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The body of a 36-year-old man with multiple torso wounds was found by the police in the forest some 200m away from home after he was reported missing by his wife in the morning. That day the deceased was to go to work as usual but never reached it. The employer notified the wife of her husband’s absence from work and the former, alarmed by the news, started the search. As she later testified, her alarm was heightened by the discovery of a missing kitchen knife, the husband’s jacket left at home and a kitchen stool placed in front of the house entrance under the ceiling beam. She also reported that for about 2 months her husband had been uneasy, anxious, had had sleeping problems and a clearly depressed mood. A few days before death he had decided to see a psychiatrist for the first time in his life. The doctor diagnosed depression and prescribed him fluoxetine in a dose 20 mg/day. Actually one full blister and one with only few tablets missing, according to prescribed dose was found at his home. Colleagues from work testified that he had recently been behaving strangely, seemed depressed and told them to get ready for his funeral.
The man’s body was found lying on the ground, face down. A kitchen knife with an 11cm long sharp edged blade was found 30cm from the right lower limb. After turning the body over, numerous stab wounds were revealed on the chest and abdomen as well as holes in the bloody T-shirt, which corresponded to the wounds. No other objects or traces such as splashes of blood, which might point to a fight or attempted escape of the wounded victim, were found near the corpse. An examination of the T-shirt showed 30 holes in total. No injuries suggesting defense wounds or hesitation marks were identified. The wounds found on the body were located in 3 groups, yet showing different direction and orientation. The cause of death was exsanguination as a result of a massive hemorrhage from the damaged lung, pleura and chest walls within the wounds channels.
The grouping of the wounds indicates that the deceased was not moving during the stabbing (neither fighting nor trying to escape). Nonetheless, the chaotic arrangement of the wounds within the groups stands in contradiction to Karlsson’s findings, according to which horizontal orientation is more common in suicides than in homicides. He states that the manner of holding the knife depends on anatomical conditions, therefore a person stabbing him or herself would hold the knife rather horizontally.
In a great majority of suicide cases due to stabbing, the stabbed areas are more commonly unclothed. In the above case the T-shirt was cut 29 times. However, this is not typical of suicide but doesn’t exclude it, as according to literature such findings are not unique and can be found in up to 39% of suicides by self-stabbing. It can be assumed that the thin T-shirt was not considered by the deceased to be an obstacle to stabbing himself, and therefore he did not uncover the skin. A similar situation can be noted when analyzing the number of wounds. Usually, a large number of wounds suggest homicide. In this case the total number of wounds exceeded 30, and what is more, 19 of them were deep and significantly damaged 4 ribs. Admittedly, there have been cases of suicide involving multiple stab wounds. Karger and Vennemann reported a case of suicide with 92 stab wounds including rib injuries and Lieske reported 120 self-inflicted wounds.
Moreover, in the case reported by Lieske the clothing was extensively cut. Recently, another case of suicide describing 54 incised and stab wounds in different locations (neck, chest, abdomen) was presented. The toxicological tests excluded the presence of alcohol and common drugs of abuse whose possible presence could explain the number and severity of the wounds, since a drug-related state of mind can sometimes justify the choice of such a manner of death. However, even the therapeutic blood concentrations of antidepressant medication fluoxetine, a selective serotonin reuptake inhibitor, which has been taken by the deceased for a few days before his death, according to the literature, may contribute to violent selfdestructive behavior.
The post-mortem examination has not disclosed characteristics explicitly pointing to suicide or homicide. The following questions are puzzling: the possibility of selfinflicting such severe injuries, including cutting the ribs in several places, the origin of the distinct tear of the T-shirt which might suggest a struggle and the character of the superficial cuts in the body integuments, i.e. whether these are the so-called tentative cuts encountered in suicides. The only arguments for suicide are the police findings from the time before man’s death, i.e. signs of depression and forecasts of imminent death, the first days of taking fluoxetine and no evident traces of fight or defense found at the scene. Hence, it is most probable that in this case we are dealing with aggressive self-destruction described in literature which would explain the chaotic and brutal manner of wounding.
The analysis of the autopsy results with comparison to the death scene findings allow to assume that the injuries were self-inflicted. Therefore, the presented case indicates that a person in a specific mental and emotional condition is capable of committing a seemingly improbable selfdestructive act.
