Misha Tseitlin's Blog

The Firing Squad, Neurons and Justice

August 1, 2018

Aleksandr Tsekalo’s “The Method” is a new popular Russian TV show depicting Rodion Meglin, a lone police investigator who tracks down serial killers, all while grappling with both his torn psyche and that of the perpetrators. Though the psychological thriller genre is familiar to Western audiences—popularised by US shows like “Criminal Minds” and “Mindhunter”—its inception in Russia paints a portrait of the country’s perceptions of mental health, psychology, and the mind. Foreign viewers were quick to write the story off as an adaptation of “Dexter,” an older American show, but the differences are stark. Tsekalo’s work asks deep and important questions about the humanity of those whose perspectives do not neatly align with our own moral sense, a reflection of neuroscientific advancements that strips away our conceptions of who and what is responsible. Indeed, we see Meglin kill characters whom he deems incompatible with society, while also granting reprieve to some whom we would consider reprehensible. This moralistic behaviour is increasingly familiar to foreign viewers and in line with new neuroscientific research, which suggests that some perpetrators are genetically predisposed to commit violent acts and reoffend after release. However, such a depiction is just as distant to Russian viewers as it is familiar to foreign ones. The country’s unique development during the Cold War affected academic, political, and cultural approaches to neuroscience, known in Russia as neurobiology or neuropsychology. The field holds significant potential, especially for countries that pioneered the research, but faces rigorous challenges in integrating different approaches and bridging cultural beliefs.



All Betz Are Off

First, we should dissect the hype behind recent neuroscientific research that attempts to dissect the causes of our behaviour: to what extent is it truly ground-breaking? Current fascination with the field, especially in the US where federal grants support academic research, has reframed our understanding of responsibility. For example, a peer-reviewed literature review of 15 studies showed that decreased activity in three specific brain regions of the prefrontal region is correlated with aggressive and/or violent behaviour. Though variance inevitably exists when attempting to predict violent behaviour, environmental context and biological variables account for nearly half of it—holding these constant allows the predictive ability of neural structures to be quite high. The result is a model which, after incorporating biological factors, accurately predicted 88.5% of aggravated behaviour.

In another study, decreased limbic system function was also found to be like to violent behaviour: “the odds than an offender with relatively low anterior cingulate activity [ACC, a limbic region] would be rearrested were approximately double that of an offender with high activity in this region, holding constant other observed risk factors”. The authors also noted that ACC plays an important role in error processing, behavioural plans, and impulse control. As impulsivity is strongly associated with recidivism, this once again shows the potential for a predictive relationship between neural activity and a behavioural outcome.

In additional research, criminal behaviour seemed to peak in males during adolescence, around age 17, hypothesised as resulting from the under-development of the frontal cortex and ensuing limbic activation. Research has thus shown how other biological factors, in this case age, interact with neural structure and activity to potentially further predict a person’s likelihood of committing a violent crime, or of re-offending.

This of course raises unique ethical questions: if dysfunction in one area of a brain region can render people predisposed to violence, ought they be held responsible? Suppose, for instance, that a hit to the back of the head were powerful enough to actually damage the occipital lobe and leave a person blind. Would they be considered responsible for an action made out of ignorance like jaywalking, or even walking into the wrong house (aka trespassing)? If not, then why should we ascribe responsibility to people who are likewise predisposed, for a combination of genetic and environmental reasons? Additionally, if such strong predictive relationships exist such that judiciaries can, with a high degree of certainty, predict criminality, what are the implications for policing?"

Legal systems, especially in the US, have jumped on the opportunity to embrace these dilemmas. Lawyers now routinely cite such information to advocate for claims of innocence, insanity, sentencing, and parole. In the US, legal literature has indicated that neuroscience testimony is becoming increasingly prevalent, doubling from 2007 to 2015. The implications are significant: in appeals, 20% to 30% of defendants receive a better outcome (i.e. a reduced sentence, insanity plea, mistrial, etc) when neuroscience is used as evidence compared to 15% without it. One researcher has noted that his findings could be applied differently depending on the stage of the criminal justice process: it could both serve as an argument to mitigate sentencing for individuals with predispositions due to childhood abuse and low socioeconomic status, but also argue for reducing their chances at parole due to a high reoffence rate.

The ethical and criminological question posed here is best represented by philosopher Thomas Nagel’s theory on moral luck. He defines the phenomenon as resulting from situations in which one’s moral responsibility hinges on circumstances not entirely under their control. The relevant category of this is constitutive luck: a person is a victim of their mind and personality, whether it be a recognised condition like schizophrenia or just predisposition towards violence. The legal standard in Russia, similar to that in many other nations, states that someone cannot be held responsible if they “could not realize the actual character and public danger of the actions or [] guide over them due to . . . mental disorder, feeble-mindedness, or other unhealthy condition.” However, that fails to account for people who are compelled to act a certain way by their brain’s biology.

