Suicide by Cop: A Psychiatric Phenomenon

When a suicidal individual provokes a law enforcement officer into killing him or her, this is known in the law enforcement vernacular as “suicide by cop” (1). Other names by which this phenomenon is known are copicide, law enforcement-forced-assisted suicide, victim-precipitated homicide, hetero-suicide, and suicide by proxy. The present case report describes this unique phenomenon, along with its commonality with the generic form of suicide, and the treatment approach to suicide by cop is also addressed.

Case

“Mr. A” was a 58-year-old self-described “faithful Christian,” African American man who carried a past psychiatric diagnosis of bipolar I disorder, generalized anxiety disorder, stimulant use disorder (cocaine), and alcohol use disorder. He presented to the Howard University Hospital emergency department with a chief complaint of depression, anxiety, and suicidal ideation with a plan to provoke law enforcement officers to shoot him. His plan was to “run down” a police precinct with a weapon such as a knife or gun in order to provoke the officers to shoot and kill him. Prior negative experiences with law enforcement agencies appeared to have been his motivation. His assurance that he could successfully provoke the police to shoot him stemmed from experiences with “a couple of people” he knew who died at the hands of officers of the law after provoking the officers to shoot them. He stated, “The easiest way to die is by police because they shoot without a second thought.”

Discussion

Those who want to kill themselves and are not willing to complete the act themselves employ diverse methods of accomplishing death. Suicide by cop is one such method. Suicide by cop is a forensic phenomenon that is relatively common in the law enforcement field. Literature on suicide by cop estimate its prevalence at about 10% (2) to 36% (1) of police shootings. The concept is credited to Dr. Marvin E. Wolfgang (3), who, in 1959, named it “suicide by means of victim-precipitated homicide.” In his publication on research conducted on the topic between 1948 and 1952, Dr. Wolfgang reported on 588 cases of police officer-involved shootings in the city of Philadelphia's Homicide Squad and concluded that 26% fit the criteria. The term was created to accentuate the fact that “the victim in these … cases is considered to be a suicide prone [individual] who manifests his desire to destroy [him]self by engaging another person to perform the act” (3). The actual term suicide by cop was first used around the early 1980s by Karl Harris, a Los Angeles County examiner.

Suicide by cop shares some statistical characteristics when compared with the generic form of suicide. For example, like the generic form of suicide, suicide by cop is reported to be more prevalent in males with psychiatric disorders (i.e., chronic depression, bipolar disorders, schizophrenia, substance use disorders, among others psychiatric diagnoses), poor stress response skills, adverse life events, or recent stressors (4). A history of previous suicide attempt is another area of commonality between the two, where it is estimated that around 36% of suicide by cop victims have previously attempted suicide (1).

From a sociodemographic standpoint, these two forms of suicide also share common characteristics profiles (see Table 1). It is estimated that over 98% of suicide by cop victims are males (1); 52% are Caucasian (1), and the mean age is about 31.8 years (5). In terms of trigger points for suicide, it is reported that stressful, adverse life events and/or conjugal conflicts (i.e., despondence over a relationship breakup, domestic violence, terminal illness, loss of a job, lawsuit, etc.) are present in over 70% of reported suicide by cop cases at the time the suicidal act was attempted or committed (5). Suicide by cop was noted to be more prevalent in those of lower socioeconomic class, with a majority of victims being unemployed and unmarried (5) (divorced or single) at the time the incident took place. In terms of psychopathology, comorbid psychiatric and/or personality disorders, especially borderline or antisocial personality disorders, were found to play a major role in this form of suicidal behavior (6).

As a method of suicide, however, suicide by cop has its unique characteristics. It is reported, for example, to be more common in those with previous encounters/experiences with law enforcement agencies. It is estimated that about 66% of victims have had criminal histories (1).

Religiosity/religious belief (1) is another aspect in which suicide by cop appears to be unique when compared with the generic form of suicide. While religiosity has been found to be a protective factor for suicide and suicidal behaviors in general, those who are religious (when suicidal) tend to choose different paths to suicide than those who are less faithfully religious. Even though we did not identify specific studies quantifying the link between suicide by cop and religiosity, suicide by cop victims, nevertheless, tend to express unique beliefs when it comes to reconciling suicidal ideations to their religious faith. The patient in the above case report reported his strong religious Christian faith as the reason for his chosen suicidal path. He reported to have reasoned that since his Christian beliefs preclude him from committing the suicidal act on his own, having officers of the law do the act would relieve him from committing what he saw, in his religious perception, as a sin (1). He reasoned that by forcing another person to kill him (i.e., a police officer) that he would still inherit heaven after death, as he would have not committed the act of taking his life on his own (1). He chose the police as his target in order to guarantee his quick demise—given his personal knowledge of past confrontational encounters—because of the potential lethality such an encounter with the police is bound to bring with it.

Suicide by cop is a form of suicide, and those who have attempted or wish to attempt it should be approached as suicidal. The treatment approach should be similar to the way one would approach any other patient with suicidal ideations. In other words, once suicidality is identified, it should be clinically treated. In this regard, psychotherapy, individual and/or group therapy, can go a long way in demystifying the suicidal thought processes in these individuals. Those who present an imminent danger to themselves or to those around them should be admitted to an inpatient psychiatric unit for safety, stabilization, and treatment. And since the biggest risk factor for suicide is untreated or inadequately treated psychiatric disorders, it is therefore imperative to identify and treat the underlying psychiatric disorder. Symptoms and diagnoses should be the guide to pharmacological treatment. In this regard, lithium has been shown to reduce suicidality in those with bipolar disorder, depression, and/or other affective components to their suicidality. Some studies have shown significant reduction in suicide risk, as well as significant reduction in completed suicides, during treatment with this agent (7). Schizophrenia and schizoaffective disorder patients would benefit from adding clozapine to their regiment, as it has been shown to reduce suicide risk in this patient population. Clozapine is the only treatment option that has been approved by the Food and Drug Administration for this purpose (8). For suicidality related to treatment-resistant psychosis, depression, or mania, ECT remains an important treatment option (7). Antidepressants can also play an important role in the treatment protocol for the suicidal patient because they can be effective in relieving symptoms in those suffering from depressive disorders. While antidepressants are effective in treating depressive symptoms, there have not been any specific studies, to our knowledge, showing the superiority of one antidepressant over another for relieving suicidality in suicidal depressed patients. In this regard, ketamine, an N-methyl-d-aspartate glutamate receptor antagonist, has shown encouraging results in most studies for its acute effect on depression and suicidality (9).

Conclusions

Each suicidal act represents a private life tragedy, often with a clear set of psycho-social triggers (financial, conjugal, socioeconomical, etc.) Suicide by cop crosses the privacy of the suicidal act to involve the life and psycho-social functioning of others. This is so, because as has been noted recently in the news media, when a police shooting takes place, the outcome is an increased friction and mistrust between the police and the public at large. In addition, suicide by cop has the potential to traumatize the officers who are forced to use deadly force that results in the death of the suicidal individual. Hence, this unique form of suicide has the potential to be a public health threat on a multitude of levels whenever and wherever it takes place. As mental health providers, we need to be aware of this unique form of suicide in our suicide screening assessment arsenal if we are to be effective in preventing it from happening.

Key Points/Clinical Pearls