CHAPTER 21. Analysis of Autoerotic Death Scenes
Mary K. Sullivan and Ann Wolbert Burgess
This chapter concerns deaths occurring in the course of autoerotic activities in which a potentially injurious agent was used to heighten sexual arousal. Autoerotic fatalities are deaths that occur as the result of, or in association with, masturbation or other self-stimulating activity.
The majority of autoerotic fatalities involving injurious agents are accidental, but scene characteristics can lead to mistaken impressions of suicide or homicide. The fact that many autoerotic fatalities share common elements with suicide, such as finding the victim alone in a locked room or dead as a result of hanging, sometimes leads to an incorrect classification of these deaths. Other features, such as the presence of a blindfold, a gag, or physical restraints, have led to mistaken suspicions of homicide. Causes of death in these cases have included strangulation by compression of the neck, hanging, asphyxiation, smothering, choking, chest compression, and gas inhalation.
It is important for forensic nurses who assist in death investigation cases of this nature to have an understanding of the unique features of the autoerotic death scene as well as the importance of the correct classification of such fatalities. Family response to the untimely death of the victim will also be discussed.
Definition
Autoerotic death has been defined as an accidental death occurring during solitary sexual activity in which some type of apparatus, material, or substance that was used to enhance the sexual stimulation of the deceased caused unintended death. Autoerotic asphyxial death then refers to the subset of cases where hypoxia is used to enhance orgasm (Byard, 2005).
The term asphyxia has a variety of meanings, but in this chapter it is used synonymously with hypoxia, a decrease in the availability of oxygen to the tissues of the body, particularly the brain. A mild degree of asphyxia results in the familiar feeling of being out of breath, causing an increase in the frequency and depth of respiration in an unconsciously controlled effort to restore the normal levels of oxygen and carbon dioxide in the blood. Greater degrees of asphyxia produce cyanosis, loss of consciousness, convulsions, brain damage, and death. Relief from asphyxia and prompt intervention may interrupt this process at any stage before death and may be lifesaving. It is important to note that carotid arteries are occluded by a pressure of 3.5 kg, jugular veins by 2 kg, trachea by 15 kg, and the vertebral artery by 16.6 kg (Parikh,1990).
Incidence
The precise incidence of this type of behavior has been difficult to determine, mostly because law enforcement and forensic pathologists become aware of these cases only when there has been the unexpected fatal outcome. In the United States alone, it is estimated that the death rate from these circumstances is between two and four cases per million of the population per year. Rates vary among regions and tend to be underreported (Byard, 2005).
In the spring of 1978, the Federal Bureau of Investigation (FBI) issued a mandate that original in-depth research be conducted on matters relevant to the law enforcement community. In response to this mandate, Supervisory Special Agent Robert Hazelwood requested that students at the FBI Academy submit cases for the study; 157 suspected cases were submitted to the Behavioral Science Unit over a three-year period.
The materials submitted varied somewhat between cases. In all instances, investigative reports were submitted along with either a description or photographs of the scene of death. Additional information was obtained related to interviews with the person who found the body and statements made by relatives. Writings, drawings, photographs, or notes that had been made by the victim were submitted in a number of cases. Although this collection of cases cannot be said to be a probability sample, it appears to be the largest collection of thoroughly investigated reported cases. The 157 cases were classified into four types of autoerotic death: asphyxial, atypical, partner involved, and suicide.
Asphyxial Autoerotic Death
Asphyxial autoerotic activity was the most common form of death among those studied, accounting for 132 deaths or 84% of the sample. The asphyxial techniques most commonly recognized are compression of the neck through hanging or strangulation, exclusion of oxygen with a plastic bag or other material covering the head, obstruction of the airway through suffocation or choking, compression of the chest preventing respiratory movements, and replacement of oxygen with anesthetic agents.
It is important to note the distinction between autoerotic or sexual asphyxia on the one hand and asphyxia as a cause of death on the other. Autoerotic or sexual asphyxia refers to the use of asphyxia to heighten sexual arousal, more often than not with a nonfatal outcome. Although not necessarily fatal, sexual asphyxial practices are clearly dangerous. The autoerotic-asphyxia practitioner who dies while engaged in autoerotic asphyxiation most often dies from an unexpected overdose of asphyxiation when, for one reason or another, the person becomes unable to terminate this means of enjoyment. From time to time, however, someone engaged in autoerotic asphyxia may die a nonasphyxial death (for example, from a heart attack, stroke, or exposure) during this activity. Conversely, it is theoretically possible that someone engaged in nonasphyxial autoerotic activities might die an asphyxial death (for example, carbon monoxide poisoning from a faulty heater or automobile exhaust system).
