Norwegian Psychiatry Is Insane

Posted on by TheLastPsychiatrist and tagged , , , . Bookmark the permalink.

In theory, a psychiatrist is not able to formulate a diagnosis without completing a full psychiatric evaluation; however, I am 100% certain of my assessment.

Five months before Norwegian exploder Anders Breivik was unanimously (=2) declared insane by a forensic panel, the head of the Norwegian Board Of Forensic Medicine said this:

The July 22 attacks were so carefully planned and executed that it would be difficult to argue they were the work of a delusional madman, said Dr. Tarjei Rygnestad, who heads the Norwegian Board of Forensic Medicine.

The very first question that you need to ask is: why is the head of the Board who is responsible for a fair assessment and thus a fair trial of a high profile defendant talking to the press before the assessment of such a high profile defendant has been completed? Hmm.  Second question: what the hell is he talking about?  “Delusional” and “madman” and “insanity” are not psychiatrically synonymous, let alone legally synonymous.

In Norway, an insanity defense requires that a defendant be in a state of psychosis while committing the crime with which he or she is charged. That means the defendant has lost contact with reality to the point that he’s no longer in control of his own actions.

The first sentence may be factually accurate, but the second sentence is not. Psychotics may have perfect control over their actions.

Rygnestad told the AP a psychotic person can only perform simple tasks. Even driving from downtown Oslo to the lake northwest of the capital, where Breivik opened fire at a political youth camp, would be too complicated. “If you have voices in your head telling you to do this and that, it will disturb everything, and driving a car is very complex,” Rygnestad said.

Again: this is the head of the Norwegian Board Of Forensic Medicine? Even a layman understands that complicated actions are not at all precluded by psychosis.  He said these things before Breivik was declared insane, and no one noticed because it jived with their own haphazard thinking about insanity. But now that he has been declared insane by that very Board, with that very guy on it, we need to reconsider what he meant.

II.

Here’s the missing piece that, even though I knew precisely what I was looking for, still took me hours to figure out.

In the U.S., having a psychosis doesn’t get you anything; for the insanity defense, the psychosis has to be shown, among other things,  to have impaired your ability to tell right from wrong at the time of the crime.  The fact that aliens told you to do it is not insanity if you still know it is wrong to shoot people.

Importantly, in the U.S.  it is a defense you have to prove, i.e. the prosecutors can/will argue against it.  The defense team may even choose not to pursue it even if the defendant is psychotic.  In Norway, however, it is introduced as a fact by a forensic board, and this fact is (almost always) accepted by both sides. Hence the paragraph that sounds weird to U.S. audiences:

But prosecutors insisted the psychiatric report describes a man living in a “delusional universe” — a paranoid schizophrenic who’s lost touch with reality.

They’re insisting on it to the public because they’ve already accepted it, because that’s how it works.

Which brings me to the other missing piece: in Norway, simply having a severe psychotic disease– that fact– reduces criminal responsibility.  At times the media will misinterpret this as “psychosis at the time of the crime”– closer to the American standard– but a more accurate wording would be “has a psychotic disease at the time of the crime.”  What matters isn’t how symptomatic he appeared to be at the time of the crime, but the severity of the disease in general.

Put on your anti-existentialism caps, it is the North, after all.  If he’s a schizophrenic then his actions are the result of a life with schizophrenia.  Schizophrenia is a disease he has, but in a twist it also becomes who he is.

To reiterate: according to Norway, having an illness made this man who he is today regardless of how symptomatic he appeared at the time of the crime.  By this logic, the crimes followed inevitably from a worldview that existed  before the crimes were committed, and since that worldview is odd and came from the mind of a schizophrenic, he was insane.

Most laws accept some form of temporary insanity as a defense– “he’s not usually like this, this is an aberration”, but this is different: this is a longstanding insanity– “yes, he’s always been like that” that lead to some very planned, carefully executed non-psychotic behavior on the day of the murders.  Even the head of the Board was baffled.

Hence the confusion throughout the media about his insanity: it simply means something different than it does in the U.S., and certainly something different than it does in the vernacular.  This distinction has even confused famous American forensic psychiatrists like Paul Appelbaum, who incorrectly apply a rest-of-the-western-world insanity standard to Norway, which has a different standard.

Legal experts contacted by New Scientist say that the crucial distinction is between medical and legal definitions of insanity. To meet the legal definition of insanity in most countries, the defendant would have to be proven to be psychotic to the point where they could no longer distinguish between legal definitions of right and wrong, and no longer appreciate the nature of their actions at the time of the offence.

