Good afternoon everybody and welcome my name is Andres Martinez. I'm vice president and editorial director here at the New America Foundation Thank you all for joining us Today for our the latest installment in our future tense series Future tense is a partnership between the New America Foundation slate magazine and Arizona State University We do live events as as we are today, and we also have a dedicated channel on slate calm and Tori Bosch who's sitting in the back of the room Stand up Tori take a bow She is our our fantastic editor and slate so we want to welcome you all today First I just want to make a housekeeping note which is bear in mind that we are live streaming the event So it'll be archived online and obviously it's all on the record for all of eternity But the relevance of this is if we have Q&A's, please wait for the microphone and identify yourself You can follow follow along and join the conversation on Twitter using the hashtag neural law At the end of the day, we're gonna have we've built in some time for coffee and refreshments at 215 so we can all mingle and continue the conversation So also that's another opportunity to engage the speakers with questions if we don't get to it during the session today's topic is one that I think Perfectly embodies what we try to do at future tense, which is to look at the policy and cultural implications of changes in technology and of emerging technologies and this question of that we've somewhat playfully tried to frame as my brain made me do it Seems to be at the intersection of science with all of that. We're learning about neuroscience in our brain culture in terms of what we understand the meaning of being human and what we understand by Free will and what that means and of course policy particularly in the judicial context And in the sort of the age-old Struggle to define, you know, what constitutes causality Personal responsibility and so forth so without any further ado I want to kick us off by Introducing our first speaker who is going to give a short presentation to kind of set the framework for the rest of the day Stephen Morse is the associate director of the Center for Neuroscience and Society at the University of Pennsylvania Law School He's a professor of both law and psychiatry He's the co-editor of a primer on criminal law and neuroscience and foundations of criminal law Professor Morse How do I turn this on so I get Okay, I Want to thank the organizers for doing this and here's what I'm here to tell you today Which is that of course your brain made me do it made you do it?  I can't possibly do this do this justice This is a this is a scan structural scan of a 40-year-old school teacher who had a lifelong interest in pornography But not child pornography about a month before this scan was taken. He started developing intense interest in child pornography Downloaded it went to massage parlors where he got more than massages Totally unusual behavior for him. No one was noticing anything though not his wife not his stepdaughter and then One afternoon he molested his stepdaughter. She ratted him to mom He was convicted of child molestation Because he had no record whatsoever. He was a good provider good home or they were going to send him into it a Inpatient program that was going to help him with his sexual problem He failed it and he failed it because he was constantly molesting or improtuning for sexual favors other patients and staff If he failed it and he knew this and he didn't want to go to prison. This is an upper middle-class guy If he failed it he had to go to prison. So the night before he was about to be sentenced He develops an intense headache. He's admitted to the hospital. The next thing you know He gets frankly neurological. He's got problems with his gait in a neurological examination He couldn't write properly and stuff like that. I'll show you. This is him before resection This is him after resection. So here's what happens at the end of this neurological examination by the way During which he's urinating on himself and not concerned. He's improtuning the staff for favors So he's really looking quite out of it and bizarre and he's frankly neurological What you don't have to be a neuroscientist or neurosurgeon to realize That shouldn't be there That's a homangio perisitoma. It's a very fast growing non metastatic But fast growing tumor and basically it's going to kill him. So they resected it. They took it out two days later He can copy the designs. He can draw a clock He's no longer neurological at all and he reports my interest in child pornography and kids is gone They sent him back to the program for inpatient treatment. He succeeds Well, do we know the tumor has not anything to do with it? It could have been coincidence Well, here's what happens eight months later. He reports the interest in child pornography once again Guess what else was back? The tumor was back So this is everyone's favorite intuition pump every neurologist that has ever talked about this case says this case is A one-off you can't infer anything from it I used to not want to talk about it at all because it's a one-off and what can you infer from this one case? But now I embrace it because if the kind of approach I'm going to give you works for this case It works for any case. I don't do very interesting slides It's just an outline, right? You've now seen my most interesting slides already. It goes downhill from here Okay, I'm gonna be talking about what neuroscience can bring to the law and bring to our picture of ourselves generally I take the law as it is by that. I don't mean I think the law is perfect What I'm gonna try to do is give an account that takes law generally as it is and doesn't try to have fantasies about what The law might be. I'm also I'm not a dualist I don't believe we have minds that are independent of our bodies and that somehow are in causal connection with them or anything like that I'm a pure physicalist. I'm a naturalist. It's all bottom up not top down When I say multi f multi l what I mean by that is when you're going to explain something like complex human behavior an adequate explanation is going to have to take into account many fields by Biology psychology sociology and it's going to have to look at different levels within each of those fields So if you want a full biological explanation, you could work at the cellular level systems level I mean it's gonna and again what particular thing you are trying to explain More of the variants may be accounted for by one field or one level than another but in complex human behavior Which is the most complicated thing there is that we know about it's going to be multi field multi level and Okay, the law is implicit psychology and concept of the person Excuse me for being breathtakingly superficial Law is a system of rules and standards that's meant to guide behavior It does other things as well, but that's its primary function notice. By the way, it's just like Morality etiquette social norms all of which are meant in part in large part to help us guide human behavior now What kind of creature could be guided by rules and standards not machines not to the best of our knowledge Other animals. Oh, you want me to work from here? Well, I can't hold two things at once. So I'll work from here. I Like to move around a lot, but I got in this and I got out of that. All right, so What kind of creature human beings we are reason responsive creatures That's what we are and by the way, this does not again mean anything that's inconsistent with a naturalistic picture I mean, we don't know how this happened, but natural selection and evolutionary processes have evolved us to be the kinds of creatures That act for reasons if I were to ask any of you. Why are you sitting in this room today? I don't know what the story is But even Kent keel wouldn't tell me a story about his brain is nervous system He'd tell me a story about he'd like to and maybe someday he'd be able to but what are you basically? Going to do I desire to learn something about No, and the future I believe that by coming to this program. I would learn something about it Therefore I form the intention to be here and here I am. It's a reason giving explanation That's what we use to explain To ourselves what we're up to and to others what we're up to it's called folk psychology And that by the way is not a pejorative That is a technical term and philosophy of mind and action and in psychology to refer to an explanation of human behavior That uses mental states as partial and I want to stress partial Explanations of behavior because again if we're going to explain why you're in this room today We also if we're going to give a full explanation we deduce biological variables Sociological variables as well as other psychological variables, but certainly the folk psychological desire belief intention Explanation is a major part of why you're here and that is the law of psychology If you think about legal criteria, especially for responsibility, they're all about actions and mental states all there is Now if you ask how come we hold some people responsible and not others What are the laws criteria for responsibility? What I want to suggest to you is the primary General responsibility criterion is you have rational capacity now How much rational capacity I have to have is a normative question. There's no right answer in the sky We could be tough about it We could be tender about it, but think about the classes of people generally who are inclined to excuse or mitigate if they misbehave young children People with severe mental disorders people with dementias. What do they all have in common? What they all have in common either as a result of developmental immaturity or as a result of some kind of disability is that their rational capacity is Impaired and that is the fundamental that is the fundamental criterion for responsibility in law And I would like to suggest in morals as well and here I think law and morality track each other very well indeed now Forget about free will None of you has it. I don't have it Nobody has it no one ever did have it no one ever will have it if having free will in the sense of being able to act Uncaused by anything but yourself and think how preposterous that is in the modern scientific age I mean there are still some people out there who believe we have that They tend to be professors because they get very inflated views of you know what they are able to do But even though we don't have that strong sense of free will the ability to act Uncaused by anything but ourselves. We do have reasons Responsiveness we are agents we are the kind of creatures that can deliberate and act for reasons now I'm not saying we always do lots of what we do is automatic thoughtless and the like But we have the ability when it's important to us to step back and to act for reasons to Deliberate now which leg you put through your undershorts in the morning. You never think about you've been doing probably the same way Since you first learned to dress yourself Why should you think about it? But if you're about to harm another person or infringe their interests Then you have reason to think about it and that's what we expect people to do to deliberate and take into account The good reasons that they have so that's from the point of view of what's called in the philosophy of Responsibility the compatibulous position that kind of capacity to act for reasons when something is at stake to be reasons Responsive is all you need to be a responsible agent You don't need to have this godlike power being able to act uncaused by anything but yourself and as it just as a matter of the law Free will or its lack is not a legal criterion in any law anywhere In criminal law for example, the prosecution never has to prove the defendant had free will and defendant to get excused Never has to show that he didn't have free will so people say well gee Okay, it's not a criterion in law an actual criterion But it's foundational if we don't have free will as the little blurb for this meeting says if we don't have free will You know, how can we ever be responsible?   What's doing the excusing work in those cases is not free will or its lack It's good folks psychological kinds of criteria gee if you don't act intentionally We're not going to attribute whatever it is that happens to you if you don't recognize what you're doing You're not responsible if someone's forcing you not in the sense of literally forcing you but metaphorically forcing you I'll kill you if you don't do X It's going to be just a good folks psychological excusing condition. I was compelled in in the metaphorical sense all right those distinctions Between two different kinds of actors those who have the criteria and those who don't are true facts about the world No one could deny them and notice they track moral theories We have good reason to endorse theories having to do with who deserves blame and praise punishment reward Who's going to be a dangerous agent and who isn't so even if determinism is true and we don't have free will There are people who act in ways that we think deserve our condemnation and those that don't come on When you finally get to see a neuro image of something you have to ask precisely how precisely do neuroscientific findings answer a legal question Notice that neuroscience is entirely mechanistic Neurons the connectome neural systems do not have aspirations They don't have goals. They don't have a sense of past present and future their biomechanical systems Only agents people like us actually Have goals aspirations a sense of past present and future Law is folks psychological Neuroscience is mechanistic. How do you do the translation?  Therefore. He's not responsible You have to translate that hole in the head into the actual Excusing condition what I would like to suggest you today is most of what we know from neuroscience is rhetorically relevant Not yet really relevant now By and large the new neuroscience is an infant science And it's not surprising that we don't know as much as some people wish we knew Because we're working on some of the hardest problems there are With it basically a brand new technology So I'm not surprised that we don't know as much as we would like to and we're going to learn more as time goes on But for now most of what we know is not relevant. I have a whole action speak louder than images Ultimately because law is about acts in mental states. You have to believe the actions If somebody is acting psychotically, I have no reason to believe they're malingering I don't care how normal their brain looks. They're a psychotic agent and probably should be excused If someone has a really broken looking brain, but they're acting totally rational. It's a rational agent At least for legal purposes All right now. I've got a whole bunch of Things about why we don't know as much as we do, but I can skip that This is the major claim.  