Renate Bugge, a psychologist affiliated with the Center for Crisis Psychology in Bergen, Norway, has been prominent for many years in the mental health field in Scandinavia and particularly in organizing mental health care after major disasters in Norway and other countries. Among other international activities, she directed psychosocial programs in Bosnia for the Norwegian labor movement’s aid agency, Norwegian People’s Aid, in the aftermath of the brutal 1992-95 war following the breakup of Yugoslavia.
After the July 22 attacks, Bugge played a key role in coordinating care for survivors and families of those who were killed. Among the activities she organized were return visits to Utøya several weeks after the attack for bereaved family members and for campers who had been on the island during the shooting but survived. In her presentation to ACIA, Bugge described the complex assortment of people and activities that had to be coordinated for an effective assistance program.
These management issues often tend to get overlooked when well-meaning outsiders rush to help or comfort victims of a large-scale tragedy, but they are vital if the response is to be truly helpful. After the mass shooting at Virginia Tech University in 2007, the subject of an earlier ACIA case study, the campus teemed with volunteer counselors and sympathizers who arrived spontaneously to offer things such as home-baked cookies or free hugs for shocked or grieving students. Those free-lance interventions were unquestionably well-intentioned but from available evidence, the effects were minimal. The more carefully planned and coordinated programs Bugge described in Norway, by contrast, appeared to have provided real benefit. In surveys conducted by the national health department, large majorities of participants in those activities described them as helpful or very helpful. That outcome did not just happen; it required close and continuing attention to the management issues that Bugge highlighted in her presentation:
I will focus on organizational perspectives, working with the Labour Party and creating a temporary organization for the collective gatherings for the bereaved people.
We were asked to come in and do the first debriefing in one of the health regions that asked for help and then a couple of days afterwards we got a phone call from the Norwegian Psychological Association that have had questions from the leaders of the party organizations headquarters. They were asking for assistance. Almost every community inNorwaywas somehow involved in the crisis. Hundreds of young people back home from Utøya were scattered all over Norway, and we have the families and the members of the families, adults, young people and children. So because of the background I have on organizational perspectives and so on, I was asked to take on that mission.
The attack happened on Friday the 22nd. I was at the Labour Party on Wednesday and stayed with them for the whole month afterwards. I stayed inOsloand was available around the clock. When an organization is in crisis it has its own affected personnel and at the same time ordinary tasks have to be done. There will always be a double focus, the dilemma of being in the middle of the crisis and having to make actions and decisions and at the same time making sure that the ordinary activity is running too. There had to be rapid decisions taken about how to approach media, dealing with employees’ reactions, organizing ongoing tasks, debriefing for the employees at the headquarters who were very close to the bomb explosion when they had been in their offices. Several of them had been out to Utøya and had just returned and sitting in the car they got phone calls from their friends who were out there and many of them also had lost close friends.
We organized psychological assistance throughout the 20 counties inNorway. I used the network of psychologists of which I am a member in another connection. Within a few hours we had names in every county whom the party secretaries could contact for assistance. We had consultations with the party secretary, Raymond Johansen, on national decisions — the memorial ceremony, going back to Utøya, contacts with the bereaved. The party secretary and leaders of the Labour Party in Parliament decided to make personal phone calls to everyone. We had to prepare them, how to make heavy phone calls like that and how to handle the reactions….
Planning [the trips] back to Utøya, started quite early, the police were ready long before expected. So it was possible to combine a visit for those affected back to Utøya at the same weekend as the national ceremony was planned. 
The day when the police allowed others to come to Utøya because they had completed their investigation, I went out with technical director of the Labour Party. The police had cleaned and done a tremendous job. That is very little talked about. But in the cafeteria where many people were shot, the police had cleaned up with their own hands, scrubbing and washing and cleaning to make it as presentable as possible. None of the cleaning companies wanted to take on that job, so the police did it themselves.
