sign in sign up
<<
Home , Dying to Win, Istishhad, Robert Pape, Suicide attack, Terror (politics)

[CRITICAL REVIEW] Are Terrorists Suicidal? A Critical Assessment of the Evidence

FUNDING: There was no funding for the by IVAN SASCHA SHEEHAN, PhD development and writing of this article. Dr. Sheehan is Graduate Program Director and Assistant Professor, Negotiation and Conflict Management Program & Global Affairs and Human Security Program, School of Public and FINANCIAL DISCLOSURES: Dr. I.S. Sheehan International Affairs, University of Baltimore, Baltimore, Maryland. is the co-author with Dr. D.V. Sheehan of the Sheehan-Homicidality Tracking Scale Innov Clin Neurosci. 2014;11(9–10):81–92 (S-HTS). ABSTRACT Conclusion: The field needs a ADDRESS CORRESPONDENCE TO: Ivan Sascha Sheehan, PhD, Graduate Objective: Most of the research more multidimensional approach, Program Director and Assistant Professor, on suicide is conducted in more systematic data at the Negotiation and Conflict Management the political science and individual level, and greater Program & Global Affairs and Human international relations fields. The international cross-disciplinary Security Program, School of Public and prevailing wisdom within this collaboration. Would-be suicide International Affairs, University of Baltimore, literature is that suicide terrorists terrorists (intercepted and arrested 1420 N. Charles St., Baltimore, MD. 21201; are not suicidal. But how good is the on their way to an attack) should be Phone: (410) 837-5328; Email: evidence for this assumption? routinely interviewed using standard [email protected] Knowing whether suicide terrorists internationally accepted psychiatric are suicidal has implications for diagnostic interviews as well as KEY WORDS: Suicide, terrorism, suicide terrorism, suicide attacks, suicide missions, prevention, rehabilitation, and the suicidality and homicidality rating martyrdom operations “softer” side of counterterrorism scales. Psychological autopsies designed to win minds and hearts. In should also be routinely conducted addition it may deepen our worldwide. Since no one research understanding of suicide itself. site can collect all of the information Design: This article uses a review that is needed, the creation of an of existing literature to examine the internationally shared database that arguments and evidence for and focuses on suicide terrorists rather against the possibility that suicide than simply incidents is encouraged. terrorists could be suicidal in the context of a broad range of INTRODUCTION explanations for suicide terrorism. Suicide terrorism is the most Results: Much of the evidence lethal form of terrorism. against the possibility that suicide Unfortunately, it is on the increase. terrorists are suicidal is based on In 2013 alone, some 384 suicide anecdote or faulty assumptions terrorist acts were carried out in 18 about suicide. Relatively few formal countries causing 3,743 . This systematic studies of suicidality in represented a 46-percent growth suicide terrorists have been over the number of attacks in 2012 conducted. Nonetheless, there is and a 66-percent increase in the emerging evidence that suicidality number of lethal casualties.1 may play a role in a significant What drives suicide terrorism and number of cases. to what extent is suicidality a

[VOLUME 11, NUMBER 9–10, SEPTEMBER–OCTOBER 2014] Innovations in CLINICAL NEUROSCIENCE 81 , however, only requires that “the attacker does not expect to survive the mission” while Ami Pedahzur of Haifa University clarifies that the odds of returning alive are “close to zero.”5,6 For Ariel Merari of University, what is critical is the “readiness to die in the process of committing a terrorist act.” This means that unintended (cases in which the attacker is coerced into detonating a suicide belt, for example, or cases in which the driver of a -laden car is not told ahead of time that he will die in the mission) are not counted as suicide terrorism. However, acts that are intercepted or interrupted or fail are counted if FIGURE 1. Percent distribution of research areas in papers on suicide terrorism, 2000–2013; Data based on Web of Science search for 2000–2013 (n=309 papers) the perpetrator is willing to kill and die in the process.7 Myths and history. In the contributing factor? Although the individual who volunteers for aftermath of the September 11, suicide terrorist acts have become the mission in the first place. 2001, terrorist attacks on New York disturbingly frequent, with more City and Washington, DC (9/11), than 3,500 since 2003,1 we still know BACKGROUND two myths were routinely promoted: very little about the individuals who Definitions. Suicide terrorism, 1) suicide terrorism was a new commit them. sometimes labeled “suicide attacks,” phenomenon and 2) it was almost As shown in Figure 1, most of the “suicide missions,” “suicide always the province of religious scholarship on suicide terrorism operations,” but also “martyrdom fanatics. In fact, suicide terrorism (63%) comes from the political operations,” has been defined as has existed since ancient times. Nor science and international relations “the targeted use of self-destructing does any society or religion have a fields (Figure 1). By contrast only a humans against noncombatant— monopoly on it. The Zealots, a small proportion originates in typically civilian—populations to Jewish sect, practiced suicide disciplines that focus on the effect political change.2 Typically, it terrorism in Rome-occupied Judea individual, such as psychology is viewed as a “ of as early as the first century. (16%) and psychiatry (5%). Within intended to Typically, a Zealot, also called Sicari this literature, the conventional affect a larger public audience” (i.e., or “daggerman,” would go up to a wisdom is that suicide terrorists are those who are “made to witness Roman soldier and stab him in front normal, well-adjusted individuals it”).2 The audience may be a of other soldiers knowing full well who turn to suicide for government, the group’s own that he would be executed on the political or religious reasons or domestic supporters, rivals, spot. The Islamic simply because of social and group potential patrons, or a diaspora. also used suicide operations in the processes. But how good is the In some definitions, the of region we now know as as far evidence for these claims and to the perpetrator is required. For back as the Crusades in the 12th what extent are arguments for and example, Dr. Boaz Ganor, Executive century.8 More recently, suicide against suicidality as a contributing Director of the International Policy operations have been carried out by factor to suicide terrorism Institute for Counter-Terrorism in a variety of secular groups including supported theoretically? , defines suicide terrorism as the Anarchists in 19th century This article reviews existing “an operational method in which the Russia and the Liberation Tigers of scholarship to try to answer these very act of the attack is dependent Tamil Elam (LTTE), a leftist Marxist questions. A basic assumption upon the death of the perpetrator.”3 group in , who became the behind the article is that suicide University of Massachusetts world leaders in suicide terrorism in terrorism is a multifaceted problem professor Mia Bloom also asserts the 20th century.9 Suicide terror has that needs to be approached from that the perpetrator’s death “is the also been sponsored by sovereign multiple perspectives at multiple precondition for the success of the states. In the of Okinawa levels: the society, the group and attack.”4 of the (April 1945), for example, Japan

