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:

1. 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.

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