Psychological autopsy

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Psychological autopsy in suicidology (or also psychiatric autopsy) is a systematic procedure for evaluating suicidal intention in equivocal cases. [1] [2] [3] It was invented by American psychologists Norman Farberow and Edwin S. Shneidman during their time working at the Los Angeles Suicide Prevention Center, which they founded in 1958. [3] [4]

Contents

The method entails collecting all available information on a deceased individual through forensic examinations, examining health records, and conducting interviews with relatives and friends. [5] [6] This information is then used to determine the individual’s risk factors and psychological state before their death to help determine their cause of death. [7]

History

Farberow and Shneidman pioneered the psychological autopsy while working at the Los Angeles Suicide Prevention Center in the 1950s. [3] [8] They developed the procedure after being asked by the Coroner to help identify the cause of death in equivocal suicides. [4] [9] The procedure was influenced by Farberow and Shneidman’s time studying suicide notes from the Los Angeles County Coroner’s Office. [4]

The psychological autopsy method was first used when Coroner Theodore J. Curphrey asked for the Suicide Prevention Center’s help in investigating a high number of drug-induced deaths.[ citation needed ] The procedure was also used after Curphrey enlisted psychiatrist Robert E. Litman and Farberow to help determine the mental state of Marilyn Monroe before her death. [4] [10] Farberow ruled Monroe’s death a probable suicide after the investigation. [11] [12]

The psychological autopsy method has been adopted by the United States Department of Defense and in 2002, psychological autopsies became a part of its training curriculum. [13]

The psychological autopsy has also been used to help determine the likelihood of suicide in criminal cases such as Jackson v. State and U.S. v. St. Jean and civil cases such as Mutual Life Insurance Company v. Terry. [13]

Processes

The psychological autopsy was developed to help clarify equivocal deaths, or deaths without a clear or appropriate mode. [14] Examples of equivocal death scenarios include drug-related deaths, autoerotic and self-induced asphyxia, vehicular deaths, and drownings. [13]

When conducting psychological autopsies, investigators attempt to identify a decedent’s intention in regard to their death. Psychological autopsies first attempt to answer how an individual died, why they died at a specific time, and the most probable cause of death. [13] If the cause of death is clear, investigators attempt to determine the reasons for an individual’s actions that led to death. [13] Suicidal intent is measured by factors such as means of death, prior threats to commit suicide, and settling of financial accounts. [15] In psychological autopsies, mental disorders are also strongly associated with suicide. [16]

Intent is determined by analyzing information about the decedent collected from interviews with friends and family, along with information gained from the related forensic examination into the decedent’s death. [5] [6] Information from the decedent’s health records is also examined, including any illnesses, treatment, and therapy and family history of death. [5] [17] [18] Investigators usually look for details such as behavioral patterns in response to stress, recent changes in behavior, suicidal ideation, use of alcohol and/or drugs, and recent traumatic events. [14] [17]

Ovenstone criteria

European Union Agency for Railways uses so-called Ovenstone criteria [19] to distinguish a death as a deliberate act. [20] Also, the British College of Policing advises to use these criteria named after Irene Ovenstone [21] to determine a suspected suicide. Irene Ovenstone introduced these criteria in 1973. [21] She applied this method in the review of the verdicts in Edinburgh. The review revealed a potential under-reporting of suicide of 40.67%. [21] These criteria are: [20]

  1. Suicide note, written or oral, where the intention is communicated and where the traffic incident supports a suicide
  2. A traffic incident that indicates a suicide in combination with knowledge of
    1. Recent suicide attempts
    2. Recent indirect suicidal communication
    3. Communication about committing suicide or having no reason to live
    4. Ongoing mental illness or prolonged depression
    5. Previous major traumatic life event
  3. A traffic incident that strongly suggests a suicide

Related Research Articles

<span class="mw-page-title-main">Forensic pathology</span> Medical speciality

Forensic pathology is pathology that focuses on determining the cause of death by examining a corpse. A post mortem examination is performed by a medical examiner or forensic pathologist, usually during the investigation of criminal law cases and civil law cases in some jurisdictions. Coroners and medical examiners are also frequently asked to confirm the identity of remains.