82 Innovations in CLINICAL NEUROSCIENCE [VOLUME 11, NUMBER 9–10, SEPTEMBER–OCTOBER 2014] dispatched some 2,000 who rammed fully fueled fighter planes into more than 300 ships, killing 5,000 Americans in the most costly naval battle in United States history.10 too sent waves of young volunteers on suicide missions, in this case against the then United States-backed Iraqi army in the Iran- of the 1980s, and Iran is now believed to have sponsored the first major modern suicide operation, namely the bombing of the Iraqi embassy in Beirut in 1981. This event is viewed as a landmark in suicide terrorism since were deliberately carried to the target and delivered by surprise—it left 27 dead and over 100 wounded. Iran is also believed to have been behind the truck bombing of the Marine barracks FIGURE 2. Number of suicide terrorism attacks 1980–2013; data extracted from Chicago bombing the following year—an Project on Security & Terrorism (CPOST)1 attack that killed almost 300 American and French servicemen and drove President Reagan to withdraw forces from . That attack served as a model for the devastating 9/11 suicide attacks, this time using airplanes driven into buildings. Recent trends. Suicide terrorism is not new, nor is it necessarily a religious phenomenon. The problem, however, has escalated in the last decade. As shown in Figure 2, the number of suicide attacks worldwide rose from an average of five per year in the 1980s to 10 per year in the . It continued to climb after 9/11, reaching a peak of 521 in 2007 at the height of the . While the frequency of these attacks began to decline in 2008, suicide operations have been on the upswing again since 2012 reaching a Number killed and wounded in suicide terrorist attacks 1991–2013; Data extracted height of 384 in 2013, a 46-percent FIGURE 3. from Chicago Project on Security & Terrorism (CPOST)1 increase over 2012.1 These trends are worrisome since suicide terrorism is the most lethal increased by a factor of 18 and the dramatically in the last decade? form of terrorism, 13 times deadlier number wounded grew by a factor of Social scientists have tried to than any other form of attack.5 17 in first decade of the 21st explain the phenomenon at three Overall, suicide attacks have taken century (Figure 3).1 general levels of analysis: the the lives of more than 37,000 since political/strategic, the 1991 and wounded more almost EXPLANATIONS social/cultural, and the personal. 102,000. Moreover, as shown in What accounts for suicide National liberation. Robert Figure 3, the number killed terrorism? Why has it increased so Pape, Director of the Chicago

[VOLUME 11, NUMBER 9–10, SEPTEMBER–OCTOBER 2014] Innovations in CLINICAL NEUROSCIENCE 83 Project on Suicide Terrorism, makes , Iraq and Palestine. suicide terror is often a strategy of the claim that suicide operations are One could argue that the liberation, observes that its almost always rational and strategic. fits this model too as is evident in a attraction may lie, in addition, in the Specifically, he argues that such 2013 headline, “Taliban vow suicide prestige it confers. In particular, she attacks are designed to coerce an and “insider” attacks in new spring notes that suicide terrorism can give adversary and drive occupiers out of .”12 a group an advantage over rivals in a . “Every group mounting Pape’s theory is not without terms of recruitment, publicity, and a suicide campaign over the past flaws. One problem is that not all money. Bloom uses the example of two decades has had as a major countries that are occupied produce the Popular Front for the Liberation objective [...] coercing a foreign suicide attackers. There is the of Palestine (PFLP), a group that state that has forces in what additional problem that many turned to suicide terrorism only the terrorists see as their homeland suicide attackers come from after it realized that had to take those forces out.”5 countries that are not occupied. gained in popularity and How well does this theory stand Consider the Madrid bombers, the recruitment when it engaged in up to the empirical evidence? The London bombers, the waves of suicide terrorism.15 Others, however, tactical benefits of suicide terrorism young people from countries such as have raised questions about the are well known. Suicide attacks are , Saudi Arabia, , extent to which market share plays cheap. Estimates vary, but the and other non-occupied lands who a significant role. Crenshaw, for operation may cost as little as $150 flocked to Iraq and to example, observes that the most per attack.11 This kind of attack can conduct suicide operations. These vigorous suicide campaigns of the be mounted anywhere and the trends have led to growing LTTE occurred well after the group perpetrator can easily pivot and skepticism about the merit of seeing had eliminated most of its change direction without having to suicide terrorism as a strategy of competition and al Qaeda’s actions make elaborate escape plans. national liberation. too are “hard to explain in terms of Suicide attacks are also effective in As Atran puts it, “When Arabs competition with rivals.”16 that they kill many more people from more than a dozen countries Poor economic development. than other kinds of attacks. rush to embrace death in Iraq to kill Political leaders have long claimed According to one estimate, the Shi’as who are probably more that poverty breeds terrorism. The average number of victims from a supportive of Iran than the United evidence to support this claim, suicide truck or car bombing is 30 States, it is quite a stretch to however, is weak. Princeton times higher than the number from identify the common thread as a economist Alan Krueger and his a shooting (97.8 vs. 3.3) and 14 secular struggle over foreign colleague Jitka Maleckova found no times higher than the number from occupation of a homeland unless correlation between poor economic a remote-control attack.5 “secular” covers transcendent conditions and terrorism. Indeed As a result suicide operations create , ‘foreign occupation’ their research indicated that a spectacle, bringing attention to a includes tourism, and ‘homeland’ Palestinian suicide attackers came cause. expands to at least three from wealthier families and had But is suicide terror always continents.”13 higher levels of education than designed to expel an occupier from The general theory that suicide those of average .17 a homeland? Professor Pape uses terrorism is always rational and These results are supported by over 300 cases to support his strategic has also come under others. Harvard professor Albert theory. He points out that that attack. Brym and Raj, for example, Abadie, for example, found that , with the support of Iran, observe that the during the Second while the freest and richest used campaigns of suicide attacks to Intifada, “the