Confessions of a Pro-Social Psychopath: Physicians, Your Quirks Are Key to Greater Professional Fulfillment

We all have quirks–a tendency to dominate, criticize, become inpatient, act as if our judgment is the best, or overlook the needs of others. Some of these helped us survive training and early professional life. But later on they may interfere with the team play and communication necessary for professional fulfillment.

These behaviors endure because our training doesn’t emphasize effective communication and how to get along with others. It encourages us to think independently, master facts, and become technically competent – sadly, in an atmosphere of intimidation that promotes insecurity and low self-esteem. So we may be out of touch with how our behavior, such as impatiently sighing, “Just give me the chart,” affects a nurse who is attempting to offer input.

So modifying some of your quirks may lead to improved communication with patients, colleagues, and your staff. It may bring you greater professional fulfillment as well. That’s what neuroscientist James Fallon, MD learned when insight into some of his quirks prompted him to change how he related with people.

Fallon always thought of himself as “a pretty average guy.” A father of grown children and still married to his high school sweetheart, he continues to work like a “hobbit” at his profession of forty years. He studies connections of the brain at the University of California-Irvine. But after stumbling upon some troubling findings in his own brain and encountering the shadow-side of his pedigree, Fallon changed some of his quirks.

Previously, after analyzing PET (positron emission tomography) scans of the brains of serial killers, Fallon developed a theory that the frontal lobes of these psychopaths were abnormal in the area where morality and “animal instinct” are processed. As result, he says, an area of the brain takes over that drives id-type behaviors such as “rage, violence, eating, sex, and drinking.”

As part of his work, Fallon compared normal PET scans–even those of his family members–with those of psychopathic killers. “Everything was going along just fine,” “I was going through the pile of my family’s PET scans,” he says. “And every one was normal. Except for one, which had no activity in critical areas of the frontal cortex. I looked down and it was me.”

Used with permission of James Fallon

Used with permission of James Fallon

[PET scan sections of Fallon’s brain (right) reveal less activity (more darkness) in the orbital cortex (region of the brain just above the eyes), compared to a normal scan (left). The orbital cortex processes moral decisions and impulse control]

About that time Fallon’s mother heard he was investigating brains of serial killers. She suggested at a family barbecue that if he looked into his own family pedigree he might find some “cuckoos.” He did: it was loaded with violence and “killers.” One of his great-grandfathers, Thomas Cornell, was hanged in 1667 for killing his mother. Seven other Cornells, including an ax-wielding “Lizzie,” were alleged murderers.

So Fallon analyses the DNA in blood samples of 10 close family members. He looks at 12 genes in the DNA that are associated with aggression and violence. In particular, he looks at the MAO-A (monoamine oxidase A) “warrior gene” gene. His DNA is loaded with it and lacking in “cuddling genes.” His brain may therefore not respond to the calming influence of the neurotransmitter serotonin.

“I’m a born killer,” Fallon wryly concludes, based on his family history, abnormal PET brain scan, and presence of the warrior gene.

Still, he didn’t consider himself psychopathic. So he asks family and colleagues for their impressions. The news isn’t good. Everyone says things like “You’re superficially glib and good at parties (but) you don’t connect to people – you’re kinda cold.” Many say they tolerate him mainly because he is an interesting guy to be around.

“Of course,” jokes Fallon, “Being a psychopath, I didn’t care. There’s really a constant number of these in all societies. Maybe society really needs them … Do we really want our surgeons to be empathic when they are doing surgery, or do we want them to be cold and calculated? Do we want our Green Berets to be empathic–or protect us?”

Ultimately, Fallon changed some of his behavior, even though that doesn’t come naturally for him.

Now, he calls himself a “pro-social psychopath” and practices “just playing the part.”
“Just being a good companion and a friend – that’s where I am now.”

So physicians, examine your quirks. Maybe start just playing the part. Consider:

Becoming more attentive to others
Inconveniencing yourself to take care of a few of the needs of someone close to you
Remembering other’s triumphs and tragedies
Dawdling at the table after a meal
Practicing saying, “I must have made a mistake” or “I’m sorry.”

To listen to Fallon’s intriguing account of self-discovery and change, “Confessions of a Pro-social Psychopath” on the National Public Radio Moth Radio hour, go to: http://themoth.org/posts/stories/confessions-of-a-pro-social-psychopath

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