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EDITOR’S NOTE: Hard on the heels of one of the deadliest Middle East bombings in more than a decade in which 175 people were killed in Baghdad on one of the final days of the Islamic holy month of Ramadan, came last week’s wave of domestic violence. So with violent demonstrations here at home, coupled with global terrorism, we wanted to know its impact on the mental health of many American. ICD10monitor Publisher Chuck Buck checked in with nationally renowned psychiatrist and past president of the American Association for Social Psychiatry H. Steven Moffic, MD. An edited transcript of that interview follows: 

CB: I want to begin our interview by going back to a letter from you last week to the editor of the Chicago Tribune in which you wrote that “mass terrorist killers are not suicide bombers. They are homicide bombers.” Does the use of the term “suicide bombers” give suicide a bad rap? 

HSM: The short answer is: no, it gives terrorists a good rap! 

What I mean by this flippant (response) is this: your question is actually a quite deep and challenging one, and therefore will take some time and argument to justify my short answer.

Suicide as a modern concept really developed in the 1700s in England in order to present an alternative to the religious belief of the time that killing (or trying to kill) oneself was a crime, and punishable as such. Thereafter, the term “suicide” became associated with mental disturbance, disturbance that caused so much mental anguish that killing oneself seemed sometimes to be the only way to relieve the pain. Remember, no professional treatment was available at that time. 

As the stigma about mental illness has slowly diminished since psychiatry emerged as a medical specialty over the past century, so has the stigma of suicide diminished, attempted or completed. As a consequence, now there seems to be more sympathy and empathy than condemnation and disgust. Most people in so-called developed countries currently feel like therapeutic resources should be available to reduce suicidal ideation and risk.

Therefore, although there are no polls or data that I know of as yet, as a psychiatrist, I would assume that attaching the word suicide as an adjective to bombers (or attackers, etc.) would make them more sympathetic, not only to the cultures the bombers come from, but even more generally.

Moreover, perhaps using the term “suicide” makes the bombing even more (fearsome) to the public, outside of the bombers’ compatriots. That is, that they are willing to die as a presumed martyr for their cause implies the power of their cause, a cause for which some people will go to the ultimate sacrifice to serve. 

Though terrorism is as old (or older) than history, the term “suicide bomber” seems to have only been first applied to the Germans in 1940. Then, a couple of years later, it was applied to the Japanese kamikaze pilots, who evoked terror in their potential targets. Recall how eerily similar the 9/11 pilots that took over and crashed into our buildings were, after which the term “suicide bombers,” though already used to refer to the terrorist bombers inside Israel, became more commonly used. Some, though, at the same time, preferred to use “homicide bombers,” including the press secretary of President Bush in 2002, but that gradually fell by the wayside.

Of course, homicide can’t help but evoke some fear at times, but it is a more everyday term associated with violence and death, especially in our inner cities in the United States. Given that, “homicide bombers” may not evoke as much fear as the term “suicide bomber.” After all, this is psychological warfare, and you don’t have the perpetrators complaining about the term, which makes me conclude that they like it.

One other use of the term “suicide” can add some insight as to when it should be appropriately used. For quite some time, the term “physician-assisted suicide” has been used in those states and countries where physicians assist patients with unbearable pain from a terminal illness to die, if that is their rational wish. Yet over time, those involved with this process have come to realize that “suicide” is not an appropriate term to apply to physicians devoted to healing, and so another terminology has gained traction: that being “physician-assisted death.”

In the case of the so-called suicide bombers, the death of the bombers is a secondary outcome, and they do not seem to have any recognizable or diagnosable mental illness. Psychologically, they seem more like gang members who, as is often the case in gangs, have above-average narcissism. As such, their action is more like a crime against other societies than it is a suicide. 

Finally, compare the term “suicide bombers” to “mass murderers.” In describing the mass murders perpetrated by non-terrorists in the United States and elsewhere, suicide is not used, even though the perpetrators often die, including by their own hand. Some of them even have mental illness, but their goal, at least the most important goal, is not suicide. That is not to say that there isn’t some overlap emerging between terrorist attacks and mass murderers. 

CB: Then, over the past week or two, there have been more organized ISIS terrorist attacks, including in Istanbul, Bangladesh, Iraq, and Saudi Arabia. These followed what appears to be a “lone wolf” terrorist attack in Orlando, Florida, here in the U.S. Could our news coverage of this global wave of bombings adversely impact America’s psyche or mental health?

HSM: Chuck, no question that the answer to your question is yes, that the news coverage will adversely impact America’s psyche if there is not an adequate response on our behalf to reduce the fear generated by the news coverage. In fact, the more news coverage (there is), the more ensuing fear (will be created) until indifference sets in, when we are saturated and overwhelmed. Indeed, the great Holocaust survivor and (figure of) conscience of our world, Elie Wiesel, who just died on July 2, said that “the opposite of love is not hate, but indifference” – the kind of indifference that we now see in the mass incarceration of our citizens and refugees turned away from our borders in the United States. 

