UP ON A HIGHER LEVEL

Is a Brave New World approaching where violence and aggression can be cured with medication like any other illness? This could be the outcome of the latest research unravelling the mysteries of the brain chemical serotonin
Click to follow
The Independent Culture
You may not realise it but you almost certainly know someone who takes a prescription drug (such as the highly publicised Prozac) to raise the levels of a brain chemical called serotonin. At present, your friend or colleague probably takes the drug for depression, eating disorders or obsession but it now looks as if it could also be employed to prevent violence as well, with dramatic implications.

On the one hand, the new research holds out the hope of a cure to one of our nastiest social ailments - the inexorable rise of violence. On the other, civil rights are at risk with resonances of a Brave New World in which aggressive children are chemically restrained from as young as age five. The new possibility asks tough questions of our politicians.

First identified in the 1940s, serotonin is just one of thousands of chemicals found at the place in the brain where physics and chemistry meet, the synapse. The synapse is a gap between the neurones down which electrical impulses pass. When the current reaches the end of a neurone it causes a chemical reaction in the synapse. Chemical messengers - including serotonin - are dispatched and pass a message to the next neurone, which fires off the next electrical impulse, and so on.

Serotonin is crucial in carrying messages that damp down and inhibit our animal selves - sex, hunger, aggression. People with low levels of the chemical suffer from a variety of problems, including depression, eating disorders and obsession, and drugs such as Prozac are used to raise the levels.

Most people imagine that if a chemical is implicated in some behaviour - be it violence, depression or sexuality - then it must be caused by genes. Chemicals cause other chemicals, right? Wrong. It is just as possible that the level of our brain chemicals is set by what is done to us, by our environment, not what we are born with.

In the case of serotonin levels, it seems they are largely determined by nurture and current circumstances. A study in Edinburgh reported last month that only 10 per cent of cases of low serotonin among depressives are caused by genes. Genes also play little part in causing the low levels found in violent men. The majority of evidence suggests it is the social environment which is crucial in determining serotonin levels.

Winning and losing - and therefore cultural and economic inequality - have a direct effect on serotonin levels. Winning raises levels, losing lowers them. Studies of rats and monkeys show that their serotonin levels can change from minute to minute according to social status. Dr Klaus Miszchek in Washington DC measured levels before a fight between two rats. The winner's serotonin was found to have risen and he was put up against a stronger rat, which beat him. The new winner then faced a Super Rat, which beat him and so on: serotonin levels rose and fell depending on success or failure.

Studies of vervet monkeys also show how much levels are effected by the environment. Vervets are very hierarchical - especially the males. Low- status ones face a beating unless they defer to high-status ones if there is a dispute over a scarce resource - like access to females.

This social hierarchy is mirrored by a chemical one: the higher the status of the monkey, the higher its serotonin levels. Most telling of all, before the high-status male has risen up the hierarchy, his serotonin levels are average. The high levels are not genetically inherited.

This chemical hierarchy is found in humans. Social winners are likely to have higher levels than losers. Students who become officers in American university clubs have higher levels of serotonin than non-officials. Team leaders in sport have higher levels than team-mates.

The social groups most likely to have low levels tend to have suffered negative experiences. Women who are most likely to be depressed have three or more children, have minimal social support, lost a parent before age 14, and have a low income. In one large survey, 100 per cent of women with all four of these risk factors were depressed. Daughters who have been abandoned by their fathers were found to have lower levels than girls from intact families.

The typical violent man has usually had the most negative environment imaginable, starting in childhood. "After bedtime, if we dared make one sound, me father'd come flying upstairs and give us a good thumping. Imagine a child getting hit by a father what's going on for 30 stone - he hits with a considerable force." The speaker, Peter Fanson, went on to murder his father.

Most violent men have been persistently attacked in this incomprehensible and random pattern as children and have been the object of a steady flow of negativity from parents and teachers. Their parents are very likely to have low incomes and when they grow up, violent men also have low-paid jobs, if they have one. The low monetary value placed on their labour is reflected in low self valuation - three-quarters suffer symptoms of depression as well.

Although no one has tested the idea directly, it is almost certain that on average the poorest sectors of society have lower levels of serotonin than the richest. The levels are an effect, not a cause: an effect of social systems. They are one indicator of the degree of inequality in a society. It stands to reason that the more low status people there are in a given society, the higher the proportion that will have low serotonin levels and therefore, be violent and depressed. By controlling degrees of inequality, governments play a major role in determining the serotonin levels of their citizens, the chemistry of their brains.

