Man with glasses: My very first contemplation of criminal behaviour was trying to put together a plan of getting away with murder, and I was going to kill my brother.

I knew that every Sunday he would jump on his bike and he'd head down the road to join up with some other fellers. He loved that bike and he used to tell me: 'You ever touch my bike, I'll kill you!'

So this Sunday morning, while he's working, I take his bike, I knew if I provoked it just a little bit more that he would chase me. So I gave him a couple of kicks and took off on a dead run for a tree that was right beside my grandfather's barn. And it went up on to the roof and on the opposite side of the barn there were cutter rakes. And sure enough he chased me up there and as he topped the edge of that roof I kicked him off it, and he fell on to those rakes.

Some court people came and got me.

Narrator: There are few more emotive words in the English language than 'psychopath', a clinical term for a condition that has only recently begun to be properly defined. It describes a dangerous pattern of behaviour which, although it's been recognised for the best part of a century, is little understood.

Every decade has produced its own particular brand of psychopaths whose horrific crimes have defied any kind of rational explanation.

Recent research in psychopathy in Britain and America is encouraging scientists to believe that they are close to discovering the root cause of the condition.

Scientist: Now we can literally look inside the mind of a murderer; we can look inside the brains of psychopaths and begin to see things that nobody else has ever seen before.

Narrator: What the scientists are discovering suggests that psychopaths are born, not made; that their condition is the result of a specific malfunction of the brain. The complexity of psychopathy has made it difficult to treat but now that could all change.

Scientist: I think the general public would characterise a psychopath as somebody who does really nasty things. In fact the public view of the psychopath is that he or she — primarily he — is a serial killer. The general public is not wrong in that respect but what has happened is that they have ignored the fact that there are tens of thousands of other people out there who are psychopaths but are not serial killers.

Scientist: Psychopaths simply do not experience emotions in the same way that we do. They don't experience empathy in the way that we do. They don't experience love in the way that we do. And because of this they are more likely to stick a knife in someone to get what they want because they just don't care about the other person.

Man with glasses: I stabbed my first man — I stabbed him, he lived. But it sent out a word, a clear word to the rest of them that you don't want to be messing with this kid: he'll stick you.

Scientist: Psychopaths can sing the lyrics but they don't respond to the melody, the melody of normal human interactions and emotions. There is something missing. He has no compunctions; he kisses or kills without a thought.

Narrator: They are dangerous, without conscience and all around us. In Britain it is estimated that one in every 200 of the population is psychopathic, and the vast majority are neither criminal nor in prison. But the kind of harm that psychopaths can cause at home and in the workplace is deeply damaging and costly in every sense.

Scientist: We must be concerned about their impact on families when they are out in the community. They move from relationship to relationship; they have multiple children who they abandon; they engage in spousal assault and a whole range of behaviours which are unacceptable.

Narrator: David Cook [sic] is a forensic psychologist at the Douglas Inch Centre in Glasgow. He's made a close study of psychopaths in prison.

David Cook [sic]: They tend to be very versatile in their criminality so they don't tend to engage in one particular type of crime but in a whole variety. So they may engage in violent crime; conning, manipulative crime; they may engage in sex crime; property crime and so forth so they cover the whole range of criminal behaviour.

In the work place they often disrupt and destroy the good working of the business or an operation because they are interested in what's in it for themselves. I think it's a very important condition and we do need resources put into treatment to see if we can find anything that works.

Narrator: The only psychopaths who are readily available for possible treatment and research purposes are those who are locked up in prison. They are a minority of the prison population but they are special. There is a growing realisation that the range of their crimes, coupled with the disproportionate amount of damage they cause, makes them public enemy number one.

Scientist: The population in which you would find a bigger concentration of psychopaths than anywhere else is amongst convicted criminals but a majority of people in prison are not psychopaths. Psychopaths are a minority, but a minority who are particularly likely to reoffend.

Narrator: David Thornton is a senior scientist with Her Majesty's Prison Service. He develops treatment programmes for serious offenders, and recidivist psychopaths are now a major concern of his.

David Thornton: Further criminal behaviour harms the victims of that criminal behaviour. It also costs the country a lot of money in terms of police time, in terms of the time of the courts, and in terms of what society spends in relation to people who've been hurt by crime. You only have to change reoffence rates by quite a small amount and you save quite a lot of money if you think of it in purely economic terms.

