Parents Who Kill

Child murder by parents is an upsetting topic for both the public and clinicians. It is even more distressing when a mother kills her child than when a father does because we expect mothers to love and protect their children at all costs.

The term filicide refers to the homicide of a child by a biological parent. Stepfathers kill their stepchildren at much higher rates than do bio­logical fathers.¹ Infanticide commonly denotes the murder of an infant during the first 12 months of life but is a less precise term. Infanticide laws exist that reduce the penalty for a mother who kills her child in the first year of life in more than 2 dozen countries (not including the United States).^2,3 The Table presents the 5 parental motives for child homicide.⁴

The 2 most famous cases of maternal filicide in the United States are those of Susan Smith and Andrea Yates. On October 25, 1994, Susan Smith reported that her 2 sons (aged 14 months and 3 years) had been kidnapped by a black carjacker.^5-7 After 9 days of searching by law enforcement, she revealed that she had rolled her car into a lake with her sons strapped into their car seats. She said that she had planned to drown herself with them, but she changed her mind at the last moment.

If her account is taken at face value, her act would be considered an altruistic extended suicide. During her trial, her turbulent life came to light, which included the suicide of her father, prolonged molestation by her stepfather, and her depression and suicide attempts.⁷ According to the prosecution theory, her motive was that of un­wanted child; she wished to rid herself of her children to increase her chances of having a relationship with a man who did not want to marry a woman burdened with children. The jury spared her life but sentenced her to life in prison.⁶

Andrea Yates called 911 to request police assistance on June 20, 2001.8 She told police that she had killed her 5 children and she led them to their bodies. Ms Yates experienced both depression and psychosis. She believed that her house was bugged, tele­vi­sion cameras were monitoring her home, and that Satan was literally within her. She became convinced that her children were not righteous and would ultimately burn in hell. She believed that she needed to kill her children before the age of accountability to save their souls. Her motive was clearly altruistic. She was eventually found not guilty by reason of insanity.⁸

Filicide
Similar numbers of filicides are committed by mothers and fathers. Research findings vary based on the sample studied. Samples from admini­strative records consist of cases with information from coroners’ reports or law enforcement data. These are the most accurate because they include all cases of filicide within a jurisdiction. However, certain information may be unavailable; for example, perpetrators may not have been psychiatrically evaluated. The filicidal mother in these samples often served as her child’s primary caregiver and experienced financial difficulties. Some had a personal history of abuse. Although some of these mothers were primarily abusive or neglectful of their children, others suffered from mental illness.⁹

Mothers studied in psychiatric populations (who were psychiatrically evaluated and/or had psychiatric dispositions) often were unemployed and had a personal history of physical abuse. As expected, mental illness was pervasive, including psychosis, depression, and suicidal ideation.⁹ Mothers from correctional population studies were often unemployed, under-educated, and unmarried victims of abuse with little social support; some had a history of substance use or mental illness.⁹

Fathers and mothers kill their chil­dren for similar reasons.⁴ How­-ever, fathers are approximately twice as likely as mothers to commit suicide after filicide (40% to 60% vs 16% to 29%).^10,11 Thus, mothers are more like­ly to stand trial, which may partially account for why we more frequently hear about mothers who kill. Fathers are much more likely than mothers to commit familicide (killing the entire family).¹⁰ After filicides, fathers are more often in­carcerated, whereas moth­­ers more frequently receive a psychiatric disposition.¹²

Neonaticide
Neonaticide is the murder of an infant in the first 24 hours of life.¹³ Neonaticide is distinct from other filicides.¹⁴ Almost always, this crime is com­mitted by the mother, acting alone. Suicide in conjunction with neonaticide is extremely rare. True neonaticide rates are hard to ascertain because no one knows how many new­­born babies are disposed of without discovery.

