Edited by Rober I. Simon, MD
Recent high-profile cases, such as those of Andrea Yates and Susan Smith, have drawn national attention to the crime of maternal filicide. Yet mothers have killed their children for thousands of years. While many parents fear that strangers might kill their children, a parent is actually more likely to be the perpetrator. In the United States, from 1976 to 2004, 30% of children younger than 5 years who were murdered were killed by their mothers, and 31% were killed by their fathers.1 Having a mother kill her children while under your psychiatric care is likely to be traumatic. Furthermore, malpractice suits may result, as in the Yates case. This column will focus on the prevention of these tragedies, in addition to forensic issues.
Maternal filicide has various motives.2
- Altruistic filicide, in which a mother kills her child out of "love," occurs because she believes death to be in the child's best interest. Altruistic filicides can occur, for example, when a psychotic mother believes that she is saving her child from a fate worse than death or when a suicidal mother does not want to leave her child to face the uncaring world that she sees through her depressed eyes.
- Acutely psychotic filicide occurs when a psychotic or delirious mother kills her child with no rational motive. For example, she may experience command hallucinations to kill.
- Fatal maltreatment occurs when death is not the anticipated outcome but rather the result of cumulative child abuse, neglect, or Munchausen syndrome by proxy.
- Unwanted-child filicide occurs because the mother thinks of her child as a hindrance.
- Spouse-revenge filicide--the most rare--occurs when a mother kills her child specifically to emotionally wound the child's father. A classic example from mythology is Medea, who killed her children in order to seek revenge on her husband, Jason.
Neonaticide is the killing of a newborn in the first day of life.3 This column will focus on filicide rather than neonaticide, since mothers who commit neonaticide usually have not come to psychiatric attention before their crimes.
Child murder by mothers is a public health concern. Psychiatrists are most likely to be able to intervene in cases associated with maternal mental illness. Mothers with altruistic or acutely psychotic motives for filicide may be depressed, psychotic, manic, or delirious. However, the majority of filicides are related to fatal maltreatment rather than maternal psychiatric illness. Some mothers with severe mental illnesses, substance use disorders, or personality disorders may abuse or neglect their children, and psychiatrists are in a unique position to inquire about child-rearing practices.
Research studies have examined different populations of filicidal mothers. General population studies indicate that mothers who committed filicide were often socially isolated full-time caregivers of lower socio-economic status who experienced substance abuse and were victims of domestic violence. Studies of women in psychiatric populations who killed their children documented high incidences of psychosis, depression, suicidality, substance use, and difficulties in their own childhood.4 A small New Zealand interview study found that psychotic mothers who had committed filicide often acted suddenly and without much planning, whereas depressed mothers had been contemplating killing their children for days to weeks before their crimes.5
