DOMINATIONbehavior has the potential to destroy their lives, but the desire circuit
doesn’t care. It only wants more. More drugs, more success. But true
success doesn’t come from cheating. If you make a mistake, people will
forgive you, but if you act dishonestly, it will stick with you for a long
time. That’s why the control circuit is so important. It’s rational. It’s
able to make cool, reasoned decisions, ones that will maximize your
welfare not just today, but far into the future. And yet, for many people,
fraud is a powerful, sometimes overwhelming temptation when chasing
the high of victory. At least in the short term, fraud works.
Or you could just punch somebody.
HOT AND COLD VIOLENCEDr. Jones stood in the elevator, dreading the patient interview that was about
to happen. It was 1:00 am, and she had been called down to the emergency
room to evaluate a patient who said he was going to kill someone. She had
to get it right. When a psychiatric patient follows through on a threat to
commit murder, the victim dies, the killer must be caught—and the doctor
who set the killer free can be held responsible.
The patient, disheveled and malodorous, stared unblinking at Dr.
Jones. He had been here before. He had been disruptive and uncooperative.
During one stay he was accused of inappropriately touching a woman being
treated for schizophrenia. He claimed he was allergic to all psychiatric med-
ications except Xanax.
Apart from cocaine use there wasn’t much wrong with him psychiatri-
cally, but tonight he demanded to be admitted to the hospital. He mentioned
multiple arrests and a three-year stint in prison. If he wasn’t taken up to
“the unit,” he said, he would carry out his plan and kill someone.
“Let’s just say it’s someone who did something to me, okay?” he said.
Paranoia is one of the most treatable psychiatric conditions associ-
ated with people who threaten violence. Paranoia makes them feel afraid,
and sometimes they conclude that the only way to protect themselves is to
kill the people they imagine are plotting against them. With antipsychotic