Dyadic deaths

Madam We read the article entitled ‘Filicide-suicide: An unusual variant of dyadic death’ with interest. In this letter, we wish to discuss the literature on the dyadic death group. In dyadic death aetiology and motivation, various bio-psychosocial factors are defined. Many factors, such as psychiatric/mental disorders, family problems, loss of job and external stresses, may direct the person towards this. In the literature, dyadic death is infrequently encountered but observed at different series ranging from 0.05% and 0.7%. An earlier epidemiology study stated that the aggressor in dyadic death cases is mostly male, older than the victim and under the effect of alcohol. Firearms are often used with the head region as the most common area of injury. In Rosenbaum’s study, he pointed out that there were findings of psychiatric problems and depression in cases and that depressive disorders were found in 75% of cases. Campanelli and Gilsen’s study demonstrated that 38% of the activists in dyadic suicide cases were depressed. In forensic psychiatry, diagnosing psychotic depressive disorders leads to a finding of mental incapacity of the perpetrator for the alleged act, while the motivation stemming from other, ‘lesser’ mental disorders might only restrict their sanity. The key element for expert opinion is to determine the perpetrators’ clinical state of mind when committing these acts, to consider the presentation of the crime without prejudging the forensic and psychiatric evaluations. When we engage in an act that is associated with ‘dyadic death’ and there is a suspicion that the perpetrator suffers from a mental disorder(s), the judicial implications are less clear. Affective disorders, impulsive and auto-destructive behaviours, apparently good social adaptation, superficial dependency, relations with environment and manipulative attitudes are included in some of the borderline personality traits. The affected people seem strange, delusional and illogical in terms of their line of thinking. They display remarkable anger, emotional instability, real or imagined sense of abandonment, accompanied by decreased ability to identify the emotional state of other people. Disorganisation and chaos, forgetfulness and extreme attitudes begin to characterise their lives. Additionally, they tend to focus excessively on negative aspects of life, exaggerate problems and downgrade self. In such cases, over time, a suicide wish/attempt may develop which is more serious and sustained (lasting for weeks). These people make plans to end their lives with detailed preparations. Their circumstances (i.e. unemployment, low salary, financial problems, low education level), maturity (c. 40 years), previous suicide attempts and a long history of psychiatric treatment can be viewed as some predictors of suicide attempts (ending in death). Suicide rates tend to increase in the elderly and in people with chronic disorders. Where couples who love each other fear that one will die before the other with ensuing loneliness, this can influence a decision to commit suicide together. We believe that presenting psychological counselling services to elderly people may be helpful. However, a suicide pact may still be made, and it is highly arguable that in these cases one death may be the result of a murder.