Guilty or ill? A crime problem or a health problem?

At one time, mentally ill people, with their often anti-social behaviour, were locked away in what were little more than prisons. Eventually our understanding of mental illness improved and allowed us to advance beyond this barbaric practice. Now we may be on the verge of yet another advance in both our understanding of and our reaction to anti-social behaviour.

Studies on impulsively violent men and psychopaths show that their brains are different from those of normal people. Brain imaging technology reveals that the amygdala, the part of the brain that processes emotions and aggression, and the orbitofrontal cortex, which handles impulses and decisions, are structurally and functionally different in psychopaths. Furthermore, levels of serotonin, the neurotransmitter that regulates aggression and impulsivity, are generally low in these people. To put it simply, their brains don't work right.

It may be hard for us to accept, but the fact is that the impulsively violent and the psychopathic are victims. They suffer from a mental handicap. They are no more responsible for their condition than a crippled man is for his crooked leg, and they are no more responsible for their antisocial behavior than he is for his limp. When they harm others, how are they more guilty of a crime than someone who has a contagious disease who unknowingly spreads it to others? Their disorder is much worse, of course, because it robs them of their basic humanity.

When they pose a threat, they must be sequestered from society, but should they be imprisoned or hospitalized? We can legally detain people with contagious diseases. It's called quarantine. It would seem reasonable to do the same with the dangerously antisocial. We have long had mental institutions for the criminally insane, but their incarceration has always depended on an arbitrary definition of "insane," specifically, knowing right from wrong. Well, psychopaths know right from wrong, at least in the legal sense, yet they too are "insane." They, too, are not responsible for their actions, or at least only marginally so. They do not have free will. (Of course, maybe none of us do, but that's another question entirely.)

This new knowledge offers real promise. If these people suffer from mental conditions, we can develop ways of treating them. By therapy, with drugs, perhaps even with a computer chip in the orbitofrontal cortex. We might eventually be able to turn a serial killer into a perfectly normal human being. Courts and prisons could be replaced by medical treatment just as the old asylums were.

This would be an enlightened age, but it would throw many of our concepts about justice into confusion. The desire for vengeance is very powerful. If a serial killer was cured, if he was literally a different person free of antisocial urges, what would be the point of incarcerating him? And if he were allowed to walk freely amongst us, how would we sate our desire for vengeance, particularly that of his victims?

And then there would be the question of our right to engage in mind control. How far might some in authority want to go in controlling the minds of "anti-social" citizens?

We might do well to ponder these questions. We see promise of knowledge that could revolutionize crime and punishment, and offer us much safer societies, yet offer us also moral challenges we haven't yet faced.