TBH ‘suicide’ finding: The impossible does not happen

Extracts from Teoh Beng Hock Royal Commission of Enquiry:

Decision on the second term of reference:

[119] Having considered all the evidence in its entirety, we found that TBH was driven to commit suicide by the aggressive, relentless, oppressive and unscrupulous interrogation to which he was subjected by certain officers of the MACC who were in the ongoing operation by the Selangor MACC on the night of the 15th and into the morning of the 16th.

- Forensic psychiatric aspects

[233] Tormented by this predicament, TBH experienced a change in his state of mind. And in a matter of hours, this change transformed him from being in the low-risk group for suicide into the high-risk group. The doubts, extreme emotional conflict and the immense feeling of guilt were all intolerable. Finally, precipitating the irreversible crisis that happened to him between 3.30am and 7.00am on the 16th, was the last straw that broke the camel's back. Finding no viable strategies to surmount the hurdle of accusations levelled, he found himself unable to escape from the suffocating quagmire in which he was trapped. TBH would have felt trapped and have succumbed to despair. Since the window on the 14th floor was either open or could be easily opened and it was conspicuous and easily accessible near where he was on the sofa outside Nasdzri's room, TBH would have found that the only way for escape from the torment he was undergoing was by jumping out of the window, even though it meant taking his own life...."

Introduction

Self-inflicted death must have meaning and a reason. In Teoh Beng Hock's death, we find neither meaning nor a reason for taking his own life, if we accept the findings of the TBH royal commission of inquiry.

Suicide is rare. It is even rarer for a normal person without abnormal psychology to commit suicide.

It is hard to believe suicide can happen within few hours of experiencing trauma. Hopelessness as an acute warning sign of suicide most often takes time to develop, days or weeks if not months. RCI has confirmed that TBH was "driven to commit suicide" within hours. The impossible does not happen and the improbable only happens very rarely.

This suicide verdict goes very much against common sense and the intuition of many Malaysians. A closer look is hence necessary to critically examine how the RCI arrived at such conclusion and whether the RCI has proved TBH's intention to suicide.

The focus of study here is essentially of the psychological aspects of the section on ‘Forensic psychiatric aspects’, pages 64 to 72 of the Report of the Royal Commission of Enquiry into the death of Teoh Beng Hock (hereafter called RCI).

Serious flaws in RCI conjecture

RCI evaluated the evidence from forensic pathology and concluded that TBH fell to his death; and from forensic psychiatry that TBH would have jumped to his death. These conclusions are used as reasons to support the suicide verdict that TBH was driven to commit suicide.

However, there are serious flaws observed in RCI's argument. The authenticity of the evidence of intention to suicide used to support the claim is doubtful. Also, the inference from evidence to the conclusion of suicide is invalid and unsound.

The commissioners' method of reconstructing TBH's psychological state prior to death is questionable. The suicide verdict is examined here from the perspective of suicide.

Making attributions without proof

One of the two main terms of reference as spelt out in the RCI is “...to enquire into the death of Teoh Beng Hock and the circumstances surrounding and contributing to his death. It does not state clearly whether ‘death’ means the cause of death (e.g. major injuries, heart attack etc.) or the manner of death (natural causes, accident, homicide or suicide).”

By RCI's verdict of the enquiry, it had taken to itself the responsibility to determine the manner or mode of death.

As for the requirement of the level of proof, RCI stated that their finding would be based on "a balance of probabilities sliding to proof beyond reasonable doubt" (RCI pp.5). This means RCI claims its standard of proof is very high. Also, it says that in order to "understand the probability that TBH took his own life", it is crucial to know TBH's traits of character and his changing states of mind (RCI, pp.64).

It is clear from the above that RCI intended to use the language of probability in the reasoning in the argument. However, the RCI commissioners used the language of certainty when giving the verdict of "driven to commit suicide"; it does not say something like "TBH probably or most probably was driven to commit suicide", but asserted that TBH was "driven to commit suicide".

The commissioners should not use categorical terms of suicide in absolute certainty as the precise mental state of the deceased could not be known.

