27 August 2012

Plea of sanity?

The trial verdict and sentencing of Anders Breivik in Oslo recently was a matter of some interest to me, not because of the harrowing testimonies given by survivors, nor was I motivated by a desire to know that a racist, xenophobic, right-wing, Nazi sympathiser would be removed from pubic society, but because his behaviour raises questions about attitudes to mental health. The suspect’s guilt was never in question: he freely admitted the killings he had perpetrated. Indeed, in his final words addressed to the court Breivik expressed regret for not having killed more people. There was, however, uncertainty about the trial verdict regarding his state of mind. I guess that one of the first questions that will have been asked was whether Breivik was fit to stand trial, that is, whether he would be capable of following and understanding the legal proceedings. It must have been decided that he was indeed fit to stand trial, and from the way in which the trial was subsequently conducted there is no reason to consider this to have been a poor decision. As the trial progressed, the judges were then required to decide whether, at the time he carried out the killings, Breivik was in a state of mind in which he was able to take responsibility for his actions. Occasionally this has been expressed in more lurid terms: speaking of Breivik as a madman, and suggesting that he may be mad, with the difficult freight of meanings and nuances carried by those two terms. The BBC presented this more politely as a decision regarding his sanity: if considered to be sane then he would be criminally responsible for killing 77 people, for which he would be imprisoned; if considered to be insane then he would be incarcerated in a secure psychiatric ward and assessed for treatment. Perhaps ironically, according to the BBC news reports, the address of incarceration would be the same regardless of the verdict. During an interview, a spokesperson from the Norwegian penal service told the BBC that while in remand Breivik had not been permitted contact with other prisoners, for his own safety as well as theirs, and that this regime would continue. There is commentator observation that, regardless of the verdict, he would be incarcerated for the rest of his life. It seems clear, therefore, that, other than access to treatment, little will change in Breivik’s circumstances whether he is held to be sane or insane. According to BBC commentators an overwhelming majority of people in Norway wanted the judges to decide that Breivik should be considered sane. My understanding of this is that they wanted Breivik to be punished for his wicked actions. The same commentators reported that Breivik also wished to be considered sane, his reasoning being that he wished his actions to be seen as having been carried out for a reason instead of dismissed as the behaviour of a person unable to behave rationally. The verdict of the five judges was unanimous: they considered Breivik to be sane, and sentenced him to 21 years imprisonment. The situation appears a little more complex to me. I understand that the psychiatrists who assessed Breivik’s mental health did not arrive at a unanimous agreement about his sanity. It seems obvious to me that this is because there neither is, nor can there be, a binary distinction between sanity and insanity. The lay and legal concepts of sanity are a convenience, verbal and conceptual. The mental health of a person may be compromised as a result of illness or injury, or because of who they have become. In attempting to determine the sanity of a person whose mental health is compromised, it is arbitrary where the line of distinction between sanity and insanity is drawn. No doubt Norwegian psychiatrists and/or psychologists subjected Breivik to a battery of tests in order to help them place him one or other side of a line. The results of those tests, however, were interpreted differently by the several people who made the assessment. When a person has some kind of mental disorder, the medical model attempts to distinguish between illness, which is treatable, and personality disorder, which is not treatable. There is a huge medical classificatory system of mental illness and personality disorders. There is also a long history of people being diagnosed differently by different medical staff. Indeed, in a famous 1960s expose, a number of medical students were diagnosed with schizophrenia simply because they were in a psychiatric hospital to which they had admitted themselves in order to carry out research on diagnosis. Equally, failure to agree on a diagnosis does not equate to there being nothing wrong, merely an inability to ascribe, or to agree on, a classification. However, if no broad medical agreement could be reached about a diagnosis of illness or personality disorder then it would be difficult to hold Breivik to be be insane. My perspective differs from the medical model. It seems obvious to me that individually murdering scores of strangers is evidence enough that there is something seriously awry with Breivik, Empathy and compassion are important components of what it is to be fully and healthily human. The desire to kill anyone, including oneself, is unhealthy. There may be antecedent circumstances in which sense may be made of the desire to kill someone, but killing is never a healthy response. It seems from the reports that Breivik showed neither empathy nor compassion when killing people, nor did he subsequently show remorse. Breivik’s actions were far from healthy. Reading on-line a few paragraphs of Breivik’s own writing, Breivik showed that he feels no connection to people. He expressed no warmth. He stated clearly that he expected to be ‘misunderstood’ and vilified for his actions. This suggests a tension between a sense of being the persecuted outsider, and a sense of being set apart, of superiority, perhaps even mildly messianic. It seems equally obvious to me, therefore, that Breivik is in considerable need of therapeutic help: to learn to empathise, to learn to feel compassion, to learn to relate to people, and to learn about the ordinary miracle of being fully human. Perhaps he is incapable of learning these things, but instead of simply locking him up as a criminal, it might have been more imaginative and hopeful had he been offered long-term therapy. Whilst prison may not be the optimum environment in which to help someone such as Breivik, the way in which he carried out the killings, and the way he conducted himself during the trial, point to him remaining an on-going threat to the safety of others, from whom the public should reasonably expect to be protected. However, the public were always going to be protected whether Breivik was considered sane or insane. The desire to define him as a criminally-responsible has denied Breivik the opportunity to receive the help that could have contributed to him becoming a more socially-responsible person. I have written this posting with reference only to news reports, mostly on the radio. There is a useful and detailed Wikipedia page about Breivik at: http://en.wikipedia.org/wiki/Anders_breivik

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