At a Loss for Words: Nosological Impotence in the Search for Justice.

The assessment and trial of Norwegian mass-murderer Anders Breivik, including disparate opinions about his sanity, raise questions about distinguishing "bad" from "mad." Although he was ultimately found criminally responsible, the tenacity and pervasiveness of his beliefs suggested delusional thinking. The author reflects on the difficulty psychiatrists have with nomenclature generally and on the application of imprecise classification to criminal justice. Ideally, a classification system should "carve nature at its joints." Barring that, psychiatry needs operational definitions to appreciate the differences between idiosyncratic, psychotic thinking, and shared subcultural beliefs or ideologies. The concept of extreme overvalued belief provides a basis for making this distinction, when applied in the criminal justice context.