2. Relationship of Perinatal Trauma To Later Violent Behaviors. It is perhaps helpful and informative to describe in more detail some of the recent experimental findings that link early perinatal trauma to adult violent behaviors. One of these most dramatic studies was reported by Jacobson, et. al (1987). The summary of this study is provided by the abstract which reads as follows:
The study was undertaken to test whether obstetric procedures are of importance for eventual adult behavior of the newborn, as ecological data from the United States seem to indicate. Birth record data were gathered for 412 forensic victims comprising suicides, alcoholics and drug addicts born in Stockholm after l940, and who died there in 1978-1984. The births of the victims were unevenly distributed among six hospitals. Comparison with 2,901 controls, and mutual comparison of categories, showed that suicides involving asphyxiation were closely associated with asphyxia at birth, suicides by violent mechanical means were associated with mechanical birth trauma and drug addiction was associated with opiate and/or barbiturate administration to mothers during labor. Irrespective of the mechanism transferring the birth trauma to adulthood--which might be analogous to imprinting--the results show that obstetric procedures should be carefully evaluated and possibly modified to prevent eventual self-destructive behavior. Specifically, the authors reported that perinatal Asphyxia ( a lack of oxygen) carried a risk factor for suicides from hanging, strangulation, drowning and gas poisoning that was five times greater than for controls; for perinatal mechanical trauma, e.g. breech presentations, forceps delivery and multiple nuchal loops, the risk factor for suicides from hanging and other mechanical injuries was twice as great as controls; for perinatal opiate/barbituate use the risk factor for drug addiction was approximately three times greater than the controls.
In a subsequent study, Jacobson, et al (1988) evaluated the role of obstetric pain medication in adult amphetamine addiction in the offspring. In this study of 200 amphetamine addicts and 195 non-addicted sibling controls he reported that there was a 5.6 times greater incidence of amphetamine addiction when nitrous oxide was given for 4.5 hours or longer vs. 0.25 hours or less. Based upon their statistical data, the authors also concluded:
To the extent that the cases in this study are representative for the addict population in Stockholm, the number of amphetamine addicts in Stockholm can be estimated to have been less than 60% of the present level if nitrous oxide had not been administered in the past (apparent from data for various exposure levels, Fig. 3.). In this writer's analyses of the data in Fig. 3, according to the percentage of amphetamine addicts and non-addicted siblings for the five conditions of duration of nitrous oxide analgesia, the risk factor for amphetamine addiction was 7.2 times greater when nitrous oxide was given for 4.5 hours or longer vs. 0.25 hours or less.
In this analyses, it should be noted that of the 141 amphetamine addicts there was a lower percentage (17.0%) in the category of nitrous oxide duration of less than 0.25 hours than of the 154 non-addicted siblings where 27.9% fell into this category. In short, for this short duration of nitrous oxide inhalation there were 64% fewer amphetamine addicts when compared to the controls. Thus, this short term duration of nitrous oxide inhalation appears to confer some prophylactic benefit for the prevention of amphetamine addiction when compared to the non-addicted siblings.
For the most extreme group of nitrous oxide inhalation which was 4.5 hours or greater, there was an 18.4 percent of amphetamine addicts in this group compared to 7.1 percent for the non-addicted siblings. In short, there was a 159% greater incidence of amphetamine addicts in this group compared to the incidence of non-addicted siblings.
When these two groups are compared, viz the 64% reduction of amphetamine addicts in the short duration of nitrous oxide inhalation of less than 0.25 hours to the 159% increaseof amphetamine addicts in the longest duration of nitrous oxide inhalation of 4.5 hours or greater (when compared to the controls), the increased risk for amphetamine addiction is 7.2 times greater for the longest nitrous oxide inhalation group when compared to the shortest duration of nitrous oxide inhalation of 0.25 hours or less.
The interesting unanswered question is why a mild exposure to nitrous oxide inhalation would confer a "protective" function of reduced risk (64%) to amphetamine addiction when compared to controls?.
In a third study by Jacobson, et al (1990) the risk for opiate addiction in adult offspring was evaluated as a consequence of the administration of opiates, barbiturates and nitrous oxide for greater than one hour in all subjects during labor within 10 hours before birth. There were 139 opiate addicts compared to 230 non-addicted siblings in this study.
It was found that in subjects who had subsequently become addicts there was a significantly increased percentage of mothers (25%) who had received opiates or barbiturates, or both, when compared to unmatched non-addicted siblings (16%); and these mothers also received nitrous oxide for longer periods and more frequently. In short, there was a 56% increase in opiate addiction, as a consequence of opiate, barbituate and nitrous oxide administration during labor. After controlling for a number of other variables it was found that the risk for adult opiate addiction increased to 4.7 times for the three drug administrations when compared to matched sibling controls.
