The case of Susan Smith, the young woman in South Carolina who was found guilty of killing her two children, raises a major question: Why do mothers kill their children? Many people, in writing editorials and comments about that case and other similar cases, have asked how a woman who brings a child into this world can then deliberately take the life of that child,
Historically, people have been killing their children, especially female children, for centuries, for a number of reasons. Superstition has prompted the killing of deformed children or those born in an unusual way. Economics has stimulated the killing of children who may be a drain on families, and in some cultures, female children were seen as liabilities rather than assets with respect to economic conditions and were, therefore, eliminated. These have been experiences involving collective decisions by families, religious groups, and communities. However, the killing of a child by an individual mother, without community approval or sanction, has remained a mystery for many.
The analyses in this article are limited to the experiences noted in forensic psychiatric evaluation of mothers who have been charged in the criminal justice system with the death of their children. Although there are variable reasons at different stages of the child's development, there appears to be a fairly recognizable pattern of motivation or conditions under which mothers kill children at various ages. Illustrations of such a pattern will be given through case examples encountered in forensic evaluations. The cases are disguised by combining the demographics of a number of different situations for each category in order to protect the privacy and confidentiality of each individual.
Mothers who kill children have been categorized as follows:
* neonaticide (the killing of a newborn),
* infanticide (the killing of an infant in the first year of life),
* early filicide (the killing of a young child), and
* late filicide (the killing of older children or adult children).
Resnick distinguishes two types of killing of one's children: neonaticide and filicide, the former limited to the first 24 hours of life, and the latter to the killing of all other children by one's parents.1^2 I find a distinction between infanticide, the killing of young children, and the killing of older children, which I have taken the liberty to label, after Resnick, early and late filicide.
Jane is an 18-year-old high school senior from a devoutly fundamentalist family who has been raised to delay sexual gratification until after marriage. Her oldest sister had been kicked out of the family at age 16 because she was found to be pregnant. When Jane learned that she was pregnant, she was unable to tell her family or her friends. She feared ostracism and feared being kicked out of the highly religious fundamentalist school that she attended. She had to experience the pregnancy by herself and received no prenatal care. Because she was small and a cheerleader, she was able to hide her pregnancy from her friends and her family. Indeed, her 24-year-old sister, a nurse, spent the weekend with her prior to her delivering the baby at home and had no recognition that Jane was pregnant.
When Jane began to experience labor pains, she became frightened and yet determined to handle the situation by herself. The baby was delivered at 3:00 a.m. in the bathroom of their home. Jane lost a lot of blood, but was able to wrap the baby and the afterbirth in sheets and clean up the bathroom before anyone discovered her situation. However, because of loss of blood, she passed out and was found by her mother in the morning on the floor of the bathroom. The baby had been wrapped in towels and sheets and placed in the closet in the bathroom.
When the paramedics were called, they discovered the dead baby hidden among the sheets in the closet. Jane was taken to the hospital for treatment and subsequently charged with the death of her newborn infant.
This is a combination of facts that have occurred with a number of young women who had been examined and charged with neonaticide. The dynamics are similar in all cases and include a very strict fundamentalist upbringing with no flexibility and very limited communication between the young mother-to-be and her family. In one case, there was no talk of sex or childbirth or "the birds and the bees" by mother, who was opposed to any such discussions. Father was absent or missing and also uncommunicative, according to the youngster.
In some cases, the pregnant mother did have a good friend in whom she could confide, but nothing could be done. In other cases, friends rallied to help by offering money for an abortion, but that was rejected by the individual because of her religious beliefs. Most did not know what they were going to do, but waited for the inevitable and would make a decision at that time. There was no proper preparation or planning, only panic. Some had rationalized that they would give the baby away and do so surreptitiously so that nobody discovered their condition or situation. The tragedy of these cases is the lack of communication and the difficult relationship the child has with her parents, especially her mother. There is no trust and no feeling of acceptance, but primarily a fear of rejection and ostracism.
In reality, after the fact, the investigation revealed the parents were much more accepting than the youngster had anticipated. When the girl was charged with murdering her child, inevitably, the parents rallied to her support (perhaps out of guilt?) and attempted to help in any way they could. Perhaps the pregnancy and subsequent delivery served as a new stimulus to communication that was more effective with the help of family therapy. Nevertheless, most of these youngsters went to prison for their behavior, which was deemed criminal and preventable. Forensic psychiatric intervention was of limited help only and, in many cases, did serve to bring about a plea bargain that resulted in a shorter sentence, treatment for the youngster, family therapy, and an avoidance of a public spectacle in court.
Infanticide is the killing of a baby from the age of about 1 or 2 months to 1 year.
