why do people hang themselves on trees? an evaluation of suicidal hangings on trees in konya,...

PAPER

PATHOLOGY/BIOLOGY; PSYCHIATRY & BEHAVIORAL SCIENCE

Kamil Hakan Dogan,1 M.D., Ph.D.; Serafettin Demirci,2 M.D.; and Idris Deniz,2 M.D.

Why Do People Hang Themselves on Trees?An Evaluation of Suicidal Hangings on Treesin Konya, Turkey, between 2001 and 2008

ABSTRACT: Hanging is the most common method of suicide in the world, and many public places offer a means or opportunity to carryout the activity. Of 4,452 death examinations and autopsies, there were 378 (8.5%) suicides and suicide method was hanging in 185 (48.9%)cases. In 20 of these (10.8%), the suspension point was the branch of a tree. The incident location was the garden of the victim’s house in ninecases, the woodlands in seven cases. The suicides were attributed to psychiatric disorders in nine cases, economic problems in six cases, andfamily problems in five cases. It is concluded that hanging on a tree as a suicide method is often committed by males and the underlyingmotive may be different in suicidal hangings on trees occurring at daytime and night. For preventional purposes, the reporting of such suicidesin public places by the media may be restricted by local authorities.

KEYWORDS: forensic science, hanging, asphyxia, suicide, death, tree

Suicide is one of the most common causes of nondisease-related death, and it is a major public health problem worldwide(1). It is ultimately a deadly violence directed against oneself.As a form of death, it has evoked and evokes a multiplicity ofreactions from the living, ranging from sadness and fascinationto repulsion and condemnation (2). It is largely preventable.Unlike many other health issues, the tools to significantlyreduce the most tragic loss of life by suicide are available (3).The incidence rate of suicide increases daily. Every year, almostone million people die by suicide throughout the world. In2020, it is estimated that one suicidal death on an average every20 seconds with one attempt of suicide every 1–2 sec will occur(4,5).Suicidal behavior can be conceptualized as a complex process

that can range from suicidal ideation, which can be communi-cated through verbal or nonverbal means, to planning of suicide,attempting suicide, and in the worst case, completed suicide,which is the act of taking one’s own life. Suicidal behaviors areinfluenced by interacting biological, genetic, psychological,social, environmental, and situational factors (6).Nearly one-third of all suicides occur in public places. The

pattern of locations is heavily influenced by local geography (7).Indoor and outdoor suicide rates may differ in some regions. Go-ren et al. (8) evaluated suicide in children and adolescents at aprovince in Turkey and reported that 12% of the victims com-mitted suicide outdoors. Nonetheless, in a study conducted in a

province of the Black Sea region of Turkey, it was reported thatmost of the female suicides (95.7%) were committed at homeand related places (9). Suicidal acts carried out in public placescan be highly traumatic for witnesses (7,10,11). The associationof bridges and high buildings with suicide by jumping is wellknown, but many other public places offer a means for commit-ting the act (12). Some of the world’s most famous structures,such as the Eiffel Tower, the Empire State Building, the SanFrancisco Bay Bridge, the Sydney Harbour Bridge, and thepagoda in Kew Gardens, hold a strong fascination for peopleprone to take their own lives. In fact, these have been called the“deadliest” architectural structures, and, as a result, the pagodain Kew Gardens was closed to the public in the early 1900s.The Eiffel Tower, for example, has lured hundreds of victimsinto committing suicide either off, on, or around it. Most havejumped, but a few have also shot or poisoned themselves in itsimmediate vicinity. Over the years, tower authorities have put upspecial grilles and fences to prevent people from jumping off thetower, but there are still people determined enough to crawlthrough ventilators to find a suitable jumping platform (2). Out-door settings such as roadways, freeways, fields, parks, andcampgrounds were reported as a suicide locale in 10.7% to 34%of the cases (5,13,14).Hanging is the most common method of suicide in the world,

because it is inexpensive and easy (15). In any given location,there are numerous materials such as ropes, cords, and fabricfrom which a ligature can be fashioned, as there are severalstructures from which a ligature can be suspended (16). In astudy which compared completed and attempted suicides inJapan, in the completed suicide group, an overwhelming numberof suicide completers used hanging as the suicide method.Because the method of suicide is one of the important factorsdividing suicides into completed and attempted, it was concluded

1Department of Forensic Medicine, Faculty of Medicine, Selcuk Univer-sity, Konya, Turkey.

