Family murder followed by suicide

Forensic Science, 9 (1977) 219 - 228 0 Elsevier Sequoia S.A., Lausanne - Printed

FAMILY

ROBERT Department (Received

MURDER

FOLLOWED

219 in the Netherlands

BY SUICIDE

D. GOLDNEY of Psychiatry, December

University

16, 1976;

of Adelaide,

accepted

March

Adelaide

(South

Australia

5000)

7, 1977)

SUMMARY are presented with relevant Four examples of family murder followed by suicide clinical data from the coroners’ reports. In retrospect it would appear that three of the offenders were suffering from severe depression, and the fourth showed features of morbid jealousy. In each case there were factors suggestive of mental illness apparent before the tragedy. This is consistent with recent studies of murder followed by suicide and of suicide alone, and raises the possibility that psychiatric intervention may have altered the course of events. Though such tragedies may never be totally e!iminated it is considered that close co-operation between coroner, forensic pathologist and psychiatrist may promote greater professional understanding of t.hese tragedies, and provide the impetus for the detection and treatment of potentially remediable psychiatric illness.

IIGTRODUCTION

Death by suicide has a profound effect on significant family and friends, but this effect pales when compared to that evoked by suicide following murder. Fortunately, this is not common, though the frequency of such events appears to vary considerably from country to country. West [l] reported that one in three murders are followed by suicide in England and Wales, and quoted figures suggesting the incidence had remained constant for many years. This is in marked contrast to a United States series [2] in which 4% of murderers killed themselves, and even more removed from a Scottish report [3] in which only one of four hundred murderers suicided, and this only after escaping detention rather than immediately following the murder. The figure of about 20% for an Australian series [ 11 is intermediate. The fact that the coroner completes the proceedings in these tragedies arouses less public and psychiatric concern than trial for murder, and the opportunity for analysis can be lost. This paper presents relevant clinical findings from the coroners’ reports of four family murders followed by suicide. Comments relating to each history are made, and a discussion of the medical and psychiatric imphcations follows.

220 HISTORY

ONE

Mr. and Mrs. A. lived with their 13 year old son and 11 year old daughter on a small market garden in an outer suburb. They were a migrant family, and a third child had been killed (aged 18 months) in June 1965 in a car accident during a holiday to their native country. On the morning of the 8th of June, 19’70, Mrs. A. arose, apparently normal according to her husband, and helped him load vegetables onto his truck before he left for the market. She then went out to a shed, brought in some Parathion weed killer and mixed it with warm milk. She and her daughter drank their cupful, but her son, who noted later that he had said “it smells like it does when dad is spraying’ only had one mouthful. Mrs. A. then sent him to school, but kept her daughter home. Mrs. A. apparently asked her daughter to phone a neighbour, who arrived about 10.00 a.m. and found Mrs. A. in the shed, moribund, with a photograph of her deceased son. Mrs. A. and her daughter died shortly after. Mrs. A’s. son vomited and complained of blurred vision at school, was sent home and then treated in hospital, and made an uneventful recovery. A neighbour noted that Mrs. A. “was preoccupied with the death” of her deceased son, and the surviving son noted she was “upset every time she spoke of him”. In contrast to this, Mr. A. was reported to have said “she has never been sad or homesick and we have had no real quarrels”. The surviving son also noted that his mother was tired of working in the market garden and added “I know she had words with dad over this”. Comment

Mrs. A. was a 34 year old migrant with no past psychiatric history. Details of any family illness are not known. It would appear that this murder followed by suicide was related to the death of her younger son and that his loss had not been adequately mourned. This pathological grief reaction had a significant anniversary component, though why it should take such a fulminating course after five years is open to conjecture. It is of interest that Mr. A. was not an intended victim. It is possible that his apparent lack of perception of his wife’s difficulties (difficulties that were clear to his son and a neighbour) was related to his need for her to help with the market garden. His sparing could well have been viewed by Mrs. A. both as retaliation for his apparent unconcern, and as the omnipotent mastery over life and death that has been reported [4] . It is possible that had her pathological mourning process been recognised and treated this tragedy could have been averted.

