- Dr. Fallon, can you tell us how our behavior can be explained from the point of view of neuroscience? Why do we experience depression, stress, shock, invigoration, disappointment, fear, etc.? How can these human conditions be explained? Is it the emission of certain chemical substances inside our bodies?

In neuroscience we think that each behavior is controlled by an entire brain circuit called a connectome, and there’s usually at least three specific areas of the brain involved in such a circuit, as well as about a hundred brain areas that interact with the circuit. The basis for the brain circuits' activity is mediated by electrochemical interactions, and the brain circuits themselves are formed genetically, at least initially. Genetics lays down our basic personality traits, and it does so by laying down the fundamental connections and the chemical interactions, such as the neurotransmitters and hormone messengers. And all things being equal, that is, everyone growing up in a nice adequate environment, their behavior will be almost entirely based on their genes. But of course that doesn't happen often in practice, because everybody has a different early environment. This is why, if there is some early abuse, mistreatment or abandonment of an infant involved, and this includes the time from birth to about three years of age, then you have a problem, because unfavorable, hostile environments at that age changes the brain connections and chemistry through gene-environment interactions that both select and modulate what genes are ultimately expressed throughout life, sometimes in a permanent way. This is a key basis of what we now know of as epigenetic modulation.

These brain connections and neurochemical processes constantly interact with the environment. For example, when you have a bacterial or a viral infection, your whole immune system undergoes changes. And this ramps up, temporarily, your entire immune system and especially specific antibody production for each type of infection. But after a couple of weeks the infection goes away, and it all these epigenetic alterations go back to normal. And a similar thing happens when we get angry, for instance. A normal person can get mad, but after a while they will calm down, because their serotonin will take effect, and that's one of the important mood altering neurotransmitters. I think that there is nothing wrong with violence in general, because it's predetermined by the genome, and there are socially acceptable forms of it – for instance, if someone attacks your family, you will defend them with violence, and that's OK. But these behaviors are context-dependent, and there is a specific brain circuit in the prefrontal cortex that puts them into context, and its main function is not to cause behaviors but to inhibit emotional behaviors. And, if you think about it, a large part of your behavior is not doing things because usually we take moral behavior not as doing something good but as not doing anything bad. But people who, due to some childhood trauma, develop we call an epigenetic markers (that is, the irreversible adaptive changes of the regulators of genes, such as the warrior genes or stress genes in the nervous system that happen as a reaction to the environment) usually have problems with putting such conditions as sudden anger into some reasonable context, but rather acting in an out-of-context way (such as running down the street naked, attacking innocent people in a predatory way, etc.) and this is why we perceive their behavior as anti-social.

Science tells us that there are about three hundred and fifty of the so-called complex adaptive behaviors. These include various forms of aggression, fear, empathy, emotional reactions, etc., and all these 350 behaviors develop automatically. It was formerly thought that you have to teach all these behaviors. But in fact you don't have to teach anything because all these things are wired into our genes. It’s almost like we know things before we’re born so we have an appreciation of beauty, fear, anger and intuitive understanding of many things. For example, infants know how to swim as soon as they’re born, but then because of the environment they learn how not to swim, they forget that skill. At the same time there’s a whole lineage of philosophers like Aristotle or the French humanists who believed that we’re born tabula rasa, or with a clean slate, and it’s actually the environment – like your parents, friends, religion, etc. – that determine who you are. This idea persisted, and even now many people believe it to be true. But the neuroscience does not support this at all, quite the opposite.

© James Fallon

– You have done extensive and serious studies of the brain structure of famous psychopaths, sociopaths and serial killers. Can you please explain for our readers, what is the difference between the people who have this sort of predisposition from the brains of “normal”, if there are any differences at all, that is?

