Monstrous Mothering: Understanding the Causes of and Responses to Infanticide

The deliberate killing of a child by its mother is abhorrent and is associated in the minds of many with mental illness and in particular with postnatal depression. However, at least 50% of perpetrators are neither "mad" nor "bad", and mothers who kill children are not "unhinged" by pregnancy or childbirth. We propose a different explanation: "blind rage" or "overwhelmed syndrome", whereby parents, stressed to breaking point by sleep deprivation or incessant baby crying, respond by lethally harming their child contrary to previous behaviour. The roots of this blind rage may be found in psychosocial disturbances, including the mother's own unsatisfactory experience of parenting which has caused attachment disorders. The legal framework guiding decisions to prosecute and structuring sentencing decision-making following conviction should acknowledge the exceptional stress experienced by such mothers postnatally. Health professionals including midwives and obstetricians should increase their vigilance and arrange referrals for mothers at risk of causing harm or committing infanticide.

[The invisible pregnancy: Clinical characteristics and perspectives about denial of pregnancy]

Denial of pregnancy is a public health problem due to maternal, fetal, and neonatal morbidity, affecting both physical and mental health. It generally involves an absence of the physical signals associated with pregnancy such as abdominal swelling, amenorrhea, weight gain, or even perception of fetal movements. Despite the potential consequences for mother and child, there is still little data on its clinical features and the neurocognitive mechanisms involved. In this paper, we provide an update on the clinical, socio-demographic, and psychopathological characteristics of pregnancy denial based on contemporary scientific literature. We first define denial of pregnancy by referring to the history of the concept, previous definitions, and nosographic classifications. We then detail the clinic of denial by distinguishing the physical and psychological symptoms of this disorder, then the socio-demographic, gynecological, and psychiatric characteristics. We describe the consequences of denial on the mother, infant, and the dyad, referring to situations of cryptic neonaticide. Finally, we show the importance of perinatal neuroscience research on maternal interoception to understand the mechanisms involved in denial of pregnancy, and improve their medical management in clinical practice.

The first COVID-19 infanticide-suicide case: Financial crisis and fear of COVID-19 infection are the causative factors

BACKGROUND

The global suicide occurrences have been aggravated because of COVID-19 crisis-related issues such as fear of infection, the financial crisis, being infected with COVID-19, loneliness, social boycott, etc. Although two studies reported about the seven dyadic suicidality cases (i.e., suicide pacts), child homicide-suicide has not been studied.

CASE PRESENTATION

On 14 May, two dead bodies (i.e., a 30-years old Indian woman and her six-month-old baby) were found in a Riyadh apartment complex. The perpetrator (a person who kills the others and later commits suicide) - a trained nurse, was in search of a job. The woman's husband was recently retrenched from his technician job at a company in Madinah Airport. Her husband was admitted to a hospital with symptoms related to the COVID-19 infection four days before the suicide incidence. The 70-year-old mother-in-law alerted the neighbors after finding that the apartment is locked from inside and there was no response on knocking the doors. After this, the neighbors gathered and called the police. Police found two dead-bodies after opening the flat and suspected that the child was killed before the woman committed suicide.

CONCLUSIONS

Based on the present findings, further child filicide-suicide possibilities in families with economically distressed and/or positive COVID-19 status are expected. Hence, proper financial supports, providing authentic information (COVID-19), and mental health promotional strategies are suggested for decreasing incidences of COVID-19 related infanticide-suicide cases.

[Regulatory evolution of the crime of infanticide]

The objective of the present study consists of the juridic-anthropological analysis of the infanticide, a phenomenon that nowadays is highly existent within the context of crime-settings. Particular consideration has been given to the legal developments of the infanticide act, which occurred simultaneously with the mutation of the socio-cultural contexts. Because the legislative process of the infanticide act has not evolved since 1981, it was possible to underline the criticisms and the inadequacy of such norm. Indeed, the legal norm has not always been able to provide an exhaustive answer concerning cases of infanticide. The process of humanisation of the law led to the introduction of a legal system, which describes the infanticide act as a condition of material and moral abandonment. This has become uncertain and ambiguous to interpret, risking to relegate the legislative matters of infanticide only to exceptional cases. The current study aims to highlight the criticisms and hypothesised different reform perspectives.

Nepal - exploited by older married man - young unmarried mother accused of infanticide

In Nepal, it is considered sinful for a woman to have sexual intercourse before marriage while the male is exonerated. The female will be branded a loose character outcast by family and society. Only a small percentage of women who feel the other way and stand mentally strong or who have family support come out to seek justice. Despite the stringent law, the loopholes in the justice mechanism re-victimise female victims. We report a case where a young unmarried pregnant woman who gave birth alone was charged with infanticide.

