In 1997, UCLA neurosurgeon Itzhak Fried described a new medical syndrome, which he called “Syndrome E.” Actually, there was nothing new about it—it was as ancient as the Old Testament. What was new was thinking about it as a medical condition: “Syndrome E” was Fried's term to describe participation in repetitive, genocidal mass murder by otherwise normal individuals, the “ordinary men” at the center of Christopher Browning's 1992 book, "Ordinary Men: Reserve Police Battalion 101 and the Final Solution in Poland," a detailed examination of the central on-the-ground dynamic of the Holocaust, in which “mass murder and routine had become one. Normality itself had become exceedingly abnormal.”
As Browning explained, “Ultimately, the Holocaust took place because at the most basic level individual human beings killed other human beings in large numbers over an extended period of time. The grass-roots perpetrators became 'professional killers.'” But how? That's what Fried sought to explain, at least in a preliminary fashion.
Fried presented his analysis in a brief, three-page submission to The Lancet. He referred to several 20th century examples—the Holocaust, the Armenian genocide, Cambodia under Pol Pol and Rwanda in the 1990s—noting that “Civil strife, extreme conditions, and ethnic conflicts have often had a role in these events.” But he pressed on to say “these events would not have happened without a distinct transformation in the behaviour of individuals. The uniformity and repeating nature of this transformation suggests a common syndrome affecting individuals for which I propose the term 'Syndrome E.'”
Recently, in late April, almost 20 years later, Fried convened a multi-disciplinary conference in Paris, “The Brains That Pull the Triggers,” to explore and critique his approach. In doing so, he was motivated both by advances in neuroscience—exemplified by a presentation by Lasana Harris, “Dehumanised Perception: A Psychological Mechanism that May Facilitate Human Atrocities”—and also by the desire to engage with the difficult questions raised by such an approach—typified by Ilina Singh's contribution, “Do Brains or Persons Pull the Trigger?: Ethics of Medicalizing Violence.”
“What struck me initially was this transformation,” Fried told Salon, “which can occur essentially in all people, where they can be moved into a situation where they will become, unfortunately, efficient killers in groups and do it on a repetitive basis.” A widespread response in the decade after the Holocaust was to view it as saying something profoundly disturbing about human nature, but Fried's behavior-based approach throws a very different light on things, stressing the otherness involved. “This phenomenon itself—which obviously plays a major role in genocide, but not only in genocide—is sort of a radical transformation in human behavior,” Fried said. “It always puzzled me, how is it really possible?”
But something more specific brought his thinking to a head, Fried explained. “It was essentially following a challenge by The Lancet, which years ago had an editorial, which summarized one of the years and it said, 'It's been a wonderful year, we discovered a new phylum [Cycliophora] in the mouth of the Norwegian lobster, and we do all these wonderful scientific things, but in the same year—the previous year, we had hundreds of thousands of people killed in Rwanda and Bosnia, and science is really not dealing with these issues.' So this was really the impetus for me,” Fried said. “I decided to approach it as a medical model, which I think is very useful in dealing with phenomena that you can observe, and do not have a full explanation for, but really defining it in operational terms.”
Much of what Fried noted was unsurprising. In a section called "Symptoms and signs," he listed items such as repetitive acts of violence, obsessive ideation, diminished affect, rapid habituation, compartmentalization, environmental dependency and group contagion. Concerning the latter, he wrote, "The group environment is necessary for maintenance of the syndrome and for its propagation. Most individuals in the group respond uniformly to sets of stimuli, and the responses of individuals in the group serves as stimuli for other individuals." However, one seemingly off-key item pointed toward a crucial departure in Fried's thinking. Under the heading "Intact language, memory, and problem-solving skills," Fried wrote, "Individuals affected by the syndrome usually appear intellectually sound and remain intact in cognitive domains such as language, memory, and the ability to plan and solve problems."
This pointed the way toward Fried's analysis, where he brought all these pieces together, with a central place for the concept of what he called “cognitive fracture.” It stands in direct opposition to what Fried called “the cultural mythology... that we have a primitive reptilian brain somewhere underneath, we're holding [it] under check by our frontal lobes, and they keep the beast from springing out,” adding, “That's how we think about ourselves.”
Although obviously a troubling view, because of the beast within, it's also a beguiling picture of our noble higher nature, our human rationality (which we can identify with) at war with its more primitive dark side (which we can disown). But for Fried, it just doesn't add up. “I really think it's a completely opposite way,” he told Salon, “because obviously animals do not engage in this kind thing, most animals, at least.” Rather, he said, “What you really have here is a hyperactive cortex or prefrontal lobes, which is where the obsessive ideation is. It's a result of evolution, which has rapidly evolved this.”
