Norway Killings: Inside the Mind of Anders Behring Breivik

(update 1: 26 July 2011)

(update 2: 29 November 2011)

(update 3: 21 December 2012)

(update 4: 24 August 2012)

Sherlock Holmes once remarked that it was a capital mistake to theorise in the absence of data. There are few settings where this is more accurate than in attempting to understand the psychology of another human being.

Nonetheless the intense interest surrounding the tragic events in Norway has prompted much speculation on what may have motivated Anders Behring Breivik to carry out mass murder.

Perhaps unwisely, I will add to that ill-founded speculation.

One of the most common statements is that “he must be mad”. It is always tempting to classify those who act outside normal social boundaries as insane. It is a cleansing statement to make, absolving us of the need to understand their motivations, and preventing us from needing to emotionally accept the uncomfortable truth that another human being was capable of such heinous acts.

While we don’t know the full details of his motives and beliefs, early reports suggest that while Breivik had some bizarre and extreme beliefs, a distorted sense of reality, and a grandiose sense of his own place in the world, it remains unlikely that he falls under any specific Axis I clinical disorder. Pending further data, it strikes me that he may better fit within an Axis II diagnosis, such as a Cluster B personality disorder, possibly a malevolently antisocial personality.

To translate the psych-jargon: one of the major diagnostic classification models, the DSM, splits diagnosis along 5 different axes. Axis I includes the “classic” clinical mental illnesses (schizophrenia, depression, bipolar, etc.); Axis II covers personality disorders and some developmental disorders; Axis III includes physical medical issues; Axis IV are socio-environmental factors; and Axis V is a general measure of the ability to function in the world. If it proves correct that Breivik has an Axis II diagnosis, he retains ultimate responsibility for his actions and legal capacity in a way that may not have been the case if, say, he had been suffering from an acute psychotic episode of schizophrenia.

This woudl be consistent with reports that Breivik operated in a very calm and logical manner during his killing spree, and also explain his surrendering in an equally calm way to police rather than the more common suiciding that often accompanies these mass murders. It is consistent with his reported statements that he recognised the killings would be seen as cruel but that he felt they were justified. It also perhaps explains his desire (so far expressed through his lawyer) that he wants to “explain” his actions in court or in a public statement.

This is a man who views the world in a very different, very amoral, and very callous way. He has a grandiose manifest sense of his own destiny and desires to change the world, but this is driven by the paranoid feeling that “his kind” have been oppressed (a brittle reflection perhaps of his inner fragility and poor self-regard). It is perhaps significant that his uniform (pictured above) bore a badge saying, Multicultural Traitor Hunting Permit. He has awarded himself the role of an avenging powerful government, not that of a weak outsider terrorist.

The above assessment may prove inaccurate; it is a gut impression formed from limited information, and as such only a hypothesis. It is inherently a more uncomfortable hypothesis than the easy “he’s mad”. But as Norway, and the world, struggles to come to terms with the mass murders, it is a hypothesis that must be confronted.

Breivik doubtless hopes he will inspire others to follow his example. It is certain the vast majority will recoil in revulsion instead; the challenge is identifying those with similar outlooks and personalities who may well see in Breivik a kindred spirit.

UPDATE 1: 26/7/11 – Breivik’s lawyer is currently being reported as saying his client “is probably insane”, although it hasn’t been decided if he’ll plead insanity. I’m not at all familiar with the Norwegian criminal justice system, but if it’s anything at all similar to the UK one with regards its interaction with mental health services, it’s worth highlighting some of the complications and subtleties in how psychiatry and the law interface:

As touched upon in an earlier reply to one of the comments below, legal constructs around “insanity” can and do vary in some regards compared to the medical/psychiatric constructs. While the two systems certainly inform each other’s practice, they are independent, as so different constructs do develop.

For instance, the concept of psychopathy is more of a legal construct with psychiatrists often preferring different terms such as antisocial or dissocial personality disorder which map approximately onto at least some of the same areas. And within psychiatric circles, Axis II personality disorders like this are not generally conceptualised as being the same kind of mental illness as Axis I disorders like schizophrenia or bipolar are. The law, on the other hand, does not really recognise these differences and views them all as potentially usable in a legal defence (or to divert the case to a psychiatric setting), although through the course of any trial and its legal argument and expert witness statements, the nuances can (and should) emerge.

