Dr. Spinelli Replies

To the Editor: Dr. Mendlowicz and colleagues describe findings derived from their “archival” study of neonaticide (1900–1995) “cases identified retrospectively through a search in the judicial files of the city of Rio de Janeiro” (Mendlowicz et al., 1999; reference 1). They hypothesize that the increase over time in reports of amnesia in their series was a result of a change in Brazil’s legislation, which provided mitigation for psychiatric symptoms in cases of neonaticide. They ascribe these reports to malingering. The authors suggest that the amnestic symptoms reported in my case series were also due to malingering and assert that the Dissociative Experiences Scale provided a psychiatric checklist as an alibi for the defendants (2).

The Dissociative Experiences Scale is a screening tool for general dissociative psychopathology as it appears in daily life circumstances, not merely at the time of pregnancy or childbirth. Amnesia is one factor among several in the Dissociative Experiences Scale. Spontaneous reports of amnesia in my study group focused on the time of delivery and viewing of the infant. The Dissociative Experiences Scale cannot preclude the possibility of malingering when secondary gain plays a pivotal role. Even so, I reported that two abnormally high scores in my study group suggested malingering. Nevertheless, Mendlowicz and colleagues raise the important issue of methodology.

A preponderance of the literature on neonaticide is derived from judicial statistics or retrospective chart reviews that have used varied and outdated diagnostic criteria (3). Contemporary reports of case interviews describe psychopathology similar to that reported in my study group (4, 5). One cannot infer cause and effect from a temporal relationship nor compare archival data derived from varied sources to contemporary interviewer data.

I addressed the lack of a malingering tool when I discussed the limits of my data. This accepted method of reporting suggests that the reader arrive at his or her own professional opinion given those limitations.

In appreciation of the authors’ concerns, I restate the purpose of my preliminary work. The vital need for further study of neonaticide should encourage inquiry and prompt phenomenological studies using structured interviews and contemporary diagnostic criteria. Once psychopathology is identified, strategies for treatment and prevention can be devised.