What is a psychological autopsy?
edited: Monday, August 23, 2004
By Sherry Russell BCBT BCETS
Rated "PG13" by the Author.
Posted: Monday, August 23, 2004
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Severe stress and pain spawned by a serious life crisis place a mentally unstable person in a suffocating fog of heaving gloom.
The Psychological Autopsy
How many times have you heard that one must be crazy even to think about suicide? The fact is most suicide attempts are made by intelligent people. These intelligent people become steadily blinded by swelling confusion and trauma. Add into the mixture an abyss of mental distress and instability put in a catalyst and this could thrust a person into self-slaughter. Suicide is a process. Severe stress and pain spawned by a serious life crisis place a mentally unstable person in a suffocating fog of heaving gloom.
Situations that may play a role in a suicidal person are:
- Mental disorders
- Chemical imbalances
- Shame and guilt causing isolation
- Erosion of self-esteem
- Loss of control in their life
- Loss of a loved one
- A drastic change in their life causing a crisis
- Living a lifestyle that loved ones do not accept
- Being diagnosed with a terminal illness
- Sexual assault
- Financial destruction
- Chronic pain
- Feeling boxed in with no way out
Many times a person who is successful with their suicide has actually attempted it before. Research indicates that most people who succeed in suicide may have made the attempt up to 100 times. Sometimes suicides are impulsive and other times they have been carefully thought out. When a surviving family looks for clues, they may not find any. You hear that when a person gives away their favorite possessions a signal should go up that something is terribly wrong but not all people blow the trumpet of their impending doom. Some leave a note but most do not.
Continuous research is showing that a person of suicide has changes in the brain chemistry and physiology. Most striking is the depleted serotonin, which is a neurotransmitter that inhibits self-harm. At the 2001 conference for The American College of Neuropsychopharmacology, expert Victoria Arango reported that "the brains of people who were depressed and died by suicide contained fewer neurons in the orbital prefrontal cortex, a patch of brain just above each eye. What is more, in suicide brains, that area had one third the number of presynaptic serotonin transporters that control brains had but roughly 30 percent more postsynaptic serotonin receptors." The more we understand and know about the mysteries of the brain, we will be witnesses to more and more discussion about the chemical basis for emotions.
Defining the hopelessness points and causes of suicide is part of what a Psychological Autopsy can provide. In 1958, Dr. Theodore J. Curhey, Chief Medical Examiner-Coroner for Los Angeles County became frustrated over the classifying the mode of numerous drug deaths. Mental Health Professionals were hired and the Psychological Autopsy was born.
This type of autopsy starts by running a fine toothcomb through a person’s life, which may unfold the circumstances leading to the suicide. It is a point by point diligent process that requires gathering information in the form of all manner of records as well as extensive interviews with those who knew the deceased.
Factors, for the mental health professional performing this type of autopsy, to consider include the following.
- Personal information such as age, marital status, religious practices, school and/or occupation
- The mental status of the individual including mental health records including highs and lows, failures and successes
- Family history
- Death history of the family including ages and causes
- Medical records
- Official account of the death, including cause or method
- Interviews with family and friends
- Accounts of any type of pressures and problems arising in the last few days to the last year.
- Description of the personality and current lifestyle
- Police reports
- Reaction of the family and friends to the news of the death
- The deceased’s writings
- Statements of co-workers, teachers
- Use of alcohol or drugs
- Physical evidence from the death scene
- Circumstantial evidence
- Emotional behavior to stress and fears
- Changes before death affecting habits, hobbies, eating, sexual patterns, other life routines
The Psychological Autopsy has four main functions:
- The first purpose is to assist in the determination of the mode of death. It is estimated that between five and twenty percent of all deaths that come before a medical examiner are puzzling and unclear. The mode of death determines if the death was by natural cause, an accident, a suicide, or a homicide.
- The second purpose is to determine the deceased's state of mind at the time of death. Reconstructing this mental assessment can be used to help determine why the decedent committed suicide and why they chose that particular time.
- The third purpose of the psychological autopsy is to conduct interviews with family and friends. To retrieve the most honest information possible in a way that will be healing for survivors.
- The fourth purpose of a psychological autopsy is to gain information that will be helpful in treating future patients and identifying behavioral patterns that seem to accompany different degrees of suicidal intent.
