PSYCHOLOGICAL AUTOPSY

PSYCHOLOGICAL AUTOPSY :-

psychological autopsy is one of the most beneficial tools in research for commited suicide. The method implicates compiling all available information on the deceased by mean of structured interview of family members, relatives, friends, besides ministering health care personnel recent psychological autopsy studies have mostly used case - control designs, thus having been better able to estimate the role of various risk factors for suicide. The future psychological autopsy studies may be more focused on interactions between risk factor domains focussed on some specific suicide populations of major interest for suicide prevention.

 

An investigation into a persons death by reconstructing what the person thought, felt, and did before death, based on information gathered from personal documents , police reports, medical and coroners records and interviews with family and friends. 

Psychological autopsy is a procedure used to identify equivocal deaths. An equivocal death is a death in which it is not immediately clear whether a person commited suicide or not (eg. Drug ingestion deaths, single car accident death). 

Types of psychological autopsy :-

1.Suicide psychological autopsy (SPA) 

2. Equivocal death psychological autopsy(EDPA) 

SPA is led to distinguishpsycho-social factors which act as a contributing variable to confer suicide and also is performed when the way of death is unequivocally a suicide; while EDPA is performed when the way of death is instantly uncertain. 

History :-

 The first psychological autopsy was carried out by Gregory Zilboorg’s in the investigation of ninety-three consecutive suicides by police official in New York City during 1934 to 1940. But Edwin S. Shneidman was the first American clinical psychologist, suicidologist and thanatologist, who coined the phrase “psychological autopsy” to portray the post-death evaluation process. In 1958, Shneidman founded the Los Angeles Suicide Prevention centre, which became a base for research into the causes and prevention of suicide, with two of his colleagues Norman Louis Farberow and Robert E. 

Methodology :-

 A review of the literature indicates that PA has developed a few iterations to produce standard guidelines for leading PA, which mirrors the Shneidman 16 criteria methodology . 

These criteria included:

1. Identifying information of victim’s age, sexual orientation, marital status, occupation status.

2. Details of the demise.

3. A brief outline of the victim’s history and past suicide attempts.

4. Psychiatric history of the family (i.e., suicides and state of mind issues).

5. Personality and lifestyle characteristics of victim’s

6. The victim’s reaction towards stress and emotional disturbances and periods of disequilibrium.

7. Recent Stressors (from the last few days to the last 12 months), pressures, tensions, or anticipation of trouble.

8. The role of alcohol or drugs in (a) overall lifestyle of the victim, and (b) his death.

9. Victim’s interpersonal social relationships (including those with physicians/mental health clinicians).

10. Fantasies, dreams, thoughts, premonitions, or fear of victim relating to death, accident, or suicide.

11. Brief Changes in the victim’s normal schedule, and habits just before death.

12. Life side information of the victim (i.e., triumphs and plans).

13. Lethality Rate of suicide method.

14. The reaction of informants to victim’s death.

15. Assessment of suicidal intention i.e., the role of the victim in his own demise.

16. Comments, any special feature.

Interviews: 

Generally, interviews are done with individuals who have a close personal relationship with the victim (parents, spouses, siblings, adolescent children and friends) but not necessarily a relative. The essential objective of conducting collateral interviews to acquire top to the bottom comprehension of the decedent’s everyday life style patterns, personality, behavioural patterns (response towards stress, adaptability, abrupt changes in habits or routine just before death), family factors, alcohol and drugs abuse history, conceivable intentions in past suicide endeavours. It must be remembered that family members and close friends may have feelings of guilt, anger, or shame, which may result in biased reporting. Usually for interview open-ended question are asked which are designed to encourage a full, meaningful answer using the subject's own knowledge and/or feelings. 

COLLATERAL RECORDS :-

Depending on the nature of the case and the concerned issue, collateral records that might be 

pertinent include:

1. Socio-economic factors (education, social status, employment history, and occupational status at the time of the death).

2. Alcohol and drug abuse

3. Medical status and history

4. Mental status and history

5. Physical and psychological stressors

6. Quality of interpersonal relationships, Behavioural, verbal and written communications.

7. Legal history and records

APPLICATION OF PSYCHOLOGICAL AUTOPSY:-

1.Assisting Medical Investigator :-

Equivocal deaths are those in which manner of death is questionable or, conditions surrounding the death are generally unclear. The following are typical equivocal death scenarios:

a) Drug-related deaths 

b) Autoerotic asphyxia 

c) Self-induced asphyxia (e.g., the “choking game”)

d) Vehicular deaths

e) Russian roulette- the practice of loading a bullet into one chamber of a revolver, spinning the cylinder, and then pulling the trigger while pointing the gun at one's own head 

f) “Suicide by cop” 

g) Staged death scenes 

2.Insurance Claims:-

 Life insurance payments following a person’s death represent is a civil litigation case for the legal challenge. Numerous life insurance policies contain a suicide provision that denies installment of advantages if passing outcomes from suicide inside a predefined day and age (more often than not 2 years) and without deliberation (insane suicide). 

3. Criminal Cases :-

 In homicidal cases, the victim’s background must be checked to better understand how and why they were targeted by the perpetrator. There are valuable insights that should not be overlooked in any death case through the eyes and thoughts of the deceased. The PA may be used to establish whether the deceased was likely to have Committed suicide, or whether the death should be viewed as a homicide . 

4. Medical Malpractice :-

 In psychiatric malpractice cases including suicide, the offended party must demonstrate that the doctor’s negligence was a proximate reason of the victim’s suicide 

LIMITATIONS:-

 There are a number of limitations in conducting psychological autopsy which likewise influences all the more commonly rehearsed psychological evaluations, including both therapeutic and forensic evaluations. Canter (2000) provided the details of validity and limitations of conducting a PA. 

1.The absence of standard assessment to measure respondent reactions to interviews that may increase the probability of unreliable assessments and invalid opinions.

2.Limitation collateral records that are available because the time of interest is in the past, and the recollections of third parties who may be interviewed by the examiner may suffer and be less accurate as to make an opinion about victim mental status.

3.The information related to victim's mental state and behaviour may be distorted by the third-party informants who are interviewed by the psychologist either purposely or unconsciously.

4. Psychological autopsies are mostly associated with recall bias. The respondent may have a tendency to recollect positive attributes and overlook the negative ones