So it's our “higher nature” that's misfired somehow. But there's more, Fried continued: “In this process of the fracture you no longer have the feedback of the lower centers. [Normally] you're not going to go out now and slaughter 50 people, you will have feedback enough from your lower center. It will tell you it's nothing that you really want to do.” That normal process breaks down due to cognitive fracture. But there are other changes as well. “You've got a sort of over-regulation of this prefrontal mechanism, where ideology is really getting in, which really dampens your reactivity in the amygdala area.” In his original 1997 “Syndrome E” paper, Fried wrote that the syndrome could be due to prefrontal hyperactivity “shutting off the amygdala and impairing its ability to regulate emotion and impart species-specific meaning to stimuli.”
Continuing in his description of Syndrome E, Fried said, “What is striking about the behavior of these people, it's not like drugged people on a revenge spree, killing hundreds of people. It's people who are doing it with a flat affect, with a lack of emotional reactivity. That's how it can propagate, and become so dangerous that you get this massive killing. In a sense it's the dehumanization process, which affects perception, but is also a dehumanization of the perpetrators, who becomes automatized, essentially, with a lack of emotional reactivity.”
Fried's insight—that what saves us is not advanced cognition, but everyday human connectedness—recalls Thomas Mann's novella "Mario and the Magician," as well as the study of psychopathy, following Cleckley, in "The Mask of Sanity," focusing on the psychopath's lack of connection with ordinary human experience. But that doesn't fully explain how so many people—more than 70 percent of the men in Battalion 101 in Browning's book—become so estranged from normal human functioning, or, more importantly, what can be done to prevent it from happening again. Which brings us back to the recent conference.
“Almost 20 years later I'm revisiting this issue in Paris,” Fried told Salon, saying several things motivated him, beginning with advances in neuroscience. “In neuroscience we're moving more and more towards affective and social neuroscience; we are trying to address more complex social and psychological situations,” Fried said. “There has been some accumulation of knowledge in areas such as dehumanized perception, areas like theories of mind, the ability of other human beings to have a theory of mind of what is in another person's mind—obviously this is completely obliterated in a situation of Syndrome E—and our understanding of neural mechanisms of empathy, a development which occurred over the last 10 years.” He added, “I think people are looking more at neuroscience correlations of interactions between people, so for instance the mirror neurons, the whole idea of mirror neurons, and what happens when you look at somebody else, what happens to your own brain.” He cited institutional developments as well—new organizations and journals supporting social cognitive research—all of which helped make the time ripe for a new look at Syndrome E.
But Fried also pointed to the ability to engage more robustly with criticisms across disciplinary fields. “I saw a renewed interest and ability to raise this question, because after I raised it initially there was really, some people were offended that I was giving a biological explanation to something that for them was just a bunch of scum shooting at innocent people, which it is, to some extent,” he admitted. Now, however, Fried sees a greater willingness to argue things through. “People are more attuned to the question of what is the relationship of neuroscience to the legal system, to the issue of responsibility—what is the definition of the responsible self—our sense of identity, our sense of responsibility. There are a lot of these types of questions which are raised with the development of neuroscience.”
To sharpen these questions, he brought together some very committed individuals. “I brought the prosecutor from Hague, from the international criminal Court there. I brought the prosecutor of the human rights court in Strasbourg, I brought Browning himself, to talk about his book again,” Fried said. “I brought some social scientists, I brought neuroscientists. So there was an interesting discussion. Everybody was getting out of their comfort zone.”
Browning's book itself is enough to shake anyone out of their comfort zone. Despite the worldwide carnage of World War II, the Holocaust stood apart as something unique, even when one attempts to view it in context. In his preface, Browning wrote:
In mid-March 1942 some 75 to 80 percent of all victims of the Holocaust were still alive, while 20 to 25 percent had perished. A mere eleven months later, in mid-February 1943, the percentages were exactly the reverse. At the core of the Holocaust was a short, intense wave of mass murder.... [T]he German attack on the Jews of Poland was not a gradual or incremental program stretched over a long period of time, but a veritable blitzkrieg, a massive offensive requiring the mobilization of large numbers of shock troops.
Yet those shock troops were not soldiers. Even the battalion's commanding officer, Major Wilhelm Trapp, was visibly distressed. “Trapp, finally alone in our room, sat on a stool and wept bitterly. The tears really flowed," according to one soldier's account. Trapp allowed anyone to opt out who wanted to, including top officers. And yet, ultimately, he carried out his orders, and his men became efficient, dedicated killers despite their shaky start. It's not just the horror of their mass murdering that's so disturbing, but also the profound disjunction between their different selves, without which the mass murdering could never have taken place.
