Anders Breivik – What is the Diagnosis?
ARE THERE ANY CLUES FROM THE BEGINNING AS TO HOW ITS GOING TO END? HAS THE TRIAL OF ANDERs BREIVIK PRODUCED ENOUGH EVIDENCE TO NOW MAKE A DIAGNOSIS? DR RAJ PERSAUD AND RAMON SPAAIJ INVESTIGATE
Anders Breivik has been relating a harrowing account of the events surrounding the massacre of 77 innocent victims in Norway, but the testimony to date has, perhaps surprisingly given its raw detail, not really yet resolved any of the questions as to his motivation or mental state. This is according to the journalists sitting in the court room and reporting the case to the world. As bewilderment mounts, public opinion appears to be congregating around two main conclusions – that he is insane or evil – or both. The problem is the legal and psychiatric processes often fail to recognise either conclusion. So after weeks of tormenting testimony, the Norwegian public could be left upset or enraged that they have been cheated of justice.
It may come as a surprise that two of the most obvious phenomena we see around us – madness and wickedness, are not recognised by experts. But this is because specialists claim they dig deeper -and therefore end up with a different conclusion. Legal and medical professionals are supposed to engage in argument and decisions over these kinds of cases, in an un-emotional manner. Yet it feels impossible to respond to Breivik in any way other than a heightened emotional one. Indeed it seems almost sick to not do so.
But flick through psychiatric textbooks and diagnostic manuals, and you won’t find ‘Evil’ formally listed anywhere. Yet you will encounter a term which appears to be the closest scientific equivalence to evil – this expression is – psychopath. The modern clinical term for evil might be psychopath, or sociopath, or anti-social personality disorder (ASPD) or dissocial personality disorder. The ever multiplying number of different expressions reflects an attempt by academics to find a dispassionate, scientific, or non-emotionally laden way of talking about, and researching the phenomenon. This is a personality disorder, which (see our previous article on this here) has been one of the most common clusters of diagnoses metered out to so-called ‘lone wolf’ killers, which is the kind of murderer Breivik appears to resemble the most.
A personality disorder refers to an enduring set of attitudes and behaviours which go on all your life – so crucially it’s not like an illness which arrives and changes you – instead you were always that way. The puzzle is the court has so far not been hearing evidence of long-standing deep personality flaws which would anticipate such gross violence. Most suffering from such deep psychopathy would have been in serious trouble with the police before, or had a history of conflict, fights, or anger management, and so on. Perhaps we will be hearing evidence along these lines later. If not, Breivik appears able to control himself for extended periods, much more than others with these diagnoses can usually. Personality disorders reveal pasts littered with social isolation or short term unsatisfactory relationships, with difficulty holding down jobs or staying within any kind of organisation such as a political one. Breivik doesn’t appear to have been able to cooperate for any extended period with even the small groups of ultra-right wing extremists that he seems to have made contact with. Those he might find himself most aligned to, have also since dissociated themselves with him.
In 2006, he moved in with his mother ‘to save money’ and then devoted 16 hours a day to playing on line computer games. At face level this is classic of a certain kind of inadequate personality type. We already covered how data from his playing of such games might be analysed to assist in the diagnosis in a previous article here. Of course neither compulsive gaming, nor living with your mother, are either in themselves signs of a disturbed mind. They are part of a pattern which emerges in a case where clues are difficult to discern. The data provided by the way he played computer games may provide additional information as to his personality, particularly when he himself is an unreliable witness to himself. The context is that Breivik appears to display a degree of social ineffectiveness and social isolation; he spent a lot of time by himself and seems to have struggled to establish and maintain intimate human relationships. But Breivik now apparently claims this was all part of a strategy which would culminate in the devastating attack five years later. Meticulous long term, relentless, single-minded planning is not usually consistent with the impulsivity linked to anti-social personality disorder, or the chaotic mind set associated with psychosis,. In court, Breivik claimed to have been ordained into a militant-nationalist group called the Knights Templar in London in 2002, but then he has to date refused to answer, apparently according to some reports, over 100 questions on the topic. This is very interesting from a psychiatric standpoint. He could just be lying, or covering up for collaborators. Someone who has a delusion, arising out of a psychotic illness, is not aware that what they are saying is not true. They firmly believe something which is palpably nonsensical to anyone else. Yet a psychopath, is more likely to know they are lying, and so endeavours to dissemble. Some clinicians would say this response ticks a box for a personality disorder such as anti-social.
