The most violent 1 percent of people there accrued 63 percent of all violent crime convictions

From We Need More Research on Violent People by Abigail Marsh.  The subheading is I study the behavior, and the brains, of antisocial people. Knowing more about them will make us all safer.

A mildly interesting and mildly frustrating essay in equal measures.  On the one hand, it is clearly an advocacy piece - we need more funding to study violent people.  Well, yes.  We need more funding for many things.  On the other hand, there are some interesting nuggets of information and some explanation for why so little progress has been made for so long.

One piece of data affirms the power of Pareto.

These conditions affect up to 4 percent of adults and up to 10 percent of children. (Antisocial behavior spikes during adolescence, but fortunately is often outgrown.) These numbers mean more people have disorders of aggression than autism, schizophrenia, or bipolar disorder. Roughly three times as many males as females are affected.

Although people with disorders of aggression make up only a small fraction of the population worldwide, they are responsible for the majority of all acts of violent crime, with one Swedish study estimating that the most violent 1 percent of people there accrued 63 percent of all violent crime convictions. A 2021 report found that two-thirds of gun violence in Washington, D.C., a city of over 600,000 people, is committed by between 200 and 500 “very high risk” young men.

Another insight which affirms something I have concluded over the years.

Disorders of aggression are not, as many believe, a simple result of experiencing trauma, abuse, or bad parenting—most children who go through that are not aggressive. Rather, they are neurodevelopmental disorders. This means some children begin life at increased risk because these disorders, like all psychological disorders, result partly from genetic factors.

Here is the crux of frustration.  Why are we not investing more in the clinical research she advocates?

In recent decades, the NIMH shifted the majority of its resources away from funding clinical research that aims to help people currently experiencing serious mental illnesses—such as schizophrenia, bipolar disorder, and major depression. What happened was that in the 1990s, the Human Genome Project contributed to a shift toward funding so-called basic research. The result was that, by 2015, only 10 percent of all NIMH funding was supporting clinical research.

Thus, despite over $2 billion in the NIMH’s annual budget, Americans’ mental health continues to decline. As reformist psychiatrist E. Fuller Torrey recently argued, this lack of focus on the most disabling illnesses needs to change. And I advocate that the list of “severe mental illnesses” requiring more research funds must be expanded to include disorders of aggression. The millions of American children and adults with these disorders need more effective treatments to prevent and reduce their symptoms. This will not only improve their lives, it will make the rest of us safer.

So the core issue is, as always, a trade-off decision.  Do we invest in clinical research or in basic research.  Presumably that decision is swayed by the probability of each generating usable information over varying time frames; the anticipated net expected benefit.  

Marsh does not engage with that discussion at all.  It is one thing to argue that there is benefit to clinical research. I am sure there probably is.  What we need to know is that there is more benefit to clinical research than there is to basic research.  Marsh does not address that.  

And of course the even harder discussion is - What is the appropriate balance between basic and clinical research.  

Marsh alludes to the history of research in this to explain why, in part, there is so little investment.

How can so little federal research funding be devoted to understanding how to prevent and treat such a common, serious set of disorders that cause so much suffering in the U.S. every year? It turns out that more than 30 years ago, when we were experiencing a major crime wave that had become a top political issue, the federal government was on the cusp of vastly expanding research into the causes and treatments of violence.

But it all came to an end in 1992 when then-administrator of the Alcohol, Drug Abuse, and Mental Health Administration, Frederick K. Goodwin, a psychiatrist who was leading a new federal initiative aimed at understanding the biology of aggression, spoke at a conference. Attempting to connect research in nonhuman primates with human behavior, Goodwin stated, “If you look, for example, at male monkeys, especially in the wild, roughly half of them survive to adulthood. The other half die by violence. That is the natural way of it for males, to knock each other off. . . . Now one could say that if some of the loss of social structure in this society, and particularly within the high impact inner-city areas, has removed some of the civilizing evolutionary things that we have built up and that maybe it isn’t just the careless use of the word when people call certain areas of certain cities jungles.”

Obviously this was a wildly irresponsible remark, one that was naturally interpreted as racist and degrading. It led to the end of the Federal Violence Initiative and any serious effort to understand the neurodevelopmental roots of disorders of aggression for 30 years. Then, finally, in 2022, a group of policy planners at the Office of Behavioral and Social Sciences Research at the NIH recognized the importance of funding aggression research and drafted a notice of special interest that signaled a desire to fund more research on the biology of aggression.

Which is a useful reminder.  Much as we might wish this to be a scientific question of amount to be invested between and basic and clinical research, this isn't only about science and refined analysis.  There is always emotion and sensitivities thrown into the mix.