What is a Psychological Autopsy?


In this blog post, we’re going to break down what a psychological autopsy is, why it may be ordered, and what kind of steps are taken during the usual procedure.


What is a Psychological Autopsy?


The term psychological autopsy was coined by Edwin Schneidman, who first defined the procedure as “a thorough retrospective investigation of the intention of the decedent.”


To put it simply, a psychological autopsy is the process of determining whether a deceased person has died as the result of a suicide. This process is often the most efficient tool for providing answers and necessary information when a suicide occurs. By analyzing medical records, conducting research, and talking to family and friends, the forensic psychologist attempts to explain why the suicide happened.


It’s not uncommon for psychologists and clinicians working in mental healthcare to hear their patients talking about suicide or having suicidal thoughts. They might also express feelings that indicate a depressive disorder. However, if the patient actually follows through with their plan to commit suicide, a psychological autopsy might be ordered.


Why is a Psychological Autopsy Performed?


The main purpose of conducting a psychological autopsy is to make a definitive determination that a person has died of suicide and to provide a death certificate.


Statistically, approximately between 5 and 20% of deaths need to be certified, meaning that an autopsy needs to be performed since the cause of death is not clear or obvious. These deaths are called equivocal deaths. Some of the equivocal deaths are drug-related deaths because it’s necessary to establish whether the death happened intentionally or accidentally.


There are many reasons why a psychological autopsy can be performed. While the first and main objective is making sure the cause of death is a suicide, it can also be used to collect useful data for suicide prevention purposes or to help clinicians better understand suicidal behavior and risks.


Other less common causes for why a psychological autopsy might be performed include determining whether a practitioner or clinician is in any way, shape, or form at fault. For example, if a suicide happens to a person who has been working with a mental health clinician, a psychological autopsy will be ordered to determine whether there was any negligence on the clinician’s part. In such cases, the autopsy would be focused primarily on gathering data regarding the quality and level of treatment that was provided to the patient prior to the suicide.


A psychological autopsy is also useful in any of the following situations (Source: Journal of Psychiatric Practice Vol. 14, No. 6 November 2008):

  1. Criminal cases

  2. Insurance claims

  3. Contested wills or estate issues

  4. Worker’s compensation cases

  5. Product liability cases


Performing a Psychological Autopsy


There is no standardized way of performing a psychological autopsy. The exact procedure and steps will be determined based upon the circumstances of the death or suicide. Generally speaking, it will involve collecting and analyzing any and all data relevant to the case. This will typically include medical records, psychiatric records, police records, visuals from the crime scene (i.e., photographs), and autopsy findings. Sometimes, a forensic psychologist might even be sent directly to the scene to examine the circumstances in which the suicide occurred.


Here are some categories that might be included in a psychological autopsy (Shneidman, 1969):


  1. Identifying information of the victim, including name, age, address, and other essential information

  2. All details surrounding the death, including method or cause, if available

  3. Brief history outline, including medical illness, treatment, therapy, etc.

  4. Family history of death

  5. Personality description and lifestyle of the victim

  6. The typical patterns of behavior of the victim, especially in response to stressful events

  7. Recent history of stressful events

  8. Substance use, including alcohol and drugs

  9. Victim’s interpersonal relationships

  10. Information on dreams, fantasies, fears, etc.

  11. Any relevant changes before death in terms of habits, hobbies, eating, and relationships

  12. Information on plans, successes, upswings

  13. Information on the victim’s role in their own death, assessment of intention

  14. Rating of lethality, which is a scale measuring the degree of lethality in a suicide attempt

  15. The reaction of informants upon finding out about the victim’s death

  16. Any special features and comments


The process of performing a psychological autopsy is complex and requires a great amount of time. Several disciplines are applied throughout the procedure, including psychology, sociology, biology, epidemiology, and anthropology. (Source: The Forensic Mental Health Practitioner, Vol. 2, Issue 1, 2019)


The Ethics of Psychological Autopsies


Even though psychological autopsies and their results provide insightful data that helps contribute to the body of research on suicide, the ethics of the procedure itself are sometimes brought into question.


Since this is an inexact science, methodologies and protocols should be reviewed before beginning an investigation. An institutional review board may be contacted to make sure that the investigation doesn’t violate the individual’s rights or privacy, as well as to make sure that the psychological autopsy is performed in an ethical manner.


As opposed to a regular autopsy, a psychological autopsy requires the cooperation and presence of family members, relatives, friends, and other people who were close to the victim, which is why the process is typically much slower. From the perspective of research ethics, it’s considered unethical to consult the aforementioned individuals during the grieving process.


This is why a psychological autopsy will usually be performed after the physical autopsy has already been concluded, with the exception of cases where it’s necessary to determine the exact cause of death and whether the death was an intentional or accidental suicide.


Another important issue that should be noted is the fact that a psychological autopsy basically retroactively diagnoses a person with a mental illness. The latest findings of the CDC indicate that up to 54% of suicide victims had no previous history or diagnosis of mental illness. (Source: Stone et al., 2018)


Conclusion


To conclude, suicide represents a significant public health issue, not only in the United States but in the rest of the world as well. The rates of suicide-related deaths have been on a steady rise. If performed up to the latest standards, a psychological autopsy can be a very useful tool in determining the exact manner of death and in providing some much-needed answers to the family of the deceased.


Even though this method may contribute to the retroactive diagnosis of mental illness, which in many cases is more challenging to accurately make than a current diagnosis, it is still widely accepted and recommended to perform a psychological autopsy in suicide cases or cases where suicide is suspected.


References


Caulkins, C. (2019, June). The Psychological Autopsy: What, Who, and Why. Www.Researchgate.Net. Retrieved February 8, 2022, from https://www.researchgate.net/publication/332835408_The_Psychological_Autopsy_What_Who_and_Why


Gottschalk, L. A. (Ed.). (1977). Guide to the Investigation and Reporting of Drug-Abuse Deaths. The Psychological Autopsy, 42–56.


Knoll, J. L. (2008). Journal of Psychiatric Practice. The Psychological Autopsy, Part I: Applications and Methods, 14(6), 393–397.


Psychological Autopsy: Definition, Steps & Ethics. (2022, January 22). Retrieved February 8, 2022, from https://study.com/academy/lesson/psychological-autopsy-definition-lesson.html.


Sengar, C. (2020, August 26). What is a Psychological Autopsy and Why It Is Done? Onlymyhealth. Retrieved February 8, 2022, from https://www.onlymyhealth.com/what-is-a-psychological-autopsy-and-why-it-is-done-1598357502


Authored by:

Nina M Benjamin Silber

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