Purported intention to suicide unconvincing

When read closely, the RCI para.[233] on "conclusion on forensic psychiatric aspects" does not confirm that TBH intended to commit suicide but speculated that TBH must have committed suicide:

"...TBH would have found that the only way for escape from the torment he was undergoing was by jumping out of the window, even though it meant taking his own life." (RCI, pp.72). However, such speculation is used as the reason to come to the suicide verdict: "...Having considered all the evidence in its entirety, we found that TBH was driven to commit by the aggressive, relentless, oppressive and unscrupulous interrogation to which he was subjected by certain officers of the MACC.." (RCI, pp.37).

Para. [233] is of utmost importance in determining whether TBH had the intention to suicide. RCI was unable to confirm the intention to suicide and yet it confirmed suicide had occurred. This is a deep contradiction and the inference is seriously flawed.

RCI is using a strange logic which is only intelligible to itself. It runs something like this: Teoh Beng Hock would have found suicide as the only way out. Therefore, TBH committed suicide. Speculation has then become hard fact. There is little wonder that the public refuses to accept the verdict.

But, why must RCI deliver a suicide verdict? Why not an open verdict? We do not know for what reasons the commissioners felt compelled or were compelled to make a verdict that contradicts its own reasoning. With an unconvincing verdict, the reasoning itself in the RCI needs to be examined critically.

Missing the mark in suicide definition

According to De Leo, Burgis, Bertolote, Kerkhof and Bille-Brahe (2006), the World Health Organisation working group had proposed a standard definition for the study of suicide:

"Suicide is an act with a fatal outcome which the deceased, knowing or expressing a fatal outcome had initiated and carried out with the purpose of provoking the changes he desired (WHO/Euro, 1986)".

The key elements of the WHO's definition involve: 1) an awareness that action has fatal outcome, 2) the self-responsibility of the subject both to initiate and to carry out the suicidal behaviour and 3) the intention to bring about wanted changes.

RCI's verdict of "driven to suicide" is not in accordance with WHO's definition of suicidal behaviour. RCI's speculation of TBH's thinking of "...would have found that the only way of escape...jumping out of the window" can only be described as suicidal thoughts rather than an act that was initiated and carried out by TBH himself.

By WHO's definition, one cannot force another to commit suicide without one's intention to commit suicide. One can force another to kill him/herself which is considered as homicidal. In 22 state and three territories of the United States of America, even assisting in suicide is a crime and the charge is murder.

RCI has not proved the crucial elements of suicide: (1) the locus of origin (self-initiated) and (2) the intention (to cause, or not to cause death). Neither has RCI proved that TBH was aware or conscious of the potential of fatal outcome.

The RCI verdict is therefore illogical conceptually.

RCI lacking legitimate data of psychology

To establish suicide or suicidal behaviours, from the legal point of point of view, both the physical act (actus reas) and the mental element (mens reas) must be present; the mental element is intentionality i.e. the intention to suicide. It is self-evident that evidence must be produced to support any claims of suicide as the manner of death.

From the psychological point of view, the legitimate data which can or should be used as evidence are derived from experimental methods, observations and introspections.

There are 4 different types of data:

• behavioural data
• personal accounts of inner experience
• symbolic data (symbolic creations of the mind such as texts or the language used), and
• material data like the biological data and neuropsychological data

Behaviour is what can be seen or observed from the outside. The data gained and evaluated is called outsider viewpoint without going into the mental state of the subjects studied.

The inner experiences involve the feelings, emotions, beliefs, thoughts, reasons, motives and intentions. The data gained/evaluated is called the insider viewpoint. These cannot be seen directly from outside and can only be accessible to others through verbal or written reports or inferred from non-verbal behaviours.

Insider viewpoint without evidence

RCI had provided an insider viewpoint of TBH's psychological state of mind without giving any basis of how the data of inner experiences were collected and evaluated. It is more appropriate to say that RCI reconstructed the reality of TBH's psychological state in such a way that the suicide verdict is inescapable. This is a serious flaw of RCI's reasoning.

The relevant passage is found in RCI para.[233] page 72 (in italics below) and my comment run as follows:

-"Tormented by this predicament, TBH experienced a change in his state of mind."

My comments: How did the commissioners know of TBH's torment of predicament and inner experience of psychological changes? What evidence?

- "And in a matter of hours, this change transformed him from being in the low-risk group for suicide into the high-risk group."

