Morality and the Brain
A sin without volition is a slap at morality and an insolent contradiction in terms:
- Ayn Rand
Morality is only moral when it is voluntary.
- Lincoln Steffens
Those who wish to go in for the business of teasing brains scientifically must first cope with a different brain-teaser - and one that helps to define the entire profession of neurology. This is the problem of how to study an object (the human brain) that cannot, ethically, be experimented upon. The traditional solution is to look at brains that are injured, so as to deduce facts about what keeps a normal brain ticking. Thus neurology is often less the study of how brains function, than of the myriad ways in which they malfunction. In such a sensitive organ, a little trauma can mean the difference between vision and blindness, or motion and paralysis - or even, as new research by Antonio Damasio of the University of Iowa suggests, between morality and psychopathy.
The relationship between moral behaviour and brain anatomy was first highlighted in the 19th century by the example of Phineas Gage. After an accident that drove an iron bar through his pre-frontal cortex (the portion of the brain situated above the eyes), Gage made a full physical recovery. But once he had done so, this erstwhile upstanding citizen began behaving in a most uncharacteristic manner - swearing, stealing, lying, and eventually dying in destitution.
Since then, the pattern has become well documented: adults who suffer injuries to that part of the brain tend to develop antisocial habits. When questioned, however, these patients demonstrate the same knowledge of social and moral convention as everyone else, showing that somewhere in their brains they have retained the information that they gained through decades of normal living. Their problem is that once their pre-frontal cortexes have been damaged they are unable to apply this knowledge to actual situations.
These findings led Dr Damasio and his colleagues to ponder exactly when and how social and moral knowledge is learnt by the brain. In a paper just published in Nature Neuroscience, they take a stab at answering these questions by reporting on the cases of two patients, now in their early 20s, who survived similar injuries to their pre-frontal cortexes during infancy. Dr Damasio wondered if these two people had had the chance to store up any moral rules of thumb in spite of their early accidents. If they had not, the prefrontal cortex would be solidly implicated, not merely as the executor, but as the maker, of manners in man (or woman).
Both subjects, judging from their ways of life, had experienced considerable difficulty in absorbing social norms. They had lived lonely, maladjusted lives, with no plans for the future and with unfortunate personal habits such as compulsive lying, petty theft, poor hygiene, irregular sex lives, and indifference to their resulting children.
Like patients who suffered comparable damage as adults, they showed ordinary aptitude for tasks such as mental arithmetic, but scored low on any puzzles that measured tactical thinking. More significantly, in the set of tests that psychologists have dreamt up to quantify moral health, their performances clearly bespoke an ignorance of the conceptual foundations of morality.
Some of these tests, such as an "awareness of consequences" test, measure spontaneous thinking in social situations, such as accidentally receiving too much money in a business transaction. Others pose an ethical dilemma - for example, a man must steal a drug in order to save his wife's life - with a subject's solution to the dilemma being scored on a standardised scale. The patients' responses to these tests were about the same as those that would have been expected from a 10-year-old child: that is, they appeared to be motivated exclusively by a desire to avoid personal punishment. This degree of pathology is significantly more serious than that found in those who suffer brain damage as adults.
The most intriguing difference between infant and adult injury, however, emerged when the researchers checked the ability of the two subjects to recall socially relevant facts. In contrast to patients injured as adults, these two could not piece together answers to moral dilemmas during verbal tests. It seemed that they had never learnt any of the basic moral rules that govern social interaction, apparently because their early traumas prevented them from ever acquiring this sort of information.
The upshot of this ignorance is that, to all appearances, they suffer from little or no sense of remorse at their behaviour. In fact, one of the subjects laid the blame for her predicaments squarely on the shoulders of the people around her.
Neurobiologists have long known that the brain can compensate for some sorts of injury that are sustained during the course of its development. It does this by recruiting new sets of nerve cells to substitute for those that have been damaged or destroyed. The pre-frontal cortex, however, seems to be unable to repair itself adequately in this way, leaving infant victims with no means of learning right from wrong during the relevant period of their growth.
The solution, Dr Damasio postulates, may lie in helping that part of the brain to annex more nerve cells. By carefully adjusting levels of the relevant neurotransmitters - chemicals that allow nerve cells to "talk" to one another - alternative pathways that skirt the damaged region could be coaxed into existence. Communication could resume between the reward and punishment pathways that are presumed to underpin the development of moral sense. Which might lead to two more intriguing questions: if it is possible to convert a brain-damaged psychopath into an upstanding citizen, might it also be possible to take ordinary humans, foibles and all, and transform them into moral exemplars? And if it were possible, would it be desirable?
