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Evil, Terrorism and Psychiatry

A study of Prof. Marazziti and Prof. Stahl

Unavoidably psychiatrists and criminologists have to cope with the evil, and very often they are asked to provide explanations for heinous behaviours that have nothing of human, except that they are perpetrated by men and also, although less often, by women (this is a real novelty of the last decades, that women may become as ferocious as men). The question becomes particularly pressing in peculiar situations, such as in war times (why the holocaust? why the torture?), or following genocides, murder rampages or, more recently, the terrorist attacks carried out by suicide bombers that are now perpetrated everywhere, not only in traditionally-recognized instable middle-east regions, but also in western countries, at the heart of what it is considered the cradle of modern civilizations.
It may be useless to discuss if evil exists or does not exist, or what its main and different philosophical conceptualizations are, 1, 2, 3, 4 when we are causal witnesses of a terrorist attack or look at the carnage following it with a deep sense of helplessness, even while relaxing on our sofa and watching on TV the dreadful images of death and destruction that media show with no respect of audience and of its most sensitive part.
Nothing to say except that evil does exist and we suffer increasingly its deeds and consequences. More important, as psychiatrists and neuroscientists we cannot disregard the evidence that evil is part of the human being, as it is good, and that are both embedded in our nature, and probably are the result of the interplay between brain mechanisms and genetic and epigenetic, familial, societal and contextual factors.
Therefore, we cannot close our eyes in front of the brutality of its extreme manifestations, but, on the contrary, we should try to disentangle its mysterious roots.5, 6 Obviously, there are a series of intrinsic obstacles in performing studies in the field of suicide bombers, and the limitations of the available studies have been widely highlighted in the literature, but one the paramount barriers, according to us, is due to the prejudice, reluctance and even repulsion of some specialists to investigate the evil. 
The present CNS issue entitled “Evil, psychiatry and terrorism” aims at filling a gap in psychology and psychiatry, while putting together different contributions that might be helpful in understanding the psychological and/or psychopathological processes that may transform apparently normal individual in suicide bombers.
Our opinion is that if we want to understand evil and its radical forms we have to understand aggression and violence, and the main mechanisms regulating it. 6, 7 Aggression can be defined as any behavior directed towards another individual carried out with the intent to cause harm. It is an innate mechanism that has evolved since it may lead to some benefits or negative consequences, while promoting or impeding survival and reproduction. 
Violence is aggression perpetrated with the goal of the extreme harm, including death and destruction, and perhaps may be identified and overlap with the evil.
The counterpart of the evil/violence is the good that might result from the entirety of the so-called socio-moral emotions encompassing empathy, sense of pity and guilty, indignation for the wrong behaviors, horror in front of a murder, theory of mind, gratitude.8
Probably violence is the consequence of our innate aggression that springs when is no longer balanced by the moral brain, so that it becomes  “radical evil” and transform “human beings as beings superfluous”, as Anna Arendt has described in a very exhaustive way.9
The questions opened by these considerations are a lot, and some were addressed by this CNS issue, in particular if there are any specific personality traits, psychological characteristics, or psychopathological conditions that may favour this lack of control on violence coupled with coldness, rationality, cruelty, lack of moral sense and, in some cases self-celebration, leading some individuals to chose deliberately to die in order to kill innocents. Unfortunately, the available data suggest a negative answer to this major issue. Similarly negative is the possible impact of familial poverty, economic factors or level of education.10
In any case, how we can consider “normal” those subjects, generally young, often well educated that become radical religious and prefer to die while anticipating a possible reward after death? Doesn’t it seem a real cognitive distortion? Who favours this distortion? What are the tools used by the charismatic leader to transform people in this way? Indoctrination? Drugs?11
It should be underlined also that all societies and groups have nourished what is the innate human morality and regulated the innate aggression, while establishing a conduct code and laws to decide what is right and what is wrong, with a primary focusing on not harming the others, and also acceptance of authority and respect of group rules.12 In the terrorist there is also a total reversal even of this normative morality, so that killing the others, labeled as impure, corrupted and enemies, according to rigid religious and group norms, is the main ethical value and not a murder.  

According to us, terrorism and violence in general should be approached also by a thoroughly understanding of the neurobiological mechanisms at the basis of human aggression and moral sense, as well as by all contextual factors that may nurture or impoverish the correct balance between the two. Recent data would indicate that that early alterations of brain development, following environmental stressors or genetic liability, may impair brain circuits, pathways, and differentiation and constitute a sort of basic “vulnerability” toward a greater risk of developing psychopathology or perhaps deviant behavior.13 In this case, subsequent life events should act through epigenetic mechanisms modulating the stress response and emotion regulation. Of interest, both serotonin transporter (SERT)-s allele carriers and sensory processing sensitivity are associated with greater sensitivity to environmental stimuli in humans.14 Taken together, these data suggest that terrorism’s prevention requires a strong interplay between different specialties, and a careful monitoring of risk factors during childhood and adolescence supported by globally changes and re-shaping of political choices. 
Last, but not least, as mental health operators and neuroscientists we should never get used or remain indifferent to terrorism violence, as if it were a normal phenomenon of our societies. By the contrary, it should be acknowledged and stigmatized on every occasion and, more important, investigated starting from its basic roots.

Check it in PubMed


1. Calder T. The concept of evil. In. Edward N. Zalta, ed. The Stanford Encyclopedia of Philosophy  2016. URL=

2. Eagleton T. On Evil, New Haven: Connecticut: Yale University Press; 2010.

3. Singer MG. “The Concept of Evil,” Philosophy 2004;79:185–221.

4. Knoll JL 4th. The recurrence of an illusion: the concept of "evil" in forensic psychiatry. J Am Acad Psychiatry Law. 2008;36(1):105-111

5. Baumeister R. Evil. Inside human violence and cruelty. New York: Henry Holt & C; 1999.

6. Raine A. The anatomy of violence: The biological roots of crime. London: Allen Lane, 2013

7. Siever. Neurobiology of aggression and violence. Am J. Psychiatry, 2008; 165:425-442

8. Haidt J. The new synthesis in moral psychology. Science 2007; 316(5827):998-1002.

9. Arendt H. The Origins of Totalitarianism, San Diego: A Harvest Book, Harcourt, Inc.1951; 1985

10. Merari A. Driven to Death: Psychological and Social Aspects of Suicide Terrorism. New York: Oxford Press; 2010.

11. Zimbardo P. The Lucifer effect. Understanding how good people turn evil. New York: Random House; 2007

12. KaganS. Normative Ethics. Boulder, Colorado: Westview Press, 1998.

13. Marazziti D. Psychiatry and terrorism: exploring the unacceptable. CNS Spectr. 2016;21(2):128-130.
14. Homberg JR, Schubert D, Asan E, Aron EN. Sensory processing sensitivity and serotonin gene variance: Insights into mechanisms shaping environmental sensitivity. Neurosci Biobehav Rev 2016;71:472–83