Inequality in Britain has risen dramatically since 1979. The government's own figures prove that one quarter of Britons were living with an income of less than half the average in 1991-92, compared with nine per cent in 1979. The real income of the poorest 10 per cent of Britons fell by 17 per cent during this period compared with a 62 per cent rise in real income for the wealthiest 10 per cent.

Not surprisingly, the amount of both depression and violence since 1979 have increased accordingly. A study of the general community by Professor Glyn Lewis of Cardiff University revealed that in 1975, 22 per cent were found to be sufficiently emotionally disturbed to warrant a diagnosis of "psychiatric morbidity" (mostly symptoms of depression). When the study was repeated in 1985, the proportion had risen to 31 per cent. Even more alarming has been the acceleration in the increase in violence, from an average of 4,000 more crimes of violence against the person a year between 1980 and 1986 to an average increase of 11,000 more crimes between 1987 and 1994.

Recent research has shown that violent people prone to impulsive aggression - unpredictable anger attacks and unpremeditated assaults - have low serotonin levels. Although the idea has yet to be properly tested, leading researchers now believe it is only a matter of time before violent men and boys are routinely treated with drugs.

In America the very notion has already caused a major row. Critics pointed out that criminal violence is far more common among poor people and since most of the nation's Blacks (who make up 10 per cent of the population) are poor, the main recipients of any drug initiative against violence would be black. Calmer analysis of the evidence suggests that the new evidence should be welcomed, if cautiously, by Left and Right alike.

American Army scientists in the late 1970s first discovered the connection between low serotonin and violence while studying servicemen who were habitually violent. Subsequent studies showed how low levels in violent prisoners successfully predicted the ones who were most likely to re-offend on release.

The relationship extends. When levels in a sample of ordinary people were lowered experimentally, they became more likely to administer electric shocks to strangers (who were in fact actors pretending to be shocked). A study at the Institute of Psychiatry in London suggested that normal people prone to irritability have lower levels than calm people.

Low levels go back to childhood and have been found in children who torture animals, are hostile towards their mothers, and who have a high score in aggression tests. Serotonin levels in childhood predicted which of 29 disruptive eight to 10-year-old boys would be the most aggressive two years later.

Given that there are several drugs that raise serotonin levels - often without side effects - the obvious practical implication of this research is to ask what would happen if levels of serotonin were raised by drug treatment. Would the impulsiveness and aggression fall as a result?

The first studies were done on rats and monkeys. Left to their own devices, rats are liable to launch unprovoked and sudden attacks on mice (known as muricide). Rats with low levels of serotonin are more likely than ones with high levels to be muricidal. Muricidal rats with low serotonin levels were injected with fluoxetine, the key ingredient in the antidepressant Prozac - effective at raising serotonin levels. Sure enough, they became less muricidal when given the drug. When levels were raised using other species, the result was the same.

What about humans? As long ago as the Seventies it was shown that prescribing the drug Lithium reduced aggression, at least in part because of its effect on serotonin levels. In the mid-Eighties a drug named BuSpa was proven to reduce violence in mentally handicapped patients by raising serotonin levels and it is still commonly used for this purpose. Two studies of depressed patients showed that they were less prone to anger attacks when given Prozac.

However, research on humans encountered a setback in 1992 which is mainly responsible for the lack of progress today. A scientific paper suggested that serotonin enhancing drugs - most notably Prozac - could cause suicidal and homicidal behaviour. Soon afterwards, further studies showed these claims to be false but the damage had been done. Solvay Duphar, a company which had begun a research programme to develop "serenic" drugs to treat violence, hastily abandoned it. It became impossible for researchers to get funding.

"I cannot think of a single drug company that's got a research programme in this area today. The drug companies were scared off by the publicity," says Ted Dinan, Professor of Psychopharmacological Medicine at London's St Bartholomew's Hospital.

The only study currently being done is by Dr Emil Coccaro in America. He has been following 40 impulsively aggressive men and women over the last four years, and said: "They are the sort of people who may fly off the handle for no apparent reason. They start screaming and shouting hysterically when in traffic. They get violent - women as much as men - towards their spouse and may throw things."

The results so far clearly show that taking Prozac makes this kind of behaviour much less common. "One guy was a comedian but when hecklers got to him he would charge down off the stage and attack them. He was losing gigs and in danger of being banned from the circuit until he took the drug that raised his serotonin levels," says Coccaro.

A definitive study would be needed to prove Coccaro's case with regard to violence. A large group of impulsively violent men would be given a serotonin-raising drug and the degree of their aggression be compared with an equivalent group who believed they were also being given the drug (they would be given a placebo).