Or are we just victims of neuronal circumstances? In other words, we are helpless puppets buffeted about by our brains our genetics And our alleged mental states is just something simply something the brain makes up Sort of to snooker us after the brain has already done what we're going to do If that were true if we were just victims of neuronal circumstances then all bets are off Because then the whole basis of responsibility is gone because the basis of responsibility is a reason responsive creature Now notice there are two Versions of us that could be true and both are consistent with determinism One we have evolved to be deterministically reason the responsive creatures Two we have evolved to be just victims of neuronal circumstances and our beliefs about our agency about our reason responsiveness Are simply an illusion both of those are consistent with the truth of determinism I will just wave my hand at this. There is nothing nothing in the current neuroscience Nothing That would lead you to conclude that you're just a victim of neuronal circumstance the radical reductionist Program may ultimately turn out to be true I really doubt it, but there is nothing for all sorts of reasons. I could give you if I had about two hours But there is nothing in the science that should cause you to give it up yet now Mr. Roft and I'll finish with him The way to think about him is not did his tumor make him do it Yes, he would not have had pedophilic desires if it hadn't been for his tumor We know that because of the way the time series worked But all pedophiles are caused to be pedophiles by something Right. So why is he any less responsible than any other pedophile? And I want to distinguish for you between two periods and I'll quit Period number one when he touched his stepdaughter that was one crime Then no one noticed anything his wife didn't notice anything. He was doing fine at work Seemingly his rational capacities at that point were relatively intact By the time he was let's say committing assault on the nurses in the neurological consulting room some months later Then he looked much much less rational So I don't know enough about the time he touched his stepdaughter But what I know is I have to evaluate his rational capacity, then that's what's doing the work Not the tumor the conclusion of all this We are acting agents not Pinocchios and our brains are not Gepettos pulling the strings. Thank you Thank you, professor Morse. That was terrific And next time my eight-year-old is sitting on the couch Wanting to just stare at a screen. I'm going to say don't just sit there like a victim of neuronal circumstance It's a great term that I learned here To continue drilling down a little bit on the science and assess where we are with this Emerging understanding of the brain. I'm going to ask Laura Helmuth to Moderate a conversation. Does a brain scan tell all? Laura is a science and health editor at our partner Slate magazine And she has a PhD in cognitive neuroscience from the University of California Berkeley She previously was a senior editor at Smithsonian magazine and an editor at science magazine And Laura will introduce the panelists and the conversation. Thank you. Yes All right, thank you very much So I'll just do a quick introduction and then we'll get right into the discussion And at the end we'll open it up for questions from the audience And also, you know, I think we'll be asking each other questions You should all feel free to get in each other too So Kent Keele is an associate professor of psychology at the University of New Mexico He studies psychopathy, neuroimaging And how to use this research to inform state and federal judges about issues regarding neuroscience and the law He was if you you I'm sure we've got a lot of New Yorker readers here There was a nice story about him in 2008 in the New Yorker and his work studying psychopathic brains in prisons And then Kayla Pope is a director of neurobehavioral research at Boys Town National Research Hospital in Nebraska She's a child and adolescent psychiatrist and she's an attorney And then Sally Satel is a resident scholar here in town at the American Enterprise Institute She's a psychiatrist at the partners in drug abuse and rehabilitation counseling And author of several books including PCMD how political correctness is corrupting medicine And another one that might be relevant today drug treatment the case for coercion Um, so I'll start out. Um, you know the the the day is sort of divided into philosophy Science and then legal implications of the science and the philosophy So we're going to sort of switch now and in our panel talk about the science What is the neuroscience that's happening now, you know, some of it's very fresh and new And what are we learning from it? What are the implications? Um, so to be clear and I think each of the panels will talk a little bit about their their own research And what methods they use but there isn't just one kind of brain scan. Um, each one has its, you know pros and cons There's uh, just straight MRI which gives you a really precise 3d image of the brain Which bits are big which bits are smaller than the shape and are in there are they in the wrong place You get functional MRI which shows which parts of the brain are You know are kind of standard metaphors lighting up which parts are active And then diffusion tensor MRI kind of shows how the different bits are interconnected and how strongly connected they are And so each of these kind of tells you different things about the brain and I think we'll get as we go through this we'll get into a little bit more about what what the limitations are what we know so far But let me start by just asking each of the panelists to tell us a little bit about your own work So can't could you start by telling us a little bit about the sort of subjects you study and what pattern? What are the like the biggest patterns that you find? Sure. So my lab is Generally oriented towards trying to understand the the issues that individuals who end up in a forensic context how they've come to get there how they've come to What are the biological environmental and you know genetic reasons why individuals end up getting themselves in a lot of trouble Generally speaking My lab mostly focuses on individuals who you would term having psychopathy or psychopathic individuals We also do a lot of work with patients with schizophrenia and other mental illnesses And we study them from bad age in my lab about age 10 to about age 60 and the The goal of the work is to try to develop a better way to Develop treatments for those individuals to help reduce the cost and incidents of recidivism and other poor, you know outcomes so like that the Latest science basically from our lab has shown which has generally been Very concerning to the legal system has been that you know We are able to use brain images to say that a patient's brain does have You know fits a pattern of other patients brains and will meet a distribution So patient comes into the emergency room you have a diagnosis of being talking to yourself or whatever And you might be diagnosed with schizophrenia or bipolar some other illness And it turns out that the pattern of brain activity from that person can be fit to a distribution and say well that person actually has schizophrenia and so In cases like the lofner case in arizona or the one up in arora and in colorado You know people are very concerned about well, what does that person actually have do they have a mental illness? Do they have those types of problems? And then the question is well does that speak at all to whether or not there's a legal question behind their Lyrical responsibility or something and neuroscience is a neuroscience is getting very very very Accurate at being able to predict and to look at those things. We now have data from other groups that shows We can predict who's going to um, you know develop those types of mental illnesses early So so they're called at risk or prodromal But in my lab what we focus on is the individuals who you would say would be on like the life course persistent trajectory of antisocial behavior the individuals who have very very very severe antisocial Trajectories they do very very very bad things and how did they get that way and how did they develop that way? And as steven mentioned to echo his Sentiments is that given that their behavior is so different and their the personality that they have is so different Their brains are different and we are now able to say how they're different and how they Potentially how they got they were or was it there from birth or was it there from early age? And that challenges the way people think about free will it challenges the way people think about responsibility and it's But most of my lab is again designed towards trying to translate that information into a more effectively treat and manage them That's generally where we're at and I think on the on the panel you work with the most severe cases, right?  Yeah, just any prisoner not just any prisoners Most of the facilities we've worked at have been maximum security We do make use of a very unique system So the the nonprofit that I work at the mind research network has a mobile MRI system And we take that system and have deployed it in eight prisons in two states to scan And bring that science to this high-risk population for the first time And so that was what the new york article was about was um, you know, we've scanned over 2,500 Individuals who volunteered for research and treatment studies in those populations from men to women to children Or youth and including forensic psychiatric and even the more the super highest risk, you know, severely committed sex offenders We've studied them as well And again the goal is to try to help understand how They got there and then how to develop a better way to keep them from doing it again Or prevent it ideally great. Yeah, so we'll come back to some more about what the implications are of that And what exactly we could you know what exactly we can know and say about individuals I'm going to to move on to kayla. And if you could tell us about just remind people what boy's town is And what kind of what kind of kids you work with there? So boy's town is a large residential or campus-wide treatment program We deal with about 900 kids on campus and about 20,000 kids in the local Omaha community As well as treatment sites across the country and our kids are not as acute as the ones that Kent's been working with these are kids that come from very troubled backgrounds engage in all sorts of very troubling behavior And sort of a broad array of pathology everything from anxiety depression to chronic disorder But we do have a fair number of kids that if they weren't they would probably be in a juvenile detention facility So Our focus at boy's town. It's always been a behavioral modification program But what we've come to realize over time is that that's not really Sufficient for all kids especially for some of these kids that have had very disturbed backgrounds are engaging in very dangerous behaviors So what boy's town is now moving in the direction of is using imaging technology to better understand the pathology in some of these children And also to really look at the biomarkers that we have now identified to see what interventions will actually be most effective in terms of altering brain circuitry I think there's a lot of really good work that can be done in this area and the comment that was made In terms of being victims of our neuro circuitry Maybe not so much a victim, but certainly a product in understanding. What are the factors that influence that? I think a big gap in what we are looking at now is the developmental piece We know very little about how these things unfold over time and also the factors that really do influence So the kids that come to our campus the vast majority of them have had significant trauma And there's no way that that has not impacted the way they approach the world see Threat see fear in their environment and certainly has an impact on their behavior. So that's what our Program is designed to look at nice And Sally what what sort of patients have you specialized in and And as you know in the past few years as neuroscience and neuro imaging has gotten you know more and more sophisticated Is that kind of changed the approaches in the field? Do you think? Well, I approach this that my original interest began Actually in 1995 in in the context of working with people who are addicted Excuse me And um And what caught my eye especially was a new rhetoric that was being um That was being invoked to talk about the concept and the actuality of addiction itself Which is that it was a a so-called brain disease and that concept was Reified by what at the time was the first one of the first functional neuro imaging devices, which was PET scan. So this was the the mid 19 about 1985 and And we can we can get back to this a little bit later but but I found that as a clinician that this was not particularly Enlightening way to think about addiction and in fact one that could often undermine clinical goals and a clinical work and Actually that's so that's been on the back burner of my mind for for a very long time and as and as brain scanning has become more and more of a cultural trope almost and taken to this this wider Um Gaining this wider territory in terms of what it says more writ large about again, you know free will and more responsibility and agency So my interest expanded, you know along with that, but within psychiatry It's clear that even though we're making Lots of advances and the dsm 6 when that comes out in um, I don't know 2020 or whatever because next year the dsm 5 is supposed to come out It's still hasn't um, I mean some of the predictions are almost poignant when you look back on what people thought they'd be able to do um in the early 90s when the previous dsm 4 was was uh under construction was we'll be able to you know have a biological essentially biological indicators of these conditions that we call schizophrenia bipolar and When it comes out in the next next year or later this yeah next year it won't be having that So in other words, we're still not nearly as advanced As psychiatrists thought they would be at this time So is yeah, and I think that's certainly true of uh of neuroscience You know we had a lot of grand ambitions early on kind of like with the human genome project. Everything's always 10 years away um but so Kind of disregarding for a minute, you know how many years it will take to get there is the end point Some sort of brain scanning technology that will identify um, you know dangerous not dangerous schizophrenic not schizophrenic I mean does it have the potential do you think to be as accurate as say dna? Testing or is it more like you know hair follicle testing which you know sounded all sciency and Accurate and forensically important a few decades ago and now is basically not Uh useful at all um, but you know what sort of looking long term Do you think neuroscience and especially neuroimaging can Give us, um, you know really important answers that will have legal implications I don't think the value of neuroimaging is going to be diagnostic in the long run I think it's really going to the value will be in helping us understand the pathology and how it develops over time Which will then lead treatment more effective treatments I know some people are now actually using the technology Diagnostically, which is rena raised some controversy in the field because of its inaccuracy. Um But that's my opinion I would say that um So as I'm a psychologist and a neuroscientist and as psychologist I want to try to quantify a different, you know aspects of some function So if that's iq or if that is um whether or not a patient has a diagnosis It meets criteria for some symptom cluster we call schizophrenia The more accurately we define that psychological construct or symptom construct the more likely there will be definitive neuroscience data that's going to fit that so if you want to say, um You know Differentiate schizophrenia from healthy based on patterns or brain scans Well that has to be based on some symptom pattern originally But then fitting a new person's brain to that is is fine So and then an example I think echoes both of our sentiments one of the biggest questions right now in early diagnosis of mental illness like schizophrenia is Does a child who starts to withdraw and starts to you know Quit shaving and stop washing themselves and then locks themselves in their room Is that child on a slope towards that mental illness? And it turns out that if all of us in this room interviewed those children, etc We could say that they meet symptoms