Melissa Drexler (known in the popular press as the Prom Mom) disposed of her newborn in a bathroom trash can at her high school prom on June 6, 1997.^5,15-17 She had kept the pregnancy secret from her family and boyfriends. After giving birth and disposing of the baby, she returned to dance at the prom. Her motive was “unwanted child,” the most common motive in neonaticides. She was sentenced to 15 years in pris­on but was released after serving 3 years.¹⁵

Perpetrators of neonaticide are usually unmarried women in their late teens or early 20s.⁹ They rarely obtain prenatal care for their preg­nancies, which are usually denied or concealed. They rarely have premorbid Axis I diagnoses. Spinelli_¹⁸ found that some mothers experienced dis­sociative symptoms around the time of childbirth. A small minority have psychoses.^13,19,20

Prevention
Because of the low base rate of child murder and the frequency of characteristics of filicidal parents that occur among parents who would never harm their children, filicide prevention is difficult. Fewer than half the cases of filicide are associated with parental mental illness; the majority of deaths actually stem from child abuse. Some parents in psychiatric treatment for personality disorder, substance use problems, or severe mental illness, for example, do neglect or abuse their children. Parents with altruistic or acutely psychotic motives are usually manic, depressed, or delirious.

When filicidal thoughts are elic­ited, the clinician must consider why the parent has these thoughts. This helps guide both treatment and risk management.

Parenting capacity should be considered in evaluating patients. Certainly, when children are present for a portion of a psychiatric visit, the psychiatrist can observe the appropriateness of the parent-child interaction. Parents should be routinely assessed for their potential to harm their children. Clinicians have a duty to report suspicion of child abuse and endangered children in all 50 states.

Most psychiatrists underestimate the percentage of depressed mothers who have thoughts of harming their young children.²¹ One study found that just over 40% of depressed moth­ers with children younger than 3 years admitted to having such thoughts.²²

Infant and child troubles also play a role. For example, in one study, 70% of mothers with colicky infants reported having “explicit aggressive fantasies” toward their babies, and fully 26% had infanticidal thoughts during episodes of colic.²³ Parents who are suicidal may also have filicidal thoughts. Those with risk factors for suicide should be asked what plans they would make for their children if they took their own lives. Parents may also be asked whether their children (and partner) would be able to do without them.

In addition, parents can be queried about thoughts or fears of harming their children.^21,24 If such fears are present, one should assess whether these thoughts and fears are secondary to an obsessive-compulsive disor­der (OCD), obsessive-compulsive spectrum disorder, depression, or psy­cho­sis. (Although mothers with OCD may experience thoughts of harming their baby, these thoughts are ego-dystonic and are more representative of fears than of plans.) Ask parents about hallucinations and delusional thoughts about their children. Some parents will bring up publicized filicide cases themselves; this can open the door to exploration of their attitudes and concerns about their children.²¹

Obstetricians and pediatricians need to screen postpartum women for evidence of mental illness. Postpartum depression and postpartum psychosis markedly increase the incidence of filicide and suicide.²⁵ Up to 4% of mothers with untreated postpartum psychosis commit filicide.^26,27 Community education about postpartum depression and psychosis has not been adequate. Mental health ser­vices for concerned mothers should be better publicized.

Parents commonly disavow their filicidal thoughts because of concerns that their children will be removed from their custody. Psychiatric hospitalization should be suggested when there is concern that a parent may harm his or her child. Consider hospitalization for parents with thoughts of harming their children, delusions of a child’s suffering, or unrealistic concerns about the child’s health.²⁸

Different strategies are needed to prevent neonaticide. Because mothers who commit neonaticide are unlikely to come to psychiatric attention before their crimes, prevention is more likely to be accomplished by pediatricians and family practitioners.¹⁴ Safe haven laws have recently been passed in all 50 US states to help reduce the number of neonaticides and abandoned babies. Although the laws vary from state to state, mothers are usually able to leave their unwanted neonates at a hospital or fire station within the first few days of life, with no questions asked.²⁹

Improved contraceptive education for girls and women can help reduce neonaticide. Teens who become pregnant should be urged to get prenatal care. Parents and health professionals must not collude when teenagers deny pregnancy. Physicians sometimes fail to diagnose pregnancies at several months’ gestation in such women.^30,31

In conclusion, to prevent child murder by parents, we must understand the motives and stressors of parents who commit these tragic acts. Clinicians must be attentive to parenting issues and the potential for filicide when we treat both depressed and psychotic parents.

