Psychological Autopsy

A psychological autopsy (or psychiatric autopsy—the terms are used interchangeably) is a reconstructive mental state evaluation (RMSE) focused on understanding a deceased individual’s mental state at and around the time of death, typically for the purpose of identifying the cause of death (accident vs. suicide or another explanation). Norman Faberow, Robert Litman, and Edwin Shneidman are credited with developing the concept and pioneering the technique of the psychological autopsy in connection with their consultation with the Los Angeles County Coroner’s Office, which requested that they assist in determining the cause of death (i.e., suicide or accident) in a subset of “equivocal” cases.

The psychological autopsy is one form of RMSE that can be defined as an expert inquiry focused on discerning some aspect of the mental state of a deceased person at an earlier point in time. Expert opinions formed by mental health professionals and based on RMSEs are typically—but not always—conducted in connection with some type of legal proceeding. As such, RMSEs can be considered as a forensic evaluation or forensic inquiry the goal of which is to provide the legal decision maker (i.e., judge or jury) with information that it would not otherwise have (based on the expert’s inquiry and opinions), so that it can make a more informed and accurate decision in the legal issue at hand. For example, expert testimony regarding a deceased person’s mental state has been introduced in testamentary capacity proceedings (when a deceased individual’s capacity to execute a valid will at some prior time is at issue), life insurance and workers’ compensation litigation (when the cause of an individual’s death, including the existence of potential psychological contributors, is at issue), and criminal litigation (when the psychological state of a decedent is relevant to some aspect of a criminal proceeding). In addition, mental health professionals and mental health agencies sometimes employ psychological autopsies as a quality assurance mechanism in cases where clients commit suicide. Such inquires serve to aid in understanding what caused the suicide and identifying good or bad professional practice surrounding the person’s care, both of which are seen as having the potential to improve future care and practice.

Because the person of interest (i.e., the decedent) is not available, the mental health professional conducting a psychological autopsy must rely solely on collateral, or “third-party” sources of information, including interviews with persons familiar with the individual of interest; interviews with persons who had contact with the individual at and around the time in question (e.g., around the time the will was executed or the decedent died); and a review of various documents including the individual’s health care records, writings, or correspondence. Depending on the type of case and the issues at hand, areas of inquiry that may be relevant include (a) alcohol and drug use; (b) medical status and history; (c) mental health status and history; (d) economic and psychosocial stressors; (e) the nature and quality of interpersonal, family, and marital relationships; (f) behavior and verbal and written communications; and (g) legal history and records.

There are a number of limitations inherent to RMSEs, some of which also affect more commonly practiced psychological evaluations, including both therapeutic and forensic evaluations. First, as noted above, the lack of a standard assessment technique or procedure increases the likelihood of unreliable assessments and invalid opinions. Second, an obvious limitation is the psychologist’s inability to assess the individual whose mental state at some prior time is of relevance (via either interview or administration of psychological testing, if indicated). Third, because the time of interest is in the (often distant) past, the available records may be limited and the recollections of third parties who may be interviewed by the examiner may suffer and be less accurate as a result. Fourth, third-party informants who are interviewed by the psychologist may distort representations of the decedent’s mental state and behavior, either knowingly (e.g., because of their desire to bring about a particular outcome in a legal case, such as when a potential beneficiary intentionally denies the deceased testator’s severely impaired mental state at the time the will is executed so that the will is declared and the beneficiary receives the inheritance) or unknowingly (e.g., when a spouse fails to recognize and report the deceased spouse’s suicidal behaviors because of guilt over the death).

Little research has been conducted examining the reliability and validity of opinions formed using RMSEs. Of course, assessing the validity of this technique is challenging because of problems with criterion validation. That is, to examine the accuracy of opinions that are formed using an RMSE, one must be able to compare the formed opinions with the actual facts or outcome (which is never knowable or known). As a result of the limited data regarding the reliability and validity of opinions formed when using RMSE techniques, commentators have recommended that professionals who are asked to conduct such examinations proceed cautiously and make clear the limitations inherent in such inquiries.

References:

  1. Ogloff, J. R. P., & Otto, R. K. (2003). Psychological autopsy and other retrospective mental state evaluations: Clinical and legal issues. In I. Z. Schultz & D. O. Brady (Eds.), Handbook of psychological injuries (pp. 1186-1230). Chicago: American Bar Association Press.
  2. Poythress, N., Otto, R. K., Darkes, J., & Starr, L. (1993). APA’s expert panel in the congressional review of the U.S.S. Iowa incident. American Psychologist, 48, 8-15.
  3. Scott, C. L., & Resnick, P. J. (2006). Patient suicide and litigation. In R. I. Simon & R. E. Hales (Eds.), Textbook of suicide assessment and management (pp. 527-544). Washington, DC: American Psychiatric Publishing.

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