Narrator: Before you can tackle the high cost of psychopathic crime, first you must reliably identify who are the psychopaths. Recently this has become easier.

David Cook [sic]: The major breakthrough, I think, has been the development of a psychopathy checklist by Robert Hare and his colleagues. That has allowed uniformity in the diagnostic process so when a researcher in Canada talks about a psychopath defined by Hare and one in Scotland talks about a psychopath defined by Hare's criteria we all know we're talking about the same sort of disorder.

Narrator: In Vancouver, the person who has contributed most to helping everyone get a better handle on psychopathy is Robert Hare. From the start Hare recognised the central problem of defining a condition about which we know little other than its symptoms.

Robert Hare: If you're going to deal with a particular condition, call it psychopathy in this case, or schizophrenia, or any other condition, you've got to make sure that you can record and measure these particular conditions reliably and validly. From the scientific perspective, psychopathy is a culmination of characteristics, inferred personality traits and behaviours that hang together. For this reason we had to figure out a way to make this idea of psychopathy as scientifically valid as possible. And we spent the next 15 years trying to develop an instrument that would actually do this job - in effect a measuring tool that was not made out of rubber.

Narrator: The measuring tool that Hare devised is called the Psychopathy Checklist. It has become the industry standard internationally for identifying psychopaths. In a carefully structured interview, an expert using the checklist, which defines character traits closely associated with psychopaths, can determine the extent to which someone is or is not psychopathic.

Robert Hare: [sic]Many of these characteristics are not uncommon but points are awarded out of 40. A score of 26 or higher is required to identify the true psychopath. Whenever I list the characteristics that define the psychopath, people will say: 'I know somebody who has got two or three of those characteristics. Are they psychopaths?' and I will say: 'Of course not.' What you've got to do is have a cluster or combination of characteristics which hangs together.

Narrator: In the present climate of the United States, prison therapy programmes are no longer fashionable but Vermont Sate Penitentiary is an exception. Behind its high security fences, in a special unit, they have some of the most difficult criminals in the country, including psychopaths.

Voice: This particular unit represents the uncontrollable, the undesirables, the ones that refuse the programme are what they refer to as the most disruptive.

Prisoner: I'm here serving a 5-20-year sentence for sexual molestation of four boys of the ages of four to 12.

Narrator: Wayne has been here for more than 10 years and perhaps has 10 more to do. He scored 40 on the psychopathy checklist. It's the maximum possible and extremely rare. The authorities here believe that time and money spent trying to reform psychopaths like Wayne is a worthwhile investment.

Prisoner: I hope that the tools that I have learned in this programme and other programmes like it um I can…

Narrator: Head of the therapy programme Tom Powell knows he's working relatively uncharted territory and Hare's checklist is invaluable.

Tom Powell: Dr Hare has provided us with some significant advances in understanding in detail the syndrome that is now known as psychopathy. He's validated a scheme that is quite good in terms of looking at a set of antisocial behaviours as well as interpersonal traits, which distinguish these folks.

Tom Powell: What can you tell us about your early years where you grew up?

Prisoner: Well I just turned 45, 23rd of January.

Narrator: Wayne's sessions with Tom Powell are little more than conversation therapy for no one yet has any real idea what works in the treatment of psychopaths, but Powell is discovering the complexities of the personalities he is dealing with.

Wayne: I keep to myself. I do a great deal of studying. I do a great deal of reading. I do a great deal of writing.

Tom Powell: Psychopaths can be wondrous in many ways and one of them is their ability to engage otherwise knowing and well-informed therapists about their sincerity and their desire to change and I have found it very easy to be seduced by the tone and the affect and the engagement of the psychopath who, with great earnestness, tells me that he's finally found the light and has seen the error of his ways.

Wayne: The therapists are wonderful. I learn a great deal from them. Sometimes it can be hard. I suppose that's the way it's supposed to be when you're growing up. I'm ready to go now. I know that decision will come from others who have already seen my change.

Narrator: Carl is another serious psychopath in the Vermont programme, a 36 on the checklist.

Carl: Had a statutorial rape on a minor, 15, I was arrested for an aggravated sexual assault on a female child, she was four years old.

