“Don't believe everything you think.”

—Anonymous

“Do you know who Stalin was?” Irena asked. Irena was the officers’ waitress—she'd noticed me eyeing the picture of “Uncle Joe” Stalin screwed into the wall beside the porthole. Captain Shevchenko shot her a warning look. It was the early 1980s, and I was a hundred miles off the coast of the Pacific Northwest on a Russian trawler—technically then part of the “Evil Empire” of the Soviet Union. As far as Shevchenko was concerned, Stalin was not a suitable subject for discussion with me—the sole American onboard. I glanced down; my tumbler had been unobtrusively topped off with more Stolichnaya, straight from the freezer.

“Of course I know who Stalin was,” I replied. “Na zdorovye.” To your health. I cocked the tumbler as the rusty two-hundred-foot trawler lurched starboard. After months at sea, I could no longer smell the belching, acrid smoke of the fish meal plant or the rotting fish on deck. The perennial thrumming of the ship's engines and salt spray that often ruffled my hair just seemed natural now—like home.

I followed Irena's question with one of my own: “Did you know Stalin was responsible for the deaths of at least twenty million people during his purges?”

“Have you ever known anyone who lost somebody during those so-called purges?” Shevchenko scoffed. The captain was a true believer in communism.

“Yes,” I said, “Most of my teachers lost at least one member of their family.”

“Oh,” said the captain. He'd thought he had me. “Well…everybody makes mistakes.”1

LENSES AND FRAMES

It has been nearly twenty-five years since my days as a translator on Soviet trawlers. I still miss the daily ration of palatalized consonants and the meandering, caboose endings I once slung so glibly. As Vladimir Nabokov muses in “An Evening of Russian Poetry”:

Because all hangs together—shape and sound,

heather and honey, vessel and content.

Not only rainbows—every line is bent,

and skulls and seeds and all good worlds are round,

like Russian verse, like our colossal vowels:

those painted eggs, those glossy pitcher flowers that swallow whole a golden bumblebee,

those shells that hold a thimble and the sea.²

The study of language, it turns out, has often played a key role in understanding neurological processes. Linguist Noam Chomsky used his ideas about the formation and learning of language to help pick apart flaws in Skinner's ideas, which helped begin the long overdue overthrow of Skinnerian behaviorism in psychology. Chomsky gave credence to the idea that the brain was composed of a modular set of units, with specialized, innately unique areas that were responsible for learning different things, such as language, mathematics, or the various motor skills. Another revolutionary investigator, Harvard psychologist Steven Pinker, cut his professional teeth on research related to language before moving on to write The Blank Slate. Pinker's brilliant book, along with the Judith Rich Harris's seminal The Nurture Assumption, was to help redefine psychology so that nature—genetics—was firmly shown to play an equal or even more crucial role than nurture—that is, the environment. Pinker, along with John Tooby and his wife, Leda Cosmides, and others, also stood on the shoulders of Chomsky's ideas to eventually conclude that the human brain, including its module for learning language, evolved by natural selection, just like other body parts.

The ability to learn a language, any language, is related to innate “wiring” that's built in to nearly all human beings. As a language and surrounding culture is learned, however, it subtly shapes perception, often in ways in which people aren't consciously aware. Those who grow up speaking Chinese, for example, process mathematics in different areas of the brain than those who grow up speaking English as their first language. Both groups use the inferior parietal cortex, but Chinese speakers also use a visual processing area, while English speakers use a language processing area. Richard E. Nisbett, codirector of the University of Michigan's Culture and Cognition Program, notes that studies involving this type of phenomena are important because they tell us “something about the particular pathways in the brain that underlie some of the differences between Asians and Westerners in thought patterns.”3 Other studies have shown that gyri in the frontal, temporal, and parietal lobes develop differently in Chinese speakers than in English speakers—acquisition of a different language appears to cause anatomical differences in the brain.⁴ Chinese speakers literally see the world differently than English speakers—eye-tracking studies show that English speakers tend to first focus on individual items in the foreground of the picture, while Chinese speakers tend to first take in the background and the picture as a whole.5

In some sense, then, language and culture might be thought of as helping to structure the neurologically based lenses that people use to perceive reality. But of course, language and culture aren't the only influences on our neurological lenses. Family upbringing, religion, political persuasion, educational background, work experience—all help create the different framing lenses people use.⁶ Practiced expertise with a musical instrument, for example, can change the structure of the musician's primary motor cortex; London's experienced taxi drivers develop enlarged back ends of their hippocampi as a result of the intricate mental map of the city that they develop and store.⁷

James Surowiecki's The Wisdom of Crowds drives home his counterintuitive thesis that multiple viewpoints from individuals with a wide range of backgrounds, rather than the restricted viewpoints of experts or specialists, are crucial in reaching informed decisions on complex topics. Such successful problem solving almost certainly reflects the value of using a wide variety of framing lenses. In some sense, getting input from a broad variety of people is like getting input from a wide variety of devices—microscopes, telescopes, litmus paper, tensile testors, ultrasound devices, and weighing scales. There is indeed a shared physical reality out there; but for complex problems, no single one of us—experts included—has the all-encompassing set of tools or ways of perceiving that are necessary to truly understand its every aspect. In fact, experts receive such similar training that occasionally they can be unaware, as a group, of shared inadequacies in their approach.

Living and working among the Russians was a terrific way for me to, in some sense, broaden my neurological frame. (Later, the study of engineering would prove enticing precisely because I knew it would provide yet another, very different, frame with which to shape my experiences.) I've a good ear for language—mirror neurons in my language module fire quite nicely, thank you. After a few months out on the boats, my Russian took on the soft Ukrainian flavor of Nakhodka's fishermen, mixed with the salty language of fishermen everywhere. I learned that Russian-speaking brains slice life differently than my English-speaking brain. Reality may be the same in Russian—but it feels different. And reality feels different in another way beyond that of language.

“The terrible things your own people say about their country,” said Captain Shevchenko one night as we sat up drinking after another late-night trawl was tucked into the hold. “No self-respecting person should ever say things like that about where they live. Not if they have any respect for their history and their culture and their race. Not if they have any patriotism.”

“You can't teach patriotism,” I began.

But Shevchenko interrupted contemptuously, as if I'd just drooled. “Of course you can teach patriotism. We do it all the time.”8

The conversation rolled on, but that part of it stuck, bothering me.

I remembered dozens of one-sided tipsy Slavic arguments, which from the Soviet's perspective involved clear-cut dichotomies of good against evil. Excessive Western personal freedom, for example, versus sacred duty to the state. All-pervasive Western drug addiction versus minor Russian drinking habits (not quite!). The wicked American invasion of Vietnam versus the high-minded Russian invasion of Afghanistan, which was solely for the good of the Afghans.