We went throughout the whole island and took a lot of pictures. They were printed up and on the day of the visit they were placed on the quay where the boats were going out from. We had them mounted there and we had them mounted at the reception in the foyer at the hotel, so looking at the picture could start a mental preparation for what they were going to see. On the first day when the bereaved were invited to go out to Utøya, we noticed that almost none stopped to look at the pictures. But when those who had survived came with their families, many of them went right to these pictures and started to tell each other, “I was running there,” “I was hiding there.” So then on board the boat and seeing the island coming towards you, it was kind of okay, it is now what it was like then. We had put the dates on so they knew exactly when the pictures were taken, that they were taken after the shooting.
The theoretical idea behind this, of confronting the site where things happened, is to get somehow a line of connection, somehow to transport individuals from their own separate emotional chaos back to a kind of feeling of community as much as possible, and also getting connected to time and distance. Many of those affected remembered that they had run much farther than the they really had run, and in their minds, the time either had been very very very quick or much longer than in reality. So this was getting together to a common perspective.
We had 69 white roses symbolizing everyone that had been killed. We had small tents where it was possible for people to retreat and get support for the both psychological and if necessary medical issues. They were very little used; people comforted each other.
There was another question about what to do with the belongings
There were tons of belongings. The rumor started that there was a plan to destroy everything. Being at the headquarters, I very quickly got that message. I phoned the police director up and asked the chief there what are the decisions? And he said you can see, we cannot give something to parents that has a hole from the shooting. That would be traumatic. And I said. no, it is possible, please keep everything that is possible to identify. So that message was given to the local police, to care of everything. They brought equipment to hang out all of this wet stuff for drying, they hired a big hall to dry everything, and then volunteers packed every single item and put them into bags, and on the weekend of the national ceremony, everyone was offered the chance to go out there and find their stuff.
This was also a discussion because some thought that would be too much to lay on affected people, both to attend a national ceremony and to go for their belongings. But on the other hand, everyone was coming from all over Norway and this is where the belongings are. So, why not offer them this possibility and leave it to the people and families to decide what they wanted to do and not to be a kind of tutor for them on what they should do.
On every bag was a list of items that were in it. There was a lot of stuff that was not identified; they put that together in another room, so people could go there and look, with assistance from the police, for things that they might recognize. I was there when a family came and found their kid’s guitar.
The belongings of those who had been killed were in a separate room. There were white cloths on the table. The police put on the names, the birth date, and the death date, and the bereaved could come there and take the suitcase or the bag, and then afterwards the police moved the bags together again so there weren’t gaps left on the tables. It was handled very much with dignity.
In talking to the police officers, it was very very clear to me that it was important to them. These were the police officers who were under pressure when the first phone calls came in and everything broke down, so for them it was kind of a way to complete the mission by doing this. Helping affected people was somehow to give new meaning to what they were doing, and I think this was very very important for them to deal with this and take the responsibility. This isn’t written about, but it was so important backstage.
We had collective gatherings for the bereaved people, the bereaved from Utøya. The public health director took responsibility and said yes, let us have these weekend gatherings, collective gatherings. We also from the beginning made a suggestion that there should be regional meetings for all the survivors and this should be done quickly. But I’m sorry to say, it did not happen until February, almost half a year after the terror attack. Knowing about young people and how quickly things change in their lives, half a year is quite a long time. The plan was for two regional meetings but at the first meeting, about 40 percent of the young people came, and then the decision makers said that with so little participation it makes no sense to have another gathering. But looking in the rear-view mirror, I think if this had been on offer already during the fall, it would have been very much more attended and useful. The same thing was true for those affected by the bomb explosion in the center ofOslo. It was just after New Year that they had their gathering for the bereaved.
We did have three meetings for the bereaved of Utøya, one in November, one in March, and one in July around the anniversary. At the first gathering there were about 59 families represented, of 69 who had lost family members. At the last meeting it was even more, 62. We prepared different topics focusing on the process of mourning and also on factual information. At the second gathering, for instance, we had officials from the trial, court officers and prosecutors. They told about what was going to happen in the trial. At the last session, we had the leader of the commission there and she told about how the commission worked.