Source: The Economist 23 October 1999
Brain-damage-induced psychopathology - and its potential (or not) for repair - hold huge implications for the field of criminology. If a criminal commits a crime not through his own volition but due to permanent damage inflicted by abuse as a child, how can a rational juror recommend punishment? But what are the alternatives? Will we one day reach a point where brain assessments could cause the death penalty to be assigned - even before a crime was committed? Certainly, this could avoid innocent victims being brutalised, robbed, murdered, et cetera and could save taxpayers huge sums in the upkeep of incorrigibles. But what a slippery slope! I think damaged individuals need to be viewed for what they are - innocent victims themselves- and treated accordingly.
Keep Taking the Tablets
Could food supplements keep Britons out of trouble?
"Doing porridge" - British slang for spending time behind bars - will never be the same if a group of academics in England and Ireland have their way. They have found that improving the diets of prisoners also reduces their tendency to behave badly.
Bernard Gesch, a researcher at Oxford University, wanted to see if bringing inmates' consumption of various vitamins, minerals and fatty acids (the stuff found in fish oil) up to recommended daily levels would affect their behaviour. These days prison canteens generally offer menus which meet national dietary standards, but prisoners often prefer the junk food they buy in the prison shop to the healthier stodge on their trays.
The study involved 231 18-to-21-year-old men in a maximum-security jail in Aylesbury. Half of the offenders received daily nutritional supplements, and the rest placebo pills. The two groups included a comparable mix of anxious, depressed and aggressive individuals. Their antisocial antics - ranging from violent assaults to swearing at the guards - were recorded before and during the experiment.
The results, published in the July issue of The British Journal of Psychiatry, are striking. Those on supplements committed 25% fewer offences than those taking placebos. Moreover, with at least two weeks' "treatment", inmates receiving supplements committed 35% fewer offences than before starting the trial, compared with a 7% reduction in those taking placebos. The team reckons that a year's worth of micronutrient supplements would cost the prison service £3.5m, less than 0.2% of its current annual budget.
These results come as little surprise to Mr Gesch, a former probation officer. He has seen remarkable recoveries in juvenile delinquents whose diets have been adjusted to account for micronutrient deficiencies. This experience, and the success of the Aylesbury experiment, leads him to hope that a similar trial outside prison walls might have a salutary effect on crime in the community.
In the meantime, Mr Gesch and his team at Natural Justice, a charity interested in the social and physical causes of crime, want to expand their prison experiment to include more inmates and more sophisticated measures of which nutrients are having which effects. Researchers in America, whose jails are overflowing, are eager to participate, but experimenting on prisoners is ethically fraught, and so initiating such studies takes time.
One question scientists are keen to address is exactly how such tiny doses of nutrients achieve such big changes in behaviour. Joseph Hibbeln, at the National Institute of Alcohol Abuse and Alcoholism, points to omega-3 fatty acids as prime suspects. There is growing evidence that such fatty acids can lighten depression and reduce irritability in adults; in animal experiments, omega-3 fatty acids have been shown to raise brain levels of serotonin, a biochemical implicated in a variety of mood disorders. Pinning down these links will be key to changing behaviour. In crime control, feeding the mind may one day prove a useful adjunct to locking up the body.
Source: The Economist 27 June 2002
Faulty Gene May Affect Behaviour of Abused Children
by Paul Recer
Washington - Abused children who become violent criminals as adults may be influenced by a gene that fails to make enough of an essential brain chemical, a study says. Based on a 26-year analysis of the lives of 442 males in New Zealand, the study found those men who had a combination of abuse and a less active brain chemical gene were about nine times more likely to commit criminal or anti-social acts as adults than others in the group.
Experts say the finding, appearing this week in the journal Science, could lead to new ways of helping abused children become responsible, nonabusing adults.
The men in the study group were tested for the activity of a gene, called monoamine oxidase A, or MAOA. It produces an enzyme that regulates chemicals in the brain which transmit signals between neurons. Among those studied, 279 were found to have normally active MAOA genes, while 163 showed a low level of action from the gene.
The study found that 64% of the men were not abused in childhood, while the balance experienced either "severe" or "probable" maltreatment - defined as rejection by the mother, frequent changes in primary caregivers and physical or sexual abuse.
