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Helsham, Samantha --- "The profane and the insane: an inquiry into the psychopathology of serial murder" [2001] AltLawJl 99; (2001) 26(6) Alternative Law Journal 269

The profane and the insane: An inquiry into the psychopathology of serial murder

Samantha Helsham[*]

New evidence suggests that psychopaths suffer from an emotional–perceptual processing disorder that deprives them of the ability to develop moral knowledge.

An act of profanity is an expression of contempt or disrespect for something that other people hold sacred. An act of insanity, on the other hand, indicates a certain mental defect, resulting in a deficiency in rational capacity.

It is unusual to categorise an act as both profane and insane, since an attitude of contempt and disrespect tends to indicate a certain level of understanding of the nature and implications of the act. Insanity on the other hand, is distinguished precisely by the absence of such understanding. It is particularly important to keep the two causes of behaviour separate and distinct for the purposes of deciding whether a person should be blamed for their actions. The evil person may be blamed, but the mentally defective person must be excused.

The behaviour of the serial killer presents a significant challenge in this regard. The callous manner in which the murders are typically carried out, the premeditation, the lack of empathy for the victim, and the lack of remorse all appear to provide evidence of profane motivations. And yet, these very same features, together with the distinctive collection of macabre activities involving the corpses of the victims, also seem to provide evidence of insanity; surely no sane person could behave in such a manner.

Unfortunately I do not have the space here to do justice to the legal definition of insanity in Australia. The statutory provisions vary from State to State, but all reflect to a greater or lesser degree the common law M’Naghten Rules. [1]Suffice to say however, that in its most stringent formulation, the test requires that the perpetrator demonstrate an incapacity, resulting from a ‘disease of the mind’, to know that his or her actions are morally wrong. Following Stapleton v The Queen [1952] HCA 56; (1952) 86 CLR 358, and owing to the serious nature of the crimes, some may argue that the serial killer must also show that knowledge of the illegality of the act is not sufficient to inform him or her of the immorality of the act.

Recent advances in the sciences of the mind suggest (notwithstanding some continuing controversy surrounding the term ‘disease of the mind’) that most, if not all serial killers would satisfy this test. The presence of serious emotional and cognitive pathologies renders the serial killer incapable of any moral knowledge whatsoever.

The serial killer: definition and profile

Serial killers should be distinguished from mass murderers, who kill a number of people at one time, at the same place. They should also be distinguished from spree killers, who go on a single rampage of killing.

With serial murder, there is an interval of days, weeks or months between killings and the victims are almost always strangers. The killing is done primarily for the enjoyment of it, not for material gain. The enjoyment is related in some way to the sense of power that the killer experiences through having control over another person.[2]

In almost all cases of serial murder, the victim is sexually violated. In other cases fetishes are indulged, for instance in the dismembering or cannibalising of the victim’s body. The killer nearly always keeps ‘trophies’ of the kill, usually body parts, photographs of the victim or diaries of the crimes. These items are used as aids to relive and fantasise about the crime after the event. Evidently, excessive and compulsive fantasising is a central feature of the inner life of the serial killer.[3]

Serial killers are virtually always male. They are not, however, always highly intelligent, although there seems to be a popular myth to this effect. They can be intelligent and organised or they can be underachievers and very disorganised. Another misconception is that victims are always slowly tortured and then murdered whilst the killer is in an emotionally cool and calm state. Many serial killers commit the crime in a state of frenzy and kill their victims very quickly. The specific details of the murder are not always planned and the victim is not necessarily chosen in advance. Rather, the crime is often committed spontaneously when an opportunity arises.[4]

There is almost always a documented history of antisocial behaviour during childhood or adolescence, including acts of cruelty to animals, bullying and assaulting other children, theft and arson. The seriousness of the crimes tends to build up over time. Not surprisingly, as children, serial killers are largely rejected by their peers.[5]

What psychopathology underlies serial murder?

