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Do psychopathic patients use their DLPFC when making decisions in moral dilemmas?

Molecular Psychiatry volume 14, pages 908–909 (2009)Cite this article

We found the letter recently published by Glenn et al.1 in Molecular Psychiatry very interesting as it sheds new light not only on the understanding of the neural correlates of psychopathic behavior but more generally on the growing field of moral cognition. The authors report that when psychopathic patients face moral dilemmas—and are asked to make decisions—they exhibit a deficit of activation in the amygdala and some other so-called ‘emotional’ cerebral structures. However, it seems that, in their study, the dorsolateral prefrontal cortex (DLPFC) was not part of the regions of interest, in spite of several studies reporting an important function of this structure in moral decisions.2, 3 In the experiment by Glenn et al., if the DLPFC was less activated than in healthy individuals, this could suggest that its activity in such a context might only be a by-product of a process of ‘cognitive control’. It would therefore not support the hypothesis that the DLPFC is specifically involved in a subsystem of moral decision making as generally reported in the literature on decision neuroscience, be it in the context of moral or economic decisions.3, 4, 5, 6

Recently, Koenigs et al.7 investigated the decisions made by patients with emotion-related brain damage in the ventromedial prefrontal cortex (VMPFC; BAs, Brodman areas 10, 11, 25 and 32) when facing moral dilemmas. These patients made unusual utilitarian judgments as they endorsed harmful actions to peers promoting greater social good (quantitatively speaking), when healthy individuals did not. They used dilemmas previously introduced by Greene et al.2 who had proposed a dual-process theory of brain functioning in moral judgement:

  • an ‘emotional’ subsystem eliciting a prepotent, negative emotional response of healthy individuals (associated with a higher activity in the amygdala, medial prefrontal cortex, superior temporal and posterior cingulate gyri) when facing personal dilemmas involving harming someone directly to save other persons;

  • a more ‘cognitive’ subsystem eliciting a utilitarian reasoning (aggregate cost–benefit analysis) and a conflict with prepotent emotions. In such a case, overriding prepotent emotional responses would require additional cognitive control and, therefore, an increased activity in the anterior DLPFC as people make difficult (non personal) utilitarian moral judgments.

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Authors and Affiliations

  1. Mediterranean Institute of Cognitive Neurosciences (UMR 6193) CNRS-Aix-Marseille University, Marseille, France

    S Tassy, M Cermolacce & B Wicker

  2. Department of Psychiatry, Sainte Marguerite University Hospital, Marseille, France

    S Tassy & M Cermolacce

  3. Human Neurobiology Laboratory (UMR 6149), Aix-Marseille University & CNRS, Marseille, France

    O Oullier

  4. Laboratoire de Psychologie Cognitive, CNRS and Université de Provence, Marseille, France

    O Oullier

  5. Physic Department, Integrative Neurosciences Laboratory, University of Buenos, Aires, Argentina

    B Wicker

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  1. S Tassy
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  2. O Oullier
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  4. B Wicker
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Correspondence to S Tassy.

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Tassy, S., Oullier, O., Cermolacce, M. et al. Do psychopathic patients use their DLPFC when making decisions in moral dilemmas?. Mol Psychiatry 14, 908–909 (2009). https://doi.org/10.1038/mp.2009.71

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