I could see the crumbling decay of the Soviet Empire all around me, from the rotten fish processing plant below decks, to the hollow-eyed fear of the political commissar and the KGB, to the “who cares” attitude toward work, to the rampant alcoholism of the crew. But despite the all-pervasive rot, it was a rare Russian who could see—much less admit to—any problem with the system of government.

I'd tried to lure the Soviets into dispassionately viewing both the Soviet and the American systems by expressing my own genuine admiration for the positives of Soviet society. (After all, how could I not love a culture where even the lowliest deck crew worker was enamored of chess, and where vulgar public displays of wealth were nonexistent?) I related positives about my own country and modeled criticism as well. “Of course the United States has made mistakes,” I admitted, proudly showing off my naive open-mindedness. I played right into their hands. The Soviets almost literally could not hear me when I said anything good about America—it just didn't mesh with anything they'd ever been taught, and anyway, I was obviously brainwashed. They tuned in only when I criticized my country—criticism of the United States was easy for them to understand because I was only reinforcing for them what they'd already learned so deeply. In psychology, such a phenomenon is called “confirmation bias.” It involves behavior where one looks for and notices things that confirm one's beliefs, while ignoring, not looking for, or undervaluing the relevance of what contradicts one's beliefs. Selective thinking. A bit of voluntary blindness. Dangerous stuff.

Fig. 8.1.

As Shevchenko had inadvertently pointed out with his crack about patriotism, I was a cultural chump. If you've been raised from childhood to think a certain way about things like the greatness of Mother Russia and the Soviet Union, if you've had a one-sided education about the superiority of communism and the evils of Western decadence, a few conversations with a foreigner to the contrary won't amount to a hill of beans of difference. Despite the incipient decay and fearful, police-state behavior visible everywhere around me, despite the deaths of tens of millions of Russians in horrendous purges that lasted half a century, Shevchenko could mindlessly, in almost cultlike fashion, assert that theirs was the best system in the world.

I'd learned one of the most valuable lessons I would ever learn—that deep-rooted emotional reasoning can often trump logic.

How does that happen?

NEUROLOGICAL SYSTEMS AND HOW THEY FUNCTION TO REGULATE EMOTION

The Cerebral Cortex

Emotion involves two very different structures in the brain, the first of which is the cerebral cortex—the newer part of the brain in evolutionary terms. But where, you might ask, is the cerebral cortex? Well, if you happened to have a preserved dead body lying around, you could use a handily vibrating Stryker saw to whir your way around the upper portion of the skull. Then you could chisel away at the bone until you were in a position to use real muscle to pry the skullcap off. In an old anatomist's trick, you could tuck the removed skullcap under the remaining part of the skull to serve as a pillow—this lifts the rest of the corpse's head into a more “comfortable,” easily viewed position. Peel away the remains of the meninges, the fibrous membranes that cover the brain, and you would see the cerebral cortex lying directly before you—the entire region just below where the corpse's hat used to sit.

If you weren't terribly squeamish after your first cut and didn't mind doing a bit of careful scalpel and forceps work, you could lift the brain out. The three-pound grayish-brown concoction of lobes and ventricles would nestle nicely in your hands, rather like a ropy, congealed pudding. It is hard to believe this compact mass once directed the cuddling of babies or dreamed of starting a business.

Next, you could take a scalpel and slice the brain in half, so you could easily compare the two halves with the areas shown on the next illustration. Poking a bit with a probe, you could pick out the four specialized areas that are particularly important in processing and controlling emotions. These areas have clunky names that can roll surprisingly swiftly off an anatomist's tongue: the anterior cingulate, ventromedial prefrontal, orbital prefrontal, and dorsolateral prefrontal cortices. We noted some of these regions earlier in relation to psychopathy. Most of these areas are in the prefrontal cortex at the very front of the brain, near the eyes and forehead. Problems involving any of these regions or the pathways connecting them may result in strange emotional behavior—impulsivity, moodiness, or the inability to weigh the soundness of a decision.

But what precisely does each of those four areas do?

The first of the four—the orbitofrontal cortex—is designed to inhibit inappropriate actions. This allows us to set aside our urges and put off immediate reward in favor of long-term advantage. When your stomach is growling but you wave away your favorite type of cookie, it's your orbitofrontal cortex that's helping you say no. (The term orbito-, incidentally, refers to the area right above the orbit of the eye.) As you might expect, the orbitofrontal cortex plays a significant role in controlling impulsivity. A dysfunctional orbitofrontal cortex doesn't “play nicely” with the rest of the brain—this may propel a person willy-nilly toward explosively impulsive behavior.

Fig. 8.2. The illustration on the left shows an external view of the brain, while the right shows a cross section. The four areas shown are those that relate most strongly to processing and controlling emotions.

The nearby dorsolateral prefrontal cortex is where plans and concepts are held and manipulated. This is the area that would, for example, process plans related to your family's trip to Disneyland—from purchasing plane tickets, to getting your hotel, to planning what you'll be seeing and doing each day. This is also the area that seems to choose to do one thing rather than another. At the grocery store, this area would help you decide to select Fuji apples rather than Golden Delicious. Subtle differences in the operation of the dorsolateral prefrontal cortex may explain the differing styles, for example, of the habitual grocery store ditherer as opposed to the fast shopper who's in and out of the store in seconds. The dorsolateral prefrontal cortex is also deeply involved in the ability to think logically and rationally about various topics. People with slight problems in their dorsolateral prefrontal cortex appear to act normally; however, they may confidently, even arrogantly, draw bizarre and irrational conclusions. Problems related to this area may help cause the gaslighting and projection seen so frequently in borderline-like behavior.9

The ventromedial cortex is located near, and has very dense connections with, an area completely separate from the cerebral cortex known as the limbic system. The limbic system composes the subconscious part of the brain where emotions are born. The ventromedial cortex therefore allows us to consciously experience our emotions, and helps link conscious to unconscious thought. (You might say that the ventromedial prefrontal cortex plays a role in emotional cognition, whereas the dorsolateral prefrontal cortex is involved in rational cognition.) The ventromedial prefrontal cortex also gives meaning to our perceptions. For example, depressed people who find no meaning in anything they do often have inactive ventromedial cortices. On the other hand, bipolar individuals in acute manic phase who find meaning in everything they do have hyperactive ventromedial cortices. As we shall see, emotion relates in important ways to our ability to make wise decisions. Not surprisingly, problems with the ventromedial cortex, much like problems with dorsolateral prefrontal cortex, can lead to subtly irrational behavior.

Finally, the anterior cingulate cortex, nestled on the underside of the cerebral cortex, helps us to focus our attention and “tune in” to thoughts. As such, this area of the brain is related to the ability to focus on boring, difficult, or unpleasant subject matter. Dysfunction here may inhibit the ability of borderlines and subclinical borderlines to focus on something they do not wish to hear. The anterior cingulate cortex also plays a role in helping to make new memories permanent and in producing feelings of empathy.