Suicide is a serious looming problem with our teens and youth. With teen/youth suicide rates tripling since 1970 and suicide being the 2nd leading cause of death among college students and the third leading cause of death among youth between the ages of 15-24, it is wise to understand and take a look at what creates such desperation. What could cause youths who should be vibrantly excited about life to commit suicide? With the help of Psychological Autopsies, hopefully more pertinent information will come forth to help us sort this out and help our young people.
Survivors of suicide struggle with connecting the dots. Trying to make meaning out of something that doesn’t make any sense at all. The more they try to understand and uncover the more questions that may arise. With the use of Physiological Autopsies some of the "what if" and "why" may be answered.
I would like to introduce you to a mother, Karyl Chastain Beal, who knows, first hand, about a psychological autopsy. She wrote "A Mother’s Perspective" and she is sharing this with us.
A Mother's Perspective
"Mom, can I go see Luke, now?" Arlyn asked, jangling her car keys in her hand.
Hmmm, I thought. Since when had Arlyn asked for permission to go anywhere?
She was eighteen; she had graduated from high school two months before.
"Of course," I replied, pleased that she asked. Maybe Arlyn wasn't eager to leave home, after all.
I worried about whether she would be strong enough to survive the rough,scary world outside our safe nest in rural Georgia. She sometimes accused me of being over-protective. In two weeks, however, I expected Arlyn would leave for college, whether she was ready or not.
But, I was wrong. Very wrong. She did not wait two weeks to leave; she left that very afternoon.Arlyn walked out the door and got into her car. She drove several miles into the country, down a long, lonely dirt road. She parked her car near a stream, and she took an old hunting rifle out of the trunk. Next, she placed its barrel into her mouth, and pulled the trigger.
Around 3:30, I heard a knock on the front door. When I opened it, a man identified himself as a sheriff's deputy and walked in. He strode across the room to a large photograph hanging on the wall. "Is this your daughter?" he asked, as he glanced from the picture to me.
"Yes," I replied proudly, too surprised to realize that this was not a social call. "That's Arlyn."
He stared at the picture for a moment, then sat down in a chair near the door. He described Arlyn's car, and I confirmed it was hers.
Then, he said, "Your daughter is dead." Just like that.
Even today as I write those words --your daughter is dead-- my hands begin to shake.
No parent ever expects to receive such a message. Deep down inside, we know our children are fragile, that life is unpredictable, but of course, we believe we are immune to such tragedies. They happen on television, and to other people, but they cannot happen to us.
Within a split second, my world changed from one of light and peace and joy to one of darkness and despair and gloom. One pull of a trigger, and the reality I knew became a nightmare I never imagined. It was more than I could possibly comprehend.
During the first few days after I heard the news, I functioned much like a puppet whose strings are pulled by an invisible hand. I do not know how I did it.
I wrote and gave the eulogy for Arlyn's funeral. I did not mince words; her death was the tragic result of violence, and I would not pretend otherwise. Some people were appalled, but at that moment, pleasing others was not high on my list of priorities.
We buried my child at a private service a few days later. I wanted to fall into the hole with her as they covered the container holding her ashes with dirt. I did not want to let her go.
During the next week, I could not think, could not feel, just existed. I moved along robot-like, one tiny step at a time. Others quietly kept order in my surroundings.
Then my friends and family left, and I could feel her absence. I called her name aloud, over and over. She did not answer. The telephone rang; I picked it up and waited to hear her voice on the other end, but it was never hers.
I checked her bedroom a thousand times, hoping to see her, but all I saw was an empty bed. Her stuffed animals were still perched on the shelf above it, as if they, too, wondered when she would come back for them, and her clothes still hung in her closet. A letter from the admission office of Tulane University she planned to attend was lying on the floor.
When I heard the back door open, I smiled, expecting Arlyn, with her guitar slung over her shoulder, to prance in and give me a hug.
I held on to the fantasy that Arlyn would return. I sat in her car, listened to her music, and wore some of her clothes. One night, I drank tea at her favorite coffee shop. A tall, slender girl with long, brown hair walked in; I stood up, ready to dash across the room and throw my arms around her; but then she moved, and I saw that she was not Arlyn.
At night, I lay in bed stiffly, corpse-like. I stared blankly at the ceiling hour upon hour, until the morning light slipped through the blinds.Then, I would get up; or I wouldn't. Every minute of the day, I struggled desperately to understand what had happened. Arlyn would never have killed herself. My daughter found joy in living; she laughed, learned and loved. Arlyn was in tune with nature and peace. How she could have taken her own life?
