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Professor Lars Weisæth: The same evening. I was on vacation in my summer house on the south coast of Norway, about 150 miles from Oslo. I was first called by NRK, the national television station. They know me, as I’ve been involved in all major Norwegian disasters in an advisory capacity. I’ve been trained in hostage psychology, helping police negotiate with terrorists or kidnappers, and I was chief psychiatrist of the armed forces.Were you involved as things were unfolding?
No, I was driving back to Oslo. I heard about the shootings on the radio, and when I arrived the situation was still not clear. To give advice to the health authorities the next day—which I had to do, as that became my role—I needed a clear idea. Ten had been regarded as killed, but the bigger numbers weren’t out yet. Then I managed to talk to some of the victims during the night and the next morning, so I got a clear picture of what had happened.And what did you put in place?
Well, when a traumatic event occurs, I diagnose it. There are three major types of large events: a company or organizational disaster; a local community disaster, when one community only is affected by an event; or a distant type of disaster—distant from the family—which this was. If it’s a local event, you move your resources there, but it was clear that the Utøya massacre was not. The 565 youngsters on the island came from all over Norway, and during the night we learned that 69 had been killed: 12 percent.
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The main problem was that there were no exact numbers. In the government quarter, it was established that only eight people had been killed. But we didn’t know who had been there. There are 4,000 people who work in this district—70 percent of the Norwegian state apparatus concentrated within a radius of 330 yards—and 1,700 offices were destroyed. But the main problem was on the island. It was dark. Nobody knew how many had been there. We learned finally that it was 565. So the uncertainty about the number who’d been killed was the main problem. The police only issue information that is certified. During that night, they only reported 10 people having been killed. But we had reason to believe it was many, many more. In my opinion, that should have been said. They created a false hope.
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In the governmental quarter, about 25 percent suffered from PTSD after seven months. On Utøya, it was 70 percent, although that is now down to about 25 percent after three years. Also, we did a national study of how the Norwegian population reacted. Grief was the main response. Half of the Norwegian population actually cried on the first weekend when it became clear what losses had occurred. The second most common response was anger—about 40 percent. Fear, which Breivik wanted to create, was far less frequent, although a bit more so among young people in Oslo.Is it possible that the families suffered PTSD, even though they weren’t directly submitted to danger?
Usually the families suffer losses, so you will have grief responses. But in this case there was a particular additional and very severe stress: namely, that a large number of the parents had had telephone contact with their sons and daughters before they were killed—actually, while they were being killed. Talking was of course itself a risk, because Breivik could hear them, and the mobile phones among the dead were going off all the time, too—families trying to reach their young ones. So, in this particular terror incident, the families took part in the ordeal, more than usually is the case.
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It did. A group of these youngsters that I’ve talked to were hiding in a small cave. Breivik shot and killed one of them, the farthest out, and then continued on his path. But when a boat came, with policemen calling out, “We’re here to save you,” they didn’t believe it. It obscured conditions for “early event identification," as we say. He also called out: “I’m here to protect you because there’s been a bomb in Oslo.” And when they went up to him, he shot them. It was really very evil.Was he insane, in your opinion?
In Norway, if you’re insane, you cannot be sentenced. In most other countries, it’s not enough to be psychotic [to escape trial]. It must also be the cause of your murdering—there must be a link between the psychosis and the crime. Actually, I think Breivik was psychotic along three dimensions: his grandiosity, his feelings of being persecuted, and his lack of affect. That is not what terrorists are usually like. To me, this is a very sick person: He smiles and kills.But is it possible to plan something so meticulously over such a long period of time and still be deemed insane?
Very good question, and that’s the other side. Along these three dimensions, he qualified for what you would call a partial psychosis—a paranoia. These people can be extremely rational, extremely logical, very good at arguing and long-term planning. They know the difference between right and wrong, and they know when they commit an act that it is wrong. And that’s the reason, I think, that in the end the court concluded that he was sane. Probably, if we had had a different law, we could have said both that he’s partially psychotic but also that he knew what he was doing and is sane enough to be sentenced.
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There is a scale: natural disasters, human error—let’s say in a traffic accident—human negligence, and finally violence (terror, war, criminal violence). With a natural disaster, nature is dangerous but not evil, so your self-esteem—your sense of value—is not harmed. There’s no one to blame. You’re not humiliated, so that’s less psychologically harmful.I try to tell these youngsters, "You’re an innocent victim. A murderer has tried to kill you and your friends." But, because he attacked these two social systems, it was also an attack on Norway, on our democracy. This provides a meaning, and that is crucial, because if I’m being maimed for life, at least it was not accidental, although I paid a heavy price.
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My main work over the next weeks was to organize psychiatric support in the government quarter. PTSD causes cognitive disturbances. It reduces your ability to concentrate; it affects your memory. So intellectual functions suffer. The main challenge was to find suitable jobs that the people could manage so they could still be productive and feel they were a part of the workforce.What about with the Utøya survivors?
One of my main jobs was to arrange a return to the island—about 1,000 people. I recommended that everyone who had lost someone there and everyone who had survived should return. It’s beneficial if the bereft family is invited to the site of death. It will make it less difficult to understand and accept what happened—where Breivik had stood when he fired the shots, how rapid death came. Second, the site of death gives a sense of closeness to the dead person, almost like the grave. Third, many families feel they have a duty to do this. It reduces the guilt. It’s like a service they owe the dead person: to find out what happened to them, where they died. And then you have the symbolic, ritual effect on those kids, many of whom were quite scared before they did this. It’s anti-phobic. Reality is far less frightening than all the fantasies you can have.

That has been a pronounced psychological reaction. We’ve found that in other disasters people struggle with difficult decisions—I call them impossible decisions—about their own survival, how much they can do to help others. That’s a very painful part of the post-traumatic stress syndrome in situations like this.Finally, how do people get over this?
By traditional, psychotherapeutic means: working through the experience, taking part in the grief over your lost friends—it’s a gradual, long-term process. These are healthy people, so it’s likely that not that many will have chronic problems. But it’s like war—you can never guarantee that all soldiers will avoid permanent psychological injury. It’s too violent for that. You must have the memory, but you shouldn’t have the re-experiences. You need to turn the flashbacks into a bad memory from earlier in your life, not something that keeps coming back to you with the quality of, “Oh, it’s happening again.”Follow Scott Oliver on Twitter.