Innovations In Clinical Neuroscience

SEP-OCT 2014

A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience

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[ V O L U M E 1 1 , N U M B E R 9 – 1 0 , S E P T E M B E R – O C T O B E R 2 0 1 4 ] Innovations in CLINICAL NEUROSCIENCE 89 organized and systematic databases. 1,72–74 These databases can be mined for factual information about suicide terrorist incidents ( when and where they occur, the targets, tactics and weapons used, and the motivations of the groups that promote them). They are not designed, however, to provide insights into the motivations or psychopathology or potential suicide tendencies of individuals who turn to suicide terrorism. To move the field forward, we need what Sageman has called "an actual terrorist database, not a database based on events or incidents, but on the terrorists themselves." 75 Given the high lethality of suicide terrorism and the fact that no single organization can collect all the information that is needed, there is a special need for a suicide terrorist database that can be mined and shared internationally. Major research and healthcare organizations around the world should work together to develop the logistics for such a database. As a first step, such organizations should exert pressure on individual countries to adopt a policy of routinely interviewing "would-be" suicide terrorists (those intercepted and arrested on the way to an attack) using standardized diagnostic interviews for psychiatric disorders, such as the International Neuropsychiatric Interview (MINI), 76 and standardized rating scales, such as the Sheehan Suicidality Tracking Scale (S-STS) and the Sheehan Homicidality Tracking Scale (S- HTS). 77–79 These instruments have the advantage of being brief, very thorough, and easily administered by nonclinicians. The MINI has already been translated into 69 languages, including Arabic and Chinese, the S-STS is available in 25 languages, and efforts are underway to translate the S-HTS. Standardized data collection will allow pooling of data and sharing. Psychological autopsies on deceased suicide bombers should also be routinely performed as recommended by Townsend. Indeed, the number of suicide events is not so great each year that psychological autopsies using c onsistent criteria could not be performed on a widespread basis. Given increasing evidence of biomarkers in suicide, psychological autopsies should be complemented by physical autopsies where possible. 80–82 Knowing whether suicide attackers are suicidal is not simply an academic issue. In the context of growing evidence that recruitment occurs among the bereaved, those with disabilities, and even mental illness, it has clinical implications. It also has implications for prevention. If suicidality (ideation, intent, planning) plays any role in the path to becoming a suicide attacker, even for a minority of such attackers, that finding could be used at population levels to design screening programs that could potentially identify and possibly reduce the numbers of individuals who are vulnerable to recruitment. In the context of recent efforts (especially in the Arab world) to "rehabilitate" would- be terrorists, it also has implications for rehabilitation and what has been called a "soft approach" to counterterrorism. 83–87 While many of these programs were designed to "de-radicalize" and encourage renunciation of terrorist ideology and systematic efforts to evaluate them are still lacking, fighting for the "minds of suicide bombers" is a promising direction. 86 There is the additional benefit that more systematic research on this phenomenon will advance the broader study of suicidal behavior itself. REFERENCES 1. Chicago Project on Security and Terrorism (CPOST). Suicide attack database. http://cpostdata.uchicago.edu/sear ch_new.php. Accessed June 1, 2014. 2. Atran S. Genesis of suicide terrorism. Science. 2003;299:1534–1529. 3. Boaz G. Suicide Attacks in Israel. In: Countering Suicide Terrorism. Herzliya: International Policy Institute for Counter- Terrorism; 2000:134. 4. Bloom M. Dying to Kill: The Allure of Suicide Terror. New York: Columbia University Press; 2007. 5. Pape R. Dying to Win: The Strategic Logic of Suicide Terrorism. New York: Random House; 2005. 6. Pedahzur A. The Root Causes of Suicide Terrorism: The Globalization of Martyrdom. New York: Routledge; 2006:8. 7. Merari A. The readiness to kill and die: suicidal terrorism in the Middle East. In: Reich W (ed). Origins of Terrorism: Psychologies, Ideologies, Theologies, States of Mind. Washington DC: Woodrow Wilson Press; 1998:192. 8. Stern J. Terror in the Name of God. New York: Harper Collins; 2003. 9. Cronin AK. Terrorists and Suicide Attacks. Washington DC: Library of Congress; 2003. 10. Axell A, Kase H. Kamikaze: Japan's Suicide Gods. New York: Longman; 2002. 11. Hoffman B. The logic of suicide terrorism. The Atlantic. June 1, 2003. http://www.theatlantic.com/magazi ne/archive/2003/06/the-logic-of- suicide-terrorism/302739/. Accessed October 1, 2014. 12. Reuters. Taliban vow suicide and "insider" attacks in new spring offensive. April 27, 2013. http://www.reuters.com/article/201 3/04/27/us-afghanistan-offensive- idUSBRE93Q01Z20130427. Accessed October 1, 2014. 13. Atran S. Moral logic and growth of suicide terrorism. Washington Quarterly. 2006;29(2):127–147. 14. Brym RJ, Araj B. Suicide bombing as strategy and interaction: the case of the Second Intifada. Social Forces. 2006;84(4):1969–86.

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