On reflection Postgrad Med J: first published as 10.1136/postgradmedj-2019-136639 on 11 June 2019. Downloaded from

doctor with no therapeutic training, and The man who confessed he was a one was a young psychology student who was prone to sharing her own traumatic childhood memories with him. What all the therapists had in common, along John Launer with the medical director of the hospital and some other staff, was that they were receiving supervision or therapy, or both, In December 1990, two men carried out a from a charismatic psychoanalyst in Stock- bank robbery in a small town in . It holm called Margit Norell. She had once went farcically wrong. The men wore been a member of the Swedish Psycho- balaclavas and Santa Claus masks, and analytic Society but had left to form a attempted to fake Finnish accents, but breakaway institute. After some time that they were well known in the town and institute also suffered a split and she was were easily recognised. They were arrested expelled, leaving her as the leader of a immediately. The younger man was small but passionate sect of followers, sentenced to three and a half years in They included most of the clinicians who prison. The other man, a forty-year old ended up treating or assessing Bergwall.2 called Sture Bergwall, was sent for psychi- Norrell’s group shared a belief that atric assessment because of a troubled past much if not all mental illness, including history. He had been a patient in a secure psychosis, resulted from severe abuse in unit for 5 years in the 1970s, following childhood, including sexual and ritual sexual harassment of boys. He had also abuse. They also believed that such abuse once stabbed someone seriously, was on Figure 1 Sture Bergwall. Credit: Andy Hall / was later forgotten, but might be compul- long-term prescription drugs, and was Observer / eyevine sively re-enacted in adult life, through known to use street drugs as well. Instead carrying out similar acts on others. of going to prison, he was readmitted to Through skilful therapy, they argued, such the same secure psychiatric unit he had patients could be helped to recover memo- been in many years previously. convictions had been quashed. He was ries of the past and hence gain insight into In the normal course of events, Bergwall finally released from the secure unit over their dreadful impulses. It is clear that they might have expected to be there for the two decades after the botched robbery expected Bergwall to provide convincing same period as the prison sentence served that originally led to his admission, and proof of their theories. by his accomplice. In fact, he remained he remains a free man [see figure 1]. The Bergwall himself, who was not a stupid there for over two decades. A year or two whole affair – generally known as the man, obligingly complied. He described after his admission, he began to disclose to Thomas Quick case, after the name that childhood episodes of bloodcurdling the psychiatric staff that he had at various he adopted during the years of his disclo- awfulness, including being forced to dates in the past committed . In the sures – shook the Swedish legal, police and witness his mother’s miscarriage and then following years, he confessed to around 39 psychiatric establishments. take part in a cannibalistic ritual with http://pmj.bmj.com/ in total, some relating to crimes the fetus. His accounts of his murders that had been prominently in the news, Lessons for all included horrific details of dismember- while others involved unknown victims. The case offers lessons that go far beyond ment and the ingestion of intimate body He was convicted of eight of the killings, the law and psychiatry. It demonstrates parts. He seems to have picked up on becoming the most notable serial killer in how entire groups of professionals, whole every detail in the leading questions his Swedish history, and a focus of huge media institutions and the media, can become therapists asked, and amplified them in his attention. In 2001, he finally announced fixated on a particular way of seeing the answers to the point of grotesque parody. on September 30, 2021 by guest. Protected copyright. that he would no longer collaborate in facts, so that they lose all sense of objec- This served to meet everyone’s needs: further investigations, so it was impos- tivity, even when the evidence to support fame and vindication for the clinicians, sible to pursue the many other murders he their view is insubstantial, inconsistent along with attention, drugs and national claimed he had carried out. or even absurd. How on earth could this notoriety for their patient. Significantly, In the years that followed, an investi- have happened in one of the most devel- Bergwall only brought his lurid disclosures gative journalist called Hannes Råstam oped and admired countries in the world? to an end, refusing to attend therapy any scrutinised the evidence produced at For an answer, it is worth looking at longer, when the medical director finally Bergwall’s trials. In 2008, he put to the intersecting systems that dealt with decided to initiate a strict regime of drug Bergwall the proposition that his confes- Bergwall, beginning with his psychiatric withdrawal. sions had been fabricated. He was correct. treatment. His medication included anti- Bergwall admitted that he had never psychotics and tranquillisers including 1 actually murdered anyone. As Råstam benzodiazepines. Increasingly, he was Flagrant confabulations had deduced, he had built some of his allowed almost unlimited amounts on The police and legal processes that took confessions by researching newspaper demand, to help him manage what seemed place during Bergwall’s years as Thomas reports of the original crimes, and had like agonising emotional distress from Quick were a remarkably parallel with his invented others entirely. By 2013, all his recalling his past crimes. In addition, he psychiatric treatment. The detectives and received intensive psychotherapy over the lawyers involved had a history of poor Correspondence to Dr John Launer, Postgraduate Medical Journal, London WC1H 9JP, UK; years from three different therapists, with judgement, and they too wanted their johnlauner@​ ​aol.com​ varying levels of experience. One was a names up in lights. It suited them entirely

