Against a backdrop of increasingly frequent violent extremism, we must explore the possibility of avoiding future atrocities by addressing the mental health needs of would-be terrorists.
Anecdotally, the friends and family of boys and young men who commit acts of extremist violence often report a rapid period of behaviour change.
They may start to associate with a different previously unknown group of friends, or spend an increasing amount of time alone or on the internet.
They may undergo a change in
appearance or start to engage in anti-social behaviour, and begin to initiate
READ MORE: Rethinking the link between mental health and political violence
This rapid change is often attributed to radicalisation, which is a process where a person, often from a vulnerable background, begins to adopt extreme political, religious, or social views and through these engages in extremist activity.
Radicalisation has been described as one of this century's most pressing child protection issues, with radicalised views commonly formed through poor guidance, misunderstanding, jealousy, anger, feelings of injustice, resentment or fear.
Access to known terrorists, who are often unwilling or unmotivated to engage with researchers, is a major barrierWho is at risk of radicalisation?
Benjamin Ramm’s recent piece on the relationship between mental health and extremist violence successfully conveys the complexity of the issue, and the ill-conceived notion of separating an ideological motivation for ‘terrorism’ from poor mental health.
However, building a scientific evidence base for the propensity and process of radicalisation and interaction with mental health is an inherently difficult task. Academic research is curtailed by practical constraints and instead journalists are relied on for evidence.
Access to known terrorists, who are often unwilling or unmotivated to engage with researchers, is a major barrier, especially given that death of the perpetrator is a common outcome of extremist violence. Equally, the accounts of family members are questionable in their accuracy, with severed family ties a by-product of radicalisation and denial being psychologically protective in the face of such brutality.
Muddying the waters further is the suggestion that vulnerability to radicalisation may differ depending on the extremist ideology. In 2011, Dr Matthew Goodwin, an Associate Professor from the University of Nottingham, provided evidence to a Home Affairs Committee warning against attempting to understand Islamist extremism in the same way as far-right extremism.
For both ideologies, Dr Goodwin stated:
“Not enough systematic, longitudinal research has been done to paint an accurate picture of who they are, how they come to be radicalised, to what extent those [far-right] pathways compare to radicalisation into Al-Qaeda-inspired groups, and to what extent their social proﬁle is similar to those who become recruited into Al-Qaeda groups.”
Terror attack in Nice: should perpetrator have been treated?
Mohamed Lahouaiej Bouhlel, the perpetrator of the recent lorry attack in Nice, was described by the Islamic State of Iraq and the Levant (Isil) as a 'soldier of Islam'. Bouhlel had reportedly only begun attending a mosque three months earlier, and appeared "to have become radicalised very quickly", according to the French interior minister, Bernard Cazeneuve. In the days following the attack, five individuals were formally charged, suggesting the massacre was not a ‘lone wolf’ incident as originally thought.
Aside from evidence of radicalisation, a profile of past experiences of poor mental health is emerging. Bouhlel saw a psychiatrist on a single occasion in 2004 in his home country of Tunisia. This was due to "troubling behaviour of a psychotic nature", Dr Chamseddine Hamouda told the BBC, and it was advised that he required treatment.
Depression may be a risk factor in the early stages of radicalisation
It has not been established whether he received treatment.
More recently, Bouhlel allegedly had struggled with depression following the breakdown of his marriage, according to French television station BFMTV.
Although it is misguided to attempt to distinguish whether mental ill health or indoctrination motivated the attack, the pertinent question is whether treating his mental health in the 12 years preceding the attack in Nice would have made him any less susceptible to radicalisation.
A terrorist personality?
One reductionist notion is that of a ‘terrorist personality’, and the idea that if we can understand the singular psychology of terrorism, we can prevent all acts of terrorism. This is in line with the spectrum of popular opinion which believes that terrorists by definition must be mentally ill to be able to commit these atrocities. Although this overgeneralisation has no evidence base, taking a middle ground and seeking to understand the psychosocial risk factors for susceptibility to extremist violence is evidently a worthwhile undertaking.
A number of related psychological and social theories of the radicalisation process have been developed, however these theories have not yet been empirically tested. Most theories suggest that radicalisation is a staged process, beginning with a period of pre-radicalisation and initial exposure, before progressing through different stages of indoctrination and training, and ending with the violent act. However, many people who begin this process do not necessarily pass through all the stages and become terrorists; early intervention in the process is a priority.
Depression may be a risk factor in the early stages of radicalisation, evidence suggests. Twenty-year old Michael Sandford, who is accused of wanting to shoot Donald Trump at a rally in Las Vegas in June, has a history of mental health conditions including depression, along with Asperger’s syndrome. Sandford’s father, Paul Davey, said in an interview with the Portsmouth News that his son must have been coerced or radicalised, and suggested his mental health conditions made him more vulnerable to coercion.
“Whether he’s been blackmailed or put up to it, that’s the only thing me and his mum can think of. It’s so against his nature and obviously with his Asperger’s, we think somebody has got hold of him and done something.”
There are also suggestions that terrorist organisations exploit those suffering with depression, with an Isil recruitment video appearing to state that “the cure for the depression is jihad”. Empirical evidence supports this link, for example, a study of teenage boys in Gaza found that symptoms of depression were common in supporters of ‘religio-political aggression’, whereas a similar study in the UK in adults of Muslim heritage found that mild depressive symptoms were associated with sympathies for violent protest and terrorism.
Although clearly supporting or sympathising with violence and committing acts of extremist violence are not one and the same, the multitude of positive societal effects which may come from addressing the sources of depression make it a worthwhile strategy.
Stereotypes and stigma
Caution must be taken when interpreting the link between extremist violence and mental health. Mental health problems are relatively common (1 in 4 people will experience a mental health problem each year) whereas violent extremism is extremely rare.
Whilst there is an increased risk of violence in severe mental health conditions, the vast majority of people struggling with a severe mental illness are non-violent. Similarly, many violent extremists will not have mental health problems. If not handled carefully, the implications of linking extremist violence to mental illness may perpetuate the stigma surrounding mental illness and consequently discourage people with mental health needs to seek help.
Mental health is just one aspect of a bigger picture, and for preventative strategies to be effective, a holistic and multi-agency approach is required, recognising that mental health is often a transient state on a spectrum, with emotional and psychological stressors affecting the degree of mental health at any one time.
Risk factors for radicalisation, which can trigger a person towards the ill health end of the spectrum, are commonly social factors including experiencing a bereavement, loss of employment or the breakdown of a relationship, financial hardship and pressure and perceived discrimination.
During his 2015 presidential address, Barack Obama likened terrorism to a cancer. A more accurate analogy is to consider the ideology underlying the terrorist action as the cancer, and make this the target of intervention programmes. If extremist ideology is the disease, then a public health response should be a weapon in our armoury to protect against disease and reduce its spread.
The long-term value of a public health approach to counter-terrorism, where we seek to identify and reduce risk factors for extremism and radicalisation, including poor mental health, and promote protective factors may be more effective than purely reactive responses at reducing future atrocities.