Psychological autopsies

Sher (2013) has written in support of psychological autopsies, observing that early versions commenced nearly a century ago and modern versions began more than half a century ago. He cited studies in which psychiatric disorders were present in 93–100% of suicide completers and ended by stating that more psychological autopsies are necessary, ‘until we have a good knowledge of what makes people suicidal’.

It is unlikely that further psychological autopsies will provide a list of risk factors that will be of practical use. As Sher mentions, the method has been employed for over half a century with little resultant progress. In the past, these endeavours would have been better termed ‘psychiatric autopsies’, for almost without exception they identified high levels of mental disorder and little else. The relentless medicalisation of the human condition is a major concern (Horwitz and Wakefield, 2007), and – notwithstanding the importance of always trying to recognise and, where present, treat underlying mental illness – some commentators maintain that only ‘a small minority of people who commit suicide are mentally ill’ (Braithwaite, 2012: 1).

Other voices in the debate need to be heard. Suicidologist Edwin Shneidman (1993) wrote that suicide is caused by ‘psychache’, a term he coined for psychological pain distinct from psychiatric categories, while Bunford and Bergner (2012) have described suicide as occurring in ‘Impossible Worlds’. Stark et al. (2011) have articulated the ‘Cry of pain/Entrapment’ model of suicide, and Zhang and colleagues (2011) have described a ‘strain theory’ of suicide, which identifies four areas of potential conflict: differential values, aspiration and reality, relative deprivation, and lack of coping skills.

The suicide rates of the countries of the world are different, and the relative difference has been maintained over decades. There are differences within countries when rural are compared to urban areas, and even between Francophones and Anglophones living in the same state (Burrows et al., 2012). There are also differences in rates across the lifespan, with older people (60+ years) who complete suicide manifesting mental disorder less frequently than middle-aged people who complete suicide (De Leo et al., 2013).

It is our view that future suicide research should avoid exclusive or excessive medicalisation, including undue emphasis on psychological autopsies, and must take a broad view of the human experience.

See Letter by Sher, 2013, 47(9): 884.