4.6  Ethics, Psychology and the Legal System; Crime Prevention

4.6.1 Historical basis of legal systems
4.6.2 Culture and primary prevention of ethics violations
4.6.3 Laws versus ethics
4.6.4 Replacement of conventional legal systems
4.6.5 Dealing with ethics violations at community level
4.6.6 Freedom of expression, nonverbal forms of self-expression
4.6.7 Prevention efforts within families and communities
4.6.8 Prevention efforts and therapy
4.6.A Appendix: Antisocial, Sociopathic and Psychopathic Symptoms – Possible Treatments   added 6/2017

4.6.1 Historical basis of legal systems
Humans appear to be inherently ethical in the sense of wanting to be “right” and improving themselves and wanting to improve the lot of their children, relatives and friends. People also want to have positive attributes:  being attractive, intelligent, acknowledged in a relatively high rank, etc. In spite of people’s ethical inclinations, there are frequent conflicts, and cultures often promote cruel practices1.
When cultures established standards of “right” and “wrong”, punishments were institutionalized. In large, anonymous societies, punishments became a monopoly of the state (this greatly reduced revenge crimes, crimes to defend honor and killings in feuds between families that had gone on over many generations). Since there was normally frequent severe physical and mental suffering, rulers sought worse agonies as punishments and often invented particular tortures trying to get confessions from suspected criminals or enemies.
Humans instinctively see people as “us-versus-them” or “our group against others”. These “others” are generally degraded and considered inferior, maybe not quite human, not deserving empathy, compassion and ethical treatment. Empathy and compassion are largely limited to restricted groups, such as male clan members. Cultures generally reinforced the natural inhibition of compassionate feelings towards “others”. Many cultures expect that people have no empathy for servants and that males have little compassion for their wives and daughters. Consequently conflicts frequently lead to discrimination and hostilities including warfare and genocidal actions.
Powerful leaders dominated the evolution of tribal religions with associated moral standards. Their main purpose was to maintain the status quo of power structure and hierarchies with social strata and/or casts, which made them easy to suppress; and they greatly reinforced “us-versus-them” thinking. Leaders usually were themselves judges and high priests or they established and controlled them.
An additional factor interfering with the expression of natural ethics is a certain enjoyment when acting out aggressive impulses, directly, when observing and cheering others on, and vicariously. Aggressive acts are then rationalized as “right” and good for their own group.
Because of contradictory natural and moral principles, progress occurs in waves. Growth of power often goes along with new cruelties. As repulsion against condoned cruelties increases, condoned cruelties eventually become legally and socially unacceptable and are driven underground, then they may slowly disappear.
In modern industrialized countries, shortcomings in cultural and legal institutions often predispose people to commit unethical acts. Western cultures usually teach a high degree of selfishness but stop short of outright advice to break laws. Psychopathologies, in part inborn, in part due to family pathology and aggravated by cultural environments, remain a main reason that inhumane and irrational actions are frequent.

4.6.2 Culture and primary prevention of ethics violations
If an orphaned baby is adopted anywhere in the world, the adopting family and local cultural-institutional environment greatly influence the likelihood of the child growing into a healthy, well-adjusted adult, a low-functioning, depressed person, or a perpetrator of violence. The same applies to all children; they are part of families and regional cultures.
Governments have a responsibility to minimize unethical acts and human rights’ violations, perpetrated as individuals or when working within and representing an institution. This model of a society is based on the understanding that, when individuals become perpetrators of unethical acts, their community and society had a significant role and may be considered to have failed them. Justice is not a reasonable goal of society, it is never ethically justified to vindicate or punish. We primarily must prevent unethical acts as feasible, and we must help victims and perpetrators.
Prevention of all forms of violence starts by supporting parents and children and by offering optimal schooling. Institutional environments, including folklore, games, all forms of entertainment and language2, influence individuals’ personal development. For many children it is crucial that they grow up essentially free of abuse experiences including witnessing abuses: good environments largely prevent the expression of psychopathology in genetically vulnerable children3. This does not exclude children learning about human suffering in history and present, but learning about suffering must always be a source of broadening empathy and teaching compassion, never entertainment or simply a byproduct of heroic war strategies. Minors have to be guided by understanding adults, and adults should benefit from stable support systems. If there is a dilemma or crisis, adults may informally receive help from friends and relatives and/or, more formally, through peer support, consultation, and individual or family therapy. As feasible, all levels of psychosocial and psychiatric treatment must be offered to emotionally distressed people, particularly if they parent children and/or are dangerous to self or others.
Primary prevention helps children and adolescents in their psychosocial development. Secondary prevention includes treating people who give indications of dangerousness and establishing enough structure for them to avert major ethical transgressions. In tertiary prevention, former ethics violators are treated in ways that prevent further perpetration. Society must not let apparently disturbed and dangerous people commit many unethical acts until there is a conviction with judgment of “guilt beyond any reasonable doubt.” Neither is it ethical or rational to punish the ‘convicts,’ and, upon completion of that punishment, return them to freedom without having provided indicated treatment and without protecting potential future victims.

