Here are five reasons why Elliott Smith’s death is probably not a suicide:
1. The method: Most stabbing deaths are homicides (1). According to many studies, suicide by sharp force injuries account for less than 2% of all suicides, and according to an article by William A. Cox, M.D. Forensic Pathologist and Neuropathologist: ‘a fundamental approach you may want to use is to consider all deaths as the result of incised and or stab wounds as homicides until proven otherwise’ (2). Among 700 cutting and stabbing fatalities studied in the article (and keep in mind that this also include death by cutting not stabbing) 80% were due to homicide, 18% to suicide and 2 % to accident (2). In another study (5), self-stabbings represented only 10% of all deaths from cutting and piercing instruments. Thus, suicides by stabbing are unusual, and ‘one of the most common sites for self-inflicted incised wounds is the neck’ (2) not the chest.
2. The circumstances of the death: Elliott and his girlfriend were arguing the day of his death: They had been fighting all morning long and the neighbors did hear the violent fight since the two were slamming doors and screaming. She said she locked herself in the bathroom because she wanted to isolate herself, used to Elliott’s melodramatic threats – he allegedly said he wanted to kill himself (3) – or because she was sick of his paranoia (4). She ignored his begging, as he was allegedly asking her to come out, apologizing, and knocking on the door. In Gil Reyes’ documentary and during the Q&A following the screening, she said she stayed there no longer than 5 or 10 minutes. When she exited she found Elliott with the knife in his chest. How many people commit suicide in the middle of a fight or even shortly after of a fight? And in comparison, how many people are killed following a fight due to domestic violence? Plus this happened in the middle of the day (the 911 call was made at 12:18 pm), whereas ‘most of the self-inflicted stabbings (69%) occurred at night or in the early hours of the morning’ (5), and very few self-stabbings are actually witnessed ‘in only 2 (7%) cases’ in this same study (5).
3. The forensics of the wounds: Elliott had two deep wounds in the chest. Although most suicides by stabbing have a single wound (6), and isolated cut wounds are predominantly observed in suicides (7), everything is possible at this level as the quantity of cuts is generally not a good predictive factor relative to the manner of death; however, another study notes only 3 out of 17 cases of suicide with more than 3 wounds (8). Furthermore, the thorax is the most targeted region for homicide victims and the upper limbs for suicides (7) and (8). In the case of suicide, self-inflicted cut wounds are usually found to the neck or wrists (1), (2) and (9). The direction of the stabbing is also sometimes an indication: in Elliott’s case, both stabs were ‘slightly downward’, although the term ‘vertical’ is not used in the autopsy, vertical orientation of any chest wounds strongly suggest homicide (7) and (8). Still according to the autopsy report, if stab wound #1 ‘entered the chest cavity through the 5th intercostal space’, stab wound #2 ‘perforated the left edge of the sternum’. According to a large study including 118 sharp force fatalities, there is ‘a higher likelihood of a homicide if bone or cartilage wounds were present and a higher likelihood of a suicide if these wounds were absent’ (7). In this same study the authors wrote that ‘in order to explain the lower frequency of bone or cartilage wounds in suicides, one can easily imagine that suicide victims avoided solid anatomical structures, such as ribs and the sternum. In contrast, the frequency of bone or cartilage wounds in homicides may be high because assailants ignore the presence of these solid structures’. Thus, the perforated sternum in Elliott’s case could indicate homicide. Also it seems that the severity of the wounds is another indicator of the cause of death as ‘wounds caused by assailants to their victims were more severe than those inflicted by the victims of suicides to themselves’ (7). On the autopsy report, the estimated depth of penetration of Elliott’s wound #2 is between 5 and 7 inch (12.7 -17.8 cm) which is quite severe. Last point, the stabbing occurred through the clothes which could indicate homicide: In most homicides, the wounds are made through clothing whereas wounds under clothing indicate suicide (1). In most suicides with chest or abdominal wounds, the chosen area is exposed (6) and clothing damage is absent (6) (9). Thus clothing damage by sharp force is interpreted as an indication of homicide (10).
