Hurlow et al1 appear to argue that psychiatrists have a major role in preventing terrorism. This might lead one to think that there has been a massive wave of attacks by people who are mentally ill. In fact, Britain is fortunate to have had only one terrorism-related murder since 2005!
By contrast, Northern Ireland saw almost 1 000 terrorist killings by unionists/loyalists and 2000 by nationalists/republicans – Dr Hurlow's home city of Birmingham had 21 people killed in the 1974 IRA bombings. The contribution of mental illness to the 3000 killings was, in essence, totally negligible. Indeed Lyons et al2 noted that terrorists were mentally healthier than ‘ordinary’ killers. This has face validity: it is doubtful that a person or persons with psychosis could plan and execute the sort of sophisticated attacks we have witnessed in Birmingham, Brighton, Enniskillen, Madrid and London. Did police contact psychiatric services in the wake of the Paris attacks in November 2015? Of course not! Terrorism is, by definition, politically motivated.
Politicians, the media and others all too often respond to terrorism by lazily and superficially claiming it to be ‘psychotic’, ‘crazy’, ‘insane’, ‘psychopathic’ or (most mindlessly of all) ‘mindless’. Islamic State are disgustingly murderous, but Abu Bakr al-Baghdadi and his activists are not driven by mental illness. It is very worrisome if psychiatrists contribute to this unscientific discourse.
There will always be a tiny number of mentally disturbed people who respond to the current zeitgeist and act out violent fantasies. Psychiatrists must always take account of the risk to other people from such individuals and act appropriately. However, to extrapolate from this a new obligation to routinely monitor our patients and work in close contact with anti-terrorism policing is both stigmatising to people with a mental illness, and damaging to our independence and professional reputation. Crucially, it is also useless in preventing serious terrorism. If colleagues are in any doubt about this, I would suggest that they speak to the real experts in terrorism: senior police officers in Northern Ireland.
- © 2016 The Royal College of Psychiatrists