for what's called a prodromal phase But only 20 roughly around the world of kids who meet that criterion will convert To actually having the illness in kind of a two to three year period the latest stuff But the latest evidence suggests that when you combine that symptom assessment with neuroscience you predict Over the 80 threshold and so if that's the case then that's what they've used to decide when to treat So that would be neuroscience helping to inform What's precipitating or that they are honest that the steepest slope and that they are going to develop that With respect to dangerousness or predicting dangerousness We have a paper in our lab that we've been looking at or a study in our lab that we've been looking at Well, if we quantify impulsivity impulsivity predicts Recidivism so I could give you a pen and paper test and you're going to fill it out And it's going to say well, you're not likely to recidivate But I might be more impulsive and then I'm more likely to recidivate that's a risk factor And then we might give you an abilities based test We might have you fill out a game and it measures how many errors you make and that predicts on top of that But if I quantified impulsivity in your brain or measured it in terms of neural activity Are we any better and the results suggest that we are so there's incremental utility as a psychologist as I'm trying to Capture brain function with the test and game or with a self report that the more accurately I assess that Be it whatever technique I want to use the more likely I am to predict If it's if it's a useful variable and predicting outcome And so what that gives me is a goal that I now know about the neural system I now know about the that it's a risk factor I now might have a medicine or one of these two Can provide a medicine that would treat them for that for example Or I might develop techniques that help to reduce impulsivity which will then change brain function Over time and so that's that's what I think we can do But the the legal system has definitely been very interested in whether or not it's you know It's relevant now or not and I think that from a theoretical perspective. There are some big questions But on the ground, I think you're seeing a lot of people are being asked this. I mean Defense attorneys ask me all the time Should I be evaluating my client for this and in a lot of cases if they've had a history of head injury or a tumor It's particularly relevant that you should get a brain scan. In fact, you might be You know, it might be overturned from ineffective assistive counsel grounds If you don't have something to look to look at that just like you would ask for a psychologist or a neuropsychologist Now the question just is how far down do you want to can you go and say something specific about some Mental illness and then or some condition and then it's up to the judicial system to decide how to use that information Or whether or not it's relevant Did you want to comment to this? I was going to mention that prediction for many things for how one's going to respond to treatment for future dangerousness. I mean that is Radically important. There's there's no question about that But it's in and not really but but and it's it's different though It overlaps with but it's different from understanding And and in psychiatry in particular Um One could argue we don't even know what schizophrenia is in in that sense that and in fact that again the dsm Acknowledges this by calling these things disorders or syndromes or collections of of symptoms that have some Certainly they have uh, they have some meaning in terms of the the way that which they they cluster in a general prognostic um picture but you know ideally you as as a taxonomist of of diseases ideally you want the kind of of Condition that the diagnosis tells you it looks backwards and forwards It tells you the etiology like you have a certain kind of pneumonia That the klebsiella pneumonia so that's caused by that bacteria and that largely indicates what kind of antibiotic you want to use That model, you know, just doesn't apply in in in psychiatry because there are often so many ideologies Just for example as someone who is what we call schizophrenic at age 40 But who had a perfectly normal course until they were 19 and then didn't leave their dorm room and then didn't wash and then started becoming paranoid about their roommate is It's just got to be a different kind of schizophrenia than one that started with a child Who was five and was never quite neurologically coordinated and always had imaginary friends and on and on and on But the my point is that there's just so much Uh complexity in psychiatric conditions and the interaction with environment Once you even have a gene that that enhances your probability that Um, I think we're a long way from from really pinpointing, you know Exactly what causes these many of these conditions I just want to go back to ken's comment So in terms, I think imaging at this point and perhaps she'll disagree is probably most effective in looking at population based Phenomenon, I mean, it's been very effective in helping us understand normal development the work of jay geed and others Which has really guided some recent supreme court decisions on juvenile culpability Um, but I am very skeptical at this point that individual scans can really give us that much information um, yeah, let's come You're not the first person to say that and there's we actually there's a large literature from my lab and others Most of my work with vince calhoun Who says that you can actually if you have a well-defined group and sally is correct too that That you need to have a well-defined group of individuals who have an onset within the standards range And you're not looking at the ones that child or late onset You're looking at this as homogeneous as a group as possible It is actually not hard to take us a pattern of brain imaging data and fit it to one of those distributions at the single Subject level we've published data showing that it's night. We're 98 percent accurate And so for schizophrenia versus healthy, but again, that's not hard for us to do by just talking to them Um, but the patterns of brain activity are I think that accurate as long as you're inputting into the algorithm the most The best data that you can and a lot a lot of people make a lot of assumptions about the data that they put into those classification algorithms um Our data with schizophrenia versus bipolar sort of are very related but Even more psychiatrically, you know trouble difficult To separate those two those two groups does a patient have schizophrenia or does a patient have psychotic bipolar disorder? That's a big problem and a big question for frontline psychiatrist And our work has been guided to try to determine Can you take a brain scan and help improve the guesswork that they do right now? People along the judicial system or in the medical community have to make decisions Have made a decision what to treat them with have to make decision with a diagnosis with And I think that imaging can help sometimes make that diagnosis. That's what the goal is And so I actually I have more of an optimistic kind of view that you can use imaging to help make these predictions and there's a lot of evidence from Different groups that you're getting more and more and more reliable But let's I don't think it should surprise people like steven said that you know for well diagnosed mental illnesses For well diagnosed syndromes even IQ or old versus young or any kind of process that's we're trying to assess There will be a very very very strong correspondence with neuroscience data at some point It's coming and it might not come in 10 years might be 20 years But it's going to be there and so the question is why does that surprise people? like um There's a beautiful image of your brain when you look when you're 40 and guess unfortunately, you know awesome over 40 Um, it starts to decline over time and I can show you that it's going to decline over time in particular Look at steven. I was kidding But we've been friends for a long time And so the the point is is that you can see these changes you can do this I mean we're on the heels right now of the FDA has recently just approved the first brain scan for a Um Alzheimer's right a PET scan is now potentially diagnostic FDA approved for determining if you have Alzheimer's or not And what it really says the scan say is do you have plaques or not? Do you have the plaques that put you at risk and they can say hopefully with some degree of specificity? Yes or no That you either don't have plaques which then means you're likely not on that trajectory or you do have plaques in which case You have a much higher risk. That's what scans. I think you're going to be capable of doing with greater and greater efficiency as we move forward All right Kayla can you tell us a little bit more about the work you did at NIH with uh In some of the work you've done on children and specifically imaging What sort of patterns are distinctive in kids with conduct disorder? So before going to boys town I was a research fellow at the national incidental health working the lab of james blair Whose life has been devoted to understanding this diagnosis of conic disorder in children And kind of building on what kent was saying we really need to understand this pathology with more discreet Understanding of the sub types of conic disorder So I love to focus a lot on these callous unemotional traits in children And whether that maps onto a particular circuitry or particular dysfunction in various brain regions And some of the emerging evidence has shown that for these kids with callous unemotional traits They really do have dysfunction several parts of the brain the major lab being the most prominent with you see hypo reactivity in these children In response to fearful stimuli Also some dysfunction in the frontal lobes and also anterior cingulate which is involved in the attentional system So again, hoping that this information will help us Better identify these children early on and to think about what interventions might be most effective And again at boys town we work with a lot of these kids and Not all of them would meet criteria for callous unemotional certainly But they do respond to the model at boys town differently the kids with more callous unemotional traits are oftentimes less responsive To the behavioral modification program that we have in place So thinking about what is it that we could supplement this program with that would really be You know able to really address these callous unemotional traits And I wanted to get at the that seems to be a very hot topic of research right now the callous unemotional kids And uh, you know is that a predictor of psychopathy in adults? And does that seem to be sort of the model right now that they're at a greater risk of becoming or you know exhibiting Some of the spectrum of psychopathic behaviors in the future Um, I think hard to say I mean certainly it is a risk factor But then again, I think we need to think about what are the environmental influences also at play And a child who grows up in a healthy normal environment who has these traits may end up falling a very different career path Um, and I don't want to identify any particular groups in society, but uh It's a it's a huge question for judges, right? That's it's a huge question They always ask I have a youth in front of me I have a just lots of discretion about sentencing Is this someone I should you know, that's high risk or not And we we would all hope that they would say that there's capacity for change in anyone And we would hope that even the kids on the steepest trajectory towards those traits Um and development of that lifelong problem potentially would be Subjective to you know better forms of treatment and and I would echo that that there's a program in Wisconsin That's at the Mendota Juvenile Treatment Center Which has shown that In that state when they are sent the highest risk kids These are the top 1 percent of all high risk offenders in the state of Wisconsin That they can make significant impact. They can do amazing things and this is an intensive year long inpatient You know institutionalized treatment program But they've shown over a 50 percent reduction in violent crime in the kids that complete their program Versus the kids that don't and all of their kids score very very very high On the callous and unemotional traits scales that we use in clinically and in research And moreover most of them come from horrendous environments And so what's amazing is that this program has made such change And 50 percent reduction in violent crime. That's millions of dollars. I mean plus all the emotional victim costs, right? So it's an unbelievably effective program And unfortunately it was one of those things as a casualty of many Of the economic downturns is that they want to limit the amount of you know funding there And I just couldn't say enough good things about that program and the guys that work there and And the development of it because it's it's such an amazing It really has changed the way I think about treating these kids I mean I've worked with adults that are psychopathic serial killers some of the worst They've done some of the worst things imaginable And a lot of these kids are on a trajectory like the kid the man I've met with when they were adults And here they are able to make a first and it's the first in my understanding It's the first real attempt to work with these super high-risk kids On an individualized basis taking into account all of what we know in the science of them to develop a better treatment program And and the first iteration works the other thing that I think is shocking is there has never been A treatment study a randomized placebo controlled treatment study of psychopathy ever So how do we say we can't treat it if we've never tried? right, so There's There's absolutely nothing that has been done in the area to try to implement state-of-the-art treatment So we're just now doing some state-of-the-art imaging and as people are pretty interested in it Imagine if we could do a state-of-the-art treatment that would actually prevent Poor outcomes in the future no more sand duskies maybe no more of those types of things. That's the goal Well, there have been randomized controlled trials of treatments for kids with a diagnosis of conic disorder But the results have been varied and I think in large part because we haven't differentiated between these kids that Are reactive versus sure. Well, there's there's there's 36,000 different combinations of items You can have to develop and get an assessment of conic disorder Alan Kasdan the former APA president argues that it's a very poor diagnosis Which is why I think DSM 5 is moving towards trying to get more and more accurate assessment And this is what I was saying is that if you poorly assess the behavior or the condition of interest you're going to have Crappy data that neuroscience data you have to be measuring the behaviors and the traits Whether it's IQ all the way up to callous and unemotional traits as accurately as possible Or you're not going to have a neuroscience phenotype that matches And that's what we typically see is I'm not a fan of the diagnosis of conic disorder I don't think it's predictive 80 percent of kids that have it don't ever develop anything as an adult And so I don't think it's that helpful. I think you have to be measuring And looking at much more severe higher risk kids if you want to have a neuroscience phenotype Because most of those kids are just reactive to their environment and they will likely grow out of it And most of them don't deserve incarceration. Most of them deserve a good treatment program And I want to know about the kids that are on the steepest