<span class="mw-page-title-main">Autopsy</span> Medical examination of a corpse

An autopsy is a surgical procedure that consists of a thorough examination of a corpse by dissection to determine the cause, mode, and manner of death; or the exam may be performed to evaluate any disease or injury that may be present for research or educational purposes. The term necropsy is generally used for non-human animals.

<span class="mw-page-title-main">Medical examiner</span> Post-mortem investigation forensic pathologist

The medical examiner is an appointed official in some American jurisdictions that investigates deaths that occur under unusual or suspicious circumstances, to perform post-mortem examinations, and in some jurisdictions to initiate inquests. They are necessarily trained in pathology.

A suicide method is any means by which a person may choose to end their life. Suicide attempts do not always result in death, and a non-fatal suicide attempt can leave the person with serious physical injuries, long-term health problems, and brain damage.

<span class="mw-page-title-main">Suicide prevention</span> Collective efforts to reduce the incidence of suicide

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<span class="mw-page-title-main">Suicidal ideation</span> Thoughts, ideas, or ruminations about the possibility of ending ones life

Suicidal ideation, or suicidal thoughts, is the thought process of having ideas, or ruminations about the possibility of completing suicide. It is not a diagnosis but is a symptom of some mental disorders, use of certain psychoactive drugs, and can also occur in response to adverse life events without the presence of a mental disorder.

<span class="mw-page-title-main">Suicidology</span> Scientific study of suicide and self-destructive behaviors

Suicidology is the scientific study of suicidal behaviour, the causes of suicidalness and suicide prevention. Every year, about one million people die by suicide, which is a mortality rate of sixteen per 100,000 or one death every forty seconds. Suicidologists believe that suicide is largely preventable with the right actions, knowledge about suicide, and a change in society's view of suicide to make it more acceptable to talk about suicide. There are many different fields and disciplines involved with suicidology, the two primary ones being psychology and sociology.

Suicide risk assessment is a process of estimating the likelihood for a person to attempt or die by suicide. The goal of a thorough risk assessment is to learn about the circumstances of an individual person with regard to suicide, including warning signs, risk factors, and protective factors. Risk for suicide is re-evaluated throughout the course of care to assess the patient's response to personal situational changes and clinical interventions. Accurate and defensible risk assessment requires a clinician to integrate a clinical judgment with the latest evidence-based practice, although accurate prediction of low base rate events, such as suicide, is inherently difficult and prone to false positives.

A suicide crisis, suicidal crisis or potential suicide is a situation in which a person is attempting to kill themselves or is seriously contemplating or planning to do so. It is considered by public safety authorities, medical practice, and emergency services to be a medical emergency, requiring immediate suicide intervention and emergency medical treatment. Suicidal presentations occur when an individual faces an emotional, physical, or social problem they feel they cannot overcome and considers suicide to be a solution. Clinicians usually attempt to re-frame suicidal crises, point out that suicide is not a solution and help the individual identify and solve or tolerate the problems.

<span class="mw-page-title-main">Edwin S. Shneidman</span> American clinical psychologist, suicidologist & thanatologist (1918-2009)

Edwin S. Shneidman was an American clinical psychologist, suicidologist and thanatologist. Together with Norman Farberow and Robert Litman, in 1958, he founded the Los Angeles Suicide Prevention Center where the men were instrumental in researching suicide and developing a crisis center and treatments to prevent deaths.

<span class="mw-page-title-main">Suicide</span> Intentional act of causing ones own death

Suicide is the act of intentionally causing one's own death. Mental disorders, physical disorders, and substance abuse are risk factors.