Well, let's start with saying that not all murderers are psychopaths. There are normal people among them too, who have motives to commit homicide. But there are times when that happens out of context, when the person doing it is reacting to their own biology and the perceived threat. These killers are called impulsive murderers, and they aren't psychopaths either, they're extreme hotheads. They will suddenly get crazy mad and stay mad and then they’ll lash out and do something violent. And that’s because the connections between different areas of their brain may be faulty. Another group of killers are people with brain damage received from either head injuries or taking too much alcohol or drugs. The behavior of such people is usually very disorganized and difficult to control.

And then there is the third major group of personality disorders most associated with murder, they are called the Cluster B type personality disorders in psychiatry. The main ones in that group are psychopathy, narcissistic personality disorder and borderline personality disorder. The latter subgroup are people who will love you one day and make you their idol, then they’ll hate you the very next day.

- Is the borderline personality disorder similar to bipolar disorder?

The bipolar disorder belongs to a different group of conditions called affective or mood disorders. There are also thought disorders such as people with psychiatric conditions like schizophrenia and major depression who usually have disordered, chaotic thoughts and feelings, they can often hallucinate and they have problems with their emotions. These mood disorders and thought disorders have similar genetic abnormalities and all may be considered on a spectrum. Naturally, those people can be murderers too but not as many of them as you’d think. When they're down, a lot of them, especially with depression, schizoaffective disorder, and negative symptom schizophrenia can't really do anything. They can't even commit suicide when they are in their most negative phases of the disease, let alone murder someone else. They simply don't have enough motivation and energy for that. And when these people are in that depressed phase they go to such areas of the human psyche that other people wouldn't touch with a 10 foot pole. And that’s why you find a high percentage of bipolars among great artists, musicians or generally creative people. Going to that "down" place for them is a very weird, disturbing and upsetting experience but they get a lot of inspiration from it. And when they come back up they shower us with their artistic genius. But here's the thing: if such a person is artistically talented, they may express all those weird disturbing emotions that way. But if they’re not, what are they going to do? And here is where all that violence and antisocial behavior may occur as a way of getting rid of all that negative energy, way of letting it out. But if you talk to such people, a lot of them will talk about that act of murder or violence almost as if it’s an artistic act. They can create an entire artistic narrative about it.

And now let's go back to the groups of psychopaths and people with narcissistic personality disorder. These two groups overlap because they both have a lack of what we call emotional empathy. And here I think I'll have to provide a brief explanation. There are 4 types of empathy that we can visually represent as two axes or two double-headed arrows. The first axis is "ingroup vs outgroup" empathy. All the decisions and actions of someone who has ingroup empathy have to do with their family or some small social group they belong to. At the same time the interests of anyone outside that group will most likely be completely ignored. All the way at the other end will be the internationalist people. These are people who believe that we all are one world or one environmental globe, and they’re connected not to their family but to the world at large, to the planet Earth. More toward the middle will be nationalists, i.e. people who do everything for their nation, clan or tribe. And these traits all can be biologically based, i.e. inherited! Based on the type of empathy people have, you can even predict their voting behaviors! For example, I gave a talk to a group of international investors with one of our senators as chair, a year before our most recent presidential election, and based on the statistical data about the type of empathy the American people have and the stress the system was under, I said that people would be driven towards a default, which is personal or family empathy, and based on that I predicted that Trump would win the election.

The second axis of empathy is "emotional vs cognitive". With emotional empathy, you sit down with your best friend or your wife or your brother or sister, or even a complete stranger, and if they’re very happy, you’re happy with them, or if they cry, you'll cry: you can mirror their emotions. When another person near them is down, a person with emotional empathy will be down too, they will feel the same. When people get married or make close friends, this is what they’re usually looking for ideally. At the opposite end of this axis is cognitive empathy, and many people don't even know it exists. It's formed by completely different brain circuits, different neurotransmitters and hormones like oxytocin, vasopressin and testosterone. People with cognitive empathy understand what people around them feel, even though they don’t feel it themselves. So many people with it won’t cry with you, won’t feel your pain but they will understand you’re in trouble so they’ll do something to help you. And by the way many people who do great works of charity have very little emotional empathy but have cognitive empathy instead! They do tremendous amounts of giving to the world or to certain groups of people but they make for unsatisfactory friends or spouses at an emotional level. These people rarely have good relations with those closest to them. A good example would be Nelson Mandela. If you’ve heard the speeches at his tribute ceremony, his daughter said something like: He was a great man but you wouldn’t want to be his daughter. Or take Mother Teresa, who also had outgroup cognitive empathy. She helped so many people, so many children, but one on one she was very prickly. And some mothers get called bad mothers because they seem distant from their babies and children despite still giving them what they need. I think now you understand why these criticisms are unfair, because these women are just differently wired genetically.

