What Makes a Psychopath? Horizon

This programme contains scenes which some viewers may find disturbing.

The modern-day psychopath is often characterised as

the stuff of nightmares.

Whether they love Chianti or crossbows,

Hollywood has no shortage

of these charismatic, violent and impulsive monsters.

If I were to tattoo myself for everybody I hurt,

my whole face would have tears.

We have a strange liking, even a romantic hankering,

for these predators.

Shocking, given what they are capable of.

I'm not going to lie, I do enjoy fighting.

It's the only therapy I get.

It is estimated that somewhere between 300,000 and 400,000

psychopaths live in Britain today.

The chances are you've come across one.

You just don't know it.

I'm Professor Uta Frith, I'm a psychologist,

and I've long been puzzled

by the chilling condition we call psychopathy.

Psychopaths seem to exist

far beyond the realm of normal social behaviour.

On occasion,

my research has touched on psychopathy

but I want to find out much more about this complex condition.

So I'm going to meet the leading experts in the field

to discover what makes a psychopath.

Nobody's born a psychopath.

However, it is very clear that there are big individual differences

that are driven by your genetics

that make the child develop psychopathically.

These studies have been able to show us

what areas of the brain are involved in psychopathic traits,

how long they might have taken to develop and get that way.

I'm going to delve into the psychopathic mind...

A lot of these people will project an aura of self-confidence

that, I think, to many of us, myself included,

can often be quite appealing.

..and discover whether you can turn a psychopath

away from the dark side.

What we've learned in the lab is the first step towards developing

possible treatments for psychopathy.

In this film, Horizon went to Indiana State Prison.

With the help of the prison psychiatrist,

four inmates were chosen to be interviewed,

and these four men told very openly and explicitly

about the crimes they committed,

and some of these are very dark acts indeed.

So be prepared.

These interviews are very graphic,

and some of them very disturbing.

My name is Ryan Klug.

And I've killed someone.

She said, "What are you doing to me?"

And I said, "Drop the knife.

"No-one needs to get hurt."

And she dropped it. But...

..I continued to choke her.

Yeah, I slit her throat

and I stabbed her in the heart.

My name is Robert Bruce Sonneborn Jr.

Humans are creatures of habit.

Find the weakness.

The back of your neck is the weakest spot on your body.

So I hit them there.

One of the officers was in a coma for two days,

and when he got out, he has the intelligence of a 12-year-old.

I am Joshua Michael Wright.

I did strangle a friend.

Afterwards, I did something to her, too.

PROFESSOR FRITH: What did you do afterwards?

I guess you could say I...

fornicated her.

My name's Mark Moye.

I was looking at kids, little girls, like, small women.

That's all they were good for, was,

my little gratification and be done with it.

But I never hurt them.

I never...went all the way with any child.

It was always... It was oral.

That's where it stopped.

Throughout this film, we will be revisiting these interviews

and explore why these men committed these abominable crimes,

and how they feel about them now.

We did try to get access to psychopaths in British institutions,

but unfortunately, regulations in the UK made it impossible.

However, we did correspond with one of this country's

most notorious psychopaths, Moors murderer...

Ian Brady.

We corresponded with Brady until a few months before his death,

and these letters also give us an insight into the psychopathic mind.

I still remember to this day the crimes committed by Brady

and his accomplice Myra Hindley for being so shockingly cruel.

Assault, torture, murder of five children.

And, yet, although we asked him directly

in these letters, he never even mentions his crimes.

It turns out Brady was a prolific letter writer -

to the press, to the families of his victims -

and he even published a book of his letters.

I think he enjoyed the attention his correspondence gave him.

He was very articulate.

He always apologised about his handwriting

but his grammar and spelling were excellent.

He was well read.

Referring to Shakespeare,

and he said that he'd read the complete works of William Blake.

But, importantly, if you didn't know who'd written them,

you would never guess that these letters

were written by a psychopathic serial killer.

How can a man commit such awful crimes and yet,

in so many other aspects of his life, appear completely normal?

Analysing these letters in more detail

alongside our prison interviews

can help us answer this question -

what makes a psychopath?

This is the Bethlem Museum of the Mind.

It charts the history of Bethlem Royal Hospital,

one of the oldest institutions in the world

to specialise in the care of the mentally ill.

I've come here to meet forensic psychiatrist Professor Jeremy Coid.

Her mental disorder was hysterical mania.

Yes.

Historically referred to as Bedlam, the hospital was notorious.

Violent patients were sometimes chained up, isolated, even starved.