2Department of Forensic Medicine, Meram Medical School, Necmettin Er-bakan University, Konya, Turkey.

Received 27 Mar. 2013; and in revised form 28 Nov. 2013; accepted 14Dec. 2013.

1© 2014 American Academy of Forensic Sciences

J Forensic Sci, 2014doi: 10.1111/1556-4029.12589

Available online at: onlinelibrary.wiley.com

that hanging was a lethal method (a method by which it is easyto complete suicide) (17).Every area will have particular sites and structures that lend

themselves to suicide attempts, and detailed analysis of localdata is the only way to identify high-risk locations. Some loca-tions may offer possibilities for suicide by a range of methods(18). As it may not be possible to prevent hanging suicidesthrough the restriction of access to ligatures and ligature pointsoutside institutional settings, the focus needs to be on under-standing the reasons for the use of this method and the preven-tion of factors leading to suicide (19).Komar et al. (14) reported that although Aboriginal people

represented only 27% of total hangings, they accounted for58.2% of the outdoor hangings, suggesting a cultural bias notonly in suicide method but also in location. Suicide was reportedto take place in public buildings or places (14.3%) as well as innature (14.2%) in Switzerland (20). The second most commonplace of suicide was in a public area (park or wooded area,bridge, or other public place), which constituted 16.9% of casesin a study by Callanan and Davis (16).Trees have been, and remain, universal symbols, totems, and

icons. Trees are creatures of admiration, reverence, fear,romance, mysticism, and worship to the people around them.Trees are more than their components of wood, leaves, and bark.They occupy the physical world but, in addition, occupy a spe-cial psychological place in human consciousness (21). While sui-cide by hanging on a tree generally accounts for a relativelysmall proportion of all suicides, such deaths are often very pub-lic events.An interesting myth about suicidal hangings on trees exits in

the west Sepik Province of Papua, New Guinea. The myth ofthe hanging tree portrays the primordial origins of suicide as pre-ceding “natural” death in mythico-historical times. As in mostimages of suicide, the myth emphasizes and depicts them as fun-damentally the consequence of a flaw in both bodily and spiri-tual constitution implanted in the fetus at conception by themysterious force of “ancestral fate or destiny.” It also recognizesthat an individual’s life circumstances, especially the experienceof severe social isolation, may exacerbate this congenital flaw(22).In Buganda, a subnational kingdom within Uganda, suicide

was normally committed by hanging on a tree or inside a house.Anyone who died by suicide was punished by shaming thatincluded being denied an honorable burial because, althoughrare, historically, the people in Buganda were very superstitiousabout suicide. If a suicide occurred by hanging on a tree, thebody was cut down from where it was hanging along with thetree and taken to the crossroads and cremated with all materialpossessions of the deceased (23).Another cultural and symbolic example of suicidal hangings

on trees is the “forest suicides” in Japan. Aokigahara-Jukai (Ju-kai), a dense forest at the foot of Mt. Fuji near Tokyo, hasbeen known as a leading suicide site in Japan since the 1340swhen the first suicide was committed by a Buddhist monk.Since then, Jukai has gradually become a popular suicide site.According to local folklore, once a person had entered this for-est, it would be impossible to find a way out (2). In the early1960s a novel which included a final scene in which the hero-ine tried to commit suicide by entering Jukai was publishedand became a best seller. Since then, Jukai has become evenmore widely known throughout Japan as a suicide site. Primar-ily young males (20–30 years) tend to enter Jukai for purposesof suicide. People use Jukai when they have definitely decided

to commit suicide. Supposedly, they develop amnesia immedi-ately after entering the forest. The meanings of suicide in Jukaihave been reported as follows: (i) infectiousness and symbolicfactors played a significant role in their choosing Jukai as thesuicide site; (ii) people tried to purify their death by commit-ting suicide in Jukai; (iii) the suicide victims at Jukai felt as ifJukai was a sanctuary where they were accepted and their sui-cides were allowed; (iv) people travelled a long way to Jukaiand while traveling, repeatedly confirmed their will to taketheir own life at Jukai; (v) they wished to share the same placewith others and belong to the same group by choosing Jukaias their suicide site; and finally (vi) they wished to disappearwithout being noticed or disturbed in Mt Fuji’s dense forest(24).Although there are studies on specific suicide methods in spe-

cific locations, that is, jumping from high-rise hotels or bridges(25–27), we have not yet encountered any studies focusing onsuicidal hangings in specific locations. There are only some cul-tural and symbolic examples regarding suicidal hangings ontrees. In this study, we aimed at evaluating the features of sui-cidal hanging on tree cases from the province of Konya, Turkey,along with published data available in the literature.