<span class="mw-page-title-main">Norman Farberow</span> American psychologist

Norman Louis Farberow was an American psychologist, and one of the founding fathers of modern suicidology. He was among the three founders in 1958 of the Los Angeles Suicide Prevention Center, which became a base of research into the causes and prevention of suicide.

Theodore Joscelyn Curphey was an American coroner who was the chief coroner for Los Angeles and Nassau Counties.

<span class="mw-page-title-main">Gender differences in suicide</span>

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A suicide bag, also known as an exit bag or hood, is part of a euthanasia device consisting of a large plastic bag with a drawcord used to die by suicide through inert gas asphyxiation. It is usually used in conjunction with a flow of an inert gas that is lighter or less dense than air, like helium or nitrogen. Continuing to breathe expels carbon dioxide and this prevents the panic, sense of suffocation and struggling before unconsciousness, known as the hypercapnic alarm response caused by the presence of high carbon dioxide concentrations in the blood. This method also makes the direct cause of death difficult to trace if the bag and gas canister are removed before the death is investigated. While asphyxiation by helium can be detected at autopsy, there is currently no test that can detect asphyxiation by nitrogen. For this reason, nitrogen is commonly the preferred choice for people who do not want the cause of death established.

<span class="mw-page-title-main">Suicide by hanging</span> Suicide via suspension from an anchor-point

Suicide by hanging is the intentional killing of oneself (suicide) via suspension from an anchor-point such as an overhead beam or hook, by a rope or cord or by jumping from a height with a noose around the neck.

In many legal jurisdictions, the manner of death is a determination, typically made by the coroner, medical examiner, police, or similar officials, and recorded as a vital statistic. Within the United States and the United Kingdom, a distinction is made between the cause of death, which is a specific disease or injury, versus manner of death, which is primarily a legal determination, versus the mechanism of death, which does not explain why the person died or the underlying cause of death and can include cardiac arrest or exsanguination. Different categories are used in different jurisdictions, but manner of death determinations include everything from very broad categories like "natural" and "homicide" to specific manners like "traffic accident" or "gunshot wound". In some cases an autopsy is performed, either due to general legal requirements, because the medical cause of death is uncertain, upon the request of family members or guardians, or because the circumstances of death were suspicious.

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Antoon A. Leenaars is a Canadian clinical and forensic psychologist practicing in Windsor, Ontario. He is known for his research on suicide.

Alan Lee Berman also known as Lanny Berman, is an American psychologist, psychotherapist, and suicidologist. He is an adjunct professor of Psychiatry and Behavioral Sciences at Johns Hopkins School of Medicine. Berman was formerly the executive director of the American Association of Suicidology. He is a fellow of the American Psychological Association and the International Association for Suicide Research. Berman has a private practice in psychological and forensic consultation.

