown
connections to changes in the neuroendocrine and immune systems, which increases the risk for
physical illness (Ramo-Fernández, Schneider, Wilker, and Kolassa, 2015). Ramo-Fernández et
al. (2015) explain that trauma survivors have shown higher risk for infections, cardiovascular
disease, diabetes, and cancer (in addition to the psychological impacts) due to changes in the
immune system as a result of trauma. The researchers explain that chronic stress in early
childhood leads to cellular and hormonal changes that impact the immune system, which is why
trauma survivors show an increased risk for things like cardiovascular disease, diabetes, and
cancer. A “prematurely aged” immune system is what leads to immunological changes that
enhance the risk for physical illness (Ramo-Fernández et al., 2015).
War trauma can lead to epigenetic changes that become intergenerational. Chronic immune
system activation in PTSD, which is a common outcome of war, correlates with changes on the
genetic level that have the potential to become inherited biological traits. Here, Ramo-Fernández
et al. (2015) use the example of children of Holocaust survivors with PTSD at risk for
developing PTSD themselves through inherited biological predisposition. As in the case of war
trauma, early childhood maltreatment can lead to the same epigenetic issues with the immune
system. Ramo-Fernández et al. (2015) describe how the exact molecular explanations (which
have a lot to do with the methylation of DNA) of intergenerational trauma transmitted on the
epigenetic level have yet to be illuminated. This points to crucial directions for future research.

Natural Disasters and the HPA Axis

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Natural disasters also have the ability to harm the HPA Axis. Pfefferbaum, Tucker, and Nitiéma
(2015) did a study examining HPA axis functioning in survivors of Hurricane Katrina. The
researchers observed survivors of Hurricane Katrina to have higher PTSD and depressive
symptoms, but lower cortisol levels, which is the primary stress hormone. This study highlights
the importance of depressive and other symptoms including PTSD in response to a natural
disaster. Pfefferbaum et al. (2015) did not observe a statistically significant result due to a small
sample size, but this study adds to the growing body of literature on HPA axis functionality
following natural disasters. This study points to the necessity of expanding research in relation to
the changes the HPA axis might undergo in response to natural disasters. Pfefferbaum et al.
(2015) additionally highlight the differences in individual levels of cortisol and explain that this
could impact results of studies that attempt to examine cortisol and the stress response. There is a
lot of difficulty in measuring stress after a disaster because natural disasters have a greater
impact on disadvantaged communities where chronic stress likely resides. Therefore, the pre-
disaster social conditions must be taken into account when examining natural disasters.

Substance Abuse and Trauma
Trauma additionally has connections to substance abuse. Muehlhan, Höcker, Höfler,
Wiedemann, Barnow, and Schäfer (2017) explain how alcohol-dependent people with a history
of childhood maltreatment are more likely to relapse as opposed to those who have not
experienced childhood maltreatment. There is a connection between stress responsivity and
alcohol dependence in people who have experienced childhood maltreatment (Muehlhan et al.,
2017). The researchers conducted a study using 130 people and concluded that one’s
physiological stress response creates a heightened inability to cope with stressful situations if the
person experienced childhood maltreatment. This explains the correlation between childhood

BIOLOGICAL EFFECTS OF TRAUMA 180

maltreatment and risk of relapse. Childhood trauma impacts the HPA axis, which causes
dysfunction in the stress response. If people are unable to cope with stressors in the environment
and alcohol allows them to physiologically calm down, it makes perfect sense that alcohol-
dependent people who have experienced childhood trauma would relapse. The connection
between childhood trauma and substance abuse will continue to remain prevalent in the clinical
world.

Conclusion
In addition to the psychological and behavioral impacts of trauma, research has shown a
significant amount of biological impacts of trauma as well. The research and literature relating to
the biological effects of trauma has grown substantially. We now know that childhood
maltreatment, witnessing repeated traumatic events as a child, natural disasters, war, and
pregnant mothers with a history of trauma all have the potential to impact one’s biology. There
are sex differences in how trauma manifests biologically, and there are multiple types of
interactions between one’s genetics and the environment. Experiencing trauma as a child can
cause the HPA axis to remain in a constant state of alarm, which can lead to physical health
problems in adult life such as infectious disease, diabetes, cancer, and cardiovascular disease. An
overactive HPA axis creates neurobiological changes that have the potential to become inherited
biological traits. This means that marginalized communities that likely experience chronic stress
are at greater risk for developing inherited genetic traits that stem from trauma. Experiencing
trauma at any point in life has the ability to change one’s biology because neurological and
hormonal changes are in continuous development throughout the lifespan. The impacts of trauma
are incredibly complicated. Not only can trauma lead to detrimental psychological impacts, it can
lead to neurobiological changes that have the potential to become intergenerational.