The Limbic System

If the cerebral cortex, with four of its subunits, is the first of the two major areas involved in emotional processing, what's the second? It is the limbic system—a far older area (in evolutionary terms) nestled deep within the brain. If you haven't happened to have tidied up yet and still have your dissected brain lying around, you could turn one of the bisected halves of the brain on its side and start picking apart the deep interior to see the main components of the limbic system—the amygdala, thalamus, and the hippocampus. Most emotions are born in the limbic system, along with our appetites and urges. Even though this part of the brain is below our level of awareness, its constant feeding of impulses to the conscious cortical areas profoundly affects us.

Neural Connections

Meanwhile, as you might expect, the connections between all the different areas we've just discussed are also critically important in handling emotion. Those connections are generally made through neurons—spidery cells that act like electronic wires to carry information in a syncopated rhythm. As the information travels down the neural wires, it leaps small gaps—synapses—between the neurons in the form of chemical flares known as neurotransmitters. Neurotransmitters come in dozens of different flavors, but, as we've already seen, two of the most well-studied and significant are serotonin and dopamine. Serotonin, as we know, plays a critical role in disorders such as depression, borderline personality disorder, bipolar disorder, and anxiety; it is also thought to be involved in sexuality and appetite. Dopamine is thought to relate to control of the brain's reward mechanisms, as well as the control of movement. Problems related to the dopamine system have been strongly related to psychosis and schizophrenia.

Fig. 8.3. The thalamus, hippocampus, and amygdala form key components of the limbic system—an older part of the brain from which our emotions emerge.

Fig. 8.4. This drawing shows the connections between a neuron that is sending a signal and the receiving neuron. Chemical flares known as neurotransmitters carry the signal across the tiny gap between the neurons. Neural signals progress in this hopscotch fashion to allow different areas of the brain to communicate all sorts of information—from sensory information related to sight, hearing, or touch, to high-level processing related to deliberative thought, to emotional reactions such as fear or aggression.

To see how the neurons make connections between the different areas of the brain, we might want to think about a map. For example, when we want to see how cities in the state of Michigan are connected to each other, we often pull out a road map and trace the connections we're interested in to figure out how to get from, say, Kalamazoo, Michigan, to Hell (yes, there is a Hell in Michigan). In just the same way, we can see how the different regions of the brain connect to each other by following a “brain map” like that shown above.

Fig. 8.5. A rough sketch of how various areas of the brain connect to one another.

To get a feel for how this diagram relates to physical processes that are occurring in the brain, start at the left, with the oval labeled “Sensory Stimuli” (that's our “Kalamazoo,” from which we can reach the different points in our neural Michigan). Information from the sensory stimuli—eyes, ears, touch—is sent undulating along neurons to the limbic structure of the thalamus. The thalamus, an egg-shaped gray mass deep in the center of the brain, is a routing station for these sensory signals, some of which are sent on to the amygdala. At the amygdala, the emotional significance of the information is determined. For example, if you were to have lesions on your amygdala so that they had to be surgically removed, you wouldn't be able to understand the meaning of growls, screams, angry voices, or other negative signs. From the amygdala, signals are sent on to the nucleus accumbens (the NAC), which determines the appropriate levels of motivation and reward—this is the common site of action for drugs such as cocaine that produce euphoria.

All of this processing at the subconscious limbic-system level is not very precise, but is fast—fast enough to get your body revved for reaction to danger. For example, if you hear a nearby gunshot, a signal from the amygdala might be shunted through to the hypothalamus and brain stem nuclei (Hypo/BSN) to produce an automatic emotional response: “Run!” Ultimately, all of these deep-brain limbic structures transmit their information up to the prefrontal cortex, where we consciously become aware of the emotional responses we refer to as feelings.

But there is one last piece to the process. Some of the original sensory information that was split at the thalamus is sent directly on to the cerebral cortex (including the four areas—the anterior cingulate, ventromedial prefrontal, orbital prefrontal, and dorsolateral prefrontal cortices—that we mentioned before). Here, slower but more precise conscious evaluation of the directly routed sensory stimuli takes place. But even so, the emotionally preprocessed signals, along with components from memory, eventually arrive at the higher, conscious, prefrontal areas, and can strongly affect, or even overwhelm, our conscious thought processes. These signals are what trigger that surge of affection we feel when we see our beloved dog, or the fear and revulsion we feel when we encounter a rattlesnake in our path. These are also the emotional signals that influence how open we are to receiving and understanding new information. This emotional overlay is intimately related to why my Soviet colleagues and friends on the trawlers often could simply not understand when I hinted that there might be something wrong with their government, or something right about the West.

“FEEL GOOD” POLITICS: HOW MACHIAVELLIANS—AND ALTRUISTS—MANIPULATE EMOTIONS

The role of emotion in shaping “rational” thinking is tremendously underrated. Strong evidence shows that human behavior is the product of both the rational deliberation that takes place in the front areas of the cerebral cortex and the “emote control”—emotional reasoning—that originates in the limbic system.10 These two neural systems operate in radically different fashions and often are in conflict with one another. As Princeton sociologist Douglas Massey writes: “Emotionality clearly preceded rationality in evolutionary sequence, and as rationality developed it did not replace emotionality as a basis for human interaction. Rather, rational abilities were gradually added to preexisting and simultaneously developing emotional capacities. Indeed, the neural anatomy essential for full rationality—the prefrontal cortex—is a very recent evolutionary innovation, emerging only in the last 150,000 years of a six-million-year existence, representing only about 2.5 percent of humanity's total time on earth.”¹¹

In an article on the effect of emotion in foreign policy and international law, law professor Jules Lobel and psychologist George Loewenstein expand on Massey's sentiments:

Human behavior…is not under the sole control of either affect or deliberation but results from the interaction of these two qualitatively different processes—like a computer that has two different types of processors it can draw upon that process information in qualitatively different ways. Emote control is fast but is largely limited to operating according to evolved patterns. Deliberation is far more flexible—it can be applied to almost any type of task or problem one might encounter—but is comparatively slow and laborious. Deliberation involves what psychologists call “controlled processes” that involve step-by-step logic or computations and are often associated with a subjective feeling of effort…. Emote control is the default mode, while deliberation is invoked in special circumstances.¹² (italics added)

Emote control is not necessarily a bad phenomenon. It can lead to harrowing rescues from burning cars, loyalty to our friends even when the costs far outweigh any benefits, and the impassioned leadership of Winston Churchill in his defense of Britain against the evils of Nazism in World War II. But it can also lead to other, less happy results—especially with regard to Machiavellians.

