An Appetite for Aggression: The peculiar psychology of war likely holds answers for avoiding future atrocities

Summarized Reading

Apr

25

An Appetite for Aggression: The peculiar psychology of war likely holds answers for avoiding future atrocities

 

Scientific American Mind

May/June 2013

p. 46

 

 

Fear is a pure form of stress.

 

We all try as best as we can to avoid fear, but the emotion is the key to survival.

When humans recognize they are in acute danger, the brain triggers a cascade of physical alarms.

 

   Senses sharpen to take in information about prospective threats.

 

   Blood rushes to the muscles.

 

   The body releases chemicals to suppress pain.

 

Then the individual is ready either to run for cover or to stand and fight.

An aggressive move often is enough to make a foe back down.

 

Lashing out in self-defense is a common response.

 

Researchers call this facilitative aggression or reactive aggression.

 

There is another form of violence--an evil form--called appetitive aggression.

Appetitive aggression arises from the thrill of the hunt.

 

The act of planning an attack can arouse intense excitement.

Appetitive aggression is a common phenomenon--which makes it truly frightening.

 

The more that young men perceive violence as giving them feelings of superiority and pleasure that otherwise are lacking in their lives--the more frequently they engage in aggressive acts and the more the young men seek out the stimulation that hunting and killing provides.

 

Inflicting pain on others is part of a human's basic stock of behaviors--every bit as much as caring for the sick and the injured.

 

The question is why it is part of the basic stock of behaviors.

A few million years ago, our ancestors began to hunt and to eat meat.

This provided a concentrated source of energy lacking in an earlier all-vegetarian diet.

 

According to one theory, eating meat allowed humans' energy-intensive brains to grow bigger and more complex.

 

This evolutionary development provided a cognitive advantage that allowed humans to dominate the planet.

 

The more successful hunters could feed more offspring, attract more sexual partners, and attain higher status in a group.

Humans not only hunt other animals, but when conflict arises, humans hunt members of our own species.

 

Culture is what constrains individuals and society from wanton violence (malicious and unrestrained violence) by outlining who is friend and who is foe.

Humans are socialized into a code of conduct that disapproves of antagonizing those belonging to our own group.

Attention has not been devoted to understanding what the consequences are when the civil code of conduct is violated on a grand scale.

 

Insights into the psychology of war are all-important to help societies rebuild after periods of conflict.

 

Trauma research documents that the greater an individual's exposure to life-threatening events, the greater the likelihood the person will develop post-traumatic stress disorder (PTSD).

 

This connection has been observed in soldiers and civilians.

 

In the evolutionary past of humans, the question becomes whether the killing of our own kind evolved as an innate strategy for securing greater reproductive success.

 

Perhaps violence might not always lead to trauma.

An opportunity to examine the idea arose with 269 Rwandan prisoners who were accused or convicted of crimes related to the genocide that occurred in 1994.

 

The prisoners were asked about the types of trauma they encountered and were asked about the crimes they committed.

 

The severity of their PTSD symptoms were assessed and the prisoners were probed to determine whether they had acquired a taste for violence.

Two questions asked of the prisoners were:

 

   Once fighting has started, do you get carried away by the violence?

 

   Once you get used to being cruel, do you want to be crueler and crueler?

 

One-third of the men answered they did; few women said that it was true for them.

 

In two other questions, more than one-half of the men agreed that they tended to get carried away by the violence of a fight, and that defeating an opponent was more fun when they saw blood.

 

30% of the women agreed they get carried away, and 40% admitted that blood made defeating an opponent more fun.

 

Although women were not as likely to develop a zeal for aggression, they were not immune to it.

Data collected from Rwanda, Ugandan child soldiers, and South African criminal offenders showed a trend.

 

The more violent the events were that these people witnesses or committed--the higher their rating on the questionnaire concerning appetitive aggression.

 

These higher scores also predicted fewer symptoms of PTSD; the correlation is that relishing violence benefited their mental health.

Observing atrocities and engaging in them predicts the enjoyment of cruelty.

Despite these findings conflicting with society's deeply held sense that violence is morally repulsive, the findings help the public comprehend how conflicts perpetuate and how so many people can die so quickly in genocidal sweeps.

In 2011, military historian Sönke Neitzel and social psychologist Harald Welzer published excerpts from the transcripts of World War II Allies who had eavesdropped on captured soldiers from the German Wehrmacht (German armed forces; combined German military branches).

 

The conversations revealed that among some of the fighters, there was a fascination with violence and the hunting down of humans.

 

The revelations upset the former war participants who feared being labeled as monsters.

 

But the transcripts were consistent with studies.

Then there is the question as to what happens when combatants return to society.

 

The hypothesis was that their lust for violence would subside.

 

Evidence showed that those who spent more time in society after the events of atrocity, the lower their scores on aggression but the higher their symptoms of trauma.

 

This is because violence is perceived as more acceptable when operating in perpetrator mode, but it becomes less acceptable when the person is returned to the tempering influence of social culture.

All the data suggests that the thrill of the kill is not a sign of mental illness and is it is not uncommon.

 

Human ancestors on the hunt were not so different from contemporary combatants.

Both groups experience great hardships; sometimes they must track their prey for days; and they must suppress their fear of being injured or killed entirely.

To endure these conditions, behaving brutally must become rewarding and potentially pleasurable.

This is not to say that humans enjoy murder.

 

Only child soldiers--who have been recruited by force before reaching puberty--sometimes describe their first kill in glowing terms.

 

Most everyone experiences extreme stress.

 

But relentless battle can break down moral inhibitions and can alter perceptions of actions.

 

War changes people.

Former soldiers talk of how their previous life provided them the opportunity to fight, rape, and kill.

 

They discuss their overwhelming sense of isolation now that they no longer are involved in heroic deeds that other fighters understand, but that civilians reject summarily.

 

Many express how they miss the power and how the sight of blood gets them going.

Because the public struggles to comprehend what happens in war, soldiers often lack finding and receiving adequate social support when they return to civilian life.

 

They may struggle with emotions that conflict with the values of their surrounding culture.

 

They may fail to adjust to new opportunities and new ways of life.

 

In order to begin counseling combatants, it is important to understand their experiences in the heat of battle so as to integrate them back into society and to help curb the calamity brought on by violence.

 

Posted 25th April by Adam Gaha

Location: Indianapolis, IN 46280, USA

 

Labels: culture blood cruelty danger killing foe violence fear hunt PTSD pain survival perpetrator mode genocide pleasure Scientific American Mind stress self-defense appetitive aggression rape

 

What do conspiracy theories, religious beliefs and detoxifying proteins have in common?