trajectory that we can try to take them off that trajectory That's the goal Can I just ask one of them a question? I probably want to move on to other things, but Um, it wouldn't surprise me if there are kids like at five and that's the age at which or even four when kids start Exhibiting these sorts of things. I don't know how young but does that sound reasonable? It's hard, but there's a lot of kids that act like that that don't continue But then there's the yes people try to say that they can Okay, there's some diagnostic instruments looking at kids as early as two and three Well, that was actually my question because in a way I wonder if there is um If if there is a kind of what you might even call an acquired psychopathy as opposed to a more innate one Um, and again being raised in some you know hell hole with parents who are in attentive and cruel and you know learn It's that that in and of itself and but that those are the well I don't know if those are the children who would manifest it younger. I would I would think I don't know. Um, and if one group might be more responsive to to treatment than others I just don't know if this has been looked at but I think you're having some twin studies, right? Um, you know show that there is one identical versus fraternal twins showing that the identical ones are how to share more Callous and emotional traits, you know suggesting that there definitely is some genetic Component to it. Oh, absolutely. I think I mean some studies have looked at and predicted 40% is actually genetically attributed But I think it's really a normal distribution I think you're going to see some kids are highly genetically loaded others are environmentally loaded And it's going to be some magic combination of those two factors. It's going to result in the pathology I think with respect to your answer, we don't really know There are some pretty good diagnostic instruments now Age two and three but the data isn't there in terms of what are the trajectories for these kids and the outcomes But at least we're now starting to monitor and follow it There hasn't been enough longitudinal studies to look at those new instruments in age two and whether or not they're they predict outcomes Whether or not they're sensitive enough, but the thing that's interesting knows that they do tend to Identify a range of individuals and then individuals at this tail are believed to be needing of some assistance Some sort of treatment something to get them hopefully back to the norm, right? That's what we're all, you know trying to achieve So um, I that's that's what I would say. Yeah Now what are the implications if there are sort of two populations? ones who are extremely genetically loaded and the ones who are extremely environmentally loaded and of course I imagine most of them have both you need both to really Really aspire to horrible things But if there are these two populations, do you have a sense and this might just be you know what you imagine Which group would be more amenable to treatment? Intuitively when we think that those that come from a more of an environmental would be more likely to be you know Malleable and treatable and the genetic would be harder. That's just I think a general statement But what if the genetic happens to be a let's just say it's a certain neurotransmitter is deficient And then we already have a drug that fixes that neurotransmitter or normalizes it Well, then maybe that's easier to treat than the other one I just don't think we have great data yet that and large enough studies just to indicate that Um, you know these things I'm more of a fan of taking the individual and trying to do the best assessments On that individual that includes every from from their parents to their You know where they come from in the environments that they came from To try to develop a plan that works best with that child So that's kind of an interesting economy most it isn't it is kind of intuitive to think that if something was Sort of environmentally or psychologically caused it would be more attract less let more tractable If you ever leave me if you've ever done psychoanalysis, you know, that's not true And in fact, I've always thought you know when I see My patients I'm a great believer in In the notion that people use drugs for a reason And I don't mean they start using drugs for a reason which they do they keep using drugs for a reason Which so that's true of addicts as well. And I I often think oh god, please have a depression I can treat and sometimes they do and they do they do get a nice response to prozac in terms of mood and then And then in turn in terms of the the need to use to drink so much or use other drugs, but But often the folks I see you don't But the people I see by virtue of being in a clinic are already selected for being You know more more resistant I want to just change the question a little bit though I mean, I think so we talk about being genetically loaded but being genetically loaded for what And it may be that what they're genetically loaded for makes them very adaptable to certain environments I always kind of like them to like autonomically in terms of their reactivity Special forces. I mean navy seals. These are people that don't have a lot of response to fear and as a result are very effective in their environment So I think the problem is or the key is really to identify these children very early on And make sure that we direct them environmentally into something that's going to allow them to make good use of Their special abilities Yeah, and I wanted to get at that, you know The neuroscience, I mean, it's not just random. It's not like you've you know Got good images of the brains of these kids It was a surprise that it was the amygdala that was small that different parts and and so I wanted to see if you could describe a little bit the sort of the I think the the best working mechanism right now for how you get callous and emotional behavior and traits And how it has to do with the fear system Um, I don't know that it's a lack of fear. I know some of my colleagues might disagree with me It's more of a disinhibitory kind of behavior and then a shallow affect kind of an inability to appreciate the kind of the significance That the behaviors that they do on others and that happen to them. That's been my kind of current thinking um I mean, I think as we've mentioned most of the like most mental illnesses psychopathy is One of those things that about half the variance is believed to be explained by genetics in the other half Is environment. I mean that's like most things tend to come down like that In our in my lab, you know, we show very clear structural, you know structural density analysis That of children who are on the same, you know elevated spectrum as adults And so there appears to be kind of I would call that a risk factor So you're born you can explain those the structural what what you're seeing and sure So the the same circuits that you've mentioned the so-called limb bit kind of regions of the brain tend to have essentially They're weaker. So I like to make likened akin to a muscle. So If I study you as an adult and you happen to score very high on psychopathic traits That is you lack empathy the guilt and remorse and you're also pretty impulsive If I if I look at your brain areas, they control those regions or are relevant to those regions I don't want to use more control to implicate causality But those regions they're less they're less dense. It's almost like they're at your feed And so the question is well, have they been that way since birth or they Develop that way because of non-use. So just like if I take my arm and I tie it to my chest My muscle is going to atrophy right over the course of the six months that my bone is healing for example And I would go to a physician and they would say well Has your arm always been atrophy like from birth or is it been there since Just because you have been using it or something and then they can't tell necessarily very easily And I think that when I if they find out that I've had that since I was 12 You know the last time they assessed me or something then they would know that it was likely been there But it would it'd be a risk factor for me not being able to throw a ball far for example or something like that And I think the neuroscience where we're at right now suggests that these are risk factors that is Individuals are different and some individuals are more high risk and when they're more high risk and it's precipitated poor parenting styles Is one of the things that precipitates These types of traits and when it's aggravated by those circumstances It can more likely end up with an individual is going to end up seeing us me when they're in prison Yeah And kayla, you're are you were a proponent of the of the there is a reduced fear response Understanding nurse. I mean, I think there's a fair amount of evidence to support that I think it's still an open question to be honest Yeah, but it's interesting how the sort of the behavioral work the neuroscience work and you know everything in between and beyond is Starting to converge in interesting ways And that's I think that's one of the things you know Even though what neuroscience is you especially neuroimaging is still such a young field The fact that really the patterns you see in the brain make a lot of sense given all kinds of information that has nothing to do with brain scanning True Absolutely one other piece. I think is kind of interesting and just beginning to emerge is there's almost like a reward response for some of these kids when they engage in these behaviors And I don't you might want to speak a little bit with your substance abuse background But I think that's another really curious piece that we should Pay more attention to I would echo that that and that's that You know, most of us just think about reward and punishment systems Most of us the threat of punishment keeps us from doing something wrong Um, and in some individuals, they're less likely to respond to that threat They're less likely to think about the sanctions or the things that are going to happen And and the people that we work with that we cause like a path that they very very very rarely respond to punishment Um, but they do typically respond to reward And so most of the treatment programs that I've seen that are very effective Ds they deemphasize punishment and they emphasize positive reinforcement And that type of positive reinforcement helps to get traction It helps to change the way they think and then the way they behave and eventually The goal is to get them to have more positive outcomes And that's the program that I that I mentioned in wisconsin, whether I'm not a paid wisconsin person or anything I know know one of those things Um conflicts, but it is embracing the science that we've we know about In terms of trying to develop it into a model that can affect change And then hopefully then they never come before the judges and have to make those decisions When you say less responsive to punishment, is it that they don't fear bad outcomes? They don't imagine bad outcomes or when bad outcomes happen. They doesn't bother them so much. I think all of the above Again for the individual at the high end of the spectrum They don't anticipate or they're not concerned about punishment or threat of punishment They don't when they get punished They're not as responsive to that punishment And then they sense don't change their behavior based on that type of punishment and they don't care about it So I think it's all of the above Suntight So we could start to are there any questions you want to ask each other before we get to the audience question portion I was going to say something about deterrence. Oh, yeah So would that be the last word before you're going to ask for questions? Well, okay, I'll just swing it back to addiction a little bit but but Sort of less than the reward context is um Uh, you know what I When I mentioned earlier about this this um, what I call a hyper medicalization of addiction and again, um Which is basically the direction that The national institutes of health have gone and I understand why it's a biomedical agency and that's what they do They they look to adopt a reductionist approach to you know, most things and that makes sense for what their goals are but um But uh, you know, it always interested me that that these the scans that used to be pet scans again For example, the typical the typical protocol was um taking someone who Had an addiction often to crack or cocaine and uh putting them in a scanner of some sort and then exposing them to a video of people who are who are Manipulating drug paraphernalia or using it and and by doing that eliciting Great metabolic activity in the areas of the brain that that Responded to or that correlated I should say with with reward and those same patients when shown more neutral Scenes like a cease. You know a cease chore did not show did not manifest that enhanced activity And normal people who had no previous experience with cocaine did not show that experience So there's pretty much no question that there's a good story here narrative here about uh this activity reflecting um the experience of having used drugs And because it was accompanied by the subjective experience of to either wanting to you know, use drugs as well like pan that looks good Um That some have said well there you have craving in the brain. Well in a in a way Yes in a loose way sure but um, but they've they would always go this other step to say this is why addicts can't can't control themselves and that's a dangerous move And uh, and it this is where it ties back to to deterrence or responding to deterrence. It's is that you know When addiction was again formulated in this way as a brain disease that the proponent of it Who was the head of night at the time had said it's a brain disease because there are changes in the brain Well, that's obviously a little silly because there are going to be changes in your brain, you know when you leave here um And uh, so that doesn't that doesn't mean anything that there are changes in the brain But obviously these are different Their quality of changes and and and and drugs do change the brain. There's no question about that But the question really is are the changes such that people can no longer respond To foreseeable consequences now in the case of some people the answer is And I don't mean some addicts. I mean some people With with troubling behavior the answer would be no they can't respond to foreseeable consequences or Or with such it would be almost nearly impossible Very difficult That's not the case with most people who have drug problems and and that's why this This formulation of focusing at the at the the neural level I mean you can think of behavior on so many levels starting with the starting with the neural and all the way to the you know, environmental factors and And that's why I've always had so much trouble with this this this Neurological level of description for for a behavior that can be so responsive To consequences now, let me just say one more thing that shouldn't surprise anyone who knows about the brain But in the public sphere there's there's so much confusion if it's in the brain That means it's somehow Something that over which one has no control some things that are in the brain. It's true People have no control over other things are more responsive and the trick is knowing the difference And then if it's the latter that it is responsive coming up with with creative behavioral modification programs that that sometimes do and don't benefit from the addition of medication, but And that's where the most successful treatments for for addicts have been And that's that's part of the goal of both of your research right is to figure out We know which which