Tuesday, October 14, 2008

Is Casey Anthony Another Susan Smith?

by Lucy Puryear, M.D.

I am often asked by the media to comment on cases where mothers have harmed or killed their children. I frequently am called by attorneys asking for help in their cases where a mother has killed her child.

Because of my work in the Andrea Yates case it is hoped that I may be able to offer some psychiatric defense for other defendants. If the alleged murderer was suffering from psychosis then a verdict of Not Guilty by reason of insanity may be successful. Many attorneys wrongfully assume (or hope against hope) that if the mother they represent has killed her child then she must be "crazy." I am sure she is "crazy" in some form, but not always in a way that mitigates her responsibility for the crime.

It is impossible for me to forget the case of Susan Smith. It was October of 1994, and I was a second-year resident in psychiatry at Ben Taub Hospital in Houston. I was learning how to diagnose psychiatric illness and treat psychiatric emergencies. We were also being trained in detecting whether someone was fabricating or exaggerating their illness for some secondary gain. It was not at all unusual to interview persons who were trying to get prescription medications from naive young doctors, or who wanted to be admitted to the hospital for a warm bed and three free meals.

But as I watched Susan Smith on television tearful and begging for the lives of her children, I felt tremendous sorrow and grief for her. I could only imagine how devastating it would be if I had been accosted and my children kidnapped. Her grief felt in sharp contrast to the drug addict trying to convince me they were terribly anxious and needed me to prescribe Valium. I knew one women was in real pain, and the other just trying to manipulate me.

The nation and I were shocked to learn that while Susan Smith sobbed, her children were strapped in to their car seats, at the bottom of a lake. The person responsible for their deaths? Their mother.

In the Casey Anthony case we have a mother who allegedly killed her child, stored her daughter's body in the trunk of the car, and then began to party. Only when questioned did she report that her daughter had been missing for some time.

Unlike Susan Smith, we never saw her on television begging for her child's return. We did see her at the disco and at Target, acting as if life couldn't be better. Even if she didn't murder her cute-as-a-button daughter, why is she acting so blase about the fact that her daughter is missing? Unexplainable.

What are the possible reasons a mother could kill her child? From a psychiatric point of view, I think there's something seriously wrong with someone who murders her own child. It doesn't mean I think they shouldn't be punished, but I also think that a diagnosis of some type can be made. Let's start with the "easier to make the connection" psychiatric disorders:

Psychosis: A person hears voices telling them to harm their child or has a delusion that makes them believe their child needs to be saved from evil or their child is evil and the world needs to be saved. This was true in the Andrea Yates case; she believed her children were being taken over by Satan, and in order to save them from hell she had to send them to heaven while they were still innocent enough for God to take them. This can happen to women who become psychotic for the first time after delivery, or in patients who have previous diagnoses of schizophrenia or bipolar disorder. This can be prevented with appropriate psychiatric intervention and medication. Mothers can be treated and children do not have to die.

2. Depression: A mother can become so severely depressed that she wants to kill herself but feels that her children would suffer without a mother. She kills the children before she attempts to kill herself. Sometimes she is unsuccessful at taking her own life and must face the emotional and legal consequences of her choice. This can happen in severe postpartum depression or in cases where a mother is depressed due to financial or marital stresses. She believes she is protecting her children from being left behind to suffer. Depression can also be identified and treated and lives saved.

3. Borderline Personality Disorder: This is a complicated diagnosis and varies in severity from individual to individual. The characteristics of this diagnosis are mood lability with terrible feelings of depression, loneliness, emptiness, and despair. This mood symptoms are often accompanied by substance abuse, risk-taking behavior, and suicidal thoughts with less serious attempts. These attempts are often seen as cries for help. Persons with BPD form intense chaotic relationships which are often passionately good early on and then become disappointing and passionately bad later on. This disorder usually occurs in people who have histories of childhood abuse, abandonment, parents with disorder, or other chaotic, "not safe," inconsistent attachments to caretakers. Borderline Personality Disorder is hard to treat. The treatment consists of long-term psychotherapy and medication.