HISTORY

TWO

Mr. and Mrs. B. lived with their four children, aged eleven to seventeen years on an isolated farm, 600 m from neighbours and 15 km from the

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nearest town. On the 10th of June, 1970 Mrs. B. shot and killed her 13 year old daughter and 11 year old son, wounded her seventeen year old daughter and then committed suicide by ingesting rat poison. The surviving children and Mr. B. noted that she had been well until the 22nd May, when Mr. B. had woken at about 3.00 a.m. and found his wife standing over their older son with a carving knife and hammer, saying “I think I must be going mad, I was going to kill him”. Mr. B. suggested she see a doctor, but she refused. Two nights later their eldest #daughter found Mrs. B. with a rifle, and this was taken and hidden in the haystack. Again, referral to a doctor was suggested by Mr. B. but refused. During the next two weeks Mrs. B. became withdrawn and wept frequently. Her tolerance to frustration was minimal, and her solitude was puncutated by occasional episodes of screaming. The surviving son noted “mum bad been stopping up for the past few nights without going to bed and having sleep”. On the 5th of June, Mr. B. developed abdominal pain and was admitted to the local hospital for observation. Three days later, Mrs. B. bought a new rifle, asking the storekeeper to explain its mechanism and not to mention its purchase to her husband. About 4.00 a.m. on the 10th of June, the elder son was woken by his wounded sister. Mrs. B. was pursuing her and shot at them both again. She was disarmed and her son went to the neighbours for assistance. However, on their return, Mrs. B. took rat poison in their presence and died. It is of note that the events of the tragedy given in History One, which occurred two days previously, were prominently displayed in an open newspaper in the room in which Mrs. B. died. Comment Mrs. B. was a 38 year old Australian born woman with no past psychiatric history. Details of family illnesses are not known. It seems evident that a profound change occurred in Mrs. B. around mid-May 1970, and that this change had symptoms of depression, weeping, irritability, profound insomnia and lack of insight into her condition. It is highly probable that Mrs. B. suffered from an affective disorder, and may well have experienced delusions of shame and guilt related to herself and her family. Few details of Mr. B’s. gastro-intestinal symptoms are available, and there is no evidence that psycho-social factors were sought as a possible contribution to his illness.

HISTORY

THREE

Mr. and Mrs. C. and their four children aged eight years to fifteen months lived in a small country town. Mr. C. was a labourer and part-time barman. In the early hours of the morning of the 30th July, 1974, Mr. C. shot and killed his wife, sons aged 8 and 6, his daughter aged 4, but spared his fifteen

222

month old son. At 4.15 a.m. he drove to the local hospital, where according to the nursing sister on duty, he “only seemed an anxious father”. He asked for a doctor to visit his home to see his daughter. He then drove to a nearby quarry and shot himself. The previous evening, Mr. C. had visited two people. He had spoken with his employer and accused a neighbour of having an affair with his wife. He appeared composed when he left at about midnight, but then visited the neighbour. He accused him of the alleged affair, and left shortly after, only to return with Mrs. C. a few minutes later. His accusations were repeated, and he then drove off alone, leaving Mrs. C. with the neighbour and his wife. Mrs. C. was reported to have said “I hope he’s not stupid enough to shoot himself and the kids”. Mrs. C. returned home alone, and was not seen alive again. Mr. C. presumably returned shortly after. The neighbours denied any suggestion of a relationship with Mrs. C. Mr. C. was described by his employer in the following terms: “he was really jealous in some ways . . . there were times when he was difficult to reach and I would say that no-one could really get close to him”. He was jealous of his wife talking to other men or women, and yet it had been observed that at dances he would leave his wife on her own and make a point of telling her how many dances he had had with other women. Mr. C. was a sports enthusiast. His neighbour noted “sport was his whole life and he never liked to be beaten”. He had been observed to smash golf clubs and tennis racquets when beaten. He had also sustained concussion on at least three occasions playing football, and had signed himself out of hospital on two occasions at his own risk. He had been a youth leader, but a long-standing acquaintance noted that he delighted in hitting youths’ genitals. A former schoolmaster said he had been “strong (and) unduly aggressive at school”. Two post-mortem findings related to Mr. C. were of note: first there was no evidence of alcohol in his blood and, secondly, there was “evidence of severe recent influenza”. Comment

