It's An Outrage

by Lucy Puryear, M.D.

"Woman Who Cut Off Baby's Arms to be Released," Houston Chronicle, November 7, 2008. Dee Schlosser was arrested in Dallas, in November of 2004 for cutting off her daughter Maggie's arms, resulting in her death. In the aftermath of the Andrea Yates case in Texas, several women have been found not guilty by reason of insanity after killing their children. All of these women, including Schlosser, were psychotic at the time of the killings. Schlosser believed that by cutting off her daughter's arms she was making a more perfect offering to God. The police came to her home and found her soaked in blood humming along to a hymn.

Schlosser was sent to a state mental hospital where she received treatment and continued to be under the jurisdiction of the court. According to law, persons found NGRI (not guilty by reason of insanity) must remain in a state mental hospital indefinitely until it is determined by their psychiatrist that they are no longer a danger to themselves or others and can be maintained in outpatient treatment. Schlosser will be released into the community where she will be mandated to meet with a psychiatrist weekly. She will no longer be allowed to have contact with her other two children, and may not be in close proximity to any other children. It is unknown where she will live when released. She will remain under the jurisdiction of the court permanently and will be forced to return to the hospital if she again becomes dangerous.

Understandably the prosecutors of Collin County are unhappy with her release and wish the laws were different. Understandably the citizens of Dallas are unhappy that she may released into their community. Understandably there may be some renewed talk about having the laws changed. Maybe Dee Schlosser should have been committed to a state psychiatric facility for the rest of her life? It is an outrage that a mother who killed her children is free to walk the streets.

I am going to ask you to believe that Dee Schlosser should be released and be free to live what ever kind of life she is able to piece together for herself. She is no longer psychotic, she is on medication, she will be monitored by a psychiatrist to make sure that she remains well. So why should she remain in the hospital; just so our sensibilities are appeased? That's a waste of money. Her being in the hospital does not protect you or your children. Dee Schlosser has no intention of coming to your house to cut off the arms of your child.

Many of you would say she should be in jail, or even executed for what she did. That would solve the problem. She did something bad and she should be punished. Does it matter that her brain was malfunctioning? That the blood flow to certain areas of the brain were increased where they shouldn't have been and decreased to other parts? Was this happening to her because she chose to be crazy or decided that hearing voices and was a good idea?

Let me ask you to fantasize for a moment. What if you had a hundred and four degree fever and you became delirious. You were hearing someone walking into your room in the middle of the night and when you looked up you saw a masked man carrying a gun. You reached for your gun on the bedside table and shot. Only later when your illness was treated were you aware that you had shot your husband. Death penalty? Think that's not possible? Hallucinations happen all the time with high fevers and brain infections. Your brain is malfunctioning.

Let's speculate again. You are driving in your car and have a heart attack. You swerve off the road and plow into a group of people standing on the corner of the street. A mother and her young child are killed. Death penalty? Clearly you didn't do this on purpose. Your heart was malfunctioning and caused behavior that was out of your control. Let me go a little further. What if you knew you were at risk for heart disease but declined diet and exercise and didn't take your heart medication because you didn't like the side effects. Death penalty? Surely you knew you were at risk for a heart attack. In fact you doctor warned you on numerous occasions. The fact that you had a heart attack isn't all that surprising. Are you responsible for those deaths?

Mental illness is a brain disorder. The symptoms are behavioral, and often the symptoms are horrific. No one wishes to be mentally ill, anymore than someone asks to have diabetes or heart disease or meningitis. And untreated the symptoms of mental illness can be deadly, just like any other medical illness. Not just for yourself, but as I described above, for others. Why do we treat the mentally ill as criminals?

Dee Schlosser will never live a care free life. She must live with the knowledge and memory of killing her child. She will no longer be able to care for or have contact with her other children, and her marriage ended in divorce. What kind of life will she have? Can you imagine waking up every day to that horror? As a matter of fact, most mothers who have killed their children eventually end up killing themselves.

Let me let you in on a secret. Every single one of you reading this has a mental illness, has a family member with a mental illness, or knows someone who has one. And if you don't know someone who does that's simply because they don't talk about it. The stigma of mental illness is so great that we can't face admitting that we are all affected. This is not unlike epilepsy in earlier times. Until the cause of and treatment for epilepsy was discovered family members were hidden in asylums, attics, and weren't allowed to marry into good families. That is where mental illness is today.

Dee Schlosser deserves to be released if she is no longer suffering from her symptoms. She is medicated and no longer poses any danger to anyone. Don't worry, if you feel the need for her to be punished she already has been. She will continue to suffer every day of her life no matter where she is living. She needs our prayers. And we need to pray that some day we can find the cause of and a cure for mental illness so that no one kills their child because they're sick.