Dr Hatters-Friedman is senior instructor in psy­chiatry and pediatrics at Case Western Reserve University School of Medicine in Cleve­land; Dr Resnick is professor of psychiatry and director of the division of forensic psychiatry at Case Western Reserve Uni­versity School of Medicine. The authors report no conflicts of interest concerning the subject matter of this article.

References:

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13. Resnick PJ. Murder of the newborn: a psychiatric review of neonaticide. Am J Psychiatry. 1970;126: 1414-1420.
14. Friedman SH, Resnick PJ. Neonaticide: phenomenology and considerations for prevention. Int J Law Psychiatry. In press.
15. Melissa Drexler. http://en.wikipedia.org/wiki/Melissa_Drexler. Accessed December 2, 2008.
16. Kantrowitz B. Cradles to coffins. Newsweek. July 7, 1997. http://www.newsweek.com/id/97832. Accessed December 2, 2008.
17. Tragedy at the prom. Newsweek. June 23, 1997. http://www.newsweek.com/id/95857. Accessed December 2, 2008.
18. Spinelli MG. A systematic investigation of 16 cases of neonaticide. Am J Psychiatry. 2001;158:811-813.
19. Putkonen H, Collander J, Honkasalo ML, Lönnqvist J. Finnish female homicide offenders 1982-92. J Forensic Psychiatry. 1998;9:672-684.
20. Putkonen H, Weizmann-Henelius G, Collander J, et al. Neonaticides may be more preventable and heterogeneous than previously thought-neonaticides in Finland 1980-2000. Arch Womens Ment Health. 2007;10:15-23.
21. Friedman SH, Sorrentino RM, Stankowski JE, et al. Psychiatrists’ knowledge about maternal filicidal thoughts. Compr Psychiatry. 2008;49:106-110.
22. Jennings KD, Ross S, Popper S, Elmore M. Thoughts of harming infants in depressed and nondepressed mothers. J Affect Disord. 1999;54:21-28.
23. Levitzky S, Cooper R. Infant colic syndrome-maternal fantasies of aggression and infanticide. Clin Pediatr (Phila). 2000;39:395-400.
24. Friedman SH, Resnick PJ. Mothers thinking of murder: considerations for prevention. Psychiatr Times. 2006;23(10):9-10.
25. Comtois KA, Schiff MA, Grossman DC. Psychiatric risk factors associated with postpartum suicide attempt in Washington State, 1992-2001. Am J Obstet Gynecol. 2008;199:120.
26. Altshuler LL, Hendrick V, Cohen LS. Course of mood and anxiety disorders during pregnancy and the postpartum period. J Clin Psychiatry. 1998;59(suppl 2):29-33.
27. Cohen LS, Altshuler LL. Pharmacologic management of psychiatric illness during pregnancy and the postpartum period. In: Dunner DL, Rosenbaum JF, eds. Psychiatric Clinics of North America Annual of Drug Therapy. Philadelphia: WB Saunders Co; 1997: 21-61.
28. Guileyardo JM, Prahlow JA, Barnard JJ. Familial filicide and filicide classification. Am J Forensic Med Pathol. 1999;20:286-292.
29. National Conference of State Legislatures. Update: Safe Havens for Abandoned Infants. Published October 21, 2003. http://www.ncsl.org/programs/cyf/ ailaws.htm. Accessed December 2, 2008.
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Evidence-Based References
Friedman SH, Horwitz SM, Resnick PJ. Child murder by mothers: a critical analysis of the current state of knowledge and a research agenda. Am J Psychiatry. 2005;162:1578-1587.
Friedman SH, Sorrentino RM, Stankowski JE, et al. Psychiatrists’ knowledge about maternal filicidal thoughts. Compr Psychiatry. 2008;49:106-110.
Stanton J, Simpson A, Wouldes T. A qualitative study of filicide by mentally ill mothers. Child Abuse Negl. 2000;24:1451-1460.