Amr isn’t sure when he started “acting weird”. It was 2007, and he was a “know-it-all” teenager in his first year of university, with romantic ideas about intellectuals. He smoked weed every day, tried magic mushrooms, and listened to a lot of classic rock.
“I was sending really strange texts and emails to a few people,” he recalls, ten years on. “They were like, ‘Oh, he must be stoned, must be high’.” Although Amr is a British citizen, of Syrian-Palestinian heritage, he grew up in Saudi Arabia, and Jordan, where his family still lived when he moved to London to start university. One grandmother in Hounslow aside, he was alone.
“All the Eighties and Nineties rock music that I liked, which was probably all written in drug-addled states, they shared these metaphors – keys, doors, getting to the other side,” he says. “It started to build up. I believed there was this secret and by taking acid, shrooms, you would unlock an ability to access this other side.”
The rock metaphor soon spiralled into a full-blown conviction that there was a parallel world, called Three – the mobile network Amr was on at the time. “In this other world, we’re telepathic, and essentially this telepathy unaided doesn’t have a long range. But what Three does is it acts as a mobile phone carrier for the normal world and then in the world of Three you can use it to extend the range of your telepathic abilities.”
If Amr’s fantastical world sounds very Noughties, then it just got a bit more so. He began to hear messages, from a very Noughties villain. “It was a kind of Osama bin Laden figure” with a “radical Islamist look – old army fatigues, a big beard, a Kalashnikov.” In other words, “the bogey man”.
***
If there’s one thing more controversial than the idea of a link between terrorism and religion, it’s the link between terrorism and mental health. In September 2016, three psychiatrists warned in the British Medical Journal that linking terrorism with mental illness fuelled stigma. In the Independent, Will Gore warned against “creating a kind of homogenised bogeyman figure – a religious fundamentalist afflicted by mental illness”.
Counter to this is the complaint that mental health is too often used to excuse right-wing terrorism. This attitude is not restricted to the dusty corners of the right, as became apparent after the conviction of Thomas Mair, who attended far-right rallies before murdering the pro-refugee MP Jo Cox. Louise Mensch, the former Tory MP, suggested Mair’s trial was unfair because his mental health did not feature. BBC veteran broadcaster John Humphrys said: “It slightly muddies the water, doesn’t it, when we talk about that as terrorism?”
Counter-terrorism officials, though, remain extremely interested in mental health and its relationship to both Islamist and right-wing extremism. Under the Prevent programme, NHS staff are encouraged to refer individuals they believe to be at risk of extremism, by assessing factors including mental and psychological health problems. In October 2016, Prevent piloted a scheme where psychologists, psychiatrists and mental health nurses were recruited to work directly alongside its officers.
The initiative began after Birmingham and Solihull Mental Health NHS Trust looked at individuals referred for radicalisation, and found up to half exhibited “a broad range of mental health and psychological difficulties”. This applied across different ideologies “including Islamist and far-right extremism”.
***
“There is something physical about being psychotic,” Amr says. “Your mind is racing at a million miles an hour, you’re sleepless. Maybe the first irrational thinking began by trying to explain that.”
Amr today is an evolutionary biologist at the University of Oxford, who works in the same department as Richard Dawkins, the celebrated atheist and author of The God Delusion. I meet him in a grand, carpeted room for academics at St Hilda’s College that looks on to expansive gardens.
Although Amr grew up in religious countries, he decided he was an atheist when he was still an adolescent. He believes his religious delusions began as a kind of skewed logic. “No one will believe something as irrational as a hallucination without a certain amount of reasoning,” he says.
Amr describes his hallucinations as close to reality, rather than dreams. His delusions centred on his mobile phone. “I was hearing messages as clear as you can hear my voice,” he says in the hush of the common room. “It sounds like audio. It sounds as if somebody was in the room, but they’re not physically there and it’s not your voice.” Terror group al-Qaeda was in fact only one of the shadowy recruiters he believed was calling – the others were the CIA, and the Israeli secret service Mossad. The only person he saw in the room was Princess Diana.
At one point, inspired by Dan Brown’s novel The Da Vinci Code, which imagines an alternative Christian history, Amr began to think he was Jesus. “In The Da Vinci Code, the main character is the descendant of Jesus and basically I replaced her with me. It all made sense because I was Palestinian.”
Amr’s sceptical view of religion extends to challenging the idea there is a firm line between faith and delusion. “How many people say I spoke to God last night?” he asks. “George Bush did it on national television. He said God told him to invade Iraq and nobody batted an eye.”
***
Delusions have been recorded for centuries, but the subject matter of the delusion seems to change over time. A 2013 New Yorker article chronicled the rise of a delusion concerning the film The Truman Show, in which a man realises he is actually the star of a reality TV programme. Noting the ubiquity of phone cameras and the rise of social media, the writer, Andrew Marantz, said: “In the 15 years since The Truman Show was released, its premise has increasingly come to seem nonbizarre.”
