INFANTICIDE
Some Medicolegal Considerations*
JULIO ARBOLEDA-FLOREZ,
On March 18, 1848 an editorial appeared in Lancet containing a stern denunciation of a Judge who during a trial had made 'unfair remarks' about the professional ability of a medical witness. The trial had taken place during the 1848 Lent assizes in Essex, England, and dealt with the case of a woman who had cut her infant's throat. The medical testimony pointed towards the presence of a puerperal insanity but the Judge considered this opinion as having been rashly formed and carelessly given. The jury however returned a verdict of not guilty on the grounds of insanity (6).
Despite general abhorrence for the act, it is not infrequent for children to be murdered. Such phenomena date back to ancient times and there have been numerous explanations for its occurrence throughout history and across cultures ranging from personal and political to religious and socioeconomical (14). The old concept that those who create may destroy what they have created was formalized in Roman law under patria potestas. It recognized a father's right to murder his children (16). In a five-year period in Canada (19641968), Rodenburg reported 1,276 homicides, involving 1,379 victims. One hundred and forty-one (11 percent) were child murders with a total of 189 child victims (20). In the United States there were 10,920 murders in 1966. One out of 22 was a child murdered by his parents 'Manuscript received January 1974 I. Lecturer, Department of Psychiatry, School of Medicine, University of Ottawa, Ottawa, Ontario. Can. Psjchiatr, Assoc. J. Vol. 20 (1975)
55
M.D.!
(16). Infanticide is frequently committed by the parents, seldom by s~rangers, and t~en usually in connection WIth a sexual cnme (8).
Definition In Canada, as in some other countries, infanticide is a medicolegal term (8, 20). The term infanticide has been used to denote all child murders. Hopwood's definition of child murders, however, was a more limited one. The murderer had to be: a nursing mother; the child had to be her own; and under one year of age, unless it was still unweaned (9). For the purpose of this paper infanticide is defined as the murdering of a child by its mother within the first year of life. When used, the term neonaticide, as introduced by Resnick, will mean the killing of a child by its mother within the first twenty-four hours post-partum (17).
The Law English law on the subject dates back to the reign of James I: a newborn illegitimate child found dead was presumed to have been killed by its mother unless she had at least one witness that it was born dead (23). Sentences may have been commuted, but a conviction would theoretically carry the death penalty. When the Infanticide Act, 1922 was introduced, it provided that a person found guilty of infanticide should be dealt with and punished as if she had been guilty of manslaughter" ... if the balance of her mind was disturbed from the effects of giving birth." A revised statute, the
56
CANADIAN PSYCHIATRIC ASSOCIATION JOURNAL
Infanticide Act, 1938, reads: "1) Where a woman by any wilful act or omission causes the death of her child, being a child under the age of twelve months, but at the time of the act or omission the balance of her mind was disturbed by reason of her not having fully recovered from the effects of giving birth to the child or by reason of the effect of lactation consequent upon the birth of the child, then, notwithstanding that the circumstances were such that for the Act the offence would have amounted to murder, she shall be guilty of felony, to wit of infanticide ... " (19). Canadian legislation closely follows the English Act. It is contained in Section 216 of the Criminal Code: "A female person commits infanticide when by wilful act or omission she causes the death of her newly-born child, if at the time of the act or omission she is not fully recovered from the effects of giving birth to the child and by reason thereof or of the effect of lactation consequent on the birth of the child her mind is then disturbed." 1953-54, c. 51. s. 204 (4). Section 216, therefore, sets infanticide as a medicolegal term. It indicates the relationship between child murder and childbirth, all other child murders being designated as murders and dealt with appropriately. Section 220 of the Code deals with the penalty: "Every female person who commits infanticide is guilty of an indictable offence and is liable to imprisonment for five years" (4). Section 538, 2-3, sets infanticide apart as an offence not to be included in murder or manslaughter but one for which an accused may be found guilty on a charge of murder or manslaughter if the circumstances warrant it (4). It is up to the Crown to prove each element that goes to make up a criminal offence beyond a reasonable doubt. The Canadian Act as it was first set up in 1948 had some difficulties in its applicability. In his analysis of the then Section 262, 2, Judge McRuer considered the elements of the offence of infanticide as: the accused must be a woman; she must have caused the death of a child; the child must have been newly born; the child must have been a child of the accused; the death must have
Vol. 20, No.1
been caused by a wilful act or omission of the accused; at the time of the wilful act or omission the accused must not have fully recovered from the effect of giving birth to the child; and by reason of giving birth to the child the balance of her mind must then have been disturbed (19). Judge McRuer felt that: the Act failed to define 'newlyborn child'; and that the onus resting on the Crown to prove all of these combined elements in the crime would be so heavy as to make it almost impossible to convict an accused person on a charge of infanticide if laid as a single count in the indictment. In effect the Act made it easy for the defence to either show that the accused had at the time of causing the death of the child by wilful act or omission fully recovered from giving birth to the child or that the balance of her mind was not at that time disturbed. With even a reasonable doubt raised in the mind of the jury the accused would be entitled to an