[5.12-9.0] Anders Breivik Psychiatric Report 2011-11-29, by Torgeir Husby & Synne Sørheim

[5.12-9.0] Anders Breivik Psychiatric Report 2011-11-29, by Torgeir Husby & Synne Sørheim

Breivik Report | 2011-11-29 | Torgeir Husby & Synne Sørheim

"[Breivik] emphasizes that if he had not been censored by the media all his life, he would not have had to do what he did. He believes the media have the main responsibility for what has happened because they did not publish his opinions.... The low-intensity civil war that he had already described, had lasted until now with ideological struggle and censorship of cultural conservatives...... He explains that this is the worst day of his life and that he has dreaded this for 2 years. He has been censored for years. He mentions Dagbladet and Aftenposten as those who among other things have censored him..... He says that he also wrote “essays” that he tried to publish via the usual channels, but that they were all censored..... The subject summarizes: As long as more than twelve were executed, the operation will still be a success. The experts ask how the number twelve comes into consideration. Twelve dead are needed to penetrate the censorship wall, he explains..... About his thoughts on the Utøya killings now, the subject says: The goal was to execute as many as possible. At least 30. It was horrible, but the number had to be assessed based on the global censorship limit. Utøya was a martyrdom, and I am very proud of it..... The subject says in the conversation that he knows the truth that is hidden from others. He believes that there is a civil war in the country. He believes he had to kill at least twelve, because there is a censorship-wall preventing an open debate about what is happening in the country..... So I knew I had to cross a certain threshold to exceed the censorship-wall of the international media." 

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5.12 Twelfth conversation with both experts on 2 November 2011

The experts meet the subject in one of the visitors’ rooms in Ila prison, Dept. G, where the subject was locked inside a small room with a glass wall.

The conversation lasted for about two hours.

The conversation took place because the subject had annouced via his lawyer that he did not want to contribute to carrying out the MRI, as requested by the experts. The experts respected this, but wanted to hear the subject’s reasons for refusing.In addition, the experts wanted a new, updated status. The conversation was announced.

The subject appears agreeable and smiling. As during previous conversations, he appears with somewhat staring eyes. He begins the conversation himself by saying he wondered whether the experts came to get more details, or whether they had forgotten something. The experts say no.

The subject is asked how he is doing in prison. He says: It was a transition from an active to a passive life. But now the combat morale is up at 35% again, and I guess that 50% is the highest possible value in prison.

The experts ask if this means that the subject has felt depressed or sad. He rejects this and explains: The scale applies to morale, not to sad feelings. I haven’t had that.

He also says that it has helped him to have access to computer games in his cell. He says that first he asked for a specific game, “Heroes of Might and Magic”, but this was rejected.He thinks this is because the game had a picture of a knight on the cover. The subject says he is now engaged in a game in which he builds up the infrastructure of a city. In addition, he has been given access to books about other countries that he finds interesting.

The experts ask the subject why he was not willing to take the MRI. It is an insult, the subject says, adding: It is insinuating for an ideological prisoner.It is like saying that all Islamists are brain damaged. I understand that it would be interesting, but no, this is an ideological matter, considering the Labour Party’s approach after the Second World War.

The experts ask whether the subject was afraid of certain things associated with an MRI. At first, the subjects says no, but then adds it can not be ruled out that someone analyzing the images might say that one can not conclude, for example.

The subject then says that he does not want the experts to take rejection personally, and adds: Maybe someone has given you a message. I think it is the government agency that sent you that has said this is to be done. I do not think you have taken this initiative.

The subject is asked to elaborate on who he thinks instructs the experts.You are nominated, I think. Those who asked you probably have opinions on this. Osama Bin Laden would never have been asked to do the MR. Nelson Mandela was a cell leader and terrorist. Everyone in the same situation as me would have been offended.

The subject continues: There is no precedent for doing an MRI of ideological prisoners. You’re obviously not used to working with the ideological prisoners. You legitimize the methods that Labor used after World War II. I wrote about this in the compendium. It is a familiar tactic to say that ideological prisoners are insane.

The experts ask the subject to comment on a part of his compendium, which describes how members of Knights Templar will receive their awards and decorations. The subject smiles for a long time. These are ideas from the U.S. armed forces, he says. It was not just my decision, but I was involved in designing the system.

The experts ask what the subject has thought out, and who has been responsible for the rest. I will not specifically say so, the subject says. But I have played a major role in the design. The subject says: We are not so strong that we trade our own factories yet. Therefore, we have temporarily adopted other people’s honors. We are a military order, and it is essential to define military achievements. It is an incentive for warriors. The experts commented that when reading in his compendium about this, it seems as if everything is the subject’ style, and his own words. The subjects smiles and his face slightly reddens. I take that as a huge compliment, he says.

The experts say: When reading the compendium, it almost seems that the Knights Templar is just you. The subject answers: It’s interesting, but it is not just me, unfortunately, it is a military order.

The subject then goes directly on to talk about Knights Templar’s inaugural meeting in London in 2002. His story coincides with what he previously told the experts on the same topic, and large parts of his statements are therefore not reported.

I was in shock after having been in Liberia, the subject says, and I could not think properly. If you knew what I knew. Will not reveal it to others. There are others who have committed crimes and who contributed to the operation.

The experts return to the compendium’s descriptions of honors and awards. The compendium contains a picture of the subject in uniform, with different awards. The subject is asked to assess how he thinks others will consider in the picture.

So you liked it! the subject says to the male expert. The male expert says that he refrains from assessing the subject’s compendium.

Others may see something provocative, says the subject. All the Marxists’ Fascist lights will flash. They will think: He is proud of the actions, rather than regretting them. They will understand that each award symbolizes the dead, which I have killed, and be offended.

The experts comment that another possibility is that the ones who see the image would think that the subject looks like he’s dressed up. The subject is entirely incapable of understanding this. Personally, I am very proud of each award, he says. It was a very complicated operation and the awards symbolize everything I’ve done.

The experts comment that the picture was taken before the subject had performed the criminal acts. I knew what operation I was going to perform, but on the picture I have two or three awards I do not deserve, he says. It is the “wounded in battle” medal in silver or bronze, and the “dead in battle cross” in gold.

The subject adds: The order is being established over the next 10 to 20 years, being the first steps towards a sophisticated resistance movement. It is a problem that if you die fighting in Phase I, you will probably fight and die alone and not have someone who can receive the medal and arrange with the tombstone. Islamists have good arrangements. We want to build something similar.

The experts ask the subject to comment on the parts he has included on farming in his compendium. I included it because I spent so much time trying to develop a “cover”, says the subject. It is essential, because you must have access to a cottage or farm, and I do not expect that farmers need to be instructed, but urban people. He continues: The compendium will prepare the individual for the journey to become a perfect knight.

The experts ask the subject if he could explain how he considers martyrdom. It is ideal, yes, he says. We try to glorify death.

The experts ask why the subject nevertheless decided to surrender alive after the criminal acts. When you manage to reach all the goals of an operation, you may do so. It is not expansionism, we will gain control over Europe. By surviving, we have control afterwards and avoid that the regime can construct cover operations to explain away the incident.

The experts ask the subject to elaborate. The regime would be the supplier og conditions, he says. They could have said that I was crazy and had escaped from Dikemark mental hospitat. Or said it was an Islamist operation.

The subject says that when he was Utøya, he actually had decided to continue until he died. I was still looking for the prime target, which was Gro, the AUF chairman and the other board members. But I found no more, he says, and had no more ammunition.I met Delta when I was on my way to the advanced ammunition base to put on the armor. It was a very traumatic experience and I was in shock.

The subject says he had expected to die, first by the government building and later at Utøya. Was not prepared to survive, he says. I was surprised and confused and did not know if I wanted to survive. Thought: Do I have an obligation to fight on, or have I done the job now?

The subject also says: I made ​​several errors of military strategy. Could not neutralise the ferry staff. And I thought that capitulation would be difficult, so I might as well continue. And then I knew that in the case of XXXXX, the media covered up the truth, they are afraid to increase the recruitment. So I knew I had to cross a certain threshold to exceed the censorship-wall of the international media.

The subject continues: A large European operation was needed, and it was the Knights Templar Europe who acted on 22 July 2011, not Norway.

On his own initiative, the subject adds that to achieve the same, he has planned to detonate a “poor man’s A-bomb” next to 40,000 Marxists, for example in the Amelie procession or the 1st of May pricession. It would have caused more deaths. But I thought it was too much. He continues: We wore silk gloves here. Labor deserves a warning. If I had hit the 1st of May procession, the whole elite would have died.

About his thoughts on what awaits him during the trial against him, the subject says: It was decided in advance that it is acceptable to give a speech at the trial. They are found in the compendium. Search in part Il – “Trial speech”. It is a generic speech. I do not expect to get fair treatment, he says. Neither of you. You do whatever is expected from you, causing an ugly character assassination.

The experts ask if the subject believes that the experts make an independent assessment of him. No, he says. You would have faced resistance, your careers would be over, for you are dependent and have direct interests in the current regime. D traitors, nomenclature, you are trapped and can not say what you really think. So it would have been better with a psychiatrist from Japan or South Korea.

The subject thinks that the experts will fit their conclusion to what is politically correct. It would be irrational of you to become martyrs. A limited framework binds you, and you would meet resustance if you gave a modified personal characterization. For I think that yoy find me sane.