BIOLOGICAL EFFECTS OF TRAUMA 181

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Running head: PSYCHOPATHY 183

Psychopathy: An Overview of Historical and Contemporary Understandings
Daphne Michie

PSYCHOPATHY 184

Overview

Due to descriptions in literature, medical reports, film, and general public rhetoric,

“Psychopathy” carries a connotation of danger and deviance, and it has a fascinating history. For

many psychologists, the terms “psychopathy” and “sociopathy” are interchangeable because they

are closely related. Sociopathy was originally encompassed in the definition of psychopathy, but

later became what we now know as Antisocial Personality Disorder. Psychopathy became a

broad term for any kind of mental illness or disorder. The key distinction between psychopathy

and Antisocial Personality Disorder (ASPD) is that people with ASPD can have psychopathic

personality traits, especially callousness, but these traits are not absolutely necessary for a

diagnosis of ASPD. Defining characteristics of ASPD in the DSM V include disregard for other

people, a tendency to lie, and a lack of regard for one’s own safety and the safety of others. The

term “Antisocial Personality Disorder” did not appear until 1980, in the publication of the DSM

III. For the purposes of this paper, I will mainly use the term “psychopathy” because it is what

appears most often in the research I found, but I will also use “sociopathy.” When attempting to

gain insight into sociopathy as a diagnosis and as a psychological disorder, it is important to

examine the history of its first reports, how it was analyzed historically, and how it is examined

using brain imaging and psychological research today.

Written reports of sociopathy can be traced to ancient eras. For example, in ancient

Greece, Theophrastus, a student of Aristotle, describes what he calls “The Unscrupulous Man.”

This description coincides with a contemporary conception of what we would call “a sociopath.”

As quoted in Millon, Simonsen, Birket-Smith, and Davis (2002, p. 3), Theophrastus writes:

The Unscrupulous Man will go and borrow more money from a creditor he has never

paid…. When marketing he reminds the butcher of some service he has rendered him

PSYCHOPATHY 185

and, standing near the scales, throws in some meat, if he can, and a soup-bone. If he

succeeds, so much the better; if not, he will snatch a piece of tripe and go off laughing.

Thus, sociopaths have appeared in written records from ancient eras, and they likely

existed long before these first written documentations.

Developing the Concept of the Psychopath

Since the 18th century, the image of “the insane” or “the mad” has been closely tied to

mental illness. Federman, Holmes, and Jacob (2009) explain that as a result, psychological

deviance has come to connote danger and a threat to society. The term “psychopath,” first coined

in the early 19th century, connotes these same ideas of evil, illness, and danger. This term

reinforced the intense stigma and societal fear surrounding mental illness in European public

rhetoric. Buhi (2011) describes how in the late 19th century, Italian physician Cesare Lombroso

tried to identify “born criminals” because he did not believe psychopathy could occur in just

anyone. Lombroso believed the root cause of psychopathy was biological, and his work is one of

the initial examples of a biological analysis of psychopathy. In the 19th century, psychologists

were developing both biological and psychological theories for psychopathy. German

psychologist Julius Ludwig August Koch published his first work describing the concept of

“psychopathic inferiority” in 1888. This term implies that people with mental illness are

psychologically inferior. Wetzell (2000) explains that as criminology was developing in

Germany during the 19th century, there arose in general public rhetoric a link between

psychopaths and crime. Not only did people begin to believe psychopaths were psychologically

inferior, they believed they were violent and predisposed to crime. Research and descriptions of

psychopathy in Germany at this time became fundamental in both the study of psychopathy and

the portrayal of people with mental illness as dangerous and inferior.