acquittal and thereafter she could not be charged with murder or manslaughter, as an accused person cannot be put in jeopardy twice for the same homicide (19). These criticisms were literally taken by Judge Brennan who applied them in Regina versus Jacobs in 1952. The woman in that case was found not guilty on a charge of infanticide (15). The present Code meets Judge Mckuer's objections by: defining "newly-born child" as a "person under the age of one year"; and by adding Section 590: "Where a female person is charged with infanticide and the evidence establishes that she caused the death of her child but does not establish that at the time of the act or omission by which she caused the death of the child: a) she was not fully recovered from the effects of giving birth to the child or from the effects of lactation consequent on the birth of the child, and b) the balance of her mind was, at that time, disturbed by reason of the effect of giving birth to the child or of the effects of lactation consequent on the birth of the child, she may be convicted unless the evidence establishes that the act or omission was not wilful" (4).
February, 1975
INFANTICIDE
The Medical Side The questions from a medicolegal point of view are: does childbirth produce effects which may induce a woman, by virtue of disturbing the balance of her mind, to murder her infant; does lactation produce similar effects; and if they do, for how long could childbirth and lactation be expected to have such potentially harmful effects? From a strictly medical point of view, the question would not only be whether childbirth and lactation could produce those effects, but if they did, what could cause them. In 1858 Marce in his monograph, as was the practice in his time, divided his cases into 'puerperal' if within six weeks of childbirth, and 'lactational' if after six weeks. That differentiation, although not scientifically based, is still echoed in the Canadian Code. Marce observed that symptoms of post-partum mental illness could be found in nonpuerperal cases. However, the combinations of symptoms, as presented in the post-partum cases, were quite different from those observed in nonpuerperal cases (11). Hamilton, reviewing the history of post-partum mental illness, divides the papers on the subject into three groups: papers which maintain that there is no specific mental disorder which occurs in relation to childbearing; papers which adduce psychogenic causes for post-partum illness; and papers which suggest that physiological factors may playa role in the etiology (7). The official view as contained in the Diagnostic and Statistical Manual of Mental Disorders (DSM-II) appears under II-A. Psychoses Associated with Organic Brain Syndromes. Numeral 294 is psychoses associated with other physical conditions, and 294.4 psychosis with childbirth. Postpartum psychoses are then believed to result from "a diffuse impairment of brain tissue function" (5). Such an opinion has been advanced amongst others by Karnosh and Hope who consider delirium as "the only consistent or characteristic element in true post-partum psychosis" (10). Hamilton hypothesized that the delirium is probably the result of a reduction in the circulating
57
amount of thyroxine. He stressed the fact, frequently observed in clinics, that a great majority of the post-partum psychoses develop after the third day post-partum typically everything seems normal during the first two days (7). Butts also feels that a decrease in thyroid secretions may be an etiological factor (3). Psychogenetic etiological reasons have been discussed by Zilboorg who felt that unresolved incestuous drives act as a barrier to parenthood because of related frigidity and potential homosexuality (24). Bender found that the mother projects her symptoms onto the child which she feels to be a part of herself (the hypochondriacal organ). Suicidal ideas are slowly transferred into a desire to kill the child (1). A disturbed mother-daughter relationship has been considered as a "fundamental cause" by Slater (22). A similar theme has been discussed by McDermaid who described the "child-centered obsessional depression". The mother's over-concern about the baby, it seems, would be a reaction formation (13). Harder thinks that an unconscious but overwhelming hatred for the child is the real motivation - the murdering of the child is seen as 'egosyntonic" (8). Rosenwald and Stonehill hypothesize that early post-partum psychoses develop in narcissistic females (21). Melges is of the opinion that the high incidence of confusion seen in post-partum psychosis most likely stems from identity diffusion centering around a conflict in assuming the mother role (12). Bridges states that mental illness becomes more common following childbirth and during the subsequent three months. The rare but possible danger is neglect of the baby and even infanticide. The latter should always be taken into account if a psychosis is suspected (2). Discussion Not every case of infanticide is the result of a post-partum psychosis. The mother may not always fall within the definition of legal insanity. This author agrees with Resnick that neonaticides are different from infanticides in diagnosis, motives and the characteristics of the mothers (18). Most
58
CANADIAN PSYCHIATRIC ASSOCIATION JOURNAL
infanticides are committed for 'altruistic' reasons. Example: C.S. a 26-year-old single mother was brought to the hospital emergency by her employer. The asphyxiated body of her fourweek old baby was also brought. C. had placed a plastic laundry bag over its face and had then tried, unsuccessfully, to kill herself by slashing her neck. She intimated that she had wished to be with her child in a "happier place" , a' 'spirit world where famous and good people go to". Her child she claimed, was not dead but "happy athome". She had become increasingly agitated, restless and unable to sleep after the first week post-partum. She seemed confused, neglected her physical appearance and became over concerned about her baby's health. According to her employer she appeared "terrible" and spoke in a confused fashion a few days before the infanticide.
