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Violent Behaviors and Their Treatment

Introduction

Human violence and aggression are ubiquitous phenomena that cause substantial costs to contemporary society. Aggression is a grave medical challenge that places healthcare providers and patients at risk. It is defined as injurious, destructive, or hostile behavior frequently brought about by frustration. The treatment options for aggression include non-pharmacologic and pharmacotherapeutic interventions (Bhagat et al., 2020). Neuro interventions appear like an attractive option for treating violent behaviors for several reasons. First, they are cheap since they eliminate the potential costs of incarceration. Irritability increases violence, leading to imprisonment (Birks & Buyx, 2018). Second, neuro interventions help regulate the expression of various genes in the brain. Third, they can increase a person’s morality and empathic capability and minimize social exclusion. Neuro interventions function quickly and are highly effective in treating violence (Ryberg, 2019). Although antipsychotic medications have been applied to aggressive behaviors, a non-invasive intervention is more humane, and a better method in the future since the harmful effects of neuro interventions outweigh the benefits.

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Aggressive Behavior and Monoamine Oxidase A (MAOA) Gene

Aggression, Depression, and Violence

Aggressive behavior is a critical issue in contemporary society as it leads to multiple social problems such as theft, rape, murder, crime, and family conflicts. Violence and aggression result in adverse outcomes for individuals and society. Violence and anger may cause coronary heart diseases, while the arousal and fear caused by aggression can result in hypertension, atherosclerosis, and tachycardia. Ultimately, aggression ruins interpersonal relationships and may cause physical injuries when individuals participate in fights. Furthermore, aggression generally leads to reckless and risky behaviors like high-speed driving. Finally, aggression contributes to the worsening and onset of various mental health disorders such as anxiety and depression. In addition, aggressive behavior leads to more than a million deaths globally every year (Labonté et al., 2021). Most people turn aggressive due to biological factors such as genes and hormonal imbalance. As a result, it is critical to review how the MAOA gene is linked to aggressive behavior.

MAOA Gene and Violence

Individuals with low MAOA gene activity become more fierce than those without the MAOA gene. Neurocriminology is an emerging discipline that attempts to discover possible links between aggression, violence, criminal behavior, and genetics. Existing scholarship indicates that the MAOA gene is associated with increased levels of violence and aggression (Kolla & Bortolato, 2020). People whose MAOA gene activity is low are often hypersensitive and lack emotion when they harm others. Thus, they are more likely to be affected by adverse experiences than those who are hyposensitive (Wang et al., 2018). Furthermore, hypersensitive persons react more defensively and aggressively as opposed to those who are hyposensitive.

The MAOA gene is found in the X chromosome and primarily codes for monoamine oxidase A, a necessary enzyme responsible for controlling the amount of serotonin and dopamine in the brain. The MAOA gene is also called the warrior gene because its abnormal versions or mutations are often linked to aggressive behavior. Generally, deficiencies in the MAOA gene activity are identified to correlate with aggressive behaviors as well as other changes but are also affected by environmental factors (Checknita et al., 2020). For example, members of a Dutch kindred who displayed abnormal and violent behavior had low MAOA gene activity caused by a deleterious point mutation located in the gene’s 8th axon. Unaffected members of the same kindred did not have the mutation. Existing scholarship on investigated behavior and provocation show that people with low MAOA gene activity display higher aggression than those with high MAOA gene activity. Under comparable provocation levels, high and low MAOA activity people show similar low aggression levels. However, in highly provocative environments, people with low MAOA gene activity often display more heightened aggression than those with high MAOA activity (Chen & Chen, 2007). Furthermore, children with low MAOA genotype activity are more likely to commit a crime than those with high MAOA gene activity.

Serial Killers and The MAOA Gene

Unsurprisingly, most serial killers are found with low MAOA gene activity. Serial killers often kill more than three persons and are depicted as whites with unusual appearances and dysfunctional relationships. However, it is critical to approach the mind of serial killers openly with no preconceived assumptions. Each serial killer’s motive for the killing is unique depending on their history. Most serial killers have faced traumatic experiences that amplify their desire to portray their violent behaviors once in their life (Safarik & Ramsland, 2019). Low MAOA gene activity heightens their aggression, increasing their likelihood of committing crimes (Allely, 2020). Ultimately, most serial killers portray low activity in the MAOA gene, suggesting that genetics can identify them.