In an earlier study of 52 adolescent suicides, Salk, et. al., (1985) reported three prenatal/perinatal risk factors that significantly discriminated the suicide group from the two matched non-suicide control groups. These were: l) respiratory distress for more than one hour at birth; 2) no antenatal care before 20 weeks of pregnancy; and 3) chronic disease of the mother during pregnancy which were found in 81% of the suicide cases. These authors could not speculate as to the mechanisms by which prenatal/perinatal birth trauma were linked to suicidal behaviors.
David Levy in a 1945 study on the "Psychic Trauma of Operations In Children" reported on three cases of male circumcision at ages 12 months (2) and 6-1/2 years. Psychological trauma included the development of night terrors, temper tantrums and rage. In the 6-1/2 year old suicidal impulses developed. Levy reports:
"...a circumcision at the age of 6 years 7 months, was preceded by a struggle of the patient with his father and the anesthetist before they overpowered him. Immediately after the anesthesia wore off, he said over and over, "They cut my penis. I wish I were dead." The rest of the day the patient never left his mother's side. Thereafter his previous temper tantrums developed into destructive rages. During the treatment he played numerous killing games, in which his father was the principal victim. The operation represented a castration by his father."(p.10).
Questions must be raised as to the extent to which rage and suicidal behaviors are engendered by the assaults of circumcision whether conducted during the newborn or child/pre-pubertal periods. (There are approximately a third more suicides than homicides in the U.S.). Is there a link between circumcision and the willingness to kill oneself or others for one's religious or national beliefs? The willingness of many fundamentalist monotheistic men to die or kill for their religious beliefs is well known and the possible link of genital mutilation to these homicidal/suicidal behaviors is more than worthy of study.
Jacobson, et al (l987) noted in their study that hypoxia during birth might cause minimal brain damage that could result in destructive behaviors. However, these authors questioned whether neurological injuries due to hypoxia could be the main factor, "since altogether rather few victims suffered from asphyxia during birth. None of the 86 suicides from poisoning by solid or liquid substance and none of the 53 alcoholics was reported to have been asphyxial."
There are several points to be made concerning these two studies. First, Faro and Windle (1969) in their experimental asphyxial studies in monkeys documented both immediate and delayed brain damage by as much as 10 years in these monkeys. In short, there is a delayed "time bomb" of brain damage that occurs long after the initial injury or insult. It would appear that later stages of brain development are dependent upon earlier stages of brain development which must be normal if later stages of development are to be normal. Secondly, there are a variety of traumas/injuries that can similate or mimic asphyxial effects. Thirdly, the criteria customarily employed for the identification of "asphyxia" may be too insensitive to reflect the actual damage sustained to the brain. Fourthly, there are interaction effects, e.g. maternal-infant separation or isolation of prematures in incubators confers a degree of somatosensory deprivation that can interact with mild degrees of hypoxia that can result in greater brain impairments than either injury alone.
For example, sensory deprivation (like asphyxia) can damage the sensory receptors and sensory pathways of the brain. This neuronal damage from sensory deprivation prevents normal sensory stimulation of the brain, like asphyxia, which is essential for normal brain development and function. The combination of these two events can and most likely are of greater damage than either event taken separately (Prescott, 1975b).
The behavioral data from cross-cultural studies are summarized below that provides further support for the role of early sensory experiences upon later behavior and thus, necessarily, the brain processes that mediate such behaviors.
3. CROSS-CULTURAL PERSPECTIVES: EARLY SENSORY INFLUENCES UPON BRAIN DEVELOPMENT AND BEHAVIOR:
There is a well established body of scientific data that documents the role of sensory stimulation and deprivation upon brain development and emotional-social, psychological and mental development (supra, p.l). From the perspective of the developmental neuropsychological sciences there can be little question that the extraordinary pain experienced by newborns, children and adolescents who are subjected to ritual genital mutilations has a profound influence upon the brain and later behaviors. It is this writers conviction that the extraordinary pain and trauma experienced through genital mutilations--an organ and brain system that is designed for the experience of sexual pleasure and the expression of sexual love--has permanently altered normative brain development for the normal expression of sexual pleasure and love. It is proposed that this genital pain, particularly in combination with the failure of affectional bonding in human relationships has long-term developmental consequences for the ability of such individuals to differentiate pain from pleasure in love relationships; to develop intimate sexual relationships; and to be characterized as peaceful, egalitarian and compassionate individuals.