At the conclusion of the research, the researchers found that the abused children with low MAOA gene activity - 12% of the study group - accounted for 44% of the violent crime convictions among all of those in the group, said Terrie E Moffitt, a psychologist at the University of Wisconsin, Madison, and a co-author of the study.
"As adults, 85% of the severely maltreated children who also had the gene for low MAOA activity developed anti-social outcomes, such as violent criminal behaviour," Moffitt said in a statement. The abused children with normal MAOA genes were no more likely to be anti-social than those who were not abused, the study found.
The findings provide evidence that genetic characteristics "can moderate children's sensitivity to environmental insults" such as abuse, Moffitt said in an e-mail. "These findings may partly explain why not all victims of maltreatment grow up to victimise others." She said the findings also suggest a new tool for evaluating the risk that a person may become a problem for society. "The combination of the low-activity MAOA genotype and maltreatment predicts anti-social behaviours about as well as high cholesterol predicts heart disease."
Dr John M Leventhal, professor of pædiatrics at Yale University School of Medicine and medical director of the child abuse program at the Yale-New Haven Children's Hospital, said the study was interesting and important because it suggests a biological factor may play a role in causing some abused children to become abusive adults. "If this paper is confirmed by other studies and we have a better understanding about what the biology means, then this may play a role in clinical evaluations in the future," he said.
"We know that not all abused children grow up to be violent. This study supports that observation," said Sid Johnson, president of Prevent Child Abuse American, a Chicago-based group that conducts child abuse research and has chapters in 39 states. "This finding could to lead to a very effective prevention approach."
Paul Recer is the Science Writer for Associated Press
Source: NandoTimes 1 August 2002 © AP Online
Why Genes Matter in Sentencing
by Matt Ridley
A very nice example of this, which is still quite a controversial study, is Terrie Moffitt's work on antisocial behaviour and the mono-amine oxidase-A gene on the x-chromosome, which is going to set the standard for how to understand the genes involved in personality and behaviour. I write about it in Nature via Nurture. She's done a study of a cohort of New Zealanders in Dunedin who've been followed ever since birth. All the kids in this town were followed every year of their life to see what happened to them. It's about a thousand kids. If you take the 400 boys in the sample who have all-white genetic ancestry up to the grandparent level - boys because we're talking about a gene on the x-chromosome - and you look at their mono-amine oxidase-A gene, and you look at whether it's the high-active or low-active version - there are essentially two versions of this gene according to how active they are, according to whether the promoter on the front of the gene has got a certain number of repetitions or a lesser number - does the less active version of the gene correlate with ending up a young adult who is antisocial and who's in trouble with the law? No, it doesn't, in significant correlation. If you then break the data down, though, into those who were abused in their childhood and those who weren't, you find a very strong correlation with this gene. It turns out that if you have the low-active version of this gene, and you had an abusive childhood, then you're going to end up with an antisocial adult - not deterministically, but with a high probability. That seems to me to be a terribly important study, because it shows that when you parcel out the gene-environment interaction, you can find genes in here that you wouldn't have found with the conventional gene-hunting techniques - genes that correlate with behaviour, but that react to the environment.
What are the social implications of finding this? Well, essentially there are none, because we were against child abuse before we knew which genes were involved, and we're against child abuse afterwards. It's possible that you can start to say to a kid who has been abused and it's too late to intervene, "You are going to be all right, because you don't have the particularly responsive version of the gene," or "You're not going to be all right, and therefore we should start putting you on Ritalin or Prozac to try and adjust your brain chemistry during your life." We're a long way from that yet, but that's the kind of social implication you could pull out of it.
Matt Ridley is an Oxford-trained zoologist and science writer whose latest book is Nature via Nurture (HarperCollins)
Source: edge.org from "The Genome Changes Everything"
Perspective on Imitation: Empathy and Criminal Responsibility
by Dr Anne Ruth Mackor
Recent research suggests that empathy plays an important role in normal social awareness and behaviour. What does this mean in regard to criminal responsibility? Do judges and forensic experts consider the capacity for empathy to be a precondition of criminal responsibility? Given the fact that recent investigations suggest capacity for empathy is required to behave "normally", lacking this, is a person who commits a criminal act responsible?
Within the last 15 years, debates have occurred in philosophy of mind and psychology. How are human beings capable of understanding the mental states and actions of their fellow beings? Is it because they develop a folk theory (use rules), or because they are capable of imagining what it is like to be another person (use intuition)? If imagining what others think and feel is important, it follows that this ability is required for at least some moral and legal interpretations and judgments - if I know whether Joe is angry and jealous and hit me on purpose, then I can pass a moral and, if necessary, legal judgment on Joe.