The overwhelming majority of victims in this sample were male and white. Of 132 persons who died by asphyxiation, 5 were female. There were 4 black males, 1 black female, 1 Native American male, 1 Hispanic male, and 1 Hispanic female. The mean age of decedents was 26.5 years. Four victims were preadolescent, 37 were teenagers, 46 were in their twenties, 28 in their thirties, 8 in their forties, 6 in their fifties, 2 in their sixties, and 1 in his seventies. Although 76 (67.9%) of the 112 decedents for whom marital data was known were single, 41 of the 132 decedents were under age 20. Available data on social class suggest that the decedents were more often middle class than upper, working, or lower class. This is an unusual observation for cases coming to the attention of medical examiners and law enforcement agencies, for members of the lowest social strata usually are disproportionately represented among traumatic deaths.
Atypical Autoerotic Fatalities
There are forms of dangerous autoerotic activity that do not involve the purposeful use of asphyxia. These activities involve a wide variety of potentially dangerous activities, such as the use of nonasphyxial sexual bondage, infibulation, electricity, insertion of foreign bodies in the urethra, vagina, or rectum, and life-threatening games.
Although it cannot be said with certainty whether these nonasphyxial dangerous practices are more widely practiced than sexual asphyxia, with the exception of electricity they seem less likely to result in death. Deaths from such activities are less prevalent than deaths during autoerotic asphyxia, and they are therefore referred to as atypical autoerotic fatalities.
Nonasphyxial autoerotic practices can result in a variety of causes of death. There were 16 such cases submitted, including death by electrocution (6), heart attack (4), poisoning (4), exposure (1), and undetermined cause (1). In two other atypical cases, autoerotic asphyxia resulted indirectly in an asphyxial death as a result of aspiration of vomitus. These 18 decedents were made up of 16 white males and 2 black females.
Sexual Asphyxial Fatalities Including a Partner
Sexual asphyxial deaths also occur in the presence of a partner. Most often, these are homicides in which a male assailant strangles, smothers, or otherwise asphyxiates a rape victim (male or female). Cases in which it was obvious that this is what occurred were not requested for this study, and none was submitted. A less common occurrence is the death by asphyxia of an individual who apparently consented to engage in sexual activity. In such instances, it is likely that there will be considerable difficulty in determining willful murder from negligent manslaughter. In addition, under certain circumstances, there may be difficulty in determining whether a sexual partner was present at the time of death.
It is also possible that a person engaged in autoerotic activity may incidentally become a homicide victim. The autoerotic activity may have nothing to do with the homicide. For example, an individual may be engaged in autoerotic activity when a burglar enters his home and kills him. The autoerotic activity may have some bearing on the homicide. In one case (not from the study sample), a wife shot and killed her husband in his bed, believing him to be her husband’s lover. What she did not know at the time of the shooting was that her husband was a transvestite and had fallen asleep dressed in his female clothing after engaging in autoerotic activity.
A remote possibility that must always be borne in mind is that of a homicide scene staged to appear to be accidental autoerotic death. In one unusual case from the study, the decedent’s wife, who had previously observed him engaging in autoerotic asphyxia, altered the death scene to make it appear like a homicide. Her effort was singularly unsuccessful, for she left the noose within sight and inflicted a minor stab wound that was readily shown to have been inflicted after death by asphyxia.
Autoerotic Suicides
True autoerotic suicides are rare. Over the years, many autoerotic fatalities have been mistaken for suicide, largely because the investigators were unaware of the phenomenon of autoerotic asphyxia. Thus, cases described as a suicide by unusual methods or a bizarre form of suicide are scattered throughout the literature.
In addition, some cases are factitious suicides in which family members or others have removed evidence of sexual activity to make the manner of death appear to be suicide. In one study case, for example, the decedent’s wife removed the female clothing he had been wearing at death and dressed his body in a suit before calling the police.
Two study cases were autoerotic suicides that could be documented as such on the basis of antemortem behavioral indicators, such as a suicide note. There is no possible means by which to determine with certainty how often other cases may have involved clear suicidal intent. It is certainly feasible that an individual fond of dangerous autoerotic activity will include that behavior in a purposeful suicide. It is conceivable that a suicidal individual, having heard of sexual asphyxia, might choose an asphyxial method of suicide over other options in order to lessen discomfort, but this possibility remains highly speculative. Also, an individual who repetitively engages in dangerous autoerotic practices might decide to end his or her life, although there is no proof of this ever having occurred. More likely, individuals fond of sexual risk taking might escalate the risk to their lives purposefully with full knowledge that death might ensue, but without formulating a conscious intent to die on one particular occasion. Courts deciding whether to award accidental-death benefits in asphyxial autoerotic fatalities have presumed the intent of the decedent, ruling that the fact of the insured’s having engaged in an obviously life-threatening act is sufficient evidence of the intent to bring about “the natural and probable consequences of the act,” quite apart from whether any particular consequence was consciously intended in a given instance.