It’s also worth noting that even while both the legal and the psychiatric definitions of insanity differ from each other,  both differ to an even greater extent compared to the general public lay perception of what insanity is. As with  most things in life, different groups will view the same phenomena through different conceptual filters and draw different conclusions.

It will be interesting to read the outcome of Breivik’s psychiatric assessment; if the Norwegian system is at all similar to the UK one, I wouldn’t be surprised if we get a rather hedged official report, and then Breivik’s lawyer arranges for further expert assessments to use in court alongside the official one.

UPDATE 2: 29/11/11 – the outcome of Breivik’s assessment is that he has been declared insane by two psychiatrists that have conducted 13 interviews with him. As tentatively predicted above, it has taken a long time, and many hours of questioning and theorising, to come up with a clinically rigorous provisional assessment of Breivik’s state of mind. It’s also worth noting that this assessment will undergo further scrutiny both inside and outside of court, by more mental health professionals not to mention legal, political, judicial and lay people. This reflects the complexity of all human minds, and the politically-sensitive nature of this particular case.

UPDATE 3: 21/12/11 – reports suggest that the medical review panel charged with deciding whether the initial psychiatric report mentioned in Update 2 is accepted or not is “completely split”. This only highlights the difficulties posed when translating from general theory to specific individual. Key quotes from broadcast NRK:

… three members had “big objections” to the November 29 diagnosis by two court-appointed psychiatrists, and at least one of them questioned the finding that Breivik could not be sent to prison.

“There are disagreements over whether Breivik is psychotic,” NRK reported, without naming its sources. “Others are critical of the fact that Breivik’s ideological convictions are not discussed in the report.”

UPDATE 4: 24/8/12 – Breivik has been judged sane, and suffering only from a Cluster B personality, as originally hypothesised by me in the original blog post above. However the exact subtype has been suggested to be narcissistic rather than antisocial. In reality, Clusters of personality disorder exist precisely because of a frequent overlap in presentation and between them, and co-existence of multiple subtypes.

How are you today?

Image via Wikipedia

What makes people tick?

That’s what drew me to medicine and to psychiatry in particular. I love trying to read people, figuring out their patterns, extrapolating their behaviour forwards and generally learning how to adjust and contain these shifting mental sands.

Most people operate linearly, most of the time. Their lives are routinised, and so are their responses. A basic illustration of this is the narrow, fixed repertoire of responses to the common question: “how are you today?”

Regardless of how they are actually feeling – even if actively feeling unwell – the initial response to that question is still often an automatic “I’m fine; you?” or similar well-rehearsed blandishment.

These pre-programmed stereotyped responses are on one level just a superficial societal pleasantry. But they are also the tip of the iceberg of how moulded people are by the society they live in, and by the role they have been trained to play within that society.

Readers of Conan-Doyle’s Sherlock Holmes will be familiar with his uncanny ability to read a person just by looking at them and noting specific details about their appearance or manner. In fact, although the ability is exaggerated in the books, there is nothing magical about the skill. Doctors are trained to perform an “end of bed examination” to take in physical details about a patient before even talking to them, to obtain potential clues as to diagnosis. A good psychiatrist draws on that basic medical skill and allies it to a more subtle understanding of human behaviour to develop deeper hypotheses.

The skill isn’t unique to medicine, being shared by good detectives, politicians, negotiators and salespersons. What is interesting about these professions is not just that they require an ability to read people, but a subsequent need to modify human behaviour. The detective has to interview and break suspects, the politician must win votes, and the negotiator and salesperson need to close sales. The psychiatrist uses knowledge of human behaviour to encourage the development of insight in the insightless.

Sometimes the initial calculation is incorrect and needs to be modified in light of subsequent fresh data. But more often than not, and despite how unique people believe themselves to be, similar underlying patterns can be recognised and ways of handling those patterns can be developed. This casual familiarity with human nature can make members of all those professions I mentioned above occasionally seem highly manipulative. When you get used to figuring out situations, you also tend to spot “angles of attack” very quickly and then it’s up to your individual conscience as to how much to use them to generate a desired outcome.

Automatic responses are necessary to function without thinking continuously, which would be exhausting. But don’t let the automaticity prevent you from actively thinking when the need arises.