Importance of a psychological autopsy to identify the manner of death; a case of fall from height

It may not be possible to determine the manner of death, in circumstances such as death following fall from height. When a dead body is found in front of a tall building, the ascertainment of the manner of death is difficult and in this case, the importance of a psychological autopsy in such circumstance is discussed. Middle-aged female with bronchial asthma, arterial hypertension, chronic venous insufficiency, Forestier disease, hyperlordosis of lumbar spine and vitamin D deficiency developed bilateral leg swelling and rash following 14 hours of air travel. Duplex scan excluded lower limb venous thrombosis. She did not have past history of psychiatric disorder but suddenly developed aggressive abnormal behaviour, confusion and bizarre activities. She removed her clothes and finally jumped off from 6th floor of her residency. She was succumbed to death due to multiple injuries following fall from height. No suicidal letter was recovered from the scene. The manner of death was ascertained as suicide based on eyewitness evidence.  Her sudden onset of abnormal and violent behaviour may be an act of automatism without volitional control due to undiagnosed inorganic or organic disease of the brain. The witnessed suicidal behaviour was reverted to accident as a manner of death.  The importance of psychological autopsy and teamwork between Forensic Pathologist and Forensic Psychiatrist in suspicious circumstances to ascertain the manner of death is highlighted. Labelling as suicide will end up in negative social stigma and loss of insurance claims.