The psychiatric autopsy: its legal application.

History written without psychological insight is like a meal without salt and spices: dull, tasteless and flat. Herodotus, the father of all historians, is so readable today because he characterized all his figures, from the most ancient Egyptians and Persians to his contemporary Greeks, by their likes and dislikes, by their loves and hates, their ambitions and frustrations, their motives good and evil. In the last twenty years, psychohistory has been successful because it has utilized dynamic concepts in the analysis of historical persons, groups and movements. Psychiatry itself has not shied away from analyzing deceased persons, sometimes brilliantly, as in Freud's analysis of Leonardo da Vinci, I sometimes in a fashion which has added to the discredit and ridicule which is often heaped upon psychiatry, such as in Freud's and Ambassador Bullitt's analysis of President Woodrow Wilson.2 The so-called psychological autopsy has been used extensively and quite regularly in an attempt to determine the psychological cause of death of suicide victims, particularly in Southern California. I consider the term psychological autopsy quite defective because it excludes the multitude of medical factors which must be taken into account, particularly in regard to toxicology, pharmacology, anatomical pathology, clinical events in the life ofthe deceased, etc. For this reason a new term, psychiatric autopsy, will be used here, meaning the psychiatric analysis of the deceased person, with full consideration of his genetic and environmental background, his personal experiences, all documents which he may have left behind, either written by himself or by others pertaining to him, but also contributions and statements, so-called oral history, by relatives, friends, acquaintances, witnesses, etc. In this light the psychiatric autopsy could be defined as the postmortem examination of all the remains of the deceased, which permit insight and knowledge of his personality structure, his behavior patterns and, most importantly, the events leading to his demise. A purely psychological autopsy without medical considerations is not sufficient. The notorious Texas mass murderer, who indulged in a shooting spree from a tower at the University of Texas campus, had an undiagnosed brain tumor, an unexpected