Materials and Methods

Konya is the fourth largest city in Turkey, and the locale inwhich this study was conducted. It is located in the Middle Ana-tolia Region, and according to the census data for 2011, the totalpopulation was 2,038,555 of which 1,009,855 were male and1,028,700 were female (28).This study retrospectively investigated 4,452 death examina-

tions and autopsies that were performed by forensic pathologistsat the Konya branch of the Forensic Medicine Council (Turkey)and in the districts of Konya between 2001 and 2008. Forensicpathologists participated in the death scene investigation of thesecases. During the autopsies, forensic pathologists were able toaccess all information on the forensic investigations as well asseek other information concerning the victims through interviewswith the relatives of the deceased persons.The detailed autopsy reports with investigation files of the

cases of suicides and particularly suicidal hanging on trees werereviewed. All of the suicide cases were evaluated according tosuicide locations (indoors vs. outdoors). Each suicidal hangingon tree case was also evaluated according to the victim’s age,gender, incident location, time of incident, ligature material,height of suspension, suicide note, previous suicide attempt, sui-cide motive, psychiatric disorder history, and other characteris-tics of suicide victims.

Results

Suicide was the manner of 378 (8.5%) of the deaths. Therewere a total of 185 (48.9% of suicides, 4.2% of total cases) sui-cidal hanging cases. Twenty-four (13.0%) of them occurred out-doors, 20 (10.8%) of which involved a tree branch as asuspension point. In the remaining four cases, the suspensionpoint was the railing of the balcony. The other suicide methodswere firearms in 86 (22.8%) cases, poisoning in 64 (16.9%)cases, jumping from height in 22 (5.8%) cases, vehicular impactin eight (2.1%) cases, self-immolation in six (1.6%) cases,drowning in four (1.1%) cases, and ligature strangulation inthree (0.8%) cases. Suicide locations according to suicide meth-ods are given in Table 1.

2 JOURNAL OF FORENSIC SCIENCES

The victims of suicidal hangings on trees were aged between18 and 65 years (average 35.8 years). The ratio of males tofemales was 4:1.The incident location was the garden of the victim’s house in

nine cases, the woodlands in seven cases, followed by one eachlocation of hill near village, empty field, highland, and garden ofhospital. All of the female victims’ incident locations were thegarden of a house or hospital. According to the statements of thevictims’ relatives and autopsy findings, in all ten hangingsoccurring in the garden of a house or hospital, the incidentsoccurred at night. On the contrary, in the other 10 cases wherethe incident locations were far from home, such as in the wood-lands, a highland, an empty field or a hill near a village, theincidents occurred in the daytime.The ligature material was rope or thin rope in 15 cases,

clothesline in four cases, and a scarf in one case. Completehanging was determined in 15 cases, whereas hanging was par-tial in five cases.Five of the victims left a suicide note, and only one victim

had a history of a previous suicide attempt. The motive for sui-cide was psychiatric disorders in nine cases, economic problemsin six cases, and family problems in five cases. There was amedical history of depression in five of the victims, schizophre-nia in three of the victims, and epilepsy with depression in oneof them.All of the victims were living in rural areas or small counties.

Three of the victims who hanged themselves far from theirhouses travelled to the incident scene by their motorcycles. Allof the other victims walked to the incident scene. Features of thecases are given in Table 2.

Discussion

The methods people use in suicide tend to have importantsymbolic content which is largely a function of the socializationprocess. A perspective has focused on convenience and accessas significant factors in methods of suicide. For example, peopleresiding in modern cities whose landscape is dominated by tallbuildings commit suicide by jumping; small city or villagedwellers may commit suicide by hanging themselves from a treeor a high beam in their home. Similarly, age affects accessibilityand therefore the choice of method. A closer examination sug-gests, however, that the choice of method may, in fact, berelated to sociocultural and social structural factors as well (2).The victims in this study were living in rural areas or smallcounties, and this may have affected the choice of suicidemethod.

