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.

About the author

Neuro Doc Gnanapavan


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  • Oh good, more dehumanizing junk science! Currently, it is thought by the autistic self-advocacy community that theory of mind may be unmeasurable by science as when you do a standard doll test on verbal autistic children and include a question about whether or not the dolls are human, autistic kids answer that dolls are not human.

    • Opinions are the lowest form of knowledge. Don't belittle social science research simply because it's not what you want to hear.

    • Neuro Doc GnanapavanTuesday, April 11, 2017 10:24:00 pm
      Opinions are the lowest form of knowledge. Don't belittle social science research simply because it's not what you want to hear.

      The problem with social science is that often it ain't science….. sometimes it's an opinion masquerading as social science.

      A population of 70 in "science" is not really very scientific at all. Determining behaviours from a population of 70 (divided amongst subjects and controls) is hardly science. Maybe they just picked an angry bunch of MSers.

      Or maybe MSers are just angry because they have to deal with MS neuros…………..


    • Lol AnonymousWednesday, April 12, 2017 6:30:00 pm – your excessively punitive response is probably the result of your MS. Do you feel others would have the same opinion of Neuro Doc's wrongs as you? 🙂

    • Touché, I was looking for more discussion around the research (see comments made by others below)

    • Anon 7:26

      I was being a tad ironic.

      But I do find some neuros pretty arrogant (will mention no names). If you prefer to think that's just my MS talking, go ahead.

      But I will say that it's a prettty cheap, convenient, unintelligent shot to discount someone's opinion because of their illness, their age, their sex, their stature, their gender… Be careful – you tread on the borders of prejudice.

      And you need not complain about irrelevant comments Nero DG if you actively encourage them (see above).

    • AnonymousThursday, April 13, 2017 2:44:00 pm I was trying to make a point through irony and sarcasm. The point was that ascribing behaviours on a basis of a 'study' like this one is dangerous, not particularly scientific and leads to all sorts of ironic things.

      AnonymousThursday, April 13, 2017 2:46:00 pm – not my MS, but perhaps it's my partner's MS talking 😉 we have done no studies, but my 15 year old anecdotal experience is that she is far more tolerant towards people and much less wishing to punish moral infringements than i am, even now with ms.

      Neuro Doc GnanapavanThursday, April 13, 2017 7:34:00 am – yes I am touche – because I abhor generalisations based on studies like this.

      I don't even necessarily disagree with your observations: I have noticed in some of many people with MS what has been described in your clinical experience and in the article. Some but not all people with MS – except the flow of this article could be used to paint everyone with same brush.

      Again I say, I don't have MS and I am fairly sure my definitions of wrongs and punitive responses would be considered excessive by most of my peers (ie. the difference between me and people with MS who exhibit these judgements is that I am aware most other people don't have the same thought processes as me).

      As I say that, I am reminded about social media warriors who dish out (what i consider) excessive judgements of tragic situations and suggest excessive punishments.

      70 people and a bunch of slides seems a bit of thin basis on which to make generalisations. You wouldn't recommend a DMT on the basis of 70 people.

  • Re. "Increasingly, research shows that those with high emotional intelligence are more successful in life as a whole and have successful careers, earning higher wages."

    This may be somewhat true but there are various other factors that need to be looked at. Such as life chances and also being informed of what well paid careers are available at an early age.

    I had a fairly well paid job around 18 years ago, I worked very hard for the money. It was a mentally and physically demanding job, travelling globally and I kept it up for over 3 years. It was not sustainable long term as a job. I certainly could not do that job now with my MS.

    • Surely these observations can be explained by MS being a dementia? The same could be said about other dementing diseases.

    • I wouldn't say my memory or cognition is a problem. Having MS has taken away my core inner strength, my stamina to work full time, my ability to get over jet lag quickly. This is probably more to do with muscle weakness and fatigue causing intermittent tiredness during the day.

