The empathy-psychopathy spectrum

Putting oneself in the shoes of another comes easily to most of us. We cry at projected images of rustic peoples who have just lost their homes to natural disasters; feel anger and resentment for minorities being discriminated against because of their race, sexual orientation, socioeconomic status, or gender; and orchestrate  rallies holding aloft powerful political slogans which reprimand illegal poachers of sea turtles, lions, and whales for their paucity of moral conscience and ethical sensibility. Similarly, we feel  our stomach in knots when we hear about somebody experiencing themselves as emotionally indistinguishable from another, or a novelist’s melodramatic description of a languishing derelict pushing their dowry and belongings down the street in a Safeway cart.

The word in contemporary English that most accurately describes that magnanimous sentiment is empathy. Repeat that word out loud and be attentive to the web of feeling that comes up for you. In fact, the word itself is derived from the ancient Greek “empatheia” [εμπάθεια], which translates to “physical affection or passion”. Under the hegemony of the German language empathy was equated with the psychological term Einfühlung and came to mean “feeling-in”. Today the Merriam-Webster Dictionary defines empathy as “the feeling that you understand and share another person’s experiences and emotions: the ability to share someone else’s feelings”. It connotes something ubiquitous, something shared; it’s that purpled, fuzzy space created by my aquamarine blue and your urgent red-a mutual gathering place.

Empathy is possible because both our perceptual interface with reality and our relational capacities within the cosmos — phenomena mediated by neurocognitive circuitry and sociocultural conditioning, respectively — are unanimously shared and understood. Fundamental to empathy are componential micro-perceptions like nonjudgment, mutuality, the automatic intrinsic appraisal of sameness, and the quality of humanization.  

Empathy, by its very nature, is diametrically opposed to hierarchical relationships, institutionalized philosophies, reductive labels, compartmentalization, dogmatic beliefs, and does not subdue, defeat, divide, multiply, dominate, contrive, or manipulate the natural order of things for personal gain. In fact, it is our most formidable weapon and defense against the evolutionary scythe of extinction, or the strong gravitational pull towards social entropy and devolution.

But is empathy integral and innate to the human condition? Is it hardwired into us? When one scours the voluminous clinical literature on psychopathic character structure, the answer would appear to be a resounding no. How could it be inborn, some theoreticians will argue, when there are individuals with deviant, diabolical minds operating with complete disregard for the welfare of others and intentionally hurting them because it satisfies some sadistic craving? It must be learned. 

Lamentably, our Eurocentric capitalist societies frequently engender mass murderers with antisocial personalities who disembowel, dismember, behead, and carve up their victims with the clinical precision of a surgeon wielding a scalpel.  Their perverse idiosyncrasies have fascinated clinicians for centuries–some have stored body parts in refrigerated jars for ritualistic use, others have imbibed the blood of their victims because they believed it would bequeath eternal life. 

Their repetitive acts of murder, rape, and torture are committed with predatory stealth, primitive hedonism, and an air of emotional detachment alien to moral self-constraint. They are the self-anointed Apostles of the devious and diabolical Mind, self-appointed to commit and chronicle his hubris at the expense of the innocent and naïve. 

Moreover, they wear “the mask of sanity” well and are lithe and skilled at creating an outward illusion of mundane normalcy by assuming social roles that are valued by contemporary society. One must admit the fascination with them has sometimes bordered on sacrilegious exaltation; we are exhilarated, fixated, and fascinated by anomalous phenomena, and the traits and manifest behaviors of psychopaths are just another manifestation of the farthest reaches of human “being.” One cannot resist looking at an exposed wolf in sheep’s clothing, especially a wolf unperturbed by its own uncontained carnivorous urges and immunity to guilt and shame. 

We cringe but become paradoxically inquisitive when listening to narrative details of how Leonarda Cianciulli, the “Soap-Maker of Correggio”, murdered three women and made soap and tea cakes from their cadavers. Or how the “Milwaukee Cannibal” Jeffrey Dahmer engaged in crude experiments with his victims. For instance, he attempted to create a human zombie by drilling burr holes into the skull of one of his victims and injecting hydrochloric acid into the frontal lobes. Dahmer also kept specific parts of bodies he dismembered and burned as mementos of his feats. Or how Wayne Gacy breathed his perversions into life–he decked himself in a clown outfit and rendered his victims vulnerable through handcuffs before torturing and molesting them. None of the above are examples of a conformist mentality, by any stretch of the imagination.   

Clinical research has identified several developmental hallmarks in the life trajectories of those who grow up to be dissolute psychopaths. These individuals are usually the unlucky spawn of sadomasochistic parents. Nurturance and guidance through unconditional love and protection is markedly absent from their lives. Conversely, neglect reigns supreme. 

Overall, these individuals are predatory and aggressive, emotionally dysregulated, and are impervious to pedagogy about feelings within a relationally grounded context. They cannot mentalize. In fact, feelings are alien to them, and the few that do possess, seize, and overwhelm them from time to time are more closely related to manic exhilaration and rage than to anything remotely connected with empathy and compassion. Their threshold for experiencing hedonic pleasure is unusually high, reflected of course in the quantitative increase of brutality and savagery connected with each successive crime. Of course, the absence of a dispositionally distinctive  phenotype does not necessarily denote an absence of the genetic and neurocognitive circuitry that make the aforementioned behaviors possible.