4.6.3 Laws versus ethics
Laws have the function to reduce arbitrary judgments and punishments, but they were largely based on the assumptions that justice equals revenge and that all adults deserve the same punishment for the same offense. Legal systems have largely failed in implementing ethical ways of dealing with unethical behaviors (crimes) and in protecting people from crimes.
Rather than judges interpreting laws and precedents, governments are to create institutions (ethics committees) that interpret human rights and civil liberties based on ethics, formulate guidelines, and take responsibility that ethical principles are taught formally and informally (in teaching that is unrelated to ethics and in entertainment) on all levels of society. Ethics committees may clarify principal exceptions of basic ethics rules, e.g. when to break confidentiality or hide truths from a patient, and offer examples of pragmatic, ethical interpretations. There may be local adaptations of morality, e.g. addressing nudity and proper expression of modesty.
The goals of human rights are not justice or equal treatment of individuals, instead, all individuals are to be treated humanely and merit a good quality of life. Rights, freedoms, and opportunities are to be adapted to individuals’ abilities and possibilities within their physical and cultural environment. Individual rights differ among groups, for instance* children of different age groups, handicapped adults, and demented people have rights that are adapted to their limitations, combined with special protections. Societies are not responsible to compensate for physical or other handicaps, but people with disabilities deserve environments that allow reasonable quality of life. No freedom is guaranteed if its expression decreases others’ potentials and/or has a significant likelihood of harming others. Rather than emphasizing rights, societies are to avoid and prevent inhumane coercion. The position and treatment of animals, rare or common, wild or domestic, must also be explored, and government directives on ethical behaviors are developed.
Ethical principles are to be discussed, studied, taught and practiced at all levels of society, particularly with regard to conflicts between self-interest versus interests of family and community versus global interests, including the interests of future generations and consideration of animals; and conflicts between institutions a person is involved with and/or loyal to versus individual interests and broad ethical considerations. Ethical teaching must address the addictive qualities of wealth, power and unreasonable competitiveness. Conflicts arising from culture-specific morals must be addressed, e.g. traditions that give a populations an identity but harm individuals. No culture-bound or religious school of moral thinking must be accepted as law.
People are taught to be considerate in interactions among friends, peers, and family members, surmising situations from many angles. Young people may learn by discussing ethical issues in school and by reading about conflicts in realistic fiction, they may become more understanding by listening to others, and they may be guided by cultural morals. The “golden rule”, “do to others what you would have them do to you” may be an initial introduction to ethical thinking in young children, but later on it is not particularly helpful since people’s desires vary greatly and people often misunderstand others’ needs and feelings. Additionally there frequently are many in need versus few with resources to give. Communities have an obligation to be supportive of its families, and all individuals should have peers they feel connected with, can depend on and discuss issues with.

4.6.4 Replacement of conventional legal systems
Legal systems that determine guilt and punishments are replaced. There are mediation and arbitration services for conflict resolution. The agency for protection of human rights (replacing police force) pursues people who transgress rules of ethics and/or appear dangerous to self or others. Human rights panels help mediate in crimes and may determine treatments of perpetrators. Human rights panels include professionals, with at least some of them not living in the region they serve. Local governments may determine the compositions of such panels. Observers and specialist witnesses may be called by any party to help clarify issues.
All people who willfully or recklessly harm themselves or others and/or who advocate violence must be considered emotionally unstable or disturbed, whether they do or do not understand the implications of their actions. Severely disturbed and potentially dangerous persons with abuse-addiction and/or antisocial personality disorder are treated like other psychiatric patients. ‘Criminals’, ‘dissidents’ advocating forms of discrimination or violent means to reach goals, or ‘mentally ill’ and ‘mentally handicapped’ persons are all considered potentially dangerous and in need of therapeutic intervention.
People are always expected to follow internationally recognized human rights and ethics and they are considered responsible to a well-developed conscience. When uncertain, people usually can widen their perspective by asking themselves how a more or less known wise, ethical person would behave and whether one would advise the behavior to a loved younger person. If individuals feel that they are ordered to commit a clearly unethical act, e.g. when working with animals, training children or participating in military operations, they must discuss perceived ethical transgressions with a superior in the leadership and usually should refuse the order.
In any transgression even in cases of accidental and impulsive injurious behaviors, manslaughter, or murder, families may mediate ways of finding peace and forgiveness. Particularly in major crimes, it is a goal that the perpetrator, victims and victims’ families work with a human rights panel unless the local culture is very forgiving and advanced in ways of processing human failures, such as some Amish communities. Mediation may seek some forms of symbolic amends or restitution, meaningful consequences and usually also treatment of perpetrators. Often it is a realistic goal that perpetrators learn to be empathetic towards their victims and feel regret and that victims may forgive. Recommended treatment may be voluntary, although there may be pressure from the community. If necessary, the human rights panel orders specific treatments including limitations of freedoms, possibly long-term residential treatment.
People may rationally understand that perpetrators are, in a strict sense, always innocent, victims of ill-fated combinations of genetic predispositions and environments they grew up in and live in. Even if believing that there is free will, scientific research leaves little space: free choices would be extremely limited. If individuals do not commit crimes, it is not because of free will but because they could not behave otherwise. However, even if recognizing and believing that a perpetrator is innocent, it is for most people emotionally difficult to feel forgiving without a process that leads ultimately to the acceptance of grim realities.

