— Vo l t a i r e
Was It Really Suicide? Vincent W. Foster, Jr.
On Tuesday, July 20, 1993, as White House Counsel Vincent W. Foster, Jr., walked out of his office in the west wing of the White House, he told his secretary to help herself to some M&M’s candy left on his lunch tray. He then drove his car to Virginia, taking the George Washington Parkway to a scenic and secluded spot in Fort Marcy Park, and shot and killed himself.
In many ways, Foster was a modern version of “Richard Cory” in the poem by E.A. Robinson. As a corporate lawyer in Little Rock, Arkansas, Foster had earned professional acclaim and was earning $300,000 per year. But in Washington, D.C., at the side of the Clintons, life was different for him, and difficult. In the week before his death, he was worried about a possible congressional investigation into the White House travel office. His connection to that discredited office had been condemned by such newspapers as The Wall Street Journal. Foster sought the names of psychiatrists but feared that his
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sessions with them might be taped. He talked to his wife about resigning and returning to Little Rock, to their former, comfortable life. On Friday, July 16, Foster confided to his sister that he was fighting depression. She gave him some names of psychiatrists to call in Washington. He attempted to reach one of the psychiatrists twice but failed to make contact.
Foster took a getaway weekend, which seemed to refresh him, because back in his White House office he appeared rejuvenated. On the day before his death, he called his family physician and obtained antidepressant medication, but to the very end, Foster exhibited few outward signs of mental distress.
Foster’s death roiled Washington. He left no suicide note and had not spoken to anyone about suicide. People who knew him were gripped with utter disbelief. How could a man of such stature and apparent stability, a man whom President Clinton called “the rock of Gibraltar,” have killed himself? Foster’s judgment and intellect had been so respected by his White House peers that he was considered a potential Supreme Court nominee. The park officer who found Foster’s body commented that his slacks were creased, his white shirt was starched, and every hair on his head was in place.
Foster’s injured professionalism has been advanced as the single cause of his death, but as a forensic psychiatrist I reject that explanation as too simple. Stock ideas about suicide have no place in a true understanding of this complex subject. At best, the broadest statement that can be made about suicide is that its goal is to escape intolerable and excruciating mental pain and problems of living, considered to be solvable only by self-destruction.
The specific circumstances of every apparent suicide are unique and must be thoroughly investigated. In Foster’s case, the more plausible explanation is an unrecognized and untreated psychiatric disorder. On June 30, 1994, Whitewater Special Counsel Robert Fiske, citing conclusive forensic evidence, officially determined that Foster’s death was a suicide. The report describes his severe depression and symptoms of panic. Consumed by depression, he could not eat or sleep. Panic caused his heart to pound and his stomach to boil. He could not concentrate.
I have seen patients who have tolerated depression for years but who could not tolerate both depression and panic. It is one thing to feel depressed and hopeless, but life can become intolerable when one is also constantly terrified. The combination of severe depression and debilitating panic attacks likely proved fatal for Vincent Foster. Both disorders are associated with an increased risk of suicide. It is particularly tragic because both conditions usually can be effectively and simultaneously treated with antidepressants. But it is likely that conspiracy theories will proliferate because definite answers are themselves improbable in apparent suicides.
Vincent Foster’s death was quickly judged a suicide. So, too, for a time, were the deaths of two other notables, Marilyn Monroe and Robert Maxwell. On August 5, 1962, at 4:30 A.M., the Los Angeles police found Marilyn Monroe dead in her home. The cause of her death was unknown, but some considered it a suicide. On November 4, 1991, publishing tycoon Robert Maxwell’s naked body was found floating in the calm waters off Grand Canary Island. Similarly, some considered Maxwell’s death a suicide. But were these really suicides? Let us first examine the facts of these two deaths.
Marilyn Monroe
On that morning in 1962, Marilyn Monroe was found lying nude, face down, with a sheet pulled over her body. Her habit was to sleep naked. No suicide note was found. The night before her death, no disturbance had been heard by her neighbors, who knew her and considered her a good neighbor. On the morning after her death, an autopsy was conducted by Deputy Coroner Thomas Noguchi, M.D. Five days later, the Los Angeles coroner rendered a preliminary judgment that Monroe had died of a possible barbiturate overdose. On August 17, that judgment was amended to probable suicide. Ten days later, the coroner issued his final judgment, saying that Monroe died of acute barbiturate poisoning that followed an overdose.
