Interview with forensic psychiatry expert Vaiva Martinkienė
We often associate forensic medicine with death, but what relation does forensic psychiatry specifically has with death and dying? Even though most doctors would think that someone must be alive and talking to be examined by a psychiatrist, we know that all aspects of our life can be analyzed through a psychiatric gaze. Even dying. Sometimes it is the objective of a forensic psychiatry and forensic psychology experts – to retrace someone’s decision to commit suicide and explain it to the court. Today forensic psychiatry expert Vaiva Martinkienė tells us what relation forensic psychiatry has to suicide, what is the most important tool in this line of work and how do forensic psychiatry experts evaluate someone who is already gone.
Greta Murauskienė: Do forensic psychiatrists often encounter death in their work?
Vaiva Martinkienė: Not directly – clinicians deal with that more often. We analyze suicides through documents and encounter the situation post factum, after something has already happened. I believe that clinical practitioners experience it more painfully, as they confront suicide directly. Questions may arise about a doctor’s responsibility for service quality. We have assessed cases where we looked at the emotional state of deceased individuals and whether doctors recognized suicidal risk signs. In one instance, we found no evidence of the doctors being negligent; the patient's behavior was ambiguous, he arrived stating that he wanted to take a break from the prison environment, did not report any depressive complaints, and his emotional state in the hospital was quite stable. He repeatedly said he had difficulties in prison and wanted to change facilities but objectively, a clinical depression syndrome was not observed. The doctor documented all this information, so there was no evidence of psychiatric negligence.
What material helps you investigate someone’s mental state prior to suicide?
Everything that can be gathered from medical records is crucial. Psychiatric records, if available, are especially valuable. In suicide cases, we assess the individuals’ entire life history focusing on work and family relationships, and witness testimonies. Messages written by the individual themselves, emails, chat transcripts are very valuable, as what the person said and wrote is the most authentic and provides the most information about their state. It also shows what kind of relationships they had with others, how they reacted and communicated, whether they felt hurt. This also gives us insights into the influence of others, as the conversations are mutual: the person acting and the one reacting.
What does it mean for you to study the psyche of those who have committed suicide?
Without empathy, forensic or clinical psychiatry does not exist. Empathy is the primary instrument of a psychiatrist – professional empathy, with emphasis on the word ‘professional’. While at work, one must step into other person’s shoes, dive into the nature of their relationships with others, how they were affected by external stimuli, how they experienced those influences, and trace the entire path of their emotional experience to understand how the actions or words of others might have influenced the decision to commit suicide. At that moment, one must feel everything, but we must compartmentalize our feelings after completing our work.
Can you provide examples of how a person may be driven to suicide?
Cases vary widely; there is no single way or model. Referring to publicly discussed cases, for example: a teenager experienced constant bullying from classmates; a student faced harassment while living in a dormitory; a woman endured continuous violence from her partner, which she hid from her family, and after two days of constant abuse, she jumped out of a window; a young doctor was subjected to ongoing psychological abuse in her professional environment, leading her to suicide; a young man took his own life because he was extorted and forced to steal.
You mention prolonged traumatic situations in your examples.
We look for either depression associated with long-term trauma or acute stress responses with certain predispositions. People who have experienced multiple instances of bullying or psychological and often physical abuse are vulnerable, less resilient, and more easily broken. Suicide typically does not occur because of a single incident. These may be individuals with signs of personality vulnerability, youths whose personalities are not yet fully formed and who lack optimal stress coping strategies, or individuals who tend to hide their experiences. Self-isolation is a straight pathway to a suicidal crisis – when such person is left alone, tunnel vision sets in, they detach from the world, and only one solution to their situation is visible. One example would be a young girl who experienced many traumatic things in her life; she was not very strong or emotionally resilient, was isolated from her environment, intoxicated, sexually abused, mocked, and felt immense guilt and shame, leading to her suicide.
How does a forensic expert evaluate the mental state of someone they have never met?
At times, an expert cannot provide a definitive conclusion about a person’s mental state in post-mortem examinations; occasionally, we offer preliminary conclusions based on the data available to us. It is important to understand that we only evaluate someone’s mental and emotional condition; the court seeks to determine guilt and responsibility. In criminal suicide cases, it is almost impossible to isolate the influence of one specific person, as many factors can play a role, and it is often impossible to pinpoint what exactly led a person to commit suicide. In exceptional cases, where just one person terrorized the deceased – usually a former or current spouse – the expert may state the influence of that specific individual.
In the context of criminal cases, when does the need to assess the mental state of a deceased person arise?
When law enforcement suspects that someone was influenced to commit suicide, meaning that the decision to commit suicide was not the individual’s independent decision (based on internal beliefs),
but was made due to external influence, breaking the person, and creating a suicidal crisis through their actions or deceptive behavior.
In your opinion, who is more often responsible for driving people to suicide – close relatives or strangers?
It varies. Both domestic violence and peer influence can provoke severe reactions. Violence is harmful regardless of its source.
Is it often possible to understand the motivations of a person who has committed suicide?
Understanding motivations is central to our work. We analyze circumstances, personality traits, and emotional responses to grasp what led to their decision.
Thank you for sharing your thoughts. □