I ransacked her bedroom, searching for clues. In her closet, in dresser drawers, under her bed, and on shelves, I found several journals and dozens of pages of her writing. I collected them all into one mountainous pile.Then, I sat down to read.
"I keep asking myself why. For my entire life, all I have ever wanted was to be dead, to not be. Why?" she wrote. "I don't know why I didn't kill myself in fifth grade when I had the chance," she also wrote.
I shook my head, confused. The handwriting was Arlyn's, but these words could not be hers. I thought back to when Arlyn was in sixth grade, eleven years old. One day,the student council held a talent contest. Arlyn signed up to sing. She picked out a long, green Victorian style dress to wear, and I tied a matching bow in her hair.
When Arlyn stepped up in front of the crowd, she scanned the audience until she spotted me. Then, she smiled. The students talked and laughed with each other, ignoring the shy little girl in front of them. I wanted to shout at them to pay attention, but I couldn't.
The music started, and Arlyn began to sing. Her song was "Wind Beneath My Wings," one popularized by Bette Midler.
After a moment, the students stopped chatting and listened. Her strong voice caressed them gently.
"Did you ever know that you're my hero?
You're everything I would like to be.
You are the wind beneath my wings."
That afternoon as we drove home, I glanced at the small trophy in her lap."When you sang" I asked, "were you thinking about the words?" Arlyn replied. "When I sing 'Wind Beneath My Wings,' I always think of you."
But now, Arlyn was dead, and I was in her bedroom, reading words that sent chills down my spine.
What happened to that innocent, trusting child who dreamed of winning the Miss America crown one day? What happened to cause a little girl who had a song in her heart stop singing? Since Arlyn's death, I have been a reluctant traveler on this roal to finding the answer.
After Arlyn died, we had a psychological autopsy done on her. (That's when a psychiatrist studies personal writings and other information about someone who is not present in order to give an assessment of the person's mental state.)
What we learned that is that Arlyn was a victim of bipolar disorder, also called manic depression. Her death was the result of a chemical imbalance and the way it controlled her; it was not a rational choice.
Arlyn, our fragile, gentle little girl struggled alone to deal with feelings she could not understand; she was confused and very afraid for years before she finally gave in and ended her life.
There are no words to describe the profound and infinite sadness that has consumed me since Arlyn died. Multiply the most horrible pain you have ever experienced a thousandfold and you may be close to understanding what each moment of my life is like.
In my saner moments, I know that Arlyn will not come back, no matter how much I want her here; it is in such moments that I know Arlyn's life must serve a purpose, and that it is up to me, her mother, to see that it does.
It is my sincere hope that everyone who learns about Arlyn will understand, first of all, that suicide is a tragedy, that it is not a sin or a crime, and that it is not cause for shame or embarrassment. It is also my hope that they will learn that suicide is an external response to internal conditions, not something that should be blamed on anyone.
It is also my hope that those who read or hear Arlyn's story will come away with the knowledge that many of our brightest young people today are responding to the overwhelming circumstances of life by suicide. This is a problem which will not go away as long as we attach a stigma to the victims or to those who love them, because in doing so, we close our minds and hearts to the search for acceptable solutions.
So, in memory of Arlyn, Darlin', my precious child, I create this memorial; she is the wind beneath my wings.
Perhaps faith, a strong personal foundation along with the knowledge for how to face our deepest fears in a workable way will help the unstable become more stable. Perhaps by learning how to be aware of mental illness, instability, depression and addiction will help us help those that need it. Perhaps by removing the stigma of mental illness and depression will allow those who need a helping hand to grasp it. Shame and guilt are heavy sledgehammers, perhaps with knowledge we can lift them off burdened shoulders. The Psychological Autopsy offers us a promise of hope to help those who are floundering out of water to find their way back. For more information and further help, Karyl provided the following suicide websites which are owned and/or managed by her.
SASE (Suicide Awareness, Support & Education) Suicide Reference Library: www.suicidereferencelibrary.com
SASE Suicide Discussion Board - www.suicidediscussionboard.com
Suicide Memorial Wall - www.suicidememorialwall.com
Parents of Suicides Memorial Website and Internet community - www.parentsofsuicides.com
Friends & Families of Suicides Memorial Website and Internet community - www.friendsandfamiliesofsuicide.com