[In arranging these meetings] we had to work together as one organization. We created a temporary organization with people from different institutions and everyone had their own agendas back home, but it was very clear that in this situation everyone had to work together under the same rules. We defined our main task, that was to contribute to the healing process for families and family members who have lost a loved one in the terrorist attack. We formed groups according to the relationship to the deceased — parents, partners, children.
We think this is obvious, but when you put it on paper you see how many roles and how many functions have to be in action when you have a gathering like this. It is not just a coming together. There are presenters, group leaders, available resource people if an emergency happened — if someone could not stand it anymore and went out of the group, or even some medical problems. There were activity leaders to plan a program for participants of all ages, coordination of the temporary organization and the administration. And the message all the time was, on this occasion we are one organization. We have a common task, common rules, a common structure during the whole weekend. We were very very strict about time, everyone has to start, has to end, at set times. And everyone had the responsibility for looking after the room. Drinking water, napkins, fresh air, that is also part of the organization. The thought behind this was that the more emotional chaos, the more important it is to have a good predictable structure. That came back a lot of times at staff meetings at the end, that it had helped the staff that it was so strict and so structured, because staff themselves got more brave in approaching the difficult questions that came up.
What have we learned? The health director conducted a survey and 72 percent of the responses after at the first gathering were that the collective gathering had been a strong help. After the last one 67 percent responded that it had been of very strong support and help.
During the year following the attacks, Bugge feels that successive events in Norway had a “containing function” for survivors and society as a whole. (As explained by psychoanalyst Gerard Fromm, an ACIA participant and Bugge’s colleague in the International Society for the Psychoanalytic Study of Organizations, containment means “providing a reliable human structure in which people can process intense, powerful emotions over time.”)
Breivik’s trial, which began in April 2012 and ended in June, had “a kind of containing function for the nation,” Bugge said, because it represented something that Norwegians trust and believe in, “a system where things would be done with respect, with dignity. That had a containing function.” After the trial, waiting for the verdict and then for the report of the investigating commission had a similar effect. But once those milestones were passed, Bugge feels containment weakened — as was also true for those immediately affected when the series of collective gatherings for the bereaved came to an end, shortly before the commission report was issued:
The last collective gathering for the bereaved ended on the 21st of July, the commission report came in August, so when the commission report came, the bereaved gatherings had stopped. There was no more containing function 55:40 for those severely affected. If we had had at that time a new date in November or January for a fourth gathering, it might have prolonged this function, but when the trial was finished and the meetings were finished, and the commission report was out, there was no more containing function.
Bugge added that along with structure and planning, leadership is also of vital importance. A particularly important quality, she said, is “the leaders’ recognition of their own competence, what they can do and what they cannot do, if you have a leader who thinks ‘I know everything’ and does not take any consultation from those who might know more.” To illustrate the point, she recounted a conversation with Raymond Johansen, the Labour Party secretary:
In our very first meeting he said, “as a leader I do not have the competence to manage this disaster situation, and as a leader it is my responsibility to ask for support by someone who knows more about this than I do. I have to make decisions and they will have consequences on the national level and with my counseling to government. It is necessary for me that I can document that I have had professional discussions and mentorship counseling around this. Are you willing to take on that role?” I mean, you need leaders like that, then you can accomplish something. I just had to say it. I usually say to my husband, he is my new hero.
Following Bugge’s presentation, Gerard Fromm observed that as well as working with human and mental health issues, working with organizations and organizational issues also plays a key role in helping a community recover after tragic loss:
When a society is traumatized, so often what you find is the breaking down of institutions and organizations under the pressure of chaotic emotion, which increases the chances for it happening again. What you have heard from Renate is an example of building structures that not only help stabilize a group of people during a time of great crisis and trauma, but also take people into the experience so they can go through it. This is a part of the process of societal mourning…. It is natural for people in the face of a disaster to try to supply something to the injured person, whether it’s a hug, medication, a therapy session. What you did instead was build a structure for a process and that is a different level of thing altogether, that takes people through something in a deeply meaningful way.