So again, psychopaths and people with narcissistic personality disorder usually have the lowest level of emotional empathy. At the same time they don't even know they're doing something wrong – they think everything is perfect! But because they have highly developed cognitive empathy, which means they know what you’re feeling and thinking, and in most cases they’ll use it against you. The other trait of psychopaths is that they’re always on the make, they’re always manipulating someone, it’s like a game for them. A lot of them don’t kill anybody but they manipulate people because it’s fun to them. They usually have high levels of aggression, too, but their aggression often manifests in that manipulation.

© James Fallon

– Do you think psychopaths can reject their own nature and their own genetic disposition? Are there ways of controlling it? Do they have any free will in that regard?

As I mentioned in another context, usually the epigenetic triggering or marking of somebody occurs between birth and two-three years of age. And if it happens, they become set to be that way, because human brain is very flexible at that age, it's still open to modifications, but then becomes more fixed after two or three years of age. Now, a lot of people who are abused or abandoned at that early age still come out normal because environment interaction only affects one in a negative way when you have the specific gene forms, or alleles (one allele per gene from one parent, the other allele from the other parent) that react that way. But when you get that combination of having all the genes associated with psychopathy, and the early triggering, that’s trouble, because that permanently sets those regulators of the genes “on” for life. The brain of such infant thinks that being extremely violent and aggressive is the only way to survive in such a hostile world. It's some sort of a protective mechanism.

But after 5-7 years, the brain gets relatively hard-wired. Some people use the behavioral modification training for psychopaths and they start with 7-8 years old. I've heard there’s some success, but since full psychopathy doesn’t develop till the age of 18, we don’t know for sure yet if those retraining techniques actually work. Also, you have to keep in mind that people will often change themselves temporarily, like film actors and models losing or gaining weight for a role. A lot of such "changes" are temporary, or often it's not even that but just pretence. But here's what I think: if someone who has psychopathy tries hard every day to treat people nicely, not to manipulate them and so on, they can probably beat the behavior. But just the behavior, not the wiring of their brain and their personality. Because you can’t just cut those tracks that your brain set early on and then reattach them. But there are two workarounds. One is that there are several areas of the brain and several patterns of connection that can produce the same behaviors in different ways. So you can switch to the other workaround circuit and start using that connectome more for specific behaviors. It’s like having a second engine in your car, a backup engine, and using it if the main engine fails. And some people can try to access those supplementary circuits and thus work around their antisocial tendencies built in their primary circuits. That’s still not really rewiring though, that’s just using the other wiring pattern. The other workaround is medicine and drug related, and it has to do with altering neurotransmitters like dopamine, serotonin, and other unmyelinated, ‘plastic’ systems, etc. and taking pharmaceutical substances that can influence these neurotransmitters and alter the temporary brain connections. It can be called plasticity in a way but it's not the same as rewiring the main myelinated brain connection systems that form the basis of personality.

© James Fallon

– Some famous doctor once said: if I hadn’t become a surgeon, I would have become a serial killer. How effective is that in fact – to follow one’s internal inclinations, but at the same time to look for some positive, pro-social ways of following them?