So, this, of course, is the horror, physical restraint,

the infamous straitjacket.

VOICEOVER: Fortunately, mental health care has come a long way

since its earliest beginnings.

But despite these advancements,

certain conditions, like psychopathy,

proved difficult to diagnose and even more so to manage,

as Jeremy's long experience in the field can attest.

A terrible case I saw of a man already serving a life sentence

suddenly gets it into as head

that he wants to eat this other prisoner.

So, two men murder the chap.

But once they see the intestines...

..effectively said, "Oh, I don't think we fancy eating that today."

It's really as trivial as that.

Meanwhile, they say,

"Well, you know, while we're waiting for the police to arrive,

"do you think you could make us a cup of tea?"

But being a violent killer doesn't simply make someone a psychopath.

They're not all criminals.

In fact, the majority of serial killers are not psychopaths.

That's a really important thing to be aware of.

So, how do you diagnose a psychopath?

Well, the gold standard in terms of a diagnostic instrument

is the Psychopathy Checklist-Revised.

This checklist has 20 traits that psychiatrists look for.

The first thing you rate is whether they are glib and superficial.

Somebody with the gift of the gab in the way that they relate to you.

The next thing is that they are grandiose.

It's not that they're just a mere bighead,

but there's something more extreme about this.

The next thing is you see in their history

a sort of proneness to becoming bored

and a need for stimulation.

They've a life where they seem to need an adrenaline rush.

So, moving around from place to place.

And they have a lack of remorse and no guilt.

They say...they profess that they feel very guilty,

but, actually, it's not terribly convincing.

The combination of all these character traits

creates a perfect storm

so that psychopaths are 15 times more likely to commit crimes

that land them in prison than non-psychopaths.

The other thing you find in their lives sometimes

is that criminality starts at an early age.

So, juvenile delinquency.

And last of all...

versatility in their criminal behaviour.

So, it's a history of sex offending, there's theft,

there's public order offences.

There's serious violence, there's minor violence.

You find all sorts of different offences

in their criminal histories.

Psychiatrists conduct lengthy interviews

to rate and score each of these traits.

You can score zero - it's just not there - 1 is there a bit,

or 2 is definitely present.

So, there's 20 items, and so it is theoretically possible to score 40.

30 is supposed to be at that point or above

that you are a psychopath.

All of us could score some points on this scale.

-Is that worrying?

-Um, a lot of us can score a few.

Actually, the majority of the population will score zero.

Given the complex nature of the human mind,

a psychiatric diagnosis is a problematic undertaking.

You can't glibly, like a psychopath, slap a label on somebody.

You've got to get to know this individual

before you begin to realise

that there's something terribly, terribly wrong.

The four inmates at Indiana State Prison

demonstrate a variety of these psychopathic traits.

I do things just to see the outcome.

I would break in a house,

take over the family,

tie them up, and I would rave out their house for a weekend.

Stealing cars started becoming an adrenaline rush.

Smuggling the Mexicans across the border, that's an adrenaline rush.

And I started living for that more than anything.

I'm not going to lie, I do enjoy fighting.

It's the only therapy I get.

It's the only outlet that's really here.

I've smashed about three different people's faces into concrete steel

where they couldn't be recognised for three weeks.

I don't feel bad, because it was necessary.

The officer that I put into the coma, he just didn't stay down.

I kept hitting him.

I knew they were going to get hurt,

but I didn't think I'd have to go that far.

How did you look at them?

An obstacle.

I mean, they're still people, but if you're in my way,

then you need to be moved.

Everybody else is run by everybody else's feelings and emotions.

Why care?

I mean, you can't look at everybody as a person all the time

or else you'd never do anything.

Feelings get in the way.

They stop every action before you think about them.

The traits of psychopathy are as diverse as they are shocking.

A huge variety of deplorable characteristics.

But where do they come from?

How does someone develop such a reckless view of the world

and the people in it?

To understand this,

we must not look at criminals

but at children whose lives have barely begun.

Emotion is arguably the single greatest force

driving human behaviour,

and it's something that Professor Essi Viding has studied extensively

in young children. She believes it's children's ability to comprehend

and understand certain emotions, not their behaviour,

that is the key precursor to psychopathy.

So, Essi, we were just observing the children chasing each other.

What was it that we were seeing?

Well, we've witnessed the children

effortlessly reading each other's emotions,

and those emotions gave their cues as to how to behave, what to do.

