IS THERE A ROLE FOR PSYCHIATRY IN DEEPENING UNDERSTANDING
OF THE “SUICIDE BOMBER”?
Donatella Marazziti
Dipartimento di Psichiatria, Neurobiologia, Farmacologia e Biotecnologie,
University of Pisa, Italy
Mailing address:
Donatella Marazziti, M.D.
Dipartimento di Psichiatria, Neurobiologia, Farmacologia e Biotecnologie,
University of Pisa,
Via Roma, 67
56100 Pisa, Italy
telephone: +39 050 835412
fax: +39 050 21581
e-mail address: dmarazzi@psico.med.unipi.it
Conflict of interest: none
Word count: 1371
No of references: 8
2
If it is true that Medicine a science deeply rooted in society, there can be little
doubt that Psychiatry especially is a discipline which is linked to and a reflection
of social urges, demands, problems and fears, since the individual may be
considered as the result of a constant interaction between the brain and its
environment (Andreasen, 1997). For this reason, when applied in the diagnosis,
treatment and, when successful, resolution of specific disturbances or disorders,
Psychiatry restores not only a deranged brain equilibrium, but, in addition, an
individual’s attitudes and behaviours and, consequently, the effects that single
individual may have upon society. It may equally be concluded that the particular
society by which an individual is surrounded, together with any conflicts which
may exist therein, can affect his or her functioning and induce mental disorders,
or act as triggering factor in those more vulnerable members of that society. It is
therefore important that Psychiatry be sufficiently flexible to take into account
constant inputs deriving from a rapidly changing world, which can affect or even
create hitherto unknown disorders. This will be the paramount challenge of
coming years and one which simply must be met successfully, since for the first
time since the end of the second world war, Western societies have to cope with
tragic occurrences which have significantly undermined their sense of safety,
their optimistic expectation of ever-increasing benefits from technological
advances and their overall trusting belief that a happy future lies ahead.
The attack on the twin towers of Sept. 2001 and the subsequent occurred in
Madrid and London demonstrated disastrously just how vulnerable to terrorism
any society has now become, and that distant wars or conflicts can no longer be
considered so far away as to be of no consequence.
Probably there will soon be (if there is not already) endemic throughout a large
part of the world a generalized sense of precariousness and awareness that a
suicide bomber can act everywhere easily. Augmenting this dreadful reality is
the fact that the mass media constantly show appalling images of prisoners,
executions, corpses and battles, with a clarity of cruel details and insistent
repetition – all in the name of ‘freedom of information’ – which can only result in
the profound disturbance of children and adults even while ensconced in their
distant and comfortable homes (Fremont et al., 2005). In this sense, the British
choice not to show images of the terroristic attacks to London public transports
is appreciable.
Therefore, nowadays Psychiatry must face two major needs, deriving from the
current atmosphere which now pervades the Western world. Firstly,
posttraumatic stress disorder (PTSD): it is undoubtedly an increasingly prevalent
pathology, especially amongst those personnel involved with combat operations
2
3
(Koren et al., 2005). However, PTSD is found nowadays even in the victims or
spectators of catastrophes, mainly under the form of sub-threshold symptoms,
so that it is sometimes difficult to assess a focused diagnosis and, consequently,
propose adeguate treatments. Unfortunately, the current diagnostic systems are
not set up in a way as to categorize isolated or atypical symptoms, such loss of
hope and awareness of an uncertain future for our children, fears related to
travel, or the faint alarm felt when meeting someone from a different culture,
which can be quite invalidating.
Besides PTSD, populations exposed to traumas may become susceptible at a
higher-than-average risk also of developing depression, substance abuse and/or
social adjustment disorders (Hoge et al., 2004), and, therefore, in definite need
of prompt psychiatric help.
Secondly, a more difficult task is the study of the suicide bomber’s
(psycho)pathology. Published literature on this topic is still practically notexistent (Krus and Ishigaki, 1992) and tends to exclude any appreciable element
of psychopathology (Atran, 2003). Our strongly held view is that this may well
not be appropriate: the problem of suicide bombing has so far been debated
largely from a socio-cultural, political and/or religious perspective and the
absence of any recurrent element of psychiatric disorder has generally been
assumed, given of course the impossibility of any qualified psychiatric
examination of the subject after the event. Although obviously there exist cultural
and religious causes for the this phenomenon, coupled often (although by no
means always) with conditions of poverty and abandonment, these factors do
not seem to be of crucial importance in determining such deviant behaviour: in
fact, suicide bombers do not seem to present any particular feature which
distinguishes them from other members of the society from which they come,
and share with them the same life opportunities (Atran, 2003). Even the broad
assumption up until now that they derive mainly from young, unmarried
members of the male sex has more recently been proven comprehensively false
by the behaviour of women, who have shown themselves equally capable of
suicidal violence, even to the point of deliberately taking children’s lives (as
recently demonstrated so dramatically with the schoolchildren of Beslam). As a
result, the increasing diffusion of the modern suicide bomber may be viewed as
an appalling new phenomenon, urgently requiring new methods of analysis
(Axel, 2002).