A path towards a solution comes from another component of Nagel’s moral luck: resultant luck. This phenomenon is best explained by the case of two drunk drivers: both swerve over an section of sidewalk, but only one is unlucky in that there is a person in the exact location where they swerved. Should he/she be responsible for murder? Our legal systems have developed a system of deterrence to deal with crimes like drunk driving that rely on deterrence and proportionality as a pretext to determining punishment. Keeping these ideas in mind, as research continues and the technology becomes more accessible, reforms will increase in importance.

As our understanding of the neurological basis of behaviour continues to develop, our legal codes will need to change. This change will present a challenge that the international community will face together: international judiciaries as well as common principles like immunity and extradition will have to adapt. In this respect, Russia and the US have the same progressive laws for the most part in dealing with mental health, with the former’s stemming from rewriting of the criminal code in the ‘90s. These challenges are ones that countries around the world will need to undertake together, reforming international understandings of the purpose of legal systems and coming to terms with changing ethical dilemmas all while continuing to unlock the circuitry behind human behaviour.

Lost in Translation

In practice, however, cultural differences lead to a markedly different climate. These lofty ideals on ethics and justice are secondary to the necessary rapprochement that needs to occur between Russian and American academic neuroscientific traditions. Tsekalo’s “the Method” provides the perfect example: underlying the show is Meglin’s own mental health struggles with oneiroid syndrome, a condition unrecognised by Western psychologists and the American psychology and mainly studied in Russian-language scientific literature (though there are a few French and German studies). This condition, which is characterised by a progression into and then regression from increasingly fantastical psychotic delusions, is noticeably absent from the DSM, the American Psychological Association’s (APA) categorical listing of disorders and the seminal text of American psychology. However, its international counterpart, the ICD, only had slight mention of the condition which it classifies as a “state” corresponding with catatonia resulting from schizophrenia in its 10th revision. Its recent 2018 update, the 11th revision, leaves the condition noticeably absent as American and European approaches to psychology continue to dominate global discourse. Nonetheless, Russia’s persistent and unique cultural heritage has led to a different progression than neuroscience in the US but left open a realm of possibility for national policy.

To understand the distinction, we need to start with Soviet neuropsychology. The field was pioneered by Alexander Luria, who, along with Lev Vygotsky and Alexei Leontiev, comprised a “troika” that shaped the course and laid the framework for Russian neuroscientific and psychological inquiry. Luria studied concepts familiar to American and European experts like such as motor pathways, even developing the Soviet Union’s first lie detector. However, his methods were qualitative like that of his peers. Vygotsky, the most renowned of the trio, focused on the cultural-historical basis for psychology, while delving slightly into development theory in children. This sociocultural approach was appealing in the political climate of the USSR, and thus found itself popularised in future research. However, the most important revelation came from Alexander Luria, who developed activity theory as a mechanism for neuropsychological knowledge. This fused with Vygotsky and Leontiev’s works to create a unique approach on the field that would priorities prioritize a phenomenological approach . Such thinking became an ingrained paradigm, so that the work of opposing academics was ignored, and in some cases even silenced. When now-renowned scholar Pyotr Anokhin developed functional systems theory as a new way to span both the fields of physiology and psychology, he was suspended from work and exiled to Ryazan. Instead, in Russia, these approaches remained distinct. While those like Alfred Yarbus would go on to identify eye saccades, a crucial component of modern theory on attention, their focus would remain isolated to physiological/medical approaches.

Meanwhile, in the West, neuroscience found its inception decades earlier in the work of Santiago Ramón y Cajal and Camillo Golgi decades earlier, two scientists who earned the Nobel Prize for their work in developing modern techniques to unlock the concept of the neuron: the building block of the brain. Since then, Western neuroscience has continued to unravel the localisation of function and tracing of neural pathways. This has contributed to a different, clinical understanding for neuroscience, markedly different from the Soviet one. While Soviet scholars and their successors have attempted to study isolated phenomena like oneiroid syndrome and treat it pharmacologically, American and European scholars have adopted a clinical psychological approach which recognises large classes of mental syndromes and attempts a combination of pharmacological and behavioural approaches to mental health. In diseases like Parkinson's, the realisation that there was insufficient dopamine inspired George Cotzias to utilise L-dopa, a related compound to treat the disease in its early stages. Concurrently, psychologists used the same application-based framework to develop approaches like cognitive-behavioural therapy (CBT), unheard of in a Soviet space that treated the field as “predominantly theoretical and meeting the requirements of classical scientific psychology.”