That's a nice phrase, I agree. You know, certain professions involve making logical cold decisions that are driven by logics and not by emotions (such as politicians, military people or surgeons), and people of these professions often tend to have psychopathic traits, because it can be very useful for leadership, for decision-making. Look at the generals of WWI and WWII: it is known that the ones that were the most successful and effective leaders, were not full categorical clinical psychopaths but had some psychopathic traits. Emotion and intuition-driven people tend to be very bad generals: you need cold, rational decisions in this field. And besides psychopathic traits in a person are often attractive to us because they create a certain charisma, a group of traits collectively called ‘fearless dominance’ look like leadership to the typical person. A study was done on American presidents several years ago, and they were ranked according to different personality traits (Obama and Trump were not assessed because it’s unethical to evaluate the most recent presidents who have not been formerly analyzed by a psychiatrist). And the ones who were the highest in psychopathic traits such as fearless dominance, radiating charisma, leadership were Teddy Roosevelt, FDR, JFK and Bill Clinton. So these are all the most charismatic presidents that had some natural charm. So, believe it or not, but we often choose people with psychopathic traits as our leaders, as heads of states, we trust them to run our monetary systems, to lead our society. And that's because people are attracted to them. If such a person comes into the room, everyone immediately turns to look at them, they have that light around them.

– One of the most interesting things you talk about in your public talks and in your book “The Psychopath Inside”, is your studies of your own brain. Tell us how you first discovered that you have the genetic and physiological inclination to psychopathy? Do you think that this inclination somehow manifests itself in the way you live your everyday life, your attitude to the world or to your work?

Oh, I found out about that as randomly and serendipitously as you can imagine. Up until a certain moment I had no more interest in serial killers and psychopaths than the average person. For a long time I didn't touch that subject in my work at all, but it just so happened that some of my ex-students became professors at the University of California, Irvine. Using a PET scanner, they did some research in psychiatry and radiology, and they had murderers come in for the scans during the penalty phase of their murder trials, that is, after they were found guilty. And they asked me to help them with their research because I am a systems neuroanatomist. I very reluctantly agreed, because at that time I was doing a lot of other things which were more important and interesting to me. But I still did some of that in 1998-2005. About a year later I got a hold of a whole bunch of scans – PET, MRI and SPECT scans of different people's brains. So I analyzed that group of scans, and found out that they fell into neat sub-groups. And then I learned from those ex-students of mine that one of these sub-groups had only the scans belonging to murderers with psychopathic personality disorder. I was surprised: "Wow! I have never before heard of their brains having any common pattern!" So as a scientist I became interested and dug into the subject and soon I started publishing papers and giving talks on that. And as it went along, me and a group of my colleagues were also doing a different study at the same time, which was looking at genes associated with Alzheimer’s disease. When we finished the main part of that study, we suddenly found out that we didn't have enough control data, i.e. scans from normal healthy people. There was little time left to write the paper, so I had to ask my family to participate, that is simply to undergo the scans and the genetic tests. And I brought in my entire family – my brothers, sisters, my wife, kids – all of them!

While I was analyzing the brain scans of Alzheimer's patients, the technicians put the pile of family's scans on my table. I went through them very quickly. I’d seen thousands of these and I’d immediately know if there was a gross abnormality, so I quickly saw that everything was normal, my family didn't have the obvious gross pathology for Alzheimer's disease. I was very happy because there were people with Alzheimer's in my wife's family, so there was a possibility of her having it too. But when I reached the bottom of the pile there was a scan that was really weird and familiar at the same time. And I said to the technicians: "Okay, this is very funny, you've played a great prank, fellows. Did you really think I wouldn't notice if you slipped one of the psychopaths’ scans into my family’s pile? Alright, this is it, the joke's over, take it away." But they persisted: "No-no, it's just your family there, we swear." So I deadpanned: “Well, whoever this is in my family, they’d better be not walking around in society, because their scan shows that they may be very dangerous.” I had to peel back the sticker hiding the name on the scan, and I did it, and there was my name.

