Psychological Autopsy

Introduction

AUTOPSY: The autopsy (from Greek autopsia which means “to see
with one’s own eyes”) is a method dating from ancient times. Autopsy
or post-mortem examination is a process of examination of body after
death. Complete autopsy is necessary to corroborate the evidence of
eyewitnesses and investigations done by investigating officer since a
poor autopsy can lead to miscarriage of justice.
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Medico legal Autopsy
Done in the Department of Forensic Medicine on request from police
or sub Divisional Magistrate, who is the Investigation Officer of the
case. The doctor conducts a full and complete post-mortem to find out
the cause of death and other relevant questions asked by the IO.

Pathological autopsy
Done in the Department of Pathology on request from the relatives,
who are consenting party. In these cases the doctor conducts a partial
autopsy of organ or cavities where the pathology is suspected to find out
the cause of death.

Virtual Autopsy
It is an alternative to a traditional autopsy, conducted with scanning
and imaging technology and used to analyse relevant forensics findings
in living and dead person.
PSYCHOLOGICAL AUTOPSY: “The
psychological autopsy is a procedure for
investigating a person's death by reconstructing
what the person thought, felt, and did preceding
his or her death”. Schneidman’s initial definition
of a PA was “a thorough retrospective
investigation of the intention of the decedent.” This
reconstruction is based upon information gathered
from personal documents, police reports, medical
and coroner's records, and face-to-face interviews
with families, friends, and others who had contact
with the person before the death.
 The term ‘psychological autopsy’ was
originally coined in 1958 by psychiatrist
Edwin Shneidman
from the Los Angeles Suicide Centre as a
means to refer to a procedure that was initially
designed to assist the medical examiner in
clarifying deaths that were uncertain or
ambiguous.  It has been estimated that up to
20% of death cases have appeared to be unclear
that have been presented to the medical
examiner, which can’t address whether the
death was the result of natural causes, accident,
suicide, or murder.
AIMS AND OBJECTIVES
 Identification in cases of unknown body.
Find out the cause of death.
Find out the manner of death whether suicidal,
homicidal or accidental.
Find out the time since death.
In new born babies, determination of viability and
cause of death.
Preserve the trace evidences and viscera when
needed.
Reconstruct the accident scene from the examination
of injuries as to nature and duration.
Nature of information
The nature of information collected would
usually include the following;
i) Biographical information (Age, marital
status, occupation).
ii) Personal information (relationships, life
style, alcohol or drug, sources of stress, social
networks, life events and chronic life stressors).
iii) Secondary information (family history,
polices records, diaries, Clinical histories and
suicide note).
Sources of Psychological Information:
1. Suicide Note (Intention, Physical illness,
Psychiatric illness, Situational Factor)
2. School/ College Records (Information such
as change in academic performance or recent absences)
3. Medical Records (Family history, visits to
physician, illness and medication taken and referrals to
specialists)
4. Police records (information about his previous
attempts of suicide and involvement in anti-social
activities)
Types of psychological autopsy
. Suicide psychological autopsy (SPA) : is understanding which
psychosocial factors contributed to the suicide. Those who conduct
SPAs are psychologists, psychiatrists, and mental health professionals
who have expertise in suicide. The PA method involves collecting and
analyzing all relevant information on the deceased. All applicable records
are reviewed, including medical records, psychiatric records, police
records, and autopsy findings. A visual inspection of the death scene via
photographs is necessary, and a visit to the scene will occasionally be
required. A thorough review of the decedent’s writings in the form of
diaries, journals, e-mails, and internet correspondence is vital. In addition
to reviewing records, structured interviews with family members,
relatives, and/or friends are necessary. Thus, a PA synthesizes data from
multiple informants and records. When performed in a comprehensive
manner, the method may take anywhere from 20–50 hours or longer to
complete.
.
Equivocal death psychological autopsy (EDPA): is performed when a
particular death is not immediately known. Psychologists and psychiatrists with
a background and training in forensic pathology and death investigation usually
conduct EDPAs.

The following are several categories of areas important in reviewing and seeking
answers in the process of equivocal death investigations.

Preliminary Questions Medical History

Psychiatric History
Alcohol and other drug history

•Early Investigative Considerations

•Threatening to hurt or kill oneself, Increasing alcohol or drug use
•Chronic and Acute Subject Assessment Factors in Equivocal Legal
Investigations Recent and/or elevated legal problems (civil, criminal, domestic),
Personal, Family, or Social Relationship history of similar behavior patterns.

•Victimology Questions (why only this victim is targeted, intentions)

•The Questions of Suicide (confirmation and possibility of suicide)

Written report of PA:
(in 6 sections)
 Introduction(requesting party for PA, procedure
used to conduct PA, records reviewed, who was
interviewed, etc.)

 Identifying information(name, age, DOB,

address, relationship status, religion, occupation,
etc.)