Advantages and Disadvantages of Current Neurointerventions

Drug Interventions

Regulation Of Gene Expression

Drug interventions are advantageous because they regulate the expression of various genes in the brain. The brain contains numerous genes responsible for multiple functions in the body. Biogenic amine neurotransmitters like serotonin and dopamine can be transmitted abnormally, often linked to schizophrenia pathogenesis. Antipsychotic drugs achieve therapeutic effects by ensuring biogenic amine neurotransmitters undergo normal transmission. The coordinated gene expression involved in the function and biosynthesis of biogenic anime neurotransmitters may explain why long-term antipsychotic treatment is therapeutic. Existing scholarship shows that long-term treatment using antipsychotics can change gene expression in biogenic amine pathways. Generally, antipsychotics regulate gene expressions in the brain to ensure that the transmission of specific genes is not abnormal, providing the body functions well (Chan et al., 2020). The clinical efficacy of drug interventions in aggression treatment targets the genes involved in controlling emotion and regulates them to facilitate the normal transmission of different genes.

Increase of mRNA Levels of Different Genes

Antipsychotics increase the mRNA level of catechol O-methyltransferase (COMT), monoamine oxidase A (MAOA), and monoamine oxidase B (MAOB) in the frontal cortex. Chen and Chen (2007) examined the effect of long-term risperidone treatment on COMT, MAOA, and MAOB mRNA levels. There was a substantial increase in the mRNA levels of COMT and MAOB in the rats’ frontal cortex for those injected with risperidone compared to the control subjects. Furthermore, the study investigated the impacts of long-term treatment of haloperidol, clozapine, and olanzapine on the gene expressions of COMT, MAOA, and MAOB in the rats’ frontal cortex. There was a considerable increase in the gene expression of COMT, MAOB, and MAOA following the long-term olanzapine treatment. However, with the chronic clozapine and haloperidol, there was no increased expression of COMT, MAOB, and MAOA mRNA (Chen & Chen, 2007). The findings offer fresh insights into the clinical efficacy of olanzapine and risperidone. The increased gene expression of various biogenic amine neurotransmitters after long-term treatment of different antipsychotics restores the abnormal transmission of neurotransmitters to a normal status (Palumbo et al., 2018). Each antipsychotic drug has differential regulation of expressions of various genes.

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Olanzapine and Risperidone

There are several antipsychotic drugs, including olanzapine and risperidone. Both drugs work differently depending on the area of the brain they target. Olanzapine refers to an antipsychotic medication used for treating depression, schizophrenia, and bipolar disorder (Taraskina et al., 2017). Olanzapine achieves its functions in the brain as it influences the activity of different neurotransmitters, especially serotonin and dopamine. Serotonin and dopamine are the neurotransmitters responsible for regulating perception, thinking, behavior, and mood (Thomas & Saadabadi, 2018). Psychotic illnesses are caused by disturbances in neurotransmitter activity, particularly dopamine, in the brain (Grinchii & Dremencov, 2020). Schizophrenia is mainly treated with olanzapine and is linked to dopamine overactivity in the brain. Olanzapine prevents the action of brain receptors that dopamine influences. The blockage of dopamine receptors reduces excessive dopamine activity, helping control schizophrenia symptoms. Ultimately, olanzapine acts as an antagonist on dopamine receptors by blocking potential dopamine action (Thomas & Saadabadi, 2018). Instead, it binds loosely to various receptors as well as dissociates quickly, enabling the normal transmission of dopamine.

Risperidone is another antipsychotic drug that functions by blocking the activity of neurotransmitters. Risperidone primarily acts by decreasing serotonergic and dopaminergic pathway activity, which reduces mood disorders and schizophrenia symptoms. Risperidone binds easily and quickly to serotonergic receptors as opposed to dopaminergic receptors in the human brain (Zhang-James et al., 2019). Risperidone affinity for binding to D2 receptors is lower compared to typical antipsychotic drugs that have extremely high affinity. Schizophrenia is caused by excess serotonin and dopamine activity, leading to overactivity of mesocortical and central mesolimbic pathways, respectively (McNeil et al., 2017). Risperidone temporarily inhibits dopaminergic receptors, which reduces dopamine neurotransmission, thus minimizing schizophrenia symptoms like hallucinations and delusions.

Risperidone binds temporarily and loosely to dopaminergic receptors, with a 60-70% receptor occupancy to achieve optimal effects. The rapid risperidone dissociation from dopaminergic receptors decreases the danger of extrapyramidal symptoms with elevated and permanent occupancy blockade of dopaminergic receptors. In addition, elevated serotonergic activity in the mesocortical pathways in schizophrenia leads to negative symptoms like decreased motivation and depression. Fortunately, risperidone has a high affinity for binding to serotonergic receptors, which reduces serotonin activity (McNeil et al., 2017). The blockage of serotonergic receptors decreases the danger of extrapyramidal symptoms, potentially by increasing dopamine release in the frontal cortex.