PSYCHOPATHY 186

Psychopathy in the 20th Century

The term “psychopathy” remained in use until the late 19th century. Sigmund Freud used

the term in descriptions and categorizations of mental illness. Freud’s work in psychology during

the early 20th century was some of the most influential and enduring. The fact that Freud used the

term “psychopathy” in his research gave it even more validation. Charland (2010) explains that

French psychiatrist Philippe Pinel was the first psychologist to use the phrase “insanity without

delusion.” Pinel described patients without moral judgment and who engage in self-defeating

acts (Charland, 2010). This was the first clinical description of sociopathy as a separate entity

from psychopathy. Pinel’s descriptions of people “without moral judgment,” and who are insane

without experiencing delusion, marked a pivotal development in the distinction between

psychopathy and sociopathy. This led to further research and analysis of sociopathy in the 20th

century.

In the first few decades of the 20th century, the term “constitutional psychopathic

inferiority” was used to describe psychopathy. This term implies that psychopathy is closely tied

to one’s genetic makeup. This term became a broad category used in research and diagnoses for

all dysfunctional or antisocial behavior (The Construct of Psychopathy). In the 1920’s,

psychologist George E. Partridge worked to narrow the definition of psychopathy to antisocial

personality, and later suggested a more accurate name be “sociopathy” (Hervé & Yuille, 2007).

In the DSM II, published in 1968, sociopathy was listed as a type of personality disorder. In

1980, psychologist Robert Hare came up with a “Psychopathic Checklist” to determine people’s

levels of psychopathic personality traits (Wahlund & Kristansson, 2009). Hare, in addition to

many other psychologists at the time, was frustrated that there was no official clinical description

of antisocial personality disorder. Hare’s checklist was designed to help people obtain a

PSYCHOPATHY 187
diagnosis and to continue the development of a widely accepted clinical description of

sociopathy. The DSM III, published in 1980, was the first edition to contain Antisocial

Personality Disorder as a clinical diagnosis (Gurley, 2009). Published in 2013, the DSM V

contains the diagnostic criteria for Antisocial Personality Disorder, and it notes that the disorder

has also been called psychopathy or sociopathy (Gurley, 2009).

Obstacles to Treatment

Sociopaths are, to use a bit of an insensitive phrase, difficult to point out. This disorder

does not have any obvious “telltale” signs from the point of view of an outside observer. There

are no physical markers or psychotic episodes, so there are essentially no obvious indicators of

any sort of disorder. Throughout history, if people looked or acted insane, they were usually put

in mental institutions. But sociopaths often appear composed enough to avoid any passing

stranger’s diagnosis as “mentally ill.” Therefore, there are historical and contemporary obstacles

to the diagnosis, treatment, and analysis of sociopathy. Twerski (1989) explains that he knows,

“no methodology that can be described or recommended for a true sociopath” (p. 3). This

statement highlights the difficulties in the clinical treatment of sociopaths—even in

contemporary society. Houser (2012) explains how most therapists today work with clients

individually to come up with a specific treatment plan; however, this is often not enough to fully

treat the disorder. Houser (2012) also explains how there are currently no pharmaceutical drugs

for the specific treatment of antisocial personality disorder (p. 36). If psychologists are

bewildered now, they were likely bewildered throughout history exactly how one might go about

explaining the causes and providing treatment for sociopathy.

Prior to the invention of brain scanning techniques, psychologists had no way of knowing

what exactly was happening inside the brains of sociopathic people. They had no idea what

PSYCHOPATHY 188

cognitive and biological processes were involved in the cause and development of sociopathy.

Due to the invention of brain scanning, we are able to gain an understanding of the biological

processes behind the development of this disorder and what parts of the brain are directly and

indirectly involved. FMRI scans have the ability to illuminate problems in the brain from the

smallest neural connections to larger maladaptive conditions. I would like to provide some

examples of studies that provide insight into the cognitive processes behind sociopathy and its

many levels of complexity.

Studies on Sociopathy

Wahlund and Kristiansson (2009) explain how violent behavior and antisocial behavior

arise due to a combination of genetic and environmental factors. They describe how certain

personality traits are a greater risk factor than are others for the development of psychopathy

including aggression, hatred, jealousy, fantasy, distortions of reality, and strong desire to gain

money and dominance. Wahlund and Kristiansson state that a lack of empathy, specifically

affective empathy, is the fundamental characteristic of sociopathy. Affective empathy controls

physiological responses such as the fight or flight response, which is regulated by the amygdala.