There appears to be a general consensus among experts working in this area that serial killers are psychopaths. The term ‘psychopathy’ is often used interchangeably with that of ‘adult antisocial personality disorder’. However, the criteria for the latter, as set out in DSM-IV (Diagnostic Statistic Manual of the American Psychiatric Association) are not of much use for current purposes as they refer only to external behavioural traits to the exclusion of internal, or mental characteristics. More useful in this regard is the Psychopathy Checklist which lists both internal and external traits. Dr Robert Hare, who was instrumental in developing these diagnostic criteria, identifies the following traits as central to psychopathy:[6]

Social deviance
Glib and superficial
Egocentric and grandiose
Poor behaviour controls
Lack of remorse or guilt
Need for excitement
Lack of empathy
Lack of responsibility
Deceitful and manipulative
Early behaviour problems
Shallow emotions
Adult antisocial behaviour

The lack of empathy, aggression, disrespect for authority, poor social skills and failure to learn from punishment are already evident in the psychopath as early as age three.[7] This would account for the childhood behaviour of the serial killer.

However, psychopathy alone does not explain the syndrome that underlies serial murder. Only a very small proportion of psychopaths become serial killers.[8] Serial killers tend to exhibit traits of additional disorders. For instance they are often thought to suffer from obsessive compulsive disorder, which is marked by persistent and intrusive thoughts and impulses, repetitive ritualistic behaviours, perfectionism, preoccupation with detail and order, inflexibility and a stifling of emotion.[9]

There is also a strong link between serial murder and sexual dysfunction. As well as paraphilias such as necrophilia and cannibalism, erectile problems, difficulties with orgasm, and anxiety about performance are also common.[10]

Probably most significant for current purposes though, is that most, if not all serial killers, are sexual sadists. A sadist experiences pleasure by inflicting pain on another person. Interestingly, a recent study revealed a significantly higher incidence of sadism in psychopathic violent offenders than in nonpsychopathic violent offenders.[11] This makes sense given that psychopaths are not motivated by affection in their interpersonal relations, but rather, by the desire to exercise power. The sadist is also driven by a need to exert control and dominance over others.[12] Psychopathy may then constitute a predisposition to develop sadistic desires.

A recent study of 68 serial killers concluded that they all met the criteria for psychopathic sexual sadism.[13] All 68 subjects had a childhood history of antisocial behaviour ‘which escalated and took on elements of sexual sadism in adulthood’.[14] All of the murders involved sadistic sexual violence and were characterised by the domination, control and humiliation of the victims. The killers displayed no remorse. Other characteristics these researchers noted were social isolation, pathologies relating to the development of the self and a lack of any ambitions other than committing the crimes.

A deficit in emotion, or flat affect is probably the most outstanding feature of the serial killer, and the psychopath more generally. As I will explain later, they do experience emotions at times, indeed, quite intense emotions. But they demonstrate a general lack of animation, and don’t experience normal emotional reactions to situations that most people would find disturbing.

Jeffery Dahmer (who killed at least 15 people between 1978 and 1991) was noted by family members to exhibit a lack of affect early in his childhood. He was said to have dull eyes, a motionless face and a rigid gait. His father referred to his demeanor as a ‘dull, unmoving mask’. Edmund Kemper (who killed 10 people between 1963 and 1973) began killing at the age of 15 when he shot his grandmother and then stabbed her repeatedly once dead. He then called the sheriff to confess. During the confession he said, ‘I just wondered how it would feel to shoot Grandma’.[15] At the age of 13, he casually, and apparently with no anger, sliced off the top of the family cat’s skull. He then ‘noted with surgical interest that he had thus exposed the brain’.[16] These sorts of accounts are typical of the childhood demeanor of serial killers.

The cause of the pathologies


Evidence that psychopathy is caused by childhood trauma is lacking. Many psychopaths come from apparently loving and well functioning families, and have normal siblings, including non-identical twins.[17]

Rather it seems that the psychopath is born with a brain disorder that causes an emotional deficit and incapacity for empathy. These abnormalities then form the basis for the development of other psychopathic traits. It has been suspected for some time that the emotional and empathic deficits are related to a cognitive processing disorder involving the frontal lobes that, among other things, leads to an intense focus on immediate, concrete events and a failure to learn from negative consequences.[18] I will look at a relatively new source of evidence for this theory shortly.

The disorder also results in a failure to learn the value of self–other relations. The internal world of the psychopath is impoverished, and little if any of the normal processes of identification and empathy take place. The pleasure that normally accompanies learning and empathic bonding is missing. In its place there is a stimulus hunger, a desperate need to fill the void.[19]

These pathologies then produce a personality syndrome which may be expressed in a number of ways, generally characterised by living on the edge and viewing others only as a means to one’s own ends. The psychopath may fall into a lifestyle incorporating a number of activities consistent with this outlook, ranging from con artistry to burglary, corporate crime, rape, murder or a combination of any of these. Some psychopaths appear to be engaging in legitimate activities, even completing university degrees and pursuing professional careers. But there is always some pattern of antisocial behaviour lurking below the surface.[20]

The real question then is why a psychopath becomes a serial killer. It is here that environmental influences appear to play a role.


