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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This experience taught psychiatrists that behavior, once begun, maintains itself. Anorexics like to see their weight and dress size steadily shrink. Alcoholics, drug addicts, and sex offenders get immediate pleasurable reinforcement to continue their activities.

The same is true of terrorists: Their behavior is maintained by its consequences, especially the publicity that draws attention to the terrorist and his ideas. The Unabomber hated to be pushed off center stage by Timothy McVeigh and so killed two more people right after the Oklahoma City bombing. Jack Kevorkian started videotaping his killings for CBS TV when Michigan ceased bringing him to court. Although the September 11 terrorists died in their assault, they were sure of worldwide publicity for their actions and their views. Their success brought dancing to the streets in certain Muslim cities and recruits to their war against America--far more recruits than any "root cause" of terrorism, such as poverty or anger at Israel, had brought.

By implication, then, to stop terrorism, the American government should devote its energies to interrupting the terrorists' behavior in all its aspects. The government should use every reasonable method to apprehend individuals who could carry out terrorist actions. It should protect vulnerable sites and situations. And most crucially, it should alter the consequences of the September 11 assault: To our injuries it should promptly add injuries to those responsible for the attack.

This policy should be judged simply and tough-mindedly by its success in preventing more terrorist behavior. Preventing terrorist events must be our prime aim, not just because each atrocity is an evil in itself, but also because terrorism, like every other behavior, grows with its performance. To accommodate ourselves to it as a "fact of life" is to sustain it.

Our government can ignore certain matters for the moment. We should not expend much energy unearthing the "preconditions" for terrorism or pay credence to the justifying explanations offered by spokesmen for terrorists, no matter how reasonable they may seem. In truth, there are as many reasons offered for terrorism as there are terrorists--just as Alcoholics Anonymous has learned that there are as many reasons offered for drinking as there are drunks.

Stop the behavior first, and then, once peace is restored, we can deal with underlying issues. We will very likely find that many of the justifications now offered for terrorism were only rationalizations intended to excuse it. But we need not waste our energies trying to change the opinions of terrorists about us and our aims. These people, like the Unabomber and Jack Kevorkian, have overvalued ideas that are inaccessible to argument and persuasion. Their behavior will continue unless they are captured or killed.

Whether we call the terrorists' atrocities acts of war or crimes should be determined by one thing: which term best helps us stop the behavior. It seems more likely that we can keep terrorists from striking again if we treat them as soldiers captured committing acts of war on a battlefield of their own devising than if we treat them as individuals indicted for crimes and innocent until proven guilty. The IRA terrorists and sympathizers confined to the Maze prison at Long Kesh in Northern Ireland demanded the status of soldier-prisoners rather than criminal-prisoners. Certainly our laws can accommodate their Muslim counterparts.

FINALLY, what of the concern that military action will generate martyrs, draw recruits to the terrorists' cause, and produce endless conflict? Psychiatrists are familiar with this worry. It crops up whenever they propose a treatment aimed at interrupting a behavior. Patients and relatives all see and object to the intrusion on the patient's autonomy--such as the demand that the anorexic stay in a hospital so that her eating can be supervised or the requirement that the sex offender take libido-reducing medications. They wonder whether this will only cause patients to "dig in their heels" or "lose self-esteem." They propose that the psychiatrist should discover and resolve some meaningful conflict behind the behavior and so spare the patient a distressing treatment. Psychiatrists must explain to patients and their families that every effort to interrupt or change behavior elicits short-term losses, which are the price of recovery. Clinicians must weigh the inevitable short-term losses against the potential long-term gains.

Sometimes the likely losses are excessive. The classic illustration is stopping a lynch mob. One had best not attempt this alone, as the short-term cost to oneself could be terminal. Better to bring an army to stop a mob. Then, after order is restored and the hard feelings that are the short-term cost of preventing the crowd from working its will have dissipated, work to end the ideas and attitudes that support lynching.

In America's effort to interrupt the behavior of terrorists, many of whom are nestled in our country, the government may need laws that temporarily reduce civil liberties. We may have to go on a war footing, with special authority turned over temporarily to the military. We may have to sacrifice privileges in travel and tax relief. Discussion and careful judgments should aim to minimize and justify these losses. All such measures should be reassessed regularly. But they should be understood as the inevitable short-term costs of interrupting terrorist behavior.

The same sort of reasoning applies to our dealings with other countries. We have spent decades building up certain political and diplomatic relationships during peacetime. Some of these relationships will be damaged as we vigorously bring war to terrorists and their sympathizers and demand help from those who would call us friends. Again, we should consider what immediate losses might be irreparable and avoid actions that produce them. A nuclear winter would obviously be an unacceptable short-term cost. An increase in the vociferous complaining about America on Arab TV, however, can be expected and tolerated.

Some short-term costs deserve extensive discussion, informed by the concerns of diplomats, economists, lawyers, and others, before they are accepted or rejected. Psychiatrists have little to contribute to these proceedings other than to point out that the criterion for judging a policy is clear: If terrorist behavior continues, then--given that each successful attack makes subsequent attacks more likely--efforts to stop it should be enhanced, even though short-term losses will increase.

When we prevail in stopping terrorist behavior, we will likely discover much support for us in the oppressed Muslim world, support now hidden by the clamor for war. We can be sure that most Muslim mothers and fathers do not want their children lured to violent deaths in the name of some wild, overvalued idea promoted by charismatic tyrants whose own sons never get sent on suicide missions. Freedom will be welcomed once the majority can speak openly. We already see this in Afghanistan. The short-term losses of the bombing phase have been overcome by the joy of long-term release from the Taliban.

In sum, a realistic, pragmatic psychiatric depiction of terrorism--one that avoids dubious theories about meaning, as well as wishful thinking about how to manage it--can dispel confusion and offer a context for the understandings contributed by other disciplines. Thus, the proposals advanced here about managing terrorism fit with the idea of proceeding with a just war.

This approach allows us to assure our critics that, even as we know short-term losses to be inevitable when behavior must be changed, we also presume that many of the losses will be repaired by the long-term gains of success. All can agree that force and destruction are not enough for a sustained peace. Eventually we must repair some of what is damaged and develop our understanding of the grievances and concerns of our adversaries. To any who doubt our capacity to use more than force to gain a long-term peace, we can offer the historical instances of American magnanimity and devoted efforts at rebuilding where we had conquered, as after the Civil War and the two world wars of the 20th century.

We are a forgiving people, but now, at the start of the first war of the 21st century, is the time for action--action directed by a coherent view of our adversaries and of what they are trying to do to us. Churchill defined these matters better than any psychiatrist. "Our aim," he said, ". . . is victory, victory at all costs, victory in spite of all terror, victory, however long and hard the road may be; for without victory, there is no survival."

Paul R. McHugh is University Distinguished Service Professor of Psychiatry and Behavioral Science at the Johns Hopkins School of Medicine and former psychiatrist-in-chief of the Johns Hopkins Hospital.