Psychologist René Diekstra argues for psychological autopsies for suspicious suicides. I agree.

On Monday August 25th the renowned Dutch psychologist René Diekstra [personal website] wrote a column for the local newspaper Noordhollands Dagblad about three cases where young women died and subsequently the police swiftly concluded these to be suicides. Yet their respective families argue different and face an uphill battle to get the recognition and corresponding action from the authorities, more specifically the public attorney’s office (Openbaar Ministerie). Here is the original piece in Dutch [in pdf just in case] and below is my translation.
Noordhollands Dagblad
By René Diekstra
August 25th, 2014 10:00am
Last update: August 25th, 2014 10:00am

Three deceased daughters 

There are this moment in our country at least three sets of parents who are struggling with intense problems. All three have lost a daughter. According to the police and public attorney’s office all three daughters committed suicide. But each of these sets of parents question these conclusions. They have taken action to get their daughter’s death re-investigated.

Both the authorities, psychiatrists, and psychologists are tempted to ascribe such behaviour by the relatives as expression of having trouble accepting that a loved one has died. Yet, there is more than meets the eye with these three deceased daughters.

First this. As far as I know it is not normal for the police or the public attorney’s office to request a psychological autopsy or a ‘regular’ forensic autopsy in cases where there is suspicion, but no certainty, of suicide.

Even though years ago former colleagues, such as Prof. Speyer and myself, argued for such psychological autopsies. We even developed a protocol. The consequence of non-action by the authorities has led to various insufficiently supported claims of suicide and thus subsequent (criminal, red.) investigations were never performed.

Furthermore it is not uncommon for two things to be mixed up, namely ‘mechanism of dying’ (arterial bleeding or suffocation) and ’cause of death’ (how did someone die). There are four causes: natural causes, accident, homicide, and suicide.

The golden rule for psychological autopsies is that the ’cause of death’ cannot be determined from the ‘mechanism of dying’. Both need to be independently investigated by respective experts. Someone can be found hanging in a bedroom, but the question how the person got there (suicide, homicide, or accident (think of erotic auto-asphyxiation) is thereby not answered.

Systematic investigation of someones psychological history, behavioural patterns, recent hardships, and documents that were left behind (diary, farewell letter) will help in determining the most likely cause of death.

No psychological autopsy was performed on Eline Melters (23) who found dead in 2009 on a grassy knoll in Limburg. The official conclusion of suicide is therefore insufficiently supported. The same can be said about Iris van den Hooff (23) who was recently found in her home. Also for a ‘third’ deceased daughter, whose name I have omitted upon request, little proof to support the conclusion of suicide was given.

It is my humble opinion that the public attorney’s office fails to consider the ramifications of quickly establishing an unexplained death as a suicide. Not only does this mean that a murderer continues to roam the streets, it also causes great confusion and distress for those left behind.

When you have never noticed anything ‘suicidal’ about your daughter, yet the authorities conclude that anyway, how much do you start doubting yourself and how well you knew your daughter? Possible forever.

A fourth case can also be added to this list, namely the initially presumed suicide of Michelle Mooij. She was found hanging in her apartment in January 2010 and the police directly assumed it had to be a suicide. Her parents did not trust the former boyfriend who was present in the apartment when it happened and filed an article 12-procedure, which they won. Now the public attorney has decided to charge the former boyfriend and a court case is pending. More than four years after her death.

The position taken by the public attorney’s office, police, psychiatrists, and psychologists with regards to families who question the conclusion of suicide also holds true for most judges in the Netherlands. After all, victims of crime and relatives of victims are just very emotional and only want revenge and loads of money to soften their pain. Anyone who has been victim of crime or is a relative of a victim knows this is only true for a very small portion of us. In general I would say that of course we would like to see justice (not revenge). Part of justice is that similar cases do not happen again or happen substantially less frequent. That we, as a collective, learn from past mistakes. Justice. Nothing more.

I can only agree with the arguments of René Diekstra that any suicide where there is (the slightest) suspicion of foul play a psychological autopsy is mandated. Currently, something similar is done for about 220 suspects per year upon court order where the suspect is placed in a closed observation clinic for 7 weeks. I addition I would argue that a ‘regular’ forensic autopsy be mandated as well for all these cases and thus igniting a corresponding criminal investigation by the authorities. This to guarantee that experts in homicide investigations critically look at the case. In Belgium for instance it is common that part of an investigation of a suicide includes the exclusion of homicide. An additional advantage of doing more extensive police/forensic work on a regular basis is that more knowledge will be gathered, both by the police, the public attorney’s office, forensic psychologists/psychiatrists, and forensic pathologists. Currently, the former two determine how many and which cases the latter two will receive for their professional analysis. Traditionally suicides, accidents, and other unexplained death are not subjected to a forensic autopsies in the Netherlands. It is to be expected that the number of autopsies is very low. To make matter worse the number of forensic autopsies in the Netherlands have been in decline. In 2005, 617 autopsies were performed by the NFI whereas in 2012 only 340 were performed. Therefore the amount of knowledge that is being gathered must be in decline as well.

Will this cost the Dutch government (more) money? Obviously! But the government has a moral obligation to protect its citizens and provide justice for all. Afterall, it is them who claim to have a monopoly on the use of violence. This leaves the Dutch citizen with little more than to (blindly) trust that the government will do its job and provide justice. And it is the public attorney’s office who is the responsible government organisation for these matters. Of course this does not mean that mistakes won’t be made, but at least a proactive attitude and subsequent protocols exist to catch as many homicides as possible. After all, homicide is one of the worst crimes anyone can encounter.

Edit 2014.08.28 – The preliminary results from the autopsy on Iris van den Hooff cannot exclude homicide [link1 link2 link3 link4].

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