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What do conspiracy theories, religious beliefs and detoxifying proteins have in common?

 

By Ashutosh Jogalekar | May 10, 2013 |  12

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People who believe in conspiracy theories display the classic symptoms of patternicity and agenticity (Image: Caffeinated Thoughts)

Why do people believe in God, ghosts, goblins, spirits, the afterlife and conspiracy theories? Two common threads running through these belief systems are what skeptic Michael Shermer in his insightful book “The Believing Brain” calls “patternicity” and “agenticity”. As the names indicate, patternicity refers to seeing meaningful patterns in meaningless noise. Agenticity refers to seeing mysterious but palpable causal ‘agents’, puppet masters who pull the strings and bring about unexplained phenomena. God is probably the perfect example of an agent.

Patternicity and agenticity can both be seen as primitive evolutionary features of our brain that have been molded into instinctive behaviors. They were important in a paleolithic environment where decisions often had to be made quickly and based on instinct. In a simple example cited by Shermer, consider an early hominid sauntering along somewhere in the African Savannah. He hears a rustle in the grass. Is it a predator or is it just the wind? If he assumes the former and it turns out to be the latter, no harm is done. But if he assumes it’s just the wind and lets down his guard and it turns out to be a predator, that’s it; he’s lunch and just got weeded out of the gene pool. The first mistake is what’s called a ‘Type 1’ or false-positive error; the second one is a ‘Type 2’ or a false-negative error. Humans seem more prone to committing false positive errors because the cost of (literally) living with those errors is often less than the cost of (literally) dying from the false negatives. Agenticity is in some sense subsumed by patternicity; in the case of the hominid, he might end up ascribing the noise in the grass to a predator (an ‘agent’) even if none exists. The important thing to realize is that we are largely the descendants of humans who made false-positive errors; natural selection ensured this perpetuation.

Before we move on it’s worth noting that assuring yourself a place in the genetic pool by committing a false positive error is not as failsafe as it sounds.

Sometimes people can actually cause harm by erring on the side of caution; this is the kind of behavior that is enshrined in the Law of Unintended Consequences. For instance after 9/11, about a thousand people died because they thought it safer to drive across the country rather than fly. 9/11 did almost nothing to tarnish the safety record of flying, but those who feared airplane terrorism (the ‘pattern’) reacted with their gut and ended up doing their competitors’ gene pools a favor.

Yet for all this criticism of pattern detection, it goes without saying that patternicity and agenticity have been immensely useful in human development. In fact the hallmark of science is pattern detection in noise. Patternicity is also key for things like solving crimes and predicting where the economy is going. However scientists, detectives and economists are all well aware of how many times the pattern detection machine in their heads misfires or backfires. When it comes to non-scientific predictions the machine’s even worse. The ugly side of patternicity and agenticity is revealed in people’s belief in conspiracy theories.
Those who think there was a giant conspiracy between the CIA, the FBI, the Mob, Castro and the executive branch of the government are confronted with the same facts that others are. Yet they connect the dots differently and elevate certain individuals and groups (‘agents’) to great significance. Patternicity connects the dots, agenticity sows belief. The tendency to connect dots and put certain agents on a pedestal is seen everywhere, from believing that vaccines cause autism to being convinced that climate change is a giant hoax orchestrated by thousands of scientists around the world.

Notwithstanding these all too common pathologies of the pattern detection machine, it’s satisfying to find a common, elegant evolutionary mechanism in our primitive brain that would be consistent with generally favoring false positives over false negatives. What I find interesting is that this behavior even seems to exist at the level of molecules.

I realized this when I was recently studying some proteins whose exclusive job is to metabolize and detoxify foreign molecules. These proteins can be seen as the gatekeepers of the cell. Throughout evolution we have been bathed in a sea of useful, useless and toxic chemicals. Our bodies need some mechanism for distinguishing the good molecules from the bad. To enable this living organisms have evolved several proteins which bind to these molecules and in most cases change their structure or simply eject them from the cell. The most important of these are called cytochrome P450 and P-Glycoprotein. Cytochrome P450 metabolizes drugs, nutrients, hormones, poisons; basically any molecular entities that living organisms encounter in a changing environment. P-Glycoprotein is a kind of vacuum cleaner that first sucks up molecules and then throws them out.

A molecular model of cytochrome P450, a protein that metabolizes and detoxifies foreign molecules such as toxins (Image: ESRF)

Cytochrome P450 and P-Glycoprotein are crucial for detoxifying our body and letting only ‘good’ molecules pass through. But like our early hominid they are imperfect and seem to often err on the side of caution, making false positive errors. This problem is routinely confronted by drug developers who are consternated to find molecules that may perform perfectly in killing cancer cells in test tubes, but that are immediately modified or ejected out of the cells by cytochrome P450 and P-Glycoprotein when administered to test subjects like rats or human beings. Finding a putative drug compound that will not be modified or rejected by cytochrome P450, P-Glycoprotein or any number of other gatekeeper proteins is one of the biggest challenges in early stage drug development.

And yet if we think about it, both cytochrome P450 and humans are doing the bidding of patternicity and agenticity. For a human as well as for a protein, generally speaking it’s much safer to make a false positive error than a false negative one. In case of cytochrome P450, it might be ok if it discards a useful nutrient or two along with dozens of toxic chemicals. But if it lets even two or three deadly compounds from, say, snail toxin or snake venom in, those might be the last compounds it encounters during the painfully short lifetime of its human owner. Now of course, at the beginning when cytochrome P450 was in the process of evolving it probably existed in many more forms than what it does today. Some of these forms committed false positive mistakes and others committed false negatives. But it’s clear from the ongoing discussion that just like the human hearing the rustle in the grass and mistaking it for the wind, proteins which committed false negative errors were declared persona non grata by natural selection and weeded out. Those making false positive mistakes lived another day to see another molecule ejected.

To me the observation of patternicity and agenticity at the level of human brains as well as individual proteins is a testament to the enormous power and elegance of evolution in molding living organisms across an incredible hierarchy of molecules, cells, organs, individuals and societies through common mechanisms. It occurs to me that if evolution had to pick favorite lines from poems, one of them would probably be “Two roads diverged on the way to life, and I took the one which made me commit a false positive error”.

About the Author: Ashutosh (Ash) Jogalekar is a chemist interested in the history and philosophy of science. He considers science to be a seamless and all-encompassing part of the human experience. Follow on Twitter @curiouswavefn.

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The views expressed are those of the author and are not necessarily those of Scientific American.

Tags: belief, chemistry, evolution, proteins, psychology

What Boston Showed about Human Nature

What Boston Showed about Human Nature

In the seconds after the explosions came an answer to an ancient question: Are we by nature good, or bad?

