Social Cognitive and Affective Neuroscience
Psychopaths know right from wrong but don’t care
+ Author Affiliations
- Correspondence should be addressed to Maaike Cima, Department of Developmental, Clinical and Crosscultural Psychology, Tilburg University, P.O.Box 90153, 5000 LE Tilburg, The Netherlands. Email: M.J.Cima@uvt.nl
- Received July 31, 2009.
- Accepted October 19, 2009.
Abstract
Adult psychopaths have deficits in
emotional processing and inhibitory control, engage in morally
inappropriate behavior,
and generally fail to distinguish moral from
conventional violations. These observations, together with a dominant
tradition
in the discipline which sees emotional processes as
causally necessary for moral judgment, have led to the conclusion that
psychopaths lack an understanding of moral rights
and wrongs. We test an alternative explanation: psychopaths have normal
understanding of right and wrong, but abnormal regulation of morally appropriate behavior.
We presented psychopaths with moral dilemmas, contrasting their
judgments with age- and sex-matched (i) healthy subjects
and (ii) non-psychopathic, delinquents. Subjects in
each group judged cases of personal harms (i.e. requiring physical
contact)
as less permissible than impersonal harms, even
though both types of harms led to utilitarian gains. Importantly,
however,
psychopaths’ pattern of judgments on different
dilemmas was the same as those of the other subjects. These results
force a
rejection of the strong hypothesis that emotional
processes are causally necessary for judgments of moral dilemmas,
suggesting
instead that psychopaths understand the distinction between right and wrong, but do not care about such knowledge, or the consequences that ensue from their
morally inappropriate behavior.
Key words
INTRODUCTION
The behavior of psychopaths is, without
doubt, morally inappropriate, including murder, sexual molestation,
fraud, and arson.
Further, clinical analyses show that they present
abnormal emotional profiles, as well as problems with inhibitory
control,
often leading to both reactive and instrumental
aggression (Blair, 1995, 1997, 2008; Blair and Cipolotti, 2000; Blair et al., 1995; Glenn and Raine, 2008; Kiehl, 2006; Kiehl et al., 2001; Raine and Yang, 2006).
What is unclear is the extent to which psychopaths suffer from damage
to morally-specific knowledge that, in healthy individuals,
guides intuitive judgments of right and wrong
independently of their moral actions. On the one hand, studies indicate
that
psychopaths, both adults and juveniles, show a
diminished capacity to distinguish between conventional and moral
transgressions
(Blair, 1995, 1997, 2008; Smetana, 2005; Turiel, 1998, 2005).
For example, unlike healthy adults, adult psychopaths will typically
judge as equally forbidden transgressions in which
a person wears pyjamas to a restaurant
(conventional) and a person who gratuitously hits a waiter in the
restaurant (moral).
Psychopaths also show diminished inhibitory
control, a deficit that may contribute to their impulsive behavior,
especially
in the context of violence (Blair, 2008; Blair and Cipolotti, 2000; Kiehl, 2006).
This research has led to the view that because of their emotional
deficits, psychopaths have corresponding deficits in
moral knowledge which, coupled with poor inhibitory
control, leads to morally inappropriate behavior (Blair, Mitchell, and
Blair, 2005; Nichols, 2002; Prinz, 2008).
Further support for the idea that the
deficit in moral psychology seen among psychopaths is due to the deficit
in emotional
processing, comes from the wealth of research
showing a significant relationship between emotional experience and
moral judgment.
For example, dozens of studies now show that you
can prime people’s emotional state, and as a result, change their
judgment
of particular moral scenarios. For instance,
putting people in a happy state is associated with a greater tendency to
allow
someone to be used as a means to some greater good
(Valdesolo and DeSteno, 2006); associating a neutral word with disgust under hypnosis is associated with more severe moral condemnation (Wheatley and
Haidt, 2006); inducing disgust is associated with more severe moral judgments (Schnall et al., 2008).
In addition to these behavioral studies,
neuroscientific experiments also support the critical role of emotion in
moral judgment.