My comments: Why the immediate grouping into suicidal and not other category? How likely is that within a matter of hours a person becomes suicidal? Having suicidal thoughts is different from suicidal behaviour. What evidence of suicidal behaviour is there with TBH?

- "The doubts, extreme emotional conflict and the immense feeling of guilt were all intolerable."

My comments: Guilt is an inner emotion and thought. How do the commissioners know? What evidence of TBH's inner feelings was being manifested?

- "Finally, precipitating the irreversible crisis that happened to him between 3.30am and 7.00pm on the 16th, was the last straw that broke the camel's back."

My comments: Metaphor is no substitute for hard evidence. What really happened?

- "Finding no viable strategies to surmount the hurdle of accusations levelled, he found himself unable to escape from the suffocating quagmire in which he was trapped."

My comments: When and how did the commissioners know that TBH knew of no other viable strategies?

- "Losing all hope, TBH would have felt trapped and have succumbed to despair."

My comments: When and how did the commissioners know that TBH had lost all hope?

- "Since the window on the 14th floor was either open or could be easily opened and it was conspicuous..., TBH would have found that the only way for escape from the torment he was undergoing was by jumping out of the window, even though it meant taking his own life."

My comments: How did the commissioners know TBH's intention to suicide?

The above reconstruction sounds more like a survivor's account of suicide attempt.

Reconstruction and interpretation of suicidal thoughts and behaviours must relate to legitimate data. Without a proper and sound method of data collection and interpretation, we can only infer that the data is manufactured out of imagination.

RCI couldn’t have known

RCI had used various terms like "extreme emotional conflict", "guilt...all intolerable", "irreversible crisis", "losing all hope", "succumbed to despair" to give an account TBH's subjective psychological state of mind after the interrogations. Then, they described TBH's judgement of the extreme situation as "no viable strategies", "unable to escape" and "trapped". The depiction of TBH's immense emotional turmoil and the judgement of "no escape" was framed in such a way as to lead to the inevitable consequence of "jumping out of the window".

The way that extremes in emotion and impairment in judgement are attributed to TBH without any correlation to any specific time, specific location, specific events and specific details raises the serious doubt of its authenticity.

Highly subjective and using loaded phraseology

RCI used a large amount of rather emotional, subjective and value-judgement words and phrases to describe TBH's state of mind. For example:

"[219]...Taking his mobile phone away would have meant robbing him of his means to reality and sanity. And the MACC officers did just that. Thus, for the first time in his life, TBH found himself totally and completely isolated from the outside world and thrust into desolation..." (RCI, pp.71)

Are the commissioners suggesting that TBH was losing his sense of reality and sanity just because of a handphone? And suggesting that TBH was going insane?

And how do they know that it was the first time in TBH's life that he felt "totally and completely isolated"? Presumably, they had special access into TBH's autobiographical memories and all the life stories.

The first sentence of the RCI finding using a third-person perspective speaks of "...would have meant...". But by the third sentence, a speculation by RCI had become a fact – "TBH found himself totally....". It is a remarkable feat to blur the reality by switching from one dimension of reality to another.

It is important to analyse this short passage as the whole argument for the suicide verdict is constructed using similar lines of reasoning or reconstruction of mental reality.

Risk factors are not causal factors

Risk factors are still risk factors, however high or acute it is. Risk factors are not causal factors unless proven so.

Just because RCI suggests that someone feels trapped and troubled by hopelessness does not mean that the individual would commit suicide. In fact, even most people who have previously harboured suicidal thoughts still do not do so.

All the three psychiatrists who gave expert opinion to the RCI were of the view that TBH belonged to low-risk group for suicide after reviewing TBH's life history against the risk factors.

The psychiatrists were Dr Badi'ah Yahya, a forensic psychiatrist and Dr Nor Hayati Ali from the Ministry of Health, and Paul Edward Mullen, emeritus professor of forensic psychiatry, Monash University, Australia. Dr Badi'ah and Dr Hayati based their argument on the observation that TBH came from an intact family, had a stable job, and had no history of mental illness, impulsivity or substance abuse.

However, RCI ignored the expert opinions of the low probability of suicide and argued that TBH had undergone dramatic psychological changes from the low-risk group to the high-risk group for suicide when taken in by the MACC on July 15, 2009.

