A few years ago, the Korean drama It's Okay to Not Be Okay became a huge hit. It was billed as "a fairy-tale-like romance between Gang-tae, a psychiatric ward caretaker who refuses love under the crushing weight of life, and Moon-young, a children's book author who has never known love due to an innate flaw, as they heal each other's wounds and learn to care." But honestly — how many of us could look at someone with psychopathic tendencies and say, "That's fine by me"? Public anxiety about psychopaths has only grown in recent years, fueled by a steady stream of crimes linked to individuals with the diagnosis.
Perhaps that is why every suspect in a high-profile violent crime in Korea now seems to undergo a psychopathy assessment. In 2022, the man dubbed the "Busan roundhouse kick attacker" — who brutally assaulted a woman he encountered on the street — and Jung Yu-jung, who murdered a woman her own age and then dismembered and disposed of the body, scored 27 and 28 points respectively on the psychopathy checklist. The average person scores around 15; anything above 25 signals strong psychopathic tendencies. News reports made sure to spell this out.
What Makes a Psychopath's Brain Different?
James Fallon's story is an especially gripping one. A neuroscientist and professor at the University of California's medical school, Fallon was comparing the brain scans of psychopaths and serial killers when he stumbled onto a discovery that shook him to his core: his own brain looked remarkably similar to those of the psychopaths he had been studying. Using fMRI, he had been cataloguing the brains of various criminals and noticed a consistent pattern — reduced activation in the regions responsible for empathy and moral reasoning. One day, while comparing these criminal scans with those of Alzheimer's patients and family members serving as controls, he noticed that one family member's scan looked disturbingly like a psychopath's. Driven by curiosity, he tracked down whose scan it was. It was his own. He published the whole story in a book called The Psychopath Inside.1
In the book, Fallon argues that most psychopaths show abnormalities in the limbic system — the brain's emotional core — which explains why they struggle to empathize with other people's feelings. He zeroes in on the amygdala and the anterior cingulate cortex. The amygdala processes instinctive fear and anxiety, while the orbital cortex — a region of the frontal lobe — serves as the brake that keeps violent impulses in check. When the orbital cortex is not functioning properly, the result is an extremely dangerous person. When both the amygdala and the orbital cortex are impaired, you get a psychopath. When the amygdala is fine but the orbital cortex is damaged, you get a loose cannon — someone who cannot control their temper, who acts on impulse, who careens from one reckless episode to the next.
As Dr. Fallon puts it, in words that send a chill down your spine: "Psychopaths are not incapable of reading other people's minds. Sometimes they read people as if they had telepathic powers. What they cannot do is feel what the other person feels."
What does oxytocin do in the orbital cortex? A fascinating study offers some clues. Forty male participants inhaled either real oxytocin or a placebo, after which researchers stroked their skin with three different instruments: a plastic brush, a coarse burlap brush, and a soft goat-hair brush. When asked how each one felt, participants who had inhaled oxytocin consistently reported more pleasure — regardless of which brush was used. Brain imaging confirmed that their orbital cortex was more strongly activated. So could oxytocin actually help people with antisocial personality disorder? Meta-analyses examining the relationship between oxytocin inhalation and antisocial behavior do exist, but the verdict is split — some studies report positive effects, while others urge caution.2
Why Empathy Matters
Research on oxytocin and empathy has produced results that are as fascinating as they are revealing. One of the most compelling studies involved prairie voles — small, unassuming rodents that scientists prize for their lifelong monogamous pair bonds. Researchers separated a female prairie vole from her mate, then subjected her to electric shocks and blaring sirens to induce stress and trauma. When the distressed female was returned to her partner's cage, the male immediately rushed to her side, pressing his body against hers, licking and grooming her with unmistakable tenderness. But when researchers blocked oxytocin's action by administering an antagonist, the same once-affectionate male did not even glance at his partner. He just went on eating his food, completely indifferent. The devoted lover had become, overnight, something resembling a psychopath. The substance that had made this tiny creature nature's most dedicated romantic was none other than oxytocin. Published in one of the world's top scientific journals, this study is considered the first to scientifically demonstrate that oxytocin drives not only empathy but the active impulse to comfort those who are hurting.3
Look around you. Some people are naturally attuned to the pain of others; some seem incapable of feeling it at all. If it is true that oxytocin's absence prevents us from sensing another person's suffering, could restoring it transform someone with psychopathic tendencies? The research approach is straightforward: measure blood oxytocin levels, check for mutations in the oxytocin receptor gene, and assess the person's capacity for empathy. Studies have found that people with oxytocin receptor mutations had significantly more difficulty empathizing with others' pain and struggled even to imagine suffering. Other research showed that people with oxytocin receptor abnormalities got into more frequent and severe marital fights — including using divorce as a threat — and experienced more relationship crises than comparison groups. The more pronounced the receptor mutation, the higher a person scored on the autism spectrum, with notable deficits in social interaction and communication.
Taken together, the evidence is clear: oxytocin is, without question, the hormone of empathy. But what about those whose oxytocin is naturally low? What are they supposed to do? Be patient. Later in this book, you will find detailed, practical methods for raising your oxytocin levels.4
The Oxytocin Reconciliation Method
No relationship stays smooth forever. Even people who get along beautifully can start bickering over the most trivial things. When oxytocin levels are high, we naturally tend to see things from the other person's perspective, which makes conflicts less likely to erupt. But what if the damage is already done? What if you and someone you care about have fallen out — and it is your fault?
First, apologize unconditionally — even to the point of overdoing it. I once stood in a long line at Starbucks, finally ordered, and received the wrong drink. When I pointed this out, the barista apologized so profusely and bowed so deeply that I felt embarrassed — and my annoyance melted away on the spot. As she remade my order, I overheard her say to the trainee beside her: "When you apologize, go overboard like that, right away. Got it?" She had been training the new employee all along. I could not help but laugh, but it taught me a useful lesson.
Second, make peace over a good meal. The other person may be too angry to sit down and eat with you. But if you can manage it, sharing something delicious while you talk will raise their oxytocin and improve the chances that they will understand — and forgive.
Third, show the other person that you trust them. When someone believes we trust them, their brain responds with a surge of oxytocin. You can say it directly, or you can ask a mutual friend to pass the message along, or send a letter or a thoughtful gift. Remember: building a new relationship matters, but repairing a damaged one matters just as much.