In particular, several imaging experiments reveal
clear patterns of activation in emotionally-relevant areas when subjects
read about moral dilemmas (Greene, 2003; Greene et al., 2003, 2004; Moll et al., 2002, 2005, 2007).
And further, recent studies of patients with severe deficits in
emotional processing [i.e. fronto-temporal dementia (FTD)
and individuals with bilateral damage to the
ventral medial prefrontal cortex (VMPC)], show a highly selective, but
significant
deficit in moral judgment (Ciaramelli et al., 2007; Koenigs et al., 2007).
For example, whereas VMPC patients, like controls, judged actions
involving impersonal harms (e.g., flipping the switch
on the trolley to kill one person, but save five)
as more permissible than actions involving personal harms (e.g., pushing
the fat man off the footbridge to stop the trolley,
killing the man, but saving the 5), VMPC patients were more likely to
endorse these personal cases, including situations
where aversive acts lead to significant benefits to others. Thus, for a
broad range of moral dilemmas, emotions appear to
play little to no role in guiding judgment; for dilemmas that pit highly
aversive actions against significant utilitarian
gains, these patients favour the outcome, providing evidence for the
causal
role of emotion for a specific class of moral
problems.
The neuropsychological data are of
particular interest because they provide a more causal account of the
relationship between
emotional processes and moral judgment. Further,
and of special interest to the present paper, several authors have
alluded
to the similarity in profile between VMPC patients
and psychopaths, especially their flat socio-emotional responses and
their
lack of inhibitory control (Anderson et al., 1999; Barrash et al., 2000). On this view, psychopaths and VMPC patients should show the same pattern of moral judgments.
Summarizing, a dominant perspective in the
current literature sees intact emotional processes as essential to our
moral psychology.
Here, we consider an alternative framework, one
that motivates the present studies of psychopaths. In particular, though
we
do not deny that emotions play some role in our
moral psychology, it is possible that our emotional experiences follow from our moral judgments as opposed to preceding and guiding them (Huebner et al.,
2008). If this view is correct, then psychopaths may well show normal
patterns of moral judgments relative to control populations.
Where psychopaths deviate is in both not caring
about their judgments (i.e. what they know about morally forbidden and
permissible
cases) and in not engaging with the kinds of
motivational systems that inspire morally appropriate behavior and
inhibit morally
inappropriate behavior.
The following study targets three issues
at the core of current work in moral psychology: (i) To what extent is
normal emotional
regulation necessary for making normal moral
judgments, especially in the context of moral dilemmas where there are
no clear,
societally-mandated or typical responses? (ii) To
what extent are the systems that guide moral judgments dissociable from
those that guide moral behavior? More specifically,
do psychopaths show deficits in both moral knowledge and behavior, in
knowledge, or in the link between knowledge and
behavior? (iii) Given the parallels between psychopaths and VMPC
patients
with respect to their deficits in socio-emotional
processing and self-control, do they show parallel patterns of moral
judgments?
METHODS
Subjects
Participants (all male adults) provided informed consent in accord with the policies of the Ethical Commission of the Faculty
of Psychology and Neuroscience, Maastricht University, The Netherlands. Healthy controls (n = 35; mean age = 30.29 years, SD = 9.99) were recruited from the south of the Netherlands. The psychopath (n = 14; mean age = 36.66 years; SD = 6.55) and non-psychopath (n
= 23; mean age = 40.95 years; SD = 9.77) offenders were sampled from
the Forensic Psychiatric Centre de Rooyse Wissel (FPCdRW)
in Venray, the Netherlands. Of the 37
delinquents, IQ scores were available for a subgroup of 20 (7
psychopaths and 13 non-psychopathic
offenders) participants. Though mean IQ scores
for the psychopaths (M = 81.6, SD = 8.66) was slightly lower than for the non-psychopathic offenders (M = 92.5; SD = 19.37), there was no group difference [t(18) = 1.41; P = 0.18; d = 0.66].
Clinical diagnosis
Psychopathy was assessed by a clinician presenting the Psychopathic Checklist-Revised [PCL-R (Hare, 1991)]
test. The PCL-R is a reliable and valid instrument, designed to measure
psychopathic traits such as antisocial behaviour,
shallowness, impulsivity, callousness, criminal
history, and lack of moral emotions, based on evidence obtained from
medical
and juridical records and documents, as well as
extensive interviews with the forensic patients. Based on a study of
Grann
et al. (1998),
a PCL-R cutoff score of 26 was used to divide the current sample into
psychopaths (PCL-R ≥ 26) and non-psychopaths (PCL-R
< 26). Total PCL-R scores were available for
all 37 offenders. However, of the 14 psychopaths, 2 were described in
the crime
record as having high PCL-R scores, without
mentioning the exact scores. Therefore, the relationship within the
psychopathic
group between PCL-R scores and type of crime (Figures 3 and 4)
were only available for 12 psychopaths. Finally, regarding PCL-R factor
scores, Factor 1 and Factor 2 scores were only available
for 15 subjects.
Fig. 1
The left column presents the results for subjects’ judgments of all 21 dilemmas. There were no differences between healthy
controls (white bar, n = 35), non-psychopathic delinquents (gray bar, n = 23), and psychopaths (hashed bar, n
= 14) for the mean proportion (+s.d.) of Yes judgments. The right
column presents the results for subjects’ judgments on
impersonal (top) and personal dilemmas.
Again, there were no differences between groups. However, all three
groups judged
impersonal dilemmas as more permissible
(i.e. a higher proportion of Yes judgments) than personal dilemmas.
Fig. 2
Scatterplot
of subjects’ judgments (mean proportion of Yes responses) for all
personal moral dilemmas, divided into self-serving
(far left, first three cases) and
other-serving (right, 11 cases) vignettes. Healthy controls are
indicated by white circles,
non-psychopathic delinquents by gray
circles, and psychopaths by hashed squares.
Fig. 3
(A) Scatterplot of psychopathy factor 1 scores for offenders [psychopaths and non-psychopathic delinquents[ [N = 15*] grouped by the proportion of yes judgments for all personal moral dilemmas. (B) Scatterplot of psychopathy factor 2 scores for offenders [N
= 15*] grouped by the proportion of yes judgments for the personal
moral dilemmas. *: For 20 individuals, crime files documented
the administration of a PCL-R interview.
However, these juridical file records only described PCL-R total score
without mentioning
both factor scores.
Fig. 4
(A) Scatterplot of psychopathy scores (PCL-R; N = 12*) grouped by type of crime, against the proportion of yes judgments for all personal moral dilemmas. (B) Scatterplot of psychopathy scores (PCL-R; N
= 12*) grouped by type of crime, against the proportion of yes
judgments for the high conflict, other-serving personal moral
dilemmas. *: For two individuals, crime
files documented the administration of a PCL-R interview. However, these
juridical
file records only described these subjects
as being a psychopath without mentioning the exact PCL-R score.
The PCL-R has two main factors. The first factor comprises interpersonal and affective characteristics of psychopathy, including
shallow affect, lack of remorse or guilt and glibness/superficial charm (Cooke and Michie, 2001; Hare, 2003). The second impulsive, antisocial and unstable lifestyle factor comprises the social deviance characteristics, and includes
impulsivity, early behavioural problems, and parasitic lifestyle (Cooke and Michie, 2001; Hare, 2003).
All psychopathic offenders had a personality diagnosis (Table 1).
Most of them (57.1%) had a diagnosis of cluster B (narcissistic
personality disorder or antisocial personality disorder),
while the minority had a personality disorder
not otherwise specified. Of the non-psychopathic offenders, the majority
suffered
a personality disorder not otherwise specified,
21.7% had a cluster B personality disorder, and 4.3% had a cluster C
personality
disorder.
View this table:
Table 1
Biographical descriptions in percentages and mean (s.d.’s) of the background information of the psychopaths (n = 14), non-psychopathic delinquents (n = 23), and healthy controls (n = 35)
To strengthen the link to emotion all subjects in our test groups also participated in a well-established, physiological test
of stress reactivity involving measures of cortisol [i.e., Trier Social Stress Test; (Kirschbaum et al., 1993; Kirschbaum et al., 1995)].
Results showed that psychopathic offenders, unlike the two comparison
groups, showed no significant increase in cortisol
in response to the stressor. Within both the
non-psychopathic group and healthy controls, cortisol levels
significantly increased
at T1 (before administering the stressor) to T3
(after administering the stressor) as demonstrated by pairwise
comparison
(all t’s > 2.81; all P’s < 0.01 and all t’s > 3.07; all P’s < 0.01, respectively). In contrast, within the psychopathic group there was no significant increase of cortisol levels
between T1 and T3 (all t’s < 1.00; all P’s
> 0.34); see Cima, Popma, and Nicolson (in preparation) for a more
detailed overview of these data. Thus, based on both
their PCL-R scores and stress reactivity
profiles, this psychopathic population showed relatively flat emotional
responses,
consistent with many other studies.
Participants had no history of
psychosis or depression, and no current alcohol or drug dependence. In
the delinquent sample
these criteria were considered by the
psychologist, psychiatrist and file records. In the healthy control
sample, these criteria
were inquired. We tested all offenders on the
moral dilemmas after they had been interviewed with the PCL-R.
Summarizing, both psychopaths and non-psychopathic delinquents differed from healthy controls in that they had been convicted
of crimes; and as in numerous other studies (Herpertz et al., 2001; Kirschbaum et al., 1995; Williamson et al., 1991), psychopaths differed fundamentally from non-psychopath delinquents in that they showed diminished emotional reactivity
based on both the standard clinical diagnostic test [i.e. the PCL-R (Hare, 1991)] and physiological measures (Cima et al., in preparation).
Stimuli
We used the moral dilemmas of Greene et al. (2001, 2004), previously tested with the VMPC patients (Koenigs et al., 2007). Each dilemma was first translated into Dutch by FT, back-translated into English by a second bilingual Dutch-English speaker,
and then checked by MH for accuracy. We presented seven impersonal and 14 personal moral dilemmas (see Supplementary Information). Subjects then answered “yes” or “no” to the question “Would you X?”. A population of native Dutch speakers (adults, 324
females, 348 males) judged these cases on a Dutch version of the Moral Sense Test (http://www.serve.com/∼harvardpcnl/MST/Dutch/),
whereas the three test groups responded to these dilemmas with paper
and pencil. Though we recognize that studies of moral
judgment and responses to artificial dilemmas in
particular, represent only one of several valid approaches to
understanding
our moral psychology, we used this approach to
provide the most direct comparison with VMPC patients, as well as other
recent
studies of intuitive moral judgments.
To control the possibility that psychopaths simply lie about their responses to our moral dilemmas, we also administered a
questionnaire [Socio-Moral Reflection; SRM-SF (Gibbs et al., 1992)],
asking straightforward and explicitly whether certain familiar
transgressions would be morally permissible. For instance,
“How important is it to keep a promise to your
friend?”; “How important is it not to steal?”. Answers could be given on
a
5-point scale, ranging from very unimportant to
very important. Scores on the SRM-SF questionnaire result in a total
score
and a score of moral standing, indicating the
level of moral development.
RESULTS
The Dutch sample responding on the web-based version of this task replicated the overall pattern obtained in prior research:
subjects provided fewer endorsements of personal dilemmas (M = 0.37, SD = 0.28) than of impersonal dilemmas (M = 0.75; SD = 0.26; U = 22; z = 2.01; P = 0.04; r = 0.08).
As in our larger Dutch sample, all three test groups judged impersonal cases as more permissible than personal cases (Figure 1): healthy controls (U = 13.0; z = 2.69; P = 0.007; r = 0.46); non-psychopathic delinquents (U = 18.0; z = 2.32; P = 0.02; r = 0.48); psychopaths (U = 23.5; z = 1.92; P = 0.05; r
= 0.52). Thus, for all four test populations, individuals are more
likely to perceive up close and personal harms as less
permissible than harms that come about by
impersonal means, such as flipping a switch in the classic trolley
problem.
To examine whether the groups differed on
the percentage of cases in which they endorsed the action – supporting
the utilitarian
outcome – and more generally, test the hypothesis
that psychopaths (like VMPC patients) are more utilitarian on personal
scenarios,
we performed a 3 (test populations) × 2 (impersonal
vs personal dilemmas) ANOVA (see also, Supplementary Information for Bayesian analyses of the same data set, designed to test the null hypothesis of no group differences). There was, as
noted above, a highly significant dilemma type effect [F(1,69) = 20.02; P = 0.0001; d = 2.03], but no significant group effect [F(2, 69) = 0.21; P = 0.81], and a non-significant interaction [F(2,69) = 0.22; P = 0.80; Figure 1]. Bonferroni corrected post-hoc tests revealed no statistically significant group effect for either impersonal (P’s > 0.18) or personal moral dilemma (P’s > 0.41).
Evaluation of educational level demonstrated a significant difference between the groups, with offenders having lower levels
of education than non-offenders, but no difference between the two groups of offenders (χ2[2] = 12.90; P < 0.05). More importantly, an ANCOVA demonstrated that there was no significant effect of education on judgments of either
personal or impersonal dilemmas (all P’s > 0.05).
Healthy controls were generally younger than both delinquent groups. Since there was a significant age difference [F(2,69) = 9.29; P
< 0.000], due to healthy controls being younger than
non-psychopathic delinquents, we conducted a correlation analysis to
examine whether age was related to moral responses.
For both personal as well as impersonal dilemmas, there was no effect
of age (r = 0.04 and −0.21 respectively with all P’s > 0.05).
Given that prior work on VMPC and FTD
patients revealed a highly selective deficit within the personal
dilemmas, with greater
endorsements of the utilitarian outcome for
other-serving (i.e. harming one for the benefit of others) than
self-serving (harming
one for self-benefit) personal dilemmas, we
explored in greater detail the variance in responses to personal
dilemmas by both
delinquent groups and our controls (Figure 2). An overall 2 (Self vs Other-serving) × 3 (Psychopaths, Delinquents, Controls) ANOVA revealed a statistically significant main effect for dilemma
type, with subjects judging other serving cases as more permissible than self-serving [F (1, 36) = 48.52; P < 0.0001]. There was, however, no main effect for the three test populations [F (2, 36) = 0.81; P = 0.45] and nor was there a statistically significant interaction between dilemma type and test population [F (2, 36) = 1.01; P = 0.37]. Thus, psychopaths were not more likely to endorse the utilitarian outcome for other-serving, personal dilemmas.
On a scenario level, there were several
dilemmas that elicited virtually complete support of the utilitarian
outcome by subjects
in all groups (80–100% Yes judgments) or virtually
complete prohibition of this outcome (0–20% Yes judgments; Figure 2).
For example, each of our test populations agreed that the actions to be
taken in dilemmas 2, 3, 4 and 6 were largely impermissible,
whereas those in dilemmas 13 and 14 were largely
permissible; furthermore, although subjects in all three test
populations
were less clear about the permissibility of the
action for several cases (e.g. 7, 8, and 11 in Figure 2),
all clustered around the same proportion of Yes responses. Lastly,
although the mean permissibility ratings for psychopaths
were higher than the control populations for 8 out
of 11 other-serving dilemmas, the variance in all three groups was
sufficiently
high to make this apparent difference
non-significant. More specifically, for 3 of the 11 other-serving
dilemmas, the delinquents
provided a greater proportion of Yes judgments; for
four of these dilemmas, the psychopaths differed from the other groups
by less than 15%, leaving only four cases where the
psychopaths judged the case more permissible by 20–40%. Thus, even on
a case by case basis, there is no consistent
pattern of judgments that is mediated by the characteristics of our
study populations.