Unlike the case with psychopathy generally, there is overwhelming evidence that serial killers have experienced significant childhood trauma. A number of theorists have linked specific types of trauma with the serial killer personality. In particular, there is a strong correlation between the experience of violent, cruel, inappropriate parenting or rejection, and the development of violent sexual fantasies, sadistic behaviour in childhood, and adult sexual dysfunction.[21] One theorist also uncovered a high level of childhood exposure to depravity, humiliation and the challenging of masculinity. These kinds of experiences may well exacerbate already existing pathologies in the psychopathic child pertaining to the concepts of self, other and intimacy, and intensify the preoccupation with adopting positions of control in interpersonal relations.[22]

A plausible hypothesis with respect to the development of sexual sadism in the psychopath is that episodes of erotic arousal (which occur randomly in boys) are frequently coupled with the occurrence of violence, and hence violence becomes associated with sexual pleasure.[23]

Kemper’s case history is illustrative in this regard. He admitted to having fantasised about having sex with dead women even as a child. The fantasies arguably provide a haven from the experience of powerlessness, where the serial killer is able to remake himself as potent and controlling. The necrophilia seems to perform a similar function. In a clinical analysis, when asked what their primary motivation for necrophilia was, the subjects often said things to the effect that they received total acceptance and unconditional positive regard from the victim.[24]

It seems clear that the murders perform a specific function by which the killer tries to maintain psychological equilibrium.[25] Hare warns though that the inner world of the psychopath is so arid that a rational understanding of the motivating thought processes may be impossible. There is simply no analog in there of the feelings and beliefs that motivate normal people.[26]

What we can say is that the emotional deficit and incapacity for empathy predispose the psychopath to developing sadistic motivations. A specific type of childhood trauma occurring during important periods of sexual development then results in the development of sexually sadistic desires. Alternatively, these desires may simply be the result of arbitrary connections developed between the child’s own sadistic behaviour, perhaps towards animals and other children, and his burgeoning sexual impulses.

In addition, the serial killer may also suffer from obsessive compulsive disorder which is also thought to involve some dysfunction in the frontal lobe area.[27] This may account for the excessive fantasising and some of the ritualistic behaviours associated with serial murder.

Rationality, emotion and the brain

Neuroscientist Antonio Damasio has argued that normal emotional orientation is crucial for rational choices, and hence rational behaviour, in the personal–social domain. Emotions integrate information about the body and the external world and the relationship between the two.[28] I will discuss the evidence for this claim in some detail as it illuminates the nature and extent of the cognitive deficit in the serial killer.

Damasio’s theory arose out of the study of an unfortunate group of patients who have suffered damage to the pre-frontal cortex, which is involved in emotional processing. These patients bear a striking resemblance to the psychopath. They suffer both from a deficit in feeling and emotion, and demonstrate flawed decision making in the personal and social domains. They are also, among other things, irresponsible, impulsive, lacking in empathy and given to boasting. And yet, like the psychopath, other cognitive capacities pertaining to intellect and language are left intact, and they know when and how the rules governing morality and sociality are applicable.[29]

Primary emotions are innate and present in very early childhood. They include basic fight or flight emotions in response to simple features such as pain or loud noise. They also include basic approach emotions, in response to pleasurable sensations. Secondary emotions, however, are only acquired by a refining and elaboration of the innate emotions, and require higher cognitive–evaluative processes for their development. Once developed, these emotions occur in response to more complex and abstract features. They include, for example, feelings of compassion, trust and grief.[30]

Arguably, the single most defining internal characteristic of the psychopath is the absence of secondary emotions. They are often described by experts as having ‘shallow’ or ‘proto’ emotions, that don’t appear to have any evaluative component. Emotional outbursts are disproportionately intense but short lived, and often expressed at inappropriate times and at inappropriate targets.[31]