Dysfunction in the amygdala is one of the primary causes of sociopathy because the amygdala is

closely tied to the development of emotional learning (p. 267). Additionally, Wahlund and

Kristiansson explain how many studies have shown that sociopathic individuals fail to react to

certain threatening stimuli (p. 267). Types of brain scanning such as CT, MRI, PET, SPECT, and

fMRI scans depict neural processing behind emotional and cognitive processing. The fMRI

utilizes the BOLD technique, or Blood Oxygen Level Dependency, to demonstrate how the

hemodynamic response relates to neural activity in the brain. Wahlund and Kristiansson state

that there is a relationship between “deviant brain structure” and dysfunction in the frontal and

PSYCHOPATHY 189

temporal lobes (p. 269). Wahlund and Kristiansson also question empathy as an innate human

trait and describe the possibility of training people to have empathetic capacity. Wahlund and

Kristiansson describe a study wherein subjects were able to activate their amygdala after

thinking of something sad (p. 269). If the techniques used in that study could be replicated and

used more widely, this could be a pivotal development in empathetic processing and the

treatment of sociopathy.

Tamatea (2015) describes the importance of including genetic and environmental factors

in the analysis of psychopathy and how biology is beginning to be taken into account in relation

to diagnoses, assessment, and treatment. Tamatea (2015) explains how epigenetics, which is the

field that examines the link between genetic and environmental influences on phenotypic traits

and how they are expressed, is used in relation to psychopathy. However, Tamatea (2015) states

that currently, there is not enough evidence gathered on the epigenetics of the psychopathic

genome to say definitively which genes contribute to the development of the disorder. Tamatea

(2015) argues that the environmental and genetic factors that contribute to psychopathy tend to

be overlooked because psychopaths are stereotypically viewed as “high-risk,” violent, socially

deviant, criminals (p. 632). Tamatea (2015) also raises the crucial point that we cannot

“overbiologize” psychopathy, especially in the courtroom. However, it is important that

psychologists, researchers, employers, judges, and others take the epigenetics of psychopathy

into account in order to obtain more nuanced opinions.

Pera-Guardiola et al. (2016) did a study examining how people with psychopathy have

difficulty with the recognition of facial expression. The researchers state that higher volumes of

the amygdala and temporal lobe correlate with better emotional facial recognition. In this study,

they used Magnetic Resonance Imaging, Voxel-Based Morphology, and morphed emotional

PSYCHOPATHY 190

facial recognition tasks to evaluate the relationship between “regional grey matter” and facial

emotion recognition in 19 male psychopaths. Pera-Guardiola et al. (2016) showed that

psychopaths demonstrate deficits in recognizing sad, happy, and fear emotional expressions.

They explain that other studies using brain imaging have shown psychopaths to have better facial

expression recognition in the prefrontal cortex, cingulate cortex, somatosensory cortex, anterior

insula, and the posterior lobe of the cerebellum (p. 1). These findings suggest that brain

modularity has an influence on psychopaths’ ability to recognize and interpret emotional facial

expressions. The researchers obtained subjects’ scores on the Psychopathy Checklist-Revised, or

PCL-R (which is Robert Hare’s checklist that was first introduced in 1980), prior to their

participation in the study. They obtained a sample mean of 27.8. During the study, the

researchers presented the subjects with photos of 12 faces, each expressing the six basic

emotional facial expressions: fear, happiness, anger, surprise, disgust, and sadness. Each trial

began with a neutral face that morphed into one of the six basic emotional facial expressions.

The subjects were then supposed to identify the emotion as soon as they recognized it. The

session consisted of 12 trials, and a mean expression recognition score was obtained for each of

the six basic emotional facial expressions. The researchers used MRI scans to see what areas of

the brain correspond to the recognition of facial emotional expression. Their results showed that

psychopaths require more steps to correctly identify emotional facial expressions than do people

without the diagnosis, and each emotion appears to be processed in a different area of the brain.

Sadness recognition appears in the dorsomedial prefrontal cortex, happiness recognition in the

anterior cingulate cortex, anterior insula, interior frontal gyrus, orbitofrontal cortex, and anterior

cerebellum, and fear in the somatosensory cortex. The results also showed that psychopaths with

larger volume in the prefrontal areas are better at recognizing emotional facial expressions. This

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study highlights the importance of the multiple different areas in the brain that process emotion.

This pattern emphasizes the complexities of the contributing biological factors of psychopathy.

