NEGLECT, STRESS, THE AMYGDALA, & NEUROCHEMICAL LESIONS

Deprivation and neglect is exceedingly stressful (Bowlby, 1960, 1982; Pankseep, Normansell, & Herman, 1988; Kraemer, 2012; Rosenblum, Coplan, & Friedman, 2005; Rots, et al., 2008; Suchecki, et al., 1993; Spitz, 1945, 1946). Even temporary periods of isolation or maternal separation may trigger significant fluctuations in neurotransmitters such as norepinephrine (NE), serotonin (5HT) and dopamine (DA), and promote the secretion of enkephalins and corticosteroids (Kehoe, et al. 1996; Kraemer 2012; Pankseep et al., 1988; Rosenblum et al., 2005).

For example, normally NE is exceedingly important in maximizing neural growth and neuroplasticity (Kasamatsu & Pettigrew 1976; Pettigrew & Kasamatsu 2008), not only during the early stages of development (Johnston 1988; Parnavelas et al. 1988), but following traumatic experiences and brain injuries sustained as an adult. For example, immediately following a brain injury, NE secretion is rapidly increased which acts to promote plasticity, synaptic development, and thus functional recovery. If deprived of NE, functional recovery is retarded (see Parnavelas et al. 1988).

In the developing nervous system, NE also acts to suppress the establishment of irrelevant neural networks and pathways, while simultaneously stabilizing and/or promoting the growth and formation of relevant synaptic circuits (see Bear & Singer 1986; Pettigrew & Kasamatsu 2008). Similarly, NE has been shown to inhibit or suppress irrelevant background activity, while simultaneously enhancing evoked responses in both inhibitory and excitatory circuits associated with the processing of relevant environmental input (Foote et al. 1983).

The NE neurotransmitter system is also directly implicated in modulating the stress response, and in fact stress increases NE turnover in the amygdala (Tanaka, Kohno, Nakagawa, et al. 1982), a structure which is also directly implicated in modulating the stress response, becoming highly active under conditions of emotional and physical stress( Henke, 2012; Ray, Henke, & Sullivan, 1987; Roozendall, Koolhaas and Bohus, 2012). In fact, the release of NE serves a neural protective function within the amygdala (Glavin, 1985; Ray et al., 1987b) , preventing damage to this structure, or the development of abnormal kindling activity under conditions of stress and high arousal.

However, under conditions of repetitive stress, NE levels may be depleted and opiates may be secreted which also exert an inhibitory effects on the release of NE (Izquierdo & Graundenz 1980). Unfortunately, NE depletion, excessive amygdala activation, and opiate release, can lead to permanent structural and functional alterations within infant and adult amygdala neurons, effecting their neocortical interconnections, postsynaptic densities and in the size of the presynaptic terminals as well as their capacity to process and transmit information (e.g. Cain 2012; Racine 2008). With repeated instances of activation or heightened activity, an abnormal form of neuronal platicity and a lowered threshold of responding also results. These changes are associated with increases in the size of the evoked potential amplitudes and can give rise to epilptiform after discharges, seizures and convulsions, as well as induce kindling (subseizure activity) within the amygdala (Cain 2012; Racine 2008).

Unfortunately, adverse early environmental influences can induce significant alterations and even exaggerations of the NE response (Rosenblum et al. 2005), followed by reductions in NE, even when the trauma is mild and/or involves varying degrees of neglect (Higley et al. 2012), or even following brief periods of maternal separation (Kraemer et al. 2009). Indeed, among its many diverse functions, NE appears to be directly involved in the experience of separation anxiety from the mother (Pankseep et al. 1988).

For example, it has been shown that if a primate mother is periodically prevented from responding or attending to her infant, the infant will suffer significant reductions in NE activity (Kraemer et al. 2009). Moreover, these infants in turn become less securely attached, more easily frightened and startled, are less social or independent and display significant NE-related abnormalities. According to Rosenblum et al.(2005) infants reared under these mildly stressful conditions display responses similar to those seen in humans suffering from post traumatic stress disorder.

Presumably, these stress related disturbances involving the NE (and 5HT) systems, particularly when experienced during infancy, abnormally influences neuronal and synaptic development thereby producing a functional lesion as well as abnormal neural circuitry. Given that the limbic system (e.g. amygdala) is also effected by stress, emotional trauma, as well as alterations in NE and 5HT, abnormalities in the development of associated limbic system circuitry may also be adversely impacted, such that they display abnormal neuroplasticity and excessive activity including kindling. Moreover, heightened activity within the immature amygdala or septal nuclei, may also induce the growth of additional dendrites which in turn act to attract axons from alternate sites (e.g. Raisman 2001). In consequence, abnormal neural networks and pathways may be formed between nuclei that "normally" do not directly interact. Conditions such as these could predispose the individual to behaving or reacting abnormally and to processing and even storing information in an abnormal fashion.

As noted, under stressful conditions not only the amygdala and septal nucleus, but the hypothalamus and hippocampus may be injured (see chapter 30). However, if these structures including the hippocampus become abnormal, not just the ability to perceive and express emotion or to feel securely attached, but the capacity to remember those who are emotionally significant may be disrupted (Gloor, 1997; Kling & Brothers, 2012; Lilly, Cummings, Benson, & Frankel, 1983; Terzian & Ore, 1955). In fact, stress induced injury to the amygdala and hippocampus can produce an amnesia so profound that personal identity, and memory for friends and loved ones may be erased (chapter 30).

Consider, for example, those individuals who have undergone the surgical resection of the (presumably normal) amygdala and hippocampus. They not only become emotionally placid and unresponsive, but lose the ability to establish new and long term personal relationships (Aggleton, 2012). As demonstrated in the famous case of H.M. who underwent the surgical removal of the right and left amygdala and hippocampus (Milner, 1970), although Brenda Milner has worked with him for over 25 years she is an utter stranger to him. Likewise, injuries localized to the amygdala can result in an inability to recognize faces (Jacobson, 1986; Tranel & Hyman, 1990) or maintain emotional attachments (e.g. Terzian & Ore, 1955), whereas bilateral hippocampal ablation results in an inability to establish new emotional attachment or relationships.

EMOTIONAL STRESS, SEXUAL ABUSE & ABNORMAL AMYGDALA DEVELOPMENT

The amygdala is implicated not only in the mediation of almost all aspects of emotion and affective motor behavior, but sexuality (Davis et al., 1997; Gloor, 2012, Halgren, 2012, Kling and Brothers, 2012; LeDoux, 1996; Rosen and Schulkin, 1998). In fact, the primate amygdala is sexually differentiated such that there are male and female pattern of amygdala neural organization which in turn is determined by the presence or absence of steroidal hormones early in development (Nishizuka and Arai, 1981, 1983).

The amygdala and hypothalamus are intimately interconnected, and as noted, electrical stimulation of the sexually dimorphic hypothalamus will induce sexual posturing including clitoral swelling, penile erection, and pelvic thrusting coupled with an explosive discharge of semen (Lisk, 1967, 2009; MacLean, 1973). Likewise, activation of the amygdala can produce penile erection (Kling and Brothers, 2012; MacLean, 1990; Robinson and Mishkin, 2008; Stoffels et al., 1980) sexual feelings (Bancaud et al., 1970; Remillard et al., 1983), sensations of extreme pleasure (Olds and Forbes, 1981), memories of sexual intercourse (Gloor, 1986), as well as ovulation, uterine contractions, lactogenetic responses, and orgasm(Currier, Little, Suess and Andy, 2009; Freemon and Nevis, 2001; Remillard et al., 1983; Shealy and Peel, 1957).

Since the amygdala has the capacity to selectively respond to male vs female faces and the emotions they convey, and as this structure is directly implicated in sexuality, presumably the amygdala can respond to these physical features by inducing sexual arousal. Moreover, in response to direct sexual stimulation, the amygdala, in conjunction with the hypothalamus can induce penile or clitoral erection, pelvic thrusting, ovulation, ejaculation, and thus the entire human sexual response.

Because of their involvement in all aspects of sexuality and the sexual response, complete destruction of the hypothalamus can eliminate sexual behaviors in total (Everitt and Stacey, 1987), whereas damage or destruction of the human and non-human primate amygdala may result in bizarre sexual changes, such as continuous masturbation and indiscriminate, often hypersexual hetero- and homosexual behaviors including attempts at sex with inanimate objects (Kling and Brothers, 2012; Kluver and Bucy, 1939; Pribram and Bagshaw 1953; Terzian and Ore, 1955). Hypersexuality following amygdala injury has been documented among numerous species, including cats and dogs (Kling and Brothers, 2012).

Humans with an abnormally activated or severely injured amygdala may expose their genitals, masturbate in public, and attempt to have sex with family members or individuals of the same sex (Blumer, 1970; Kolarsky, Freund, Macheck, and Polak, 1967; Terzian and Ore, 1955). Moreover, abnormal activity involving the amygdala (and overlying temporal lobe) has been associated with the experience of orgasm (Backman and Rossel, 1984; Warneke, 1976) and the development of hyposexuality (Taylor, 2009; Heirons and Saunders, 1966; Toon, Edem, Nanjee, and Wheeler, 2009), hypersexuality (Blumer, 1970) as well as homosexuality, transvestism, and thus confusion over sexual orientation (Davies and Morgenstern, 1960; Kolarsky et al., 1967). In fact, abnormal- or seizure activity within the amygdala or overlying temporal lobe may induce an individual to engage in "sexual intercourse" even in the absence of a partner.

For example, Currier and colleagues (2009, p. 260) described a female temporal lobe seizure patient who was "sitting at the kitchen table with her daughter making out a shopping list" when she suffered a seizure. "She appeared dazed, slumped to the floor on her back, lifted her skirt, spread her knees and elevated her pelvis rhythmically. She made appropriate vocalizations for sexual intercourse such as: It feels so good...further, further."

As will be detailed below, sexual abuse can also induce the development of sexually abnormal behaviors which are identical to those associated with abnormal amygdala activity and injury. This association is not coincidental, for repeated instances of abuse and other forms of abnormal environmental input can induce amygdala abnormalities, including the development of kindling and seizure activity as well as abnormal neuroplastic where inappropriate and abnormally active synaptic connections are formed.

If the amygdala is injured, becomes excessively active, or develops abnormal kindling or seizure activity, emotionality and sexuality may become abnormal (Kling and Brothers, 2012; Remillard et al., 1983; Terzian and Ore, 1955). For example, patients may demonstrate hypo- or hypersexuality, or develop severe depression, anxiety, fear, or rage reactions--abnormalities and symptoms identical to those exhibited by adults and children who have been severely sexually abused (Courtois, 2008; Beitchman, et al. 2012; Finkelhor, 1988; Harper, 1993; Simons and Whitbeck, 2011).

In fact, not just sexuality, but emotion and personality functioning are significantly altered with amygdala destruction(Lilly, Cummings, Benson and Frankel, 1983; Marlowe, Mancall and Thomas, 1975; Terzian and Ore 1955 ). Those suffering from abnormal activity involving the amygdala and overlying temporal lobe , may experience severe depression, fear, anxiety, and rage as well as dramatic alterations in personality (Devinsky and Bear, 1984; Egger and Flynn, 1963; Gloor, 2012, 1997; Halgren, 2012; LeDoux, 1996; Mark et al., 1972; Mesulam, 1981; Trimble 2011). They may become severely withdrawn and contemplate or successfully commit suicide. In some cases, these mood swings and personality changes are so dramatic patients appear to be suffering from a multiple personality disorder. In fact, increases in temporal lobe activity and blood flow changes have been documented among patients diagnosed with multiple personality disorder (Drake, 1986; Fichtner, Kuhlman, and Hughes,1990; Mathew, Jack and West, 1985; Mesulam,1981; Schenk and Bear, 1981) , which is significant as the medial temporal lobe is not just contiguous with but part of the medial amygdala.

SEXUAL ABNORMALITIES AND SEX ABUSE

It is now well established that children who were severely sexually abused may develop a broad range of emotional, sexual, and cognitive abnormalities (Becker, Skinner, Abel, and Chirchon, 1986; Beitchman et al., 2012; Brown and Finklhor, 1986; Courtois, 2008; Harper, 1993), including, while still children, inappropriate and hypersexualized behavior (Deblinger, McLeer, Atkins, Ralphe and Foa, 2009; Friedrich, Urquiza and Beilke, 1986; Harper, 1993; Kohan, Pothier and Norbeck, 1987; Lusk and Waterman, 1986; Pomeroy, Behar and Stewart, 1981). Children who are sexually abused sometimes become sexually precocious and behave in a sexual manner with friends, school mates, and sometimes adults. They may fequently pull down their pants, or pull up their skirt and expose their genitals as well as play with the genitals of friends or allow them to play with theirs. They may also sexually act out what has happened to them with adults and may in fact solicit sexual abuse. Moreover, although removed from the home and hospitalized or placed in foster care, severely sexually abused children may behave seductively, expose themselves and masturbate with objects, aggressively solicit sex, and become angry or enraged when their sexual advances are thwarted (Kolko, Moser, and Weldy, 1988; Mannarino and Cohen, 1986; Mian, Wehrspann, Klajner-Diamond, Lebaron and Winder, 1986).

