Author: Adrian Raine
The title of this book is both a figurative, and a literal, reference to its main thesis-that violence has strong biological roots in the brain. The author paints a picture of violence, not as the prerogative of a few bad apples, but as a natural human tendency which makes every human being liable to ‘readily use violence…when the time and place is ripe’ (pages 14 and 22). As a psychologist and criminologist who researches violent crimes and notorious murderers, the author posits that genetic and environmental factors underpin most vicious acts. Indeed, the book’s forceful contention is that most acts of cruelty are pre-determined by pre-natal and early developmental events which are out of the control of the perpetrators of violent crime. The book however mitigates this fatalistic perspective of violence by affirming that ‘biology is not destiny‘, and noting that there are several ‘benign and acceptable ways of reducing the suffering violence causes to societies’ (pages 7 and 10).
The most enlightening facet of the book is undoubtedly its discussion of the early life circumstances that predispose to later adult violence, and the most significant of these is the environment during pregnancy and early childhood. Supporting its compelling argument that prenatal factors predict later criminality, the author cited maternal alcohol consumption as the singular most destructive agent of violence, a behaviour which ‘triples the odds‘ of childhood delinquency (page 205). He went on to discuss several other impactful perinatal conditions which contribute to making criminality almost a fait accompli, and these range from maternal smoking and maternal micronutrient deficiency, to maternal rejection and birth complications (pages 200, 187-189, 206-211, 217-219, and 223-231). Equally disturbing are the powerful influences of the genetic mutations that are known to predispose to violent tendencies, the most prominent of which are the monoamine oxidase A (MAOA) gene, also called the ‘warrior gene‘, the serotonin receptor (5HTT) gene, and the dopamine receptor (DRD2, DRD4, and DAT1) genes (pages 50-57).
Perhaps the most fascinating feature of the book is its discussion of the physical and behavioural signs that identify violent criminals. The author, for example, referred to the various structural abnormalities that characterise the brains of violent criminals, the reason he remarked that ‘criminals do have broken brains‘. The brain anomalies he discussed include a reduced prefrontal cortex grey matter, a reduced amygdala volume, excessive hippocampal asymmetry, a large corpus callosum, and the frequent occurrence of cavum septum pellucidum – a marker of disrupted limbic system development (pages 180, 139-140, 158-167). The book also referred to how violent criminals may be recognisable by some bodily stigmata, the so-called ‘marks of Cain‘: these include low set ears, curved little fingers, long ring fingers, and a single palmar crease (pages 110-113 and 191-197). The book goes further to describe how the dysfunctional autonomic nervous system of violent criminals generates their fearless, risk-taking, conscience-free personality’, a factor that also explains why ‘many violent offenders barely break a sweat when they violate the law’ (pages 101 and 107).
To graphically illustrate his arguments, the author narrated many gripping stories of high-profile criminals, ranging from calculating, proactive murderers, to bungling, reactive killers (pages 64-65 and 76-77). For example, he used the story of Henry Lee Lucas to demonstrate how the early developmental environment creates the violent mind: he did this by depicting Lucas, one of the most prolific serial killers in history, as the product of ‘a horrendous home brew of head injury, malnutrition, humiliation, abuse, alcoholism, abject poverty, neglect, maternal rejection, overcrowding, a bad neighbourhood, a criminal household, and a total lack of love‘ (page 270). To portray the callousness of serial killers, the author also chronicled the horrific story of “Jolly” Jane Toppan, describing her as an emotionally dead nurse who murdered more than thirty of her patients because she lacked a ‘feeling of what is moral‘ (pages 93-98). Other stories portrayed the influence of genetic factors on criminal behaviour, as demonstrated by James Filiaggi, a short-tempered man whose string of violent acts, including the killing of his estranged wife, was driven by his low serotonin and high dopamine levels. Some stories, on the other hand, showed how violent criminal acts may arise from medical disorders such as large arachnoid cysts and brain tumours (pages 134-136, 304-305, and 57-58). The book’s anecdotes also brought to life the depraved actions of many famous serial killers such as Harold Shipman, Ted Kaczynski, Peter Sutcliffe, Ted Bundy, the Kray twins, and Randy Kraft (pages 61-62 and 77).
In light of the scientific understanding of its origins, how should society confront the problem of violence? This was a major concern of the author who, throughout the book, conceived of violence as a public health issue of epidemic proportions, urging society to view it as more of a medical concern than a criminal matter. To buttress this view, the author observed that violence is now ‘the leading cause of death across the world for those aged fifteen to forty-four’, and this has driven medical practitioners to become increasingly involved in its management (pages 183-185). With this perspective, the author recommended varied preventative strategies to mitigate the problem of violence, ranging from early family intervention and cognitive behaviour therapy, to omega-3 supplementation and mindfulness. The author also reviewed the therapeutic approaches to violence such as psychopharmacology and chemical castration. More significantly, he exhorted the criminal justice system to treat violent crime with more compassion and less retribution, and to consider the biological foundation of violence in its assessment of mental capacity, freewill, and legal responsibility (pages 330-335).
The educational value of the book was enhanced by the countless helpful facts it put across about the nature of criminal behaviour. This was evident, for example, when the author pointed out that most murders are carried out at home, and the perpetrators are more often not strangers, but family members – with stepparents being ‘particularly pernicious‘ in these situations (page 23). Other pertinent facts include the facts that younger mothers are more likely to kill their offspring than older mothers; rapists ‘consciously or subconsciously select more fertile women‘; and the violence that arises from genetic mutations is uniquely characterised by ‘criminal careers that ‘are persistent and severe’ (pages 23, 28-30, and 42). The book’s comprehensive approach to violent crime is also reflected in the vast number of related subjects it treated, such as sexual jealousy, spousal abuse, white collar crimes, and the psychiatric dimension of crime (pages 28-33, 82-87, 169-175, 180, 114-117, 231-241 and 264). Importantly, the book supported its contentions by citing a broad spectrum of experts in diverse fields, for example Robert Hare, Antonio Damasio, Antoine Bechara, Edwin Sutherland, and Tim Beck (pages 120, 135, 141, 176 and 291).
This book covers a subject that is as relevant to health care as it is to society, making the important point that the rising tide of violence is impacting on the health and well-being of all societies. The author explored the huge range of issues that are relevant to violence, from anatomy and psychiatry, to anthropology and sociology. The writing is clear and the content grounded in scientific research. His easy, conversational narrative not only makes this a pleasant reading, but it also mitigates the gruesome nature of the subject he discusses. His style of weaving historical case studies with academic research findings worked to seamlessly enhance the educational and reform goals of the book. The statistics on violent crimes were as enlightening as they were scary, and they are clearly geared to transform the health care and justice systems.
Violence is a significant social and health issue, and this book does a god job of publicising its widespread ramifications. The book successfully frames violence in biological terms and promotes a pragmatic public health and judicial perspective. Most importantly, the book identified the disparate causes of violence, and advocated practical measures to address these. Tracing the roots of violence, and recommending preventative strategies, the author sets out an agenda for managing violence in all its ramifications. The book raises an important clinical and public health concern, and I recommend it to all doctors.
Publisher, Place, Year: Penguin, London, 2013
Number of chapters: 111
Number of pages: 478
Star rating: 5