Psychological Autopsy

The term psychological autopsy refers to the reconstruction of a deceased biographical and psychological state preceding death when suicide is suspected. The procedure is used in clinical settings and within the scientific field, as well as in the development of suicide prevention and therapy programs. A psychological autopsy is conducted when the circumstances of death are uncertain. In this case investigators collect oral and written information from the environment of the deceased, such as in interviews with survivors (e.g., family, friends, and medical personnel) and documents (e.g., letters, diaries, police reports, and coroner's records). The main questions a psychological autopsy should reveal answers to are (a) How did the person die? (b) Why did the person (possibly) commit suicide? and (c) What was the exact nature of death?

In the late 1950s the term psychological autopsy appeared for the first time in the work of suicidologist Edwin Shneidman and his colleagues at the Los Angeles Suicide Prevention Center and the Los Angeles Medical Examiner's Office. After the investigation of a great number of unsolved death cases, Shneidman and his coresearchers developed this procedure to rebuild a person's history and to reveal the victim's motivation to commit suicide. In the first place, the psychological autopsy focuses on the last days before death, although Shneidman emphasizes that the investigation must range further than that. Survivors are asked about the personality, lifestyle, and relationships of the deceased. A brief outline of the personal history must also be provided, and questions regarding psychological stress can go back to about a year before death.

The traditional use of a psychological autopsy had been in coroners' reports in addition to the regular physical autopsy, because rather than focusing on the cause of death it focuses on its context. Furthermore, the procedure had been used in research for defining risk factors of suicide in adults. Later the research had been expanded to the investigation of suicidal children and adolescents. From the 1970s the focus shifted increasingly toward examination of risk factors, and the psychological autopsy became an important instrument for the treatment of potential suicides and failed suicide attempts. Another function had been recognized in the interviews with survivors. If the investigator is working with much accuracy and empathy, the interviews can have a therapeutic value for the bereaved. By talking about and confronting their feelings and thoughts, the survivors [Page 829]are able to deal with this difficult experience. The psychological autopsy can thus be used for pre-and postvention of suicidal acts.

In the investigation of suicide, data can be divided into two sets: prospective and retrospective. The retrospective data are collected during a psychological autopsy, whereas prospective data refer to clues before death (e.g., the person talking about suicide, previous suicide attempts, feelings of depression and hopelessness). This division is important in the study of suicide because there are different clues, which therapists and doctors should be aware of. Psychological autopsies reveal that when suicide is certain as the mode of death (e.g., when a goodbye letter or a weapon in the hand of the victim is found), prospective clues can be found in almost all cases. Suicidal people are aware of the fact that they want to die, and they also think of how they will be remembered after death. Shneidman refers to the imagination of how a person wants to be remembered as the “postself.” The psychological autopsy is in fact a way of measuring the postself by collecting information from the environment of the deceased. The suicide note is the most direct measure of the postself in the case of suicide. The person leaves his or her last words to the world, words that will be remembered. In other personal documents, such as diaries or notes, the postself becomes visible when the victim fantasizes how the world would be without him or her. In the analysis of retrospective data in a psychological autopsy, the postself is represented in the memory of the survivors.

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