ANALYSIS AND COMMENTARY Naked Suicide

1 Naked SuicideRobert I. Simon, MDSuicide attempts and completions by individuals while Naked remain unexplored, both by clinicians and in theprofessional literature. Nakedness at the time of the incident conveys important information about an individual smental state. Motivations for attempting or completing Suicide while Naked are discussed. Nakedness during asuicide attempt is presumptive evidence of high risk for Suicide completion. Deliberate self-harm, without intentto die, is not usually inflicted while Naked . The clinical and forensic implications of Naked Suicide are explored. Incompleted suicides, the state of dress, including partial undress and nakedness may provide important clues in apsychological autopsy. Forensic psychiatrists and treating clinicians who encounter Naked suicides are afforded aunique opportunity to advance our knowledge. Letters to the editor and case reports would stimulate discourseabout this little understood Am Acad Psychiatry Law 36:240 5, 2008 Naked came I out of my mother s womb, and Naked I shallreturn.

2 Job 1:21 Marilyn Monroe was found lying nude, face down,with a sheet pulled over her dead muchpublicity and controversy, the coroner ruled that shehad died of acute barbiturate poisoning by controversy about the cause of her death contin-ues to this Naked body of Robert Maxwell, billionaireBritish tycoon, was found floating some distancefrom his yacht in the waters off Grand Canary was facing a scandal on his return to En-gland involving the disappearance of corporate assetsand pension fund monies. Although his death wasruled an accidental drowning, there was much doubtabout the cause of his death. Theories of his demiseincluded murder, Suicide , heart attack, completed Suicide shortly after MarkAntony fell on his sword. The legend is that shecommitted Suicide by allowing herself to be bitten bya poisonous snake, an asp. A famous painting by theFrench artist Jean Andre Rixens (1846 1924) de-picts Cleopatra lying Naked in her death bed. Apainting by Reginald Arthur (1892) entitledTheDeath of Cleopatrashows Cleopatra partially ,2who wrote about Cleopatra many yearsafter her death, described her as Stone-dead, lyingupon a bed of gold, set out in all her royal orna-ments.

3 The psychiatric and forensic literature is mostly silenton the topic of Naked Suicide . A Google search for sui-cide Naked revealed some anecdotal comments bybloggers and a spate of newspaper stories about individ-uals who had jumped to their deaths while Naked . APubMed search found no information on Naked sui-cide. The author interviewed forensic psychiatrists,general psychiatrists, coroners, and forensic patholo-gists. A review of textbooks on Suicide and forensic pa-thology was conducted. Little or no information wasfound from any source about Naked Suicide . The au-thor s review of Suicide cases in litigation revealed thatan estimated five to eight percent had completed suicidewhile Naked . The percentage of all suicides that arecompleted while Naked is the dearth of information available aboutnaked Suicide , this article is offered as an initial ex-ploration of this topic. It is hoped that letters to theeditor and case reports in response will stimulate dis-course about this little understood Asphyxia or Naked Suicide ?

4 Autoerotic asphyxia is the use of strangulation toenhance the pleasure of is usuallypracticed by white, middle-class men younger than30 who do not have a history of mental illness. Thebodies are often found Naked or in various states ofundress. Props such as sexual aids, pornographicmagazines, or women s clothing are present. Trans-vestism occurs in a minority of cases. StrangulationDr. Simon is Clinical Professor of Psychiatry, and Director, Programin Psychiatry and Law, Georgetown University School of Medicine,Washington, DC. Address correspondence to: Robert I. Simon, MD,8008 Horseshoe Lane, Potomac, MD 20854-3831. Journal of the American Academy of Psychiatry and the LawANALYSIS AND COMMENTARY death occurs when a rigged self-safety release mech-anism fails. The purpose of autoerotic asphyxia is toachieve a more powerful orgasm, but not to asphyxia is also practiced by women,although less commonly than men. A study of fataland near-fatal autoerotic asphyxia revealed that ho-micide, Suicide , and accidental death were errone-ously suspected a few of the womenused props, devices, or unusual clothing.

5 Most of thebodies were found completely Naked . The authorsunderscored the subtle features of this practice inwomen and the underdiagnosis and confusion withnonaccidental death. Nonetheless, autoerotic as-phyxia may be the route that a person takes whointends to commit Suicide . A Naked strangulationwith all the indicia of autoerotic asphyxia may still bea Suicide , not an wisdom has it that a woman foundhanging Naked is most likely a homicide or a is thought that feminine modesty car-ries over into a suicidal death. Nonetheless, womendo hang themselves or induce asphyxia by othermeans while UndressingWedinet a phenomenon called paradoxical undressing. They reported 33 cases offatal hypothermia evenly distributed by sex, age, andgeography. The cases usually occurred on open landduring the winter months. Arteriosclerosis andchronic alcoholism were associated illnesses. The au-thors hypothesized that the paradoxical undressingcould be explained by peripheral vasoconstriction inseverely hypothermic individuals.

