When Punishments Don’t Fit the Crime - Rehabilitation Institute of Chicago

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When Punishments Don’t Fit the Crime

Published on October 15, 2015

When Punishments Don’t Fit the Crime: Study first to assess how people with traumatic brain injuries assign inappropriate punishment


Traumatic brain injury (TBI) is pervasive in America, affecting 1.7 million patients per year — as well as countless others, including family members, colleagues and people encountered in everyday activities.


TBI is often connected to altered social behaviors — from the veteran struggling with a short temper to the football player in hot water for public altercations. New research led in part by the Rehabilitation Institute of Chicago (RIC) sheds additional light on this connection, by focusing on a common effect of TBI, frontal lobe injuries, and in particular on how frontal lobe injuries affect a patient’s ability to punish. The research is the first to assess this important ability, which is a key indicator of how TBI patients will function in society.


“The ability to judge such things as a crime or a child’s misbehavior and then assess a reasonable amount of punishment is fairly indicative of one’s ability to rationally, socially integrate within society,” said Jordan Grafman, PhD, study investigator and director of brain injury research at the Rehabilitation Institute of Chicago (RIC). “It suggests how people will do in the real world; it’s an important predictor for life outcomes.”


Grafman and his co-authors explored the effect of frontal lobe injury on the ability to punish others appropriately in “Neural signatures of third-party punishment: Evidence from penetrating traumatic brain injury,” published this month in Social Cognitive and Affective Neuroscience (SCAN).


Impartial third-party punishment, or TPP, is the ability to judge the severity of a crime and to assess a reasonable punishment. If a patient is unable to assess crimes and other types of misbehavior, it indicates that she or he struggles with several important social skills, such as interpreting another person’s intentions, showing empathy and making rational judgments. People with brain injuries who lack some of these skills, which regulate behavior, have poorer prognoses for resuming normal work, school and family life.


From 2009 to 2012, Dr. Grafman’s team worked with 114 Vietnam War veterans who had suffered penetrating brain injuries as part of the ongoing Vietnam Head Injury Study, an investigation launched in 1967 and sponsored by various entities, including the Department of Defense and the National Institutes of Health. The study includes more than 100 research projects. Dr. Grafman has been lead investigator for the Vietnam War-related projects since 1990.


The researchers used whole-brain imaging studies to pinpoint damage in subjects’ brains. They also gave the subjects a series of tests to measure various abilities, including the ability to put items in order, remember things or judge the severity of a crime.


To test judging severity, they showed each subject index cards describing 24 different scenarios, ranging from innocuous activities such as delaying an oil change to graphic violence. The veterans rank-ordered the cards to reflect the relative degree of punishment deserved.


The researchers repeated the experiment with 32 non-injured Vietnam-era combat veterans, who served as a control group.


Study findings underscored the significance of frontal lobe injuries. Veterans with frontal lobe injuries did worse than the control group when it came to assigning punishments, and had lower test scores for two abilities: concept formation (the ability to put together different pieces of information to determine their overall theme) and altruism. Veterans with the lowest scores on these two tests performed particularly poorly at ranking crimes appropriately.


These two deficiencies accounted for a startling 39 percent of the difference in answers between wounded veterans and control subjects — and pinpointed for researchers the brain locations of the underlying problems. Subjects with altruism deficits tended to have right frontal lobe injuries, while subjects who had trouble forming concepts showed left frontal lobe damage.


“This is a translational study with important implications for clinical and real-world settings,” said Grafman. “Being able to translate research real time accelerates and improves our ability to understand and treat traumatic brain injuries.”


Having deeper understanding of challenges faced by patients with frontal lobe injuries — whether due to a traumatic brain injury, stroke, tumor or other neurological disorder — can guide doctors in providing patients with more effective treatment. By mobilizing cross-disciplinary teams including a range of specialists from cognitive neuroscientists to psychologists, physicians can target problems sooner and better guide patients in achieving improved outcomes. The goal is always to find new and better ways to help patients recovering from traumatic brain injuries — and their families — at home, at work and in society.


Glass, L., Moody, L., Grafman, J., and Krueger, F.  Neural Signatures of Third-Party Punishment: Evidence from penetrating traumatic brain injury. SCAN, 2015.


Media inquiries can be directed to Meg Washburn.