Tom Powell: I think it is very important when therapists undertake to work with psychopaths that they know the entire record and that they not be deceived into believing that they have therapeutic magic that they can work with these individuals.

Carl: It's not good for me to be around any female child whether it be a young child or a teenager.

Tom Powell: In this gentleman we see a striking shallowness of affect. He speaks a language of treatment that is quite articulate in many ways. He's able to talk about his risk factors, his past, in what appears to be a deceptively open way.

Carl: One of my main concerns is that when I someday return to society I am going to have to be very careful where I'm at, at all times, and who I'm around.

Tom Powell: If one looks beyond the words, and gauges the affect, the emotion, the feeling that goes with them, at that point you start to see it disconnect with what he's saying and what he's experiencing. I think that is characteristic of psychopaths.

Scientist: Critics and commentators in the past have said that to study 1% of the general population seems to be a waste of time. Why not spend our time studying in general? There are far more criminals than there are psychopaths and even when we get them into prison we're only talking 15-20% of the prison population. Is it worth really paying attention to them? It sure is. The reason is that there may only be small number of psychopaths in the population but the damage they inflict on society is very widespread. And in fact I would estimate that 15-20% that I am talking about are responsible for at least half of the violent crime in our society. So we have got to understand this particular disorder.

Narrator: And what about those who are not behind bars? The successful psychopaths who are still out there wreaking havoc?

Part 2

Narrator: In America it's estimated that one in 100 of the population is psychopathic, but psychopaths make up 20% of the prison population and this criminal 20% is responsible for half of all violent crimes. It's a fact that law enforcement agencies take very seriously.

Officers in the line of fire are now given special training in dealing with psychopaths.

Policewoman: We deal with primarily the most violent of violent crimes, the most horrendous of all the crimes. In this kind of work perhaps most of the offenders that I see are primarily psychopaths and for me the importance of people in law enforcement, whether it be in parole or corrections, in a state agency, or in a federal agency, to be able to understand these people is really critical.

Now perhaps a patrol officer won't encounter a psychopath every day but when they do it may be in that one terribly important case or in that one very violent crime. If they miss it, the crime can go unsolved; the body can go unlocated; the victim can go for long periods of time without been found. So these people, when they do act out violently, can cause just an enormous amount of trouble and problems and heartache.

The nature of some of their offences can be so unbelievable that to normal people we have to have an explanation for that and one of the most common explanations is they have to be crazy. But psychopaths are not crazy. They know right from wrong and if you're standing on a street corner and they're next to a uniformed police officer and they wanted to commit a robbery they would know not to do it as long as the police officer's there.

Narrator: Psychopaths may not be insane but they're certainly capable of irrational and unexpected behaviour. In 1995 in Los Angeles, where the bizarre is always several sizes larger than life, an extraordinary incident shocked the city and challenged the police.

Policeman: As we were on the Santiago freeway heading towards the off ramp that became famous, to where he exited on Sunset Boulevard, there was literally hundreds of people standing on the freeways and the overpasses waiting for him to come by. Millions watched mesmerised as the prime suspect in a murder case was pursued by police on prime-time television. The fact that he was a national hero didn't exclude the possibility that he was also psychopathic.

Courtroom scene

…on the evidence shown that the face you will see and the man that you will see will be that face of a batterer, a wife beater.

Voice: OJ Simpson certainly has some of the features of psychopathy. He's glib, he's superficially charming, he has a grandiose sense of worth, he's impulsive, he's certainly committed spouse abuse, he's committed antisocial acts like a psychopath, he had the history of being a juvenile delinquent, early on in his life. He certainly seems to show a lack of emotional depth, the type of features that go to make a cold-blooded killer.

Policeman: Our task was the same no matter if it was OJ Simpson, a gang member, a husband who's had a fight with his wife. Our task is to resolve the situation peacefully, and talk him into our custody.

Narrator: Peter Wireter was the police officer who had the delicate task of talking OJ Simpson out of his car and into handcuffs. He had the support of most of the Los Angeles police department but those who advised him how to deal with a suspected psychopath were vital.

Peter Wireter: Dr Mahondy and I have been on numerous incidents together. He's the one who gives me a profile of the person we are dealing with. It allows me to stay away from certain subjects that might trigger the rise when I'm really trying to get a calming effect and downward. And that's what he really lends so much support to.

