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.


Reflections on San Antonio


I wrote this piece tonight as I thought about what happened this past weekend in Texas. It is a very long piece. Much of the piece is ok to read but there is a paragraph quite a ways down in which I discuss some rather graphic thoughts I had about my own children back when I was in the grips of Postpartum Obsessive Compulsive Disorder. If you are still fragile, you may not want to read the entire piece. And if you need help and are unsure where to find it, please start with Postpartum Support International. They will get you pointed in the right direction. They will not judge, they will not blame, they WILL take good care of you and give you a compassionate shoulder on which to lean as you recover.

In today’s society, news smacks you in the face before it’s even managed to hit the snooze button. By the time an event is fully engaged in the morning commute to the office, many of us have already shared our opinions about what it had for breakfast – how it was prepared, what the choice of bacon v. veggie protein substitute says about it, and why the pinstripe power suit was chosen over sweats for the day. We wax poetic about the potential fall-out of the course taken, what may have led up to the formation of said course, and continue to share these thoughts with each other in a show of solidarity and human curiosity. We do all of this irregardless of our intimate knowledge of said event. Many of us don’t give a second thought to this habit because it’s become so ingrained in our culture, even since elementary school. Remember playing Telephone? What the last person called out almost never was what the first person said, was it?

Every so often there is an event so horrific we’d rather it not be discussed or it gets twisted somewhere along the line. It may start out as the picture of perceived perfection but by the time the tale escapes, it’s got disheveled hair, bloodshot eyes, frayed flannel shirt, stained jeans, ripped shoes and the stench of life wafting over at us from the dusty corner of the room. We’d much rather turn to each other or any other direction but towards this horrible aberration crouching in the vestibule of our day. It sways back and forth as it begs for attention. Many times we rush to judgment. Disgust fills our hearts with judgment quickly following. Often we fail to even attempt to understand or develop compassion. What made her this way? Or worse – could THIS happen to us? Out of fear we explain away her existence. We justify her behavior and experience with ignorance and labels so sensational they could only belong to other people – never to us. Never to us, right?

Never…….

Until it does. Until we awaken one day with disheveled hair, bloodshot eyes and a pile of frayed and filthy clothes in the corner. Suddenly discover we are the aberration in the corner. What then? Where do we turn? What do we do? How do we rejoin society, shed the aberration mask now super-glued to our psyche? How do we help those who find themselves trapped in the same vestibule after us to escape as well?

We slowly build scaffolding around ourselves as we heal. If we are fortunate, we are able to lean on family, qualified and understanding professional caregivers, peers and others. And once we have become strong enough we begin to knock the scaffolding down. Once the dust has cleared after the scaffolding has been removed, we fling open our newly renovated doors to shelter those who are just beginning to realize they too, need scaffolding. We provide the necessary hardware – support, compassion, education. As they begin to heal they find the same empowering passion exists inside themselves as well. So it spreads as they too, break free from their scaffolding to fling open their newly painted doors to shelter others as well, all of us paying forward the compassion and knowledge we received when we were at our worst.

Even with this process there is mourning. Mourning of the loss of innocent souls, mourning those who were not fortunate like us to find shelter in the storm. Mourning that maybe we didn’t do enough to protect those around us.

There is also anger. Anger at the loss of innocent souls, anger that a safe harbor was not provided, anger that not enough was done to protect those we love the most.

Then there is confusion. Confusion over why this happened. Confusion over what went wrong, what could have prevented this horrific tragedy. Confusion as the details are sensationalized as the story is repeated over and over.

And last but not least, there is blame. Blame pointed at the doctors who shouldn’t have let her out of the hospital. Blame pointed at the family for not recognizing the gravity of the situation. Blame, blame, blame.

In the end, we were all failed. We were failed because we are all flawed. We are human. In the throes of tragedy and chaos, we are all tossed about in a rough sea, struggling to find our True North. Each of us has a different True North. Each of us is not equipped to direct others to find their True North. While we may have friends to help us on our journey, there are stretches we must tread alone. These stretches are made easier by the travels of those who have gone before us – especially if they leave comforting words of wisdom behind to guide us.

We may never understand why Otty Sanchez did what she did. We may never fully understand the aberration crouched in the corner. But there is absolutely no reason we can’t reach out to her and show her some compassion. Her family has suffered a tragic loss. An infant brutally murdered by his own mother who then tried to harm herself. I cannot begin to imagine the whirlwind of emotions swirling about this family as they move forward and process the events which unfolded this past Sunday. Events which left even hardened law enforcement officials nearly unable to process the crime scene. Events which left me wanting to to put on blinders. Yet here we are.

Some point. Some judge. Some are eager to throw her to the wolves. Some dissect her situation with an authoritative voice. Others continue on their own journeys, ignoring the aberration in the corner, even if she reaches out desperately for their aid.

Some are willing to reach out to offer compassion, understanding, help.

And each one of us is not wrong in our initial reaction. When an aberration occurs we react from a very visceral and primal place. Our attitudes are deeply rooted in the history of humanity, planted firmly within lessons handed down from generation to generation. We often do not have a choice in our initial reaction. However; we have a choice in what we choose to do with this reaction.

We can choose to let this reaction destroy us and build hatred in our hearts or we can allow this reaction to propel us into compassionate action. Action that will help to prevent this aberration from occurring over and over again. This is the path I have chosen. Many others have also chosen this path. (Or as some of them would tell you – the path CHOSE them!) Regardless, myself and those on this path with me believe deeply in compassion, respecting the journey of others, know the importance of social support and understand the importance of professional education in relation to Postpartum Mood & Anxiety Disorders.