The disorder of autism plays an important role in this debate. Normally-intelligent autists have some understanding of the mental states and behaviour of other human beings, as well as of moral and legal rules. However, their knowledge is impoverished when compared to the "norm". As an example:
Autists apparently use a more explicit and inferential, "theoretical" route than "normal" human beings to understand others. For most people, social knowledge is largely a matter of implicit practical knowledge. The following two examples illustrate the detached nature of autistic social understanding:
Developmental studies show that the innate capacity to simulate in newborn babies is the building block of social knowledge and that this capacity does not work properly in autistic children.
There is also physiological research that shows that subjects who are instructed to describe the negative emotions of others are better at the task if some of their physiological states "resonate", that is become similar to, those of the people they observe. The discovery of mirror-neurons is relevant in this respect. Mirror-neurons not only fire when you do something or when something happens to you (for example, when you prick yourself with a needle), but also when you observe someone else doing the same thing (pricking himself with a needle). Thus, these neurons "resonate". Some theorists think deficiencies in the mirror-neuron system play a crucial role in the disorder of autism.
Research on autists shows that physiological changes do not occur in autistic children; similar physiological changes are also absent in psychopaths. Thus, disorders such as autism and psychopathy seem to offer a serious argument in favour of the claim that empathy plays an important role in understanding social expectations. Purely inferential and detached knowledge of mental states, actions, and social rules is impoverished and insufficient when compared to the seemingly practical, seemingly automatic and intuitive knowledge of "normal" human beings.
Moral psychologists argue that a capacity for empathy is necessary for the development of moral emotions - compassion, shame, guilt, feelings of justice and the like. If someone lacks the capacity for empathy, he is not capable of precisely those emotions that form the foundations of ethics and criminal law. The question is, to what extent do these deficiencies affect his culpability and responsibility? There are two categories of people who have serious deficiencies in their capacity for empathy: psychopaths and autists. (Other categories of people with empathic deficiencies are: people with prefrontal damage, fronto-temporal dementia, and anorexia nervosa.)
Psychopathy is characterised by "an early onset of extremely aggressive behaviour that is not tempered by any sense of guilt or empathy with the victim." Although most serial killers and rapists are psychopaths (for example Hannibal Lecter in The Silence of the Lambs is supposedly a psychopath), many psychopaths perform less extreme anti-social behaviour. Some commit only white-collar crimes (fraud), or even manage to keep within the boundaries of criminal law. All are characterised, however, by the fact that they have very shallow emotions and do not experience feelings of empathy and guilt.
In view of the deficiencies of psychopaths, it might seem right to accord a crucial role to affective empathy in moral cognition and conclude that Kantians are wrong to emphasise the feeling of respect for the "categorical imperative" as the only foundation of ethics. [Immanuel Kant was the 18th-century sage of Konigsberg whose iron reverence for absolute truth as the core value of human nature defeated many a dialectical opponent.] But autists are much more morally responsible persons than psychopaths and this fact can only be accounted for from Kantian perspective.
Autism, too, is characterised by lack of empathy. However, although autists can exhibit aggressive behaviour as a consequence of their deficiencies, autism is not characterised by aggressive behaviour. Moreover, autists, unlike psychopaths, do adhere to rules, distinguish between merely convential and moral rules, experience feelings of guilt and have a strong sense of justice. The following example serves to illustrate the differences between psychopaths and autists:
Thus, although autists apply rules too rigidly and are incapable of weighing interests appropriately, they seem to be moral agents in a Kantian sense of the term, precisely because they have such a rigid view of the world.
An important question to be addressed therefore is how to account for the fact that although both autists and psychopaths lack empathy, autists perform much less anti-social behaviour and are much more responsible beings than psychopaths. What role does empathy play, and what roles do other criteria, such as respect for the law, play in normal behaviour? The answer will help determine whether empathy should be a precondition of criminal responsibility.
