Suicide note written on the forearm using a sharp pointed object

Introduction

A suicide note is a message left by someone who later attempts or commits suicide. ¹ Suicide notes provide valuable insight into the drivers of suicide victims before the fatal act.^2,3 However, in most cases, suicide notes are not found. The prevalence of suicide notes ranges between 5% and 43%.^3–6 Victims usually prefer commonly available materials, such as a piece of paper, note book, diary, wall, doors or mirrors (a suicide note written on the body is unusual) usually with a pen or marker. In one case henna was used. ⁷ However, a suicide note engraved on the body using a sharp pointed object is rarely seen.

Case report 1

An 18-year-old unmarried girl was found hanging by a ligature (a chunni) from an iron angle at her home. The room was found locked from inside. On examination, during autopsy, the body was found to be that of a female of average build. There were signs of asphyxia present along with a characteristic ligature mark from hanging. There was a note on the ventral aspect of her left forearm written in Hindi in the deceased’s handwriting, made with a sharp pointed object (Figure 1(a)). The writing was a linear abrasion and reddish brown in colour. A note ‘I BORUN LOVE YOU’ and ‘maigalataurpapinahihu’ in Hindi (on close translation to English, it means ‘I am not wrong and not a sinner’) was found written on the left palm and fingers by mehndi (henna) (Figure 1(b)). There was a note written in English language in mehndi which read BORUN I L U inside a heart symbol over medial aspect of left thigh (Figure 1(b)). The mehndi was reddish brown in colour. The same colour mehndi design was also present on the dorsum of the left hand. Autopsy findings concluded the cause of death was asphyxia as a result of hanging. OPEN IN VIEWER

On investigation, it was found that the deceased was right handed. She had written the note (both with a sharp pointed object and mehndi) one day before the hanging. She had also taken the photographs of the note with her mobile phone camera which was later recovered by the police. According to her parents, she was in love with a boy named Borun, but the family opposed the love affair. She had been depressed for the last month.

Case report 2

A 34-year-old male was found hanging by a ligature from a ceiling fan in his bedroom. At autopsy, there was a ligature mark 3 cm wide, reddish brown in colour, incomplete, obliquely present over the upper part of neck. Signs of asphyxia were present over the body. External examination revealed a note depicting ‘RANU’ was written with a sharp pointed object on the ventral aspect of the left forearm (Figure 2). The note was a linear abrasion and was reddish in colour. Multiple tentative superficial cuts ranging from 1 to 3 cm long were also present on the ventral aspect of the left forearm and wrist. The cause of death was asphyxia due to ante-mortem hanging. During the last few days of his life, the deceased had been depressed due to a failed love affair. He was a right-handed man and had written the name of his girlfriend on his left forearm.

Discussion

The presence of suicide notes shows the intention and often the causes of the victim's actions, but these are found only in 10–30% of cases. ⁸ Detailed analyses of the notes have shown that most of them are apologies for the act (74%), expressions of love for those left behind (60%), expressions of hopelessness (36%) or general advice (21%). ⁹ The writing of messages on the suicide's body is not common behaviour. Taylor and Hnilica, ¹⁰ Demicri et al. ¹ Behera et al. ¹¹ and Austin and Byard ¹² have reported few cases of suicides where suicide notes have been written on the body using pen or markers.

Tumram and Ambade ¹³ reported a case of suicide, where the victim used a metallic object to engrave a suicide note on his body. Despite a thorough literature search, we could not find any reports where a victim had used two different methods to create suicide notes on their body.

In the first case we presented, the girl was in a relationship with a boy ‘Borun’. However, this affair was opposed by the girl's family members. The girl was very depressed for this reason. Before committing suicide, she expressed her emotions and helplessness by writing notes on her body. She had pleaded with the boy, that although she was ending her life, she should not be blamed for her act, because she had no other option left. Twin notes, written by the victim on her body with henna and a pointed object, make clear her determination to commit suicide and further ensure that her notes would be read by any concerned persons. In the other case, the victim was a young unmarried man who was deeply in love with his girlfriend ‘Ranu’ and had some psychological problem. In both cases, breakdown of love was the reason for their suicides. In both cases, the notes showed mixed feelings of sorrow and hopelessness.

Suicide notes provide valuable information on the psychological state of the person and sometimes a hidden message in the note can help with suicide prevention programmes. ¹⁴ OPEN IN VIEWER