How To Make a Terrorist

Tamerlan and Dzkohar Tsarnaev, the Boston Bombers

It seems that when someone plans or executes a multiple murder, I have mentioned schizophrenia. Some say I see it in my sleep, but there is reason to the madness.

James J. Lee Discovery Channel

James J. Lee didn't like the Discovery Channel's programming. He thought Planet Green should encourage mandatory sterilization of the human race. His website is replete with paranoid ideation.
He didn't kill anyone, but was prepared, carried weapons. James J. Lee went down when police raided the building where he held his hostages.

James Egan Holmes, the Joker who pumped 33 bullets into twelve people in a Colorado movie theater, had been treated for mental illness. Unable to communicate verbally, he drew the doctors pictures of what went on in his head. He didn't just go postal.

James Egan Holmes-Batman Joker

Cho Seung-Hoi, a student at Virginia Tech, murdered 32 and wounded 17 others before killing himself. With a diagnosis of either Schizoid Personality Disorder, prodromal to Schizophrenia, or both, he likely had the angst of a psychotic.

What are we to think about the Boston Bombers, Tamerlan Tsarnaev and his brother, Dzhokhar?  Is there something sick about them? Is being pro-terror a sickness?

Most think that the older brother influenced the younger, that Dzhokhar looked up to Tamerlan, did what many younger brothers do, tagged along. Families are powerful.

Tamerlan, taken down by the police, has been implicated in other murders, back in 2011.  A drug deal gone bad, three dead. Tamerlan's alter-profile, a religious Muslim who used or sold drugs, doesn't sync. The religious tend to be aesthetics, not drug users. They have conscience. This is clearly a complicated person. He had friends, too, people who were with him at the time of the murders, partners in crime.

Ibragim Todashev, who died during the interview with authorities, not only confessed to his direct role in slashing the throats of three people in Waltham, Massachusetts, but also fingered Tsarnaev.

Seems the victims were Jewish, at least one, Brendan Mess, who boxed with Tamerlan. The gloves came off, apparently, over something more than drugs and money. Perhaps hatred.

Investigators of the crime reported at the time that the heads of the three victims were pulled back and their throats slit ear to ear with great force. Marijuana was spread over the bodies in a "symbolic gesture," and several thousand dollars in cash was found at the scene.

When parents talk about their kids smoking pot, stealing, acting out, they want to believe that other kids have brainwashed theirs. It would be nice if youthful criminal behavior was a stage, a coming of age thing, having to prove independence. A way to be cool, garner the respect of their peers.

But acting out, scoffing laws, sociopathy, isn't a stage. Family dysfunction and genetics conspire to interact with social influences, shape personality. Tamerlan's mother, for example,  surely a social influence, doesn't respect the law. She's been arrested for stealing expensive designer dresses from high end retail stores. She allegedly ripped off the sensors, stole the dresses, then attempted to return them, cash out.

Tamerlan's uncle, Ruslan Tsarni  speaks of his nephew finding a new friend at Cambridge, a convert to Islam. Misha, from Armenia, a neighboring region of North Caucasus, lured Tamerlan away from the family. He told him that boxing, the youth's passion, isn't the way to God. This friendship, according to Mr. Tsarni, changed the Boston Bomber.

The US government is calling Tamerlan and Dzokhar self-radicalized terrorists, but they apparently had help radicalizing. Others are complicit.

No evidence of Schizophrenia. The 2011 murders point to Antisocial Personality Disorder, however. The features? A callous disregard for exacting pain and suffering, no guilt or remorse. Begins in childhood. No auditory hallucinations. We call it a personality disorder because there is something seriously wrong with hurting others. It is antisocial. The current research buzz is to have compassion for those who have the disorder-- abnormalities in their brains.There is a movement for leniency in the courts.

Except that Antisocial Personality Disorder is usually picked up in early childhood. These are the kids who throw cats in the river, who trip little old ladies, who cut up insects. 

The lite version, when a child or an adult knows enough not to get caught, when the behavior is sneaky, the crimes less overt, when cheating matures to rising up the corporate ladder at the expense of the reputations of colleagues, we think-- almost a sociopath. 