The subject says: What if you had said: He is indeed a hero! You would become martyrs. No one in the system would dare to sympathize with you, and you would be left alone. There is no reason to believe that you will report the truth here.

The experts then briefly inform the subject about the work ahead in the case and the conversation ended.

Present status by both experts on 2 November 2011

The subject is awake, in clear consciousness, and aware of time and place and situation. Intelligence clinically assessed to be in the normal range. The subject uses numerical values ​​and percentages to a greater extent than is common in regular speech. He uses a technical, unemotional and not very dynamic language in the conversation.

He appears emotionally shallow, with complete emotional distance to his own situation and to the experts. He is polite and cooperates to the best of his ability. He laughs and smiles quite often, when related to issues concerning his own individual significance and/or his actions.

The subject has a light glaring look and blinks a lot. He appears with a somewhat reduced facial expression and a somewhat rigid body language, as he moves very little in the chair during the hours of conversation.

The subject is unable to take the community perspective of how he will be considered by the outside world.He maintains that he is proud of the criminal actions. The subject appears with an emotional flattening and severe empathy failure.

The subject uses unusual terms, exemplified by military order, military achievements, warriors, awards, resistance movement, “cover” operation, cover-up operation, advanced ammunition base, military strategic mistakes, and capitulation. The terminology used is entirely linked to the subject’s notion that there is a civil war going on in the country and is considered as expressions of underlying, paranoid delusions.

The subject uses words like ideological prisoner, “trial speech”, and perfect knight to describe his own position. The terminology used is considered as an expression of underlying, grandiose delusions.

As previously, the subject presents ideas about his own supremacy as regards his own abilities, his written work and its supreme importance in what he perceives as an ongoing civil war in Norway. He compares his own person with opposition leaders such as Osama Bin Ladder and Nelson Mandela and believes that he represened the European resistance movement when carrying out the criminal actions on 22 July 2011. The ideas are considered to be grandiose delusions of psychotic quality.

The subject thinks it is likely that the experts and the current regime in Norway will deliberately manipulate and present him erroneously in the upcoming trial against him. The ideas are considered as paranoid delusions.

Auditory hallucinations and possible influence phenomena cannot be confirmed, since the subject maintains that his forms of communication with like-minded persons are secret.

The subject appears to have an unclear identity feeling, as he switches between describing himself in the singular and plural.

The subject says he has had thoughts about setting off a bomb in the 1st of May procession or a political demonstration in Norway, and by doing this to kill the power elite and up to 40,000 people. The ideas are considered as extensive, homicidal thoughts.

The experts have sometimes had difficulty in following the subject. In parts of the conversation, he is exhibiting a moderate association disorder and formal thought disorder in the form of perseveration. There is no latency or thought block during the conversation.

The subject appears without depressive thoughts in the form of guilt, shame, hopelessness, or thoughts about his own death by suicide. He denies experiencing sadness, joylessness, reduced initiative or lack of initiative. There is thus no evidence of a depressed mood.

The subject does not exhibit increased psychomotorical tempo or perceived high mood. The subject’s speech is coherent and with normal syntax. He has no mind or voice strain. He is “affect stable”. There is no evidence of lack of impulse control, neither verbally nor physically. There is thus no evidence of a high mood.

The subject appears without clinical suspicion of intoxication.The subject denies having suicidal thoughts or plans.


5.13 Thirteenth conversation with expert Husby on 21 November 2011

The conversation was notified and the expert meets the subject in the department’s specially designed visitors’ rom, where the subject was locked inside a small room with glass wall. The conversation lasted for about half an hour. Two themes were planned, namely knights and martyrdom. The subject was in his normal smiling condition when the expert arrived.

Initially, the subject told that he had been dreading the last imprisonment session a bit. He says he’s not used to talking in such a large assembly. He says he also missed the talks with the experts, as he considers us as intelligent, interesting and challenging interlocutors.

The expert then begins by asking if he can define what a “knight” is. The subject answers a warrior. He says that he can not explain this without going back in history and wants to talk about Charles Martel and the original knighthood. The subject gets a little pensive and says knight on horseback. Yes, it’s not a requirement that he must be on a horse. But the essence is the spirit of self-sacrifice, to sacrifice oneself for the weak. The opposite of someone who wants money. A selfless warrior who does not give priority to his needs and who is willing to die. Spirit of self-sacrifice and selflessness. I have not mentioned that it is also asceticism.

The expert asks whether knights can be identified today and the subject answers it is much more fluid than you think. I have helped to build the façade of a house by describing titles, symbols and rhetoric. I am the closest you get to a knight today. Perfect knights are Charles Martel and Sigurd the Crusader. There haven’t been many knights after him. The subject gets pensive and adds perhaps noone until now. He then says am basically a foot soldier. The expert reminds him of the many statements he has made ​​about knighthood and titles and regent, and he replies engaged what I have tried to do is to use psychological warfare. I use provocative twists and absurdity tochange and redefine the ideological spectrum. For example beheading. It is extreme. The former conservatives were pathetic. Guess there was one whotried to blow up a grenade and he ended up blowing up himself.

My compendium will redefine the ideological axis. I use words like ethnic cleansing and beheadings to change the picture.

Then the conversation switches to the royal family and his thoughts about DNA testing to find descendants of St. Olav or Harald Hardråde, as reported from previous conversations. This is not reported here. He also mentions the possibility of a rotation scheme for the sovereigns from the Guardian Council, with a 25 years’ regency period.

He then repeats that much of what I have talked about with you is floating. I use humor in the struggle. Haven’t you seen the news reader with a burka.

The expert says that we are to talk about martyrdom and what it consists of. He says martyrtdom is a tool for dealing with fear. The expert points out that it seems like he really had intended a martyr’s role as deceased, and that he e.g. had “given himself a medal for martyrdom, dead in combat”. He is asked why he chose differently. He answers it is not just martyrdom that is important. Shall fight with the pen. I see for instance that the incarceration meeting in a privileged manner provides me with the opportunity to shape Europe, and a lot of good info can be present during the trial. I just hope my mother is not there. She is the only one who can make me emotionally unstable. She is my Achilles’ heel

Continuing, he says: One thing I want you to know, we are willing to use any illegal strategies. I’m going to suggest to the police that if they create three NGOs (non-governmental organizations), each one supported with 30 million, as well as a daily newspaper getting 20 million, and establishes a rightwing version of the Blitz house, if all this is met, we will refrain from chemical, biological and flame weapons. Shall refrain from beheading and obliteration of the families. He said that NGOs shall be

• one for the Norwegian indigenous people’s interests (i.e. the “real, true Norwegians”; expert’s note)
• one against the Islamization of Europe, and
• one for reproduction.

When asked by the expert what the latter one is, he says that he does not know and that he has not quite finished thinking it out.

Then he says he thinks five reserves for Norwegians must be established, to be controlled by local guardian council under a national guardian council.

Finally, the expert asks the subject about his future. He says if I have misjudged and noone wants to work with me, I have missed so badly that I will self-terminate after the trial. But the requirement for continuing to live is that I can fight on, and I will do this if only one individual will work with me. If I have been wrong and noone will work with me, I self-terminate, he repeats. It was a brutal operation, but ingenious.

Present status by expert Husby on 21 November 2011

The subject is awake, in clear consciousness, and aware of time and place and situation. Intelligence clinically assessed to be in the normal range. The subject uses numerical values ​​and percentages to a greater extent than is common in regular speech. He uses a technical, unemotional and not very dynamic language in the conversation.

He appears emotionally flattened, with complete emotional distance to his own situation and to the criminal actions. He is polite and cooperates to the best of his ability. He laughs and smiles quite often, when related to issues concerning his own individual significance and/or his actions.

The subject has a light glaring look.

The subject is unable to take the community perspective, i.e. how he will be considered by the outside world. He maintains that he is proud of the criminal actions and characterizes them as brilliant. The subject appears with a marked affective flattening and severe empathy failure.

The subject uses unusual terms, e.g. military order, warriors, awards, medals, resistance movement, operation, ethnic cleansing, DNA testing, executions, extermination. The terminology used is entirely linked to the subject’s notion that there is a civil war going on in the country and is considered as expressions of underlying, paranoid delusions.

The subject uses words such as reproduction and reserves when describing his own position. He also points out that he is decisive in the war for Norway’s existence, and he is at war with chemical, biological and flame weapons. The terminology used is considered as expressions of underlying, grandiose delusions, partly also of a bizarre nature.

Auditory hallucinations and possible influence phenomena cannot be confirmed, since the subject maintains that his forms of communication with like-minded persons are secret.

The subject appears to have an unclear identity feeling, as he switches between describing himself in the singular and plural.

There is no latency or thought block during the conversation.

The subject appears without depressive thoughts in the form of guilt, shame, hopelessness, or thoughts about his own death by suicide. He denies experiencing sadness, joylessness, reduced initiative or lack of initiative. There is thus no evidence of a depressed mood.

The subject does not exhibit increased psychomotorical tempo, or perceived high mood. The subject’s speech is coherent and with normal syntax. He has no mind or voice strain. He is “affect stable”. There is no evidence of lack of impulse control, neither verbally nor physically. There is thus no evidence of a high mood.

The subject appears without clinical suspicion of intoxication.

The subject confirms suicidal thoughts regarding the possibility that he may commit suicide (“self-terminate”) after the trial if he does not succeed in his enterprise and noone wants to work with him.

