Mapping brain lesions for clues to criminal behavior

Harvard researchers worked with colleagues to map brain lesions in 17 patients who exhibited criminal behavior after — but not before — the lesions appeared.
 Researchers who studied brain lesions in individuals exhibiting criminal behavior found that the injuries fell within a particular brain network involved in moral decision-making.

The findings follow past studies showing that the brains of some criminals exhibit abnormalities, but in most cases without determining a clear association between the injury and the behavior. The new study is published in the Proceedings of the National Academy of Sciences.

“Our lab has developed a new technique for understanding neuropsychiatric symptoms based on focal brain lesions and a wiring diagram of the human brain,” said senior author Michael Fox, an assistant professor of neurology at Harvard Medical School and the associate director of the Deep Brain Stimulation Program at Beth Israel Deaconess Medical Center. “We’ve successfully applied this technique to hallucinations, delusions, involuntary movements, and coma — and in perhaps its most interesting application to date, we applied it to criminality.”

Perhaps the most famous case in decades of interest on possible links between brain injury and criminal behavior is that of Charles Whitman, who was found to have a brain tumor after killing 14 people in the Texas Tower massacre of 1966.

First author Richard Darby, formerly of BIDMC and now an assistant professor of neurology at Vanderbilt University, noted that he personally became interested in how neurological diseases might cause criminal behavior after caring for patients with frontotemporal dementia, who often commit nonviolent crimes as a result of the condition.

To investigate the issue, Fox, Darby, and their colleagues systematically mapped brain lesions in 17 patients who exhibited criminal behavior after — but not before — the lesions appeared. Analyses revealed that the lesions were located in diverse brain regions, but all mapped to a common network.

“We found that this network was involved in moral decision-making in normal people, perhaps giving a reason for why brain lesions in these locations would make patients more likely to behave criminally,” said Darby. The network is not involved with cognition control or empathy.

The findings were supported in tests of a separate group of 23 cases in which the timing between brain lesions and criminal behavior was implied but not definitive.

Researchers were quick to note that not all individuals with brain lesions in the network identified in the study will commit crimes. Genetic, environmental, and social factors are also likely to be important.

“We don’t yet know the predictive value of this approach,” said Fox. “For example, if a brain lesion falls outside our network, does that mean it has nothing to do with criminal behavior? Similarly, we don’t know the percentage of patients with lesions within our network who will commit crimes.”

Darby added that it is important to consider how the study’s findings should not be used.

“Our results can help to understand how brain dysfunction can contribute to criminal behavior, which may serve as an important step toward prevention or even treatment,” he said. “However, the presence of a brain lesion cannot tell us whether or not we should hold someone legally responsible for their behavior. This is ultimately a question society must answer.”

Indeed, doctors, neuroscientists, lawyers, and judges all struggle with criminal behavior when a brain lesion is present. Is the patient responsible? Should he or she be punished in the same way as people without a lesion? Is criminal behavior different than other symptoms suffered by patients after a brain lesion, such as paralysis or speech trouble?

“The results don’t answer these questions, but rather highlight their importance,” said Fox.

This work was supported by funding from the Sidney R. Baer Jr. Foundation, the National Institutes of Health, the Dystonia Foundation, the Nancy Lurie Marks Family Foundation, the Alzheimer’s Association, and the BrightFocus Foundation.

Driven by ego? This book’s for you


Mark Epstein

GAZETTE: The subtitle of your new book seems to suggest the impossible. Can you talk about it, and your thoughts on the challenge of making peace with ego?

EPSTEIN: I wanted to write from a place of being a mature therapist. A lot of my earlier books were written from the perspective of having just discovered Buddhism. This is 40 years later and I thought it was worth writing from the place I am at, having had a psychiatry practice for 35 years. I’ve always been very cautious in laying mindfulness on my patients, who might not be so interested. I’ve tried to work in my therapy practice in a traditional manner to let a patient’s concern take the lead, but the Buddhist influence on me, which really came first, does influence the way I think and it must influence the way I work. I was letting it happen on its own accord rather than striking a Buddhist posture. What I realized is that the ego is the common ground between Western psychotherapy and Buddhist psychology. Both recognize that an overreliance on the ego is a cause for suffering.