4.6.5 Dealing with ethics violations at community level
Communities may find culture-specific ways of addressing nonviolent ethical transgressions. Even if there are no formal laws, any locally organized way of dealing with such problems is a significant progress compared with the inept law enforcement of modern anonymous societies.
Local governments may create disincentives and negative consequences for breaking rules and regulations, comparable to disciplinary rules. Such disincentives are adapted to the wrongdoer’s circumstances, e.g. fines for dangerous traffic violations may be calculated by formulas that considers income and level of danger. With obviously aggressive and dangerous driving or skiing, logical penalties or disincentives may include suspension of drivers license and work in a hospital trauma or rehabilitation unit. Such consequences may be instituted even if no accident occurred or an accident did not cause serious injuries. Children and adolescents are treated appropriate to their age but unethical behaviors, such as petite theft, dangerous carelessness and recklessness, bullying or vandalism, must be addressed and have consequences.
If enterprises break laws and rules, local governments may institute reasonable consequences. If damage was caused, community elders and/or other governmental agents may mediate orders for reparation, real or symbolic, and changes in the operation of the enterprise to avert further damage. In any large infraction with many damage claims, mediation and arbitration services must seek a solution. If a major issue is not resolved, an enterprise may be prohibited to continue operating.
For pragmatic reasons, addictive and abusable drugs (including alcohol and tobacco) must not be illegal, at least not during the time such a model of government is instituted in a country; however, it is child abuse to sell or give drugs, including nicotine and alcohol products, to minors. Adults must keep abusable drugs well secured and protect minors from exposure, e.g. adults are to avoid being with minors while intoxicated, and minors must be protected from second hand smoke. Adults are to smoke outside and out of sight of minors. School-age children and adolescents are informed about problems of abuse-addiction and abusable chemicals. In particular, ethical issues of abuse behaviors are to be discussed: drugs and other abuse behaviors compete with nature and culture, and they reward and reinforce bad feelings, thoughts, and behaviors.
Drugs, including nicotine and alcohol, are highly taxed and governments institute comprehensive programs for the prevention and treatment of substance abuse and other abuse behavior patterns. Private marketing, import, and export of abusable drugs are forbidden.

4.6.6 Freedom of expression, nonverbal forms of self-expression
Freedom of expression is considered pragmatically: if an educated person considers any speech or publication unethical, for instance by inciting bigotry and hatred, and one or multiple academicians concur, officials are to warn the speaker or author. Speakers and writers have always an obligation to correct themselves, when knowledgeable persons indicated that they made false statements, and they are obliged to clarify if they offer educated guesses or opinions that leading scientists consider probably wrong. Language in public speeches and publications should be precise: it is considered unethical to call impressions and beliefs opinions; the term ‘opinion’ refers to personal interpretations of data, knowledge and experiences, not religious-like beliefs, prejudices or first impressions.
Self-expression through tattoos and body modifications must be addressed by local governments and ethics committees that include medical specialists. As people are expected to grow mentally and spiritually throughout their lives, permanent ‘self-expression’ on one’s body is hardly justifiable. Most people who choose to get tattoos do not question what impression others will form, even though they themselves rarely see the tattoos while others are compelled to look at them. Tattoos that are readily perceived as symbolizing unethical attitudes or gang membership appear unethical. There must be rules against any tattooing or body modifications in minors and young adults, and any form of peer pressure is unethical. Similarly, agencies must look at unhealthy, uncomfortable and extreme practices of self-expression, including clothing and shoes that are too tight and gradually deform, ballet and gymnastics training that is painful and harms joint, extreme sports training that precludes a healthy and balanced development, etc.
It is important that religious leaders clearly formulate what is a religious belief and religious teaching, as opposed to personal opinion, and that there is never hostility against nonbelievers. Even when teaching and preaching, religious leaders should state if an interpretation of the religious texts is not broadly agreed to by religious scholars and especially if the teachings contradict scientific teachings and/or global ethics. Particularly during times of social and political tension, religious leaders have an ethical obligation to calm situations and denounce any form of violence, other than immediate defense of the weak and self-defense. Local governments determine how to deal with unethical speech and publications, if warnings fail and/or the authors refuse to correct themselves.

4.6.7 Prevention efforts within families and communities
As social organization and support systems are much improved, societies also emphasize prevention approaches directly addressing individuals’ attitudes and practices. Parents may participate in socially structured support and educational groups, e.g. addressing subtle behavior modification principles that do not stress results but encourage positive and discourage negative attitudes and behaviors. Children are to learn early to be empathetic, putting themselves into other’s place and considering many aspects those persons’ experiences. Ethics teachings may include the practice of virtues as described by the Dalai Lama, other spiritual leaders, and some psychotherapists, e.g. Pierro Ferrucci4.
Research indicates that feeling good and happy is mainly related to positive associations in everyday life experiences, focusing on positive aspects of past, present and possible or probable future, not on dangers and uncertainties, trusting that one will handle adversities if or when they occur. Good feelings appear primarily derived from social instincts, and we can develop positive habits and attitudes: feeling grateful, wanting to do small things for others, being pleasant and agreeable to improve relationships, improving or building friendships by working out conflicts, etc.
Parents must also understand and teach children about avoiding unethical thoughts, distracting themselves and perceiving shame, guilt and/or disgust about them. Thoughts that may be understandable in a developmental phase must become unacceptable as the young person matures. People cannot stop impulses and urges but we must learn not to pursue unethical ones. While it is much less unethical to have bad thoughts than executing them, entertaining unethical thoughts, mentally accepting and enjoying them, damages healthy human relationships. It is hardly possible to feel close towards a loved person while enjoying violent thoughts towards his/her relatives; unethical sexual fantasies damage relationships with all persons who have characteristics of visualized victims. Pursuing unethical thoughts also makes persons vulnerable to executing them when intoxicated, sleep-deprived, psychotic or demented, or in extreme unfamiliar situations. Free speech and expression are important and people should be informed about conditions in the world. However ways of journalistic or artistic depictions of cruelties may lead some people to become desensitized and fascinated. Empathy for the perpetrator may move vulnerable individuals closer to condoning or imitating a cruel practice.
A sense of coherent communities, support and ready access to all forms of education and therapy are designed to prevent most forms of violations. If abused, a child benefits greatly from a loving bond with at least one stable parental figure, even if unable to express what happened. If an abused child becomes “clingy” and the mother allows the regression without any hint of criticism or rejection, the abuse probably does not need to be addressed in specific ways and the child can heal. Persons who are in danger of passing an abuse pattern to the next generation benefit from therapy.
There is a danger that people are overly cautious with regard to boys expressing mild forms of violence, however, for adults, there is hardly a place for any form of physical violence and indirect forms of causing harm and pain. For boys it is normal to aggressively establish and defend positions among each other and children of both sexes often behave in competitive ways. A distinction may be needed between normal aggressive thoughts and behaviors versus cruelties, and boys must learn to stop any form of violence when winning: instinctively, opponent stop feeling violent when a losing boy shows signs of submissiveness, but there may be an impulse to punish him for having challenged the stronger male. Most boys understand that they may be victimized in the same minor ways as they harm others when aggressive, but they may need to learn to readily distinguish between a fair competition and bullying with cruelty towards a in some ways weak or socially isolated person. Particularly one or multiple boys beating a girl, allegedly punishing her for disloyalty, should be considered despicable; males have some instinctive inhibition against fighting females but sometimes think cruel physical punishments are justifiable. Girls should never imitate boys by fighting each other violently or by participating in violent traditional boys’ games (girls’ and boys’ bodies are quite different, girls are more likely to be injured in sports and head injuries tend to be more serious). Competitiveness may enhance children’s, particularly boys’ motivation, but group competitiveness is much preferable to competing as individuals. Generally competitive impulses should be expressed in ways other than physical aggression even if including somewhat aggressive games. Sports and games that are as or more violent and dangerous than American football are hardly appropriate for any participants or spectators.