Mary is a 26-year-old woman who has a history of depression, anxiety in social situations, and serious emotional problems on a monthly basis, just prior to having her menstrual period. She has what has been termed premenstrual syndrome (PMS), with an increase in her depression and anxiety. She had one child at age 21 and suffered a postpartum depression that lasted about 3 months. She was treated effectively with psychotherapy and medication. She was advised to delay having her next child for several years.
Mary did get pregnant at age 25 and delivered her son at age 26, while her daughter was age 5. She was alerted to her previous postpartum depression and every effort was made by her family doctor and her husband to prevent a recurrence, if possible. As soon as the baby was born, she was placed on antidepressants and was never alone with the baby for the first 2 months. At the first opportunity that she was alone with her baby, she suffocated her son in a fit of anger and panic, with loss of control.
Psychiatric examination revealed a woman who had experienced hallucinations and delusional thinking, even while on antidepressant medication following the birth of her son. She kept these symptoms to herself for fear she would be seen as "crazy" and would not be able to have "a normal life." It was only after the death of her son that she revealed her psychotic symptoms. The diagnosis was made as postpartum psychosis due to hormonal changes, chemical effects, and psychological disruption. Psychotherapy and medication were helpful in reversing this condition within 6 months. Unfortunately, Mary was incarcerated for several years by a judge who either did not understand or did not accept the testimony of the forensic psychiatrist with respect to postpartum changes that can affect a woman's stability, her judgment, and her behavior. Fortunately, Mary received further treatment while incarcerated and has done quite well since her release from prison.
This scenario is also a combination of cases that have been evaluated in similar circumstances. The major reason for infanticide by mothers is postpartum changes of depression or psychosis that need to be observed, monitored, and treated. Certainly, there are other reasons for maternal infanticide such as irritability, lack of support from others, and a feeling of being overwhelmed. Not all infanticides are due to postpartum hormonal changes with depression or psychosis, but a substantial number appear to have that etiology. This comment is also not to imply that all women who have children will have a postpartum depression or psychosis, because they do not. The condition is unusual, but not rare. This is also not to imply that women who do have postpartum depression or psychosis will kill their children, because that also is a rare occurrence within the number of women who have children and even the number who have postpartum depression.
A number of women have sought psychiatric treatment because they have urges or feelings that they may harm or kill their child shortly after birth. These women often have histrionic or borderline personality disorders and do require careful treatment and monitoring, at least for several months following the emergence of the symptom and the complaint for which they request help.
Theresa is a 29-year-old mother of four children who has attempted to raise her children without the help of the children's fathers. She has been sustained on welfare and gifts from family and friends. However, on a daily basis, she has to raise her four children, all under the age of 5, virtually by herself. She is absolutely overwhelmed by the amount of work in changing diapers, preparing formulas, and handling the intrafamily disputes that lead to incessant crying, bickering, and fighting. Typically, Theresa will use corporal punishment to quiet the children. She has even resorted to tying a child to the bedpost and keeping them separated by physical means. Increasingly, Theresa has become anxious and depressed, with feelings of hopelessness and helplessness. Her sleep has been disturbed and she has had horrible dreams and nightmares, often where her children have died. Her appetite has become poor and she has lost considerable weight. She has lost interest in socializing and being with others, even family. She has lost interest in being with men and she has begun to drink alcohol to excess in order to "treat" herself.
Finally, Theresa can go on no more and believes the only solution is suicide. However, she cannot leave her children to the ravages of the world that she has experienced and devises a plan to kill them and then herself. Theresa takes her children down to the local creek and drowns her four children. Before she is able to kill herself, she is apprehended and brought to official attention.
Forensic psychiatric evaluation reveals the increasing degree of depression and hopelessness that Theresa has felt over the past several months and her inability to care effectively for her children or for herself. She has had suicidal wishes and her homicidal intent occurred only to "protect my children." She showed evidence for some delusional material, but no overt hallucinations. Theresa is still in a psychiatric hospital awaiting trial.
This scenario is also a combination of experiences that women have had who have been charged with killing their young children. Theresa, as others, had been overwhelmed by the responsibilities and had little or no support system or availability of help. Furthermore, they did not have the motivation or desire to ask for help and hoped to be able to handle the situation by themselves. However, their plight became more serious until the "only solution" was murder-suicide. Most of these women were religious and concerned about God and Heaven. However, they also were concerned about the welfare of the children in a world that had not been particularly good to them. They did not wish their children to have the same terrible experiences in life that they had. Resnick has called this type of filicide "altruistic" and notes the high proportion of psychotic diagnoses in such mothers.1
In one case, there was a boyfriend who was menacing and threatening and the mother of his five children attempted to kill them before she killed herself. Her delusional thinking was that if she had died and left the children, the father would rape the girls and torture the boys. She said she could not tolerate that in her thinking, so she attempted to kill them before dying herself.
