The inability of psychiatrists to agree on how to define categories of mental disorder has long been a subject of public concern, especially as a greater percentage of the population ends up diagnosed in one way or another. Current estimates are that one quarter of those in the U.S. will manifest symptoms sufficient to receive a diagnosis of mental illness during their lifetimes.
Yet the criteria for deciding whether a given behavior is or is not the result of a disorder remain unclear. Consider the case of Anders Behring Breivik, the man who proudly admits to murdering 77 of his fellow Norwegians last summer, and whose trial is currently taking place in Oslo. Mr. Breivik has been assessed by two separate teams of psychiatrists, who cannot agree on the basic question of whether he is sane or not. In current diagnostic systems, committing mass murder is not in and of itself evidence of mental illness.
Murderers are seen by psychiatrists either as delusional or as having antisocial personalities. Terrorists, in contrast, are treated as political actors rather than psychiatric patients. But surely some kinds of killing are the result of psychopathology, even if others aren't; the question is how to tell one type from the other. Since the killer's intentions and state of mind are key to interpreting his actions, Mr. Breivik's case is attracting special interest, because he gave himself up to authorities after the massacre (unlike many others, who die at the scene), and he has chosen to participate actively in his own defense.
The facts of what happened are not at issue. The 33-year-old Breivik, a white Norwegian, planted a bomb outside government offices in Oslo last July that killed eight people, and he then shot 69 teenagers at close range while they were attending a summer camp for political activists on a nearby island.
He says that he acted to prevent a Muslim takeover of Europe, and that advocates of multiculturalism like the young people he gunned down have created a climate that fosters excessive Muslim influence. He links his efforts to those of right-wing nationalist parties in the UK and The Netherlands, and has angrily claimed that it is only because of racism that his mental health is even being questioned. "If I were a bearded jihadist, no one would have asked for a psychiatric examination," he declared to prosecutors at the start of his trial.
The line between intentional political violence -- however despicable its ideology -- and mental disorder remains vague and subject to multiple interpretations. And psychiatrists seem strangely silent on this issue, choosing to focus their debates on the criteria for mental illnesses they can treat with medication or other interventions. Still, Mr. Breivik's case raises useful questions. Are people like him insane or extremists? What's the difference, and how do we make sense of their actions? Is it acting alone that makes a person seem more suspect?
Anders Breivik claims to be part of a broader network called the Knights Templar, but police have not located any other members. If they did, would his actions appear less pathological? Would he then be seen as part of an organization rather than a madman? Is he more like Timothy McVeigh or Charles Manson, and how can we go about deciding this?
The decision is an important one for all of us as citizens, and perhaps shouldn't be left only to psychiatrists in the first place. We all have a stake in understanding what motivates the disturbing acts of violence that increasingly unfold on the world stage.
One thing is certain: Since psychiatrists cannot agree on how to categorize Anders Breivik's state of mind, either now or last summer when he committed his crimes, this case is likely to generate continued controversy regardless of how the trial ends.