Sometimes, however, after being abused children may seek out more abuse. For example, children who are neglected or physically abused, may find sexual interactions with an adult to be a satisfying method of obtaining love and emotional comfort, a sense that someone cares about them (Finkelhor, 1979; Landis, 1956). However, they may also begin to associate love with being abused, or abuse with sexuality and orgasm. As such, they may then act in an abusive manner with others or solicit abuse in order relive the familiar of the long ago, and to obtain the satisfaction they associate with sexual fulfillment and love, and to achieve an orgasm; that is, they seek out those who will abuse them.

Yet others may become exceedingly fearful, withdrawn, anxious, severely depressed, and suicidal as well as hypersexual (Kolko et al., 1988; Livingston, 1987). These and related sexual emotional abnormalities may persist into adulthood.

Women with a history of severe childhood sexual abuse (CSA) may become promiscuous, engage in prostitution, and/or experience confusion over sexual orientation, or complain of hyposexuality, frigidity, and fear of sex and of men (Alexander and Lupfer, 1987; Becker, et al., 1986; Fromuth, 1986; Meiselman, 2008; Simons and Whitbeck, 2011; Stein, Golding, Siegel, Burnam and Sorenson, 1988; Tsai, Feldman-Summers and Edgard, 1979; Wind & Silvern, 2012). Promiscuity, even among those who dislike sex, is not uncommon, and a significant percentage of these women are more sexually active than non-abused females (Alexander and Lupfer, 1987; Fromuth, 1986; Tsai, et al., 1979; Wind and Silvern, 2012). A significant minority also tend to associate with men who will beat or sexually exploit them, and/or they engage in behaviors which increase the risk and which result in a higher incidence of being sexually assaulted and raped (Brown & Finkelhor, 1986; Gorcey et al., 1986; Russell, 1986). It has been found that between 40% to 60% of prostitutes report a childhood history of sex abuse (Silbert & Pines, 1981; see also James & Meyerding, 1977; Miller 1986; Weisberg, 1985).

However, there are also individual differences, and many women with a history of CSA deny any significant sexual pathology, or, as noted, complain of hyposexuality and loss of desire. Moreover, perhaps less than 10% admit to engaging in homosexual activities (Gundlach, 1977; Meiselman, 2008; Runtz & Briere, 1986), whereas bisexual activities among heterosexual women in the general population is rather common (see chapter 8). Moreover, there is no evidence to suggest that a majority of victims engage in prostitution; though a majority of prostitutes may well have been victims. Indeed, sexual as well as emotional disturbances such as excessive and chronic fear, depression, and anxiety, coupled with feelings of isolation, anger, and worthlessness are common (Herman & Schatzow, 1987; Murphy et al., 1988; Stein et al., 1988). Moreover, there is a high incidence of suicide attempts (Briere and Runtz, 1986; Bryer, Nelson, Miller and Krol, 1987), though not all investigators concur with this latter finding (e.g. Peters, 1988).

Likewise, a significant number of males with a history of CSA, report sexual disturbances (Finkelhor, 1979; Johnson & Shrier, 1985; Rogers & Terry, 1984), including hypo or hypersexuality, compulsive masturbation, and difficulty forming sexual relationships or performing adequately with a female sex partner (Duncan & Williams, 1998; Elliott & Briere, 2012; Hunter, 2011). Like their female counterparts, some sexually abused males may also experience confusion over their sexual identity or engage in homosexuality (Johnson and Shrier, 1985; Simari & Baskin, 1984). Finkelhor (1979) reported that males with a history of CSA are four times more likely than non-abused males to engage in homosexual activities. In addition, a significant relationship between CSA and teenage- or adult-onset pedophilia and violent criminal behavior has been reported (Haaspasalo & Kankonon, 1997; Knight & Prentky, 1993; Rubinstein et al., 1993; Watkins and Bentovim, 2012; Widom and Ames, 2005), including violence toward loved ones and intimate partners (Duncan and Williams 1998), including rape. And, as with women, men who were sexually abused suffer significant emotional problems, including depression, fear, anger, and anxiety, and not infrequently experience homicidal, suicidal, and self-destructive feelings (Mendel 2008; Urquiza and Capra, 1990; Watkins and Bentovim, 2012).

It is noteworthy that although men with a history of CSA often become exceedingly homophobic (Urquiza and Capra, 1990), there are also those who view the abuse as "positive" (Bauserman and Rind, 1997; Finkelhor, 1979; Laumann et al. 2005). In these latter instances, those who respond "positively" tend to have been "abused" by women rather than men, whereas some of those abused by men and feel positively about the experience, may well have been homosexual in orientation to begin with (e.g. Johnson and Shrier, 1985). Hence, although a significant number of males tend to be severely traumatized by CSA, others feel neutral or even positive and thus do not appear to be excessively stressed or upset by these experiences (for additional discussion see Bauserman and Rind, 1997). By contrast, the vast majority of females overwhelming tend to feel devastated and many forever have difficulty forming meaningful long-term relationships as they are plagued by feelings of loneliness and rejection even when they are truly loved.

THE SEXUAL SELF-DESTRUCTION OF "NEGLECTED" NORMA JEAN

It must be emphasized that there are varying degrees of sexual abuse and neglect. For example, a child who is beat, suffocated, tortured and repeatedly raped by a sadistic adult who then denies the abuse, and who repeatedly accuses the victim of manufacturing "false memories," will be affected much more severely and profoundly than a child who also repeatedly has sex with adults but who is instead provided with gifts, money, toys, clothes, as well as love and affection (Joseph, 1998b, 1999d). Hence, not only the age at which the child is abused, but the nature and degree of the abuse, coupled with other predisposing factors, all contribute to the resulting symptomology and the degree of damage to the limbic system (see below).

For example, some children may be neglected early in life and then sexually abused later in life which in turn will effect different limbic structures to different degrees. Moreover, and as noted, those who are neglected only to be sexually exploited, may discover that sexuality is a briefly satisfying means of escaping their loneliness and satisfying their cravings for affection. That is, children who are neglected or physically abused, may find sexual interactions with an adult to be a satisfying method of obtaining emotional comfort.

As also noted, injury or abnormalities involving the amygdala are associated with hypersexuality. Hence, children who are sexually abused sometimes become sexually precocious and behave in a sexual manner with friends, school mates, and sometimes adults. If they were also neglected as well as sexually abused, they may also sexually act out what has happened to them with adults and may in fact solicit sexual abuse as they find that sexual interactions with an adult to be a satisfying method of obtaining love, a sense that someone cares about them. Moreover, this inappropriate sexual behavior often continues well into adulthood, even if the victim claims that they do not obtain pleasure from sex. As noted above, they may become prostitutes, or seek anonymous sex from strangers of members of their own gender. And, if the sexual abuse was coupled with neglect, the victim may seek out those who will instill feelings of rejection as well as have sex with them. Indeed, they may feel rejected even by those who love them, and may be unable to obtain satisfaction from sex.

Hence, even when truly loved they may feel alone or rejected and neglected, such that they feel compelled to repeatedly seek a temporary sexual antidote to their depression and sense of isolation. Again, however, these feelings and behaviors, although "learned" are also neurologically based, for the same structures implicated in sexuality, abuse, and neglect (e.g., the amygdala) are also implicated in feelings of depression and become activated under conditions of isolation and emotional deprivation (see chapters 9, 13).

As an illustrative example, consider the case of Norma Jean. Norma's mother had been married and divorced twice and had several affairs before she was born. She had no idea who Norma's real father might have been.

Norma's childhood was a nightmare of neglect, abandonment, and rejection. Although she had a promiscuous past, Norma's mother was religiously superstitious and was consumed with fears regarding sins, some of which she claimed little Norma harbored in her soul. Norma's grandmother shared these beliefs and tried to smother little Norma to death when she was about 2 years old. Her mother also suffered from violent fits of rage and depression and frankly did not like being a mother. Hence, Norma was not just abused but severely neglected and her mother would often leave her with friends or relatives for days and weeks at a time. Finally, she put her little Norma in a foster home in order to free herself of the burden. After several months she reclaimed her.

This pattern of neglect, abuse, rejection, and abandonment was repeated for over a dozen years, during which Norma was placed in 10 different foster homes, including two years spent in the Los Angeles Orphan's Home. However, she was not just neglected and repeatedly abandoned, but was repeatedly sexually abused and raped and in fact became pregnant when she was 14 years old. Norma was allowed to have the baby and then it was taken away from her soon after birth. She never saw her son again.

When Norma turned 15, her current guardian presented her with the option of being returned to the orphanage (as she was planning on moving out of state) or marrying the son of her neighbor and best friend. Norma chose marriage. After a few years they divorced.

Over the next several years she "worked" as a prostitute even though she did not enjoy sex, but then obtained employment as a model, as she was very beautiful. Nevertheless, she continued her promiscuous ways, had numerous sexual affairs with strangers, maintained simultaneous sexual relations with several older men, but was unable to find the love and affection she craved. Indeed, although numerous men sought her affections, she nevertheless felt alone and rejected and suffered from severe depression and an overwhelming sense of insecurity. Although she claimed did not really enjoy sex, she continued to have numerous sex partners, allegedly repeatedly became pregnant, allegedly had at least12 abortions, was in and out of psychiatric treatment, married and divorced several very prominent and not so prominent men, made repeated suicide attempts, and abused alcohol and drugs. Surprisingly, she managed to forged a briefly promising and very successful career, but as her fame grew so did her depression, her sense of loneliness and feelings of rejections, as well as her frequency of her suicide attempts. She finally committed suicide (or was possibly murdered at the behest of the brothers "K") at the age of 36. They buried her under the name of Marilyn Monroe.

CHILDHOOD SEXUAL ABUSE AND THE AMYGDALA

Although there are exceptions, it is thus well established that CSA can significantly disturb all aspects of social, emotional, sexual, and personality functioning, with some females becoming so traumatized that they repeatedly dissociate and reportedly form multiple personalities (Putnam et al., 1986; Salama, 1980). However, although negative "conditioning," the "learning" of inappropriate behaviors, and "psychological" or unconscious conflicts regarding self-esteem and sexuality certainly contribute to the development of these disturbances, these same exact symptoms, including depression and suicidal ideation and successful suicide attempts, are associated with abnormalities involving the amygdala, and associated forebrain structures such as the hypothalamus, septal nuclei, and hippocampus--brain areas which can be injured by traumatic stress (Joseph, 1998b, 1999d; Lupien and McEwen, 1997; Sapolsky, 1996). In fact, the development of some of these abnormal sex-related behaviors may be due to abnormal stress-related learning occurring within the amygdala--abnormal learning associated with the abnormal neuroplastic changes and the establishment of inappropriate synaptic connections.

Abnormal (deprived-left) vs Normal (right) neural development

Synaptic development is associated with learning and increased and repetitive instances of arousal and neural activity, coupled with alterations in NE and other neurotransmitters. However, whereas some structures implicated in learning and memory, such as the hippocampus, may cease to function or display synaptic growth under conditions of repetitive and high levels of arousal, especially if the arousal is stress-related (chapter 30), the amygdala is directly implicated in modulating behavioral and physiological changes in reaction to stress and becomes highly active when stressed or physically restrained (Henke, 2012; Ray et al., 1987a). The amygdala also becomes activated and may become potentiated or undergo neurplastic changes if the individual is experiencing fear or perceives frightening stimuli (Chapman, Kairiss, Keenan and Brown, 1990; Clugnet and LeDoux, 1990; Halgren, 2012; Morris et al., 1986). Likewise, the amygdala becomes highly active when experiencing sexual arousal or engaging in sexual behaviors (Kling and Brothers, 2012; Remillard et al., 1983). In consequence, if physically restrained, experiencing fear and engaging in sexuality simultaneously, those amygdaloid pathways which subserve these behaviors and the stress reaction may be abnormally activated and mutually potentiated, such that aberrant neuroplastic alterations are induced and abnormal pathways become established (chapters 2, 30). Victims become afraid when experiencing sex, or associate sex with pain, or become aroused when frightened or injured, and then seek out or engage in dangerous activities, etc; a possible function of abnormal associative learning and the possible establishment of aberrant neural pathways which link sex with fear or pain coupled with stress-induced abnormal amygdala activity.

