A recent issue of Forensic Magazine reviewed the progress of forensic science since Marilyn Monroe’s death 50 years ago, on August 5. She was just 36, and debates continue today over whether she killed herself with barbiturates intentionally or accidentally, or whether someone murdered her. Like the “royal conspiracy” for Jack the Ripper, the “Kennedy conspiracy” is a favorite.

If we had known then what we know today, investigatively speaking, this case might have been less murky. There would have been complete phone records to analyze, instead of questions about who had called her, as well as a full toxicology work-up. If someone had been with her, or had tampered with her medications, there might have been DNA evidence in her room. In addition, a state database would have yielded accurate information about Monroe’s prescriptions, voiding the contradictory witness reports.

However, the holes remain, and many today believe that even with complete information, the manner of her death would still be intentional suicide.

There’s plenty of speculation on that score, and I’m not here to resolve it. Instead I want to discuss something that no one else is talking about. Few people realize that just two years before Marilyn died, the LA Coroner’s Office had formalized a unique approach to analyzing manner of death.

In 1958, the Los Angeles Suicide Prevention Center (LASPC) opened. It was a multidisciplinary collaboration, and one of its founders, Edwin S. Shneidman, coined the term, suicidology. Around this time, the city’s chief coroner, Theodore Curphey, was overwhelmed with a rash of drug-related deaths. Any one of them could have been an accidental overdose, a suicide, or even a homicide.

Curphey heard about the LASPC, so he enlisted Shneidman and his colleagues to assist. They were to use their knowledge of psychological factors to help swing the balance for an ambiguous death in favor of its most likely manner. They went right to work.

Shneidman sought to formalize the process in a 1961 article, as he and a co-author described what was involved. They were the first to call it a “psychological autopsy.” The name stuck.

They identified sixteen categories for inclusion, such as medical and psychiatric history, personality, family history, relationship status, evidence of “psyche-ache,” and suicidal ideation. They created a four-level scale of lethality related to the decedent’s knowledge and intent. In simplistic terms, these professionals proposed that psychologists explore the “why,” “how,” and “what,” with special reference to the timing of the death (i.e., an anniversary).

Shneidman classified motive as intentional, subintentional, and unintentional, and found that just 20-30% of suicides included a note explaining their act. Another study revealed that 62% had communicated their intent to at least one person. Others do something they know could be fatal, but did not necessarily intend to die while doing it, such as racing a car on slick pavement. (In fact, Marilyn apparently liked to overdose and then get someone to rescue her; her “suicide spells” were well-known to her companions.)

As psychological autopsy proved helpful, Los Angeles officials continued to consult with mental health experts on a regular basis, and in 1962, the case of Marilyn Monroe became a candidate for this “Suicide Panel.” It involved a number of professonals working anonymously and converging to discuss their findings. Coroner Thomas Noguchi, who had performed Marilyn's autopsy, would later dub this process a “Mode Conference.”

Other psychologists have expanded the number and type of categories for a full psychological autopsy, but there is as yet no wholesale endorsement from the profession. Thus, courtrooms have not accepted it as peer-reviewed scientific practice. Nevertheless, suicidology, the scientific study of suicide risk and prevention, offers a growing body of research and more professionals are interested in psychological autopsy today than ever before.

When Marilyn succumbed to an overdose of Nembutal and chloral hydrate, it was concluded that she fit the profile for frequent suicidal depression. Noguchi discussed it in his 1983 book, Coroner. He was mystified that people had not accepted his determination, although he admitted to several puzzling elements.

Yet there were other indicators of a fatal form of “psych-ache”: Marilyn had recently been fired from a movie set; had gone through three failed marriages; had a drug addiction, and in her background was a miscarriage and a mentally ill mother. She had overdosed on a drug that one must take in large quantities to be fatal, which indicated clear intention.

In contrast, she had reason to live. She had made significant plans, and many who saw or spoke to her during the day before she died had failed to see signs of depression. In addition, those who knew her well were aware of how often she forgot which drugs she was mixing with liquor. To them it seemed accidental. She was not hopelessly depressed.

In 2010, I watched a presentation dedicated to 50 years of doing psychological autopsies. Noguchi, now white-haired and fragile, was present. Those who carry on the tradition today described how Curphey had recognized the value of psychological evidence in the investigation of contested or confusing deaths. The presenting team hoped to encourage other coroner-medical examiner offices to follow their lead.

Although a psychological autopsy did not close Marilyn’s case, it has helped to close many others. Curphey should be acknowledged as a pioneer.

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