The dissolution of the Iron Curtain brought widespread political, economic, and social reforms—this touched psychology and mental health as well. However, while other post-Soviet nations found it easy to change their approaches to reflect a modern take on neuropsychology, the situation in Russia remained stymied. Soviet institutions consisted entirely to institutionalise individuals deemed unhealthy or dangerous, treating them almost exclusively via a biological approach. Though legal reforms were swift and effective, a shake-up of the scientific leadership was complicated by the fact that all leading experts of Soviet psychology and neuroscience were Russian, specifically located in Moscow—presenting the country with a unique challenge. The logic was simple: a changing government doesn’t necessitate a rehaul in physics, mathematics, or chemistry, so why would there be an unequal standard for psychological experts? All this occurred while individuals like Aleksandr Tiganov—an associate of Snezhnevsky, a notorious abuser of human rights during Soviet times—remained at the helm of national organisations. Reformers in St Petersburg, Kaliningrad, and Siberia successfully implemented some reforms and changed the discourse. However, eventually the public’s patience with reforms ran out—as initiative stalled in economic and political affairs, it affected mental health policy as well. Reformers like Yuri Nuller died in the early 2000s, while others like Valery Krasnov had to deal with changing public opinion and slowly retreated from public view. Instead, much of the current scholarly community were trained and appointed during Soviet times, and so there continues to be a lack of reforms that facilitate participation by caretakers, relatives, or patients themselves. Academically, PubMed, a database that holds all English-language health-related publications, noted just 153 publications on Russian neuroscience in 2018. Of those, just 10 were public-facing, or dealing with issues relevant to applications; in this case the focus was entirely education or drug policy. Of those 9 included a Russian author, and none were exclusively Russian-authored, speaking to the legacy of Soviet preferences in ongoing research in the discipline.

However, there has certainly been improvement. Russian psychologists no longer recognise Snezhnevsky’s condition of “sluggish schizophrenia which was characterised by almost completely normal behaviour but an aggrandised sense of self-importance and ambitions of reforming society. Nor do they ignore serial rampages like that of Andrei Chikatilo under the guise that crime itself is a capitalist phenomenon. However, much of the stigma and biases remain. They exist especially in regard to drug policy, where addiction is still treated as a choice rather than a disease. Stigma is an especially large problem, with patients themselves often fearing osticisation by others and the lack of proper treatment. As mental health abuses continue in state-run psychiatric hospitals by overburdened and Soviet-trained psychiatrists, patients don’t trust the system. However, the Russian public does trust the system in one important way: to keep the mentally ill away from them. A 2015 survey found 75% of respondents supporting the involuntary hospitalisation of mentally ill individuals. Nonetheless progress continues, albeit with ways to go. Institutionalisation is down, from 112 per 100000 in 2004 to 102 per 100 000 in 2014. Still, psychiatric wards house significantly more in Russia than in other countries: in 2014, the US had just 23.6 per 100 000 individuals institutionalised, and its admission rates were 53 per 100 000 compared to Russia’s 549.2 per 100 000, more than 10 times greater. These are the core issues Russia needs to face first: cultural aversion, a clinical practice reliant on institutionalisation and singularly biological approaches, and a lack of integration between academics and policy.

Mapping the Big Picture

America and Europe have a lot to learn from Russia. Its scientists are world-class and have the potential to present unique insights to their counterparts aboard. Many discoveries that continue to alter our understanding of the brain and its interactions with our behaviour will originate in the country’s academic institutions, especially as artificial intelligence and neuroscience come closer together. These new discoveries will continue to push the ethical boundaries to which we have grown accustomed to, and will introduce important questions on responsibility, punishment, and policing. Deterrence, rehabilitation, and proportionality will continue to be at the forefront of these considerations, but as preventative policing and punishment will increase in possibility and effectiveness, the international system will need to learn to cope. However, before Russia can concern itself with changing its legal institutions, it will need to alter its psychological ones. On the academic side, neuroscientists and psychologists must be conscious of the public impact of their work, and act with the responsibility it behoves. Concerning its institutions, the country has struggled to make the remnants of a Soviet system compatible with modern standards all while meeting the demands of a particularly-minded public. It’s a tall order but a manageable one; it will require relinquishing the familiar but has the potential to help not just help scientific inquiry within Russia, but also common people who tackle increasingly complicated health challenges. TV shows like “The Method” are just one way that victims of mental illness are being humanised in the public view; now is the time for policymakers and academicians to seize the opportunity for progress.

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