Although I have not personally interviewed Susan Smith, this is most likely her diagnosis. She was raised by a violent alcoholic father who later committed suicide when her mother divorced him. Her mother remarried a man who molested Susan for many years without reprisal. Susan began to engage in relationships with married men while she was in high school and was in the middle of a divorce and rejected by her lover when she released the parking brake in her car and watched her children drown. She knew what she was doing was wrong, but at that moment was feeling such despair and hopelessness that it felt like a way to make life less complicated. She also believed that without her two children her boyfriend might take her back. She was terrified to be alone without a man in her life to allow her to feel complete.

4. Narcissitic Personality Disorder: This is an unfortunately common personality disorder that often does not cause the person who has it much discomfort. Persons with this type of character have little regard for needs or feelings of others, but use others to meet their own needs and desires. Often those with this type of disorder are successful in their business or careers and can appear outgoing and charismatic, but they draw people to them for their own personal gain. If a loved one or colleague stops being useful to them then they can be easily disposed of without much pain. If there are problems in their lives, they are blamed on the inadequacies of others. Narcissistic individuals have a hard time taking personal responsibility. The causes for this disorder are not entirely clear, but often there is a childhood history of being highly adulated by parents, not made to take responsibility for mistakes with parents often helping to cover-up or fix problems, and having things given without having to learn the value of hard work and disappointment.

I don't know Casey Anthony's history, but her behavior certainly fits one who has little regard for others, is primarily interested in her own welfare and happiness, and will go to great lengths to escape consequences or punishment. Susan Smith confessed to what she had done and felt remorse. Casey Anthony continues to lie and deceive.

5. Antisocial Personality Disorder: These are the people who fill our jails. People without conscience, morality, or the ability to live within societal norms. I can give too many examples of this. . . . Mothers who drown their kids to get back at cheating boyfriends . . . Mothers who leave their kids alone to go hang out at the crack house . . . Mothers who abuse and torture their children for . . . enjoyment. At the moment there is no treatment for this disorder. Therapy as an adult doesn't work. Early childhood intervention is most likely the key. There has been one study published that links those in jail to having had mothers who had postpartum depression. By the time someone reaches jail it is mostly too late.

Mothers will continue to kill their children. Jail may most certainly be appropriate for some individuals, but it is not a deterrent to other mothers. Fortunately there are some causes of maternal filicide that are very treatable with proper screening, identification, and treatment.

The Mother's Act in Congress failed but will be brought out again for another vote. This law would require more money be earmarked for the recognition of, treatment for, and research of postpartum psychiatric disorders. (If only it been part of the "pork" in the bailout, like the Parity bill which mandates insurance companies pay equally for psychiatric illnesses.)

Early childhood intervention to prevent child abuse, neglect, ensure quality education and day care, and support for single mothers could go a long way towards decreasing the incidence of antisocial personality disorders. Susan Smith could have benefited from intensive therapy and intervention by someone to stop the abuse by her stepfather. We have the means and the knowledge to stop some of these heinous crimes.

Casey Anthony? There was a book written in 1954 called The Bad Seed. A good read.


Anonymous said...

The Bad Seed by William March - from Mobile, AL it is said to be based on a real little girl who was extremely spoiled. Although she didn't murder anyone in real life. A very popular book and movie in the '50's.

Very good post. I enjoyed it very much.

FleaStiff said...

I've no real knowledge of these cases other than gleanings from the press reports which are, ofcourse, often of dubious quality.

My understanding is Susan Smith was offered a way out of her relentless poverty and stress but the man didn't want "her baggage" whereas the Florida woman appears to have simply opted for nightclubs rather than wet diapers. There were some reports that she had not wanted to continue her pregnancy and that her mother had at one time promised to adopt the child. I don't know if any of these press reports are valid, but it seems that if this woman had lived in Nebraska at the time there would have been no headlines.

Desertion used to be called the poor man's divorce. Has homicide become the lazy parent's adoption?

Some people do not want to be parents. They know that and they act accordingly. Some people do not want to be parents but find themselves in situations involving wet diapers and restricted social lives. I really don't know what sort of adoption options were available to her, but society generally seems to agree that having a child imposes obligations irrespective of the parents desires or abilities.

Lucy Puryear MD said...

Thanks for the comments. I'm not sure that Casey Anthony would have used the abandoned child laws to give up her child. That decision might have required more maturity and fore thought than she has displayed so far. I believe she felt her daughter an inconvenience that she did not want to have to deal with ever again. That is how teenager's and children deal with things they don't want to do---if I hide the peas under the mashed potatoes no one will notice and I won't have to eat them. They feel no remorse until caught.