In summary, just as those with histories of CSA may behave in a hyposexual or hypersexual manner, and display other sexual abnormalities, and just as they may become chronically and severely depressed, fearful, withdrawn, isolated, suicidal, self-destructive, angry, or enraged, identical disturbances are associated with abnormalities of the amygdala including even the development of multiple personality disorder. Again, these commonalities are not merely coincidental, for traumatic stress, including the stress of sexual abuse, can induce limbic system injury and seizure activity, and can promote abnormal stress-related neuroplastic changes and associated synaptic abnormalities particularly within the amygdala. In this regard, it is likely that the sexual abnormalities and long term sexual traumatization associated with severe sexual trauma, may be directly due to stress-related abnormalities induced within the amygdala as well as the hypothalamus.

STRESS, SEX, CORTICOSTEROIDS, AND AMYGDALA, HYPOTHALAMIC INJURY

Corticosteroids and other stress hormones are released as part of the stress and fight or flight response. However, under prolonged or repeated episodes of stress, these substances are released in such massive amounts that they may destroy neural tissue (Joseph, 1998b, 1999d; Lupien and McEwen, 1997; Sapolsky, 1996). Specifically, in response to fear, anger, anxiety, physical restraint, or severe sexual or emotional abuse, the amygdala becomes highly active (e.g. Henke, 2012; Ray et al., 1987a; Roozendall, Koolhaas and Bohus, 2012; Stevens et al., 2001 ). In addition, the hypothalamus secretes corticotropin releasing factor which activates the andenohypophysis which begins secreting ACTH which stimulates the adrenal cortex which secretes corticosteroids (e.g., Hakan, Eyle, and Henriksen, 2005; Roozendall, et al., 2012). These events, in part, appear to be under the modulating influences of neuropeptides, and aminergic transmitters including NE which also serves a neural protective function (Glavin, 1985; Ray et al., 1987b). That is, since NE can activate the hypothalamic, pituitary, adrenal system (HPA) thus inducing the secretion of corticosteroids, and as these stress hormones can suppress or injure neural tissue (Lupien & McEwen, 1997; Sapolsky, 1996), increases in NE also act to protect these neurons from the damaging effects of these transmitters (Glavin, 1985; Ray et al., 1987b). However, as stress increases or becomes prolonged, NE levels may eventually become depleted (Bliss, Ailion and Zwanziger, 2008; Glavin, 1985) which exposes neurons to the damaging effects of corticosteroids and related stress hormones and renders them susceptible to becoming suppressed, or developing abnormal activity and undergoing aberrant neuroplastic changes (chapters 2, 30).

As noted, if the hypothalamus and the HPA axis are injured, the result may be chronic depression and a host of related emotional abnormalities (see Carrol et al., 1976; Sachar et al. 1973; Swann et al. 2005). This includes a tendency to hyper secrete glucocosteroids and to maintain high levels of cortisol even under neutral conditions--thus continually suppressing or subjecting neural tissue to possible injury and reducing the ability to cope with stress.

However, because the amygdala and hypothalamus are sexually differentiated (Allen et al., 2009; Bleier et al., 1982; Nishizuka and Arai, 1981, 1983; Rainbow et al., 1982; Raisman and Field, 1973; Swaab and Hoffman, 1990 ) and as the male vs female pattern is dependent upon the presence of circulating steroids, not only might the hypothalamus become inadvertently effected and abnormally differentiated due to the hypersecretion of corticosteroids, but so too may the amygdala and amygdala pathways. As noted, it has been shown that the ventromedial and anterior nuclei of the hypothalamus of male homosexuals demonstrate the female pattern of development (Levay, 2011; Swaab and Hoffman, 1990). Likewise, the anterior commissure (which interconnects the right and left amygdala and inferior temporal lobes) has been found to be significantly larger in homosexuals and females, as compared to heterosexual males (Allen and Gorski 2012); findings, however, which may be due to genetics, or other unknown factors.

Coupled with animal studies which demonstrate that sex specific behaviors and cognitive activities can be enhanced or altered by steroids (Joseph et al., 2008; Reinisch & Sanders, 2012) or suppressed due to early environmental influences, including the stress of deprivation (Joseph, 1979; Joseph and Gallagher, 1980), and given that the sexual differentiation of the hypothalamus may be altered by steroidal manipulations( Raisman and Field, 1973), it can also be assumed that traumatic stress and the massive secretion of steroids, particularly during early sexual development, may alter the neural organization of these same structures. In consequence, sexuality, sexual orientation, as well as emotion, personality, including the ability to cope with stress may be disrupted and become abnormal among those who have been severely or repetitively sexually abused and traumatized.

SEPTAL DESTRUCTION AND SEPTAL DEPRIVATION

The amygdala maintains a mutually influential and counterbalancing relationship with the septal nuclei as both are richly interconnected via the stria terminalis axonal fiber bundle and both interact in regard to the hypothalamus and hippocampus. In general, the amygdala exerts inhibitory and excitatory influences on the septal nuclei, which in turn exerts inhibitory influences on the amygdala and both exert counterbalancing influences on the hypothalamus via the stria terminalis (see chapter 13).

For much of the first postnatal year, septal influences are relatively minimal as this nucleus matures and develops at a much later age than the amygdala (Brown, 1983; Joseph, 2012a, 1999b). In fact, the initial development of the septal nuclei is influenced if not triggered by the extended amygdala, the tuberculum olfactorium (Humphrey, 1967), and later, it is only upon the receipt of, and activation by amygdala afferent fibers that the septal nuclei begins to differentiate (Brown, 1983). Moreover, the myelination of the septal nuclei is "extraordinarily protracted" (Yakovlev & Lecours, 1967). Indeed the septal nuclei and septal pathways do not display a significant degree of myelination until around 4-months of age and takes well over 3 years to reach advanced stages of development (Yakovlev & Lecours, 1967).

These differential rates of septal vs amygdala maturation are exceedingly adaptive. For example, as the inhibiting septal nuclei develops, the indiscriminate contact seeking of the amygdala comes to be suppressed, inhibited, and sufficiently restricted so that a very narrow and intense attachment is fashioned in its place.

In addition, as the septal nucleus is associated with internal inhibition and oppositional feelings of negativity (Heath, 1976) including rage (Blanchard & Blanchard, 2008; Jonason & Enloe, 1972), the later maturation of this structure likely contribute to the oppositional and defiant childish attitude that emerges around age two: the so called "terrible twos." These behaviors do not promote intimate social interactions and are probably produced secondary to septal influences on the amygdala and hypothalamus as these latter structures commonly trigger rage reactions (see chapter 13).

Destruction of or injury to the septal nucleus eliminates in part those counterbalancing inhibitory influences exerted on the amygdala and hypothalamus. However, septal injury secondary to deprivation and abuse experienced later in development can also induce septal seizure-like activity (Joseph, 1999b). If the septal nucleus is injured or develops seizure-like activity and if the the amygdala is released from septal inhibitory activity, and as the amygdala promotes indiscriminate socializing, there results an extreme desire for social and physical contact coupled with aggressive, explosively violent, and bizarre behavior (Jonason & Enloe, 1972; McClary, 1966; Meyer, Ruth, & Lavond, 2008). That is, since the amygdala as well as the septal nuclues mediates aggressive and social behavior, and since septal destruction of injury results in amygdala disinhibition, the disinhibited amygdala (coupled with septal stressed-induced abnormalities) promotes aggressive, emotionally bizarre behaviors including an extreme desire for indiscriminate social stimulation; some of the same exact behaviors displayed by older infants and young children deprived of maternal contact.

With complete bilateral septal destruction (and amygdala disinhibition) the drive for social contact becomes irresistible and so intense animals will form attachments with species they normally avoid, fear or dislike. Rats with septal lesions will readily seek out rabbits and mice (whom they usually avoid) and will even hug and cuddle with creatures that might kill and eat them, including ill-tempered cats. Septally lesioned animals who are placed together will hug and cling tightly together, forming a squirming ball of living flesh (Jonason & Enloe, 1972; McClary, 1966; Meyer et al., 2008).

Among humans with right sided or bilateral disturbances in septal functioning, or in cases of septal or amygdala seizure-like activity, a behavior referred to as septal "stickiness" or "viscosity" is sometimes observed (Joseph, 2012, 1999b). Such individuals seek to make repeated, prolonged, albeit superficial and inappropriate contact with anyone, even complete strangers so as to tell them stories, jokes or incessantly pass the time. Moreover, they may become irritable, angry and upset if that person leaves or attempts to break off contact; behavior somewhat similar to a 6-month old infant, or animals with septal lesions.

So intense is the need for social contact following septal lesions, that if other animals aren't available, they seek out, cling to, and hug blocks of wood, old rags, or bare wire frames; behavior identical to that of deprived infants, as well as normal children who may form attachments to blankets or "Teddy bears."

However, although seemingly starved for social stimulation, septally lesioned animals and humans also become explosively violent (Jonason & Enloe 1972, MacLean, 1990; McClary, 1966; Meyer et al., 2008). This behavior is similar to that of humans who suffered maternal deprivation late in development(Goldfarb, 1945,1946; Koluchova,1976; Spitz, 1946). That is, these deprived children will display an insatiable need for social stimulation, but also behave in a socially bizarre, bullying, sadistic, and explosively violent fashion.

As noted, for the first 8 months the infant behaves in a socially disinhibited manner and will readily accept hugs and kisses even from complete strangers. As the septal nucleus matures, however, the contact seeking amygdala comes to be inhibited and the formation of loving attachments becomes restricted to the primary caretaker and significant others.

Nevertheless, because the septal nucleus matures at a later age it also becomes more vulnerable to the disruptive effects of neglect and abuse at a later age as well. In fact, Heath (1972) found that monkeys reared under deprived conditions displayed abnormal electrophysiological activity in the septal nuclei. That is, whereas the amygdala first becomes vulnerable to deprivation and abuse suffered during the first 2 to 8 months (and beyond), the septal nucleus (as well as other forebrain structures) becomes increasingly susceptible over the ensuing months and years. Hence, children who are deprived or isolated after the first 6 months or year of development display abnormalities which are identical to those following septal destruction.

For example, children placed in foundling homes for long time periods after they have reached 6 months of age sometimes respond to strangers with extreme social stickiness and persistently express an intense desire for social contact. They may hug, cuddle, and kiss indiscriminately, as well as behave in an exceedingly aggressive and explosively violent fashion (Goldfarb 1943, 1945, 1946; Langmeier & Matejcek, 1975; Spitz 1945). Those reared for the first 4 years under isolated conditions behave similarly (Koluchova, 1976 Langmeier & Matejcek, 1975). Likewise, those placed in an institution after age one display an insatiable need for attention and affection but behave in an aggressive, unfriendly, inappropriate and socially bizarre fashion (Goldfarb 1943, 1945, 1946 Langmeier & Matejcek, 1975).

As the septal nucleus, like the amygdala and hypothalamus, is also implicated in sexuality (MacLean, 1990), abnormalities in this structure can also produce abnormal sexual (as well as aggressive) behaviors. Because these structures are all vulnerable as well as immature, those abused or chronically stressed at an early age, may suffer HPA, amygdala, and septal injury, all of which can produce a constellation of social, emotional, and sexual abnormalities, the nature of which being determined by the degree, repetitive nature, and age at which the infant was traumatized. For example, children placed in foundling homes after they have reached six months or even one year of age, not only become pathologically shy, but also may respond to strangers with extreme stickiness and persistently express an intense desire for social cohesion, which in many cases may include bullying, and abnormal or inappropriate sexual behavior, including unsolicited hugging and kissing, touching and sucking on genitals, or exposing one's self and even urinating on other children (Goldfarb, 1945,1946; Koluchova,1976; Spitz, 1946). That is, they crave social stimulation while simultaneously behaving in a pathologically shy, withdrawn, bizarre, bullying, sadistic, and socially, emotionally, and sexually inappropriate and sexually aggressive fashion: behaviors which are identical to those following septal destruction and associated limbic abnormalities.

Consider, an illustrative case provided by Langmeier and Matejcek (1975, p. 41-42). "F.J. was an illegitimate child of a... mother... who concealed the fact she had a child. Up to almost two years of age the boy was left alone for days at a time, locked in her room, in complete isolation." At age two he came to official notice, was placed in foster care. He "cried all the time... and made only one meaningless sound... The boy veered from being very frightened of people to embracing and kissing everybody... He attacked other children... urinated on other children, touched their genitals and... wanted to kiss and cuddle."