6.0 Psychometrics


6.1 SELECTION OF TESTS

The experts have found it appropriate to include the Global Assessment Functioning (GAF) score to give a complete picture of the subject’s overall functioning.

The experts have found it appropriate to use some further psychometric investigations. Because our mandate requests a diagnosis in accordance with the International Classification of Desease (ICD) – version 10, there are few diagnostic tests available. We have chosen to use the Mini International Neuropsychiatric Interview (MINI), version plus, for this purpose, since the interview has a supplement with approximate, ICD-10 diagnoses.

The experts have also chosen to go through some modules from the Structural Clinical Interview for DSM disorders (SCID) for the same purpose, although this is solely a diagnostic manual of the American diagnostic system Diagnostic and Statistical Manual (DSM) version IV.

For a meaningful diagnosis of any personality disorder in ICD 10, it is required that the described differences not be directly attributable to a different psychiatric disorder. Since the subject at the time of the survey and prior to this has had severe psychotic symptoms, the experts have not found it correct or appropriate to score him after the SCID II.

The subject’s score is not inclusive of affective disorders. The psychometric measures Montgomery and Asberg Depression Rating Scale (MADRS) and Young Mania Rating Scale (YMRS) shall be used only when the diagnosis is known to be, respectively, depression or mood elevation. The experts therefore concluded that these structured interviews cannot be used, but have nevertheless chosen to go through all stages of investigations to ensure that all symptoms are explored.

The subject scores inclusive of schizophrenia, current and lifetime, using the diagnostic tests in SCID and MINI plus.

6.2. Global Assessment Functioning (GAF)


GAF – F

The subject’s functioning is assessed to fit the description Unable to function in almost all areas, as well as the additional comment With this conduct disorder, symptoms and functions go into each other.

GAF Score – F: 23

GAF-S

The subject’s symptom level is assessed to fit the description Persistent danger of harming oneself or others seriously. The additional comment Most serious psychopathological conditions, needs constant assistance, supervision and protection over time is also judged to be present.

GAF scores – S: 2

x.3. MINI plus

The Norwegian version 5.0 for DSM IV is used. Conversation data were obtained from 20 September 2011 and 22 September 2011. The subject found it difficult to limit his answers to many questions to yes or no and he took up issues that were beyond the questions.

Since schizophrenia was suspected, Part I, module M, was coded first. Then the modules were coded in the order A – D, then Part 2, module M, and finally the other modules in the usual order.

The results are presented as they are chronologically present after the completed coding.

Regarding depression, module A

The subject does not satisfy the required entry criteria for a major depressive episode, neither current nor past.

Regarding dysthymia, module B

The subject does not satisfy the required entry criteria for current or past dysthymia.

Regarding suicidality, module C

The subject confirms that he on one occasion during the past month has considered taking his own life. (Self-terminate). He has previously had recurring thoughts of ending his life through the criminal acts. (Martyrdom). He has had a plan for how this would take place. After weighting of replies with sum 17, the subject fills the criteria for suicide risk, ongoing high risk.

Regarding manic (hypomanic) episode, module D

The subject does not satisfy the required entry criteria for current or past hypomanic or manic episode.

Regarding anxiety/panic disorder, module E

The subject does not satisfy the required entry criteria for current or past anxiety – or panic disorder

Regarding agoraphobia, module F

The subject does not satisfy the required entry criteria for current or former agoraphobia

Regarding social phobia, module G/specific phobia, module H

The subject does not satisfy the required entry criteria for current or former phobias

Regarding obsessive – compulsive disorder, module I

The subject does not satisfy the required entry criteria for obsessive – compulsive disorder

Regarding posttraumatic stress disorder (PTSD), module J

The subject fills one entry criterion of the module, in that he has witnessed murder and has been afraid of being killed during the criminal actions. He does not fill the entry criteria for the next module, since he denies having been afraid, having had nightmares about the event, having experienced avoidant behavior or having had flashbacks. Thus he does not fill the necessary entry criteria for PTSD.

Regarding alcohol abuse and dependence, module K

The subject does not satisfy the required entry criteria for either past or present alcohol dependence.

Regarding substance abuse and dependency, module L

The subject confirmed to have taken marijuana at a couple of occasions in 2010. He says he has used steroids in three cycles, each of a couple of months’ duration. He has taken the drug ECA stack, an estimated total of 60 capsules over a decade.

His scores are not inclusive on any of the elements that explore dependence, current or lifetime.

Regarding psychotic disorder, module M, Part I

The subject believes that his life is in danger. He believes that the Norwegian people is about to be raped and killed, that there is ethnic cleansing in the country, and that he is commander in an ongoing civil war. The symptoms are jugded as bizarre delusions. The subject thinks he knows what others think and believe. The symptom is considered a perceptual delusion.

The subject says he has never had auditory hallucinations. The experts’ assessment is that it seems difficult to know for sure, as the subject says that all the information about his communication and communication is confidential.

The subject does not believe there is an outside force that can place thoughts into his head or influence him. He confirms that friends and family members have reacted to his opinions and ideas. The subject suspects having been under surveillance, possibly filmed in his home, and has searched for microphones and cameras. He has been afraid of infection and radiation. He believes he has received messages in code.

Observanden responded negatively to whether he had ever believed that he was featured in TV, newspapers, radio or over the Internet. The experts find it difficult to gain an overview of this, since the subject does not want to provide details on his use of electronic communication.

The subject is considered to have a mild to moderate association distraction and perseveration.

His behavior during conversation is not disorganized, and he is polite and tidy.

Throughout the interview, the experts find that clear, negative symptoms appear in the form of alexithymia, as well as affective flattening.

The duration of the symptoms is more than six months. The symptoms have had great influence on the subject’s work and social life. It is commented that the subject, in accordance with his own desire, has not been somatically examined. The subject fills the criteria for psychotic disorderish, lifetime and current.

Regarding the module Psychotic disorder, decision tree

The subject’s psychotic symptoms have never coexisted with ongoing mood disorder. The duration of symptoms is more than six months. Serious dysfunction is present. The subject meets the criteria for schizophrenia, lifetime, and schizophrenia, ongoing.

Regarding eating disorders, modules N and O

Module is not completed.

Regarding generalized anxiety disorder (GAD), module P

The subject does not satisfy the required entry criteria for past or current GAD.

Regarding anti-social personality disorder, (optional) module Q

The module is not completed, as ongoing and lifetime psychotic disorder do no make this meaningful.

Regarding somatoform disorders, module R (optional), Module is not completed.

Regarding hypochondriasis, module S

The subject does not satisfy the required entry criteria for hypochondriasis, since he says he has never been ill.

Regarding dysmorphophobia, module T

The subject has had thoughts about his appearance not meeting society’s norms of beauty. He has considered having plastic surgery and fixing the position of his teeth. There is no evidence that the subject has thought about this all the time. The subject does not satisfy the necessary criteria for dysmorphophobia.

Regarding somatoform pain disorder, module U

The subject does not satisfy the required entry criteria for somatoform pain disorder.

Regarding behavioral disorder, 17 years or younger, module V, and attention deficit and behavioral disorders (ADHD), module W, children – adolescents

The subject’s age renders the module irrelevant.

Regarding attention deficit and conduct disorder (ADHD), module W, adults

The subject does not satisfy the required entry criteria for ADHD

Regarding adjustment disorder, module X

The module should not be used when the individual scored meets the criteria for another specific Axis I disorder. The subject meets the criteria for schizophrenia, lifetime and current, and the module is irrelevant.

Regarding Pre-Menstrual Dysphoric Disorder, module Y

The module is irrelevant

Regarding mixed anxiety and depressive disorder, module Z

The subject does not satisfy the required entry criteria for mixed anxiety and depressive disorder.

Overall assessment

The subject meets the criteria for schizophrenia, current corresponding to DSM – IV diagnoses 295.10 to 295.60 and ICD – 10 diagnosis F.20.XX.

The subject meets the criteria for schizophrenia, lifetime corresponding to DSM – IV diagnoses 295.10 to 295.60 and ICD – 10 diagnosis F.20.XX.

The subject meets the criteria for suicide risk, ongoing high risk.

The subject is not found to fill the criteria for other diagnoses through scoring.

6.4 SCID 1

Norwegian version 2.0 for DSM IV is used. Conversation data were obtained 20 September 2011 and 22 September 2011. The subject found it difficult to limit his answers to a yes or a no on a great many questions, and he took up the issues that were beyond questions.

The experts found it appropriate to limit the code to module A, (Affective episodes) module B (Psychotic and associated symptoms), module C (Differential diagnosis of psychotic disorders), module D (affective disorders) and module E (Substance abuse disorders).This was done ​​because the subject was already scored for all parts of the DSM IV through a full review of the MINI Plus, see above.

Module A, affective episodes

The subject did not fill the entry criteria for current marked depressive episode.(A1)

He did not fill the entry criteria for previous significant depressive episode (A12)

He did not fill the entry criteria for current manic episode (A18) He did not fill the entry criteria for current hypomanic episode (A24)

He did not fill the entry criteria for previous manic episode (A 28)

He did not fill the entry criteria for dystym disorder (A 38)

Module B, psychotic and associated symptoms

The subject scored inclusive on questions about self-captivating delusions, as he believes that in many cases he has been especially noted.

He believes that his surroundings, both privately, in previous employment, in former school contexts and in his political involvement in the Progress Party, noted him as very special and that everyone remembers him as extraordinary.