All too often we think we are the ego and that identification constrains us, limits us, and makes us less than we could be. The ego is all about maintaining control. It comes from a place of fear and separation. It emerges in childhood when we are just beginning to figure out who we are. We need the ego, but if we give it full reign we actually become more insecure. We think of it as giving us high self-esteem, but the ego can be [just] as attached to self-judgment and self-loathing. It’s always trying to think its way out of whatever predicament it finds itself in, and it doesn’t make room for the more mysterious qualities that also constitute us. The point is not to get rid of the ego. It’s to change our relationship to it — it not being our master and we its slave.

GAZETTE: Patients come to you with their own experiences and struggles. How do you determine how to use Buddhism in therapy, and vice versa?

EPSTEIN: The goals of both Buddhism and Western psychotherapy are interlocking. I see them as threefold. Firstly, we all need a sufficient amount of self-esteem. We have to feel good enough about ourselves to function sufficiently in the world. Buddhism recognizes this in the concept of the “precious human birth,” and Western therapy is very concerned with healing the psyche’s childhood scars. Some amount of ego or self is very important. But we also need the ability to observe our own mind, thoughts, and feelings. This is the second important thing. That’s something that both meditation and psychotherapy encourage, in different ways. Therapy is built on a therapeutic split in the ego that promotes a kind of watchfulness of our inner lives. Meditation does that by training the mind to observe itself. Finally, both therapy and meditation can help us get past the ego’s need to control everything. There’s so much in life we can’t control. In my work as a therapist, influenced so much by Buddhism, I think I’m working on all three levels depending on what people need.

GAZETTE: How did Buddhism play a role in your time at Harvard?

EPSTEIN: I was fortunate to actually discover Buddhism in a world religion class my freshman year. It was a class I took by chance because I met someone taking it and she seemed interesting so I followed her. I had no real interest in world religion, but the whole first half of the semester was Eastern religion and I was really excited about what I learned.

We read a collection of Buddhist verse called the Dhammapada, which is written for laypeople. I loved it. It really spoke to me. There is a chapter called “Mind” that I identified with. It described an anxious mind as a fish flapping on dry ground. That opened up the Buddhist world for me. There were a lot of later courses that touched on Buddhism peripherally and I found them all, and created a few for myself in independent study.

«All too often we think we are the ego and that identification constrains us, limits us, and makes us less than we could be.»

— Mark Epstein

© Larry Bercow NYC


GAZETTE: You worked as an apprentice for the Dalai Lama’s physician during your time at HMS. How did that experience shape your medical journey?

EPSTEIN: During my fourth year, I, along with a Herbert Benson [a cardiologist and a pioneer in mind-body medicine], got a grant from the National Science Foundation to travel to India to do physiological measurements on the Tibetan monks who were practicing a kind of heat yoga where they could raise their temperatures at will. As part of that, I spent a lot of time with the Dalai Lama’s physician every morning. One of the things I discovered working with the Tibetan Buddhist tradition was that they have an understanding of a meditation-induced anxiety disorder. It’s possible to strive with too much effort, even in meditation, which makes people more stressed. The Buddhists were very familiar with this. As a young psychiatrist in training, I had some indication this might be true, but I was very interested to find that this was a well-documented phenomenon among the Tibetans.

GAZETTE: “Advice Not Given” is filled with personal stories — yours and your patients’. Is there one that stands out?

EPSTEIN: One that comes to mind is of a teacher of Buddhism who discovered he had colon cancer after completing a three-year retreat. One of his students cared for him, and recounted his final words: “No, no, no. Help, help.” She was disturbed because he was so experienced as a meditator: Why would he still have fear at death? But I was comforted by that because it made me feel that any pretense I might have about how it would be for me, I could drop. If there’s one thing we don’t know, it’s how we will be at death. Maybe he was just being honest.

I have some faith as a therapist that if I can encourage my patients to be with their fears in as open and vulnerable a way as this man was, that they will find a way through. It’s the pushing away because we think we’ll be overwhelmed by some sadness or anxiety or shame that keeps us locked up. If we can experience them fully, without aversion, that’s where the sense of freedom comes from.