By Adrian F. Ward

The Boston Marathon Bombings: An In-Depth Report The deadly April 15 explosions unnerved a city and a sport. How can science and technology stop terrorist attacks and save lives? New stories will be added daily   » April 16, 2013

At 2:50 PM on Monday, April 15, I was sitting in my Cambridge office, separated from the finish line of the Boston Marathon by 2.5 miles of parks, city streets, and the iconic Charles River.  Around 3:00 PM, I started receiving what would soon become a flood of messages—texts, emails, and Facebook chats, from friends, family members, and high-school classmates: “Are you ok?” “Are you safe?” “You’re not at the marathon, are you?”

This is how I learned what else happened at 2:50 PM.  This is how I learned that mere miles away, two home-made bombs had detonated, killing three people and wounding 183 more.  And this is what led me to pace the halls of my building, knocking on every door; to contact, in any way possible, friends I knew were there, at that finish line; to make sure that these people—my people—were safe.
In times of distress and unease—of apparent attack—it’s easy to think in us-vs-them terms: to care only about our people, our city, our country.

But if these attacks were perpetrated against any “us,” it was the “us” of humankind.  The official list of marathon participants includes more than 23,000 athletes: males and females ranging in age from 18 to 83; runners, handcyclists, and wheelchair operators; citizens of 96 different countries and 6 of 7 continents (only Antarctica—which is not home to any permanent human residents—was not represented).  They were us.  And they were diverse.

The bombs exploded at a site celebrating this magnificent diversity—along the home stretch of the Marathon, a section of Boylston Street lined with the flags of each participant’s native country.  This diversity was also displayed by the injured, and the dead—an 8-year-old boy, a 29-year-old restaurant manager, a 23-year-old Chinese graduate student.

This was, and is, a tragedy.  There is no denying it.

But in the midst of this tragedy, there also was—and is—an unmistakable beauty.
In the immediate aftermath of the explosions—even as debris continued to fly through the air—countless people ran not away from the blasts, but towards them.  These people had no way of knowing whether or not there would be more explosions, no way of knowing whether or not they were putting their own lives in danger; they simply saw others in need and immediately rushed to help.  At the same time, more people—many of them marathoners who had just completed a draining 26.2 mile test of endurance—began to rush en masse to nearby Massachusetts General Hospital, seeking to give their own blood for the hundreds of wounded that would soon follow.  In fact, so many people showed up that the hospital was forced, multiple times, to turn away would-be donors; there were simply too many people trying to help.

These overwhelming displays of helping—of selflessness and what psychologists call “prosocial behavior”—are beautiful in and of themselves.  But they are even more beautiful because they transcend us-vs-them ways of thinking.  These actions were not reserved for members of one group, one city, or one country; they were enacted without preference or prejudice, directed at victims of every color, creed, age, and gender.  And they are still more beautiful because of their immediacy.  These actions were not the result of carefully considered decisions, of weighing the pros and cons of each possible behavior; they were virtually instantaneous, seemingly born of a raw, instinctive urge to help those in need.  In the face of overwhelming tragedy, people sought to help the “us” of humankind—immediately, prodigiously, and with little regard for their own safety.

A long tradition of research in social and evolutionary psychology tells us that this behavior doesn’t make sense.  That people operate according to fundamentally selfish instincts, and that these selfish instincts can be found in every organism, every cell, and every gene.  According to this tradition, thinking of any “us” at all can be explained as a means to the end of preserving one’s own physical and psychological well-being, living to see another day, and producing children that have a reasonable chance of doing the same.  Ostensibly altruistic behaviors—everything from sharing resources to laying down one’s life to save others—can be explained by fundamentally selfish motives like reputational concerns (the desire to be seen in a positive light), kin selection (the desire to preserve one’s genetic material, sometimes even at the cost of one’s own life), or simply a desire to ease the personal discomfort that comes along with viewing others in distress.  In short, people help others to help themselves.

But other research tells a different story.  When people find “lost” letters on the sidewalk, they tend to mail them to the intended recipients, even though this good deed will receive no recognition or reward, does nothing to further their own genetic legacy, and probably does not relieve much personal distress.  People make anonymous financial donations, and as many as 32% are even willing to anonymously donate their own internal organs—while still living—to complete strangers.  Even children who are four years old spontaneously help others with no apparent concern for approval from friends and/or authority figures, personal benefits, or moral (good/bad) imperatives.  Examples such as these provide a counterargument to the selfish view of human nature that has long dominated psychological research.  They suggest that people may help others with little or no thought for their own well-being; people may help others simply because they need to be helped.

Of course, it could be that these heartwarming actions can also be explained by selfish motives, ones that are simply more difficult to pin down.  Or it could be that these actions represent the outcome of hard-fought battles pitting conscious control against selfish core impulses—victories for virtue, yes, but ones that require continuous effort and are likely to be surrendered as soon as people are unable or unwilling to continue overriding their selfish impulses.  It could be that when caring for others threatens people’s own welfare, they will retreat into increasingly smaller moral circles—from caring for the “us” of humankind to the “us” of their families, friends, and ingroup members; from caring about this restricted “us” to only caring about themselves.  It could be that, when people are put to the ultimate test, self-preservation will always win out.

The Boston Marathon bombings put people to this test.  The attack created chaos, pain, and destruction; it destroyed lives and landscapes.  It destroyed pretense.  Those on the scene were immediately forced to face the jarring reality of those who had already been injured—a reality that represented both these victims’ need for help and the possibility that providing help could result in personal injury from further explosions.  In this situation, people had neither the time nor the resources to override impulses or think strategically; they could only react, behaving intuitively and emotionally.

It is in these reactions that I see beauty.  In the initial movements of the helpers—the first responders, the blood donators, the countless men and women who rushed in to do anything and everything they could to fix the gaping hole left by those Monday afternoon explosions—I see an extreme example of the human capacity for selflessness.  I see evidence that people tend to intuitively, instinctively, and perhaps automatically reach out to others in times of need.  I see that extreme situations can cause people to transcend us-vs-them thinking, uniting diverse peoples into the “us” of humankind.

In the few days since the bombings, the intervening events—continued loss of life, a night filled with sirens and shootouts, a day spent in “lockdown,” the capture of a 19-year-old, and the heartfelt displays of appreciation for law enforcement—have threatened to prematurely relegate the explosions on Boylston Street to the past.  Similarly, the delayed reactions of some—actively seeking a “them” to set up in opposition to “us”—have threatened to overshadow the immediate and selfless reactions shown by those at the scene.  Taken together, these actions and reactions show that people are complex, confusing, and often self-contradictory.  However, they also highlight the immense capacity for human goodness present in the midst of this complexity.
They offer the hope, at least, that the good in people will always overcome the bad.

