What's New Online from the BMJ editor draws attention to the poll on bmj.com, which asks "Is fanaticism a form of madness?" This is linked to two published articles that debate whether Anders Breivik is sane .
The argument in the Breivik trial is about whether he is psychotic (see previous post in which I suggest there is little doubt that he is not psychotic). That is not to say that he is not psychopathic (mentioned in neither of the BMJ articles). Psychopathy is distinguished from psychosis, although it was originally named "moral insanity". Psychopathic people are not deluded.
And being deluded is not just about whether fanatical ideas are shared by others, which is the argument used by Taylor in his BMJ article for regarding Breivik as insane. What matters is whether the thinking process that led to the ideas is abnormal - in Karl Jaspers words whether the ideas are "of morbid origin". Jaspers regarded delusional ideas as "ununderstandable", because even putting oneself in the deluded person's position and seeing the world from their point of view, one is still unable to understand how they could hold such a belief with delusional intensity. Obviously there may be a metaphorical sense in which one could understand the thoughts but delusional ideas are believed literally.
Interestingly, the Mental Health Act in England and Wales was amended in 2008 to abolish the distinction between mental illness and psychopathy in terms of the way in which the conditions are regarded under the Act. Because of Breivik's determination not to go to a psychiatric hospital, it could be argued that he is not detainable in psychiatric hospital because he is not treatable (under the old Act) or because there is no appropriate medical treatment available to him (under the amended Act).
Aubrey Lewis (who I've mentioned in another previous post) wrote a Lancet editorial in 1940 on the mind of Hitler. Hitler wasn't deluded. Lewis quoting Oswald Bumke points to the extent to which cold, unfeeling, ruthless, apparently conscienceless, violent, cruel people attain their ends and "how great a role fanatics and other psychopaths play in history and especially the history of revolution". Martyrdom, eg. suicide bombing, may be one outcome of fanaticism. But others, such as Breivik develop the "unshakeable conviction that they are in the right" and end up in a law court. Others play their part on a larger stage, such as Hitler or more modern tyrants.
The real problem with Breivik and Hitler is their personality not mental illness as such. They represent the uglier side of human nature. It is important to recognise this rather than trying to distance ourselves from them by labelling them as insane.