The aim of the suicide bomber is generally supposed to be that of creating a
widespread sense of alarm and thus influencing a large target audience, but
individual personalities and motivations remain oscure, although violent
behaviours are generally performed under conditions of group pressure and
charismatic leaders, or even from a sense of obligation in situations of authority
(Atran, 2003).
3
4
In psychiatric terms, a sense of revenge (or despair, or humiliation) which is
induced to a point of dominance where normal instincts for survival become
sublimated to a conviction that death will somehow be rewarding, could well be
judged to present elements of delusional intensity and paranoia. Alternatively,
suicide bombers might be affected by double personality disorder, or, more in
general, by complex personality disorders shaped by specific contexts, and
rendered common by peculiar historical and social events, or victimization from
violence (Atran, 2003). A common trait of suicide bombers seems to be, in fact,
experiences of familial or personal violence that may constitute the “core” events
acting as a psychopathology organizer.
If we are to succeed in identifying with any degree of reliability and depth these
motivations which are inducing people to kill both themselves and others, we
simply must overcome a natural sense of repugnance and begin to find the
means of setting up reliable studies. Although prevalent conditions will always
render any psychiatric intervention difficult in the extreme, it remains crucially
important that some kind of pragmatic programme be developed for initiating a
practical approach to the problem.
To achieve this, Psychiatry will have to overcome some of its current cultural
constraints and adopt a more neutral (multiethnic?) approach, which will require
enormous efforts to understand the unacceptable. At the same time, those
societies currently viewing the West as contaminated by indiscipline, immorality,
etc. will hopefully begin gradually, in their more free-thinking sections, to
appreciate those Western aspects which can bring much needed improvement
to their lives, even in terms traditionally acceptable to them.
Perhaps the key principle to establish is this: that understanding does not have
to equate to agreement. All societies, in fact, stand to benefit from a population
which is not deeply troubled and divided by fear, hatred or uncertainty caused by
pathological mental conditions (or conditioning) which, by their very definition,
preclude a peaceful and contented existence for all.
If psychiatrists and scientists are to work towards this goal of increased
reciprocal understanding amongst both themselves and patients, they must first
find a way of systematically and steadfastly removing many of the cultural,
procedural and theoretical barriers currently blocking any real progress. The first
step would be simply to discuss scientifically about these specific topics which
seems to neglected or only partially approached by academic environments and
debated only by journalists, sociologists and common people.
If serious, professionally conducted, medical and/or psychiatric forums were to
be organized, under the umbrella of “Understanding the Unacceptable”, under
the auspices of well- respected focal points of medical opinion, with the specific
4
5
objective of debating the mental aspects of self-destructive terrorist activity, we
do believe that there would have been created a very valuable adjunct to the
different counter-efforts already being pursued, in order to prevent people from
becoming terrorists.
5
6
REFERENCES
Andreasen N. What is Psychiatry? Am J Psychiatry 1997; 154: 591-593.
Atran S. Genesis of suicide terrorism. Science 2003; 299: 1534-1539.
Axel A. Kamikaze. Longman: New York, 2002.
Fremono WP, Patagi C, Beresin EV. The impact of terrorism on children and
adolescent: terror in the skies, terror on television. Child Adolesc Psychiatr Clin
N Am 2005; 14: 429-451.
Hoge CW, Castro CA, Messer SC, McGurk D, Cotting DI, Koffman RL. Combat
duty in Iraq and Afghanistan, mental health problem and barriers to care. New
Eng J Med 2004; 351: 13-22.
Koren D, Norman D, Cohen A, Berman J, Klein EM. Increased PTSD risk with combatrelated injury: a matched comparison study of injured and uninjured soldiers
experiencing the same combat events. Am J Psychiatry 2005; 162: 276-28.
Krus DJ, Ishigaki Y. Contribution to psychohistory: XIX. Kamikaze pilots: the
Japanese versus the American perspective. Psychol Rep 1992; 70: 599-602.
Shalev AY, Freedman S. PTSD following terrorist attacks: a prospective evaluation. Am
J Psychiatry 2005; 162: 1188-1191.
6