Italy. An 83-year-old man, killed by his son, was found dead in the dining room of his apartment, with plenty of blood staining the surrounding floor and the walls. Following the murder, the offender phoned his sister and brother-in-law to reassure them that “everything had been fixed”. He then rang the neighbor’s doorbell, but they did not open the door, so he remained in a state of perplexity on their stairs with a tattered towel in his hands.
The victim was lying supine on the floor with his head adjacent to a broken marble baseboard. He was wearing a white t-shirt that had been raised above the chest, a pair of male underpants, and a pair of shorts that had been lowered to the ankles. He was holding a bread knife loosely in his right hand. The man’s face, abdomen and arms were covered with blood, and multiple buttonhole-shaped skin lesions were evident on the abdomen. No traces of blood were observed on the man’s legs or on his back. Two crime scene investigations were undertaken; before and after performing the forensic autopsy required by the public prosecutor.
Fig.1 Victim lying on the floor with his head adjacent to a broken marble baseboard, holding a bread knife in his right hand.
Autopsy
The external examination of the body revealed fingerlike imprints of dried blood on the left side of the victim’s face (Fig. 2) and on the left arm. The scalp was widely contused, and a series of lacerated wounds with jagged margins was observed in an area on the right frontoparietal region (Fig. 3). Confluent hemorrhage of the eyelids as well as a contusion of the nose, and the right and left side of the face, were also detected (Figs. 3-4). Numerous small abrasions, possibly reflecting injuries caused by fingernails, were described near the right eye, at the root of the nose, on the left cheek, around the mouth, and on the lower lip (Figs. 4-5); such injuries were also seen on the neck and the upper part of the chest, surrounded by areas of slight contusion.
Fig.2 Fingerlike imprints of dried blood; and on the left arm.
Fig.3 Lacerated wounds with jagged margins on the right frontoparietal region and contusion of the right side of the face.
Fig.4 Confluent hemorrhage of the eyelids and contusion of the nose; fingernail abrasions on the nose and around the mouth.
Fig.5 Contusion of the left side of the face with fingernail abrasions.
Inspection of the oral cavity revealed the presence of a set of five metal keys with a whistle-like keychain, which were gently removed (Figs. 6-9). In the epigastric region, there were seven skin lesions showing a single pointed end and a unilateral “fishtail” split, consistent with stab wounds (Fig. 10). These injuries, numbered from 1 to 7, were of different sizes, the largest being those labeled from 2 to 4. Several bruises were observed on the back of the trunk and on the upper limbs.
At autopsy, a hemorrhagic infiltrate of the scalp and temporalis muscles was found, in the absence of skull fractures; a slight subarachnoid hemorrhage in the right temporal lobe was also observed. Hemorrhagic infiltration of the masseter and pterygoid muscles was described bilaterally. The tongue presented superficial blood infiltrates which were also detectable in the palatine region, along with a small laceration of the mucosa, and in the hypopharynx. Blood was seen in the trachea and the bronchial tree. No skeletal fractures were observed. Toxicological analyses were negative.
Fig.6 Set of keys with keychain in the oral cavity.
Fig.7 Set of keys with keychain in the oral cavity.
Fig.8 Set of keys with keychain in the oral cavity.
Fig.9 Set of keys with keychain from the oral cavity.
Psychiatric history of the offender
The perpetrator was the decedent’s 45-year-old unmarried son, who lived with his father. He was the third and youngest son, and no family history of psychiatric disorders was found. A regular psychosocial development was reported, and his personality was described as lively. He had graduated from high school despite failing 2 years. Thereafter, he had had occasional jobs before finding a permanent job in a shoe factory.
The man had been unemployed for 19 years before the crime when he underwent his first psychiatric admission due to acute delusions; he was then diagnosed with bipolar disorder. An initial unspecified psychopharmacological therapy was introduced, and the case notes analysis revealed good treatment adherence and a diagnostic change to a delusional disorder. Following a readmission 12 years prior to the crime, he was diagnosed with “depression and personality disorder”. At the time of the crime, he was supposed to be taking prescribed quetiapine and lithium carbonate.
No significant changes were reported in the medical records until the day before the murder, when a request for a medical examination was made by the offender’s father, apparently due to treatment non-adherence. After the homicide, the forensic psychiatric expert examination yielded a diagnosis of a schizoaffective disorder with acute paranoid delusion. The expert concluded that the offender should be held criminally irresponsible due to acute delusion that motivated an uncontrollable homicidal behavior. The offender affirmed that he killed his father because he had been replaced by an impostor that threatened both his father’s and his own life. He also reported that at times he perceived the impostor as an inanimate object, such as a “sack of potatoes”.
In this case, the murderer’s delusional conviction that his father had been replaced by an impostor, as well as the persecutory delusion toward the perceived impostor, can be framed within a delusional misidentification syndrome, such as Capgras syndrome.
Capgras syndrome is a type of delusional misidentification syndrome in which the subject holds that a well-known person has been replaced by an identical or very similar impostor. Schizophrenia and other psychoses have been associated with an increased risk of committing homicide and there is initial evidence suggesting a possible association between parricide and delusional misidentification syndromes.
Fig.10 Left: Skin lesions showing a single pointed end and a unilateral “fish tail” split. Right: Injury of the abdominal aorta.
Discussion
A history of psychosis is frequent in parricide offenders, who often perceive their father as threatening due to delusions involving the parental figure. The killer usually blames the external situation for his internal tension and holds the victim responsible for his actions. A review of the studies carried out on parricides shows that adult male perpetrators often present the following common traits: they are frequently unmarried, unemployed, and living with their parents at the time of the crime; murders usually take place in the victim’s house.
Conclusion
Parricide is a complex, behaviorally and criminologically heterogeneous crime, as it results from a multiplicity of personal, environmental, and clinical factors. The case reported here highlights the association between a major psychiatric disorder (schizoaffective disorder), in a phase of acute decompensation with delusional misidentification syndrome, resulting in overkill which includes a rare form of asphyxiation. The evocative relationship between severe mental disorders, delusional misidentification syndrome, and overkill deserves further attention.
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