I want to reiterate what you said very well--I do not have personal information or knowledge of this case. We may one day know a very different story and I may feel very differently.



Anonymous said...

I have a friend who has adopted children who's mother most likely has 5 and has had her parental rights terminated. Neglect is involved. Abuse is involved.
Meth is involved. Murder is invloved but no charges have been filed.
How do you tell children that mommy and mommy's friends are dangerous? How do you make them believe it? It is odd but children tend to gravitate toward the abusive parent.
How do you protect them?

Leah said...

I believe some of Casey Anthony's decision to kill her daugher was for spite and hatred of her mother, among the narcissistic reasons. She didn't have to do it and she knew her parents would have taken and raised the child.

Lucy Puryear MD said...

It is curious and sad how children will still protect and defend the parent who abused them. The truth of the matter is, children love their mothers unconditionally. They need their mothers to feel safe and protected and loved. And if the mother is also the abuser, then the child turns the badness on themselves. It feels safer to believe that Mommy is not bad, I am bad. That way the child can protect the love they have for their mother.

A four year old can not process that mommy is sick or mommy is bad--who would then protect them and feed them? A four year old has to believe that the grownup they are with is safer than the outside world. It's why children will often deny child abuse, out of fear that they will be taken away.

I think the best way to explain it to children would be to say that mommy is very sick and not able to take care of you in the way she needed to. It is not your fault, but because your mommy wants you to be taken care of you are hear with me. Heartbreaking every time.

Anonymous said...

Anonymous - You should report it to DHR and try to be their friend if possible. They need counseling.

Children want to have good parents. They deserve to have them. It's very sad.

There's many good books on this subject. Ludy Bancroft is a real expert on the subject.

"The Batterer as Parent: Addressing the Impact of Domestic Violence on Family Dynamics" by Lundy Bancroft.


Anonymous said...

Anonymous 6:13
DHR is involved. They are receiving counseling. I just wondered what a counselor would say. I am their friend. Thanks for the links and advice I'll forward them.

geovani said...

David Smith felt that justice was not served because Susan was not sentenced to death. He said that he respected the jury's decision and the verdict, but did not agree with it. David also said that he would appear at Susan's parole hearings each time she might be considered for release to make sure that her life sentence means life.


Gritsforbreakfast said...

I'm glad you added this caveat in the comments, Lucy: "We may one day know a very different story and I may feel very differently."

However I wish it were included in the original post and as part of the thought process about the case. There's a rush to judgment aspect to most discussions of this story, to the point that Leah (above), e.g., feels comfortable discussing "Casey Anthony's decision to kill her daughter," as though anybody knows that's what happened.

Things may well be as they appear, just as the prosecution claims, or they may be very different. I've reacted to the drumbeat on this story before by recalling the JonBenet Ramsey episode, where virtually the whole nation believed the parents were being deceptive and were entirely wrong. At that point, "sorry" doesn't cut it, though by then the media have moved on to other stories, like this one, that they treat the exact same way. (The Duke lacrosse team was subjected to similar, unjustified vitriol.)

Accusations of mothers killing their children are particularly subject to media hounding and distortion because the topic is so emotionally charged. The innocence project in Arizona has begun taking "shaken baby" cases because the so-called science behind accusations against mothers based on "shaken baby syndrome" forensics turns out to be mostly bogus and unconfirmed. Even so, when a woman is accused based on false forensics, or for whatever reason, of killing her baby, it launches a drumbeat of self-righteous media browbeating that makes it more difficult to ever reach the truth.

You had some great and useful information here - I respect your depth of knowledge and learned a lot from your post. But something deep inside me is unsettled by treating "Guess Momma's Diagnosis" as some sort of blogospheric parlor game.

Anonymous said...

Gritsforbreakfast do you have dust for brains.

Casey Anthony is a habitual liar and moved her child's dead body around in her trunk. There's forensic evidence proving this.

Of course people are concerned when we see a possible murder suspect walking around free and no solid information on the whereabouts of their child. Thank God there's an outcry for that!

I thought the comparison to Susan Smith was perfect and loved the hide the peas under the potatoes statement. The crocodile tears she shed yesterday were for herself.