Culpability and responsibility in (Dutch) criminal law
The principle "no punishment without guilt" is a foundation of Dutch criminal law. Contrary to civil law, criminal law does not allow for strict liability for any criminal act. For a defendant to be punishable, he should be guilty of committing the criminal act. For someone to be guilty, his act must be culpable. An act is culpable if defendant "could have done otherwise." Although Dutch criminal law is guilt-based law, the question whether defendant is guilty is not the first question to be dealt with. The court must first determine
If either proof or qualification fails, the verdict will be "not guilty". Otherwise, a further question must be answered:
Defences can be either justifications or excuses. Justifications are defences that take away the unlawfulness of otherwise criminal facts; excuses take away the culpability. If the defendant has either a justification or an excuse, he is not punishable and the court will discharge him from further prosecution.
It should be noted that the distinction between justifications and excuses is developed more in the theory than in case law. The statutory description of the special defences in articles 40 - 43 of the First Book of the Dutch Penal Code reflects another distinction, that is, between internal and external causes. As a consequence, some of the articles which deal with external causes deal with both justifications and excuses.
There are two kinds of external causes. They are related to justifications and excuses, respectively. Some external causes are of such a nature that in reasonableness we should not ask of any normal human being to refrain from committing a criminal act (for example self-defence). Therefore such external causes take away, not just the culpability, but the unlawfulness of the act. Characteristically, the defendant acted freely and rationally in such cases.
There are also external causes that affect otherwise normal human beings to such an extent that they were not capable of acting fully rationally and freelyat the time of the crime (for example, excessive self-defence). These external causes do not take away the unlawfulness, but only the culpability of the act.
Finally, internal causes are conditions in the personality of the defendant that have caused him to commit a criminal act. The criminal code recognises two kinds of internal cause: the juvenile age and the insanity of the defendant. The juvenile age (in the Netherlands under 12 years) takes away the possibility of prosecution altogether. The insanity of the defendant might take away the culpability of the act and therewith the possibility of prosecution. Article 39 says:
Although it is common to talk about the responsibility of a disturbed person in general, it should be noted that article 39 deals with criminal responsibility for a particular act only. In cases where article 39 might apply, a forensic expert must determine whether there is a causal relationship between the mental disorder and the criminal act; the court must then decide whether the defendant therefore lacked responsibility for his act. Obviously, whether having a mental disorder results in diminished responsibility for a particular act will depend on the type of act and the circumstances of the act. Thus, a psychotic defendant might be liable for tax fraud, but not for manslaughter.
If there is total absence of responsibility, the court will discharge the defendant from further prosecution. The court can, but need not, combine this decision with an order. Article 37 allows for admission into mental hospital for one year. Articles 37a and 37b allow for placing defendant at the disposal of the government, and this order can be combined with an order to stay in a secured hospital.
Finally, although article 39 suggests that criminal responsibility is an all-or-nothing affair, a five-point scale is commonly used to indicate the degree of criminal responsibility:
In cases of diminished responsibility a combination of punishment and an order is possible.
Does lack of empathy count as an internal cause?
What role do lawyers and forensic experts in fact accord to a lack of empathy? Preliminary investigations into these matters suggest that the capacity for empathy is not systematically taken into account when the mental state and possible excusability of the defendant is investigated. Only one forensic psychologist has explicitly addressed the question what role the capacity for empathy plays in forensic diagnosis. He argued that neither judges nor forensic experts accord a systematic role to the capacity for empathy.
Have the courts given any arguments for according full responsibility to defendants who did not show feelings of empathy and guilt towards the victim? Lack of empathy is more often seen as a reason against mitigation of a sentence than as an excuse for one's action. There is at least one legal case where a lack of empathy was explicitly mentioned as a mental incapacity, but this empathic deficiency did not result in according diminished responsibility. Is there evidence that some of these defendants who were held fully responsible were, in fact, psychopaths or autists? Is there evidence that some of them should have been considered as having diminished responsibility but this was overlooked by the prosecutor or the examining judge or misdiagnosed by forensic experts? Almost certainly, as most jurisdictions around the world consider psychopaths to be legally sane.
Should lack of empathy count as an internal cause resulting in diminished responsibility? Since the legislation intends not only "thinking" disorders, but also strong impulses and emotions to count as "mental disorders" when appropriate, lack of empathy could be a reason for according diminished responsibility.
From an "empathic" point of view, there is an interesting difference between pervasive thought disorders and emotion disorders. Whereas it is difficult, if not impossible, to empathise with someone who has a pervasive disorder, we (or rather some forensic experts and judges) do seem capable of empathising with people who suffer from an emotional disorder. For example, although we know that someone in an acute psychosis is capable of murdering his mother whom he has always loved dearly, we seem to know it in a theoretical way only. Our knowledge is based on explicit inferences from psychiatric theories, not on an imaginative or emotional perspective. Both the content and the structure of psychotic thought are incomprehensible to us. It is in part because we cannot empathise with psychotic defendants that we consider them to be severely diminished responsible. In such cases, perhaps we understand their behaviour in the same way as autists understand our behaviour: our knowledge is explicit, inferential, detached and third-person.
