The
specific circumstances of every apparent suicide are unique and must be
thoroughly investigated. Murder masquerading as suicide is not rare. It is less
likely to occur with a public figure or celebrity, however, because close
scrutiny may uncover the deception. Murder masquerading as suicide is more
likely to remain unsolved when the individual murdered has a history of mental
illness.
An
individual may have no intention of dying when he or she makes a suicide
gesture—the sole purpose of the gesture may be as a cry for help or to bring
about a desired result, in a relationship or in the external world.
Most
common methods of suicide are:
•
Firearms, 60% (males 65%, females 40%)
•
Hanging, 14% (males 15%, females 12%)
• Gaseous
poisons, 10% (males 8%, females 11%)
•
Solid/liquid poisons, 9% (males 6%, females 27%)
• All
other methods, 7% (males 6%, females 10%)
The
family and friends of suicide victims are at increased risk of suicide
themselves. They are also more vulnerable to physical and psychological
disorders. Suicide intent is frequently an issue in criminal cases in which it
must be determined if the victim was murdered or committed suicide. In civil
litigation, determination of intent is necessary to recover death benefits
under insurance policies, in legal actions involving workers’ compensation
benefits, in malpractice claims, and when suicide is alleged to be the result
of injurious actions by third
parties.
The most insidious tangle is in regard to insurance benefits.
Most
naked suicides are fraught with psychological meaning, if that meaning can be
divined. The professional literature has little data on the topic. Most
information is anecdotal, coming from individuals who have attempted suicide
naked, but survived. The reasons given reflect highly individual psychodynamics
in each instance.
Forensic
psychiatrists are experts who understand the pertinent legal issues as they
apply to psychiatric cases before the court. They translate psychiatric
principles into the language of intent as it is defined by the legal system.
Forensic psychiatry is a recognized subspecialty of psychiatry, and specialists
can earn board certification. Years ago, forensic psychiatrists were known
primarily for their work with criminals. Today, they also consult on a wide
variety of administrative, legislative, and civil law matters, some of them
involving suicide.
Psychiatric
theories of behavior tend to be deterministic; that is, they say that the
individual contends with psychological forces that are often beyond his or her control.
On the other hand, legal theories are based on the belief that humans have free
will—that they are not deterministic. In evaluating suicide intent, therefore,
the forensic psychiatrist must keep both understandings in mind, adapt
psychiatric principles to the legal framework, and perform what is, in essence,
a psychological autopsy.
In
elderly persons or persons suffering from chronic or terminal illnesses, deciding
when a contemplated suicide is rational can be a very tricky business.
Evidence
of intent is generally derived from two basic sources. The first is from the
persons who knew the individual’s behavior and desires for some time prior to
the moment of death—such as family members, friends, neighbors, coworkers, and
treating physicians. The second source is forensic, and is provided by experts
and based on the development of all relevant information about the individual
at or around the time of death. In an insurance claim contest, this latter
information will be given by forensic psychiatrists, who attempt to determine
the most likely psychological reason or cause for the insured person’s
death.
Complex
and nuanced medical-psychiatric issues are often present in determining intent
to commit suicide. The psychiatrist who only treats patients, or who seldom
thinks along the lines necessary for forensic evaluation, has a tendency to
overidentify with the family of the bereaved and give a judgment that favors
the family over the insurer. Forensic psychiatrists, trained in clearly
separating the treatment component from the role of evaluator, are more able to
minimize or to avoid emotionally biased conclusions in litigation.
The legal
context evaluates motive, intent, and act in regard
to a particular happening. In clinical psychiatric contexts, it is conception, planning, and execution that must
be assessed, and the two sets of notions are only roughly similar.
Acknowledgements:
The Police Department;
www.politie.nl and a Chief
Inspector – Mr. Henk van Essen©
www.aivd.nl AIVD – Mr. Erik Akerboom ©
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