Front Matter
Publication: Infanticide and Filicide: Foundations in Maternal Mental Health Forensics
INFANTICIDE AND FILICIDE
Foundations in Maternal Mental Health Forensics
INFANTICIDE AND FILICIDE
Foundations in Maternal Mental Health Forensics
Gina Wong, Ph.D.
George Parnham, J.D.
Note: The authors have worked to ensure that all information in this book is accurate at the time of publication and consistent with general psychiatric and medical standards, and that information concerning drug dosages, schedules, and routes of administration is accurate at the time of publication and consistent with standards set by the U.S. Food and Drug Administration and the general medical community. As medical research and practice continue to advance, however, therapeutic standards may change. Moreover, specific situations may require a specific therapeutic response not included in this book. For these reasons and because human and mechanical errors sometimes occur, we recommend that readers follow the advice of physicians directly involved in their care or the care of a member of their family.
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Library of Congress Cataloging-in-Publication Data
Names: Wong, Gina, 1971- editor. | Parnham, George J., editor. | American Psychiatric Association Publishing, issuing body.
Title: Infanticide and filicide : foundations in maternal mental health forensics / [edited by] Gina Wong, George Parnham.
Description: First edition. | Washington, DC : American Psychiatric Association Publishing, [2021] | Includes bibliographical references and index.
Identifiers: LCCN 2020044380 (print) | LCCN 2020044381 (ebook) | ISBN 9781615373512 (paperback ; alk. paper) | ISBN 9781615373703 (ebook)
Subjects: MESH: Infanticide | Forensic Psychiatry—methods | Mother-Child Relations—psychology | Mental Disorders—psychology
Classification: LCC RA1148 (print) | LCC RA1148 (ebook) | NLM W 867 | DDC 614/.15—dc23
LC record available at https://lccn.loc.gov/2020044380
LC ebook record available at https://lccn.loc.gov/2020044381
British Library Cataloguing in Publication Data
A CIP record is available from the British Library.
Contents
Contributors
Introduction
Foundation I: Legal Aspects Surrounding Maternal Infanticide and Filicide
1 Honoring the Legacy of the Andrea Yates Case
George Parnham, J.D.
2 Becoming a Legal Expert in Infanticide and Filicide Cases in the United States
George Parnham, J.D.
3 A Groundbreaking Illinois Postpartum Law Brings Hope for Change in the United States
Susan Benjamin Feingold, Psy.D., PMH-C
Barry Michael Lewis, J.D.
4 Delineating the Meaning of Disturbance of Mind in Canadian Infanticide Law
Kirsten Kramar, Ph.D.
5 Fathers and Filicide
Mental Illness and Outcomes
Susan Hatters Friedman, M.D., DFAPA
Foundation II: The Impact of Perinatal Psychiatric Complications in Maternal Infanticide and Filicide
6 Role of Perinatal Psychiatric Complications in Infanticide and Filicide
Kimberly Brandt, D.O., PMH-C
Amanda Kingston, M.D.
7 Altruistic Filicide
A Trauma-Informed Perspective
Diana Barnes, Psy.D., LMFT, PMH-C
8 Understanding the Mysteries of Pregnancy Denial
Diana Barnes, Psy.D., LMFT, PMH-C
Anne Buist, M.D., FRANCP
Foundation III: The Role of the Expert Witness in Maternal Infanticide and Filicide Cases
9 Reflections of an Expert Witness in the Andrea Yates Case
Phillip Resnick, M.D.
10 Becoming an Expert Witness in Maternal Filicide Cases
Gina Wong, Ph.D.
Kathryn Bell, M.C.
11 Writing the Maternal Filicide Report
Pearls of Wisdom for Expert Witnesses
Susan Hatters Friedman, M.D., DFAPA
Daniel Riordan, MBBS, M.A., M.Sc., MRCPsych, FRANZCP, MInstGA
Jacqueline A. Short, M.B.Ch.B., B.A., FRCPsych, Affiliate RANZCP, Dip.For.Psychotherapy, Dip.Soc.Pol&Criminology
Foundation IV: Sociocultural Considerations and Feminist Approaches to Prevention and Treatment
12 Maternal Filicide in Canadian News
A Decade in Review
Kimberly Rock, M.C.