The subject scored inclusive on questions about persecution delusions, as he believes his life is threatened by the Labour party’s politics and think there is a civil war going on in the country. He believes that he, his friends and his family are to be imminently exterminated, with genocide and displacement from home.

The subject scored inclusive on the questions about grandiose delusions. He believes he has the power to decide who shall live and die in Norway, that he may be appointed as the new regent, and that his organization Knights Templar will take over power in Europe.

He scored below the threshold on questions about somatic delusions, as he confirmed to have been increasingly concerned that his appearance does not meet society’s beauty standards, and therefore has considered plastic surgery as well as dentistry.

The subject does not have sure religious delusions, but uses terms like salvation about his own mission, and the gift about his written work. He scores below the threshold on this question.

The subject does not have delusions of guilt, jealousy or of erotoman nature.

The subject has no delusions about his thoughts or actions being governed by external forces.

The subject has not experienced thought broadcasting

The subject explains the content of his delusions (the responsibility of deciding who shall live and die) with his exceptional and unique properties, he is the most perfect knight after World War II. He believes that by this and through established rights, he is intended to rule and transform Europe. The phenomenon is considered as bizarre.

The subject denies having experienced auditory hallucinations. The phenomenon is encoded as incomplete information, as the subject does not want to talk about how he communicates with his principals and like-minded persons.

The subject denies having experienced visual or tactile hallucinations. He also denies hallucinosis of taste and smell.

The subject does not have any symptoms in the categories for catatonic behavior, or grossly disorganized behavior.

He scores inclusively in the category grossly inappropriate affect, as he consistently appears with inadequate and blunted affective responses. When he tells about having killed a lot of people, he says he is proud and satisfied, laughing and smiling. He has no visible sense of guilt or shame.

The subject scores inclusively in the category incoherent speech, as he constantly diverts, returning to the contents of his delusions, almost no matter what is the topic under discussion. He thus has an association disorder with perseveration. He has no incoherence or latency.

The subject scores inclusively on weakness of will, as he over a period of at least five years has not been able to live alone, has been given practical help and assistance in all daily activities, has not been working or in education, and only to a negligible extent has interacted with others.

He has no language poverty.

The subject has a marked affective flattening, generally with few signs of emotional expression.

The subject describes symptoms of the above from 2006/2007, possibly also from 2002, but this is more uncertain. The subject describes an intensification of symptoms from 2009.He describes having acted on his delusions from early 2010.(Began the practical preparations for murder and destruction)

Module C, differential diagnosis of psychotic disorders

The subject’s psychotic symptoms have appeared without major depressive, manic or mixed affective episodes having been present.

The A criterion for schizophrenia: Is met, since the symptoms are delusions, disorganized speech, and negative symptoms have been present for a significant portion of time during a period of one month. The delusions are bizarre.

The D criterion for schizophrenia: Schizoaffective disorder is ruled out because no affective episodes have been jointly present with the A criteria above.

The C criterion for schizophrenia: Met. The duration of the subject’s totality of symptoms is above six months.

The B criterion for schizophrenia: Met. The subject has, in parallel with his symptoms, had a falling level of functioning, with a lack of interaction with others, inability to function in work, and inability to live alone.

The E criterion for schizophrenia: Met. The disturbance is not due to direct physiological effects of a drug, medication or a somatic state.(It is added here that the subject has not wanted to permit an MRI of his head.)

The subject meets all the criteria A to E for schizophrenia and accordingly scores inclusively for schizophrenia.

Criterion A – schizophrenia, paranoid form: Met. The subject is constantly preoccupied with his delusions.

Criterion B – schizophrenia, paranoid form: Met. The subject has no pronounced symptoms in the form of disorganized speech, erratic behavior, flat or inappropriate behavior or catatonic behavior.

After the A and B criteria for schizophrenia, paranoid form are met, the subject scores inclusively for paranoid schizophrenia.

Chronology (C 21): The subject has met the disorder criteria in the course of the past month. The state is considered serious, as the symptoms are persistent and have a prominent effect on his behavior.

The subject says that he has had the described symptoms at least since 2006, perhaps since 2002.Since the beginning of 2010, the symptoms have had a prominent effect on his behavior.

Progress description: Considered to be point 4) contiguous with clear negative symptoms since 2006, as characteristic A criteria (bizarre delusions, withdrawal, inability to work and self-care) have been present throughout most of the course.

Module D, affective disorders.

The subject misses the entry criterion, because the clinically significant affective symptoms have never been present.

Module E, substance abuse disorders

E1 alcohol abuse disorders: The subject has not had episodes with excessive drinking. Nothing points to alcohol-related problems. He lacks the entrance criteria for alcohol abuse disorders.

E 10 Non-alcohol-related substance abuse disorders. The subject has used marijuana twice in 2010. He confirms the intake of anabolic steroids over a few months each time, a total of three times, most recently until the criminal actions. He confirms intake of the homemade drug ECA Stack, and estimates his consumption to about 60 capsules in his lifetime. Last intake half an hour before the criminal actions.

None of the drugs have been used for a longer time than he had planned, he has never thought about cutting down or stopping consumption, he has not had a failed attempt to gain control over consumption, he has not spent much time trying to obtain drugs, the drugs have not affected his activities negatively, and he has not developed tolerance. He has never had withdrawal symptoms.

The subject does not score for dependence or abuse for either anabolic steroids, marijuana, or ECA stack.

Diagnostic summary:

After coding of module A, (Affective episodes) module B (psychotic and associated symptoms), module C (Differential diagnosis of psychotic disorders), module D (affective disorders) and module E (Substance abuse disorders), the subject meets the criteria for schizophrenia, paranoid form according to DSM IV

6.5 MADRS

The instrument measures the depth of a depression after a certain diagnosis of depression is established. The experts cannot find that the subject satisfies the requirement, consequently they can not use the scoring form.

The experts have examined observanden with regard to sadness, inner tension, reduced sleep, reduced appetite, experienced concentration difficulties, experienced fatigue, inability to experience pleasure as well as pessimistic thoughts, and note that he denies having had any of these symptoms.

The subject denies having or having had thoughts about taking his life by suicide. He does, however, express that death through martyrdom is welcome and desired. He also considers the possibility of self-terminating after the trial if he perceives a failure. The experts note that the subject’s suicide risk is considered high.

6.6 YMRS

The instrument measures the severity of mania after a certain diagnosis of mania has been established. The experts cannot find that the subject satisfies the requirement, consequently they cannot use the scoring form.

The experts have examined the subject with regard to any experience mood elevation for more than a week, increased motoric activity, increased sexual interest, shortened sleep, irritability and experienced loquacity, and observe that he denies such symptoms.

7.0 SUMMARY

The subject is now a 32 year-old man. He was born in Oslo XXXXX XXXXX.

[...]

His parents had previously been married, and both had children from previous relationships. The subject’s parents are both alive. XXXXX XXXXX. His mother lives alone in Oslo. The subject has three half- siblings, the six years older XXXXX on his mother’s side and XXXXX who is between eight and twelve years older than subject on the father’s side.

[...]

There is no information about serious financial difficulties or substance abuse problems in the subject’s family.

The subject’s parents divorced when he was eighteen months old, and he moved back to Frogner in Oslo with his mother and half sister XXXXX.

After the divorce, the subject has never lived permanently with his father. His father moved to XXXXX and the subject visited him there in the period from he was six to 14 years old. After this, the contact with his father was less frequent, and after the subject turned 16, there was little contact between them. The subject has not had any contact with his father after the age of 22

When the subject was three years old, his mother contacted the local social services to apply for a weekend home for the subject. The reason was that the mother found the subject demanding. This was tried, but did not work, and the arrangement ended.

In 1983, when the subject was four years old, mother contacted the local family counseling office, and the family was referred to the then State Center for Child and Youth Psychiatry (SSBU).The family was admitted there over a period of about a month in 1983.

[...]

The other facts of the case have not provided any evidence of serious psychopathology in any of his relatives, XXXXX XXXXX. There is no information regarding anyone in the family about serious mental health problems requiring hospitalization or assistance from specialists. There is no information about family members, on the father’s or mother’s side, having ended their lives by suicide.

[...]

The family was considered in need of help. It was suggested that the subject were placed in foster care, but this never happened.

The same year, his father petitioned to transfer custody and general care for the subject. The case was brought to court and it was determined that the mother should continue to have custody of the subject, while further investigation was to be done. In the meantime, his father waived his claim for custody and the matter came to a settlement.

In 1984, an investigation case was opened in the home, based on SSBU’s expression of concern. After investigation, no basis was found for foster care placement. The case was brought before the Child Welfare Committee, where it was dismissed.

Three or four years old, the subject started going to kindergarten. He adapted well, had friends, and nothing conspicuous is reported as to his motoric, psychological or educational development.

I 1982, the subject, his mother and half sister moved to a new, five-room apartment at Skøyen in Oslo. The subject started attending Smedstad elementary school at the normal age. He completed elementary school and there is no information about social, behavioral or learning difficulties. He got on well academically and at no time customized training, assessment or special assistance was discussed or implemented.

The subject then completed Ris Junior High School. Nor from this period is there any information that the subject’s functioning at school was conspicuous in terms of learning, social or behavioral matters. In 1994, the family moved to a smaller apartment, also at Skøyen in Oslo.

[...]

At the end of 1994, the Child Welfare Services received a message that the subject had been arrested by the police and reported for tagging. A survey case was opened and discussions held with the family. After a few months, the case was ended without any assistance measures.

