Much has been made by the media over the tragic death of David Carradine who was found hanging in his Bangkok hotel room. The initial report, indicating a suicide, was later replaced with the news that he died of possible autoerotic asphyxia; meaning, possibly an accidental death, rather than intentional suicide.
Either way, it's still a tragedy for Mr. Carradine's family, made much worse by the intense scrutiny of the news media. My heart goes out to them. While David Carradine was a well known celebrity, he was still a human being, with a family who loved him, and they should be afforded a certain amount privacy.
Having said that, because of that intense scrutiny, I feel it's important to post some facts about this unusual manner of death in order to get the word out to the public and, hopefully, prevent copy cat deaths from occurring.
Although, according to Dr. Park Dietz, co-author of Autoerotic Fatalities ( Dietz, et al., 1983), the media is "not a suitable medium to discuss this syndrome", due to copy cat behavior. It's for that very reason that I feel it's appropriate to discuss it in this blog. In fact, according to the above cited article, two fatal incidents occurred following the viewing, against Dr. Dietz' advice, of a show on autoerotic asphyxia, by persons who had viewed the show.
Autoerotic asphyxia is an unusual, though not unheard of, manner of death. It has been documented since the 1600's, for treatment of erectile dysfunction and impotence, and is described as being among the most bizarre of the "paraphilias," or abnormal sexual behaviors. It occurs primarily among adolescents and young adult males.
In the book, Autoerotic Fatalities by Hazelwood et al. (1983), the authors suggest that the most common psychological processes underlying autoerotic asphyxia ". . . are the desire for the subjective experience of hypoxia, the acting out of a masochistic fantasy that includes being abused, tortured, or executed, and the desire to be sexually aroused through risk-taking."
Autoerotic asphyxia typically begins in adolescence and most fatalities occur in this age group. According to the paper, The Autoerotic Asphyxiation Syndrome in Adolescents and Young Adult Males, "A study of five teen survivors showed "a history of choking, physical abuse, sexual abuse, other risk-taking behaviors, and pairing of sexual arousal with the choking experience.
Their behavior was found to be ritualistic and compulsive . . . physical and sexual abuse can be precursors to the abnormal sexual behavior." This behavior is often seen in introverted male teens engaging in increased sexual fantasies. The adult practice has been named "terminal sex" or "scarving". Most victims are heterosexual and there's usually no known history of deviant sexual behavior. Unfortunately, since there are few survivors, there is still too little information to determine the exact causes.
Of course, from a death investigation stand point, the first question is whether it was an intentional suicide or an accidental death? Two elements are required to conclude suicide:
(1) The intent of the victim to commit suicide
(2) A specific act which carries out the suicide. The scene of death, if left undisturbed, will usually reveal the clues.
The obvious question is what was the intent of the victim? Was it an intentional suicide or the acting out of sexual fantasies? And how do we tell? According to Dr. Mary H Dudley, Chief Medical Examiner for Sedgwick County, Wichita, KA, from whom I took my death investigator training, those investigating the death scene, "should not jump to conclusions . . . examine the scene very closely, listen to the family, and check that nothing has been moved."
This last part is very important, as family members often conceal or destroy evidence at the scene, or alter the body. "The visual memory of the death scene becomes imprinted in the family member's mind forever." It can be done for any number of reasons, including embarrassment, financial gain, religious beliefs, or the social stigma involved with suicides. In a hanging death, the knot of the ligature is the most valuable piece of evidence. It should never be altered. If the ligature has to be cut off the body, it should be cut away from the knot.
According to the media reports, David Carradine was found hanging with his hands tied behind his back. However, photographic evidence from the scene, published by Thai Rath newspaper, showed "hands apparently bound together above the head" [Carradine family upset by Thailand By: Bangkokpost.com and Agencies], which would indicate an accidental autoerotic asphyxiation death, rather than an intentional suicide.
Suicide
A death investigation of suicide begins with interviewing family and friends in order to create a "psychological autopsy," followed by reviewing the victim's past medical and mental history. The medical examiner will search the body for signs of previous attempts, such as "hesitation marks". These are marks and scars along the wrists, arms, or neck, made by someone who starts to cut, then changes their minds. Multiple old scars, from such attempts, are often seen. In my work I've seen this on several females, from a few old, healed, superficial cuts along the wrist areas, to multiple scars all over their bodies.
Past history of depression is also a strong indicator. Prior attempts are seen in as much as 20-60 percent of successful suicides. While the CDC states that teen suicide was the 3rd leading cause of death among young adults and adolescents, 15 to 24 years of age, peak age for suicide by males is 55-65 and females is 60-70.
Suicide Risk Signs
Sudden, unexpected mood changes - especially going from an extremely agitated state to one of "calm deliberation"
Increased depression or exalted mood
Increased fatigue and sleeping
Suddenly giving away personal belongings
Making peace with others
Suicide Death Scene Signs
A suicide note
A tape/video recording
The body is found in a locked room
Firearm residue on the hands
Evidence of prior rehearsal
Presence of the book, Final Exit or a recent membership in the Hemlock Society
Recent grief over loss or threat of losses
Recent purchase of weapons
Prior suicide attempt
Autoerotic Death Scene
The victim:
Usually male, between the ages of 12-25
Is found dead of asphyxia by hanging, a plastic bag over his head, or by gas.
He is either naked or is wearing female clothing
There is usually pornographic material and a mirror found close by
He's usually found by a family member in his bedroom or other private area of the home
Appearance of solo sexual activity in conjunction with the Asphyxia
Suicide Intent
Victims often found alone or in a secluded location
Signs of suicide (see above)
Ligature will have no release mechanism
No pornographic material or mirror
Usually a note or video left behind
Accidental Autoerotic Suicide
Victims often found alone or in secluded location
No apparent suicide attempt
No obvious intent
Evidence of a physical mechanism for enhancing sexual gratification
Evidence of a safeguard mechanism
Evidence of sexual fantasy aides
May have bondage items
Evidence of prior dangerous autoerotic practice
Caution
Parents, it's important that you monitor your teen's activities both online and off. Studies have shown that many learned of this behavior through word of mouth, detective magazines, sex manuals, and pornographic literature and media - easily available on line.
Counseling, education, law enforcement, and clergy should all be used to help family and friends cope with such an extremely traumatic event. In addition, in my opinion, while they should be offered strong emotional support, they should also be allowed their privacy in which to grieve for their loved one.
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