It could be that Tamerlan was an almost turned definite. We're sure to find out over time.  

One more story of disaffected youth. William Plotnikov's son Vitaly, shot down by police in Russia last week. Plotnikov had turned on his son, called authorities. He was concerned that Vitaly left his Canadian home to join an Islamic terrorist cell  He did not want his boy responsible for flying arms and legs, mayhem, destruction. Russian authorities found the young man in the woods with known and wanted gang members. Weapons  abound, Kalashnikovs everywhere, ammunition, improvised explosive devices. They took no prisoners. 

Ironically, Vitaly Plotnikov is thought to have known Tamerlan Tsarnaev. 

Vitaly, like Tamerlan, turned to radical Islam as a young adult, bored. His father says he always looked for excitement. Strangely enough, he had boxed, too.

So what is the recipe here, what does it take to become a terrorist, or a jihadist? We're aware that self-proclaimed jihadists believe in personal agency, their own justice. Are terrorists modern day Robin Hoods? Is the creed to rob from the rich, give to the poor? They identify as idealists, for sure, which might be cute, were the goods not human lives.

This is so complicated, it begs a new DSM diagnosis. We'll call it Terrorist Disorder, just to be clear: 

Terrorist Disorder

I. To make a diagnosis, must meet eight of the eleven criterion below.

A. Age 16-29

B. Tends to split beliefs, events, people, into good/bad, black or white, idealization or devaluation.

Splitting between one extreme or another is considered the defense of an immature personality-- reduces stress. In adults It is associated with Borderline Personality Disorder. Splitting is normal in early childhood.

C. Perceives those who do not agree with extreme beliefs as weak, ineffectual, cowardly and inferior. Minimization mirrors the rationalizations of persons affected with Antisocial Personality Disorder. It is not limited to Antisocial Personality Disorder, however.

D.  Describes spiritual attachment to God, having a mission inspired by God to better all of humanity. May feel appointed by a Superior Being to perform mass destruction of human life (in the absence of Schizophrenia).

E. Takes on self-denial, aestheticism associated with mystics, chooses a subsistence lifestyle believing the afterlife will be more rewarding.

F.  Embraces a creed, belief system, or manifesto that is either religious or political that the majority of citizens in peaceful nations would deem dangerous and antisocial. 

G.  Either volunteers for or is recruited by a group or an individual that recognizes psychological vulnerability, a need for approval, and/or inclusion in a group.

H.  Before associating with a jihad group, was disaffected, depressed, and underprivileged, suffered financially. The depressed mood and emotional detachment are relieved upon identification with the creed, sense of community, and purpose. 

I.  Manifests features of a manic episode: inflated self-esteem, grandiosity, a decreased need for sleep, flight of ideas, and goal-directed activity.

J. Identifies with a group that serves as an alternative family, brothers and sisters who advocate criminal acts, destruction and violence, mass homicide and suicide.

K. Cuts off entirely from former family and friends who do not advocate violence.

 II. The patient is not suffering from a Schizophrenia and does not meet the criterion for Antisocial Personality Disorder, but may suffer Bi-polar Disorder or other Axis I and Axis II disorders.

What did I forget? 

Oh, why not see it all in action. 

Michael Lavigne's The Wanting

Read Michael Lavigne's new novel, The Wanting, an engaging, fanciful (in its way) treatment of the development of a Palestinian suicide bomber in Israel. 

Amir, one of the many Jerusalem Bombers that we are all too complacent about today, a fictional anti-hero, wears an expensive suit, carries an expensive brief case. He blows himself up, takes others along.  

Wanting is the essence of a terrorist. Wanting. Dissatisfied. Told in three voices, Lavigne is master of first person. We hear from: (a) a survivor of the bombing, a middle-aged Russian architect, a man who doesn't even identify with religion; (b) his adolescent daughter who changes in its wake, becomes vulnerable to "religious educators" with a political agenda; and (c) Amir, the regretful terrorist, the haunting third voice.

Mr. Lavigne researched the book for three or four years. He granted permission to the following excerpts.  The terrorist, narrates. 

