From The New England Journal of Medicine
Margaret Spinelli has gathered a group of experts to examine the subject of maternal infanticide from biologic, psychosocial, legal, and cultural perspectives. Her book handles the material sensitively, with an eye toward prevention. It also serves as a compendium of knowledge to aid mental health providers in diagnosing and treating psychiatric disorders related to infanticide, while assisting experts involved in the legal defense of women charged with the crime. The heart of the book, an exploration of psychiatric aspects of infanticide, emphasizes postpartum depression and psychosis, neurohormonal mechanisms, diagnosis, and treatment. An entire chapter is devoted to the denial of pregnancy and its relation to infanticide, with evocative case material used throughout. A banner is raised to improve early detection and intervention among at-risk mothers and their children. The case of Andrea Yates (Yates v. Texas) is used to illustrate how the poorly understood biologic and psychosocial aspects of infanticide led to a tragedy that could have been prevented. Considerable attention is paid to legislative issues, including the disparity in legal standards across countries and states. For example, the British Infanticide Act (1938) contains a special provision for women who have killed their infants as a result of psychiatric disturbances associated with childbearing. Such women are charged with manslaughter rather than murder, and sentencing often involves probation or psychiatric treatment. The stunning fact is put forward that for more than 50 years, no woman found guilty of infanticide in England has been incarcerated. No such legislation exists in the United States, resulting in a lack of uniformity in charges and sentencing. A woman in one state might be convicted of unlawful disposal of a corpse (a misdemeanor) and receive probation, whereas in another state, she could be convicted of first-degree murder (a felony) and sentenced to life in prison. Thus, this book not only provides legal information about infanticide for attorneys and medical experts but also calls for legislative reform. The book addresses common misconceptions in an attempt to foster a more humane view of women who kill their infants. The contributors form a chorus in asserting that many of these mothers have been the victims of poorly diagnosed and treated psychiatric disorders and have lacked the social and familial supports that could have prevented the tragedy. Although the view of the perpetrator as the victim is a notable bias of the book, it is a view that I share, at least in part. In my clinical work, I too have been pained to discover that too often a woman who killed her infant had been turned away by health care professionals, law-enforcement officers, or family members just before the crime, despite her obvious psychiatric disorganization and violent impulses. Although the portrayal of these women as victims may reflect a bias, at-risk mothers, children, and society may benefit from this point of view. The book neglects a few key issues. Many mothers who kill their infants fit the profiles described by the authors, but others are affected by chronic mental illness, substance abuse, and severe personality disorders -- factors that are addressed only in a cursory fashion. And although a sophisticated overview of contemporary attachment models is provided, relevant psychopathy, narcissism, and malignant attachments are not explicitly linked to the crime of infanticide. Specifically, the authors do not examine what makes these mothers resort to violence as a solution to their predicament. Because so many personal and societal taboos must be overcome in order to kill one's own child, this central question begs for an answer: What is it about the biologic and psychosocial factors that lead these women to cross the boundary from violent impulse to action? In the end, however, this excellent book leaves readers well equipped to ponder this question themselves. Jennifer L. Kunst, Ph.D.
Copyright © 2003 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
"[T]he book is a welcome addition to the small literature on infanticide." -- Leslie Hartley Gise, M.D., JAMA, June 18, 2003