Amy Corkett, M.C.
Nancy Shekarak Ghashghaei, M.C.
Gina Wong, Ph.D.
13 Trauma and Attachment
Preventing Maternal Filicide Through the Generations
NoraL. Erickson, Ph.D.
Megan M. Julian, Ph.D.
Jonathan E. Handelzalts, Ph.D.
Gina Wong, Ph.D.
Maria Muzik, M.D., M.S.
14 Maternal Filicide in Malaysia
Structural Inequality and Cultural Disparity
Salmi Razali, M.D., M.Med. (Psychiatry), Ph.D.
Jane Fisher, AO, Ph.D., B.Sc. (Hons), MAPS, FCCLP, FCHP
Maggie Kirkman, Ph.D., B.A. (Hons), MAPS
15 Postpartum Support International
A Leading Resource Center for Maternal Filicide in the United States
Jane Honikman, M.S.
Tiffany Ross, M.S.S.W.
Wendy Davis, Ph.D., PMH-C
Clinical Cases: Application of Foundations and Practical Considerations
16 Clinical Case 1: The Dark Side of Mother
A Clinical Case in Italy
Nicoletta Giacchetti, M.D., Ph.D.
Liliana Lorettu, M.D.
Guido Maria Lattanzi, M.D.
Franca Aceti, M.D.
17 Clinical Case 2: Falling Between the Cracks of Medical Care
A Case of Infanticide in South Africa
Ugasvaree Subramaney, M.B.B.Ch., FCPsych(SA), M.Med. (Psychiatry), B.Sc. (Psychology) (Hons), Ph.D.
Daniel Hoffman, B.A., B.A. (Psychology) (Hons), M.Sc. (Psychology), D.Phil.
Glossary
Index
Contributors
Franca Aceti, M.D.
Assistant Professor, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
Diana Barnes, Psy.D., LMFT, PMH-C
The Center for Postpartum Health, Sherman Oaks, California
Kathryn Bell, M.C.
Graduate Centre for Applied Psychology, Athabasca University, Alberta, Canada
Kimberly Brandt, D.O., PMH-C
Perinatal Psychiatrist, Associate Professor of Clinical Psychiatry, Psychiatry Residency Training Director, Department of Psychiatry, University of Missouri—Columbia School of Medicine, Columbia, Missouri
Anne Buist, M.D., FRANCP
Professor of Women’s Mental Health, Department of Psychiatry, Austin Health, University of Melbourne, Melbourne, Australia
Amy Corkett, M.C.
Registered Provisional Psychologist, Canadian Certified Counsellor, Alberta, Canada
Wendy Davis, Ph.D., PMH-C
Postpartum Support International, Portland, Oregon
Nora L. Erickson, Ph.D.
Psychologist, Clinician Investigator, Hennepin Healthcare Mother Baby Program, Redleaf Center for Family Healing, Minneapolis, Minnesota
Susan Benjamin Feingold, Psy.D., PMH-C
Susan Benjamin Feingold and Associates for Perinatal Mental Health, LLC, Skokie, Illinois; Advisory Council of Postpartum Support International, Illinois
Jane Fisher, AO, Ph.D., B.Sc. (Hons), MAPS, FCCLP, FCHP
Clinical Psychologist, Finkel Professor of Global Health, Head of the Division of Social Sciences, and Director of Global and Women’s Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Immediate Past President, International Marcé Society for Perinatal Mental Health, Brentwood, Tennessee
Susan Hatters Friedman, M.D., DFAPA
The Phillip Resnick Professor of Forensic Psychiatry, Professor of Reproductive Biology and Pediatrics, and Adjunct Professor of Law, Case Western Reserve University, Cleveland, Ohio; Honorary Associate Professor of Psychological Medicine, University of Auckland, Auckland, New Zealand
Nancy Shekarak Ghashghaei, M.C.
Graduate Centre for Applied Psychology, Athabasca University, Alberta; Master of Arts student in clinical psychology, York University, Ontario, Canada
Nicoletta Giacchetti, M.D., Ph.D.