Are you a scientist who specializes in neuroscience, cognitive science, or psychology? And have you read a recent peer-reviewed paper that you would like to write about? Please send suggestions to Mind Matters editor Gareth Cook, a Pulitzer prize-winning journalist at the Boston Globe. He can be reached at garethideas AT gmail.com or Twitter @garethideas.

ABOUT THE AUTHOR(S)

Adrian F. Ward is a doctoral candidate in the Department of Psychology at Harvard University.  His research focuses on morality, social networks, decision-making, memory, and technology.

Study: Belief in an angry God associated with variety of mental illnesses

Study: Belief in an angry God associated with variety of mental illnesses

By Stephen C. Webster

Wednesday, April 17, 2013 10:19 EDT

 

Topics: anxiety disorders 

Marymount Manhattan College Assistant Psychology Professor Nava Silton

People who believe in an angry, punishing God are much more likely to suffer from a variety of mental illnesses, a scientific study published in the April edition of Journal of Religion & Health finds.

The study, conducted by Marymount Manhattan College Assistant Psychology Professor Nava Silton, used data from the 2010 Baylor Religion Survey of US Adults to examine the links between beliefs and anxiety disorders like social dysfunction, paranoia, obsession and compulsion.

To do this, Silton viewed the data through the lens of what’s called Evolutionary Threat Assessment System Theory, which posits that parts of the brain specifically evolved to detect threats, and suggests that many anxiety disorders may be a result of dysfunction in the brain’s perception of those threats.

In keeping with prior studies on this very subject, she queried the data on three types of believers: those who see God as angry, those who see God as neutral and those who see God as loving. Controlling specifically to weed out the non-believers, Silton found that a belief in a forgiving, loving God is associated with positive psychological traits, “almost protecting against psychopathology,” she told Raw Story.

But for those who think God is angry and preparing punishments for sinners, “that belief seems to be very much related to these negative symptoms,” Silton said.

“If you look at the previous research, they’ve connected it to depression and all sorts of other psychiatric disorders,” she said. “We were looking at social phobia, obsession, compulsion, paranoia and a lot of features of anxiety disorders.”

One thing Silton stressed is that her study should not be construed to have found a cause for such symptoms. “We are not looking at casual findings here,” she said. “We are looking at correlational findings. That means we’re not saying belief caused psychiatric symptoms, but we see relationships between beliefs and these psychiatric symptoms.”

Silton said that while her study was mostly quantitative in nature, she’s looking forward to “asking more qualitative questions” in future work, specifically “to look into what else belief systems might be related to.”

“We’d like to look more specifically at depression and eating disorders,” she said. “Do different beliefs in God relate to eating disorder symptoms? So, [we want to be] looking beyond just anxiety disorders.”

——
Photo: Shutterstock.com.

The Boston Marathon Bombing and the Limits of Human Empathy

Posted by Chauncey DeVega at 10:19 am

April 16, 2013

The Boston Marathon Bombing and the Limits of Human Empathy

 

Photo Credit: Wikimedia

We can grieve and mourn the victims of the Boston Marathon bombing. However, the ritual of loss--and of beginning a righteous search (as opposed to a witch hunt where our Arab and Muslim brothers and sisters are abused and harassed, while the White Right and the American militia crowd is treated as de facto above suspicion) for those individual(s) who committed this crime--should not interfere with critical thinking, national introspection, or truth-telling.

Moreover, I would also suggest that this is precisely the time, when a people are surprised, hurt, and made to feel vulnerable, that difficult questions about justice and the human condition should be asked. Once the shock passes and a callus forms, it is easy to ignore foundational questions about our shared human existence and what ties us together.

Ultimately, when the illusion of perpetual safety and security has been shattered a bit--and when all Americans across the colorline have been made to feel  "vulnerable, unsafe, and insecure"--is precisely the time when a critical moment of self-reflection should take place.

A question. What are the limits of human empathy?  3 people were killed and many dozens injured and maimed by the Boston Marathon bombing on Monday. By comparison, many more people are killed by American drones and other weapons of war on a weekly, if not daily basis, across the Middle East and in other parts of the world.

The language of "war" and "terrorism" deems these people not human, but rather "targets" and "terrorists" to be "neutralized." The CIA and other organs of the United States government admit that their targeting procedures are imprecise, and that in killing one "terrorist" many more people who are guilty of nothing more than being nearby are also annihilated, broken apart, burned alive, and shattered.

The metrics are against the United States: her war machine is killing many more innocents than the "guilty," thus, ensuring blow back for years to come.
Speech is political. It reinforces certain types of realities and norms. Here, "those" people are deemed legitimate targets of violence and death. "Our" people are innocent and should be safe in their personhood and body at all times.
Is this calculus the necessary result of nationalism and "patriotism?" Why are the lives of those folks who just happen to live in other countries cheaper and less valuable than Americans?

Is the nation state built upon the fictive ties of those who live in geographic proximity to one another, or in the same imagined country or territory? By design, are our ties to other human beings, who by coincidence of birth live in other parts of the world, diminished and minimized?

I wonder how much better, or perhaps worse in some counter intuitive ways, our world would be if the American people could be as upset about the deaths from the bombing of the Boston Massacre, as those others which occur almost everyday, all over the world--many of which are either directly or indirectly done in supposed pursuit of "national defense" and/or the the United States' "national security."

Do we dare to dream?

What Psychopaths Teach Us about How to Succeed

What Psychopaths Teach Us about How to Succeed [Excerpt]

We can learn a lot from psychopaths. Certain aspects of their personalities and intellect are often hallmarks of success

By Kevin Dutton

Adapted from The Wisdom of Psychopaths, by Kevin Dutton, by arrangement with Scientific American/Farrar, Straus and Giroux, LLC (US), Doubleday Canada (Canada), Heinemann (UK), Record (Brazil), DTV (Germany), De Bezige Bij (Netherlands), NHK (Japan), Miraebook (Korea) and Lua de Papel (Portugal). Copyright © 2012 Kevin Dutton

Traits that are common among psychopathic serial killers—a grandiose sense of self-worth, persuasiveness, superficial charm, ruthlessness, lack of remorse and the manipulation of others—are also shared by politicians and world leaders. Individuals, in other words, running not from the police. But for office. Such a profile allows those who present with these traits to do what they like when they like, completely unfazed by the social, moral or legal consequences of their actions.