THE UNABOMBER

"The many rejections, humiliations and other painful influences that I underwent have conditioned me to be afraid of people. This fear of rejection--based on bitter experiences at home and at school--has ruined my life, except for the few years that I spend alone in the woods, largely out of contact with people." Ted Kacynski.

Over the course of 17 years, Ted Kaczynski severely injured, maimed, or killed 27 people in 16 different bombings (Douglas, 1996; Graysmith, 1998). He had been living as a hermit and a recluse in a tiny plywood cabin in Montana, when he was arrested by FBI agents, on April 24, 2008. Described as "pathologically shy" Kaczynski was born on May 22, 1942, to Polish immigrants who eschewed learning, but who were otherwise, according to Kaczynski, emotionally cold, distant, and "rejecting" and who he "couldn't come to..." because they used him as a "defenseless butt." "The rejection I experienced even affected me physically," he complained in one letter to his mother.

According to his family, baby Ted has initially been the all American "bouncing... bundle of joy." However, around 9 months of age, he became severely ill with a dangerous case of the hives, was hospitalized and isolated, and even his parents were forbidden to make contact, to touch, hold, or hug him. This was "hospital policy" his mother was informed and sick children were to have "no visitors." There he remained, for over a month, and not once was she allowed to to touch, hold or comfort her son. According to his mother, after an initial protest phase, in which he cried incessantly and would stretch out his arms and plead and cry for her, he becoming increasingly listless, withdrawn, disinterested in and unresponsive to human contact, and "developed an institutionalized look." Thus he rapidly passed through all three stages associated with a condition Spitz referred to as "hospitalism."

For example, according to Spitz (1945, 1946) children between the ages of 6 months to 2 years, even if briefly isolated, would, within minutes, begin crying and screaming for their mothers. This was followed by a stage of despair in which they would cease to cry, lose interest in the environment and withdraw. In the final stage the children ceased to show interest in others and no longer responded to affection. Instead they became passive and unresponsive, sitting or lying quite still with a frozen expression, staring for hours at nothing (see also Bowlby, 1982). If the separation continued there was further deterioration, with children becoming ill or dying. Moreover, Spitz (1945, 1946) found that some children would quickly pass through all three phases, sometimes within a few days, and that those who experienced long-term separations often became permanently emotionally and even sexually abnormal.

However, Ted was not merely isolated, he was placed in full body restraints, and was pinned to his hospital bed with splints, spread eagle and completely naked. Hospital personnel felt that full restraint was necessary so as to prevent him touching his sores, or rubbing off the ointments and dislodging the compresses. As noted above, the amygdala becomes excessively active not only when stressed, but when stressed by physical restraint.

After Ted returned from the hospital all aspects of social and emotional functioning became bizarre. He ceased to respond to affection or social stimulation and became pathologically shy, severely withdrawn, and unable to relate. According to his mother, he was "no longer that happy, bouncing, joyous baby, but a little rage doll that didn't look at me... that was slumped over--completely limp... like a bundle of clothes."

Ted never recovered, and instead remained "always apart, aloof, alone." At age three when he was placed in nursery school, his teacher explained to his mother that "he will not play with other children." As he grew older, his remain isolated and alone, and if visitors arrived at his home, he would withdraw to his bedroom and lock the door. Throughout his undergraduate and graduate college days, Ted continued to avoid others, failing or refusing to acknowledge greetings even from those sharing his dorm at the University of Michigan. He would sweep past them, and quickly close the door to his room.

Although socially retarded, Ted was described as brilliant and a mathematical genius. After graduating from Harvard with a BS, he went on to the University of Michigan and published several papers in prestigious math journals. In 1976, his doctoral thesis on "Boundary Functions" won the annual Sumner Meyers Prize for best doctoral thesis. However, Ted was offered a professorship at Berkeley even before he obtained his Ph.D (Douglas, 1996).

Once at Berkeley, he continued to live the life of a recluse, avoiding human contact, refusing to look at his students, and often ignoring even their questions while he lectured facing the blackboard. He also became increasingly sexually confused and even sought a sex change operation. Nevertheless, he also craved social stimulation which he expressed through his voluminous writings, but when he personally interacted with others, including family or members of the opposite sex, he would react in a bullying, sadistic, and angry fashion often becoming profoundly enraged.

According to his brother, Ted Kaczynski "through the years has shown sudden and unpredictable mood swings, a preoccupation with disease, extreme phobias, compulsive thinking and an inability to let go of minutia. One senses a psyche that feels itself terribly isolated and threatened by the world, tormented by its own complexity, unable to hold things in their proper perspective or to find comfort, security, or rest in itself."

Indeed, Ted himself admitted that his entire life he has felt "always under stress."

As noted, not all humans or animals react the same to stress, abuse, or insufficient social stimulation, as there are individual, gender, and other predisposing factors which differentially contribute to the outcome. In the case of Mr. Ted Kaczynski, it is noteworthy that he complained that his mother had always been emotionally cold and distant. In addition, his father committed suicide, and his brother David, also briefly lived as a recluse, in a hole in the ground, twenty miles from the nearest road. When it rained, or got too cold, David would pull a tarp over the hole to keep out the weather. In this regard, it could be argued that Ted Kaczinsky was already at risk and was predisposed to suffer catastrophic consequences from the brief period in which he was completely isolated around 9 months of age. Nevertheless, in this regard, Mr. Kaczynksi also developed and forever displayed the characteristic symptoms associated with septal and amygdala abnormalities secondary to insufficient maternal and social-emotional stimulation during infancy (Joseph, 1999b).

Although Mr. Kaczynksi developed sexual problems, there is no evidence of sexual abuse in his early history. Of course neglect and isolation coupled with physical restraint, like sexual abuse, is exceedingly stressful, and may induce, to varying degree similar sexual and social-emotional problems due to the damaging effects on the limbic system.

Of course, it would be expected those who are neglected, deprived of sufficient mothering, and who are also sexually abused, would be even more severely and profoundly affected that Mr. Kaczyksi. Although also harboring murderous or at least aggressive and violent impulses, in cases of neglect and sexual abuse, symptoms associated with "sexual traumatization" would likely predominate.

THE CASE OF THE HETERO/HOMOSEXUAL TRANSVESTITE RAPIST AND PEDOPHILE

Children who are sexually abused sometimes become sexually precocious and behave in a sexual manner with friends and school mates. They may fequently pull down their pants, or pull up their skirt and expose their genitals as well as play with the genitals of friends or allow them to play with theirs. They may also sexually act out with adults, or once they become an adult, they may sexually act out with children, or with individuals and in situations which are associated with the original sexually traumatizing experiences--a function of the abnormal activation of those structures involved not only in stress and sexuality, but memory.

Moreover, as noted, males with a history of CSA are four times more likely than non-abused males to engage in homosexual activities (Finkelhor, 1979); disturbances also seen with amygdala dysfunction. In addition, a significant relationship between CSA and teenage- or adult-onset pedophilia and violent criminal behavior has been reported (Haaspasalo and Kankonon, 1997; Knight and Prentky, 1993; Rubinstein et al., 1993; Watkins and Bentovim, 2012; Widom and Ames, 2005), including violence toward loved ones and intimate partners (Duncan and Williams 1998), including rape--and violence including sexual violence is also associated with abnormalities involving the amygdala, as well as the septal nuclei.

As noted, the amygdala becomes activated when stressed, and when subject to physical force, threat, when engaged in sex acts, or all of the above. The amygdala, as well as the hypothalamus, may also become abnormally sexually differentiated in response to abusive, stressful, and in reaction to sexually stressful and abusive episodes repeatedly experienced early in life. In addition, the septal nuclei may be adversely affected. Due to the consequent neuroplastic alterations induced (including those which are learning-related) a range of bizarre sexual and aggressive abnormalities may ensue, again depending on the nature, repetitiveness, and age at which the abuse was suffered.

Moreover, as the amygdala is associated with the production not only of sexual behavior, but sexual imagery and affective memories, and as the septal nuclei interacts with the hippocampus (as does the amygdala) in learning and memory (see chapter 14), the combined abnormalities involving these structures may result in the uncontrolled and obsessive production of bizarre sexual thoughts and fantasies. Hence, a child who was repeatedly sexually abused may frequently think and fantasize about what happened, or he/she may act out the abuse with others, and, depending on the nature of the early sexual abuse, may seek out abusive homosexual or heterosexual relationships and/or fantasize about engaging in abnormal sex acts--behaviors, thoughts, and fantasies which may persist into adulthood.

Consider, for example, a 36 year old burglar I was appointed to evaluate by the Santa Cruz County Superior Courts, in California. "Allen" had been charged with 11 counts of burglary, but oddly, he had only stolen women's clothing; items that he could have easily purchased from any store. Like many burglars he admitted that breaking into homes was sexually arousing, and like many burglars he felt compelled to masturbate and to ejaculate on the bed or clothing of the victim. However, unlike other burglars, "Allen" would first put on the clothing of his female victims, usually panties and bra, and would then proceed to ejaculate.

Allen claimed that he felt an irresistible compulsion to commit burglaries and to steal and wear women's clothes. In fact, he been discharged from the Army for dressing in women's clothing, and for exposing his penis to other soldiers when dressed in this fashion. Allen in fact had frequently engaged in homosexual acts while dressed as a woman, and had sex with numerous little boys while so attired.

Allen was not purely a homosexual transvestite with a compulsion to steal and expose himself and to have sex with little boys, for he was also sexually attracted to women. Indeed, he fantasized about raping women while dressed in sexy panties, bra, and women's clothing, stalked women while dressed in women's clothing, and in fact raped several different women while so attired, after encountering them alone in various laundry mats.

Disgusted and repelled as well as uncontrollably aroused by his compulsions and behavior, Allen realized that he was "sick" and that his acts could only be committed by a "very sick person" and he made several suicide attempts and frequently slashed and cut his own body. After he was finally arrested, he made several more suicide attempts and slashed his body.

Although there was likely a genetic component to his behavior (or at least a genetic predisposition), Allen was also an obvious product of his early rearing environment which was characterized by maternal neglect and severe sexual abuse. Born out-of-wedlock in a state mental hospital to a schizophrenic mother, he was placed in and out of various foster homes only to be returned to his mother every time she was discharged from the hospital. Finally, at age three, when it became clear to the authorities that Allen was being profoundly neglected, he was placed in yet another foster home where he was then repeatedly sexually abused and raped by his homosexual "foster" father. His "foster" parents, however, obtained a particularly perverse pleasure in forcing Allen to dress as a girl, incuding bra and panties, his "foster" mother sometimes applying makeup and lipstick. Moreover, while Allen was costumed in female attire his "foster" mother would sometimes watch or even hold him down while his "foster" father orally raped and sodomized him. According to Allen, his earliest memories were of being dressed in girl's clothes and being sodomized and "forced to suck dick."

Apparently this nightmare of oral rape and sodomy continued on a daily basis for two years, at which point he was returned to his mother at age five. However, because his mother was still psychotic and was not providing him with care, he was finally declared a ward of the state. Allen spent the next 13 years living in various foster homes under varying conditions of neglect and emotional and sexual abuse. Indeed, he states that although he hated what had happened to him when he was regularly raped as a child, and although he felt sexually attracted to girls and women, that he nevertheless felt a compulsion to secretly wear bra and panties and would solicit sex from older and younger boys as well as an occasional man--behaviors that led to his discharge from the army, and to his sexual crimes against women while dressed as a girl.

HENRY LEE LUCAS: SERIAL SEX KILLER

Whe he was finally arrested, after first pleading innocence, Henry Less Lucas eventually admitted to killing somewhere between 100 to 200 people; a number that has since been disputed and an admission that he subsequently retracted and now denies. However, that Henry Lee is a killer, and that he derived considerable enjoyment from knifing, slicing, dicing, and stabbing a number of women, including his mother, and then having sex with the eviscerated bodies, seems to be beyond dispute. However, although Henry may well had a genetic predisposition, like Allen, he too was a product of a neglectful and sexually abusive environment.

Henry Lee Lucas was born in the back woods of Appalachia in an isolated, clap board one room shack, and to a mother who was described as being as "vicious and as mean as a rattle snake." It is alleged that neither she, her husband, or her children ever bathed but used water only for drinking and making moon shine. Her husband (whose legs had been severed below the knees) and both her two sons, which included Henry, were terrified of her, particularly when she was drunk, which was most of the time.