By contrast most neonaticides are carried out simply because the child is not wanted (18). Neonaticide mothers rarely make attempts to abort and often fail to seek medical assistance during their pregnancies. They often deny that they are pregnant or assume that the child will be stillborn. At childbirth the baby is flushed down a toilet, placed in a drawer or disposed of in some other way (18, 20). A cool premeditation of the murder seems to be a frequent finding in neonaticide. Neonaticide mothers seldom attempt suicide nor do they appear to be particularly concerned, and they may use extreme cleverness to avoid detection.
Example: G. H. a 33-year-old single mother was first examined at the jail. She had been detained after she was discovered to be the mother of a baby found wrapped in a plastic garbage bag in a garbage can at a shopping centre two blocks from her home. She had not had medical attention during per pregnancy. She delivered at home alone in her bedroom and proceeded to asphyxiate the baby by covering its mouth and nose with her hand. She lived with her elderly parents who had not 'acknowledged' that G. was pregnant. She was afraid her parents would find out so she asphyxiated the baby as soon as it started to cry. After placing the body in the garbage can she went about her daily routine until she was apprehended two weeks later.
The law does not differentiate between neonaticide and infanticide. Both are cons i-
Vol. 20, No. I
dered 'infanticide', which the law assumes is a less severe crime than the murdering of an adult or an older child, circumstances or monstrosity notwithstanding. In the past infanticide was punished harshly as it was considered to be a crime against nature, but the tendency now is to take a less stem view (8). The twelve-month cut off line for the offence infanticide simply means that if a thirteen month post-partum mother murders her child she will most likely be charged with non-capital murder; whereas an eleven month post-partum mother who did the same would be charged with infanticide. The mental condition of the former may be worse than the latter's, and obviously much worse than that of a mother who may have murdered her infant within twenty-four hours of birth (neonaticide). The first mother, however, would draw the most severe charge, and her liability would be higher in case of conviction. From a psychiatric point of view there is normally no difficulty in the assessment of an infanticide case when it has been associated with a post-partum psychosis. Theoretically the mother could be found not guilty by reason of insanity. There is, however, with some regularity, little evidence on medical-psychiatric grounds to exonerate a neonaticide mother from her criminal responsibility. Section 590 of the Criminal Code of Canada stipulates that if a woman has killed her newlyborn child, and if she is charged with infanticide (Section 216), she could still be found guilty of that offence whether its basic elements are present or not (4). C.S., whose case had all the basic elements that make up the offence of 'infanticide', was not charged with such but with non-capital murder. She was found not guilty by reason of insanity. G.H. 's case did not have the elements that make up infanticide but she was charged with such. She was found guilty and given a three-year probation sentence. From these two vignettes it can be seen that a woman charged with infanticide may have been perfectly sane and may have artfully premeditated the killing of her infant but still she may benefit from a potentially mild disposition of her crime by
February, 1975
INFANTICIDE
the Court. The possibilities of future similar offences can never be discarded (8). Unless the Crown obtains psychiatric assistance before the charge of infanticide is laid so as to verify the elements making up the offence, it would be better not to make this charge. The offence of infanticide as a separate indictment is, at best, unnecessary, and at worst, discriminatory as is exemplified in the two cases presented above. The genuine cases of post-partum psychoses associated with schizophrenic, manic or depressive symptoms, and which tragically terminate in the murdering of an infant could be dealt with within the spirit of Section 16 (Insanity defence) of the Criminal Code (4), should the circumstances warrant it. Section 216 of the Code could then be abolished.