If you are born under the right star, for example, and have power over the human mind as the moon over the sea, you might order the genocide of 100,000 Kurds and shuffle to the gallows with such arcane recalcitrance as to elicit, from even your harshest detractors, perverse, unspoken deference.

“Do not be afraid, doctor,” said Saddam Hussein on the scaffold, moments before his execution. “This is for men.”

If you are violent and cunning, like the real-life “Hannibal Lecter” Robert Maudsley, you might take a fellow inmate hostage, smash his skull in and sample his brains with a spoon as nonchalantly as if you were downing a soft-boiled egg. (Maudsley, by the way, has been cooped up in solitary confinement for the past 30 years, in a bulletproof cage in the basement of Wakefield Prison in England.)

Or if you are a brilliant neurosurgeon, ruthlessly cool and focused under pressure, you might, like the man I'll call Dr. Geraghty, try your luck on a completely different playing field: at the remote outposts of 21st-century medicine, where risk blows in on 100-mile-per-hour winds and the oxygen of deliberation is thin. “I have no compassion for those whom I operate on,” he told me. “That is a luxury I simply cannot afford. In the theater I am reborn: as a cold, heartless machine, totally at one with scalpel, drill and saw. When you're cutting loose and cheating death high above the snowline of the brain, feelings aren't fit for purpose. Emotion is entropy—and seriously bad for business. I've hunted it down to extinction over the years.”

Geraghty is one of the U.K.'s top neurosurgeons—and although, on one level, his words send a chill down the spine, on another they make perfect sense. Deep in the ghettoes of some of the brain's most dangerous neighborhoods, the psychopath is glimpsed as a lone and merciless predator, a solitary species of transient, deadly allure. No sooner is the word out than images of serial killers, rapists and mad, reclusive bombers come stalking down the sidewalks of our minds.

But what if I were to paint you a different picture? What if I were to tell you that the arsonist who burns your house down might also, in a parallel universe, be the hero most likely to brave the flaming timbers of a crumbling, blazing building to seek out, and drag out, your loved ones? Or that the kid with a knife in the shadows at the back of the movie theater might well, in years to come, be wielding a rather different kind of knife at the back of a rather different kind of theater?

Claims like these are admittedly hard to believe. But they're true. Psychopaths are fearless, confident, charismatic, ruthless and focused. Yet, contrary to popular belief, they are not necessarily violent. Far from its being an open-and-shut case—you're either a psychopath or you're not—there are, instead, inner and outer zones of the disorder: a bit like the fare zones on a subway map. There is a spectrum of psychopathy along which each of us has our place, with only a small minority of A-listers resident in the “inner city.”

Think of psychopathic traits as the dials on a studio mixing deck. If you turn all of them to max, you'll have a soundtrack that's no use to anyone. But if the soundtrack is graded, and some are up higher than others—such as fearlessness, focus, lack of empathy and mental toughness, for example—you may well have a surgeon who's a cut above the rest.

Of course, surgery is just one instance where psychopathic “talent” may prove advantageous. There are others. In 2009, for instance, I decided to perform my own research to determine whether, if psychopaths were really better at decoding vulnerability (as had been found in some studies), there could be applications. There had to be ways in which, rather than being a drain on society, this ability actually conferred some benefit. And there had to be ways to study it.

Enlightenment dawned when I met a friend at the airport. We all get a bit paranoid going through customs, I mused. Even when we're perfectly innocent. But imagine what it would feel like if we did have something to hide—and if an airport security officer were particularly good at picking up on that feeling?
To find out, I decided to conduct an experiment. Thirty undergraduate students took part: half of them high on the Self-Report Psychopathy Scale, and half of them low. There were also five “associates.” The students' job was easy. They had to sit in a classroom and observe the associates' movements as they entered through one door and exited through another, traversing, en route, a small, elevated stage. But there was a catch. They also had to note who was “guilty”: Which one of the five was concealing a scarlet handkerchief?

To raise the stakes and give the observers something to “go on,” the associate with the handkerchief was handed £100. If the jury decided that they were the guilty party—if, when the votes were counted, they came out on top—then they had to hand it back. If, on the other hand, they got away with it, and the finger of suspicion fell heavier on one of the others, they would, in contrast, stand to be rewarded. They would, instead, get to keep the £100.

Which of the students would make the better “customs officers”? Would the psychopaths' predatory instincts prove reliable? Or would their nose for vulnerability let them down?

More than 70 percent of those who scored high on the Self-Report Psychopathy Scale correctly picked out the handkerchief-smuggling associate, compared with just 30 percent of the low scorers. Zeroing in on weakness may well be part of a serial killer's tool kit. But it may also come in handy at the airport.

Trolleyology

Joshua Greene, a psychologist at Harvard University, has observed how psychopaths unscramble moral dilemmas. As I described in my 2011 book, Split-Second Persuasion, he has stumbled on something interesting. Far from being uniform, empathy is schizophrenic. There are two distinct varieties: hot and cold.

Consider, for example, the following conundrum (Case 1), first proposed by the late philosopher Philippa Foot:

A railway trolley is hurtling down a track. In its path are five people who are trapped on the line and cannot escape. Fortunately, you can flip a switch that will divert the trolley down a fork in the track away from the five people—but at a price. There is another person trapped down that fork, and the trolley will kill him or her instead. Should you hit the switch?

Most of us experience little difficulty when deciding what to do in this situation. Although the prospect of flipping the switch isn't exactly a nice one, the utilitarian option—killing just the one person instead of five—represents the “least worst choice.” Right?


Now consider the following variation (Case 2), proposed by philosopher Judith Jarvis Thomson:

As before, a railway trolley is speeding out of control down a track toward five people. But this time you are standing behind a very large stranger on a footbridge above the tracks. The only way to save the five people is to heave the stranger over. He will fall to a certain death. But his considerable girth will block the trolley, saving five lives. Question: Should you push him?

Here you might say we're faced with a “real” dilemma. Although the score in lives is precisely the same as in the first example (five to one), playing the game makes us a little more circumspect and jittery. But why?

Greene believes he has the answer. It has to do with different climatic regions in the brain.

Case 1, he proposes, is what we might call an impersonal moral dilemma and involves those areas of the brain, the prefrontal cortex and posterior parietal cortex (in particular, the anterior paracingulate cortex, the temporal pole and the superior temporal sulcus), principally implicated in our objective experience of cold empathy: in reasoning and rational thought.

Case 2, on the other hand, is what we might call a personal moral dilemma. It hammers on the door of the brain's emotion center, known as the amygdala—the circuit of hot empathy.

Just like most normal members of the population, psychopaths make pretty short work of the dilemma presented in Case 1. Yet—and this is where the plot thickens—quite unlike normal people, they also make pretty short work of Case 2. Psychopaths, without batting an eye, are perfectly happy to chuck the fat guy over the side.

