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
- Depression
- Drugs
- Alcohol
- Addiction
- 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.
Copyright Sherry Russell 2004
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