Dr Mahondy: I see my role in these situations when I go out with Pete, is in terms of helping the hostage-negotiating team understand what motivates this person and if it happens to be a psychopath there are different things to do in that situation based upon that knowledge.

Here you have an individual who we categorise as having some extreme need to have his ego stroked. There was a pretty big ego that we're dealing with, a person that's used to being put up on a pedestal by others, which some people might characterise as narcissistic. Towards that end, face-saving is an extremely important issue, and anything that you can do to protect that person's ego from getting any more injured, that pride from being any more harmed is what we would tend to support. I think our task was to come up with a face-saving way for this individual, with strong narcissistic and grandiose tendencies, to give him an out to save face. And in fact that is what we did.

Voice: There are many psychopaths in society that we know virtually nothing about. These are the psychopaths who don't necessarily commit homicide, commit serious violence, or even come to the attention of the police. They may be successful businessmen, successful politicians, successful academics, successful priests; they exist in all areas of society. There is a growing awareness that psychopathic behaviour is around us in all walks of life. There are telltale signs in road rage incidents and in the violence that surrounds sport. But it's in the cut and thrust of the business world, an arena where traditionally ruthlessness verges on a virtue that it's becoming increasingly worrying. Paul Barbiac [sic], a personnel consultant has had his own daunting experiences with psychopaths in suits.

Paul Barbiac [sic]: I was brought into an organisation to work on a team-building project. There had been some conflict amongst people in this particular team and, as I interviewed them, half of them identified one person as the source of the conflict but the other half of the group thought this person walked on water, was an absolute dream and even a future leader of the company.

As I interviewed him I found that I personally liked him very much, however over time he began to do things that were very bizarre. He would accidentally bump into a vice president and then, once he realised who it was (of course he really knew who it was), he would start praising this individual and fawning after him and ingratiating himself with the vice president. Others would see him with the VP and think that he had some sort of influence which he really didn't have. Then he would take this perception in their mind and pretend that he did have secret information about what was going on in the organisation. As he did this with different people, they were more willing to share information with him because they thought that he was in the know.

He discovered that one of the vice presidents was having an affair with one of the individuals in the office. He became very good friends with this individual, a young lady, and began to give her not only positive information about himself, because he was very gracious and charming, but he also spread negative rumours about his boss, the person who he really wanted to replace.

I called Bob Hare, he sent me a copy of the psychopathy checklist. I was shocked by the results. This person came out with 30 out of 40. I called Bob back and he said to me that, yes, in fact I had been dealing with a psychopath. He referred to this person as a sub-criminal psychopath. I now refer to them as industrial psychopaths.

Narrator: The notion of industrial psychopaths rising through the ranks to become captains of industry could mean that the character traits are a positive business asset.

Voice: Take the Robert Maxwell example: it may be that he was able, through his energy and drive and lack of concern for other people, to develop a business, effectively but the damage he did to people along the way was very considerable. I find it hard to think of any clear examples where people have positively contributed because of their psychopathic traits.

Narrator: Recognising psychopaths early on may limit the damage they can cause, but their natural ability to be both manipulative and beguiling makes it difficult.

Voice: One of the things that the medical students with whom I've worked have noted is that they are shocked at how normal they look and how engaging they are. I do not know one clinician who hasn't at one time been taken by a psychopath. It happens to the best of people.

Voice: I knew I had to get in touch with some deeper level of interconnection so that I could identify with humanity. We're all born with a conscience, we learn not to touch the stove because it's hot, until we touch the stove and get burnt. Then and only then we don't touch the stove again. Compassion and empathy is a learned process, it starts off at a very early age.

Female voice: They are very gifted at being able to convince you 'I'm harmless, I did not do it, there's absolutely no way I'm responsible for this crime.' These are very good actors.

Voice: They can read an audience or an individual as well as any one that I've ever seen. While they appear to be speaking about themselves, they are constantly monitoring the facial expressions, the responses, they will then tailor what they say to see if they can get the kind of response that they want.

Wayne: My idol was John Lennon and of course on the other side of the tracks we have Willie Nelson. He represents freedom in different ways: love, peace, harmony, togetherness, connection, with the polar bears and freedom in general.

