DALLAS
MORNING NEWS
February
17, 2001
From
maternal instincts to killer impulses: Hallucinations,
delusions, despair may torment mentally ill mothers who murder
By
KAREN PATTERSON
A
good mother swaddles her child in a sturdy weave of love and care. But
mothers with severe mental illness might offer only a threadbare cover.
Frayed
by psychosis or a profound depression, the fabric of these mothers' minds
can, in rare instances, leave their babes dangerously exposed. Such women
often struggle mightily to be good mothers, research suggests. And in many
ways, they would succeed - if they didn't kill their children.
Motherhood
is considered a sacred duty. So last June, when Andrea Pia Yates drowned
little Noah, John, Paul, Luke and Mary, people wondered exactly what evil
had possessed her.
For
any individual, science can't answer that question. But scientific studies
can help define differences among mothers who kill. In fact, research
dating back three decades has outlined several categories of such mothers,
with some overlap.
"Women
who kill their children as a group are going to be just as disparate as any
other population," says Carol Holden, a forensic psychologist and
researcher at the University of Michigan.
Some
mothers fatally beat their children but don't mean to kill them. Mothers
also kill to spare a child some real or imagined suffering. They kill for
revenge on their partners. They kill children they no longer want - or
didn't want to begin with.
"You
have everyone from a terrified 13-year-old who doesn't even realize she's
going to give birth and doesn't know what to do and smothers the newborn,
to someone who cold-heartedly decides children are too much trouble,"
Dr. Holden says.
Mothers
also kill because their minds have wrung reality into a bizarre new form.
Such killings, and the women who commit them, tend to be distinct from the
others, psychological studies show.
Overall,
"these mentally ill mothers ... look quite different than the
non-mentally ill mothers," Dr. Holden says. On the other hand, "that's
not to say that anyone who looks like that is definitely mentally ill."
Statistics
on child murders in the United States show just how vulnerable the youngest
children are. Among preschoolers, the younger the child, the greater the
risk of being a homicide victim.
Victims
of filicide - the term used
when a parent kills a child - also
tend to be very young. Of the U.S. children in one maternal filicide study,
"we didn't find a single child killed ... who was over age 12, and
almost all of them - 85 percent -
were under age 5," says forensic psychologist Geoffrey McKee.
Matching
threads weave through much of the research on filicidal mothers. Compared
with other such mothers, those who are severely disturbed are more likely
to be older. They are more likely to be married. They tend not to conceal
their act. They more often try to kill themselves at the same time. And
they are more likely than other such mothers - who kill during abuse or
moments after childbirth - to murder more than one child.
Such
threads connect even mothers of different nations - at least in some
English-speaking cultures, says Dr. McKee, a clinical professor at the
University of South Carolina School of Medicine. He and colleague Steven
Shea have compared 20 U.S. women accused of killing their children with
earlier studies of such women from Britain, Canada and a multinational
sample.
The
women in the U.S. group had been referred to a psychiatric hospital for
pretrial evaluation, and thus were more likely to be mentally ill than, say,
the broader group of women in the English study. Still, the research noted
a "consistency of characteristics across countries."
The
cross-cultural comparison suggests that women who kill their children
typically "are nonaddicted, married, low-income, mentally ill, new or
recent mothers under 30 who, acting alone and without weapons, kill only
one of their children, likely of preschool age," the scientists wrote.
"In
our study, only 15 percent had more than one victim," Dr. McKee says.
"However, when there is more than one child who's killed, typically
all the children are killed."
In
his clinical and research experience, he adds, "if there are multiple
children who die, the mother is mentally ill."
Dr.
Holden and her colleagues have detected similar strands. They studied 28
Michigan women who had pursued the insanity defense for killing their
children. Eight of the women had been held criminally responsible for their
killings; 20 had been found not guilty by reason of insanity. Those in the
latter group were more likely to have had a history of psychiatric illness,
and less likely to have held a job - "which is a good measure of ...
adjustment" psychologically, Dr. Holden notes.
Among
those found not guilty by reason of insanity, 60 percent had been diagnosed
with schizophrenia (a brain disorder characterized by strange thinking,
feelings and behavior) and 35 percent with a mood disorder - most often
severe depression with psychotic symptoms.