4. The lack of hesitation wounds and the possible defense wounds: Often when a person stabs itself, hesitation wounds (superficial incised wounds) are made before the fatal deep wound. They indicate indecision before the final act. Elliott didn’t have any hesitation wounds around the large stab wounds in his chest and his neck and wrists were intact. Schultz wrote that Scheinin suggested that hesitation marks could have been obliterated by the stabbing itself, but she never said this to me when I interviewed her and I have never found anything related to this in literature. According to many studies, hesitation marks are a strong indicator of suicide, and ‘are believed to be the most useful indication in distinguishing suicide from homicide’ (9). According to many investigations, they are present in most cases of suicides (>70%) from sharp weapon injury (6) (9), (10), (11) (12) (13) (14) and (15). On the other hand, the small cuts on his left palm and right upper arm could be interpreted as possible defense wounds, although they could have been done by mishandling the knife. They were very small, but they were certainly not due to self-injury. And yes Elliott was right handed, which makes the cut on his right arm a bit weird. Obviously, defense wounds are a strong indication of homicide (2), were detected in 61% of the cases in a large study (15) and they are most frequently found on hands, arms and forearms (15).
5. The removal of the knife: Despite the fact that she holds an MA in Clinical Art Therapy from Loyola Marymount University, has 15 years of experience working as an art therapist for a number of non-profit, community mental health organizations, his girlfriend removed the knife from the wound when she saw him, still standing. After an inquiry about the training of art therapist, the assistant Director of Human Resources of Five Acres, where she has worked, told me: ‘All of our direct care staff, including our therapists, is trained in CPR and First Aid.’ She had been a licensed therapist since 1995, and has worked with damaged children. A colleague of hers confirmed me she should have known better ‘I cannot stress this enough: Anyone who takes a Basic First Aid class, even the people who sleep through it, are scared straight from any idea of removing an impaled object of any kind. It creates a second trauma and increases the bleed. You leave it in and wrap it to staunch the bleeding. This is particularly stressed in training for clinicians who work with children!!!’
All these points are facts, not opinions, and I know that statistics don’t always explain everything, but suicide in Elliott’s case would make him an incredibly odd statistic. After going through all this, it is difficult to understand why many people still believe it was a suicide.
(1) ‘Criminal investigation’ by Christine Hess Orthmann, Kären Hess
(2) ‘Sharp edged and Pointed Instrument Injuries’ by William A. Cox, M.D. Forensic Pathologist/Neuropathologist (2011)
(4) ‘Torment Saint: The Life of Elliott Smith’, By William Todd Schultz
(5) ‘Suicide by Self-stabbing’ by R.D. Start, C.M. Milroy and M.A. Green, (1992) Forensic Science International 56
(6) ‘Suicide by self-stabbing’ by Start RD, Milroy CM, Green MA. Forensic Sci. Int. (1992) 56:89–94.
(7) ‘Homicidal and suicidal sharp force fatalities: Autopsy parameters in relation to the manner of death’ by Christophe Brunel, Christophe Fermanian, Michel Durigon, Geoffroy Lorin de la Grandmaison, Forensic Science International 198 (2010) 150–154
(8) ‘Homicide-Suicide by Stabbing Study Over 10 Years in the Toulouse Region’ by V. Scolan, N. Telmon, A. Blanc, J. P. Allery, D. Charlet, and D. Rouge, Am. J. Forensic Med Pathol (2004) 25: 33–36
(9) ‘Retrospective study on suicidal cases by sharp force injuries’ by Setsuko Fukube, Takahito Hayashi MD, Yuko Ishida PhD, Hitoshi Kamon, Mariko Kawaguchi, Akihiko Kimura PhD, Toshikazu Kondo PhD, MD, Journal of Forensic and Legal Medicine 15 (2008) 163–167
(10) ‘Patterns in sharp force fatalities – a comprehensive forensic medical study: part 2. suicidal sharp force injury in the Stockholm area’ by Karlsson T, Ormstad K, Rajs J., 1972–1984. J Forensic Sci (1988) 33: 448–61.
(11) ‘Sharp injury fatalities in New York City’ by Gill JR, Catanese C. J Forensic Sci (2002) 47: 554–7.
(12) ‘Suicides by sharp force: typical and atypical features’ by Karger B, Niemeyer J, Brinkmann B.. Int. J Legal Med (2000) 113:259–62.
(13) ‘Tentative injuries in self stabbing’, Vanezis P, West IE.. Forensic Sci. Int. (1983) 21:65–70.
(14) ‘Criteria for homicide and suicide on victims of extended suicide due to sharp force’ by Dettling A, Althaus L, Haffner HT. injury. Forensic Sci Int. (2003) 134:142–6.
(15) ‘Suicidal and homicidal sharp force injury: a 5-year retrospective comparative study of hesitation marks and defense wounds’ by Stephanie Racette, Celia Kremer, Anne Desjarlais, Anny Sauvageau, Forensic Sci Med Pathol (2008) 4:221–227
Originally published on Rock NYC (January 2 2015)