In a study which evaluated suicides in Turkey between 1996and 2005, it was reported that the most applied suicide methodwas hanging with 44.8% (29). Demirci et al. (30) reported thatthe suicide ratio was 8.2%, and of these, 47.8% were hangings.Their study retrospectively evaluated suicidal death cases in Ko-nya, Turkey, between 2000 and 2005. The results of this studywere concurrent with those of Demirci et al., in that 8.5% of thedeaths were suicides, and of these, 48.9% were hangings.The male to female ratio in suicidal deaths has been reported

between 1:1 and 2.5:1 in the literature (5,9,29,30). As the ratioof male to female was 4:1 in this study, it is concluded thathanging on a tree as a suicide method is often committed bymales.The first and the most famous suicidal hanging on a tree took

place in the first century. Judas Iscariot, one of the twelve origi-nal Apostles of Jesus, is said to have hanged himself on a tree(Cercis siliquastrum, known as the “Judas tree”) (31,32). In theliterature, there are few reports of hangings on trees. Komaret al. (14) reported that of the 55 suicidal hangings occurringoutdoors, in 30 (54.5%) of these cases, the suspension point wasa branch of a tree. Owens et al. (7) reported that 12% of hang-ings occurred in public places and 72.7% of these cases were inopen country and woods. In the present material, 24 (13.0%) ofthe suicide cases occurred outdoors which is compatible withOwens et al. (7).Feigin (33), in his study on neck organ fractures in hanging,

reported that in three of 29 suicidal hanging cases, the suspen-sion point was a tree branch. Shetty et al. (34) reported on a 55-year-old depressed man who hanged himself on a tree. Cingolaniand Tsakri (35) reported on three complex suicides, and one ofthem referred to a man who hanged himself on a tree after pilingup branches under the tree and setting them on fire. T€oro andPollak (36) reported a 38-year-old man who hanged himself ona tree, but because the rope broke, he fell from a height and acomplicated suicide occurred. The most common method indi-cated by male Botswana participants was reported as hanging ona tree, ceiling, or rafter by 51.2% (37). In some studies regardinghanging series, a tree as a ligature suspension point constitutedbetween 9% and 16.4% of the hangings (19,38,39). In thisstudy, 20 (10.8%) of 185 suicidal hangings used a tree as thesuspension point, which is concordant with the literature.One study of suicides in public places found that some of the

places were associated with a range of methods. For example, atone wooded country park, there were six suicides during a 5-year period: three involved car exhaust poisoning, two individu-als hung themselves from trees, and one jumped from a tower(7). Research indicates a strong relationship between the methodof suicide and the lethal means available in a given populationor community, suggesting that suicide attempters may seek toemploy lethal means that are most readily available in their ownenvironment (40). The suicide location was a house garden innine of 20 cases in this study, and this finding suggests thathanging on a tree was the most readily available method forthese nine victims in their own environment.In all ten of the incidents in the gardens of houses or hospi-

tals, the incidents occurred at night. It was concluded that if itwere night and the family was at home, the victim may not havethought to go away; instead, he/she may have wanted to leavethe house or building and to hang himself/herself on a tree inthe garden.There is also increasing concern about persons who seek

opportunities to commit suicide outside of their own environ-ment (41,42). In the other ten cases, where the incident locations

TABLE 1––Suicide locations according to suicide methods in Konya, Tur-key, between 2001 and 2008.

Suicide method

Suicide location

TotalIndoors Outdoors

n (%) n (%) n (%)

Hanging 161 56.7 24 25.5 185 48.9Firearms 71 25.0 15 15.9 86 22.8Poisoning 52 18.3 12 12.8 64 16.9Jumping from height – – 22 23.4 22 5.8Vehicular impact – – 8 8.5 8 2.1Self-immolation – – 6 6.4 6 1.6Drowning – – 4 4.3 4 1.1Ligature strangulation – – 3 3.2 3 0.8Total 284 100.0 94 100.0 378 100.0