According to a 2007 paper in the World Culture Psychiatry Research Review, “Paranoid-hallucinatory Syndromes in Schizophrenia”, different cultures have different delusions. While hallucinations in Christian countries might include the belief the individual was a god, this was unheard of among Pakistani patients. Lithuanian and Polish patients, on the other hand, were most likely to feel apocalyptic guilt. In the UK, a study of old medical case notes found that religious delusions were more common in the 19th century than today.
“There are changes,” says Andrew Sims, a veteran psychiatrist and the author of Is Faith Delusion? “I remember talking to a friend of mine about the moon landing. It was two to three weeks later and he said ‘I have already had a patient who believes he has landed on the moon.’”
Sims, though, argues that the difference between a religious delusion and faith is clear. “We would make the distinction between the content of the delusion and the form of the delusion.
“The form of the delusion is the delusion. The content is usually something highly significant in that person’s life. We get delusions of religion, we get delusions of people believing they’re being stolen from.”
So what about Christians who claim to hear voices? “If a lot of other people in the religious community have the same sort of experience, and he is saying he is hearing these voices, not an outside voice but an inside voice in his head about what he should be doing, that is more likely to be a religious belief.”
Delusions also do not tend to be shared. “In the old days you might find two patients who believed they were the Virgin Mary,” says Sims. “But if Mrs Jones believes she was the Virgin Mary she would not believe Mrs Brown was.”
The distinct characteristics of delusions may be apparent to psychiatrists, but in the wider world, they can be missed. In 2015, Alan Pean, a black Houston student with a history of delusions, tried to drive himself to hospital for psychiatric help, but crashed his car, and was taken to the emergency room instead. His father, a doctor, tried to alert staff to the fact his son was not just physically, but also mentally disturbed. But when Pean refused to follow the nurse’s orders, rather than referring him for psychiatric help, she called security. After an altercation, a police officer shot Pean in his hospital room. Pean, who survived, told the radio programme This American Life he believed the officer had not seen him for what he was – mentally ill – but assumed he was an “angry black guy”.
***
One day during his delusionary period, Amr went to Hyde Park and ended up at Speaker’s Corner. Using his Palestinian background, he managed to talk his way on to an Islamist soap box.
“I remember getting up and saying ‘I’m not with them, I don’t believe in God by the way.’” Then he went “into an inarticulate rant about Palestine and Israel, maybe got one half-arsed round of applause”.
The stint at Speaker’s Corner was just the start of Amr’s delusions driving his actions in the real world. As they got more intense, he spent several days wandering around London, performing invented rituals.
In one, he lined up his shoes in a park and ran around it barefoot. He sought out zebra crossings, which he believed were connected to the alternate world, and tried to mimic the way The Beatles had walked across the one at Abbey Road. He even slept under a bridge. Much of this was designed to stop the telepathic signals reaching him. “I didn’t want the voices,” he says. “I remember trying to resist them.”
Eventually, worried he would give in to al-Qaeda, Amr decided to turn himself in to the police. He showed up at a station on a Sunday, and tried to hand in his passport to a sleepy receptionist. “I suppose what I was trying to do, retrospectively, was transfer agency away from me because I felt so helpless,” he says. The receptionist, though, handed it back. “He said ‘I understand, come back tomorrow, it’s a Sunday,’” Amr recalls. “Which baffles me to this day.”
Rebuffed, Amr retreated to his room in university halls. He lit candles, stripped naked and began mixing Islamic prayer and meditation. “I went into some weird, intense, solitary moment where I was almost seduced.”
Still unable to rid himself of the voices, he went down to the foyer. There were only two other people there – an Egyptian receptionist, and a woman in a hijab in a glass-walled computer room. “I thought, ‘Aha, they must be the conduits’,” Amr says. “I walked over to the computer room, and screamed through the glass at the woman. When the receptionist noticed, I went over to him and screamed for several minutes straight.”
***
The relationship between mental health and terrorism has been scrutinised by Emily Corner and Paul Gill, two crime scientists from University College London. In a 2017 article, they described this relationship as “far more complex than typically presented”. Lone wolf terrorists were more likely to have a diagnosed disorder than the general population, but were also 13.5 times more likely to have one than group-based terrorists. Of 76 individuals involved in attacks between 2014 and 2016, a history of psychological instability was noted in 21, or more than a quarter.
In another analysis of individual referrals, Corner and Gill found just 10 per cent of those with psychosis were religiously inspired, compared to 15 per cent who had right-wing beliefs and 32 per cent who held a single-issue ideology.
Corner dismissed the idea of a causal link between mental illness and terrorism – “we have been very clear that mental health doesn’t cause violence” – and the paper she co-authored criticises sensationalist media reporting of “mentalhadists”.
