Postdiction in the Psychological Autopsy: A Clue or Algorithm

Abstract

Clinicians have long looked for the clue to suicide, whether depression, the perception of being a burden, deception, whatever. Different practitioners have focused on different cues, often with many suicidal people dying. It will be argued that the most important development in suicidology, since Shneidman and Farberow’s 1957 original work on multidimensional clues to suicide, is the conclusion that an algorithm or formula may be more predictive than a single cue. The classical example of this approach in health is anesthesiologist Virginia Apgar’s use of multiple variables in a formula to predict possible brain damage or death after infant birth. Her, now called, Apgar score saved and continues to save lives. She argued for a formula. It is suggested that similarly the use of a multidimensional approach is equally more effective in suicide prediction than any single symptom or clue. This is as true in death scene investigation (DSI), called the psychological autopsy (PA), as in the therapy room. The question, posed in this chapter, can suicidology develop an effective tool to postdict in DSI, a death as a suicide versus another mode of death (e.g., homicide, accident). This chapter will explore the question, “Should we use a cue or formula in our formulations in the PA?” An answer will be provided, based on decades of research, and illustrated by the internationally known forensic case of The State of Indiana vs. Bei Bei Shuai. Conclusions will be addressed.

Appendix 1 Thematic Guide for Suicide Prediction