Commentary on: Prats M, Raymond S, Gasman I. Religious radicalization and lone‐actor terrorism: A matter for psychiatry? <i>J Forensic Sci</i>. 2019;64(4):1253–8. doi: 10.1111/1556‐4029.13992

The topic of the role of the psychiatrist in preventing radicalization and acts of terrorism is a contentious one [1, 2]. We read with great curiosity the case report by Prats et al. entitled “Religious Radicalization and Lone-Actor Terrorism: A Matter for Psychiatry?” [3], where the authors did an excellent job at summarizing the current literature on terrorism from a psychopathologic perspective. In their case report, they described a young patient who became vested in “extremist Islamic ideology” on the background of a likely primary psychotic disorder. While we appreciate the authors' insight into this issue, we believe it is vital to ensure the choice of language used reflects the sensitive intersection that exists between religiosity and extremism. There are two important problems within this paper. First, the authors did not define the term “jihad” in their case report. Although this may have been the term that the patient himself had used, it is important to define it properly so as to adequately contextualize it within the Islamic framework. By definition, jihad literally means a “struggle,” and Muslims use it to describe any action related to bettering the community or oneself [4]. However, many individuals have a limited understanding of this term and only comprehend it in a radical sense, equating it solely to violence and terrorist attacks [5]. As the authors point out, only about a third of lone-actor terrorists are religiously motivated [3, 6], and the usage of politically charged terminology without adequate definitions only serves to further stigmatize the Muslim population by automatically equating it to extremist ideology. This is especially important in the field of forensic psychiatry, as Muslims are overrepresented in European correctional systems [7]. As such, it is crucial that any paper addressing radicalization define this term properly or avoid its usage altogether. Second, as an example of a cause for hospitalization in a secure unit, the authors state that “if a patient shouts ‘Allah Akbar,’ the question of his/her hospitalization in a secure unit emerges” [3]. Again, when using terms from the Islamic lexicon, especially ones that have been pejorated into a term of hostility and associated with terrorists [8], it is critical to define them beforehand. The phrase “Allahu akbar,” also known as the “takbir,” signifies “God is the greatest.” In this sense, it is used to celebrate times of joy, to declare support to a speaker, or to express awe, among the many other ways it is used across the spectrum of human emotion [8]. Therefore, the authors' suggestion that the usage of this term is pathologic and should make the psychiatrist consider hospitalizing the one who said it is problematic. Indeed, despite the innocence of the phrase, it has become a greatly politicized term. It is not uncommon for members of the public to associate any usage of the takbir to terrorism, with Muslims often being automatically seen as perpetrators of terrorist actions [9, 10]. Thus, if such an unjustly contentious term is to be used in an academic paper, it is crucial for it to be properly defined so as to not support the negative stereotyping of Muslims. The issue of radicalization and terrorism is important to explore from a psychiatric lens, as there may be a role for our profession to play in preventing loss of life. Given the sensitive nature of this matter, it must be approached sensibly and objectively. In addition, the heedless use of language that stereotypes Muslims may lead to only recognizing members of the Islamic faith as terrorists. For example, there were notable controversies surrounding the Anders Breivik case in Norway. The country's response to this mass murderer was in stark contrast to their approach to “Islamist” terrorists, and the legal process even included a controversial forensic psychiatry report [11]. If we do not approach this issue with the sensitivity that it deserves, it is possible that our lack of diligence will lead to missing instances of radicalization as well as harm to our Muslim patients, especially those under the forensic system. This is in part a reflection of the lack of training we receive in this area, highlighting the need for further discussion and research.

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