The patients with pre-frontal damage also lack secondary emotions. This is evidenced by skin conductance tests that detect an increase in the fluid secretion from the skin’s sweat glands when an emotional response occurs. The pre-frontal patients generate skin conductance responses to stimuli such as sudden loud noises or bright lights just as well as normal people. However, when the stimulus consists of material requiring some cognitive evaluation, for example disturbing or sexually explicit images, they do not generate any response at all. Despite this, they demonstrate a comprehensive understanding of the content of the images.[32]

These observations present a serious challenge to the traditional ‘high reason’ view of how we navigate the personal and social domains. This view would have us carefully and unemotionally considering all of our options and comparing the outcomes in terms of their costs and benefits. This is in fact exactly what pre-frontal patients appear to try to do, with appalling results.[33]

The brain clearly deploys a different strategy. Damasio suspected that the relationship between his patients’ emotional deficits and cognitive–behavioural impairments were not coincidental, and that emotions may be the brain’s portal to the moral and social world.

To test this idea, Damasio carried out a set of gambling experiments involving punishment and reward with monetary values. Subjects played a card game, where they chose to play cards from four available decks. Each deck incorporated varying degrees of risk and reward. The game was set up so as to exclude the possibility of subjects making informed estimates of the risk associated with each deck, forcing them to rely on ‘gut feelings’. Normal subjects initially showed a preference for the high risk decks, but after a while, generally opted for the lower risk decks. The patients with pre-frontal damage systematically preferred the riskier decks and quickly became bankrupt.[34]

All subjects generated skin conductance responses immediately following wins and losses. However, after a number of plays the normal subjects (and not the pre-frontal patients) began to generate conductance responses immediately before picking a card from a high risk deck. The most plausible explanation for these results is that emotional responses are playing a role in performance and learning, subconsciously directing the normal brain away from ‘bad’ decks.[35]

Other tests and analysis of the gambling experiment ruled out the suggestion that the pre-frontal patients are just insensitive to punishment and sensitive only to reward. Rather, it seems that immediately rewarding options are preferred over-long term ones. Damasio argues that these patients have ‘myopia for the future’.[36]

It appears that functioning in complex domains depends on the development of a repertoire of secondary emotions. As we act in the world, consequences are tagged by these secondary emotions and these taggings (or somatic markers, as Damasio calls them) constitute a repository of evaluative knowledge that drives future decision making, biasing our choices in certain directions. They push us towards some possible courses of action and rule others out before we even have a chance to consciously consider them. They mark situations as stressful, exciting, disgusting or fulfilling.[37] In effect, they are the basis of value judgments.

Somatic markers are crucial for long term planning, when we can only achieve positive but distant goals by sacrificing pleasure in the short term. They focus attention on the greater long term benefit, overriding any initial resistance to short term sacrifice. Their absence causes deficits in working memory and attention. Either future consequences are not made salient, or those consequences are swamped by the significance of short-term prospects.[38]

Recently, a gambling experiment, very like the one described above, was carried out using psychopaths and nonpsychopaths as subjects, with functionally equivalent results to the experiment carried out by Damasio.[39] The astounding inability of the psychopath to learn from punishment runs thick through the literature. They have a narrow focus on whatever they are interested in at the time with an apparent blindness to other details that might alert them to long-term consequences. They don’t tend to make long-term plans, but if they do, they don’t follow them up.[40]

One may of course wonder just how similar the psychological profile of Damasio’s pre-frontal patients is to that of the psychopath.[41] Damasio’s patients are not noted to be deliberately antisocial or violent. But then Damasio’s patients have lost previously normal emotional processing capacities. Presumably they retain some remnants of the constraints imposed by normal processes of bonding and socialisation.[42]

Psychopaths on the other hand never go through those processes. This may result in a skewed developmental path leading to deviant behavioural patterns that become entrenched over time. The young brain may try to compensate for the deficits by developing unusual associations between stimuli and the innate emotions. Indeed there is evidence that supports this idea. Although psychopaths don’t experience fear as normal people understand it, and have a lower general level of emotional arousal in the absence of stimuli, they become even more highly aroused by aversive stimuli than normal individuals, and experience more acute primary anxiety.[43] One hypothesis is that without any experience of fear, the anxiety may be interpreted as exciting or thrilling. Anxiety inducing activities, for instance antisocial behaviour, may then be pursued as a form of self-medication of the low level of arousal.[44] Discovering this form of self-medication at an early age may account for the differences between the psychopath and Damasio’s pre-frontal patients.

