Monday, 16 June 2008

The boy who thought 9/11 was his fault

Researchers in London have documented the case of a ten-year-old boy with Tourette's syndrome and obsessive compulsive symptoms, who believed the terror attacks of 9/11 occurred because he had failed to complete one of his daily rituals.

Mary Robertson and Andrea Cavanna claim this is the first ever case reported in the literature of a person believing they were responsible for causing a major disaster of the proportion experienced in America in 2001.

The boy - described as "extremely pleasant and likeable" and with good school grades - was first referred for consultation a year before 9/11 took place. As is characteristic of people with Tourette's syndrome, the boy displayed several forms of uncontrollable tics, including excessive blinking and vocal outbursts, and he also showed obsessive tendencies and attentional problems.

Robertson next saw the boy two weeks after 9/11, at which point he was in a terrible state - "tortured", as he put it, by his tics, and wracked with guilt, believing that 9/11 occurred because he had failed to walk on a particular white mark on a road.

This was just one of the many rituals the boy had developed during the course of the year. Others included so-called "dangerous touching" rituals, including the need to feel the blade of knives to check their sharpness, and to put his hand in the steam of a kettle to check its heat.

Importantly, the researchers said the boy's beliefs about 9/11 were distinct from the kind of delusions expressed by people with psychosis, and instead reflected an extreme form of the anxiety that people with obsessive compulsive disorder often experience when they fail to complete their rituals.

Fortunately, a mixture of drug treatments and reassurance (including explaining to the boy that his missed ritual actually occurred after 9/11, given the time difference between the USA and UK), led to him realising that he was not responsible for the attacks.

Robertson and Cavanna said this case study brings attention to the way our modern media - "immediate, realistic, and evocative" - can lead to terrorist attacks and other disasters having harmful effects on vulnerable people miles away from the immediate environment of what happened. "Only time will reveal the many further psychosocial sequelae of 9/11, as well as the Madrid and London terrorist bombings," they said.
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Robertson, M., Cavanna, A. (2008). The Disaster was my Fault!. Neurocase DOI: 10.1080/13554790802001395

Post written by Christian Jarrett (@psych_writer) for the BPS Research Digest.


Update: Following our coverage of this case study, BBC Radio Four's All in the Mind followed up the story and spoke to Dr Andrea Cavanna in July 2008 about the boy.

4 comments:

  1. Anonymous4:25 pm

    "Importantly, the researchers said the boy's beliefs about 9/11 were distinct from the kind of delusions expressed by people with psychosis, and instead reflected an extreme form of the anxiety that people with obsessive compulsive disorder often experience when they fail to complete their rituals."

    What on earth distinguishes this belief from a supposedly 'delusional' or 'psychotic' one? Perhaps it is because he resists the belief or because it is judged by psychiatrists to be understandable? But I'll bet he had a high but varying conviction in the belief being true and I can think of far less bizarre bizarre beliefs that are labelled as 'psychotic'.

    Rather than call this boy psychotic, why can't we just learn to understand 'psychotic' beliefs as reflections of extreme anxiety or depression as well?

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  2. Anonymous8:06 pm

    By "psychotic" the authors mean someone with schizophrenia who might honestly believe they caused 9/11 (with accompanying hallucinations that "prove" it to the schizophrenic).

    So I think it is fair to distinguish a so-called psychotic delusion and a delusion brought on by extreme anxiety or depression.

    For example, I used to suffer from GAD (generalized anxiety disorder). The anxiety caused me to be convinced of different terrible things... like when I was on a plane I started to believe that the pilots and stewardesses knew we were going to crash but they wanted to keep us calm and believe everything was okay. Deep down I realized how ridiculous this assertion was but my uncontrolled mode of (fear-based) thinking couldn't let me let go of the thought...

    So this is very different from a truly delusional man who honestly believes he is a poached egg. The anxiety-based delusions can be handled with therapy and re-training a person's mode of thinking, whereas strong psychotic delusions would require medication.

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  3. Anonymous7:14 pm

    "By "psychotic" the authors mean someone with schizophrenia who might honestly believe they caused 9/11 (with accompanying hallucinations that "prove" it to the schizophrenic)."

    But one of the putative first-rank symptoms of schizophrenia are psychotic delusions. The argument you present would then go something like this:

    Certain beliefs are classified as psychotic because the person who holds them has schizophrenia. Why does the person have schizophrenia? Because they have psychotic beliefs... The tautology is clear I hope.

    "Deep down I realized how ridiculous this assertion was but my uncontrolled mode of (fear-based) thinking couldn't let me let go of the thought..."

    There's pretty convincing evidence that the conviction with which people hold beliefs classified as 'delusional' varies a great deal across time (see work by Garety and colleagues).

    People often use examples of patently bizarre beliefs (i.e., your poached egg example) to paint what they believe is a qualitative difference between 'normal' anxiety disorders and 'psychosis'. But the most common 'delusions' associated with a 'schizophrenia' diagnosis are paranoid delusions (i.e., that others intend to cause the person harm). Bizarre beliefs occur, but the recent success of psychological approaches suggests these are far from un-understandable when located within the context of a person's life and their pre-existing beliefs about themselves, others and the world.

    Indeed there are a host of bizarre beliefs associated with anxiety disorders such as OCD, somatoform disorders such as body dysmorphic disorder, and eating disorders - to name but a few. Paranoid delusions occur frequently in depression and PTSD.

    My point is, those who treat anxiety disorders and those who experience them often have much more invested in the concept of 'mental illness' and 'schizophrenia' than those who have received such diagnoses. The reassurance one receives from knowing one is 'not going mad' is partly founded on believing that there are a group of 'mad people' who have something wrong with them (e.g., schizophrenia) that you do not.

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