(1) In the days leading to my shahadah, I was immersed in prayer. I bathed my feet and hands in the waters of el-Kas, the well of al-Aqsa, which they told us rises up from the rivers of Eden, and I entered the great mosque and stayed there for hours on end, meditating. Then I would take the bus back to Jabal, to Walid's place, where we would talk and study late into the night. Only then would I sleep a few hours, lying between Walid and Fayez on the hard floor. In the morning we would wash, pray, and prepare a little hummus and tea. He always had dates and figs, sliced apples, and sweets of various kinds, and at night there was usually maqluba. We were never hungry, even though we fasted on Tuesdays and Thursdays.

(2) The slave may rebel from his master, the son from his father. Your father does not have the power to stop you, for your power comes from Allah, praise be to the All Merciful.

(3) And Yusuf al-Faruk trained me day and night and I, like a falcon on the path of All-Knowing Allah, swooped up his leavings. These were my happiest days. These were my days of light. "For the call!" I repeated after him. "For the Muslim Brotherhood!"

He writes poetry. But what have we here?  Religious asceticism, a call to a mission, the cut-off from family, the mentor. Religion, many of us are aware, feels good. We are called, follow a creed because we believe it is right, and that others are probably wrong, not as right. Some of us believe that nonbelievers will ultimately learn the error of their ways. One day. Rarely do believers take matters into their own hands.

When it is a matter of personal agency, when the methods are violent, when even parents and friends are disavowed, cut off, when human lives are dispensable, clearly something is wrong, something is sick about the creed. It is a cult, not a religion.

Deprogramming is the answer, if there is an answer at all. 

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James Egan Holmes

Does he look like The Joker?  Does he think he's Batman's nemesis?

What is wrong with this guy?

What we have is a shy kid, a boy who didn't engage when others tried to talk to him.  Or so says a San Diego neighbor, a young man who played on the same soccer team in high school.  He never socialized, never had friends.

What we know is that James Holmes is a brilliant young man.  A neuroscientist, at the top of his university class, an honors student.  Then, after graduation, no jobs.  He flipped burgers.

Graduate school, obviously, a PhD should be the next step.  Why wouldn't that be taken for granted?  Why McDonalds?  McDonalds?????  Something's not tasting right with that.

So he started school in Colorado, but he quit in June.  Quit?  Why would a nerd, clearly destined for academia, quit graduate school?

Tempting to think--psychopath.  Or Anti-social Personality Disorder, Social Phobia, Schizoid Personality Disorder.  Even people with Asperger's can't handle the social pressure of college.  It isn't the academics, not usually.  It's the socialization, the expectations.  We live in a social world.  But violence isn't associated with Asperger's.

And psychopathy is diagnosed during childhood.  James didn't even have a traffic ticket, let alone an altercation, a fist fight, a stolen candy bar.  This 24 year old man didn't pick pockets.

It is likely we'll hear that he suffered from Schizophrenia.  Or another psychosis, even Bi-Polar Disorder (see how not romantic that one really is).  Paranoid Schizophrenia affects reasoning, patients hear voices, believe that God talks to them, tells them to do things.  Some think they are Jesus Christ.  And some think. . . they are the Joker.

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Your Worst Nightmare

Some of you who have read old posts might remember that I have had recurrent home invader dreams once or twice a year for as far back as I can remember. Always the same thing. Some big, unshaven, muscle-bound criminal-looking type, sometimes more than one, pushing against the front door to my family home. Me alone, pushing to keep it closed from the inside, trying to keep him out.

Poor FD. I always lost the struggle and woke him up.

Then, for no apparent reason, they stopped. The nightmares just stopped.

As much as I like doing anger management with people, there’s anger management and there’s anger management. I generally don't work with people who are court-ordered, very few hardened criminals. An occasional sex offender, is all.

And if a patient has a psychosis that is disinhibiting, or is ruled by voices in his head and doesn't like the medicine they tell him to take, it's likely I'll punt him along to someone who likes this kind of challenge. An ER doc, even. I won't be discussing identity or teaching any muscle tension and breathing.

Most people who have anger problems aren’t in it to hurt anyone. They’re just poor emotional regulators, and tend to have trouble with very strong emotions. We all have them, you know, strong emotions. And they can make some of us feel like hurting ourselves, or hurting someone else.

