11 March 2018

The making of a psychopath - A vignette

by Mary Fernando

If Leigh Lundin suggests an article topic, it is always one that is both intriguing and complicated. His ideas keep me up at night. They get under my skin.

When Leigh asked me what creates a psychopath, I knew that was a question worth tackling. It is too big a question to answer fully. I would, however, like to present a small vignette, a window into this issue: please let me introduce Phineas Gage and the ventromedial prefrontal cortex, or VMPC.

In 1848, a railway foreman named Phineas Gage, had a horrific accident. An explosion shot a metal rod shot through his head. If you look at the diagram of how the rod entered his brain, the fact he survived was remarkable. At first it appeared that Phineas survived the accident with his physical and mental abilities intact. However, as time passed, it became increasingly clear that his personality changed. He went from being a well-liked, balanced man who was socially adept, to being socially inappropriate and uncaring.

Phineas and metal rod
Phineas and metal rod
What is interesting for the purposes of our question, is that Phineas developed an ‘acquired sociopathy’, or ‘pseudo-psychopathy’. Since then, we have noted that lesions to this part of the brain have left other people with similar impairments, with otherwise normal intellectual function. They have an absence of empathy. They lack interest in the well-being of others.

Every area of the brain is a true team player. No area functions independently, each receiving inputs from many areas and sending outputs to many areas. So, to just talk about one area is a little odd but for the purposes of this essay, I will treat the VMPFC as a sole player. It deserves a spotlight and to take centre stage.

We know that damage to this area causes a defect in empathy. However, few psychopaths have injuries to their brain like Phineas. There may be a genetic component to the development of psychopaths, but here I would like to concentrate on the development of this area.

The VMPC does not come fully developed at birth. It grows and develops, most rapidly before one year of age, and continuing during early childhood.

The VMPC changes in response to the relationships the baby has which can either enhance or diminish its growth.

Enhancing the VMPC growth comes from being loved, with hugs, holding and – most importantly – a responsive adult who says, hey, you are hungry, scared, alone, in pain, let me help. I will hold you, feed you, take care of you. That interaction is the opposite of neglect. It is love in action. And love for a baby is always love in action. From this, the baby gets the social information to form connections later on, and the happiness bathes the VMPC with growth enhancing substances released by the brain.

If an infant is neglected, the VMPC does not grow as successfully, in part, because of the lack of social information and growth enhancing substances. The rest of the story is that the stress of being unattended bathes the baby’s brain in the stress hormone - cortisol - that has a corrosive impact on brain development. This is not an all-or-nothing situation. However, true neglect, like that found in infants raised in orphanages with no interaction, results in true deficits. In some severely neglected infants, we find a functional hole in not just the VMPC, but in the area around it called the orbitofrontal cortex.

Abuse is another way that the VMPC gets damaged. The VMPC of a frightened infant will be bathed in corrosive cortisol and that does not bode well for future empathy.

Now that I have introduced a few of the players in the crafting of a psychopath, I would like to emphasize another one: nuance. Many neglected and abused people do not turn into psychopaths. There is something in the severity of the early experiences and also, likely, a genetic predisposition.

A final thought. For mystery writers, the issue is often about murder and, quite frankly, most murders are not committed by psychopaths. The vast number of murders are committed by people who forget to look into someone’s eyes and see another person. This can be momentary or it can be part of a general lack of empathy. So, nuance means that people who are neglected and/or abused may have a deficit of empathy that allows them to commit murder.

If Phineas and the VMPC have another lesson to teach us, I believe it is that we need to treat our infants well. We all make mistakes as parents but if, on balance, we love them, hold them and don't let them live in fear, we are likely to grow that part of the brain that allows them the most human gift of all: empathy.


  1. Mary, your column contains so much more than I’d hoped for. For the first time, I see the reverse linkage between the physical brain and emotions, the hardware and software. Damage to the brain causing mental problems seems obvious, but I’m truly gobsmacked to learn emotional afflictions alter the physical brain.

    Your writing reminds me of one young mom who worked at Disney. People were dismayed that she refused to cuddle, coddle, or hold her young son, especially if he cried. The mother insisted cuddling spoiled and weakened boys and she was toughening him up so he wouldn’t grow up a wuss.

    I wasn’t the only one who instinctively believed her wrong, but your article frighteningly makes clear she might have been shaping something far beyond her darkest imagination.

    Thanks, Mary. Beyond our mystery readers and writers audience, I hope every parent gains something from this article.

  2. Leigh, I cannot thank you enough for your question. It kept me up and made me think. It is a complicated issue, and I apologize for the limited answer. You are amazing - you always get me thinking.

  3. Another good and useful post.

  4. Thank you for your post, Mary. Phineas' psycopathy was the result of a horrible accident, but so often the child really is the father of the man.

  5. Thanks Janice!
    Eve - powerful comment. Thank you

  6. That was both fascinating and horrifying! One wonders if a certain Fat Orange Baby currently in power was thus afflicted as a small child.

  7. Mary, a very interesting and thoughtful post. Thanks.

    During my years working the streets, I met several of those hail-damaged children after they grew up. I've no doubt that Eve met several more behind the walls.

  8. Elizabeth - Hmm🤔
    R.T. - I think many of them end up on the street. Phineas lost his job, went from one menial job to the next and ended up in a circus. Sad tale, repeated in so many damaged people.

  9. I've heard that if a child has been given love until he is 5 years old that he may stray for many years but eventually will come back to being a loving adult.

  10. Jan - agreed. Further, he will have empathy and likely to have successful relationships.

  11. Reportedly the Koch Brothers were raised in a deliberately combative, competitive environment, where they were made to face off against one another in every aspect of their childhood lives, "gladiatorial" to my mind to harden them. Their twisted old man often made competition unfair, because life's unfair, yada yada. Even his will was designed to pit them against one another. Their unbelievable wealth means nothing without love and kindness. Little wonder they're hostile to the poor, the homeless, the injured and the ill. I can't think of a sicker situation.


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