Launer J. Postgrad Med J May 2019 Vol 95 No 1123 293 On reflection Postgrad Med J: first published as 10.1136/postgradmedj-2019-136639 on 11 June 2019. Downloaded from to accept the narrative offered by the evidence was ever found. All Bergwall’s believe in an idea, however unfounded and clinicians: a textbook example of deeply convictions were made on the basis of irrational it may be, the harder it becomes repressed childhood abuse, its helpless his confessions alone. Faced with the for anyone to assess the facts dispassion- repetition in acts of unspeakable savagery, absolute clarity and unanimity of all the ately, and to see the world in a different followed by painfully recovered memories professionals, and an escalating tally of way. Perhaps the most important tendency of the abuse and the crimes. previous judgements, the courts barely highlighted by the case, however, was that The transcripts of Bergwall’s inter- paused for breath before determining his people can find comfort in someone else’s rogations, along with records of his guilt on each occasion. Uncritical news- insanity. Only too easily, it can serve as a various trials, reveal how his flagrant, papers and television reporters revelled distraction from noticing how readily we almost jaw-dropping confabulations are in the procedures instead of scrutinising can fall prey to it ourselves, both as indi- continually spurred on by the agents of them. A review by the Swedish chan- viduals and collectively. justice. Time and again, Bergwall gives cellor of justice concluded in a matter of ludicrously inconsistent accounts of his days that the convictions were watertight. F unding The authors have not declared a specific actions, often at variance with the testi- After Bergwall’s retraction, the fiasco took grant for this research from any funding agency in the 3 public, commercial or not-for-profit sectors. mony of other witnesses including his several years to unravel. own family members, who think he is Competing interests None declared. making things up. Consistently, police Groupthink and insanity Patient consent for publication Not required. and lawyers discount his ‘inaccuracies’ as The biggest challenge posed by the story Provenance and peer review Not commissioned; the distortions of the murderer’s troubled of Bergwall is neither its gruesomeness internally peer reviewed. conscience. as they nudge him towards nor its irresistibly comical side. It is that, © Author(s) (or their employer(s)) 2019. No commercial more accurate memories (for example, the in retrospect, it seems utterly obvious that re-use. See rights and permissions. Published by BMJ. victim’s hair was short and brown rather a man who could not even plan a robbery than long and blonde; the meeting was without getting caught could scarcely have in not Uppsala, and so on). murdered several dozen people without To cite Launer J. Postgrad Med J 2019;95:293–294. Impossibilities are ignored, such as the fact leaving one shred of evidence. It is hard that one murder took place when he was Received 3 April 2019 to prevent oneself thinking: “I would Accepted 3 April 2019 demonstrably hundreds of miles away. never have been taken in; my team or In the hope of finding the scattered Postgrad Med J 2019;95:293–294. hospital would never fall for such fraudu- doi:10.1136/postgradmedj-2019-136639 heads, hands and other body parts lent nonsense; only psychiatrists could be Bergwall claimed to have concealed, his that crazy; I live in a country where we References psychiatric and police teams took him on do things differently.” Yet Bergwall must 1 Råstam H. Thomas Quick: the making of a serial killer. numerous visits to possible crime scenes have intuitively understood a number of Edinburgh: Canongate, 2013. – travelling to one of these by chartered human tendencies that are widespread, 2 Josefsson D. The strange case of Thomas Quick. The plane. Bergwall could never do more including among doctors, and he managed Swedish serial killer and the psychoanalyst who created than stagger around in a drugged stupor to exploit these brilliantly. him. London: Portobello Books, 2015. 3 Heath C. The serial killer has second thoughts: the and point suggestively to various possible One of these tendencies is that everyone Confessions of Thomas Quick. Available: https://www.​ burial sites, before being rewarded with prefers to hear what they want to hear. If gq.com/​ ​story/thomas-​ ​quick-serial-​ ​killer-august-​ ​2013 yet more tranquilisers for the distress this our questions do not elicit the answers we [Accessed 22 March 2019]. http://pmj.bmj.com/ appeared to cause him. Massive excava- expect, we will ask again until the other 4 Crouch D. Lawyers blame groupthink in Sweden’s worst miscarriage of justice. Guardian 5 June 2015. tions took place in many of these places, person works out what to say, in order to 4 Available: https://www.​theguardian.com/​ ​world/2015/​ ​ as well as the complete draining of a lake please us. Another factor is ‘groupthink.’ jun/05/​ ​groupthink-sweden-​ ​miscarriage-of-​ ​justice-sture-​ ​ in , all at huge cost. No forensic The larger the number of people who bergwall [Accessed 22 March 2019]. on September 30, 2021 by guest. Protected copyright.

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