Month: November 2019

Criminal JusticeExpert WitnessForensic PsychiatryUncategorized

Coerced Suicide: Forensic Psychiatry Expert Witness Details Murder by Proxy

Last week the news exploded with the story of Alexander Urtula’s suicide. The story garnered attention because of the allegedly outrageous actions of Mr. Urtula’s ex-girlfriend, Inyoung You, who is accused of psychologically manipulating Urtula and pushing him to kill himself.

Reports from the Boston Globe outlined the accusations against Inyoung You, a 21-year old former Boston College student and South Korean national, who badgered her ex-boyfriend into committing suicide.

In an editorial article calling for a coerced-suicide law in Massachusetts, the Boston Globe stated “According to prosecutors, You psychologically and physically abused her boyfriend, Alexander Urtula, over an 18-month relationship, and repeatedly urged him to kill himself. The two exchanged 75,000 text messages, which Suffolk County District Attorney Rachael Rollins said showed You’s ‘complete and total control over Mr. Urtula both mentally and emotionally.’”

Readers may recall a similar incident, out of Massachusetts, which made headlines back in 2017 when Michelle Carter was tried for involuntary manslaughter for the death of her boyfriend, Conrad Roy. You can read more about that case in this Washington Post piece.

These two cases from the same state, with strikingly similar fact patterns, ending in the suicide death of two young men has made the state consider a law about coerced-suicide. An issue, I might add, my lay mind never would have considered necessary.

The reason Massachusetts is considered a coerced-suicide law is pretty straight-forward. Michelle Carter was prosecuted and convicted of involuntary manslaughter. Inyoung You, is now being charged with the same crime. However, the punishment for involuntary manslaughter in Massachusetts, carries a punishment of up to 20 years. Whereas a proposed law, Conrad’s Law (named after Michelle Carter’s victim), would make punishment for coerced-suicide a 5 year maximum sentence.

To me this makes sense. If you do not actually cause the death (i.e. pull the trigger or pilot the automobile) then you should not face the same criminal liability as someone who did cause loss of life. With that said, you need to be punished for being a truly terrible person and manipulating someone to take their own life.

Now, I do have difficulty with words being used to convict someone of a crime. The ACLU had difficulty with this too when they criticized the Michelle Carter case. They felt it would chill free speech. I understand that concern, so I needed to dig into the psychological manipulation and coercion aspect a bit deeper.

Lucky for me, I have access to an incredible database filled with expert witnesses and consultants. Turns out I didn’t have to look far, because one of my members, Dr. Sanjay Adhia was already sharing about the subject matter on social media. So we coordinated a little question and answer on the topic.

Forensic Psychiatry Expert Witness Dr. Sanjay Adhia:

Dr. Sanjay Adhia is triple-Board-Certified in Psychiatry Forensic Psychiatry and Brain Injury Medicine. In addition to forensic/expert witness practice, Dr. Adhia serves as the Assistant Professor of Psychiatry at University of Texas Health and Science Center and a Psychiatry Consultant at The Institute for Rehabilitation and Research (TIRR) Memorial Hermann in Houston. He treats those with brain and spinal cord injury who have complicating psychiatric disorders along with general psychiatry and addiction psychiatry patients.

His forensic practice focuses on the psychiatric impact of personal injury, abuse, competency, violence, intoxication and complicating mental illness. He is experienced at assisting attorneys in medical malpractice and wrongful death claims. He also performs occupational and other Independent Medical Exams. In addition, Dr. Adhia works with Physicians for Human Rights and DAYA Houston to assess victims of kidnapping and false imprisonment, human trafficking, undue influence, physical and sexual abuse and rape. Learn more about Dr. Adhia’s practice by visiting his webiste: www.forensicpsychiatrynow.com.

Let’s get to the nitty-gritty. I provided questions and Dr. Adhia provided some outstanding answers regarding coercion.

NR: According to the article from the Boston Globe, coerced-suicide has not been defined by law. Does forensic psychiatry have a definition? If not, can you describe how you would define “coerced suicide?”

Dr. Adhia: As far as I know, there is no formalized definition of “coerced suicide” for forensic psychiatrists. With coerced suicide, there could be an element of undue influence which is defined as “influence by which a person is induced to act otherwise than by their own free will or without adequate attention to the consequences”[1]. I believe “coerced suicide” should be distinguished from “assisted suicide”.

NR: Can you describe what one may be going through when considering suicide?

Dr. Adhia: Suicidal ideations are generally accompanied by severe distress.  Suicide is seen as a solution to the distress and may be perceived as the best if not only solution. It may start with fleeting thoughts without intent to more frequent thoughts with intent. One may then consider various methods of suicide and develop a plan. There could be several suicide attempts before a completed suicide.  Of course, there are instances when a catastrophic stressor or coercion may lead to an impulsive suicide without a preceding history.

From the media account, Mr. Urtula was described as having depression. One of the potential symptoms of Major Depressive Disorder (MDD) are suicidal ideations.  Additionally, victims of abuse can have suicidal ideations without necessarily having depression.

With additional information, we may be able to determine if Mr. Urtula had suicidality brewing for months or if he was suddenly coerced to jump without any preceding suicidal intent.