Ned Benton, president of the ACIA Council, reflected on findings in earlier ACIA case studies that touched on — or contrasted with — some of the themes in Bugge’s presentation. A particularly uncomfortable comparison was that between Norway’s gathering around its tragedy’s survivors and bereaved families and Americans’ much less sympathetic response to tens of thousands of their fellow citizens who were displaced by Hurricane Katrina. As Benton recalled about Katrina’s victims:
These people’s homes and neighborhoods were destroyed and they were randomly put on buses and taken far away, separated from everything and then in a way there was no connection in how they were received. In some places they were hated or thought of as some kind of bad people. A contrast between their experience and the care that you describe.
I also think of theWorldTradeCenterand all the troubles in memorialization and the way in which various victims felt not cared for in important ways. And I remember the conversations about Virginia Tech. There was research following Virginia Tech about the college students who stayed at the campus and participated in voluntary service and meetings and events, and they had a reduced level of post-traumatic stress symptoms compared to students who were sent home and got to watch the event being replayed on television.
Two months and one day before her 18th birthday, Marte Gustavsen Odegarden was on Utøya Island when Breivik arrived and began his murderous attack. She was one of 32 people who were shot but survived. Gravely wounded, Marte was hospitalized for five months. More than a year later, she still has severe pain and loss of mobility in her lower back and left leg, and still has to use a wheelchair or crutches to move around. Marte attended ACIA’s case conference together with her mother, Laila Gustavsen, who is a Labour Party member of the Norwegian parliament.
Marte spoke to ACIA’s participants with remarkable frankness about her physical and emotional wounds, the long, difficult process of recovery, and her remarkable encounter with Breivik when she testified at his trial. Explaining her candor, she said: “It is important to me to be open about these things because if you are not open about it, you have to deal with it all by yourself, and by being more open about it, more people can help you.” She began by reflecting on the fact that her struggle was a private event but at the same time a highly public one:
For me it is just something that happened to me but everybody else talks about it as well and that’s the weird part because everybody has a story about something terrible in their lives but everybody else is not talking about it. Every time you say that you are in a wheelchair or use crutches because you were shot at Utøya, some people don’t want to talk about it and others ask a lot of questions. If you are at a club with friends and meet new people, they ask you all night and that becomes the headline of the night.
I have talked about it a lot, I don’t have a problem talking about it. But sometimes you almost feel like a freak. InNorwaywe have another culture about disabilities. In theU.S., there is more access to buildings, to restaurants, and inNorwaywe do not have that as much. So, once you are different than the others you automatically become a freak and everybody looks at you in a different way. That is probably the hardest part. I don’t feel like a different person than I was last year but everybody else thinks that I am.
I was in the hospital for five months and four of them were atSunnaasHospital. They are maybe the best hospital in the world when it comes to nerve damage. So the people there were really glad to work there and that had an effect on the patients. We got more motivated to train and to become more healthy because of the people that worked there. But when you came out in the society it was a whole other story. That was the hardest part, maybe, to come out in the society again. Some friends were the same as always, but some of them took many months before they contacted me or talked to me in any way. It has also been hard because I want to belong somewhere, and when I was at the hospital I did not get the chance to be with the others, as Renate talked about. I had to do things on my own all the time. Even if you have friends and support from family it was not the same because you didn’t belong somewhere like the others did.
I had a lot of nightmares, pictures in my mind and that sort of thing. I started to talk to the psychologists on the 26thof July. So it was pretty fast, faster than a lot of the others that did not have injuries. [But] when you are physically injured, the focus is on the physical and not on the psychiatric. The physical pain was there all the time. It took a long while before I got to feel this psychiatric pain. It took maybe five or six months before I got to work with all the stuff that bothered me in my head.
From my birthday on the 23rd of September, I got to go home every weekend, but it wasn’t the same as living at home. That was hard because I am young and I hadn’t lived away from home before for so long. But the fact that I had been home every weekend made it a little bit easier to move home in December.
The weirdest part was maybe this autumn when I started to go to school. My friends were gone, they had gone to college and universities and moved on with their lives. So I was stuck at the high school without my friends and I had to make new friends. I had to start all over again — again. I started all over again last year and I started all over again in December when I moved home, so it has been a lot of starting over.