Summary This paper presents some legal and medical-psychiatric considerations relating to the offence of infanticide. The history of this offence in the Criminal Code of Canada is reviewed. Highlights in the literature of post-partum psychosis are presented, and it is contended that the offence of infanticide as a separate entity is unnecessary and discriminatory. It is felt that it should be abolished and that Section 16 of the Criminal Code is sufficient to deal with the cases of infanticide resulting from post-partum psychosis. References 1. Bender, L.: Psychiatric mechanisms in child murders. J. Nerv. Ment. Dis. 80, 32, 1934. 2. Bridges, P.U.: Psychiatric Emergencies, Diagnosis and Management. Springfield, 111., Charles C. Thomas, 197I. 3. Butts, H. 1.: Psychodynamic and endocrine factors in post-partum psychoses. J. Natl. Med. Assoc. 60:224, May, 1968. 4. Cartwright, I.: Martin's Annual Criminal Code, 1972. Agincourt, Canada Law Book Limited, 1972. . 5. Diagnostic and Statistical Manual of Mental Disorders. DSM-II. American Psychiatric Association. Washington D.C., 1968. Note: The Canadian Dominion Bureau of Statistics: Manual for the Classification of
6. 7. 8. 9. 10. II.
12. 13. 14.
15. 16.
17. 18. 19. 20. 21. 22. 23.
24.
59
Psychiatric Diagnoses, has been taken from DSM-II. Editorial, Lancet 1:318, Mar. 18, 1848. Hamilton, J. A.: Post-partum Psychiatric Problems. St. Louis, C. V. Mosby Company,1962. Harder, T.: The psychopathology of infanticide. Acta. Psychiatr. Scand. ,43, 196, 1967. Hopwood, J. S.: Child murder and insanity. J. Ment. Sci., 73,95, 1927. Karnosh, L. 1. and Hope, 1. M.: Puerperal psychoses and their sequellae. Am. J. Psychiatry. 94 ,536, 1937-38. Marce, L. V.: Traite de la Folie des Femmes Enceintes, des Nouvelles Accouchees et des Nourrices. Paris, J. B. Bailliere et Fils, 1858. Melges, F. T.: Post-partum psychiatric syndromes. Psychosom. Med., 30:95, 1968. McDermaid, G. and Winkler, E. G.: Psychopathology of infanticide. J. Clin. Exp. Psychopath. 16, 22,1955. Radbill, X.: "History of Child Abuse and Infanticide", in The Battered Child. Eds. R. E. Helfer, C. H. Kempe, Chicago, University of Chicago Press, 1968. Regina vs. Jacobs, Brennan Co. Ct. 1., Canadian Criminal Cases, 105, 291, 1952. Resnick, P. J.: "Infanticide", In Modern Perspectives in Psycho-Obstetrics. (Modern Perspectives in Psychiatry Series - 5. Ed. Howells 1. G.) New York, Brunner/Mazel Inc., 1972. Resnick, P. J.: Child murder by parents: A psychiatric review of filicide. Am. J. Psychiatry, 126,325,1969. Resnick, P. 1.: Murder of the newborn: A psychiatric review of neonaticides. Am. J. Psychiatry 126: 10,1414, April, 1970. Rex vs. Marchello, McRuer C. J. H. C., Canadian Criminal Cases. 100,137,1951. Rodenburg, M.: Child-murder by depressed parents. Can. Psychiatr. Assoc. J., 16: I, 41,1971. Rosenwald, G. C. and Stonehill, M. W.: Early and late post-partum illnesses. Psychosom. Med., 34, 129, 1972. Slater, A. L.: Infanticide - Report of two cases. Med. J. Aust., 819-21, 1961. Victoroff, V. M.: A case of infanticide related to psychomotor automatism; psychodynamic, physiological, forensic and sociological considerations. J. Clin. Exp. Psychopathol.16, 191,1955. Zilboorg, G.: Depressive reactions related to parenthood. Am. J. Psychiatry, 10, 927, 1931.
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Resume L'intention de ce rapport fut de presenter quelques considerations legales et psycho-medicates se rapportant au cas d'infanticide. Dans le sons-theme consacre a I' etat psychologique de la patiente apres I' accouchement, les points principaux sont
Vol. 20, No.1
presentes, II est dit que le cas d'infanticide, comme entire separee, n'est pas necessaire, et, discriminatoire. II est pressenti qu'il devrait etre aboli et que la Section 16 du Code Criminel est suffisante pour resoudre les cas d'infanticide resultant de I'etat psychologique de la patiente apres l' accouchement.