Professor Dinan predicts: "Those on the drug would become less impulsive than those not on it - the only question is by how much more. If the results were as impressive as seems likely, the widespread introduction of such treatment could have a major effect on violence statistics. The Medical Research Council (the British government research body) should fund the study if the drug companies won't."

Most psychiatrists emphasise that the drugs would be used in combination with therapy as well and that violent men would never be forced to take them. The drugs are not like barbiturates (such as Valium) which dull the senses; if anything, they make users more alert and realistic. They are totally non-addictive.

Based on their experience of treating violent men already, clinicians such as Dr Veronica O'Keane, a liaison psychiatrist in Cambridge, are confident the approach would work. "A man came to me after he had seriously hurt his wife - given her a real beating. He felt terrible about it and wanted to change. The drug helped him to drink less and his violence ceased."

Alcohol lowers serotonin levels. When these are raised by serotonin enhancing drugs, alcoholics drink less. Since three quarters of violent men are heavy drinkers and invariably commit crimes under the influence of drink, serotonin treatment of violent men would in many cases double up as a treatment for heavy drinking.

Not everyone is convinced that drug treatment would be practical. Although Professor Malcolm Lader of London's Institute of Psychiatry agrees the pills would reduce impulsive aggression, he sees major potential pitfalls: "Would young men actually take the drugs or just pretend to, perhaps to satisfy probation officers or court orders? A lot of them might not be motivated to do so if they suffered side effects. Sexual problems like delayed ejaculation and even impotence are quite common; they would be completely unacceptable to most young men." This could rule out as much as 30-50 per cent of men taking the drug.

However, Lader admits there are drugs (such as Lustral) available that have fewer side effects and he is convinced that within 20 years there will be side-effect-free drugs available.

These practical objections are anyway as nothing beside the public and political outcry that might accompany a widespread drug programme. The reason goes back to personal and political basics. That serotonin levels are mainly caused by the environment challenges both Right and Left, geneticists and environmentalists. The Right and the geneticists (who often band together) are forced to rethink their claim that the status quo is caused by inevitable evolutionary, genetic processes.

The Left argues that the best way to change serotonin levels would be to reduce economic inequality. Using drugs is seen as an unnatural, side effect filled substitute for social change. Pills - however wonderful - would never be preferable to striving for a more equitable society in which everyone feels good "naturally".

When I contacted his office, Jack Straw MP, the shadow Home Secretary refused to offer any comment on the possibility of drug intervention. Perhaps the use of pills to reduce violence is too hot a potato to even talk about.

Like him, most British people - not just the Left - find the idea of taking prescription drugs to change mental states unattractive. We are perfectly happy to change our natural state with vitamins, alcohol or even marijuana but the idea of using mind altering drugs other than as a stimulant is abhorrent.

Yet, according to our leading psychiatrists, we should all be open to the potential of these pills. "I feel that socialists should be in favour of testing the drug-treatment-of-violence thesis out - it may be the best chance some young men will get. Less aggressive and depressed, they would be better able to take advantage of educational and job opportunities," says Dr O'Keane.

Another major problem is the strong gender bias when it comes to drug prescriptions. In 1995, there were 4.1 million prescriptions for antidepressants made out to women, compared with only 1.5 million for men. Nearly one half of low income mothers are prescribed psychoactive pills (tranquillisers and antidepressants) by their doctor at some point in their lives. Little is heard about this fact yet uproar greets talk of their husbands and sons also receiving drug treatment. Apparently it's alright for women to take these pills but for some reason if young men do so, it connotes George Orwell's 1984.

The political fears multiply the younger the age that drug intervention is proposed. It is now possible to predict which six-year-old boys will become adult criminals with about an 80 per cent accuracy. Targetting could be highly effective in cutting violence. To date, there have been no studies directly testing if serotonin drug treatment of children reduces aggressiveness. An American study of 96 eight to 17-year-old depressives revealed that raising their serotonin levels with drugs relieved the depression.

Although it is rarely mentioned, there is anyway already widespread use of drugs to treat conduct disorders in British children. An amphetamine- like drug called Ritalin is used to treat aggressive, hyperactive children.

Dr Eric Taylor of the Maudsley Institute is Britain's top researcher in this field. "Insofar as Ritalin enables many hyperactive children to concentrate and to make use of educational opportunities, sometimes without any side effects, socialists can no more afford to ignore it than other kinds of politicians."

Oliver James is a clinical psychologist and the author of 'Juvenile Violence in a Winner-Loser Culture'. His next book is entitled 'The Way We Live Now: Conquering the Chemistry of Despair'.

Is there a Brave New World approaching where violence can be cured with medication? This could be the outcome of new research unravelling the mystery of the brain chemical serotonin

Comments