Psychiatrist, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
Jonathan E. Handelzalts, Ph.D.
Clinical Psychologist, Senior Lecturer, Graduate Program in Clinical Psychology, School of Behavioral Sciences, The Academic College of Tel-Aviv Yaffo, Israel
Daniel Hoffman, B.A., B.A. (Psychology) (Hons), M.Sc. (Psychology), D.Phil.
Department of Psychiatry, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
Jane Honikman, M.S.
Postpartum Action Institute, Postpartum Support International, Portland, Oregon
Megan M. Julian, Ph.D.
Psychologist, Clinical Lecturer, Department of Psychiatry, Zero To Thrive, University of Michigan, Ann Arbor, Michigan
Amanda Kingston, M.D.
Forensic Psychiatrist, Assistant Professor of Clinical Psychiatry, Forensic Psychiatry Training Director, Department of Psychiatry, University of Missouri—Columbia School of Medicine, Columbia, Missouri
Maggie Kirkman, Ph.D., B.A. (Hons), MAPS
Academic Psychologist and Senior Research Fellow in Global and Women’s Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
Kirsten Kramar, Ph.D.
Instructor, Criminal Justice Program, Department of Economics, Justice and Policy Studies, Mount Royal University, Calgary, Alberta, Canada
Guido Maria Lattanzi, M.D.
Psychiatrist, Department of Human Neuroscience, Sapienza University of Rome, Rome Italy
Barry Michael Lewis, J.D.
Licensed Attorney, Law Office of Barry M. Lewis, Chicago, Illinois
Liliana Lorettu, M.D.
Assistant Professor, Department of Medical, Surgical and Experimental Sciences, University of Sassari–AOU Sassari, Sassari, Italy
Maria Muzik, M.D., M.S.
Psychiatrist, Associate Professor of Psychiatry, Obstetrics and Gynecology, and Director, Zero To Thrive and Women and Infant Mental Health Programs, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
George Parnham, J.D.
Criminal Defense Attorney, Parnham & Associates, Houston, Texas; licensed to practice in Texas and New York as well as federal courts; Board Certified in criminal law by the Texas Board of Legal Specialization, Co-Founder of the Yates Children Memorial Fund; Director Emeriti, Mental Health America of Greater Houston
Salmi Razali, M.D., M.Med. (Psychiatry), Ph.D.
Consultant Psychiatrist and Associate Professor in Psychiatry, Department of Psychological and Behavioural Medicine, Universiti Teknologi MARA, Selangor, Malaysia
Phillip Resnick, M.D.
Professor of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, Ohio
Daniel Riordan, MBBS, M.A., M.Sc., MRCPsych, FRANZCP, MInstGA
Consultant Forensic Psychiatrist, Psychotherapist, Group Analyst, Austinmer Women’s Unit, Forensic Hospital, Justice Health, New South Wales, Australia
Kimberly Rock, M.C.
Registered Provisional Psychologist, Saskatchewan, Canada
Tiffany Ross, M.S.S.W.
Postpartum Support International, Portland, Oregon
Jacqueline A. Short, M.B.Ch.B., B.A., FRCPsych, Affiliate RANZCP, Dip.For.Psychotherapy, Dip.Soc.Pol&Criminology
Clinical Director Forensic and Rehabilitation Service, 3DHB Mental Health, Addictions and Intellectual Disability Service; Honorary Clinical Senior Lecturer, University of Otago, Dunedin, New Zealand
Ugasvaree Subramaney, M.B.B.Ch., FCPsych(SA), M.Med. (Psychiatry), B.Sc. (Psychology) (Hons), Ph.D.
Adjunct Professor, Department of Psychiatry, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
Gina Wong, Ph.D.