Even telling someone off reduces tension, sarcasm, too. People who suffer from Borderline Personality Disorder are particularly vulnerable to this solution, hurting themselves, hurting others, in any kind of way, and we see this disorder present quite often in therapy. We’re getting better at helping people with BPD, and in the process, recognize how difficult it can be, emotional regulation.

Therapists have weeks in which this is all we work on, above all else, it seems, emotional regulation, behavioral blunting. Stop signs.

I think it's what makes this a dangerous profession, that which Freud called id, the very human drive for aggression. We’re not an endangered species, but therapists are at risk for harm.

And we take in a lot of verbal abuse. We either don't take it, won't see a verbally violent individual, or learn to address it dialectically.

"You can get away with talking to me that way," I will tell a patient, "but it won't make you popular at parties."

Some of us get good at this kind of challenge, even welcome it, say, bring it on, even, to change the behavior. We won't debate facts, won't get into it like they want us to, just talk about quality of life.

"Is this what you want to do, put other people down, yell and scream and distance people from you? Or would you rather try to get a tennis date?"

That's DBT, Dialectical Behavioral Therapy, changing the meaning of a person's behavior. Some people do it naturally. We call them masters of the paradox. But ultimately what it is, is getting through. If a therapist never learns how to do this, get through, then there will be no therapy, no changing anyone suffering from Borderline Personality Disorder.

Very occasionally, for it has to happen if you work with people, a therapist will encounter someone in the throes of a psychotic episode. That person might be on the brink of hurting himself or others, might be paranoid or psychotically depressed, or flying manically, not in control of thoughts or behaviors. Out of reality times three might be an apt description, unaware of person-place-time. And this can get violent. People do get killed.

I've been lucky. My only encounter with one of these individuals who actually lost it with me was with a psychotic ten-year old. Never saw him before, but you don’t easily forget the brute strength of a psychotic ten-year old throwing table lamps. Not that I was really at risk. Truth be told, I’m pretty strong when my adrenaline's pumping. FD doesn't sneak up on me anymore.

So yesterday, I’m working with a kid on anger problems, no less, and we’re talking about how it's worse when you don't have parents who want to help with this thing we call emotional management. At least her parents are into the process, we agree, want to learn about it themselves. We finish and she goes out to the waiting room. Her mother takes her place. Mom and I are talking about how in her family there were eight kids and her mother, like her, couldn't control the aggression between her many siblings, and how powerless she feels when everyone totally ignores her efforts at Time Out. Can you imagine that? Time Out doesn't always work. When suddenly . . .

We hear banging on the sliding door of my office (the door for my bike, not people). I jump up and open the usual other door, the one with a handle. I see her. She’s my height, my build, in dirty jeans and a man’s shirt, tennis shoes. I don’t know her, but I know psychosis when I see it, glaring at me with fury. She scowls at me as if I'm dirt, snarls loudly,

“You a doctor?”

I’m sure I blanch. But she's not well, I get my cap on (the therapy cap) and respond in the most quiet, gentle, compassionate voice I can muster, a clinical voice.

“What can I do to help you?”

She pulls up her shirt sleeve, rips off a flimsy Bandaid to show me a freshly wounded, bloody forearm. The blood has already dried, doesn't seem to need any stitches. “You can fix this!”

Now I’ll be honest. I don’t want blood on my carpet, so I’m getting nervous. And I don’t want to turn to my desk to call the police, because I’m afraid that if I turn my back on her she’ll attack me from behind. She’s flying. This is anger. That other stuff we talk about is frustration, powerlessness, aggravation, the other words.

“Oh, that needs a doctor’s attention," I suggest, concerned. "I think we have a doctor downstairs.”

She furrows the brow, lowers an eyelid, then backs out of my office slowly, never taking her eyes off of me, like a bank robber in the Wild West holding a gun to the people in the saloon. The crazy part of this is that if I had to pick her out of a line-up, I’m not sure I could. I'm not thinking, look for birthmarks, eye color.

