Anders Breivik leaving an Oslo courthouse in a police car in 2011 (Photo via)
On the 22nd of July, 2011, right-wing extremist Anders Breivik detonated a bomb in downtown Oslo, killing eight people. He then drove 25 miles to Utøya island, where the ruling Labour Party’s Youth Rally was being held, and began an hour-long shooting spree that ended in the deaths of 69 more people, most of them teenagers.
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Professor Lars Weisæth, an expert in psychotraumatology and post-traumatic stress disorder (PTSD), was asked to step in and “crisis manage” the situation. Just over three years later, I spoke to him about that day and the impact it had on the thousands of affected people he cared for.
Professor Lars Weisæth (Photo by Heike Bartel)
VICE: Hi professor. So at what stage were you called in on the 22nd of July?
Professor Lars Weisæth: The same evening. I was on vacation in my summer house on the south coast of Norway, about 150 miles from Oslo. I was first called by NRK, the national television station. They know me, as I’ve been involved in all major Norwegian disasters in an advisory capacity. I’ve been trained in hostage psychology, helping police negotiate with terrorists or kidnappers, and I was chief psychiatrist of the armed forces.
Were you involved as things were unfolding?
No, I was driving back to Oslo. I heard about the shootings on the radio, and when I arrived the situation was still not clear. To give advice to the health authorities the next day – which I had to do, as that became my role – I needed a clear idea. Ten had been regarded as killed, but the bigger numbers weren’t out yet. Then I managed to talk to some of the victims during the night and the next morning, so then I got a clear picture of what had happened.
And what did you put in place?
Well, when a traumatic event occurs, I diagnose it. There are three major types of large events: a company or organisational disaster; a local community disaster, when one community only is affected by an event; or a distant type of disaster – distant from the family – which this was. If it’s a local event, you move your resources there, but it was clear that the Utøya massacre was not. The 565 youngsters on the island came from all over Norway, and during the night we learned that 69 had been killed: 12 percent.
So, an Information Support Centre [ISC] was established in both places – this ISC was grasped by the World Health Organisation in 1991 and included in the guidelines for how countries should respond to disasters. You need to invite family members to come to the site. You need to feed them, to house them, but most of all you need to inform them – ongoing information on what has happened, what is happening. You have to anchor families to the ISC otherwise they will try to find out for themselves by doing desperate things. You have families all over Norway, and they do not know what the fate of their child is. More than 1,000 people met at this hotel, the ISC, during the night and the next day.
Were there any especially difficult decisions you had to make?
The main problem was that there were no exact numbers. In the government quarter, it was established that only eight people had been killed. But we didn’t know who had been there. There are 4,000 people who work in this district – 70 percent of the Norwegian state apparatus concentrated within a radius of 300 metres – and 1,700 offices were destroyed. But the main problem was on the island. It was dark. Nobody knew how many had been there. We learned finally that it was 565. So, the uncertainty about the number who’d been killed was the main problem. The police only issue information that is certified. So, during that night, they only reported 10 people having been killed. But we had reason to believe it was many, many more. In my opinion, that should have been said. They had created a false hope.
Another problem was that – and today it sounds crazy – many were hospitalised with serious injuries, and not all of them could be identified. So when the police called the hospital to find out who had been admitted, the hospital refused to give out names. It’s a typical symptom of stress: people cling to rules; they become more bureaucratic.
How widespread was PTSD in the aftermath?
In the governmental quarter, about 25 percent suffered from PTS after seven months. On Utøya, it was 70 percent, although that is now down to about 25 percent after three years. Also, we did a national study of how the Norwegian population reacted. Grief was the main response. Half of the Norwegian population actually cried on the first weekend when it became clear what losses had occurred. The second most common response was anger – about 40 percent. Fear, which Breivik wanted to create, was far less frequent, although a bit more so among young people in Oslo.
Is it possible that the families suffered PTSD, even though they weren’t directly submitted to danger?
Usually the families suffer losses, so you will have grief responses. But in this case there was a particular additional and very severe stress: namely, that a large number of the parents had had telephone contact with their sons and daughters before they were killed – actually, while they were being killed. Talking was of course itself a risk, because Breivik could hear them, and the mobile phones among the dead were going off all the time, too – families trying to reach their young ones. So, in this particular terror incident, the families took part in the ordeal, more than usually is the case.
One of the thousands of memorial messages left outside Oslo Cathedral following Breivik’s attacks (Photo via)
The fact that Breivik turned up in a police uniform must have had a huge impact on later PTS symptoms.
