PSYCHOLOGICAL AUTOPSY

Importance of Psychological Autopsy

Suicide is one of the major growing concerns in the world especially more so during these stressful times of a pandemic where people are largely isolated and in lesser contact with each other thus becoming more vulnerable to mental illnesses.

Suicide can be defined as the act of intentionally ending one’s own life. Nonfatal suicidal thoughts and behaviors (hereafter called ‘‘suicidal behaviors’’) are classified more specifically into three categories:

·       Suicide ideation, which refers to engaging in thoughts that involve ending one’s own life

·       Suicide plan, which refers to the formulation of a specific method through which one intends to die

·       A suicide attempt, which refers to engagement in potentially self-injurious behavior in which there is at least some intent to die [1].

A psychological autopsy (PA) is a systematic method to understand the psychological and contextual circumstances preceding suicide [2]. In simpler words, we can say that psychological autopsy is an endeavor to ascertain the mental state of the deceased. The psychological autopsy plays a vital role in reconstructing the psychical state of the victim’s mind which in turn helps us to resolve whether his or her death was suicide, homicide, or accidental. PA is most useful when the evidence of the deceased person’s intention is ambiguous [3].

It entails obtaining and reviewing information from police reports, suicide notes, drawings, medical practitioners records, psychiatric notes, and interviews of eyewitnesses, close friends, and relatives to form an integrated picture of the victim’s psyche and events leading up to his or her death.

Why Psychological Autopsy?

A Psychological Autopsy can be viewed as having four major goals [4].

Manner of death

The first is to conclude as to whether the manner of death is consistent with the evidence or not [4]. Determining MOD is one of the important aspects of psychological autopsy. It helps in ruling out whether the death was natural (caused by some illness or natural process), accidental, suicide, or homicide. The determination of suicide requires establishing that death was both self-inflicted and intentional [5].

Self-inflicted harm is determined during pathological autopsy whereas the intent can be established from a suicide note. But in cases where suicide notes are absent some obscure shreds of evidence like serious depression or mental disorder, previous suicide attempts, expression of hopelessness can be noted. Intent can be harder to determine if the death is abrupt or if the victim is unable to understand the consequences of their activities, especially in cases of small children, like jumping from the window, running towards a car. The procedure is used to classify the equivocal death. The studies have suggested that up to 20% of cases have an unclear mode of death that is brought to the attention of the medical examiner.

Circumstances encompassing death

The second is to provide insight into the circumstances surrounding the death, regardless of intent. This insight may help the loved ones of the deceased through the grieving process [4]. The ambiguity related to the circumstances of death can be resolved by critically reviewing interviews and information collected while dealing with the case. This may help in reconstructing that person’s attributes, lifestyle, background, and personal ties. Understanding the thought process of the deceased can help in better understanding the circumstances or events which may have led to the victim’s death.

Research on Suicide & Estimation of Suicide Risk Factor

The third objective is to contribute to the body of research on suicide [4]. Understanding suicide is one step toward preventing it. The causes of suicidal behavior are not fully understood; however, this behavior results from the complex interaction of many different factors [6].

Suicidal behavior is widely observed in the age category of 15-29 years. Adolescents are at greater risk because they undergo psychological as well as physical changes. They have to face many new challenges like constructing their own identity, procuring new responsibilities and freedom, developing intimate relationships, academic stress, dealing with high expectations of society, etc. Everyone agrees that numerous factors can contribute to suicide and that ultimately each suicide is caused by a highly unique, dynamic, and complex interplay of genetic, biological, psychological, and social factors [7].

Prevention

The last goal is to refine suicide assessment which in turn helps us in improving prevention techniques to lessen the number of suicides. A more solid understanding of suicide can help in developing advanced suicide prevention programs with better physicians which can ultimately facilitate better treatment to people. . Small interactive and intimate sessions shall be conducted by a psychologist counselor in colleges and institutions for adolescents to help them deal with these types of issues. Effective mental health and suicide awareness programs shall be conducted at the community level, especially in those sub-levels which are identified as high-risk groups.