Just because you spell “offence” with a “c” doesn’t mean the standard applies to all of Europe.  This is wrong in Norway.  So while people are arguing about whether the psychiatrists made a mistake– “driving a car would be hard if he was psychotic” the actual source of the controversy is the principle that mentally ill people should not be punished.

III.

Breivik may be schizophrenic, I have no idea, the argument I am making is that it is irrelevant to Norway.  The issue here is that the moment someone is diagnosed with schizophrenia, everything he does is seen in that context.  In other words, if Breivik is indeed a true DSM-IV schizophrenic, then it is impossible to see his ideology and murders as separate from that.

So now try it in reverse; what does a guy have to do to be labeled psychotic?

Consider his manifesto. If there were no other signs and symptoms of schizophrenia except that manifesto and the murders, would that be enough to diagnose him with a thought disorder, a psychosis?   No, no, not what was written in it and I am aware he plagiarized a lot of it– the existence of it. Others have made the observation that this perhaps is a way of Norway pathologizing extreme right wing views, “anyone who believes in racial purity is crazy.” But it is a deeper, existential view of humanity: all ideology is  insane.  No rational person acts so… aggressively… from abstract principle, they act in response to concrete forces, under duress, out of interest, for something, against something– but never on some pre-existing, immutable worldview based on nothing. No. The presence of personal ideology is evidence (though not proof) of a broken brain.

Note that it is precisely this thinking that Breivik believed he was fighting against.

Here’s an example.  The media likes to make analogies to TV or movies to describe the “killers are evil” vs. “killers have a disease” sides of the debate.  This time, inevitably, it is to the zombies in The Walking Dead:

the walking dead

In AMC’s zombie series “The Walking Dead,” tensions build between an old-fashioned veterinarian farmer named Hershel Greene – who thinks zombies have a disease that may be cured someday – and a caravan of gun-packing refugees led by Deputy Rick Grimes. Because Hershel wants to protect the zombies he has hidden in his barn, he orders Rick and company to leave his property – even though leaving could make Rick, his family and friends easy pickings for the undead. It’s disturbing how self-congratulatory humanitarians can be willing to endanger the lives of others in order to maintain their worldview.

 

So old man Greene thinks zombies aren’t evil, but ill and in need of treatment.   Rick judges them more on what they do (kill people) and believes execution is the proper response.  Because of the setup of the analogy (Breivik is like the murderous zombies)  she wants us to side against the “self-congratulatory humanitarians.”

The problem with her analogy is that it uses the right TV show but the wrong characters, and thus leads to the wrong conclusions.  If you recall that the point of any zombie show is that the zombies are only a macguffin for the conflicts between characters and not nearly the existential threat they appear to be, then her analogy is wrong.  Breivik isn’t a zombie, Breivik is Hershel Greene.

Greene has an ideology (fundamentalist Christianity) that leads him to conclude that other people (Rick and his crew) are dangerous to others (zombies.) He puts actual people in actual risk for this belief.    No one had occasion to observe that he was able to kill humans before, but it turns out he is quite willing to do so if it is for something he believes in, even if that ideology happens to be crazy to everyone else.   He has no other symptoms of psychosis except the unshakable belief that zombies are people because God made them.

I am not stretching the analogy: under the most restrained psychiatric understanding, the moment Greene believed something that no one else believed, that was outside of the ordinary limits of his religion  and put others in danger, he was delusional.  If it helps: pretend Greene was keeping actual dead bodies in the barn in the hopes someday death would be cured; and he’d kill anyone who tried to stop him.

The problem is that Greene didn’t temporarily become delusional, this delusion existed for his entire life– it just never came up.  And if it had, say, in casual conversation, “hey, hypothetically, do you think zombies are people?” and he answered yes, nothing would have happened.

The problem that faces Norway isn’t whether Breivik was more symptomatic than Greene, but that even if he was less the conclusion would have inevitably been the same, because the premise– that strong ideology is an evidence of pathology– is itself a dangerous ideology.

Related posts:

  1. Crazy? In Love?
  2. A Refresher Course in Ideology
  3. They never get you on the crime, they get you on the cover-up
  4. No Law For The Wicked

13 Responses to Norwegian Psychiatry Is Insane

  1. JohnJ says:

    This is a good argument for why legal insanity should rest on biological factors. Letting the government (which is the capacity in which those psychiatrists were acting) decide what beliefs constitute insanity is, as well, “itself a dangerous ideology.” Literally any beliefs that the government doesn’t like will become de facto proof of insanity, and they’ll start locking people up before they can do any real harm.

