Crime & Punishment, morality in MS

Soc Neurosci. 2017 Jun;12(3):308-329. doi: 10.1080/17470919.2016.1175380. Epub 2016 Apr 20.

Elevated moral condemnation of third-party violations in multiple sclerosis patients.

Patil I, Young L, Sinay V, Gleichgerrcht E.


Recent research has demonstrated impairments in social cognition associated with multiple sclerosis (MS). The present work asks whether these impairments are associated with atypical moral judgment. Specifically, we assessed whether MS patients are able to integrate information about intentions and outcomes for moral judgment (i.e., appropriateness and punishment judgments) in the case of third-party acts. We found a complex pattern of moral judgments in MS patients: although their moral judgments were comparable to controls' for specific types of acts (e.g., accidental or intentional harms), they nevertheless judged behaviors to be less appropriate and endorsed more severe punishment across the board, and they were also more likely to report that others' responses would be congruent with theirs. Further analyses suggested that elevated levels of externally oriented cognition in MS (due to co-occurring alexithymia) explain these effects. Additionally, we found that the distinction between appropriateness and punishment judgments, whereby harmful outcomes influence punishment judgments to a greater extent than appropriateness judgments, was preserved in MS despite the observed disruptions in the affective and motivational components of empathy. The current results inform the two-process model for intent-based moral judgments as well as possible strategies for improving the quality of life in MS patients.

In his novel Dostoyevsky says that "it takes something more than intelligence to act intelligently".

Patil and colleagues state that in MS that there are problems not only with intelligence per se, but also with emotional/social intelligence. They state that previous studies have found impairments in the capacity of PwMS to represent others epistemic states (i.e. thoughts, beliefs, desires etc.), and these are apparent even after controlling for co-existing impairments in intelligence. Worryingly, the evidence points to this being apparent even in early disease, and even in paediatric MS cases. Moreover, it appears to get worse with disease duration and disability progression.

This is a complex paper, packed with neuropsychology and neural network data - I'll try to distil as much of this work in simplified terms as possible.

In essence, the way the brain makes moral judgements (if anyone wandered about this?!) is by two distinct processes:
  1. Causal reasoning (this is activated in the presence of a harmful outcome e.g. the victim suffering); and 
  2. Intent-based reasoning (involves an assessment of the person's intent to bring about the outcome e.g. malicious intent/desire).
Ultimately, the final conclusions are based not surprisingly by a competitive interaction between the two evaluations, and informed by their relative weights (which in part is influenced by personality traits). The mental state reasoning process at a neural level revolves around a concept called theory of mind (ToM); or the ability to attribute or reason about the mental states of others; and anatomically consists of the right and left temporo-parietal junctions (rTPJ, lTPJ), and medial prefrontal cortex (MPFC). The rTJP is the most important region within the ToM network and is recruited mostly in response to attempted harms and relies heavily on intent information. Not surprisingly, disruption of rTJP leads to reduced condemnation of attempted harms! In general terms, those with neurological disorders tend to deliver more favourable assessments of attempted harm owing to a reduced emotional response to harmful intent (as do sadistic individuals).

Patil et al. assessed RRMS subjects outside of a relapse with no antecedent history of alcohol/drug abuse, major psychiatric disorder or traumatic brain injury. They were presented with 24 different stories equally divided among (see Figure 1 below) a) belief: neutral, negative; b) outcome: neutral, negative (i.e. the story either created a neutral outcome or a harmful outcome while acting on the belief that they were either causing a neutral or harmful outcome). Here is an example of one of the case scenarios:

"Juan is instructed by a doctor to give his senile wife
pills for her heart disease. The doctor says that she must
not intake vitamin K within an hour to take the pills
safely. One day, his wife tries a new kind of fruit. The
new kind of fruit is high in vitamin K, so it is deadly for
Juan’s wife to take the pills right away. Juan does his
research and believes that the new kind of fruit does
not have vitamin K and that it is safe to give her the
pills. Juan gives his wife the pills right away. His wife
dies of heart failure."

Subjects were provided with three types of moral judgements: 1) appropriateness: how appropriate was it for x to do y? (1=completely inappropriate to 7 completely appropriate); 2) punishment: how severely should x be punished for y? (1=no punishment to 7=severe punishment); 3) egocentrism: out of 100 people answering this scenario, how may do you think would answer like you? (from 0-100).

Figure 1: Four types of possible harms (conditions) from a 2 (belief: neutral, harmful) × 2 (outcome: neutral, harmful) design. One example is also shown in the form of an abbreviated story.

In PwMS they found a complex pattern of moral judgements than the one commonly described in other neurological disorders, but one which clearly also deviated from that found in those without a neurological disorder. Not only did they find that PwMS judged others' behaviours to be more wrong and were more punitive in their response than controls, but they were also more likely to say that others in the same situation would do the same.

This moral profile increases the likelihood of social dysfunction in MS as those interacting with them (i.e. friends and families) may be put off by their punitive attitudes (especially in more neutral cases where the subject in question neither intended to nor caused harm). Unfortunately, day-to-day life judgements also recruit similar underlying neural processes.

Increasingly, research shows that those with high emotional intelligence are more successful in life as a whole and have successful careers, earning higher wages. As MS affects a majority in their formative years, and if this is true, it could well hamper their future prospects. Strategies need to be developed by individuals to overcome this inherent bias in day-to-day life.