So, if we display cues of being scared,

for instance, that's a strong sign to somebody else

that what they're doing is unpleasant and they should stop.

And if we look happy,

it's a sign that the other person

should keep on doing what they're doing

because it's giving us pleasure.

It is something that we pick up from very early on in life,

and we use throughout our lives

to make sure that we are tuned to other people and their needs.

Absolutely.

To see this process in action, Essi uses a simple test.

Pick me the face that looks happy.

I think this one.

Remarkably, children can read other people's emotions

from the first few months of life.

And which one of the faces is looking scared?

-He's scaring him.

-Yes!

And it's this ability to read emotions

that helps them to moderate their behaviour towards others.

But Essi noticed that children classified by psychologists

as callous and unemotional did not do so well on the test,

especially when it came to recognising

faces that looked scared.

When we give these sort of face pictures to children

who lack empathy and lack remorse,

we find that these children have difficulty in recognising emotions

-and in resonating with other people's emotions.

-Wow.

Essi believes it's because these callous and unemotional children

don't feel certain emotions themselves, such as fear,

that they struggle to recognise them in other people,

and it's a trait that continues into adulthood.

A few years back I was using

an emotion-recognition test with prisoners,

and an inmate who had very high levels of psychopathic traits

was watching a fear face

and had some trouble naming it and eventually said,

"Well, I'm not quite sure what to call this face

"but it's how people look like just before you stab them."

And what was really, really curious

was this absolute detachment with which he talked about

this other person's extreme distress.

Gosh, it is quite frightening.

It is.

Essi showed that the origin of these emotional deficits was in the genes.

CHILDREN LAUGH

It's never a simple story in every human trait,

but our research very clearly showed

that children who lacked the ability to empathise with others

have a strong genetic predisposition to being that way.

This predisposition probably

interacts with some environmental factors,

so nobody's born a psychopath.

However, it is very clear that there are big individual differences

that are driven by your genetics

that make the child develop anti-socially and psychopathically.

Just as our eye colour is determined long before we are born,

inherited from our parents,

so, too, it appears,

is our predisposition for psychopathic traits.

What were you like when you were growing up?

My conduct wasn't always great, you know?

My moral compass wasn't really...

I guess it wasn't really on anything,

so I didn't know...

..a lot of what I was doing and the right and wrong, but I have...

..over 100 family members, or more,

and I was...

..not good enough for them,

so they pretty much shunned me since I was about eight or nine.

My interaction with people was socially awkward.

I couldn't really connect with many kids.

No matter how much I tried to fit in with anybody, it never worked out.

So I always did stay apart. I was always...

..different, I guess.

I was the first born, so, you know, I started out all right.

But then, as I started to get older, I noticed I was...

out of place, for less of a better term.

I mean, I excelled at everything.

I had a 4.0 grade average for most of my schooling career.

I...

I got into trouble cos I was bored.

It's because I was always done before everybody else.

I got suspended a couple of times.

A lot of times. So then I'd be sent home and get in trouble at home.

Who knows whether the behaviour these men showed as children

played any role in the crimes they committed later.

Perhaps, with the most caring parents in the world,

their behaviour could have been mitigated.

But, for many, the environment they grew up in is not so kind.

This is Mendota Juvenile Treatment Center in Madison, Wisconsin.

It is one of the most progressive,

secure psychiatric facilities in America.

A last resort for the state's most violent

and emotionally disturbed adolescents.

The facility is led by its director, Dr Gregory Van Rybroek.

We've had this programme for about 20 years,

and, typically, we take kids who are not adjusting well

in high-security juvenile corrections.

They've committed a lot of armed robbery or gang involvement,

a lot of drug involvement, lots of different violent crimes,

including homicide.

These boys may be too young to be diagnosed as psychopaths

but many of them have already been classified

as callous and unemotional.

Before they're placed inside an institution,

they've a lot of social deficits, such as interpersonal problems,

inability to make friends. They may have hurt animals,

don't have a great sense of consequences.

Many of these youths don't have a high degree of empathy and concern

for the pain and suffering of other people.

They have an idea of what is right and what is wrong,

but don't seem to mind choosing what is wrong.

Damien is one such boy.

His relationship with the state correctional department

started when he began taking knives to school.

It got increasingly more serious when he developed a drug habit.

I was 15.

I needed money so I started going out burglarising houses,

robbing people. I'd strip the whole house.

Take it anywhere to get money.

After I get the money, buy what I want - food, clothes, drugs.

More guns.

Just getting into it felt like I was a badass,

do whatever I want.