I arranged with my teacher to talk in front of the class for about an hour and tell them about what happened there. After that, the environment changed and people started to actually talk to me. Since they didn’t know me before, it was pretty hard for them to talk to me.
Steven Gorelick of Hunter College, who was a member of the ACIA Norway delegation, facilitated Marte’s and Laila Gustavsen’s presentations at the case conference. He asked Marte about “the stunning moment” during her testimony at Breivik’s trial when, as Gorelick recalled, “people were sort of not looking at him, and then — after some thought which I hope you can tell us about — you looked him straight in the eye, and wouldn’t stop looking at him. And all reports are that it really unnerved him. What went into that?”
Actually I planned to say something to him, but my lawyer said that the judge didn’t want people saying things to Breivik. So, I had to make another plan, I planned to look at him because for me he is just a person, a small person, a person that has killed many of my friends and almost killed me. He was sitting there and I am not afraid of him because I had the power. Last year, he had the power. But at this moment I had the power and it was up to me what to do. I had thought about it for quite a while because I got to know in December that I had to testify, three months before, and I thought about it almost every day, what am I going to do. I had to do something to maybe affect him in a way. When I get angry I have pretty strong eyes. A sort of killer blink, what is it called? Killer look, yes!
Here her mother interjected,: “I have seen it!” Marte went on:
I thought that maybe that would affect him. So, in the courtroom Breivik was sitting maybe two meters from me, three maybe, and he looked at me, so I looked back. I used the same technique as I do with cats. When you are going to show cats that you are angry, you just look at them, look them straight in the eyes for a long while. And it worked. I did it two times and he got affected and afterwards I felt proud because no one else has done that and no one before or after me managed to get him affected in any way. So I felt like it was a victory for me, sort of showing him that I have got the power without saying anything to him because the judge didn’t like it.
Gorelick commented that in the trial session he observed (before the “killer stare” episode), “I happened to be sitting with three or four world-renowned forensic psychiatrists and the discussion was always the same: in our whole careers, we have never seen anything like this person, we have not seen anybody like this. and what would it take to get to him? That is the question that they were asking, because they could not figure out a way. You did.”
Gorelick then invited Marte to say anything she might have wanted to say but “that people never asked you about.”
A few things. What Renate said about the belongings: I got my jacket back with bullet holes in it. We thought that I was shot once, and when I got the jacket back it had two bullet holes. I have it at home and I am going to have it for the rest of my life to show to people because it shows in another way than my scars and my story do.
And social media. Social media has helped me a lot. It reaches out to many more people than if you just say something. And one thing that has been important to me is that I want to tell my story. I don’t want media to tell my story for me. So I used a blog and I wrote about what happened to me because it was my story to tell. Because of my blog, because I write about how it is, it affects many more people. It is so important that people do not forget that people are still struggling both physically and psychologically. People aren’t living the lives they had before Utøya. They are living a new life with Utøya with them.
Twitter has been a place where I can discuss other things, especially football. Football has helped me a lot. It is like you have recess when you watch a football match. You can think about other things than what you are thinking about all the time, like your body and what you cannot do and what you can do, and the future and all those types of things.
Could I just say some other things? The first is that other accidents affect me emotionally more than my own accident. I cry sometimes because a girl is kidnapped or killed. I don’t know the girl, I don’t know her family, but that affects me more than my story, and I think that is so weird because why doesn’t my own story affect me more? It affects my daily life, but it doesn’t affect me emotionally in the same way that other accidents do.
The hardest thing is when I meet the bereaved. I don’t know what to say. I am here; their daughter, their son, or their wife, or other family member is not there anymore and I live, and I don’t know what to say. Even the bereaved of my friends that are dead, I don’t what to say to them. I say hello, and I answer their questions, and I say nice to meet you, but there are so many things that I want to say that I don’t manage to say.
