An usual death of a masochist: accident or suicide ?

death of a masochist resulting from autoerotic behavior.This presentation will impact the forensic science community bybringing attention to the unusual practice of compressing the neck andchest during masochistic activities, along with other information relatedto basic crime scene investigation, reconstruction of events, and autopsyfindings in these type cases.Fatal masochistic asphyxia is a relatively rare phenomenonsecondary to the malfunction of apparatus used to provide sexualpleasure. The basic mechanism of sexual asphyxia is the creation ofcerebral hypoxia which, according to the literature, is generally broughtabout by constriction of the neck by use of a ligature. In a smallpercentage of cases, less typical methods of sexual asphyxia involvingchest and abdominal compression are also employed. In all such cases,hypotheses of suicide and homicide must not be ruled out.Acase of a 52-year-old man found dead in the house where he livedalone is reported here. The corpse was found in his study, lying supineon the floor, underneath an open chair bed with a 1.3 x 3.2 metermattress. The victim’s head protruded from under the mattress and waspartially covered by two blankets. One of the legs of the chair-bed wasdiscovered pressing perpendicularly into his throat, between which arubber slipper was positioned, and whose sole was facing the anteriorportion of his neck in midline. An iron support bar, which made up partof the bed frame, was pressed against the chest and upper abdomen,causing the bed frame to be elevated off floor. He was wearing typicalmen’s pajamas, underneath which he wore boxer shorts with the flyopen. Autopsy revealed the clear imprint of the slipper’s sole on theanterior side of the neck. There was no fracture of the hyoid bone orthyroid cartilage, but several deep muscle bruises of the neck wereidentified. Histological analysis revealed a hemorrhage of the jugularvein and injury to the vagus nerve. An examination of the lungs revealeda large solid mass (7 cm in diameter) occupying the inferior lobe of theright lung; nodules and sclerotal patches involving the omentum wereobserved, along with the presence of very large adhesions of theperitoneum together with sub-obstructions of the bowel. Toxicologicalexamination revealed no substances of abuse in the blood or urine. Thecause of death was attributed to asphyxia by external compression ofbreathing apparatusFurther investigation of the victims’ history revealed that he wasunder the care of a psychologist, due to the fact that he the had habit ofplacing heavy objects (especially books and chairs) onto his chest orabdomen with the purpose of engaging in masochistic sexualgratification. This practice interfered with his ability to becomeintimately involved with women, and so he sought out psychologicalhelp to free him from this behavior. The victims’ medical history isunknown, including the fact that he had cancer. As far as is known, nosuicidal ideation was ever expressed by the victim.These findings suggest that the manner of death should be classifiedas accidental. However, the unusual circumstances involved in this case,including the presence of cancer, does not rule out that the death mayhave indeed been suicidal.