Gregory believes that many of Mendota's inmates

were simply unlucky that they grew up in an environment

almost designed to nurture criminal behaviour.

Something that the local police department see regularly

on their patrols.

There is an incredible amount of drug sales that are here.

The gang members will sometimes take over the park and then of course

it happens right around when the younger kids are also there

so the younger kids are learning.

This is where their role models are.

The majority of the youth at Mendota

were raised in challenged neighbourhoods like this.

There's a lot of substance abuse, there's a lot of alcoholism,

and we have a lot of shootings here.

In the households I've been in, it's just unreal sometimes.

Deprived neighbourhoods are found right across the world,

and children raised in them are often exposed to crime,

abuse, violence and neglect -

a devastating combination

that can push callous and unemotional children

into becoming very dangerous individuals indeed.

Perhaps this helps explain why paedophile Mark Moye has committed

such dreadful acts.

My childhood,

my real mother,

she had psychological problems.

She held a knife to my neck.

She tried to kill me when I was a few months old

by throwing me down some stairs.

I watched a lot of death in my life.

I had a cousin get his head blown off when I was 16.

I heard a loud pop, and I just felt warm, sticky fluid on my face

and on my pants,

and he was dead.

Just like that.

That was my problem.

I saw a little too much, more than most should have.

My dad sexually abused me, physically abused me.

He would rub his dick all over my face,

make me give him oral.

And my dad really cared for me when he was doing nasty things to me.

You know, he loved me then.

But once his...

Once he climaxed and got off...

I was back to busting dishes

and cutting the yard.

So I'm what to my dad made me.

My childhood pretty much consists of

anything and everything that was wrong.

If what this man is saying is true,

he had a monstrous upbringing.

But we mustn't forget, many people are abused as children

and do not become psychopaths.

I think he was dealt a terrible hand in life,

an awful environment, and going by the parents' behaviour,

he inherited their predisposition, too.

But regardless of which factors are to blame,

research suggests that the brains

of psychopaths are physiologically different,

not just from ordinary people

but different from the brains of other violent criminals.

Dr Kent Kiehl is a pioneer,

an explorer of unchartered territories.

He's trying to map the twists and turns of the psychopathic brain,

and to do that, he has toured all across America.

So, we built this unique mobile MRI scanner

and put it in a 50-foot trailer,

and we've been able to use that system

to access and study prisoners.

So we've taken it to eight prisons in two states,

and scanned nearly 5,000 different inmates over the last eight years.

This allowed Kent to navigate around the criminal brain.

He observed brain activity

as inmates viewed offensive images and answered provocative questions.

They ranged from very simple all the way to very, you know,

the worst possible kind of moral behaviour.

Some pictures were just neutral pictures -

pictures of landscapes, etc -

some pictures are of emotional things, like maybe a car crash.

And then there's other pictures that are clearly something

that is high moral content,

like a Ku Klux Klan picture of people burning a cross,

and questions like, "How do you feel about killing your mother?"

Kent focused his studies on a very discrete area of the brain.

The areas that we're really interested in for psychopathy

are these areas above the eyes, called the orbitofrontal cortex,

an area deep in there called the amygdala,

the little brain's amplifier, that helps to, you know,

raise awareness or process anything in the environment

that might be important - so distressed faces, fearful faces,

snakes or other types of things -

and then this cingulate cortex here that runs all the way around.

This is a whole part of the limbic lobe.

And together, we refer to this circuitry

as the paralimbic circuitry of the brain.

He found that, compared to other violent criminals,

psychopaths show clear differences

in both the structure and function of this area of the brain.

American psychopath and serial killer Brian Dugan

proved the perfect test case.

They found that, like other individuals

who score high on psychopathy,

Brian had less grey matter in those limbic structures,

in particular the areas right above the eyes, that orbitofrontal cortex,

and we also found that Brian has a very dampened kind of response,

less reactivity in those circuits,

so he was basically an exact prototype

that fit the topology of how we understand the psychopathic brain.

Kent's study found that psychopaths have around 7% less grey matter

in the limbic system of the brain than non-psychopaths,

as well as significant differences in brain activity.

It is still unclear as to whether the psychopath makes the brain,

or the brain makes the psychopath.

But, like other neuroscientists,

Kent believes the data cannot be ignored.

The brain data truly is the ground truth.

Your psychopathy score comes from your brain and, so,

if we can quantify the brain and decode it in such a way,

we can develop treatments that fix them, that remediate them.