treatments might work how to find out whether they're working and we do a lot of We also do a lot of studies of addiction and and how The brain does change over time and and we do see that the same circuits that you mentioned are actually therapeutically change would we believe therapeutically changing over time with certain forms of treatment And the the idea there is that you know, you've used and abused a wide range of drugs You have helped to make change in brain But guess what the brain changes all the time and we can actually you know Do some treatments be that pharmaceutical or cognitive behavioral in this case? It was a cognitive behavioral program and you see changes over time and the responsiveness of those same types of stimuli And then guess what that predicts that predicts that they're not going to come back to drugs Better than some of the other measures. So when you can institute change and that's what we're looking for is What can we do to implement and get those systems back to a more normal level that will allow Them, you know, us to know that that treatment was effective. It doesn't work for everyone So that means those people that we think we can work with in this program go here And these people should go into a different treatment program Again with the ultimate goals. They don't end up in front of judges, you know Having to make other tough decisions based on other imperfect data so So if you're ready, we'll open it up for questions from the audience and just a reminder that we're We're being webcast and recorded I believe so if you do have a question, please wait until the microphone gets to you Anybody want to start us off? Dr. Kill you mentioned the structural densities of psychopaths is is less Than normal or more than normal? Yeah, the the the results we found were less So in certain areas of the brain that's limbic circuitry that we both all mentioned or a number of us have mentioned We find that it's less dense in both These are men and boys and you know average. This is a study of over 300 individuals though So it's quite profoundly less dense. So I guess my question is is These people these 300 people they exhibited Psychopathic behaviors and they had this less density in their brain. Yes Do do people who have this less density in their brain? Not exhibit psychopathic behaviors. I mean if you have this, I mean I would take a scan of my brain and I had this Density issue does that define me as a psychopath or is it my behaviors that define me as a psychopath? So it was a clinical assessment that defined the individuals in that study and could define you as well Is where you fit on on that scale? So people range from low medium to high on the scale and it just turned out that the higher they scored the less dense Was the data so we can't say specifically whether or not Everyone with low dense activity or low dense low density in those circuits scores high on psychopathy We've only studied a couple thousand people and this was the first study of 300 We did replicate the same effect though in a study of 200 boys who were also at very elevated levels of the traits But again, it's a dimensional kind of an assessment and you find that the higher they do score the less dense You know are these areas and like I said, I it conveys to me that it's a risk factor Um, I would be rather surprised though if there were individuals who fit that typical very that profile That wouldn't have some evidence of the symptoms. That would be a surprise to me But it's possible. I'm not studied everyone But um, I've only you know, we've we've tried to move away from these small studies Which I was guilty of as well publishing ends of 8 10 12 14 subjects And we've moved into the hundreds if not thousands of subjects to try to say with what confidence and how much variance is explained Um, a lot, you know, with these these brain scan measures Yes, um about six years ago I used to work in mental health and I had three patients all of whom exhibited psychotic behaviors One had typical schizophrenia One had a drug induced psychosis and the other had a rare enzyme disorder and what was Important about each of these cases is the schizophrenic responded well to anti psychotic drugs The woman with the enzyme disorder atypical anti psychotics actually aggravated her symptoms And then the woman with the drug induced disorder wasn't really impacted And you'd sort of touched on this earlier when discussing separating bipolar disorder from schizophrenic disorder From a treatment perspective I'm sort of interested. Uh, do you think you're going to be able to really sort of fingerprint These disorders such that you could maybe when these people come into the emergency room separate between schizophrenia and a drug induced disorder or an enzyme disorder or is it just going to be a way to sort of Rapidly narrow down symptoms, but you're still going to need sort of that trial and error phase of therapy. Sure. So, um the The exact goal of that study the original one that we did was to answer that exact question What is is that when a patient first presents the emergency room? It's the first time they've been ill and they've had those psychotic behaviors So they're they're hearing voices delusions hallucinations, etc Can the brain scan help determine what the eventual diagnosis would be by matching that person's brain now To a template of well diagnosed other patients and I think that we're at the point where it's um, it's helpful I've actually had I give grand rounds to a lot of different psychiatry departments And I explain the science and a lot of them have said like my gosh We really have some patients we've been struggling with for six eight nine months We can't figure out exactly what they're going to have because it takes a course A longitudinal course to sometimes develop what the illness is going to be and what's the best medicine So, um, I think I don't know if we're ready for clinical trials yet with this technique But I that's the goal of the technique is to try to help do that And there may be other ways there might be other biomarkers that might be relevant blood related markers, etc For an enzyme related problem or etc. They could be you know an on addition on top of that. So instead the point is is that Is there any way that neuroscience can help improve that because and then what if we have Everybody has schizophrenia that we've fit into this distribution. Is there a way even within that base? As Sally mentioned, there's people that onset at different ages There's different courses in the conditions of it's more severe less severe Can we help you determine? What's the best medicine to put them on at the time? And if we could that's the goal of that work I mean it just happens to be that the legal system has been fascinated by the fact that neuroscience Actually is getting better and better able to do this and then and then how are they going to deal with those images in court? Basically is what they're concerned about or interested in Yes, sir Yeah, when you were speaking occurred to me remember when they put the death the Oklahoma City Murrow federal billing bomber and he had kind of kept his right to remain silent. I was wondering in my mind if we were kind of extinguishing Key resource to understanding predicting maybe future favorite patterns like that. Do you ever sense that putting to death? people who have done atrocities That we might regret it. Later as we unlock more brain science mysteries interesting, yes. Oh, well Well, there are two questions here. I suppose one is your One is a feeling about the death death penalty in and of itself, which I know we're not going to probably get into The the other I guess is what you're asking Would we regret the fact that we ended up executing someone who was truly not responsible We're already Oh There's the ethical issue of voluntary involvement in research Oh, you mean you could get a presumably if you have all the work Yeah, if you volunteered for one of his studies, that would be a mitigating factor right there. I would have been happy to study him But I think you've asked a bigger a bigger question I I work with individuals on death row and in different states and we've interviewed tried to understand how they developed the way again The the goal is to try to prevent Subsequent individuals from ever following that path So I think it would be valuable if we could learn a lot from individuals As as much as we can to prevent it. That's the goal Where do we think we stand in terms of the predictive value of this? I'm thinking especially of the case where you have a very young child and generations and generations of his family have been Exhibited psychopathology And this kid shows up presenting badly on a on a on a scan Is this a minority report situation? What do we do with this kid? That's a very good question. I mean, I think that if there's a lot I'm I'm a proactive I'm a proponent of proactively helping to treat and remediate problems But first there has to be a problem So if the child is just presented to the first time for the criminal justice system I'm a fan of trying to put that kid in the best treatment program as possible to remediate those types of problems Like I said, there's a lot I think that youth in particular There's a lot of capacity for change and we certainly do not have a strong hold on Whether or not we can predict with some degree of Certainty scientific certainty to use the legal term Whether or not that child that presents is going to end up on that trajectory. We just don't know But I am a fan of trying to identify as carefully as possible The issues that child is brought to the table be it the you know the Family incidents of the same problems and then how you might develop a better treatment program based on What that child is presented with and maybe the best thing is to remove them from that family environment So that doesn't continue to precipitate bad problems Help no I think you'll hear about it if we disagree I'm just trying to get a sense of how this all applies to The general population and take for example the boy's town example there are a lot of kids with very troubled environments very troubled backgrounds and Probably some majority don't end up Having behavioral problems I mean is it a majority and then of that group that Get into trouble and sort of become the boy's town pool Then how many of those are the ones that really don't respond to the behavioral modification and And you know you're starting to look at drugs and that kind of thing So just sort of put it in perspective With the general population and in a related question is You know if you just took a brain scan of 100 people off the street Is could you tell from those people? Who's schizophrenic? Who's bipolar? Who's psychopathic? Or is it only once you've identified? A problematic group then you can identify the psychopaths among them Well, so just the boy's town model most the kids that come into our program again with very troubled backgrounds and with a wide range of pathology About 85 percent of them do really well.  They graduate from the program go off get jobs go to the military Or go to go to college But no, I don't think the science is to the point where we can use a brain scan without using other identifying diagnostic Instruments to really narrow down the pool For so that imaging would actually be meaningful in any way You know Reminds me of a of a phenomenon that that researchers and and clinicians Tend to find themselves in which has been called the the clinicians illusion And and that refers to the fact that Most of our well by definition almost all of our research is is done on people who as you say already Are already ill and usually not just a little ill But really ill, you know, for example, if you want to talk about post-traumatic stress disorder I mean most most people that say they've been in a horrible car crash You don't get some variant of of that and you know, and it'll probably for several weeks. They'll still have you know still have some Startle effect and they'll be anxious and they're in trouble sleeping and they might want to avoid the situation In which it happened want to ride in cars, but you know, it'll resolve and they'll come to terms with it You know at every level of severity you get you know more people funnel off until you see the folks that that we all see and and by then It's it's tempting to make Conclusions about all people with this condition based on this minority of people that we see So what you're when you said how does this relate to? Probably every day people or everyday situations where some something's problematic But you know not of you know the magnitude of something that's clinical or come to legal attention We're don't we probably don't have a lot to say about those sorts of things except thank god They usually resolve on there on their own because that's not who who we're studying And I've always personally wished that we we had more research on people who who were able to again You can see my focus is always through drugs, but I meant everything. I just said there was more generic But when it comes to addiction, I'd love to see people who can handle their drugs and even handle their addiction But we don't study these people because they don't they don't come to see us I mean actually are you asking generally what can the general population take from a conversation like this? and I think that a couple of take-home messages I would offer would be that You know neuroscience has wonderful tools that make you Kind of beautifully visually capture kind of what's going on inside someone's you know inside the brain And as we get better and better we're going to be able to help say that there are differences There's men and women differences. There's differences between you know young and old There's differences between and and as we get better and better able to to match these techniques to different behaviors There's going to be a picture of a brain of a specific behavior. Okay, there's a picture of a brain It was always in there anyway. We just have a camera now that can take a picture of it And the question is what we're trying to do most of us is figure out How to use that picture to help implement better outcomes How to use that to help determine better treatment better? out for people so It I just hope people aren't too surprised by all the images that they're likely to see You know coming out in in these different areas Because most of it's pretty good science. Most of it's people trying to do their best science Um, and then of course to pick on the attorneys, you know, it gets the legal system will distort Or pervert a lot of the science for an adversarial system to fight to use it for one case and not for another case and to Say it's aggravating or it's mitigating. They they will tug and pull at that information sometimes prematurely Sometimes it's a good science that should be you know tug and pulled in the legal system Um, so Say Yes, my my question relates to a resolution. So psychiatric disorders are complex disorders Characterizations of of different behaviors and If the dsm has so much difficulty in defining these disorders How do you see how do you see the challenge? of Defining behaviors that could actually stem from different Causes so you can have fear Which is very distinct behavior even very primitive behavior That could be elicited by different causes. So so talk about The resolution in terms of like how deep do you need to go to the brain to actually Define and characterize specific behaviors Um I um I try to emphasize that that you know the neuroscience is only going to be as good as the phenotype that we're trying to assess So if we're trying to assess some transience event like a In fact of a trauma from a car crash It's going to be very difficult to assess that