 Theproblem presentation section (all info that

involves the death such as details about the
investigation.)
Past history section (everything that
psychologist studied about the deceased life)

The victimology section (info such as deceased’s

stress levels, coping methods, relationship status,
hobbies, interests, substance use, dreams)

Expert opinion (expert opinion as to the manner

&/or reason for the death)
Ethical issues
Conducting a psychological autopsy is a
sensitive undertaking and it places
emotional demands on participants.
There are many ethical considerations to
be taken while designing and carrying out
such investigation.
They include:
taking informed consent from the
participants, establishment of mutual
respect and ensuring confidentiality of
the facts.
Participants also have their right to expect
that the procedure will be carried out in a
sensitively designed format and there can
be a legal action if the key informants feel
their right and dignity has been infringed.
Admissibility
Legal use of psychological autopsies involves investigations of a
single death in order to clarify why or how a person died.
These often involve descriptive interpretations of the death and
may include information to help family and friends better
understand why a tragic death occurred.
They also may lead to suggesting means of preventing suicides,
for example by suicide prevention in jails.
Despite many weaknesses of the evidence and procedure used in
the psychological autopsies, there is certainly evidence to support
the validity of psychological autopsies as an investigative tool.
The burden of proof required during the course of investigations
is different from that which is required in court. It may be,
therefore that psychological autopsies could currently have a more
productive role outside the court than they have inside.
Applications of PA
1.Understanding Suicides: Understanding suicides requires a sensitive
under taking. Thus carefully conducting psychological autopsy it
will be helpful to understand suicides and its causes in order to
develop effective services, thus reducing the rates of suicides.
2. Understanding Personality: By collecting information from people
who are in direct or indirect contact it is most likely to describe the
personality of the deceased which is perhaps the most significant thing
in understanding the thought process and personality of the deceased
person prior to death.

3. Understanding intention and motive: It is reflected from suicidal

notes and it is strengthened by history of previous attempts and from
history collected.

4. Criminal Cases: In criminal Cases Psychological Autopsies have

been admitted in US courts to help juries decides whether a parent
should be held responsible for suicides of a child or whether a
decedent died by her own hand or at; the hand of her husband.
5. Life Insurance: As the suicide is viewed as an intentional act, the
burden of proof rests on with the insurance company to prove that
death was a suicide. Thus an opinion regarding the state of mind of the
decedent derived from psychological autopsy will be of relevance.

6. Institutional care: With regard to suicide risk, institutions like jails

and prisons have responsibility to assess that risk and take necessary
precautions against suicide. If the suicide was a result of depressed
mental state as result of position of the person at this institutions.

7. Malpractice: Systemically conducted psychological autopsy, allows

the plaintiff(prosecutor)
to recover the damages if breach(act of breaking) of the standard care
to the patient was found to be proximate cause of suicide.
 Limitations
The term psychological autopsy is neither particularly well defined nor
standardized for operational use.

One major concern is that there does not appear to be systematic

procedure in place for the conduct of these interviews.

Another area of concern is that depending on the nature of the case under
review, the procedure will vary from one case to other and the time interval
between the death and the interview will also influence the quality of
information obtained.

Problems are expected as there will be more than one single informant in
the interview, as their perception of deceased and his/her actions will be
conflicting.
Conclusion
psychological autopsy is a powerful tool for investigation.
Information derived from PA will necessarily be
incomplete but in totality it will serve to create a mosaic
that is more impressionistic than factual.

A systematically conducted PA which provide valuable

information in understanding state of the mind of the
victim which might enable the investigation to reach a
more convincing conclusion.
Case study
1.A 23 year male was rushed to the causality with bleeding
injury abdomen, with strong smell of alcohol, with alleged
history of tripping and falling over an sharp vegetable cutting
weapon in an inebriated condition. He maintained the same
history up to his death. By practicing our guidelines of
psychological autopsy the investigation revealed that there was
a scuffle between two brothers with a double edged weapon,
which lead to his death. Hence the opinion as to accidental
injury was changed as homicidal.
2. A psychological autopsy study of pathological gamblers who died by suicide.
Pathological gambling is associated with suicidal ideation and attempt. There is no
known report on pathological gambling preceding suicide. By examining a series of 17
suicide cases with evidence of pathological gambling prior to death, we sought to generate
hypotheses for further study of this under-researched but rapidly-increasing worldwide public
health problem. Psychological autopsy interviews using a semi-structured format were
conducted with proxy respondents for suicide and control subjects aged 15-59 years in
Hong Kong SAR, China. Of the 150 suicides and 150 controls examined, 17 suicides
(11.3%) and one control case (0.6%) met criteria for the diagnosis of pathological gambling
at the time of death or interview. All 17 suicide cases with pathological gambling had
unmanageable debt at the time of death. Fourteen cases (82.4%) had other associated
psychiatric disorders, most often major depressive disorders (n=10, 58.9%) and substance-
use disorders (n=3, 17.6%). None had ever received psychiatric treatment. Along with
unmanageable debt, a high proportion of the suicide cases with pathological gambling also
experienced other psychiatric illnesses, most often depression, at the time of death. None
sought treatment for their addictive behavior or psychiatric illness prior to death.
Pathological gambling is a modifiable risk factor for suicide for which means to enhance
case identification and engagement in treatment are urgently needed. Clinicians treating
depression should explore the presence of pathological gambling behavior or
unmanageable debts among their patients. Addressing pathological gambling should be one
important component of a comprehensive suicide prevention strategy especially in countries
where gambling activities are legalized and expanding.
References
psychological autopsy a review - MedIND
 medind.nic.in/jbct10/i2/jbct10i2p101.pdf
Application of Equivocal Death Psychological Autopsy for Investig
ation ...
 oaji.net/articles/2015/1170-1427637654.pdf by D Puranik - 2015 -
Related articles
http://eprints.hud.ac.uk/id/eprint/8669/1/canterpsychological.pdf
VAISHNAVI THAKRE
MSC I