This work may still be in its infancy

but we must not underestimate the importance of proving the link

between the physiology of the brain and psychopathic behaviour.

Could these brain differences

explain why the inmates in Indiana behaved as they did?

The door was left open sometimes for me to come over.

And I simply reacted as an animal would

and lashed out and...got my release.

It had a terrible price.

And I did strangle her.

And I guess afterwards I did something to her, too.

What did you do afterwards?

I guess you could say I...

fornicated her.

I had no control that night, really.

I didn't even know what I was doing until it was happening.

It's like a surreal dream, is what it felt to me at that time.

I'm not depreciating it was violent.

I'm just saying it wasn't something that was intentional.

It's a tragedy that I cannot change.

Adaobi was a professional woman

and, you know, I just wanted to be room-mates.

I wish I could give you a sense of the kind of paranoia that I felt.

I was surfing the channel guide, and it said,

"Redneck, kill her. Kill her."

And...

HE CLEARS HIS THROAT

..I thought it might be a way to end my paranoia.

So I choked her...

and stabbed her in the heart...

..and slit her throat,

because the television said, "Kill her, make sure she's dead."

You know? I wasn't thinking, "Why am I doing this?"

I was just doing it.

I let her bleed out on the floor,

and then I fled to Texas.

I remember I was downtown, I was at a bar.

I just picked up a girl that I met there.

Some people might say it's quite extraordinary

that, after committing that kind of crime,

that you can go out in a bar and pick up a girl.

What would you say to that?

Well, I was trying to start a new life.

You know, if I couldn't work again,

I needed to find someone who could work again.

So part of me was just being logical.

It's difficult to listen to stories of callous rape and murder

and not be horrified,

yet I also feel a degree of sympathy for the psychopath.

If you're born with the inability

to resonate with other people's emotions,

is psychopathy always the inevitable destination?

Is there no escape?

Perhaps.

But is there also hope?

Can psychopathy be cured?

The threat of incarceration has never worked

as a deterrent to the psychopath.

So, instead, clinicians have long tried to fix the psychopathic mind.

One approach was trialled with the predator and child serial killer

David Krueger, interviewed here by the BBC in 2000.

In the strangling of children,

I found a degree and a sensation of pleasure

and of accomplishment that I didn't feel anywhere else.

40 years ago,

Krueger took part in intensive patient-led group therapy

in an attempt to cure his psychopathic impulses.

Patients like Krueger took part

in over 80 hours of group therapy a week.

The aim was to create an environment where they could develop empathy

and take responsibility for each other.

They engaged in discussions about their offences, their backgrounds,

their motivation and their feelings.

Those patients who performed particularly well

even got to lead therapy sessions,

and they could advise on other patients,

whether they were transferred or released.

What's this group for, anyways?

This group is for you.

For you to talk, to get you to change your behaviour.

To further encourage communication among the patients,

a range of mind-altering drugs were administered, including LSD.

I have a lot of hate in me and I don't know why, you know?

The team behind the treatment were hopeful

that their unique type of therapy had helped the psychopaths,

but they were quickly proved wrong.

In 1991,

during the first hour of his very first pass

to a medium-security hospital, David Krueger murdered another patient.

I just wanted to know what it felt like to kill somebody.

-INTERVIEWER:

-But you'd already killed three people.

Yes, but that was years and years and years ago.

And he wasn't alone in reoffending violently, post-therapy.

It turned out that the psychopaths at Oak Ridge

who had undergone group therapy

were MORE likely to reoffend violently than those who had not.

The findings at Oak Ridge were deeply dismaying.

People had long suspected that psychopaths were incurable

but had never considered that this type of group therapy

could actually make them even more violent.

The question is - why?

Researchers who conducted this study

suggested that group therapy

actually provided the cunning psychopath

a lot of really useful information -

how to perceive subtle emotions, how to use emotional language,

how to fit into the group.

All this is incredibly useful for the psychopaths

to fit in really smoothly into society.

Non-psychopathic inmates in the facility

used these skills to adjust back into family life, work and so on

in the outside world.

But not so the psychopaths.

For the patients at Oak Ridge,

group therapy became a kind of empathy finishing school...

..and it allowed the psychopaths

to learn to lie even better,

and manipulate others for their own gain.

It enabled them to wear the mask of sanity.

Psychiatrists have learned from the mistakes at Oak Ridge.

Today, therapy based on proven science

and carried out by trained professionals can help.

For those inmates incarcerated in Indiana,

therapy has had mixed results.

I got a therapist that I see...