Mr. C. was a 32 year old Australian born man with no past psychiatric history and no family history of psychiatric illness. The accounts of his premorbid personality, including his inability to make close friends, anger at sporting defeat, non-acceptance of reasonable medical care when injured, and difficulties in psycho-sexual adjustment with extreme jealousy of his wife, are consistent with paranoid and schizoid personality traits. The role of alcohol as a final precipitant was excluded by the post-mortem findings, but his recent influenza may have played a role in the precipitation of a psychosis. This could have been an endogenous depression with paranoid delusions or, more likely, the onset of a paranoid schizophrenic illness. This would be consistent with his pre-morbid personality.

223 HISTORY

FOUR

Mr. D. was a 31 year old secondary school teacher wh.o lived in a country town with his wife and three children aged five, four and two years. On the morning of the 11th of August, 1975, a neighbour found all members of the family dead. Mrs. D. had been fatally wounded in the head with an axe, and the children and Mr. D. had been shot. The positions of the bodies and injuries left no doubt that Mr. D. had murdered h:is family and then committed suicide. They had previously lived in other small country towns, but this was not unusual for school teachers of Mr. D’s. age. They neither smoked nor drank and were regular church-goers. A neighbour noted they “both appeared to be in good spirits and acting quite normally” on the day before the tragedy. Mr. D. had had regular contact with a family doctor from the age of seven until 1972. IIe reported that Mr. D. had been depressed in December 1967, and this had responded to Amitriptylhe. Mr. D. had consulted him in December 1967 and January 1971 when again his symptoms of depression responded to Amitriptyline. In January 1972 he prescribed Amitriptyline but the response was not satisfactory and he was referred to a psychiatrist who diagnosed “obsessional personality with depressive reactions”. Amitriptyline in doses up to 225 mg daily helped control this episode which resolved about September 1972. Mr. D. was then well until October 1973 when he visited another doctor In a retrospective examination of who also prescribed Amitriptyline. pharmacy scripts it was apparent that Mr. D. was obtaining Amitriptyline from at least one other doctor at this time. Mr. D. was Ion Amitriptyline in varying doses until July 1974. It was noted that Mr. D’s, second doctor had commented on the number of tablets he was taking, and the local pharmacist had, in fact, told him that he was having too much Amitriptyline. There was no Amitriptyline prescribed after mid-1974, and Mr. D. had not recently attended a doctor before the events of August 1975. Comment

Mr. D. had a family history of psychiatric illness, his father having been treated for severe depression. He had had brief episodes of depression in 1968, 1969 and 1971, each of which had responded to the antidepressant, Amitriptyline. His depression of 1972 lasted seven months and that of 1973-74 about eight months. It is possible that these were modified by Amitriptyline, although their length suggests there may have been natural resolutions. It is on record that both his new doctor and pharmacist had expressed concern about the amount of Amitriptyline he was taking, and that the pharmacist had told him so. There appears little doubt that Mr. D. suffered from a recurrent affective disorder which was originally modified with the tricyclic antidepressant, Amitriptyline. Severe episodes occurred in 1972 and 1973-74 and it was in

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the latter that the thought was expressed to him that he may be taking too many tablets. Certainly, he had felt the need to obtain extra medication from a third doctor in the first severe episode. The periodicity of his illness was approximately twelve to fifteen months, and the tragedy occurred fourteen months after the resolution of his last depression. He may well have been aware of his impending depression and the effect it would have on him and his family. He may also have feared rejection by his local doctor and pharmacist in seeking medication. Clearly, his depressions had worsened with each episode, and it would appear that on the last occasion he lost touch with reality with disastrous consequences. The pathologist’s report is particularly poignant: “That no antidepressant drugs were identified on the post-mortem specimen submitted to the Government Analyst is, therefore, highly significant for obvious reasons, in terms of possible explanation of why the events preceding the deceased’s death took place”.

