Mad, bad or ill?

“One of the things said about people with antisocial personality disorder is that they lack a conscience. Now for someone who has been teaching ethics for a long time, this raises more questions than it answers.” Professor Jonathan Glover, of the Centre of Medical Law and Ethics at King’s College London, has always been attracted to applied ethics rather than abstract philosophical inquiry, and has studied various aspects of psychiatry in his 30 years as a philosopher. His current research is a two-pronged study, investigating antisocial personality disorder (the formal diagnosis for people traditionally labelled as psychopaths) and fronto-temporal dementia.

Professor Glover had noted the tendency of much research on antisocial personality disorder (ASPD) to be written ‘from the outside’, with very little reference to the people actually diagnosed with the condition. He explains, “There is this tendency to have checklists: are they impulsive, are they unreliable, do they have a history of antisocial behaviour? All external observation. I found myself talking about this to Gwen Adshead at a conference, and she said she was working with people in Broadmoor who had this diagnosis, who may be interesting for me to talk to. So we made an application to the Wellcome Trust to look at the cognitive, emotional and moral capacities of people with ASPD. To actually talk to them about it. It’s the first piece of empirical research I’ve done, and I have to say it is absolutely fascinating.”

Professor Glover and Dr Adshead, together with research assistant Sarah Nicholson, are conducting in-depth interviews with approximately 40 patients in Broadmoor Special Hospital, all of whom have been diagnosed with ASPD. The first interview, the ‘ethic of care’ interview conducted by Dr Adshead and Ms Nicholson, involves presenting the patient with everyday ‘moral dilemmas’. For example, you are in the middle of your life, your elderly mother turns up at the door saying she can’t live alone any longer and has come to live with you. What do you do?

Professor Glover’s interviews focus more on the moral reasoning of a patient. “I say to them, for example, ‘the only space in the car park is the disabled parking space, do you use it?’ I’m not so much interested in the ‘right’ answer, but the reasons given. These could be merely self-interest – ‘I wouldn’t because I might get caught’, or they could be ‘because the disabled person has a right to that space’, or because ‘I don’t want to be seen to be mean’. It’s termed the ‘Socratic’ interview, though that does seem a quite unbelievably pretentious way to describe it in this context! Basically I am trying to find out what their moral beliefs are, and what their reasons are.”

Professor Glover admits to some anxiety before the research started. “You have to do a week’s induction on security at the hospital. I was a little worried. Though when it came to learning how to throw someone over your shoulder in the event of an attack, I decided my chances of dying of a heart attack while practising my technique were higher than my chances of being murdered by a patient…”

The aim of the Broadmoor study, which Professor Glover sees as a pilot, is to get a more fine-grained psychological picture of what people with ASPD are like, with a particular focus on the issue of conscience. “I wanted to study personality disorder in more depth, and I didn’t want to do it from the position of a purely abstract philosopher writing away about people I’d never met.”

Dementia

The work on fronto-temporal dementia (FTD), in collaboration with Professor Martin Rossor, a consultant neurologist at the National Hospital for Neurology and Neurosurgery, also involves interviews with patients. Research assistant Susie Barker is conducting the ethic of care interview, and Professor Glover is carrying out the Socratic interview with 40 people recently diagnosed with FTD - a progressive degeneration of the brain which in its early stages can cause uncharacteristic aggressive or antisocial behaviour. All the patients are also undergoing neurological tests to assess their cognitive status at the time of interview. The interviews will be conducted in parallel with brain imaging studies, with the idea of seeing how far changes in capacities are linked with degrees of atrophy of the brain at specific locations.

“These interviews are proving more difficult,” says Professor Glover, “because people are sometimes too demented to take part in the conversation, or because they are putting up a ‘front’, making no reference to their aggressive or antisocial acts. We may need to think about broadening this study and formally talking to carers, as the picture I get from the individual concerned is so different from that the carers give.”

“The big issue lurking behind all this is determinism,” points out Professor Glover. “It tends not to be mentioned, because we all like to believe in free will. But as we start to fill in the detail of the causal story, as we know more about the genome, the influence of the early environment and of the chemical and physical state of the brain on our actions and behaviour, how can we confidently say, ‘If I had been in that person’s position I would have done better or differently’?”

