[Forensic Life] Death Invited by Seeking Euphoria

Assistant Manager Kim arrived at the factory early in the morning, seeking even a slight chill. He leisurely dissolved a packet of coffee in hot water. Stirring the paper cup, he looked around the empty factory. In a corner against the wall, he noticed a dark, shadowy object. Assistant Manager Kim nearly dropped his coffee.

"Factory Manager!" Kim called out urgently. The factory manager, with a noose tied around his neck from a string attached to a shelf, hung motionless with his entire body limp. His knees were bent, and his bare feet weakly touched the cold factory floor. Kim hurriedly untied the string around the neck. The factory manager was a large man?over 180 cm tall and weighing more than 100 kg. Kim, small and slight in build, exerted all his strength.

He barely laid him down on the floor, but there was no sign of breathing. He ran to the office and made a call. "Ah, is this 119? This is the xx factory. Please come quickly. Hurry, hurry. It's urgent." After ending the call, Kim looked again at the factory manager lying on the floor and suddenly felt a chilling and eerie sensation, as if goosebumps were rising on his back. The factory manager was wearing no other clothes except a women's T-back panties and bra. Next to the body on the floor was an adult magazine featuring a blonde Caucasian woman wearing the same bra and T-back panties as the factory manager, smiling broadly.

The 119 paramedics arrived within five minutes. They were also shocked upon arrival. However, if the person lying there was still alive, they needed to perform CPR immediately. They attached ECG stickers and checked, but there was no electrical activity in the heart. There was no breathing or pulse. The jaw seemed to show slight rigor mortis. One paramedic said to Kim, who was staring blankly nearby, "Report this to the police. Quickly."

Officer Park and Sergeant Kim arrived at the scene. "What is this? Even though it's a hot summer, he's only wearing women's panties and a bra. Huh? What's that?"

Officer Park picked up the adult magazine scattered near the body and said,

"Whose is this?"

Assistant Manager Kim replied,

"Actually, I've seen the factory manager looking at that before. I think it belongs to him."

The police were puzzled. It was a strange crime scene. An inquiry into the factory manager revealed he was well-regarded. He liked drinking, had a straightforward personality, and was a kind man who never cursed his employees. Investigations showed no reason for anyone to hold a grudge against him, his family relations were harmonious, and the deceased was healthy. The police thought an autopsy was the best way to clarify the case. The family agreed to the autopsy.

The factory manager's body from the strange scene showed no signs of decomposition. The noose marks on the neck were clear. After the autopsy, the cause of death was relatively easy to determine. The cause of death was hanging (縊死, hyoe), that is, strangulation by hanging. Ligature strangulation, where the neck is constricted by a rope or similar object by someone else, is almost always homicide, whereas hanging is mostly a result of suicide. Cases where children accidentally die by getting their necks caught in window blind cords are also classified as hanging.

This case involved death by neck compression due to the weight applied to the tool around the neck, and the type of death could be considered accidental. Rarely, in cases of hanging or ligature strangulation, death occurs during autoerotic asphyxiation, where a person intentionally restricts their own breathing to enhance sexual pleasure. This is called autoerotic death. Autoerotic death usually occurs secretly and unintentionally during sexual stimulation enhancement, resulting in accidental death. The act intended for self-satisfaction goes too far, tragically causing the loss of precious life. The scene often contains adult magazines or sexual aids, and sometimes the deceased is found in altered gender roles.

Typically, evidence of asphyxiation by hanging or ligature strangulation is found, along with sexual aids or solitary sexual activities such as masturbation or paraphilia. There is often no clear sign of suicide, and escape routes exist.

When the feet (or even the buttocks) touch the floor while the neck is constricted by a rope or self-strangulation occurs, it is believed that releasing the rope or letting go of the hands would prevent death. However, reality is different. In fact, strangulation causes temporary cerebral hypoxia, leading to euphoria and other states, followed by arterial occlusion in the neck, and consciousness is usually lost within 10 to 15 seconds. One must stop before this point, but a mistake of just 1 to 2 seconds more results in loss of consciousness and death.

A famous case of autoerotic death is actor David Carradine, who played Bill in Quentin Tarantino's film "Kill Bill." He was found dead in a hotel in Bangkok, Thailand, hanging from a closet. Initially ruled a suicide, a thorough forensic investigation later corrected the cause of death to accidental.

Autoerotic death is rare but does occur. According to studies published in Australia and Sweden, it happens at a rate of 0.1 to 0.3 per million people annually. Although there are no clear statistics domestically, applying this rate suggests 5 to 15 cases per year. Having worked in forensic medicine for over ten years, I have examined and judged several unfortunate cases.

A general cable TV broadcast once reported on autoerotic death. After the broadcast, a university student died attempting to imitate it out of curiosity. Acts for sexual satisfaction are natural and healthy, but engaging in dangerous behaviors for this purpose can lead to tragic accidents. This is a matter requiring renewed caution and vigilance.

Professor Seongho Yuseong, Department of Forensic Medicine, Seoul National University College of Medicine