Sooner murder an infant in its cradle than nurse unacted desires Proverbs ofHell William Blake
1757-1827
Some Medicolegal Considerations*
JULIO ARBOLEDA-FLOREZ,
On March 18, 1848 an editorial appeared in Lancet containing a stern denunciation of a Judge who during a trial had made 'unfair remarks' about the professional ability of a medical witness. The trial had taken place during the 1848 Lent assizes in Essex, England, and dealt with the case of a woman who had cut her infant's throat. The medical testimony pointed towards the presence of a puerperal insanity but the Judge considered this opinion as having been rashly formed and carelessly given. The jury however returned a verdict of not guilty on the grounds of insanity (6).
Despite general abhorrence for the act, it is not infrequent for children to be murdered. Such phenomena date back to ancient times and there have been numerous explanations for its occurrence throughout history and across cultures ranging from personal and political to religious and socioeconomical (14). The old concept that those who create may destroy what they have created was formalized in Roman law under patria potestas. It recognized a father's right to murder his children (16). In a five-year period in Canada (19641968), Rodenburg reported 1,276 homicides, involving 1,379 victims. One hundred and forty-one (11 percent) were child murders with a total of 189 child victims (20). In the United States there were 10,920 murders in 1966. One out of 22 was a child murdered by his parents 'Manuscript received January 1974 I. Lecturer, Department of Psychiatry, School of Medicine, University of Ottawa, Ottawa, Ontario. Can. Psjchiatr, Assoc. J. Vol. 20 (1975)
55
M.D.!
(16). Infanticide is frequently committed by the parents, seldom by s~rangers, and t~en usually in connection WIth a sexual cnme (8).
Definition In Canada, as in some other countries, infanticide is a medicolegal term (8, 20). The term infanticide has been used to denote all child murders. Hopwood's definition of child murders, however, was a more limited one. The murderer had to be: a nursing mother; the child had to be her own; and under one year of age, unless it was still unweaned (9). For the purpose of this paper infanticide is defined as the murdering of a child by its mother within the first year of life. When used, the term neonaticide, as introduced by Resnick, will mean the killing of a child by its mother within the first twenty-four hours post-partum (17).
The Law English law on the subject dates back to the reign of James I: a newborn illegitimate child found dead was presumed to have been killed by its mother unless she had at least one witness that it was born dead (23). Sentences may have been commuted, but a conviction would theoretically carry the death penalty. When the Infanticide Act, 1922 was introduced, it provided that a person found guilty of infanticide should be dealt with and punished as if she had been guilty of manslaughter" ... if the balance of her mind was disturbed from the effects of giving birth." A revised statute, the
56
CANADIAN PSYCHIATRIC ASSOCIATION JOURNAL
Infanticide Act, 1938, reads: "1) Where a woman by any wilful act or omission causes the death of her child, being a child under the age of twelve months, but at the time of the act or omission the balance of her mind was disturbed by reason of her not having fully recovered from the effects of giving birth to the child or by reason of the effect of lactation consequent upon the birth of the child, then, notwithstanding that the circumstances were such that for the Act the offence would have amounted to murder, she shall be guilty of felony, to wit of infanticide ... " (19). Canadian legislation closely follows the English Act. It is contained in Section 216 of the Criminal Code: "A female person commits infanticide when by wilful act or omission she causes the death of her newly-born child, if at the time of the act or omission she is not fully recovered from the effects of giving birth to the child and by reason thereof or of the effect of lactation consequent on the birth of the child her mind is then disturbed." 1953-54, c. 51. s. 204 (4). Section 216, therefore, sets infanticide as a medicolegal term. It indicates the relationship between child murder and childbirth, all other child murders being designated as murders and dealt with appropriately. Section 220 of the Code deals with the penalty: "Every female person who commits infanticide is guilty of an indictable offence and is liable to imprisonment for five years" (4). Section 538, 2-3, sets infanticide apart as an offence not to be included in murder or manslaughter but one for which an accused may be found guilty on a charge of murder or manslaughter if the circumstances warrant it (4). It is up to the Crown to prove each element that goes to make up a criminal offence beyond a reasonable doubt. The Canadian Act as it was first set up in 1948 had some difficulties in its applicability. In his analysis of the then Section 262, 2, Judge McRuer considered the elements of the offence of infanticide as: the accused must be a woman; she must have caused the death of a child; the child must have been newly born; the child must have been a child of the accused; the death must have
Vol. 20, No.1
