On Friday, August 24, 2012, a Norwegian court found militant mass murderer Anders Behring Breivik sane, guilty, and sentenced him to up to twenty-one years in prison. (See my prior post.) The center of controversy during this trial concerned the conflicting findings of two different forensic evaluations of the defendant, the first taking place in November, shortly after the shootings, and the second in April of this year. The initial court-ordered evaluation concluded that Mr. Breivik suffers from Paranoid Schizophrenia, a psychotic disorder. Unlike other forms of Schizophrenia characterized by chronic debilitation, grossly disorganized behavior, and severe functional impairment,  paranoid schizophrenia does not typically cause major cognitive impairment or disorganization, but still requires a clear history of classic schizophrenic symptoms. Onset may occur later than other types of schizophrenia, and, according to the American Psychiatric Association, " Associated features include anxiety, anger, aloofness, and argumentativeness. The individual may have a superior and patronizing manner and either a stilted, formal quality or extreme intensity in interpersonal interactions. The persecutory themes may predispose the individual to suicidal behavior, and the combination of persecutory and grandiose delusions with anger may predispose the individual to violence." (DSM-IV-TR, p. 314)

All psychotic disorders are not the same. (See my prior post.) Some are acute rather than chronic. There are other psychotic disorders that can masquerade as Paranoid Schizophrenia, such as Delusional Disorder, Major Depressive Disorder with Psychotic Features, and Bipolar Disorder during severe manic episodes. In forensic evaluations such as this, it is essential to diagnose accurately the first time, since the differences between, say, Schizophrenia and Delusional Disorder are very significant. How? Typically, the person suffering from Delusional Disorder is functioning socially and otherwise at a much higher level than someone stricken with Schizophrenia. This can become extremely important in understanding and explaining how such a defendant was capable of such meticulous premeditation and planning of his evil deeds over the course of many years, as well as his ability to carry them out successfully. Mental illness does not necessarily mean gross disorganization and a total deficit of reality testing. Paranoid delusions tend to become systematized over time, elaborate and deeply ingrained in the psychotic person's philosophy and worldview. And they do strongly influence feelings, attitudes and behaviors. But that does not always preclude the presence of intact reality testing in other areas necessary to carefully plan and execute such homicidal massacres.

Had Breivik been tried in an American court, in most states, including California, his attorneys would have needed to assert that not only was he psychotic, but unable to distinguish between right and wrong or comprehend the nature and quality of his actions at the time of the alleged crime. Here in the U.S., a defendant can be clearly schizophrenic, for example, but not necessarily legally insane. Our definition of insanity is a legal rather than diagnostic one. But not so in Norway, where the law states that the defendant can be found not responsible or not guilty by reason of insanity based simply on a psychiatric diagnosis of psychosis causing an inability to control one's actions at the time of the crime due to these compelling psychotic symptoms. Nothing more. In the case of Anders Behring Breivik, convicted of killing 77 Norwegian citizens in cold blood, the crucial question concerned whether he was in control of his actions or compelled by his paranoid delusions to kill. The presence of paranoid psychosis, schizophrenic or otherwise, does not, for me, necessarily indicate an inability to control one's behavior or automatically exculpate personal responsibility for such actions. Yet, other forensic psychologists and psychiatrists disagree, depending in part on their theoretical understanding of psychosis and its causes in general. (See my prior post on psychosis.)

The Norwegian system thus sets a somewhat lower and less stringent bar for the insanity defense than does the United Kingdom or United States. Therefore, had the most recent forensic evaluation of Mr. Breivik confirmed the findings of the first, that the defendant was indeed psychotic, he could conceivably not have been convicted and held fully responsible for his atrocious crime. Such an outcome would have been passionately opposed by the vast majority of Norwegian citizens, who feel, like most Americans, that individuals who allegedly commit terrible mass murders like Anders Breivik, James Holmes, and Jared Lee Loughner (see my prior post), must be held responsible and appropriately punished for their bad acts against society. The philosophical issue of personal responsibility looms large when it comes to the insanity defense. For underlying the insanity defense is the existential query regarding personal responsibility. And the problem of human evil. Assuming that individuals do, as a rule, bear responsibility for their evil deeds, might there be exceptions to this rule? Can the evil of mental illness irresistably drive an individual to behave violently? And should that person be held fully responsible for their mental illness and its consequences?

The second (evidently extraordinary) forensic evaluation was ordered following a public uproar upon learning of the first evaluation's findings of psychosis and criminal insanity. But according to the dissatisfied Norwegian Forensic Board in a letter addressed to the court, there were "significant deficiencies" in Breivik's second evaluation. While I do not wish to impugn the integrity of the Norwegian justice system and/or the forensic evaluators involved in this case, the dramatically contradictory findings of the second examination begs the obvious question: Was the game rigged? Did the second team of forensic evaluators succumb (consciously or unconsciously) to situational pressure to repudiate the first regarding the presence of psychosis? (The second evaluation apparently mentions some characterological issues only, including narcissistic and antisocial personality traits. See my prior post on what I call "psychopathic narcissism." ) Or could the first team of trained forensic evaluators simply have misdiagnosed the defendent in such a fundamental way? What's really going on here? Though the upshot may not have been all that different regarding incarceration, it remains important to differentiate between severely mentally ill offenders and those that are not psychotic but manifest various personality disorders. (See my prior post.) This will likely be one of the questions posed during the trial of James Holmes, the alleged perpetrator of the bizarre "Batman massacre" in Aurora, Colorado last month. (See my prior post.)

Breivik himself must have been delighted by the court's verdict, and reportedly smiled when it was announced. Like Ted (the Unabomber) Kaczynski, he did not want to be perceived as being insane by the public, but rather desires his outrageous racial/religious political agenda to be taken seriously. (See my prior post.)  I believe he, like Osama bin Laden (see my prior posts), also wished to be made a martyr for his cause, fantasized about this happening (he feared facing a firing squad when first arraigned), and sees the trial and verdict as fulfilling this grandiose, messianic fantasy. From the perspective of a forensic psychologist, this is all cause for concern. Was Breivik better able to "fake good" during his second evaluation, so as to appear less mentally ill? Did he con his forensic psychiatrists or psychologists? (See, for example, my prior post on the Casey Anthony case.) Or was he just "faking bad" in the first? Were his extremist political beliefs delusional in nature, and therefore, psychotic by definition? Were they part and parcel of an intricate and pervasive underlying persecutory delusional system that had been gestating over the years as part of his psychosis? Or is Breivik just another narcissistic, sociopathic right-wing political extremist who, perhaps like white supremacist Wade Michael Page's hateful rampage at a Sikh Temple in Wisconsin a few weeks ago, perpetrated a violent terroristic act to draw attention to himself and his radical cause? Another angry young man with a wicked rage for recognition. (See my prior post.) We may never know.

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