Maternal Infanticide and Filicide in a Psychiatric Custodial Institution in Hong Kong

OBJECTIVE

The aim of this study was to review the history, legislation, and psychiatric perspective of filicide, to compare the characteristics of mothers who committed neonaticide versus infanticide, and to discuss the infanticide law in Hong Kong.

METHODS

Data of mothers remanded to the Siu Lam Psychiatric Centre from 2008 to 2016 for filicide were reviewed, as were data of filicide from the Child Fatality Review Reports published by the Social Welfare Department.

RESULTS

From 2008 to 2016, eight mothers were remanded to Siu Lam Psychiatric Centre for filicide. Four were convicted of infanticide; the other four were convicted of manslaughter. Those convicted of infanticide were single and aged <18 years. They had concealed their pregnancies and received no antenatal care. They delivered at home and then either smothered or abandoned the newborn. They reported no suicidal attempts after the index offence and had no record of mental illness. They were given supervision orders instead of prison sentences. In contrast, those convicted of manslaughter were in their 30s and married. They were documented to have killed the victims by charcoal burning, strangulation, mutilation, or defenestration. They all attempted suicide immediately after the killing and had histories of mental illness: paranoid schizophrenia (n = 2), severe depressive disorder with psychotic symptoms (n = 1), and recurrent depressive disorder (n = 1). They were sentenced to Hospital Orders for unspecified periods.

CONCLUSIONS

In Hong Kong, the incidence of maternal filicide is low. However, the infanticide provision grants leniency to mothers, including those who show no evidence of mental illness.

Obsessions of child murder: underrecognized manifestations of obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is a common illness that remains underdiagnosed and undertreated. Distressing obsessions of violence are a frequent manifestation of OCD, related to overattribution of meaning to passing thoughts, a sense of overresponsibility, and concurrent confessing rituals to decrease related anxiety. These intrusive thoughts can include infanticidal or filicidal obsessions in new parents. There is little to no evidence to suggest that these thoughts pose a significant risk of harm, which is reflected in related professional treatment guidelines. In this study, we sought to examine the recognition and risk management preferences among psychiatry professionals and trainees regarding a case example description of filicide obsessions as a manifestation of OCD. A questionnaire regarding a case marked by filicide obsessions was emailed to psychiatrists and psychiatry residents. Respondents provided their preferred and differential diagnoses, reporting their perceptions of risk and optimal case management. Of the 43 respondents, only 62 percent considered OCD in the differential diagnosis. Those considering OCD in the differential diagnosis assessed risk of harm as being lower than did those who did not consider it (3.7 versus 6.6; F(1,36) = 12.18; p < .005). Despite this result, the majority of respondents included involuntary admission (60%) and reports to child welfare authorities (68%) among their preferred management strategies. This survey supports our contention that greater awareness of OCD and understanding of management strategies is needed among psychiatrists and trainees. As well, a greater awareness of the low risk of violence associated with this population is necessary to avoid penalizing individuals with OCD-related aggressive and infanticidal obsessions.

A case series of twenty one maternal filicides in the UK

OBJECTIVE

This study reports a case-series study of 21 women from the United Kingdom convicted of the murder or manslaughter of their child (maternal filicide: MF). These cases were reviewed using data provided from police forces and from publicly available resources.

METHODS

Content and thematic analysis and multidimensional scaling techniques were used to analyse the relationships between the variables present in the commission of the crimes.

RESULTS

Mothers who killed their children could be categorised as emotionally driven and in despair at their situation, or rejecting their children due to perceiving them as a threat. Mothers who killed their babies (neonaticides) appeared to form two distinct subgroups: reluctant and detached neonaticidal offenders.

CONCLUSION

These findings offer an insight into the factors that may be of relevance in understanding how a mother may come to commit MF, and are interpreted in terms of disturbed attachment processes.

Can denial of pregnancy be a denial of fertility? A case discussion

BACKGROUND

For many years, several cases of neonaticide resulting from a denial of pregnancy were reported in the press. Recently, a case of neonaticide made headlines in Belgium: a woman realised that she was pregnant during childbirth. A few minutes after the delivery, the baby was asphyxiated to death. In the obstetric history of the patient, we note six pregnancies, of which three births were given to anonymous adoption. Mrs D. was not able to explain why she was not using any method of contraception despite all of her pregnancies. Many questions need to be asked in order to further understand denial of pregnancy. Do these women understand the link between sexual intercourse and the potential of pregnancy? Which women are more at risk of denying their pregnancy? Is there a certain personality profile at risk?

