I’m going to put forth informed conjecture about what I think may be happening within a particular subpopulation of COVID-19 sufferers. By no means do I mean to say that all persons affected by Covid will be so affected, or even all those who have subsequent (i.e., Long Covid) complaints of neurological sequelae. But I do mean to posit that a significant number of people are affected and so implicated, and we should consider what this means for our society going forward.
My caveats: My background, academically speaking, is in social science, specifically sociology (my specialty is American studies). However, for the last two decades I have had more than a passing interest in neuroscience (primarily in psychopharmacology and branching out from there); and ever since the onset of Covid, I have delved into the neural manifestations of the disease.
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Now, in regards to sociology, I have in the past few years expanded my focus to include social psychology, both as a means to itself as well as using it as a bridge to enter the plane of psychology as a field more broadly. The main reason I did this was to truly try to understand the central draw and the structure of the movement surrounding Donald Trump (that is, MAGA). I saw the movement as a unique social growth, but a malignant one; and for that, I needed to know more about the manner of the psychology of social movements in general as well as individual psychology in particular, and how these two interact as a whole.
I recognized, over time, that MAGA operates both as a formalized group (as it utilizes the structure and mechanisms of a political party, with all of its attendant organizational interactions) as well as what a layperson would call a cult.
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In sociology, cults are known alternatively as high-intensity or high-demand groups. These high-intensity groups are usually commanded in a pyramidal structure, with one leader (rarely a very small group, such as a triumverate) commanding a top-down organization. Often regarded as charismatic, in the best of times this person is seen as a visionary; however, more often than not, this pyramidal structure becomes susceptible to those more power-hungry or unstable. That is, it tends to attract social predators, those we would term psychopaths.
Psychopaths have been called “wolves in sheep’s clothing” as they tend to hide among us, chameleon-like; and in fact they disarm those around them by their superficial or glib charm. Often driven by a desire for power or social reward (such as money, prestige, or sex), these social predators, if successful, can end up in positions of high regard in our society. It is estimated that in the general population, psychopaths comprise about 1%; however, it is further estimated that in corporate positions and other platforms of power, psychopaths make up approximately 4%.
I recently penned a diary about Vladimir Putin after his invasion of Ukraine, titled Psycho, as opposed to psycho. There, in an off-hand manner, I called attention to the fact that in everyday parlance most people tend to confuse or conflate the term “psycho” as an abbreviation for both psychopathic and for psychotic. This distinction is important, because even the Atlantic in an article this week about Covid-19 did the same thing. Let me disambiguate the terms, and then I will explain why I am bringing the terms up in the context of Covid.
Psychopathy is not listed as a separate personality disorder in the DSM-V (Diagnostic and Statistical Manual of Mental Disorders, Fifth edition), although it did appear in much older editions; indeed, a firm definition of psychopathy is still in search of firm consensus in the psychiatric field. However, it can be considered as an extreme version of anti-social personality disorder. The DSM-V states, “The essential feature of antisocial personality disorder is a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood. This pattern has also been referred to as psychopathy, sociopathy, or dyssocial personality disorder.”
It’s important to realize that while nearly all psychopaths can be diagnosed with having ASPD, only about 30% of people who have been diagnosed with ASPD could be considered psychopathic. (The logic resembles that of “all cats are mammals, but not all mammals are cats”.)
As far as consensus does exist, there are three general aspects of the disorder.
- They exhibit fearless dominance.
- They lack empathy. This is also described as coldheartedness or callousness.
- They use instrumental violence (as opposed to reactive or “hotheaded” violence) to get what they want.
(To the last point, psychopathic individuals also use reactive violence. R.J.R. Blair, an expert in the field, states, “The only clinical condition associated with an increased risk for instrumental aggression, psychopathy, is also at elevated risk for reactive aggression. Notably, the clinical description of psychopathy emphasizes an individual with reduced empathy but intact or possibly exaggerated anger.” Instrumental violence is a hallmark of the disorder.)
Among psychiatrists, there is a rough division of psychopathy into two categories, that of primary psychopathy, viewed as having a biological basis and/or as beginning in very early development of the child’s personality, and secondary or acquired psychopathy, seen as a reactive formation resulting in the wake of environmental deficits or disorder (trauma, severe neglect, etc).
Often, the acquired form may be outgrown by the end of adolescence, which is why the diagnosis of ASPD cannot be given until after the age of 18. Still, a persistent 5% diagnosed with the precursor of conduct disorder will continue on with their antisocial behaviors, which at that point ASPD will be conferred.