Anderson and Stanford (2012) did a study examining the allocation of attention and how

it contributes to emotional processing deficits in psychopathy. In this study, volunteers from their

local community, which was Albuquerque, New Mexico, completed the Psychopathy Personality

Inventory-Revised (PPI-R). Anderson and Stanford then selected the people with the highest and

lowest scores on the PPI-R. The researchers selected people of different demographics and levels

of education. They then had the participants do several different tasks that involved the

processing of emotion using different emotional stimuli and emotional content. They used ERP

scans to see how neural activity differed in psychopathic subjects and non-psychopathic subjects

when given various emotional stimuli and content. It was found that attention does play a role in

emotional processing and that psychopathic individuals have deficits in emotional processing

because they have difficulties processing peripheral cues. The researchers explain that

subsequent studies show psychopaths are less prone to interference from external distractors. The

data obtained in this study through ERP scans suggest that psychopathic individuals cannot

achieve the same level of differentiation that appears in non-psychopathic individuals. The

researchers observed that the psychopathic individuals in this study were able to categorize

emotional stimuli. The critical difference between the psychopathic and non-psychopathic

individuals in this study was the fact that the psychopathic individuals utilized affective content

only in relation to prime defense networks. This means they were only able to utilize emotion

when there was an automatic, primal response to threat. The psychopathic individuals also

showed poor autonomic response to punishment cueing. Overall, the results in this study support

the hypothesis that abnormalities in attention correlate with psychopathic deficits in emotional

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processing. Not only does dysfunction in various parts of the brain correspond with psychopathy,

but deficits in the allocation of attention can additionally contribute to the development of this

disorder.

Seara-Cordoso and Viding (2015) explain the “psychopathic personality traits” that

appear in adults. These traits include callousness, manipulativeness, lack of remorse, grandiosity,

interpersonal charm, and impulsiveness. Seara-Cordoso and Viding describe multiple previous

studies that utilize techniques in classical conditioning, mood induction, reward versus loss tasks,

and response to emotional stimuli to examine psychopathic individuals’ responses to emotional

stimuli and the various personality traits that contribute to this disorder. The main tool used for

analysis in these studies is fMRI scans. These studies all showed differences in the BOLD

response of psychopathic and non-psychopathic individuals. For example, when photos of faces

were paired with an unpleasant odor, non-psychopathic individuals showed less activity in the

amygdala and dorsolateral prefrontal cortex, whereas psychopathic individuals showed increased

activity in these areas of the brain. This outcome demonstrates that differences in emotional

learning are fundamental to the development of psychopathy. Callousness is the quintessential

attribute of psychopathy. Decety, Skelly, and Kiehl (2013) observed that incarcerated men with

high levels of psychopathy exhibited reduced activity in the interior frontal gyrus and dorsal

anterior cingulate when shown photos of facial expressions of pain. These areas of the brain

typically show a great deal of activity in the perception of others’ experience of pain in non-

psychopathic individuals. When shown photos of body parts in painful situations, these

psychopathic individuals showed increased activity in these regions. This research suggests that

psychopathic individuals might have an easier time picturing themselves in pain rather than other

people in pain. Seara-Cordoso and Viding also explain that research demonstrates that

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psychopathic individuals show reduced activity in the amygdala during moral processing. Prehn

et al. (2013) observed that psychopathic individuals present atypical brain functioning during

decision-making that reflects diminished emotional arousal in the anticipation of possible

punishment. FMRI scans used in this study showed psychopathic individuals to have less activity

in the right anterior frontal gyrus before selecting low-risk options. Non-psychopathic

individuals show increased activity in the anterior frontal gyrus when making difficult decisions

in relation to safety. This study demonstrates how psychopathic and non-psychopathic

individuals differ in brain activity involved in decision-making. Pujara, Motzkin, Newman,

Kiehl, and Koenings (2013) examined monetary reward in incarcerated men with high and low

levels of psychopathic personality traits. Pujara et al. (2013) found that the psychopathic

individuals had a strong response in the ventral striatum, which plays a significant role in reward

processing, when they completed monetary loss and reward tasks. Each study Seara-Cordoso and

Viding (2015) explain provides valuable insight into the personality traits that define

psychopathy. All of these studies utilize different techniques that appear to be localized in

different regions of the brain. Through the use of fMRI scans, researchers are able to determine

which situations and stimuli elicit emotional response or recognition in psychopathic individuals.

