The Magazine

A Psychiatrist Looks at Terrorism

There's only one way to stop fanatical behavior.

Dec 10, 2001, Vol. 7, No. 13 • By PAUL R. MCHUGH
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The major contemporary clinical disorder prompted by an overvalued idea is anorexia nervosa. Patients suffering from this illness take an idea common among young women in our society--thinner is better--and amplify it into a commitment so dominant that they starve themselves. At first an anorexic may claim that she is no different from any woman "thinking thin." As she persists with a worrisome starvation diet, she may justify eating only low fat salads as her way to "health." All therapeutic attempts to correct the behavior by dissuading her of this idea or uncovering its root cause fail, because the overvalued idea--one cannot be too thin--resists logical argument and compromise. Only stopping the behavior--which may require bringing the patient under 24 hour supervision--can lead the anorexic to recover.

But overvalued ideas also crop up outside the clinical setting. Two recent examples of individuals with overvalued ideas are the Unabomber and Jack Kevorkian. The Unabomber, preoccupied with what he saw as the materialism and destructive reliance on technology of our society, carried out vicious and cowardly letter bomb assaults against many defenseless people he associated with these enterprises. When his rambling, expansive, and tedious explanations were published in the Washington Post, many readers reported that they agreed with much of what he said.

Jack Kevorkian, despite killing scores of sick, emotionally vulnerable people in Michigan, persuaded several juries that his ideas about assisted suicide were well intended, even though contrary to law. Juries repeatedly freed him, until his indiscriminate killing and disdain for the courts became too much to stomach. Kevorkian and the Unabomber now sit in jail because only incarceration could keep them from continuing their violence. Neither of them is mad in the sense of being out of contact with reality, but both of them are bad because of their vile opinions and vicious behavior. Their "brain images" would make no difference to such judgments.

Three historical figures with overvalued ideas are Adolf Hitler with his anti-Semitism, Carrie Nation with her excessive devotion to temperance, and John Brown the abolitionist. Note that an overvalued idea may not in itself be wrong. Enough people agreed with Carrie Nation to pass the 18th Amendment; and all now agree with John Brown that slavery is evil, even though they deplore his assaults on defenseless farmers in Kansas and his killing spree at Harpers Ferry.

Overvalued ideas develop as ruling passions in some vulnerable individuals. Anorexics tend to be introverted young women, impressionable and easily conditioned by criticism of their physical appearance. The Unabomber, Jack Kevorkian, and the World Trade Center terrorists also tended to a personality type, arrogant and over-confident, suspicious of others, lacking in warmth, and tediously argumentative, shifting their ground to justify their fixed opinions when faced with strong objections. Cold, paranoid, and aggressive are terms that describe them. All efforts to correct the behavior of such people by addressing its "root causes" will fail because those "causes" are not actually motivating these people's behavior--their passions are.

DEFINING the September 11 attacks as behavior and the terrorists as men driven by the overvalued idea that America is a satanic nation whose citizens deserve death has implications for ways of defeating them. Here, recent psychiatric experience in treating behavior disorders can help.

Before about 1975, psychiatrists treating patients with destructive behaviors such as anorexia, alcoholism, and sexual disorders believed that one should first find the psychological roots of these behaviors by uncovering their meaning in the patient's mental conflicts. They thought that if these meaningful conflicts could be resolved, the abnormal behavior would wither away. This approach failed. Treatment programs for anorexia, for example, that ignored the failure to eat while attending to its meaning had death rates of between 10 percent and 15 percent of their patients. Alcoholics continued to drink, sex offenders to offend, even while their psychiatrists claimed to be reaching an understanding of their problems.

These results eventually caused doctors to try treatments that directly interrupted the harmful behavior. Anorexics were brought under dietary supervision, alcoholics were detoxified and sent to clinics implementing the 12 step program of Alcoholics Anonymous, and sex offenders were given testosterone-suppressing medications and vigorous group therapy concentrated on discrediting their activities and their justifications. These treatments worked far better: Many more anorexics, alcoholics, and sex offenders recovered.