Jennifer Skeem and colleagues, in their 2011 66-page monograph “Psychopathic Personality: Bridging the Gap Between Scientific Evidence and Public Policy” collating studies on psychopathy, note that neuropsychologists have noted several areas of the brain that are involved, or have been implicated, in the neural basis of psychopathic behavior. (For context, PCL-R refers to the Psychopathy Checklist Revised, devised by Robert Hare as a measure of psychopathy particularly within the prison population.)
Most such [neuroimaging] research with adults has either compared groups selected to be low or high in overall PCL-R psychopathy in volume or functional activation in particular [brain] regions. These studies have often revealed a wide variety of structural or functional differences in high PCL-R psychopaths, most notably in the amygdala, hippocampus and parahippocampus gyri, anterior and posterior cingulate cortex, striatum, insula, and frontal and temporal cortex. (Psychological Science in the Public Interest, Vol. 12, No. 3 [December 2011], p. 114)
This would have bypassed my attention completely, except for the last six months or so I have been immersed in the nitty-gritty of neuroanatomy, trying my best to come to grips with the nuts and bolts of the neurodysfunction that can result as complications following Covid-19 infection. Just within the last month, the journal Nature published a landmark study where patients of the UK Biobank who later contracted Covid had already had MRIs on file; the scientists were able to not only match these patients demographically with healthy controls, they were able to compare each of these patients, before and after, to their own brains.
As I mentioned in a previous diary about the results, “the study authors detail the top ten areas affected by the virus, according to the imaging. They include ‘the anterior cingulate cortex, orbitofrontal cortex and insula, as well as the ventral striatum, amygdala, hippocampus and parahippocampus gyrus[…], the frontal and temporal piriform cortex, as well as the olfactory tubercle and anterior olfactory nucleus.’”
These show direct correspondence with those areas implicated in psychopathy.
Shared Brain Areas
|
Psychopathy |
Covid-19 dysfunction |
Amygdala
|
✓ |
✓ |
hippocampus |
✓ |
✓ |
parahippocampal gyrus |
✓ |
✓ |
anterior cingulate cortex |
✓ |
✓ |
posterior cingulate cortex |
✓ |
|
striatum |
✓ |
✓ |
insula |
✓ |
✓ |
frontal cortex |
✓ |
✓ |
temporal cortex |
✓ |
✓ |
olfactory tubercle |
|
✓ |
olfactory nucleus |
|
✓ |
cerebellum |
|
✓ |
For reference, please see at right a diagram noting select structures involved in addiction; many shown are also implicated in psychopathy. I present the diagram to note their nearby or contiguous nature. (For a 3-D tour, you can view this YouTube video.) Also realize that the striatum (along with the ventral medial prefrontal cortex) is especially recognized as being involved in psychopathy when the region is damaged and that “the entire cerebral cortex projects to the striatum.”
Again, I want to stress that this overlap does not necessarily mean that those who have cognitive issues following Covid-19 infection are suffering from a form of acquired or environmental psychopathy. But I am suggesting that some indeed may. We have been trying for the last two years to put into context the rise in aggressive and frankly antisocial behavior seen in various parts of the general population. We have, at the same time, seen an environmental hazard settle over not only the nation but the globe that has had widespread and in some cases devastating physical consequences. I am positing that some of that irregularity could be traced to physical substrates as sequelae of the disease.
By the by, approximately a quarter of those who contract Covid report some neurological symptom, and the UK Biobank study shows that this is true even of those who experience “mild” forms of the disease.
The Atlantic’s error of conflation
Just this week, Olga Khazan of the Atlantic published an article on Covid-19, called “Why People Are Acting So Weird,” and therein she lists several general ideas as to why behavior has gone somewhat haywire since the onset of the pandemic. She brings up stress, stating that “rudeness can be contagious”; she also lists rising rates of alcohol use and abuse, as well as the unprecedented level of isolation brought upon us by the sheer circumstances of the pandemic. These are in fact societal phenomena that may be exacerbating the trends in antisocial behavior we are seeing, and she is right in highlighting them. However, she goes further in her description of Covid psychosis.
It has been documented more and more solidly that Covid-19 can precipitate episodes of psychosis, which can be defined as a psychological break with reality. This is an internal error of perception, where the sufferer may experience an onset of unusual beliefs, concomitant with hallucinations (often auditory or visual, but any sense data may show corruption—sometimes a person suffering from psychosis may feel tactile hallucinations, like bugs crawling under their skin). Many times the person will have a sense of grandiosity or, alternatively, persecution or paranoia. They will present with disorganized speech or disorganized behavior. Psychosis is often seen in the context of either schizophrenia or mania and in the latter case can be accompanied by a sense of euphoria.
