PSYCHOLOGICALAUTOPSIES
A psychological autopsy (or psychiatric autopsy—the
terms are used interchangeably) is a reconstructive
mental state evaluation (RMSE) focused on under-
standing 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 sub-
set of “equivocal” cases.
The psychological autopsy is one form of RMSE
that can be defined as an expert inquiry focused on dis-
cerning 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 evalua-
tion or forensic inquiry the goal of which is to provide
the legal decision maker (i.e., judge or jury) with infor-
mation 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’ com-
pensation litigation (when the cause of an individual’s
death, including the existence of potential psychologi-
cal 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 qual-
ity assurance mechanism in cases where clients
commit suicide. Such inquires serve to aid in under-
standing 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 conductinga 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 corre-
spondence. 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 mari-
tal 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 avail-
able 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 dece-
dent’s mental state and behavior, either knowingly
(e.g., because of their desire to bring about a particu-
lar outcome in a legal case, such as when a potential
beneficiary intentionally denies the deceased testa-
tor’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 tech-
nique is challenging because of problems with crite-
rion 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 actual638 ———Psychological AutopsiesP-Cutler (Encyc)-45463.qxd 11/18/2007 12:43 PM Page 638