Anders Breivik is the Norwegian white supremacist who killed 77 of his countrymen in 2011: 8 in a car bomb in Oslo, and then 69 later that day in a worker’s camp on an island. Many of the dead were young people. Before the murders he had written manifestos about his opposition to Muslims in his country and his desire to see all Muslims expelled from Europe. If ever there was a case of a crime motivated by “Islamophobia” (I prefer “Muslimophobia”), this is it.
But was it? Perhaps it was really mental illness that made him run amok. After all, some blame the crimes of Muslim terrorists like the Tsarnaev brothers not on religious motivations, but on simple mental illness. Today’s post is about a new paper that tries to distinguish between these motivations.
Before Breivik was tried, the courts, as they often do in the U.S., ordered him to undergo a psychiatric examination. The team of forensic psychiatrists pronounced that he was legally insane—suffering from paranoid schizophrenia. And, according to Norwegian law, if that was the case he’d be off the hook. This is what the paper I’m about to discuss says:
. . . The General Civil Penal Code of Norway [states] A person who was psychotic or unconscious at the time of committing the act shall not be liable to a penalty. The same applies to a person who at the time of committing the act was mentally retarded to a high degree.
Now I’m not sure if that meant he’d get of scot-free or simply be put in a mental hospital. Is hospitalization considered a “penalty”? Perhaps a Norwegian can weigh in here. But at any rate, that initial diagnosis caused a huge uproar, because people wanted Breivik punished for the crime. After all, 77 people died by his hand! Sure enough, he was re-examined by a second group of experts who found that he was not psychotic when he committed his crimes. He could then be tried nomally. After trial and conviction, he was sentenced to 21 years in prison—the maximum sentence possible under Norwegian law. (I’ve posted about Norway’s enlightened justice system here, and noted that if he’s found not to be reformed after 21 years, he’ll do another five, get re-evaluated, and so on, so the sentence isn’t really fixed.)
I’m dubious, however, about people immediately pronouncing such murderers as “mentally ill,” as well as mandating any formal judgment on that issue by psychiatric teams. First of all, if you simply think someone’s mentally ill because they’d have to be to do such a crime, that makes the whole judgment tautological. In such a case “mentally ill” simply becomes equivalent to “mass murder”, and the perpetrator is automatically exculpated. No, there has to be an independent way to judge mental illness—independent of the action itself.
And that’s what the forensic team is for. The problem is that they’re saddled with archaic and confusing formal definitions of “psychosis” and “mental illness”. In the U.S., these definitions are embodied in the deeply problematic Diagnostic and Statistical Manual of Mental Disorders (DSM), which lays out what behavioral criteria must be met to be diagnosed medically with depression, psychosis, schizophrenia, obsessive-compulsive disorder, and so on. And the criteria change over time. At one time even being gay was diagnosed as a form of mental illness!
It’s just a mess, and you can have competing “expert” psychiatrists give contradictory diagnoses, which is what happened in Breivik’s case.
The solution, to me, is to do away with these formal diagnoses completely. One’s object should be threefold: protect society from the perpetrator, deter others who might do similar crimes, and reform the criminal so he can reenter society without posing further danger. The second goal is a sociological problem, while the first and third can be accomplished without formal diagnosis of the criminal. You simply see what kind of treatment is most likely to reform the behavior of the criminal, apply that treatment, and tweak it under confinement. That allows for a whole spectrum of antisocial behavior rather than the rigid categories of the DSM, and takes into account what I believe as a determinist: all criminals had something about their brains that made them commit crimes, whether it be a bad childhood, a desire for money, or more formal “diseases.” All should be treated, and, of course, all will require treatment tailored to their “disorder.”
My scheme, then is this: first try the accused to see if he/she did the crime. If the person is convicted, then tailor the punishment to the criminal and the crime, taking into account deterrence, sequestration, and reformation—but not retribution. The punishment, or treatment, should be determined by experts rather than judges or juries, though the experts don’t have to settle on a formal diagnosis. Norway conforms to this approach much more closely than the U.S., which may be why Norway’s prison recidivism rate is just 20% over five years, compared to 77% percent in the U.S.
However, a new paper by Tahir Rahman et al. in the Journal of the American Academy of Psychiatry and the Law (reference and free download below) suggests another approach, one I’m sympathetic to but don’t agree with completely. The title of the paper gives its thesis: “Anders Breivik: Extreme beliefs mistaken for psychosis.”
What the authors claim is simply that psychiatrists haven’t learned to distinguish between psychosis, which has conflicting definitions but is generally seen as a behavioral syndrome that includes delusions, and what they call “extreme beliefs
and “overvalued ideas”: beliefs like Breivik’s about Muslims that, while misguided, are not themselves medically delusional. And Rahman et. al use, as the definition of Breiviks’ syndrome, one concocted by the German psychiatrist Carl Wernicke (1848-1905):
An overvalued idea differs from an obsession in that, al-though it dominates the mind as an obsession does, the subject does not fight an overvalued idea but instead relishes, amplifies, and defends it. Indeed, the idea fulminates in the mind of the subject, growing more dominant over time, more refined, and more resistant to challenge.
Rahman et al. see Breivik’s right-wing and anti-Muslim views as one of these “extreme overvalued beliefs.” They also mention extreme religious views that lead to similar murders, like Christian killings of abortion doctors or Islamists’ killings of civilians in places like Paris and Istanbul. They would not, as many atheists do, see extreme religious belief as either delusional or a form of mental illness. The God Delusion might be re-titled The Overvalued God Idea.
What’s the upshot? To Rahman et al., their analysis shows that courts need to consider that beliefs like Breivik’s aren’t a species of insanity, and thus aren’t subject to the insanity defense:
We believe that Mr. Breivik’s behavior is an example of violence stemming from extreme overvalued beliefs. The evidence suggests he had vehement emotions regarding Muslims, immigrants, and liberal political parties. It appears to have dominated his mind. Based on our review of the data, Mr. Breivik’s beliefs were unaccompanied by other cardinal symptoms seen in severe mental illness, and his beliefs were not considered bizarre by the court, especially in the context of right-wing ideologies. His manifesto was not a form of disorganized speech, but rather a series of beliefs that he had sought out, copied, selectively altered, and incorporated and thereby “relished, amplified, and defended” throughout his trial.
And these are the implications they see for the legal system:
The fact that a defendant committed a crime because of a delusional belief is a common basis for an insanity defense. It is therefore critically important that forensic psychiatrists properly identify a defendant’s belief as either a delusion or as an extreme overvalued belief.
This seems, however, like a distinction without a meaningful difference. Yes, it would affect Breivik’s fate if his motivations were determined to be “overvalued beliefs” rather than psychosis. In the former case he’d go without punishment, in the latter he’d sit in jail. Sadly, it was not facts that determined his fate, but the public outcry that he’d get off scot-free if found psychotic—an outcry that led to a second and more “satisfactory” diagnosis.
But this whole reliance on formal diagnoses is nonsense. First find out if he did the crime, which he did. Then levy the punishment based on the factors delineated above. Here one needn’t lean on formal definitions, but on ways of treatment that would purge Breivik (if possible) of his malfeasance. Perhaps “psychosis” vs. “overvalued beliefs” could be a form of guidance here, but at least the criminal’s ultimate fate—hospital or freedom versus jail—wouldn’t depend on arbitrary categories.
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T. Rahman, P. J. Resnick, and B. Harry. 2016. Anders Breivik: Extreme beliefs mistaken for psychosis. J Am Acad Psychiatry Law 44:1:28–35.
