Saturday, December 4

Sanity is barely black and white

  • By R. Anthi
    By R. Anthi


Can both expert reports in their own way give a true picture of Breivik’s state of mind? Per R. Anthi asks. The image is from courtroom 250 in the Oslo courthouse, where much of the July 22 trial against the terrorist took place.

Psychiatric diagnoses are not as objectively based as an inflammation of the appendix.

This is a discussion post. Opinions in the text are the responsibility of the writer.

Psychiatry professor Tor K. Larsen raises a number of important questions in a discussion post in Aftenposten on July 28. Was Breivik sane or not?

But what do we really mean when someone is considered sane? And is it the case that a person suffering from a psychotic disorder should be implicitly considered insane?

Like Larsen, I have also been an expert in a Supreme Court case in which there was disagreement about whether a person was psychotic or not. For many years I was a clinical psychologist in various departments at Gaustad Hospital. From experience I know how difficult it can be to give a clear idea of ​​whether a person is psychotic or not.

Psychiatric diagnoses are not based as objectively as, for example, an inflammation of the appendix.

False opposite

In Aftenposten, on July 24, 2011, a psychiatrist at Haukeland Hospital claimed that Breivik was not crazy. The argument was that “he must have planned the attacks for a long time. He must have looked credible when he tricked Utøya with a boat, and later when he went looking for a savior and lured the terrified AUF-ers.” such reasoning.

Insanity is not necessarily something that can be concluded on the basis of external behavior. I also agree with Larsen that some people with severe mental illness can be drawn to extreme ideologies. There is not necessarily a contradiction between ideology and psychosis, of which one can get the impression when discussing these issues.

An example that there is no such contradiction is Rudolf Hess, Hitler’s deputy commander and one of his main ideologues. In May 1941, Hess left Germany in a fighter plane and crashed in Scotland. Apparently the intention was to enter into peace negotiations with the British.

Hess was considered psychotic and therefore did not hang up like the other key war criminals. Instead, he had to spend all his days in Spandau Prison in Berlin.

Anyone or?

The most common symptom of psychosis is not, as many believe, delusions (64 percent) or hallucinations (74 percent). It is rather mental withdrawal and a lack of self-understanding and insight (97 percent), according to English psychiatrist Richard Lucas in the book. The psychotic wavelength (2009).

This lack of perception is expressed by denying and rationalizing any signs of psychotic processes. If we are not aware of such defense mechanisms, we are in danger of overlooking an underlying psychotic disorder.

Psychotic patients are very different. Everyone has their unique personality. Some have neurotic traits, others a non-psychotic part separate from the psychotic. Others may have severe personality disorders in parallel with psychotic symptoms.

I think the discussion about Breivik’s mental state has been characterized by one attitude or another: psychotic or personality disorder. This is clearly illustrated by the two psychiatric reports That came before the verdict.

Can both expert reports in their own way give a true picture of Breivik’s state of mind? What conclusion, then, should be drawn regarding the question of sanity?

Too bad the conditions in psychiatry

We still know very little about mental illness. We have a lot left in how we organize psychiatric health services, as Larsen also suggests.

We need better conditions for those who work in psychiatry, and it is an important social project to catch young people who are struggling mentally. Otherwise, they can, in the worst case, develop psychotic disorders.

Current conditions are characterized by detailed and standardized procedures, reorganizations and reduction of hospital beds. It does not improve the offer for people with serious mental illnesses.

Research indicates that it is very difficult to develop new and better drugs, according to Dr. Svein Haugsgjerd in To face the mental pain (2018). Instead, we should train more skilled healthcare workers and establish professional environments in which new knowledge and skills can be created, so that their difficult work becomes more interesting and rewarding. It is a big problem that there are so few doctors who want to specialize in psychiatry.

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