Voice: Culturally we find some difference between the United Kingdom and North America. Our psychopaths tend to be less overt in their glibness, their superficial charm and so forth. These things are not so obvious as they are in the North American prisoners. For example, we've done studies where Canadian prisoners and Scottish prisoners have been rated by Canadian and Scottish researchers and we can show that the Canadian prisoners are more extrovert, more glib, more superficial, more charming than our Scottish prisoners who tend to be a bit dour, as they say.

Prisoner: And of course the feathers represent freedom and er, the leaf represents the changing of the times, and er this is something some little thing I stuck together and my philosophy is it's our life and we have a right to cry if we want to.

Voice: A lot of people, particularly those who tend to believe in the goodness of humanity, say the problem with the psychopath is that he or she was not properly treated as a child and never learned to be empathetic towards other people; never learned to become attached or bonded with somebody else. That's the problem and we can resolve it in adulthood simply by giving them a hug, maybe a music lesson and a puppy dog, and they're all going to be OK, give them lots of love and understanding. With a psychopath I would argue that emotion is like being colour blind for them and nothing we can do is actually going to instil a sense of empathy. This is really a waste of time. I think biologically, or neurobiologically, the mechanisms that should in part affect our emotion to one's cognitions and thoughts and attitudes are not working properly in psychopaths.

Narrator: But are psychopaths born or shaped by their environment? Is it nature or nurture that has so distorted their emotional makeup?

Voice: There are some individuals who come from fantastic home backgrounds, dedicated parents, all advantages in the world, and yet they grow up to become these psychopathic violent monsters later in life. You ask the question: how the heck did they get there?

Voice: If you were a scientist and, as an experiment, you decided to try to create a psychopath by actually having all the right circumstances you thought would create one, I suspect you'd fail. It's not something one can cause environmentally.

Narrator: But there are those who argue that deeply traumatic influences in early childhood will surely have a damaging effect on an otherwise normal child, possibly causing psychopathy.

Martin Smedley: People are going to say, if you've been abused as a child, if you've been deprived, if your environment's been so shocking, then inevitably that's going to have consequences in the way that you impact on your environment and on other people. But it's just not enough. It's an inadequate answer. If you look at areas of deprivation in the world, if you look at Third World countries, if you look at children who've got nothing, who've been abused, they don't turn automatically into psychopaths. This is something that is innate to the child, which the child is born with - not, I would stress, directly inherited. It's not that if your dad's a psychopath then you're a psychopath but it's much more to do with a combination of genes working together or not working properly together that creates a predisposition for this.

Narrator: Martin Smedley works with seriously disturbed children at a leading London hospital. He's certain there are signs of psychopathy in some of them who are very young but the law forbids him to diagnose it formally as such.

Martin Smedley: You can't call a child a psychopath; you can't call a child somebody with a personality disorder. One is still of the view that children can change, that change can take place over time, and that personality disorder is something that you have as an adult and not as a child. I think there also ethical considerations for taking a small child and saying: this person's a psychopath. It has a certain sense of inevitability about it, of incurableness, and one doesn't want to look at children in that way. I think one needs to intervene as early as possible if there is any suspicion that this child is likely to develop a personality disorder that is likely to become psychopathic or is showing signs of psychopathy. One needs to be able to identify what those signs are and intervene.

Narrator: The law as it stands forbids the diagnosis of a personality disorder in any child under the age of eight, therefore treating psychopathy in children at an early age, however advisable, is difficult. And anyway, remedial intervention when the root cause of the condition is unknown at best can only be guesswork.

Voice: They are a complex mix of social, familial, genetic and biological processes, but we've almost entirely excluded biological processes from our understanding of crime violence and psychopathy. I'm absolutely convinced by the research, by the science, that there is a biological basis to psychopathic violent behaviour.

Narrator: A biological basis to the condition raises the question: can psychopaths fairly be held responsible for their actions? As scientists move closer to pinpointing the cause it's a moral issue that society will have to confront.

Part 3

Narrator: There is a growing consensus among the experts that psychopathy is a specific biological condition, the result of a malfunction in the brain. Bob Hare's psychopathy checklist is the accepted benchmark for identifying psychopaths. It could also be the key that unlocks the cause of the condition.