objectives and countries have experienced the drive the United States and France precipitants of suicide bombing least terrorism, this is also true of out of Lebanon, that the LTTE used reveal little of the strategic logic the poorest and most oppressed.18 suicide operations to get Sri Lanka that, according to Pape, lies at its James Piazza’s findings are to accept a Tamil State, that core.” Indeed they claim that consistent with these results.19 On Palestinian groups used suicide retaliation for specific Israeli actions the other hand, Efraim Benmelech attacks to try to get Israel out of the was more pertinent, and, in this and colleagues at Harvard have and Gaza, that Chechen case, suicide tactics could hardly be produced more nuanced findings rebels also used the same modus to considered rational since they showing that while economic get Russia out of , and al resulted in so many arrests, conditions are not associated with Qaeda fits the model insofar as one assassinations, and other collateral the quantity of terror, they may idea behind the 9/11 attacks was to damage.14 impact its quality. In particular, they get the United States to withdraw Gaining an edge over rivals. note that poor economic conditions from Arab heartlands including Mia Bloom, while agreeing that may lead more able, better educated

84 Innovations in CLINICAL NEUROSCIENCE [VOLUME 11, NUMBER 9–10, SEPTEMBER–OCTOBER 2014] individuals into terror attacks, attacks.25 Building on Sageman’s that among the female suicide allowing organizations to send the work, Atran put forward the theory bombers in Chechnya she studied, best qualified to the highest impact that being part of a group that most were widows or bereaved terrorist missions.20 encourages camaraderie and siblings.30 Others have found that The pull of cultures of conforming to the group may be the significant proportions of suicide martyrdom. Mohammad Hafez of most important motivator for attackers suffered other losses at the the University of Missouri, among suicide terror especially in diaspora hands of an enemy. Based on post- others, has called attention to the communities.26 mortem results, Rona Fields and her pull of “cultures of martyrdom” as a But again how good are these coauthors, for example, found that contributing factor in suicide theories? Cultural and small group five of the nine suicide terrorists operations.21–23 There is no question theories, while compelling, still do they examined had been injured as a that some terrorist groups not explain why some of those who result of the intifada in Gaza. Eight consciously cultivate cultures of join terror groups strap on had been imprisoned and tortured, martyrdom and promote them in a and kill themselves while others and in five of the eight, their families “top-down” way to draw recruits. take on other roles (e.g., as had been reportedly beaten and Hamas calendars, for example, organizers, recruiters, or humiliated by soldiers.31 herald the “ of the Month.” reconnaissance). What differentiates Material incentives. Material Similarly the LTTE and ’s the ones who actually strap on a incentives, including cash, free Kurdistan Workers party (PKK), bomb to kill themselves? apartments, and the guarantee of a both secular groups, celebrate the This brings us to explanations at place in heaven, have also been cited anniversary of their first suicide the personal and psychological level. as playing a role.9 bombers every year, while Chechen Here there is quite a bit of groups are known to commemorate controversy. ARE THEY MENTALLY ILL? the first Chechen suicide bomber in Personal motivations. Suicide The general consensus among a popular song.24 The extent to attacks are almost always organized scholars is that suicide terrorists do which consciously created cultures by groups that recruit, train, and not have significant of martyrdom play a role in suicide provide logistics (e.g., time, place, psychopathology.2,5 But how good is operations, however, may be target, and weapon). At the same the evidence for this claim? overstated. time, the suicide terrorist actor Most of the “evidence” is The pull of social networks belongs to what Ariel Merari and impressionistic. Based on interviews and ties. Others have suggested colleagues call a “select group.”27 with 250 Palestinian suicide terrorist that suicide terrorism is better Whether there is social support, and recruiters, trainers, and would-be explained as a “bottom-up,” some societies are more supportive suicide bombers and their families, leaderless group or cultural of suicide operations than others,28 Nasra Hassan of the phenomenon. Mark Sageman, a the individual still has to make the Office on Drugs and Crime simply forensic psychiatrist and former irretrievable decision to participate asserts that suicide bombers seem to intelligence officer, studied the in the act. What distinguishes those be normal: “They all seemed to be biographies of more than 400 who do? normal members of their families. members of so-called Islamic Despair, humiliation, injustice. They were polite and serious; and in terrorist groups with ties to Al Harvard’s Jessica Stern has argued their communities they were Qaeda. In particular, he looked at that suicide terrorists are almost considered to be model youth.”32 ones who joined extremist Salafi always driven by a sense of Using case studies designed to groups. What he found was that humiliation and injustice.8 Hafez examine the strategic motivations many were uprooted, living away places the act in the context of an behind suicide attacks, Robert Pape from their homelands, often away escalating sense of victimization. makes similar claims: “Few suicide from family, in countries where they Similarly, Atran emphasizes feelings attackers are social misfits, suffered insults and humiliation for of “injustice” and “humiliation” as criminally insane or professional being foreign and, for that matter, driving factors.2 losers [...] Most are deeply integrated for being Arab. They joined groups Loss and revenge. For individual into social networks and emotionally that espoused suicide terrorism perpetrators of suicide acts, there attached to their communities.”5 largely because their friends joined. may be an additional desire for In a similar vein, Riaz Hassan of Many went off to missions in personal revenge after the loss of a Flinders University asserts that “the friendship pairs, sibling pairs, loved one. Sageman, in his work on causes of suicide bombings lie not in husband and wife pairs, and even extremist Salafi groups, found that individual psychopathology but in parent/child pairs. In one case, 8 of nearly all of those he studied had broader social conditions.”33 11 members of a Hamas-associated someone close to them suffer injury A few scholars simply note that football club carried out suicide or death.25 Anne Speckhard reports suicide terrorist recruiters “screen