METHODS

In the following article, we report the case of Mrs D. who presented to the consultation of the clinic of CHU Mont-Godinne (Belgium). We will also discuss the literature available on the online databases (PubMed, PsycArticles, PsycInfo and Cairn.info) using the following keywords: denial of pregnancy, neonaticide, contraception.

RESULTS

In the results of retrospective studies, we notice that indeed most women who have had a denial of pregnancy were not using any method of contraception. This observation suggests the hypothesis of a denial of fertility in these women. In addition, it appears that a specific personality profile is very difficult to establish, due to the lack of sufficient data and due to the discrepancy of the results concerning these women, especially in the matters of age and socio-economic status. However we can note that some psychological characteristics are similar.

CONCLUSIONS

The denial of pregnancy is a complex mechanism, which still raises many questions in the clinical setting and in matters of etiopathogenesis. In these patients, we note that denial is a defense mechanism regularly used, even in other aspects of their lives. Moreover, the frequent non-use of contraceptive method might therefore be more in favor of a denial of fertility than of a denial of pregnancy.

[Infanticide or murder in a forensic psychiatric assessment. A case study 5-fold infanticide--the search of psychopathology]

OBJECTIVE

The difficulties to distinguish between infanticide and murder of the woman own child, experienced by both experts and the court, have been discussed on the example of the psychopathological description of the perpetrator killing five of her children, and data from the literature.

CASE

This paper describes an extremely rare case of the woman who has killed five of her children immediately after their birth over several years.

COMMENT

It is very difficult to decide whether the seemingly rational motivation to kill her own child shortly after their birth can be a proof of specific psychopathological state which is a consequence of childbirth or an assassination planned in cold blood. The act of killing a child by their own mother is so contrary to nature that it seems easy to find the ground for psychosis or a state of emergency. However, when neither of them has been proven the experts are left with the conviction of both diagnostic deficiency and inexplicability of human behaviour.

[Major psychiatric disorders and filicide: a descriptive analysis of filicides perpetrated by women with psychotic mental illness]

INTRODUCTION

This study aims to reflect on the connection between maternal filicide and major psychiatric disorders based on international literature, and analysis of filicides perpetrated by women and ending with compulsory medical treatment based on a not guilty by reason of insanity verdict.

METHOD

For the purpose of the analysis we collected cases back to 1993 from the archives of the Forensic Observation and Psychiatric Institution (IMEI), when a female perpetrator committed homicide against her blood-related offspring, after which she spent her compulsory medical treatment in the Institution. We had 14 cases which were only descriptively analysed due to the low number of cases. We collected data through overview of the documentation of the patients. We focused on several factors: demographic characteristics of the victims, characteristics of the homicidal act, demographic and psychiatric characteristics of the perpetrators.

RESULTS

Most importantly, our results show interesting findings in the field of gender distribution of the victims. In relation to suicide risk, our results concur with previous findings pointing out its strong connection with filicide. Furthermore, our findings point out the relevance of schizoaffective disorder, as it was the most frequent diagnosis in our cases.

CONCLUSION

We make our conclusions primarily in regard of prevention, we emphasise the strongest risk factors according to the results, which can draw the clinical practitioner's attention to the danger of filicide.

No worries, mate: a forensic psychiatry sabbatical in New Zealand

Sabbaticals were initially intended to take place one year of every seven and to provide an opportunity for study or travel. Psychiatrists rarely take sabbaticals, but they can be of tremendous value in widening professional and personal horizons. It is not merely the psychiatrist taking the sabbatical who reaps the benefits, but also the home institution and patients. Sabbatical-takers have an opportunity to learn across cultures, to experience a new system of medical care, and to develop a less provincial view of their work and indeed their place in the world. A sabbatical can be a time of substantial accomplishments, such as writing or reorganizing programs. In this article, the benefits of a forensic psychiatry sabbatical experience in New Zealand are described.

"Asia's missing women" as a problem in applied evolutionary psychology?

In many parts of Asia, the Middle East and North Africa, women and children are so undervalued, neglected, abused, and so often killed, that sex ratios are now strongly male biased. In recent decades, sex-biased abortion has exacerbated the problem. In this article I highlight several important insights from evolutionary biology into both the origin and the severe societal consequences of "Asia's missing women", paying particular attention to interactions between evolution, economics and culture. Son preferences and associated cultural practices like patrilineal inheritance, patrilocality and the Indian Hindu dowry system arise among the wealthy and powerful elites for reasons consistent with models of sex-biased parental investment. Those practices then spread via imitation as technology gets cheaper and economic development allows the middle class to grow rapidly. I will consider evidence from India, China and elsewhere that grossly male-biased sex ratios lead to increased crime, violence, local warfare, political instability, drug abuse, prostitution and trafficking of women. The problem of Asia's missing women presents a challenge for applied evolutionary psychology to help us understand and ameliorate sex ratio biases and their most severe consequences.