We also explored the difference in
judgments within the class of other-serving cases in which sometimes,
harming one to benefit
many others makes the one worse off (e.g., the
footbridge trolley case where pushing the man off the bridge kills him
but
saves five) whereas in others, harm to the one is
inevitable, does not make the individual worse off, and yet benefits
many
others (e.g., every person in a war bunker will be
killed by enemy soldiers if anyone makes noise, so if a baby starts
crying,
killing the crying baby doesn’t make her worse off,
but saves the others); these latter cases are often described as Pareto
dilemmas, and in previous work, are typically
judged more permissible than non-Pareto cases where the one is made
worse off
(Huebner, Pettit, and Hauser, in review; Moore et al., 2008). Group contrasts for the Pareto cases failed to reveal a significant difference (P’s > 0.22).
Of the 37 delinquents, PCL-R factor scores were available for 15 subjects. There was no statistically significant correlation
between subjects’ moral judgments on personal dilemmas and their factor 1 (r = −0.02, P = 0.95) or 2 scores (r = −0.02; P = 0.93; Figure 3A and B).
Though there is a generally agreed upon
cut-off on the PCL-R diagnostic for classifying individuals as
psychopaths (i.e.,
scores of 26 or higher), there was, as in all
previous work, variation among our subjects in such scores, as well as
in the
nature of their criminal conviction. To assess
whether such variation was related to their moral judgments, we plotted (Figure 4A)
each psychopath’s PCL-R score against the proportion of personal
dilemmas that they endorsed, and further grouped the subjects
by their type of crime. Though the sample size is
too small to evaluate statistically, neither the scatter in the data
shows
relationship between PCL-R score and proportion of
personal dilemmas endorsed, nor a clear pattern for type of crime.
Similarly,
there was no effect of PCL-R score or type of
conviction on the proportion of utilitarian outcomes endorsed for the
other-serving
cases (Figure 4B).
Results on the SRM-SF showed that overall there was no statistically significant difference among the groups, with psychopaths
showing slightly lower SRM-SF scores (M = 276.14; SD = 33.43) than healthy controls (M = 286.03; SD = 45.15), whereas non-psychopathic offenders had slightly higher SRM-SF scores (M = 290.01; SD = 46.59) than healthy controls [F(2,69) = 0.45; P = 0.64]. None of the post-hoc tests were statistically significant (all t′s < 0.98; P > 0.34).
DISCUSSION
Philosophers, legal scholars, and scientists agree that our moral judgments are influenced by processes of reasoning, intuition
and emotion (Damasio, 1994; Dwyer, 2004; Greene, 2003; Haidt, 2001; Hauser, 2006; Mikhail, 2007, 2009; Posner, 1999),
where controversy emerges in deciding which of these processes alone or
in combination provide the source of our moral
judgments. For example, though we often reflect
upon moral problems, weighing the pros and cons of particular actions
and
outcomes, using our knowledge of similar cases to
deliberate, several recent studies indicate that such rational and
reasoned
contemplation often arises after an intuitive
system has fired off a judgment of moral permissibility. Commonly, this
intuitive
process has been aligned with the emotions, and
more specifically, the source of our moral judgments lie in our feelings
about
particular actions and outcomes (Blair et al., 2005; Haidt, 2001; Moll et al. 2007; Nichols, 2004; Prinz, 2008). Support for this position comes from three lines of evidence: (i) subjects are dumb-founded by their judgments, unable
to provide a coherent explanation for why a particular action is morally forbidden (Haidt, 1993, 2001); (ii) emotional priming influences moral judgment (Schnall et al., 2008; Valdesolo and DeSteno, 2006; Wheatley and Haidt, 2006); (iii) when healthy subjects process moral scenarios, classic emotional areas activate (Greene et al., 2001, 2004; Moll et al., 2002a, b, 2005); in contrast, patients with diminished emotional processing (i.e., FTD, VMPC, and psychopaths) show different patterns of
moral judgments than healthy subjects, at least for a particular set of moral problems (Anderson et al., 1999; Blair, 1995, 1997; Koenigs et al., 2007; Mendez et al., 2005).