Not all women who kill their children are psychotic. Some have serious drug and alcohol problems and lose control in a fit of intoxication. Others are charged with killing their children by aiding their boyfriend or husband who has lost control. In rare instances, the woman has indicated that she could not function with the children present and would not be able to achieve her goals with the responsibilities of caring for the children. In those cases (which are rare), the women had left the babies or children on doorsteps or abandoned them. In other cases, the mothers kill the children in order to be free of the responsibility and did not have the suicidal intent, as did Theresa and many women like Theresa.
Late Filicide (The Killing of Teenage and Older Children)
Janice is a 42-year-old mother of three who has been having difficulty with her early teenage daughter, Emma, who had become involved in excessive drug and alcohol use. Emma comes home drunk almost every night and is high on various drugs that she has obtained from her 19-year-old boyfriend. Emma has been skipping school; she is a junior in high school. She has had a number of suspensions from school and does not obey mother's rules at home. Mother has asked her to leave on several occasions, but Emma does not leave and continues, not only to taunt her mother and insult her, but also to tease the younger children. Emma has a younger sister, Sally, age 11, and a younger brother, Brian, age 9. Father has long since left the home, leaving the care of the children to Janice. The tension between Janice and Emma has increased daily and they have come to physical blows on many occasions. There is no forgiveness and apology, but merely increased tension and violence.
On one particular Saturday morning, about 1:00 a.m., Emma came home from a party at which she became drunk and intoxicated with various chemicals. She began throwing furniture around, breaking mirrors, and cursing everyone out loud. She took a knife from the kitchen and threatened to kill her younger sister, Sally, for wearing one of her items of clothing. Mother rushed into the room and attempted to stop Emma's uncontrolled rage. In the course of the altercation, Janice was cut severely on her arm and her leg. She managed to get the knife away from Emma and, in doing so, plunged the knife into Emma's heart. Although she had no intention of killing her daughter, she was clearly relieved at Emma's death. She could now raise her two other children in some degree of tranquility without Emma's constant haranguing and threatening the family. Janice was acquitted of charges of murder and manslaughter, as the death was seen to be in defense of her children and herself. Nevertheless, Janice experienced significant psychiatric problems, requiring long-term treatment. Her guilt about her ineffectiveness in raising and controlling Emma in her earlier years led her to believe that she was responsible for Emma's drug and alcohol abuse. She saw herself, in some ways, as enabling the condition as a means of retaliating against Emma's father, toward whom she harbored serious angry feelings for abandoning her and the family. It was Emma's father who encouraged the prosecution to bring serious charges against Janice, as he was convinced that she had deliberately killed Emma. Resnick refers to one of the motives for filicide as "spouse revenge."1
This scenario is also a combination of a number of different experiences encountered with women who kill their teenage or older children. A similar case involved a mother who shot her son who was threatening to kill his father in an altercation. The son was 23 years of age, was mentally retarded or developmentally disabled, and was in a rage that could have erupted in severe violence toward the other members of the family. Another mother killed her 30-year-old son who, in a fit of psychotic rage, attempted to rape her when she was alone in her bedroom. In the course of the struggle, she stabbed him with the knife that he brought to threaten her life if she did not comply with his sexual demands.
In the latter cases, where mothers kill older children, it is clear that it is the children who have the mental aberrations or psychiatric conditions rather than the mother who, in fear for her life or the lives of other family members, has to end the life of her child. Most mothers in these situations were rarely prosecuted or, when they went to trial, were acquitted on the grounds of self-defense or the defense of others. Nevertheless, the experience took its toll on the mother, who then required intensive psychiatric treatment, often with medication.
OTHER FAMILY KILLINGS
The focus of this article is on mothers who kill their children, because most people ask the question when there is a "Susan Smith" case in the newspapers, "How could a mother do such a thing?" or "How could a mother kill her own children?" It is often difficult to understand how a mother could do such a thing unless one understands the extreme conditions under which such killings occur. Whether it is the panic of the adolescent in neonaticidal cases, the illness of the postpartum psychotic mother who kills her infant child, or the desperate situation which leads to major depression and suicidal impulses in the mother who kills her young children. There is little in the literature or in the experience of this forensic psychiatrist to indicate that mothers kill their children in a cold-hearted, calculating manner. Mostly, the killings are done in a state of fear, panic, depression, psychosis, or in dissociative states.