To compound matters further, this difference in behavior is mirrored, rather distinctly, in the brain. The pattern of neural activation in both psychopaths and normal people is well matched on the presentation of impersonal moral dilemmas—but dramatically diverges when things get a bit more personal.
Imagine that I were to pop you into a functional MRI machine and then present you with the two dilemmas. What would I observe as you went about negotiating their moral minefields? Just around the time that the nature of the dilemma crossed the border from impersonal to personal, I would see your amygdala and related brain circuits—your medial orbitofrontal cortex, for example—light up like a pinball machine. I would witness the moment, in other words, that emotion puts its money in the slot.

But in a psychopath, I would see only darkness. The cavernous neural casino would be boarded up and derelict—the crossing from impersonal to personal would pass without any incident.

The Psychopath Mix

The question of what it takes to succeed in a given profession, to deliver the goods and get the job done, is not all that difficult when it comes down to it. Alongside the dedicated skill set necessary to perform one's specific duties—in law, in business, in whatever field of endeavor you care to mention—exists a selection of traits that code for high achievement.

In 2005 Belinda Board and Katarina Fritzon, then at the University of Surrey in England, conducted a survey to find out precisely what it was that made business leaders tick. What, they wanted to know, were the key facets of personality that separated those who turn left when boarding an airplane from those who turn right?

Board and Fritzon took three groups—business managers, psychiatric patients and hospitalized criminals (those who were psychopathic and those suffering from other psychiatric illnesses)—and compared how they fared on a psychological profiling test.

Their analysis revealed that a number of psychopathic attributes were actually more common in business leaders than in so-called disturbed criminals—attributes such as superficial charm, egocentricity, persuasiveness, lack of empathy, independence, and focus. The main difference between the groups was in the more “antisocial” aspects of the syndrome: the criminals' lawbreaking, physical aggression and impulsivity dials (to return to our analogy of earlier) were cranked up higher.

Other studies seem to confirm the “mixing deck” picture: that the border between functional and dysfunctional psychopathy depends not on the presence of psychopathic attributes per se but rather on their levels and the way they are combined. Mehmet Mahmut and his colleagues at Macquarie University in Sydney have recently shown that patterns of brain dysfunction (specifically, patterns in orbitofrontal cortex functioning—the area of the brain that regulates the input of the emotions in decision making) observed in both criminal and noncriminal psychopaths, exhibit dimensional rather than discrete differences. This, Mahmut suggests, means that the two groups should not be viewed as qualitatively distinct populations but rather as occupying different positions on the same continuum.

In a similar (if less high-tech) vein, I asked a class of first-year undergraduates to imagine they were managers in a job placement company. “Ruthless, fearless, charming, amoral and focused,” I told them. “Suppose you had a client with that kind of profile. To which line of work do you think they might be suited?”
Their answers couldn't have been more insightful. CEO, spy, surgeon, politician, the military … they all popped up in the mix. Amongst serial killer, assassin and bank robber.

“Intellectual ability on its own is just an elegant way of finishing second,” one successful CEO told me. “Remember, they don't call it a greasy pole for nothing. The road to the top is hard. But it's easier to climb if you lever yourself up on others. Easier still if they think something's in it for them.”

Jon Moulton, one of London's most successful venture capitalists, agrees. In a recent interview with the Financial Times, he lists determination, curiosity and insensitivity as his three most valuable character traits.

No prizes for guessing the first two. But insensitivity? The great thing about insensitivity, Moulton explains, is that “it lets you sleep when others can't.”

This article was originally published with the title The Wisdom of Psychopaths.

ABOUT THE AUTHOR(S)

Kevin Dutton is a research psychologist at the Calleva Research Center for Evolution and Human Sciences at Magdalen College, University of Oxford.

MORE TO EXPLORE

What “Psychopath” Means. Scott O. Lilienfeld and Hal Arkowitz in Scientific American Mind, Vol. 18, No. 6, pages 80–81; December 2007/January 2008.

Inside the Mind of a Psychopath. Kent A. Kiehl and Joshua W. Buckholtz in Scientific American Mind, Vol. 21, No. 4, pages 22–29; September/October 2010.

How to Act Like a Psychopath without Really Trying [Excerpt]. John Whitfield. Published online December 9, 2011, at www.ScientificAmerican.com/article.cfm?id=how-to-act-like-a-psychopath