[VOLUME 11, NUMBER 9–10, SEPTEMBER–OCTOBER 2014] Innovations in CLINICAL NEUROSCIENCE 85 out” the mentally unstable—as if evidence, however, has limitations. addition, three of the would-be that closes the case.34,35 As Ariel Merari observes, suicide terrorists, but no controls, Others, however, have provided information from family and friends had evidence of PTSD. In contrast, anecdotal evidence that suggests may be “skewed by the wish to only three of the organizers (8%) that such screens may not be present them in a positive light.”41 In had depressive tendencies and none successful, if they are conducted at addition, as the authors themselves of the controls or organizers had all. Reporting on her interviews with observe, “loved ones can be evidence of PTSD. Merari also found the families of female suicide oblivious to the internal turmoil” of a much higher incidence of bombers in Chechnya, the West the person engaging in these acts.41 dependent avoidant personality in Bank, and Gaza, Lisa Ling notes that Somewhat different results were the would-be suicide bombers many had lost a husband or close obtained by Anne Speckhard of (69%) compared to controls (20%) relative in the war and most were Georgetown University and her and organizers (8%). As another “vulnerable broken women who saw colleague Khapta Akhmedova in difference, he found that while no way out.”36 Similarly, Brian Glyn their study of 26 female Chechen three of the controls (25%) and one Williams, in his study of suicide suicide bombers. Based on organizer (7%) exhibited attacks in Afghanistan, notes that interviews with family members and psychopathic tendencies, none of Afghan told him that large close associates, they found that the suicide bombers showed these numbers of suicide bombers the nearly all had lost close family traits.27 These results are supported police arrested after failed suicide members in air raids, bombings, or by case studies of deceased suicide bombing attempts were “mentally landmines carried out by Russian bombers conducted by University of unsound, deranged” or cognitively forces and in battle. Many had Alabama criminal justice professor impaired.37 Others have supported personally witnessed death or Adam Lankford.43 these claims.38 According to Yusef beatings of family members at close Yadgani, a pathologist at Kabul hand. According to their family ARE THEY SUICIDAL? Medical University, three of every members and friends, none had Arguments against suicidality five suicide bombers he studied in significant personality disorders or as a contributing factor. The his lab had a physical ailment or psychiatric symptoms before the prevailing view among scholars is disability. Adding those who suffer trauma, but all changed afterwards. that suicide terrorists are not from mental illness, the number of In particular, all had dissociative suicidal. Again, how good is the sick and disabled bombers climbs to symptoms characteristic of evidence? Ellen Townsend of more than 80 percent in his posttraumatic stress disorder University of Nottingham argues estimate.39 (PTSD). In addition, in the period that suicide terrorists are not To date, relatively few formal before they engaged in suicide suicidal based on the following studies of psychopathology in terrorism, three fourths (73%) propositions: 1) suicide is suicide terrorists have been showed signs of depression, 92 associated with psychopathology, published, and the results are percent became socially isolated, 23 and suicide terrorists do not exhibit mixed. University of Toronto percent became aggressive, and 31 overt psychopathology; 2) recruiters professors Robert Brym and Bader percent began talking repetitively screen out the mentally ill; 3) Araj conducted 42 sets of in-depth about “revenge.”42 suicide using violent methods is an semi-structured interviews with the The latter results are supported impulsive act while suicide immediate family members and in a controlled study of “would-be" terrorism is meticulously planned; friends of a random sample of suicide terrorists by the Israeli 4) suicide terrorism has murderous suicide bombers who died in suicide psychologist Ariel Merari. Merari intent, and murderous intent is rare missions in the West Bank and Gaza. interviewed 15 would-be suicide in suicide; 5) many suicide terrorists Using a battery of questions and terrorists (intercepted moments are religious, but religion protects documentary evidence, they found before their attacks), 12 nonsuicide against suicide.44 Another that although 21 percent of the terrorist matched controls, and 14 assumption that is sometimes made bombers had expressed a desire for terrorist organizers. None of the is that suicide terrorists could not martyrdom, 76 percent did not subjects had a diagnosis of be suicidal since suicide terrorists manifest any outward sign of psychosis or a history of often act in familial networks of depression or personal crisis in the hospitalization for mental disorders. relative pairs (siblings, parent-child, year preceding the attack. While 24 Eight (53%) of the would-be suicide or cousin pairs) and such acts are percent did show outward signs of terrorists displayed symptoms of more likely to be a result of depression, this rate, they claim, depression—melancholy, sadness, socialization and family bonds. How was not unusually high given hopelessness, low energy, well do these arguments hold up? population statistics for depression tearfulness, emotional constriction, Psychopathology argument. The in the West Bank and Gaza.41 This and distracted attention. In proposition that suicide terrorists

86 Innovations in CLINICAL NEUROSCIENCE [VOLUME 11, NUMBER 9–10, SEPTEMBER–OCTOBER 2014] could not be suicidal because they that, contrary to the conventional intent. They may be both suicidal have no psychopathology has clear wisdom, dispatchers are often told and homicidal. And, depending on flaws. It is true that to “look for sad guys.”55 Nor is it just the culture in which the act occurs, psychopathology is the most that we have anecdotal evidence, at the degree of homicidal intent may important antecedent and correlate least from Afghanistan, that many of be higher or lower. Williams notes of suicidal behavior worldwide.45 those who are recruited are that, at least in the initial phases, However, as Brooke Rogers and “mentally challenged.”37 There is an suicide attacks were less effective colleagues of Kings College London additional problem. How exactly do and took fewer victims in observe, studies on the these recruiters actually screen out Afghanistan than in Iraq. This may psychopathology of suicide the mentally ill? What tools do they be because of cultural taboos on terrorists have not been systematic use and to what extent are they killing innocents in Pashtun and what evidence does exist is influenced by cultural frames? culture.37 mixed.46 It is possible that Cultural frames may be particular Religiosity argument. Finally, psychiatric disorders such as barriers for recruiters in the context the notion that suicide terrorists depression and PTSD are higher in of Islamic terrorist recruitment. cannot be suicidal because many are this population than is generally Okasha and Okasha observe that religious and religion protects assumed. To complicate matters, religious people in the against suicide is debatable on the precise role of psychopathology often miss psychiatric symptoms or several counts. First, not all suicide in suicide is not as straightforward interpret them from a religious terrorists are religious. Many are as might