David Smith was right. He will have to spend the rest of his life fighting her parole. He will be re-victimized each time he has to go before the parole board. Life should mean life. I can't believe she didn't get the death penalty!

PS The Ramsey's did it! Patsy wrote the note.

Lucy Puryear MD said...

Thank you for your comment "Grits." I too am uncomfortable with diagnosis via TV. I tried to be careful about that, but should have included my comment in the original blog. I do think that trying to understand why people do what they do hopefully leads to better ways of preventing future bad behavior.

I am always inclined to remind myself that all is not always what it seems. My experience in the Andrea Yates case was a prime example--a lot of what the public heard just wasn't true.

I hope that Casey Anthony didn't kill her daughter. I hope that Callie Anthony isn't dead, although it is likely that she is. I hope that someone else is responsible.

Thank you for your comment. Lucy

FleaStiff said...

Unusual examples that you selected.
JonBenet Ramsey? I never felt the parents were being deceptive or where in any way involved.
Shaken Baby? I know thats usually bogus and the oft bandied about figure of equivalent to a 3-story fall is utter nonsense.
Its more a choice to believe in things like Facilitated Communication and Day Care Molestation.
For the Florida case, I would agree that the daughter may well have also been striking out against the mother rather than just against wet diapers and lack of nightclubbing. Unfortunately the law does not impose good parenting obligations on grand-mother.

Gritsforbreakfast said...

Note: Sorry for the deleted comments, I kept getting Diane's link wrong!

Re: "there's forensic evidence proving this"

See Diane Fanning's recent WICI post on all the forensic errors in a double homicide investigation, then tell me again how prosecutors' announcing they have forensic evidence means we know all there is to know!

What if, as Lucy said of the Yates case, that "a lot of what the public heard just wasn't true"? I don't know if that's the case here, but I've been around the block enough to make me hesitant about jumping to conclusions.

Fleastiff, If you never suspected the Ramsey family, I'm guessing you were lonely in that opinion for quite a while. Hell, I'm even willing to grant it looks like this woman did it, I just object to the fact that, long before there were any forensics announced, the blustering Concern Trolls on TV and the blogs had convicted her because of the look on her face at the Walmart, or whatever the hell. Different people grieve differently, and the assumptions about the implied meaning of a post-mortem trip to a nightclub, e.g., struck me as harsh and unfair.

Also, I don't see why my examples were unusual - the common themes were mom killing kid and cases with a public "outcry," to use our anonymous friend's word (I might say "witch hunt") that pressures prosecutors to get somebody, anybody, and leads to false accusations/convictions.

Left Coast Mom said...

Dr Puryear, thank you for a thoughtful and sensitive article on Casey Anthony. The whole world hopes this baby isn't dead but science keeps getting in the way.

Susan Smith is a very frightening woman. With so many news shows doing comparisons between moms who kill, her press conference is all over the place again. To stand there in front of the camera , begging for her children's safe return, knowing what she knew. Just chills me every time I see it. I hope her ex-husband lives a very long time, so he can carry out his plans of keeping her behind bars forever.

If the evidence proves Casey caused her baby's demise, we can at least look back with relief that we were spared from her insincere pleading.

I never understood how Andrea Yates was convicted of murder. I am seldom in favor of the insanity defense but if anyone ever deserved
a get out of jail card Andrea Yates
did. One look at her was all it took to know this poor woman needed help not incarceration.

Again, thanks for the great read, bookstores will be getting a rush from the next generation needing to read "The Bad Seed"!

Anonymous said...

Wow! I wish I had all of you to email with while I was raising my three adopted daughters.

1 2 & 4 when they were found living on their own the oldest begging for food.

When their mother was found she volunatarily signed away her rights.

They never had Christmas, birthday's, ate out of garbage cans, went to the bathroom outside, cussed. The oldest was rude and fearcely protective of "her" baby.

After a year and 1/2 my husband bailed. Life was hard. The oldest was beating up boys at school and stealing from any one or anyplace. She made her own rules and when confronted turned it on the one confronting her.

I took them to counseling their entire life. They eventually did well. Straight A's. Awards.. and then High School.

At about 16 they each faltered and began to fail. I tried everything and the youngest two now at 25 & 27have a good life. But it was tough.

