Multiple stab wounds to chest – suicide or homicide?

Poland. The body of a 36-year-old man with multiple torso wounds was found by the police in the forest some 200 m (656 feet) away from home after he was reported missing by his wife in the morning. That day the deceased was to go to work as usual but never reached it. The employer notified the wife of her husband’s absence from work and the former, alarmed by the news, started the search. As she later testified, her alarm was heightened by the discovery of a missing kitchen knife, the husband’s jacket left at home, and a kitchen stool placed in front of the house entrance under the ceiling beam. She also reported that for about 2 months her husband had been uneasy, anxious, had had sleeping problems and a clearly depressed mood.

A few days before death he had decided to see a psychiatrist for the first time in his life. The doctor diagnosed depression and prescribed him fluoxetine in a dose of 20 mg/day. Colleagues from work testified that he had recently been behaving strangely, seemed depressed, and told them to get ready for his funeral.

The man’s body was found lying on the ground, face down with the head placed on the right arm, with the left upper limb adducted in the elbow joint and the hand placed under the chest. A kitchen knife with an 11-cm-long sharp-edged blade, dug up to the hilt was found 30 cm from the right lower limb. After turning the body over, numerous stab wounds were revealed on the chest and abdomen as well as holes in the bloody T-shirt, which corresponded to the wounds. No other objects or traces such as splashes of blood, which might point to a fight or attempted escape of the wounded victim, were found near the corpse.

An examination of the T-shirt showed 30 holes in total, located over the front surface. An external examination of the corpse revealed the presence of numerous stab wounds on the chest and abdomen as well as a dozen or so superficial pricks and several superficial chafes of the epidermis in these areas. There were no injuries to the back of the body. No injuries suggesting defense wounds or hesitation marks were identified either.

The wounds found on the body were located in 3 groups, yet showed different directions and orientations. Each of the groups comprised numerous wounds: 19 distinct wounds located on the left side of the chest; 4 in the middle part of the abdomen and 2 superficial ones on the right side of the abdomen. They included 14 deep wounds of the chest mostly directed slightly downwards, penetrating to the left pleural cavity, one of which, suggested that the same area had been stabbed several times. In the channels of the chest wounds, a multifocal cut of the intercostal structures and a complete cutting of the bone sections of the 3rd, 4th and 5th ribs and twice of the 6th rib.

Eleven deep wound channels were found in the left lung parenchyma and a single cut of the heart sac and a cutting of the heart apex wall, which indicates that the length of the wound channels reached 10 cm. 900 ml of blood was found in the left pleural cavity, and 20 ml in the heart sac. In addition, the chest wounds with channels directed downwards in four places penetrated the diaphragm on the left, with a superficial cut of the wall of the stomach and transverse colon, without interrupting the continuity of their walls.

The wounds located on the abdomen were superficial and their channels reached the abdominal muscles without damaging the peritoneum. Additionally, numerous small wounds in the integuments of the chest and abdomen with channels reaching no further than the subcutaneous tissue or skin were revealed. The post-mortem internal examination showed no natural disease.

The blood and urine samples collected during the post-mortem were tested by gas chromatography for ethyl alcohol and gave a negative result. The urine was further examined for amphetamine and related compounds, benzodiazepines, barbiturates, tricyclic antidepressants, cannabinoids, opiates, cocaine and its metabolites, all with negative results.

The cause of the man’s death was exsanguination as a result of a massive hemorrhage from the damaged lung, pleura and chest walls within the wounds channels. According to the literature, the findings in this case are consistent with suicide comprise: lack of signs of a fight or struggle at the scene, presence of blood limited to the area of the body and no defense injuries.

The grouping of the wounds indicates that the deceased was not moving during the stabbing (neither fighting nor trying to escape). The toxicological tests excluded the presence of alcohol and common drugs of abuse whose possible presence could explain the number and severity of the wounds since a drug-related state of mind can sometimes justify the choice of such a manner of death. However, even the therapeutic blood concentrations of antidepressant medication fluoxetine, a selective serotonin reuptake inhibitor, which has been taken by the deceased for a few days before his death, according to the literature, may contribute to violent self-destructive behavior.

In this case, the only arguments for suicide are the police findings from the time before the man’s death, i.e. signs of depression and forecasts of imminent death, the first days of taking fluoxetine, and no evident traces of fight or defense found at the scene. Hence, it is most probable that in this case, we are dealing with aggressive self-destruction which would explain the chaotic and brutal manner of wounding. However, the question remains whether so numerous and severe bodily injuries could have been self-inflicted and if yes, would a person wounded in such a way still be able to dig the knife deep into the hard forest bed?

The analysis of the autopsy results in comparison to the death scene findings allows to assume that the injuries were self-inflicted. Therefore, the presented case indicates that a person in a specific mental and emotional condition is capable of committing a seemingly improbable self-destructive act.