© James Fallon

It still felt like some stupid joke. How was this possible? I'm a scientist who studies psychopaths, and I’ve got the same brain pattern as them! And frankly I just laughed at it back then. Because I knew who I was, and I was definitely not a psychopath. I thought to myself: I’m a family man, I’ve been in a relationship with the same woman for 50 years, I have a job, kids and even grandkids, and I’ve never been arrested for anything in my life. This is ridiculous! So I did what any scientist would do, which is: I assumed that my theory about that brain pattern of psychopathic people was wrong. But later it turned out that the theory was not wrong, because other researchers found the same thing after I had published this theory.

But also on that day I went home and I said to my wife: "Listen, today I saw the damnedest thing! My PET scan looked just like that of a psychopathic killer", to which I got a very odd reply: “Well, it doesn’t surprise me.” And she was absolutely serious when she said that. Later I received the genetic test results of my family, and it turned out that they all had very normal, average levels of most indicators – average aggression, average anxiety, average empathy, etc., I had inherited all the genetic alleles associated with psychopathy, absolutely all of them. My natural aggression level was high, too. "What the hell is going on here?" I asked myself. "I have both main biological markers for psychopathy: the brain pattern and the genetics!"

But I was also very busy at that time: we were finishing that study of Alzheimer's disease, I had several other projects including starting a stem cell company to treat chronic stroke, and I didn't have time to bother about this discovery I had made about myself, so in a couple of years I simply forgot about it. Only several years later, in 2009, I gave a TED talk about it. And it became very popular, because of the subject matter, of course. After another year I was invited to give a talk at the University of Oslo in Norway. And after my talk the chairman of the Department of Psychiatry of that university stood up in the auditorium, thanked me for the presentation and said: "I think you have bipolar disorder and don’t know it, my colleagues and I want to talk to you (after which they told me I really might have some psychopathic tendencies that I just don't know about. This happened five years after I looked at those scans, and that was the first time I took it seriously. So I went back to California and asked all my friends and family – my wife, kids, brothers and sisters – to tell me honestly what each of them thought of me. And they all said basically the same thing: "You have always had some psychopathic behaviors, you don’t care about people really. You’re fun and interesting to be around with but basically you don’t really value the people around you." I was very surprised to hear this, of course.

In 2014 I wrote the book “The Psychopath Inside” about it, and in the same year I decided to get more fully psychiatrically analyzed. The psychiatrists said that I was a borderline pro-social psychopath and they proved to me that I did a lot of things psychopaths usually do (like manipulating people), only all of the things I did were within the boundaries of the socially acceptable. I also learned that I had the urges and dreams and thoughts of a full blown psychopath, I just never acted those things out. And it all made sense to me, so I was finally convinced.

The last thing I did is that I decided to try to change these behaviors. As I have said, psychopaths usually can’t change their nature but I was sure I could change mine and relied on my own narcissism to do it. I thought that I’d start with my wife. Every time I interacted with her I asked myself: “How would a good guy behave in this situation? What would he do?" I also started to look at my friends who also had families, wives and kids. And I realized that they were really sacrificing themselves every day. I had never even thought about that before! So I started doing this every day for two months, trying to control what I do and what I say. And in about two months my wife said to me: “Hey, what’s come over you?” And I replied: “Well, don’t take it seriously, this is just an experiment.” But to this she said something that surprised me: “I don’t care if it's just for science, I don't care if it’s phony, I like it anyway! I just want you to treat me better." Then I also tried the same mode of behavior with other people, and after a while I noticed that I started to sleep much longer every night. I usually sleep for only about 4 hours a day, and I started sleeping 7-8 hours a day because I was so exhausted worrying about other people and constantly controlling myself. It’s damn exhausting to be a good guy, as it turns out.

© James Fallon

– We have recently talked to American researcher of dementia and Alzheimer’s disease James E. Galvin of Florida Atlantic University. He says that the most effective way of battling these brain diseases is preventive medicine. Can the same thing be said about mental conditions, psychopathic and sociopathic disorders?