    • Anon 3:53 am Yes, there are in MS factors that make a busy career unmanageable – I know two medics personally with the disorder, often you have to change directions and become more inventive on goals. The key, however, would be to utilise the advantage offered in the workplace of a high emotional intelligence, simply because you're better than anyone else out there at bringing together the talent which makes your team at the end of the day successful. People apply for a position partly because of the position, money but also because they aspire to be like the person they work for (from word of mouth, journalism, conferences etc.). My advice is don't be limited by the end game.

    • "People apply for a position partly because of the position, money but also because they aspire to be like the person they work for (from word of mouth, journalism, conferences etc.)."

      Sorry, huh?

  • Lol maybe the interest in this mumbo jumbo is the reason the MS neurological community is so behind on MS treatments and can't even grasp the concepts of NEDA…

    On a more serious note, I hope the designers of the study sufficiently took into account the findings of the Stanford experiment when they designed this study 🙂

  • Very interesting post NDG, I always enjoy your evening Monday posts for the train ride home in this time zone.

    I have wondered about this for years, my mother's MS was very difficult for me and rest of the family, the main reason I spend 4 hours a week with a shrink.

    • I realised this in some of my interactions early on as a fellow in the institute of neurology 12y ago; since then have become very adapt in handling it and pointing it out to baffled relations when it has been damaging. A lot of this was taboo back then, but things are very different now.

    • It's been very hard to fix in me, but am doing everything to make sure that I do a much better job with my two girls.

    • "Neuro Doc GnanapavanTuesday, April 11, 2017 10:54:00 pm
      I realised this in some of my interactions early on as a fellow in the institute of neurology 12y ago; since then have become very adapt in handling it and pointing it out to baffled relations when it has been damaging. A lot of this was taboo back then, but things are very different now."

      Dear god. Can you imagine the fights between spouses when you inform the family that the person's brain is damaged in a way which makes them an egocentral moral nazi?

      Wife with MS: I'm so sick of cleaning after you, you don't help me with housework, you're out all the time, the children are running amuck and MS is making my body ache.

      Husband: Not now, I'm busy.

      Wife with MS: I just want you to pick up your shirt, is that too much to ask for? I wish I wasn't here and then you'd see how much work I have to do…

      Husband: Oh FFS, I can't deal with your MS and your judgements, get over yourself………

  • A few observations :

    1 The number of participants was tiny – 38 PwMS and 38 controls.

    2 Although age, gender and educational attainment were matched in PwMS and controls, attachment type was not considered or matched. Attachment type has been shown in other studies to have a bearing on Alexythymia.

    3 The authors suggest the variance between PwMS and controls could be related to Anxiety, Depression and/or Fatigue, so not directly linked to de-myelination.

    4 The participants were shown four segments for each of the 36 scenarios, each segment lasted 8 seconds and once all four segments had been seen the participant had 6 seconds to respond to each question posed. It could be that reading and thinking processes were slower in the PwMS and it affected their responses.

    • Not to mention that perhaps with ms (and other chronic illnesses) could possibly be a bit more bitter than the 'healthy' controls lol.

      Pity no-one seems to want to study my behaviour: I'm bitter as all hell and I don't have MS.

      Just ask me about the types of punishments I'd like to dish out to various sections of society lol. I'm certain my responses would be off the roof.

  • So what about Juan and his missus? Did he get off? I think he should because he did his research, but unfortunately (for his wife) got the wrong answer!

    Anyway, back to the reason for the article! I'm surprised that the outcome was that people were considered more harsh. If anything, the advent of MS has made me more empathetic and more likely to judge people (like Juan!) leniently. I wonder if there's a link with people's level of disability and the judgements they give.

  • Was any attention paid to whether or not the participants were taking a DMT or which ones?

    When coming off of mine, apart from the pysical difficulties it had been causing, improvements in my mental/emotional states were also noticeable. After about 2 weeks I went through 2 weeks of insane anxiety then a gradual realisation of previous attitude/behaviours dawned on me. Not a pleasant experience. I wonder if any of the participants were also experiencing side effects of their medication.



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