with some stability for sure, especially if it resolves But also with um any accuracy The measures that we're I'm generally talking about where we get good neuroscience data Are traits are things that are present for the vast majority of life in most domains of your life And they really characterize your personality And they characterize the problem They help to they're highly related to the problems that you're experiencing at home at work in school and family and friends And when you have that kind of a trait then there's we are more able to accurately map the neuroscience data at any time point You know to that data and the same thing with symptoms, you know With patients with schizophrenia they cycle through all different types of symptoms And there are definitely neuroscience correlates of the symptoms at the time of the scan But there are also traits that are common across multiple time points. So what we do is we extract At the first episode when the patient presents then it's six months later And then another year later and we look for not what's we look for what's common across that patient across all of those time points Um as our measure of The illness the measure of symptoms is all the other stuff that's varying with the symptoms that the patient presents with And both are relevant both are treatment were relevant for treatment So you want to reduce the symptoms you treat that part of the system that's relevant And then if it's the it's a real disease process that's precipitating a wide range of symptoms That might have a very different treatment. So we try to take into consideration, you know, all of those things And I think we're about out of time for questions. Unfortunately did either of you want to have any final comments? Before we go there'll be a greater conversation afterwards too Okay, all right. Thanks a lot Thank you, Laura. Thanks to all the speakers That was a great conversation and and great questions from the audience just a reminder. It's nice When you ask a question to introduce yourself That includes you Joel Garot Joel is one of our future tense fellows and he's on the faculty at asu And he's sort of our co-director in coordinating the future tense program and in his question. You might have noticed he alluded to minority report and Joel back in that in those years was instrumental in bringing that movie to life I think he sat next to Steven Spielberg and figured out the script or something like that, but a slight exaggeration there That conversation serves as a great segue to our next presentation Which will be conducted by Abigail Marsh and it's entitled empathy in the adolescent brain Abigail is the assistant professor of psychology is an assistant professor of psychology at georgetown university Her research focuses on understanding emotions such as empathy And how they relate to aggression altruism and violence Abigail Well, thanks for a great prelude. I have a lot of overlap with both k-line kent kent and i grew up in the same neighborhood as it turns out in university place, washington just a few miles Just a few miles from where uh, ted bendy grew up Which may explain both of our ending up in this field and both kail and I worked in uh, common lab at the NIH In any case, I think most of us would agree that it's pretty messed up to kill the family dogs with an axe You just you don't do it and I think most of us would agree that anybody who did do it was a criminal michael shardle Is a 19 year old who did kill his family dogs with an axe and he clearly is a criminal But that's probably not all he is suggested by the reason that he killed the dogs At the time of the killing shardle was living at home Uh, wasn't in school and had no job to speak of but for a while his mother was willing to give him $50 a day and pocket money anyhow The problem was that she drove a school bus and eventually she couldn't afford to keep paying him and she told him that he needed to find a job Shardle's response was to kill the family dogs in the barn with an axe So that when he returned he could take his mother and grandmother hostage while he described in great detail What he had done to the dogs and threatened to do the same thing to them unless they paid up So also from washington state And so this combination of an irresponsible lifestyle parasitic orientation towards other people And the use of threats and violence for personal gains suggests that michael shardle may be a psychopath Uh, so psychopathy is it's sort of that basically robs the human brain of empathy and it can be identified as early as adolescence That's a period of life that in terms of brain development lasts from age 11 or 12 to about age And not coincidentally adolescence is when antisocial behavior and violence peak So understanding empathy and psychopathy in this age group is especially critical and a key thing A key thing to know about psychopathy is that it varies continuously across the population.  It's it doesn't work exactly like that. Uh, lots of functional people in the world Have moderate levels of psychopathy with a bona fide quote psychopaths like michael shardle at the far end of the distribution Uh, and psychopathy consists of two basic groups of traits Antisocial behaviors like stimulation seeking impulsivity and temper tantrums note There aren't no actually floored criminal behaviors In that group. Uh, and then also the callous and emotional traits Like low empathy low remorse and shallow emotions. However, not all emotions are equally affected by psychopathy Rather psychopathy seems to mainly impair fear. And this is something we've alluded to so far today So for example, whereas most people get jumpy and sweaty when they're under threat Psychopaths, uh, don't they don't show this response at all. They show no startle response Well in a very limited skin conductance response And this is by the way one reason that the polygraph is such a problem It measures fear responses, uh, and psychopaths who are arguably the criminals that we most want to catch don't show these responses Uh, psychopathy also impairs averse of conditioning, which is basically learning to avoid scary things This again is one of the reasons that simple imprisonment of people with psychopathic traits is a problem because we Hope that the threat of imprisonment serves some sort of a preventative Effect and in people who have no Ability for averse of conditioning who don't Fear punishment. Um, it's much less effective. Uh, and then finally psychopathy impairs this objective experience of fear Uh, so clearly psychopaths don't experience fear the way that most people do these are, you know, some of the most comprehensive metrics We have of the fear response and they're very consistently Um different and people who are psychopathic Psychopaths also don't understand what other people are experiencing fear So they don't recognize expression to fear in the face or the body or the voice and this may be essential Because and this is what empathy research is starting to show Just recognizing another person's emotional state is maybe the most fundamental basic form of empathy that there is So is where most people can read the terror in this face rapidly and effortlessly. I hope most of us can in this room Psychopaths seem to more or less draw blank So one psychopath who was being tested in prison got every single fear expression that he was shown wrong Finally and he was shown expressions just like the one we saw before and finally he commented You know, I don't know what that expression is called, but I know that's what people look like right before I stab them Right, so clearly he knew something about this face. He just couldn't link it to an emotion So why would this be why would psychopaths be so blind to other's fear? Maybe it's because you can't really understand an emotion that you don't experience yourself Uh, here's a quote from another psychopath who was in prison for rape and it was interviewed by uh, Robert Hare and he was asked why he didn't uh empathize with his victims and he said well, they're frightened, right? But you see, I don't really understand it. I've been frightened myself and it wasn't unpleasant Right and clearly this is not the statement of somebody who really understands what it means to be afraid I think and so it's such a young gap in human experience suggests some sort of fundamental defect in the brains of psychopaths. No problem Um and studies of people with damage to the amygdala suggests what that defect might be So the amygdala is an evolutionarily ancient structure embedded deep in the temporal lobes of the brain and it's known to be involved in A number of aspects of fear And interestingly people who have damage to the amygdala through a variety of different causes show Extremely similar deficits to psychopaths So they show no physiological or subjective experience of fear and they show impaired recognition of fear in other people's through a variety of modalities So if psychopaths don't feel a recognized fear and if amygdala lesions impair the ability to feel a recognized fear Seems reasonable that uh psychopaths problems may stem from some deficit in amygdala And this is what my colleagues and I at the NIH Including james blair set out to test in one of the first brain imaging studies ever conducted in psychopathic adolescents And we wanted to find out whether they reduced empathy and sensitivity to fear that we see in these kids relates to amygdala dysfunction So we asked psychopathic adolescents between the ages of 10 and 17 As well as healthy controls as well as controls with pure adhd right who also are impulsive But don't seem to have the call us on emotional traits And we asked them to look at fearful and angry and neutral expressions while we scan their brains using fmri And we found that both healthy kids and kids with pure adhd showed increased Amygdala activity when they looked at the fearful expressions and we didn't see this for example for anger expressions And this is a nice confirmation of the amygdala's known role in processing fear cues And by contrast psychopathic kids showed either no increase in amygdala activity or in some cases Even a decrease and this result has now been replicated several times by several different labs So what's going on here Uh clearly fear sensitivity is impaired somehow in psychopaths probably due to defects in the amygdala And this seems to leave psychopaths unable to recognize fear and other people But what we really want is an answer to our million dollar question, which is why do psychopaths do things that cause fear? Right. Why do they threaten people and bully them and assault them? Why do they tell their moms that they got to kill her with an axe unless she keeps giving them pocket money? Can sensitivity to fear help to explain why psychopaths do things that cause fear? So to answer this question We tweaked the classic emotion recognition task and people have lots of different studies that have been done for decades now Look at faces just like these and figure out what emotion each person is feeling And we wanted to see Something a little different, which is can people figure out what causes emotions like these in the first place Uh, so first we generated a list of emotionally evocative statements Which are a really nice way of uh evoking strong specific emotions in a laboratory context like fear and anger Ethically speaking, it's difficult to elicit Fear and anger and uh some of the ways that are known to elicit them in the real world But we can do it with these um evocative statements And then we measure the psychopathy levels of 40 adolescents and adults that we recruited from the community And they read all of these statements and they try to figure out what emotion each one of these statements could cause And then the critical phase of the tasks Uh subject read all the statements again, and they judge whether it would be uh ever morally acceptable to make a statement like this to other people and again Uh, we expected that psychopathy would keep people from recognizing what causes people to be afraid And that maybe this can help us figure out why psychopaths don't believe that causing people fear is such a big deal And again, uh, usually the kinds of statements that elicit fear in people are things like threats That are used to for instrumental gain or for personal gain, which is a very common feature of psychopathy perhaps one of the defining features So what are our results show first a psychopathy was very strongly associated with fear blindness again This is a result we've never replicated several times So people with high psychopathy scores had trouble figuring out that statements like I could easily hurt you and you better watch your back Would make someone afraid right? It just doesn't occur to them that that's the the end result And the judgments of other emotions are pretty normal except interestingly happiness, which I could talk about if that's interesting What about judgments of whether it's okay to do things that cause people fear? And here is psychopathy it was closely associated with judgments that scaring people is acceptable And then these two judgments are themselves correlated So if you can't figure out what would make somebody afraid you're much more likely to think that frightening people is okay And you're much more likely to be psychopathic So do mistakes in understanding what makes people afraid also involve and make little problems To find out we ran an fmr study at georgetown where we asked people to make moral judgments while we scan their brains And we use special recruitment techniques to attract psychopathic adolescents from the community Which apparently worked our high psychopathy sample had scores similar to those previously seen in prison populations and had pretty high Self-reported sorry about the the little format change. I think it's like a mac to pc transition issue there in any case The psychopathic sample we recruited from the general population reported high levels of aggression They also responded to the statements that they read during the task pretty similarly to subjects in our first study people with High psychopathy scores basically thought it was fine to scare people But their judgments of causing people other emotions like anger and sadness and disgust were more or less normal And this difference was accompanied by a group difference in amygdala activity during the task So people with low psychopathy scores saw scaring people as a You know bad thing to do and they recruited the amygdala during these judgments Whereas people with high psychopathy scores saw scaring people as no big deal and they showed no increase in amygdala activity And here's the percent signal change that you can see plotted out in the amygdala for both groups So you can see this big difference in amygdala activity that again only pops up when subjects consider whether it's okay to make somebody else afraid What were the high psychopathy subjects doing? This is something that's been found in a number of other moral judgment tasks with a variety of psychopathic populations as well Which is that they try to reason their way through the task They sort of try to blunt force logic their way through decisions about whether it's okay to threaten to kill people And across all of the different emotion categories The more psychopathic subjects showed a lot of activity in a region of the lateral prefrontal cortex That's involved in working memory and attention During all sorts of cognitive tasks But we assume that based on the fact that the high psychopathy subjects showed pretty distorted response patterns Cognitive reasoning through a task like this is only going to get you so far when it comes to moral judgments So I think these findings highlight the importance of fear for normal social functioning We all know that the