One such example is the twenty-five-year crusade to prove that a Virginia man, Roger Coleman, was innocent of the rape and murder of his sister-in-law. Coleman was a likable, good-looking man who resolutely insisted on his innocence. Thus, despite a large body of evidence—that is, rational facts—that proved beyond a reasonable doubt that Coleman was guilty, death penalty opponents rallied to his cause. Jim McCloskey was Coleman's principal advocate—he fought for years to save Coleman's life and even founded a group, “Centurion Ministries,” to help get the falsely convicted out of jail. McCloskey says, “I promised Roger Coleman the night he was executed [that] I would do all within my power to prove that he was innocent. Those were my last words to a dying man.”13 Eventually, the state was convinced to make use of new DNA technology to reexamine the case. Hopes were high among death penalty opponents that Coleman's name would prove to be an effective rallying cry to help prevent future executions. When Coleman's DNA analysis came back, however, he was shown to have been guilty as charged. (This is not to suggest that all those convicted of murder are in fact guilty. The Innocence Project at the Benjamin N. Cardozo School of Law at Yeshiva University has proven otherwise for dozens of the poor and forgotten.)

But why was McCloskey so certain that Coleman was innocent? The ultimate source of McCloskey's certainty is revealed by his statements after Coleman's “guilty” DNA results came back. McCloskey “felt betrayed by the man whose last words included the statement ‘An innocent man is going to be murdered tonight.’ ‘How can somebody, with such equanimity, such dignity, such quiet confidence, make those his final words even though he is guilty?’ McCloskey said.”¹⁴ McCloskey had made an “emote control” decision that Coleman could not have been guilty—this decision had been deeply confirmed by Coleman's body language. The intrusion of reality in the form of Coleman's betrayal must have been devastating. Machiavellians such as Coleman often take advantage of an emotionally based—perhaps even genetically predisposed—desire on the part of some honest individuals to believe that others are also honest. This can occur despite sometimes overwhelming evidence to the contrary.

A recent imaging study by psychologist Drew Westen and his colleagues at Emory University provides firm support for the existence of emotional reasoning.15 Just prior to the 2004 Bush-Kerry presidential elections, two groups of subjects were recruited—fifteen ardent Democrats and fifteen ardent Republicans. Each was presented with conflicting and seemingly damaging statements about their candidate, as well as about more neutral targets such as actor Tom Hanks (who, it appears, is a likeable guy for people of all political persuasions). Unsurprisingly, when the participants were asked to draw a logical conclusion about a candidate from the other—“wrong”—political party, the participants found a way to arrive at a conclusion that made the candidate look bad, even though logic should have mitigated the particular circumstances and allowed them to reach a different conclusion. Here's where it gets interesting.

When this “emote control” began to occur, parts of the brain normally involved in reasoning were not activated. Instead, a constellation of activations occurred in the same areas of the brain where punishment, pain, and negative emotions are experienced (that is, in the left insula, lateral frontal cortex, and ventromedial prefrontal cortex). Once a way was found to ignore information that could not be rationally discounted, the neural punishment areas turned off, and the participant received a blast of activation in the circuits involving rewards—akin to the high an addict receives when getting his fix. In essence, the participants were not about to let facts get in the way of their hot-button decision making and quick buzz of reward. “None of the circuits involved in conscious reasoning were particularly engaged,” says Westen. “Essentially, it appears as if partisans twirl the cognitive kaleidoscope until they get the conclusions they want, and then they get massively reinforced for it, with the elimination of negative emotional states and activation of positive ones.” Interestingly, a more extreme version of this type of behavior may underlie borderline-like splitting.16

A completely different process occurred when a participant had no emotional investment at stake, as with statements concerning the “neutral” Tom Hanks. In this straightforward, rational process, only the dorsolateral prefrontal cortex was activated—both Democrats and Republicans were swayed toward reaching the logical conclusion by the mitigating statement. Dorsolateral activation is, notably, the part of the brain most associated with reasoning as well as conscious efforts to suppress emotion.

Ultimately, Westen and his colleagues believe that “emotionally biased reasoning leads to the ‘stamping in’ or reinforcement of a defensive belief, associating the participant's ‘revisionist’ account of the data with positive emotion or relief and elimination of distress. ‘The result is that partisan beliefs are calcified, and the person can learn very little from new data,’” Westen says.¹⁷ Westen's remarkable study showed that neural information processing related to what he terms “motivated reasoning”—that is, political bias (in this case, at least)—appears to be qualitatively different from reasoning when a person has no strong emotional stake in the conclusions to be reached.

The study is thus the first to describe the neural processes that underlie political judgment and decision making, as well as to describe processes involving emote control, psychological defense, confirmatory bias, and some forms of cognitive dissonance. The significance of these findings ranges beyond the study of politics: “Everyone from executives and judges to scientists and politicians may reason to emotionally biased judgments when they have a vested interest in how to interpret ‘the facts,’” according to Westen.¹⁸

But is emote control really that common—particularly in such areas as public policy, which cry out for reasoned and rational discourse?

Absolutely.

For example, well-intentioned, emotionally based concerns about the sanctity of human life have led to the United States withdrawing support for birth control programs to third world countries—despite the fact that many of those in favor of withdrawing support have never lived in those countries and have absolutely no idea of the magnitude or devastating effects of overpopulation there. Interestingly, people who are against such birth control programs, based on the sanctity of human life, are often also firmly pro–death penalty. When I point out the inconsistency of being pro–death penalty but anti–birth control to these friends, they suddenly decide that not quite all human life is sacred. Then they change the subject.

Similar emotional reasoning has led kindhearted individuals to support “feel-good” programs such as busing, which seemed, on the face of it, to be an outstanding method to integrate school systems. Opponents of this program—whatever their reasons—were seen as racists, which meant that rational concerns about the program were discounted.19 The result was that cities such as Detroit were devastated as the well-to-do moved to the suburbs, out of range of the mandated busing system. This worsened the segregation the busing had been designed to remedy. Similarly, a laudable desire to eliminate shabby housing, drug use, and crime in poor areas led to “the projects,” which were to house even more highly concentrated areas of drug use and crime. Such government-mandated programs as busing and the projects, often generated by emote control related to genuinely altruistic considerations, have wasted billions of taxpayers’ dollars and led to a worsening of the very conditions they were meant to solve.

No one can claim to be truly unbiased. We all come at issues through our experiences and values, filtered by the emotional and cognitive processes of our hardwired neurological makeup. But if we socialize only with members of our own particular religious persuasion; if we work in an environment with only one-sided political input; if we read only Web sites or other news sources by writers who echo our views, then we strongly reinforce the emotional, rather than logical, basis for our beliefs. After all—if “everyone” we know believes what we believe, we find an emotional reinforcement that helps close off consideration of other perspectives. (So much for the wisdom of crowds.)

