Can mentally ill people join the military?

Violence and terrorismNot all perpetrators are psychopaths

For Henning Saß, violence and aggressiveness are ubiquitous phenomena - a component of all human societies.

"It is sometimes ritualized in games, in fighting games, in sports. But asserting oneself with strength, being angry, being aggressive, and also having feelings of revenge, is a perfectly normal, psychological human quality.

Unfortunately it is the case that in the context of mental illness there can be disturbances in the regulation of such aggressive impulses. That is why we occasionally have cases of mental illness, by no means all of them, where there is a problem of the disposition to use violence. "

A 50-year-old man kills his mother, with whom he lives in the same house and works in the family business. Is he mentally ill, culpable or not? These questions concern forensic psychiatrists like Professor Henning Saß, who prepare medical reports as part of a trial, including in cases such as the NSU series of murders and the knife attack on Henriette Reker one day before her election as mayor of Cologne. Or in the case of the co-pilot who crashed a Germanwings plane in the French Alps in March 2015, killing him and another 149 people. The investigators assume the act of an extended suicide.

Premature stigma

Because this action is so difficult to understand, the perpetrators are often prematurely described as mentally ill - and stigmatized. Radical acts are rarely associated with a mental illness. The forensics expert identifies three different causes for these cases:

"One thing is that in the context of a mental illness there may be an increase in the habitual willingness to be aggressive in every person, that is, in times of disgruntlement, they are more aggressive, irritable, hostile, hostile than usual. The other is that there are misperceptions , misinterpretation of the environment occurs, for example that one feels persecuted, impaired, hostile by others and then reacts aggressively in a reactive manner based on a misinterpretation of reality. "

In addition, there could be a reduced ability to steer. The aggressive impulses that are easy to deal with in healthy times are then no longer controllable.

Today, research assesses the connection between violence and mental illness differently than it did a few decades ago. A 1973 study compared the frequency of violent crimes in the population with that among the mentally ill - and found no significant differences. More recent studies from Scandinavia come to different results. They link national psychiatric case registers with the violent crimes established by the police and judiciary:

"And it shows, unfortunately one has to say, that the risk of violence is increased in the case of mental illnesses, only very slightly, but at least it can be shown. And that there are certain disorders that are more obvious This includes above all so-called psychotic illnesses and physically justifiable psychoses and addictions. Especially when a psychotic disorder and addiction are combined. "

Psychoses such as schizophrenic or bipolar disorders - the latter formerly known as manic-depressive illness - are associated with an increased risk of acts of violence, while depressive illnesses are associated with a lower risk.

A political-sociological phenomenon

Even terrorist acts cannot primarily be explained as a psychiatric-medical problem, emphasize the experts. Rather, they represent a political and sociological phenomenon, the causes of which have not yet been adequately researched. Nahlah Saimeh, a specialist in psychiatry and psychotherapy, explains why people join terrorist groups such as the so-called "Islamic State":

"There is a small group of schizophrenic people who radicalize themselves and who incorporate political-ideological thoughts into their delusions and become capable of acting out of them. Then there is the large group of antisocial, that is already violent, criminally socialized people, for whom terrorist ideologies an incredible justification for serious violence. And then there are people who are not actually violent, but who allow themselves to be radicalized in a political context. "

The first, the small group of those who plan and commit terrorist acts due to schizophrenia, include people who hear voices, have delusional thoughts, detach themselves from reality and have greatly changed in their personalities, says the Medical Director of the LWL Center for Forensic Psychiatry Lippstadt.

Suicide with Meaning

But there are also people who are ready to commit a suicide attack because they are not attached to life. By engaging in a fight, they add meaning to suicide. It is not enough to speak of mental illness here, emphasizes the doctor. Rather, different mental readiness to behave and personality styles played a role - such as the antisocial, narcissistic or a borderline personality structure. Or personality disorders such as stereotypical behavior and consistently limited self-esteem.

For Saimeh, the second group of those who

"who were primarily noticed differently violent even as young men, who were already noticed differently with criminals, who have a high affinity for weapons, for violent solutions to personal conflicts. And for whom radicalization is the opportunity to go from being a social outlaw in a civil society Leaders, to belong to an elite - or at least to convince themselves that they are. And of course, think of such terror camps, they find a Dorado to live out their affinity for violence and to break a taboo completely - and without being punished for it, but for it to be recognized. "

Anyone can radicalize

Mentally healthy people can also become radicalized. The triggering moment is, for example, a life crisis. These people are not inclined to violence from the outset, says Saimeh, but find themselves in a difficult life situation that is perceived as unjust. That makes them receptive to radical ideologies. Those who are disoriented, dissatisfied and fearful in life experience this as pointing the way.

"Radicalization reduces complexity. Radicalization makes the world simple and (...) promises incredibly simple solutions, while our world is so complicated that we have to constantly live in contradictions. And we have to endure these contradictions and we have to put opposing positions in our thinking In the public discussion there is always an either-or-discussion: If I am for foreigners, I am against foreigners. (...) Of course this is all nonsense. The truth lies in the overlapping of various supposedly even opposing positions and Considerations. "

In terrorist, radical organizations, people with the most varied of motives come together. Even someone suffering from schizophrenic psychosis can incorporate right-wing extremist ideas into their delusional experience, says the psychiatrist. A dissocial, violent person is just as susceptible to nationalist ideologies in this country as to the positions of IS in another cultural area. Others were based on hyper masculine role stereotypes, according to Saimeh - the image of the intrepid, ruthless fighter.

But how can you act preventively? The population must be better informed about the possible backgrounds of violence, radicalization and acts of terrorism, the experts demand. Nailah Saimeh considers a comprehensive political education, intensive social work and de-radicalization programs in the youth centers and prisons to be necessary in order to convey social values ​​and norms.

More understanding of mental illness

For Henning Saß, more understanding must be aroused in society that there are not only physical but also mental illnesses. Then, he hopes, going to a psychiatrist or psychotherapist will no longer be postponed:

"The studies have shown that unrecognized or untreated or not regularly treated mental disorders are most likely to be associated with an increased risk of the use of violence. In other words, it is important to diagnose early, to seek treatment early, the treatment (.. .) with good cooperation and consistency to maintain continuity.

Unfortunately, this is countered by so-called stigmatization: Mental illnesses are still stigmatized in society. The patient himself, but also the relatives, sometimes shy away from standing by the mental illness. "