4.6.8 Prevention efforts and therapy
People in need of psychological help may receive informal help and supervision in their community. If needed, they may receive appropriate institutional outpatient services, and they may be closely supervised by a multidisciplinary team. If they are dangerous, function poorly, or do not respond to appropriate community approaches, they are placed into safe residential treatment centers, therapeutic camps, or supervised therapeutic communities. Such placements may be short-term, long-term, or open-ended. In case of war crimes violating human rights, there is no punishment but neither is there a possibility of “amnesty.” Perpetrators of severe violence may be assessed to be indefinitely dangerous or potentially dangerous, and they may be kept in a therapeutically oriented camp permanently, partly to protect them from acts of vindication. Pragmatic treatment approaches may be pursued, such as castration in case of untreatable, violent and/or pedophilic sexual perpetrators or in people with untreatable urges to spread catastrophic sexually transmitted diseases. However, every person, no matter how dangerous, disturbed or handicapped, must be treated in a humane way.
Residential treatment centers and therapeutic communities should be small, possibly clustered in campuses. Therapeutic camps are settings closer to nature rather than in solid urban structures. Units may stress a monastic simplicity and structure with focus on ethics, meditation, and spirituality, but they must not indoctrinate religious notions, such as the belief in a personal god. The main functions are to offer therapy, a social role, work, and learning in a humane and healthy environment, and to assure adequate structure to prevent dangerous acts. When a disturbed person loses the ability to earn a for his/her family adequate income, government funds provide for dependent family members.
In all psychiatric disorders, a combination of multiple treatment approaches is used. These may include forms of psychotherapy, pharmacological and other organic therapies, and practices of nonwestern cultures, such as singing rituals, sweat baths, Asian and other meditation techniques, yoga and acupuncture. Since the human mind changes slowly and pathological patterns show a high degree of recidivism, long-term treatment approaches are used. During treatments, patients are expected to function in many ways, being fairly self-sufficient and productive.
The office of ombudsman serves to facilitate access to available services and may mediate between individuals, families, governmental agencies, and private service providers. This office is particularly important for children and for people with handicaps and limited rights.
1 Cultural morals are often contradictory; they may ostensibly prohibit but simultaneously condone and even encourage natural unethical inclinations. People are supposed to be benevolent and generous but cultures rarely discourage “Schadenfreude,” feeling pleasure about the misfortune of a competitor, and aggression in rank order conflicts. Most cultures allow severe domestic violence, when children and wives do not appear adequately submissive or the violence is meant to prevent insubordination. If somebody invents a damaging approach meant to make children more masculine or feminine, cultures tend to promote rather than stop the fad.
2  For instance:  Western folklore appears to stress opposites, good and bad, while Chinese culture seems more aware of the ambiguity of events, having good and bad aspects. Such folklore may influence cognitions and forms of psychopathologies.
Terms that are typically used in a language also influence cognitions. The Chinese term for crisis contains a negative and positive notion, it includes the concept of opportunity, while the Germanic terms are unambiguously negative. In the English language frequently used words such as ‘should’, ‘must’, and ‘try’, contain adverse meanings:  ‘should’ expresses that the action is disagreeable and that inaction commands guilt, a situation of only two bad options; ‘must’ assumes that a knowledge or a higher power compel a person’s actions while in reality people often do something else; ‘try’ implies that the person is drifting or out of control, even if there is nothing to stop him/her from pursuing a goal such as not to eat unhealthy food for a day.
3  Research indicates that antisocial traits develop when both, a genetic predisposition and an adverse childhood environment coincide. Genetically predisposed children rarely become perpetrators of crimes and violence if they grow up in a stable environment with loving, stable parental figures and free of significant abuse experiences. Children without genetic predisposition to aggressive and criminal behaviors are not likely to become abusers if growing up in an abusive environment, at least if there is a bond with a stable, caring parental figure; however, they may later suffer more from depression, anxiety, and other symptoms.
Some research data is summarized in “Nature Versus Nurture: How Is Child Psychopathology Developed?” by Leslie Knowlton, Psychiatric Times, 7/2005, Vol. 22, No.8, p.1,8f .
4  Piero Ferrucci, The Power of Kindness, translated by V. R. Ferrucci, 2006, J. Tarcher/Penguin

4.6.A Appendix: 
Antisocial, Sociopathic and Psychopathic Symptoms – Possible Treatments

It is one of the shameful issues in psychiatry that persons with antisocial personality disorders (“sociopathy“ and “psychopathy”) are not considered worthwhile, treatable patients. Sociopathy and psychopathy are similar; psychopathy usually refers to a seeming lack of a conscience.