fear of experiencing pain or injury is useful for helping us to avoid danger And it's true that people who are psychopathic tend to just get themselves in a lot more hot water because They don't seem to fear injury or punishment as much as other people But beyond this it seems that when the experience of fear is dysfunctional So is the ability to understand other people's experiences of fear and to appreciate the moral seriousness of making them afraid Right if you if you've experienced fear as not such a bad thing to experience Why would it be such a bad thing to cause somebody else? And we suggest that it's this inability to empathize with experiences of fear that they don't have that lies at the core of Psychopathy or is at least essentially related to the relationship between the callous and emotional traits and the behaviors that we see And this obviously leads to sobering questions when it comes to adolescents who are psychopathic Realizing that they genuinely don't comprehend the distress that their actions cause other people Definitely helps us understand their behavior better. But is it an excuse for their behavior? And even if we can assume that we can reliably confirm that defects and the amygdala under a lot of psychopathy And research that's been coming at this from a lot of different angles again Not just fmri studies, which are useful, but can ever be the only means of understanding anything Do seem to implicate the amygdala in psychopathy over and over again. Well, what then right should this lead to harsher lighter sentences for affected teens And these are not Questions with easy answers as we saw from our panel discussion a moment ago. So I think maybe the best we can hope for for now is that the the next Upcoming generation of neuroscience research gives us new options for treatment Even prevention and maybe a means of restoring empathy to brains where it has failed to emerge Thanks, Abigail So it was interesting to learn that for some people the only thing they have to fear is not necessarily fear itself and Yes Earlier in during the panel conversation, there was some very gentle shots taken at lawyers So our next conversation is going to be a chance for The legal side of the equation here to have it say So i'd like to go ahead and introduce jeffrey rosen To be our moderator jeffrey probably doesn't need much introduction. I know i've been Reading him for years and learning from him. He's a professor of law at george washington university And the legal affairs editor at the new republic, which is one of many publications where he is written prolifically On many subjects jeffrey Thanks for doing this and you will introduce the other speakers Thank you very much Thank you. It's great to be here. This is a wonderful subject My brain made me do it.  And I cannot think of two people better equipped to discuss it. Hank, please come up I first started learning about this subject from hank grilly A few years ago and I wrote about it. Welcome He has written some path breaking Articles about its effect on the criminal justice system and we have a lot to learn from him I'm going to read his impressive titles He's a professor of law at stanford the director of stanford center for law and the biosciences And director of the stanford interdisciplinary group on neuroscience and society And he is joined by gary marchand who I've begun corresponding with Who is equally broad and illuminating in his Commentaries on this and other subjects. He is the lincoln professor of emerging technologies law and ethics at Arizona state university sandra day o'connor college of law and the faculty director of asu's center for law science and innovation Gentlemen, so we are the legal panel and we need to discuss To what degree is the brain made me do it defense actually transforming the criminal justice system Hank when you and I started talking about this a few years ago As as well as uh, steven morris who's taught me so much about this subject We talked about that famous case from the early 90s Involving spider cyst cough and this was the guy and mr. Weinstein who killed his wife by Throwing her off their 12th story apartment building on 72nd street in new york to make her murder look like a suicide and then a trial he introduced a brain made me do it defense He said that he had an arachnoid or spider shaped cyst that was Around his amygdala and this Made his impulse control dramatically lessen the judge considered the evidence and came up with a Solomonic solution he allowed the jury to hear evidence that Mr. Weinstein had an arachnoid cyst but not that there was a correlation between the cyst and violence And since then I gather This evidence has been most likely to come in in death penalty trials given the relaxed evidentiary standard So the defense introduces a brain made me do a defense the prosecution counters But it's not clear that it's actually had much of an effect on jurors So I want to begin by asking both of you to what degree is this evidence coming in and how influential is it Hank, why don't you begin? Okay, although first I'd note that although we are a legal panel and not an illegal panel Stephen morse was also a legal speaker earlier in the day um And this the spider syscoff case westcoff case is really kind of an interesting example the judge made that solomonic decision But what happened next? They copped a plea the prosecution knowing that this evidence was going to be introduced Then offered a reduced a plea to a lesser included offense which the offense took So the criminal justice system is really complicated in lots of ways just because something comes in doesn't mean it gets to the jury Because most cases never actually go through trial most cases never get to the jury they settle both in the civil and in the criminal context one way or the other and these are They're chips. They're poker chips If you can if you can throw in some more evidence if the judge lets you put in more evidence that Might make the case go longer might confuse the jury might increase the uncertainty It changes the calculation about when when one settles when one doesn't But to get back to your specific question. We don't really know how often this is happening We've made a few stabs at it various people have Anita Farahani who's a professor now at duke law school has been collecting reported decisions involving neuroscience and criminal cases neuroimaging in criminal cases now reported decisions are the tip of the icebergs tip They're the seagull sitting on top of the tip of the iceberg Because most cases never actually go to trial And of the ones that go to trial most never get appealed and increasingly of the ones that get appealed Most never actually lead to a published opinion. They get resolved in some Some very summary way But she's found an increasing number of cases in which neuroimaging evidence has been discussed in these appeals from 40 five years ago To 102 years ago to her latest unpublished data. She told me a couple of weeks ago Four or 500 in 2011 So quite a expanding curve The interesting thing is Many of those are for things like ineffective assistance of counsel So on appeal after you've been convicted you say Well, I should have been convicted because my trial lawyer was an idiot because he didn't get my brain scan put in However, some of them are being introduced for issues of insanity issues of competence issues of the ability to form a relevant intent As far as we can tell very few of those are winning But it's not zero The tougher thing to do and I try and I know this is tough because I tried doing it Is to try to see what's happening at the trial level where cases are not reported Um, we looked by surveying district attorneys and public defenders in all 58 of california's counties For cases where neuroimaging evidence had been brought in at the trial level because there's no general way to find out what happens at trial And we found about 40 to 50 cases over the span of two or three years Again, most of them failures most of them where the defense brought it up Didn't work But of course, we don't see is how many of those the threat of bringing it up may have led to A lighter sentence or may have led to some sort of plea deal Very interesting and it's good to have those numbers Kerry, do you have a sense of what the latest influence is in any cases you find especially? Well, I think Hank has described it exactly right. Um, uh Debra Dano just published a law review article looking at genetics cases and found about 80 of those cases I'm doing a project with linda that whose Ken's wife happens to be we've got about 150 cases. We're looking at right now and So there definitely is a lot of cases where this is being raised But as as hank said, these are all reported cases that that it makes it easy to find them Not the ones that actually a trial where it could really be making a difference And when it's up at the appellate level, it's usually because of as hank said an effective assistance counsel Which is a very hard standard for a criminal defendant to overcome And it's actually gotten a lot harder from some recent supreme court decisions So they're almost always losing but not always There's no cases really where there's any success on the guilt phase It's really that where the action is is on the mitigation on the sentencing after someone's already been found guilty So they've been found have committed this horrible crime usually and then This is is tried to be introduced for the purpose of mitigation And it's fairly actually easy to get it admitted because the standards for mission and mitigation is actually pretty low And so it is being presented But a lot of times on appeal and so it's not to the jury and and the court is saying basically this wouldn't add anything New or just be duplicative or you waved it or whatever And so we don't see a lot of actual trial cases The other dynamic is is that the lawyers who are doing a lot of the trial cases aren't the best lawyers They're you know public defenders who spend only a few hours on the case And then when the the person gets convicted and sentenced to death Then they have some top much higher caliber lawyers put a lot more resources into it But now the legal standard is very hard to overcome at that point So the question will be if you actually start introducing this at the trial stage with competent lawyers Will it have any kind of impact and there are at least a couple cases. There's a brain scanning case in florida The grady nelson case where a couple of the jurors said the fact of this brain scanning convinced me not to sentence them to death And then a genetics case in tennessee where again the genetic test combined with some other data Convince the jury not to go with capital murder So there's at least some cases where this is actually working at the trial stage But as hanks said it's very hard to look at it generically But if your defense counsel particularly if it's in the capital case You've had a conviction.  It's not his fault. We shouldn't kill him On the other side on the other side of the other edge of the sword is this guy's a natural born killer We have to put him down And I think um one of the most prominent cases one that kent was actually involved in the dugon case from illinois Was a case where the facts were so awful I think the defense counsel figured they didn't have anything to lose their client was in such serious shape That the jury couldn't think any worse of them And they rolled the dice And ended up having the jury stay out a lot longer than they expected it to His client was still sentenced to death It's uh, I'm not sure whether you count that as a moral victory or not But the defense counsel uh did think that that evidence at least made the jury think harder a lot and think a lot longer We'll say more about that double-edged story, which is so interesting on the one hand as you suggest It could lead jurors to say that uh, it wasn't the guy's fault So he should get off more easily on the other hand if he's almost certain to offend again You could put him in jail for longer or even uh Executed and carter sneat has expressed concern that neuroscience evidence If it does lead to the end of retribution by focusing on specific deterrence could lead more people to sentence to death Not fewer any empirical evidence in the aggregate about whether jurors are more likely to be moved to mercy or to uh Execute based on this evidence Well, I don't know of any evidence One way or the other about that the ends are so small that at best you'd have anecdotes And although we lawyers like to think data is the plural of anecdotes non-lawyers generally don't buy that There's an interesting study just published by one of hanks former students and some colleagues on judges In science they've found a little bit of a reduction in the sentences for when you introduce an neuroscience evidence So that's these judges, but although The case I had a little bit involvement with the jeff landergan case is a genetics case the ninth circuit In their decision said this is all the more reason to execute them not last because of that double-edged sort So some there's at least some judges who view it the other way and then in terms of jurors again As hanks said it's really just anecdotes, but if you look at the anecdotes, they're out there and you know Some from from articles you written jeff, but other ones They go both ways and so you wonder why in this case of the jurors think this one's was it the way the expert presented it Was the way the attorney presented it was a nature of the crime It's very hard to know why sometimes it goes one way and some the other yeah the piece in science Where my former student tenille or former postdoc tenille brown now at the university of utah law school was one of the co-authors Was I think a nice piece of work, but it's hypothetical Ask a bunch of judges a set of hypothetical questions And one always wonders how realistic is that if they're actually in the situation Would they do the same thing that? Taking answering questions when they know they're in the middle of an experiment Would they enter the same way and we don't know That's why it would be really nice to have real data to have enough of these cases to have them followed To have them collectible in a way that would lead us to be able to get a big enough end to be able to answer some of these questions empirically Now what is the fact that judges and jurors are dividing about this evidence say in response to steven morse's challenge He has written eloquently about brain overclaim syndrome And noted that the idea that neuroscience evidence was going to mean the end of free will and responsibility Seems hyperbolic after all the law generally holds people account if they Act voluntarily as long as they're not under duress or can't appreciate the difference between right and wrong And doesn't care whether it was the mingle that made me do it or a bad mommy and daddy or twinkies And on the other hand there are people like Cone and green who say that We really are helpless slaves of our brain that when I just gestured dramatically right now And I thought that was an intentional act to emphasize my point But it really probably my intention to move my hand may have taken place 400 milliseconds before I became aware of the desire to move my hand and 10 100 milliseconds before I had the ability to stop it So if i'm just a completely determined creature the idea that i'm intentionally acting as Nonsensical my question to you gentlemen is are these philosophical debates? Although terribly interesting at all reflected in the legal debates or are they just Too abstract to really matter and judges and jurors are dealing with more practical questions So my answer to that I think is yes and no I don't think they're like a philosopher andemore. Yeah, it's a