Surprisingly, although she was big, fat, and rather ugly, she regularly sexually serviced the men who lived near her out in the West Virginia hills, charging them "50 cents a screw." However, because the house had no bedrooms to speak of, she would often turn tricks while her children and husband were home, and she allegedly derived considerable enjoyment from having her husband, and Henry watch her laying there with her legs spread and wrapped around some stranger. According to Henry, she forced him to watch, and one when he tried to leave, she threatened and then beat him.

Allegedly, this big woman enjoyed hitting and screaming, particularly when she was drunk, and would not only slug and knock around her husband and children, but would sometimes, but would sometimes turn on her paying customers. Henry claimed that on many an occasion he had seen his mother chase the men she had been screwing out of her house by shooting at them.

His mother was a brutal, drunken, whoring, tyrant. According to Henry his mother would kick, punch, and even pick up a board or tree limb to beat him with, and on one occasion she hit him so hard across the head with a board, that he was unconscious for three days. He states that following that particular beating he began suffering dizzy spells and blackouts, problems that plagued him his entire life.

On yet another occasion, his mother beat him so severely with a board that his left eye was knocked partly out of the socket and was severely damaged. Although he was hospitalized for almost 3 weeks, his mother never bothered to visit. Unfortunately for Henry, a few years later while in school, a teacher accidentally hit Henry in the same eye with a ruler, causing it to burst open. From that point on he wore a glass eye which hung slightly askew and which he never bothered to clean, thus giving him a definite deranged appearance.

According to Henry, it was soon after his second eye injury that his teachers discovered that he was not a girl, but a boy. Although Henry knew what he was, his mother had forced him to wear a dress around the house and to school, and his hair long and curly so that he looked liked a girl. However, after his second eye injury, one of his teachers cut off his hair and demanded that he dress like a boy, apparently sending a note home to that effect which in turned caused quite an uproar.

As noted, Henry's father was also terrified of this woman, and having no legs beneath the knees, he simply could not stand up to her. According to Henry, his father had been maimed in a railroad accident, and both his legs were severed at knee level. From that point on he turned into a hopeless drunk who made money hopping about on his hands and butt, begging and trying to sell pencils. The town folk soon began referring to him as "Ass and elbows," and "No legs." When Henry was still a boy, his father met with another accident, and was found dead outside their house in the snow one morning with severe head injuries. The death was never formally investigated.

Soon his mother had a new lover, a slightly mentally retarded man who had a tendency to wet the bed. Henry's new "Pa" not only didn't mind watching his new "wife" turn tricks with other men, but had his own peculiar way of enjoying sex, and on more than one occasion invited Henry along to watch and to share the experience.

Henry's new "Pa" liked to have sex with animals, dogs, cats, sheep, goats, and calves, but only once they were dead. According to Henry, he was initiated into this strange way of love making, when one day his "Pa" stole a calf and then took the animal and Henry up into the hills. While Henry watched, his "Pa" slashed and cut open the calf's throat and while the poor creature lay on the ground bleeding to death, he pulled down his pants and fucked it. Then he made Henry do the same; which Henry admits, was exceedingly exciting--so exciting that he not only would tag along with his "Pa" on these sexual escapades but began stealing dogs, cats, and so on, and would stab and cut them up and then have sex with the creature while it died and bled to death. According to Henry, he derived as much if not more excitement out of killing as having sex. His mother was his first human victim.

Once he was released from jail, having served his sentence, he went on a sexual killing rampage for the next ten years. According to Henry, he simply drove up and down the highways, picking up female hitchhikers, or those whose cars had broken down, and would brutally cut and stab to death those who voluntarily or who were forced to get in his car.

For example, in one case verified by police, Henry had come across a young woman whose car had broken down. After checking under the hood, he convinced her to get in the car, promising to drive her to the next gas station. However, as soon as he pulled out into the road, he pulled out a big knife and put it to her throat and told her he was going to have sex with her. When they got to an isolated spot, he made her get out of the car and ordered her to disrobe. However, she didn't do it quickly enough so he attacked her and ripped her clothes off her, beating and pummeling her in the process. Once she was naked, Henry began stabbing her, and then while she was bleeding to death and then again after she was dead, he had sex with her.

However, his sexual mahem was not limited to hitchhikers or women having car trouble, as he began killing and sexually assaulting shop owners or clerks he found alone in their stores, as well as women he found alone in their homes after breaking in. Sometimes he would eviscerate and disembowel his victims as he found that especially sexually exciting. Indeed, according to Henry, he would only have sex with the body after it was dead, bloody and sometimes chopped up into little pieces. He even chopped up his own 13 year old niece and then had sex with what was left of the body before scattering the pieces over a field.

THE ANTERIOR CINGULATE GYRUS

Limbic system nuclei do not function in isolation but in conjunction with the frontal and temporal lobes and a variety of forebrain and brainstem structures. Hence, damage to one structure can often lead to abnormalities in otherwise normal tissues. Likewise, early deprivation, and thus environmentally induced functional lesions, tend to involve vast regions of the brain including the cingulate gyrus which is an integral aspects of the limbic system and interacts with the amygdala and septal nuclei in the development of social-emotional behavior, including language (chapter 15).

Among its many functions, the anterior cingulate (which sits atop the corpus striatum and corpus callosum, but beneath the neocortex) is associated with the vocal expression of emotional, melodic, and prosodic nuances. Related functions include attention, emotional learning, identifying the affective attributes of noxious psychic stimuli, maternal behavior, separation anxiety, and the formation of long-term attachments (Devinsky, Morrell, & Vogt, 2008; MacLean 1990). Depth electrode stimulation of the anterior cingulate can induce feelings of anxiety, pleasure and fear, and can trigger a wide range of divergent vocalizations including growling, crying, laughing, cackling, blood curdling screams, and sounds similar to an infant's separation cry (Devinsky et al., 2008; Jurgens, 1990; MacLean 1990; Meyer , MacElhaney, Martin, & MacGraw, 1973; Robinson, 1967).

The anterior cingulate also assists in setting thresholds for vocalization (Jurgens & Muller-Preuss, 1977; Robinson, 1967), including modulating the prosodic and melodic features which characterize different speech patterns, e.g. happiness vs sadness, and thus laughing vs crying. This is made possible via connections with the brainstem periaqueductal gray (Jurgens 1990). The cingulate's involvement in speech is also made possible through its thick axonal projections to the right and left frontal speech areas, including the amygdala which acts to comprehend these same emotional vocalizations. Indeed, Broca's speech area, and the emotional-melodic speech area in the left and right lateral frontal lobes, evolved from and responds to cingulate impulses by vocalizing (chapter 5). If the cingulate were destroyed, the patient would become mute, inattentive, and socially and emotionally unresponsive (Barris & Schuman, 1953; Devinksy et al., 2008; Joseph, 1999a; Jurgens, 1990; Laplane, Degos, Baulac, & Gray, 1981; Tow & Whitty, 1953).

Whereas vocalizations triggered by excitation of the amygdala, hypothalamus, or septal nuclei are usually accompanied by mood-congruent behaviors (Jurgens, 1990; Robinson, 1967) the cingulate is capable of producing exceedingly complex social emotional vocalizations which sometimes have no bearing on the organism's mood or true emotional state (Jurgens, 1990; Jurgens & Muller-Preuss, 1977; Meyer et al., 1973). In addition, completely different emotional calls can be elicited from electrodes which are immediately adjacent (Jurgens, 1990). Thus the cingulate is capable of considerable vocal flexibility and enables an individual to modulate the emotional, prosodic, melodic components of speech so that one's true feelings can be disguised or emphasized in order to produce sounds suggestive of, for example, incredulity, hilarity, or sarcasm.

The anterior cingulate, like the medial amygdala, begins to myelinate around the second postnatal month and reaches advanced stages of myelination by the end of the first year (Benes, 2005; Yakovlev & Lecours, 1967). The cingulate is also richly interconnected with, and compliments amygdala related functions, including the fear response. As noted, the cingulate can generate and vocalize feelings of separation anxiety, including a separation cry which is identical to that produced by a frightened infant (MacLean 1990; Robinson, 1967).

Hence, the maturation of the cingulate is important not only in the formation and strengthening of emotional attachments, but various aspects of speech. This includes those vocalizations which infants produce in accompaniment to those produced by their mothers (Bayart, Hayashi, Faull, Barchas, & Levine, 1990; Jurgens, 1990; Wiener, Bayart, Faull, & Levine, 1990). When mothers and infants mutually vocalize, these interactions reinforce and promote attachment behaviors, and contribute to the development of language.

However, like the amygdala and septal nucleus, the immature cingulate is also vulnerable to the disruptive effects of social and emotional deprivation (Diamond, 1985, 2011; Joseph, 1999b). Moreover, deprivation experienced early in life can produce symptoms identical to those following anterior cingulate destruction; i.e. extreme passivity, emotional unresponsiveness, and mutism (Barris & Schuman, 1953; Joseph, 1999a; Laplane et al., 1981; Maclean, 1990; Tow & Whitty, 1953).

Consider, for example, the results from a 1930's Nazi experiment designed to raise "supermen." German infants were reared in a special home designed to maximize their innate superiorities with the single exception that mothering was not provided as it was thought undesirable to expose these infants to those who might instill in them womanly feelings of nurturance, compassion, etc. Within two years 19 of the 20 children raised in this "superior" environment became severely withdrawn, unresponsive, and mute, and would "lay in their beds like dead fish."

Likewise, in a study of over 100 children reared under similar conditions, R.A. Spitz (1945) found that within one year these infants would lay passively on their beds, almost completely mute and unresponsive to social stimulation. In fact, and as detailed above, over 70% of infants placed in foundling homes during the early 1900's, died within one year. Of 10,272 children admitted to the Dublin Foundling home during a single 25 year period, only 45 survived.

As also noted, early abuse or neglect can injure the HPA axis and result in the chronic hypersecretion of corticosteroids, whereas primates with elevated cortisol tend to "waste away and die with no apparent pathological cause" (Johnson et al., 1996, p. 333). Hence, children who are denied sufficient emotional stimulation, would also hypersecrete corticosteroids, which explains why they are at risk for laying in "their beds like dead fish," wasting away and dying as was common in orphanages and institutions early in this century and throughout the 1800s.

Again and again, however, it must be emphasized that the nature and extent of any subsequent symptoms and the development of brain damage, is dependent on the age, degree, duration and nature of the abuse and/or neglect. Moreover, some chidlren may be more at risk due to genetic predisposing factors. Indeed, in some cases, the brain damage given rise to these symptoms may be congenital. For example, children with profound congenital disturbances in all aspects of social emotional functioning, and who behave in a fashion that is almost identical to those who have been reared under deprived conditions, i.e. autistic children, have also been found to have microscopic abnormalities in the anterior cingulate, amygdala, septal nuclei, and hippocampus (Bauman & Kemper, 2005).

Nevertheless, under severe and chronic conditions, it is rather clear that deprivation experienced early in life produces symptoms similar if not identical to the destruction of not just the amygdala, and septal nuclei but the anterior cingulate, a structure which is intimately interconnected with the right and left frontal (Broca's) speech areas, and which in fact sets vocalization thresholds and is the most vocal region of the entire brain (Jurgens, 1990; Robinson, 1967). Hence, not surprisingly, children who are severely neglected or reared under deprived conditions, not only become emotionally and sexually abnormal but display significant language-related abnormalities, including, in the extreme, a passive mutism that is occasionally punctuated by "blood curdling screams" (Koluchova,1976; Spitz 1945, 1946).

NEURAL PLASTICITY & SOCIAL-EMOTIONAL REHABILITATION

It is noteworthy that young primates who suffer bilateral amygdala destruction, although severely disturbed in all aspects of social and emotional functioning, are not as profoundly effected as their adult counterparts and recover some ability to relate (reviewed in Kling & Brother, 2012). In large part, this mild degree of functional recovery can be attributed to neural plasticity and the immature status of the amygdala and surrounding tissues, and the fact that these youngsters continue to receive considerable social-emotional input from mothers, siblings, and group members.

The amygdala does not act in isolation but receives input from other brain regions. Hence, following the surgical destruction of the immature amygdala, the severed and disconnected axons from intact tissues likely seek out and establish new connections with immature non-amygdaloid neurons which surround the lesion but which are not yet committed to any particular function. Once intact tissue is innervated by these severed axons, and so long as social and emotional stimulation is provided, those neurons surrounding the lesion (which have subsequently received those disconnected axons normally destined for the ablated amygdala), in turn come to subserve some amygdala related functions.