been caused by a wilful act or omission of the accused; at the time of the wilful act or omission the accused must not have fully recovered from the effect of giving birth to the child; and by reason of giving birth to the child the balance of her mind must then have been disturbed (19). Judge McRuer felt that: the Act failed to define 'newlyborn child'; and that the onus resting on the Crown to prove all of these combined elements in the crime would be so heavy as to make it almost impossible to convict an accused person on a charge of infanticide if laid as a single count in the indictment. In effect the Act made it easy for the defence to either show that the accused had at the time of causing the death of the child by wilful act or omission fully recovered from giving birth to the child or that the balance of her mind was not at that time disturbed. With even a reasonable doubt raised in the mind of the jury the accused would be entitled to an acquittal and thereafter she could not be charged with murder or manslaughter, as an accused person cannot be put in jeopardy twice for the same homicide (19). These criticisms were literally taken by Judge Brennan who applied them in Regina versus Jacobs in 1952. The woman in that case was found not guilty on a charge of infanticide (15). The present Code meets Judge Mckuer's objections by: defining "newly-born child" as a "person under the age of one year"; and by adding Section 590: "Where a female person is charged with infanticide and the evidence establishes that she caused the death of her child but does not establish that at the time of the act or omission by which she caused the death of the child: a) she was not fully recovered from the effects of giving birth to the child or from the effects of lactation consequent on the birth of the child, and b) the balance of her mind was, at that time, disturbed by reason of the effect of giving birth to the child or of the effects of lactation consequent on the birth of the child, she may be convicted unless the evidence establishes that the act or omission was not wilful" (4).
February, 1975
INFANTICIDE
The Medical Side The questions from a medicolegal point of view are: does childbirth produce effects which may induce a woman, by virtue of disturbing the balance of her mind, to murder her infant; does lactation produce similar effects; and if they do, for how long could childbirth and lactation be expected to have such potentially harmful effects? From a strictly medical point of view, the question would not only be whether childbirth and lactation could produce those effects, but if they did, what could cause them. In 1858 Marce in his monograph, as was the practice in his time, divided his cases into 'puerperal' if within six weeks of childbirth, and 'lactational' if after six weeks. That differentiation, although not scientifically based, is still echoed in the Canadian Code. Marce observed that symptoms of post-partum mental illness could be found in nonpuerperal cases. However, the combinations of symptoms, as presented in the post-partum cases, were quite different from those observed in nonpuerperal cases (11). Hamilton, reviewing the history of post-partum mental illness, divides the papers on the subject into three groups: papers which maintain that there is no specific mental disorder which occurs in relation to childbearing; papers which adduce psychogenic causes for post-partum illness; and papers which suggest that physiological factors may playa role in the etiology (7). The official view as contained in the Diagnostic and Statistical Manual of Mental Disorders (DSM-II) appears under II-A. Psychoses Associated with Organic Brain Syndromes. Numeral 294 is psychoses associated with other physical conditions, and 294.4 psychosis with childbirth. Postpartum psychoses are then believed to result from "a diffuse impairment of brain tissue function" (5). Such an opinion has been advanced amongst others by Karnosh and Hope who consider delirium as "the only consistent or characteristic element in true post-partum psychosis" (10). Hamilton hypothesized that the delirium is probably the result of a reduction in the circulating
57
amount of thyroxine. He stressed the fact, frequently observed in clinics, that a great majority of the post-partum psychoses develop after the third day post-partum typically everything seems normal during the first two days (7). Butts also feels that a decrease in thyroid secretions may be an etiological factor (3). Psychogenetic etiological reasons have been discussed by Zilboorg who felt that unresolved incestuous drives act as a barrier to parenthood because of related frigidity and potential homosexuality (24). Bender found that the mother projects her symptoms onto the child which she feels to be a part of herself (the hypochondriacal organ). Suicidal ideas are slowly transferred into a desire to kill the child (1). A disturbed mother-daughter relationship has been considered as a "fundamental cause" by Slater (22). A similar theme has been discussed by McDermaid who described the "child-centered obsessional depression". The mother's over-concern about the baby, it seems, would be a reaction formation (13). Harder thinks that an unconscious but overwhelming hatred for the child is the real motivation - the murdering of the child is seen as 'egosyntonic" (8). Rosenwald and Stonehill hypothesize that early post-partum psychoses develop in narcissistic females (21). Melges is of the opinion that the high incidence of confusion seen in post-partum psychosis most likely stems from identity diffusion centering around a conflict in assuming the mother role (12). Bridges states that mental illness becomes more common following childbirth and during the subsequent three months. The rare but possible danger is neglect of the baby and even infanticide. The latter should always be taken into account if a psychosis is suspected (2). Discussion Not every case of infanticide is the result of a post-partum psychosis. The mother may not always fall within the definition of legal insanity. This author agrees with Resnick that neonaticides are different from infanticides in diagnosis, motives and the characteristics of the mothers (18). Most
58
CANADIAN PSYCHIATRIC ASSOCIATION JOURNAL
infanticides are committed for 'altruistic' reasons. Example: C.S. a 26-year-old single mother was brought to the hospital emergency by her employer. The asphyxiated body of her fourweek old baby was also brought. C. had placed a plastic laundry bag over its face and had then tried, unsuccessfully, to kill herself by slashing her neck. She intimated that she had wished to be with her child in a "happier place" , a' 'spirit world where famous and good people go to". Her child she claimed, was not dead but "happy athome". She had become increasingly agitated, restless and unable to sleep after the first week post-partum. She seemed confused, neglected her physical appearance and became over concerned about her baby's health. According to her employer she appeared "terrible" and spoke in a confused fashion a few days before the infanticide.