The coroner’s decision was based on toxicologic analysis, for no external signs of violence to the body were found. Blood analysis revealed 8 mg of chloral hydrate, a non-narcotic sedative, and 4.5 mg of pentobarbital, a sedative barbiturate. A much higher concentration (13 mg) of pentobarbital was found in the liver. It was theorized that the chloral hydrate may have interfered with the metabolizing of the pentobarbital and increased the pentobarbital’s lethal potential.
Many drug bottles were found at Monroe’s bedside table, some full, others half-empty. One bottle contained antihistamines for a sinus condition. An empty canister, dated August 3—only 2 days before her death—had previously contained twenty-five 100-mg pentobarbital capsules. There were also ten 500-mg capsules of chloral hydrate, and the remainder of a 50-capsule bottle dated July 25 and refilled on July 31st, which had been prescribed by Monroe’s longtime psychiatrist, Dr. Ralph Greenson.
Dr. Greenson spoke with a suicide prevention team that the coroner had assembled to compile a psychological profile of Monroe at the time of her death. This was done so the coroner could more judiciously consider whether there had truly been a suicide. Neither Dr. Greenson nor Monroe’s caretaker, Eunice Murray, believed she had deliberately taken her life. Other evidence assembled by the team showed that Monroe had not been mentally unbalanced or physically dependent on drugs. Her drug intake was considered to be light to medium. Pressed to make a decision—as one member later admitted— the team concluded that Monroe had either committed suicide or had made a suicide gesture that had turned lethal. The coroner’s office was reportedly anxious to have the investigation completed, to issue a death certificate, and to put the Monroe matter behind them.
Because the controversy over her death has continued to this day, that last aim was never achieved. The haste with which the suicide investigation was conducted almost ensured that the case would, at least in the mind of the public, remain open. It has been reported that Dr. Noguchi and other forensic experts familiar with the facts at the time did not believe that Marilyn Monroe committed suicide. For example, they had learned that Monroe had made positive plans for the future. Also, the difference in drug levels in the blood and liver suggested that she had lived many hours after ingesting the pentobarbital. Further, the forensic experts cited the fact that no trace of the drugs had been found in her stomach or duodenum. To them, this meant that a lethal dose of pentobarbital could not have been taken by mouth or by injection. (An examination of the body with a magnifying glass concluded that there were no needle marks.)
In a biography of Monroe, author Donald Spoto examined carefully and rejected all the fanciful theories that contend Monroe’s death was ordered because she “knew too much” about the Kennedy family. However, Spoto was convinced that her two caregivers, an attendant and Dr. Greenson, were accomplices in her death. He theorized that they could not tolerate Monroe’s emerging independence and capacity to achieve happiness apart from them. Spoto believed that Dr. Greenson had become so enmeshed in Monroe’s life that her plan for i
mminent departure to a new life was an intolerable rejection of him, one that impaired his professional treatment of her. Spoto contended that the chloral hydrate enema ordered by Dr. Greenson for Monroe capriciously imperiled her. There is no evidence, however, that Dr. Greenson consciously attempted to harm Marilyn Monroe.
Was Marilyn Monroe’s death a suicide, murder, or an accident? We may never know, because there was no opportunity to do a complete forensic psychiatric autopsy or postmortem evaluation drawing on how she lived her life in the days and weeks prior to her death.
Robert Maxwell
A few days before Robert Maxwell’s death, he had suddenly ordered the captain of his yacht to sail for Madeira and Tenerife Island, off the northwestern coast of Africa. The captain reached Grand Canary Island and sailed around it, since Maxwell had decreed no particular course. At approximately 5 A.M. on that morning in 1991, Maxwell called the bridge to complain that his room was too cold. Then, unseen by anyone, he made his way up to the deck and either fell, jumped, or was pushed to his death. Was it suicide? An accident? Murder? Or natural causes? The answer was not an academic matter, for if it could be determined that Maxwell’s death was accidental, his family could collect $36 million from his life insurance.
