Mental health is not just the absence of mental disease or disorder. It is defined as a state of well-being. Every individual realizes their full potential, can cope with the everyday stressors of life, productively and fruitfully work, and contributes to their communities. Mental health gives individuals the capacity to grow emotionally, communicate well with others, learn, reason, have high self-esteem and be resilient in life.
People who are healthy mentally have some attributes. They can play and laugh, experience joy and love, deal with conflicting emotions, and take responsibility for their actions. Additionally, they have an accurate appraisal of reality, live without undue fear, anxiety, and guilt, control their behaviors, and work productively. Mental health is responsible for people's ability to reason logically, use good judgement, make insightful conclusions, solve problems, experience empathy, and manage interpersonal conflicts. The earlier discussed attributes underscore the importance of mental health in our societies in ensuring that people live peacefully and in harmony with each other.
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Psychopathy is a serious neuropsychiatric personality disorder characterized by personality and behavioral deficits (Anderson & Kiehl, 2014). Psychopaths are untruthful, irresponsible, lack empathy, lack guilt, and have callousness and insufficient control of behaviors. A person's personality is defined as an enduring pattern of feeling, thinking, behaving, and relating to oneself and the environment in a consistent manner and various social contexts. The Diagnostic and Statistical Manual 5 (DSM-5) defines personality disorders as the enduring patterns of behavior and inner experiences that markedly deviate from an individual's culture. These deviations are inflexible and pervasive, have their onset in early adulthood or adolescence, stable over time, and leads to impairment or distress in occupational, social, and other roles.
Psychopathy is chronic and hard to treat because traits are inflexible and ingrained deeply, making it tough to modify attributes. There has been an exponential rise in technological advancements in the past two decades, which has given rise to brain imaging studies. Research findings and brain imaging studies strongly support that brain factors cause psychopathy. Genetic influences precipitate deleterious effects in specific brain regions, causing or leading to psychopathy.
In this paper, I will be exploring the identifiable brain factors, structural and functional alterations that are influential in causing psychopathic tendencies.
Prefrontal Cortex
The prefrontal cortex is an association area of the cerebral cortex. It is concerned with personality, learning abilities, recall of information, intellect, reasoning, intuition, complex learning abilities, judgement, conscience, and foresight (DeSaix et al., 2018). Any alterations in this area lead to alterations in personality. The accidental occurrence of Phineas Gage in 1848 is an important medical history that provided more in-depth insight into the roles of the prefrontal cortex (Patrick, 2018). He was a worker at a railway construction. A tamping iron rod measuring 4 feet and weighing 13 pounds was driven into his head through the frontal cortex and landed 50 feet away. He survived the ordeal and was able to perform his usual daily businesses. However, he became irreverent, profane, irresponsible, and fitful. According to Kenneth (2014), from Gage’s case, neuroscientists understood and recognized that the prefrontal cortex’s functions included emotional control, planning, and moral judgment. Structural alterations in this area led to personality disorders.
Neuroimaging studies have demonstrated that psychopathic individuals have significant deficits in the orbitofrontal/ventromedial prefrontal cortex (vmPFC) (Patrick, 2018). Psychopaths have reduced connections in their vmPFC, the part responsible for guilt and empathy sentiments. According to Anderson and Kiehl (2014), other structural alterations in the prefrontal cortex of psychopaths include a reduction in the gray matter in the orbitofrontal area and reduced volumes in the anterior frontopolar region in the prefrontal cortex.
Structural Magnetic Resonance Imaging (sMRI) studies reveal volumetric reductions in the posterior precuneus/cingulate and dorsomedial areas of the PFC (Umbach et al., 2015). There is a significant reduction in the uncinate fasciculus's integrity, which connects the amygdala and the orbitofrontal cortex. Furthermore, functional MRI studies have demonstrated a decline in the functioning of the prefrontal cortex.
Amygdala
The amygdala is part of the limbic system, the ring of structures that encircle the upper part of the brainstem and the corpus callosum. The limbic system is described as the seat of emotions and learning that plays a primary role in a range of emotions such as docility, anger, affection, pain, fear, and pleasure. Other parts of the limbic system include the cingulate gyrus, orbitofrontal cortex, and the hippocampus.
Essential aspects of our personalities are highly and exclusively dependent on the functional hypothalamus and amygdala. If specific regions of either of the two were destroyed or stimulated artificially, human beings would exhibit exaggerated or blunted expressions of pleasure, pain, love, parental affection, anger, and self-defense (DeSaix et al., 2018). Individuals would also have abnormalities in their motivation, learning, and memory.
Psychopaths have reduced volumes in their amygdala. There are also functional and structural dysfunctions in individuals with personality disorders. Additionally, psychopathic individuals may also have lesions in their amygdala, which lessens their visual recognition of emotions and auditory recognition of anger and fear (Anderson & Kiehl, 2014). Impaired personalities and behaviors such as lack of empathy and anxiety and a blunt affect in psychopaths are directly related to an impairment in the processing of emotions. The antisocial behavior of psychopaths places forth the argument that their manifestations are an implication of structural and functional alterations in the functioning of their amygdala.