You see, whenever people feel threatened, our hard-wired brain response to fight or (take) flight kicks in. This was a lifesaving response once upon a time to dangers that our early tribes felt from natural risks as well as from people who seemed different. However, in the case of these terrorist attacks, where does one go to fight, other than joining our armed forces, or where does one go to flee when no one knows there the next terrorist attack will be? Maybe, as I will elaborate more upon in a bit, we go to the political arena.

To add more psychological injury, the news media makes the risk seem much higher than it realistically is for each of us. I mean, for the everyday American citizen, it is less than getting hit by the proverbial lightning, and way less than being killed by guns or in accidents. 

So, if our news media causes us to, in general, feel more fearful than what is warranted, then it does adversely impact our country’s psyche, though we may differ individually in our responses. 

CB: On the campaign trail, presumptive Republican presidential nominee Donald Trump said in a written statement following the Orlando mass shooting at a gay nightclub, “I said this was going to happen – and it’s only going to get worse.” Are his remarks likely to acerbate fear among Americans about future terrorist attacks in this country?

HMS: Yes, Chuck, candidate Donald Trump’s prediction just adds onto the news coverage impact, whether he turns out to be right or wrong. Often, the news coverage and Mr. Trump’s prediction of more terrorism go hand in hand to intensify our fears. Indeed, one could conclude that just as the terrorists use terror to evoke fear, so does Mr. Trump use words about terror to evoke fear. Here, we do have poll after poll that indicates that we feel less safe in the U.S.A., numbers that escalate after any terror attack around the world. 

In other words, perhaps the increasing terror attacks around the world and the intense media coverage are Mr. Trump’s best allies in his presidential campaign. Rather than “make America great again,” as his favorite campaign slogan goes, what he is doing, and what may be attracting his supporters, is actually “make America fearful,”, whether that be about terrorism, the economy, immigration, or the character of his opponents. No wonder that he uses such terms as “weak,” “corrupt,” “careless,” and much worse. 

To be fair, this whole climate of fear and frustration may have also contributed to the unexpected popularity of another candidate, Bernie Sanders, though in the case of Mr. Sanders, the perceived problems and solutions posed seemed to be much different. Mr. Sanders posited the need for a “political revolution” over politics as usual. 

CB: What advice do you offer for those here in the U.S. who might be susceptible to possible depression because of this news coverage? 

HMS: Chuck, the advice I have for those psychologically vulnerable goes beyond possible depression. Depression can arise in part after any major loss. So, if someone in the United States was a relative or friend of someone killed or severely injured, then that, by all means, might lead to full-blown depression. 

However, the biggest risk (involves) the various anxiety-based disorders, because anxiety comes from anticipated loss. With anxiety, a certain level of it, not too little and not too much (just like the temperature of the porridge in the Goldilocks story) is what is helpful to us as human beings. So people who come to think that they are going to lose out as a result of terrorism, whether that be from immigration, jobs, or violence, will likely feel more anxious and fearful. For those who have suffered much prior trauma and loss, perhaps up to post-traumatic stress disorder (PTSD), this kind of news coverage is not helpful, but rather a trigger to bad memories and future scary fantasies. 

Another risk is to respond with violence, one of the fight-or-flight responses possible. When threatened like that, we tend to lose the best of our humanity, our compassion, and empathy for others. Already, we have seen violence at some of the recent campaign events, and that could escalate at the conventions and thereafter. 

Finally, our bodies can be adversely affected by too much fear. It can result in heart conditions and strokes. 

The advice I have? One is to simply minimize or stop watching such news coverage, or at least to get a balanced view of the news and not the same coverage over and over. Second is how we humans have learned to overcome our unnecessary fight-or-flight responses. We use our rational thought processes to analyze the real risk involved. We do not try to scapegoat others in order to reduce our fear and our own responsibility. In so doing, we do not blame all Muslims when ISIS attacks, especially since mainstream Muslim countries and people have been victimized even more. 

And, lastly, we go beyond sound bytes to probe deeper into the news and what it means, just as you are doing here, Chuck.

About H. Steven Moffic, MD

Over a 45-year career in psychiatry, H. Steven Moffic, M.D. has won numerous awards for his educational, ethical, clinical, administrative, and artistic work, including two from the American Psychiatric Association (APA), the one-time Hero of Public Psychiatry Award, and the intermittently awarded Administrative Psychiatrist Award, the latter to be presented to him at this fall’s APA meeting in Washington, D.C.


Chuck Buck

Chuck Buck is the publisher of RACmonitor and is the program host and executive producer of Monitor Monday.

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