appear. Indeed, there is perspective. For example, negative secular. The Palestinian , the increasing evidence from twin signs of psychosis (, PFLP, and the PKK, for example, studies that while psychopathology poverty of thought) may be have little or no connection to is often associated with suicide, interpreted in terms of piety while fundamentalist . Moreover, one susceptibility to positive ones (auditory or visual of the terrorist organizations that and behavior may be transmitted hallucinations) are viewed as “gifts have regularly employed suicide genetically independently of the of God.”56 The express focus of terrorism as a strategy in modern presence of a psychiatric disorder.47 recruiters on finding candidates times is the LTTE. Not only are There is growing evidence, with high motivation and a sense of members of this organization not moreover, that suicidality is duty may also backfire. In fact, Muslim, most of them are not associated with a long list of medical there is good evidence that these religious at all. Second, the and psychiatric disorders, and that very traits, together with lack of protective power of religion in it is not always associated with help-seeking, are the ones that best preventing suicide may be depression as is popularly predict suicidal behavior in soldiers overstated.60 It is true that religious assumed.48 These findings have led in combat situations.57 affiliation has been found to be to the suggestion that suicidality Impulsivity argument. The associated with lower rates of may be made up of several primary notion that suicide terrorists could suicide attempts in some clinical disorders that can be comorbid but not be suicidal because their acts populations.61,62 These findings, are independent of other psychiatric are meticulously planned and however, may be biased since disorders.49,50 In support of this view suicide is impulsive is simply wrong. disclosure of suicidal ideation and is the finding that in the treatment While impulsive traits have been behavior might be lower in people of depression medication may make shown to increase the risk of suicide with religious affiliations because of suicidality worse in some, better in in some populations, especially the taboos against it.63–65 In relation others, and have no effect in a third those with bipolar disorder and to Islam specifically, Okasha and group. On the other hand, some alcohol abuse, decades of research Okasha note that suicide is medications associated with suicide have shown that the majority of forbidden by the Qu’ran, and few reduction (e.g., lithium and those who commit suicide do not do will admit to suicidal clozapine) are not indicated or so impulsively and, in fact, have had behavior when questioned directly approved for the treatment of suicidal ideation for some time and although they will do so when the depression.51–54 made prior plans for these acts.58,59 questions are open-ended.56 Taboos Recruitment argument. The Murderous intent argument. against suicide can result in assumption that recruiters The proposition that suicide underreporting of suicide,66 and successfully reject candidates who terrorists could not be suicidal there is growing evidence that are mentally ill is also problematic. because they have murderous intent suicide is underreported in Muslim It’s not just that recruiters may represents a false dichotomy. Even countries. For example, in an actually seek out depressed if suicide terrorists have murderous analysis of suicide and candidates— in her intent, that fact does not mean that undetermined deaths in 17 interviews in Israeli prisons found they cannot also have suicidal predominantly Islamic countries,

[VOLUME 11, NUMBER 9–10, SEPTEMBER–OCTOBER 2014] Innovations in CLINICAL NEUROSCIENCE 87 Pritchard and Amanullah report that claim is weak. Nasra Hassan simply wanted to kill myself. I used to reclassification of suicides to include asserts that suicide terrorists she stand in front of Israeli tanks, “hidden suicides” (otherwise interviewed did not exhibit “suicidal hoping they would shoot me. I tried classified as “other violent death” symptoms.”32 Rex Hudson makes it more than once, but it didn’t [OVD]) resulted in the finding that similar claims based on his review of work. I didn’t know anymore what suicide rates in Islamic countries theoretical literature and 12 profiles to do…Then I met people that were as high as those in the United of terrorists from government offered me the chance to carry out Kingdom and at least eight times archival data.34 Neither the literature an act of [martyrdom]. I higher than otherwise officially nor the profiles, however, contain had been thinking for a long time reported.67 any evidence of systematic about an opportunity to die, and Familial network argument. evaluations of suicidal symptoms. when these men showed up, I said The idea that suicide terrorists Based on “semi-structured” to myself that this was a good could not be suicidal because interviews with 35 terrorists and opportunity.”41 suicide bombers often act in familial commanders in Israeli jails, Jerrold pairs (mother/son, father/daughter, Post and colleagues also claim that CONCLUSION and FUTURE siblings) is problematic in light of suicide terrorists are not suicidal. DIRECTIONS growing evidence of genetic factors However, they provide little The literature on suicide in suicide.68 According to one study, information about the methodology terrorism has been dominated by identical twins share suicidal they used to come to this political and social theories. This tendencies in 15 percent of cases.69 conclusion, relying instead on may be because the political and There is additional evidence from quotes from terrorist commanders social aspects of suicide terror are adoption studies showing that the who told them that, unlike suicide, thought to be more important or at biological relatives of people who suicide terrorism is istishad least more pertinent to commit suicide are six times as (martyrdom or self sacrifice) and counterterrorism than individual likely to commit suicide as members that in any case recruiters screen aspects. It may also be because of the families that adopted them.70 out those who are suicidal.35 information on what motivates an Among individual genes that have In the controlled Merari study individual to engage in this behavior been associated with suicide are cited earlier, different results were is so difficult to obtain. Suicide those involved in the brain’s obtained. Merari found that as many terrorists, after all, operate in response to mood-lifting serotonin as 40 percent of the would-be secret, they are protected by and a signaling molecule called suicide bombers, but none of the clandestine groups, and many do brain-derived neurotrophic factor controls (no-suicide terrorists), not live to tell their stories. For (BDNF) that regulates the brain’s displayed suicidal tendencies on a scholars, there may be an additional response to stress. In a recent standardized battery of tests; and 13 concern—that any inquiry into the study, a group of researchers at percent had made previous attempts psychological or psychiatric aspects MacDill University compared the not related to terrorism. These