Truth be told, I can sit down with her every single day,

from this day until the day I get out of here,

and I still won't be right in the head.

It's not just me in this body,

it's another personality.

Because he rules my mind, and it's literally...

I've got an angel over here

and I've got a devil on this side.

I see them once a week.

Talk about everything. I mean...

Not everything, but...

What's wrong, what's not wrong, what's been going on.

Do you find it helpful?

It's entertaining.

I mean... I read body language very well.

People call it manipulation, but it's not manipulation.

It's just...being aware.

Although therapy can help to manage someone's behaviour,

it can never change their personality entirely.

But there may be another solution that could help.

Dr Molly Crockett has devised a test

to see how chemical messengers in the brain can alter behaviour -

a tool that would be fantastic if it worked on the psychopathic brain.

It involves cold, hard cash

and a jolt of electricity.

So, when you're ready, I'm going to deliver a shock.

In order for the experiment to be tailored accordingly,

the test subject is having his pain threshold measured.

That was a nine.

So, what is the aim of the experiment?

What we're really interested in is,

can we quantify how much people

dislike causing harm to another person?

Measuring how much harm someone is prepared to inflict

sounds like an audacious idea, but this experiment does just that.

This volunteer, known as the decider,

is faced with multiple scenarios.

In each, he must choose how much money he would need to be paid

to give a varying number of electric shocks to another person.

On this occasion, he must decide between giving two shocks for £15.30

or an extra 12 shocks for £1 more...

..which he chooses.

Ouch!

Fortunately, he'll never encounter his victim.

They never meet, and that's very important

because we want the choices to be confidential.

We don't want the decider to be making their choices

based on a concern about looking good in front of other people.

So the experiment isn't quite finished.

What's happening next?

So, one of those choices was randomly selected

and now we have to implement that outcome.

This is not simply a thought experiment.

All right, whenever you're ready to start the shocks, press the S key.

This task shows just how anti-social some of us can be.

But the main purpose of the experiment was to see

how this behaviour changed when half of the volunteers

were administered the common antidepressant citalopram

before they took the test.

You can get it in liquid form, like this.

This drug basically enhances the action of serotonin in the brain.

It works by prolonging the amount of time that serotonin can spend

activating its receptors and sending its message.

Serotonin is a common neurotransmitter

thought to affect mood and social behaviour.

So, what did you actually find with the drugs?

-What did they do?

-In the placebo group,

people on average required about 44p per shock

to deliver the shocks to somebody else,

whereas in the citalopram group,

that increased to about 73p per shock.

So we had to pay them twice as much to deliver the same amount of pain

after they received this drug.

So they became a little bit nicer?

-Exactly.

-A little bit less anti-social.

-That is remarkable.

-Hmm.

Increasing serotonin appears to make people

more averse to harming others.

So, what I immediately want to know is,

is that a hope for treatment of psychopaths?

Unfortunately, we're quite far from an answer to that question.

What we're measuring is how people make a trade-off

between a benefit for themself and harm to somebody else.

And so what we've learned in the lab is a first step

towards developing possible treatments for psychopathy.

But we still have a long way to go.

We're not, I think, going to be able to make dramatic changes

in the extreme behaviour of a psychopath

into the behaviour of a healthy person.

While chemicals like serotonin can't cure or psychopaths,

psychoactive medication is routinely used to help manage

the behaviour of inmates in prison.

I don't take it every day. I mean...

I notice in situations that I haven't taken it for three days,

and it's like, "Damn, I wish I had that buffer.

"I wish I didn't have to pull myself

"back from 100 all the way by myself."

It makes it so I have that one extra millisecond to stop.

It makes me grey, for less of a better term.

My lows are real low and my highs are real high,

but with this I just kind of... deadpan.

Clearly, medication can alter how people think and behave

but it's unlikely that it can permanently erase

deep psychopathic personality traits.

But perhaps we don't need to change the way psychopaths think at all.

A harrowing but hypothetical scenario called a moral dilemma

suggests that, if needed,

psychopaths can make rational choices,

even if it is for entirely selfish reasons.

Imagine enemy soldiers have taken over your village

and they have the orders to kill all remaining civilians.

You and your baby and a handful of your neighbours have found refuge

in the basement of your house.

You can hear the soldiers walking upstairs.

And then the baby starts to cry.

Ssh-ssh!

Now, what would you do?

Would you let the baby cry

and the soldiers find you and kill everybody?

Or would you smother the baby

and save everyone?

It's a horrible dilemma.

