Recently, there has been a cluster of terrorist murders committed by individuals acting alone, under the influence of extremist propaganda they accessed on the internet. It is too soon to tell whether this is a statistical blip or the beginning of a new and dangerous trend.

Media discussions immediately focus on the psychology and motivations of the killers. What leads someone to murder massively and randomly? How much are these true believing political/religious extremists? Or are they mentally ill?

Mental illness is pretty clearly not the motivation of terrorists who act as members of organized groups- the screening process that is part of their recruitment takes care of that. But what about those who kill alone - are they more likely to be lone wolves or mentally ill stray dogs?

Dr Tad Tietze is a Sydney psychiatrist who is particularly interested in this intersection between politics and mental illness. He writes:

"With more terrorist acts on Western soil perpetrated by locally born and bred extremists there has been a resurgence of the notion that such behavior is caused by mental disorder. But such explanations are almost always based on shaky assumptions.

The classic case of this in recent years is that of Norwegian right-wing mass murderer Anders Behring Breivik, who killed 77 people in July 2011. Despite Breivik releasing a coherent 1500-page political “manifesto” on the internet just before committing the crime—large slabs of it copied verbatim from well-known right-wing publications and websites—many commentators rushed to portray him as a mentally disturbed “lone wolf," arguing his actions had no further social or political relevance.

Yet for anyone who has followed the rise of Europe’s racist Right the connections were obvious. My dismay at this process of depoliticisation led me to write extensively on the case, and to co-edit the book On Utoya: Anders Brevik, Right Terror, Racism & Europe. More recently I’ve published an article specifically on the psychiatric controversy in Australasian Psychiatry.

In that article, I recount how the first court-appointed psychiatric team diagnosed Breivik with “paranoid schizophrenia”. Astonishingly, they reached this conclusion while admitting they had “not taken a position on the subject’s political message or point of view.”

Their non-engagement with Breivik’s politics led them to overlook non-psychotic explanations for his beliefs and behavior. For example, they defined a series of terms well known in the far Right and online gaming sub-cultures Breivik was aligned with (e.g. “national Darwinist," “justiciar knight”) as self-coined “neologisms,” a symptom of schizophrenia. When challenged on this fact in court, one of them said Breivik’s personal use of these words was anyhow psychotic because it formed part of his delusional system. As the judges commented, “such a view may easily lead to circular reasoning”.

One British psychiatrist later called the report “a source of cringing embarrassment to the profession of forensic psychiatry."

There was public outcry at the contents of the report when it was leaked to the media, and the court took the unprecedented step of ordering a second examination. This report, which was favored in the court’s judgment, took into account Breivik’s politics, finding him legally sane and responsible for his crimes (although it also diagnosed him with personality disorder).

Past attempts to label terrorists as mentally ill have been similarly fraught. As one authoritative summary of research up to the late 1990s concluded, “the findings supporting the pathology model are rare and generally of poor quality. In contrast, the evidence suggesting terrorist normality is both more plentiful and of better quality.” This didn’t prevent a new wave of research during the War on Terror, but despite overblown claims by some investigators, little evidence has emerged to suggest mental health problems are a significant driver of Islamist terrorism.

Foreign terrorist threats tend anyhow to be popularly defined not as psychopathology but in religious, ideological or ethnic terms. However, “homegrown” terror has implications for how Western societies view themselves. The rush to paint Breivik as insane was, in my opinion, partly driven by discomfort at how a white, middle class Norwegian man could carry out such a heinous crime. If he was mad then no further explanation was needed.

The risk of psychiatric overreach in such cases is great. Politics is a profoundly social activity and cannot be reduced to the psychology of the individuals involved. By trying to apply psychiatric principles to political extremism, psychiatrists may misinterpret the situation and end up as unwitting servants of political agendas beyond their control."

Thanks so much, Dr. Tietze, for these wonderfully clarifying comments.

Psychiatric diagnosis works best in clinical practice and when the presentation is clear cut and follows the classic pattern of symptoms, behaviors and course laid out in one of the DSM criteria sets.

Psychiatric diagnosis works worst in forensic settings (and in media discussions) when forced to make black and white distinctions at inherently fuzzy boundaries.

Psychiatric diagnosis is also subject to great cross-cultural misinterpretation. Dr. Tietze points out just how far off base wandered the first set of Breivik evaluators because of their unfamiliarity with radical right ideology and terminology. A fixed, false, even bizarre idea is not a delusion when held by a whole bunch of similarly misguided people.

You cant pluck the person out of his social/political/religious context and evaluate psychiatric diagnosis in isolation. Psychiatrists are well advised to heed the warning: "Don't talk unless you are very sure you can improve on the silence."

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