Atrocity in the City of Nice: An Act of Clinical Insanity?

Can the past psychiatric history of the mass murderer explain what happened?

Posted Jul 18, 2016

BBC News is reporting that Mohamed Lahouaiej-Bouhlel, who killed more than 80 people during Bastille Day celebrations, apparently had a history of mental illness. The BBC is claiming that he was briefly seen by Chamseddine Hamouda, a psychiatrist apparently based in the Tunisian city of Sousse, 12 years ago.

During an interview with the BBC, the psychiatrist explained that he did not think the atrocity in Nice should be blamed on mental illness.

Raj Persaud
Source: Raj Persaud

When tragedies such as these occur, the kind of warped thinking involved in mentally transforming a lorry, or an aeroplane, into a weapon, and deliberately killing large numbers of innocents, prompts public and politicians to invoke mental illness.

As psychiatrists we take issue with this simplistic argument as, amongst other confusions, it serves to stigmatise the mentally ill, who usually represent no harm to anyone.

But surely it takes a ‘sick’ mind to perpetrate such ‘sick’ acts?

Lone individuals who commit terrorist acts without being formally part of an organization are labelled ‘lone wolf’ terrorists. But are ‘lone wolf’ extremists psychologically different from those who join terror groups?

A recent study, published in 2015, and entitled "Deadlier in the U.S.? On Lone Wolves, Terrorist Groups, and Attack Lethality," found that the number of lone wolf attacks has increased each decade since the 1970s in the United States, and in other developed countries as well.

The review, by Brian Phillips from the Division of International Studies, Center for Research and Teaching in Economics, Mexico City, published in the journal, Terrorism and Political Violence, found that in the United States, between 1955 and 1977, only 7% of terrorism fatalities were killed by lone wolves, but between 1978 and 1999, ‘unaffiliated actors’ were responsible for 26% of terrorism deaths in the country.

Ramón Spaaij, in a study entitled "The Enigma of Lone Wolf Terrorism: An Assessment," published in the academic journal, Studies in Conflict & Terrorism,’finds that in Europe lone wolf attacks quadrupled between the 1970s and the 2000s.

From Victoria University, Australia, Ramón Spaaij’s investigation concludes that ‘lone wolf’ terrorists tend to create their own ideologies that combine personal frustrations and problems with broader political, social, or religious aims. Lone wolf terrorists draw on the ‘communities of belief’ and ‘ideologies of validation’ associated with extremist movements.

Ramón Spaaij points out that although most terrorists are found to be psychologically within the bounds of ‘normality,’ the rate of psychological disturbance is considerably higher among lone wolves.

Raj Persaud
Source: Raj Persaud

Three of the five lone wolf terrorists which Ramón Spaaij studied in depth, were diagnosed with personality disorder, while one was diagnosed with obsessive-compulsive disorder and another was also treated for an anxiety complaint. Four of the five appeared to have experienced severe depression. Lone wolf terrorists appear relatively likely to suffer from some form of psychological disturbance.

The reason they connect with terrorist ideology is that these movements, according to Ramón Spaaij, provide ‘ideologies of validation,’ so playing an important role in the psychological mechanism of ‘externalization.’ This involves channelling personal frustrations and projecting responsibility for all their problems, on to someone else, who commonly may be seen then as an enemy.

Identifying with political or religious struggles encourages the lone wolf terrorist’s categorization of the world into “us” and “them,” so stereotyping and dehumanizing the enemy. This effectively weakens psychological barriers against violence.

Lone wolf terrorists not only internalize such ‘black and white’ thinking, but may also, as a result, physically withdraw from mainstream society. All five that Ramón Spaaij studied were loners.

It’s possible that increasingly, it’s going to be disaffected loners with no connection with, or formal ties to anyone, far less terrorist organizations, who will be the perpetrators that fill our TV screens and news pages with horror. This is precisely because traditional counter-terrorism strategy focuses on connections between people.

In his study, Brian Phillips concludes that in countries with a great deal of counterterrorism capacity, terrorist organizations face mounting hurdles, so lone wolves become relatively lethal in these environments.

But perhaps, as counter-terrorism activity increases and improves, so fanatic organizations find it more difficult to operate, then it follows we should become aware of a possible increase in lone wolf terrorist incidents in the future. Security services can’t infiltrate a lone wolf nor intercept communications with themselves. It’s their precise disconnection which makes them so difficult to target.

Raj Persaud
Source: Raj Persaud

The links with some psychological disorder might become an argument for better mental health services provision, as this may possibly represent a more productive prevention strategy than simple counterterrorism.

Would recent history have been different had Mohamed Lahouaiej-Bouhlel actually engaged with treatment from Dr Chamseddine Hamouda?

Brian Phillips quotes the U.S. Attorney General Eric Holder, who in early 2015 said that the core of Al Qaeda was no longer a substantial threat, but the potential for lone wolf attacks, or attacks by small cells, ‘keeps me up at night worrying.’

Raj Persaud and Peter Bruggen are podcast editors for the Royal College of Psychiatrists and also now have a free app on iTunes and Google Play store entitled "Raj Persaud in Conversation." See: and Also, Raj Persaud's new novel is Can't Get You Out Of My Head.