4.6.A.0 Summary:
It has long been known that the human mind has great plasticity and that environmental factors greatly influence the development, expression and course of all psychiatric disorders. In adulthood, the brain maintains considerable plasticity; in some conditions, medications change brain structures and successful psychotherapies may lead to similar changes. All experiences and all forms of learning change the brain, be that developing an addiction, studying law or being very successful in business or politics. If one identical twin has any psychiatric disorder, the other one never has a close to 100% likelihood of also having developed it, even if the two are raised together1.
For the development of psychopathy and sociopathy, a genetic predisposition appears to be a factor, but there are always in addition significant environmental problems, mainly lack of stable caring bonds and/or chaotic early childhood. However, abuses, even if extremely painful, hardly contribute to sociopathy, if perceived as normal punishments and/or required by culture.
An inherent inability to recognize faces, facial expressions and develop empathy, starting in infancy, has been found in children who later became psychopathic criminals; however it is a primary symptom of autism, and autistic children, raised in a relatively healthy family environment, rarely become aggressive, violent or criminal adults. But, if for some reason moved to criminal acts, autistic persons may plan and execute crimes with extreme cruelty and complete lack of compassion.
Children developing psychopathy have usually low resting heart rates and under-stimulated or blunted emotional response-reward systems. People are moved by emotional responses to stimuli and the pursuit of emotional rewards rather than by rational thoughts, but psychopathic persons hardly feel usual rewarding events; they thus need violence, possibly sadism, and drama to achieve reward feelings. Seeking rewards may also lead to drug abuse; particularly people who seem unable to form bonds get a false sense of “belonging” or “being loved” from alcohol and even more powerfully from opioids.
Humans naturally do not have a conscience in the sense of wanting to alleviate and avoid others’ suffering. Social instincts to help are limited and may be more related to family and group bonding than compassionate empathy. Humans, at least males, naturally enjoy observing and participating in vindication and violence. In addition, young males are naturally rather fearless and must be taught to become broadly compassionate and careful. Steven Pinker’s book “The Better Angels of Our Nature” describes how widespread broad empathy is relatively new in human history.
If there is sympathy and true, compassionate empathy (putting self into other’s place, making efforts to understand his/her feelings, thoughts, concerns and fears, and wanting to minimize the other’s suffering), it is learned and naturally limited to people considered “us.” Many frequently changing lines separate the perceived “us” from the “others” or “them”, e.g. throughout history, parents often treated ‘dirty’ and ‘uncivilized’ children as ‘others,’ and mature men have been treating girls and women as “others” (much older men enjoying that sex hurts a young scared bride and avoiding empathetic feelings when their hardly mature wife gave birth; men frequently raping attractive, lovable girls without consideration, whenever punishment appeared unlikely).
Antisocial personality is a bad diagnosis that is largely defined by extreme male characteristics.
In treatment, these patients need to “re-tune” their emotional response and reward system by, in residential settings frustrating harmful forms of instinct fulfillment and making efforts to slowly build reliable bonds (if there are no other rewards, short caring human contacts and exposure to plants, possibly animals, become valued and emotional responsiveness to subtle social stimuli improves). The fact that everybody can feel pain and that we can, in limited ways, identify with any human and higher animal is an opening to learning empathy, Art is probably helpful, both for learning to appreciate subtle rewards and to incorporate acting and literature in teaching empathy.

In virtually all people developing ‘psychopathic’ characteristics, there are genetic factors and histories of bad early environments. If care in early childhood is loving and there is a consistent bond with at least one person, a predisposition to psychopathy or sociopathy hardly ever expresses itself; even some very traumatic and abusive experiences may be tolerated and successfully processed (until recently and in some culture even today, severe forms of abuse are the norm, including cruel punishments, female genital mutilations, etc.; and children may be exposed to severe accidents, crimes, wars and very painful medical treatments). The unpredictable or chaotic environment probably leads in genetically predisposed ‘antisocial’ children to an under-active, blunted emotional response and reward system with children having low pulse rates and no major responses to normally arousing or fear inducing stimuli.
The notions of antisocial personality disorder, “sociopathy” and “psychopathy” need further evaluation. Distinguishing the two as separate entities is probably not helpful; there is more a gradation of severity than of principally different abnormalities. With regard to brain anatomy, there is always the question of how significant abnormalities are: If the brain looks like that of a dangerous criminal, how likely is it that he actually is a psychopath? And: Have life developments a significant effect on brain structures? – Are influences two-sided (bidirectional)? Furthermore, descriptions of sociopathy and psychopathy are contradictory. Are antisocial people planning, calculating and manipulating criminals or are they impulsively expressing aggression? Are they unable to feel empathy or are they considering most people to be “others” with any compassion and empathy being blocked (as in the cruel treatments of domesticated animals or, in religious fervor, believing that inquisition, witch burnings and today terrorist acts have been mandated).