Ssh-ssh-ssh!

Now, there's no right or wrong answer to this test.

Some people might say, "Save my baby."

For others, the rational decision may be to save everyone else.

I don't think I COULD smother my baby.

I would have to let everyone die,

baby included.

Now, there are people who would make the opposite decision,

and they can make an amount...

incredible sacrifice for the greater good.

So, what about the psychopath?

They would make exactly the same decision

but without any struggle they would kill the baby,

not for the greater good, but because of sheer self-preservation.

And that's the key in unusual situations -

where our feelings of empathy might compel us towards disaster,

psychopaths could make rational choices.

It suggests some aspects of a psychopathic personality

can have a valuable role in society.

Professor Scott Lilienfeld has looked for

aspects of the psychopathic personality

in 42 American presidents,

up to and including George W Bush.

One suite of traits stood out above all others.

It's a constellation of traits

that has been called fearless dominance,

which is very closely related to physical and social boldness,

to adaptive risk-taking, to a kind of emotional resilience

and immunity to stress. Those traits seem to be somewhat elevated

in the overall sample of US presidents and, also, those traits

seem to be somewhat predictive of overall presidential performance.

But it's not just world leaders who seem to score highly

on some psychopathic traits.

Being self-confident, being bold,

those are traits that are probably going to be conducive to

better functioning in things like the corporate boardroom,

on Wall Street, in the court room, maybe even the bedroom.

Whether they sit on the other side of your office

or across the kitchen table,

these people pervade society.

If Scott's theory is correct,

then successful political leaders

and violence psychopaths are twigs of the same branch.

They both seek gratification by exerting power over other people.

The political leader gets it by taking charge of a whole country,

the pathological psychopath

by controlling and often harming someone else.

So, if we are to safely manage the psychopath,

perhaps we should tap into the mechanics of the mind

when it is working for reward.

The team at Mendota Juvenile Treatment Center

are doing just that.

They have an experimental programme that offers rewards

to the young offenders in their care.

And it's getting results.

So, this is the unit at MJTC, the Juvenile Treatment Center.

Every youth has their own room, and there are 29 beds here.

At first glance, this place looks like an ordinary prison,

with security at the forefront.

So, this is the secure nursing station,

and you can see here, we have a lot of security cameras.

But the staff on the unit are not just prison officers.

They're clinically trained as well,

enabling them to try and rehabilitate

any budding psychopaths.

What we're trying to do here at Mendota is create a programme

that involves a positive reward one day at a time

called the Today Tomorrow Programme.

So today's behaviour determines tomorrow's level of privilege.

By delivering short-term privileges for good behaviour

and consequences for bad behaviour,

this programme is an effective way

to get the young and dangerously violent offenders

to abide by the rules.

So our goal here is not necessary to change the personality of the youth.

If we do, and for the better, hurray.

What we're really trying to do is improve the behaviour.

And that improvement comes by targeting their need for reward.

If we get that behaviour,

then he gets able to stay up later, extra food,

extra phone call, more time in the day room.

If the boys continue to behave, by staying out of fights, for example,

they earn certificates of appreciation, too.

What we see here on this wall

are representations of a young man doing well.

Each little certificate means that he has done well

for a week at a time, or even longer, on a daily basis.

Damien is doing well in the programme.

So, you've been here since November. How does this make you feel,

this whole wall?

It makes me feel proud because I worked hard for it.

With repeated good behaviour,

he has earned the right to control his radio.

This is your key. It gets you through everything, basically.

Damien is extremely proud of his work

in the Today Tomorrow programme.

It shows the power of positive reinforcement

and the desire for others to see it and to praise.

This sets a better foundation

and a chance for this youth to make it in the world.

Rewarding criminals for not misbehaving

may be an uncomfortable idea,

but this consistent behavioural approach does work,

allowing the team to treat the boys' psychological issues.

I was having a lot of anger problems.

I kept getting the same problem wrong over and over again.

I ended up flipping my desk and snapped the leg off the table

and then I ended up turning round and hitting her with it.

-You hit the teacher with the leg that you snapped off?

-Yes.

Treatment is tailored to each individual.

It includes the specific support, therapy and medication they need

to alter their behaviour.

You don't come across to me as a kid who would flip a desk.

It's intensive work, but the results ARE promising.

This kind of programmed intervention seems to work.

We found that, over time, that institution behaviour improvement

actually continues into the world,

and the community, and predicts lower reoffence rates.

Impressively, on release,

inmates from Mendota reoffend violently half as much

as those who have not been through the programme.

