Inside the Mind of the Lone Wolf Killer - have the psychiatrists made the correct diagnosis of Breivik?
The new psychiatric report on the mental state of suspected terrorist Anders Behring Breivik released two days ago ensures his sanity will be the key issue in the forthcoming Norway massacre trial. The report concludes that Breivik was not psychotic or mentally impaired when he killed 77 people in a double attack in Oslo and on the island of Utøya, on 22 July 2011. Breivik was (and is) sane, the two court-appointed psychiatrists behind the new report argue, though he may be suffering from a narcissistic personality disorder.
Narcissistic Personality Disorder is a description of a personality rather than a mental illness. The arrogance, lack of empathy for others, relentless need for admiration, a preoccupation with fantasising about unlikely personal outcomes, like fame, and a demanding requirement for special treatment, means that if this diagnosis is correct, so far the trial proceedings are in fact playing right into Breivik's fantasies.
Controversy over his sanity, given it follows very similar disagreements amongst court-appointed psychiatrists who have interviewed similar lone wolf killers in the past, all over the world, signals there is a dilemma at the heart of the profession. One core problem is how to reconcile some of the most disturbed and irrational ideas ever recorded, with such a cold, clinical execution of the final fatal acts, which themselves betray no sign of chaotic reasoning.
Breivik's lawyer, Geir Lippestad, told reporters his client would not only defend his actions during his 10-week trial, but added, "he will also regret that he didn't go further." Is this an indication of a continuing delusion - given it's hardly rational to make this statement if trying to obtain as lenient treatment as possible from a court? Does it betray the kind of failure to grasp how others view your actions, which is a cardinal sign of serious mental illness? Or is it a sign of an ultimate chilling internal consistency of ideas?
This kind of conundrum has lead some psychiatrists to suggest mass or spree killers such as Breivik suffer from a rare disorder so far unclassified and unknown in the textbooks, because it's so difficult to gather enough of a sample to study effectively. Most mass killers die as a consequence of the spree killing because of armed police intervention, or they kill themselves, leading some to speculate that this is an act of self-destruction. Embitterment and self-hatred become entwined when some recent humiliation provokes a final realisation that the central narcissistic actor is not going to ever achieve what they had their hopes pinned on all their lives. This leads them to take revenge on an unfair world which has relegated them to a bit player in history. So they decide to take the ultimate and final step to prove how wrong everyone else was to write them off.
Spree killers differ from simple homicides because the rage is directed not at an individual but at a community or the world. Also they are not at all like serial killers, who generally perpetrate killings over an extended period, not against random individuals but instead a particular type of person, such as prostitutes, for their own warped reasons.
This new psychiatric report was commissioned by the Oslo District Court as a result of the controversy and intense criticism surrounding the conclusions of the first psychiatric evaluation, which had been leaked to the press. That evaluation concluded that Breivik was suffering from paranoid schizophrenia and was therefore criminally insane, which meant he would probably avoid a prison term and be committed to a psychiatric institution instead. Both reports are going to be considered by the court meaning this and other similarities suggest Breivik so far most resembles David Copeland, the notorious London Nail Bomber, a former member of far right political groups and at whose trial psychiatric opinion also divided over a diagnosis of schizophrenia or personality disorder. Copeland perpetrated a series of London nail bombings in 1999, which killed three people and injured 129.
Breivik declared his actions were "atrocious but necessary", guided by a strong political ideology in the face of an "imminent threat of the dark force that is trying to undermine all things civil we believe in", he writes in his manifesto 2083: A European Declaration of Independence. He is sane, responsible, even rational, he argues, and reportedly called the insanity declaration "a fate worse than death."
Diagnosis of Breivik's mental state at the time of the attacks is most important because few lone wolf terrorists are either caught alive or willing to cooperate with their psychiatric evaluators while in captivity. This means Breivik presents a rare opportunity to understand the mind of the perpetrator of such crimes which could assist in preventing them in the future. It's possible that a significant proportion do present themselves to medical and psychiatric services before their mental state turns so deadly.