The subject then went to Hartvig Nissen upper secondary school. He completed the first year successfully. He then changed school to Oslo Handelsgymnasium, where he successfully completed the second year. There is no information about lack of social or behavioral function from this period. He dropped {1out of school by Christmas in third grade, after which he has never commenced or completed any formal education.

After he left school, the subject started his own company, negotiating telephone subscriptions. He tried investing in the stock market, but lost a large amount of money on options. He also had shorter and longer employment contracts in several companies doing telemarketing and customer support.

The subject moved out from home in 2001.He lived for a year in a commune XXXXX XXXXX in Oslo. From 2002 to 2006, he lived alone in a rented apartment in XXXXXXX. Since 1999, the subject has been engaged in various business activities as an independent self-employed. There is information that the business of one of the companies was based on the production of all kinds of false diplomas. He also sold space for outdoor billboards and sold a variety of services within the IT business. The subject’s different companies were gradually closed down, and the last one went bankrupt in 2006/2007.

In 2006, the subject’s mother offered him to move home with her in XXXXX XXXXX, which he did. Subsequently, he has never been involved in any activities, neither as self-employed nor as an employee. He has not had any income or received any support from public agencies. The subject withdrew from social contact with friends, and has until the criminal actions mostly stayed in his own room. His mother cleaned the house, washed his clothes, shopped and cooked for him.

The subject lived with his mother until May 2011, when he moved to a rented farm in the valley Østerdalen.

The subject has no known abuse of alcohol, addictive drugs or illicit drugs. He confirms having smoked marijuana on a few occasions. In three periods of a few months’ duration, he has taken anabolic steroids. The last period lasted until the criminal actions.

The subject is now charged as detailed in the statement’s opening chapter. The subject has shown psychotic symptoms during the investigation.

8.0 DISCUSSION/ASSESSMENT


8.1 INTRODUCTION:

The experts’ assessment is based on the case documents, including a larger number of interrogations on DVD/CD, information obtained from persons who know the subject, collected health data, psychometrics and the experts’ own conversations with the subject.

To understand the terms of the assessment, one must read the descriptive parts of the statement. This applies both to the document excerpts (including the assessment of the subject’s compendium) and the experts’ conversations with the subject.

After the minutes of each conversation in the statement’s Chapter 5, a psychiatric present status is given that presents the experts’ summary and assessment of the symptom picture described through the current conversation. In the following diagnostic assessment chapter, ​​a summary of the experts’ findings is made in a final diagnostic conclusion.

The assessment is presented chronologically, with a review of the subject’s life, both in terms of symptom development and functioning.

8.2 DIAGNOSTIC EVALUATION

Through the case documents and the conversations with the subject’s mother, information is obtained that the subject evolved inconspicuously with respect to motoric and verbal skills throughout his first years of life.

Starting from 1981, the subject and his family were in contact with the local child welfare services. At that time, the subject was described by his mother as demanding. No information emerges through this contact about specific psychopathology in the subject.

The subject and his family stayed at the National Center for Child and Adolescent Psychiatry in the period from 1 February 1983 to 25 February 1983.In the discharge summary from the stay, interaction difficulties with the mother are described. There is no information about specific psychopathology in the subject.

In a letter to the child care services after the same stay, the subject is described as avoiding contact, a passive and little anxious child, with a manic defense characterized by restless activity and a fake, deprecating smile. In the letter to the local child welfare services, there is no diagnosis associated with the subject’s mental health, and no specific description of any other psychopathology.

Through conversations with the subject and with his mother, as well as through the additional information obtained, the experts have not found evidence measures have been implemented that during the subject’s upbringing related to his behavior, his intellectual development, or his mental functioning. There is no information to indicate that there has been any concern related to his development until puberty.

When the subject was 15 years old, in 1994-1995, the local child care services again opened a case regarding the subject and his family. The background was that the subject during the course of 1994 on several occasions was reported to the police for graffiti/vandalism. After conversations with the subject and his mother, the case was not found to be severe enough to implement assistance measures. In the case documents from the child welfare services, no concern emerges regarding the subject’s mental functioning.

Through the mandatory school as well as the first two and a half years of high school, the subject did slightly better than average. He did, however, drop out of the high school before the final exam. As far as the experts know, in this connection he was not referred to follow-up or investigation by any authority.

The experts therefore do not find evidence of any form of sure uneven development throughout the subject’s childhood and adolescence, and therefore no evidence that the subject meet the criteria for any behavioral or developmental disorder according to the diagnostic manual ICD-10.

The subject has never experienced depressive phases with a duration of two weeks or more. He appears through the experts’ investigations without depressive ideas in form of guilt, shame or feeling of hopelessness. He denies having experiencing sadness, joylessness, reduced initiative or lack of initiative.

The subject has never experienced a lifted mood lasting for more than a week. Throughout the experts’ investigation, he exhibits no increased psychomotoric activity, or perceived lifted mood. The subject’s speech is coherent and with normal syntax. He has no mind or voice strain. He is affect stable. There is no evidence of lack of impulse control, neither verbally nor physically.

There is thus no evidence of either depressed or raised mood, neither at the time of investigation nor earlier. Through the information obtained from persons who know the subject, as well from the witness examinations, no evidence emerges of such symptoms, neither current nor previous. Thus the experts do not find evidence that the subject meets the ICD-10 criteria for any affective disorder.

In the period from 1998 to 2002, the subject was self-employed and lived with friends 2001in a shared housing. A normal connection with friends and family is described. Relationships with women of his own age are also mentioned, though not of a very long duration. Through conversations with the subject and with his mother, as well as when reviewing the witnesses examinations, the experts find no sure evidence of psychopathology in the subject during this period.

Starting from 2002, the contact with his peers decreases. The subject lived alone in a rented apartment. No relationships with women are mentioned. The subject’s different commitments to various business activities are described by himself as successful, with many employees and high earnings. These informations cannot, according to the subject’s own information, be verified, neither through his tax certificate nor the business register.

The experts find that the subject in the period from 2002 to 2006 had an increasing tendency to isolate himself, and that he gradually lost his functional ability. The experts have no sure evidence that can say when the subject’s psychotic symptoms started, but it cannot be excluded that the onset of symptoms was already in this period.

Based on the overall documentation of the case, there is surely a change in the subject’s function from 2006.Witness examinations of his friends describe that from this point, the subject withdrew from social contact, was more quiet, moved home to his mother, and stopped working. The experts consider the phenomena to be withdrawal, isolation and inability to meet the demands of professional life.

The subject’s mother has described how he turned the day, played a lot of video games, and from that time on was the mostly alone in his room. The subject did not participate in cleaning or caring for the apartment, the care of his own clothes, or cooking. His mother did all the grocery shopping. The subject’s mother says that he did not give in to pressure for contacting the employment and social security office NAV to get assistance, be it of a practical or an economical character. The symptoms are assessed by the experts to be extensive loss of function, both practically, socially, economically and in terms of employability.

From 2010 the subject’s mother describes a qualitative change in his behavior. She says that the subject from this point was concerned with infections and his own appearance, and he was uncomfortably intense, irritable and angry. He was increasingly keen to talk about politics and history, and his mother felt under pressure from him. She says that she had a hard time understanding what he wanted to say. She describes the subject as completely beyond, and he believed all the crap he said. The phenomena are considered by the experts to be expressions of psychotic delusions.

The subject’s mother says that he no longer seemed to know how much distance he should keep to her, as he could switch between sitting too close to her on the couch, and not wanting to accept the food she served. The behavior is assessed by the experts to be regulatory difficulties as a result of paranoid delusions.

The subject has up to the present never received treatment from a psychiatric specialist. A survey through the medical records from GP XXXXXXX XXXXXXX does not reveal information about symptoms related to severe, mental illness. A note from April 2011 has been found, in which the GP says the subject in a phone consultation says he uses a face mask indoor. The phenomenon is considered to be caused by a paranoid delusion.

Throughout all the experts’ research, the subject appeared with clear consciousness, and aware of time and place and situation. The subject used numerical values ​​and percentages to a greater extent than is common in regular speech. He uses a technical, unemotional and not very dynamic language in the conversation.

The subject appeared emotionally flattened, with complete emotional distance to his own situation and to the experts.

The subject maintains it was fair that the victims were killed; he does not regret and feels no guilt. He believes that the victims died as a consequence of his love for the Norwegian people. When asked for an assessment of his own actions, his considerations remain without empathy. The subject estimates the consequences of the murders for his own reputation and future impact, and further how the killings could influence and possibly accelerate the political project of a future takeover of power in Europe. The subject is unable to take the victims’ or the community’s perspective in relation to the criminal acts.

The subject does not express feelings for the persons closest to him. He describes all topics, from childhood to the criminal actions and their executions, with an operationalized language without any emotional component. The subject appears with a marked emotional flattening and severe empathy failure.

The subject has a light glaring look and blinks a lot. He appears with a slightly reduced facial expression and a somewhat rigid body language, as he moves very little on the chair during the investigations. The experts consider this as light psychomotoric retardation.

The subject uses unusual terms, e.g. low-intensity civil war, military order, military tribunal, executioner, and operation. The terminology used is entirely linked to the subject’s notion that there is a civil war going on in the country and is considered as expressions of underlying, paranoid delusions.

The subject uses unusual terms such as established rights, sovereign, power of definition, responsibility, love of the (my) people, unique, pioneer and new regent related to descriptions of his own position. The terminology used is considered as an expression of underlying, grandiose delusions.