The oldest...y'all would recognize her in Casey Anthony. I am not Cindy. When my daughter had her daughter and refused to be a responsible parent I took action and she snatched her child and left. We immediately went into detective mode to find her. Her brother and sister's all had part of her life. So we followed all leads and after two weeks snatched our granddaughter back. TG she was in grave danger not because her mother would intentionally harm her, because of her mothers choices for herself. (This was a very complicated sordid,involved story....to much to go into here)

Since then our daughter has burned down our house, stolen money from our bank accounts. Used her sister's ID.... Our oldest daughter has custody of our granddaughter and she had to move away to keep her safe. 6 years and still our granddaughter misses her mom...

The rest of us have cut her out of our life. I hate it but it's what we had to do.

Cindy... she must know what her part in this is and that is why she will not accept anything less than her daughters innocence and Cayle being alive.

All those years and all those psychologists and psychiatrists, hospitalizations and no one ever helped or really agreed. I begged for help I saw her and not one healthcare worker acted on it in a way that helped, long term.

Question, these types (from my experience) are smart. So how do you get past the facade, flush them out and help them so they are not a safety issue to themself or others?


april gosa said...

i do have personal info on casey she did this out of jealousy and hatred both for her mom and for caylee the baby was taking all the spotlight and the spoils away from her and cindy confronted casey about her stealing and threatened to kick her out and keep caylee and no way in hell was casey gonna let that happen caylee was not gonna have a nice roof over her head if casey couldn't and casey did not want caylee but she'd be damned if she was gonna was gonna let cindy have her that is why casey killed caylee

april said...

and it was intentional

Anonymous said...

April - WOW, that's so sad. Do you have any knowledge of her childhood? What would have made her be so self centered and resent her own child?

Anonymous said...

I believe Casey has sociopathic tendencies (New term is now "Antisocial") and she is such a skilled liar who believes her own lies by now. Look at it this way, if she admits anything her whole existence will fall to the ground, exposing only the shell of a human being she really is. At some point most of the personality disorders overlap and that is why she seems to have Borderline characteristics, as well as Narcissistic characteristics, along with Antisocial, but in the end, I would be everything I own that she didn't feel remorse for her actions, but ONLY remorse that she has been caught, and thus her freedom taken away. How can you recognize someone like this? They must get your sympathy, that is how and they will avoid taking responsibility for their actions. Are they dangerous? Well, if it looks like a duck, acts like a duck.....um, you get the picture.

raj said...

Personality theory is almost always the place forensic psycologists go for their ammunition. Listen; I enjoy Clarkin, Cleckley, Hare, Kelly, Livesley, Meloy, Millon and Mike Stone as much as anyone, but my principle difficulty with all of them is that they describe an end result without very much edification of where the result came from.

For that, I've gone to a combination of anthropology, sociology and psychodynamic, as well as behavioral, cognitive and even neuro- psychology. And as a result, I tend to cringe when "experts" like this make such pronouncements to the un-edified masses.

CA didn't just wake up one day and start going as nuts as she ultimately seems to have become. Moreover, she presents a stack of behaviors commonly seen in the complex post-traumatic stress disorder (and borderline personality disorder) regularly seen in females her age who were repeatedly incested and threatened with extreme harm (or death) if they ever told on the perpetrator. I'd venture to say that there are at least a hundred women like this at Chino and Chowchilla.

Miller, Russell and Herman started making noises about this in the '70s. Kluft and Putnam described the links between incest and borderlinism in the 1980s. Van der Kolk -- probably the leading authority on childhood trauma alive today -- read Janet's recently translated work from the 1890s and made more noise in the =19=90s. And in this decade, the heaps of research available from Wiley and Elsevier make it clear that all of those mentioned in this paragraph have been barking up the right tree.

Surprisingly to many, Freud himself had been barking up that tree in 1896... but when he found himself facing a quiet but powerful lynch mob in Vienna, he recanted.

Call me whatever you wish, but because I have seen so many of CA's traits in those known to have been serial-incested, and because I see indicators in the family member's behavior that at least suggests the possibilities, it does seem possible that CA's screwy behavior before and after the death of her daughter may have roots in her own life at just about the time =she= was two years old.

