The Berlin car crash proves 'running amok' is a global phenomenon

On June 8, German police detained a 29-year-old after he drove his Renault Clio into a group of pedestrians in western Berlin, killing a teacher and injuring 14 children . German Chancellor Olaf Scholz described the incident as a "cruel rampage". Interior Affairs Minister Iris Spranger said: "The latest evidence suggests this is a case of a mentally ill person running amok." The driver did indeed turn out to have a history of mental health problems, including a diagnosis of schizophrenia. But what exactly does it mean to "run amok" in an industrialised 21st-century nation? The expression was popularised more than 200 years ago by the British explorer James Cook after he claimed to have observed it among Malay tribesmen. Mengamok, as it is known in the Malay language, refers to a disordered mental state characterised by a murderous frenzy. Traditional beliefs attributed the state to possession by "Hantu Belian", an evil tiger spirit. Afflicted individuals would run through the village, indiscriminately killing and maiming men, women, children and even animals. The manic killing spree would typically end when the amok runner – almost always a lone male – was killed by the authorities or bereaved and outraged onlookers. For a long time, western psychiatry considered amok a culture-bound syndrome, a psychiatric condition limited to a particular society or cultural group – in this case, South-East Asian nations such as Malaysia, Indonesia, the Philippines and Papua New Guinea. One theory suggests that, in these societies, amok represents a way of "ending it all" while allowing the distressed individual to get around the cultural or religious taboos against suicide. More recently, however, the notion that amok is restricted to South-East Asia has unravelled. The rising rates of indiscriminate slayings at the hands of lone individuals – almost always men – suggest that 21st-century amok is perhaps a global phenomenon. In some nations, such as the US, for example, the issue is greatly exacerbated by easy access to military-style assault weapons and ammunition. Imagine the outcome of the Berlin incident if the driver also had a couple of AR-15 assault rifles and 1,000 rounds of ammo in the backseat. Mental health professionals are rightly concerned about the increasing prevalence of such incidents. In 1999, an article was published in the Journal of Clinical Psychiatry titled "Running Amok: A Modern Perspective on a Culture-Bound Syndrome". This compelling article argues that amok should be considered the possible outcome of an undiagnosed or untreated psychiatric illness regardless of cultural context. In other words, if people can't get or don't get appropriate help for specific mental health complaints, then "running amok" is a possible consequence anywhere. Predicting who might be at risk of running amok is difficult, but it is the first step toward prevention. Preventative efforts, however, require that individuals experiencing mental health problems feel okay about seeking help in the first place. Unlike the vast majority of physical health problems, mental health issues are still frequently stigmatised. An article published in the American Journal of Men's Health in 2020 argues that mental health stigma is magnified when the potential help-seeker is a male. Men and boys are generally reluctant to discuss emotional hurt for fear of appearing "weak". A tragic consequence of this persisting social norm is that men often don't seek help until it's too late. For example, In western nations, death by suicide is three to four times more common among men than women. In the UK, suicide is the biggest killer of men under 45. It is also responsible for a quarter of deaths among males under 35. Males are also far more likely to attempt self-medicating with drugs and alcohol, leading to higher rates of addiction and substance-related disorders. Drug and alcohol problems are, in turn, risk factors for suicide and other impulsive behaviours. Of course, the stigma around help-seeking for mental health is not the only factor at play here, but it is a major one. Thankfully, incidents of people running amok are still relatively rare. But mental health problems are "pathoplastic"; they are shaped and re-shaped by socio-cultural change. Anorexia nervosa, for example, was once extremely rare – considered a clinical oddity. Today, it is relatively common. So we need to guard against modern-day amok following a similar trajectory. Redoubling our efforts to destigmatise all mental health problems – not just depression and anxiety – is a must. However, reducing stigma and promoting help-seeking is only half the equation. We also need to ensure that quality help is available and easily accessible for all. Notably, we must design services and mental health promotion initiatives with men and boys in mind. The next person to run amok will almost certainly be a male.