    • claudius says:

      No need to worry about that. 93 senators want to lock you up with no proof of anything at all. Unless you count 7 days worth of food, missing fingers, or having a gun as what constitutes a “terrorist.”

      The road to serfdom begins…

  2. Madison says:

    If it helps: pretend Greene was keeping actual dead bodies in the barn in the hopes someday death would be cured; and he’d kill anyone who tried to stop him.
    And if he kills someone, that someone as a dead person would immediately become a part of the Barn People, the group Greene is so obssesively protective of.

    Any risk of cognitive dissonance avoided!

  3. sunshinefiasco says:

    Let’s not forget, the Norwegians have an implicit interest in labeling him as psychotic and dismissing his actions as consequences of his psychosis. If he’s a paranoid, violent, loon, then it means everyone can go back to assuming that Norway is a racially tolerant, liberal paradise, which is what they want to do anyway. If he’s a paranoid loon whose actions are a product of psychosis and some issues in Norwegian culture/society, then we have to have a dialogue about tolerance which is embarrassing and uncomfortable.

    If Norwegian society is quite similar to Swedish society, then from what I’m told, there are all kinds of racial issues that are being swept under the rug.

  4. Guy Fox says:

    the premise– that strong ideology is an evidence of pathology– is itself a dangerous ideology.

    Funny parallel from ‘international law': much of international law is customary, which just means that what States habitually do and feel obligated to do counts as law. But there is, of course, no international legislature, which raises the problem (among several others) of how to change a customary law you don’t like. You can’t submit a petition anywhere, and the only way for your peers to vote on your ‘proposal’ is to emulate or condemn your behaviour. So the only way to change customary law is to become an outlaw and hope you’ll develop a following. The process, if a little absurd, is easy enough to understand, but here’s where it gets tricky: how do you tell from the outside whether someone is an outlaw or a legislator? (perhaps the two Federalists above can help) And of course this matters: engaging in legislative/legal discourse is a legitimate activity anywhere that isn’t under pure tyranny, but willfully breaking the law anywhere is criminal – by definition.

    If the analogy isn’t clear, reapply it in the Norwegian context: if sanity is defined as conformity with the majority’s ideology, how can anyone contest that ideology without being automatically and analytically zapped beyond the pale of reason and admissible discourse. Either you’re one of us, or you’re just babbling crazy talk, you insane crazy-person.

    So, Iran/Israel (take your pick)=Breivik? Condemned as Rebels with a Cause? Law makers, Law breakers, or Criminally Insane?

  5. sigjung says:

    I tend to agree with you.

    Some details about the case:

    Breivik has (so far) been declared insane by two psychiatrists, who have based their conclusion on interviews with him in prison for 36 hours in all. Contrary to common practice, the psychiatrists conducted the interviews together (their reason for this was the extraordinary “intellectual and emotional strain” the case presented). They also studied his various writings and gathered information from family members.

    The validity of the rapport will now be evaluated by a board of forensic psychiatrists, headed by Tarjei Rygnestad. In all but very few cases such rapports are approved by the board. So, in all likelihood the conclusion will be that Breivik is insane and cannot be punished.

    Many Norwegians were taken by surprise by this, and there is an ongoing debate in the media. One of the biggest issues is whether or not the conclusion of the rapport is valid. Several Norwegian and Swedish psychiatrists have questioned the validity of the diagnosis. The rapport has been leaked to the press. Some observations from the rapport:

    Breivik denies auditory or visual hallucinations, does not seem to have ever suffered from affective illness, and has never been treated for psychiatric illness. During the interviews he was present and clear. Use of flat, emotionless language, reference to perecentages. Emotionally withdrawn. Slight psychomotor retardation. Expresses no regret or sense of guilt. Says he did the killings because of his love for the Norwegian people.

