Postpartum Depression: A Silent Killer

by Katherine Scardino

I was horrified to hear in the local news that Houston is home to another mother who has killed her baby. Najres Modarresi joins Andrea Yates as another Houston mother who is now accused of the capital murder of her two-month-old son, Masih. As someone who grew up in an area and during an era where psychological issues were just not allowed, it has been an education for me to learn how serious postpartum depression can be for some women.

Hearing the facts of the Modarresi case, any rational person would be initially enraged. Ms. Modarresi first lied to police and accused “two black men” of accosting her and kidnaping her baby. This led Houston police on a wild goose chase for a couple of days, even to the point of issuing an Amber Alert for little Masih. Ms. Modarresi eventually led police to a muddy stream and pointed out where her infant lay buried in the dirt and muck. Autopsy results showed the baby's lungs contained mud and other particles, which means he had been buried alive.

It wouldn't be difficult for any normal person to wish Ms. Modarresi the maximum punishment for this crime. However, we have to remember all that our society learned during and after Andrea Yates’s two trials. Initially, Ms. Yates was found guilty of murdering her children. Then, after an appeal and a reversal, she was retried and found not guilty by reason of insanity in 1996. Andrea’s case had national appeal, and everyone seemed to have an opinion about her state of mind when she drowned her children. Observing the progress of the Yates case taught me about the seriousness of postpartum depression. I learned that there are four levels of depression: mild, moderate, severe and psychotic. It appears that a person can bounce into a depression at any one of those four levels at any time. The question a lot of people had about Andrea Yates had to do with her treating psychologist. Why didn't he see the severity of her condition?

It was reported that Ms. Modarresi was prescribed mood-altering prescription drugs. So apparently she also has a doctor who is, or should be, fully aware of her condition. How can this disease overcome a mother who is under medical treatment?

It is surprising to learn that around 50 to 80 percent of all women experience some degree of emotional problems following childbirth. Only about one in 1,000 new mothers graduate to the most extreme and rarest disorder, postpartum psychosis. The mildest form of postpartum depression, more commonly known as “baby blues,” usually lasts only a few weeks. If the moodiness lasts longer, the new mom may be suffering from a more severe condition, a mood disorder called postpartum depression. If a new mother experiences the more severe condition, she may lose her connection to reality. The break is debilitating and known as postpartum psychosis. There is no logic to this psychosis. The mother doesn't know right from wrong nor the consequences of her actions. She may feel that she is “saving” her child by killing him.

So back to the question of how the treating physician can fail to recognize severely depressed and psychotic patients. It's possible for the depressed mother to go to sleep slightly or moderately depressed and wake up in a psychotic state. This shift can happen quickly and be deadly.

If a new mother suffering from this type of depression doesn't get to a doctor before her symptoms escalate, it becomes more and more likely that a tragedy like the Modarresi case will occur. Then the mother is charged with murder or capital murder. Capital murder is applicable when the victim is younger than two years old; conviction carries the possibility of the death penalty. By the time she is sitting in front of a jury of her peers, the mother looks and sounds sane. She's been under psychiatric treatment for most likely a year or two. The jury looks at her and finds it hard to believe that this defendant was insane at the time of the offense. Insanity is a hard defense. But there is no doubt in my mind that at the time of the murder, Ms. Modarresi knew neither right from wrong nor the consequences of her actions. Unfortunately, nothing we do now can bring back this two-month-old baby boy.

The good news about the Yates case and now the Modarresi case is that women today are much more aware of the symptoms of postpartum depression. They can express themselves and explain their feelings candidly to their doctors without feeling ashamed and degraded, like they are the scum of the earth. These cases have given credibility to this dreaded disorder.

There is also hope for the future in recognizing and preventing postpartum depression. The Melanie Blocker Stokes MOTHERS Act was recently passed into law as part of President Obama’s healthcare reform bill. This act provides for research, education and screening for postpartum depression and related mood disorders. Hopefully, it will lessen stigma attached to maternal mood disorders and get more women the help they so desperately need before more young lives are lost to this disease.

Tweet

Mothers Who Kill

by Lucy Puryear, M.D.

I can imagine few things more horrific than a mother killing her own child. Mothers are warm, kind, nurturing people who would rather die than have anything happen to one of their precious children. But as we know all too well mothers do kill, and unfortunately it's all too frequent.