Maxwell had been a billionaire, the exuberant wielder of enormous power through his newspapers and other businesses, and through statesmen whom he had befriended. Given Maxwell’s previously demonstrated ability to rebound from personal scandals and business disasters, suicide seemed out of character for him, although he—much more than Marilyn Monroe—seemed to have had reasons for committing suicide. Adversity had always inspired him. He seemed to crave challenges. Many who knew him, however, came to the conclusion that his death was not an accident, or by natural causes, such as cardiac arrest either before his fall into the ocean, or by the shock of the water. They believed he had committed suicide to avoid complete personal disgrace and jail that might await him upon his return to England. Outraged bankers and members of his own corporate board were scheduled to confront him about the disappearance of corporate assets and monies from pension funds. These intimates believed that for Maxwell, who desperately sought the respect of people in high places, the humiliation that would have followed revelations about the disappearing assets would have been unbearable—and, therefore, pushed him to a shame suicide.
Some believed that Maxwell had not died at all and that the body identified by family members was that of someone else. The Spanish authorities who recovered the body refused to do a dental plate comparison. They could not use fingerprints on file because the files were too old. The autopsy that they performed was suspect because it described the corpse as having chestnut-colored hair, when Maxwell’s was gray and dyed jet black. Other people—members of Maxwell’s family—advanced the theory that Maxwell had been murdered by a treasonous crew member or by a frogman assassin.
What was known about Maxwell’s personality gave rise to these and other theories because he was an enormously complex man of myriad contradictions, capricious behaviors, mood swings, and dark corners of mind. Some intimates thought he possessed multiple personalities; one, a former editor, believed him to have had as many as 20, each struggling with the others for control.
Evidence that Maxwell lived in a fantasy world of some sort was not hard to find. He had invented his background, his name, and parts of himself. Born Jan Ludwik Hock, he changed his name at various times to Leslie DuMaurier, James Maxwell, Ian Maxwell, and finally Robert Maxwell. He told people that he had been with the Czech underground in World War II, fighting the Nazis. But his tales were unsubstantiated and also at odds with the facts of the underground activity in the area of Czechoslovakia where he had lived at that time. Maxwell once refused to be interviewed by a Jewish magazine, asserting that he had joined the Church of England, but later claimed that the conversion was only a prank played on a journalist.
The most likely theory of Maxwell’s death is that he killed himself because he was at a point in his life where the final identity that he had created for himself was about to be destroyed. The idea of Maxwell having multiple personality disorder also provides a theory if, in fact, Maxwell suffered from this disorder. It was not beyond possibility that because of the extreme stress of events, a murderous alter personality could have emerged and killed Maxwell. The explanation of his death could also be a lot simpler: a Spanish pathologist took note of the fact that Maxwell’s stomach contained a barely digested banana and surmised that he could have slipped on a banana peel and fallen to his death.
Suicide, Accident, Murder, or Natural Death? Enter the Forensic Psychiatrist
What happened in the deaths of Vincent Foster, Marilyn Monroe, and Robert Maxwell—that despite the availability of sophisticated scientific analyses, the intent to suicide has not been definitively established but also cannot be definitively dismissed—is often true of suicides. Although most suicides are intentional, some are not, as I explain later in this chapter. What appears to be a suicide, even if unintended, may be murder. For example, preliminary results of a recent forensic examination on the exhumed body of germ warfare researcher Frank R. Olson appear to contradict government conclusions that he jumped to his death in 1953 from a Manhattan hotel after unwittingly taking LSD in a CIA experiment. This recent finding at last verified the suspicion, long held by Olson’s family, that he was murdered.
Murder Masquerading as Suicide
Murder masquerading as suicide is not rare. It is less likely to occur with a public figure or celebrity, however, because close scrutiny may uncover the deception. Murder masquerading as suicide is more likely to remain unsolved when the individual murdered has a history of mental illness.