Psychologist, Professor, and Program Director, Graduate Centre for Applied Psychology, Athabasca University; Director, Centre for Perinatal Psychology and Forensics International, Alberta, Canada
Introduction
All human life on the planet is born of woman. The one unifying, incontrovertible experience shared by all women and men is that months-long period we spent unfolding inside a woman’s body. Because...women not only bear and suckle but are assigned almost total responsibility for children, most of us first know both love and disappointment, power and tenderness, in the person of a woman.Adrienne Rich 1976, p. xi
American poet and feminist author Adrienne Rich considered all essence of human life to emerge from woman. Indeed, a mother is the root of all life, and when she ends the life of a child she bore, it breaks a cardinal rule and violates the natural course of life. Maternal mental health forensics is at the intersection of maternal mental illness and the criminal justice system, wherein a woman comes into contact with the legal system after an alleged criminal act for which perinatal or maternal mental illness may have been a catalyst. Before determining guilt or innocence, courts assess for criminal responsibility in the event that an insanity plea is warranted. A defendant is also assessed for competency to stand trial if the defense attorney thinks the client lacks the ability to understand the charges against her and is unable to assist in her own defense.
Maternal mental health forensics is heavily impacted by the existence or nonexistence and application of infanticide or postpartum mental health laws, as well as the legitimacy given to diagnosis of perinatal mental disturbances. Given that representation of women in their childbearing years in our correctional system has been rising exponentially (Hatters Friedman et al., in press), it stands to reason that maternal mental health forensics is an essential area of focus. This specialty has been in its infancy relative to the field as a distinct discipline of study. However, reproductive and perinatal forensic psychologists and psychiatrists have been involved for decades in the pursuit of justice for legal wrongdoings perpetrated by mothers in the perinatal and postpartum period.
The field of maternal mental health forensics comprises theories and standards of practice that are benchmarks in the legal jurisdiction where criminal justice is practiced. This often includes medical standards of diagnosis, such as DSM-5 (American Psychiatric Association 2013) and the International Statistical Classification of Diseases and Related Health Problems, 11th Revision (ICD-11; World Health Organization 2019), laws at the federal level, standards of the insanity defense, case law, existing and current knowledge bases (including research in woman’s reproductive mental health and maternal mental well-being), and cultural mores as well as necessary analysis of the influence of social, gender, and race inequities and biases.
Maternal mental health forensics is advanced by professionals who work within the legal system in the area of maternal mental health or mental health in general. Experts may be psychologists, counselors, and social workers; medical professionals, such as psychiatrists, medical doctors, and obstetrician/gynecologists; or lawyers and judges (criminal experts). Professionals may be those defending, prosecuting, or assisting; assessing level of criminal responsibility or fitness to stand trial; providing expert opinions and testimony; or monitoring and treating mothers who have perpetrated filicide. It is for these professionals, and associated professions, that this book is intended.
This book provides key considerations in the successful criminal defense of mothers who commit neonaticide, infanticide, and filicide. This collection is firmly rooted in research and amplified by real case examples from more than 30 experts in the field, representing eight countries. It offers practical information and serves as an educational and training resource. Infanticide and Filicide: Foundations in Maternal Mental Health Forensics is an accessible read for a broad range of audiences involved in their first maternal filicide case, involved in multiple cases, or generally interested in this field. In addition, practitioners, scholars, researchers, and academics in related professions dedicated to understanding risk factors, profiles, behavioral patterns, and effective strategies to prevent maternal filicide will also appreciate this collection.
Readers already may have a wealth of education and training in perinatal mental health or may have little to no such training; they may possess specialized training in the criminal justice system or be new to understanding this area. Perinatal forensic psychiatrists and psychologists are well poised at the intersection of the two fields and optimally trained in the field of maternal mental health forensics; however, the pursuit of justice for offenses committed by mothers in the perinatal and postpartum phases involves expert witnesses with a variety of professional training backgrounds. Given the breadth of professionals who may be involved and the women’s lives that hang in the balance within the criminal justice system, we in the field of maternal mental health forensics must establish chief foundations and converge upon definitions of terms and concepts; advance main clinical, legal, and cultural perspectives; and incite necessary dialogue as we move toward establishing this specialized area of forensics. Presenting the foundations of maternal mental health forensics, culminating in didactic application, is integral to this endeavor.
