Intended for healthcare professionals

Head To Head Maudsley Debate

Do cases like that of Anders Breivik show that fanaticism is a form of madness? No

BMJ 2012; 345 doi: (Published 11 July 2012) Cite this as: BMJ 2012;345:e4647
  1. Tom Fahy, professor of forensic mental health
  1. 1Institute of Psychiatry, London SE5 8AF, UK
  1. thomas.fahy{at}

The trial of Anders Breivik, who murdered 77 people in two attacks in Norway, has attracted considerable controversy because of the questions concerning his mental state. Max Taylor (doi:10.1136/bmj.e4612) argues that such extreme fanatics should be considered insane, but Tom Fahy believes that a psychiatric diagnosis is an abrogation of personal and societal responsibility

In January 1843, Daniel McNaughton, a 30 year old Scottish woodturner, travelled to London to assassinate the prime minister. He mistakenly shot Peel’s private secretary, Edward Drummond. At his subsequent murder trial, McNaughton’s motives were revealed to be delusional. He believed that he was being persecuted and kept under surveillance by the ruling political party. In the modern era he would receive a diagnosis of schizophrenia. McNaughton was found not guilty by reason of insanity and was transferred to Bethlem Hospital, then to Broadmoor Hospital, where he remained until his death.

McNaughton’s case established the legal criteria for insanity. These criteria are strict, which is appropriate since the verdict results in an acquittal even though the accused is clearly the agent of the crime. The legal criteria require that those found insane must have a recognised mental disorder that prevented them from knowing the nature of their action and that it was legally wrong, or (in some jurisdictions) that gave …

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