A
history of suicide attempts, psychiatric hospitalizations and being abused
is not uncommon. "When we're talking about mentally ill mothers, we're
talking not just of psychotic mothers," Dr. McKee says, but also
mothers with a history of major depression or clinical depression.
Severity
of illness is a crucial distinction, notes Dr. Josephine Stanton, a New
Zealand clinical psychiatrist. Dr. Stanton and colleagues have conducted
detailed interviews with six mentally ill mothers who killed their children.
Most of her subjects had schizophrenia or schizo-affective disorder (schizophrenia
symptoms accompanied by a major depression or manic episode). One had major
depression and anxiety.
Thirty
percent of people have some sort of mental disorder, Dr. Stanton says, but
illness that severe occurs in only about 1 percent. "So we're not
talking about someone with a mild depression."
Scientists
are instead talking about someone who probably has hallucinations (imaginary
sensory perceptions) or delusions (false, irrational beliefs). Among women
acquitted for reasons of insanity in Dr. Holden's study, hallucinations and
delusions were common.
The
delusions included such notions as the child "was defective or
monstrous, possessed by Satan - something is seriously wrong with them,"
Dr. Holden says. "Or there was some sort of delusional disaster that
was going to befall the children, and the mothers were saving them."
For
the mothers hobbled by depression and psychosis, she says, the delusions
"were very much in line with depression - these horrible senses of
what was going to happen."
The
mothers Dr. Stanton studied also had stitched crazy quilts of false ideas.
For one set of mothers, wild fantasy governed decision-making. One woman
had persecutory delusions "where a whole group of people were running
her life," Dr. Stanton says. "According to her delusions she had
to do all sorts of things to save the world, and she couldn't." She
also couldn't leave her child behind.
For
the other mothers, "life was absolutely terrible and they couldn't
leave their children in such an awful world," Dr. Stanton says. "It's
not bizarre, but the intensity of it is delusional."
Suicidal
mothers may decide to kill so their children won't have to grow up without
a mother, Dr. McKee says. Psychotic mothers may be trying to save a child
from a lifetime of psychosis.
"So
they have a very altruistic reason for killing their child, even though it's
pure delusion," he says. In their minds, they are good mothers.
And
by some measures, they can be good mothers.
"Most
are women who really care a lot about being mothers," Dr. Stanton, of
the University of Auckland, found. "It's very important to them ...
and I think that's partly why, when they develop the illness, the
delusional stuff tends to relate to their children."
Some
of the women showed Dr. Stanton pictures of their children and talked of
them lovingly. One of the mothers spoke of feeling guilty because she had
carted her daughter around shopping. Another described mincing steak
herself, rather than buying mince that would have contained ingredients
other than beef.
"They
would take a lot of trouble to make sure things were done really well,"
says Dr. Stanton. "I think in some ways that increased the burden of
parenting for them; it was harder because they thought they had to be
perfect."
Other
burdens can consume anyone with a grave mental illness.
Certainly
for the mothers who are psychotic, says Dr. McKee, mental distortions
disrupt sleep and intrude on the ability to think.
"Delusions
and hallucinations are very emotionally draining, especially if these are
new-onset symptoms" -
such as those that, in rare cases, arise just after childbirth. For some,
the symptoms persist, evolving into a more chronic psychosis, such as
schizophrenia.
Some
women experience severe depression after the birth of one child but not
another, Dr. Holden says. Others suffer depression or psychosis after each
child is born. The biological swing that can follow childbirth could cause
anything from a mild case of the blues in a number of women, to serious
depression in a smaller group, and psychosis in a fraction.
Many
recent mothers who develop mental problems aren't sure how to mend their
minds. "There are lots of women who don't seek treatment," Dr.
Holden says, "because they get told everybody gets the blues."
Meanwhile,
routine pressures mount. "Someone who's been mentally ill for a while
is going to have the difficulties that go along with mental illness -
impaired social and work relationships," Dr. Holden says. It's
hard to relate to people whose reality is distorted, adds Dr. Stanton,
because their behavior can be so odd. "They're quite difficult to get
close to."
Each
individual case of filicide, however, is not cut from the same cloth.
"That's part of the reason why ... [scientists] are looking for
commonalities," Dr. Holden says.
Among
the mothers with severe mental illness, the decision to kill a child can
arise abruptly. But then, so can the mental problems.
