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edited by Margaret G. Spinelli, M.D.; Washington, D.C., American Psychiatric Publishing, Inc., 2003, 300 pages, $49.95
The stated goals of this edited volume are to provide background for future research endeavors in identifying women who are at risk of committing infanticide and to help attorneys and mental health experts who participate in infanticide criminal cases. Infanticide: Psychosocial and Legal Perspectives on Mothers Who Kill gives very good coverage to a variety of topics, including postpartum mental illnesses, denial of pregnancy, epidemiology of infanticide, and legal issues related to infanticide. Most chapter authors are nationally known experts. Laura J. Miller, M.D., provides an excellent discussion of pregnancy denial, and the chapters by Katherine L. Wisner, M.D., M.S., and coauthors and by Debra Sichel, M.D., present useful information about postpartum disorders in an easily understood manner.
Spinelli's chapter on neonaticide—murder of the newborn during the first 24 hours of life—is one of the less scientifically based chapters, making broad generalizations that are not supported by the author's evidence. Spinelli reports on forensic interviews, largely requested by the defense, of 16 women charged with neonaticide and one charged with attempted neonaticide. A majority of the defendants' scores on the Dissociative Experiences Scale (DES) suggested dissociative disorders. However, the DES is easy to fake in the absence of measures for malingering. Mendlowicz and associates (1) observed that the accused women were given "an extensive checklist of mental symptoms [that] may inadvertently educate them about psychiatric symptoms" in order to provide a defense for their actions. Spinelli suggests that when these women went into labor, they often did not realize it was labor. She adds, "Because the reality was intolerable, a brief dissociative psychosis occurred. On reintegration, they could not account for the dead infant."
In contrast, authors in multiple countries (2,3,4) have reported that neonaticide is primarily a phenomenon of nonpsychiatrically ill young mothers who kill their unwanted infants in desperation. Spinelli's work is useful in that it offers an alternative way to view neonaticide in specific cases. However, her suggestion that dissociation predominates in neonaticides is not consistent with other studies and may be due to referral bias.
The book includes a thorough analysis of legal defenses presented in infanticide cases. In several chapters, authors search for ways to relieve young women of responsibility when they may or may not have a valid defense. One chapter author, Judith Macfarlane, J.D., suggests the "involuntary act defense" as well as the insanity defense, stating that "in many cases the mother fails to rescue her baby from a toilet or is unable to move subsequent to delivery and thus leaves the child to die. … Depersonalization disorder may be a good defense … since this dissociative state leaves the mother with the sensation that she is unable to control her own movements."
Macfarlane also argues for the unsubstantiated "neonaticide syndrome," which thus far the courts have wisely rejected (5). No act alone should be allowed to define an illness. For example, "homicidal insanity," a form of "moral insanity," was a defense in the 1800s. It was ultimately rejected as having no valid scientific basis.
We do recommend this book to clinicians treating women of childbearing age and to attorneys seeking to increase their knowledge about perinatal mental illnesses. Hopefully, the contributions of various authors can lead to earlier identification of women at risk of harming their children to avoid these tragedies. "The murder of one single child is made negligible by nothing, not even Hiroshima" (6).
The authors are affiliated with the department of psychiatry at Case Western Reserve University in Cleveland, Ohio.
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