Recalling her two visits back to Utøya after the shooting, Marte remembered feeling
that the island was in two parts. There was one good part, where I had only good memories, but in the bad part of the island, I got anxiety, and a lot of physical responses in my body. That was hard. I was so glad that there were almost no people there. I had my mom and my dad, but it wasn’t enough. I needed control over every single person that was on the island beside the persons that I knew well. There was a man who walked around the island very often near us, and I looked at him all the time because I had to watch if he had a gun in his pocket or something.
The second time I was there my shrink and I made a plan that I wouldn’t go to those places that affected me physically and psychologically, so I was just on the hill. But I still got anxious. It was so many people, a thousand people, and in my mind I had to have control over every single person, and that was impossible. I managed to be there about two hours and then I just had to leave. It was impossible for me to be there.
For Laila Gustavsen, Marte’s mother, life after the Utøya shooting became a constant juggling act. While caring for her injured daughter and struggling not to neglect the needs of her son, she also had to meet the demands of her several political positions. Trying to maintain two lives, one private and one public, was almost like trying to be two different selves:
In August I was still the head of the Labour Party in the municipality where I live and there was a local election. I was a leader in Labour Party and had the responsibility for the election campaign. Before this trip toNew York, I started to read again some of my notes from that time. There was a report in a local newspaper from the opening of the election campaign — and I just observed it, I just felt this actually does not concern me. I understood that it happened, but it is one of those things in the surroundings, like for instance seeing people do ordinary things, going to the grocery store, standing at the bus stop. You just drive past and think, oh, can people laugh? Can people do these things? Can people live ordinary lives? But I understood that this was my responsibility. I am a leader of this organization, we are going to win this election, that was the goal. And we started to campaign.
Marte’s father — we are not married, we haven’t lived together since 1999 — he is also politically active. He is actually the chair of the county party. We were sitting in shifts together with Marte, and also running the campaign in the local municipality. Doing that was I think the right thing to do for me at that moment, but I had a very bad conscience about leaving Marte. I felt very bad about it because I felt that it wasn’t right to leave Marte. Could I do that, could I really feel joy about campaigning?
It was an experience that I would never have prayed for, but that experience has made me a stronger person, a person who understands more. For instance when I was on sick leave because of the extreme situation — I had never done that before — and the shame I felt when I was on sick leave, I never thought about that before. That a strong person with a lot of resources can be like a prisoner in her own home because you feel ashamed that you cannot cope with the situation. That is a part of the story but it has made me stronger.
As a politician, Gustavsen had to recognize that the attack was a political event as well as a personal and national tragedy, and had to find a way to detach the emotional — including her own emotion — from the political:
After the election, the journalists and comments in the newspapers started to talk about the Utøya effect, and I remember I was so provoked, it was like waving a red flag. But when I look back from a distance, I understand what they mean. Because we were a victim, so you can discuss whether or not Labour had sympathy in that period. And the prime minister’s leadership of course was one of the major issues. It’s trust, and we know that trust means a lot when people vote. So, when I look into the rear-view mirror, I can say okay, I don’t wave the red flag anymore.
When the commission’s report came out of course we had a debate in the society, what went wrong and what didn’t. I feel that debate about the facts has been quite good, but in the parliament there are parties that want to take this debate as close as they can to the next election to cause as a much damage to Labour Party or to the coalition as they can. If I were a supporter of the opposition I would probably feel the same way or do the same, so I am not saying that we are better or worse than anybody else. But it is a fact.
Gustavsen added this final comment:
Just to finish, a lot of people ask me are you mad at Behring Breivik? No, I am not mad at Behring Breivik. I am mad at the consequences of his act.
Like her mother, along with her pain, Marte found new strength in her ordeal:
I am more certain of what I want to accomplish in my life, and use more of my energy on things that are important to me. My dreams are still the same, but I am more certain of them… I feel more adult because I have so much life experience now, more than people that have lived 70 years. So I grew up really fast. I feel much stronger than before. I know myself better, I know who I am and that is important, to know who you are before deciding what to do with your life.
 Two visits to Utøya were organized, one for family members of those who were killed and one the next day for those who had been on the island during the massacre and survived. The visits took place on successive days, August 20 and 21, four weeks after the attack.