Diagnosis of the 22 July terrorist at a distance
A widely debated case is the involvement of doctors in the assessment and diagnosis of the 22 July terrorist in Norway. Numerous doctors made statements regarding the first forensic psychiatric report before the trial in 2012, and believed that they had better knowledge of the nature of the terrorist’s psychiatric diagnosis than the expert witnesses.
These cases were never submitted to the Council for processing as complaints, but it nevertheless made the following statement in a newspaper chronicle (3): «It is, however, the Council’s opinion that a number of professionals went too far in their statements. This is particularly related to making alternative diagnoses without having personally examined the perpetrator. There is a difference between adopting a critical stance with regard to a diagnosis based on use of methodology, and putting forward an alternative diagnosis. The requirement for objectivity is especially important in a case where those being subjected to criticism have no opportunity to take part in the discussion.» And further: «There is little doubt that a number of violations of the duty of confidentiality were committed on the part of several actors.»
In spring 2016, a trial was held concerning the 22 July terrorist’s prison conditions. Once again, «diagnosis at a distance» was the order of the day. In his article Is it worthy of a cultural nation? Ulrik Malt, professor of psychiatry at the University of Oslo, wrote the following (4): «By mocking and ridiculing Behring Breivik we demonstrate a lack of will, and for some perhaps also an inability, to attempt to understand mentally ill persons.» While stopping short of making a psychiatric diagnosis, Malt went a long way in his psychiatric assessments.
Malt’s newspaper article caused the philosopher Einar Øverenget to react (5). Øverenget is of the opinion that when a psychiatrist makes a diagnosis, he is subject to the Health Personnel Act and the Patients’ Rights Act, and he claims that making a diagnosis without a person’s consent constitutes an offence. «He thus undermines the psychiatrist’s professionalism. He does this by showing contempt for the basic principles of the philosophy and ethics of science,» wrote the philosopher, challenging the psychiatric profession to clean up its act with regard to the unprofessionalism in its own ranks (5). In her response to this criticism, Anne Kristine Bergem, president of the Norwegian Psychiatric Association, emphasised freedom of speech and in addition referred to the supervisory bodies for possible sanctions (6).
The case in question has not been discussed by the Medical Ethics Council, but in principle it is extremely problematic to «diagnose at a distance» (cf. Chapter I, paragraph 1 of the Code of Ethics, which includes the respect for fundamental human rights). However, our Code of Ethics contains no explicit formulation in this regard.
On the other hand, the code of ethics of the American Psychiatric Association does contain such a formulation. The so-called Goldwater rule states that psychiatrists should not provide a psychiatric assessment without having examined a person: «… A psychiatrist may share with the public his or her expertise about psychiatric issues in general. However, it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement» (7).
Despite this rule, it is easy to find examples of psychiatrists and psychologists in the USA who have made professional assessments of public figures without having examined them personally. The Russian President, Vladimir Putin, has been assessed as having an autism spectrum disorder, and Donald Trump as having narcissistic traits (8, 9).
The motive for such pronouncements may vary. One motive might be to provide a psychological perspective to enable a better understanding of a politician, possibly to predict a politician’s behaviour or to warn against the person concerned. A considerable problem with this type of practice is the use of professional power to influence public opinion indirectly instead of participating in a discussion offering explicit political viewpoints.