Suicides and unnatural deaths have baffled people for ages, and there is a never-ending urge in people to unearth any rationale behind them. Psychological autopsy is what they want to do. Just as a medical autopsy is a physical examination of the deceased’s body, a psychological autopsy is essentially an examination of their mental state. It evolved as an investigative tool that can help to clarify the cause of death, where the precise mode of death is unclear. An estimated twenty percent of such cases are presented to medical examiners or coroners where the mode of death is not confirmed because of ambiguous circumstances. Such cases leave people perplexed about whether the death was due to natural causes, suicide, accident, or murder.
Rejecting the diagnosis-based medical model, Dr. Shneidman and his staff used this procedure most famously to establish the probability of suicide in the world-famous case of Marilyn Monroe’s death. Although she died from an overdose of barbiturates in 1962, it was finally agreed that her death was a case of probable suicide, as suggested by the post-mortem interviews with her family and friends. They revealed that she had been deeply depressed and had tried to take her life twice previously. In fact, the coroner’s report also agreed with the above contention.
No one has ever died of depression but rather of suicide. Depression is a precursor to suicide, and suicide is the route taken by those affected by psychache, i.e., hurt, anguish, aching psychological pain in mind. It is impossible to predict a suicidal action or draw a precise portrait of the suicidal subject. Nonetheless, the technique of psychological autopsy has been able to identify various risk factors over time.
The principle behind psychological autopsy is to collect as much information as possible to reconstitute the psychosocial and medical environment of people who have committed suicide. The analysis of the events helps medical practitioners to understand the circumstances of their death. The ‘autopsy’ consists of interviews with family and friends of the deceased to evaluate his or her frame of mind and the possible motive for suicide.
The interview process was employed as a data collection tool. A vital component of the procedure is examining the medical records or obtaining the medical history of the deceased and interviewing the attending doctor. The type of information collected would typically include information on a wide array of factors, such as biographical information (age, marital status, occupation, and working conditions), personal information (relationships, lifestyle, physical/mental health and history, alcohol/drug use, sources of stress, etc.), family history, police records, diaries, etc.
There is a major difference in a person’s mode of death versus the cause of death, and many people look upon both as one. While the cause of death is a typically straightforward reason behind death, such as asphyxiation due to choking, bleeding to death (exsanguination) due to a gunshot wound, cardiac arrest, etc., the mode of death is about mental pain and unnatural other circumstances that pushed a person to his or emotional limit.
Recent neurobiological studies have highlighted the role of ‘mental pain’ behind suicides. Irrespective of whether the pain is physical or emotional in nature, it is processed via the same structures and mechanisms in the brain. During any distressful event, mental pain overlaps with the pain circuitry in the brain. Unfortunately, there are currently no medications to subside suicidal thoughts. Considering the difference between depression and suicidal thoughts, many medical practitioners doubt the potential of antidepressants.