Koenigs, Baskin-Sommers, Zeier, and Newman (2011) evaluated different studies that

examined the abnormalities associated with psychopathy using various brain imaging techniques.

They also explain the correlations between violence, impulsive behavior, and pathological lying

in relation to psychopathy. Koenigs et al. (2011) state that these traits “may commonly overlap

with psychopathy” but are not unique to psychopathy (p. 792). This is an interesting perspective

because most authors argue that traits such as the ones listed above are some of the fundamental

indicators of psychopathy. The researchers argue that these traits do not have to “inform the

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neural basis of psychopathy” (p. 792). This article gives a list of studies that examined different

areas of the brain and how they relate to psychopathy including the hippocampus, limbic system,

and the corpus callosum. Interestingly, these regions, along with many others given in the study,

are the less expected regions one might analyze in relation to psychopathy. The abnormalities

shown in these areas of the brain correlated with the presence of psychopathic traits. Koenigs et

al. (2011) also state that differences in methodology could account for much of the variability in

findings related to which regions of the brain correspond with psychopathy. This study

introduces even more areas of the brain that, when containing abnormalities, correlate with the

development of psychopathy. The point that variability in methodology could account for all

these different findings raises the question of how exactly studies of psychopathy are conducted.

Maiese (2011) describes the influence of emotion in moral cognition and reasoning.

Maiese argues that “reasoning and emotion are… inseparable during the course of human moral

cognition,” and that although emotion is necessary for moral judgment, emotion alone is not

sufficient to make a moral judgment (p. 824). Greene et al. (2004) describe the conflict between

an intuitive emotional response and a reflective response. Sometimes, we are able to have

emotional responses automatically. These do not require deliberate moral cognition and

judgment. Reflective responses require intentional moral consideration. Maiese explains that

both responses involve emotion and that every judgment we make requires emotion because it is

how we view the world (p. 825). Maiese explains that intuitive and reflective responses are not

easily distinguished and that deficits in either response can cause a breakdown in moral

reasoning and decision-making. Maiese argues that if either emotion or conscious reasoning is

absent in a person, then moral judgment will not be possible (p. 826). Therefore, in the case of

psychopathy, in which empathy is absent, true moral reasoning and judgment is impossible.

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Miller and Lynam (2015) describe the emergence of the “prototypical trait profile of

psychopathy” (p. 585). O’Boyle et al. (2015) explain the components of the Dark Triad:

psychopathy, Machiavellianism, and narcissism (586). O’Boyle et al. (2015) found that

agreeableness was a key predictor of all three components of the Dark Triad, which Miller and

Lynam describe as the prototypical profile of a psychopathic individual. Miller and Lynam

additionally give examples of studies demonstrating that psychopathy can be identified in

children. Frick and Ray (2015) did a study examining the presence of callous and unemotional

personality traits in children and adolescents. They found that these traits correlate with the

presence of aggression and antisocial behavior. Miller and Lynam (2015) describe the debate

over whether or not antisocial behavior is an essential component of psychopathy. Many

researchers believe it is strongly correlated with psychopathy, and others disagree. Miller and

Lynam believe antisocial behavior is a strong indicator of psychopathy. They also discuss the

importance of violence, substance abuse, corporate misbehavior, and ethical misconduct among

leaders in studies relating to psychopathy. Miller and Lynam also give examples of other

personality traits such as interpersonal antagonism, low agreeableness, angry hostility, and

assertiveness that are correlated with psychopathy. Patrick and Drislane (2015) consider all these

traits necessary for the “full prototypic psychopathy profile” (p. 588). Miller and Lynam explain

that many researchers differ on exactly which traits define the psychopathic profile, but they all

agree that there are many traits that contribute to this definition. These studies highlight the

configuration of personality traits and resulting multifaceted nature of psychopathy.

Thompson, Ramos, and Willett (2014) describe several difficulties within the treatment

of psychopathy. They explain that psychopathy is historically a very difficult disorder to manage

and treat. Thompson et al. (2014) explain the necessity of drug therapy for psychopathy that

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targets serotonin and dopamine. The researchers state that antidepressants have been shown to

reduce neuroticism and aggression and increase social desirability in studies relating to Major

Depressive Disorder. They explain that psychopathy exhibits stability in serotonin functioning.