The case for the defence

Such themes are echoed in a Wellcome Trust PhD studentship project being undertaken by Jennifer Bostock, who is looking at neurobiological genetics evidence being presented in murder trials. “This kind of defence probably first began in the 1960s,” says Ms Bostock, “with the XYY syndrome.” Claims had been made that an extra Y chromosome in men was associated with violent behaviour, and the evidence was used in homicide cases in Australia, the USA, West Germany and France to try and exculpate or mitigate the offence. None of them was successful, and the scientific evidence has been subsequently discredited.

However, some US cases in the 1990s have brought the genetic defence back to the fore in homicide trials. Stephen Mobley shot and killed a man during a robbery in Georgia. His lawyers used a 1993 Dutch study, which seemed to show a correlation between a particular genetic abnormality and aggressive behaviour, to argue that Mobley, whose family had a history of aggressive behaviour, had a genetic predisposition to violence. The defence was not successful - the court argued that ‘the theory of the genetic connection is not at a level of scientific acceptance that would justify its admission’ - and Mobley is currently on death row in Georgia.

Another landmark case, also in Georgia, involved Huntington’s disease, an inherited neurological disorder that can cause violent behaviour and emotional disturbance. In 1985, Glenda Sue Caldwell killed her son. She pleaded insanity but was convicted of murder and sentenced to life imprisonment. During her time in prison she began to show symptoms of Huntington’s disease. At the retrial, the genetic evidence showing that Caldwell suffered from the inherited condition, combined with psychiatric evidence about her state of mind at the time, convinced the court of her insanity, and she was released.

“I am not a neuroscientist or lawyer,” says Ms Bostock, “I am a philosopher, and this research is a philosophical inquiry. What is important to me about these defences is not necessarily their scientific or their legal validity, or whether or not they are successful, but the way in which they shift perceptions about responsibility and free will, which result from beliefs in what we might term ‘neurogenetic determinism’. These are philosophical questions, but ones that have profound practical implications. Serious doubts might be raised about the underpinnings of our legal system, which currently assumes that we act at least as if we are free and responsible agents. Furthermore, the issues of what we do with people who commit violent acts become ever more crucial as these defences increase - do we free them, punish them or treat them? Finally, on a wider note, there is a question which affects us all, that of how we might operate and act both as a society, and as individuals, if we come to believe that much of our behaviour is genetically determined.”

See also

• Biomedical ethics research projects funded by the Trust: Mental health/neurosciences. Research summaries of Professor Jonathan Glover's work including Jennifer Bostock's project

External links

• Centre of Medical Law and Ethics at King’s College London: Details of Professor Jonathan Glover research
• Dr Gwen Adshead: Consultant Psychiatrist and Psychotherapist at Broadmoor Hospital. Biography and contact details
• Dr Martin Rossor: Research interests and contact details at the National Hospital for Neurology and Neurosurgery.

Further reading

Alper J S (1998). Genes, free will, and criminal responsibility. Social Science and Medicine 46(12): 1599-1611.

Botkin J R, McMahon W M, Pickering Francis L. (Eds) (1999). Genetics and Criminality. Washington, DC: American Psychological Association.

Botkin G R, Goode J A (Eds) (1996). Genetics of Criminal and Antisocial Behaviour. Chichester: Wiley, (Ciba Foundation Symposium 194), p248-264.

Gaudet C (1997). Linking Genes with Behaviour: The social and legal implications of using genetic evidence in criminal trials. Fordham Urban Law Journal, Spring 1997.

Greenspan P S (1993). Free Will and the Genome Project. Philosophy and Public Affairs, 22(1): 31-43.

Moir A, Jessel D (1995). A Mind to Crime. London: Penguin.

Rose S P R (1998). Neurogenetic determinism and the new euphenics. British Medical Journal. 317: 1707-1708.

Schopp R F (1991). Automatism, Insanity, and the Psychology of Criminal Responsibility. Cambridge: Cambridge University Press.

Spence S A (1996). Free will in the light of neuropsychiatry. Philosophy, Psychiatry, Psychology, 3(1): 75-88.