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Mothers Who Kill: Postpartum Depression and the Insanity Plea
Mandi Moore
Academic affiliation: Oklahoma State University
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Mothers are the very people expected to nurture and protect their children. That is how the world has worked from the beginning of time. So why is it that there are mothers who harm, and in extreme cases, kill their children? "50% to 85% of women suffer from some type of postpartum mood disorder" (Nonacs 127). While childbirth is supposed to bring joy and fulfillment to a woman's life, it can also cause much stress and a complete metamorphosis of a woman's hormone environment. The different stages of postpartum mood disorders are illnesses and can make a woman crazy. Mothers who suffer from postpartum mood disorders and kill or harm their children are obviously not in a sane state of mind, or at least that is what they claim. This essay will further examine scholarship which focuses on cases of postpartum mood disorders, current insanity defense laws, and the relationship of the two.

To begin to understand postpartum mood disorders and their severity it is crucial to define each stage and some symptoms associated with each. There are three categories of postpartum mood disorders: postpartum blues, postpartum depression, and postpartum psychosis. Women experience postpartum blues most frequently. The symptoms of postpartum blues, often times called baby blue, "include irritability, diminished appetite, crying, mood swings, anxiety, and disorientation. Postpartum blues typically begin within a few days of delivery and last from a few hours to a few days, but rarely continue past twelve days" (Manchester 719). Agreeing with Jessie Manchester, Ruta Nonacs adds that "during the postpartum period, 10% to 15% of women will present with more significant mood symptoms or postpartum depression" (127-28). Unlike postpartum blues, postpartum depression may be persistent and may significantly interfere with a mother's ability to care for her child: "Depression most commonly develops insidiously during the first three postpartum months. The symptoms associated with baby blues are present along with the ambivalent or negative feelings toward the infant" (Nonacs 128). During this time it is common for a woman to express doubts or concerns about her ability to care for her child. "Puerperal psychosis" referred to above as postpartum psychosis, "is the most severe form of postpartum psychiatric illness. It is a rare event that occurs in approximately 1 - 2 per 1000 women after childbirth. The majority of women with puerperal psychosis develop dramatic symptoms within the first two weeks postpartum" (Spinelli 2).

"Postpartum psychosis is receiving increased attention in current literature since it has appeared more frequently as a defense to criminal activity" (Waldron 1). The insanity defense has always been the subject of great debate in both legal and non-legal circles. According to Waldron, "In the past five years, the defense was pleaded in at least eighteen cases in which mothers have harmed or killed their babies while allegedly suffering from postpartum psychosis. About one-half of these cases resulted in verdicts of not guilty by reason of insanity" (1). Postpartum psychiatric illnesses were initially conceptualized as a group of disorders specifically related to childbirth, and therefore were considered "disorders distinct from other types of psychiatric illness" (Slobogin 325). However, this view has changed in the recent past: "More recent evidence suggests that affective illness that occurs during the postpartum period is clinically indistinguishable from affective illness occurring at other times during a woman's life" (Nonacs 127).

The case of Andrea Yates, a Houston mother of five who drowned her children one-by-one in the family bathtub, is one of the most recent and most publicized postpartum psychosis cases. It is one that has "spurred public debate about methods of prosecuting the mentally ill, the dangers of postpartum depression, sanity, and the appropriate use of the death penalty" (Paquette 77). The articles of Jessie Manchester, Christine Michalopoulos, Mary Paquette, Christopher Slobogin, and Margaret Spinelli all focus on the Yates case as a prime example of severe postpartum psychosis. The insanity standard applicable and used in Texas during the Yates case was the M'Naghten test. The M'Nagten test is either briefly mentioned or explained in depth by every scholar who discusses the Yates case.

The M'Naghten test is the most widely used insanity standard in the country. It is a cognitive test that acts to determine whether the defendant was "laboring under such a defect of reason, from disease of the mind, as not to know the nature and quality of the act he was doing; or if he did know it, that he did not know what he was doing was wrong" (Michalopoulos 3). However, when a question of insanity is raised, courts generally avoid defining the phrase "knowing right from wrong." Michalopoulos holds that there are three possible interpretations of the "wrongfulness standard under M'Naghten: the illegality standard, the objective moral standard, and the subjective moral standard" (2). She explains that under the illegality standard, a defendant is insane if he or she lacks the capacity to know or appreciate that the committed acts violated the law. According to the objective morality standard, insanity exists if someone lacks the capacity to know or appreciate that society considers the acts to be wrong - in other words, the acts were contrary to public standards of morality. Finally, the subjective morality standard would result in a defendant being found insane if he or she believed that he or she was morally justified in his or her behavior, even if the person believed may have understood that his acts were illegal or contrary to public standards (Michalapolous 4). For all of these standards, the knowledge or belief must result from a mental disorder.

According to Manchester, "The prevailing insanity defense test applied across U.S. jurisdictions is extremely narrow and makes proving legal insanity exceptionally difficult for even the most severely postpartum psychotic women" (714). This is exactly the problem doctors and lawyers are faced with every day. Most people do not think a person who is severely insane should be treated like someone who commits a murder while in his or her right mind. However, the person did commit a crime and laws do apply to everyone. This is where the M'Naghen test and other cognitive and volitional tests come to play. Take for example the Yates case: although Yates pled innocent by reason of insanity to capital murder, the prosecution asserted that she knew right from wrong at the time of the killings because, she called 911 and her husband right after the killings. According to Dr. Park Dietz, a forensic psychiatrist vital in the Yates case, "She called 911 right after the murder and she told the police in a straightforward manner that she killed her children - that she was Satan, or that she was trying to save the children" (qtd. in Slobogin 317).

