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The case of Anders Breivik

Outrageous crimes do not always mean mental illness

In a Comment in this week’s edition of The Lancet, Professor Simon Wessely from the Institute of Psychiatry, King’s College London, takes a critical look at the case of Anders Breivik. He concludes, among other things, that there is still the widespread misconception that outrageous crimes mean mental illness. 

In September 2011, Professor Wessely was asked by the Norwegian Government to join an International Advisory Council tasked with reviewing the emergency response, both medical and psychosocial, to the dreadful events of July 22, 2011.

Professor Wessely says: '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 Oslo, 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.'

Professor Wessely believes the Breivik case highlights two popular misconceptions. First, that outrageous crimes must mean mental illness. The second misconception is that the purpose of psychiatry is to ‘get people off’. 

Regarding the first misconception, Professor Wessely says: '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 disorganisation 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.'

And on the perception that psychiatry helps people avoid punishment, Professor Wessely says: 'In the UK, however, if you commit murder and want to spend as little time in detention as you can, putting forward a mental illness defence 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 than 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.'

For more information, please contact Seil Collins, Press Officer, Institute of Psychiatry, email: or tel: 0207 848 5377

The Comment article is available from The Lancet website