DOGAN ET AL. . WHY DO PEOPLE HANG THEMSELVES ON TREES? 3

were far from home, such as woodlands, highlands, empty fields,and hills near a village, the incidents occurred in daytime. Allvictims were male in this group. We speculate that this isbecause, as the victim needed seclusion from his family andother people, in daylight, he went away from his house andfound a lonely spot to hang himself on a tree.Individuals who commit suicide in public places (e.g., away

from home) are less likely to leave suicide notes (43). It wasreported that of the 53 cases involving outdoor suicidal hang-ings, 15 (27.3%) left suicide notes (14). In this study, five(25%) of the victims left a suicide note.Past suicide attempts have been found to be a major risk fac-

tor for both repeated attempts and completed suicides (44–46).As far as prevention is concerned, only in one of the cases wasa prior suicide attempt found.Several risk factors for suicide have been identified, including

psychiatric illness, previous suicide attempt, being male, accessto lethal methods, poor health care, debilitating physical illness,economic instability, poverty, unemployment, childhood mal-treatment, impulsive or aggressive tendencies, and relational,

social, or financial loss (47). As for the social and psychologicalbackground, major psychiatric disorders have been reported,such as depression. Depression is a major diagnosis among alltypes of mental disorders that occur before suicide. The literaturereview supported a statistically significant association betweendepression and suicide (48–50). In the present material, therewere five cases of depression and one case of epilepsy withdepression.Suicide rates among psychiatric inpatients are reported to be

higher than in the general population (51,52). In Case 16 of thisstudy, the 45-year-old woman who had been hospitalized in thepsychiatry unit of a hospital with a diagnosis of schizophrenia2 days prior hanged herself on a tree in the garden of thehospital.The differentiation between homicidal and suicidal hangings is

important, especially if the scene is outdoors. Homicidal hangingor hanging as a cover-up for murder by some other means israre, and it presents special problems for forensic pathologists(53). The few cases described in the literature have been charac-terized by the victim being either drugged by someone else,

TABLE 2––Features of the suicidal hangings on trees in Konya, Turkey, between 2001 and 2008.

No Gender AgeIncidentLocation

Time ofIncident

LigatureMaterial

Height ofSuspension

SuicideNote

PreviousSuicideAttempt

SuicideMotive

PsychiatricDisorderHistory Other Characteristics

1 M 18 Hill nearvillage

Daytime Rope Partial + � Psychiatric Reactivedepression

The girl he loved wasengaged to another man. Hewent to the incident locationby motorcycle

2 M 21 Garden ofhouse

Night Rope Partial � � Psychiatric Depression Hands were tied limply infront of the body withclothesline

3 F 24 Garden ofhouse

Night Clothesline Complete � � Familyproblems

–

4 M 25 Woodland Daytime Clothesline Complete � � Familyproblems

–

5 M 26 Woodland Daytime Rope Complete + � Economic(indebted)

–

6 M 27 Emptyfield

Daytime Rope Complete � � Economic(unemployed)

–

7 M 28 Woodland Daytime Thin rope Complete � � Economic(bankruptcy)

– He went to incident locationby motorcycle


Night Rope Complete + � Economic(bankruptcy)

–

9 M 30 Woodland Daytime Clothesline Complete � + Psychiatric Schizophrenic10 M 31 Woodland Daytime Rope Complete � � Economic

(bankruptcy)–

11 M 32 Highland Daytime Rope Complete � � Psychiatric Reactivedepression

He was charged withcorruption


Night Rope Complete � � Psychiatric Schizophrenic


Night Scarf Complete � � Psychiatric Reactivedepression

She was infertile

14 M 41 Woodland Daytime Rope Partial + � Familyproblems

– He went to incident locationby motorcycle


Night Rope Complete + � Psychiatric Epilepsy +Depression

16 F 45 Garden ofhospital

Night Clothesline Partial � � Psychiatric Schizophrenic She had been hospitalized inpsychiatric services two daysprior


Night Rope Complete � � Psychiatric Depression He had alcohol dependence

18 M 51 Woodland Daytime Rope Complete � � Economic(indebted)

–


Night Rope Partial � � Familyproblems

– She was at odds with herdaughter-in-law


Night Thin rope Complete � � Familyproblems

–

M, Male; F, Female.


