The massacre in Norway raises many points about mental health, bereavement, grief and trauma.

Let’s look first at Anders Behring Breivik whose actions resulted in 76 people being killed or, as we write this, unaccounted for. While it might have been legally judicious for his lawyer to label Breivik “insane”, using that word says more about prejudice than it does about understanding mental health.

When people retreat from the norm “behaving anti-socially, whether by withdrawing from others or behaving inhumanely towards themselves or others“ it is often because they feel out of kilter with the world, or misunderstood by it, or because they cannot manage their emotions. This is not a defence of Breivik’s behaviour (clearly extreme and exceptional) but it is an example of what can happen if mental illnesses are not recognised, diagnosed or treated.

While the majority of our clients are well-informed and self-aware, mental illness remains a taboo. Talking about mental health issues with partners, family, friends or with colleagues at work is not something everyone has the chance or inclination to do. Keeping concerns private does not often lead to extremes of behaviour but it can cause significant shifts in behaviour or personality, turning people in on themselves. And that could lead to self-harm, eating disorders, mis-using drugs or alcohol, an over-reliance on smoking; it could cause anxiety, panic, stress, phobias, sleep issues. It can also affect behaviour and performance at work and relationships. Anyone feeling they do not fit in, that others are against them, or that they cannot cope deserves support and encouragement. Yet, as our human instinct is often to shy away from exposing what we think of as private weaknesses or inadequacies, support is often hard to seek.

The Norwegian tragedy also shows how others can be affected, directly or indirectly.

We’ve heard about the guilt that some survivors of the incident feel “that they escaped his attention or were just of out range so they lived but others didn’t. There is anger at the police“ for taking what the public considered too long to respond to the incident, and for not having the right means to get their fast. Many who witnessed the incident were immediately traumatised and may remain affected by the trauma for some time. Some parents felt relief on learning their child was safe, but their relief was tinged with sadness at others loss. We saw the tearful response of the King and Queen of Norway at the memorial service, shocked and saddened by the individual deaths and by what was the country’s biggest loss of life since the second world war. And we noted the stunned expression on the Norwegian prime minister’s face as he took control of the incident, balancing his emotions with his responsibilities to set a lead for the country and protect its reputation as a tourist destination.

Paramedics who reached the scene described the people they found as traumatised. Those paramedics are likely to have built up resilience that helps them manage their reactions to traumatic incidents but they might need continuing support to maintain that resilience.

And we’ve experienced our own reactions, at a distance from the incident, trying to make sense of it from our perspectives, with many of us reliving grief at lives lost years ago or recently.

All of these reactions are normal; grief is a complex emotion even when a death or loss occurs naturally and is expected. Sometimes it takes an extreme act for people to notice the extent of their own or others’ mental distress and to give themselves permission to seek help to overcome it.

If this traumatic incident has triggered difficult emotions, changed behaviours, or reopened issues you thought were under control, do get in touch with us for professional, therapeutic support. We offer a range of therapies including EMDR (recognised by NICE as particularly effective for recovering from trauma), CBT, hypnotherapy, psychotherapy and counselling – and often recommend a blend of therapies so each person receives the form of therapy that is best for them.