The subject presents self-made words like national Darwinist, suicidalMarxist and suicidal humanism, Knight Chief Justice, Chief Justice Knight Commander, Knight Chief Justice Master and Knight Chief Justice Grand Master. The terms are considered to be neologisms.

The subject believes that he by established right is the ideological leader of the organization Knights Templar, which has a mandate to be a military order, martyr organization, military judicial chair, judge, jury and executioner. He believes he has the responsibility of deciding who shall live and die in Norway. The responsibility is perceived as real, but burdensome. The phenomena considered as a bizarre, grandiose delusions.

He believes that a significant proportion of the population (several hundred thousand) supports the criminal actions. He believes that his love is over-developed. He thinks he is a pioneer in a European civil war. He compares his situation to historic war heroes such as Tsar Nicholas and Queen Isabella. The phenomena are considered grandiose delusions.

The subject believes it is likely, although with somewhat varying estimates of the probability in percent, that he can become the new regent in Norway after the coup and takeover of power. If he becomes the new regent, he will take the name of Sigurd II the crusader. He believes he has given five million kroner to the struggle. He thinks he may one day be responsible for the deportation of several hundred thousand Muslims to ports in North Africa. The phenomena are considered grandiose delusions.

The subject believes that ethnic cleansing is going on in Norway, and he lives with the fear of being killed. He believes that a nuclear third world war may be triggered as a result of the events he is a part of. He believes there is a civil war going on in the country. The subject is working on suggested solutions that would improve our ethnic Norwegian genetic pool, eradicate disease, and reduce the divorce rate. He envisions reserves (for “indigenous Norwegians”), DNA testing, and lots of birth factories. The ideas considered as part of a bizarre, paranoid delusional system.

The subject believes that the Glücksburgers (The Norwegian and European royal house, experts’ note) will be revolutionarily removed in 2020. As an alternative to the new regent being recruited from the Guardian Council, DNA tests will be conducted of the remains of St. Olav and Harald Hardråde. Then the Norwegian population will be DNA tested to find the one with the greatest genetic similarity, who can then be appointed as the country’s new regent. These ideas are also assessed as part of a bizarre, paranoid delusional system.

Auditory hallucinations and possible influence phenomena cannot be confirmed, since the subject maintains that his forms of communication with like-minded persons are secret. The experts suspect that auditory hallucinations and/or influence phenomena have been or are present, but have no evidence for this.

The subject shifts between referring to himself as I and we, i.e. singular and plural. The experts assess the symptom to represent a fuzzy identity experience and depersonalization.

The subject is sometimes difficult to follow, because he quickly switches topics and must be brought back by to it by questions. He associates a lot, and his associations almost always take him, regardless of the approach, back to his political message, its perceived mission and position. The phenomenon is considered as a moderate association disorder.

When he is given the opportunity to talk freely, the subject incessantly circles around the same themes. He repeats over and over again the same details relating to his own knighthood, radicalization, organization, Knights Templar, upcoming coup and takeover of power in Norway and Europe. The phenomenon is considered by the experts as perseveration. There is no latency or thought block during the conversation. The subject does not exhibit disorganized behavior.

The subject considers his own private and personal experiences of paramount importance to social issues and decisions. For example, the subject believes that his use of smokeless tobacco, nicotine, and candy is war strategy. Furthermore, he describes private movements and activities as guidelines for future revolutionary knights in his compendium.

The subject’s cognitive functions are inconspicuous as regards limited intellectual capabilities. He is focused in conversation, he has unusually good memory both of details and circumstances, and his compendium testifies a great capability of detail and dealing with a large amount of issues. He has also managed to plan and carry out a highly complicated act.

The subject’s ability to reach an overall cognitive understanding of himself and his relationship to the outside world, is failing. The subject is not able to see himself from another perspective than his own. In particular, this is manifest in his inability to understand or empathize with the outside world’s reaction to the criminal acts. The subject presents his expectations to the outside world’s reactions in accordance with his own delusions. He describes the explosion and killing as brutal but brilliant. His comments to the actions are peculiar and somewhat bizarre, as he describes himself as a hero, knight, and with too much love.

The described, psychotic symptoms appear to have come gradually. There is evidence of continuous deterioration from 2006, perhaps also with prodromi (“for” symptoms, experts’ note.) much earlier. The time of first appearance coincides with a total failure, both socially, practically and professionally. Since 2009, the subject has described thoughts about eavesdropping and surveillance. From 2010, it is described that the subject, also through acquiring weapons and doing reconnaissance, has acted in accordance with his psychotic symptoms.

In his explanation given to police at 20.15 on 22 July 2011, the subject says that he is the commander and says further: We are crusaders and nationalists. The subject says the criminal acts on that day manifest the start of a very bloody civil war. In the same explanation, he maintains that Knights Templar Norway has given him authority to execute A, B and C traitors, and that the organization is the top military, police and political authority in Norway. The symptoms are considered to be grandiose and paranoid delusions.

The diagnostic manual ICD-10 lists as general requirements for diagnosing schizophrenia, that at least one very obvious, (or alternatively two or more if the symptoms are vague) symptoms in the symptom groups a) to d) must have been present for at least a month or more.

The experts find that the requirement is met, as the subject for a period of one month or more has had clear symptoms in the following symptom groups:

(b): Delusions regarding perception and control, as exemplified by the feeling that the subject knows what others think.

(d): Persistent, bizarre delusions, exemplified by the idea that he is participating in a civil war where he is responsible for deciding who shall live and die, and that he expects a power takeover in Europe.

The diagnostic manual ICD-10 says that the diagnosis can also be made if symptoms from at least two of the symptom groups e) to h) have been present for a substantial part of a month or more. The experts also find that this alternative requirement is met, as the subject for a period of one month or more has had clear symptoms from the following symptom groups:

(f): Interrupted or sudden thoughts, exemplified by occasional perseveration, associative speech and neologisms.

(h): Negative symptoms, as exemplified by the marked emotional flattening.

The experts add that symptoms from ICD-10 symptom group i) also have been present for a period of more than six months;

(i): A significant and sustained qualitative change in some aspects of personal behavior, described by a marked decline in social functioning, practical and economic collapse.

After the general requirements for schizophrenia are found to be satisfied, the condition is classified according to the diagnostic manual ICD-10 subgroups, depending on the working out of the symptom profile.

The subject exhibits a picture of stable, detailed and comprehensive, paranoid and grandiose delusions. The symptoms have a bizarre character. The subject exhibits no prominent interference in his will, his speech is not disturbed, and he has no catatonic symptoms.

Thus, the experts find that the subject satisfies the criteria for the ICD-10 diagnosis F 20.0 Paranoid schizophrenia. The experts refer to the investigation of the subject by psychometric tests in Chapter 6. The investigations referred to confirm the diagnosis.

During the conversations, the subject appears with comprehensive ideas of killing named individuals, such as the Royal Family, the Prime Minister and Foreign Minister. His list of Norwegians who must die if they do not change the political course encompasses hundreds of thousands, including journalists, party politicians, prominent social commentators and intellectuals, as well as the experts. The ideas are considered as extensive, homicidal thoughts.

The subject denies specific suicidal thoughts or plans. However, he says that his own death by martyrdom is desirable and an ideal. He has considered self-terminating, which he thinks is related to a capitulation during combat operations. The experts find that both the subject’s term martyrdom and his concept of self-termination must be understood as suicide. The subject has had specific ideas and plans for this, and does not exclude that it may be necessary at a later date, for example, after the trial.

The experts find that there is a considerable risk that the subject may attempt to end his life through an act directed against him and/or the ones he threatens on their lives. The subject thus appears both as suicidal and as a real danger to others.

The experts have considered whether the subject’s symptoms may be consistent with the diagnostic manual ICD-10′s criteria for the diagnosis F 22.0 Paranoid psychosis. According to ICD-10, this is a condition characterized by either one single or several related delusions. The criterion is not met, as the subject’s bizarre delusions cover his entire life and thought.

Clear emotional flattening, altered speech and behavior change are, according to the ICD-10, not compatible with the diagnosis. The subject has a marked affective flattening, altered speech in the form of association disturbance and perseveration, and his behavior is motive by his psychotic symptoms. Thus, the experts find that the ICD-10 criteria for this diagnosis are not met.

The experts discussed the possibility that the subject meet the criteria for various personality disorders. For such diagnostics to be meaningful, the subject’s basic illness, paranoid schizophrenia, must be well treated first. Only in a phase where he, stably and over time, does not have any psychotic symptoms, it will be possible to evaluate whether the subject’s lack of empathy and his overall cognitive failure are also rooted in qualities related to his personal characteristics.

From the case documents and the experts’ investigations, no evidence has been discovered that the subject has abused alcohol. He confirms having taken marijuana on two occasions, the last intake several months before the current actions. The intake does not qualify for any substance abuse diagnosis. Apart from this, he has not used illegal drugs.

The subject confirms that he in a total of three periods has used anabolic steroids. The first period lasted from February to May 2010.The second period lasted from December 2010 to February 2011. He used the drug marketed as Winstrol.

The third period lasted from 27 April to 15June 2011, when the subject used the drug marketed as Dianabol. This period went directly over in a period that lasted until the criminal actions, when the subject says to have taken Winstrol.

The subject has further stated that he used the restorative drug ECA stack (Ephedrine, caffeine and aspirin, experts’ note) prior to the action time. He said that he used three capsules during the week before the criminal actions. The last intake is said to have been at 14:30 hours on 22 July 2011.

