Bad Men Do What Good Men Dream: A Forensic Psychiatrist Illuminates the Darker Side of Human Behavior (33 page)

Murder Masquerading as Suicide

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.

Angela, a 36-year-old married but separated woman, was found hanging naked in her bedroom closet by her landlord. Her knees were approximately 4 inches off the floor. The police found no signs of a struggle in the apartment, and no suicide note. Angela had told friends and coworkers that she was taking a few days off to put the finishing touches on a novel she was writing. A manuscript was found on her desk. She did not have significant financial problems.

The body was cut down so as to preserve the knot made for the noose. Fingerprints were obtained but were inconclusive. The forensic pathologist retained by the prosecution opined in her report that the death was suspicious. She noted that suicide by hanging is not a preferred method for women. The slipknot that was used contained clumps of the deceased’s hair tangled within the knot. The forensic pathologist stated that persons who hang themselves usually do so with a simple slipknot that is not intertwined with their hair. The slipknot is tied first and then the noose is placed over the head without entangling the hair in the knot. The rope around Angela’s neck was on a horizontal plane, as if it were tightened first before any strain was applied. The forensic pathologist explained that a diagonal misplacement is more pronounced in suicides. The rope’s impression on Angela’s neck was not as pronounced as seen in hanging deaths. Moreover, the forensic pathologist observed that women who kill themselves do not ordinarily do so in a naked state. Furthermore, it could not be determined whether Angela sustained any trauma to her body because of advanced bodily decay. There was no evidence of a sexual assault. Blood analysis did not indicate evidence of drugs or alcohol. The pathologist concluded that Angela was murdered.

The defense’s forensic pathologist’s report states that it is not uncommon for hair to become entangled in a noose, that no conclusions should be drawn from the knots used, and that his experience was that women hang themselves in various states of undress. Also, the angle of the ligature was an equivocal piece of evidence. This pathologist concluded that Angela’s death was a “garden-variety” suicide.

After further investigation, the police learned that Angela’s husband, age 49, a retired military officer, had a police record for spousal abuse. After 10 years of marriage, Angela was planning a divorce. A year prior to her death she had obtained a protective order against her husband for stalking. Witnesses testified that Angela was afraid of being stalked again by her husband, who had once threatened to kill her. She had begun a new romantic relationship at work. Angela had told friends that her husband said that he would kill her rather than “give her up” to another man. Neighbors provided sworn statements that they had heard loud, angry voices and the sound of furniture falling over at about the time of Angela’s death. One witness saw the husband’s car in the parking lot and observed him entering the apartment building where Angela lived at around the time of her death. Hair samples found in Angela’s apartment matched those of her husband.

The husband was questioned but denied any knowledge of Angela’s death. He claimed that he had not spoken to his wife in more than a year. He stated that she had an extensive psychiatric history, and had attempted suicide on several previous occasions. His alibi was that he was out of town attending a regatta during the time his wife had died, but the alibi could not be substantiated.

Because of the suspicious circumstances, the district attorney requested a postmortem psychiatric assessment to determine the presence or absence of suicide risk factors at the time of Angela’s death. Witness statements and medical and psychiatric records were obtained and reviewed. The records indicated that she had developed bulimia nervosa at age 17. The breakup of a romantic relationship had resulted in depression, superficial wrist cutting, and a brief hospitalization at age 19. A maternal grandmother had attempted suicide during a postpartum depression. The inpatient psychiatrist had made a diagnosis of Angela as having an adjustment disorder with depression.

Angela had married at age 26 after graduating from college with a master’s in business administration. Because of psychological and physical abuse by her husband—a particularly violent beating—she then sought outpatient treatment. Her physical injuries included six fractured ribs and a facial fracture. Her husband was arrested, briefly jailed, and ordered to attend a treatment program for wife abusers. Angela’s new psychiatrist diagnosed dysthymic disorder (chronic depression). He noted that Angela had experienced brief flurries of unbidden suicidal thoughts after being assaulted, but had no suicidal intent or plan. As a way of medicating her marital stress symptoms, she occasionally drank wine excessively. She received 3 years of psychiatric treatment, which ended 1 year before she obtained the protective order.

Further information of note came from Angela’s parents, who revealed that she was about to receive a $500,000 inheritance from an aunt who had recently died. Angela and her husband knew of this bequest. Angela’s husband was a secondary beneficiary of the inheritance as long as the couple remained officially married.

The estranged husband was indicted for second-degree murder, convicted, and sentenced to life in prison.

Did You Intend It?

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.

Friedrich Nietzsche, in
Beyond Good and Evil
, said, “The thought of suicide is a great consolation: by means of it one gets successfully through many a bad night.” For some very disturbed patients, the freedom to terminate one’s own life is a fundamental solace. It is conservatively estimated that 30,000 people kill themselves each year. In fact, the actual figure is likely much higher. The World Health Organization estimates that nearly a million people around the globe take their lives each year, The same organization also estimates that 10 to 20 million people attempt suicide each year. Almost everyone has thought of suicide at one time or another, usually when seriously depressed or during a difficult personal crisis. Although there is quite a spectrum of intent among those who have contemplated suicide, often only a fine line exists between those who think about suicide and those who actually commit it.