References

  1. ↑ Abondo, M.; Masson, M.; Le Gueut, M.; Millet, B. (September 2008). "L'autopsie psychiatrique". L'Encéphale. 34 (4): 343–346. doi:10.1016/j.encep.2007.06.005. PMID   18922235.
  2. ↑ Litman, Robert E. (1963). "Investigations of Equivocal Suicides". JAMA: The Journal of the American Medical Association. 184 (12): 924. doi:10.1001/jama.1963.03700250060008.
  3. 1 2 3 Shneidman, Edwin S.; Farberow, Norman L. (January 1965). "The Los Angeles Suicide Prevention Center: A Demonstration of Public Health Feasibilities". American Journal of Public Health and the Nation's Health. 55 (1): 21–26. doi:10.2105/AJPH.55.1.21. ISSN   0002-9572. PMC   1256136 . PMID   14246103.
  4. 1 2 3 4 "Cries for Help". TIME. 2007-12-28. Archived from the original on 2007-12-28. Retrieved 2023-04-06.
  5. 1 2 3 Isometsä, E. T. (November 2001). "Psychological autopsy studies--a review". European Psychiatry. 16 (7): 379–385. doi:10.1016/s0924-9338(01)00594-6. ISSN   0924-9338. PMID   11728849. S2CID   12224177.
  6. 1 2 Hawton, K.; Appleby, L.; Platt, S.; Foster, T.; Cooper, J.; Malmberg, A.; Simkin, S. (September 1998). "The psychological autopsy approach to studying suicide: a review of methodological issues". Journal of Affective Disorders. 50 (2–3): 269–276. doi:10.1016/s0165-0327(98)00033-0. ISSN   0165-0327. PMID   9858086.
  7. ↑ Mohanty, Pallavi; Kumar, Rajeev; Sankhla, Mahipal Singh (September 2021). "Importance of Psychological Autopsy in Forensic Science". Indian Internet Journal of Forensic Medicine & Toxicology. 19: 1–6. doi:10.5958/0974-4487.2021.00001.8. S2CID   244311911.
  8. ↑ Canter, David V. "Psychological autopsies" (PDF). University of Huddersfield Repository.
  9. ↑ Botello, Timothy; Noguchi, Thomas; Sathyavagiswaran, Lakshmanan; Weinberger, Linda E.; Gross, Bruce H. (July 2013). "Evolution of the psychological autopsy: fifty years of experience at the Los Angeles County Chief Medical Examiner-Coroner's Office". Journal of Forensic Sciences. 58 (4): 924–926. doi:10.1111/1556-4029.12138. ISSN   1556-4029. PMID   23551031. S2CID   42590948.
  10. ↑ Fraga, Kaleena (2022-04-06). "Inside Marilyn Monroe's Controversial Autopsy Report — And The Eerie Conspiracies Behind It". All That's Interesting. Retrieved 2023-04-06.
  11. ↑ "Norman Farberow dies at 97; psychologist was pioneer in suicide prevention". Los Angeles Times. 2015-09-15. Retrieved 2023-04-06.
  12. ↑ "Norman Farberow, psychologist at forefront of suicide". Washington Post. 2015-09-18.
  13. 1 2 3 4 5 "The Psychological Autopsy, Part I: Applications and Methods" (PDF). Law and Psychiatry. 14 (6): 393–397. November 2008.
  14. 1 2 "The Psychological Autopsy". Suicide and Life-Threatening Behavior. 11 (4): 325–340. Winter 1981. doi:10.1111/j.1943-278X.1981.tb01009.x.
  15. ↑ "Death Investigation – Introduction to Psychological Autopsy". www.ojp.gov. Retrieved 2023-04-06.
  16. ↑ Cavanagh, J. T. O.; Carson, A. J.; Sharpe, M.; Lawrie, S. M. (April 2003). "Psychological autopsy studies of suicide: a systematic review". Psychological Medicine. 33 (3): 395–405. doi:10.1017/s0033291702006943. ISSN   0033-2917. PMID   12701661. S2CID   7469249.
  17. 1 2 Silber, Benjamin (2022-02-12). "What is a Psychological Autopsy?". forensic-evaluations. Retrieved 2023-04-06.
  18. ↑ Ebert, Bruce W. (February 1987). "Guide to conducting a psychological autopsy". Professional Psychology: Research and Practice. 18 (1): 52–56. doi:10.1037/0735-7028.18.1.52. ISSN   1939-1323.
  19. ↑ Ovenstone, Irene M. K. (July 1973). "A Psychiatric Approach to the Diagnosis of Suicide and its Effect upon the Edinburgh Statistics". The British Journal of Psychiatry. 123 (572): 15–21. doi:10.1192/bjp.123.1.15. PMID   4729869.
  20. 1 2 Andersson, Anna-Lena; Svensson, Kenneth (2023). "Suicide in the Transport System". The Vision Zero Handbook. Springer International Publishing. pp. 1103–1115. doi: 10.1007/978-3-030-76505-7_42 . ISBN   978-3-030-76504-0.{{cite book}}: |journal= ignored (help)
  21. 1 2 3 "Suicide and bereavement response | College of Policing". www.college.police.uk. 4 July 2016. Retrieved 23 January 2024.
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