The Blogs: Sarah Halimi’s murder and the moral challenges of Forensic Psychiatry

Yesterday, on the 25th of April 2021, approximately 25.000 people gathered in Paris to demonstrate against the Supreme Court of Cassation’s decision to declare the killer of Sarah Halimi z”l as not criminally responsible for the gruesome and tragic murder, that took place just over four years ago. Not only in Paris, but also in Tel Aviv, Jerusalem, London and other cities around the world, Jews and others gathered to demand justice for Halimi.

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Dr. Sarah Attal-Halimi z”l was a beloved Orthodox-Jewish mother and grandmother, who dedicated her life to caring for others as a family physician. On the night of the 4th of April 2017, a 27-year old neighbour broke into her home in Paris. He then beat her up and threw her lifeless body off the balcony. Sarah was murdered at age 65.

The killer – Traoré: an immigrant from Mali – was quickly after the incident arrested: another family of the same building phoned the police for help, after Traoré had gained access to their apartment as well. They describe the murderer as having screamed ”Sheitan” (devil) and “Allahu Akbar” as he killed Sarah. In addition, they stated that Traoré recited verses from the Quran repetitively while being in their home.

After the arrest of Traoré, he was submitted to a psychiatric hospital for further assessments, where he has been residing since. Several psychiatrists have evaluated Traoré’s medical, psychiatric, and social history, his clinical symptoms, his behaviour, his response to medications, and his ability to take responsibility for his actions. In the media, the results are bluntly summarized with the statement: ”Not fit to stand trial, because he smoked weed”.

Now, the case is obviously much more nuanced than what the media portrays. However, because of patient confidentiality and privacy issues, most of the details will never be known to the public. To my own best knowledge, Traoré was ultimately diagnosed with a chronic psychotic (schizophrenic) disorder, and/or with an acute and transient psychotic disorder called Boufféé délirant. [Source].

Within psychiatry, it is well-established that the use of cannabis often leads to (transient) psychotic episodes and increased psychotic symptoms in those with (schizophrenic) psychotic disorders. Many patients with schizophrenia use cannabis, but on the other hand: the risk of developing a psychotic disorder with the use of cannabis also significantly increases in already vulnerable people. [Source]. The correlation between cannabis use and psychotic symptoms is so strong, that the psychiatric classification systems such as the DSM (Diagnostic and Statistical Manual of Mental Disorders) has it listed as a separate clinical disorder: the Cannabis-Induced Psychotic Disorder.

During my years working in both acute and forensic (closed) psychiatric wards in the Netherlands, we admitted many patients with court orders for treatment. Both schizophrenia, as well as cannabis-induced psychosis and other psychotic disorders, were highly prevalent. Often patients were admitted because of danger to themselves, of imposing threats to others, but sometimes even after having committed the most gruesome crimes. Therefore, one of our main tasks involved the assessments of the patients’ ability to adequately judge situations and take responsibility for one’s actions.

First as a nurse and medical student and later as a junior physician, I have encountered many antisemitic comments. Not only curses addressed to me personally, but also more broadly to the clinics’ treatment methods as being especially ”fitted for Auschwitz” or in a total general sense: to the Jews as a people. However, in those situations, putting the psychotic cries of anger, despair or anxiety into the context of who said it, in what context, and with what underlying psychiatric illness, often those obvious anti-semitic statements are brushed off. Why? Because as treating physicians we sometimes think that our patients are incompetent and can’t be held responsible for their behaviour, which is largely fueled by a psychiatric disorder such as untreated schizophrenia.

Now, I can’t say if Traoré can be held criminally responsible for murdering Sarah. I have not seen his case reports, nor have I talked to him or assessed his clinical symptoms. I therefore also cannot say if the French court judged fairly in this complex case. The pain, frustration and utter helpless feeling of Sarah’s family and other loved ones: it’s only human nature to want judgement for murder and the killer to be sentenced. And it is crucial that we keep questioning both the psychiatric and the legal systems. However, ultimately we – as outsiders – do not have full insight into Traorés examinations, evaluations and psychiatric state during the murder. Something which the court must have access to and base their judgement on.

However painful a court judgement sometimes is, in our current societies we highly value the protection of the weakest members in our society from being judged for crimes committed in states of florid, acute psychotic episodes. This evaluation must be left to independent psychiatrists that have personally assessed the patient, as well as the court that evaluates the clinical reports based on their own judgement and criminal law frameworks.

Criminal responsibility does not always give us the same results as a moral or ethical responsibility. It does not always lead to satisfactory judgement and it absolutely does not take away from the pain of the actual gruesome event (in the case of Sarah: her murder). Truth isn’t black and white, and may at times be extremely painful. There is no doubt that Sarah Halimi’s murder was a horrible, deeply disturbing, and absolutely tragic event.

But instead of questioning the Supreme Courts decision based on expert psychiatrists recommendations, we have to focus on the other, underlying – much broader – problems that fuel the current protests: i.e. rising antisemitism and the lack of proper judgement by governments and state institutes. Antisemitism is so very prevalent, unfortunately, and especially in France. It is a serious threat that may lead to threats, attacks and sometimes even murder of Jews. Criminal culpability matters. Sarah Halimi’s life mattered. [Source] And in no way should drug or alcohol use or any other psychiatric illness ever be used as a ”quick excuse” for antisemitic or other criminal offences. Period.

But adequate legal protection for severely ill psychiatric patients for acts that they committed while being under the complete influence of their psychiatric illness also matters. And just because a killer may not be criminally responsible for his or her actions because of a psychotic episode, doesn’t mean the attack or murder can’t be called Anti-Semitic.

Anti-Semitism MUST be addressed and brought down by strict consequences and adequate punishment. But in the case of Sarah — horribly so — this won’t come through criminal punishment of a man that is – according to psychiatric and law specialists – not accountable for the crime he committed.