Terrorism and forensic psychiatry.

Media and news agencies often call psychiatrists and psychologists and pose questions about mental illness (a worthy topic) or some inane but catchy topic (such as the one I received from a reporter asking, with a straight face, “How do you diagnose people who talk to themselves?”). Big news about crimes, and especially terrorism, may push psychiatrist interviews from the local feature to the cover story. The favorite questions are iterations of “What makes people become terrorists?” and “What’s going on in the terrorist mind?” Some of our colleagues take this opportunity to launch into a serious discussion of perpetrators and personality types, talking about leaders and followers, psychopathy, dependence, and yearnings for absent mothers. That may charm some listeners, but it is almost always a mistake. First, there are many different kinds of terrorism and terror-violence (a term coined, or at least popularized in the field, by Professor M. Cherif Bassiouni of the Loyola School of Law, Chicago). The answers to the media questions, to the extent that anyone knows them, vary from type to type and from event to event. Second, although everyone has a personality, and personality is important in behavior, the idea that there are archetypal terrorist personalities or mental illnesses that predispose one to what most people call terrorism is largely a myth. People want terrorists to have particular psychological characteristics, so that we might be able to “figure them out” and eliminate, mitigate, or at least define the foe. But wishing doesn’t make it so. The real explanations are simpler than that, and the real solutions, unfortunately, more complex. The mental health professions, for the most part, should not be expected to have many answers to the vexing sociopolitical problem of transnational terrorism. Over two decades ago, the American Psychiatric Association (APA) developed a task force that worked with government agencies and produced a small volume on terrorism and its victims. The consensus of the task force and the various agencies and organizations with whom we worked was that, with some highly specialized exceptions in military, law enforcement, and diplomatic consultation, the roles for and expertise of the mental health professions lie primarily in victim care and sometimes, when mental illness is a factor, in perpetrator assessment or treatment. That view has been replicated many times, in both social study and practical application. My definition of terrorism, for purposes of this (albeit one-sided) discussion, is a pattern of sudden violent or fear-inducing action against civilians, not part of a national military action in a declared war between nations. My comments refer to terror-violence aimed at groups rather than individuals, although particular events may have one physical victim. To focus the topic, the definition omits hostagetaking during ordinary robberies and isolated incidents spawned by delusion or paranoia. It does not address wars, no matter how cruel, or states’ acts against their own citizens (which kill far more people than international and nonstate actions) or torture of state-held prisoners. “Revolutionary” acts organized against military targets within the revolutionary’s own country are excluded; I will try to avoid the conundrum of “one man’s terrorist is another man’s freedom fighter,” a commonly held view first expressed to me years ago by Professor J. K. Zawodny, an expert in transnational terrorism and former Polish freedom fighter. During the 1970s, Frederick Hacker, MD, gave a thoughtful psychiatrist’s view that terrorism could be divided into, as the title of his book suggested, Crusaders, Criminals, and Crazies. He saw most events Dr. Reid is Clinical Professor of Psychiatry, University of Texas Health Science Center, San Antonio, TX. Some of the material in this editorial was first published in Reid WH: Controlling political terrorism: practicality, not psychology, in The Psychology of Terrorism. Edited by Stout CE. Westport, CT: Greenwood Press, 2002, pp 1–8. Address correspondence to: William Reid, MD, P.O. Box 4015, Horsehead Bay, TX 78657. E-mail: [email protected]