In
Dr. Stanton's interviews, some women, draped with depression, had
contemplated the killing for perhaps a week. For the others, blanketed in
psychosis, the murder was an impulse.
But
something had definitely snapped.
"They
all had either a new illness that nobody knew about ... or their illness
changed," Dr. Stanton says. "When you listen to these stories you
can hear that they had signs and symptoms of illness, but they hadn't been
recognized."
Among
the symptoms: Thought becomes disorganized. Emotions may disappear - or
escalate irrationally. Impulses are hard to control. Consequences aren't
clear.
"It
makes people in that state very, very difficult to relate to and to have an
idea of what's going on," Dr. Stanton says.
Despite
the erratic nature of the illnesses, her research team was surprised at the
mothers' lack of premeditation. Especially among the psychotic women, she
says, the killing was more the result of disorganized thinking.
"I
think that's the reality of the risk," she says. "When you have
someone who's actively psychotic, they can do anything."
After
the mother's arrest, treatment begins in earnest. And a tapestry of
realization, despair and agony unfolds.
For
the psychotic mothers, as delusions and hallucinations are tamed, a deep
and lasting depression can ensue - one
that stems from both the declining symptoms and a growing grasp of the
horror of the crime, Dr. McKee says.
Remorse
is great and suicide is a risk. When the psychotic reasoning subsides, Dr.
Holden says, "they're left with the fact that they killed their
children."
Furthermore,
says Dr. McKee, "often they're not viewed very sympathetically by
others. ... I've found few mothers or fathers who have much sympathy for a
mother who kills her children."
Experts
are working to figure out just which mothers might someday kill their
children - and how to get their mental illness treated.
Disturbed
mothers may be contemplating killing themselves, says Dr. Stanton,
"but suicide ideation is common - and killing children is uncommon.
That's one of the reasons it's so difficult to do prevention."
And
since the crime is rare, science can't really forecast which ill mothers
might murder their child, Dr. Holden notes.
Because
the few hundred U.S. filicides each year are spread across 50 states, just
gathering subjects for a study can take a decade, Dr. McKee says. During
that time, there may be changes in how diagnoses are made or how cases are
prosecuted.
In
addition, studies frequently focus on filicidal mothers who are mentally
ill because those women are concentrated in psychiatric hospitals where
researchers work. Other filicidal mothers, in jail or elsewhere, are a
looser-knit group. Yet stopping fatal child abuse, and preventing
overwrought teens from smothering their newborns, could save more lives.
Still,
mentally ill mothers often can't keep their troubles under wraps, providing
some chance for prevention.
Dr.
McKee cites a report that up to 75 percent of mothers who murdered their
children had psychiatric symptoms before the killing, and up to 40 percent
had been seen by a psychiatrist shortly before the killing.
"If
a woman with children presents with depression, and with suicidal ideation,
a question clinicians want to ask this person is, 'What are your plans for
the children?' " he says.
The
question, originally posed by another researcher, allows the women to
discuss their feelings about the children in relation to the suicide -
"and perhaps allows them to talk about unthinkable topics, like
killing your children."
Watching
for postpartum mental problems - those that follow childbirth - also
deserves more emphasis, Dr. McKee says. He cites statistics showing that
hospitalization for psychosis is 25 times higher among women in the first
30 days and 14 times higher in the first 90 days after childbirth.
Getting
help for mothers before their minds unravel is not easy. In Dr. Stanton's
interviews, "a number of these women talked about people in their
lives worrying about them, but the people didn't quite know what to do with
them," she says.
Doctors
and others need to work harder. "Sometimes I think it's actually easy
to get help to the people who are quite functional and who are able to ask
and get help," Dr. Stanton says. "We need to be more assertive
about following up the people who need more help but don't reach out."
Maternal
filicide has victims other than the slain children. The family that remains
is shattered.
Take
the siblings who survive. Researchers know little about them, Dr. McKee
says.
"You
can imagine the conflicts that they would have," he says. Rage.
Depression. Relief. Guilt. They may have witnessed the slaying. And they
may miss mom.
The
mothers themselves wear a mantle of guilt and grief for years. "When I
interviewed these women," Dr. Stanton recalls, "it was just so
painful, still incredibly painful for them. It's a terrible thing to have
to live with."
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