Blair (Reference Blair2003) outlined a neurobiological basis for psychopathy. The orbitofrontal cortex has also been implicated in psychopathy by other authors (Reference DolanDolan, 1999). A strength of Blair's article was its proposal of an integrated model of psychopathy in which the process of socialisation is impeded at a neural level. Such a ‘biosocial’ theory seems to make intuitive sense. However, concerns arise based on the drawing of parallels with research done over a century ago by Cesare Lombroso, an Italian psychiatrist and criminologist. Modern researchers share with Lombroso (and some of his predecessors, such as Pella and Gall; see Reference WalshWalsh, 2003) a desire to explain criminality in terms of innate biology. But as Gould states (Reference GouldGould, 1980), ‘Major ideas have subtle and far reaching extensions’ and a brief glance at Lombroso's theory and its ‘social extension’ can flag up the dangers associated with modern neuroimaging in this area.

Lombroso believed that 40% of criminals were ‘born criminals’ who could be distinguished by physical features including relatively long arms, prehensile feet with mobile big toes, low and narrow forehead, large ears, thick skull, large jaw, etc. (Reference GouldGould, 1980). A particularly unnerving aspect of Lombroso's work is that he campaigned on the basis of his theory for a preventive criminology: ‘society need not wait for the act itself, for physical and social stigmata define the potential criminal. He can be identified, watched and whisked away at the first manifestation of his irrevocable nature’ (Reference GouldGould, 1980). Lombroso also ‘recommended irrevocable detention for life for any recidivist with the telltale stigmata’ (Reference GouldGould, 1980).

This should serve as a warning in the modern era, where the spirit of Lombroso lives on. One fears a scenario in which a brain scan diagnosis of psychopathy legitimises the preventive incarceration of a ‘high-risk’ individual, and in which a static neurostructural deficit may lead to a therapeutically nihilistic approach to such an individual on the grounds that he is ‘beyond rehabilitation’. Combining the above two positions, the perception of an individual as both dangerous and unchanging may lead to a ‘lock them up for good’ ethos.

Lastly, there are dangers in assuming a causal link between psychopathy and structural brain change. One consequence of this, in terms of individual responsibility, would be the inappropriate invocation of a deterministic argument by a defendant seeking exculpation for an offence.