However, there are other violent domestic situations in which fathers kill their children. The experience of this examiner is that fathers will kill infants when the infant cries excessively, either with colic or irritability, and the father has little tolerance or patience for such disruption of his routine. The father is impatient either because he is suffering from antisocial personality disorder or, more likely, because he is under the influence of alcohol or drugs and has little control of his behavior, so that he overreacts and "disciplines" excessively and violently. Some fathers kill their sons when the son is old enough to challenge the father's authority and they physically fight. Some fathers have been found to have killed their daughters following raping or sexually exploiting the daughters, who then threaten to reveal to the authorities what father has been doing. Also, some fathers, as mothers, kill their older children if that child has been threatening to kill other family members.
Parricide (the killing of parents) is also noted in the literature and in the experience of forensic psychiatrists.3'4 Siblings who kill each other have also been examined in forensic psychiatric situations and the major cause of such domestic violence is sibling rivalry, with fighting and the added problem of drug and alcohol intoxication. It is rare for one brother to seek out the death of another brother or sister through revenge; more likely, the killing occurs spontaneously in the course of a domestic altercation aggravated by intoxication or drug influence. In other cases, the fratricide or sororicide has occurred when the brother or sister was psychotic. In those rare events, the individual is often found not guilty by reason of insanity and spends a number of years in treatment in the hospital.
SUMMARY AND CONCLUSIONS
Thus, there are a number of reasons why mothers kill their children. The reasons often lie in the mental state of the mother and the age of the child. These categories are not mutually exclusive and there is much overlap with age and motivation. However, there appears to be a fairly definite pattern for neonaticide and infanticide. Mothers who kill their newborn are often suffering from dissociative disorders at the time of the birth of the child because they feel overwhelmed by the pregnancy and perceive a lack of environmental support, necessitating their handling the traumatic experience on their own.
Mothers who kill infants often have postpartum psychosis resulting in aberrant violent behavior related to hormonal changes that are temporary and reversible. It is important for the physician caring for a pregnant woman to be able to determine particular stresses and pressures that might lead to an aberrant or unusual postpartum reaction. Consultation by psychiatrists at that time may often prevent the tragic result if treatment is instituted promptly and appropriately.
The paranoid condition of the mother killing her older children is a recognizable situation that may also be effectively treated and the mother removed from the stress of caring for her young children. Signs and symptoms of deterioration are present, but often ignored. It is more than just the feeling of being overwhelmed or stressed. A number of young mothers have that feeling, but cope with it without breaking down. What is needed is an ability to observe the young mother by the family physician or pediatrician to determine the effect of such pressure or stress on her and her ability to cope and to properly care for her children. In the total care of the family, the physician should look for evidence of abuse, evidence of isolation, and evidence of lack of support from family or friends. It is not always easy to determine such conditions, and certainly not possible always to predict. However, if the proper set of conditions is identified, a tragedy may be prevented, with proper referral and appropriate care.
Prevention of violence to older children is also possible through identification of family tensions, use and abuse of alcohol and drugs, truancy from school, deterioration in performance, and previous experiences of violence, with bruising, lacerations, or fractures.
Domestic violence has become a major concern for all of us. Killing the children may prevent further violence by the child in the future. However, abusing children continuously when they are young, physically, sexually, and emotionally, has been correlated with future violent behavior by those who had been abused. My experience with mass murderers and serial killers and others who have been charged with violent crimes reveals a fairly consistent history of significant parental abuse over a long period of time.
Thus, the question of mothers who kill their children really raises many larger, more profound questions about family violence, sometimes leading to death of children and others, which results in disturbed children who may become violent adults and go on to abuse their children or others. It is essential that we understand the dynamics of domestic abuse and prevent the death of children and the violence to children whenever possible. Such an undertaking would be a complex, multidisciplinary approach involving medical, educational, and political cooperation. People receive the least training for the most important job in their lives - being parents. Most model themselves after their own parents and the repetition of negative parenting practices continues. We all have a stake in the prevention of violence and death to children. A massive effort is needed if we are to break this cycle of violence. Domestic violence, child abuse, and child killing is the place to start. We may then shift attention from the family to other institutions in the community, including schools, churches, and other social community organizations. It is worth the effort.
1. Resnick PJ. Child murder by parents: a psychiatric review of filicide. Am J Psychiatry. 1969; 126:325-334.
2. Resnick PJ. Murder of the newborn: a psychiatric review of neonaticide. Am J Psychiatry. 1970; 126:1414-1420.
3. Tanay E. Adolescents who kill parents - reactive parricide. Aust NZJ Psychiatry. 1973; 7:263.
4. Sadoff RL. Clinical aspects of parricide. Psychiatr Q. 1971; 45:65.