Filicide Terms
Historically, maternal infanticide has occurred since 4000 B.C.–2000 B.C., as documented by Babylonian and Chaldean civilizations (Meyer and Oberman 2001). It was not specific to any culture and occurred for various reasons (Putkonen et al. 2016). The killing of offspring by parents is a most intriguing and reprehensible crime; however, despite more recent focused research, its complexity continues to elude many, and it has not decreased in incidence. Adding to the challenge is that filicide terms are used interchangeably to describe the perpetration of child death by a parent, stepparent, or legal guardian. The terms infanticide, neonaticide, and filicide generally are distinguished by the age of the child whose life is taken by a parental figure. Infanticide commonly refers to the killing by a parent of an infant older than 1 day and younger than 1 year. Neonaticide, a concept introduced by Philip Resnick in 1969, involves the killing of a newborn within 24 hours of birth and is almost always perpetrated by a young biological mother (McKee and Bramante 2010; Meyer and Oberman 2001; Resnick 1969). Filicide is a complex and multifaceted term used in multiple ways in the scholarly literature. For example, some authors define filicide as taking the life of one’s child who is between 1 and 18 years of age (West 2007). It is also used as an overarching term delineating the killing of a child at any age by a parental figure. In this book, we refer to filicide both generally, as an overarching term encompassing neonaticide and infanticide, and specifically, as the killing of one’s offspring who is older than 12 months and younger than 18 years by a parental figure, namely the biological mother or father.
Prevalence of Filicide and Rate of Psychosis
The United States has the highest rate of child murder among developed nations (Resnick 2016), estimated to be 8 per 100,000 live births, which is comparatively higher than the 2.9 per 100,000 births in Canada (Hatters Friedman et al. 2005; Resnick 2016; Tang and Siu 2018). The most common perpetrators of filicide are parents; 15% of child homicides in the United States are perpetrated by parents (Mariano et al. 2014), the highest rate among industrialized nations (Hatters Friedman et al. 2005; Resnick 2016). An estimated average of 500 filicide arrests are made per year in the United States (Resnick 2016). Although the United States reportedly has the highest rate of filicide, it endorses the harshest criminal rulings. It was not until June 2018 that any of the 50 states passed infanticide legislation.
The prevalence of filicide is difficult to truly represent given the different reporting structures, inconsistent methods of data collection for child homicide among various countries, categorization of deaths (West 2007), and reality of underreporting (Koenen and Thompson 2008). Infant deaths may also go undetected or be misattributed to sudden infant death syndrome (Spinelli 2004). Child homicide is tragic at any occurrence, and the perpetration of filicide as a result of the mother’s mental illness is in its own category of devastation.
Perinatal psychiatrists estimate that women are 25 times more likely to experience psychosis in the postpartum period than in any other period in their life (Marks 1996). In the first 4 weeks postpartum, women experience first-onset psychosis at a rate 23 times higher than any other period life (Bergink et al. 2016). Furthermore, in a systematic review, VanderKruik et al. (2017) confirmed the incidence rate of postpartum psychosis (PPP) to be consistent with the often-cited 1–2 in 1,000 births in the general population. Five studies reported a range from 0.89 to 2.6 in 1,000 women, and one reported a higher prevalence of 5 in 1,000 women (Vesga-López et al. 2008). The World Health Organization (2020) declared that psychosis in a mother following the birth of a child may lead to suicide or maternal filicide.
DSM-5 links postpartum psychotic episodes (with command hallucinations or severe postpartum mood episodes) with infanticide and describes postpartum psychotic episodes as occurring in relation to bipolar disorder and postpartum depression. In fact, Hatters Friedman et al. (2019), among many perinatal mental health experts, identified a previous PPP diagnosis and a history of bipolar disorder as strong indicators of future PPP diagnosis, with as much as a 50%–80% chance of a subsequent psychiatric episode. McKee and Bramante (2010) indicated that 4% of mothers with PPP may go on to commit maternal infanticide.
Although DSM-5 links psychosis in the postpartum period with infanticide, it has no formal diagnostic category for PPP. Rather, the word “postpartum” is used as a specifier that can be attached to a diagnosis if it occurs in the first 4 weeks after birth (6 weeks postpartum in ICD-11; World Health Organization 2019). However, according to researchers, the classic symptoms of puerperal psychosis are evidenced as markedly distinct from the presentation of psychosis unrelated to childbirth (Wisner et al. 1994, 2003).