The key seems to be intervening

whilst these boys are still teenagers.

That's because they have a very young and immature brain

that is much more plastic or malleable

and much more subject to influence.

That's our best shot at really influencing

in a way that would stick with them for the remainder of their life.

The team at Mendota aren't trying to make these young people nice.

What they're doing is tapping into

the reward learning mechanisms of the brain

to deter them from committing future crimes.

Through the making of this film, it has become clear that psychopathy is

absolutely not the black-and-white picture that Hollywood paints.

I believe that psychopaths, more likely than not,

have been dealt a genetic and environmentally bad hand in life.

Some might argue that we need to do more to intervene

when these individuals, as children,

first show signs of being callous and unemotional,

because if we don't, the consequences can be devastating.

I know I took her life,

but, growing up, there was a lot of misguidance

that didn't allow me to...

..understand the gravity of what I did until after it happened.

I know my victims are suffering,

hostages I took... people I shot at,

the kids I've messed up, but...

..please believe, they just...they ain't suffering as much as I am.

You know, I've lost my job, I've lost my car, I've lost my house,

I've lost my...my credit.

You know, everything that I... that people value in the world

I'm not going to have any more. It's not like I'm a murderer by design.

I don't go around killing people because I think they deserve it.

It's, er...

you know, terribly unfortunate that it happened

..to Adaobi.

Do you think people would describe you as a psychopath?

I hope not.

Narcissistic, maybe.

Not a psychopath.

God says I'm not a psychopath.

I do feel remorse for what I've done.

Do I regret my actions?

Yes, but not my success.

And you look at it as a success?

I completed what I set out to do.

I'm here for 30 years. I pray for an early death every day.

I hope God takes me in my sleep,

but either way I just want to be done with it.

This life sucked.

These men prove how difficult it is to identify what makes a psychopath.

And that's because,

though they may have demonstrated many of the traits,

none of them have been clinically diagnosed as psychopaths.

However, they have been diagnosed with other conditions,

from antisocial personality disorder to schizophrenia.

That's the problem with psychopathy -

it rarely presents itself alone,

often appearing alongside other psychiatric conditions...

..as illustrated by child serial killer Ian Brady.

More than 30 years ago, following a diagnosis of paranoid schizophrenia,

which he later said he'd faked,

Ian Brady was moved from prison

to Ashworth high-security psychiatric hospital.

And it's Brady's being in this hospital that enabled us

to enter into a dialogue with him.

A year before he died, we approached Brady

and asked to interview him for this programme.

He declined our invitation to be filmed,

but he did continue to write to us.

And here are those letters.

He even wrote a Christmas card.

He often lists his good deeds, so here he says,

"At Durham, Ronnie Kray and I cooked prisoners meals."

At one point, he talks of winning prizes for his oil paintings.

He repeatedly talks about how he transcribed books into Braille

for the blind - grandiose, some might say.

When asked why he did this kind action,

he replied that, "A blind stranger outside did a favour for M."

Who was M?

Myra Hindley?

His mother?

But he also plays the victim.

He repeatedly complains about

how he was maltreated by the authorities.

Brady frequently displays emotion when he doesn't get what he wants,

but not towards his victims.

Despite repeated questioning, he shows no remorse for his crimes -

another classic trait of psychopathy.

But what I find most interesting

are Brady's thoughts about morality...

thoughts he claims he formed during his first stint in prison,

aged just 17, long before the Moors Murders ever took place.

He discusses his resolve to emulate

the legal and moral elasticity of the privileged.

If political leaders can commit murder in times of war,

then surely he should be allowed to kill, too.

It's a fascinating insight into his mind.

In fact, it's his attempt to put his own crimes,

the kidnap and murder of five children, into context.

Indeed, he tries to belittle his crimes.

Quoting Jonathan Swift, he says,

"Laws are like cobwebs. They catch small flies

"and let wasps and hornets fly freely through."

With respect to any hope of treatment, Brady suggests,

"Establishment psychiatry should be exposed and debunked."

Regardless of how we feel about psychopaths like Brady,

we must remember that the essence of psychopathy is not criminality.

That depends on the circumstances.

The essence is an insufficiency of social emotion...

..and that is a brain abnormality.

Rather than trying to answer the question -

"What makes a psychopath?"

we should instead be asking, "How can we identify them better?"

Then we can intervene before they commit a crime,

and then there is hope.

But, for those like Brady,

perhaps locking away the psychopath is our only option.