Bob Hare: A lot of people say that this causant of psychopathy is nothing more than a myth and people have said that it's a moral judgement masquerading as a science. Well, if we define people according to this cluster of characteristics, do they have brain images for a particular task that are different from those of other individuals? The answer is definitely yes.

Narrator: Hare has been using brain-scanning techniques to determine whether the mental processes of the psychopath are different from those of the non-psychopath. If they are it could be revealed in brain images.

Bob Hare: Some of the brain imaging research that my group and other groups in several parts of the world are now conducting indicates that it appears that the psychopath had difficulty in actually processing, understanding and using emotional material. Now is this because they are biologically put together differently, or they are wired differently right from birth, or are the brain differences that we observed the results of using different strategies to perform the tasks that we use? We just don't know that yet.

Narrator: In one experiment, a psychopath's response to emotive words is tested and the brain activity it produces is compared to that of a non-psychopath. The difference is significant. The white areas denote parts of the brain that are actively processing an emotional response to the words. In the brain of the non-psychopath there is considerable activity; in the psychopath's brain there is far less. It seems there is less emotional involvement. Hare's research into the workings of psychopaths' brains is encouraging. It's clear that there are striking differences in areas that are associated with processing emotions.

Bob Hare: We're interested in what parts of the brain are activated when you are looking at something neutral in connotation, with an ordinary picture or a person or object, or looking at something that has intense emotional connotations, something that is very negative, very, very disturbing to most people. And our prediction is of course is that the psychopaths will not show the same activation of the same brain regions that we would observe in normal people.

Voice: There's a lot of current interest in the limbic system. One part of the limbic system that plays an extremely important role in emotionality is the amygdala and one could argue that the amygdala is the problem, that there's something wrong with the way the amygdala functions.

Narrator: James Blair lectures on developmental psychology at University College London. His research into psychopathy has focused on the part of the brain called the amygdala. The amygdala is a small structure that is housed underneath the temporal cortex, almost in the middle of your brain. It's crucial for emotion and particularly emotional learning. It's most important for the generation of fear and also seems to be very crucial in processing sad faces. From some of the imaging work we've done, we've shown that if you show a sad face to another human being you see activation of the amygdala.

James Blair: I'm just showing you some pictures on this screen, and whilst I'm showing you these I'm going to be measuring your emotional reaction with these electrodes. They pick up the degree to which you are sweating when you're looking at the pictures.

Narrator: Blair is convinced that his research shows that the cause of psychopathy is in the amygdala in that it functions differently in the psychopath from the non-psychopath.

James Blair: When you're looking at pictures, you have to give a score between one and 10 - one being that you hate the picture never want to see it again, 10 being it's an excellent picture and you wouldn't mind having that picture on your wall.

Subject: One, three, five, five…

Voice: There are various strands of evidence all pointing towards the fact that there may be some problems in amygdala functioning in psychopathic offenders. They perform very poorly on a range of tasks that directly assess how well your amygdala is functioning. It's definitely a biologically based condition in the sense that the amygdala is functioning poorly. The degree, or where that, um, impairment comes from, whether it's genetic or whether it's early trauma, or whether it's some sort of social variables that are affecting the development of the amygdala, that's what we can't tell. But it's clear that there is pathology in the brain of these individuals.

Narrator: Bob Hare is not convinced that it's that simple.

Bob Hare: Our own research indicates that it's more complex than that. The amygdala is certainly important, as it would have to be if you were dealing with emotionality. We're now beginning to find that there are anomalies in the frontal cortex, temporal cortex, maybe the connections within and between different parts of the brain are extremely important.

Narrator: There are those who believe that the answer to psychopathy is in the brain but not necessarily with the amygdala. At the University of Southern California, Adrian Rain is comparing how the prefrontal cortex functions in the brains of psychopaths with those of non-psychopath student volunteers.

Adrian Rain: The prefrontal cortex is involved regulating and controlling behaviour. It's the part of the brain that says: 'Hey, let's stop and think about this before we actually go through with things.' It's the emergency brake.

Narrator: It's a restraining mechanism that psychopaths seem to be lacking.