It is common for axons which have been disconnected from their terminal substrate to seek out and establish interconnections with nearby, functionally intact neurons (Juliano, Eslin, & Tommerdahl, 2005; Ramachandran 1993; Weiller, Ramsay, & Wise, 1993). For example, if the somastosensory neocortex which normally receives sensory impressions from the hand is destroyed, those disconnected axons which still serve the hand, will search out nearby intact neurons and dendrites such that the cortex surrounding the lesion will be innervated by axons representing the hand (Jenkins, Merzenich, & Recanzone, 1990). Thus sensory capacities associated with the hand will be reestablished.

Hence, so long as an amygdalectomized infant continue to receive considerable social, emotional and maternal stimulation, some sparing and recovery of function is likely; a consequence of neural plasticity and the proliferative capacity of intact neurons and axons to seek out interconnections.

Likewise, humans (Koluchova, 1976; Langmeier & Matejcek, 1975) and non-human primates (Harlow, Harlow & Suomi, 2009; Mitchell, Maple, & Erwin, 1979) reared under isolated and maternally deprived conditions, but who are then later placed with young or nurturing older females, will subsequently display some recovery of normal social and emotional functioning. Indeed, if provided considerable social, emotional, physical, and enriched sensory stimulation, the prognosis for a significant recovery of language and intellectual skills is greatly enhanced even in cases of severe and profound emotional neglect (Koluchova, 1976; Langmeier & Matejcek, 1975).

Unfortunately, although many children who suffer brief episodes of neglect or abuse may appear to quickly recover if provided sensitive and nurturing maternal stimulation, there remains an increased risk for developing and suffering severe emotional disturbances in reaction to traumas experienced later in life. In fact, although they are not incapacitated, individuals reared under even less extreme conditions may continued to function in an emotionally and sexually abnormal fashion their entire lives and may seek out individuals who will neglect or abuse them, or will form relations with women or men who will allow themselves to be abused. As noted above, they may engage in criminal acts and torture and murder innocent men.

PATERNAL INFLUENCES: PSYCHOLOGICAL REACTIONS TO REJECTION

H uman males, and in fact most male primates have little interest in infants children (Belsky et al., 1984; Clarke-Stewart, 2008; Frodi et al., 1982) and generally provide little or no nurturant care for their offspring (Fedigan, 2012; Kummer, 2008, 2009; Mitchell, 2008, 1979, Goodall, 2009; Gordon and Draper, 1982; Rossi, 1985; Rowell et al., 2008). Human males and fathers rarely behave in any manner that approximates normal female maternal behavior (Belsky et al., 1984; Clarke-Stewart, 2008; Frodi et al., 1982). Rather, human and non-human primate males only begin to show interest when the young reach adolescence or late childhood. In regard to fathers, often this interest is disciplinary and centers on the of enforcing rules and the provision or threat of physical punishment. Of course, fathers also serve as role models, and as models of responsibility and restraint--behaviors that may be incorporated by the child. Indeed, it is through the father that the child learns to control his or her behavior so as to avoid the physical consequences.

Father and mothers, serve different roles in the shaping of the child's personality, as it is the mother who is most important for much of childhood whereas the father becomes more important later in development. Hence, if the child is deprived of these fatherly/paternal influences later in life, they may be severely effected emotionally and behaviorally, particularly in regard to the ability to control and inhibit inappropriate behaviors (U.S. Public Health Services, 1998).

For example, in a 1998 survey of 50,000 households by the U.S. Public Health Services, it was found that boys aged 15-17, who were living without their father were almost twice as likely to repeat a grade (28% vs 16%), more than twice as likely to be expelled (16% vs 6%) and to engage in anti-social behavior (45% vs 18%), almost twice as likely to be socially withdrawn (19% vs 10%), and almost a third more likely to display symptoms of depression and anxiety (54% vs 37%).

The failure to receive proper paternal (adult male) guidance is only one factor in the development of these disturbances, however, as even boys raised with step-fathers show high frequencies of anti-social behavior. There is in fact a psychological component and it entails a psychological reaction to abandonment. That is, although the child may not verbalize these feelings, the child nevertheless feels rejected, the child feels bad, and the child may decide that they have been rejected because there is something wrong with them. "I feel bad, therefore I must be bad." And, because they feel bad, and feel they must be bad, then they act badly. They act badly in order to retaliate and as a form of self-destruction, and to act out a self fulfilling prophesy (Joseph, 2012b). They create situations where they are punished and thus rejected. Being rejected and feeling badly becomes "normal."

Of course, if the child has already been deprived of normal mothering, then they will be even more profoundly effected if they are later deprived of appropriate fathering. Consider, for example, Henry Lee Lucas, described above.

MATERNAL INFLUENCES ON PSYCHOPATHOLOGY: SERIAL SEX KILLERS

The human female is neurologically predisposed to provide her infant with considerable social emotional and loving stimulation. Indeed, as noted in the introduction, human females demonstrate an extraordinary interest in babies and will engage in play-mothering during even the earliest phases of their own childhood, and will eagerly cuddle, groom, and hold babies including those that are not her own. This is exceedingly adaptive as the infant requires this input in order to thrive and to develop normally.

However, just as fathers serve as role models, provide discipline and whose rules of law may be incorporated, mothers too serve as role models. A mother teaches her daughter how to be a mother, and she teaches her son how women should be treated. If she is in an abusive relationship, then when her son grows up he may treat women abusively and when her daughters grow up they may seek out men who will abuse them. If the mother is a single mom and she has sex with numerous males, her daughter may also grow up to be a "whore" and her son may grow to hate all women who he then treats as "whores" (Joseph, 2012b).

And, just as a boy or girl may feel badly, rejected, and worthless if they grow up without a father, they may feel even worse if their mother is also absent, neglectful, and abusive. Indeed, as detailed above, the developing limbic system may become abnormal, such that all aspects of social, emotional and sexual development becomes abnormal. Again, consider the case of Henry Lee Lucas.

SERIAL SEX KILLERS

EDWARD "GEIN THE FIEND"

When the local sheriff and a police captain arrived at Ed Gein's isolated farm house, he wasn't home, so, they broke in. It was a very old dilapidated house with no electricity, no indoor plumbing, no telephone. It was also littered with filth, rotting food, and trash. Drawing their flashlights and holding their noses, the two officers carefully wandered among the debris. Shining his light here and there the sheriff took a step back and felt something bump his shoulder. Turning slowly he directed his beam of light on the headless, completely gutted body of Gein's latest victim. She was hanging naked by her heels from the rafters. Her vagina and anus had been cut away, probably with a circular saw.

Upon searching the house further, they discovered that it was littered with body parts, some of which had been turned into household utensils and furniture or sewn into the shape of clothing. They found soup bowls that had been the top half of sawed off human skulls, as well as skulls and complete human heads hanging from bed posts, or lying about the floor and even under furniture. There were chairs upholstered with human skin that had lumpy bits of human fat still attached to the underside. There were lamp shades, a waste basket, a drum, and bracelets, which were made of human skin, as well as a belt that had been fashioned out of female nipples.

In Edward's bedroom they discovered a shoe box that was filled with vaginas and vulvas, some with the anus still attached. Included in this collection were a nipple belt and leggings made of human skin. It wasn't just a random collection, however, for Gein was making a suit of clothes composed entirely of human skin and body parts.

Edward Gein also possessed a huge collection of what the officers at first thought to be masks. Gein, however, had carefully peeled the scalps and faces, minus the eyes of course, from the heads of at least ten women. In fact, one of the officers happened to pull one of these masks from a paper bag, not knowing what it was, and immediately recognized the face of woman who had been missing for some time. On some of these faces Gein had applied makeup and lipstick.

As Gein later admitted, he would actually put on these faces, the nipple belt, and the leggings as well as a vest made of skin which he had carefully carved from the upper torso of a victim. He would prance naked around his house, or outside in the moonlight, making believe that he was in fact a woman. He even put the vaginas he had cut from his victims on his penis.

As one might suspect, Edward had a somewhat unusual upbringing. His father had been an orphan and was an angry resentful man who seemed to fail at everything. Edward's mother took a peculiar delight in pointing this out as well as reminding Edward that his father was incompetent and a complete failure as a man. All men were no good, she said, and she made it clear to Edward that she was bitterly disappointed that he had not been born a girl. However, she also made it clear that most women were also "no good," especially the "loose" and "sinful" women who populated the small town where they purchased goods on weekends. Sex was an abomination and women were sinful creatures deserving damnation and the worst punishments of god.

"God" was a major focus of the Gein household. However, this was not a loving, but a vengeful God. His mother was in fact quite fanatical about religion and the need for religious discipline. Her own father, an extremely moral man had frequently beat her when she was a child. So, she not only criticized Edward and his father, but she was forever slapping him around, screaming at him, hitting him, and belittling him for his moral failures, for thinking sinful thoughts, and warning him about thinking sinful thoughts about the sinful women of the town.

Edward's mother was not just a harsh and rigid tyrant, she was also seductive and overprotective, and would often cuddle and sleep with him. Edward was completely under her spell and completely dependent on her, for she had him on a variable reinforcement schedule where she would punish and then provide him with seductive love. By contrast, Edward's father ignored him and usually ignored his mother; that is, until her acid tongue became too much for him. Edward's father had a propesenity for suddenly lashing out with extreme violence. He would beat her until she fell wailing to the floor. Often, following these beatings, Edward's mother would seek him out, and cuddle and sleep with him, seeking solace in his little arms.

Love, sex, beatings, verbal and physical abuse, this was Edward's little world; that and his farm and the small town with its sinful women. What was even more confusing was his mother's tendency to sometimes sleep with him and to seek solace in his little arms when he was a child.

When Edward became a teenager, his father suddenly took an interest in him. he began beating him for almost any reason, particularly when he was drunk. However, his father soon died, and he and his mother drew even closer together. She apparently made him swear that he would not contaminate himself with women, for all women were whores, deserving of the worst punishments of hell.

When his mother had a stroke and became bedridden. Edward found that he thoroughly enjoyed caring for her. In fact, he felt completely exhilarated by her helplessness. She was in his power, under his control and subject to his tender mercies and loving care. He did everything for her, and continued to sleep with her at night.

When she died, he was devastated. Edward began to deteriorate. He was alone and miserable. He began thinking about the sinful women who lived in the nearby town, some of whom, he noticed, bore a striking resemblance to his mother. And he missed his mother terribly. Could he resurrect the extreme pleasure he derived when she was completely in his power? Might he even become the girl and woman that his mother had hoped for?

A few years after Edward Gein was arrested and convicted of his crimes, Alfred Hitchcock made a movie about him. He called it Psycho.

TED BUNDY

Ted Bundy was handsome, charming, and a darling of the Republican Party in Washington. He rapidly worked is way through the Party hierarchy to become a top assistant to the Republican Central Committee, and then an aide to the Republican Governor of Washington. The Governor was so impressed with Bundy he wrote him a letter of recommendation for admission into law school. Ted was a rising star, and had even saved someone from drowning, risking his life in the process. The Seattle Police Department later commended him for capturing a purse snatcher. And then, inexplicably, Ted was arrested for a minor crime. But members of the Republican party came to his rescue and helped raise bond to get him out of jail.

Ted Bundy was also educated and had earned a BA in psychology. This truly caring young man and budding psychologist and politician even volunteered to work a crisis telephone hot line at the Seattle Crisis Clinic. Ted not only enjoyed helping patients with their problems, but would call them back, anonymously, at night, and would ridicule and torment them, even making threats. Soon thereafter, he began stalking women, and then attacking them, and then kidnaping them and forcing them to disrobe and to perform a strip tease, after which he would attack them with hammers and knives. Ted associated sex with pain and had a most confused concept of normal heterosexual relations--a confusion which can be traced to his relationship with his mother.

For the first 4 years of his young life, Ted Bundy was brought up believing that his mother was his sister, and together they shared the same bed, hugging and cuddling at night. He was also told that his grandparents were his mother and dad--though why his "mom" and "dad" generally ignored him and frequently beat both him and his "sister" he just couldn't understand.

What Ted didn't know was that his mother had shamed her own parents, by becoming pregnant after a one night stand. Because of the conservative nature of the community in which they lived, and for proprieties sake, not just little Ted but the neighbors were made to believe that his mother's parents, were in fact his own. Ted was given her parents name, and was therefore raised believing they were his parents. And strict "parents" they were for his "father" would become enraged at the slightest provocation, and would beat not just Ted but his mother, after which they would be banished to their room, where his mother would strip naked and then together they would hug and cuddle tearfully under the covers of their mutual bed.

And, despite the frequent and painful beatings, the result of which often caused his mother/sister to seek solace in his little arms, Ted dearly loved and feared his father/grandfather. Hence, Ted was shocked and devastated when his 26 year-old mother/sister had decided she had had enough, and with Ted in hand moved to Washington. Ted just could not understand, nor could he forgive her for taking him away from his beloved parents, and he raged, cried, and accused and threatened to run away. It was then that she informed him, as they presumably lay together under the covers of their new bed, that she was not his "sister" but his mother. And to prove it she had his name legally changed.