Aren't there times when we as citizens should respond with healthy emotions, to fight for what we believe in, especially when we feel policies are causing people actual harm? Of course. But simply looking at the research results, one must conclude that people's first emotional responses about what's wrong, who is to blame, or how to proceed, particularly in relation to complex issues, must always—always—be considered suspect.20 There is no simple algorithm for teasing rationality from emotion. An ardent Democrat or Republican, a dyed-in-the-wool communist union organizer, a young devotee of Scientology, a Palestinian suicide bomber, or a KKK grand kleagle could each read the above paragraphs and think, I'm not irrational—it's those other idiots who can't see the obvious. But we all have pockets of irrationality, some large, some small, no matter if we are mathematicians who make our living doing proofs, wealthy philanthropists, or stay-at-home housewives.

If there is one thing that is important for us to know, it is that emote control allows our best traits—love, caring, loyalty, and trust—to be used as manipulative levers. Me-first Milosevic-like Machiavellians, with their convincing masks of integrity and charm, climb in every social hierarchy, schmooze in every community, saunter through every neighborhood. Whether we care about children, students, families, factory workers, fellow followers of Christ, brothers in Islam, blacks, whites, Mongolians, or Democratic or Republican political planks, the successfully sinister have no compunction about using our best intentions to further their own purposes—and themselves. By believing a heartbreaking speech about how important it is for us to be treated “fairly,” or a tale of how we've been victimized, or a plea to put our hearts and minds toward helping others, we may be doing our tiny part to stoke the fires and empower a Machiavellian. It is bitter balm indeed to learn how easily Machiavellians can use our own neurological quirks to fool us into actively working against the very ideals we hold most dear.

SEEING SUBTLE DEFECTS IN THE EMOTE CONTROL SYSTEM—BORDERLINE PERSONALITY DISORDER

If an irrational emote control is the default mode on even normal people, what happens when there are subtle defects in the emotional system?

A lot, as it turns out. Some of these defects allow us to be more easily manipulated, as with the Alzheimer's victim who is conned into giving all her money to an “investor,” leaving her with nothing. But other defects can lead, it seems, to some of the insidious, duplicitous, sometimes irrationally self-serving thought processes of the successfully sinister.

Probably the best way to begin to understand these latter effects—and certainly one of the ways most relevant to Machiavellianism—is to take a careful look at the dysfunction that occurs in borderline personality disorder. In this condition, three sets of neural circuits appear to be disturbed—all involving the neurological areas we've explored thus far. Here's the list:

• emotional dysregulation (moodiness, depression, anxiety, feelings of emptiness): limbic system
• impulsivity: anterior cingulate and orbitomedial prefrontal systems
• cognitive-perceptual impairment: dorsolateral, ventromedial, and orbitofrontal systems

Superb recent results from imaging and other studies are providing information that can help each of us intuit a sense of what can go wrong with these circuits. We'll examine each in turn.

Emotional Dysregulation: Limbic System

In those with borderline personality disorder, we can actually see how some poorly tuned portions of the limbic system seem to cause the characteristic fluctuating moods, depression, anxiety, and feelings of emptiness. The amygdala and the hippocampus of the limbic system play key roles in memory and emotional responses. Magnetic resonance imaging has shown that both organs are noticeably smaller than usual in borderline patients.21 This decrease in the size of the hippocampus is intriguing in that this organ seems to be associated with a person's ability to “catch” contextual cues. Abnormalities in the hippocampus may explain why borderlines don't seem to be able to pay attention to important but placidly unemotional task-relevant information. Instead, their brains seem to key in on emotionally related cues—especially if these cues are negative.²² Just because these cues can be detected, however, doesn't mean the borderline reacts to them in the same way as a person without the disorder.

In fact, it appears that the amygdala, as well as other parts of the brain, actually function differently in borderlines under conditions that provoke emotional responses. The functional magnetic resonance imaging results above show what happens to cerebral metabolism in borderline patients, as opposed to normal controls, after viewing repulsive images on slides (imagine, if you will, something grotesque, like roadkill.) The light spots indicate unusual excess activity found only in the borderline patients. These spots are related to increased metabolism in the amygdala as well as the prefrontal and temporo-occipital cortex.

Fig. 8.6. In this view peering down from the top of the head at a cross section of the brain, activated areas are shown in a lighter color. You can see a big difference in the neural responses of patients with borderline personality who viewed repulsive slides (left), compared with healthy volunteers who viewed the slides (right). The borderline patients showed high activity in the amygdalae and the temporo-occipital cortex, while the healthy volunteers showed a normal, subdued response.

Researchers believe that hyperactive amygdalae are a cause of the intense and slowly subsiding emotions experienced when borderlines suffer even minor irritation. The increased activities in the prefrontal and temporo-occipital cortices—which indicate increased attention to emotionally relevant input from the environment—may be due to the boosted signal from the amygdala. Translated into practical terms, this would explain why a borderline might overreact to a minor constructive criticism by a spouse or friend, evoking an angry response that leads to a major argument.

Similarly revved-up amygdalae were found after borderline patients were exposed to faces showing various types of emotion. The overly hefty amygdala response is likely to be a key component of borderline emotional vulnerability, especially in the context of disturbed interpersonal relations and the crucial role of the amygdala in processing emotional stimuli and reactions. It may also be related to the borderline hypersensitivity to the state of other people and their uncanny ability to read emotions.23

Impulsivity: Anterior Cingulate and Orbitomedial Prefrontal Systems

The second type of dysfunction common in borderlines relates to impulsivity. Borderlines often have difficulty controlling their impulses and behaving in a reasonable and rational manner—especially when they are feeling strongly emotional. One recent study has revealed that borderlines appear to suffer the same problems with impulsivity as those who have suffered damage to their orbitofrontal cortex.24 To understand the revealing recent imaging studies, you might want to look at the augmented version, shown below, of our neural map. In this expanded version of the drawing, several new areas have been added: the dorsal raphe nucleus and the ventral tegmental area.²⁵ These two areas produce key neuromodulators—molecules that can boost or dampen the effect of those chemical flares that ferry information across the synapses. The dorsal raphe nucleus produces the neuromodulator serotonin, while the ventral tegmental area produces the neuromodulator dopamine. As the many spidery connections show, the neurotransmitters of the ventral tegmental area and the dorsal raphe nucleus affect many areas of the brain at both conscious and unconscious levels.

The next figure gives a sense of the underpinnings of the strange neural behavior of those with borderline personality disorder.²⁶ Neural PET scans of normal subjects are shown in the top row, while similar scans of borderline subjects are shown at the bottom. (“PET” stands for positron emission tomography—which produces images of the brain's chemicals that look almost like color x-rays.) These scans indicate that serotonin levels for borderlines are much lower than normal in many neural regions, including the medial, lateral, and orbital prefrontal cortices—precisely those regions thought to be involved in the increased impulsivity that afflicts borderlines. Other studies have indicated similar problems with imbalances related to neurotransmitters with big-handled names like acetylcholine, norepinephrine, and gamma-aminobutyric acid (GABA). Indirect evidence also points to problems related to dopamine.²⁷ These neurotransmitter imbalances may well be related to the mood imbalances we discussed in relationship with the amygdala.²⁸

Fig. 8.7. A more detailed sketch of how various areas of the brain connect to one another.