DISCUSSION

The retrospective examination of any subject is fraught with pitfalls, and this is probably more so when considering such emotionally charged issues as murder and suicide. The problem is also compounded by the uncertainties of psychiatric nosology and different medicolegal interpretations of insanity. For these reasons, the discrepancies noted in comparing the incidence of mental illness in different reports of murdersuicide offenders may be more apparent than real. For example, the American studies of Cavan [5] and Wolfgang [2] reported only 1 of 18 and 3 of 24 offenders respectively, to be “insane”, whereas West [l] in his comprehensive study of ‘78 offenders in England and Wales convincingly demonstrated that 45 showed “mental abnormality”. A more recent study of suicide alone, in which the investigators interviewed persons most likely to know about the suicides after each inquest, reported that 93 of 100 cases could have been diagnosed as mentally ill [6]. Their careful study enabled them to corroborate much of their information from different sources, and to obtain invaluable data from which to draw conclusions. Their basic method was considered for this study, but appeared impossible to implement. In two cases over five years had elapsed since the tragedies, and in the other two cases, there was no surviving member of the family who could assist. Having reviewed the coroners’ reports, it became clear that certain implications could be drawn with some confidence, and it was felt that to pursue further evidence at a time so removed from the events would be an unnecessary intrusion upon relatives and friends. West [l] distinguished five categories of mental abnormality. In his series, there were 28 with depressive ilness, four with schizophrenia, two morbidly jealous, four aggressive psychopaths and seven with “severe neurotic instability”.

225

A depressive component would appear to predominate in the first, second and fourth case histories. The most clear-cut, and the only history in which the person who suicided had been seen by a psychiatrist, was Mr. D. who had a recurrent depressive illness with a periodicity of twelve to fifteen months. With the benefit of hindsight it is deceptively easy to suggest that the sequence of events may have been different if Mr. D. had not been discouraged to pursue medication; if he had recommenced Amitriptyline, or if he had had the benefit of prophylactic lithium. Persons with severe depression are particulary sensitive to real or fantasied rejection, and it is possible that entirely well-meaning and, in many instances, potentially therapeutic comments regarding medication were interpreted in a self deprecatory manner. The tricyclic antidepressants have been shown effect.ive both in the treatment and prevention of relapse of affective disorders [6, 71 and the efficacy of lithium as a prophylaxis against further attacks of depression is well established [8, 91. Barraclough [lo] in a series of IO0 cases of suicide, noted that 21 had histories of severe recurrent affective illness, and could have reasonably been treated with lithium, and such would appear to be the case with Mr. D. The first and second histories are less clear-cut, but the evidence points to both Mrs. A. and Mrs. B. being depressed. The observations of Mrs. A’s. son and neighbour of her apparent unresolved grief relating to her dead son were in marked contrast to her husband’s lack of perception of abnormality. The possible psychodynamic significance has been alluded to in terms of omnipotent mastery and retaliation. In this case, one could postulate that the anniversary of her son’s death caused an exacerbation of depressive ideation in Mrs. A., and this may well have been coincident with (or in fact related to) difficulty in interpersonal communication with Mr. A. This second factor may have been the final precipitant required to produce a depressive illness with loss of reality testing, five years after the initial loss. The importance of mourning and the morbidity which can result from inadequate ‘grief work’ have been clearly described [ll, 121 and it is possible that had Mrs. A. had access to services which could have allowed adequate expression of her grief, this tragedy may have been avoided. The second history is remarkable both for the fact that ample warning of Mrs. B’s. disturbed mind was given to two family members and, in addition, that little pressure was put on her to seek help. In this respect one is reminded of the folie a famille situation, although in this case it. was a tolerance of abnormal actions rather than a sharing. Mrs. B’s. change of personality in becoming withdrawn, weeping and irritable combined with early morning insomnia and lack of insight, are very suggestive of an affective disorder, and would certainly warrant psychiatric investigation. An opportunity for the detection of Mrs. B’s. psychological state would also appear to have been lost when Mr. B. was hospitalised with gastro-intestinal symptoms. That suicide is a frequent accompaniment of severe depressive illness is more easily understood than the infrequent association of depression with