The forensic nurse should follow these rules in a suspected autoerotic death investigation: (1) always keep an open mind because what you think you see is not always what you think you see, (2) never make a threshold diagnosis, (3) never go against what the forensic evidence indicates, and (4) never allow the seriousness of the injury to determine the manner of death (Hazelwood, June 2007).
The Autoerotic-Death Scene
As in all death investigations, the autoerotic death scene should be preserved through photographs and sketches to complement the written record. The scene will vary according to age, resources, sexual interests, and level of fantasy. The possibility of a victim’s parent or spouse legally challenging the cause or manner of death listed on the death certificate should be anticipated. There have been situations in which parents have litigated cases believing their child was murdered or pressuring a local coroner to change a ruling from accident during autoerotic acts to accident due to physical exertion. Furthermore, the decedent’s insurance company may also contest the manner of death when accidental-death benefits are at stake. Thus, a careful investigation and documentation of the death scene is of utmost concern.
Role of fantasy
It is important to note that fantasy and sexual preferences are key factors in autoerotic death investigations. Fantasies are the mental representations of sights, feelings, and other sensations and are a universal component of sexual arousal. These individuals attempt to duplicate the fantasy in real life as much as physically possible. The most effective fantasies vary widely among individuals.
Sexual preferences are as varied as the persons themselves. The individuality of sexual preference is such that activities abhorrent to most people are sexually arousing to others (Hazelwood, 2007, course lecture).
Location
Sexual fantasies precede and accompany an autoerotic act. Thus, the individual preparing to act out fantasies typically selects a secluded or isolated location. The selection and location itself play a significant role in the victim’s fantasy, and preparation is part of the arousal. The locations involved in the FBI study sample included locked rooms; isolated areas of the victim’s residence such as attics, basements, garages, or workshops; motel rooms; places of employment during nonbusiness hours; summer residences; and wooded areas. The victim’s desire for privacy is paramount in that all future concentration can be devoted to the minute details of the fantasy itself. The fantasy scenario depends on the use of props and may require considerable preparation time. Thus, the individual takes all precautions to avoid disruption.
A 28-year-old repairman was discovered dead by coworkers when he failed to return to the office. His repair truck was located on a rural road approximately 2 miles from his last service call. The body was located in a heavily wooded area 250 feet from the roadway. The victim was lying facedown with the upper portion of his body resting on his forearms. Around his neck was a 3/8-inch hemp rope secured by a slipknot. The rope extended from his neck to a tree limb approximately 6 feet overhead. To the left front of the victim were four magazines depicting nude females. The victim’s pants were undone, and his underwear had been lowered sufficiently to expose the penis and scrotum. Medical authorities recorded the cause of death as asphyxiation due to constricted carotid arteries.
Victim position
Most commonly, the victim’s body is partially supported by the ground, floor, or other surface. Occasionally, the victim is totally suspended. The most common position noted in the study was one in which the deceased was suspended upright with only the feet touching the surface. In most such cases, some type of ligature was around the neck and affixed to a suspension point within the reach of the victim. Accidental-death victims have been found sitting, kneeling, lying face upward or downward, or suspended by their hands.
The injurious agent
The forensic nurse death investigator at the death scene is charged with the responsibility of gathering information that will allow determination of any action or lack thereof that contributed to the victim’s death. That includes that the injurious agent be studied in great detail, including a careful search for and analysis of possible malfunctioning.
In the study, the most common injurious agent was a ligature of some sort that compressed the neck. Other injurious agents included devices for passing electrical current through the body; restrictive containers; obstruction of the breathing passages with gags; and the inhalation of toxic gases or chemicals through masks, hoses, and plastic bags.
In the construction or use of these devices, the individual risks miscalculation. Depending on the mechanism used, the individual may misjudge the amount of time, substance, pressure, or current.
The self-rescue mechanism
The self-rescue mechanism is any provision that the victim has made to reduce or remove the effects of the injurious agent. This may appear insignificant to the investigator or even overlooked at first. The self-rescue mechanism may be nothing more than the victim’s ability to stand up straight, thereby lessening the pressure about his neck, or it may be as involved as an interconnection between ligatures on the extremities and a ligature around the neck, thereby allowing the victim to control pressure on his neck by moving his body in a particular way or pulling on a key point. Any of a wide variety of items or potential actions that the practitioner had available may have been intended as a self-rescue mechanism. If the injurious agent is a ligature, a slipknot or knife may be involved; if locks are involved, a key may be present; if chains are involved, a pair of pliers may be nearby. As with the injurious agent itself, the possibility of a malfunction of the self-rescue mechanism must be carefully considered.
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