Ted was understandably traumatized by all that had occurred, but although he blamed and hated his mother, he also loved her and they continued to not only seek solace in each other's arms, but to sleep in the same bed. Indeed, a nightly ritual may well have been watching her strip naked before she slipped beneath the covers to take him in hand.

But then she betrayed him again. His mother found a boyfriend whom she married and Ted was banished from her bed. Ted's name was changed yet again, this time to Bundy.

Apparently his mother married a man who, like her father, beat her, beatings that Ted would observe. And Ted could also hear them at night, as she screamed and moaned. He was convinced that his step-father was doing terrible, painful things to his mother in the bedroom

Ted became even more confused and upset by these terrible turns of events. He was also very jealous of this new man in his mother's life and was upset and aroused by what they would do at night. Ted frequently wet his pants and bed and threw tantrums, and in response he was beaten, or his mother would again take him in her arms and comfort him and try to kiss away his tears. He was still his mother's darling and he tried to obtain what comfort he could given the terrible events which had shaken his life. But that situation soon changed as well.

His mother became pregnant and now the number one son was replaced by a real sister. This time, of course, his sister was his sister, and his mother and step-father made her importance quite clear. His life was thrown again into turmoil by yet another female and the actions of his mother.

Bundy' had almost no self-esteem and felt worthless and rejected. First he had lost his grandparents/parents, and then he lost his sister/mother to this terrible man, and then he was replaced by his sister. And then he was subjected to yet another trauma. A cousin began to torment him, telling Ted that he had no father. Of course he had a father, Ted argued back, only to be shocked yet again when he found his birth certificate which listed "unknown," under "father." Ted was overwhelmed with self-loathing and hatred for his "whore" of a mother. "How could she do this to him?" he wondered. "Was she just a dirty whore?"

Ted was extremely upset, angry, and confused. He had no roots and was completely adrift, victimized by the actions and whims of his untrustworthy mother. Ted began to hate not just his mother, but women. Insofar as Bundy was concerned, women were no good, could not be trusted, and were deserving of punishment. Bundy knew what punishment was. He had observed his grandfather beat his mother, and he knew that his step-father did painful things to her in the heat of the night.

And yet, Ted was smart, handsome and attractive to women who made their interest obvious to him. But Ted did not know how to relate, and was so filled with anger and bizarre images from his past, that he would drive them away. He was sadistic, some women complained, and would humiliate and even threaten and terrorize them, sometimes tying them up and choking them while having sex. In consequence, Ted would be abandoned again and again.

Even the first love of his life dumped him for being so immature. Rejection was normal to Ted, so months later he begged her back, even asking her to marry him, explaining to her that he had changed his ways, he was no longer immature, no longer insensitive, had become an aide to the Governor of Washington, and was going to go to law school. She agreed to marry him, but then quickly broke off the engagement. Ted had not changed. And then things got even worse, for he flunked out of a law school that his Republican friends had arranged for him to attend. Everything had spiraled out of control. Ted felt he had no control over his life, and certainly no control over women who seemed to delight in flaming his desires only to shoot him down in flames.

Bundy claimed that he began his career in crime as a "peeping Tom," crimes he would commit even when he was working for the Central Committee of the State Republican Party. Several nights a week he would creep around the local college campus and watch women undress. He claimed he felt some kind of uncontrollable urge which would come over him when he had been drinking. Soon he began fantasizing about forcing women to undress just for him; fantasies in which he would control them completely and make them into his private toy. He began to follow young attractive women and fantasizing about taking them prisoner and making them into a private possession who would do a strip tease for him and him alone.

Bundy was drinking quite heavily when he made his first attempt at killing, and followed a woman to her door. While she fumbled with her keys, he struck her in the head with a piece of wood, causing her to fall. But, lucky for her, she began to scream and so he ran away. After sobering up he became horrified at his actions, almost suicidal. The urges, however, returned and he again felt compelled to act.

A couple months later after spying on another woman for about a week, he broke into her place after she was in bed, and climbed in with her and attacked. She screamed and again he ran away. Nevertheless, he found the experience enormously exciting and soon felt an overwhelming need to hunt down and attack another woman. This time he would do it differently.

Sharon Clark, a pretty coed was his next victim. After following and thinking about her for days, he snuck into her bedroom. Bundy beat her about the head and fractured her skull and jaw with a steel reinforcing rod. She was unconscious and completely helpless when he took his pleasure. Incredibly, she lived but had no memory of what happened to her.

Bundy was positively orgasmic with excitement. It had been so easy. The power of politics no longer interested him for he had found a new calling and was soon beating, raping, and strangling to death any woman he found alone. He would follow women who were out for a walk. He would pick women up at bars. He would attack women as they got out of their cars. He would rape and kill women he picked up hitchhiking. He also developed elaborate schemes to trick college coeds into getting into his car, and once they did, he pounced.

For example, he would stand around outside the Oregon State or Washington State University campus libraries at night with his arm in a sling, and would be loaded down with books that he obviously needed help carrying. Bundy would approach young women who were leaving the library at night and request their help. If they agreed he would then lead them to a railroad underpass where he kept his Volkswagen and would either immediately handcuff and threaten them with death, or savagely and repeatedly beat them about the head if they resisted. He would then drive them off to some isolated spot, force them to disrobe or he would tear off their clothes. Once they were cowering and naked, completely in his power, he would rape and sodomize them, sometimes with a foreign object, such as a knife. He would then bite off their nipples and hunks out of their buttocks and then strangle them with their nylon stockings while he was sodomizing them. He found this latter activity particularly enjoyable for strangulation causes contraction of the anal sphincter muscle which causes a milking sensation around the penis.

Sometimes Bundy would drive hundreds of miles with the dying or dead bodies of his victims so that he could have sex with them again later, after which he would dispose of them in remote places. The bodies of most of his victims were never discovered.

Bundy sometimes kept women alive long enough so that he could have two victims to play with simultaneously. For example, one afternoon he again placed his arm in a sling and approached pretty young women who were sitting alone along the beach at Lake Sammamish, in Washington. Giving them his boyish handsome smile, he would ask if they could help him unload his sailboat. One they arrived at his volkswagon and noting that their was no sailboat he would tell them it was at it house nearby. On that afternoon he first kidnapped one young woman, and then returned lateral in the afternoon and found a second young female to assist him. He had taken them both to the same isolated spot, where he then demanded that they disrobe and perform sex acts for him. Bundy them brutally and savagely murdered them both.

Bundy also liked to pretend he was a cop. On one occasion he approached a young woman who was in a shopping mall looking at books. He identified himself as a police officer and informed her that someone had burglarized her car. He talked her into leaving with him. After they inspected her vehicle and determined it was OK, he informed her they would have to drive to the police substation to make a report. She reluctantly complied, got into his car and off they drove when he suddenly pulled in front of a darkened school building, grabbed her roughly by the arm and slapped a handcuff on her wrist. She immediately began screaming and struggling and clawing for the door handle while he tried to put the other cuff on her other hand. Fortunately for her, she fell out into the street just as he was about to strike her over the head with a large metal bar. She managed to escape.

Bundy was arrested several times and placed in custody as a suspect in the murders he had committed. Bundy, with an IQ in the Superior range, managed to escape. In fact, he was caught again, convicted of his crimes, and then escaped again. He escaped from Colorado jails, on two separate occasion, once by simply walking out the courtroom and jumping out an open window when no one was watching. He had planned the escape, however, and had dressed in two sets of clothes the top layer of which he immediately discarded so that his description would be in error. He escaped the seond time by hiding in the attic region of the Garfield County jail. After his guard had left him unattended to go watch a movie with his wife, Bundy broke through the plasterboard and slipped away.

To celebrate his good fortune he went on a homicidal rampage down in Florida. First, he broke into the Chi Omega Sorority house, and with a club in hand went into the bedroom of 20 year old, Lisa Levy, a beautiful blond fashion-merchandizing major. While she was sleeping he struck her savagely about the head with the club, fracturing her skull in several places. After raping and sodomizing her with an aerosol spray can, and possibly the club he had been carrying, he bit off one of her nipples and then bit a hunk of flesh out of her buttocks, leaving an impression of his teeth in her flesh. He then strangled her with one of her nylons. Bundy then went to the bedroom of another coed, 22 year old Margaret Bowman. While she slept he struck her so hard across the skull and face that she was almost decapitated. Bundy then raped and sodomized her. From there he then went from room to room where he savagely beat and raped two more women before escaping into the night only to attack, rape and savage yet another coed sleeping in a nearby house.

Three weeks later he committed his final murder, attacking, sexually assaulting and killing a 12 year old girl by slitting her throat and savaging her vaginal region with a knife. In total, he probably killed at least 40 young women and girls before finally being put to death for his crimes.

THE HILLSIDE STRANGLERS

Kenneth Bianchi always wanted to be a a cop, or a psychologist and he in fact read several books in the field. He even purchased a number of fake degrees in psychology and claimed to have earned a Ph.D. from Columbia. He was apparently so convincing that a licensed psychologist consented to share and rent him office space in North Hollywood. Bianchi then set up a private practice specializing in weight problems. His walls were adorned with diplomas indicating he was a Certified Sex Therapist as well as an expert in many other areas of psychology. He even printed up a flier advertising that he would answer any five questions for ten dollars.

His cousin Angelo Buono, never had any such interests. Rather, his desire was to dominate, humiliate, and have sex with an endless supply of girls and young women. Women and girls in fact found Angelo Buono to be exceedingly attractive and he had a number of willing sex partners, sometimes having sex with two or more women or young girls in a single day. Angelo had also been married several times and fathered several children. However, he had a special fondness for young girls and enjoyed victimizing them. This included his own step-daughter whom he repeatedly repeatedly raped. Indeed, he derived particular enjoyment from making her have sex with one of his sons and others as well.

Angelo was no prince charming. His relationships with women were pretty brutal. He loved to beat and pinch them until they cried and would tie them spread eagle to his bed where he would violently rape and sodomize them. He took particular delight in straddling them and forcing his penis down their throat until they gagged and almost passed out. If his wives or girlfriends dare to complain he would just laugh and slap them around, saying that he knew they liked it. However, he would also threaten to kill them if they tried to refuse his demands or they even thought about leaving him. He so brutalized and frightened two of his wives that they escaped by moving out of state. That they dared to leave enraged him and he extracted vengeance on those who followed. Insofar as Angelo was concerned, all women were untrustworthy, vile whores, including his own mother. Angelo hated women.

Angelo's parents divorced when he was four years old, and he, his mother and sister moved to L.A. Why his parents divorced, and why his father, who had also moved to LA, completely avoided him, he had no idea, though he suspected it was because his mother was "a two bit whore." Angleo knew his mother was a whore because she had a succession of boyfriends who would sometimes drop by and have sex with her while he watched. She was having sex with anyone and everyone, he soon discovered: "fucking repairmen, delivery boys, shop owners," either because she liked it, or in exchange for favors, such as a reduced bill on some merchandise, or because they were giving her money. Not uncommonly she would take Angelo along on her regular visits to various men, and would make him wait outside while she serviced them. Angelo was humiliated and enraged. Even as a child Angelo began referring to her openly as a whore and a cunt, names he soon applied to all women.

Angelo apparently had a lot of trouble in school. He had "emotional problems" and a severe learning disability, and had difficulty learning how to read, write and do math. He also had a reputation as a thief, and a thug, and would often encouraged his high school buddies to pick up and rape various female hitch hikers, and to "fuck 'em in the ass," as he put it.

Although he grew up without a father, he knew what men did to women, what they did to his mother. And he knew what he would have liked to have done to his mother, which was to "kill the whore." Fucking, killing, and beating and humiliating women was a central aspect of his thought processes and heterosexual orientation, so it perhaps is no surprise that Angelo openly admired and wanted to emulate, Caryl Chessman, also known as the Red Light Bandit. Caryl Chessman's specialty was pretending to be a cop, stopping couples or young girls alone, then raping and forcing them to perform oral sex. Chessman, however, never killed his victims which led to his being caught, convicted and sent to the gas chamber. Angelo learned from his hero's mistakes: "Leave no witnesses" he calmly explained to his cousin, Kenny Bianchi.

Kenny Bianchi never knew his father. But he knew who his mother was: A prostitute. She gave Kenny up at birth and he was placed in several foster homes until being adopted. However, he grew up in the same community in which she plied her trade. Even as a little boy "the whore" his mother, had been pointed out to him. His mother was the local prostitute who frequented neighborhood bars and working class nightclubs where she plied her trade. Like his cousin, Kenny soon developed a very warped sense of the female sex.