What about those people who seem to be in contact with reality and who are capable of means-ends reasoning and thus seem to be fully rational? Could they yet be have diminished responsibility due to their empathic deficiencies?
Normally intelligent autists are capable of means-ends reasoning and of adhering to rules. Moreover, they experience feelings of guilt when they break a rule. They also are capable of distinguishing between merely conventional and truly moral rules. They fail, however, in properly understanding and weighing the interests of different people and they apply the rules too rigidly.
Psychopaths, conversely, are impulsive, live for the moment, and lack feelings of guilt. Most of them are normally or even highly intelligent and their behaviour appears to be the outcome of a cold but rational choice. Since many psychopaths are glib and charming and capable of deceiving and manipulating, they seem much more normal than autists. As a consequence, we are inclined to think of them as normal but evil beings. Only if we pay careful attention, we notice that the emotions they express so vividly are in fact shallow and that the structure of their thought is defective (they contradict themselves a lot). There is neurophysiological evidence for these defects. The question to be investigated is whether their empathic deficiencies should result in diminished responsibility.
Preliminary investigations strongly suggest that neither legal schoalrs, nor forensic experts, pay systematic attention to the relation between empathy and criminal responsibility. The empirical-philosophical findings, on the other hand, give a more up-to-date and systematic account of the capacity for empathy and the relation between empathy and "normal" thought in general to assist in answering the question "Should empathy be a precondition of criminal responsibility?" The answer seems to be, "While It may not feel 'right' to you, probably, 'Yes.'"
I've summarised a lengthy paper presented by Dr Anne Ruth Mackor at Royaumount Abbey, France, 24 - 26 May 2002. She is a member of the faculty of Law, University of Groningen, PO Box 76, 9700 AS Groningen, The Netherlands and could correct any mistakes I've inadvertently introduced. Email her at A.R.Mackor@rechten.rug.nl. Please access the .pdf file (address below) for the original paper, which has copious references, if you have interest in this subject. Thanks.
I have some concerns. If psychopaths are not responsible for their actions, how do some of them manage not to break the law? Do we assume they just haven't been caught? If they cannot seem to control their actions, then why wait until a law is broken? Shouldn't all persons be required to take an empathy test and, if any fail, be sent to a mental hospital forthwith? And what of those with too much empathy? What are their distinguishing characteristics? Schizophrenia? Angst? Excessive guilt? Are they too moral? Always getting fleeced? They need protection for their own good! (Are we well down that slippery slope yet?)
"Sickened" Reveals Munchausen Victim's Struggles
by Deirdre Donahue
Review of the book Sickened: The Memoir of a Munchausen by Proxy Childhood by Julie Gregory, Bantam, 244 pages, $24.95
The most compelling element of Julie Gregory's Sickened: The Memoir of a Munchausen by Proxy Childhood comes not from the abuse she suffered at the hands of her mother. Rather, it is the way Gregory captures how parenting a child near death can be alluring to a mentally ill woman. And if the child doesn't cooperate - in fact, she possesses good health - then starve, hit and terrorise the child into mimicking the necessary symptoms.
For Gregory's mother, visiting doctors, going to the hospital, and talking to cardiologists and other medical experts gave her life the intensity she craved. A former trick rider and a genuine beauty, to judge from the photos in the book, Sandy Sue Smith grew up in an abusive home, was widowed at 26 and then married a Vietnam veteran named Dan. You know the marriage isn't going to be a happy one when the priest sits the bride-to-be down and asks, "Do you realise this man is crazy, my child? He's crazy."
In fact, it is the wife and later mother who is mentally ill.
Named after an 18th-century aristocrat famous for his outrageous stories, Munchausen by Proxy is one of those diseases that most people have a strange time believing truly exists. How could a parent drag her children from doctors to hospitals to medical centres, insisting that they are sick when they aren't? And how could she watch her children undergo invasive, often painful operations for non-existent ailments? Although Gregory's brother was born healthy and apparently happy, his mother soon had everyone convinced he had asthma.