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murder. In considering murder followed by suicide with depressive illness, a component of altruism has been invoked, and from this the concept of “extended suicide” has arisen, with the victim allegedly being spared the wretchedness of life to be reunited with the aggressor in a better after-life. The concurrence of any altruistic thoughts with an act so manifestly hostile as murder is an indication of the degree of disturbed thinking possible in psychotic depression. That hostility plays a part in depression has been well recognised since the early psychoanalytic work of Abraham [13] and Freud [14] . A recent report [15] has again demonstrated both the significance and complexity of hostility in depressive illness, points amply borne out by these case histories. Mr. C. (History Three) would appear to conform to the picture of morbid jealousy, but the apparent brief duration of delusional beliefs is in contrast to the average of 4.5 years described by Mowat [16]. The fact that Mr. C. committed suicide is uncommon for this group as indicated by there being only two such subjects in West’s [l] series and by the fact that although Mowat [16] noted 28% of his series attempted suicide, none succeeded immediately after the murder, and only two of 63 subsequently did so in prison. The doubtful nature of “morbid jealousy” as a discrete entity has been acknowledged by West [l] and its status reviewed by Shepherd [17]. West [l] commented on both the depressive and schizophrenic features in some offenders, and suggested that “the greatest risk of homicidesuicide would occur in paranoids whose aggressive emotions are not yet blunted by schizophrenic apathy, and especially in those in whom the emotional distress takes a depressive form”. This theory is consistent with the third case history, though, as noted before, Mr. C’s. recent influenza1 illness may have precipitated a depressive episode with paranoid ideation rather than a schizophrenic illness. It is of interest that on t,wo occasions in his past medical history, Mr. C. had taken his own discharge from hospital against medical advice. This may be coincidence but, superficially, it would appear to be a striking vindication of the observation that a “high incidence of disturbed relationships with hospital staff resulting in premature discharge, often against medical advice” distinguished a group of patients, who subsequently committed suicide, from a control group [18]. Patients who take their own discharge are, ipso facto, difficult to assess, but their inability to form trusting relations with persons in society may be a sign of some traditionally considered “care-givers” importance, and it would appear to demand close scrutiny. There are several other points for consideration. First, each of these tragedies only involved the nuclear family, a fact consist,ent with previous studies. domestic nature of West [l] has commented on “the overwhelmingly murder-suicide”, and Guttmacher [19] in a study of 175 murderers, reported that less than one-third of the victims of the “normal” murder were family members, whereas nearly two-thirds of the victims of psychotic murder were close relatives. The second point is that each occurred in relative isolation, with three occurring in the country; the fourth, which may

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well have had the additional isolation from extended family that migration can impose, occurred on an outer suburban market garden. It is possible that this common factor of isolation from the reality testing of every-day contact may have mitigated against earlier detection of psychological illness, and may have made referral more difficult because of distance involved. A third point for consideration is the role of the open newspaper depicting the events of the first case history in possibly precipitating the second tragedy. The study of Motto [20] would appear to absolve newspapers from any responsibility in encouraging suicide. However, a recent review “Suicide, suggestibility and contagion” quotes several reports which lend some contrary evidence, and considers it too early to draw reliable conclusions on this topic [ 211. In this case, there is clear evidence that Mrs. B. was severely disturbed before the events of the first case history. However, on those occasions, even though disturbed, she had had enough impulse control not to act. The reported events may have helped loosen ego control just enough to trigger the tragedy, though it is more parsimonious to consider that she became less in touch with reality due to her presumed mental illness.

Tennent [22] reported “there is little evidence to support the popular beliefs, either that mentally ill offenders are necessarily dangerous or that all dangerous offenders are mentally ill”. In considering the ubiquity both of mental illness and, to a lesser extent, dangerous offend(ers, this statement is correct, though it should not be taken as grounds for complacence. Indeed, it has become increasingly recognised that the medical profession may be in a unique position to modify some of these behaviours. Solomon 1233 has written of “the burden of responsibility in suicide and homicide” which the physician must bear in evaluating patients, and Barraclough [24] considers that the hospital and medical services have had some impact on the suicide rate and suggests that this “medical approach” should be improved further. In reviewing these tragedies, it is clear there were certain features indicative of mental illness in each case history. In suggesting this, it is both recognised that events seen in retrospect often attain a clarity impossible to conceptualise at the time, and conceded that many of the comments are quite speculative. It is probable that such tragedies can never be totally eliminated. However, it is considered that close co-operation between coroner, forensic pathologist and psychiatrist, promote greater professional may understanding of these tragedies, and provide the impetus for the detection and treatment of potentially remediable psychiatric illness.

