Updated | Maria Lourdes Agius murder: prosecution asks whether accused's psychosis came before or after murder

A psychiatric expert told the court that Michael Emmanuel is criminally insane but that there is a possibility that his psychosis developed after the trauma of the criminal justice system
 

Accused of the murder of Maria Lourdes Agius, Michael Emmanuel is escorted to court to face trial by jury
Accused of the murder of Maria Lourdes Agius, Michael Emmanuel is escorted to court to face trial by jury

A psychiatric expert has said that Michael Emmanuel is criminally insane but that it is possible that he had developed his psychosis after going through “the trauma that is the criminal justice system.”

This emerged during Psychiatric Consultant Joseph Cassar’s four-hour grilling on the witness stand on Tuesday.

A jury is currently hearing witnesses in an effort to establish whether Emmanuel was capable of forming the criminal intent required to murder Maria Lourdes Agius when he allegedly strangled her in September 2018.

Consultant Psychiatrist Joe Cassar who was appointed by Court of Magistrates to examine the accused testified today. At the time he had concluded that Emmanuel had “acute psychosis and is therefore insane according to the criminal code. He has no insight whatsoever into his actions and was driven to do what he did by his disease.”

Emmanuel claims to have done what he did because there was a “bad omen” inside his wife and she had asked him to remove it, explained the specialist. “The omen had been controlling the whole issue in the family for several months.”

Prosecuting Lawyer Charles Mercieca from the office of the Attorney General asked a series of questions which established that the consultation had taken around one hour and that the witness had not spoken to Emmanuel’s friends, family or other psychiatric professionals about it.

“I basically asked him about his past history. He told me where he comes from, said he has no family psychiatric history and that his father was a pastor, so part of his religious delusion was formed that way.

He didn’t say anything about his mother. There was no family history of mental illness psychosis. He’s from the Ivory Coast.”

To know a character you must have been seeing the patient for over 6 months. “Taking a history which could have character issues is one thing, but knowing a character is different.”

The accused was psychotic during the 1 hour meeting, he said. “He was on heavy anti psychotics at the time. I saw him roughly a month after the incident.”

Clarifying a point for the jury, he said the man “had delusions, delusions on their own are a psychosis.”

A delusion is a fixed, false belief, the court was told.

“I did write he had magical thinking…but in African culture, magical thinking can be associated with religious beliefs.”

Grilled by Mericeca on when the patient had alleged that God spoke to him for the first time, he said the accused had claimed it had occurred when he was young “and still in the village.” According to him God spoke three times to him. “A delusion is not a brief psychotic episode,” corrected the consultant. “We do not know whether Michael Emmanuel was spoken to on the night of the murder.”

What he did know was that Emmanuel was on antipsychotic and anxiolytic medications, although he could not say whether the accused was actually taking them at the time. Although the accused had used marijuana in the past, which is associated with paranoid delusions, he had not been suffering from paranoid delusions at the time of the offence.

“In this case there were no paranoid delusions,” he said.

“I believed that when he was talking to me at the time, he was genuine. His facial expressions, the way he said what he said…The way he was speaking about when he got the spirit out of her was very emotional, it was like something he was called to do. The probability is that he had a delusional disorder.” Giving an example, he said that on one occasion, the accused had been drilling in cement and the cement had come out in a star shape, added Cassar, explaining that Emmanuel had taken it as “a sign.”

The accused had mentioned that after removing the “bad omen” from the victim, he had pressed the crucifix on to her neck to bless her.

A delusion is related to one’s beliefs. "You can be a high functioning deluded person," said the witness, "but unless they get you in trouble you may never be diagnosed."

“If you have a belief that you have a mission to remove omens it is a delusion.”

“Was he in control of his mind when he acted under a delusion?” asked the court. “No,” he replied, although the witness could not say with certainty whether the accused had been in such control in the past. When he spoke to him he was anxious but cognisant of what he was doing, said Cassar.

Emmanuel had no recorded psychiatric history prior to September 2018 in Malta, the jury heard. “There is no other psychiatric file and the patient declared that he had no prior psychiatric history recorded in the file. If he had said that he had a history 20 years ago in the Ivory Coast we would have no way of confirming this, but he said he had none.”

There are notes of delusions of grandeur and paranoia written by another psychiatrist in his file, observed the witness, but before 2018 he had not been seen by a consultant.

Through defence lawyer Marc Sant’s cross-examination it emerged that the accused was discharged on a heavy dose of an antipsychotic drug. “It lowers the thinking process to a basic level,” said Cassar. Another medication was an anxiolytic to calm the patient down. The dose was also high, added the witness.

Taking questions from jurors, the expert said he had not contradicted the accused’s version with evidence such as strangulation marks. “We always go with what the patient tells us…I do not give the patient leading questions, so if I had asked him that [why the strangulation marks] that would have been a leading question.”

The case was a complex one, Cassar said, adding that the man had been heavily medicated when he examined him.

It is extremely rare to see an actual, functional, non drug-induced psychosis which goes away in 24 hours without medication, said Cassar.

“I feel that with experience you feel a patient and with the build up to the event you see that and remember that I wasn’t seeing someone on a low dose. He was on a very high dose. I am reasonably convinced.”

“Is it possible that he developed the psychosis after the trauma that is the criminal justice system?” asked lawyer Charles Mercieca.

 “Yes it is," replied Cassar. 

"No further questions, your honour."

The jury continues at 3pm.

Lawyers Charles Mercieca and Matthew Xuereb are prosecuting for the office of the Attorney General. Lawyers Mark Sant and Dustin Camilleri are defence counsel.

Victim's cause of death was asphyxia caused by pressure on the neck

“There were bruises everywhere,” two pathologists told the jury, as the case continued on Tuesday afternoon.

Doctors Salfraz Ali and Prof. Marie Therese Camilleri Podesta presented the jury with a report on the autopsy they carried out on the victim on Maria Lourdes Agius on the day of her death as part of the inquiry appointed by Astrid May Grima.

The cause of death was established as asphyxia caused by pressure on the neck. “We found a lot of bruises on the face, neck and scalp, haemorrhage on the underlying muscles of the neck on both sides, as well as in the pharynx… these haemorrages are a sign of the asphyxia. There were also haemorrages in the whites of the eyes. These, as well as petechiae in the lungs, are consistent with asphyxia.”

Lawyer Marc Sant cross-examined. The bruises were of recent origin. “Not days. Hours," said Dr. Ali.

Asked about the circumstances of the woman’s death Camilleri Podesta’ that they had been told that the victim had gone to casualty two days before due to a blow to the left ear.

“There were bruises everywhere,” said Camilleri Podesta’ of the deceased's body, listing the face, abrasions on the chin, left side of the face, both sides of the neck, both ears, and a haemorrhage in her pharynx, likely caused by pressure.

Agius had also suffered bruises to the scalp, thought to have been caused by blunt trauma, as well as a cut lip and lacerations to the mouth caused by blunt trauma against the teeth. The woman had several bruises on her leg.

The injuries to her neck were compatible with hands choking her, they said. 

A juror asked how long she would have survived. “Probably three to four minutes,” she replied. None of the marks on her body were struggle marks, Dr. Ali said.

The jury continues tomorrow.