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CASE STUDY #12 - MOTOR VEHICLE ACCIDENT

IN A SUDDEN CHOICE SCENARIO

The last case study we will report is that of a motor vehicle accident (MVA) involving a 51-year old male driving a passenger car late at night on a wet country road. The subject had a long history of depression (see appendix A, "DIARY OF A DEPRESSED SUBJECT). He was being treated with any-depressant medication and seeing a psychiatrist. While it is true that at the time of the accident the subject was showing signs of improved emotional functioning, he nonetheless carried a history of despondency into the critical moments that led to his death.

As we found in the preceding eleven case studies, the subject scored below .40 on the DSI-HSC Scale of Happiness and Social Integration, as developed by Saleh and Lombardo (See Table # 6, "COMPARISON OF SUBJECTS LIVING ACCIDENT-FREE AND SUBJECTS WHO DIED BY ACCIDENT").

As we explained in PART I, A THEORETICAL MODEL LINKING DEPRESSION AND ACCIDENTAL DEATH, subjects who score low on the DSI-HSC Scale have a statistically significantly increased risk of death by "accident." Scores of .18-.37, which put them well into the Despair & Social Isolation range, are typical of this group, while those subjects who score high in Happiness and Social Cohesion (HSC) have a low probability of accidental death or injury.

Case #12 is typical of this group. The subject has a mean DSI score of .21, one of the lowest in the study. We found written evidence of subjective despair in the subject's diary, and anecdotal evidence of a long history of depression in letters and other evidence from family members(See Appendix B, "LETTERS FROM A DAUGHTER,".

It is clear that this individual, like all those with low scores, lack a strong social cohesive bond. This subject's only network consisted of students and immediate family. Other than these socially mandated ties, the subject had very little Social Cohesion, and, hence, was SOCIALLY ISOLATED.

The isolation of this subject fed the feelings of despair and low self esteem, as evidenced in the diary notes, and confirmed by the psychiatrist's note to the coroner, (See "PSYCHIATRIST MEMO," same appendix).

In subjects such as these, a positive feedback loop occurs, whereby depression reinforced isolation, isolation reinforces depression, and the two drive the individual down in descending circles of despair.

This analysis is consistent with the reports of Zymenski (1991), Beckwith (1992) and Saleh (1988), and it supports the theoretical model which was first proposed by Saleh and Lombardo in 1986.

These studies have demonstrated that depressed individuals who score low on the DSI/HSC Scale have a statistically significant increase in accidental deaths. There is an inverse relationship between scores and the probability of accidental death, and as the scores lower, the accident rate increases.

The Subject Questionnaire developed by Zymenski (Appendix A, "A Survey Tool for Measuring Affective States and Social Bonds," Zymenski, 1989) and modified for our research has allowed us to quantify this emotional and behavioral state, and thus has led to a predictive tool.

Moreover, through our research we have identified a heretofore unreported social-psychological factor in the study of depression and accidental death. This factor, which we have chosen to call "The Altruistic Factor," has proven to be a crucial "trigger" in the complex of emotional states and sudden choice scenarios which lead to accidental death.

Put another way, we believe that persons with a high sense of moral duty and a long pattern of depression and social isolation, are likely to suffer accidental deaths when suddenly and unexpectedly placed in a Sudden Choice Scenario.

Our research suggests that accidental deaths in the presence of the Risk Factors stated above are most likely to occur in a sudden choice scenario. The subject's decision is sparked by the appearance of a threat to another living thing, either person or animal, or, in some cases (Zymenski, 1990, Tussloe, 1985), prized objects. Rather than risk injuring or destroying this other living or treasured thing, the subject chooses his/or own death. The primordial drive for self-preservation is overcome by the inner sense of self-destruction and the outer sense of moral obligation to others.

To put it succinctly, and, indeed, to put it bluntly, depressed people are much more likely to commit spontaneous suicide. Statistical evidence further suggests that even when these subjects are expressing a relatively POSITIVE OUTLOOK, and even showing signs of mood elevation, the risk of suddenly choosing death remains. We believe the evidence supports the scenario whereby Subject #12 swerved to avoid an animal in the road (4) (See Appendix B, "REPORT OF MOTOR VEHICLE ACCIDENT"), knowing that his life would be ended. The terminal event, an accident, involved a choice which put the subject's life second and the life of a wild animal first.

In the final section, PREDICTING SUDDEN CHOICE ACCIDENTAL DEATHS, we will look at predictors of spontaneous suicide as a useful and externally valid predictor of suicide. We will attempt to define this population with greater precision than Saleh or Lombardo have, and we will investigate a therapeutic model that may, with further study, diminish the probability of unexpected death by accident in a sudden choice scenario for this underreported, at-risk population.

We will also offer a brief summary of Grief Theory as it applies to family members who have unexpectedly lost a loved one. We will offer anecdotal evidence describing individuals who have escaped the dysfunctional family traits (See Appendix B, LETTERS FROM DAUGHTER).

Proposals for further social research are appended. It is clear that this area has been both poorly researched and given only a cursory examination in the literature. The difficulties of uncovering motivations and decision-making processes among these subjects notwithstanding, we will propose study models which are practicable and valid.

ACKNOWLEDGMENTS: The author wishes to express gratitude to his thesis committee, in particular to INSTRUCTOR RAUL CASTRO, Chairman Ch....

Timothy Sheard is a member of the New York Mystery Writers of America. He has published over twenty mystery and suspense stories this year in Kracked Mirror Mysteries, Mystery Notebook and the National Examiner's “5-Minute Mystery Series.” Tim is a veteran RN who has sold many articles to the nursing journals and mainstream press, including the Philadelphia Inquirer and Detroit Free Press Sunday Magazines. He has also published on the WWW in Walter Sorrell's The Mystery Zone.

“Descending Circles” was inspired by Tim's sons' computer mystery games.

Email:Timothy Sheard

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