[Suicidal and infanticidal risks in puerperal psychosis of an early onset]

OBJECTIVE

A sample of patients with a puerperal psychosis of an early manifestation is investigated in respect of special risks of suicide and infanticide.

METHODS

During a 20-year period 96 patients who had been fallen ill with a puerperal psychosis within four weeks after delivery were admitted to a psychiatric university hospital. Patients with an acute exacerbation of a known schizophrenic disorder were excluded. In a subgroup of 37 patients states of a previous (affective, bipolar affective) psychotic illness were recorded already before the puerperal index episode, in a subgroup of 59 patients puerperal psychosis was the first manifestation of a psychotic illness. Suicide- and infanticide-relevant psychopathological symptoms were analysed (suicidal ideas/behaviour before/during inpatient treatment, general disorganized aggression, psychotic anxieties related to baby, infanticidal obsessions, aggressive ideas/behaviour towards baby, neglect, infanticidal impulses).

RESULTS

Puerperal psychoses were distributed to the diagnostic categories of psychotic depressive disorder, bipolar affective disorder, and schizoaffective disorder. Six patients died due to suicide, tragically already some few days till weeks after discharge from psychiatric hospital, despite a pronounced or even complete remission of puerperal psychotic symptoms at the time of discharge. Three patients committed an extended suicide attempt that resulted in two infanticides. All isolated and extended suicides were committed in a state of depressive mood and presumably synthymic delusion.

CONCLUSIONS

Suicidal ideas and behaviour play a major role in patients with puerperal psychosis before and during inpatient treatment. An increased risk for mothers and babies may persist, however, even after a seemingly good symptomatic remission. Besides the clinical challenge of general prevention of puerperal psychosis the request of adequate models of inpatient treatment, carefully prepared discharge, close afterdischarge follow up, and continuous outpatient care have to be stressed.

Filicide, medical empathy, directives of the Supreme Court and reduced punishment

The role of empathy in the preparation of legal-psychiatric assessments is a controversial issue which has been discussed in the professional literature and in the practice in Court. The focus of the controversy is the question of objectivity versus subjectivity in the examiner and the worries about empathy leading to over-identification with the examinee. In this paper the authors will discuss relevant literature. They will also, for explanatory reasons, analyze a landmark decision of the Israel Supreme Court dealing with a case of filicide--a decision which may be understood as giving an increased role to the empathic perceptions of the evaluating psychiatric expert".

Analysis of the relationship between neonaticide and denial of pregnancy using data from judicial files

OBJECTIVES

Using judicial files on neonaticides, (1) to examine the frequency of the association between neonaticide and denial of pregnancy; (2) to assess the accuracy of the concept of denial of pregnancy; (3) to examine its usefulness in programs to prevent neonaticides.

METHODS

Quantitative and qualitative analyses of data collected from judicial files during a population-based study carried out in 26 courts in 3 regions of France over a 5-year period.

RESULTS

There were 32 cases of neonaticides identified; 24, perpetrated by 22 mothers, were solved by police investigation. Aged 26 years on average, the mothers had occupations that resembled those of the general population and 17 had jobs, 13 were multiparous and 11 lived in a couple relationship. No effective contraception was used by women in 20 cases. Psychopathology was rare but mothers shared a personality profile marked by immaturity, dependency, weak self esteem, absence of affective support, psychological isolation and poor communication with partners. No pregnancy was registered nor prenatal care followed. Two (perhaps 3) pregnancies were undiscovered until delivery. No typical denial of pregnancy was observed in the other cases. Pregnancies were experienced in secrecy, with conflicting feelings of desire and rejection of the infant and an inability to ask for help. Those around the mothers, often aware of the pregnancy, offered none. In the absence of parallel clinical data, it is not possible to calculate the frequency of the association between neonaticide and denial of pregnancy.

CONCLUSIONS

The term 'denial of pregnancy' cannot fully reflect the complexity of emotions and feelings felt by all perpetrators of neonaticide and is used differently by different professionals. The term itself and its excessive generalization contribute to pathologizing women while absolving those around them and has little operational value in preventing neonaticides. The authors suggest rethinking the terms presently used to describe the phenomenon of pregnancy denial.