NR: This is now the second high-profile case involving young women encouraging a boyfriend to end his own life. Would this qualify as a form of domestic abuse according to psychiatrists?

Yes. However, I would expect there be other forms of abuse present preceding the coerced suicide. The literature often refers to domestic abuse as Intimate Partner Violence (IPV). According to the Centers for Disease Control and Prevention[2], there are four types of IPV:

  1. Physical violence
  2. Sexual violence
  3. Stalking
  4. Psychological aggression

Coerced Suicide would be consistent with psychological aggression which is defined by the CDC as “use of verbal and non-verbal communication with the intent to harm another person mentally or emotionally and/or to exert control over another person”. According to prosecutors, Mr. Urtula endured both physical and psychological abuse. The fact that he was located at the parking garage may represent stalking.

Of note, Intimate Partner Violence in of itself, absent suicide coercion, can lead to unintended suicide.[3]

NR: Would coercion in a suicide case (involuntary manslaughter) be similar to the coercion involved in an “undue influence” matter? Are the power dynamics similar?

Dr. Adhia: Coercion is one of the tactics involved in undue influence. Undue influence constitutes controlling others by utilizing the dominance or authority in a relationship, taking advantage of a vulnerability and by employing certain tactics.[4] These tactics include controlling necessaries in life, using or withholding affection, intimidation and coercion. Coercion is the act of threatening to compel an act.

It is worth referring to the proposed “Conrad’s Law” which indicates coerced suicide involves “substantial control or undue influence over the victim, or to have manipulated their behavior through fraud or deceit”.[5]

NR: Some stories I’ve read, indicate Inyoung You had “complete and total control” over Mr. Urtula. How would a person find themselves under complete and total control of a significant other?

Dr. Adhia: To understand how Ms. You would achieve such control; one can look at the cycle of IPV[6] which consists of:

  1. Tension Building Phase
  2. Acute Battering Episode
  3. The Honeymoon Phase

In the first phase, the victim attempts to appease the perpetrator in hopes of avoiding abuse. It may feel as if the victim is walking on eggshells. Eventually the tension will build and phase two will occur with the abuse. Afterwards, there will be a honeymoon phase where the abuser will convince the victim to stay in the relationship. The abuser could promise an end to the abuse. Many of the victims have been are conditioned to be highly dependent on the abuser. They may be convinced they will be unable to obtain love and happiness without the abuser. This may help explain why Mr. Urtula did not leave Ms. You and how she was able to gain control of him.

According to the CNN article, Ms. You threatened self-harm to manipulate Mr. Urtula in order to control and isolate him. She sent him over 47,000 texts and commanded him to end his life.  The abuse escalated just prior to the suicide. She tracked the location of Mr. You and was at the scene of the parking garage where he jumped to his death.

In Mr. Urtula’s case, it is likely he was rendered particularly vulnerable due to depression. Some of the symptoms of depression include fatigue, indecisiveness, decreased concentration along with feelings of worthlessness, helplessness and hopelessness.

With the interplay of Depression accompanied by the tactics and dynamics of IPV, one can get a sense of how Ms. You could achieve “complete and total control” over Mr. Urtula.

NR: Anything additional you feel like you need to add to this story… Please do so.

Dr. Adhia: The hope is someone with suicidal ideations in a relationship would have a supportive partner who will encourage their loved one to seek help. In extreme cases, a partner can call 911 and involuntary treatment in a psychiatric hospital can be sought. There are unfortunate instances when the partner does not recognize the signs of suicide or does not know help is available.  In Mr. Urtula’s case, it appears his partner literally pushed him off the parking garage.

The mass suicide in Jonestown by devotees of Jim Jones could be considered a mass coercion. Jim Jones had his followers practice drinking the Kool Aid. Having the children drink the Kool Aid first served to coerce the parents to follow course.

The Urtula and the Conrad case reminds us both males and females can be victims of Intimate Partner Violence. It is worth noting that the dynamics could be more complicated if there are children involved and the victim is financially dependent on the perpetrator.

If a victim is danger of imminent violence or suicide, call 911 to obtain immediate assistance. Other phone numbers can be found https://ncadv.org/resources.


Special thanks to Dr. Sanjay Adhia for taking the time to help educate us about this unfortunate matter of coerced-suicide. Please share this article with those who need to read it. Please take care of those around you. Let’s all try to be a little nicer to each other.

[1] Lexico Definition https://www.lexico.com/en/definition/undue_influence

[2] Preventing Intimate Partner Violence https://www.cdc.gov/violenceprevention/intimatepartnerviolence/fastfact.html

[3] Intimate Partner Violence – A Pathway to Suicide By Tony Salvatore https://leb.fbi.gov/articles/featured-articles/intimate-partner-violence-a-pathway-to-suicide

[4] Defining Undue Influence Mary Joy Quinn (October 15, 2018) https://www.americanbar.org/groups/law_aging/publications/bifocal/vol_35/issue_3_feb2014/defining_undue_influence/

[5] Bill calls for coercion to be a crime https://www.sentinelandenterprise.com/2019/07/25/bill-calls-for-coercion-to-be-a-crime/

[6] The Cycle of Domestic Abuse https://www.domesticviolenceroundtable.org/domestic-violence-cycle.html