Angela, a 36-year-old married but separated woman, was found hanging naked in her bedroom closet by her landlord. Her knees were approximately 4 inches off the floor. The police found no signs of a struggle in the apartment, and no suicide note. Angela had told friends and coworkers that she was taking a few days off to put the finishing touches on a novel she was writing. A manuscript was found on her desk. She did not have significant financial problems.
The body was cut down so as to preserve the knot made for the noose. Fingerprints were obtained but were inconclusive. The forensic pathologist retained by the prosecution opined in her report that the death was suspicious. She noted that suicide by hanging is not a preferred method for women. The slipknot that was used contained clumps of the deceased’s hair tangled within the knot. The forensic pathologist stated that persons who hang themselves usually do so with a simple slipknot that is not intertwined with their hair. The slipknot is tied first and then the noose is placed over the head without entangling the hair in the knot. The rope around Angela’s neck was on a horizontal plane, as if it were tightened first before any strain was applied. The forensic pathologist explained that a diagonal misplacement is more pronounced in suicides. The rope’s impression on Angela’s neck was not as pronounced as seen in hanging deaths. Moreover, the forensic pathologist observed that women who kill themselves do not ordinarily do so in a naked state. Furthermore, it could not be determined whether Angela sustained any trauma to her body because of advanced bodily decay. There was no evidence of a sexual assault. Blood analysis did not indicate evidence of drugs or alcohol. The pathologist concluded that Angela was murdered.
The defense’s forensic pathologist’s report states that it is not uncommon for hair to become entangled in a noose, that no conclusions should be drawn from the knots used, and that his experience was that women hang themselves in various states of undress. Also, the angle of the ligature was an equivocal piece of evidence. This pathologist concluded that Angela’s death was a “garden-variety” suicide.
After further investigation, the police learned that Angela’s husband, age 49, a retired military officer, had a police record for spousal abuse. After 10 years of marriage, Angela was planning a divorce. A year prior to her death she had obtained a protective order agains
t her husband for stalking. Witnesses testified that Angela was afraid of being stalked again by her husband, who had once threatened to kill her. She had begun a new romantic relationship at work. Angela had told friends that her husband said that he would kill her rather than “give her up” to another man. Neighbors provided sworn statements that they had heard loud, angry voices and the sound of furniture falling over at about the time of Angela’s death. One witness saw the husband’s car in the parking lot and observed him entering the apartment building where Angela lived at around the time of her death. Hair samples found in Angela’s apartment matched those of her husband.
The husband was questioned but denied any knowledge of Angela’s death. He claimed that he had not spoken to his wife in more than a year. He stated that she had an extensive psychiatric history, and had attempted suicide on several previous occasions. His alibi was that he was out of town attending a regatta during the time his wife had died, but the alibi could not be substantiated.
Because of the suspicious circumstances, the district attorney requested a postmortem psychiatric assessment to determine the presence or absence of suicide risk factors at the time of Angela’s death. Witness statements and medical and psychiatric records were obtained and reviewed. The records indicated that she had developed bulimia nervosa at age 17. The breakup of a romantic relationship had resulted in depression, superficial wrist cutting, and a brief hospitalization at age 19. A maternal grandmother had attempted suicide during a postpartum depression. The inpatient psychiatrist had made a diagnosis of Angela as having an adjustment disorder with depression.
Angela had married at age 26 after graduating from college with a master’s in business administration. Because of psychological and physical abuse by her husband—a particularly violent beating—she then sought outpatient treatment. Her physical injuries included six fractured ribs and a facial fracture. Her husband was arrested, briefly jailed, and ordered to attend a treatment program for wife abusers. Angela’s new psychiatrist diagnosed dysthymic disorder (chronic depression). He noted that Angela had experienced brief flurries of unbidden suicidal thoughts after being assaulted, but had no suicidal intent or plan. As a way of medicating her marital stress symptoms, she occasionally drank wine excessively. She received 3 years of psychiatric treatment, which ended 1 year before she obtained the protective order.
Bad Men Do What Good Men Dream: A Forensic Psychiatrist Illuminates the Darker Side of Human Behavior Page 25