For the most part, the doctors and nurses come across as sympathetic, listening attentively to the mother, giving her the attention she craved. But something is clearly very wrong. After a week of tests, a cardiologist tells Sandy that her daughter's heart is fine, but instead of relief, the mother displays fury and intense disappointment that open-heart surgery won't be performed. Bells should have gone off in the doctor's head, but people simply do not want to believe that a mother would violate her child in this bizarre manner.
Gregory makes the syndrome comprehensible. If you have a sick child, you don't have to hold a job, you garner enormous sympathy, you consult with doctors, and you exist at the very epicenter of life-or-death drama.
Gregory, who is now an expert in Munchausen by Proxy and a graduate student in psychiatry, skillfully traces how her feelings changed over time. She adored her mother, then began to fear her. And eventually she recognised her to be a potentially fatal menace. To supplement the family's income, Sandy and Dan take in foster children and aged veterans whom Sandy mistreats. And because the state pays for the children's medical expenses, Sandy also hauls them around to doctors.
Gregory's father comes across as a malleable lunk who simply wants to watch TV. But Sandy goads him into beating his daughter by attacking his shaky masculinity. Had he not married such a drama queen, one suspects he might have made an OK father. Yet when the adult Gregory confronts her now-divorced dad, he simply cannot accept responsibility for not protecting his children or the physical abuse he inflicted.
Sandy fascinates. Herself a victim of terrible sexual and physical abuse, she turned her pain toward the world, which she described to her children as a malignant, terrifying place. She would threaten suicide periodically and turn her daughter into her confidant.
Yet the book lacks the usual "woe is me" victim tone. Gregory takes action, gets help, and now is an advocate for Munchausen victims. She's a talented writer and a strong woman.
Source: USA Today Tuesday 28 October 2003
I read this book with mixed feelings. My mother, too suffered from Munchausen by Proxy syndrome. She went to two dozen doctors before she found an old man willing to treat a small growth on my eyelid with radium - which caused me to lose my right eye along with the growth. I didn't just have measles - I had meningitis. I didn't just have mumps - it was encephalitis. I was of course allergic to penicillin, necessitating out-of-the-ordinary treatment. (How did she know I was allergic? Because it made me itch. This was news to me. I said I wasn't itching. She said I was wrong - that I had scratched myself in my sleep.) When my sister was in the 4th grade, she was diagnosed by my mother with rheumatic fever (because she had a sore throat). My mother kept her home in bed until she was 17. (I wasn't allowed to leave the house during those years except to go to school. I couldn't go out to play with friends because it wouldn't be fair to my sister.) When she was about 14, my sister defied my mother and said she felt fine and was going to get up and go to school. My mother gasped and told my sister that her face was white as a sheet, she was obviously going into heart failure and she must immediately return to bed or else fall dead. My sister returned to bed. At one point, my mother found a doctor to prescribe cortisone. My sister went from a raisin to a grape and damaged her kidneys before a different doctor stopped the medicine. Today, my sister's heart shows no sign of ever having been damaged. However, her child died shortly after birth due to her severe edema from her kidney damage and she was advised to have no more children. I could dredge up bazillions of examples. My father had good insurance and my mother immensely enjoyed the position of martyr, saddled with such difficult-to-raise children. Hundreds of times, we kids were ordered front and centre and made to display our infirmities for our guests. Yet we were told daily that we were lucky to have a mother willing to devote her life to our welfare. Yeah, right. When I told her once (at 14) that I had been sexually molested by my 26-year-old cousin, she asked me to forget it - she didn't want to say anything to him about it because it might embarrass her sister (his mother). I married the first person that asked me - someone I had known 2 days. He wasn't the best choice - he later beat me and drank too much and we divorced - but at least it got me out of the dreadful place that up until then I had called home.
No Hard (Genetic) Feelings
by Adriel Bettleheim
Laboratory mice usually are attentive parents, constantly herding their pups into nests and crouching over the offspring to nurse them and keep them warm. So why would the lab mice at the University of Washington start neglecting their young? Because neurobiologist Steven Thomas and molecular biologist Richard Palmiter inactivated a gene in the mice that plays a key role in preparing the brain for motherhood. This gene creates a protein needed to manufacture the brain chemical norepinephrine, which is believed to promote nurturing. When the mice with the altered gene gave birth, they left the pups scattered around the cage, not even bothering to remove placental material. Nearly 3 out of 4 of the pups died of neglect. But when the surviving pups were given to foster mothers with the normal gene, 85% survived.
