Monday, January 21, 2008

Book Review: "Infanticide; Psychosocial and Legal Perspectives on Mothers Who Kill"

Overall rating: 4 out of 4 stars

This book, edited by Margaret G. Spinelli, M.D., is an amazing compilation of chapters by some leading experts on postpartum disorders, infanticide, and the law. Although the chapters were written by a variety of experts, the book flows reasonably well. The book is intended to help save the lives of children by revealing what is already known about infanticide and providing a framework for future research on the subject.

There are many things that stand out to me in this book. Here are some of them:
  • The US legal system has a long way to go to catch up with the rest of the world in response to infanticide. The US laws are inconsistent; depending on where she lives in the US, a woman who commits infanticide could be given hospitalization, probation, a short prison sentence, and lengthy prison sentence, or the death penalty. That just isn't fair. Consider Andrea's case. We resided in Harris county, Texas, which has sent more people to death row than any other county (and 48 states!) in the US. The DA in Andrea's case, Chuck Rosenthal, treated Andrea exactly as he would have treated a serial killer (i.e., charged her with capital murder, sought the death penalty, and spent about $1M to prosecute her) in spite of the fact that Andrea has hundreds of pages of medical records that indicate she suffered from a severe postpartum illness. If Andrea had taken the lives of our children in almost any other state in the US, she would have received more civil treatment. In fact, in England and in many other countries around the world, Andrea would have been charged with manslaughter and given probation and medical treatment.
  • Women are at much greater risk of developing mental disorders after having a child. Throughout the life of a woman, her highest risk for psychiatric disorders and hospital admissions occurs during the first three months after childbirth. The risk of developing psychosis during the first 30 days after giving birth to a child is over 20 times greater than the two year period preceding the birth. The risk for developing a psychiatric disorder is highest during the first week, declines fairly sharply to the first month, and then continues to slowly decline during the months that follow.
  • The symptoms of postpartum psychosis (PPP) are different than other psychoses. Women who suffer from PPP tend to appear disorganized and confused. This may be due to the lack of sleep associated with pregnancy and childbirth. A couple of other symptoms are suspiciousness and self-neglect. Andrea had all of these. She did not sleep well. She seemed restless and fidgety. She did not take care of herself. Also, the book points out that PPP patients should also be considered bipolar. Andrea's family has a history of bipolar illness, and bipolar is a genetic disorder. It is clear to me that Andrea suffered from PPP.
  • Neonaticide is the killing of a newborn child. The mothers of these children are generally young mothers who tend to deny their pregnancies. Oftentimes, their denial is caused by a strong contradiction between their own beliefs (e.g., "Good girls don't get pregnant before marriage") and being pregnant. Curiously, their denial can be so severe that their bodies do not appear pregnant and their family and friends (and sometimes even doctors!) participate. In many cases, when the baby is finally born, the mother can not face the reality of having a child, and she enters a dissociative state during which she takes the life of her baby, either through a deliberate act or through neglect.
  • Our insanity laws in the US require that the accused suffer from a recognized mental disease or defect. Unfortunately, the "gold standard" for defining mental disorders, the Diagnostic and Statistical Manual of Mental Disorders (DSM), does not recognize postpartum disorders. Instead, there are other disorders (e.g., "Major Depressive Disorder with Psychotic Features") that are designated as having "postpartum onset" if they occur within 30 days after giving birth. There are a couple of problems with this. First, PPP and neonaticide have unique symptoms that are not included in the other disorders. Second, postpartum symptoms can start beyond 30 days after giving birth. This leaves a defense attorney with the difficult task of mapping his defendant's symptoms to recognized disorders with slightly different symptoms in order to prove that she was insane.
  • The American Academy of Psychiatry and the Law (APPL) has written guidelines for the evaluation of mentally ill defendants entitled, "Practice Guidelines for Forensic Psychiatric Evaluation of Defendants Raising the Insanity Defense." I am going to add a review of this as a future topic for this blog. One thing that disturbs me about our legal system is how two "experts" can look at the same facts and draw completely different conclusions. Also, I believe that there are "hired guns" within our legal system who have a lot of credentials and purposely offer testimony that favors their employer (either the defense or the prosecution). Of course, most defendants can not afford their testimony. Having guidelines such as these could help remedy these problems.
  • There is a chapter in this book on attachment theory. I had never heard of this before, and I find it fascinating. Basically, a baby will develop an attachment style that mimics his mother's attachment style. The book lists four attachment styles for the child and three attachment styles for the mother. A "secure" mother will have a "secure" baby. I am not completely clear on the other mappings. However, it is clear that any underlying attachment problems that the mother has are passed on to her child. Some therapists rely on mother-child interaction to identify their attachment styles, to work through underlying issues, and to practice appropriate behaviors. This is actually a treatment for both the mother and the child. Sadly, it is very difficult (if not impossible) for a woman who suffers from a postpartum disorder to form a secure bond with her child.
  • Andrea's case occurred just before this book was completed. In many respects, Andrea's case reaffirmed many things that Dr. Spinelli had already planned for her book. In her conclusion, she mapped the circumstances of Andrea's case to some risk factors that were described in the book. Some of them are true, and some of them are not. In particular, she stated that I offered "poor partner support" which is simply not true. It is true that we had a more traditional lifestyle. What is not written is that I worked hard to provide for my family, I worked hard around the house, I helped care for our children, and I diligently sought medical treatment for Andrea. In 2000, I suggested to her that she could work half time and I could work half time; her response was, "I am a mother now." The item listed after "poor partner support" in the book is "isolation". I would say that this is true. We had some friends, but not a lot of friends. We also did not belong to a church which I now regret. If Dr. Spinelli combined these two items into a single item entitled, "poor support system", then I would agree with that. While Andrea was sick, my Mother and I formed most of her support system, and we were not enough. Both of us were completely exhausted. After the book was published and Dr. Spinelli learned more about the case, she called me and apologized for some things that she had said about me which I appreciated.
At the end of her book, Dr. Spinelli writes that the goal of saving lives is attainable. She encourages us to not turn away from these mothers and their families, but rather to learn from them so that we can prevent future such tragedies. I agree wholeheartedly.

Future Topics

This post contains future topics for the blog. If you have any suggestions for other topics, then please let me know.
  • Review of the American Academy of Psychiatry and the Law (APPL) "Practice Guidelines for Forensic Psychiatric Evaluation of Defendants Raising the Insanity Defense."
  • FAQ: Why do you support Andrea?
  • FAQ: Why did you divorce Andrea?
  • FAQ: How is Andrea doing? (with her permission)
  • FAQ: What role did the Woroniecki's influence have on the tragedy?
  • Steffi K. case (Germany)
  • Review of 2002 trial transcript
  • Review of 2002 report of Dr. Dietz to the state