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 to change and redefine the ideological spectrum. For example beheading. It is extreme. The former conservatives were pathetic. Guess there was one who tried 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
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.
6.1 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
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.
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.
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
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.
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.