Psychiatric Expertise in Tragic Circumstances: The Role of the Forensic Psychiatrist in Infanticide

Women in the reproductive and postpartum period are in the most vulnerable stage of life for developing a mental illness and requiring psychiatric hospitalization. Perinatal mood and anxiety disorders (PMADs) are a spectrum of mental illnesses specific to women.

It is estimated that women are 25 times more likely to experience psychosis in the postpartum period than in any other period of their lives. In the first four weeks after having a baby, first-onset psychosis occurs at a rate 23 times higher than any other developmental period. The World Health Organization last year linked postpartum psychosis to suicide and/or maternal filicide. Classic symptoms of postpartum psychosis are markedly distinct from psychosis unrelated to childbirth. The relapse rate of women with postpartum psychosis is up to 80%, and DSM-5 indicates that 4% of women diagnosed with postpartum psychosis perpetrate filicide.

Some of these women have been evaluated to be psychotic during the commission of the offense and found not guilty by reason of insanity (NGRI). In those cases, they are likely to receive proper treatment; the fate of other women is to be found guilty by the courts and receive life sentences or execution, even though they too were assessed to be in a psychotic state at the time of the offense.

For example, one ruling by the U.S. courts occurred in 2014 with Carol Coronado in California. Coronado took the lives of her three daughters, aged 2.5 years, 16 months, and 2 months. After the stabbings, she was found by the police, lying naked in bed next to her deceased children, attempting to pry her stab wounds open with her fingers. She was unresponsive and had no recollection of the events. Coronado was evaluated by defense experts to be suffering from postpartum psychosis at the time of the crime, and the prosecution’s first forensic expert also found her to be insane. However, a second evaluation by the state’s expert produced a diagnosis of sanity and only mild depression. The trial judge noted the significant gap between the state expert’s testimony and other accounts but sentenced Coronado to three consecutive life sentences, without the possibility of parole.

In contrast, 20 years ago in Houston, Andrea Yates took the lives of her five children and faced the death penalty. In her first trial in 2002, she was convicted of murder and sentenced to life in prison. The state argued that she was not insane at the time because she knew what she was doing was legally wrong. The second trial, in 2006, was granted because perjury by the prosecution’s expert witness in the first trial was discovered. The jury upheld the insanity defense, and Yates was acquitted as not guilty by reason of insanity (Psychiatric News).

In her psychotic mind, ending her children’s lives was necessary to protect them from eternal damnation. Yates also believed that Satan lived within her and that by her own execution at the hands of the state, she would expunge the world of Satan’s evil. The courts demonstrated rightful compassion for the impact of postpartum psychosis, and its interpretation by case law was apt. Clearly, myriad factors influence the outcome of these trials. Determining criminal responsibility and the guilt or innocence of a woman includes a wide range of inconsistencies as seen in the cases of Yates and Coronado. Women’s lives hang in the balance, and too often the outcome of their fate is dependent on a host of idiosyncratic variables:

Psychiatrists are among the professionals responsible for providing forensic evaluation of the defendant in such cases; it is crucial to know the full scope, as well as the limits, of the role. In a chapter in our new book, Infanticide and Filicide: Foundations in Maternal Mental Health Forensics, the authors cite research showing three competencies foundational to success as an expert witness: criminal justice, psychiatry, and maternal mental illness.

Reproductive and perinatal forensic psychiatrists are optimally trained as experts in maternal filicide cases. As such, it is prudent to consult with them.

When serving as an expert witness in court, a psychiatrist needs do the following: