Is a Postpartum Depression Defense a Cop-Out?


A few of you who read my blog regularly and follow me on Twitter may remember a conversation I held with a woman who asked at her blog if Postpartum Depression is a cop-out defense when it comes to infanticide. This post is my response. It’s taken me some time to write due to research and the intense emotional aspect of this issue. The post below is lengthy. It is triggering. There are graphic descriptions beginning in the first paragraph. If you are easily triggered, go watch this video instead. Oh, and if you go watch the video? I’m not responsible for the ensuing addiction. (I’ve been listening to it almost non-stop for the past 36 hours.)

Humankind cannot bear too much reality.

T.S. Eliot

Since the dawn of time, humanity has grappled with parental induced deaths of infants and children. In Paleolithic and Neolithic ages, infanticide was an acceptable practice, one meant to preserve the balance of man and his immediately available resources. Later, in some cultures, infanticide grew to be gender-based with girls specifically sacrificed due to the cost of dowry required at marriage. Ritual sacrifice, unwanted birth, illegitimate birth, gender disappointment (including financial reasons such as dowry), birth defects or deformities, preservation of ecological balance, and a number of additional reasons peppered several cultures as legitimate reasons for the practice of infanticide.

Common early methods of infanticide included but were not limited to: exposure, suffocation or asphyxia, ritual sacrifice, brute force, blunt force trauma, and others. The most common method was exposure as this freed the parents from any direct involvement in their infant’s actual death according to societal belief. In fact, Romans often abandoned their infants with the hopes they would be raised by others, in which case they were referred to as “foundlings.”

Infanticide, the murder of a child older than 24 hours yet younger than 12 months, is carried out in our modern ages primarily by the mother and typically does not involve brute force or violent methods. The child is instead smothered, drowned, poisoned, or asphyxiated. Some cases do involve more force and more heinous methods.

Most mothers who commit infanticide are in a lower financial class and lack support from family and community. It’s also important to note many victims of infanticide are not first born but instead second or later born children.

Interestingly enough, not many fathers were cited in the research in regard to infanticide. In fact, only four known cases of infanticide with fathers at fault are present in current literature spanning the subject of infanticide. Fathers are far more prevalent in filicide cases which are cases involving children over 12 months of age. In these cases, the father is more likely to also harm the mother and himself in addition to any children involved.

In many infanticide cases involving mothers, a mental health disorder is cited as part of the defense or reason for the crime. Occasionally this directly relates to a Postpartum Mood Disorder, specifically Postpartum Psychosis. But for the mothers who use a Mental Health defense, is it a worthwhile defense or is it a cop out?

Postpartum Mood Disorders have been mentioned in literature since Hippocrates. Within the past several years, research and community awareness has exposed these conditions as real and palpable. While the true cause is not yet known or fully understood, researchers are working to expose the root cause and improve treatment for those affected. To date, we understand some physical roots but experts are still teasing out the specifics of these causes. Increasing social support surrounding mothers has proven time and again to be key to preventing and shortening the Postpartum Mood Disorder experience. Creating awareness and understanding of a less than Utopian postpartum experience lends a helping hand as well. Improving access to knowledgeable professional resources such as psychiatrists, therapists, and the like, also increases the potential for recovery success in families struggling with Postpartum Mood Disorders.

In many infanticide cases, the mothers and their families did not have adequate access to knowledgeable and compassionate personal, community, or professional help. If they did realize help was needed, they were either discouraged from reaching out for it via societal stigma (ie, the husband didn’t want his wife on medication, they were told to get “over it,” or there were religious beliefs preventing the necessary help) or there simply was not adequate sympathetic and knowledgeable care within physical or financial reach. That said, every infanticide case, as with every Postpartum Mood Disorder case, is different from the next. There are important basic factors from each which carry over into the next but the idiosyncrasies differ which make each case nearly impossible to successfully compare in entirety to the next.

From a legal perspective, choosing a Mental Health Defense is more of a crap shoot or a game of roulette. Postpartum Psychosis and Depression, while a real and experienced phenomenon, is not a guaranteed defense against the crime or action of infanticide. It is a transient defense at best, one wholly dependent upon the current legal status of mental health defense within the state and/or country in which the accused mother resides.

The legal definition of Postpartum Psychosis is not congruent with the medical definition. Both are based, at this time, officially on speculation. The DSM IV eliminated Postpartum Psychosis as a classification. The DSM III listed Postpartum Psychosis in the index but not as a separate illness. According to the DSM III, Postpartum Psychosis was thought to fall under: schizophreniform disorder, brief reactive psychosis, atypical psychosis, major affective disorder, and organic brain syndrome. Postpartum Psychosis occurs in 1 to 2 births out of every 1,000, or at a .1% rate. Postpartum Psychosis is considered a medical emergency with immediate treatment necessary. Onset is sudden and occurs within the first 4 weeks after birth, most often within the first 2-3 days. Postpartum Psychosis is the deadliest of the Postpartum Mood Disorders with a 5% rate of infanticide.

The legal definition of Postpartum Psychosis is no different than that of any other Mental Health Disorder as far as fault-finding and therefore subject to the same rigorous testing of any other Mental Health defense. In the United States, this is dependent on the state of residence. Some states abide by the M’Naughten rule while others abide by the A.L.I. test. In three states, Montana, Idaho, and Utah, the Insanity Defense has been abolished even though these states still admit evidence of mental status in cases.

Even with access to a state by state chart of current Mental Health Defense guidelines, it’s confusing at best to determine what your outcome would be in a court of law. In the United States, there is argument against setting a legal specification for Infanticide  as England did in 1922. The current argument against this specification cites lack of a true medical definition for Psychosis along with the potential for a growth of sympathy for mothers who kill and would then invoke the status.

If a mother who commits infanticide invokes a Mental Health Defense, she is not guaranteed freedom if not convicted of murder in the criminal sense but is instead found Not Guilty By Reason of Insanity (a conviction, by the way, not available in ALL states and very dependent upon which test your state uses to determine sanity at time of criminal action). She instead opens herself up to be remanded to a State Mental Institute more than likely with high security. This is not like going home after trial or heading off to a luxurious Club Med vacation. This is dark, gloomy, filled with meds, psychiatrists, therapy, and communing with a population who is equally if not more disturbed than the remanded mother. She is cut off from family, from friends, and from her life, just as if she were sentenced directly to jail. Also, she is continually judged by society, regardless of her convicted status as a psychiatric inmate versus a mainstream high security or possibly death row inmate.

Once remanded to a Mental Institution, the sentenced mother is at the hands of whatever governing body is responsible for releasing psychiatric inmates. This also differs from state to state. More often than not, it is the Court but a few states hand this responsibility to various agencies within their purview. She may also be sentenced to spend a specified amount of years at the Mental Institution despite therapeutic or rehabilitation status, thereby subjecting her to additional exposure to a less than preferable environment for years after conviction just as if she were a mainstream inmate.

The legal and medical diagnosis and defense of Postpartum Psychosis are at best subjective to the diagnostic technologies, sound judgment, and ethics of the medical and legal professionals privy to each individual case of infanticide, thereby further complicating the transient nature of this defense. Therefore a conclusion claiming Postpartum Depression/Psychosis defense as a “cop-out” is erroneous at best as this defense rarely guarantees the defendant the freedom to which she had access prior to her accusation and subsequent proceedings regardless of any legal outcome.

As David G. Myers stated in Social Psychology, “There is an objective reality out there, but we view it through the spectacles of our beliefs, attitudes, and values.” Infanticide has an objective reality in the courtroom. It is a crime. The precise charges depend upon the circumstances of the commission of the actual crime. The defense relies upon the knowledge of the psychological and criminal experts examining the accused. The prosecution relies upon them as well but relies heavier upon the requirements set forth by the law and the justice system to which they are bound. Society at large, meanwhile, is set free to judge, convict, and develop opinions not bound by the court. Our convictions of the accused mothers may be harsher, intrinsically darkened with our own emotions and experiences.

In the end, far more than one life is lost in every case of infanticide. Yes, one life moves on to eternity, but the lives of those surrounding the one lost will never recover. Infanticide is therefore not an incident captured in a vacuum but a ripple vacillating through families and communities like a tornado. Conversations must be held, action must be taken, and the stigma of asking for help signifying failure at motherhood must dissipate if we are to begin to battle the further destruction and loss of mothers, families, and infants to this crime.


MOTHER’S Act supporters gather to celebrate enactment of historic postpartum legislation


Today, at 1130 a.m. EST, a gathering will take place. A gathering that has been years in the making, has had some of the most amazing and dedicated supporters I’ve ever had the pleasure of meeting, and a gathering that celebrates the thousands and possibly millions of lives which will be saved in the years to come.

Senator Menendez, Rep. Bobby Rush, Carol Blocker, Susan Dowd Stone, Katherine Stone, Sylvia Lasalandra, and several other advocates are gathering on Capitol Hill to celebrate the enactment of the MOTHER’S Act. This is a momentous day indeed.

This past year I spearheaded a blog event to help increase grassroots support of this bill. Several other women also worked diligently to increase support and gather signatures for a petition which was presented to Senators in support of this bill. It was not an easy task. We had opposition. Opposition which attacked us like nothing I’ve ever experienced. They said things about us that simply were not true in an attempt to bring us down and decrease our support for the bill. But it didn’t work. We persevered through their words, through their hatred, through their guilt-ridden tactics. Was it easy? Heck no. But we kept on in the trenches because we had truly been IN the trenches fighting off our own battles with Postpartum Mood Disorders before our births as advocates. We knew what it was like to be tragically alone in that cold, damp place. And we were gonna be damned if we let that continue to be the norm.

Along the way, we proved our compassion for all new moms. We provided resources and supported them as they cried out for help in the darkness of their battle with Postpartum Mood Disorder instead of attacking them for choosing to use certain therapies available to them.We lifted women and families up with love, warmth, and cherished each one of their experiences. We cried with them, laughed with them, celebrated victories and comforted in times of loss and grief. We were there.

We won a good fight.

And today?

Today’s just the icing on the cake – the party.

But beneath that icing, rest assured we will continue our hard work. We WILL be there for all those who contact us, who lean on us for support, for reassurance that yes, YOU too can beat this beast.

Today though, I’m giving you permission to have your cake and eat it too. We’ve damn well earned it.

Heartbreaking News out of Houston, TX


I debated about whether or not I should blog about this topic. It’s graphic, it’s disturbing, and it’s deeply saddened me. I finally made the decision to blog about it to clear up a certain point I’ve found in most of the news stories.

Unless you’ve been on a news blackout or under a rock, you’ve undoubtedly heard about the tragedy which occurred in TX this past weekend. I will not be delving into the details here. They are quite graphic and disturbing. I had a hard time reading the news story. I do not wish to trigger any suffering women who regularly read or subscribe to this blog. If you have a stronger stomach and do not feel you would be triggered by the details, you can read the story here.

The news story states the mother was mentally ill, having been previously diagnosed with schizophrenia.(Dad also had been diagnosed with schizophrenia)

Once again though, Postpartum Depression is mentioned in the story. Postpartum Depression is being bandied about as a possible cause of her behaviour.

I’d really like to make something perfectly clear.

Women with Postpartum DEPRESSION do NOT murder their children.

Let me say that again.

WOMEN WITH POSTPARTUM DEPRESSION DO NOT MURDER THEIR CHILDREN!!!!!!!

However, women with Postpartum PSYCHOSIS are much more likely to follow through with these horrific thoughts.

Postpartum Psychosis is a medical emergency. The onset is fast and furious and this particular Postpartum Disorder carries the highest risk of suicide, infanticide, and filicide of ALL the Disorders on the spectrum.Women with Postpartum Psychotic symptoms should absolutely not be left alone with their infants.

According to MedEd PPD, Symptoms of Postpartum Psychosis are:

  • Risk of harm to self (suicidality)
  • Risk of harm to others (homicidality)
  • Inability to provide basic care for self (usually due to psychosis). Psychosis is associated with both suicidality and homicidal ideation toward the infant or others.

Mothers with Psychosis may also show signs of delusional thinking, hear voices, or experience hallucinations.

And what should family members do if they suspect a new mother may be exhibiting signs of Psychosis?

Most importantly, the mother should NOT be left alone with her infant. She should be immediately transported to the ER for professional assessment and treatment. In the above article, it is stated that the mother’s family noticed her decline in mental status just a week prior to her crime. She was hospitalized but signed herself out.

Risk Factors for developing Psychosis include (but are not limited to) family or personal history of bipolar disorder or schizophrenia. In this particular case, the mother had been previously diagnosed and hospitalized for Schizophrenia.

How often does Postpartum Psychosis occur? One per 1000 mothers may experience Psychosis.

If you want to truly understand Postpartum Psychosis, go read my interview with Teresa Twomey, author of Understanding Postpartum Psychosis. Both she and her daughter fortunately survived Postpartum Psychosis. With the publication of her book, she hoped to help remove stigma from this condition which is so very often sensationalized in mainstream media and made to seem more common than it really is.

How many more of these cases do we need to read about? How many more times do we have to confuse Postpartum Depression with Postpartum Psychosis in mainstream media? How many more times do we have to mourn the loss of another infant because a mother was left behind by an uneducated system which failed her? How many more times are we to read about a family destroyed by something which could have been prevented if swift action had been taken?

Why weren’t preventative measures already in place given the mom’s mental health history? Why was this tragedy allowed to occur? And why are moms in TX murdering their infants at such a high rate?

Why?

When will we wake up and realize that we need to reduce stigma, increase awareness, educate, research, and inform medical professionals in ALL fields about the dangers of Postpartum Psychosis? Educate them about the differences between Postpartum Depression, Anxiety, Obsessive Compulsive Disorder, Post-Traumatic Disorder – WHEN?!?!

THE MOTHER’S ACT needs to be passed NOW! Families cannot wait any longer for relief!

Just Talkin’ Tuesday: The MOTHER’S Act


LegislationOn February 23, 2001, Melanie Stokes gave birth to a baby girl. Just three months later, she committed suicide. Melanie’s death gave birth to a very dedicated activist – her mother, Carol Blocker. Frustrated with the failure of physicians to appropriately care for her daughter, Carol worked endlessly to keep Melanie’s tragic death from becoming meaningless. Through Carol’s tireless advocacy and work with Representative Bobby Rush (IL), the Melanie Blocker Stokes Act has now become The MOTHER’S Act.

The MOTHER’S Act as it reads in the current version would provide funds for a public awareness campaign, education campaign for caregivers, increase availability of treatment options and entities as well as require the current Secretary of Health & Human Services to conduct a study regarding the validity of screening for Postpartum Mood & Anxiety Disorders.

More and more research is slowly uncovering potential underlying causes and risks related to Postpartum Mood & Anxiety Disorders. More and more women and caregivers are becoming educated as more of those who have survived a PMAD speak up to share our story.

If passed, The MOTHER’S Act would further reduce the stigma surrounding new mothers not ensconced in the Johnson & Johnson glow of infantdom. If passed, the MOTHER’S Act would increase funding for research and possibly open even more doors to understanding the cause and more importantly, the potential for truly preventing Postpartum Mood & Anxiety Disorders. If passed, the MOTHER’S Act has the potential to prevent tragic deaths like that of Melanie Blocker Stokes.

Much of the debate surrounding the MOTHER’S Act has centered on the word “medication.” Medication does not necessarily mean Anti-depressants. It does not mean this is the ONLY way to treat a PMAD. It is merely listed as an option for treatment. And frankly, if one has a doctor with a quicker draw on his/her prescription pad than Billy the Kidd, I’d run away. I’d run away faster than a cheetah.

Another key point of the opposition has been that the MOTHER’S Act mandates screening. In the current version, there is no mandate for screening. The only mention of screening is to require the Secretary of Health & Human Services to conduct a study regarding the validity of screening for Postpartum Mood & Anxiety Disorders. The current standard for screening is the Edinburgh Postnatal Depression Scale, which you can learn more about here.