Nevertheless, she notes there have been a number of cases where intervention could have pre-empted an incident: “They were making violent statements, and the reason they went on to act violently was because they didn’t get help.”
The Prevent programme is often criticised for its blunt approach – including from medics who fear it is damaging patient-doctor relations. But Corner, who has interviewed a number of Prevent practitioners, praises it for helping to identify those in need of medical attention.
It is ironic, perhaps, that mental health services could be protected in the name of counter-terrorism, when elsewhere they are in line for NHS budget cuts.
Corner is keen to see all mental health services improved, with more emphasis on the early stages of identifying problems: “When you go through the NHS, unless you’re actually unwell at that stage, booking an appointment for care takes months and months and months.”
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After Amr finished screaming, the stunned receptionist called the university dean, who sent him to hospital. He received anti-psychotic medication and was eventually released into the care of his parents. The delusions did not vanish immediately. “Even after I was released I still believed a few things,” he says. He still heard voices. “I eventually joined the CIA because they promised to help with my exams.”
This particular belief helped him to re-join university – “They gave me the answers while I was taking my exams, but the condition was you had to stop talking about the theories.”
Eventually, only Princess Diana was left, whom he considered a guardian. “She would appear crouched on lamp posts.” Then, even she disappeared.
Ten years on, Amr has not experienced delusions again. He feels lucky that he received treatment in time, and wonders how the media would have reported it if his delusions had driven him to do something newsworthy.
“Let’s go to this alternate world, headline, British Muslim – because that’s what I’m going to be, never mind I stopped believing in God at age 12 – from an Arab background who grew up in the Middle East, politically outspoken and opinionated. Was seen in Hyde Park Corner shouting about Palestine, Israel. Has emails of all sorts of opinions, acted weird for several weeks.” He pauses. “If I ran into a crowded space shouted Allahu Akbar…”
He also wonders if he would receive the same medical support today. “With funding cuts to all these services, what we’re ultimately doing is relying on band aids. Entire communities or groups of vulnerable people are barely kept in check.”
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“Most people may be intuitively inclined to attribute the willingness to carry out suicide attacks to the offenders’ individual traits,” writes the psychologist and terrorism expert Ariel Merari in his book Driven to Death. “This intuition presumably reflects the notion that there must be something psychologically wrong with, or at least peculiar about, young, physically healthy people who kill themselves willingly.”
Mental health does not explain terrorism, even lone wolf attacks. But mentally ill people watch the news like everyone else. Those experiencing psychotic episodes in 2017 may well have delusions about Islamic State, just as in 2007 an atheist student could have them about al-Qaeda.
The academics I spoke to felt the British police were well-trained in the distinction between a delusion and a genuine ideological motive. As armed police become more common on the streets, this training will be even more important.
Wider society, intentionally or unintentionally, still often blurs the two. On 5 December 2015, Muhiddin Mire, a 30-year-old British Somali man, ran into London’s Leytonstone Tube station with a knife. As he attempted to murder the musician Lyle Zimmerman, he was heard shouting: “This is for Syria.” When Mire was arrested, police found images of Isis on his phone. The incident was initially reported as a terrorist attack.
At Mire’s trial, though, two psychiatrists described how Mire had been previously hospitalised for psychosis, and about a year before the attack had been diagnosed with paranoid schizophrenia and given anti-psychotic medication, which he was believed to have stopped taking.
Mire was also reported to have visited a local mosque, where he asked to be exorcised of “spirits”. He believed he was being followed, and that Tony Blair was his guardian angel. Mire’s brother told Channel 4 that in August 2015, four months before the attack, “he started calling me up and saying odd things. Not radical…saying he’s seeing demons and stuff.” He called the local authorities and the police to try to get his brother help, but did not succeed.
Mire’s sentencing illustrates the difficulties society still has distinguishing illness from ideology. He was found guilty of attempted murder, rather than terrorism, and sentenced to life in a psychiatric hospital, rather than a prison. Nevertheless, during the sentencing, Judge Nicholas Hilliard QC said while he accepted the man was suffering from paranoid schizophrenia at the time of the offence, his “brazen” actions were “an attempt to kill an innocent member of the public for ideological reasons”. The Daily Mail called him a “jihadi attacker” in its headline on the story.
Six months after Mire’s trial, the newly-elected US president Donald Trump released a list of “terror attacks” he claimed had not been reported by the European press. The Leytonstone stabbing was one of them.
Zimmerman, the victim of the attack, had a different view. “I was very clear in my mind within a day or so of the attack that it was just a mental health tragedy,” he said at the time. “This guy had had a really profound history of mental illness and his family had been trying to get him help.”
If you’re affected by any of the mental health issues mentioned in this piece you can call the Mind helpline on 0300 123 3393.
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