In my clinical experience, patients may be suicidal for just seconds, minutes, or hours. Other patients have been seriously suicidal for days, weeks, months, years, or much of their lives. Sometimes a quirk of fate makes the only difference in whether a person survives a suicide attempt. One of my patients, prior to coming to me for treatment, survived a massive overdose of pills that she took as she lay in a bathtub full of water. It was in the middle of winter. The water rapidly cooled as she lost consciousness, lowering her metabolism enough so that she survived until the next day, when she was discovered by her housekeeper. Having attempted suicide once and failed, she never again had the urge to harm herself. However, of those who do commit suicide, anywhere from 9% to 33% have made previous attempts. It is estimated that 8 to 25 suicide attempts occur for every completed suicide. Between 7% and 12% of patients who make suicide attempts commit suicide within 10 years, which means that attempted suicide is a significant risk factor for suicide.

In the United States, the statistics on suicide provide some hard facts. The rate of suicide in the general population in 2005 was 11 per 100,000 people per year. The rate has remained steady for many years. For persons with schizophrenia, mood disorders, or those who abuse alcohol or drugs, the rate soars to 180 per 100,000. In one study, the leading methods of suicide were

• 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. Insurance companies that suspect suicide may invoke a policy’s exclusionary clause to deny responsibility to pay benefits, whereas the deceased individual’s estate may contend that the death was accidental and not suicide. Stakes regarding suicide intent can be as large as the $36 million riding on the cause of Robert Maxwell’s death.

Why Naked Suicide?

Legend has it that when Cleopatra committed suicide by allowing the bite of an asp, she was naked. A famous painting of Cleopatra’s death reveals an obvious erotic theme. Both Marilyn Monroe and Robert Maxwell were naked when discovered dead, she in her bed, he floating in the ocean. There is little mystery about Monroe’s naked state, since she was known to sleep in the nude. Why Maxwell was naked when he died is a mystery, and the authorities seemed to take little note of it in their autopsy. They should have. As an expert witness in a number of suicide cases in litigation, I found that in approximately 5% of my cases, the individual committed suicide naked. Even so, attorneys and other experts in most of the cases showed little interest in the fact of the suicide’s nakedness. Only in one case did it make a difference; the attorneys for the defense in a suicide malpractice case postulated that the patient was found hanging naked as the result of an autoerotic asphyxia gone wrong. The case was settled.

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. I have asked a number of experienced psychiatrists for their interpretation of naked suicide. Many spontaneously recited Job 1:21: “Naked came I out of my mother’s womb, and naked shall I return.” Other psychiatrists postulated that naked suicide symbolizes a new beginning, a rebirth and cleansing or a sloughing off of an intolerable world. Naked suicide challenges the forensic psychiatrist’s sleuthing abilities.

Mysterious Deaths: The Psychological Autopsy

The psychological autopsy originated in 1958, from the Los Angeles Suicide Prevention Center, to assist the Los Angeles County Medical Examiner’s Office in distinguishing drug overdoses from suicides. The basic principles for performing the psychological autopsy were established, as was its goal: the psychological autopsy is a procedure that assists in the classification of equivocal deaths, where the manner of death is unclear. A lack of standardization of the psychological autopsy procedures is a significant limitation on the practice, raising admissibility issues in criminal and civil cases.

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.

The forensic psychiatrist is frequently called upon in insurance litigation to evaluate suicide intent, sometimes by the plaintiff—the estate that is bringing the suit—and sometimes by the defendant—the insurance company. Although, as Oliver Wendell Holmes once observed, “Even a dog knows the difference between being tripped over and being kicked,” the forensic psychiatrist’s job in establishing suicide intent can be a complex, daunting task. The basic problem comes from the fact that psychiatry and law have views that differ in trying to understand the conundrum of suicide intent. 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.

The
intentional injury exclusion
of insurance policies is designed to prevent enrichment for immoral or illegal acts that have been performed by a
competent
individual. Competency itself is vague and complicated. When is someone competent, and when not? It is necessary in individual suicide cases to determine whether the victim intended to end his or her life. Approximately 90% to 95% of all those who commit suicide are suffering from a mental disorder. In a given case, did the individual understand that the self-destructive act would end his or her physical existence or was he or she not able to understand that?

One factor affecting the legal definition of
intent
is the presumption against suicide that is maintained in many jurisdictions. This presumption is a legal restatement of the common belief that the instinct for self-preservation in a rational person renders suicide improbable. This, of course, is not always true. So-called rational suicides occur, for example, among individuals who have terminal illnesses.