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.
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.
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:
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.