Adrian Rain: We're using the continuous performance task because this is the task that we use to challenge or activate the prefrontal cortex in our murderers. We were applying it to psychopathy in our community study here because again what we want to do is activate or challenge the prefrontal cortex in psychopaths. We suspect that the prefrontal cortex is dysfunctional or potentially damaged in psychopathic individuals.

Narrator: Adrian Rain and James Blair may both be on the right track for there is an important relationship between the prefrontal and orbitofrontal cortex regions of the brain and the amygdala.

James Blair: In healthy brains there are massive interconnections between the amygdala and the orbitofrontal cortex. What might be occurring is that because the amygdala is not working properly, it's beginning, over time, to have long-term consequences for our orbitofrontal cortex function.

Narrator: Research today into psychopathy is contributing greatly to a new understanding of a very old condition and it brings with it the possibility of an effective treatment of this dangerous minority who cause so much harm.

Voice: I believe in science, I believe in the study of the mind, but it's very complex. I'm not sure if there will be, in my lifetime, any ground made on that and so for the time being we have to look at what we have with regard to forms of prevention. We have to protect people; we have to protect society and I understand that today.

Prisoner: The programme's a sham. You lie to these people. The programme sucks.

Prisoner: I don't want that life any more.

Narrator: Current therapy programmes for psychopaths in prison are not proving very successful. Indeed, the extraordinary fact is that there is a higher incidence of reoffending among those who have received treatment than those who've not. Not only does the treatment not work; it seems to exacerbate the condition.

Voice: By the time you get to adulthood, I think the cause is pretty lost actually. If you think about trying to shape or reshape your own behaviours, behaviours that you might find to be, or other people might find to be, irritating or unacceptable and you make a conscious effort, you even get therapy, for these behaviours, actually trying to change even the most trivial behaviour that you're well used to, where the pattern's very well established, is extremely difficult. If you are talking about a pre-set mental condition that's been operating since birth or before birth, how on earth are you going to be able to attempt to change that?

Voice: The standard programmes are ineffective because they're targeting the wrong thing. They are trying to target an increase in one's capacity for feeling empathy towards somebody else or they try to develop a flabby conscience into one that is fairly strong. Well this is a waste of time with the psychopath.

Voice: Since we seem to be picking up these indications of poor amygdala functioning, what we can hypothesise is that any kind of pharmacological agent that may help boost the functioning of the amygdala may help these individuals and make them safer to be around.

Narrator: The fact that attentions are turning to new methods of treatment when the cause of psychopathy is yet to be firmly pinpointed, suggests that its discovery may not be far away. When it happens. The question is whether we will be prepared to administer a treatment as radical as that which Adrian Rain predicts.

Adrian Rain: We're not too far away in the future when what we will be able to do is replace dysfunctional brain mechanisms with microchips. This sounds like science fiction, and clearly it's not here yet, but within the next 10 years we will have the first microchip brain implant.

And it raises an important moral and ethical question in society. Do we intervene with psychopathic offenders who we can't currently treat and change them completely, reshape them entirely, change their brains, make them a new person? Is it really right of society to go into the holy of holies, go into a person's brain, their essence and change the neural wiring and structure of their brain?

Now I think there are two ways of looking at that. At one level we can say: no, we must not change the cell, it's the one thing that's God-given, we mustn't interfere with that. Biological research, biological manipulations of people are out, we mustn't change the nature and essence of what is God-given. Another approach is to say: look, psychopaths are creating major problems in society and we have to do something about that no matter how radical it may be.

We have to do something about reducing the rate of crime, violence and murder in society. Psychopaths are exponentially responsible for the horrific things that happen to people, innocent people, in society. Treatment approaches have simply failed to alter psychopathic behaviour and we can't wait much longer.

Narrator: It's certainly true that until a concerted effort is made to eradicate psychopathy, one of the most dangerous forces of our times will continue to plague society. The solution must lie in effective treatment. If surgical intervention in the brain proves to be the best option, it will surely polarise public opinion but it is a decision we cannot put off. The cost of evasion is far too high.

Voice: There will always be moral difficulties in deciding whether to treat criminals or not and that is really an issue for society as a whole and politicians and people who have expertise in ethics and so forth. I think the scientists have to provide the evidence, which other people can then use.




The Equinox program in which Dr. Hare appeared was first shown on Channel 4 Television in 2000: www.channel4.com. Reproduced with permission.