Status of Psychological Autopsy in India

Psychological autopsy is still emerging practice in India but many studies have been conducted in this field. There have been some shocking cases in India where a psychological autopsy was performed as per the need of the case.

Two of those famous cases are-

Sunanda Pushkar case (2014) – This case was of an Indian businesswoman named Sunanda Pushkar who was also the wife of a former Indian diplomat and politician Shashi Tharoor. She was found dead in mysterious circumstances in a luxury hotel room. Police suspected it to be a suicide case however later on when the doctors conducted post-mortem they reported that it appeared to be a case of “sudden and unnatural death”. When ‘psychological autopsy’ was finally conducted by the Special Investigation Team (SIT) and various interviews with her family members and friends were conducted to understand the psychical state of Sunanda Pushkar and also to investigate the alleged conflict between the couple. Delhi police ultimately charged Shashi Tharoor with abetting the suicide of his wife Sunanda Pushkar.

Being a high profile case there were lots of late revelations and twisting of facts and events but based on the testimony given by relatives during psychological autopsy finally four years later, in 2018 Shashi Tharoor was accused of subjecting cruelty to Sunanda Pushkar. Thus psychological autopsy came handy even when physical autopsy couldn’t.

Burari case (2018) – The whole nation was shaken when the mass suicide of 11 family members was reported in the Burari area in Delhi. The ten family members were found hanging under unusual circumstances while the oldest member of the family was strangled. The Delhi police decided to conduct the psychological autopsy where they went through the notebooks found at the scene of the crime to understand the psyche of the victims which ultimately helped them to uncover the reason behind this drastic step. The police finally concluded that it was a case of a ritual gone wrong thus leading it to ‘mass suicide’.

Psychological Autopsy once again coming into play and helping police to understand the circumstance surrounding the death of 11 innocent common people which further helped the family’s acquaintances in grasping the ominous reason behind this tragic act and granting them a closure.

Hence Psychological Autopsy is an important tool in Forensic Science that empowers our investigative teams to solve an unsolvable crime that lacks motives. Despite of no proper standard set of guidelines for it, investigating officers and police officials should undergo training and orientation programs related to criminal psychology and human psychology. This will probably help them interpret all the pieces of evidence better which can eventually help them to resolve the suicidal and equivocal deaths.

References

1.     Nock, M.K., Borges, G., Bromet, E.J., Cha, C.B., Kessler, R.C., Lee, S. (2008). Suicide and Suicidal Behavior. Epidemiologic Reviews; 30, 133–154.

2.     Connor, K.R., Beautrais, A.L., Brent, D.A., Conwell, Y., Phillips, M.R., Schneider, B. (2011). The Next Generation of Psychological Autopsy Studies. The Official Journal of the American Association of Suicidology, DOI: 10.1111/j.1943-278X.2011.00057.x

3.     Saxena, G., & Saini, V. (2017). Psychological Autopsy- A Way to Revealing the Enigma of Equivocal Death, International Journal of Forensic Science, ISSN: 2573-1734.

4.     Caulkins, C.G. (2019). The Psychological Autopsy: What, Who & Why. The Forensic Mental Health Practioner, Vol. 2, Issue 1.

5.     Rosenberg, M.L., Davidson L.E., Smith, J.C., Berman, A.L., Buzbee H., Gantner, G., Gay, G.A.,  Lewis, B.M., Mills, D.H., Murray, D., O’Carroll, P.W., Jobes, D.  (1988).Operational Criteria for the Determination of Suicide, Journal of Forensic Science, Vol 33 No 6, 1445-1456.

6.     O’Connor, R.C., & Nock, M.K. (2014). The Psychology of Suicidal Behaviour, Lancet Psychiatry, 1: 73–85.

7.      Heeringen, K.v. (2001). The suicidal process and related concepts. In: van Heeringen K. editor. Understanding Suicidal Behaviour. Chichester: John Wiley & Sons Ltd, 136–59.