Skeem and associates state that it is common to conflate psychosis and psychopathy, saying,
Although psychopathic traits can occur in some cases in conjunction with psychotic symptoms[,] people with psychopathy alone generally look quite different than those presenting with psychosis only. In contrast with psychotic patients, psychopathic individuals are generally rational, free of delusions, and well oriented to their surroundings[,] and those who commit crimes are almost always aware that they have done wrong in the eyes of the law, despite their apparent inability to appreciate the moral gravity of their misbehavior.
Yet Khazan does just this as she attempts to present reasons as to why Covid-19 should not be seen as directly contributing to this mass aberration. She states plainly—in a header!—that “mental illness cannot explain this.”
Some of the strange behavior that has attracted the most attention seems to involve people suffering from delusions or hallucinations. A few weeks ago, Twitter seized on a story of a flight attendant who subdued an unruly passenger by hitting him on the head with a coffeepot. It was a moment of seeming righteousness, of a jackass getting what he deserved. But the fuller story is more disturbing: The man told flight attendants that “people were attempting to hurt him and they followed him on the plane” and that “he heard the individuals harming his family over the telephone.” The man who shoved a woman in front of a train at Times Square in January—another incident widely cited as an example of the uptick in assaults—showed symptoms of schizophrenia and had spun through a cycle of jail stints, psychiatric hospitalizations, and discharges to the streets.
The pandemic has had some measurable effects on mental health. Though the most common issues among people who contracted COVID-19 were anxiety and depression, a small percentage of people infected with the coronavirus appeared to develop psychosis for the first time. [...]
The majority of people with mental illness, though, are not violent. Most people with mental illness who commit violence have other problems, such as anger issues, substance abuse, or a recent trauma. People with severe mental illness are only a tiny percentage of the population, and past research shows that they commit only 3 to 5 percent of violent acts, so they couldn’t possibly be responsible for the huge surge in misbehavior. According to the FAA, 72 percent of unruly-passenger incidents last year were “mask-related,” suggesting that they have more to do with politics than paranoia. Regarding the people causing scenes, “I think those are assholes,” said Tom Insel, the former director of the National Institute of Mental Health and the author of Healing. “It’s so important to distinguish people who have a mental illness from people who just do egregious things.”
She is exactly right that mentally ill patients are not known for being violent. While about 3-5% of the population at large can be classified as having a mental illness and they only commit about 5% of violent acts, psychopaths on the other hand, while comprising only about 1% of the population, commit about 50% of violent crime (mainly due to recidivism). The error she commits is to focus on the very concerning but relatively minor phenomenon of Covid psychosis and extrapolate it to encompass the whole of possible misbehavior possibly owing to Covid complications. This is simply a logical error but a severe one, as she has presented this argument to a wide audience in a respected journal with a broadly accessible platform.
Instead, what the rise in antisocial acts may point to could be the onset of dysexecutive syndrome (due to damage to the ventromedial prefrontal cortex), disinhibition syndrome (via damage to the orbitofrontal cortex), or a combination of both, in people who otherwise would have been subclinical or subsyndromal for these conditions in the absence of Covid or other activation of neurodegeneration. These people may have remained within the bounds of normal had not it been for Covid causing interference in their ability to put brakes on their behavior. These people may have been your garden-variety “assholes” in 2019, but they are more than that today.
The takeaway
What I mean to impress is that we’ve never seen a disease like this. It’s novel. From the beginning, with the horror of ground-glass lung, we have been aware that Covid could be seen as potential contagious organ disease, and with Long Covid we’ve acclimated to the idea of the disease being potential contagious organ damage. With the news from the UK Biobank in March, we have learned that Covid could be understood as potential contagious brain damage. And now, what I hope is that you will begin to consider Covid as potential contagious brain disorder: long-lasting, with the underlying damage (in the case of demyelination of oligodendrocytes) possibly irreversible.
This is not to say that Covid will transform a nation into instant violent offenders. What I am saying is that, in those people who were right on the edge of controlling their behavior in the first place, this could trip the wire. (And, as we’ve already seen, there is a conspicuous segment of the population where the disease ultimately has been concentrated.)
Thursday, Apr 7, 2022 · 2:41:30 AM +00:00 · novapsyche
Tonight I was able to locate a more precise schematic of areas of the brain that are particularly affected in psychopathy. The figure comes from a talk given by James Fallon, a neuroscientist who by chance found out in the course of his research that he himself has a “psychopathic brain”.