He does not describe symptoms of addiction or experienced mental change as a result of the use. Neither does he describe acute intoxication symptoms related to the use of steroids or the combination of ephedrine, caffeine and aspirin.

In the periods he used anabolic steroids and/or ECA stack, the subject has had psychotic symptoms. The experts find no evidence that the steroids or the combination of ephedrine, caffeine and aspirin have caused the symptoms, that were described as certainly present before the first cycle of steroids started in 2010, and also present regardless of consumption of ECA stack.

The experts thus find no evidence that the use of steroids or the combination of ephedrine, caffeine and aspirin justifies any diagnosis in the ICD-10 chapter Mental and behavioral disorders due to psychoactive substances, F 10 – F 19, before, after or during the acts on 22 July 2011

The experts find that the subject had taken steroids, ephedrine, caffeine and aspirin on 22 July 2011. The use was not based on medical needs, and is thus considered medically unfounded. The subject thus meets the criteria for the ICD-10 diagnosis F-55 abuse of addictive substances on the time of action on 22 July 2011.

After he was remanded in custody, the subject has not taken drugs, steroids or any combination of ephedrine, caffeine and aspirin. Thus, he does not meet any of the diagnosis criteria at the time of investigation.

Overall, the experts find that the subject at the time of action met the ICD-10 criteria for the diagnoses F 20.0 Paranoid schizophrenia and F 55 abuse of non-addictive substances (steroids, caffeine, ephedrine and aspirin.)

At the time of the survey, the subject met the criteria for the ICD-10 diagnosis F 20.0 Paranoid schizophrenia.

8.3 DETAILED RESPONSE TO THE MANDATE

Regarding the forensic psychiatric term “psychotic”, cf. Penal Code § 44, first paragraph, the experts state the following:

General comment:

A psychosis will involve a serious departure from reality in terms of perceptual disturbances, thought disorders, or clear delusions.

• A sense illusion will consist of auditory, visual, odor, taste, or tactile hallucinations. Hallucinations have the same clarity and clarity as normal visual or auditory sensations, but without the existence of any real external cause of the experience.

• Thought disorders are changes in form of thought (not the content) 

Examples include interruptions of thought, new formations of concepts, or lack of coherence in thought or speech.

• A delusion is a change in thought content (not form), having a false sense of something, a strange idea, like feeling persecuted and systematically monitored or influenced, without being based on reason or observation, and being difficult to correct. Delusions (s) may be single, isolated, fragmented, or more extensive and complex, even all-encompassing.
• Depersonalization is a change in the experience of oneself. The person in question may feel that he/she is an alien, changes identity, is unreal or that he/she sees him/herself at a distance.
• Derealization is when someone experiences the world as different, as changed, or as unreal.

Specific comment:

We refer to the diagnostic assessment above, where the subject at the time of action on 22 July 2011 is found to fill the criteria for ICD-10 diagnosis F 20.0 paranoid schizophrenia. The subject’s serious mental illness was at this time untreated. He has not, neither before nor after the criminal acts, received adequate treatment for his disease.

The experts have conducted extensive investigations of the subject, and the conversations and the psychotic symptoms that emerged through these investigations are elaborated in the statement’s Chapter 5, Background and explanation by the individual under observation.

The subject’s symptoms and diagnosed disorder are within the symptom and diagnostic circuit that meets the criteria of the legal concept of psychosis as intended by the Penal Code § 44 relating to mental incapacity.

Since at least 2006, the subject has had a clear disease progression with both positive symptoms (delusions, thought disorder, depersonalization, and derealization), and negative symptoms (total empathy failure, severe affective flattening and an inadequate expression of affect).He also lacks complex and overall cognitive functions, as pointed out by the experts above.

The subject’s loss of function possibly began as early as 15-16 years of age with tagging, police reports, and then drop-out before finishing high school. The experts have no sure evidence of disease progression, i.e. consisting of active symptoms, in the period 1998 to 2006. The subject’s function does, however, appear to have been gradually weakened during the period, as he gradually withdrew from social contact, and eventually dropped completely out of the professional life.

After the subject’s return home to his mother in 2006, his functional impairment became complete, with a total failure of a practical, economic, social and professional nature. At the same time a progressive development of symptoms is described, with a gradually developed system of bizarre paranoid and grandiose delusions, where the subject believes he is a participant in an ongoing civil war, and that he after a coup and takeover of power will participate in the design of a new Europe.

The subject starts to act in accordance with his delusions at the beginning of 2010, with purchases and planning of armed action. Over the last eighteen months before the criminal actions, he has dedicated all his time and attention to his delusional universe, and his mother confirms extensive symptoms, conspicuous behavior and lack of communication skills right up to the current events.

The subject acknowledges having carried out the criminal actions. The actions are considered to be in direct correlation with the delusional world in which he perceives to be in a civil war, with the threat of extinction of his race, as well as fear of violence and the genocide of what he describes as my people. He claims to have the responsibility to decide who shall live and die in the country. His extremely egocentric universe with almost all-encompassing ideas of greatness characterizes all his assessments and his whole appearance, regardless of context, and then becomes the driving force behind his actions on 22 July 2011.

There is no evidence of abrupt or intermittent changes in the subject’s psychotic symptoms during the period before the current events. Thus, there is no evidence that the manifestation of the subject’s symptoms was changed as a result of taking steroids or the invigorating drug ECA stack prior to the criminal acts.

Based on the descriptions, the experts find that the manifestation of his symptoms remains unchanged from before the criminal actions and throughout the whole investigation.

The conclusion is thus that the subject is believed to have been psychotic at the time of the criminal actions and that he was psychotic during the observation.

Regarding the forensic psychiatric terms “unconscious”, cf. Penal Code § 44 first paragraph, and “acted under a strong disturbance of consciousness that was not a result of self-intoxication”, cf. Penal Code § 56 c, the experts state the following:

General comment:

With loss of consciousness is intended that a person for organic or psychological reasons is unable to absorb or process sensory input (perform cognitive functions), and therefore has not been able to recall what has happened.

This is in contrast to a psychological repression, where an episode is imprinted and stored in memory, but difficult to recall because it is perceived as threatening, embarrassing or unwanted.

Examples of organic causes are concussion, brain damage after being exposed to solvents, and intoxication. A psychogenic failure of imprinting can happen e.g. after extremely shocking emotional experiences.

Specific comment:

The subject reports no epileptic seizures, blackouts, head injury with loss of consciousness, severe sleep disorders, sleep deprivation or sleepwalking.

Both during extensive interrogations and many long conversations with the experts, the subject has described his actions on 22 July 2011 to the smallest detail. Also during the reconstruction of events at Utøya, he has given a detailed explanation that does not omit any period of time. He indicates, however, some memory loss regarding the most detailed descriptions there, and he believes that he does not remember because at that time, he was under tremendous pressure and stress. He is, however, able to make a coherent account of his movements and partly of his thoughts, also from this part of the lapse of time.

The experts have no reason to believe that his intake of steroids and ECA stack had any effect other than stimulating himself to overcome physical barriers with heavy equipment, as well as small mental barriers, without the intake having affected his reality orientation significantly. Thus, the information that the subject has provided from the period of action is detailed, and he describes having carried out complex processes immediately prior to, during and immediately after the criminal actions.

Unconsciousness assumes complete memory loss during the relevant period, and therefore cannot be said to have been present. In this connection, one refers to NOU 1990:5 and circulars from the Attorney General on 3 December 2001.

In an expert statement dated 7 November 2011, professor of forensic toxicology at the NIPH, Jørg Morland, writes the following in the section. Analysis results:

In his chapter Drug Effects in the period from 1200 to 1530 on 22 July 2011, expert Morland writes:

(…) According to the expert’s assessment, the impact in the period 1200 to 1530 may be described as a slight to moderate influence of a central nervous stimulant, depending on the concentration. The impact is difficult to compare with the influence of alcohol, due to fundamental differences in the effect mechanism between ephedrine and alcohol, but according to the expert’s assessment, the impact can probably be equated to the impact that may be achieved by an intake of amphetamine (by mouth) of doses of the order of 10-30 mg of amphetamine by non-habitual users. The expert assumes a certain reinforcement of the ephedrine effects because of the significant effects of caffeine concentrations that may have existed.

In his chapter Possibility of additional exposure as a result of regular use of ephedrine and steroids in the period prior to 22 July 2011, expert Morland writes the following: The reported use of ephedrine does not represent a long-term high-dose intake. Neither do the analytical results point toward high dosage consumption. Therefore, the possibilities of a psychosis of some duration triggered by ephedrine must be considered as minimal.

According to the expert’s assessment, the stated use of anabolic steroids is unlikely to have caused additional influences, but the possibility of enhanced aggression and hypomania/mania cannot be completely excluded.

Strong disturbance of consciousness is a legal term that does not have any clear medical interpretation. The Penal Code Council described the concept of strong disturbance of consciousness in NOU 1974:17, page 57, as a condition where an individual’s perception, orientation, perception and judgment are greatly impaired or severely disrupted. Based on the present expert descriptions, the expert assessment by professor Morland and the above considerations, it is assumed, with the reservation that the court may assess the information differently, that such a state has not been present. There is no evidence that the concept of strong disturbance of consciousness would be applicable.

The experts therefore conclude that the subject is not believed to have been unconscious or having acted under a strong disturbance of consciousness at the time of the criminal acts.

