Psychological autopsy explained

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.[4]

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.[8] They developed the procedure after being asked by the Coroner to help identify the cause of death in equivocal suicides.[9] The procedure was influenced by Farberow and Shneidman’s time studying suicide notes from the Los Angeles County Coroner’s Office.

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. 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.[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.

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.

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. If the cause of death is clear, investigators attempt to determine the reasons for an individual’s actions that led to death. 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. Information from the decedent’s health records is also examined, including any illnesses, treatment, and therapy and family history of death.[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.

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
        1. Ongoing mental illness or prolonged depression Previous major traumatic life event
  3. A traffic incident that strongly suggests a suicide

References

  1. Abondo . M. . Masson . M. . Le Gueut . M. . Millet . B. . L'autopsie psychiatrique . L'Encéphale . September 2008 . 34 . 4 . 343–346 . 10.1016/j.encep.2007.06.005. 18922235 .
  2. 10.1001/jama.1963.03700250060008 . Investigations of Equivocal Suicides . 1963 . Litman . Robert E. . JAMA: The Journal of the American Medical Association . 184 . 12 . 924 .
  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 . en . 55 . 1 . 21–26 . 10.2105/AJPH.55.1.21 . 0002-9572 . 1256136 . 14246103.
  4. 2007-12-28 . Cries for Help . dead . https://web.archive.org/web/20071228075855/http://www.time.com/time/magazine/article/0,9171,870056,00.html . 2007-12-28 . 2023-04-06 . TIME.
  5. Isometsä . E. T. . November 2001 . Psychological autopsy studies--a review . European Psychiatry . 16 . 7 . 379–385 . 10.1016/s0924-9338(01)00594-6 . 0924-9338 . 11728849. 12224177 .
  6. 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 . 10.1016/s0165-0327(98)00033-0 . 0165-0327 . 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 . 10.5958/0974-4487.2021.00001.8. 244311911 .
  8. Canter . David V . Psychological autopsies . 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 . 10.1111/1556-4029.12138 . 1556-4029 . 23551031. 42590948 .
  10. Web site: Fraga . Kaleena . 2022-04-06 . Inside Marilyn Monroe's Controversial Autopsy Report — And The Eerie Conspiracies Behind It . 2023-04-06 . All That's Interesting . en-US.
  11. Web site: 2015-09-15 . Norman Farberow dies at 97; psychologist was pioneer in suicide prevention . 2023-04-06 . Los Angeles Times . en-US.
  12. News: 2015-09-18 . Norman Farberow, psychologist at forefront of suicide . Washington Post.
  13. November 2008 . The Psychological Autopsy, Part I: Applications and Methods . Law and Psychiatry . 14 . 6 . 393–397.
  14. Winter 1981 . The Psychological Autopsy . Suicide and Life-Threatening Behavior . en . 11 . 4 . 325–340 . 10.1111/j.1943-278X.1981.tb01009.x.
  15. Web site: Death Investigation – Introduction to Psychological Autopsy . 2023-04-06 . www.ojp.gov.
  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 . 10.1017/s0033291702006943 . 0033-2917 . 12701661. 7469249 .
  17. Web site: Benjamin . Silber . 2022-02-12 . What is a Psychological Autopsy? . 2023-04-06 . forensic-evaluations . en.
  18. Ebert . Bruce W. . February 1987 . Guide to conducting a psychological autopsy. . Professional Psychology: Research and Practice . en . 18 . 1 . 52–56 . 10.1037/0735-7028.18.1.52 . 1939-1323.
  19. Ovenstone . Irene M. K. . A Psychiatric Approach to the Diagnosis of Suicide and its Effect upon the Edinburgh Statistics . The British Journal of Psychiatry . July 1973 . 123 . 572 . 15–21 . 10.1192/bjp.123.1.15 . 4729869 .
  20. Book: Andersson . Anna-Lena . Svensson . Kenneth . Suicide in the Transport System . The Vision Zero Handbook . The Vision Zero Handbook: Theory, Technology and Management for a Zero Casualty Policy . 2023 . 1103–1115 . https://www.safetylit.org/citations/index.php?fuseaction=citations.viewdetails&citationIds[]=citbooksection_413_20 . Springer International Publishing . 10.1007/978-3-030-76505-7_42 . 978-3-030-76504-0 . en. free .
  21. Web site: Suicide and bereavement response College of Policing . www.college.police.uk . 23 January 2024 . en . 4 July 2016.

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