We too often blame acts of terrorism on mental illnesses
The better we treat potential lone terrorists for depression, the safer we are likely to be
Members of the Czech quick reaction forces take part in an anti-terrorism drill. According to a 2014 study, people with poor self-reported health were less likely to show sympathies for terrorism. Photograph: David W Cerny
With the recent wave of terrorist attacks in Europe has come a worrying trend. Many of the perpetrators, especially the lone ones, had a reported history of mental illness. Is there evidence for a link between terrorist acts and psychological illness? And if so, what can we do about it?
An editorial published last week by the British Medical Journal says that an “automatic assumption” to link terrorist acts with mental illness unfairly stigmatises the millions of people with mental health problems and impedes prevention efforts.
Prof Kamaldeep Bhui and colleagues call for careful media reporting of terrorist events, similar to the reporting of suicides, to reduce copycat episodes. Reviewing the literature, the psychiatrists note that terrorist groups and networks seem to avoid recruiting people with mental health problems, “probably because they share some of the same stigmatised views as the rest of society and see people with mental health conditions as unreliable, difficult to train, and a security threat”.
However, when it comes to “lone actor” terrorism, mental illnesses are more common. No single diagnosis is associated with this form of terrorism; reported diagnoses include antisocial and narcissistic personality disorders, schizophrenia, delusional disorder, and autism spectrum disorder.
A 2014 study of some 600 people of south Asian ethnic origin and Muslim heritage living in Bradford and East London, found that 4 per cent showed some sympathy for violent protest and terrorist acts. Sympathy was more likely to be articulated by the under 20s, those in full-time education rather than employment, those born in the UK, and those speaking English at home.
People with poor self-reported health were less likely to show sympathies for violent protest and terrorism. In particular people who had symptoms of anxiety and depression, and those who had experienced adverse life events, were no more likely than others to voice sympathy for terrorism.
In a separate analysis of the same data, however, the authors found that symptoms of depression were more common among those showing the most sympathy towards violent protest and terrorism.
“These cognitive biases may be seen as adaptive if they reflect social and economic injustices . . . or these may reflect depressive illness if there is not a history of such adversity,” they say. They come down firmly on the side of depressive symptoms that are independent of psychosocial adversity having an association with sympathies towards terrorism.
But we know from the science of predicting extremely rare events – for example, suicide and homicide – that precision is impossible to achieve. We must rely on the art of good clinical practice supported by research evidence.
My concern is that we reflexly invoke “terrorism” as the cause of most sudden and unprovoked acts of individual or group violence, while simultaneously assuming mental illnesses as the explanation behind such complex behaviours.
To date the media have been restrained in its reportage of this area. But I agree with Simon Wessely, professor of psychiatry at King’s College London, when he says that we should draft sensible and voluntary guidelines for media reporting of terrorist events.
Similar to those developed for the reporting of suicide, these should include guidance on not glamorising events or the perpetrator, and not focusing on methods or details, in order to avoid copycat incidents.
Wessely argues that the single best thing we can do is to make it easier for people to be referred to psychiatric services while improving the treatment that they get. “That will improve mental health – and may also reduce risk to the public of these extremist acts,” he says.
Counterterrorism measures must engage fully with mental health professionals while acknowledging that their prime role is not to detect extremism. Doctors and others can contribute best by focusing most on helping those with mental health challenges.
The better we treat potential lone terrorists for depression and other disorders, the safer we are likely to be.