rates of suicide terror somehow brains of 46 people who had are far in excess of the rates in the marginalizes or deligitimizes the real committed suicide with those of 16 general population. In addition, political and social grievances that people who died of natural causes. Merari found that 64 percent (9/14) are thought to lie at the heart of the In those who committed suicide, 366 of the organizers said they would pheonomenon. genes, mostly related to learning never volunteer themselves for a Emerging evidence that suicidal and memory, had a different set of suicide mission. One of the ideation and behavior do play a role epigenetic markers—chemical organizers put it this way: “No, it’s in a “significant minority” of cases of switches that turn genes on and off. very difficult. Every man has suicide terrorism should not be These results may be complicated different character and traits. I was dismissed. Just because suicidal by the fact that many of the people destined to organize [suicide ideation operates at some level in who committed suicide had attacks] and others were destined to some cases does not mean that psychiatric disorders, but the perform martyrdom operations [...] I political and social factors do not authors found that suicide, rather am willing to fight but not to die in a also operate at other levels or that than the presence of a psychiatric . For me life is very these levels are not equally disorder, was the only significant basic.”41 important. predictor for these specific Another explained: “I wouldn’t be What is needed is more epigenetic changes.71 willing to carry out a martyrdom systematic, cross-disciplinary What the evidence shows. operation. Everyone has his role. I research and cross-national Despite widespread acceptance of was an organizer.”41 collaboration on the subject. The the claim that suicide terrorists are On the other hand, a would-be field has benefited from the not suicidal, the evidence for this bomber made this statement: “I development of several well

88 Innovations in CLINICAL NEUROSCIENCE [VOLUME 11, NUMBER 9–10, SEPTEMBER–OCTOBER 2014] organized and systematic recommended by Townsend. 2003;299:1534–1529. databases.1,72–74 These databases can Indeed, the number of suicide 3. Boaz G. Suicide Attacks in Israel. be mined for factual information events is not so great each year that In: Countering Suicide about suicide terrorist incidents psychological autopsies using Terrorism. Herzliya: International (when and where they occur, the consistent criteria could not be Policy Institute for Counter- targets, tactics and used, performed on a widespread basis. Terrorism; 2000:134. and the motivations of the groups Given increasing evidence of 4. Bloom M. Dying to Kill: The that promote them). They are not biomarkers in suicide, psychological Allure of Suicide Terror. New designed, however, to provide autopsies should be complemented York: Columbia University Press; insights into the motivations or by physical autopsies where 2007. psychopathology or potential suicide possible.80–82 5. Pape R. : The tendencies of individuals who turn Knowing whether suicide Strategic Logic of Suicide to suicide terrorism. attackers are suicidal is not simply Terrorism. New York: Random To move the field forward, we an academic issue. In the context of House; 2005. need what Sageman has called “an growing evidence that recruitment 6. Pedahzur A. The Root Causes of actual terrorist database, not a occurs among the bereaved, those Suicide Terrorism: The database based on events or with disabilities, and even mental Globalization of Martyrdom. incidents, but on the terrorists illness, it has clinical implications. It New York: Routledge; 2006:8. themselves.”75 Given the high also has implications for prevention. 7. Merari A. The readiness to kill and lethality of suicide terrorism and the If suicidality (ideation, intent, die: suicidal terrorism in the fact that no single organization can planning) plays any role in the path Middle East. In: Reich W (ed). collect all the information that is to becoming a suicide attacker, even Origins of Terrorism: needed, there is a special need for a for a minority of such attackers, that Psychologies, Ideologies, suicide terrorist database that can finding could be used at population Theologies, States of Mind. be mined and shared internationally. levels to design screening programs Washington DC: Woodrow Wilson Major research and healthcare that could potentially identify and Press; 1998:192. organizations around the world possibly reduce the numbers of 8. Stern J. Terror in the Name of should work together to develop the individuals who are vulnerable to God. New York: Harper Collins; logistics for such a database. As a recruitment. In the context of 2003. first step, such organizations should recent efforts (especially in the 9. Cronin AK. Terrorists and exert pressure on individual Arab world) to “rehabilitate” would- Suicide Attacks. Washington DC: countries to adopt a policy of be terrorists, it also has implications Library of Congress; 2003. routinely interviewing “would-be” for rehabilitation and what has been 10. Axell A, Kase H. Kamikaze: suicide terrorists (those intercepted called a “soft approach” to Japan’s Suicide Gods. New York: and arrested on the way to an counterterrorism.83–87 While many of Longman; 2002. attack) using standardized these programs were designed to 11. Hoffman B. The logic of suicide diagnostic interviews for psychiatric “de-radicalize” and encourage terrorism. The Atlantic. June 1, disorders, such as the International renunciation of terrorist 2003. Neuropsychiatric Interview (MINI),76 and systematic efforts to evaluate http://www.theatlantic.com/magazi and standardized rating scales, such them are still lacking, fighting for ne/archive/2003/06/the-logic-of- as the Sheehan Suicidality Tracking the “minds of suicide bombers” is a suicide-terrorism/302739/. Scale (S-STS) and the Sheehan promising direction.86 There is the Accessed October 1, 2014. Homicidality Tracking Scale (S- additional benefit that more 12. . Taliban vow suicide and HTS).77–79 These instruments have systematic research on this “insider” attacks in new spring the advantage of being brief, very phenomenon will advance the offensive. April 27, 2013. thorough, and easily administered broader study of suicidal behavior http://www.reuters.com/article/201 by nonclinicians. The MINI has itself. 3/04/27/us-afghanistan-offensive- already been translated into 69 idUSBRE93Q01Z20130427. languages, including and REFERENCES Accessed October 1, 2014. Chinese, the S-STS is available in 25 1. Chicago Project on Security and 13. Atran S. Moral logic and growth of languages, and efforts are underway Terrorism (CPOST). Suicide suicide terrorism. Washington to translate the S-HTS. Standardized attack database. Quarterly. 2006;29(2):127–147. data collection will allow pooling of http://cpostdata.uchicago.edu/sear 14. Brym RJ, Araj B. Suicide bombing data and sharing. ch_new.php. Accessed June 1, as strategy and interaction: the Psychological autopsies on 2014. case of the . deceased suicide bombers should 2. Atran S. Genesis of suicide Social Forces. also be routinely performed as terrorism. Science. 2006;84(4):1969–86.