Mothers who kill their offspring: testing evolutionary hypothesis in a 110-case Italian sample

OBJECTIVES

This research aimed to identify incidents of mothers in Italy killing their own children and to test an adaptive evolutionary hypothesis to explain their occurrence.

METHODS

110 cases of mothers killing 123 of their own offspring from 1976 to 2010 were analyzed. Each case was classified using 13 dichotomic variables. Descriptive statistics and hierarchical cluster analysis were performed both for cases and variables, and significant differences between clusters were analyzed.

RESULTS

The Italian sample of neonaticides (killings of children within the first day of life) was found to satisfy all evolutionary predictions for an evolved behavioral, emotional and motivational pattern to increase fitness, showing a consistent profile for offending mothers. Relatively young, poor women with no partner kill their offspring non-violently, either directly or through abandonment, and they attempt to conceal the body. These women have no psychopathologies and never attempt suicide after killing their children. All neonaticide cases fall in a single cluster that is distinct from all other offspring killings by mothers. Infanticide (killing of children within the first year of life) and filicide (killing of children after the first year of life) do not significantly differ according to any of the variables measured. The common profile of mothers who have committed infanticide or filicide includes psychopathology, suicide or attempted suicide after killing their children, violent killing of their victims, and no attempt to conceal the victims' bodies. These results suggest that maternal infanticide and filicide represent an improper functioning of adaptation, and their profile are much more variable than those of neonaticide offenders.

CONCLUSION

Our study confirms that only neonaticide is an adaptive reproductive disinvestment, possibly evolved in the remote past, to increase the biological fitness of the mother by eliminating an unwanted newborn and saving resources for future offspring born in better conditions. Neonaticide is shown to be clearly distinct from infanticide and filicide and therefore should be approached, prevented, and judged differently.

"They have already thrown away their chicken": barriers affecting participation by HIV-infected women in care and treatment programs for their infants in Blantyre, Malawi

HIV-infected infants and young children are at high risk of serious illness and death. Morbidity and mortality can be greatly reduced through early infant diagnosis (EID) of HIV and timely initiation of antiretroviral therapy (ART). Despite global efforts to scale-up of EID and infant ART, uptake of these services in resource poor, high HIV burden countries remain low. We conducted a qualitative study of 59 HIV-infected women to identify and explore barriers women face in accessing HIV testing and care for their infants. To capture different perspectives, we included mothers whose infants were known positive (n=9) or known negative (n=14), mothers of infants with unknown HIV status (n=13), and pregnant HIV-infected women (n=20). Five important themes emerged: lack of knowledge regarding EID and infant ART, the perception of health care workers as authority figures, fear of disclosure of own and/or child's HIV status, lack of psychosocial support, and intent to shorten the life of the child. A complex array of cultural, economic, and psychosocial factors creates barriers for HIV-infected women to participate in early infant HIV testing and care programs. For optimal impact of EID and infant ART, reasons for poor uptake should be better understood and addressed in a culturally sensitive manner.

Postpartum psychosis and the courts

Although mental state defenses frequently are raised in cases of infanticide, legal criteria for these defenses vary across jurisdictions. We reviewed outcomes of such cases in states using M'Naughten or model penal code (MPC) standards for insanity, and the factors considered by the courts in reaching these decisions. LexisNexis and Westlaw searches were conducted of case law, legal precedent, and law review articles related to infanticide. Google and other Internet search engines were used to identify unpublished cases. Despite the differing legal standards for insanity among states, the outcomes of infanticide cases do not appear to be dependent solely on which standard is used. The presence of psychosis was important in the successful mental state defenses. This case series suggests that states that use the stricter M'Naughten standard have not been less likely than states with an MPC standard to adjudicate women who have committed infanticide as not guilty by reason of insanity.

Maternal neonaticide following traumatic childbirth: a case study

Recent work has documented the relatively high incidence of Posttraumatic Stress Disorder (PTSD) symptoms in women during the birth delivery process and afterwards, even in uncomplicated births. This phenomenon, however, has yet to be linked with cases of neonaticide (child homicide in the first 24 hr of life) or infanticide (child homicide within the 1st year of life). Women are more likely to experience mental disorder after childbirth than at any other time in their lives, and the intentional killing of an offspring by a mentally ill mother is likely underreported. The immediate postpartum period is a time of heightened vigilance by health providers and, when the tragic death of an infant occurs, forensic professionals should specifically assess for PTSD. As an illustration, the authors present a case of maternal neonaticide that was directly linked to PTSD without any other concomitant mental disorder. PTSD is a viable mitigating factor to be examined in legal defenses of infanticide either in isolation or in conjunction with other factors.