In the case of extreme psychopathy, it seems there’s a disruption to the proliferating connectivity between brain regions intimately involved in the appraisal of intentional states besides one’s own [known as “Theory of Mind”]; in social cognition and the metacognitive evaluation of reward and punishment; in tagging and connecting affective responses with visual imagery of persons, objects, social behaviors, and natural phenomena during formative years when the immature brain is developing and self-organizing. 

These areas include the orbitofrontal prefrontal cortex and anterior cingulate in the frontal lobes, the insular cortex tucked deep inside the Sylvian fissure, and the superior temporalimbic areas including the amygdala and entorhinal areas of the parahippocampal gyrus. Normative connectivity between these areas allows for experience to be colored a certain way–we can feel our stomach become knotted at the thought of a punitive professor, or disgust at the sight of a mutilated body, or our heart beat so hard it might smash out of our ribcage at the sight of an approaching lover. The circuitry that makes these experiences possible may be grossly disrupted in the psychopath. 

Interestingly, the phenomenological characteristics of a psychopath (i.e., lack of empathy, aggression, unbridled expression of hedonism) with a neurodevelopmental profile much different from our own mirror those of persons with the acquired neuropathology of Witzelsucht disease. Meaning hollow or inappropriate jocularity, Witzelsucht disease is often seen in patients with meningiomas or some kind of neoplasm [tumor] in the orbitofrontal areas of the prefrontal cortex. Lesions here result in acute and radical shifts to the axis of one’s personality; there is usually a mental degeneration characterized by hedonism, euphoric levity that is bizarrely out of context, impulsivity, and social disinhibition. 

In his highly esteemed book The Man Who Mistook His Wife for a Hat, the neurologist Oliver Sacks describes one such case, the case of Mrs. B. On this occasion, development of a carcinoma had impacted the orbitofrontal cortex correlated with deterioration of her personality. The behavioral shift was acute and voluminous, and her kaleidoscope of perception became nonsensical, meaningless, and saturated with blithe and nonchalant feeling-tones, or as Sacks puts it, “the whole world was reduced to a facetious insignificance”. She was “de-souled”, an empty shell no longer couching the coherent, rational sense of self and vitality that friends and family recognized as Mrs. B. Something intangible, zestful, and distinctly human, had been extirpated.

The semblance to developmental psychopathy is uncanny. In fact, Witzelsucht disease is sometimes called “pseudopsychopathy”. Juxtaposed we see that one phenomenological variant is considered a severe personality disorder and the other an organic brain dysfunction, but if the correlations of neurophenomenology are anything to go by, both must be phenotypic microexpressions of the same or similar neuroanatomical profile. Perhaps it is all in the head, quite literally. 

Ineffable Nature has given us the feared psychopath but it has also given us the mirror-touch synesthete, an ostensive polar opposite. Psychopathy is a condition where there is a dearth of empathy. However, in mirror-touch synesthesia the faucets of emotional empathy are surging with the pressure of a salt-water geyser. There are many who have never heard of the latter, a condition whereby watching an individual being touched elicits a corresponding tactile hallucination on an analogous or same part of the percipient’s body. 

When a normal human brain witnesses or experiences physical touch,  it activates a neural network called the mirror-touch activating system. This includes the primary and secondary somatosensory cortices, the premotor cortex, the intraparietal sulcus, and the superior temporal sulcus. Mirroring properties have been implicated for pain, disgust, action, and many other affective states.

One fMRI study with a mirror-touch synesthete demonstrated neural hyperactivity in the primary somatosensory cortex and the insula not present in non-synesthetic controls. Unlike the non-synesthetic controls, the mirror-touch synesthete exhibited bilateral activation of the insula, a paralimbic area involved in self-referential processing. Hyperactivation in this region may underpin contrived distortions of body space and body schema, or self-other boundaries, so that observing touch to another is erroneously ascribed to the percipient’s own body. Not surprisingly, one study (Banissy and Ward, 2007) found mirror-touch synesthetes to be more emotionally empathic [experienced a congruent emotional response when witnessing another’s affective state] than non-synesthetic controls.   

Subsumed under the umbrella term “synesthesia,” this fascinating neurological condition is now beginning to attract the interest of the scientific community. Like the concepts of neuroplasticity and neurogenesis, it is entering the abode of the Western mind sciences through theoretical, clinical, and experimental research, thanks to the existence of scientific tools (i.e., fMRI, structural MRI) sensitive to structural and functional anomalies that legitimize perceptual excesses as described by an experient. 

Mirror-touch synesthesia is not just a figment of a florid and overactive imagination, as a naïve psychiatrist might claim. Who are these mysterious mirror-touch synesthetes? They are probably the hypersensitive, innovative, and eccentric visual and performance artists among us, and possibly some that self-define as “empaths.” The paucity of famous examples could be attributed to a reluctance to self-disclose experiencing the world in a profoundly different way; people who make claims that stand outside the frontiers of science run the risk of stigmatization and derision, of losing their professional credibility, and in worst case scenarios, pronounced mentally ill. More and more people with this neurocognitive profile will probably self-disclose in the imminent future given the auspicious change in scientific opinion. 

Whoever said that Nature reveals herself through anomalies and deviations was not wrong. In the psychopath, empathy is poignantly absent, perhaps because the kernel was not irradiated by loveliest light. In mirror-touch synesthetes, empathy is overelaborate, overwhelming, and overstated. One witnesses a disparity in dose amount when it comes to the rest of the population. Empathy, then, must be in the fleshy kernel and made possible by the light.

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