Moral knowledge

It seems that although people lacking secondary emotions can respond to direct stimuli, information about that stimuli that is not available via direct perception is missing from the cognitive process.[45] This information pertains to the values we place on complex and abstract features of situations. It can only be created, stored and processed via the emotions. They are, in effect, part of our sensory apparatus. The secondary emotions in particular, are to the moral and social world as the eyes are to the world of light and colour.

Recognising the actual cognitive role that the secondary emotions play in normal people sheds significant light on the nature of the mental deficit that underpins the psychopath’s behaviour. It appears, that like Damasio’s patients, psychopaths are cognitively bound to immediate and concrete aspects of the world. They do not possess the medium through which the subtle and abstract features of the social and moral domains are perceived, stored and processed.

Somatic marking via the secondary emotions is most likely the brain’s strategy for highlighting not only temporally distant consequences, but also broader, big picture consequences, particularly those requiring a level of empathy for others. In an individual who has experienced the normal processes of empathic bonding, bad consequences for others would be negatively somatically marked. Entertaining courses of action that promise immediate gratification, but that harm others, would produce unpleasant sensations. This provides a reason to consciously avoid such courses of action, as doing so prevents discomfort.[46] Over time, those markers would rule out certain types of action before they are consciously considered. If psychopaths do not experience empathy, then the suffering of others is not somatically marked, and their decision space is left dangerously open. In effect, they would have no capacity to perceive moral features and thus no way of perceiving that an action is morally wrong.

There is independent evidence that psychopaths do not understand the meaning of emotional words. Consequently, their inner speech, which is the basis of conscience in most of us, has no motivating or inhibiting effect. There is just no moral information in there driving behaviour.[47]

We may conclude that while sexual sadism (perhaps helped along with obsessive compulsive traits) may motivate the serial killer to act immorally, the real pathology lies in the psychopathy, which prevents him from understanding, and hence being moved by the moral implications of his actions.

However, the import of Damasio’s research may be even more radical than this. The presumed division between a person’s desires, feelings and drives on the one hand, and their beliefs and knowledge on the other hand, may simply not exist. What a person may know and understand to be good or bad would appear to be tied very much to their capacity to place emotional values on things that happen in their lives. Believing something to be good is then identical to experiencing a positive emotion when contemplating it.

One can only know about something by perceiving it, and moral features are perceived through the secondary emotions. Clearly the serial killer does not have the means of knowing whether any action is morally right or wrong.

Unlike the blind, who have other portals to the physical world that let them know that there are objects out there that they cannot see, psychopaths are apparently oblivious to their moral incapacity. They attribute the problems in their lives to the rest of the population that inflict a set of inconvenient and apparently irrational norms on them.[48] They probably attribute our moral outrage at their actions to pathological hysteria. So for the psychopath, knowledge that something is against the law is not equivalent to knowing that it is morally wrong. Knowing what moral, social and legal rules others abide by does not equate with understanding the meaning of moral interaction. The temptation to conflate the two arises from an antiquated ‘high reason’ view of knowledge which no longer stands up to empirical evidence.

[*] Samantha Helsham is a doctoral candidate and tutor in the Philosophy Department at Flinders University of South Australia.The author would like to thank Nicole Vincent and Heather McRae for helpful comments on the draft.©2001 Samantha Helsham (text)©2001 Stuart Roth (cartoon)

[1] See McSherry, Bernadette, ‘Mental Impairment and Criminal Responsibility: Recent Australian Legislative Reforms’, (1999) 23 Criminal Law Journal, pp.135–45, for an overview of the various formulations.

[2] Giannangelo, Stephen J., The Psychopathology of Serial Murder: A Theory of Violence, Praeger, Conneticut, 1996, p.5.

[3] Giannangelo, above, ref 2, pp.29, 33, 41, 91.

[4] Gerberth, Vernon J. and Turco, Ronald N., ‘Antisocial Personality Disorder, Sexual Sadism, Malignant Narcissism, and Serial Murder’, (1997) 42(1) Journal of Forensic Sciences 2–3 (page numbers refer to a version printed from the Proquest 5000 database).

[5] Giannangelo, above, ref 2, pp.35, 37, 81, 86.

[6] Hare, Robert D., Without Conscience: The Disturbing World of Psychopaths Among Us, Pocket Books, New York, 1993, p.34.