Human individuals differ naturally in several important spectrums:
Lack of empathy and very early apparent lack of recognizing human faces and body language, is primarily a characteristic of autism (or autism spectrum disorder). Autistic people are usually not criminal, but they lack an understanding of many social norms and depending on their environment, may commit violent crimes with detailed planning and a complete lack of compassion2.
Aggressiveness, often combined with cruelty and/or associated with male sexual behavior, is in virtually all, mammal (if not all vertebrate) species much more expressed in males. Violent aggression is instinctive and a common source of pleasure (even in the “watered-down” version of watching sports). As a ‘tool instinct,’ it naturally serves individuals to dare exploring and to defend and/or gain territory and rank; Konrad Lorenz talked of a hierarchy of instincts with aggression being on a lower level than instincts to explore and to establish and defend territory and rank. Until recently, warfare appeared “normal” and “honorable” in most civilizations, and violent vindication is often encouraged or condoned. Aggression is widespread and even previously loved ones may be treated most viciously, e.g. when a previously loved person is condemned to stoning; or as described by Jane Goodall in the ‘war’ between one group of chimpanzees and a small splintered-off group.
Females may go along with male aggressive acts. Cruel behaviors by women (such as performing genital mutilations in girls) were/are mandated by culture and usually considered needed for the girl to be acceptable for marriage. Virtually all these women had suffered the same horrendous procedures when young.
Rebelliousness (noncompliance, lack of guilt feelings): may be related to aggressiveness but is different. It may be defined as a strong propensity to do what is outside conventions and teachings. Probably associated with the language center, people appear to have a “moral center” that incorporates cultural-religious morality, family rules, local laws, etc.; the moral center specifies how to enforce what the culture considers fair, e.g. ‘proper’ ways of courting and behaving sexually, etc.3 Some rebelliousness is a normal stage of development. Children may experiment with lying and stealing and they may imitate what they know others do (at least in stories or movies) even if the action is forbidden. Success versus non-response or immediate punishment influences or determines whether the experiments in forbidden behaviors are short phases or become a behavior pattern.
The by cultures modified and shaped ways of expressing instincts usually start feeling natural; in many situations, e.g. when eating processed, ‘artificial’ food with forks and knives, people hardly know what is instinctive versus cultural, that is, previously learned. When developing loving relationships, there is no clear line between spontaneous instinctive and learned cultural behaviors. But generally, failing to fulfill instincts feels merely frustrating; failing to comply with learned and integrated cultural expectations causes shame and guilt. Children must become aware of the social importance of cultural rules and mandates, otherwise they feel no guilt or shame.
Rebellious behavior may also be part of group subcultures, for instance of angry children who do not feel accepted by their peers.
Callous egotism, versus social thinking and valuing what others think of one’s social-interpersonal behaviors, is also more prevalent in males. There are always conflicts about what feels or seems good for an individual versus what is good for society and future generations, and/or what is ethical. Studies indicate that males are likely to lie in self-interest and females more often to protect loved ones. If something goes wrong, males are more likely to blame others or circumstances, females are more likely to accept blame and express regret. Girls are less aggressive when establishing rank order and/or in fights over boys, and they use more manipulation and psychological rather than physical violence. In group competition, they are more likely to have compassion for the losers.
Cultural-religious morals and local laws are usually not ethical (they may mandate or condone the maltreatment of women, children, animals and/or slaves, justify wars and witch hunts, etc.), and people may rebel against them in pursuit of a higher level of ethics (Gautama Buddha, Jesus, Mohammed, and many others made efforts to elevate moral standards of their times to a higher level of ethics). However, there are also people who have little sense of culture, which may be compared with having inadequate linguistic abilities. Others may feel isolated to the degree that most social aspects of civilizations, including what others think, become irrelevant. Social feelings, raw and by cultures modified, mainly concern people perceived as “us” – for “others”, different rules are applied or there are no rules. (If an outsider meets an indigenous person, he/she will decide if the outsider is considered a guest, temporarily one of “us,” or an enemy outsider. Even in an unwanted-undesirable pregnancy, the new mother’s postpartum depression appears related to the conflict about accepting the newborn as family versus the intuitive consideration to let the infant die or to kill it).

Having a “conscience” is always relative, and people are least likely to feel guilty when certain that they will not be caught. Since humans instinctively want to be “right”, they rationalize their actions trying to find some twisted logic to make grossly unethical behaviors feel “right” (as often noted in alcoholism, politics and religions). However, to maintain a conscience, individuals must feel part of a family, group, religion, etc., and, if feeling completely abandoned and isolated, they probably must believe in some spiritual guiding principles to maintain their conscience.
All the above described spectrums, autism, aggressiveness, rebelliousness and callous egotism are much more expressed in males. Autistic girls, lacking inclination to normal, social girl play, may behave more like typical boys. Girls and women are more obedient towards parental figures and cultures, and they are more religious even though virtually all religions mandate subordinate roles if not worse abuse of women. If aggressive and seemingly without conscience, girls are still hardly ever sadistic and they probably are also vaguely suicidal when planning to kill.
If combinations of these symptoms (resulting from genetic and environmental factors) lead to severe antisocial, sociopathic or psychopathic characteristics, there are usually early signs of minimal empathy, as in autism, but also relative fearlessness with aggressiveness (which is usually not the case in autistic boys), and rebellious disregard of social-cultural expectations, thus the under-active, blunted emotional response and reward systems and lack of true socialization. If behaving socially, it is more exploiting situations than related to feeling social bonds. What empathy may have developed can be used to exploit or to hurt others sadistically, that is, in ways victims fear most and find most painful.
Sociopathy and psychopathy may be considered forms of extreme maleness, boys having excessive male characteristics and lacking adequate cultural learning. More indirect explanations are needed when girls show many of these characteristics.
That everybody sometimes feels major pain opens a way to compel empathetic, compassionate feelings: children identifying to some degree with protagonists of stories can be led to imagine being a very different person and ending up being cruelly treated.