By contrast most neonaticides are carried out simply because the child is not wanted (18). Neonaticide mothers rarely make attempts to abort and often fail to seek medical assistance during their pregnancies. They often deny that they are pregnant or assume that the child will be stillborn. At childbirth the baby is flushed down a toilet, placed in a drawer or disposed of in some other way (18, 20). A cool premeditation of the murder seems to be a frequent finding in neonaticide. Neonaticide mothers seldom attempt suicide nor do they appear to be particularly concerned, and they may use extreme cleverness to avoid detection.
Example: G. H. a 33-year-old single mother was first examined at the jail. She had been detained after she was discovered to be the mother of a baby found wrapped in a plastic garbage bag in a garbage can at a shopping centre two blocks from her home. She had not had medical attention during per pregnancy. She delivered at home alone in her bedroom and proceeded to asphyxiate the baby by covering its mouth and nose with her hand. She lived with her elderly parents who had not 'acknowledged' that G. was pregnant. She was afraid her parents would find out so she asphyxiated the baby as soon as it started to cry. After placing the body in the garbage can she went about her daily routine until she was apprehended two weeks later.
The law does not differentiate between neonaticide and infanticide. Both are cons i-
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dered 'infanticide', which the law assumes is a less severe crime than the murdering of an adult or an older child, circumstances or monstrosity notwithstanding. In the past infanticide was punished harshly as it was considered to be a crime against nature, but the tendency now is to take a less stem view (8). The twelve-month cut off line for the offence infanticide simply means that if a thirteen month post-partum mother murders her child she will most likely be charged with non-capital murder; whereas an eleven month post-partum mother who did the same would be charged with infanticide. The mental condition of the former may be worse than the latter's, and obviously much worse than that of a mother who may have murdered her infant within twenty-four hours of birth (neonaticide). The first mother, however, would draw the most severe charge, and her liability would be higher in case of conviction. From a psychiatric point of view there is normally no difficulty in the assessment of an infanticide case when it has been associated with a post-partum psychosis. Theoretically the mother could be found not guilty by reason of insanity. There is, however, with some regularity, little evidence on medical-psychiatric grounds to exonerate a neonaticide mother from her criminal responsibility. Section 590 of the Criminal Code of Canada stipulates that if a woman has killed her newlyborn child, and if she is charged with infanticide (Section 216), she could still be found guilty of that offence whether its basic elements are present or not (4). C.S., whose case had all the basic elements that make up the offence of 'infanticide', was not charged with such but with non-capital murder. She was found not guilty by reason of insanity. G.H. 's case did not have the elements that make up infanticide but she was charged with such. She was found guilty and given a three-year probation sentence. From these two vignettes it can be seen that a woman charged with infanticide may have been perfectly sane and may have artfully premeditated the killing of her infant but still she may benefit from a potentially mild disposition of her crime by
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INFANTICIDE
the Court. The possibilities of future similar offences can never be discarded (8). Unless the Crown obtains psychiatric assistance before the charge of infanticide is laid so as to verify the elements making up the offence, it would be better not to make this charge. The offence of infanticide as a separate indictment is, at best, unnecessary, and at worst, discriminatory as is exemplified in the two cases presented above. The genuine cases of post-partum psychoses associated with schizophrenic, manic or depressive symptoms, and which tragically terminate in the murdering of an infant could be dealt with within the spirit of Section 16 (Insanity defence) of the Criminal Code (4), should the circumstances warrant it. Section 216 of the Code could then be abolished.