[7] Murphy, Jennifer M., ‘The Role of the Amygdalar Circuit in Adolescent Antisocial Behaviour’, Dissertation, 2001, p.14.

[8] Hare, above, ref 6, p.178.

[9] Giannangelo, above, ref 2, pp.15–16.

[10] Giannangelo, above, ref 2, p.83.

[11] Holt, Susan E, Meloy, J. Reid and Stack, Stephen, ‘Sadism and Psychopathy in Violent and Sexually Violent Offenders’, (1999) 27(2) Journal of the American Adademy of Psychiatry and the Law 30.

[12] Holt and others, above, ref 11, p.29.

[13] Gerberth and Turco, above, ref 4, pp.7–8. These researchers initially located records about 387 people who had killed three or more people. Of those records, 248 actually documented evidence that the crime was sexually motivated. They then eliminated four cases where the killers were female. Of the remaining cases, there were only 68 where there was sufficient data to analyse for the purpose of their study.

[14] Gerberth and Turco, above, ref 4, p.8.

[15] Giannangelo, above, ref 2, pp.72–3.

[16] Giannangelo, above, ref 2, p.76.

[17] Hare, above, ref 6, pp.6, 17, 167.

[18] Hare, above, ref 6, pp.169,173, and Murphy, above, ref 9, pp.37–8.

[19] Gerberth and Turco, above, ref 4, pp.4–5.

[20] Hare, above, ref 6, pp.109, 165, 173, 174.

[21] Gerberth and Turco, above, ref 4, pp.2, 4.

[22] Giannangelo, above, ref 2, p.27.

[23] Gerberth and Turco, above, ref 4, p.7.

[24] Giannangelo, above, ref 2, p33–9, 76.

[25] Gerberth and Turco, above, ref 4, pp.8–9.

[26] Hare, above, ref 6, pp.140-41.

[27] Giannangelo, above, ref 2, p.16.

[28] Damasio, Antonio, Descartes’ Error: Emotion, Reason and the Human Brain, (1996) Macmillan Publishers Ltd, London, pp.70, 84, 96.

[29] Damasio, Antonio, above, ref 28, pp.35–6, 41–9, 53–8. Damasio himself (p.177) notes that psychopaths suffer from similar emotional–cognitive deficits as his pre-frontal patients.

[30] Damasio, ref 28 above, pp.130–37.

[31] Hare, above, ref 6, pp.53, 59–60.

[32] Damasio, above, ref 28, pp.207–9.

[33] Damasio, above, ref 28, pp.169–72.

[34] Damasio, above, ref 28, pp.212–15.

[35] Damasio, above, ref 28, p.219.

[36] Damasio, above, ref 28, pp.217–18.

[37] Damasio, above, ref 28, pp.173–174, 181–83.

[38] Damasio, above, ref 28, pp.175, 218–19.

[39] Murphy, above, ref 7, p.101.

[40] Hare, above, ref 6, pp.39, 59, 77.

[41] Hare, above, ref 6, p.169, and see his footnote 13 to comments on that page. He notes that although studies have not revealed any actual damage to the frontal lobes in psychopaths, it may be the case that there are abnormalities in the connections between populations of neurons throughout the frontal lobes or between the frontal lobes and other parts of the brain that cannot yet be detected by current brain imaging techniques. Quite frankly, neuroscientists are only beginning to scratch the surface in their attempts to understand how the normal brain is ‘wired up’, and it is becoming increasingly clear that this is as crucial as the actual structural features of the neuronal populations in the various subsystems of the brain.

[42] Damasio, above, ref 28, ch 3. Damasio only provides information about the personality of one of his patients and there appears to be no evidence of antisocial behaviour. He does however (at pp.57–8) discuss a case study of a person who suffered damage to the frontal lobe as an infant. In this case, the history described very much resembles that of the psychopath, with episodes of stealing, disorderly behaviour as well as the emotional and cognitive deficits characteristic of the subjects in Damasio’s primary study.

[43] Hare, above, ref 6, pp.54–6; and Murphy, above, ref 7. pp.9, 24–32.

[44] Murphy, above, ref 7, pp.7, 28, 36.

[45] Damasio, above, ref 28, p.220.

[46] Damasio, above, ref 28, p.176.

[47] Hare, above, ref 6, pp.129–32.

[48] Hare, above, ref 6, pp.195–96.

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