The Mind of a Madman: Norway's Struggle to Understand Anders Breivik. By Richard Orange. Kindle Single, $1.99.
Review by Maia Szalavitz
Following Aurora and Sandy Hook— and the concerns that have not surprisingly arisen over the questions of violence, guns and mental illness— I was eager to read journalist Richard Orange’s Mind of a Madman: Norway’s Struggle to Understand Anders Breivik .
The book ably and lucidly details the story of the trial of the man who carried out the world’s deadliest mass shooting by a single individual. It’s full of twists and turns, with Orange expertly doling out the suspense as to whether the killer will ultimately be declared sane or not. But it lacks the context and analysis I’d hoped to find in an account of an event in which psychiatry faces off against what can only be called evil.
Orange, a foreign correspondent for the UK’s Daily Telegraph, covered Breivik’s trial after the Norwegian right wing ideologue killed 8 people in bomb attacks on government buildings in Oslo, then gunned down 69 people, mostly teens, who were attending a political youth camp in July 2011.
Breivik claimed he committed the attacks to “save” Norway from Islam, multiculturalism, “cultural Marxism” and feminism. Initially, a psychiatric report by two of the country’s leading experts claimed that he had paranoid schizophrenia.
Their evidence for this diagnosis was his apparently false claims about being connected to a larger terrorist network, his self-bestowed medals and handmade military “uniform” and his belief that he had the right to kill for his ideas. These were seen as “delusions,” which occurred after a period of social withdrawal before the attacks and his rants were said to contain “neologisms” or made-up words, additional evidence of disordered thinking.
According to the initial report, these factors were apparently enough to qualify Breivik for a diagnosis of schizophrenia under the ICD 10, which is the international medical diagnostic manual and is similar in its psychiatric classifications to the DSM.
“His political world exists just to have a world to be psychotic in,” one of authors of the report testified.
But after the report was leaked, experts on the far right argued that Breivik’s “neologisms” were actually common terms used by others with similar views, making the diagnosis controversial. The ICD criteria apparently require that schizophrenic beliefs be “culturally inappropriate,” and the fact that the other far right groups he saw as his peers had similar views called that into question.
Breivik was surprisingly insightful about this paradox: “What I think is that [they] could not believe that a normal person could do such a thing. A person who does something so terrible cannot be normal. He must be sick.”
After widespread outrage, a second report was ordered. This time, a new group of professionals determined that Breivik had not been psychotic while carrying out the attacks. The second report accepted that his ideology and resulting actions, while clearly despicable, were not in and of themselves evidence of psychosis.
But there was still disagreement among the experts who testified as to what Breivik’s diagnosis— and everyone agreed that there should be one— actually was. Breivik had been diagnosed with an autism spectrum disorder as a child because of his “pedantic” ways and obsessive compulsive behavior, so one psychiatrist suggested that this led to his “lack of empathy.”
However, a psychologist disagreed with the accuracy of that diagnosis, testifying that during an evaluation, Breivik was “polite and friendly and seemed empathetic.” One of Brievik’s childhood friends had called him “one of the most sociable people” that he knew.
Other psychiatrists argued that Brievik’s real problem was a personality disorder— either narcissistic personality disorder or antisocial personality disorder, probably well into psychopathy— or some toxic combination of the two, along with his racist ideology.
Mind of a Madman, however, does not provide readers enough context to draw conclusions about Breivik's true state of mind. It does not include the ICD diagnostic criteria or give any background information about conditions like personality disorders, schizophrenia and Asperger’s. As a result, it’s very difficult to weigh the battling reports and conflicting testimony. The book doesn’t mention that autism spectrum disorders are not linked with violence, nor does it explore the controversy over the link between schizophrenia and violence. It also fails to examine the question of empathy itself. This quality is critical to several of the diagnoses and seems to have been misunderstood by some of those who testified, incorrectly claiming that autistic people always lack empathy.
While this probably reflects a newspaper journalist’s attempt to be “objective” and simply detail the (most certainly compelling) story of the trial, it left me frustrated. Underneath this story is a tale of the ongoing problems with our current system of psychiatric diagnosis and the lack of objective measures available to characterize mental illness. There’s also a story about why some diagnoses— like schizophrenia— are seen as mitigating, while others— like personality disorders— are seen as aggravating. And of what brain science suggests about moral responsibility.
Moreover, there’s also an untold story of a country which is not bent on vengeance even after such an unimaginable crime, a country that would have accepted either an insanity verdict or the one that came down, which found Breivik morally responsible and sentenced him to 21 years, a sentence that can and likely will be extended if he is still found dangerous at that time.
Of course, a short ebook may not be the place for such depth, but some basic facts about diagnosis and the controversies it evokes would have been extremely useful. There’s certainly room for greater exploration of the Breivik case in light of these distressingly frequent events— and especially for an examination of the role of culture, psychiatric ideas and varying legal systems so that we can become better at preventing or dealing with them.
Maia Szalavitz is a neuroscience journalist for TIME.com and the author of five books, most recently Born for Love: Why Empathy is Essential—and Endangered, with Bruce Perry, M.D. Ph.D.