The next PET images reveal that glucose metabolism (“feeding” of various areas of the brain), was found to be much larger in borderline patients than in normal people in prefrontal and frontal regions (the patterned area of the images). But glucose metabolism was decreased in the limbic regions of borderlines, for example, the hippocampus.29 Other studies have confirmed unusual activities in these areas. For example, it has been found that when serotonin levels are increased in the gaps between the neurons, borderline patients, unlike normal controls, show decreased metabolism in the anterior cingulate gyrus and orbitofrontal cortex—important areas for inhibiting impulses.³⁰

Fig. 8.8. A neural PET scan typical of a normal subject is shown at the top—the lightness indicates serotonin levels are high. A borderline patient, shown below, reveals dark shades that indicate lower serotonin levels in many neural regions, including those affiliated with impulsivity.

Fig. 8.9. Glucose metabolism (“feeding” of various areas of the brain), was much larger than normal for borderlines in the crosshatched areas shown.

Yet another study showed that borderline subjects had a significantly smaller right parietal lobe—smaller by 11 percent.31 (The parietal lobe stretches from ear to ear in a band around the top of the head.) Less is known about the functions of the parietal than the frontal lobes, but the parietal lobes are thought to play a role in integrating information from the various senses, as well as in using objects. It appears that signals to the parietal lobe may arrive out of sync with signals elsewhere in the brain—this may contribute not only to cognitive impairment and impulsivity but also to the borderline's sense of personality fragmentation, as well as her inability to integrate the positive and negative aspects of herself and the external world.³²

Fig. 8.10. Slow metabolism in borderlines was observed in the left hippocampus (the white area targeted by the crosshairs).

Interestingly, researchers have found that the smaller the size of the right parietal lobe in relation to the left, the stronger the psychotic symptoms and schizoid personality traits seen in borderlines. Additionally, the volume of the hippocampus has been found to be an extraordinary 17 percent smaller in borderline patients—the smaller the hippocampus, the stronger the borderline symptoms.33 All these deep-set structural differences in the brain, invisible to the naked eye, appear to be profoundly related to the unusual behavioral “choices” of borderlines.

But there is another important factor to consider. Why do some people show strong indications of borderline personality disorder and, as a result, become clinically diagnosed, whereas others show many of the same symptoms yet are never diagnosed? Oddly enough, the reason may lie beyond mere chance and instead may be related to the nature of their impulsivity.

Impulsivity, if you'll remember, relates to “bottom-up” kicking of the brain into emotional gear by the limbic system. But it also relates to the ability to exert “top-down” control over those emotions once they've been kicked into gear. Top-down control is a function of the conscious control over your sensory and emotional systems that you exert to stop yourself from, for example, swearing in front of your four-year-old after slamming your finger in the car door. The neurological pathways related to conscious control can be seen by looking back at the second flow chart a few pages back—the dotted lines with arrows indicate the top-down conscious control of the body from the prefrontal cortical areas (the anterior cingulate and orbital prefrontal cortices) back down to the thalamus, the amygdala, and the nucleus accumbens. Note that “top-down” executive control is separate from the “bottom-up” pathway.

The capability to exert executive control over emotion may be one of the defining differences between a clinically diagnosed borderline and a person who shows many borderline traits. This ability to avoid emotional meltdown, at least when it is imprudent to melt, can allow a person to avoid personality disorder diagnosis, notwithstanding other emotional dysfunction and cognitive-perceptual impairment. It can also allow for the borderline coping characteristic of “situational competence.” As noted psychiatrist Ken Silk has observed, when one of his borderline patients becomes upset, she becomes so swallowed by emotion that she is incapable of logic and is completely unable to assert emotional self control.a. This contrasts markedly with what some refer to as a “high-functioning,” subclinical borderline—a person with many borderline-like traits but who is able to exert executive control as needed. An example of a high-functioning, nonclinically diagnosed person with borderline-like symptoms might be the manipulative supervisor whose angry tirades, threats, and general malicious behavior toward his subordinates is legendary. Yet this same supervisor, even in the midst of a raging fit, is able to flip a mental switch and slip smoothly into a calm greeting if the company president were to pop in.

A difference in circuits related to executive control capability between those clinically and nonclinically diagnosed individuals with borderline traits has been exposed through a recent set of clever experiments from an interdisciplinary group of collaborators led by psychologist Michael Posner from the Sackler Institute for Developmental Psychobiology in New York.³⁴ The group hypothesized that there were two differences in temperament between borderline patients and normal controls. The first difference was thought to be in negative affectivity, which lies behind the strongly negative mood and volatile anger of borderline personality disorder. The second involved what the group termed effortful control—that is, conscious control. Problems here underlie instability in relationships, impulsivity, and difficulties in controlling emotion. (Both negative affectivity and effortful control appear to be strongly heritable traits.)35 A test of effortful control and negativity, the Adult Temperament Questionnaire, was given to borderline patients and a control group of one thousand students at New York's Hunter College. As expected, the borderlines revealed far higher levels of negativity and far lower ability to demonstrate effortful control than the controls. Then—and this is the clever part—the researchers combed through the large pool of students to find controls who happened to match the borderlines in their scores on negative affect and apparent degree of effortful control. What, the researchers wondered, was the difference between a clinically diagnosed borderline and a nondiagnosed individual who shared the same, often problematic, temperament?

Before they even did any further testing, the researchers noticed that they had difficulty working with the nondiagnosed controls with negative affect and low effortful control. Even though these individuals were prescreened and did not meet the criteria for diagnosis with any personality disorder, they showed unreliability in keeping appointments, made frequent changes of address and phone number, and evinced heightened anxiety and paranoia regarding the experimental procedures. The researchers felt that this subset of the control group contained people whose behavior showed evidence of emotional dysregulation, even though they were functioning in school and did not meet the stringent criteria required for diagnosis of a personality disorder.

Test results surprisingly revealed that there was a single, but very distinct, difference between borderlines and the temperamentally similar controls: clinically diagnosed borderlines had much more difficulty in quickly resolving conflicting information than the temperamentally matched controls and the normal controls.

