Can a brain disease determine violence? – 03/06/2023 – Luciano Melo

At a health center in the interior of São Paulo, a neurologist attended a different patient. Instead of having worried relatives nearby, a hurried and indifferent police escort.

Occasionally, that clinic assisted people who were serving time in a prison dozens of kilometers away. This was the case of the 70-year-old man who was present for the clinical evaluation. But the sick man could not say why he was there, nor was he able to imagine a justification for it. He said, more than once, that other prisoners touched him on the shoulder and said they would protect him, without being able to understand the reason for that rite, which was repeated, probably, every day. He didn’t even understand why he was trapped. His thinking gaps were clearly the symptoms of Alzheimer’s disease, memories and the erased biographical references.

The neurologist could not know whether the man had committed a crime before or after the first symptoms of the disease, which at that moment expressed itself in frank dementia. He had no information for that.

The doctor thought, briefly, whether that gentleman was the central character of a story, heard for a long time, which he considered a regional legend.

On a gruesome night, a man would have come out of his bloodstained apartment, screaming if anyone knew about his wife. Neighbors, when they came to help, would have found the woman’s corpse on the carpet in the couple’s living room. Her husband had stabbed her, but he had no memory of her action. Months after the crime, he spent his days asking about his spouse, expressing longing and concern. He didn’t remember the violence of her hands, nor that he had already asked the same question several times. The neurologist, in soliloquy, disregarded the association of the stories, judged the coincidence too extravagant.

Episodes that mixed crimes and brain diseases were nothing new for the neurologist. He had once been asked to say whether a 60-year-old detainee had any neurological disease. The prisoner had strangled his mate to death in revenge for betrayal. However, the murderer could not say how he had discovered the infidelity, his reasoning was vague, uncritical and with preposterous conclusions. It was a case of delirium of jealousy in a patient who showed initial symptoms of dementia, possibly caused by alcohol abuse.

There are historical examples that correlate violence to diseases inside the skull. In 1966, in Texas, Charles Whintman, began to suffer from headache, obsession with writing and violent thoughts. His last act in life was shooting people, he murdered 17. He didn’t make more victims because the police killed him. In his autopsy, coroners found a malignant brain neoplasm, igniting the hypothesis that the tumor, not his will, determined the massacre. The massacre caused by Whintman served as a harbinger of an unprecedented rise in the number of mass murders in public places in the USA.

Understanding how certain diseases alter behavior to the extreme can give us clues about the neurological substrates that predispose to misdemeanor. Neurologist Ryan Darby, from Vanderbilt University, in Nashville (Tennessee), gives us some ideas to unravel this problem. He collected information from 17 people who committed a crime after suffering a brain injury. Of that group, two people had improved after being treated. Darby discovered that there is no specific brain locus whose shutting down by some malfunction would unlock criminal impulses. With some coincidences, the evaluated clinical cases suffered lesions in areas different from each other.

However, the damaged sites belonged to a unique brain network, which connects brain regions to take care of morality, choices driven by subjective preferences, and theory of mind — the latter is the human ability that allows someone to infer how the other thinks. But this network is not concerned with empathy and cognitive control.

However, the dysfunction of this circuitry is not an unequivocal force that pushes its bearer to crime. A minority of people affected by this disorder will engage in acts against the law that are possibly non-violent, such as petty theft. Other factors, such as genetics, environmental circumstances, social support and personality characteristics before falling ill, can act independently for the crime, or interacting with the consequences of a particular illness.

Certain brain injuries increase the risk for the development of criminal actions, but they should not be considered as their only cause, or at least not as deterministic as that. But let’s be clear: an adult who changes his ways and commits his first crime may be expressing the first symptoms of brain disease.

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