ATTACK IN PARIS PSYCHIATRY AND TERRORISM

WHY THE CARE INJUNCTION

IS IT NOT THE PANACEA ?

After the knife attack in the heart of Paris on Saturday evening, Gérald Darmanin points out the follow-up of the attacker as “a psychiatric failure” in the follow-up of the assailant.

He wants a change in psychiatric practice.

This hot and perhaps political reaction surprised more than one person, Darmanin's argument being a bit facile, even demagogic.

This is also the opinion of Antoine Pelissolo, professor of psychiatry, head of department at CHU Henri-Mondor de Créteil.

“It is, in any case, a sweeping judgment to find scapegoats, while we do not yet have a complete, detailed analysis of the situation.

I cannot say if the follow-up of this French suspect was perfect, not having access to his file, but Gérald Darmanin cannot cast shame on psychiatric professionals.

Known psychiatric pathologies

Placed in police custody, covered by an “S sheet”, he had already been convicted and declared to the police that he “was tired of seeing Muslims die”, particularly in Gaza, and that France was “complicit” of Israel. The profile of the attacker, who claimed responsibility for his terrorist act, was quickly presented, as well as his serious radicalized past.

But unlike the assassin of Samuel Paty and that of Dominique Bernard, the perpetrator, arrested in Paris and designated as Armand Rajabpour-Miyandoab., suffers from known psychiatric pathologies.

Already in 2019, while he was in detention incarcerated for a planned attack at La Défense, the latter made disturbing remarks "I hear the voice of all the people imprisoned for terrorism"

These remarks are recorded in a legal document consulted by colleagues as an incident reported by a prison guard.

“Senior officer, something dirty is going through my head. I hear the voices of all the people imprisoned for terrorism.

I even hear the voices of the Bataclan jihadists asking me to take action. I'm lost and I don't know who I am anymore," the assailant said. "I want to slit my parents' throats on the way out.

My release date is near, and I don't know where I stand. I will end up taking action,” he added, while addressing the supervisor.

.One night in April 2019, Armand Rajabpour-Miyandoab saw the doctor, following an anxiety attack in the cell. He had thus indicated to him his conviction that “the prison administration wanted to poison him through meals”.

There is no doubt that the murderer suffers from psychological disorders; he had also been the subject of psychiatric monitoring for many years.

It was during his detention that the first psychiatric disorders were detected. He is then placed on an atypical neuroleptic, a treatment that he will continue after his release in 2020.

In March 2022, a doctor gave his approval to stop it. But six months later, based on a psychiatric assessment, the sentencing judge ordered an injunction for treatment.

The possibility of an “administrative care order”

One thing is certain, however: Armand Rajabpour-Miyandoab has not been subject to any treatment since April 2023, when his probation ended after three years. The coordinating doctor's reports about him were rather encouraging: he kept his appointments, had worked in the same company since 2020.

On several occasions in his reports, he dismisses the possibility of psychiatric danger.

Certain elements, however, raise questions. Last October, his mother reported to the specialized services a worrying withdrawal towards him.

However, she refused to request forced hospitalization.

And the intelligence services' room for maneuver is limited...

The law passed in 2021, which gives the possibility of extending the monitoring of prisoners convicted of terrorism for five years, including treatment orders, was not in force at the time of the attacker's release.

Much already exists in this area. The prefect can order hospitalization or psychiatric monitoring, but always with the advice of a doctor, since this must be strictly within the framework of a pathology.

Today, the prefect can only request hospitalization without consent from a patient if the latter has caused harm to "the safety of people or, seriously, to public order".

“Even if we had managed to take him to see a doctor, he would probably not have ordered compulsory hospitalization in the absence of any obvious disorder,” insists a source close to the case.

"But the articulation of acute psychological suffering with an ideology offers the individual a perspective of action to be taken seriously. It is not uncommon for an individual to channel himself with religion, according to his follow-up to the letter of certain hadiths, collections of the actions and words of Mohammed.