We are not perfect. None of us are. But as we work together we can heal those imperfections. The key is to work tirelessly together towards a common goal encompassing knowledge, awareness, compassion and respect for the journey each and every woman and family embarks upon as they grow our great country. No family deserves to be sent down the dark path of Postpartum Mood & Anxiety Disorders without a road map of support. No family deserves to feel the heartache and horror Otty Sanchez’ family must be feeling right now. NO FAMILY should have to suffer this when there is hope. When there is knowledge. Where there is such a strong potential for light and happy endings.

So I ask – with all the knowledge available today, why are we still stuck here? Stuck in the dark ages of ignorance about Postpartum Disorders? Why are there people still denying that mothers struggle with Postpartum Mood Disorders? Trying to convince the masses that Postpartum Mood Disorders have been cooked up by the Pharmaceutical Industry? Hippocrates first wrote about Mood Disorders and Moms way back in 400 B.C. Yes, 400 B.C., well before any industry had been started. Documented episodes of “Milk fever” and maternal madness continue throughout history – before and after the beginnings of the Pharmaceutical industry.

What will it take for us to wake up? If not now, when?

How many more mothers, infants, and families must be destroyed before we come to our senses? Motherhood has been shamelessly turned into a factory process in this country. Birth is unnecessarily medicalized. Recovery is anticipated to be swift as we expect new moms to rip themselves from their infants at a mere six weeks postpartum. After nine months of tremendous change and all we get is 6 weeks to recover? All is well we expect to hear! But what if all is not well? What if they are guilt ridden? What if they truly are depressed? What if they cannot function? What if they are afraid to share these feelings for fear of the stigma? For fear of judgment? For fear of ignorance or pill shoving physicians who won’t explore the potential of physical underlying causes of these negative emotions such as anemia or hypothyroidism/hyperthyroidism? For fear of shaming their family? For fear of being told to just suck it up or that only the weak cry?

I started to wake up five years ago as I imagined myself stabbing my daughter because I wondered what it would feel like to drive a knife into her tiny body (and no, I was not medicated when I had these thoughts). I fully awoke three years ago as I found myself daydreaming about smothering my daughters, convinced it would all be so much easier if they were just gone. Instead, I crawled into bed and called my husband. I ended up hospitalized. From that point on, my eyes were open. Suddenly my life slid into place much like a solved Rubik’s Cube. I planted my feet, turned, and fought the beast.

Today I stand with arms constantly stretched back to reach out to those who now find themselves desperately struggling to make sense of the negative emotions rushing around them after the birth of a child. I wake each and every day with the goal of empowering at least ONE woman to not allow those around her to mislead her towards believing she is at fault and should just duck her head down as she lives her life in misery.

Please, at the very least, familiarize yourself with the following if you or someone you love is pregnant or postpartum:

KNOW the warning signs of Postpartum Psychosis.

KNOW the signs and symptoms of all the Postpartum Mood & Anxiety Disorders.

DISCUSS what to do if signs and symptoms begin to occur. Recruit family members and friends to be on call to help with childcare, meal preparation and household chores if needed.

TALK with your care provider about actions to be taken once signs and symptoms have been identified.

HAVE a plan in place!

EDUCATE your family and friends about Postpartum Mood & Anxiety Disorders. Knowledge is empowering.

Above all, remember that with the birth of a new baby comes the birth of new parents. Yes, they are grown but now they have suddenly been thrust forth into the hardest job they’ll ever have. The learning curve is vicious. They’re now on-call all the time. These new parents need training. They need 24-7 tech support. They need to know there’s someone there they can rely on when they need it most.

So please, check in with those you know with small children. Ask if there’s anything they need. If there’s anything they need to talk about. Offer to take the kids so they can go to a movie, out to dinner, or just stay in to enjoy some much needed silence or catch up on sleep.

Bring back social support. Share your knowledge. Bring back the village. It’s so desperately needed.

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!

Proposed TX Bill seeks to limit jail time for Psychosis sufferers


Susan Dowd-Stone shares the following at her blog:

Representative Jessica Farrar (D-TX) has introduced a new bill to the Texas Legislature which could limit jail time for mothers who commit infanticide while suffering from postpartum psychosis. While adoption of this historic bill would not replace or affect the appropriate use of the insanity defense for such crimes – a defense which can eliminate jail time while mandating sustained psychological treatment – it would limit jail time consideration during the penalty phase to two years for mothers deemed to have been under the influence of a pregnancy or lactation related psychosis within 12 months of giving birth at the time of the offense.

Click here to read the entire article.

Nicholas Fuelling promises to wait for his wife


Earlier this week, Kristina Fuelling found herself sentenced to the lowest possible sentence for the death of her eight day old infant. Fortunately she found herself in the presence of a very compassionate judge and prosecutor who were both able to recognize her actions were a result of Postpartum Psychosis. She is currently being held at a mental facility and will be transferred to a state prison for the remainder of her sentence once her mental state stabilizes.

Her husband, in exclusive first statements to a local news station, has promised to wait for Kristina and opened up about signs and symptoms of Postpartum Depression and Psychosis. He encourages fathers and loved ones of new mothers to educate themselves and become familiar with signs that things are not going well.

According to the article, Nicholas’ statement of encouraging awareness is:

“I would tell new mothers, or expecting mothers and fathers to research it, look into it. It’s just as important as any other factor of raising a child,” he said. “There are signs: lack of sleep, having trouble with breast feeding, having trouble taking care of the baby, lot of anxiety. But sometimes it comes just unexpectedly.Even in hindsight now, I don’t even think I could’ve been able to change it unless I knew beforehand,” Fuelling said.

“So I would tell people out there to look for signs of severe anxiety. Get help. Ask your friends and your parents, family, to come over to help take care of the kids. Don’t be alone on it if you feel any feelings of being scared or not being able to handle the situation,” he added.

You can read the remainder of the article by clicking here.