On July 22, 2011, Anders Breivik killed 77 people in a series of attacks in Norway. He first detonated a car bomb outside the Prime Ministers office killing 8 people and then shot dead 69 people on Utøya Island.

Professor Simon Wessely, a UK psychiatrist at the Institute of Psychiatry at London’s King’s, examines Breivik’s case in this week’s edition of The Lancet, concluding widespread misconception still remains that outrageous crimes are associated with mental illness.

In September 2011, the Norwegian Government asked Wessely to join an International Advisory Council to examine the medical and psychological response to the July 22, 2011 events.

Professor Wessely explains:

“When people struggle to comprehend what lies behind the mass murder of adolescents gathered for a weekend of discussions and campfires, the simplest response is that the killer ‘must be mad’.

The inexplicable can only be explained as an act of insanity, which by definition cannot be rationally explained. The act was so monstrous, the consequences so grievous, that the perpetrator had to be insane.

Yet whilst I was in Olso, the country was preparing to learn the results of Breivik’s psychiatric examinations and all those who we spoke to were insistent that he should not be regarded as mad. And when, to everyone’s surprise including my own, the psychiatrists did indeed state that Breivik was suffering from schizophrenia, there was an outcry.”

According to Professor Wessely, there are two popular misconceptions in the Breivik case:

  • The purpose of psychiatry is help people avoid punishment
  • Outrageous crimes must mean mental illness

Wessley said:

“For schizophrenia to explain Breivik’s actions, they would have to be the result of delusions…The meticulous way in which he planned his attacks does not speak to the disorganization of schizophrenia. My colleagues in forensic psychiatry struggle to think of anyone who has had the foresight to bring along a sign stating ‘sewer cleaning in progress’ to avoid drawing attention to the smell of sulphur from the homemade explosives in the back of his vehicle.”

He continues:

“In the UK, however, if you commit a murder and want to spend as little time in detention as you can, putting forward a mental illness defense may mean that you will spend more – not fewer – years behind bars.

And the forensic psychiatry system is not a soft or popular option either. Most offenders have the same prejudices towards mental illness as the general population, and would rather take their chances in prison that be what they call ‘nutted off’.

Similarly, it is a commonplace observation among British forensic psychiatrists that those who have experienced both prison and hospital often prefer the former because ‘at least they don’t try to do your head in’.

The widespread anger when it seemed that Breivik was going to be sent to hospital rather than prison reminds us that liberal attitudes to mental illness are still often only skin deep.”

Written By Grace Rattue