Running amok is a modern mental health issue

Providing mental health promotion and services that men feel comfortable accessing is an urgent challenge, writes Justin Thomas

Police secure the area where a truck drove into a crowd during Bastille Day celebrations in Nice, France in July 2016. Andreas Gebert / EPA
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Last month, Khalid Masood killed four people and injured at least 50 as he indiscriminately mowed down members of the public in a hired SUV. After crashing the car his attack continued on foot, with the assailant using a knife to fatally stab policeman Keith Palmer. Shortly after that, Masood was shot dead by the authorities.

In July last year, on Bastille Day, Mohamed Lahouaiej Bouhlel drove a 19-tonne lorry through the celebrating crowds in Nice, indiscriminately killing 84 people. Bouhlel was shot dead by the authorities. A month earlier, Omar Mateen killed 49 people and wounded 53 others when he indiscriminately opened fire at a nightclub in Orlando, Florida. Mateen was later shot dead by the authorities.

The phrase “running amok” was popularised by Captain James Cook in 1772. The term amok refers to a disordered mental state of an afflicted individual who is typically running through the streets indiscriminately killing people. The frenzy usually ends with the afflicted person – it is almost always a man – being killed by the authorities or outraged onlookers.

Amok is a Malay word and the traditional belief was that the afflicted person had been possessed by an evil tiger spirit. For a long time, psychiatry considered amok to be a culture-bound syndrome: a disorder limited to a particular cultural group or society, in this case Malaysia and Indonesia. Beyond tiger spirits, another theory suggested the disorder was a means of “ending it all” that allowed the distressed individuals a way of circumventing a taboo against suicide.

In more recent years, the idea that amok is restricted to South East Asia has crumbled. The rising rates of indiscriminate killings at the hands of seemingly deranged individuals has reignited questions about the geography of the condition. In the United States, for example, the American Lone Wolf Terrorism Database, which goes back to the 1950s, reports that the rate of these attacks has more than tripled since the 1980s.

An article published in the Journal of Clinical Psychiatry argues that amok should be considered the possible outcome of an undiagnosed or untreated psychiatric condition. The characteristics associated with this contemporary conceptualisation of amok include, among other things, anger, depression, antisocial personality, having experienced significant personal losses and thoughts centring on hopelessness and revenge.

Attempting to predict who might commit such acts is the first step on the path to prevention. Given that these attacks typically end with the death of the assailant, we can’t always know for certain whether the attackers were primarily motivated by twisted religiopolitical ideologies or psychopathology. It is also possible that their motivation involved a toxic blend of both.

It is worth considering that terrorist groups propagating twisted religiopolitical ideologies might attempt to recruit individuals who are depressed and who also happen to have histories of anti social behaviour (drugs and violent crime). Such individuals would arguably be relatively easy to coax into running amok, especially if they were already suicidal. The idea of dying for the “cause” (suicide by cop) also circumvents the strong taboo that some cultures/religions ascribe to ending one’s own life.

A greater focus on promoting mental health might go some way towards preventing modern day amok. It might also contribute to making recruitment more difficult for terrorist groups. Male mental health, however, presents a particular challenge. Men are three times more likely than women to take their own lives. In the UK, suicide is the biggest killer of men under 50 and responsible for a quarter of deaths among men under the age of 35. Men are also far less likely to seek help for emotional problems, and far more likely to self-medicate with drugs and alcohol. Providing mental health promotion and services that men feel comfortable accessing is an urgent challenge.

Dr Justin Thomas is an associate professor at Zayed University

On Twitter: @DrJustinThomas