Questions of multiple selves haunted those assembled as well, along with more commonplace disciplinary tensions: neuroscientists reluctant to speculate about complex social interactions, social scientists leery of reductionism to biological explanations. As Nature put it, reporting on the conference:
This is tricky terrain for academics, and many researchers at the conference admitted some discomfort at being asked to consider their findings as being relevant to the neuroscience of repetitive killings. For some of the sociologists, it felt like an attempt to medicalize a social issue. For some neuroscientists, it felt like over-extrapolation of results from much simpler experiments. In the air was an uneasy feeling that such interpretations could seem superficial and trite, and could trivialize crimes against humanity.
In fact, the researchers present made a brave contribution to what was a bold and important attempt to bring a multidisciplinary approach to one of the biggest questions facing humanity."
On the neuroscience side, Harris's presentation on dehumanized perception isolated one of the key factors, summarizing results from a series of papers co-authored with Susan Fiske. Fiske had earlier taken the lead in developing the "stereotype content model" which goes beyond earlier views of prejudice as uni-dimensional animosity, and posits that all social groups are perceived within a two-dimensional matrix of warmth and competence.
Beginning in 2006 with “Dehumanizing the Lowest of the Low: Neuroimaging Responses to Extreme Out-Groups,” Harris and Fiske developed evidence that only groups identified as low-warmth and low-competence, such as drug addicts or the homeless, were perceived by the brain in ways that did not register them as persons, which subsequent work further fleshed out. Part of the brain known as medial prefrontal cortex (mPFC) had already been found necessary for social cognition. In that first paper, “Analyses revealed mPFC activation to all social groups except extreme (low-low) out-groups, who especially activated insula and amygdala, a pattern consistent with disgust, the emotion predicted by the SCM.”
A 2011 paper, “Dehumanized Perception: A Psychological Means to Facilitate Atrocities,Torture, and Genocide?” presented additional specific neurologically-grounded evidence, while further detailing the connection to genocide:
Here we explore a phenomenon whereby people spontaneously fail to consider the minds of other people – they fail to engage social cognition – perceiving them instead like disgusting objects. In that sense, people dehumanize those allegedly disgusting others. Since person perception imbues the subsequent social interaction with moral norms, “dehumanized perception may be necessary to facilitate extremely inhumane acts like torture against other people, robbing them of their moral protection. Indeed propaganda depicting Tutsi in Rwanda as ‘‘Inyenzi’’ or cockroaches, and Hitler’s classification of Jews in Nazi Germany as vermin may have facilitated atrocities like torture and genocide; both examples tag the victims as disgusting less than human creatures.
The paper reported on two studies; the first showed that participants failed to spontaneously think about the contents of dehumanized targets’ minds when imagining a day in their life, and rated them differently on a number of human-perception dimensions. The second study showed correlations with brain activation beyond the social-cognition network, “including areas implicated in disgust, attention, and cognitive control,” which in turn suggested “that disengaging social cognition affects a number of other brain processes and hints at some of the complex psychological mechanisms potentially involved in atrocities against humanity.”
Harris is clearly confident of the significance of his findings. “Syndrome E is a clinical/medical approach to the same phenomenon I describe as dehumanized perceptions,” he told Salon. “The symptoms Itzhak describes are all consistent with dehumanized perception. The differences lie in that dehumanized perception empirically tests the neural correlates, and describes how the social context can trigger such a phenomenon.”
This work is clearly promising, but it cannot be said to capture everything involved in Syndrome E. While some victims of genocide—such as Native Americans in the U.S. and Canada—have been instantly recognizable as “other,” this has not always been the case. This raises the question of how the dehumanized categories are created in the first place. Another aspect of this difficulty arises concerning genocidal killings of infants and small children—in Browning's account this was particularly troubling to many who did not opt out beforehand. Indeed, the entire process by which Battalion 101 became a routine killing machine cries out for detailed understanding.
Still, there's no denying that Harris's work significantly advances our understanding, and validates Fried's broader conception. At the same time, the challenge of assimilating these new insights, and developing measures in light of them to prevent future genocides remains daunting, to say the least. Many other more traditional fields of study will still have plenty to say about that, if we, as a species, are ever to take Fried's diagnosis and develop a cure to prevent it. Which is why Fried's decision to invite such a broad cross-section of participants was so encouraging—as was the response.
“I contacted a lot of people on short notice, and I was quite impressed by the way that people were really affected by the question, and how seriously they wanted to try and provide some useful dialogue into it,” Fried said. “There was a sense that you are dealing with one of the critical questions that we are facing, really, and of course at the same time, there was a realization of how difficult the problem is.” Consequently, he said, “It was encouraging for me to see how earnestly people are looking, and the importance of this question. There was an impression that we were dealing with something very, very, very significant, and we obviously do not yet have the full tools to deal with this.” But at least we are looking for them—and that in itself represents a giant stride forward.