The researchers' work is part of a fast-growing field that is attempting to answer the age-old nature-nurture question: does biology or the environment playa greater role in determining behaviour? More than 130 years after Austrian monk Gregor Mendel formulated the laws of heredity while studying pea plants, researchers continue to disagree over how much genes control destiny and what that means for public policy.
Research in behavioral genetics is different, but no less controversial, than the burst of cloning research that has dominated news in recent months. Though both come under the rubric of "barnyard biotech," the developmental research does not involve the creation of new organisms. Instead, it explores how genes in DNA carry chemical messages that may influence behavioural traits. Scientists since the mid-1930s have known that certain mutant genes, acting alone or in combination with one another, can cause hereditary diseases. Technology has since been perfected to identify the precise genetic code for conditions such as cystic fibrosis, Huntington's chorea and Tay-Sachs disease, and, in limited cases, physicians are applying gene therapy to treat symptoms.
But over the last two decades researchers have found ways to isolate and characterise DNA sequences from individuals. With these new tools, some scientists now are searching for biological explanations to far more complex phenomena, such as sexuality, risk-taking and violence. Popular attention to the field was sparked by the publication of the controversial 1994 book The Bell Curve in which authors Richard Hermstein and Charles Murray asserted that IQ is largely hereditary and that poverty is a function of inherited low intelligence.
Biologists, psychologists and others drawn to the field say they are concerned about drawing similar broad societal conclusions from limited studies that could have weaknesses in methodology. But their work is nonetheless presenting headline-grabbing evidence that genes may account for previously unexplainable, but commonplace, behaviors. In 1996, a research team reported discovering a link between anxiety-related behaviour and a gene that controls the brain's ability to use a neurochemical called serotonin - the same neurotransmitter targeted by Prozac and other antidepressants. Researchers at the National Institutes of Health (NIH) and the University of Wurtzburg in Gerinany found that individuals who have a slightly shorter version of the gene for the serotonin transporter tend to be more anxious and harbor more negative thoughts and feelings.
That same year, two groups working independently at NIH and in Israel reported a link between excitability, thrill-seeking and quick temper and a gene involved in the activity of the neurotransmitter dopamine, which, among other things, transmits sensations of pleasure. The studies focused on a segment of the gene's molecular code that is repeated either 4 or 7 times in a row. Novelty-seeking seemed more common in people with the sevenfold repetition.
Since then, there have been near monthly announcements of newly discovered suspect genes, often with the caveat that they act in tandem with other genes and the environment to express a trait. Arguably the most controversial connection between genes and behaviour concerns suspected links to crime and violence. Researchers studying a dysfunctional Dutch family announced in 1993 that aggressive behaviour may be linked to a single faulty gene that causes a shortage of enzymes needed to break down serotonin. Since then, scientists and policymakers have engaged in a stormy debate over the roots of crime and possible solutions.
Proponents of continued research say that while the concept of a single "criminal gene" may be the stuff of science fiction, biological markers exist that could make a person more likely to commit crimes or provide clues about populations that are more at risk. Gene therapy to correct any inborn problems could also make an attractive and humane alternative to incarceration, they argue. But critics say labeling a group as predisposed to violence recalls the eugenics movement of the early 20th century, which led to the sterilisation of convicts and some mental patients in the hope of reducing crime among future generations. Many social scientists say researchers, in a rush to "biologise" behaviour, are ignoring environmental influences, such as poverty, broken families and racism.
"We tend to seek quick and easy technological conclusions that aren't always for the public good," says Dorothy Nelkin, a New York University sociologist. "Clearly, there are some genetic factors that contribute to behavior. (But) it's easier to blame the individual than take up what's wrong with the social system."
Many researchers in the pro-gene camp are uncomfortable with such criticisms and take pains to note they are only seeking to study specific biological systems, not prescribing broad solutions. "When you study how a biological pathway works, you know the details, but you're not always able to see the forest from the trees," says Judith Greenberg, director of the division of genetics and development biology at the National Institute of General Medical Sciences. University of Colorado psychologist Gregory Carey says talk about genetic advances is oversimplified and contributes to a misunderstanding of DNA's power, especially when it comes to predicting individual traits.
"We may be able to say a certain percentage of the population is predisposed to a condition, but I doubt we'll ever be able to identify whether Joe Smith will have it or not," Carey says. "Any big headlines have to be taken with a lot of caution."
Source: Congressional Quarterly 1st quarter 1998
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