Not All Serial Killers Have Low MAOA Gene Activity

Drug interventions cannot be explicitly used in treating aggression caused by low MAOA gene activity. Drug interventions are effective, especially when treating patients with low MAOA gene activity; however, not all serial killers or criminals have low MAOA gene activity. Such evidence suggests that drug interventions alone cannot explicitly manage aggression. Indeed, it is true that not all serial killers possess the genetic predisposition for killing. Serial killers are both made and born since genetics and other factors affect their decisions to take other people’s lives. The majority of the dangerous and prolific serial killers are genetically predisposed to have antisocial personality disorders and often grow up in environments that cultivate disregard of other individuals’ lives (Malizia, 2017). Although the extent to how genetics influences serial killers, most brutal murderers often have antisocial personality disorders.

The majority of serial killers manipulate and exploit others to gain an advantage. Furthermore, serial killers disregard the feelings and rights of others, morals, and social norms. They lack empathy and show no remorse to others, and exhibit hidden hostility, aggression, agitation, and irritability. In addition, serial killers do not usually fear dangerous behaviors and situations, leading to unimportant risk-taking. Serial killers often have a history of relationships that are unstable, including friendships, parental, and romantic relations. Antisocial personality disorder’s heritability is approximately 38 percent (Raine, 2019). Heritability refers to the proportion of differential traits caused by genetic distinction but not environmental factors in a particular population. Although serial killers have antisocial personality disorder, most individuals are not brutal serial killers. As a result, heritability is questioned since many people with antisocial personality disorder simply fail at being functional humans without committing any crimes (Reid et al., 2019). The chance that an average person with antisocial personality disorder becomes a serial killer is meager, which means that heritability or genetics cannot alone account for aggressive behaviors.

Not all serial killers are affected by low MAOA gene activity. Some are influenced by other genetic and non-genetic factors. For instance, most serial killers want to find the ultimate thrill when they torture their victims. Some are driven by the adrenaline rush of catching and stalking their victims, as well as the art of perfecting their skills. Other serial killers are encouraged by the pleasure they gain when they control entirely a person’s life, including how and where they die, their feelings during their last moments, and what happens after their demise. Most serial killers feel gratified when they know they are the reason for a person’s fear. After controlling citizens, media, and law enforcement, such persons obtain deep satisfaction (Raine, 2019). The existence of other factors that influence serial killing and the probability that not every serial killer has low MAOA gene activity renders drug interventions partially ineffective.

Brain Intervention

Transcranial Direct Current Stimulation

Transcranial direct current stimulation (tDCS) refers to a non-invasive technique of neuromodulation that inhibits or stimulates a specific brain region through the increase or decrease of neuronal excitability by low and constant direct current electrodes. tDCS is a proven and effective intervention that can modify the brain’s activity, hence the increased interest among scholars. There are two types of stimulation within tDCS: cathodal and anodal motivation. Cathodal stimulation reduces or inhibits neuronal activity, whereas anodal stimulation acts as the excitement of neural activity (Stagg et al., 2018). Although it is an experimental brain stimulation, tDCS has various advantages compared to other techniques. tDCS is exceptionally cheap, safe, painless, and non-invasive. Furthermore, it can be administered quickly, and the required equipment is portable (Razza et al., 2020). However, tDCS has a widespread side effect because it causes slight itching on the scalp.

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Enhancement of Cognitive Control

First, tDCS improves cognitive control during the regulation of emotions. The capability to have mental control over one’s feelings is essential. The dorsolateral prefrontal cortex (dlPFC) is a core brain region that primarily influences cognitive reappraisal. Emotion regulation refers to different intrinsic and extrinsic processes that help modify, evaluate, and monitor emotional reactions, specifically temporal and intensive features, to achieve a person’s goals. Feeser et al. (2014) investigated the impacts of the right dlPFC stimulation after cognitive reappraisal. During downregulation, anodal tDCS led to low arousal ratings and minimal responses on skin conductance. In contrast, anodal tDCS caused high arousal ratings with improved responses regarding skin conductance. The differences between the conditions for regulation were more profound in the group with active tDCS than the one with no tDCS (Feeser et al., 2014). Such results support the idea that subjects with active tDCS conditions have increased ability to reappraise negative emotions.

