Psychological autopsy ( Latin opsis - looking at, seeing) is a procedure consisting in the posthumous creation of a person’s psychological profile (establishing a hierarchical structure of his personal qualities) during a psychological and psychiatric examination, most often with the aim of establishing the fact of committing suicide [1] .
The procedure of psychological autopsy includes two main elements:
- Extensive interviews with family members and other close people of the deceased. Interviews can be conducted both in person and by telephone. Optimum interview period: 3-12 months after the death of the alleged suicide (to avoid unnecessarily traumatic interviews for those who are suffering grief and loss of loved ones). The information obtained allows us to reconstruct the everyday life of the deceased, his relationship with people, habits and other behavioral characteristics.
- Collection of all possible medical, psychiatric and other relevant data about the deceased (including personal diaries, letters and suicide notes, if any).
Next, the profile is analyzed from the clinical and psychological position and / or other psychological approaches [2] , on the basis of which the final assessment of the factors that led to the death of a person is built.
In forensic psychiatry , a retrospective study of a person’s mental state for a certain period of time during a forensic psychiatric examination in order to establish the presence or absence of a mental disorder that influenced the crime.
Content
History
The first studies of self-destructive and suicidal behavior through the collection of information about suicides appeared in the early twentieth century in Paris and New York [3] , but the first modern study of psychological autopsy was conducted by Eli Robins and his colleagues at the University of Washington, USA in 1956-57 . [4] The study consisted of collecting and thoroughly analyzing information about 134 suicides throughout the year. Around the same time, Robert Litman, Norman Farberough, and Los Angeles Suicide Prevention Center developed an auxiliary method for conducting post-mortem examinations to determine the cause of death of the alleged suicide. Thus, the authorship of the term is attributed to the founder of the American Association of Suicidology , professor of thanatology , clinical psychologist and suicidologist , who introduced it in 1958 [5] . The term “psychological autopsy” was first used in a scientific article in 1963 [6] . Schneidman himself writes that he actively applied this procedure in the further practice of research in the field of suicide , giving it a more special, namely forensic medical meaning [7] .
Grounds for holding
Most often, psychological autopsy [8] is performed under unclear circumstances of a person’s death, as well as in the presence of other factors that may be affected by the nature of a person’s death (features of a will and other legal aspects). The goals of psychological autopsy are not only to prevent further attempts of suicide among the population, but also, to a greater extent, to identify the characteristics of a person’s death, as well as to establish the presence of suicidal risk factors in the deceased. For example, E. Schneidman proposed 15 main points for a full-fledged psychological autopsy:
- General information about the deceased: age, marital status, profession, religion, etc.
- Death details
- A brief description of the life of the deceased (including previous suicide attempts)
- The history of deaths of the family of the deceased (including family suicides, mental disorders of relatives, etc.)
- Description of the personality and lifestyle of the deceased
- A typical pattern of a person’s reaction to stress, emotional upheaval and difficult life situations
- Immediately prior death stressors, psychological problems and life difficulties
- The role of alcohol and drugs in the life of the deceased and their involvement in death
- The essence and main features of the interpersonal relations of the deceased
- Changes in habits and other daily activities of the deceased (including hobbies, appetite, sexual behavior, etc.)
- Information about the latest successes of the deceased (life upsurge, plans for the future, etc.)
- Assessment of Intent
- Mortality Index (a quantitative measure of the likelihood of a person committing suicide) introduced by Schneidman)
- The reaction of loved ones to the death of a person
- Comments and other case specific notes
Validity
Despite the unequivocal usefulness of conducting a psychological autopsy for various purposes, it is worth considering that the term “psychological autopsy” is not standardized or fully operationalized. [9] The main problem of psychological autopsy at the moment is the lack of a standardized protocol for autopsy, as well as generally accepted instructions. In addition, the ethical side of the issue causes difficulties: many individual ethical factors must be taken into account when conducting a specific psychological autopsy. For example, the written consent of informants to the processing of data, strict confidentiality of the received data, and other legal aspects of an autopsy are mandatory.
Notes
- ↑ Maris, Berman, Silverman Ronald, Alan, Mortan. Comprehensive Textbook of Suicidology. - 72 Spring Street, New York, NY 10012: The Guilford Press, 2000 .-- P. 3.
- ↑ Hawton, K., Appleby, L., Platt, S., Foster, T., Cooper, J., Malmberg, A., & Simkin, S. (1998). The psychological autopsy approach to studying suicide: a review of methodological issues. J Affect Disord, 50 (2-3), 269-276.
- ↑ Clark, DC, & Horton-Deutsch, SL (1992). Assessment in absentia: The value of the psychological autopsy method for studying antecedents of suicide and predicting future suicides.
- ↑ Robins, E., Gassner, S., Kayes, J., Wilkinson Jr, RH, & Murphy, GE (1959). The communication of suicidal intent: a study of 134 consecutive cases of successful (completed) suicide. American Journal of Psychiatry, 115 (8), 724-733.
- ↑ Knoll JL, Hazelwood RR (2009). Psychological Autopsy. In: Wiley Encyclopedia of Forensic Science. doi: 10.1002 / 9780470061589.fsa302
- ↑ Litman RE, Curphey T., Shneidman ES, Farberow NL & Tabachnick ND Investigations of Equivocal Suicides. Farberow, NL, & Tabachnick, ND doi: 10.1001 / jama.1963.03700250060008
- ↑ Shneidman, ES (1980). Voices of Death. HarperCollins; 1st edition, 209 p. ISBN 978-0060140236
- ↑ Houston, K., Hawton, K., & Shepperd, R. (2001). Suicide in young people aged 15-24: a psychological autopsy study. Journal of affective disorders, 63 (1), 159-170.
- ↑ Brent, DA, Perper, JA, Moritz, G., Baugher, M., Roth, C., Balach, L., & Schweers, J. (1993). Stressful life events, psychopathology, and adolescent suicide: A case control study. Suicide and Life-Threatening Behavior, 23 (3), 179-187.
Literature
- Antoon A. Leenaars (2004). Psychotherapy with Suicidal People: A Person-centred Approach. John Wiley & Sons, 480 p. ISBN 978-0470863435
- Antoon Leenaars (2017). The Psychological Autopsy: A Roadmap for Uncovering the Barren Bones of the Suicide's Mind. Taylor & Francis, 378 p. ISBN 978-1351969482
- Guy Donald Niswander, Thomas M. Casey, John A. Humphrey (1973). A Panorama of Suicide: A Casebook of Psychological Autopsies. CC Thomas, 149 p. ISBN 978-0398028756
- Shneidman, ES (1980). Voices of Death. HarperCollins; 1st edition, 209 p. ISBN 978-0060140236
- Shneidman, ES (1993). Suicide As Psychache: A Clinical Approach To Self-Destructive Behavior. Northvale, NJ / London: Jason Aronson, Inc., 258 p. ISBN 978-0876681510
- Shneidman, ES (1998). The Suicidal Mind. Oxford University Press, 187 p. ISBN 978-0195118018
- Shneidman, ES (2004). Autopsy of a Suicidal Mind. Oxford University Press, 208 p. ISBN 978-0195346718
Links
- Practice Guidelines for Suicide prevention , American Psychiatric Association, 2010.
- Siddamsetty AK, Aggarwal NK, Bhatia MS (2014). Concept of Psychologucal Autopsy . Dehli Psychiatry Journal, vol. 17 (2), October 2014. P. 459-461.
- Knoll JL, Hazelwood RR (2009). Psychological Autopsy . In: Wiley Encyclopedia of Forensic Science. doi: 10.1002 / 9780470061589.fsa302