You can read a copy of the current bill by clicking here.

Go read it. (Don’t worry – it’ll pop up in a new tab/window – I’m cool like that here)

Seriously. Read. The. Bill.

Then read it again.

And then come back here. Be honest.

Unlike this week’s TIME article which failed to present both sides, I promise to allow unedited comments in support of or opposing the bill as long as they are civil. (Any comments including personal attacks will NOT be allowed!)

So let’s get to Just Talkin’ Tuesday already!

TIME Magazine misfires debate on MOTHER’S Act


Awhile back, I was contacted by Catherine Elton regarding an article which was to examine Postpartum Depression and the Mother’s Act. The email somehow got buried and I did not get a chance to participate in the discussion.

It seems that it would not have mattered if I had been able to discuss my story with her.

Time published the story this week. While the online version has been modified to correct an error with Ms. Amy Philo’s story, you can still see the original version in the hard copy. (Which by the way, I am personally asking you to boycott – even asking if you can take the copy of TIME home from the doctor’s office in order to keep other moms from reading it! And make sure you ASK – because just taking it would be stealing and that’s illegal.)

The original version, entitled “The Melancholy of Motherhood” includes one quote from Carole Blocker, the mother of Melanie Blocker Stokes, a mother who tragically committed suicide after unsuccessful treatment for severe postpartum depression after the birth of her daughter. The quote reflects Ms. Blocker’s confusion as to how someone could oppose the MOTHER’S Act, a bill which is designed to increase public and professional education regarding Postpartum Mood & Anxiety Disorders. Frankly, I’m confused right along with Ms. Blocker.

The only survivor story featured in this article is that of Amy Philo, one of five recipients of an Outstanding Achievement for Mothers’ and Children’s Rights awards from the Citizens Commision on Human Rights or CCHR. CCHR was founded in 1969 by none other than the Church of Scientology, well-known to oppose the entire psychiatric field.

Amy has tirelessly worked against this bill for quite some time now but continues to be tragically misled. Few discussions with her have led to quite the round robin with Amy unable to come up with legitimate research to back up her claims. When asked for said research, Amy refers to her own websites instead of to specific research articles supporting her claims.

I happen to know that Ms. Elton did indeed interview fellow survivors who support the bill. One has to wonder then, why did their stories not make it into the article? Was it length? Was it editing? Or was it intentional? Regardless, the finished piece as published presents a very frightening and deceiptful picture of what new mothers face is this bill is passed. To begin with, the MOTHER’S Act no longer mandates screening. It requires a study to be completed by the Secretary of Health and Human Services (Kathleen Sebelius) as well as funds for an educational campaign for both caregivers and the general public.

I agree that just because a new mother shows emotion she should not immediately be diagnosed as having a PMAD. I also believe that a woman should have free choice when it comes to her treatment decisions and should NOT be judged for those choices. I chose to take Anti-depressants. My first prescription did not work out. But my second one did. Just as with any other medication, sometimes they don’t work so well with your system. So you try another one. You don’t suddenly take your own care into your hands – that’s ridiculous. Would you try to heal a broken leg or diabetes on your own? No? I didn’t think so. So why would you rely solely on self-care when it comes to mental illness? Self-care should be part of the picture but it shouldn’t be the ONLY part of the picture.

I am so tired of being judged and accused of not having informed consent. You know what? When I made my decision to go on Anti-Depressants, I had carried around an informational packet about AD’s & Breastfeeding given to me by the NICU Lactation Consultant with me for a week. I read that thing through and through. I was exclusively pumping for my daughter at the time and did not want to jeopardize her receiving my milk if I ended up having to take something. But I couldn’t function. I couldn’t take care of my family, I couldn’t take care of myself, and a lot of the same thoughts were coming back. Negative, scary thoughts about knives and hurting myself and my family. Yet I wasn’t on anti-depressants. I needed to be able to function. So I made a very informed decision to do so, one I do not regret to this day.

TIME – I am very disappointed in your lack of sharing both sides of this debate. Very very disappointed.