All of the mentioned articles demonstrate that most scholars agree the insanity defense must be retained and modified: "Retaining the insanity defense will not compromise public safety, nor will abolishing it lead to the remedying of associated social problems such as the substandard mental health care in jails and prisons" (Morse 138). In fact, scholars feel that the retention of the insanity defense is morally necessary and that most of its admitted problems can be remedied by sensible reforms: "When convicting someone who claims to suffer from mental illness, there are two problems. First is the problem with the meaning of the word insanity, and second, what that conviction means to the jurors" (Paquette 77). Insanity is a legal term with a very narrow definition and courts need to give different instruction to juries regarding the consequences of finding a person not guilty be reasons of insanity. Furthermore, the basic moral issue is whether it is just to hold responsible and punish a person who was insane at the time of the crime. Morse adds, "Tiny children are not thought guilty for the harms they cause precisely because they lack these capabilities. Similarly, adults who cause harm while terrifically distraught will typically be thought less responsible" (138).

Another thing that experts agree on is the fact that many of the crimes committed by mothers could be prevented: "Mental illness and criminal behavior do not emerge suddenly from a vacuum" (Paquette 77). Despite a mother's multiple contacts with medical professional after the birth of a child, postpartum depression frequently goes undiagnosed. There are many factors that have been found to contribute to the onset of postpartum depression: "Many groups have investigated that relationship between risk for postpartum psychiatric illness and various demographic variables, including age, marital status, parity, education level, and socioeconomic status. . . . There is a well defined association between all types of postpartum psychiatric illness and a personal history of affective disorder. . . . Women with bipolar disorder appear to be particularly vulnerable with rates of postpartum relapse ranging from 30% to 50%" (Nonacs 129). Other indicators that a woman might be prone to postpartum depression include previous episodes of postpartum psychosis with prior pregnancies, suicide attempts, and a history of other types of depression. Nonacs suggests that the Edinburgh Postnatal Depression Scale, a 10-item self rated questionnaire used for the detection of postpartum depression, be integrated into the standard postpartum obstetrical visit and at subsequent pediatric well-baby visits (129).

Moreover, one of the major steps that needs to be taken, according to all of the mentioned scholars, is public awareness. Spinelli argues that "The public needs to be educated about the nature of psychosis and mental illness" (Spinelli 1). Spinelli goes on to state, "The psychiatric community should develop guidelines for the treatment of postpartum disorders, foster sharing of knowledge between psychiatry and the law, and do more to inform society about the effects of mental illness on thought and behavior" (10). Several postpartum depression groups and national figures have attempted to educate the public on the concept of postpartum depression: "As postpartum depression research continues and more doctors recognize the nuances of this condition, American courts still lag behind in reassessing the insanity defense and its impact in postpartum psychosis cases" (Manchester 723). Decisions about the treatment and punishment of mentally ill persons would not be left exclusively in the hands of the judicial system if society was more informed. These statements go back to what was said before about professionals knowing that there has to be modifications to the current insanity laws.

New mothers will continue to suffer from postpartum mood disorders, it is just a fact. The hope is that harm towards children can be prevented through awareness and mental health care. This is something that all of the mentioned scholars agree has to happen and many are making personal suggestions about. Furthermore, the insanity defense will never be perfected. However, maybe with enough research and new studies, people pleading innocent by reason of insanity will get the most just ruling in court and the help they need. By examining current scholarship on the subject of postpartum mood disorders and the insanity defense, one can see that people are becoming more concerned about the topics and are beginning to see that something has to be done to improve them.

Works Cited

Manchester, Jessie. "Beyond accommodation: reconstructing the insanity defense to provide an adequate remedy for postpartum psychotic women." Journal of Criminal Law and Criminology 93.2/3 (2003): 713-52.

Michalopoulos, Christine. "Filling in the Holes of the Insanity Defense: The Andrea Yates Case and the Need for a New Prong." Virginia Journal of Social Policy and the Law Association 10 (2003). National Criminal Justice Reference Service. Oklahoma State University Library. Article 383. 13 Oct. 2004 <http://campus.westlaw.com/result/documenttext.aspx?MT=Westlaw&RS;>.

Morse, Steven J. "Retaining a Modified Insanity Defense." The Annals: of the American Academy of Political and Social Sciences. Moran, Richard, Alan W. Heston, Richard D. Lambert, and Erica Ginsburg eds. Beverly Hills: Sage Publications, 1985. 137-47.

Nonacs, Ruta. "Postpartum Mood Disorder: Diagnosis and Treatment Considerations." Women's Health and Psychiatry. Pearson, K.H., S.B. Sonawalla, and J.F. Rosenbaum eds. Philadelphia: Lippincott Williams & Wilkins, 2002. 127-36.

Paquette, Mary. "This is Insane!" Perspectives in Psychiatric Care 38.3 (2002): 77-78.

Slobogin, Christopher. "The Integrationist Alternative to the Insanity Defense: Reflections on the Exculpatory Scope of Mental Illness in the Wake of the Andrea Yates Trial." American Journal of Criminal Law 30.3 (2003): 315-41.

Spinelli, Margaret, G. "Maternal Infanticide Associated with Mental Illness: Prevention and the Promise of Saved Lives." American Journal of Psychiatry 161.9 (2004). Factiva. Oklahoma State University Library. Article 1548. 6 Oct. 2004 <http://global.factiva.com/en/arch/print_results.asp>.

Waldron, Kimberly. "Postpartum Psychosis as an Insanity Defense: Underneath a Controversial Defense Lies a Garden Variety Insanity Defense Complicated by Unique Circumstances for Recognizing Culpability in Causing." Rutgers Law Journal 21 (1990). National Criminal Justice Reference Service. Oklahoma State University Library. Article 669. 13 Oct. 2004 .

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