The ability to resolve conflicting information—an essential aspect of what is known as the executive attentional network—appears to be centered in the anterior cingulate cortex. This region undergoes substantial development relatively early in childhood, between the ages of two and seven years old. Posner and his colleagues hypothesized that “certain individuals possess a genetic propensity related to temperamental characteristics present prior to the disorder. Patients with borderline personality disorder often report incidents of abuse during childhood. These environmental events, together with the genetic propensity, may interfere with development of executive control, which in turn influences the ability to develop clear ideas and empathy for the minds of others as well as the experience of diffusion of one's own identity.”36 In summary then, a very difficult childhood can take a predisposition for borderline personality disorder and turn it into a devastating reality. A decent upbringing, however, can mean that a person with the same predisposition will grow up only to be difficult to deal with, but not necessarily someone who comes to the attention of a clinician.

Interestingly, Posner's work regarding the importance of the attentional network to borderline-like behavior ties neatly with Joseph Newman's work involving psychopathy. Newman, if you'll remember, proposed that psychopathy is actually a disorder related to the attentional network. In fact, just as diseases such as schizophrenia may be found in individuals with a wide variety of underlying personality traits, Newman has found evidence that psychopathy may be found in individuals with many different personalities. The underlying personality appears to shape the expression of the psychopathy. A nonviolent sort might become a con man, while a more violent type might become a hit man.

I can't help but remember Carolyn's brief visit to the store to pick up a few things—during which time she disappeared, to reappear in my life five years later. Once Carolyn's attention was turned to the man she met at the store, it seems, she lost focus on the fact that she was supposed to come back to the cabin and her waiting family.

Cognitive-Perceptual Impairment: Dorsolateral, Ventromedial, and Orbitofrontal Prefrontal Systems

The third type of dysfunction commonly seen in borderlines involves cognitive-perceptual impairment. More subtly, this might show itself as the philandering husband who accuses his faithful wife of cheating on him after he gives her venereal disease. Or the business executive who is unable to recognize that her “brilliant” financing strategy has so many obvious flaws that it will ruin the company. Stronger versions of this might manifest as the stroke victim who believes her husband's body has been taken over by an imposter. These types of cognitive-perceptual impairments relate to the dorsolateral prefrontal system, which underpins our ability to reason, to develop strategies for solving complex problems, to think abstractly, and to maintain a working memory. Strangely enough, people with damage to the dorsolateral and nearby ventromedial areas can have normal intelligence but have no common sense—they are unable to make reasonable decisions.

This phenomenon has been studied in relation to gambling experiments with play money. Players, including brain-damaged patients and normal controls, were given four stacks of cards to draw on—two of which were rigged to give large penalties, while the other two were rigged for small penalties. Unlike normal controls, brain-damaged patients, even those who became consciously aware that some decks were riskier than others, continued to play equally from all decks. Their skin showed no change in conductance, which indicated the patients’ lack of concern about their risky behavior. It is thought that this dysfunctional pattern of performance was due to the fact that the patients weren't able to develop an emotional “gut” feeling related to the high-risk decks—a theory known as the somatic-marker hypothesis.37 (Somatic is from the Greek word meaning “body.”) It seems that conscious, overt knowledge is not enough to ensure common sense decision-making ability; other neural circuits—with the surprising inclusion of those involved in emotion—play a powerful, but hidden, role.

Subtle brain damage has also been affiliated with odd “end justifies the means” behavior. Logically, it might seem rational, for example, to push a hefty man into the train's path to slow a train and save the lives of people farther down the tracks—but normal individuals just can't bring themselves to even think about doing it. Those with damage to their frontal lobes, on the other hand, can easily imagine pushing the man in front of a train to impede its motion and thus save other people's lives. (This example may seem a bit contrived, but it's the example that was presented to the test takers.) Brain-damaged individuals, it seems, focus primarily on the consequences, ignoring whatever nasty means might be involved. It may well be that subtly miswired or damaged neural circuits lie behind some of the can't-make-an-omelet-without-breaking-eggs type of behavior seen in dictators and their supporters as they justify the killing of thousands, or even millions, to further their goals.38

The medial orbitofrontal cortex appears to be particularly important in suppressing emotional memories that are irrelevant to the current situation. Thus, individuals with borderline personality disorder and its subclinical cousin often seem to respond in “characteristically inflexible and maladaptive ways based not upon current social contexts, but rather according to implicit emotional memories of past interpersonal experiences.”³⁹ This inflexibility may well relate to orbitofrontal cortex dysfunction. Subclinical examples of such behavior might include the supervisor who refuses to see the need for spending money to update equipment despite obvious cost savings, or the father who beats his daughter for being late despite the fact that her car broke down. On a scale of wider importance, it might explain, for example, Hitler's utter inflexibility once he had made a decision.^b.40 Borderlines, it should be noted, tend to become particularly irrational when strong emotions are stirred up.⁴¹

Interestingly enough, substance abuse also appears to produce prefrontal dysfunction, which has been associated with various aspects of addictive behavior and impaired decision making in people with antisocial personality disorder.42 Patients with borderline personality have been found to have similarly impaired decision-making ability and are thought to have dysfunction in the orbitofrontal region.⁴³ And, of course, some individuals with borderline-like traits attempt to self-medicate with drugs or alcohol, worsening their already impaired prefrontal dysfunction.

Some studies have also shown that volumes of the left orbitofrontal cortex, right anterior cingulate cortex, amygdala, and the hippocampus are all smaller in patients with borderline personality disorder—the shrinkage forming a very distinctive pattern that might help distinguish borderline personality disorder from other disorders.⁴⁴ Unfortunately, in a chicken and egg situation, it's not clear whether the smaller size of those neural features causes borderline personality disorder, or whether the disorder itself causes the deterioration. In one form of schizophrenia, for example, brain scans of affected children show a remarkable loss of gray matter in the cerebral cortex between the ages of thirteen and eighteen—the anatomical abnormalities mirrored the increasing psychotic symptoms.⁴⁵ And in fact, there is an association between borderline personality disorder and schizotypal personality disorder (often thought to be a mild version of schizophrenia), as well as with schizophrenia itself.⁴⁶ One study found reduced N-acetylaspartate (NAA) compounds in the dorsolateral prefrontal cortex in borderline patients. This is significant because NAA depletion, which has been observed in both adults and children with schizophrenia, reflects a state of neuronal damage that often precedes cell death.⁴⁷

BUT WHAT'S THE BIG PICTURE?

At this point, it might be nice to paint a bold picture of precisely what is going awry in the neural circuits that handle emotional information processing, impulsivity, and cognitive-perceptual activity in people with borderline personality disorder. But, although researchers are zeroing in on a variety of differences between normal and borderline neural functioning, they still don't know enough about the many different signal pathways, or how defective signal pathways compensate, to be able to state definitely what is going on. In any case, it appears that many borderline features, including poorly regulated emotions, impulsivity, and identity disturbances, are caused by disrupted connections between the prefrontal cortex and other regions of the brain that underlie higher cognitive functions.48

Evidence from family studies strongly supports the separate inheritance of impulsivity, moodiness, and cognitive dysfunction—all of which are found in unfortunate confluence in a borderline. Mood and impulsivity traits, for example, are often found in relatives of borderlines, but piecemeal—one relative might have a mood disorder, while another may have problems with impulsivity. Inheritance of such traits means that some of the defects we see so clearly in medical imaging are almost certainly due to problematic genes. Genetic bad luck means getting the whole constellation of a predisposition toward borderline-like personality traits—or, in some cases, outright borderline personality disorder, even without obvious environmental stressors.

