Prof Philip Morris
Bond University
Australian and New Zealand Mental Health Association
Responding to Nationwide
Psychological Trauma
Norway’s Trauma
Anders Behring Breivik
Anders Behring Breivik
Norway’s mass killer
July 2011
69 people murdered at gunpoint on the island and 8
people murdered in a city bombing in Oslo
Trial just started
He has confessed to the killings
Not guilty plea as “acting is self defence”
He defends his actions as “cruel but necessary” against
“state traitors” for opening up Norway to a “Muslim
invasion” and multiculturalism
Saluted in a raised arm and clenched fist
Said he does not recognise the court’s legitimacy
Court Decision
As there is little doubt he carried out the carnage,
the court’s decision is about whether he is sane
and accountable for his actions
Psychiatric spectrum
Psychotic – drug intoxication – unusual personality
(paranoid/schizoid/schizotypal/eccentric) –
antisocial/narcissistic psychopath – or just plain
Most psychiatric patients are anxious, withdrawn, shy and
Hardly likely to engage in threatening behavior
But, the combination of psychosis, substance abuse and
antisocial personality make-up can be associated with
violent actions
Psychiatric opinion in Norway is divided
For the record my opinion about Breivik is that he has
schizotypal/paranoid personality traits embedded in an
antisocial psychopathic personality
The court will have to make up its mind
77 deaths and a large number of other ‘survivors’
in population of five million
Many adolescents and young adults
All have families, school and college friends, and
A significant proportion of the entire population
likely to be affected either directly, indirectly or
The nation and individuals feel –
fear, anger, sadness, survivor guilt
And will ask “why?” – a question not easily
Followed by realization of loss with associated
feelings of posttraumatic stress and intense grief
National trauma response
Reassurance and comfort from authority figures
Initial help to provide ‘basics’ – safety, water, food,
shelter, medical care
Connect affected individuals to ‘natural’ supports –
family, friends, church, community services
Make a register of identity and contact details of all
survivors and bereaved families so all can be
monitored over time
Provide information to affected individuals on
what to expect, what are ‘normal’ and other
reactions to the devastating circumstances, and
when and how to get help
Provide information to the public on what to
expect about individual and community responses
to the disaster, and how to be of assistance to
people more directly affected
Arrange national observance services and
ceremonies to recognize the losses and the
survivors experiences and needs
For all individuals and the nation life will never be the
For most affected the intense distress will fade and
recovery will gradually build – the value of resilience
Unfortunately a small proportion of survivors and
bereaved will remain emotionally unwell
A regular follow-up program for those registered
initially is essential to identify and provide early
medical and psychological assistance – that may need
to be ongoing
Suicide The ‘silent’ nationwide psychological trauma
In Australia more suicides than road deaths annually – 2400
deaths from suicide
Yet no national ‘suicide toll’
Journalist reporting guidelines have muzzled public debate
about suicide
Suicide is not a personal event – there are many survivors
and others affected and bereaved by suicide
Suicide is a multi-determined behavior
But psychiatric illness and the quality of psychiatric
services must play a part
In Queensland (2007) more than half (86) of 140
unexpected deaths in Q Health patients were
psychiatric cases – nearly all from suicide within a
week of not being admitted or within a week of being
discharged from hospital
In Victoria (2005) 42 deaths by suicide in young adults
were linked to inadequate psychiatric treatment
Publish mortality data from individuals under care of
public and private mental health services
Suicide deaths
Fatal single driver road death ‘accidents’
Unexpected deaths
Police shootings
A standing audit or commission of inquiry into all
suicide deaths
Independent of health department and executive
Review hospital or community deaths
‘Pathway to death’ explored
Nature of contact with mental health services in
three month period prior to suicide
Monitor accessibility and quality of services
Comment on application of mental health acts
Make recommendations to parliament
Where is our nationwide response
to the psychological trauma of
A challenge for the future!
Thank You!

Prof Philip Morris MB BS BSc Med PhD FRANZCP