Psychiatric Times. Vol. 29 No. 7 CLINICAL  Narcissistic Personality Disorder: Rethinking What We Know By Giancarlo Dimaggio, MD | July 18, 2012 Dr Dimaggio is Psychiatrist and Psycotherapist at the Center for Metacognitive Interpersonal Therapy in Rome. Surprisingly, to the eyes of many experts, DSM-5 better captures the essence of narcissistic personality disorder (NPD) than previous versions did. Many clinicians (myself included) were dissatisfied with the descriptions of NPD in earlier versions of DSM. Persons with NPD are aggressive and boastful, overrate their performance, and blame others for their setbacks; current editions of DSM portray them as arrogant, entitled, exploitative, embedded in fantasies of grandeur, self-centered, and charming but emotionally unavailable. This portrayal of persons with NPD conveys only a minimal sense of their self-experience and misses their complexity. (MORE: Psychotherapy Tips: Working With Persons With Narcissistic Personality Disorder) Characteristics of NPD The draft of DSM-5 gives hints of what persons with NPD experience and, most importantly, provides a snapshot of a complex set of their self-experiences and disturbed mental processes. This description, though it may not be complete, is consistent with much of what we know from clinical experience and personality research about both NPD and narcissistic traits in the general population. An inherent problem of NPD is a disturbed internalized representation of self and others. Self-states and self-other schemas Feelings of grandiosity and fantasies of power and success are certainly important but are not the core theme in a narcissistic stream of consciousness. The DSM-5 prototype notes how self-appraisal can swing from hypervalued to self-derogation along with fluctuations in self-esteem. This is consistent with the idea that nuclear narcissistic states are not lim-ited to “being the one who sets people’s standards for the year to come,” as the disdainful protagonist of The Devil Wears Prada loved to say. NPD manifests as anger triggered by feelings of social rejection and tendencies to derogate those who give negative feedback. Persons with NPD often feel hampered in pursuing goals and blame others for being inept, incompetent, or hostile. States in which the self-image is extremely negative are important but are so hard to bear that fighting with others and blaming them for any personal flaws is a more suitable defensive maneuver. When shortcomings are impossible to deny (eg, being fired from work, breaking affective bonds), persons with NPD are likely to become depressed; as they age, the risk of suicide increases. Following the lead of the psychoanalysts Kohut 3 and Modell,4 states of emptiness, emotional numbing, and devitalization are now included in NPD models. Such states are quintessential to the disorder, but they are not included in the current DSM-5 prototype and have been overlooked by researchers. Other prominent narcissistic states include an inability to forgive and feelings of shame, guilt, and envy at others’ successs. In persons with NPD, self-experience patterns coalesce into self-other relational schemas: the dominant motives are concerns with social rank/antagonism, and the need to be admired and recognized by others as being special; the dominant image is of an “other” person unwilling to provide attention. The main schema is the “self” who desires to be recognized or admired and the “other” who is dominant and critical. In one schema, the self reacts with overt antagonism or by resorting to a metaphorical ivory tower.5 Another prominent schema is the self that needs attention while the other rejects and again criticizes the self, which, in turn, steers the self to compulsive self-soothing and denial of attachment needs.5,6 In general, such persons spend much time ruminating about issues of antagonism/social rank and avoid forming or thinking about attachments, thus concealing their vulnerable self. Empirical support has been found for the possibility that patients with NPD or narcissistic traits tend to seek self-enhancement, to overreact when they perceive others are setting limits, and to self-soothe.7 The development of NPD There is no consensus on the causes of NPD, although lack of parental empathy toward a child’s developmental needs may bear some responsibility. In the context of disturbed attachment, parents may fail to appropriately recognize, name, and regulate the child’s emotions, particularly in cases of heightened arousal.8 The developing child is therefore left with intense affects that receive no appropriate recognition or appropriate responses, which leads to affect dysregulation. In children, with their basic needs unmet, attachment becomes an issue; this translates to being attachment-avoidant in adulthood yet, at the same time, constantly striving for attention and admiration. Another trigger for NPD may be that the child is raised in a family where status and success are of utmost importance and only qualities that lead to sustaining a grandiose self-image are valued while other behaviors are disregarded or punished. Another possibility is that overt grandiosity is a reaction to slights and humiliation, a sort of armor used to avoid subjugation. Other factors, such as an externalizing personality and the role of culture (the narcissistic society) in paving the way to narcissism, should also be explored. Although studies on causation are scant, Tracy and colleagues9 summarize some recent findings in which parenting styles, such as mixtures of overt praise and coldness, lack of supervision, corporal punishment, and authoritarian parenting, predicted future narcissism. What is already known about narcissistic personality disorder? ■ Narcissistic personality disorder (NPD) is characterized by complex self-experiences, including grandiosity, anger, self-derogation, and emptiness or apathy. Lack of empathy is a feature of the disorder. Frequently, there are impaired romantic and professional outcomes as well as co-occurring disorders. What new information does this article provide? ■ Impaired ability to recognize inner states is a feature of the disorder. Evidence for affective but not cognitive empathy is presented. An agency deficit is a core characteristic of the disorder, with typical oscillations between diminished agency and hyperagentic behavior. Structured options for psychotherapy are succintly offered. What are the implications for psychiatric practice? ■ Persons with NPD are amenable to treatment. Understanding that underlying feelings of vulnerability, impaired self-reflection, and diminished agency are core features of the disorder may lead to refined psychological treatments, keep these persons in therapy longer, and promote structural personality change. The need for testing the effectiveness of manualized treatments for NPD is called for. Regulatory processes NPD features unrelenting standards for maintaining a sense of self-worth and personal goals valuable enough to be pursued. As a result, narcissism seems to include perfectionism as a trait and, after any accomplishment, the target is usually raised even higher, which results in never-ending dissatisfaction.5 Perfectionist standards are also set for others, which leads the narcissist to easily derogate others for not living up to his expectations. Other strategies for affect and interpersonal regulation are blaming others, withdrawing from relationships, adopting controlling and domineering strategies when facing problems and conflicts, and typically self-enhancing when facing others’ expected feedback. Agency and goal-setting The early observation by Kohut 3 that persons with NPD lack an inner drive to act was counterintuitive, because at least from the overt, blatantly arrogant type, one would expect a tendency to ruthlessly keep singing “I shall overcome.” But, when persistence is needed, strongly narcissistic persons tend, after some initial sparkling moments, to decline. Clinical experience with such patients highlights the fact that when they are not struggling for grandiosity or fighting against a tyrant, they lack access to those innermost wishes that could make them feel alive and vital and instead feel flat and inanimate. They lack a sense of existential agency. Thus, they are other-directed and their striving for admiration is a coping strategy for avoiding a sense of nothingness. DSM-5 observations such as “excessive reference to others for self-definition” or “goal-setting is based on gaining approval from others” capture this agency deficit—a problem that is a primary psychotherapeutic target. Overall, agency in narcissism is 2-sided: when social rank is at stake and narcissists feel competent, they are self-sufficient and feel mastery over the situation, which triggers grandiosity. When there are other motives, such as when success is not in sight, and when narcissists feel vulnerable or in difficulty, agency diminishes. In this latter case, they feel paralyzed, empty, and passive. Impaired empathy and poor understanding of mental states Empathy dysfunction is considered central to narcissism, with cognitive empathy considered less diminished than affective empathy.1,10,11 Persons with narcissism are able to understand how someone else feels but cannot respond appropriately. Only recently has empirical evidence appeared in support