[VOLUME 11, NUMBER 9–10, SEPTEMBER–OCTOBER 2014] Innovations in CLINICAL NEUROSCIENCE 89 15. Bloom M. Palestinian suicide 28. Pew Research Global Attitudes bombers in Afghanistan. Middle bombing: public support, market Project. Muslim publics share East Policy Council. 2008;15(4). share, and outbidding. Political concerns about extremist groups. http://www.mepc.org/journal/middl Science Quarterly. September 10, 2013. e-east-policy-archives/- 2004;119(1):61–88. http://www.pewglobal.org/2013/09/ omars-missiles-field-report- 16. Crenshaw M. Explaining suicide 10/muslim-publics-share-concerns- suicide-bombers- terrorism: a review essay. about-extremist-groups/. Accessed afghanistan?print. Accessed Security Studies. October 1, 2014. October 1, 2014. 2007;16(1):133–162. 29. Hafez MH. Manufacturing 38. Fatah S. Why the disabled do 17. Krueger A, Maleckova J. Human Bombs: The Making of Taliban’s deadly work. Globe and Education, poverty and terrorism: Palestinian Suicide Bombers. Mail. May 7, 2007. Is there a causal connection? J Washington, DC: United States http://www.theglobeandmail.com/n Econ Perspec. 2003;17(4):119–44. Institute of Peace Press; 2006. ews/world/why-the-disabled-do- 18. Abadie A. Poverty, political 30. Speckhard A, Akhmedova K. The -deadly- freedom and the roots of new Chechen : work/article18138707/ Accessed terrorism. Am Econ Review. wahabism as a radical movement Oct. 1, 2014 2006;96(2):50–56. and a source of suicide terrorism 39. Nelson SS. Disabled often carry 19. Piazza JA. A supply-side view of in post-war Chechen society. out Afghan suicide missions. suicide terrorism: a cross-national & Security. National Public Radio, Morning study. J Politics. 2006;2:1–53. Edition, October 15, 2008;70(1):28–39. 31. Fields RM, Elbedour S, Hein AF. 2007.http://www.npr.org/templates 20. Benmelech E, Berrebi C, Klor E. The Palestinian suicide bomber. In /story/story.php?storyId=15276485 Economic conditions and the Stout CE (ed). The Psychology of . Accessed October 1, 2014. quality of suicide terrorism. J Terrorism: Clinical Aspects and 40. Brym RJ, Araj B. Are suicide Politics. 2012;74(1):113–128. Responses. Westport, CT: Prager bombers suicidal? Stud Confl 21. Hafez M. Suicide Bombers in Publishers; 2002:193–223. Terror. 2012;35(6):432–443. Iraq: The Strategy and Ideology 32. Hassan N. Letter from Gaza: an 41. Merari A. Driven to Death: of Martyrdom. Washington DC: arsenal of believers. New Yorker. Psychological and Social Aspects United States Institute of Peace; 2001:36–41. of Suicide Terrorism. Oxford, 2007. 33. Yale Global Online. Hassan R. UK: ; 22. Moghadam A. The Globalization What motivates the suicide 2010. of Martyrdom: Al Qaeda, Salifi bomber? September 3, 2009. 42. Speckhard, A. Akhmedova K. Jihad and the Diffusion of http://yaleglobal.yale.edu/content/ Black widows: the Chechen female Suicide Attacks. Baltimore: Johns what-motivates-suicide-bombers- suicide terrorists. In: Schweitzer Y Hopkins Press; 2008. 0. Accessed October 1, 2014. (ed). Female Suicide Bombers: 23. Glucklich A. Dying for Heaven: 34. Hudson R. The Sociology and Dying for Equality? Tel Aviv: Holy Pleasure and Suicide Psychology of Terrorism: Who Jafee Center for Strategic Studies; Bombers—Why the Best Becomes a Terrorist and Why? 2006:63–80. Qualities of Religion Are Also Its Honolulu, HI: University Press of 43. Lankford A. The Myth of Most Dangerous. NY: HarperOne; the Pacific; 2005. Martyrdom: What Really Drives 2009. 35. Post J, Sprinzak E, Denny L. The Suicide Bombers Rampage 24. Gill P. A multi-dimensional terrorists in their own words: Shooters and Other Self- approach to suicide bombing. Int interviews with 35 incarcerated Destructive Killers? New York: J Confl Violence. Middle Eastern terrorists. Terror Palgrave Macmillan; 2013. 2007;1(2):142–159. Polit Violence. 44. Townsend E. Suicide terrorists: 25. Sageman M. Understanding 2003;15(1):171–184. are they suicidal? Suicide Life- Terror Networks. Philadelphia, 36. Handwerk B. Female suicide Threat. 2007;37(1):35–49. PA: University of Pennsylvania bombers: dying to kill—an 45. Nock MK, Borges G, Bromet EJ, et Press; 2004. interview with Lisa Ling. National al. Cross–national prevalence and 26. Atran S. Mishandling suicide Geographic News. December 13, risk factors for suicidal ideation, terrorism. Washington 2014. plans and attempt. Br J Quarterly. 2004;67–90. http://news.nationalgeographic.co Psychiatry. 2008;192:98–105. 27. Merari A, Diamant I, Bibi A, et al. m/news/2004/12/1213_041213_tv_ 46. Rogers MB, Lowenthal KM, Lewis Personality characteristics of suicide_bombers.html. Accessed CA, et al. The role of religious suicide bombers and organizers of October 1, 2014. fundamentalism in terrorist suicide attacks. Terror Polit 37. Williams BG. Mullah ’s violence: a social psychological Violence. 2009;22(1):1061. missiles: a field report on suicide analysis. Int. Rev Psychiatry.

90 Innovations in CLINICAL NEUROSCIENCE [VOLUME 11, NUMBER 9–10, SEPTEMBER–OCTOBER 2014] 2007;19(3):253–262. patients with major depressive in twins: a replication. J Affect 47. Pedersen NL, Fiske A. Genetic disorder or bipolar disorder. Am J Dis. 2001;66(1):71–74. influences on suicide and nonfatal Psychiatry. 2004;161:1433–1441. 70. Brent D, Mann JJ. Family genetic suicidal behavior: twin study 59. Smith A, Witte TK, Teal N, et al. studies, suicide, and suicidal findings. Eur Psychiatry. Revisiting impulsivity in suicide. behavior. Am J Med Genet. 2010;25:264–267. Behav Sci Law. 2005;133C(1):13–24. 48. Harris EC, Barraclough B. Suicide 2008;26(6):779–797. 71. Labonte B, Suderman M, Maussion as an outcome for mental 60. Pritchard C. Suicide—The G, et al. Genome-wide methylation disorders: a meta-analysis. Br J Ultimate Rejection? A changes in the brains of suicide Psychiatry.1977;170:205–228. Psychological Study. completers. Am J Psychiatry. 