Yes. Although there are a lot of psychiatric disorders that are predetermined by genes, in many cases there is also the very important environment interaction factor. We don't know how to reverse the already established epigenetic changes in the brain connections. I don't think that's possible at all. In my opinion, psychopathy is incurable. But we know how to prevent it: for that you have to simply prevent the child from being abused, bullied or abandoned at the early age. So if a child with these psychopathy-related genes and brain patterns avoids childhood abuse (like I did, for instance), they’ll still be quite aggressive and they’ll still have some specific traits, but their behavior will be pro-social and in context. The problem is that the families that these kids are born into also tend to be sociopathic or psychopathic (hence the genes and behaviors that these kids inherit), and as you can imagine these people don’t often go to the doctor saying their kid shows psychopathic tendencies. So we need to think how to do it legally and ethically. You could have a psychiatric system for kids in which they would get analyzed and then the doctor could tell the parents what to watch out for and what the risks are. But really you have to have a trained eye to see psychopathic tendencies in children.

The paper I wrote on this had a chapter that imagined my own two-year-old granddaughter as a psychopath. She isn't a psychopath, of course, but kids already have behaviors that in adults would be qualified as psychopathic. Such as when they want some toy or a cookie and don't take no for an answer. They simply don't care about anything else in the world but that damn toy! But experts can really see the difference between a normal behavior of a two-year-old and actual psychopathy.

– How much of your field is still unresearched? What advice would you give to a beginner in neuroanatomy?

Neuroscience is an incredibly vast field. I have already tried so many things within it. In the 1990s I studied neuroscience aspects of creativity, music and art. Then I worked as an advisor to the Pentagon about how to optimize the soldiers’ behaviors and help them not to be susceptible to psychopathy. I worked with artists, architects, musicians, politicians, businessmen. I give annual talks to economic, political, religious groups, even air traffic controllers. The point is not how awesome I am but that in neuroscience you can now do an unbelievable amount of different things. It's such an extensive science that I would advise to any student and young researcher to create their own discipline. That's exactly what I did all the time. Except I don't like to dig deep into just one narrow subject, I've always been all over the place, I study a little bit of everything. Everyone around you would want you to be an expert on just one thing, but I always resisted that.

The great thing in neuroscience, for me, is taking its fundamental ideas and then applying them to what you love. For instance, if you’re a cello player you can analyze the neuroscience aspects of cello playing. There is an ocean of possibilities here, so I would encourage those who want to do neuroscience to do what they personally are passionate about. It has to be something you can sustain your whole life, day and night, simply because you’re extremely interested in it.

– In conclusion, could you tell us about the projects that you’re involved in right now and your plans for the near future?

What we’re doing right now with a group of researchers is a large project on paleoneurology. The people involved in it are researchers of archaeology, genetics, neuroscience and paleontology. We’re looking at Paleolithic humans like Neanderthals – we take their skulls and we recreate their brains micron by micron, to see what they would have looked like. Then we do the genetic tests too and we’re trying to piece together the different parts and aspects of human evolution. We are currently focusing on language, so we’re examining those parts of the brain from Neanderthals to see how language emerged. Human language is quite a unique phenomenon because it’s not an adaptation (i.e. something that emerged as a result of evolution, some very slow change) but an innovation, as is the mammalian placenta and bird feathers (in the sense that it basically came out of nowhere), and as part of this and our work on psychopathologies we look at the transposons, short strands of DNA that used to be called ‘junk DNA.’

I also continue to work with the military to help them solve different psychopathy-related problems. I work with various political groups. I do a lot of advising for films and TV, too. For instance, I was recently involved in the production of Ilya Khrzhanovsky’s much-talked-about (but yet unreleased) film “Dau”, about Soviet physicist, Nobel prize winner Lev Landau.

So I do quite a lot of things, but it's always something that I'm really interested in. When I said to my wife: "You know, I have to do this interview for a Russian magazine, it’s for work", she was like: "Oh come on! It's all just fun to you!"