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FLORIDA MOM CHARGED WITH MURDER

Casey Anthony was arrested today for the fourth time in as many months. This time, Casey was charged with the murder of her toddler daughter Caylee, missing since June.

As many months as the investigation has dragged on . . . a Florida grand jury took only half an hour to return a seven-count indictment, charging Casey, 22, with first-degree murder, aggravated child abuse, aggravated manslaughter, and four counts of providing false information to law enforcement—all in relation to her child's mysterious disappearance.

The grand jury heard from a handful of witnesses: the lead investigator, a cadaver dog handler, an FBI agent, and George Anthony, Casey's father.

"This is going to be very hard for me to do," Mr. Anthony told reporters before testifying. He loved his daughter, he said, but "the focus has always been on my granddaughter and always will be."

Mr. Anthony asked the public to "take a moment out at eleven o'clock this morning and eleven o'clock tonight and just pray for her."

Though Caylee is presumed dead, her body has not been recovered.

"Despite the charges against Ms. Anthony we have not achieved our objective," said an official spokesman. "We have not found little Caylee Anthony."

Tonight, Casey Anthony is expected to be kept in protective custody. She is scheduled to make an initial appearance in the morning, when Casey will face a judge and formal charges of misleading investigators and murdering her daughter.

For details on today's arrest, watch WCI's newest contributor, Diane Dimond, on CNN tonight.

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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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The Murder of Lauren Lofquist

by Susan Murphy-Milano

It was Sunday morning, March 26, 2006. For Neil and Lisa Lofquist and their children, 8-year-old Lauren and 6-year-old Lars, it was their usual weekend routine. The family enjoyed Sunday breakfast together before heading off to church. Neil taught Sunday School and Lisa was active in church activities. The couple had been married for sixteen years and raised their family in an upscale suburb of Illinois.

The Lofquists had deep roots in the Clarendon Hills community. They were educated—Lisa was an occupational therapist and Neil had his MBA and was in business for himself. Lauren was a great student, active in Girl Scouts and in swimming. Lars loved baseball, digging in the dirt for worms, and pulling his sister's hair. As far as anyone knew, the family was close and loving.

That evening, around 8 p.m., Neil Lofquist had offered to put the kids to bed while his wife remained downstairs. Lisa was still in the family room watching television when Neil returned from putting the kids down for the night. He had a deep, unexplained wound to this hand.

Neil Lofquist, his son, and Lisa headed to the hospital. Using their cell phone, they called next door and asked a neighbor to check on Lauren who was sleep while Neil sought medical attention for his hand. Oddly, they left Lauren upstairs, asleep.

When the neighbor went upstairs to check on 8-year-old Lauren, the little girl was on her knees on the cold bathroom tile floor, her lifeless head was slumped down into the toilet bowl.

Around 10 p.m. police responded to a 911 call in the 100 block of Chicago Avenue.

The following morning, media were camped out in front of the Loftquist home and reporters canvassed the coffee shops and surrounding area for any tidbits on the family and reaction to Lauren's murder.

The front page news: "Neil Loftquist sexually abused, stabbed, strangled and drowned his daughter inside the family home, claiming he believed Lauren was the devil."

Neil Lofquist was charged with murder. The Chicago Tribune reported he strangled and stabbed his own daughter. He took her into the bathroom and, according to reports, drowned her in the toilet bowl.

That weekend the murder of Loren Lofquist did not make national news. Had it been a slower news day, more than likely the story would have received the attention it deserved.

Over the next several days, people pointed fingers as they often do in these cases. The town Web site was filled with residents demanding answers as to why a mother would leave her child alone to take her husband to the hospital in the first place. Why didn't Lisa go upstairs and check on Lauren's well being? Why did Lisa take the one child and not the other? Why didn't Lisa know their daughter was being sexually assaulted? Why didn't she help her daughter?

Answers do not come easily in tragedies where a parent has been arrested or is a suspect in the murder of their child. And only skilled and trained professionals can evaluate and determine what happened in each case. And sometimes their conclusions are wrong. I suspect we will never know "why" Neil Lofquist murdered his daughter.

Last month, Lofquist appeared before a judge in DuPage County, along with his three public defenders, to argue whether or not psychological interviews can be taped. It will be some time before a trial date is set in the case. And it is likely you will not see this case covered on FOX News or CNN.

Lauren's death was, in my opinion, a great loss to the world. She was one of those kids whose eyes sparkled like stars when she spoke. Loren talked of being a nurse when she grew up.

Lauren could have been your neighbor or your child's school mate or someone you bought Girls Scout cookies from at church. Lauren is a reminder to each of us that life is precious.

In memory of Lauren's death, let us all remember to make time and give our kids extra hugs and kisses. Let them know how important they are each and every day.

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