Regarding the forensic psychiatric terms “mentally retarded to a high degree” cf. Penal Code § 44, second paragraph, and “mentally retarded”, cf. Penal Code § 56 c, the experts state the following:

In early childhood, the subject was observed by the child and adolescent psychiatry. The reason for this was said to be a somewhat active boy who exhausted his mother, an interaction problem between the mother and son was also described. After observation, one concluded by recommending foster care for the subject, in order to avoid the development of a more severe psychopathology. Nothing was stated after observation regarding any developmental disorder, nor anything about reduced abilities of any kind.

During the interviews with the experts and police interrogation, the subject appears with intellectual resources above average. During primary and lower secondary school, his performance was slightly above average, as was the case in upper secondary school, until he dropped out in the middle of third grade. After this, the subject had some relatively inconspicuous years in the normal job market. The experts find no reason to suspect any capacity reduction of any kind or degree.

The experts conclude that the subject is not believed to be mentally retarded, neither in a high nor in a low degree.


Regarding the forensic psychiatric concept of “serious mental disorder with a significantly reduced ability of realistic assessment of one’s relationship with the outside world, though not psychotic”, cf. Penal Code § 56 c, the experts state the following:

Positive conclusion of the forensic psychiatric term psychosis, cf. Penal Code § 44, and positive conclusion of the forensic psychiatric term serious mental disorder with a significantly impaired ability of realistic assessment of one’s relationship with the outside world, though not psychotic, cf. Penal Code § 56 c are mutually exclusive. Due to the positive conclusion of mandate item 1 above, this item is not answered.

If the court were not to uphold the experts’ conclusion regarding item 1 of the mandate, cf. Penal Code § 44, the experts may produce a supplementary statement on this point.

As a consequence of the positive conclusion of the mandate’s item 1, one turns to the answer of the following item:

In addition if particular sanctions in the case of mental insanity are applicable

7. If the experts believe that the subject was in a condition described by the Penal Code § 44, or they are in any doubt about this, they are asked to investigate the prognosis for the disease/condition. The experts are asked to consider what treatment and what other measures are needed to obtain an optimal prognosis, what improvement may then be achieved, and the time frame for this. The support that the subject is getting from the health care system shall be particularly examined.

The experts are also requested to examine the prognosis in case the subject does not receive such treatment, including the risk of future violent actions.

Prognosis for the condition

The experts have found that the subject meets the diagnostic manual ICD-10 criteria for the diagnosis F 20.0 Paranoid schizophrenia. He has had symptoms of the disorder at least since 2006, with gradual worsening. He has at no time sought or received psychiatric treatment for his disorder.

Schizophrenia is a lifelong mental disorder with an overall lifetime prevalence of around 1%.The symptoms usually arise in early adulthood. Diagnosis is based on the patient’s own report of experiences, as well as observed behavior. There are currently no laboratory tests that prove schizophrenia. Neither is there any curative treatment for the disorder.

Research has not been able to isolate a single organic cause of schizophrenia, but one knows that genetics plays a significant role in the development of the disease. Neurobiology, substance abuse and psychological and social processes also seem to play a role.

As a result of the numerous possible combinations of symptoms, it is disputed whether the diagnosis describes a single disorder, or whether we are talking about multiple, separate syndromes.

An unusually high dopamine activity in the mesolimbic areas of the brain has been found in people with schizophrenia. The cornerstone in treatment of schizophrenia is antipsychotic medication. This type of medication primarily works by suppressing dopamine activity in the brain.

In severe cases, where patients can be a danger to themselves and/or others, hospitalization may be needed for shorter or longer periods.

The disorder is believed to primarily affect cognitive abilities, but it also contributes generally to chronic problems with behavior and feelings. Average life expectancy for people with schizophrenia is 10 to 12 years lower than for people without the disorder, due to multiple physical health problems and a higher suicide rate (about 5%).

According to survey articles, there are three forms of treatment that show a significant effect when treating paranoid schizophrenia. These are psychoeducation, assertive community treatment (ACT) 2 and treatment with antipsychotic medication 3.These forms of treatment are overlapping and must be considered together, since psychoeducation is part of the ACT, and one of the primary purposes of ACT is to maintain the drug treatment.

The psychoeducation aims at increasing the patient’s knowledge and understanding of his or her own illness. The training must be structured and systematic, and one of its purposes is to teach the patient to recognize warning signs and even have a repertoire of appropriate coping strategies ready upon increased symptom pressure.

The main principle of the ACT organization is multi-disciplinary team work by psychiatrists, psychologists, social workers, nurses and rehabilitation staff. These teams provide services in hospitals, at home, at school or work or where the patient is located and is available around the clock. They also maintain contact with patients who do not cooperate. Teams are especially focused on the prescribed medication being taken. The therapeutic approach is psychoeducational.

Continuous drug therapy is the single most important prognostic factor in the treatment of paranoid schizophrenia. Survey articles 4 show that interruption of treatment or non-optimal intake of antipsychotic medication represents a formidably elevated risk of relapse, both in the short and longer term.

Pharmacological treatment of paranoid schizophrenia is not a static, but a continuous and dynamic challenge. For example, weight loss, weight gain, fever, or incidence of other bodily disease may necessitate rapid changes in the dose or choice of medication.

Similarly, side effects or poor treatment response may require drug adjustments. It may also be necessary to decide compulsory drug treatment if it turns out that the subject is unable to follow up medication on a voluntary basis.

Since the subject has not received treatment of the disease, the experts have no basis for assessing how he can be expected to respond to treatment. Generally speaking, it is believed that his symptom profile will be difficult to treat adequately. This is because faster and better effect on perception disorders and severe thought disorders are observed more often compared to extensive delusions that have persisted for a long time. Only the further clinical development may provide accurate knowledge about this.

By far the most important challenge in terms of the subject’s medication will be to catch up if he is careless or completely refuses to take antipsychotic medication. With reference to Nancy Andreassen 5, this can be done in an optimal manner by regular ​​use of tools that can quickly pick up even minor changes in the subject’s symptom picture. Considering the shape his symptoms have taken, such monitoring would be done e.g. by the use of PANSS, positive and negative subscale.

The experts have also been asked to assess the risk of future violence in case the subject does not get such treatment/follow-up.

The experts have considered whether structured risk assessment instruments, such as the HCR 20, might help to investigate the risk of future violence by the subject. The premise basis for such a scoring is broad, and the experts consider that such a score would underestimate the actual risk of future violence by the subject, because this danger seems to be entirely related to his active psychotic symptoms.

It is taken into consideration that the subject has carried out the criminal actions, and thus killed 77 people with a desire to kill several hundred. The reason for the killings is his paranoid psychotic delusions that he is participating in a civil war, where he is responsible for determining who shall live and die. His mission is to save the culture and the genes of the Western world. He believes that he, through these murders, shows his knighthood and boundless love, and thus has an established right to future positions of power in Europe and Norway. The killings were planned.

The subject has shown his ability to long-term planning and implementation of his murderous intent. In conversation with the experts, he has maintained that a number of persons will be killed also in the future. The number has varied from a few thousand to several hundred thousand, and the subject mentions different scenarios that may result in murder.

The subject says that the killings would have to take place as retaliation of actions the above-mentioned persons have already carried out. The subject’s homicidal thoughts are related to official persons like the prime minister and members of the royal family, but also people with no official status, like university employees, employees of the various media companies, employees at the nuclear reactor in Halden and political demonstrators.

The subject also included the experts in his homicidal thoughts. These thoughts appeared after the subject having had discussions with the experts for some time. The experts see is as appropriate to mention this, because it shows that the subject’s homicidal thoughts are obviously dynamic and influenced by the context in which the subject finds himself at any time.

The experts assume that a similar scenario might unfold in the future, and believe there is a significant risk that people in the subject’s proximity, like prison or hospital employees, may also become part of his paranoid delusional world and included in his homicidal thoughts.

Continuous, antipsychotic medication with adequate dosage, monitoring of his condition by qualified staff, and eventually training in recognizing his own symptoms will be needed to achieve symptom control. Monitoring is also relevant for measuring blood concentrations after antipsychotic treatment. Failure to control symptoms may be due to the subject not receiving treatment, or a result of a lack of effect of the assumed adequate treatment.

For reasons mentioned above, the experts find that a possible outcome is that the treatment response may be small or absent. The subject has no insight in his illness. Thus, there is reason to expect problems with achieving a therapeutic alliance and voluntary intake of antipsychotic medication.

If one does not succeed in achieving symptom control, the experts consider that the risk of future violence by the subject is very high.

The experts’ assessments in accordance with the mandate are deemed justified by the above.

Reservations are made regarding the court’s assessment of the available information.

All of the above assessments are based on a clinical judgment involving uncertainties.

9.0 CONCLUSION

After having conducted a forensic psychiatric examination of Behring Anders Breivik, born 13/02/79, the experts find the following:

I. Regarding mental insanity (§ 44)

1. The subject was psychotic at the time of the criminal actions

2. The subject was psychotic during observation

3. The subject was not unconscious at the time of the criminal actions

4. The subject is not mentally retarded to a high degree

II. REGARDING PENAL CODE § 56 C

1. The subject did not act under strong disturbance of consciousness

2. The subject is not mentally retarded to a light degree.



Oslo, 29 November 2011

Torgeir Husby, Department chief physician and specialist in psychiatry

Synne Sørheim, specialist in psychiatry

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