228 ACKNOWLEDGEMENTS

The ready assistance of Mr. K. B. Ahern, the State Coroner of South Australia, is gratefully acknowledged. I also thank Dr. D. J. Rampling and Dr. R. James for their helpful comments.

REFERENCES 1 D. J. West, Murder Followed by Suicide, Heinemann, London, 1963. 2 M. E. Wolfgang, An analysis of homicide-suicide, J. Clin. Exp. Psychol., 19 (1958) 208-218. 3 H. Gillies, Homicide in the west of Scotland, Br. J. Psychiat., 128 (1976) 105-127. 4 H. Hendin, The psychodynamics of suicide, J. Nerv. Ment. Dis., 136 (1963) 236-244. 5 R. Cavan, Suicide, University of Chicago Press, Chicago, 1928. 6 B. Barraclough, J. Bunch, B. Nelson and P. Sainsbury, A hundred cases of suicide, Br. J. Psychiat., 125 (1974) 355-373. ‘7 S. C. Rogers and P. M. Clay, A statistical review of controlled trials of imipramine and placebo in the treatment of depressive illnesses, Br. J. Psychiat., 127 (1975) 599-603. 8 J. Angst, P. Weis, P. Grof, P. C. Baastrup and M. Schou, Lithium prophylaxis in recurrent affective disorders, Br. J. Psychiat., 116 (1970) 604--614. 9 A. Coppen, R. Noguera, J. Bailey, B. H. Burns, M. S. Swani, E. H. Hare, R. Gardner and P. Maggs, Prophylactic lithium in affective disorders, Lancet, 2 (1971) 2755279. 10 B. Barraclough, Suicide prevention, recurrent affective disorder and lithium, Bri. J. Psychiat., 121 (1972) 391-392. 11 C. M. Parkes, Bereavement and mental illness, Br. J. Med. Psychol., 38 (1965) l-26. 12 D. C. Maddison and W. L. Walker, Factors affecting the outcome of conjugal bereavement, Br. J. Psychiat., 113 (1967) 1057-1067. 13 K. Abraham, Notes on the psychoanalytical investigation and treatment of manicin E. Jones (ed.), Selected Papers of Karl depressive insanity and allied conditions, 14 15 16 17 18

19 20 21

22 23 24

Abraham, Hogarth Press, London, 1927. Collected Papers Vol. IV, Hogarth Press, S. Freud, Mourning and Melancholia, London, 1934. I. Pilowsky and N. D. Spence, Hostility and depressive illness, Arch. Gen. Psychiatry, 32 (1975) 1154-1159. R. R. Mowat, Morbid Jealousy and Murder, Tavistock Publications, London, 1966. M. Shepherd, Morbid jealousy: Some clinical and social aspects of a psychiatric syndrome, J. Ment. Sci., 107 (1961) 687-753. R. A. Flood and C. P. Seager, A retrospective examination of psychiatric case records of patients who subsequently committed suicide, Br. J. Psychiatr., 114 (1967) 445450. M. S. Guttmacher, The Mind of the Murderer, Strauss and Cudahy, New York, 1962. J. A. Motto, Suicide and suggestibility - the role of the press, Am. J. Psychiatry, 2 (1967) 156-160. D. Lester, Why People Kill Themselves, Charles C. Thomas, Springfield, 1972. T. G. Tennent, The dangerous offender, Br. 9. Hosp. Med., 3 (1971) 2699274. P. Solomon, The burden of responsibility in suicide and homicide, J. Am. Med. Assoc., 199:5 (1967) 321-324. B. Barraclough, A medical approach to suicide prevention, Sot. Sci. Med., 6 (1972) 661-671.