Similar confusion surrounded previous lone wolf killers such as Franz Fuchs and Theodore Kaczynski. Austrian Franz Fuchs, killed and injured using improvised explosive devices and mail bombs in the early 1990′s, claimed to be acting for a fictitious group, the Bavarian Liberation Army. Theodore Kaczynski, AKA the ‘Unabomber’ waged a letter bomb campaign in the US over almost two decades, stated that he was the leader of the Freedom Club (FC), fuelling the perception that a larger movement existed that thought as they did. The difficulty of deciding between personality disorder and psychosis with these other lone wolf killers, who appear very similar to Breivik, has been discussed in our previous articles. So far, Breivik hasn’t been reported thus far in court to suffer overt classic psychotic symptoms such as delusions or auditory hallucinations (hearing voices). A psychotic illness strikes you down and deviates you from your previous life path, and so is distinctly different from a personality disorder which dates back to childhood. Someone suffering from a psychosis, like schizophrenia, has therefore often experienced a dramatic personality transformation, and most with this diagnosis are not at all violent.
In this context it’s intriguing that it has been reported that about ten years ago Breivik started to change profoundly, around the age indeed that, statistically, paranoid psychotic disorders are most likely to start. As a schoolboy, it’s reported he was fond of hip-hop music and had a Muslim best friend. But then he began to view immigrants as enemies, and those accommodating them as traitors who must be killed. Did this reported shift arise out of some psychotic mental illness which started then? But not all extremists, or even the majority, are frankly psychotic. Some espouse extremist causes because politics can provide an external focal point for everything going wrong in your life. Blaming enemies can be a convenient explanation for your own lack of success. Yet demanding to be released and treated as a hero, as he apparently has done in the past, appears delusional. As does his statement to the court last week that they only have two options – to release him, or execute him, when neither is a likely outcome.
In one of the most pivotal moments in the last few days of testimony, before shooting his first victims, Breivik claimed he heard “100 voices” in his head telling him not to do it. Does this mean he was literally hearing voices? It’s quite a strange expression. If he wasn’t formally experiencing auditory hallucinations, is this a hint that he may have in the past? What is key about this evidence is that it sounds like Breivik has come the closest he has ever done in describing a strange kind of conscience. If he had doubts and was torn, then this provides a clue that he’s not falling into the category of psychopath quite so neatly. This is why investigating exactly what was going through his mind at that precise moment is so important. These so-called ’100 voices’ telling him not go ahead appears contradictory to his other plans to detonate more bombs, decapitate the Prime Minister, and kill more than he managed to. It is also at variance with apparently the only display of emotion by him in the court last week, being when he was shown one of his own propaganda films. This is in marked contrast to the apparent lack of remorse demonstrated day after day of monotone testimony. The crucial bit of the evidence is missing – how come he just moved on and started shooting people? How did he rebut these voices in his head – if they really were there? Did he say to himself that these people deserve it? The ends justify the means? Did he remind himself of his grand mission to save Norway? Did he know, delusionally, already what the outcome would be?
Unfortunately we don’t know the answer to these questions, and that could be because Breivik so far doesn’t appear to have been yet subject to the right kind of cross-examination which would clarify the darkening mystery surrounding him. We can only hope these questions are yet to come. But as it’s reported his personal evidence is going to finish on Monday, we might be running out of time. It might seem almost offensive to try and understand the motivation and psychology of mass killers, but given there is some tentative evidence this kind of tragic event might be increasing in recent times, it becomes imperative to spot patterns so that preventive action can be taken. But another reason we might be against the clock, is it’s not unknown for this kind of mind set to be contemplating suicide. This might be the only way now left of eluding the ultimate indignity, and impotence, of incarceration. Suicide also assists in avoiding confronting many truths a murderer may have psychologically side-stepped so far, which living a long time might be the only treatment for. While suicide prevention strategies may well be in place, one truth that has emerged this week, is this is a person who appears capable of delivering death, against all odds.
Dr Raj Persaud is a Consultant Psychiatrist based in London, and Emeritus Visiting Gresham Professor for Public Understanding of Psychiatry. Dr Ramón Spaaij is a specialist in the area of lone wolf terrorism and author of Understanding Lone Wolf Terrorism: Global Patterns, Motivations and Prevention published by Springer. He is based at La Trobe University in Melbourne, Australia.
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