In summary, the study results showed that anodal tDCS facilitates cognitive reappraisal in upregulation and downregulation. Emotional arousal was reduced or elevated depending on the condition for reappraisal. Based on the study findings, it is wise to conclude that tDCS affects the cortical excitability level because it increases the neurons firing rate in the right dlPFC (Sergiou et al., 2020). Ultimately, the study findings indicate that amplifying dlPFC activity using tDCS facilitates emotion regulation, as evidenced by alterations in arousal ratings and skin conductance response.

Improvement of Empathic Capabilities and Morality

Second, tDCS can be used as an intervention that enhances empathic capabilities as well as reduces violent behaviors in forensic offenders. The ventromedial prefrontal cortex (vmPFC) is a brain region that controls empathic abilities, and it plays an essential role in aggressive behaviors in cocaine and alcohol abusers. According to James Blair’s model, empathy can potentially inhibit violent behavior. Persons with reduced empathic abilities are motivated and susceptible to committing violent behaviors since their risk of aggression is increased. Existing scholarship shows that modulating specific brain areas could serve as an intervention for violent behaviors and substance abuse. tDCS is an example of such interventions targeting certain brain areas (Sergiou et al., 2020). Modulation enables tDCS to change certain brain functions because of increased susceptibility to facilitate and generate electrical impulses related to the brain.

Repeated brain stimulation sessions can achieve susceptibility. Functional changes in the brain caused by substance abuse in the long term improve with tDCS application, which reduces drug craving. The anodal tDCS influences emotional processes in the prefrontal cortex. tDCS can inhibit or stimulate emotional pain and strengthen empathy to painful experiences. Ultimately, existing research shows that the prefrontal cortex’s tDCS increases the feeling of empathy and morality (Sergiou et al., 2020). Furthermore, morality and empathic capability rise when the right vmPFC is stimulated.

Reduction of Social Exclusion

Third, anodal tDCS can target the prefrontal cortex, which minimizes social exclusion and the aggressive behaviors brought about by the exclusion. In addition, anodal tDCS can decrease violent behaviors when people are unprovoked and the intentions of harboring aggression. The right ventrolateral prefrontal cortex is essential in the down-regulation of emotional responses regarding social exclusion. tDCS can stimulate the right ventrolateral prefrontal cortex, which ultimately improves the down-regulation of emotional reactions regarding social exclusion (Sergiou et al., 2020). When the right ventrolateral prefrontal cortex is activated with tDCS, it induces a powerful regulation impact on social exclusion.

No Cure for All Problems and Safety

The current interventions focused on people that have low MAOA gene activity. However, a nation’s population is diverse and extensive, so not every person with low MAOA gene activity will exhibit aggressive behavior. Surprisingly, contemporary society labels such people as probable criminal offenders. People living with low MAOA gene activity and a high risk of aggressive behaviors are often stigmatized. For instance, persons with psychotic diseases such as schizophrenia are portrayed as violent, dangerous, and often stigmatized. While many people suffer from differential aggression and struggle to cope with anger and violence, most do not commit actual violence. Despite such a discovery, the pervasive image of individuals perceived as violent remains unchanged.

Furthermore, if individuals exhibit the genetic factors for aggression in prisons, they are automatically presumed to be violent and dangerous. Like any other system plagued with stigma, most prisoners and civilians who suffer from anger issues and aggressive behaviors feel unsafe because of violent people’s prejudice and negative image. Fostering a hazardous environment for civilians and the incarcerated has devastating effects on society. For instance, such people do not seek help from hospitals and other medical assistance. Instead, they are ashamed of their conditions, which may ruin their lives. When such persons do not seek treatment, violence and aggression are likely to increase and could have been prevented if not stigmatized (Sabatello & Appelbaum, 2017). It is critical to comprehend that most people with high MAOA gene activity labeled as potential offenders are humans who have simply failed to function normally. Thus, they should not be stigmatized and presumed guilty without committing crimes.

Ethical Issues

Coercive Treatment

Imprisonment is always lawful because it is provided for in the constitutions of different countries. However, neurointerventions face several ethical problems that undermine their effectiveness. First, coercive treatment undermines the principles of ethics. Coercing began in the 1920s in the narcotic farms that provided treatment for non-criminal volunteers and offenders who accepted medical interventions instead of punishment. When medical treatments are offered for penal reductions, such a phenomenon is called coercive treatment (Ling & Raine, 2018). The significant reasoning is that such treatments are coercive because they violate the validity and requirement of consent. The issue of consent in coercive treatment is highly controversial. However, consent is required to be freely given and informed. The voluntariness clause is violated when the alternative to neurointerventions is a shortened incarceration period.

