Why the legal version of insanity too often leads to insane verdicts for suffering moms

Three years ago, I testified as a defense expert on a case of a young woman who had been charged with three counts of premeditated murder and the use of a knife, having taken the lives of her three children: a 3-year-old, 2-year-old and 3-month-old.

The details of her actions are so disturbing that even here, I find myself hesitant to describe exactly what occurred, but simply to reiterate what those of us in the field of maternal mental illness grapple with every day — how virulent and horrifically unpredictable postpartum psychosis can be when overlooked and left untreated. Tragically, at trial, the state had an entirely different perspective of events. In so many words, the prosecution’s expert declared that there is no such thing as women’s reproductive mental health or maternal mental illness, chalking up this young woman’s psychotic thinking and behavior to a bad day and revenge against an unsupportive husband. The judge found her guilty and sane, sentencing her to life in prison without the possibility of parole.

Then there’s the story of Alisha who drowned her infant in the bathtub because she believed that he would transition peacefully to the next world where he would be well taken care of. Although she loved him desperately, in her delusional state she believed she was incompetent as his mother and he would be safer and better cared for in the spiritual world beyond. She was charged with intentional homicide but the judge at trial found her not guilty by reason of insanity and she was transferred to a psychiatric facility where she could receive treatment.

Maternal mental illness has increasingly become a subject of interest in the criminal justice system. Unfortunately, the tabloid journalism that exploits these heart-breaking tragedies with sensationalist headlines like “Killer Mom” has a powerfully negative effect by instilling fear and stigma about postpartum illnesses that are extremely treatable, and in a number of cases, even preventable.

Those uneducated about this very specialized field of mental health continue to defend the conventional idea that women who take the lives of their children are despicable and deserve nothing less than a lifetime of incarceration, and in some circumstances, even death.

There is however, a slowly growing awareness in the courtroom that at the root of infanticide may be psychotic illness.

In 2002, I was retained as an expert on one case. Within the last year alone, I have been asked to consult or testify on 16 different cases both locally and nationally involving maternal mental illness. These cases are often complicated by a basic conflict between the legal definition of insanity and the clinical meaning of insanity. In the legal community, an individual is deemed insane only if they were unable to distinguish right from wrong at the time of the act. But psychiatry understands that when a woman experiences a postpartum psychotic episode, her thoughts, perceptions and emotions are so disturbed and disorganized that it becomes difficult to distinguish what’s real from what’s not. Consequently, it would be impossible for a woman to know the difference between right and wrong. In fact, she may be doing the wrong thing in the eyes of the law, but the right thing according to her delusional logic. The above discrepancy between the law and mental health has felt for me at many moments, well, insane.

Those uneducated about this very specialized field of mental health continue to defend the conventional idea that women who take the lives of their children are despicable and deserve nothing less than a lifetime of incarceration, and in some circumstances, even death.

Mental health providers are trying to help the courts understand the implications of complex trauma in addressing maternal mental health in the criminal justice system. It is more often being considered as a mitigating factor in sentencing decisions. I remember specifically a former case in which I testified. Being able to explain to the jury how the defendant’s childhood history of abuse, battering, and abandonment had a neurobiological impact that impaired her adult capacities of judgment, decision-making and insight not only resulted in a lesser verdict, but a significantly reduced sentence as well. 

Fortunately, from state to state, some inroads are being made with a number of states mandating screening for pregnant and postpartum women. Many hospitals are now discharging new mothers with information about identifying risks and symptoms that could be signs of a postpartum mood disorder. In California, there is much advocacy work being done to change the tide of thinking about maternal mental health. The California Commission on the Status of Maternal Mental Health was formed in 2016, and new recommendations from the commission were presented at a meeting in Sacramento last year. And Illinois recently enacted the first criminal law in this country to consider postpartum depression and postpartum psychosis a mitigating factor in sentencing. For the first time, the law provides for a new sentencing hearing post-conviction when maternal mental illness may have played a role in the crime.

It’s my hope that with a growing understanding of the connections between early trauma and later maternal mental illness, the courts will turn more often to treatment rather than incarceration.

[Photo by mliu92 via Flickr.]