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.

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Do You Believe in Evil?

by Lucy Puryear, M.D.

My last post referenced the case of Joshua Mauldin, a 20-year-old man found guilty of putting his two-month-old daughter in a microwave for ten seconds. The defense was hoping he would be found not guilty by reason of insanity. That plea was rejected by the jury and he was sentenced to twenty-five years in prison.

In reality, less than 1% of defendants use the insanity defense, and of those who do, less than 20% are successful. That is a good thing. We want people who do bad things to be punished. We most certainly want them put in an environment where the chance that they will re-offend is limited. We also don't want lawyers and their clients to abuse the insanity defense and make it less effective for those who are truly and severely mentally ill.

So if Mr. Mauldin wasn't insane, what was he? And was he fully responsible for the crime he committed? I know I have just raised the hackles of several of our contributors, but hear me out. How do we explain what causes people to commit heinous acts of violence against others? In Mr. Mauldin's case, the defense tried to claim that he had a long history of mental illness and at the time of the crime was unaware of what he was doing. The jury didn't buy that explanation.

But Joshua Mauldin did have some form of mental illness as testified to by both the defense and the prosecution experts. Was he adequately treated? Did he have appropriate follow-up to assure that he was on the proper medication and that he had been taking it as prescribed? Was he depressed? Psychotic? Not an excuse, but a factor? The legal system even allows for mitigating factors to be considered when deciding upon a sentence. Rage, passion, mental illness, poverty, and abuse are acknowledged as possibly contributing to the perpetration of a crime.

As I psychiatrist I often try to understand why people do the things they do . . . hopefully so they can stop making bad decisions that hurt themselves or others. When someone commits a violent crime it's often not that hard to understand why. A psychotic person hears Satan's voice telling him to kill. A pedophile was sexually abused as a young child by a close family member. A teenager panics when she delivers a baby she's told no one about. These explanations help us to make sense out of how someone can do some things so awful to others and give us some hope that we might be able to prevent future tragedies. We can make sure there is access to psychiatric care, we can work to identify children who are being abused and get them help, and we can set up laws that allow mothers to turn over infants to hospitals or fire stations (Baby Moses Law).

But I must admit, after I count up the mentally ill . . . and the abused . . . and the neglected . . . and the disenfranchised . . . how do I account for those who, despite fairly reasonable upbringings, inflict terrifying and horrific acts against innocent others? I want to find some brain disorder, some chemical imbalance that makes sense of this for me. I don't believe people are born to commit atrocities. And yet . . .

There are some whose eyes you look into and see darkness. Despite my best efforts I can't find a way to make human contact--find that piece of them that connects to others. Often these people are good at "pretending" to be human. They have studied others and can mimic appropriate reactions or responses. But inside there is no true capacity to know or care what another thinks or feels. In his novel No Country for Old Men, Cormac McCarthy depicts a character, played by Javier Bardem in the film adaptation (pictured above), who kills and makes sport of it. He enjoys the chase and the terror that his victims experience as he flips a coin to decide whether they live or die. It gives you chills as you watch this inhuman human, kill.

Medical science is trying to find the cause and hopefully the "cure" for people without a conscience. At the moment there is no medication nor therapy that has been very effective. It is hard for me not to want to find a reason for the horror: brain damage at birth, poor nutrition, maternal deprivation? It is hard for me as a healer not to want to heal. And yet I must acknowledge I am helpless. And maybe there is just such a thing as evil.

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