Dueling diagnoses roil trial of Norway killer Breivik

Much hangs on whether Anders Breivik, who confessed to killing 77 people last summer, is ruled to be sane or insane. Psychiatrists who found him insane defended their view in Norway court today.

The Norwegian psychiatrists behind the much-debated report deeming Anders Behring Breivik insane defended their diagnosis in court today, despite mounting evidence that the self-confessed killer was possibly sane and hence criminally punishable for claiming 77 lives last July.

Torgeir Huseby, one of the two psychiatrists behind the forensic report released in November that found Breivik to be paranoid schizophrenic, testified in court that they intentionally did not delve into Breivik’s political beliefs during their psychiatric evaluation.

The self-described militant nationalist claims the policies of the Norwegian Labor party forced him to bomb government buildings in Oslo and go on a shooting spree at a Labor party youth camp. He says the party’s lax immigration policies and promotion of multiculturalism have allowed Muslim "colonization" of Europe and threaten Norwegian society.

“We are psychiatrists, not historians,” said Mr. Huseby. “The main rule regarding a delusion is not the setting … but the role [in which] one sees oneself in that picture. When we have a new Jesus, we don’t call in religious experts...”

“It has been the egocentric bias in [Breivik's political] compendium which has been of interest, both his own appointed role July 22 [in the 2011 attacks] and his future importance for Europe and the world,” he added.

Huseby and report co-author Synne Sørheim have come under increasing fire after a second forensic psychiatric report in April concluded Breivik was not psychotic when he placed a car bomb outside government buildings and later shot teenagers at the summer political camp on Utøya island. In particular, they have been criticized for writing off Breivik’s extreme political ideology as paranoid rants.

“One ought to have talked to the person one has diagnosed, as [Ulrik Fredrik] Malt has pointed out,” Huseby said in his opening statement today, in a direct poke at one of his critics.

Mr. Malt, an independent psychiatric expert on behalf of the legal counsel for the victims, testified last week that in his “academic opinion,” Breivik possibly had Asperberger or Tourette syndrome, but not signs of psychosis, after having observed Breivik in court and read the forensic psychiatric reports.

Attacks on the first report

Malt was one of a slew of psychiatric experts in court over the past two weeks – many of whom observed Breivik at Ila prison – who have attacked the conclusion from the first report. Psychiatrist Randi Rosenqvist, senior adviser at Ila prison and former head of the Forensic Board of Medicine, testified in Oslo court on Tuesday that she found no signs of psychosis after meeting with Breivik three times in November, December, and March. She also highlighted that the gruesomeness of his actions was not of itself a sign of psychosis.

“Naturally, I am shocked that a young man from [the upper middle-class neighborhood] Oslo West could do something like that, but I cannot use it as the decisive factor in a diagnosis,” Ms. Rosenqvist told Geir Lippestad, Breivik’s defense attorney, in court.

The first report deeming Breivik insane was also the subject of much scrutiny earlier this week, when the Board of Forensic Medicine was forced to answer numerous questions regarding how it was possible to have two highly differing psychiatric conclusions. The board has been criticized by the court for being unclear about what it meant when it said if found “significant deficiencies” in the second report, causing many – including Breivik’s defense – to conclude that the board was leaning in favor of the first report deeming him insane.

Karl Heinrik Melle, leader of the board’s psychiatry commission, apologized in court yesterday for the vagueness in its opinion. Mr. Melle told Inga Bejer Engh, Oslo public prosecutor, that in hindsight, it should have written in the supplementary statement to the second report that it was still in disagreement over whether Breivik fulfilled the criteria for personality disorders, as the second report found. Melle also revealed there was some internal disagreement over the first report.

Ruling could go either way

Despite the mounting evidence this week in favor of Breivik’s sanity, the final ruling could still go either way. The opinion of the forensic board is key in helping determine his sanity, but the five judges in this case do not have to follow it. Another problem is that if there is reasonable doubt over his sanity, the judges can chose the alternative that is best for the accused – in this case, that he is insane – because prison is considered a worse alternative.

The prosecution is seeking to have Breivik remanded into compulsory mental health care based on the first report, which was the only one available at the time. The prosecution team will consider next week whether to adjust the indictment from a recommendation of compulsory mental healthcare to a criminal punishment of a maximum of 21 years on terror charges and premeditated murder.

A final decision on Breivik’s sanity will be taken by the five judges, which will announce the ruling either on July 20 or August 24.