The present work was aimed at both the
general thesis that proper emotional processing is necessary for moral
understanding,
and the more specific thesis that the compromised
emotional processes of psychopaths accounts for their abnormal moral
psychology,
including most specifically, their heinous violence
and disregard for others. Our results license two conclusions. First,
like healthy subjects and non-psychopath
delinquents, psychopaths judged impersonal moral actions as more
permissible than
personal moral actions. As previously noted (Greene
et al., 2001, 2004),
this distinction is anchored on an emotional gradient, with impersonal
cases considered less emotionally intense than personal
cases. Thus, even though psychopaths show
diminished emotional processing, either a sufficient level or type of
emotion is
preserved or non-emotional processes can carry out
the relevant computation required to evaluate these particular moral
scenarios.
Second, though psychopaths showed diminished
emotional processing relative to both control groups, and even though
both delinquent
groups differed from healthy subjects in their
morally inappropriate behaviors (e.g., paedophilia, murder), there were
no
group differences in moral judgments for either
impersonal or personal scenarios. Furthermore, though there was
variation
among our psychopathic participants in terms of
their PCL-R scores, as well as the nature of their criminal convictions,
there
was no relationship between these factors and their
moral judgments.
At one level, these results could be
perceived as conflicting with both previous studies of psychopaths as
well as those with
VMPC patients. In particular, adult psychopaths
generally make less distinction between conventional and moral
transgressions,
whereas VMPC patients tend to provide a higher
proportion of utilitarian judgments for a subclass of personal moral
dilemmas.
These data have been used to argue among the
critical and causal role of emotion in generating normal moral
judgments. However,
it is difficult to provide firm evidence for a
causal link between emotion and moral judgments, since both the
theoretical
arguments and empirical evidence to date are
unclear about how specific types of emotion, impact upon moral judgment
with
moral concerns. Consider, for example, the Koenigs et al. (2007)
paper, though it is generally agreed that patients with damage to VMPC
have emotional deficits, and in particular, show
difficulty with social emotions such as empathy,
embarrassment, and guilt, it is not clear how the absence of these
emotions,
or the reduction in their manifestation would cause
subjects to provide more utilitarian judgments for the narrow range of
other-serving dilemmas. That is, why would the
aversiveness of harming one person be diminished because one feels less
embarrassment,
empathy, or guilt? And even if one could provide a
coherent account, including the possibility in the absence of guilt, one
is simply less affected by harming one person, then
why would not the same argument go through for other cases of harm that
were present but that showed no group differences?
Furthermore, even if there is a coherent account for this aspect of
process,
it doesn’t necessarily show that emotions dictate
how we decide whether an action is morally right or wrong. For example,
it could be some other set of processes that makes
this decision, but emotions titrate the severity of judgment. Thus, for
example, when the social emotions are diminished
with respect to their impact on decision making, we see harming one as
less
bad when there is a greater good, i.e. both VMPC
patients and normals see harming one for some greater good as bad, but
VMPC
patients simply see the harm as less bad. On this
view, emotions are like a gain function, moving our judgments up and
down
a scale from very bad or forbidden to obligatory or
required (see Huebner et al. 2008, for further development of this argument).
There are at least two reasons why the
psychopathy data on the moral-conventional distinction leave many
questions unanswered,
especially in terms of the specific role of
emotions: 1) since both adults and juveniles received scenarios that
were designed
for children, it is unclear how adult psychopaths
would fare on adult versions; 2) the adult and juvenile psychopaths
appear
to have opposite judgment biases, with adults
judging most cases to be forbidden whereas juveniles consider most to be
permissible;
why differences in emotion would lead to this
developmental flip-flop is unclear.