There are mothers who kill because they want revenge against their boyfriends or because they are desperate to keep the man they love. These women, like Susan Smith, the mother who drowned her two children in the lake while they were asleep in their car seats, are criminals. Although women like Smith (pictured right) may have many mitigating circumstances that make them feel desperate and alone, all of them have alternative choices besides killing.

There are some women who, feeling trapped in an untenable situation, decides that the only way out is suicide. But before they do this, they take the lives of their children. This sounds illogical to you and me, but consider the tragic case in Texas where a mother hung her four children before hanging herself. She was a 25-year-old Mexican immigrant, who had a restraining order against her common-law husband for domestic violence. She was working at Wendy's in order to support herself and her family. She was depressed, financially in crisis, and away from her extended family.

It is believed that this was an example of altruistic filicide, motivated by a mother's love and her belief that her children's deaths were better than leaving them in this world without a mother. Were this woman to have lived she would have been tried for murder, but is she the same type of criminal as the examples above?

Today is the seventh anniversary of the Yates children's death at their mother's hand on June 20, 2001. She was tried, convicted, and sentenced to life in prison with the option of parole after 40 years. Due to non-factual testimony by Dr. Park Dietz, the State's highly paid expert, Andrea Yates was given a new trial five years after her original conviction. This time the jury found her not-guilty by reason of insanity. She was sent to a maximum security state psychiatric facility in Vernon, Texas. She was no longer a criminal.

What few realize is that Ms. Yates remains under the jurisdiction of the courts. Although no longer in maximum security, she will remain in a state hospital until a judge determines that she is no longer a danger to herself or others. Even if she were well this is unlikely to happen.

So why rehash the Andrea Yates case? Yes, I testified that she was psychotic at the time of the drownings (hearing voices speaking to her from the TV, believing that she was invaded by Satan and that he was trying to ruin her children through her and send them to hell) but I've had many arguments with others who believe that although mentally ill, she was responsible for the killings and should be punished. I'm not going to continue to try to change the minds of others about this particular case.

I do want to talk about postpartum psychiatric disorders, which are real and treatable. In the case of postpartum psychosis, if recognized and treated, mother's and children's lives can be saved. Andrea Yates is not an isolated case. There were two more incidences reported in Texas within a few years after the Yates tragedy. Those are just the cases that made the news and only in Texas. These were also women who heard God or Satan speaking to them and believed killing their children would somehow save them or save the world. Putting these women in jail or executing them will not stop maternal filicide from happening.

It is estimated that between 1 and 2 women per 1000 deliveries will develop postpartum psychosis. This is a psychiatric emergency. The psychotic thoughts revolve around the baby and often include thoughts of harming the child and themselves. The only way to treat these disorders is through prompt diagnosis and medical treatment. A mother who is psychotic should never be left alone with her child.

Criminologists and forensic psychiatrists are desperate to understand why people commit crimes and how to prevent them from doing so. Many criminals have been so damaged in childhood that changing their character and behavior is impossible. But postpartum psychosis and infanticide is preventable.

Andrea's treating psychiatrist took her off her anitpsychotic medication two weeks prior to the drownings. She was seen by him two days before the drownings. Although mute and catatonic he sent her home. She had been hospitalized twice, and despite medical records that doccumented she was still paranoid and ill, she was released. It is not noted in the records that at any time anyone asked her if she had thoughts of harming her children.

On June 4-7, 2008, Houston was host to the 22nd annual conference of Postpartum Support International. Supported by the Yates Children's Memorial Fund (YCMF) of Mental Health America of Greater Houston (MHA) and Texas Children's Hospital, over 300 attendees heard lectures about about postpartum psychiatric disorders, their recognition and treatment. The more we educate health care providers, mothers, and those who love them the more lives will be saved. The more we talk the more mothers will feel safe to speak out loud the confusing feelings they are experiencing. The more we destigmatize postpartum psychiatric disorders and make it safe to ask for help, the fewer tragedies will end up on the front page of the newspaper.

Andrea Yates was not a woman destined to be a killer. She came from a good family, was highly educated, and loved her children enormously. It could have happened to you or me or to any other woman who delivered a baby. Society let her down. Doctors let her down. Our criminal justice system initially let her down.

We can't stop every mother from taking the life of her child. There are those who do so that we can find no explanation for why they made that choice. And those mother's should be punished. There are many who say that Andrea Yates got away with murder, that she should be punished and suffer for what she did. She does, every day when she opens her eyes and remembers Noah, John, Paul, Luke, and Mary, and remembers how they died.

Tweet