Other fragile individuals give meaning to their apocalyptic vision of the world with elements of reality allowing them to fuel a delusion of persecution, redemption, megalomaniac or mystical.

They can achieve a form of unstable equilibrium, until they feel psychologically forced to act,” explains Laure Westphal, clinical psychologist, Doctor in psychopathology and psychoanalysis.

This order for care “ahead of any disturbance to public order” ?

Gérald Darmanin's additional proposal would therefore be to put in place this care order upstream, in a preventive manner, before any potential action, on the basis of suspicion or alert information.

To remedy this legal void – already pointed out for several years by the intelligence services – the Minister of the Interior has therefore demonstrated his desire to give prefects the possibility of requesting administrative care injunctions.

In short: to allow them to order a psychiatric examination "ahead of any disturbance to public order", specifies the minister's entourage.

This would perhaps be a small step forward in the care of these terrorists with identified “psychological disorders”. It remains to be seen in what legal framework this could fit – the ministry is already specifying that this is not a question of not a measure of deprivation of liberty – and when.

But the border is not watertight; a radicalized person may be prey to psychiatric disorders which can therefore play a role in the act.

Convictional radicalization, choices that have rationality

Certainly in Armand RM the meaning of the act certainly escapes its author, but not the meaning he gives to his murderous action: he exercises the latter consciously in the name of an ideological logic, that of radical Islam . This Islamist terrorist made choices that had rationality. He is also a rational individual who theorized his act, as the doctor-psychiatrist at the Paris La Santé prison center and director of the Center for the Study of Radicalization and Their Treatments rightly recalls.

The war in Israel may have accelerated the project of fanatics to fight for a common identity, taken as a sort of unique political-religious frame of reference. He “was tired of seeing Muslims die”, particularly in Gaza. “The jihadists do not only have the prophet to “defend”. There is also what they consider to be the suffering caused to the Umma, the homogeneous and mythical Muslim community. The Israeli-Palestinian conflict has long been identified as the focal point of Arab humiliations.

With the globalization of Islam, new generations of terrorists have replaced the conflicts in Afghanistan, Bosnia, Chechnya, Iraq and Syria. The military weakening of IS on Syrian and Iraqi territories has not extinguished desires for engagement. », underlines Laure Westphal.

1 6% of them only: “medium to strong” psychological fragilities.

And all the radicalized, far from it, have the profile of Armand

Indeed in 2022, a study by the Ministry of Justice, based on a panel of 350 detainees passed through radicalization assessment units, indicated that 8% of them presented psychiatric disorders and 16% fragilities. psychological “medium to strong”. .Among the large number of radicalized people, there is a proportion – not necessarily greater than in the general population – who suffer from psychiatric illnesses. The experience of the Center for Prevention, Integration, Citizenship, in 2016, confirmed this: only one of the beneficiaries of this structure for the prevention of radicalization suffered from psychiatric disorders. In the vast majority of cases, radicalization is conviction-based, there is strong ideological consent.

A significant number of radicalized individuals not covered by psychiatry !

Since the closure of the CPIC in 2017, support for radicalized people has been prioritized at the local level.

An information report, recorded at the Presidency of the National Assembly on June 27, 2019, states that, according to the Anti-Terrorism Coordination Unit (UCLAT), in April 2019, support was relayed in 269 municipalities.

These measures seem insufficient, if we believe that every year since 2015, attacks have been committed on our soil, although many are foiled. At the same time, in France, in March 2022, there were 570 radicalized common law prisoners and 430 prisoners for Islamist terrorism.

Armand M. had, according to French media, sworn "to no longer be Muslim", after several years spent behind bars for a planned attack in 2016 in the Parisian business district of La Défense. He was one of the 340 radicalized prisoners released since 2018 (around thirty others should be released in 2024).

Around fifty have been since the beginning of October, even though the DGSI reported this summer that the terrorist threat was still the number one in France... Potential bombs?