Though VMPC patients show some of the
same kinds of emotional deficits as do psychopaths, no one has yet
established how specific
kinds of emotion are causally linked to specific
kinds of moral problems. For example, though VMPC patients generate
normal
judgments for most moral dilemmas tested so far, it
is not clear why diminished capacity to experience empathy,
embarrassment
and loyalty should lead to a selective deficit for
other-serving moral dilemmas in which a highly aversive action is pitted
against a significant utilitarian outcome. Given
these uncertainties, it is perhaps less surprising, and at odds with the
existing data, psychopaths show normal patterns of
moral judgments for moral dilemmas. More specifically, though
psychopaths
show some of the same emotional deficits as
patients with damage to VMPC, other aspects of their emotions may be
relatively
preserved, and these may be the most important with
respect to moral understanding. At present, however, this literature is
unclear, with some studies reporting normal
recognition and judgments by psychopaths of basic emotions such as
anger, fear,
sadness and disgust, whereas other studies show
differences, including evidence of abnormalities in brain activation
during
imaging studies of emotional processing (Blair et al., 2002; Fullam and Dolan, 2006; Muller et al., 2003; Pham et al., 2000).
Furthermore, though psychopaths may show deficits in distinguishing
conventional from moral cases, whatever cognitive function
is necessary for this distinction is apparently
unnecessary with respect to judging moral dilemmas, and especially, for
perceiving
the difference between personal and impersonal
cases. This conclusion is reinforced by a recent imaging study of
psychopaths
in which individuals evaluated the same set of
dilemmas presented here, showed reduced activation in the amygdala
relative
to controls (Glenn et al., 2009), but no difference in judgments (Glenn, Raine, Schrug, Young, and Hauser, in press). Moreover, Glenn et al.
(in press) show that non-prison convicted psychopaths (classified based
on the PCL-R) evidence significantly lower amygdala
activation relative to controls, and significantly
higher DLPC activation. Amygdala is associated with processing
predominant
negative emotions, and especially fear. In
contrast, the DLPC plays a critical role in conscious reasoning and
decision making.
Despite these neural differences, population of
non-prison convicted psychopaths showed no differences in moral judgment
from
a control group.
Lastly, it is possible that the emotional deficits of psychopaths only show up, or show up most intensely, under pressure
to respond quickly, or feel compelled to do so, thereby triggering their more impulsive character (Kiehl, 2007). Here, there was no such pressure, perhaps resulting in normal patterns of judgment.
We conclude that psychopaths make the
same kind of moral distinctions as healthy individuals when it comes to
evaluating the
permissibility of an action embedded in a moral
dilemma. Consequently, these results support the hypothesis that normal
social
emotional processing does not appear necessary for
making these kinds of moral judgments. Normal emotional processing is
likely
to be most important in generating an appreciation
of these distinctions and in guiding actions (Huebner et al.,
2008). Psychopaths know what is right or wrong, but simply don’t care.
Given that legal distinctions often turn on whether
crimes are committed knowingly (e.g., Model Penal
Code), these results could have bearing on court decisions concerning
the
nature of moral knowledge – i.e. instead of
strictly focusing on criminal actions carried out knowingly, we should also focus on whether such knowingly immoral and illegal actions are carried out caringly. Equally important, these results may shed light on treatment, pushing clinicians to distinguish between the sources of deficit
regarding morally relevant decisions and actions.
Acknowledgments
This study was supported by a grant to MC
from the Netherlands Organization for Scientific Research (NWO) grant
number: 451-05-020,
and to MH from the National Science
Foundation-Human Social Dynamics. We would like to thank the patients of
the Rooyse Wissel
for participating in this study. For comments on
the data and earlier drafts of the manuscript, we thank James Blair,
Joshua
Greene, Kent Kiehl, Walter Sinnott-Armstrong, Liane
Young, and two authors of SCAN. The authors declare they have no
competing
interests.
- © The Author (2010). Published by Oxford University Press. For Permissions, please email: journals.permissions@oxfordjournals.org
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