of an NPD criterion that to date was only based on clinical observations. This evidence provides insight into how diminished empathy works in the mind of such persons. Narcissism is associated with less emotional empathy in laboratory tasks but not in self-reports, which is to be expected: narcissists think they are empathic, when in reality they are not. Cognitive empathy is unaffected, although lack of motivation may reduce the ability to empathize. A functional MRI study showed that persons high in narcissistic traits displayed decreased activation in the right anterior insula during an empathy task.10 Study participants were unaware of their empathy impairment, which is a typical feature of narcissism and warns against using self-reports for investigating empathy in the NPD population. It is interesting to note that study participants who were high in narcissism and low in empathy were also more unaware of their own emotions. This finding is consistent with claims that reduced empathy is part of a wider impairment in the system of abilities to understand mental states, which includes poor self-awareness.5,12 Indeed, persons with NPD feature an inability to recognize some emotions in the self and, in particular, to understand the triggers for emotional reactions. DSM-5 ascribes dysfunctions in self-awareness to NPD, “often unaware of own motivations” or noting narcissistic tendencies to be “excessively attuned to others’ reactions but only if perceived as relevant to self.” Poor self-awareness is the underlying problem in NPD. Although narcissists are fully aware of being annoyed by persons who hamper their goals and attack their vacillating self-esteem, they have difficulty in accessing wishes and needs and in understanding what triggers some of their reactions. As a consequence, they constantly need others to understand their wishes and provide validation and support. Therefore, empathy is a costly and risky action for persons with NPD. This is likely to be connected to the inadequate parenting they received during their development, with caregivers who were unable to appropriately recognize, name, and regulate their affects. Such poor parenting is thought to leave narcissistic adults constantly looking for someone to help them recognize what they feel and to support their wishes, which leave them deprived of any possibility of focusing on others’ mental states. In short, poor self-awareness yields confusion about wishes and puts the person with NPD at risk for being influenced by others. When others display signs of suffering, the narcissist feels these others are distracting attention that rightly be-longs to him or her and the perception of loss increases. Empathy shuts down. CASE VIGNETTE Fred was a brilliant manager in his late 20s who had NPD. He was a perfectionist who was emotionally constricted, was unable to enjoy life, and reacted to any slights and criticisms with frozen anger or by overcontrolling his behavior to prevent any further criticism. His goal was to reach the highest performance level at work and to be recognized by others for his special qualities. To him, social life made sense only in terms of professional achievements. Any attempts at autonomy or acting spontaneously were inhibited because of fear of criticism and rejection. Self-esteem was regulated either by being successful at work or by physical exercise in order to reach perfect harmony in the functioning of his body. He wanted his girlfriend to be perfect and criticized her when she gained weight. His rigid, overcritical attitude and his inability to fully enjoy sexual life strained their relationship. During therapy, I adopted a validating stance: recognizing and accepting his wishes for autonomy and need to relax instead of striving to be accepted only when he reached the highest standards. I also pointed out that receiving criticism instead of emotional recognition had made him suffer, something I empathized with. He was offered a job in a major firm in the Netherlands that would have required him to move abroad. His girlfriend was supportive but also sad at the idea of separation. Fred interpreted this as a sort of emotional blackmail and became angry because he felt she was constraining his freedom. During sessions, associations were made between his current NPD and events that had taken place when he was younger. He was always an excellent student and at the top of his class, but his father was never satisfied and always expected more. In therapy, Fred understood that for his family, not meeting unrelenting moral and performance standards spelled terror and inability to give life meaning. He realized that he took his girlfriend’s reaction to the job offer as another sign that he could not be free to follow his own plans without evoking negative reactions in others. He realized that she was not being tyrannical, but supportive. Empathy for her increased while at the same time he was able to successfully apply for the new job. To the best of my knowledge, there have been no randomized clinical trials that have looked at treatment for NPD; therefore, the idea that NPD can or cannot be treated relies solely on clinical judgment. Different approaches, both cognitive and psychodynamic, have devised procedures to deal with narcissism, including, among others, relational psychoanalysis, object-relation psychoanalysis, schema-focused therapy, cognitive analytic therapy, and metacognitive interpersonal therapy.3,4,5,6,13,14 Although treatment guidelines have never been formulated, I have distilled tips for treating narcissism using the reported evidence and the DSM-5 prototype as a potentially reliable guide, with no intention, however, of advocating a specific approach (Table). TABLE Psychotherapy tips for working with persons with narcissistic personality disorder Conclusions Research is needed on the hypervigilant NPD subtype, which has been largely understudied in spite of clinicians’ warnings that this is the most frequent presentation in patients. Studies need to focus on the covert/hypervigilant subtype and discover its correlations with symptoms and social functioning. A new and more nuanced description of the narcissistic prototype will generate new case studies, empirical research, and clinical trials. Answering the following questions will help us better understand this problematic personality: • Will the overt and covert types of narcissism, now lumped together, end up being 2 distinct disorders? • Are dysfunctions in self-awareness, such as poor understanding of the triggers of an emotion, a feature of NPD? • Are persons with NPD self-reliant and avoidant of attachment? Do they tend to withdraw when they feel others are accessing their vulnerable self? • Is it possible to measure problems in goal-directed behavior—ie, impaired agency—and see whether this is a narcissistic feature? • Will the empathy deficit appear in future studies and the self-report/objective measures inconsistency stay? • Does the empathy deficit lie at the foundation of narcissism, or is it a consequence of poor self-awareness? • Are anger at being socially (or privately) rejected and states of numbness, anhedonia, and shutting off the prominent features of NPD? Related content Narcissistic Personality Disorder: Rethinking What We Know Psychotherapy Tips: Working With Persons With Narcissistic Personality Disorder References 1. Ronningstam E. Narcissism personality disorder: facing DSM-V. Psychiatr Ann. 2009;39:111-121. 2. Levy KN, Chauhan P, Clarkin JF, et al. Narcissistic pathology: empirical approaches. Psychiatr Ann. 2009;39:203-213. 3. Kohut H. The Analysis of the Self. New York: International Universities Press; 1971. 4. Modell AH. Psychoanalysis in a New Context. New York: International Universities Press; 1984. 5. Dimaggio G, Semerari A, Carcione A, et al. Psychotherapy of Personality Disorders. London: Routledge; 2007. 6. Young JE, Klosko JS, Weishaar ME. Schema Therapy: A Practitioner’s Puide. New York: Guilford Press; 2003. 7. Bamelis LM, Renner R, Heidkamp D, Arntz A. Extended schema mode conceptualizations for specific personality disorders: an empirical study. J Pers Disord. 2011;25:41-58. 8. Fonagy P, Gergely G, Jurist EL, Target M. Affect Regulation, Mentalization, and the Development of the Self. New York: Other Press, 2002. 9. Tracy JL, Cheng JT, Martens JP, Robins RW. The emotional dynamics of narcissism: Inflated by pride, deflated by shame. In: Campbell WK, Miller JD, eds. Handbook of Narcissism and Narcissistic Personality Disorder: Theoretical Approaches, Empirical Findings, and Treatments.Hoboken, NJ: John Wiley & Sons; 2011:330-343. 10. Fan Y, Wonneberger C, Enzi B, et al. The narcissistic self and its psychological and neuralcorrelates: an exploratory fMRI study. Psychol Med. 2011;41:1641-1650. 11. Ritter K, Dziobek I, Preissler S, et al. Lack of empathy in patients with narcissistic personality disorder. Psychiatry Res. 2011;187:241-247. 12. Dimaggio G, Lysaker PH, eds. Metacognition and Severe Adult Mental Disorders: From Basic Research to Treatment. London: Routledge; 2010. 13. Kernberg OF. Borderline Conditions and Pathological Narcissism. New York: Jason Aronson; 1975. 14.< Ryle A, Kerr IB. Introducing Cognitive Analytic Therapy: Principles and Practice. Chichester, England: John Wiley & Sons; 2002.
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