In summary, then, it seems that disrupted amygdala function may cause the negative emotions a borderline feels when he is first appraising a person or situation. Disrupted orbitofrontal cortex function may cause impulsivity. And disrupted hippocampal function can cause the typical difficulty a borderline has in ignoring emotional cues that are not relevant to the task at hand. (This would account for the irrational roommate described earlier who was unable to focus on the facts and instead overreacted to her own emotions.) A problematic anterior cingulate cortex may underpin a borderline's inability to resolve conflicting information, while dysfunction in the dorsolateral prefrontal cortex may be involved in the borderline's impaired ability to effectively reevaluate negative stimuli. Ultimately, some of these disrupted activities may be a consequence of reduced activity related to serotonin, particularly in the orbitofrontal cortex.

Underlying all of these issues are the borderline's problems with identity, which, as psychiatrists Katherine Putnam and Ken Silk note, “may be the most profound and damaging result of a chronic state of emotional dysregulation.” Problems with identity would include the chameleon-like behavior so often seen in borderlines, as well as the paradoxical mixtures of inflexibility and malleability.49 (This is much like Milosevic's inability to be swayed by reason or facts, coupled with his utter dependence on his wife, Mira.) Putnam and Silk add: “As emotional experience constitutes the most fundamental part of our selves, it is impossible to know who we are if we cannot identify our feelings, figure out what triggers them, and learn how to modify them to achieve our goals. This enduring frustration, which stems from this primary experience of dysregulation, is an integral part of the experience of BPD.”⁵⁰

A LINK WITH THE IMMUNE SYSTEM?

Interesting hints have emerged in recent years that borderline and other personality disorders may be linked with abnormalities in the immune system.⁵¹ These ideas were first proposed by Russian scientists in the 1930s.⁵² The linkage the Russians proposed seemed so improbable, however, that it was ignored by the scientific community, even when the ideas were undergirded with more substantive research studies by George Solomon at Stanford in the 1960s. Part of the problem was that conventional research wisdom held that there was no connection between the immune and the neurological (behavioral) systems. Eventually a number of researchers discovered that the seemingly independent nervous and immune systems actually “speak” a similar chemical language that allows the two systems to interact with each other. Finding this connection has given impetus to the small but fascinating body of research that has recently been emerging in this area.

OVERLAPPING PERSONALITY DISORDERS

Borderline personality disorder often shades in with other personality disorders. One study of fifty-nine borderline patients found that all but one was also suffering from an Axis I disorder—almost 70 percent had three or more.53 The overlap with disorders such as depression, narcissism, and antisocial personality disorder can often make diagnosing the borderline into a complex chess game. If you clear up the depression, for example, will the borderline symptoms go away? Is the patient primarily suffering from antisocial personality disorder with some borderline co-symptoms? Or is he suffering from borderline personality disorder with some symptoms of antisocial personality disorder? Or perhaps the apparent overlap of disorders is just a tool employed by a compassionate doctor to obtain much needed insurance coverage.

But the traits of the different disorders overlap for good neurological reasons. Imaging studies of borderline patients as well as patients with antisocial personality, for example, show that both disorders, which share common attributes of impulsivity and cognitive dysfunction, have diminished regional cerebral blood flow in large areas of the right prefrontal and temporal cortex.⁵⁴ Both disorders also show dysfunction in the frontal cortex and limbic systems, which do the heavy neural lifting involved in processing emotions. There are differences, however, which can be more or less distinct, depending on the symptoms of the patient. Borderlines possess general functional dysregulation, along with hair-trigger amygdalae that respond to even tiny emotional cues. Psychopaths, on the other hand, can sometimes show laid-back responses in the limbic system, including the amygdala, accompanied by revved-up prefrontal areas in response to emotional stimuli. Under fearful situations, however, the limbic and prefrontal areas in psychopaths swap their activation patterns.⁵⁵ Notably, many of the “coping characteristics” of both disorders are precisely the same—projection, blame shifting, gaslighting, and narcissistic demands.

Fig. 8.11.

In the end, it is clear that human cognition is an extraordinarily slippery creature, which neuroscience is exposing as far less logical and more emotional than we had ever previously realized. This is true even for normal individuals. But for those with even a soupçon of personality disorder, it can be worse—sometimes far worse. Such irrationality can have lose-lose consequences. Not only is personality disorder associated with problematic and even sinister behavior, but it is also related to the naivete that can make relatively normal individuals such easy prey for Machiavellians.

But what is perhaps worst of all is that a person can appear entirely normal, free of any consequential diagnosis of personality disorder, yet have sometimes extraordinary deficiencies in his ability to reason. We saw this with Serbia's Slobodan Milosevic, who, it seems, fooled even himself into believing that the many wars he initiated and people killed were none of his own doing, or were trivial offenses, and that his destruction of the Serbian economy was beside the point.

But there is yet another example of a seemingly normal leader who masked deep cognitive dysfunction. A leader whose charm, duplicity, vindictiveness, and unparalleled desire for adulation, as we shall see, makes Milosevic look gentle by comparison.

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a.Many psychologists and psychiatrists prefer not to treat borderline patients, since their manipulative tactics can take a psychic toll. Ken Silk, on the other hand, is that rare therapist who truly likes his borderline patients. He understands that their inability to grasp positive emotions, combined with the pervasive and unremitting emotional distress that borderlines experience, can make their lives into a veritable prison, not only for those with the disorder, but for those who are attempting to treat or help them. Silk's ability to deal so compassionately with borderlines may stem in part from his own strong ego boundaries. I once watched a conference audience fall raptly silent as Silk explained how he deals with middle-of-the-night suicidal phone calls, telling his patients: “We are both working very hard in the sessions to decrease your suicidality. But you also need to know that I do not keep special ideas or plans at home that would make you all of a sudden not suicidal. If I had such tools, I would, of course, use them in the office. So if you are really unsafe, then you should go to the emergency room and have the emergency room folks call me. But if you are feeling suicidal but know that you can be safe until the next appointment, then thanks for calling me and letting me know and we can concentrate on this in our next session.”

b.Hitler's utter inflexibility regarding decisions he had made could be awesome. Some who tried to counter what Hitler himself called his unshakable obstinacy found that their efforts were in vain and sometimes counterproductive. Toward the end, when it was suggested to him that some things might have been done differently, he exclaimed, “But don't you see I can not [sic] change!”