    The psychiatrists interpret several things as delusions:

    Paranoid delusions: His use of therms such as civil war, military order, operation. His belief that there is an ongoing civil war in the country is interpreted by the psychiatrists as a

    Grandiose delusion: His descriptions with regards to his own position: unique, love for his people, pioner, new regent, responsibility. His belief that he is the ideological leader of the organization «Knights Templar», which is the military order, martyr organization, military court, judge, jury, and executioner. He thinks it is his responsibility to decide who should live and die in Norway. Thinks the Norwegian people should be DNA tested to find the person with DNA most similar to some ancient Norwegian kings, who can become the new regent. It’s a bit unclear from what the psychiatrist write if thinks he has a good chance of becoming regent himself. This is interpreted as a bizarr, grandiose delusions.

    Use of words such as: national Darwinist, suicidal humanism, night justice, night justice commander are interpreted as neologisms and thus a sign of psychosis.

    *

    Several of the psychiatrist’s interpretations are questionable — their interpretation of neologisms in particular, but also what they term delusions, which can be seen as extreme ideology. One element I found particularly strange was an instance they used as an examle ofa paranoid delusion: While building his bomb, Breivik observed a police patrol nearby his farm. This led him to suspect they were on to him. He also inspected his house for surveillance cameras and once suspected a car with a lot of antennas for being a police surveillance car. For the everyman this might be a bit paranoid — but not when you are a terrorist building a huge bomb on your farm. The obnoxious idiocy of the psychiatrists’ interpretation here is mind blowing.

  6. Edwin says:

    The maximum sentence for murder in Norway is 21 years. But Breivik can be kept away from the public forever with a psychiatric diagnosis. Given that he is a mass murderer, diagnosing him with a psychosis seems rational if that is the only way to keep him away from the public.

    • sigjung says:

      With a psychiatric diagnosis he could also, in theory, become well and be released from hospital out on the streets in three years…

    • Torgest says:

      Bingo, Edwin. The Occam’s-razor explanation is that the diagnosis is pragmatic, not medical. The maximum sentence under the law is 21. That is clearly inadequate. Norway is not the kind of place where you can retroactively change the laws to fit a particular crime, so the only available solution is to declare him legally insane.

      Is that a troubling use of psychiatry? Yes. Does it indicate that Norwegian psychiatrists are insane? No. Bear in mind that this is an extreme edge case, without precedent in Norway. The country’s response to it doesn’t necessarily say much at all about its regular legal or psychiatric practices — it’s an ad-hoc, improvised response to an abnormal situation.

      Bear in mind also that, provided he isn’t actually at some point declared “rehabilitated” and let out, there’s little actual difference between the psych ward and a Norwegian prison. It’s not as if he’d somehow suffer more in jail than at the fruit farm. In fact, in terms of narcissistic injury, what could be worse for this guy than not to be rewarded with martyrdom but to have his grandiose fantasies dismissed as delusions and the entire identity he spent so many years constructing declared, in a word, nuts?

      • Guy Fox says:

        The country’s response to it doesn’t necessarily say much at all about its regular legal or psychiatric practices — it’s an ad-hoc, improvised response to an abnormal situation.

        Agreed, but how do you prevent it from becoming a slippery slope? Sure, cases arise that past legislators hadn’t even considered when writing the laws, and these cases might require standing law to be applied ‘creatively’. But who decides when the rules can be bent and on what principles? Unless that’s clear, convenience will often be mistaken for necessity, and you wind up with Russia.

        Of course law should and does have the function to preserve some social order by constraining individuals, but it also should (and does?) have the function of preserving freedom by constraining the state. If the state starts giving itself the right to improvise, watch out.

    • Comus says:

      From a scandinavian perspective I agree with this. It is blatantly using psychiatry as a utilitarian tool. Which, as Foucault has posited is one of it’s main functions. Breivik would after all be a first timer, which usually means only having to be in for half a sentence. Also just stating his acts being against the law, would leave the door for ideological martyrdom more open and copycats more probable, than when declaring insanity. He is after all working against the system, so if the system legally punishes him, it does not nullify him quite enough than the taboo of insanity. There’s something fishy going on though, I’ve never seen someone that functional (in the most raw sense) score 2 on GAF, which assesses global functioning. This is usually a indication for a severe nonfunctional state. Maybe it is post-trauma, but still.

  7. sigjung says:

    No, man, this is not using psychiatry as a utilitarian tool. Norway is one of the countries in the world with the most offenders being found insane and not punished. It’s an established practice in the Norwegian system, not something new.

    @Torgest: Just a couple of days after the psychiatrists’s finding Breivik declared to his lawyer that this “could be beneficial for his cause”. Well, that’s just his rationalization of the benefits it will gain him. Even in Norway the psychiatric ward is better than the prison.

Leave a Reply