The above described relationships seem more plausible when it is considered that the brain system which is designed for the experience of pleasure and the expression of sexual love is first encoded with extraordinary and excruciating pain through genital mutilations. In such individuals, all subsequent acts or experiences of genital pleasure are experienced upon a neuronal background of genital pain that is now deeply buried in the subconscious/unconscious brain.
As previously stated, it is this developmental neuropsychologist's conviction that these early experiences of genital pain contributes to the encoding of the brain that begins the neurobiolgical foundation for sado-masochistic behaviors. The brain system that has been designed for pleasure has first and foremost become saturated or encoded with pain that now limits and qualifies all subsequent experiences of pleasure. When these early experiences of genital pain are followed by a developmental deprivation of physical affectional pleasure in the maternal-infant relationship and in the adolescent sexual relationship then violent destructive behaviors are an extremely likely outcome (Prescott, 1975, 1979ab, 1989,1990).
A summary of the cross-cultural studies conducted by this writer that have related measures of infant/child/adolescent pain (genital mutilation, harsh child rearing practices and painful initiation rites); pleasure; and pleasure deprivation (failure of affectional binding in the maternal-infant relationship and adolescent sexual repression) to later adult anti-social and violent behaviors are provided in Tables 1-VII to provide further behavioral support for the basic hypothesis of this study.
It should be noted that in primitive cultures, genital mutilations during infancy are rare and commonly occurs at later childhood or at adolescence as initiation rites or "rites of passage". Thus, genital mutilation rituals in these cultures are not expected to have the same consequences upon the developing brain and behavior, as expected in those cultures that perform genital mutilations during the neonatal period or early years of childhood.
Tables 1 and II summarize the social-behavioral characteristics of primitive cultures that engage in male and female genital mutilations. Tables III & IV provides a similar summary for those cultures that punish pre-marital and extramarital sex. Table VI provides a similar summary for those cultures that inflict pain on the infant by the nurturant agent. In general these cultures are patrilineal, subordinate women to men, have low nurturance of children, are sexually repressive, violent and have a high god that is perceived as violent and involved in human morality (Tables 1-VI).
Table VII summarizes the 49 primitive culture study which was able to predict with 100% accuracy the torture, mutilation and killing of enemy captured in warfare in 49 primitive cultures distributed throughout the world from two measures of deprivation of physical affection, viz. in the maternal-infant relationship and in the adolescent sexual relationship (Prescott, l975;1979;1990). The deprivation of infant physical affection alone predicted the adult violence and non-violence in 80% (39/49) of the cultures, thus, attesting to the powerful role of early sensory experiences upon later adult behaviors. It is emphasized that there is other theory or data base that has yielded such high predictive validity for violent and non-violent behaviors and which is based upon the known sensory systems and brain processes that mediate these behaviors.
Further, there is persuasive scientific evidence that brain dysfunction/damage very likely underlies those violent behaviors induced by Somatosensory Affectional Deprivation--SAD--(Prescott,1968,1975,1976; Saltzberg, Lustick and Heath,1971; Heath, 1972ab, l975; Berman, Berman and Prescott,1974; Struble and Riesen,1978; Floeter and Greenough,1979).
Equally significant is the prediction that the cumulative consequences of these developmental experiences of genital pain and affectional deprivation precludes the possibility of realizing the spiritual dimensions of human sexuality. These relationships have been discussed elsewhere and are mentioned herein to indicate some of the far-reaching implications of this SAD theory and the proposed study (Prescott, 1990).
In summary, the above cross-cultural data provide support for the thesis that the confounding of pain and pleasure during the formative periods of brain development has far reaching implications for the development of patterns of adult behaviors and value systems that involve peaceful and violent behaviors. It is again emphasized that this theory and data support the hypothesis that the early encoding of those developing brain structures that are designed to experience pleasure with excruciating pain provides the neuropsychological foundation for individuals who are predisposed to experience pain to experience pleasure; or who derive pleasure from the experience of pain, i.e. sado-masochistic behaviors which are reflected in the measure of "torture, mutilation and killing of enemy captured in warfare", as reported in the cross-cultural studies cited above.
The above cited studies and many others provide support for the unequivocal conclusion that variations in the sensory/physical environment during the formative periods of brain development influence the structural and functional development of the brain and behavior, particularly, the effects of maternal stress upon fetal and neonatal brain development and behavior,as well as the effects of post-natal stress of various kinds upon brain development and behavior.
