Tuesday, July 09, 2013

The Stylized Neuroscience of Psychopaths

The eighth and final season of the hit series Dexter takes a scientific look at serial killers. British actress Charlotte Rampling plays Dr. Evelyn Vogel, a neuropsychiatrist who has written the definitive book on the brains of psychopaths. She's consulting with Miami Metro Homicide on an unusual case where the killer saws open the skull post mortem and scoops out part of the brain (with a melon baller).

Neuroscience is depicted as a somewhat ghoulish yet artistic and stylish endeavor (the corpse with a sawed off head is not shown in this still). This autopsy scene is particularly artsy with its use of red lit retro cabinetry and colorized MRI films on an old school light box.

Dr. Vogel is philosophical about her chosen field. In a conversation with our favorite serial killer and "blood spatter guy" she says:

"I was drawn to forensics too, but I chose to focus on neuroscience. Psychopaths. We both chose murder. Maybe we're both a little crazy."

"Maybe," Dexter replied.

Dr. Vogal continued: "Mad scientists' strange look at this -- a biological mass -- a body part -- yet somehow from all those firing of neurons something intangible emerges -- emotions, trust, morality, love. Unless you're a psychopath. But even then belief systems emerge."

WARNING! Fake grisly fake image below the jump reveals the role of the anterior insula in psychopathy.

"Looks like a piece of it has been scooped out," says Dexter at the crime scene.

And indeed, a piece of insular cortex has been scooped out with a melon baller. Looks like someone is trying to send Dr. Vogel a message. And a collection of insulae in jars...

At the police station, Dr. Vogel points out what is supposed to be the insula on a bizarre-looking MRI scan (the sawed off skull is presumably slapped back onto the rest of the body, and the genu of the corpus callosum and the ventricles look odd).

"See this part here? That's the anterior insula cortex, the portion of the brain that processes empathy. And, the hallmark of a psychopath is -- they have no empathy."

In real life, there is an extensive literature on the role of the anterior insula in empathy. Structural and functional alterations in the anterior insula have been observed in individuals with psychopathy and/or antisocial personality disorder:
  • ...children with CP [conduct problems] showed reduced blood oxygen level-dependent responses to others' pain in bilateral anterior insula...
  • ...Psychopathic traits were negatively associated with gray matter volumes in right insula...
  • Female adolescents with CD showed reduced bilateral anterior insula and right striatal grey matter volumes...
  • ...psychopaths had significantly thinner cortex in a number of regions, including the left insula ...
  • The review illustrates that the brain regions implicated in psychopathy include the orbital frontal cortex, insula...
  • etc.

So yes it's only a TV show that's unbelievable in many ways, but they did consult with someone on the neuroanatomy, at least...

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At July 10, 2013 4:45 AM, Anonymous Anonymous said...

Hmmm, I stopped watching Dexter after the first few episodes. The premise was rather interesting, but then it got a bit repetitive. Perhaps I'll reconsider.

At August 14, 2013 9:49 PM, Anonymous Anonymous said...

Maybe it's just me... but isn't where that skull is cut that far too posterior to make the scooped out part "anterior insula?"

At August 20, 2013 2:20 AM, Blogger The Neurocritic said...

After seeing the most recent episode (#8), I took a closer look at the latest victim. You're right, the skull would need to be removed more anteriorly to reveal even the mid-insula. This is still true if you consider the less than customary "slice angle" used in the TV cadaver. Looking at the Brain in situ atlas (coronal sections) provides a good view of where the insula is relative to the ears, which are quite intact.


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