The Psychopath Inside by James Fallon Page B

others and arising very early in life, and “theory of mind,” a more elaborated medial prefrontal system that allows us to consider others’ thoughts and beliefs, even if they’re different from our own. People with autism lack theory of mind but not empathy, while people with psychopathy lack empathy but not theory of mind. Without empathy you can still have sympathy, though—the ability to retrieve emotional memories, including those that can predict what painful event is probably about to befall another person, and the will to help that person.
    These brain circuits mature at different times during development, and although there are major maturational events that take place in the terrible twos, puberty, late adolescence, the twenties, and the mid-thirties, some are not completely integrated until one is in the sixties, which appears to be the typical average peak time of human insight, cognition, and understanding in many realms of life.
    The central cube in the Rubik’s Cube brain consists of the subcortical structures that lie deep in the cortex, and these include the basal ganglia, the thalamus, and the brain stem. The basal ganglia are a region important for understanding how cognition and emotion interact to facilitate or turn off behavior. It is a yin-yang area in dynamic balance where dopamine and the endorphins may have opposite effects on adjacent neurons, and where motivation, drive, hedonism, addictions, sensory-motor activity, and all sorts of fascinating behaviors get their oomph.
    There are millions of so-called loops of neuronal connections that pass through the basal ganglia, integrating cortical command information with other subcortical way stations such as the thalamic structures (called the thalamus, epithalamus, subthalamus, and hypothalamus), brain stem, and cerebellar circuits.
    Some of these loops are closed, or direct, feedback loops connecting the same brain areas over and over, while others are open loops where the information is passed to adjacent brain channels for integrating, say, different modalities of perception, emotion, consciousness, attention, planning, and will.
    Within each loop there are parallel channels, one of which leads to motor action and is thus a “Do It” channel, and its partner, which keeps you from doing something, and is thus a “Don’t Do It” channel. These two converge on motor neurons that add up the “Do Its” (excitation) and the “Don’t Do Its” (inhibition) and determine whether you move. Since dopamine turns
on
the “Do It” channel, and simultaneously turns
off
the “Don’t Do It” channel in the loops, dopamine is the key neurotransmitter that flipsthe switch when you are lying on your couch watching the game and decide you want to go get a beer. People whose dopamine cells die do not have this ability to get up from the couch. These people have Parkinson’s disease. They have the will to get up (prefrontal cortex), and they have the plan (premotor cortex) and command signal (motor cortex) to get up and start walking, but they don’t have the dopamine to activate and deactivate these “Do It” and “Don’t Do It” channels to get the movement started.
    There are millions of these closed and open loops in the brain connecting the cortex and subcortical areas, and in this way broad areas of the brain become involved in even the seemingly simplest of behaviors we take for granted. This is why when we look at a PET scan or fMRI scan or EEG, just a finger tap can activate many brain areas in both cortical and subcortical areas.
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    As I looked at the scans of killers Amen sent, there were a few features I expected to see in the psychopaths. They would have decreased activity in the orbital cortex—the part of the prefrontal cortex just above the orbits, or eye sockets—and the nearby ventromedial