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The informed consent doctrine needs a voluntary and knowledgeable decision to proceed with the proposed treatment. However, offering an incarcerated person castration to replace a long jail time constitutes a coercive practice that makes sincere and voluntary consent impossible. Similarly, offering neurointerventions for a reduced prison term does not give the offender a real choice. Rationally, people are programed to select the option that benefits them the most. However, offenders’ choosing capacity is overwhelmed when the choice involves a reduced prison sentence for neurointerventions (Ryberg, 2019). There is nothing they can do since the probability of voluntary consent is undermined.

Compulsory Treatment

Second, compulsory treatments raise the issue of moral acceptability. Many people worry if neurointerventions adhere to conventional and accepted standards. They are morally acceptable because often they are necessary for the betterment of the incarcerated and do not contradict the freedom objection. For example, an offender possesses the thinking capacity to break into a person’s home and steal their electronics. However, he does not understand the real consequences of a break-in and assumes that the act will have no stressful effects on the owner. Such a criminal would require compulsory treatment to regain his cognitive skills to think rationally. Morality is expressed as an act accepted by many people and considered right (Ryberg, 2019). Thus, mandatory treatments are only morally acceptable when they make sense in terms of the widely accepted rights and wrongs.

Treatment As Punishment

Third, neurointerventions can constitute punishments if they are appropriately imposed. The first property of punishment is the harm requirement, which argues that discipline should do something burdensome to the receiver. Punishment may cause pain, unpleasantness, and suffering. Furthermore, punishment should cause an individual to be in a bad state. For instance, compulsory treatment satisfies the harm requirement because it is undesirable to the offender. The incarcerated are compelled to complete the intervention, and some procedures may entail aspects of suffering, such as surgery (Birks & Buyx, 2018). Another property is the retribution requirement that potentially is taken because the recipient is a criminal. For instance, a person found guilty of a crime is treated using specific interventions to satisfy retribution punishment (Ryberg, 2019). Another property is the authorization requirement carried out by doctors in various treatments and punishments such as the death penalty.

Role of Physicians

Fourth, doctors and scientists are part of the criminal justice system as they play several roles and deal with legality problems. Doctors and scientists have researched new ways to carry out the death penalty. More humane methods have been implemented by utilizing medical research. However, the participation of physicians in the death penalty arouses the question of legality. Their participation is morally wrong since the act is a lethal injection which seems cruel. In addition, doctors are bound to the Hippocratic Oath, which aims to preserve human life and does no harm to patients. Ultimately, medical skills should not be utilized to fulfill outside standard clinical treatment purposes (Ryberg, 2019). Using neurointerventions in criminology could be extremely dangerous for prisoners in a dystopian future. They would be watched, their rights disregarded and forced to undertake compulsory treatments.

Better Ways

Aggressive Behavioral Control (ABC) Program

The ABC program was started at a regional psychiatric center located in Saskatoon, Saskatchewan. The regional psychiatric center is an accredited, forensic, and maximum-security psychiatric hospital in Canada. It is responsible for providing high-intensity treatment programs focusing on cognitive behavioral therapy. The intervention is designed for high-need and high-risk offenders, particularly those showing low responsiveness to rehabilitation. Its duration is approximately six to eight months and is efficient for chronically and impulsively aggressive lawbreakers with an extensive history of violent crimes. The ABC program has high levels of success as overall criminal recidivism is reduced among those treated (National Gang Center, 2021). Thus, the intervention can potentially reduce criminal recidivism among the incarcerated. Furthermore, the program identifies the risk factors of aggressive behavior, helping society understand the phenomenon.

Family Tree

The intervention is based on the association of MAOA gene and environment interactions, antisocial behavior, and maltreatment exposure. The MAOA gene is essential in studying gene and environment interactions among people who face childhood maltreatment. Those with low MAOA gene activity and who were maltreated during their childhood had a high chance of reporting antisocial behaviors. Other outcomes reported by the same individuals include conduct disorder symptoms, hostility, and violence. Generally, the study shows that people with low MAOA gene activity are responsive to childhood maltreatment and exhibit antisocial behavior (Fergusson et al., 2011). As a result, an intervention can be formed based on family traits. Despite being non-invasive, the intervention creates stigma.

Conclusion

Although antipsychotic drugs have been applied to aggression treatment, a humane and non-invasive method is better since their drawbacks outweigh the benefits. The MAOA gene is linked to aggressive behaviors since people exhibiting low gene activity depict extreme violence. Drug and brain interventions effectively treat aggression; however, they cannot eliminate all problems. Furthermore, not every individual with low MAOA gene activity commits a crime. In addition, current neurointerventions have several ethical issues of morality and legality. Better aggression interventions include the ABC program and the family tree.

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