twinkie that made me do it The absence of my normal morning twinkie Our frontal lobes are not functioning very well I think that with respect to the actual judges and the discussion Of legal doctrine we're not seeing very much of this We're seeing discussion in the standard legal terms You know was their mens rea was their insanity was their competency etc And not discussion at sort of a deeper philosophical free will level I actually think that the jurors reaction does reflect Thoughts about free will the fact that the jurors go in every different direction and and that All of us are torn to go in other directions Reflects the fact that we're deeply confused about free will because it's deeply confusing It doesn't seem I I can't figure out how I can have free will But I feel like I have free will that seems like a useful kind of feeling to have I kind of believe that you moved your hand because you wanted to make a gesture and not because of your twinkie deficit or twinkie surplus I can't figure out how that can be the case scientifically And the neuroscientists who still seem to believe in some broad sense of free will will wave their hands and talk about quantum mechanics and a variety of other fairly silly things I think But at the same time I can't really accept that I don't have free will I think jurors are As philosophers are deeply puzzled and conflicted about the reality of free will and what it means And that means if you throw a set of attractive facts at them You get a bunch of different answers back I think ken's comment about the courts and the legal system being sort of overusing this is actually true I mean you think about it. It's not like science where we just have this open and ongoing Search for truth. It's a one-time shot and there's huge stakes at at issue here of people's lives and and the victims of rights And and so the lawyers tendency we try to throw everything they can at it any argument They can and frankly from the defense lawyers in a lot of these cases. They don't have his hands It a lot going for them. There's you know, the guy's been found guilty. He's clearly guilty. It's mostly a guy And and and they don't have a lot of of ammo to really throw at it So they're gonna I think throw this stuff more and more at juries and try to get it to juries and and see what happens And so we may eventually get more empirical data. Look at this But you know, how do I come down and I had the privilege hearing Steve and many times and every time I hear him I'm convinced and yet I would still vote not to send that guy to jail Mr. Apt or what do you call off off, Mr. Off I was still if I was on a jury, I don't think I'd send him to jail I don't know if I'd find him guilty and and and you know send him to the hospital or whatever But I don't think I'd put him in jail and I want how many other people would feel about that I don't know but even though I when I follow you a philosophical I tried to sentence his tumor to death, but it didn't work Let me ask about detention for propensity. This is the most controversial potential use of neuroscience evidence So I'm walking down the street and a mobile Brain scan looks at my brain along with a picture of a training camp in Afghanistan And if I've not been there, I am sent happily on my way But if I have my brain alerts in a certain way and I'm taken off the street and carted off To guantanamo and detained indefinitely as a potential enemy combatant Would this be permissible under current constitutional doctrine? Could we imagine anything along these lines this sort of cognitive profiling happening in the future? Or maybe I should just be surveilled a little bit and not actually hauled off to guantanamo You know, it's not very often that I get asked a legal question for which my answer is not it depends But I think for this one I can say no that would not be allowed under current legal doctrine And I hope that will stay at least in the United States Although there are other countries and countries that we think of as sharing many of our views on freedom like Great Britain The United Kingdom, which has some stronger views about preventive detention Uh permissible of preventive detention than we are I don't so Won't happen today I think if it does happen, it's going to be a long time Before anybody is confident enough in neuroscience findings by themselves It certainly should be a long time Before anyone's confident enough about neuroscience findings by themselves to do that one of the things that Stephen who just left has pointed out often is neuroscience is usually cumulative if it's useful at all It's cumulative evidence you start with behavior We start with the fact that you've been downloading a whole bunch of interesting stuff from al Qaeda Websites that you've been inquiring about fertilizer purchasing large quantities of fertilizer and so on Then maybe The narrow image Is some additive evidence And in that case it might actually be relevant evidence that might push you over the edge one way or the other But I think just to have the brain scans used Is a is a big leap I mean even so for two Two reasons and I actually think that neuroimaging will be used in law fair amount I just don't think it's likely to be used for this In that kind of setting one is Plasticity I mean people or people's brains are different Um your brain may react to that in some way 99 brains out of 100 may react to that in some way But you may be the hundredth and right now We don't even know whether it's 99 out of 100 or 9.9 out of 100 or 3i out of 100 Imaginary numbers we just don't have that kind of data and it's going to be a long time before we get it So individual differences are going to be a real problem particularly in high stakes like detention The other problem is even if you do react as if you've seen that camp before Is it that you've seen that camp or you've seen a picture of that camp or that camp looks like that summer camp That your parents sent you off to when you were 11 that you'd never forgiven them for Right, I mean we you know those kinds of problems are uh are going to be uh serious no matter what so It's a great science fiction theme. I love science fiction But I don't think it's likely to show up in our courts in my lifetime or in yours At least that way Is there any A less science fictiony version of cognitive profiling whereas Psychopaths have brains with underactive amygdala's and less gray matter that might raise some suspicions for further investigation I don't think here, but I mean you know other countries like say in north korea It's possible some point in the future they could start using that kind of technology possibly But I think that the lesson here is is the science panel is talking about is Is the legal system and some of the tragedies you read about there really Underscored the importance of trying to use this this new science for prevention Not to put people in jail not to punish them for having these tendencies, but to try and prevent them from occurring You know you read these cases are just so horrific of these horrible crimes that occur and just say you know Can you imagine that having someone in your family? It's just absolutely devastating then You know even on the on the people who did it side I remember I talked to the the lawyer for jeff landergan So he was a guy who's adopted at a young age and Had a horrible upbringing and he made this claim that he has this murder gene He didn't use it in that that wording But he made this claim and it went all the way to u.s supreme court and and they ruled it was too late for him to Introduce that evidence so he never had a chance to introduce it but uh The claim was he had this mao ageing and and in talking to his lawyer It's clear he his entire life was was ruined by this reaction He had whenever he got frustrated or really put upon he just flashed out really violently And uh he committed two murders both where he basically was sort of provoked and he just lost control He would do it with the judge in the cases. He would do it with his own lawyer and he now recognizes it He he he would he's now executed, but he before he was he would recognize this. I just did it again He'd say and uh his lawyer saying you know there's something just wrong with him Metabolically that probably could have been treated with some kind of drug or some way that could have been controlled And his life wouldn't have been ruined and the people he killed wouldn't have been ruined And you look at these stories over and over in our criminal justice system and say if we could have prevented this There's so much suffering that could have been prevented. Um, you know, surely we can try and do better And you know the problem was we never had any markers really any any Factors that showed that there is a risk and now the work that kendon other people are doing We're now starting to get some suggestive evidence as we can maybe identify risks again The great news is it's not deterministic. It doesn't mean they will do this It means they're at a greater risk and so Now that we have that the question is can we pair that one with treatments? And it seems only really worth doing this if we can pair with treatments But if we can put some resources into finding these treatments and making them work We can maybe prevent some of these horrible cases from actually occurring Gary said the great news is it's not deterministic If you're trying to use it as a predictor the fact that it's not deterministic is not such great news That's troubling news. How many false positives do you get? How many people with small inactive amygdalas turn out not to be psychopaths Versus how many people who are psychopaths don't have big amygdalas? What's the To use the jargon specificity and sensitivity as well as the positive and negative predictive value Accuracy turns out I've had to learn this going into bio as a lawyer. I had no idea But accuracy turns out to be a complicated thing with lots of different meanings And many of the mean I think predicting going from brain scans to actual future behavior Is usually going to be pretty hard. Mr. Aft is a wonderful example because he's his own case in control Twice. I mean he you see him without the tumor. You see him with the tumor Then you see him without the tumor. Then you see him with the tumor Interestingly, I think that means he has no excuse in the future if he begins to feel those urges again He should have a duty to go to the emergency room Get himself scanned and see if the tumor has grown back And I don't think we'd let him off the hook if he knew that he had the propensity just as somebody who knows They have epilepsy and should be taking their meds in order to drive Isn't off the hook if they have a seizure while they drive when they haven't been taking their meds. So I think in the in the Though the cases like mr. Aft Are very rare are going to stay very rare. I think at least for a while On the other hand, I think there are other ways where the stakes are lower And what you're predicting or trying to ascertain is Probably easier than future behavior where neuroimaging is going to be useful in law my own bet on this I haven't bought stock in any company that would really be a bet on it is pain You know pain is in the brain It feels like it hurts here. It actually hurts here They're neuroscientists who think they can see signatures in the brain when people have that ouch subjective pain reaction That's not as sexy as psychopathy But there are a lot more lawsuits and administrative proceedings every year in the united states About pain and there are about murder There are hundreds of thousands of social security disability determinations That hinge on whether somebody's really in pain and if so how much we don't have good tests for them Now even if the pain test is only say 90 percent sensitive and specific That's better than we've got now and you're not putting somebody away for life You're deciding Whether they get disability or not. So I think there are areas where this will work I think predicting future dangerousness And doing something really serious about it locking them up now treatment If there is a proven treatment And it doesn't have big side effects We may be willing to treat on lesser less powerful evidence but um I think locking people away Scientifically won't be justified for a long time if ever. Yeah, I don't think ever that's a case I think that the risk is is more stigmatizing them right of testing them and saying Oh, you're at risk or telling the parents you're at risk and therefore stigmatizing that kid And so that's something as we as we do these studies and try and develop the science to be able to have better predictability That's going to be a sensitive issue to handle You know the false positives if if if we can deal with the stigmatization issue And the treatments are not giving some radical drug, but really, you know, some better Family life and some better nutrition and so on It's not going to be a real risk of that But so it depends what kind of treatments we're looking at But you know as I've been looking through this literature I'm actually quite encouraged that we are actually making progress But it's an area that's really underfunded. There has not been much funding at all in these actual treatment programs I mean a little bit and and there's been some really interesting initial results not enough to Implement this on any kind of broad scale But in terms of actual focused studies and more research This is an area that I think would be worth putting the money into and it would actually pay off in terms of preventing crime If it actually works, although if we could do it I don't think we need neuroscience to say giving people better family lives would be a good thing No, but I mean I think part of the issue is I mean it's just like what's occurring now in these complex neural diseases like autism Or epilepsy or schizophrenia. It's a combination of all kinds of different symptoms And syndromes and so if you can understand that biology and segment like you can Starting to do with some autism now and say look at this mutation has this as a result And this is the prognosis and maybe this is a treatment where this one is a different one Or this epilepsy has this or and this one you can start to do with some of these kids as well Let's say the neuroscience can help you pin down which of the You know trajectories is this kid going to be on or help predict that better and then you know Let's can't sit if you look at some of his papers That's exactly what it's actually starting to show now that you can actually predict that trajectory Based on differences in some of these brain scans as well as from the work of aging rain and others So, you know, again, it's not a done deal yet, but it's showing that it actually could be fruitful to to follow this up Let me ask about a few other immediate practical effects What about on lying and truth telling? Hank you've written about the possibility of being truth tested And could you be impeached if you refuse to take an fmri lie detector test that's much more accurate than the current ones Could truth testing become de rigueur in trials and also talk about the possibility of memory downloads down the line where you can actually Download the equivalent of a video reel of someone's procedural and episodic memories I'll take the second one first because I think that's still quite implausible In part because as far as we can tell it's not that our memories are A master untouched videotape file somewhere in our brain Our memories are not like the dna molecule which cuts which is in theory not mutated Although in fact it mutates our memories seem to change every time we call them up in ways that are very Difficult to pin down. I think the memory research that's going on is really interesting The download I think is going