49. Mann JJ, Arango VA, Avervole S, Buckingham, UK: Open University 2013;170:511–520. et al. Candidate endophenotypes Press, 1996. 72. Global Terrorism Database. for genetic studies of suicidal 61. Dervic K, Oquendo MA, National Consortium for the Study behavior. Biol Psychiatry. Grunebaum MF, et al. Religious of Terrorism and Responses to 2009;65(7):556–563. affiliation and . Am Terrorism (START). 2012. 50. Brent DA, Melhem V. Familial J Psychiatry. http://www.start.umd.edu/gtd. transmission of suicidal behavior. 2004;161:2303–2308. Accessed October 1, 2014. Psychiatr Clin N Am. 62. Nonnemaker JM, McNeely CA, 73. National Security Studies Center 2008;31(2):157–577. Blum RW. Public and private of the University of Haifa, Israel. 51. Tondo L, Balldesarini RJ. Can domains of religiosity and Suicide Terrorism Database. suicidality be prevented? adolescent health risk behaviors: http://nssc.haifa.ac.il/index.php/en Psychiatric Times. 2011;28(2). evidence from the National /. Accessed October 1, 2014. 52. Tondo L, Balldesarini RJ. Long- Longitudinal Study of Adolescent 74. Terrorism Resesarch & Analysis term lithium treatment in the Health. Soc Sci Med. Consortium. Suicide Terrorism prevention of suicidal behavior in 2003;57(11):2049–2054. Database—Flinders University, bipolar disorder patients. 63. Bughra D. Commentary: religion, Australia. Available at: Epidemiol Psychiatr Soc. religious attitudes and suicide. Int http://www.trackingterrorism.org/r 2009;18(3):179–83. J Epidemiol. 2010;9(6):1496–98. esource/suicide-terrorist-database- 53. Balldesarini RJ, Tondo L. Lithium 64. Moghadamnia AA, Abdollahi M. An flinders-university-australia. and suicidal risk. Bipolar Disord. epidemiological study of poisoning Accessed October 1, 2014. 2008;10(1):114–5. in northern Islamic Republic of 75. Sageman M. Fighting the right 54. Meltzer HY, Okayli G. Reduction of Iran. E. Mediterranean Health J. war. National Defense University suicidality during clozapine 2002;8:88–94. Joint Operations Symposium. treatment of neuroleptic-resistant 65. Al-Jahdali H, Al-Johani A, Al- March 16–17, 2006. schizophrenia: impact on risk- Hakawi A, et al. Pattern and risk http://www.artisresearch.com/artic benefit assessment. Am J factors for intentional drug les/Sageman_Fighting_the_Right_ Psychiatry. 1995;152:183–190. overdose in Saudi Arabia. Can J War.pdf. Accessed October 1, 55. Berko A. The Path to Paradise: Psychiatry. 2004;49;331–334. 2014. The Inner World of Suicide 66. Wasserman D, Cheng Q, Jiang GX. 76. Sheehan DV, Lecrubier Y, Bombers and their Dispatchers. Global suicide rates among young Sheehan KH, et al. The Mini- Potomac Books; 2009:1. people aged 15 –19. World International Neuropsychiatric 56. Okasha A, Okasha T. Suicide and Psychiatry. 2005;4(2):114–120. Interview (M.I.N.I.): the Islam. In: Wasserman D, 67. Pritchard C, Amanullah S. An development and validation of a Wasserman C (eds). analysis of suicide and structured diagnostic psychiatric and : A undetermined deaths in 17 interview for DSM-IV and ICD-10. Global Perspective. Oxford: predominantly Islamic countries J Clin Psychiatry. 1998;59(20 Oxford University Press; contrasted with the UK. Psychol Suppl): 22–33 2009:50–55. Med. 2007;37:421–430. 77. Coric V, Stock EG, Pulz J. 57. Bodner E, Ben-Artzi E, Kaplan Z. 68. Zai CC, de Luca V, Straus J. Sheehan-Suicidality Tracking Soldiers who kill themselves: the Genetic factors and suicidal Scale (S-STS): preliminary results contribution of dispositional and behavior. In: Dwivedi (ed.) The from a multicenter clinical trial in situational factors. Arch Suicide Neurobiological Basis of generalized anxiety disorder. Res. 2006;10:29–43. Suicide. CRC Press; 2012. Psychiatry (Edgmont). 58. Oquendo M, Galfalvy H, Russo S, http://www.ncbi.nlm.nih.gov/books 2009;6(1):26–31. et al. Prospective study of clinical /NBK107191/. Accessed October 1, 78. Preti A, Sheehan DV, Coric V et al. predictors of suicidal acts after a 2014. Sheehan Suicidality Tracking major depressive episode in 69. Roy A, Segal NL. Suicidal behavior Scale (S-STS): reliability,

[VOLUME 11, NUMBER 9–10, SEPTEMBER–OCTOBER 2014] Innovations in CLINICAL NEUROSCIENCE 91 convergent and discriminative 82. Pan LA, Hassel S, Segreti AM, et Rehabilitating the terrorists? validity in young Italian adults. al. Differential patterns of activity challenges in assessing the Compr Psychiatry. and functional connectivity in effectiveness of de- 2013;54(7):842–849. emotion processing neural programs. Terror Polit Violence. 79. Sheehan, IS, Sheehan DV. circuitry to angry and happy faces 2010;22:267–291. Homicidality Scale (S-HTS). in adolescents with and without 86. Angeli A, Gunaratna R. Terrorist http://professorsheehan.com/categ suicide attempt. Psychol Med Rehabilitation: The U.S. ory/homicidality-scale/. Accessed 2013;43(10):2129–2142. Experience in Iraq. Boca Raton, October 1, 2014. 83. Perspectives on Terrorism. FL: Taylor and Francis; 2012. 80. Le-Niculescu H, Levey DF, Ayalew Stracke N. Arab prisons: a place 87. Bell S. Reason to live: in Southeast M, et al. Discovery and validation for dialogue and reform. 2007. Asia, fighting terror includes of blood biomarkers for suicidality. http://terrorismanalysts.com/pt/ind fighting for the minds of suicide Molecular Psychiatry. ex.php/pot/article/view/15/html. bombers. National Post (Canada). 2013;18(12):1249–1264. Accessed October 1, 2014. 2006 Feb 25. 81. Pandey GN, Pandey SC, Dwivedi 84. Boucek C. Counter-terrorism from http://www2.canada.com/national/ Y, et al. Platelet serotonin-2A within. Assessing Saudi Arabia’s nationalpost/news/cnspolitics/stor receptors: a potential biological religious rehabilitation and y.html?id=1ac3ee9e-4c7f-450f- marker for suicidal behavior. Am. disengagement programme. RUSI 9e21-f0dc94e0dd01&p=1. J. Psychiatry. J. 2008;153(6):60–65. 1995;152(6):850–855. 85. Horgan J, Braddock K.

92 Innovations in CLINICAL NEUROSCIENCE [VOLUME 11, NUMBER 9–10, SEPTEMBER–OCTOBER 2014]