After his arrest in 1999, Copeland claimed that he had been having sadistic dreams from the age of 12. In 1998, he was prescribed mild anti-depressants to help him cope with anxiety attacks and told his General Practitioner he was 'losing his mind,' citing difficulties concentrating and sleeping. Copeland stated that the idea of conducting a bomb attack would not leave his mind and that he had to do it. He claimed that he did not want to kill anyone, but that if anyone died it would not bother him either. He later described his actions by saying it was his destiny to commit the offense. Psychiatric opinion was influenced by the visions Copeland spoke of as a teenager which were felt to be consistent with the first stages of a diagnosis of paranoid schizophrenia, where hallucinations and delusions are a prominent feature.
The psychiatrist authors of the new report, Agnar Aspaas and Terje Tørrisen, described Breivik's cooperation with their inquiry as 'very good', even though he had initially refused to partake in the evaluation. In conjunction with the ideological documents Breivik has himself produced, such as his manifesto, letters and blogs, the two reports provide an important insight into the mind of a lone wolf. This level of cooperation with the assessment may have significantly influenced the psychiatrists towards their conclusion of sanity.
In an insight into what may be most likely Breivik's future, given both psychiatric reports are going to be considered in his trial, the jury in Copeland's case went against the 'diminished responsibility' argument and he was sentenced to six life sentences for murder.
Theodore Kaczynski (a.k.a the Unabomber) also attracted a diagnosis of paranoia by court appointed psychiatric opinion, and was responsible for a US mail bombing campaign spanning nearly two decades, killing three people and injuring 23 others. But he himself rejected an insanity plea which his own lawyers tried to enter on his behalf. This again echoes Breivik's own rejection of the first report and psychiatric diagnosis.
One important reason why it may be significant for the wider community whether doctors declare a lone wolf criminally insane is that it can reduce copycat behaviours where lone wolves become 'role models' for other alienated individuals. For example, David Copeland stated that he was inspired by the American lone wolf terrorist Eric Rudolph, who was responsible for four bombings between 1996 and 1998 that claimed three lives and injured more than 120 others. In his manifesto, Breivik writes that with his actions he hopes to inspire like-minded individuals to carry out similar attacks elsewhere.
The role that the media may play in this modeling process has been documented in academic research.
Christopher Cantor and Paul Mullen of the Australian Institute for Suicide Research and Monash University, who, along with other colleagues, published a study in the journal Archives of Suicide Research which investigated a series of seven mass homicides occurring in Australia, New Zealand and the United Kingdom between 1987 and 1996. They found that a kind of modeling process may have occurred whereby perpetrators were being influenced by previous mass killing incidents. In particular the reporting via the media was thought by Cantor and Mullen to be influential and could have lead to so-called ripple effects extending over a period as long as ten years.
While the media can't be stopped reporting on these incidents, Paul Mullen, a famous Forensic Psychiatrist based in Australia, argues in another paper published in the journal Current Opinion in Psychiatry that one clue as to the correct policy approach to preventing such dreadful occurrences comes from the history of Malaysia where the term Amok first arose.
In colonial times, in that particular region of the world, there was a well known syndrome of young men running 'amok' and killing others in a spree. The British colonial masters of the area actively pursued a policy of avoiding killing these perpetrators in apprehending or sentencing them. Instead they were consigned to asylums for the insane. This was such an ultimate humiliation, for that culture, at that time, that this denied these young men status and death, so depriving the mass killer, argues Mullen, of their raison d'être.
Mullen's argument is that if perpetrators of massacres are predominantly awkward, obsessive individuals overwhelmed by resentment at their own powerlessness, actively attempting to portray them as they are, is a much more helpful prevention strategy, at least when compared to the inadvertent global media attention which reinforces an idea that in death they achieve the power, which always eluded them in life.
Mullen asks: "who would want to join the ranks of obsessive 'wimps' who can only feel potent facing unarmed civilians with a gun in their hand?"
Breivik's dismissal of the initial psychiatric report that declared him criminally insane and recommended that he be committed to a psychiatric institution as 'the ultimate humiliation', provides a clue as to the important wider implications of these crucial psychiatric decisions.
Dr Ramón Spaaij is a specialist in the area of lone wolf killers 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. Dr Raj Persaud is a Consultant Psychiatrist and Emeritus Visiting Gresham Professor for Public Understanding of Psychiatry.