Trauma and Identity: A Psychological Autopsy

“The psychological autopsy is a procedure for investigating a person’s death by reconstructing what the person thought, felt, and did preceding his or her death.”

—Brian L. Mishara, Encyclopedia of Death and Dying

I think it is fair to say that I have been preparing this ‘autopsy’ ever since I was born—if not before. That is to say, it has been in my awareness first implicitly and later explicitly for a very long time. And thus I begin this work with excitement and dread. Excitement because of what I may learn. Dread because of what I may learn.

But I have never done a psychological autopsy, and so I must ask, where do I start, what do I do? “This reconstruction is based upon information gathered from . . . face-to-face interviews.” Brian L. Mishara (2012) continued as if anticipating my uncertainty, “talking in a tactful and systematic manner to key persons—a spouse, lover, parent, grown child . . .” As I read, I realized that the “grown child” was the only key person still alive. And in interviewing him, I would be “face to face” with my self.

But I am a doctor, and this brings up another conflicted point—self-disclosure. “The doctor should be opaque to his patients and, like a mirror, should show them nothing but what is shown to him” (Freud, 1912, p. 118). I first read Freud’s “papers on technique” as a psychiatric resident. I understood then, as I understand now, why Freud felt “the doctor should be opaque.” Why the “mirror” was intended to be held in front of his patient, not himself. Why he cautioned against self-disclosure. And so I understand now (perhaps better than I might have understood then) that with this autopsy I will be crossing a line I thought I never would.

For an autopsy there must be a death. Let me start there. “The cause of death in hanging depends on the condition related to the event,” I read again throughout the Internet—an unsurpassed place to learn about the taking of a life, one’s own or another’s. “When the body is released from a relatively high position, the main cause of death is trauma to the upper cervical spine—the classic hangman’s fracture with severe sub-luxation of C2-C3 crushing the spinal cord and disrupting the vertebral arteries. The prisoner dies of asphyxiation. His face loses color and will appear white.” This information enlightened me as to what to expect at state sponsored executions. It also was informative as to the correct placement of the hangman’s knot—“It is placed in a submental position—[‘submental,’ under the chin]—to ensure violent displacement of the neck.”

But what if one were not released from a relatively high position? What if one were released from a chair below a water-pipe not much more than seven feet above the floor in the basement of the house where one lived? And what if one fashioned one’s own knot without benefit of the fingers or advice of the State?

Postpartum depression is characterized by low mood, tearfulness, emotional lability, fatigue, excessive anxiety, shame, guilt, attachment difficulties and social withdrawal. Psychotic thinking and suicidal ideation are not uncommon in postpartum depression. Women with post-partum depression exhibit greater psychomotor retardation and cognitive impairment than those with non-postpartum depression. The incidence of postpartum depression is between 10% and 15% (McKenzie-McHarg, Cockburn, and Cox, 2007). That is, when one thinks about it, a surprisingly high percentage, as usually one thinks of motherhood as protective. But perhaps the problem lies in the fact that one confuses the mother with motherhood itself. The mother is protective but that protection is not actually conferred onto motherhood.

I consciously learned that my mother suffered from post-partum depression years after my birth. I also learned that she had had one other clinically significant episode of depression about seven years before that. Her inter-current function was by all accounts, excellent. She was an admired teacher, an accomplished athlete, a dedicated mother. Energetic, beautiful, sexy, smart...