It did. A group of these youngsters that I’ve talked to were hiding in a small cave. Breivik shot and killed one of them, the furthest out, and then continued on his path. But when a boat came, with policemen calling out, “We’re here to save you”, they didn’t believe it. It obscured conditions for “early event identification”, as we say. He also called out: “I’m here to protect you because there’s been a bomb in Oslo”. And when they went up to him, he shot them. It was really very evil.
Was he insane, in your opinion?
In Norway, if you’re insane, you cannot be sentenced. In most other countries, it’s not enough to be psychotic [to escape trial]. It must also be the cause of your murdering – there must be a link between the psychosis and the crime. Actually, I think Breivik was psychotic along three dimensions: his grandiosity, his feelings of being persecuted and the lack of affect. That is not what terrorists are usually like. To me, this is a very sick person: he smiles and kills.
But is it possible to plan something so meticulously over such a long period of time and still be deemed insane?
Very good question, and that’s the other side. Along these three dimensions, he qualified for what you would call a partial psychosis – a paranoia. These people can be extremely rational, extremely logical, very good at arguing and long-term planning. They know the difference between right and wrong, and they know when they commit an act that it is wrong. And that’s the reason, I think, that in the end the court concluded that he was sane. Probably, if we had had a different law, we could have said both that he’s partially psychotic but also that he knew what he was doing and is sane enough to be sentenced.
You know, it came out in a recent book about his mother that he gave her a dildo for her birthday when he was a teenager. I never heard that from any other family, getting involved in one’s mother’s sexual life like that. To me, that is an early sign that something is very wrong. The whole family was observed in a child psychiatric department when he was four or five years old. It was clear that something was disturbed. The childcare agency was worried that he was suffering from negligence, that he was a deprived little boy, but the mother was allowed to keep him.
Oslo immediately after the attack by Anders Breivik (Photo via)
Is there a qualitative difference between PTS arising from this type of event – an atrocity “out of the blue” – and from other situations of extreme danger?
There is a scale: natural disasters, human error – let’s say in a traffic accident – human negligence and, finally, violence: terror, war, criminal violence. With a natural disaster, nature is dangerous but not evil, so your self-esteem – your sense of value – is not harmed. There’s no one to blame. You’re not humiliated, so that’s less psychologically harmful.
I try to tell these youngsters, “You’re an innocent victim. A murderer has tried to kill you and your friends.” But, because he attacked these two social systems, it was also an attack on Norway, on our democracy. This provides a meaning, and that is crucial, because if I’m being maimed for life, at least it was not accidental, although I paid a heavy price.
What did you do in the subsequent weeks?
My main work over the next weeks was to organise psychiatric support in the government quarter. PTS causes cognitive disturbances. It reduces your ability to concentrate; it affects your memory. So, intellectual functions suffer. The main challenge was to find suitable jobs that the people could manage so they could still be productive and feel they were a part of the workforce.
What about with the Utøya survivors?
One of my main jobs was to arrange a return to the island – about 1,000 people. I recommended that everyone who had lost someone there and everyone who had survived should return. It’s beneficial if the bereaved family is invited to the site of death. It will make it less difficult to understand and accept what happened – where Breivik had stood when he fired the shots, how rapid death came. Second, the site of death gives a sense of closeness to the dead person, almost like the grave. Third, many families feel they have a duty to do this. It reduces the guilt. It’s like a service they owe the dead person: to find out what happened to them, where they died. And then you have the symbolic, ritual effect on those kids, many of whom were quite scared before they did this. It’s anti-phobic. Reality is far less frightening than all the fantasies you can have.
Bomb damage in Oslo (Photo via)
Was there any “survivor guilt”?
That has been a pronounced psychological reaction. We’ve found that in other disasters people struggle with difficult decisions – I call them impossible decisions – about their own survival, how much they can do to help others. That’s a very painful part of the post-traumatic stress syndrome in situations like this.
Finally, how do people get over this?
By traditional, psychotherapeutic means: working through the experience, taking part in the grief over your lost friends – it’s a gradual, long-term process. These are healthy people, so it’s likely that not that many will have chronic problems. But it’s like war – you can never guarantee that all soldiers will avoid permanent psychological injury. It’s too violent for that. You must have the memory, but you shouldn’t have the re-experiences. You need to turn the flashbacks into a bad memory from earlier in your life, not something that keeps coming back to you with the quality of, “Oh, it’s happening again.”
Thank you, Professor Weisæth.
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