Notable structural deficits in the amygdala's superficial and basolateral nuclei are seen in structural Magnetic Resonance Imaging studies (Umbach et al., 2015). Structural deficits in those specific nuclei are associated with psychopaths' inability to learn from anxiety, stress, and punishment, contributing to their poor socialization. Functional Magnetic Resonance Imaging studies dovetail with sMRI studies in showing amygdala abnormalities in psychopaths. The amygdala of psychopaths is hypoactive while making moral decisions, in social cooperation, fear conditioning, and reacting to affect-related activities.
Corpus Callosum
The corpus callosum is the large C-shaped bundle of nerves that connects the two halves of the brain (the cerebral hemispheres) (DeSaix et al., 2018). Studies focusing on the corpus callosum in psychopathic individuals revealed an increase in the callosal white matter volume, length, and thickness reduction. These findings were associated with interpersonal and affective deficits (lack of close friends, social closeness, and a blunt affect) and low reactivity to autonomic stress (Patrick, 2018). The alteration in the callosal structure leads to a delayed interhemispheric transfer of cognitive and affective information, leading to the impairments in psychopaths.
Striatum
The striatum is part of the basal ganglia of the brain and includes the lentiform and caudate nuclei. Structural alterations in this area are positively related to features of psychopathy (Patrick, 2018). Alterations include an increase in the total volume, changes in the morphology, and the activation levels.
Endocrine and Autonomic Responses
Hormones and neurotransmitters are responsible for the physiologic responses people exhibit ( DeSaix et al., 2018) . An alteration in their levels, either an increase or decrease, and a change in the sensitivity and response by receptors, may cause mental illnesses. Neurotransmitters include dopamine, serotonin, and norepinephrine. According to Townsend and Morgan (2017), an increase in the level of dopamine activity results in mania, while a decrease causes depression. On the other hand, higher serotonin and norepinephrine activities result in anxiety and mania, respectively.
Thompson et al. (2014) asserts that the brains of psychopaths have altered serotonergic and dopaminergic systems responsible for the behavioral and personality abnormal behaviors in psychopaths.
Conclusion
Psychopathy is a personality disorder characterized by deficits in behavioral and personality traits. It is challenging to treat personality disorders since it is hard to modify attributes. Advances in neuroscience and imaging studies have enabled the study of notable brain changes in people suffering from psychopathy. Psychopaths have structural and functional alterations in their prefrontal cortex, amygdala, striatum, and corpus callosum. The mentioned areas are responsible for personality, learning abilities, conscience, and emotions. Altering with them, therefore, leads to significant behavioral and personality changes observable in psychopaths. Additionally, hormones and neurotransmitters have an implication in the expression of emotions. Alterations in neurotransmitter pathways lead to mental deficits common in people with mental illnesses.
References
Anderson, N. E., & Kiehl, K. A. (2014). Psychopathy: developmental perspectives and their implications for treatment. Restorative neurology and neuroscience , 32 (1), 103–117. https://doi.org/10.3233/RNN-139001
Blakey, R., Askelund, A. D., Boccanera, M., Immonen, J., Plohl, N., Popham, C., Sorger, C., & Stuhlreyer, J. (2017). Communicating the Neuroscience of Psychopathy and Its Influence on Moral Behavior: Protocol of Two Experimental Studies. Frontiers in psychology , 8 , 294. https://doi.org/10.3389/fpsyg.2017.00294
DeSaix, P., Betts, J. G., Johnson, E., Johnson, J. E., Korol, O., Kruse, D. H., ... & Young, K. A. (2018). Anatomy & Physiology: OpenStax.
Kenneth, S. (2014). Saladin’s Human Anatomy 4th Edition.
Patrick, Christopher J. (2018) Handbook of Psychopathy (2nd. Ed.), New York: Guilford Press | ISBN-13: 978-1462535132 | ISBN-10: 1462535135
Thompson, D. F., Ramos, C. L., & Willett, J. K. (2014). Psychopathy: clinical features, developmental basis and therapeutic challenges. Journal of Clinical Pharmacy and Therapeutics , 39 (5), 485-495. https://onlinelibrary.wiley.com/doi/pdf/10.1111/jcpt.12182
Townsend, M. C., & Morgan, K. I. (2017). Psychiatric mental health nursing: Concepts of care in evidence-based practice . FA Davis.
Umbach, R., Berryessa, C., & Raine, A. (2015). Brain Imaging Research on Psychopathy: Implications for Punishment, Prediction, and Treatment in Youth and Adults. Journal of Criminal Justice, 43 (4), 295-306. http://dx.doi.org/10.1016/j.jcrimjus.2015.04.003