Kenny had severe emotional problems as a child and was soon recognized as a chronic compulsive liar. At age five he was diagnosed as suffering from petit mal epilepsy, and would frequently go into trances and suffer severe temper tantrums and rage attacks. Unfortunately for him, his adoptive mother was apparently quite emotionally disturbed. She would also take him from doctor to doctor where Kenny would often undergo painful genital examinations in order to discover why he was wetting his pants. Apparently his adoptive mother would also engage in these exams, sometimes tightly wrapping his penis in rubber bands in order to shut off the flow of urine. Genital pain became a major focus of his life; that and having a mother who was a whore, and another mother who would torment his penis.

Although he felt considerable disdain for the female sex, women found Kenny Bianchi attractive, and he apparently had no difficulty obtaining sex partners. Inevitably, however, these women would break off these affairs. Kenny was strange and weird. Kenny, in fact, was a failure and soon moved in with his cousin, Angelo. Together they would have sex with neighborhood girls and women, with Angelo scoring most of the action.

One day while attending a party in L.A, Kenny met a very pretty blond girl named Sabra. She was 16 years old and claimed to be from Texas. According to Kenny she was absolutely stunning, with full lips which gave a pout to her smile, and large round eyes which made her very precociously sexy and beautiful. She looked like a teen age Brigitte Bardot. Kenny asked her if she was a model, and she replied in the affirmative, explaining that she was currently looking for work, but had had no luck and was planning on traveling to Phoenix. Kenny then proceeded to lie and told her he owned a modeling agency and could put her to work modeling for $500.00 a week. He gave her his card and told her to think about it.

About a month later Sabra called him from Phoenix, told him she was out of money and would like to begin work. After first consulting with his cousin Angelo, he then wired her a ticket. When she arrived, Angelo and Kennyh gave her $100.00 and told her she was bonded to them for a year. She agreed to those conditions and was soon given strict instructions including a warning that she was not to leave Angelo's house without permission as a job might suddenly come up. Several days later, as modeling jobs had not turned up yet, she got bored and left the house without telling anyone. She had decided to do some shopping. Unbeknownst to her, they followed.

When she returned to Angelo's house they began beating and slapping her around, threatening her with death, explaining that they belonged to a secret organization and that she had been followed. As they slapped and beat her with their belts, they described her every move since she had left the house, and then ordered her to take off her clothes. She tearfully complied and the two cousins took turns slapping her buttocks and her breasts with a wet towel, and then forcing her two spread her legs. They repeatedly raped her and forced her to perform fellatio, explaining that from that moment on she was their sex slave and that she was going to work for them as a prostitute until she paid them back all the money she owed. If she refused or tried to escape, they told her she would be followed, caught, and would be cut into tiny pieces. Sabra tearfully submitted to all that they demanded of her.

Angelo took pictures of her naked, and showed them to men who worked in nearby businesses and those came by his upholstery shop which was adjacent to his home. Sabra was soon servicing sometimes a half a dozen or more men a day. She was also expected to serve as Angelo's personal sex slave. Angelo loved to order this beautiful little girl at all times of the day or night to come into his room or his shop, undress, and then perform fellatio or to fornicate with him or his friends and customers. As the word got out, business increased.

And then, she did the unthinkable. She, and another young girl they had enslaved, escaped. Angelo and Kenny were enraged. Not only had these young girls defied them, they had made fools of them, and had caused them to lose income as well. "Whores like them don't deserve to live," Angelo fumed, and the more he and Kenny thought about it, the more they felt like seeking revenge. They would find a "whore" and kill her to even the score. So began their raping and killing spree with each subsequent victim being treated in an increasingly brutal fashion.

Kenny and Angelo were pretty cool and controlled about what they were doing. They would shower, put on deodorant, splash on after shave, and put on clean clothes almost as if they were going out on a date. And then, all spruced up, they would head out to find a victim. Sometimes they would even impersonate cops and would also carry handcuffs and fake police identifications and would cruise Hollywood streets looking for victims while driving a metallic blue Cadillac. They also had a sticker bearing the official seal of the County of Los Angeles displayed on the lower corner of the windshield, courtesy of a Los Angeles councilman who had given it to Angelo as a token of his appreciation for in return for having had sex with Sabra.

At first, Angelo and Kenny would pick up prostitutes, calmly informing them they were under arrest. The victims always allowed themselves to be handcuffed before being transported to the "station."

Kenny and Angelo would also follow young women who they saw driving alone at night. Once a woman had parked and exited her vehicle, they would approach, and using a flash light, would announce they were police officers, show their badges, and then explain that there had been a robbery and that the woman's car had been reported as leaving the scene. They would then persuade the victim to get into the Cadillac where they would then handcuff her telling her it was all standard procedure. One evening they picked up two young teenagers, right off the street, telling them they were the police and would be taking them home for their own protection. Kenny and Angelo even went to a woman's apartment who had spurred Kenneth for a date, and convinced her that her car had been dented in a hit and run accident. She also willingly went with the two cousins to the "station," i.e. Angelo's house.

Once the victim had arrived at the "police substation" the cousins would have them come inside and would instruct them to sit down in an easy chair. Then the two cousins would pounce. stuffing a rag into the victim's mouth, and placing thick tape over her mouth.

Usually, most victims were treated calmly so as to minimize their resistance. The two cousins would simply them to just do what they were told and they would be let go. If she was cooperative the two rapists would then remove the tape, and order the girl to take off all her clothes including her bra and panties. If she resisted, they would handcuffs her and and cut her clothes off her. The clothes and her other possession would be put into a large plastic bag and disposed of. The victims were then brought into a bedroom where they were sodomized and forced to orally copulate the two cousins. Angelo Buono generally liked to force his entire penis down the girl's throat and make them almost pass out. The cousins also liked to hog tie their victims and would take a large dildo or root beer bottle or some other object and force it repeatedly into the girl's anal region. Finally, after they had their fill they would strangle their victims as they particularly enjoyed watching the victim gasp for breath. Sometimes the cousins would repeatedly strangle each victim until they lost consciousness, usually while simultaneously sodomizing her. Then they would revive the woman and then strangle her again. In fact, each of the cousins would take several turns, sodomizing while strangling them so that they could repeatedly enjoy the pleasure of the sphincter muscles contracting around their penis.

The last several victims were also tortured by electric shocks, gassed via a tube that was led from a gas outlet to the bag placed over their head, and some were injected with window cleaning fluid which would cause massive convulsions but not death. After finally strangling their victims to death, they would then take the body and dump it where it could be easily seen, such as on hillsides as they liked the idea of shocking the public. Hence, their moniker, the Hill Side Stranglers.

CAVEATS

In the cases described above, it is noteworthy that some of these individuals had learning disabilities, seizures, evidence of mental illness in the family, and/or left handedness. In this regard, it is likely that these "predisposing" factors may have contributed and exaggerated the effects of abnormal mothering and/or lack of fathering on subsequent psychological and emotional development including criminality. On the other hand, it has recently been pointed out, by Stanford Law professor, John Donohue, and Steven Levitt, a University of Chicago economist, that the drop in the U.S. crime rate, during the 1990's appears to be directly correlated with the legalization and widespread availability of abortion during the 1970s. According to Levitt, "women who wanted to abort but were denied the opportunity seem to have given birth to children more likely to become criminals." However, with the availability of abortion, these unwanted children, and thus these future criminals were aborted which in turn accounts for the dramatic reduction in the U.S. crime rate. In other words, children reared by mothers who don't want them are profoundly effected and often engage in criminal behavior; behavior which they sometimes cannot control.

CONCLUSIONS

Sex and aggression are linked and both are mediated by the limbic system, the same structures which mediate maternal behavior, the establishment of the maternal infant bond and the formation of emotional attachments. If maternal input is lacking or abnormal, then all aspect of limbic system functioning can also become abnormal including sexuality and even speech.

The limbic system (as well as the neocortex) requires considerable social and emotional stimulation in order to develop normally. If that stimulation is insufficient or abnormal, these nuclei and other forebrain structures may atrophy, develop abnormal activity, form inappropriate interconnections, and in the extreme can produce disturbances identical to those following their destruction. Even temporary separation or brief episodes of trauma or abuse can induce significant emotional distress and limbic system injury.

However, even the brain of an adult is exceedingly plastic and is capable of undergoing tremendous functional reorganization (Feldman et al. 2012; Jenkins, et al. 1990; Juliono et al. 2005; Ramachandran 1993; Strauss et al. 2012; Weiller et al. 1993). It is because the adult brain retains neuroplastic capabilities, including even the capacity to regenerate damaged neurons (Joseph, 1998c,d,c), that adults also retain the capacity to learn and remember new experiences. Likewise, since the adult nervous system remains plastic, there is some chance for recovery of function secondary to brain damage. Indeed, even if reared under conditions of extreme maternal, social, sexual and emotional abuse, and/or deprivation, there remains some likelihood of at least partial functional recovery if the child is later provided considerable and intensive maternal/therapeutic loving stimulation.

Over the course of human evolution the brain tripled in size; a development which in turn required that infants remain relatively immature and dependent on their mothers for increasingly long time periods. A bigger more complex brain requires a number of years to reach maturity. This is because the relatively small size of the female-pelvic opening requires that the infant be born with a brain that is reduced in size. Moreover, because of its prolonged immature neurological status, the human infant requires considerable maternal and emotional stimulation throughout much of early life in order for the "experience expectant" nervous system to develop normally.

Fortunately, the human female is also neurologically predisposed to provide the infant with considerable social emotional and loving stimulation, which is why women experience a biological desire to become pregnant and to hold and care for infants. Be it chimpanzee, baboon, rhesus macaque, or human, females demonstrate an extraordinary interest in babies and will engage in play-mothering during even the earliest phases of their own childhood (Berman, 1983; Berman and Goodman, 1984; Blakemore, 1981, 1985, 1990; Devore, 1964; Elia, 1988; Fedigan, 2012; Frodi and Lamb, 2008; Goodall, 2009, 1990; Jolly 1972; Kummer, 2009; Melson and Fogel, 1982; Mitchell, 1979; Nash and Fledman, 1981; Strum 1987; Suomi, 1972; Zahn-Waxler et al., 1983). Female humans (Ainsworth and Wittig, 2001; Berman, 1983; Blakemore, 1990) and non-human (group living) female primates will eagerly cuddle, groom, and hold babies that are not their own (Jolly, 1972; Devore, 1964; Kummer, 2009, Strum, 1987; Suomi, 1972; Mitchell, 1979; Goodall, 2009).

Hence, whereas the nervous system of the infant requires considerable maternal input in order to thrive and to develop normally, the nervous system of the mother predisposes her to provide this input to her infant; which is a most adaptive relationship. However, because of the tremendous need for this stimulation, even subtle differences in the degree and quality of maternal contact can differentially effect the brain and cognition. For example, infants who are held and breast fed display superior neurological and cognitive capabilities as compared to those who are given a bottle or formula and allowed to lie alone in their beds (Lanting et al., 2008). These latter children are twice as likely to develop neurological abnormalities and cognitive-motor disturbances (Lanting et al., 2008). Similarly, it has been reported that infants who had been held and breast fed had a higher level of polyunsaturated fatty acids in their brains (Farquharson, 1993), which in turn effects and improves nerve cell conduction and cell membrane fluidity. Of course, in part, these latter effects may also be due to inferior quality of "baby formula" vs mother's milk.

Nevertheless, because the infant requires loving maternal input, the greater the degree of deprivation, the more serious might be the consequences. Children who are severely deprived of maternal contact may even die--even if all physical needs are being taken care of. Indeed, the mortality rates for infants placed in foundling homes during the 19th and early 20th century was found to be over 70% (Langmeier & Matejcek, 1975 )--a consequence not of poor nutrition, but lack of maternal care from the biological mother. Likewise, it has been found that the risk of infant motorality increases by a factor of five if the mother dies even if care is provided by female relatives (Hill & Hurtado 1996). The tremendous need for prolonged maternal care may explain why women undergo menopause around the late 30's; that is, to insure that there will be a healthy mother to care for her infant. Until the 20th century life expectancy, on average, was not beyond the late 30 or 40s.

The infant and young child requires considerable loving and maternal contact, especially from its own mother. However, if that maternal input is abnormal, neglectful, or abusive, the child's development brain, and all aspects of social and emotional functioning can become profoundly abnormal (Joseph, 1999b).

REFERENCES

Copyright: 1996, 2000, 2010, 2018 - Rhawn Joseph, Ph.D.