It has yet to be established, however, whether a specific form of extreme sensory trauma to the developing brain, viz, genital mutilation, has demonstrable effects upon the structural and functional development of the adult human brain. It is the objective of this research proposal to attempt to document such effects and that this search is more than warranted by the available scientific findings on the role of early sensory experiences and trauma upon brain development and behavior.
4. Specific Hypothesis To Be Tested Specifically, it is proposed to evaluate the genital sensory projection fields in the cerebral neocortex and cerebellar cortex; the frontal cortical fields defined by projections from medialis dorsalis; somatosensory projection fields in cerebral neocortex and cerebellar cortex; and selected limbic system structures in genital mutilated and intact adults utilizing NMR imaging of the above described brain structures. Surface coil technology will be utilized to obtain optimal imaging enhancement of specially selected brain structures. Visual and auditory sensory projection fields will also be examined, as part of the "controls" in this study. Abnormalities are not expected to be found in the visual and auditory sensory projection fields of the cerebral neocortex and cerebellar cortex.
It is expected that MR Imaging will detect structural differences in the genital sensory projection fields in the cerebral neocortex and cerebellar cortex and in those brain sites involved in mediating pain and pleasure between genital mutilated, intact and super-nurtured subjects.
Additionally PET Scans will be conducted to evaluate how the brain processes positive (non-exploitive, non-violent) images of a sensual-sexual-erotic nature and negative (exploitive, violent) images of a sexual nature. It is anticipated that there will be less activation of neocortical and cerebellar cortical structures associated with the above imagery in genital mutilated subjects than in intact or super-nurtured subjects. This PET scan test will also be able to document the variability of higher brain integrations of sexually pleasant and unpleasant imagery in the subjects to be evaluated.
Although, the challenges are great to demonstrate the injuries of a single massive sensory assault against the developing brain, it is anticipated that for the reasons cited above and with appropriate subject selection and controls that the hypotheses will be confirmed. It is emphasized that the continuing sequalae of pain and discomfort over many months, if not years, during "recovery" has a continuing influence upon the brain and its development which enhances the possibility of finding brain effects consequent to genital mutilation. As previously stated, it is well know that not all consequences of early "insults" or "injuries" to the developing brain are immediately manifested but are often delayed in their manifestation many years later (Levy, 1945; Faro and Windle, 1969; Jacobson, et al,1987, 1989, 1990 and Salk, et al., 1985).
Further, it is emphasized that it is not only the effects of acute sensory trauma upon brain development and behavior that will be evaluated but also the necessary co-factors of diminished or failed "affectional bonding" due to the impairments inflicted upon the pleasure sensing systems of the brain (by this neonatal pain) that now becomes cumulative throughout development; and which are also manifested in major differences of "affectional bonding" due to significant differences in child rearing practices in the subjects tested. The expected impaired ability to experience and integrate sexual pleasure with the higher neocortical systems of the brain, as a consequence of limited early affectional bonding, will also be contributory to finding differences between the experimental and control groups.
5. Specific Brain Structures For Enhanced MR Imaging Evaluation a) Cerebrum and Cerebral Neocortex
The rationale for selecting specific sites of the cerebral neocortex for enhanced imaging rests upon the thalamocortical radiations to the neocortex (all information from the sensory systems are routed to the cerebral neocortex through the dorsal thalamus); and from specialized studies that document specific neocortical foci associated with stimulation of the genital system. The sensory system of primary importance for this study is the somatosensory system with its projections to somatosensory cortex (Sm l and Sm 11). The prefrontal neocortex which has strong connections with the limbic system receives and integrates information about sexuality and emotionality and is also a cortical area for intensive evaluation.
The specific genital sensory projection field within Somatosensory Cortex can be seen from Figure l(Geschwind, 1980) which portrays the "homonculus"--a body image projection upon the cerebral neocortex. Guerit and Opsomer (1991), not surprisingly, demonstrated that the largest somatosensory cortical evoked potential (SCEP) from stimulation of the dorsal nerve of the penis/clitoris is recorded over EEG position Cz (See Figure 2). The smaller SCEP from genital stimulation compared to posterior tibial nerve stimulation was attributed, in part, to the anatomical deeper location of the genital sensory projection field within the interhemispheric fissure (Penfield and Rasmussen, 1950) and poses special challenges for MR Imaging Analysis.
Specific areas within the frontal lobe is another primary area for enhanced MR Imaging Analyses. In numerous studies involving methods of stimulation, lesions and ablations, MacLean and his associates have provided extensive documentation of the cerebral representation of penile erection in squirrel monkeys (MacLean and Ploog, 1962; MacLean, l962; MacLean, Denniston & Dua, 1963; MacLean, Dua & Denniston, 1963; Dua & MacLean, 1964; MacLean, 1978; MacLean, 1990).