under the influence of self-administered drugs, intoxicated, weakfrom illness, stunned or unconscious, or substantially smaller insize than the assailant (e.g. a child) (54–58). In another casereported by Kipper (59), the discovery of the fight scene and thetrail of disturbed vegetation led searchers to a victim who hadbeen dragged 20 m by two men and subsequently hanged froma tree branch. People hanging themselves on trees far from theirhomes may be especially suspicious, and these deaths may besuspected as homicides (60). In ten cases in this study, the inci-dent locations were far from home such as woodlands, high-lands, empty fields, and hills near villages, but the autopsyfindings and the investigation revealed that in all cases, thecause of death was mechanical asphyxia caused by hanging andany finding indicating homicidal hanging or hanging as a cover-up for murder could not be determined.The tying together of the wrists in hanging cases is rare but

may not indicate a homicide, so long as the hanging ligaturecould have been self-applied. At first glance, a hanging bodyfound with hands tied together would give the impression of ahomicide, but some suicidal people try to avoid being rescuedby others or themselves (61). The victim in the second case wasthought to have tied both hands together limply in front of thebody to prevent any change of mind.It may be difficult to find the corpses of the people who hanged

themselves on trees. These people may be found decades after theincident (62). In a scene investigation by criminal police in Portu-gal, a skull and some bones under a tree from whose branch a beltwas suspended were found. An empty bottle of whiskey next tothe cadaver, the autopsy, and subsequent police investigation ledto the conclusion of a suicide by hanging (63). None of the vic-tims in this study was putrefied or skeletonized, and all of themwere found on the same day as the incident.A detailed investigation should be performed by a team includ-

ing a forensic pathologist, while the corpse is still at the deathscene and in the suspended position to determine the cause andthe manner of death in hanging cases. Further evidence from thedeath scene investigation, statements from witnesses, the presenceof a suicide note, and autopsy findings can all help to determinewhether the victim was responsible for his or her own death (61).The circumstances of the people who were found hanged on treesshould be evaluated carefully. The investigation of the death sceneand the autopsy processes should be performed carefully in hang-ings on trees to determine the manner of death.Epidemiological studies so far have provided useful data to

identify the “at-risk” groups for suicide prevention. Suicide is apublic health problem that requires more effort and participationfrom stakeholders in the community to formulate effectivenessof community-based strategies (64). Cognitive availability of sui-cide encompasses an individual’s awareness of suicide as anoption in response to distress and the knowledge of possiblemethods, including how these can be implemented and theirapparent acceptability in terms of factors such as painfulness(65). Cognitive availability may therefore influence choice ofmethod, which is of particular importance where methods withhigh fatality rates, such as hanging, gain social popularity (66).The people who witness the victim hanging on a tree may preferthe same method in their own possible suicides. Cognitive avail-ability of suicide is also considered exclusively in relation to themedia. Suicides occurring in public places are considered morenewsworthy than those occurring at home, and media reportingmay encourage further suicides (67,68). Suicidal hangings ontrees are generally reported by newspapers and televisions andmay therefore trigger further suicides.

Limitations

Certain limitations of the study must be acknowledged. Thisstudy was not designed as a prospective investigation, but ratheras a retrospective analysis of suicidal hangings on trees, and forthat reason, some contextual neighborhood factors could not beenanalyzed. The sample size was relatively small as suicidal hang-ings on trees are rare events. Another potential limitation of thestudy is although there are studies on specific suicide methods inspecific locations, that is, jumping from high-rise hotels or bridges(25–27), we have not yet encountered any studies focusing on sui-cidal hangings in specific locations for comparing our findings.

Conclusions

According to the findings of this study, it is concluded that (i)hanging on a tree as a suicide method is often preferred bymales, (ii) victims may want to leave the house to hang them-selves in the garden if it is night and the family is at home, (iii)in daytime, victims may seek seclusion from the family andother people and may leave the house to find a lonely spot forhanging, and (iv) for preventional purposes, reporting such sui-cides in public places by media may be restricted by localauthorities and in addition, when scene investigation of hangingon a tree is being performed, the people in the surrounding areamust be removed.There is also need for multicentric studies to compare suicide

by hanging in a public place and suicide by different techniques,which will be useful for clinicians working with a high-riskpopulation.

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Additional information and reprint requests:Kamil Hakan Dogan, M.D., Ph.D.Department of Forensic MedicineFaculty of MedicineSelcuk University42075 SelcukluKonyaTurkeyE-mail: [email protected]


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