Quite early in their argument, RCI chose to categorise that TBH belonged to a high-risk group for suicide. Instead of choosing to argue out what was the probability of each of the manners of death (natural, accident, homicide or suicide), RCI ruled out all other scenarios and was fixated on the sole verdict of suicide.

RCI then used the hypothesised emotional state to justify suicide was the only way out for TBH.

No warning signs of suicide

RCI adopted the approach of insider viewpoint in arguing for the suicide verdict. RCI first classified TBH belonging to high-risk group for suicide and then provided purported details of TBH's inner emotions and thoughts before he purportedly took the decision to ‘jump’.

From their approach, we would have expected that RCI had managed to gather evidence of signs of TBH of wanting to commit suicide. Strangely, no such evidence was produced.

According to the American Association of Suicidology, a person in acute risk for suicidal behaviour most often will show the following warning signs:

• “Threatening to hurt or kill himself or herself, or talking of wanting to hurt or kill him/herself; and/or
• Looking for ways to kill him/herself by seeking access to firearms, available pills, or other means; and/or
• Talking or writing about death, dying or suicide, when these actions are out of the ordinary.”

RCI had not provided any credible and convincing evidence that TBH had suicidal thoughts or suicidal behaviour. It is at best mere speculation and at worst the manufacture of inner experience of a supposedly insider viewpoint.

RCI had failed immensely to establish TBH's intention to suicide.

TBH stable and supported

Van Orden et al. (2010) proposed that the most dangerous form of suicidal desire is caused by the simultaneous presence of two factors – the thwarted belongingness (I am alone) and perceived burdensomeness (I am a burden) – and the hopelessness of these situations.

Also, the individual must acquire the capacity to engage in suicidal behaviour.

It is most unlikely that TBH would have felt hopeless when he was only detained less than 24 hours and there were ample opportunities for him to be reconnected to the outside world.

There is no reason for TBH to entertain the thought that his family, friends and colleagues in the outside world had abandoned him.

Subsequent events following news of TBH’s death saw an outpouring of support – including many friends, colleagues and ex-colleagues – for the family. It is clear from this that TBH had a sound social network of support to cope with any traumatic events.

Thus, the attribution of despair and hopelessness by RCI onto TBH is falsely created.

A physical and mental wreck will not commit suicide

Para. [229] stated that "By the time the fourth or final stage of the interrogation was over, TBH would have been almost a mental and physical wreck. When Ashraf fetched him a glass of water [demanded impolitely by TBH], TBH was said to have sat up very slowly."

It is clear that in such a tortured weakened state, TBH would not have sufficient strength to commit suicide. When he could hardly move, he could not be expected to jump out of the window. This RCI conclusion now of TBH’s physical near collapse is self-contradictory to its melodramatic reconstruction of a fevered, despairing mind planning an energetic act of self-annihilation.

It is more probable that TBH would want to get out of the dreaded MACC building the moment he had the chance and the energy.

Conclusion

The RCI's suicide verdict is questionable as the reasoning in its argument is deeply flawed. Mere speculation of TBH's psychological state prior to death had become hard facts.

The authenticity of the evidence of intention to suicide used to support the claim is doubtful.

The inference from such evidence to the conclusion of suicide is invalid and unsound.

RCI based its reasoning on reconstructed suicidal thought. It is not inevitable that suicidal thoughts would lead to suicide. Also, it has not provided any evidence of suicidal behaviour or warning signs of suicide. The seriously weakened mental and physical state TBH as described by the commissioners shows that suicide is implausible.

RCI should have delivered an open verdict as it is a matter of intellectual honesty and integrity to respect facts and evidence.

Death would only have meaning when the truth is revealed and justice is done.

Reference List

De Leo, D., Burgis, S., Bertolote, J.M., Kerkhof, A.J.F.M., and Bille-Brahe, U. (2006), Definitions of suicidal behaviour. Crisis, 27(1), 4-15.

Van Orden, K. A., Witte, T.K., Cukrowicz, Braithwaite, S.R., Selby, E.A. and Joiner, Jr., T.E. (2010), The Interpersonal Theory of Suicide, Psychological Review, 117 (2), 576-600.