6 Just before losingconsciousness and death, these individuals feel over-heated and discard their clothing. There is no sui-cidal may be partially or completely removed tofacilitate the method of Suicide . For example, theindividual may remove or reposition clothing to ex-pose the wound shirt may be removed tomake hanging easier or to be used as a noose. Indi-viduals who engage in autoerotic asphyxia may par-tially disrobe, sometimes causing confusion aboutthe type of death ( Suicide or accidental), especially inthe absence of erotic disposition of clothing found at the site of anaked Suicide attempt or completion can yield valu-able clues to the individual s mental state. Clothesthat are neatly arranged point to a planned strewn about raise the question of impulsiv-ity or mental disorganization secondary to a severepsychiatric condition, substance abuse, or in Suicide attempts or completions in atub or shower may seem incidental, since people taketheir clothes off to enter a tub or shower.

7 Nonethe-less, knowing that one s body will be found nakedand taking the trouble to remove clothing has psy-chological import. The state of an individual s cloth-ing, including partial undress and nakedness, canprovide important clues in a psychological of DeathNaked Suicide can be associated with any methodof Suicide ; however, anecdotal evidence indicatesthat it occurs more frequently with hanging, over-dose, or drowning, but to a lesser extent in jumpingdeaths. With the exception of jumping, most nakedsuicides occur Suicide appears to be less common in sui-cides by gas asphyxiation. Still, the act may be asso-ciated with asphyxiation, especially if it is example, a couple may decide to complete sui-cide by carbon monoxide and engage in sexual activ-ity before death ensues. However, a Naked coupleengaged in sex may die accidentally from a gas leak for example, in a car with closed drowning, as occurred with Robert Max-well, occurs infrequently, except when drowningtakes place in a bathtub.

8 Suicidal drowning in a bath-tub or pool tends to be achieved when individuals arepartially or totally Naked . Encumbering clothes aredoffed before recent spate of individuals who jumped to theirdeaths when Naked has been reported in the , substance abuse, or intoxication should besuspected in individuals who jump or threaten tojump Naked from a building or bridge. Auditory hal-lucinations may command the individual to attemptsuicide by jumping while firearm suicides occur by gunshots to thehead. In such cases, disrobing is unusual. Tidy suicides can be an occasion for nakednessat death. Some individuals, before completing sui-cide by firearm or deep cutting, arrange the Suicide soSimon241 Volume 36, Number 2, 2008that it does not create a mess for their may also disrobe to avoid leaving bloodyclothes. Tidy suicides take place mostly in a bath-room, usually in a tub or may be a factor in Naked individuals spend at least some part of each daynaked. An impulse to commit Suicide may strikewhile the individual is Naked .

9 In their study of sui-cides, Simonet that 25 percent of individ-uals studied made attempts within 5 minutes of hav-ing suicidal Naked Suicide ?Little is known about the reasons why individualsattempt or complete Suicide while Naked . Suicidenotes rarely indicate a reason for a Naked gained from the treatment of patients,however, can shed light on the motivation for nakedsuicide. As mentioned earlier, individuals who havemade Suicide attempts while Naked are the bestsource of information. Table 1 lists some psycholog-ical themes that may be associated with 95 percent of completed suicidesare associated with mental Suicide ,by itself, does not suggest a specific mental noted above, individuals who jump to their deathsnaked may be psychotic. The psychodynamics of anaked Suicide often remain Suicide suggests a variety of psychologicalthemes. The shedding of clothes may symbolize anew beginning, a rebirth and cleansing, or a slough-ing off of the world. In the biblical description ofChrist s resurrection, his clothes, a symbol of an un-regenerate world, were left behind as he ascendedinto and vengeance can be expressed by com-pleting Suicide while Naked , especially when it is in-tended to traumatize a survivor.

10 The shock of discov-ering a Naked Suicide inflicts an indelible, traumaticmemory that can haunt a survivor for a person who completes Suicide while Naked mayintend to add insult to a Suicide survivor s alreadydevastating severely depressed individuals, a Naked suicidemay be an expression of vulnerability, utter despair,desolation, and worthlessness. Psychotic patientsmay be responding to delusions or auditory halluci-nations commanding them to commit Suicide whilenaked as a an illustrative case example, a suicidal psychiat-ric inpatient with a psychotic depression (case dis-guised) believed that he was the cause of the world scalamities. During Suicide risk assessment, it was dis-covered that the patient planned a Naked Suicide toatone for his sins by becoming a sacrificial lamb,shorn of my clothes. Marilyn Monroe, an American sex idol, was ad-mired by many for a physical beauty that defined herlife. Her Naked death led to speculation of foul playwith erotic overtones.