Summary This paper presents some legal and medical-psychiatric considerations relating to the offence of infanticide. The history of this offence in the Criminal Code of Canada is reviewed. Highlights in the literature of post-partum psychosis are presented, and it is contended that the offence of infanticide as a separate entity is unnecessary and discriminatory. It is felt that it should be abolished and that Section 16 of the Criminal Code is sufficient to deal with the cases of infanticide resulting from post-partum psychosis. References 1. Bender, L.: Psychiatric mechanisms in child murders. J. Nerv. Ment. Dis. 80, 32, 1934. 2. Bridges, P.U.: Psychiatric Emergencies, Diagnosis and Management. Springfield, 111., Charles C. Thomas, 197I. 3. Butts, H. 1.: Psychodynamic and endocrine factors in post-partum psychoses. J. Natl. Med. Assoc. 60:224, May, 1968. 4. Cartwright, I.: Martin's Annual Criminal Code, 1972. Agincourt, Canada Law Book Limited, 1972. . 5. Diagnostic and Statistical Manual of Mental Disorders. DSM-II. American Psychiatric Association. Washington D.C., 1968. Note: The Canadian Dominion Bureau of Statistics: Manual for the Classification of
6. 7. 8. 9. 10. II.
12. 13. 14.
15. 16.
17. 18. 19. 20. 21. 22. 23.
24.
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Psychiatric Diagnoses, has been taken from DSM-II. Editorial, Lancet 1:318, Mar. 18, 1848. Hamilton, J. A.: Post-partum Psychiatric Problems. St. Louis, C. V. Mosby Company,1962. Harder, T.: The psychopathology of infanticide. Acta. Psychiatr. Scand. ,43, 196, 1967. Hopwood, J. S.: Child murder and insanity. J. Ment. Sci., 73,95, 1927. Karnosh, L. 1. and Hope, 1. M.: Puerperal psychoses and their sequellae. Am. J. Psychiatry. 94 ,536, 1937-38. Marce, L. V.: Traite de la Folie des Femmes Enceintes, des Nouvelles Accouchees et des Nourrices. Paris, J. B. Bailliere et Fils, 1858. Melges, F. T.: Post-partum psychiatric syndromes. Psychosom. Med., 30:95, 1968. McDermaid, G. and Winkler, E. G.: Psychopathology of infanticide. J. Clin. Exp. Psychopath. 16, 22,1955. Radbill, X.: "History of Child Abuse and Infanticide", in The Battered Child. Eds. R. E. Helfer, C. H. Kempe, Chicago, University of Chicago Press, 1968. Regina vs. Jacobs, Brennan Co. Ct. 1., Canadian Criminal Cases, 105, 291, 1952. Resnick, P. J.: "Infanticide", In Modern Perspectives in Psycho-Obstetrics. (Modern Perspectives in Psychiatry Series - 5. Ed. Howells 1. G.) New York, Brunner/Mazel Inc., 1972. Resnick, P. J.: Child murder by parents: A psychiatric review of filicide. Am. J. Psychiatry, 126,325,1969. Resnick, P. 1.: Murder of the newborn: A psychiatric review of neonaticides. Am. J. Psychiatry 126: 10,1414, April, 1970. Rex vs. Marchello, McRuer C. J. H. C., Canadian Criminal Cases. 100,137,1951. Rodenburg, M.: Child-murder by depressed parents. Can. Psychiatr. Assoc. J., 16: I, 41,1971. Rosenwald, G. C. and Stonehill, M. W.: Early and late post-partum illnesses. Psychosom. Med., 34, 129, 1972. Slater, A. L.: Infanticide - Report of two cases. Med. J. Aust., 819-21, 1961. Victoroff, V. M.: A case of infanticide related to psychomotor automatism; psychodynamic, physiological, forensic and sociological considerations. J. Clin. Exp. Psychopathol.16, 191,1955. Zilboorg, G.: Depressive reactions related to parenthood. Am. J. Psychiatry, 10, 927, 1931.
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CANADIAN PSYCHIATRIC ASSOCIATION JOURNAL
Resume L'intention de ce rapport fut de presenter quelques considerations legales et psycho-medicates se rapportant au cas d'infanticide. Dans le sons-theme consacre a I' etat psychologique de la patiente apres I' accouchement, les points principaux sont
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presentes, II est dit que le cas d'infanticide, comme entire separee, n'est pas necessaire, et, discriminatoire. II est pressenti qu'il devrait etre aboli et que la Section 16 du Code Criminel est suffisante pour resoudre les cas d'infanticide resultant de I'etat psychologique de la patiente apres l' accouchement.
Sooner murder an infant in its cradle than nurse unacted desires Proverbs ofHell William Blake
1757-1827