She’s backing out to the waiting room from my suite, past the door that should never have been left unlocked. I follow her. She points down stairs. “Down there?” she asks skeptically. "There's a doctor down there?"

“Uh, huh,” I reply gently. “Down there.”

My patient is in the waiting room now, too, has followed me out and is with her daughter. "It's okay," I tell them. "Please come back into my office. I'm pretty sure nobody's working downstairs today." They join me and I lock the outer door to the suite after them. Inside we process what happened, they hadn't felt threatened, particularly, didn't realize what was going on.

They're my last patients of the day. I lock up after them. Locked doors make me happy, the one time I forget to lock up, this happens.

I realize I hadn't called 911. Should have called the police.

Moments later, calm, I hear a loud bang on the door to the suite. I shiver, ignore it.

Then the phone rings. It’s my patient. “You have to see this,” she insists, breathless. “You have to come outside and see this.”

"Was that you banging?"

"Uh, huh."

Okay, okay.

Out on the street, about a half block away, three big policemen are working to subdue her. They’re having trouble, too. Arms and legs are flailing.

I feel absolutely terrible, as if I could have talked her into waiting for them, convinced her to surrender peacefully. She would have had a free ride to the ER for her wrist. Instead it seems likely that someone hit a panic button. And she’s treated as a savage.

My patients are spellbound. “How did you know?” the mother asks me. “How did you know she was crazy?”

“I never used that word,” I object. “I said she has a mental illness, isn’t a well person.”

“But how did you know,” she insists that I tell her, “that she was dangerous?”

“You just know, is all.”

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FYO, all of the details of the story have been changed to make it fiction. But I think you get the gist of it. The truth is, truth is better than fiction, but sometimes you go with fiction.

Bruce Ivins

Bruce E. Ivins, a microbiologist, killed himself on July 29 with an overdose of Tylenol. He had a history of mental illness. People blame his death on pressure from the FBI, accusations and "proofs" tying him to the 2001 anthrax murders. I blame it on mental illness.

Prior to 9/11, Dr. Ivins suffered what FBI court documents deemed "serious mental health issues." He had been in treatment and talked about it in emails that dated from 2000 to 2001. He wrote about his depression, his counseling, and his medication.

Reporting for the Wall Street Journal, Evan Perez, Siobhan Gorman, Gary Fields, and Elizabeth Williamson, paint a Chilling Portrait of Dr. Ivins.

In August 2000, he wrote,

"I get incredible paranoid, delusional thoughts at times, and there's nothing I can do until they go away, either by themselves or with drugs."

We hear that in late 2001, he emailed a series of short poems ruminating about what he called his split personality:

"Hickory dickory Doc - Doc Bruce ran up the clock

But something then happened in very strange rhythm

His other self went and exchanged places with him."

And then there's this one,

"I'm a little dream-self, short and stout,

I'm the other half of Bruce-when he lets me out.

When I get all steamed up, I don't pout.

I push Bruce aside, then I'm Free to run about!"

Sounds like Free is a name, does it not? The word is capitalized in the middle of the sentence. Free is another Bruce.

Dr. Ivins thought he had a split personality, but when we speak of such a thing, a split personality, we're really referring to at least two separate personalities, separate people within the same body that co-exist.

Each personality is whole, if not altogether well. Each personality may have multiple Axis I or Axis II disorders, or not.

This sounds like Dissociative Identity Disorder, what used to be called Multiple Personality Disorder. A person like Dr. Ivins, if he suffered from it, had at least one high functioning self, the doctor, the microbiologist who worked diligently for the United States government on a vaccine to immunize us against the deadly effects of Anthrax.

And he had a second personality, clearly disturbed, but also high functioning, one that escaped detection while under FBI investigation for three full years. He is the one referred to as Free.
Free could carry out destruction, wreak havoc without conscience. Free could even justify his atrocities, say to himself, If the government associates these deaths with a terrorist group, then surely I will have funding for my vaccine. The ends justify the means.

Perhaps he had a third self, the one who fell in love with a sorority girl and stalked her. With his counselor, Ivins discussed killing the young woman. From the Washington Post,

More than a year before the anthrax attacks that killed five people in 2001, Bruce E. Ivins told a counselor that he was interested in a young woman who lived out of town and that he had "mixed poison" that he took with him when he went to watch her play in a soccer match.