Generally, humans feel probably much more pain than animals and humans learned to inflict extreme pain on others. During fights, war injuries and severe accidents, the sympathetic reaction may lead to dissociation so that whole body parts are not felt. During healing of injuries and non-acute pain, we expect reasonable pain relief from endorphins, but that is rarely the case: people often need artificial medical opioids to relieve pain.
If infants (human as other mammal infants) are abandoned for some time, there is an endorphin response that alleviates the fears and distress while unprotected and completely alone. The infants may utter soft distress signals that only their mother can hear, rather than loud cries that attract predators. Children that were neglected or abandoned in early life may later have more effective endorphin responses when injured and suffering other pain; later, when anxious and depressed, they may start self-injurious behaviors. Even older children and adults, when feeling abandoned, have a mild endorphin response; it appears that if feeling completely abandoned and disregarding or disbelieving attempts of others to befriend them may feel slightly rewarding. Alcohol, which has a mild endorphin enhancing effect, and opioids greatly alleviate the sense of loneliness, they make being alone much more tolerable. Very lonely people have comparable symptoms to people with posttraumatic stress disorder (PTSD), since a main PTSD symptom is the perception that what happened should never happen to anybody and that one can no longer trust anybody, thus feeling an absolute loneliness. PTSD-like symptoms predispose to alcohol and opioid abuse and sometimes crimes that imply ill-defined revenge. Victims of early neglect with possible abuse that may not be remembered and PTSD patients often develop qualities of borderline personality (particularly in young women) characterized by fear of abandonment with mood instability, fluctuating between trying to trust a person and feeling exploited; and they may also develop symptoms of antisocial personality disorder, which is more expressed in men. They may also develop bipolar disorder if there is a predisposition.
Everybody feels pain to some degree, even though perception, tolerance and subjecive meaning of pain differs significantly. In addition to ameliorating pain and a sense of absolute loneliness, endorphins is are also involved in forms of dissociation, but can also contribute to flashbacks in PTSD4. (The endorphin blocking medication naltrexone decreases or prevents forms of dissociation and flashbacks.) To some people who had suffered severely due to early abuse and neglect or illnesses and medical procedures, mild to moderately severe injuries and physical punishments are ‘neutral’ experiences or they may feel rewarding, as if having taken a drug; there may be much less fear and a lack of understanding of what one should fear and what others fear, unless actions are dramatic and sadistic. Anecdotal data indicates that some patients become masochistic.

Regarding the supposition that abuse experiences in early childhood are “abnormal” and a major factor in pathological developments: Much anecdotal data shows that humans are very resilient to single horrible events, like losing one’s mother or an extremely painful procedure. However it is much harder to process repeated traumas in short succession, particularly similar traumas and particularly traumas that according to one’s culture “should not happen.” Having at least one stable relationship (e.g. with an aunt or grandparent) is probably very important; without, children may never develop stable attachments, and if there are no attachments, there may be little concern regarding social-cultural norms and expectations and great vulnerability to alcohol and opioid abuse-addiction.
Today people in advanced cultures want to believe that being compassionate is ‘normal.’ Humans need to learn to be compassionately empathetic. Children like to help as a social behavior and generally do not like to see a friend hurt, but many children do not learn to be broadly compassionate. Lacking compassion is hardly a symptom of psychopathy: as Steven Pinker describes in “The Better Angels of Our Nature,” until recent centuries, it was considered entertaining to watch animals being tortures, people being ‘broken on the wheel,’ and as witches declared, previously loved girls being burned alive. Religious children are supposed to be happy to know that they can reach heaven, and the question is not asked how heaven can be enjoyed when others are tortured incessantly in hell and people keep suffering atrocities on earth. When possible, children, boys more than girls, usually want to watch animals being slaughtered, people being executed or abused, people being injured in accidents, etc.5
There is no contradiction between cruelties towards “others” and being very compassionate with friends, family members and pets. Towards “others” or “them,” even former friends, cruel behavior such as bullying becomes possible. Virtually everywhere until recently and still in some cultures, one’s children and wives, certainly slaves and animals, have been considered “not us (mature men)” but “(inferior) others” or “them,” often to be subjected to cruel treatments and/or exploited without pity. At the same time cruel people have gentle feelings towards some people or groups of beings, e.g. Hitler loved dogs and was a vegetarian.
Also: we must not confuse the ability to have empathy with having a conscience and/or being compassionate. Having empathy may not mean being compassionate. Empathy is often used to manipulate, for instance a man thinking ‘what would she like to hear?’ when he wants sex, or sales persons thinking ‘what is most important to this customer?’ And empathy can be sadistic: What would hurt him/her most (when wanting to punish or simply enjoy seeing others suffer)?