These investigators found positive loci for erection from electrical stimulation in three corticosubcortical subdivisions of the limbic system. The first subdivision corresponds to the known anatomical distribution of hippocampal projections to parts of the septum, anterior and midline thalamic nuclei, and hypothalamus. The second subdivision involves parts of the anatomical system comprising the mammillary bodies, mammillothalamic tract, anterior thalamus, and cingulate gyrus. The third subdivision involves loci found in the gyrus rectus, the medial part of the medial dorsal nucleus of the thalamus, and regions of their known connections. Other anatomical systems were found to be associated with penile tumescence, e.g. rhythmic hippocampal after-discharges where the animal assumed a quiescent state upon termination of the hippocampal after-discharges; and the ponto-cerebellar system.
The finding most relevant to this study is the central role that the medial dorsal nucleus of the thalamus has in penile tumescence because of the projections of medialis dorsalis to prefrontal cortex, particularly, orbitofrontal cortex. As MacLean (1962) noted: "Indeed, it (medialis dorsalis) is such a potent point that stimulation here may elicit close to full erection even under deep anesthesia" (p.299). MacLean (1962) continues:
The prefrontal cortex, which is connected to the medial dorsal nucleus, is a relatively recent addition to the new mammalian brain. From our limited knowledge of its functions, it might be inferred that it is largely concerned with anticipation and planning as it pertains to both self-preservation and preservation of the species (p.299); and
In regard to this last finding it is pertinent to recall that frontal lobotomy, which severs the connections between the medial dorsal nucleus and the orbitofrontal and prefrontal cortex, sometimes results in bizarre, uninhibited sexual behavior (p.294).
It does not take a great deal of interpretive skills to suggest that genital trauma may induce damage/dysfunction in medialis dorsalis and its resulting connectivity with orbitofrontal and prefrontal cortex. Such damage/dysfunction could well provide the beginning neural substrate for the latter manifestation of sexual-social dysfunctions of various kinds dependent upon subsequent developmental experiences involving the affectional systems of the brain.
More specifically, Prescott (1971) outlined the special importance of medialis dorsalis and its projections to orbitofrontal and prefrontal cortex with respect to his SAD(Somatosensory Affectional Deprivation) theory of depression, sociopathy and violent behaviors:
The inhibitory forebrain areas, particularly the frontal orbital cortex, are implicated in this theoretical neuronal model not only because of the study of Anand, et al. (1959) but also because of those studies by Kennard and Ectors (1938); Kennard, Spencer and Fountain (1941); and Ruch and Shenkin (1943) in which lesions in frontal orbital cortex (Area 13 of Walker) produced hyperactivity in the form of 'pacing' or 'forced circling' movement stereotypes which would perseverate for as long as the test period of three hours. Equally important was the observation of a 'definite reduction in emotional expression' with reduction or elimination of 'fear' and 'aggressive' behaviors which were apparently replaced by 'gazing into the distance with a blank expression' when the animal was not engaged in stereotypical pacing or running. This was interpreted as an'over-reactive' response to the presence of an observer. The dramatic similarities of these behaviors in animals with frontal orbital cortex lesions with the behaviors of isolation reared animals hardly need further emphasis. Additional evidence implicating the frontal orbital gyri (Areas 13 & 14) in the behavioral disorders of the somatosensory deprived animal are the marked autonomic changes produced by stimulation of these areas, particularly, the development of sham rage by stimulation of Area 14 (Livingstone and Davis, 1947). More recent evidence has been obtained in implicating the orbital gyri in emotional behaviors in the study of Butter,et al. (1970), in which orbital frontal lesions in rhesus produced hyper-reactivity, heightened oral tendencies, and a reduction in aggressive behaviors. As noted above, it is of more than passing interest that sham rage was also produced by cerebellar stimulation (Dow and Moruzzi, 1958), which may be suggestive of further support for a possible functional link between the cerebellum and frontal orbital gyri.
It should be noted that any cerebellar-orbital gyri linkage that would be mediated by thalamic relay nuclei would necessarily involve the dorsomedial nucleus since Rose and Woolsey (1948) have proposed that the frontal granular cortex be defined as that part of the frontal lobe which serves as a projection areas for the dorsomedial nucleus. More specifically, it is known that medialis dorsalis (MD) consists of three distinct substructures: Pars paralamellaris,Pars parvocellularis, and Pars magnocellularis which projects to Areas 8, 9, and orbitalis (Areas 1, & 14), respectively, within frontal granular cortex (Akert, 1964).