Therefore, attempting to treat psychopathy with selective serotonin reuptake inhibitors (SSRIs)

may exacerbate psychopathic traits. Thompson et al. (2014) explain the positive impacts of

supplemental oxytocin on interpersonal attachment. Mitchell et al. (2013) did a study wherein

they measured urinary oxytocin concentration in 47 male criminals with psychopathic traits to

determine whether psychopathy is associated with abnormalities of oxytocin levels. They

discovered higher levels of oxytocin in subjects possessing psychopathic personality traits.

Although Mitchell et al. (2013) originally thought psychopathic personality traits would correlate

with low levels of oxytocin, they found that high levels of oxytocin may contribute to the basis

of psychopathy. Therefore, supplemental oxytocin would likely be detrimental if used as a

treatment for psychopathy. This research demonstrates that SSRIs and supplemental oxytocin,

which were thought of as plausible treatment options for psychopathy, would actually be

counterproductive in the treatment of this disorder. This finding emphasizes the necessity for

further research into potential forms of treatment for psychopathy.

Anderson and Kiehl (2014) describe how psychopathy is a combination of genetic

factors, personality traits, and environmental influences. They explain that due to the many

possible abnormalities in brain structure and function that may contribute to psychopathy,

treatment is quite difficult. Anderson and Kiehl additionally explain the implications and

obstacles to treatment in relation to incarcerated populations. MacKenzie (1997) states that

success rates of rehabilitation of psychopathic individuals who have been incarcerated are fairly

low. This is primarily due to the lack of investment in and care of incarcerated populations. Most

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institutions view incarceration as incarceration, not as rehabilitation. Therefore, satisfactory

treatment for psychopathic individuals in prison is usually unlikely. Lipton et al. (1975)

articulate similar treatment of juvenile offenders. They explain that not only do adult offenders

face difficulties in the ability to obtain treatment, but also that juvenile offenders face the same

obstacles. Anderson and Kiehl explain that, “an element of psychopathy which has contributed to

its enigmatic reputation is that it is notoriously resistant to treatment” (p. 110). This has led to “a

generally pessimistic view among many experts as to the potential for improved outcomes

among psychopaths” (p. 110). Hare (1999) explains that many psychopathic individuals are

resistant to treatment because they do not believe that anything is wrong with them, and many

use treatment as an opportunity to manipulate administrators of therapy. Wong and Hare (2001)

advocate for identification and direct implementation of specific strategies for incarcerated

psychopaths. They argue that targeted treatment is crucial in any rehabilitative attempt. Wong

and Hare also articulate the necessity of harm reduction and behavior control using reward

incentives for violent incarcerated psychopathic individuals. This research highlights several

obstacles to rehabilitative efforts for psychopathic individuals. These difficulties are especially

prevalent for incarcerated people. It is critical that more rehabilitative strategies are implemented

if there is to be any progress in prison reform.

Heinze (2017) explains the psychodynamic perspective of psychopathy and the role of

unconscious shame in behavior and personality traits. Heinze also describes the impact that

dysfunction of interpersonal attachment can have in the development of shame. This article

provides insight into how unconscious shame can create behavior and personality traits that

correlate with psychopathy. Gilligan (1996), who is a prison psychiatrist, argues that

unconscious shame plays a role in remorseless and irrational violence. Both Heinze (2017) and

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Gilligan (1996) discuss the psychodynamic theories of psychopathy. Unconscious shame leads to

the development of psychopathic personality traits such as callousness and aggression, which

then become engrained in the cognitive processes behind behavior and the processing of

emotion.

Psychopathy has a complex and fascinating history. Its earliest written documentations

date back to ancient eras. There was a good deal of debate over how to distinguish psychopathy

from sociopathy, but sociopathy became its own diagnosis in 1968 in the DSM II. Today, it is

known as Antisocial Personality Disorder. Psychologists have always argued over the

appropriate diagnostic criteria for sociopathy, and there has been extensive research into the

biological factors, personality traits, and environmental influences on this disorder. Research has

shown many different regions and neural pathways of the brain to play a role in the development

of sociopathy. This disorder is extraordinarily complicated to diagnose, understand, and treat.

Even with contemporary brain imaging and developments in research, sociopathy continues to

surprise.

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