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Prof Philip Morris MB BS BSc Med PhD FRANZCP FAChAM (FRACP) AmBPN AmBIME Bond University President Australian and New Zealand Mental Health Association Responding to Nationwide Psychological Trauma. Norway’s Trauma Anders Behring Breivik.

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responding to nationwide psychological trauma

Prof Philip MorrisMB BS BSc Med PhD FRANZCP FAChAM (FRACP) AmBPNAmBIMEBond University PresidentAustralian and New Zealand Mental Health Association

Responding to Nationwide Psychological Trauma

norway s trauma anders behring breivik
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 tothe 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 ‘evil’


Most psychiatric patients are anxious, withdrawn, shy and avoidant

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 associates

A significant proportion of the entire population likely to be affected either directly, indirectly or vicariously


The nation and individuals feel –

fear, anger, sadness, survivor guilt

And will ask “why?” – a question not easily answered

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 same

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 government

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

thank you www drphilipmorris com
Thank You!