All people, not only people with psychopathic predisposition, should make great efforts in learning to overcome “us-versus-them” thinking and always attempt to compassionately empathized with all sentient beings we deal with and influence. In the USA, we are not doing well; many adolescent boys cannot even empathize with their ‘dates’ or girlfriends – they have no compassion, do not want to understand what unprotected sex and possible/actual unwanted pregnancies mean to a teenage girl. And war as revenge and/or to solve political conflicts is still widely considered acceptable.
While much progress was made, we must move further and include so-called antisocial people. Steven Pinker suspects, and there appears to be overwhelming anecdotal evidence, that the printing press and widespread distribution of novels, travel reports, etc. lead people to become more humane and compassionate (‘humanitarian revolution’). Empathy is often learned by reading what others describe: while reading being enticed or compelled to identify with a person very different than oneself, and to identify with persons who are apparently ‘good’ but still will be severely hurt, rather than visualizing the “good guys” getting away with ethically questionable behaviors and the “bad guys” being tortured, etc.
That everybody feels major pain and can be tortured opens a way to teach empathy if not compassion. In children’s stories, the child usually is made to identify with a “good” person who, in the end, does not get hurt and is successful. Stories in which the readers identify with a seemingly good child who is later severely hurt, compel some empathetic feelings. Stories should portray severe injustices and the alleviating effect of loving people, even though these people cannot take away the proponents severe pain6.
Treatment: In residential treatment, removing all forms of stimulation other than short social, caring contacts, has been shown to at least partially ‘retune’ the underactive emotional response and reward system: patients finally learn to slightly enjoy and then look forward to such small rewards7. Much, that feels intuitively helpful, may be used in trial and error fashion. Efforts may be made to use stories and theater to teach compassionate empathy. It would most likely also be helpful to use artistic stimulation, e.g. classical music (not songs with lyrics), and exposure to nature, observing birds and/or gardening to teach responding to subtle stimuli. If the same great music is heard many times, listeners will appreciate its beauty more and start looking forward to the most melodic and most emotional, dramatic parts. Certain domesticated animals (donkeys?) may be helpful in developing emotional bonds. Choirs may help groups bond while learning to appreciate complex music.

1  There are other psychiatric conditions that are not generally recognized and cannot (yet) be treated (voluntarily or involuntarily) although they harm many victims, e.g. addictive pursuit of wealth and power that brings no happiness to the addict, leads to unethical acts including “white color crimes” and severely harms the patient’s family and society at large Also many people that pursue a law or military career develop distortions of human relationships and perceptions of ethics that harms them and others and should be considered pathological and needing treatment.
2 Autism may lead to violent crimes, probably due to being brought up in a very disturbed family e.g. by a mother with a ‘gun fetish,’ as in the Sandy Hook massacre by a young man with autism spectrum disorder.
3  It has been argued that there is no specific moral center, assuming it could be identified in a fMRI while the patient ponders a moral question; however, thinking about what is morally right is like any in words formulated dilemma and involves frontal lobe activities, speculating about consequences of possible decisions, etc.
4  According to my own anecdotal data, the endorphin system, designed to make abandonment and major pain tolerable, is in most people very weak. We may speculate that, because of the widespread traditions of injurious and mutilating procedures in most prehistoric cultures, many people suffered severe infections and sometimes died; consequently, in human evolution, endorphin induced pain relief and reward feelings during and after such procedures may have been unfavorable. Decorative scarifications are still practiced by some tribes (on women more than men?); otherwise most cruel body modifications have been primarily performed on young girls, compelled by their female relatives and usually considered a condition for marriage (Chinese foot binding; genital mutilations).
Today, early abuse, neglect and abandonment may “prime” the endorphin system. As adolescents and adults abuse and neglect victims are likely to get feelings of relief from self-injuries behaviors and tattooing, (some of my women patients reported reading and falling asleep while getting large tattoos); they may also report that childbirth was hardly painful, etc. [anecdotal information]. Apparently tattooing much of the body has become a popular fad in many areas of highly industrialized countries and may, among other things, be related to exhibit one’s willingness to bear pain.
5  Most cultures throughout history have incorporated very unethical traditions, but people rarely see what is unethical within their own culture. Outsiders, however, intuitively recognize what is wrong, be that slavery, torture, child marriage, exploiting the vulnerable, letting the poor starve, etc. In many African tribes, all girls must undergo genital mutilation and men have to buy brides, in India a girl’s nutrition and health are generally inferior to that of boys, parents have to promise high dowries to get her married and non-payment has been considered to justify that the in-laws burn her, supposedly compelling her to immolate herself. Particularly in Arabic cultures, male relatives are expected to kill a raped girl to preserve the “family honor.” In many cultures, specific minor crimes are considered to deserve extremely cruel punishments. Any outsider can readily see that such ancient cultural traditions are grossly unethical but it is very difficult to change traditions from within, and we do not consider perpetrators of these ‘crimes’ to be psychopaths.
6  Parents, children’s media producers and teachers feel far too often that stories should not lead to hurt feelings in the child and that the stories must have a moral: that the protagonist the child most likely identifies with is good and ends up being lucky; good things happen to good and bad things happen to bad children. Such stories foster “us-versus-them” thinking and they help suppress empathy and compassion; they also justify enjoying imagined aggression and even cruelties. In addition, children will, if they have bad luck, seek reasons to feel guilty, e.g. if parents divorce or a close relative dies prematurely, particularly girls readily blame themselves.
7  Atlantis Magazine article, June 2017 “When Your Child Is a Psychopath”, by Barbara Bradley Hagerty. In the described treatment center there is a focus on the behavior modification aspect of the treatment, (not responding to cursing, insult, feces throwing, etc.; consistent short social interactions with caring therapists; point systems that may shortly punish but are reward oriented). Though the treatment is behavioral and tries to instill some insights, these patients’ pathological reward system does change. However, the described treatment may not properly address the need to teach broad compassionate empathy. A described former patient seemed to have later learned empathy in a different way: acting as if feeling empathy in his work as funeral director. Acting as if gives the brain a feedback of feelings, as is the case when acting happy, sad, afraid, etc.; the portrayed feeling is then more or less perceived; the longer the acting, the more it is perceived. That patient also stated he was helped by religion, which may be unfortunate: when people believe to find religion, they readily subsume many bad assumptions as part of their faith.” (It is amazing how many Americans stress that they believe in Jesus but live lives in every way contrary to Jesus’ exemplary ethical teachings and life. Many crimes have been justified by religious “beliefs.”)
Teaching compassionate empathy and ethics, based on global and empiric ethical principles, is more important than seeking religion-based morals.    

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