"If she lost, he was going to poison her," said the counselor, who treated Ivins at a Frederick clinic four or five times during the summer of 2000. She said Ivins emphasized that he was a skillful scientist who "knew how to do things without people finding out."

And yet a fourth, a religious Catholic:

. . . a churchgoing family man and volunteer whose mental health eroded -- culminating in suicide -- because of escalating pressure applied on him by federal investigators as they came to regard him as the prime suspect in the attacks.

Surely a troubled, angry, psychotic individual, a scientist who struggled against his admitted paranoia, depression, and mounting social and professional pressures, a man who lived with a voice in his head, a violent amoral voice.

That voice talked to him, I think.
I think Dr. Ivins heard Free, and that Free, as such, was a delusion, not a conscious perception of self, not him. But when the stress got the better of Ivins Free broke out. Ivins became his delusion. Then he had more than one self.

And when he looked back on what Free had done, assuming it is true that he is the man who committed the anthrax murders, he said to himself, This is the work of another person inside me, the bad me. I did all of that as Free. But the ends justified the means, and the FBI should have canonized me, not punished me.

Insanity reigned. People died.

So although it sounds like definitive Dissociative Identity Disorder, there is a second diagnosis, Schizophrenia.

I would bet that Free wasn't another self at all, not until he acted out. Until Ivins gave in, Free had been only a voice, one who mocked and scolded him for years. Then, when the time was right, when Ivins could take it no longer, he gave in to what he had been hearing for years, "Do it. And don't tell anyone about me."

Since he was a smart man, it is likely he knew about things like multiple personalities, perhaps from his treatment even. But he decided to not make mention of the voices to anyone, as is often the case in schizophrenia. He used his poetry to suggest that what he had was a split personality, for to him, schizophrenia, carried more stigma.

He carried the shame honestly. The illness went undiagnosed in his family, Dr. Ivins said. Read this Washington Post excerpt:

"The skeletons are all out," he wrote in one GreekChat posting from 2006.

"I'm having a devil of a time rounding them back up. Let's see . . . how about mom who was an undiagnosed paranoid schizophrenic. . . . Is that bones enough?"

Dr. Ivins was delusional. He suffered from paranoid schizophrenia, like his mother. And ironically, the FBI actually did follow this poor man with schizophrenia.

At some point, when a mentally ill person takes his life, perhaps, diagnosis becomes moot. It's a so what? Dr. Ivans died. He left two children. Other people died, no matter what the diagnosis. (See the comments section for a more thoughtful discussion of how the two diagnoses are related).

He was a scientist who shouldn't have passed a background check. And much worse, he did not get sufficient treatment for his mental illness.

You can read all about this at WSJ, The New York Times, the Washington Post, everybody's telling the story, so I don't have to repeat the details here. Suffice it to say that Ivins spent late nights in the lab, ostensibly cooking up the anthrax for delivery the following week. He was one of the world's foremost anthrax experts, according to news reports. He fooled the FBI for three years, switching anthrax samples on them, deliberately hiding the flasks with mutations that would have made a direct match. When it became clear he would be charged for the crimes, he killed himself.

I imagine that Free told him to do that.

I looked for childhood history but so far, nothing. He did work for the government, so perhaps his history is top secret.

I feel that the people he worked for should have picked up on his suffering, his severe emotional stress. Why treat only depression? His counselors, his doctors must have known he had delusions. Anyone reading his poetry (maybe they didn't) should have said,

"Dude, take off a month. Get into a hospital. Get the proper doses of the right medication. Get well. Shake off Free."

That is the treatment in schizophrenia, shaking off the delusion, muting the voices, ending their tortuous reign, by using medication.

People who notice strangeness in co-workers should get closer, not move farther away. We should wonder, when a person is cooking up Anthrax, What is he doing with that?

I know, 20-20 hindsight.

Yet I have to wonder. Where were his people? Weren't there people watching him slide? He did have a previous suicide attempt.

But then I think, mental illness is masterful. It can hide itself pretty well.

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