And here's one major reason why: If I have seen this once, I have seen it 20 times: The young mother who was incested and threatened into dissociative denial of her memories usually cannot stand to see her own "self" in her own innocent, vulnerable child. The image of her own self right there in front of her is just too much to take. Many serial-incested mothers abandon, ignore, abuse or even batter their children to try to keep the memories of their own abuse from creeping into consciousness.

I don't "know" that CA did precisely =this=, of course. But my experience in dealing with such people over the past two decades tells me it needs to be considered.

See my citations to follow...

raj said...

Clarkin, J.; Lenzenweger, M.: Major Theories of Personality Disorder, New York: The Guilford Press, 1996. (Cleckley is extensively cited herein, as well as by the other personality people.)

Hare, R.: Without Conscience, New York: Guilford Press, 1993.

Kelly, G.: The Psychology of Personal Constructs; New York: Norton & Company, 1955.

Livesley, W. J.: Practical Management of Personality Disorder, New York: Guilford Press, 2003.

Meloy, J. R.: The Psychopathic Mind: Origins, Dynamics, and Treatment, New York: Jason Aronson, 1994.

Millon, T.; Simonsen, E.; Birket-Smith, M.; Davis, R.: Psychopathy: Antisocial, Criminal, and Violent Behavior, Guilford Press, 1998.

Millon, T.; Grossman, S.; Meagher, S., Millon, C., Everly, G.: Personality Guided Therapy, New York: John Wiley & Sons, 1999.

Millon, T.; Grossman, S.: Moderating Severe Personality Disorders: A Personalized Psychotherapy Approach, New York: John Wiley & Sons, 2007.

Millon, T.; Grossman, S.: Overcoming Resistant Personality Disorders: A Personalized Psychotherapy Approach, New York: John Wiley & Sons, 2008.

Stone, M.: Abnormalities of Personality Within and Beyond the Realm of Treatment, New York: W. W. Norton, 1993.

Miller, A.: For Your Own Good: Hidden Cruelty in Child Rearing and the Roots of Violence, London: Farrar, Straus & Giroux, 1979, 1983.

Miller, A.: Prisoners of Childhood / The Drama of the Gifted Child, New York: Basic Books, 1979, 1996.

Miller, A.: Thou Shalt Not Be Aware: Society’s Betrayal of the Child, London: Farrar, Straus & Giroux, 1981, 1984, 1998.

Miller, A.: Breaking Down the Walls of Silence, New York: Dutton/Penguin, 1991.

Russell, D.: The Secret Trauma: Incest in the Lives of Girls and Women, New York: Basic Books, 1986.

Herman, J. L.: Trauma and Recovery, New York: Basic Books, 1992.

Kluft, R.; et al: Childhood Antecedents of Multiple Personality Disorder, Washington DC: American Psychiatric Press, 1985.

Putnam, F.: Dissociation in Children and Adolescents: A Developmental Perspective, New York: The Guilford Press, 1997.

Van der Kolk, B.: The Compulsion to Repeat the Trauma: Re-enactment, Re-victimization, and Masochism, in Psychiatric Clinics of North America, Vol. 12, No. 2, 1989.

Van der Kolk, B: Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body and Society, New York: Guilford Press, 1996 / 2007.

Van der Kolk, B.; Hopper, J.; Osterman, J.: Exploring the Nature of Traumatic Memory: Combining Clinical Knowledge with Laboratory Methods; in Journal of Aggression, Maltreatment & Trauma, Vol. 4, No. 2, 2001.

Van der Hart, O.; Brown, P.; and Van der Kolk, B.: Pierre Janet’s Treatment of Traumatic Stress, in Journal of Traumatic Stress, Vol. 2, No. 4, 1989.

Van der Hart, O.; Friedman, B.: A Reader's Guide To Pierre Janet: A Neglected Intellectual Heritage, in Dissociation, Vol. 2, No. 1, 1989.

Van der Hart, O.; Horst, R.: The Dissociation Theory of Pierre Janet, in Journal of Traumatic Stress, Vol. 2, No. 4, 1989.

Gay, P.: Freud: A Life for Our Time, New York: W. W. Norton, 1998.

Oakley Sunglasses said...

This is the most bizarre and heartbreaking story and trial! I haven’t kept up with it much, but found the link in your post interesting – thanks. When will the whole trial wrap up?