Complex suicide by drowning and self-strangulation: an atypical “holy” way to die

Abstract About 1.5-5% of suicides are committed in a complex way. The present paper reports the case of a 72-year-old man who committed suicide by throwing himself into the sea after tying a large stone with a rope and tying the other end with a slipknot around the neck. The postmortem analysis revealed asphyxia as that the cause of death, resulting in a combination of strangulation and drowning. Even if the prevalence of different means of suicide changes widely among different reports, there is a lack of evidence of such a combination in the scientific literature. Surprisingly, in the catholic tradition, several martyrs died by combination of drowning and strangulation. The gospels of Luke and Matthew also describe this particular combination of lethal means, which was also represented in several Renaissance paintings showing the martyrdom of saints. Here we describe the forensic pathological findings of the case that we report, and we make some hypotheses to interpret the possible influence of literary and iconographic representations in the choice of lethal means.