Regarding the diagnostic classifications of PPP, Margaret Spinelli, a prominent forensic perinatal expert witness and a clinical professor of psychiatry at Columbia University College of Physicians and Surgeons in New York, is leading the charge to advance recognition of PPP in the formal DSM diagnostic nomenclature. What was categorized as “postpartum onset” in relation to other classifications of psychosis in DSM-5 requires upgrading to recognize PPP as a distinct classification with its own diagnostic criteria, including psychotic symptoms, mood instability, and cognitive disorganization, in the next edition of DSM.
At present, the DSM committee agreed that present specifiers were insufficient; however, they indicated they would place PPP in Section III requesting further research (personal communication, August 16, 2020). In response, Spinelli implored reconsideration. The following was her response:
Dear DSM Committee Members,I am making this appeal for diagnostic inclusion of PPP in the DSM because this is psychiatry’s opportunity to save lives and help families. In view of the facts that:•Postpartum psychosis is the only psychiatric disorder associated with homicide (infanticide).•The highest rate of suicide by women is in the first year postpartum using self-incineration, firearms or jumping (methods often used in psychosis).•Many women are incarcerated for life because they were innocently afflicted with a mental illness that caused them to kill their infants.•The diagnosis is minimized in the courtroom where it could save the lives of women and their families. (i.e. Prosecutor says, “Dr. Spinelli, isn’t it correct that PPP is not a diagnosis in the DSM?”)•Because of the rarity of this illness (1–2/1000) it will take many years to collect data and provide the research that you request. We do not have mother–baby units like Europe where these women accumulate. That is why the research is limited. Should we wait another 10 or 15 years to assist these mothers?In my 24 years evaluating women who have killed babies, not one was diagnosed or treated properly. The floridly psychotic Andrea Yates was misdiagnosed and discharged from 2 hospitalizations before she killed 5 children. A few days before she killed them she was taken off her antipsychotic because her catatonia was diagnosed as “akinesia.” This humble and good woman was a victim of this illness and must live out her life in a psychiatric facility with the fact that she killed them. She lives through every birthday reminded that they would be in college.Postpartum psychosis was included in the DSM-2 and expunged in DSM-3 because it was incorrectly determined that it was the same as nonchildbearing psychoses. The decision to remove the diagnosis was not obtained through cognitive tests...It seems that it was a whim of a group of American psychiatrists.I have been a researcher and clinician for more than 25 years....If a new diagnostic heading can support these criteria for acceptance, I implore those of you who undermine the importance of this diagnosis to see beyond, to accept my suggestion and protect these women and babies and save lives.
Adverse Childhood Experiences and Later-Life Psychopathology
In recent decades, research underscoring the impact of childhood adversity on adult psychological and physical health has advanced significantly (Hughes et al. 2016). In their study (N = 9,508), Felliti et al. (1998) identified adverse childhood experiences (ACEs), namely abuse and household dysfunction, as having a dose-response relationship: a greater number of childhood adversities amounted to a greater risk of later-life psychopathology. Classically, the ACEs questionnaire identifies 10 childhood adverse experiences in three categories of abuse, neglect, and household dysfunction. Rates of victimization and perpetration of violence in adulthood (Centers for Disease Control and Prevention 2019) also escalate as ACEs scores increase, as does the propensity to engage in high-risk behaviors related to earlier death. Varese et al. (2012) found that childhood maltreatment such as “sexual abuse, physical abuse, emotional/psychological abuse and neglect, and experiences of parental loss and separation are risk factors for psychosis and schizophrenia” (p. 661). The possibility of being diagnosed with psychosis is decreased by 33% in persons who have not experienced any childhood traumas.
Individuals with an ACEs score ≥ 4, compared with those who have no ACEs, have a 4- to 12-fold risk of drug and alcohol dependency, depression, and suicidality (Felitti et al. 1998), and a score of ≥ 4 has been linked to a 10-fold increase in schizophrenia (Chase et al. 2019). Neurodevelopmental disruptions associated with the pathogenesis of mental disorders (Read et al. 2014) are also prevalent in those who have higher scores. Specific types of ACEs occurring at discrete neurocognitive development periods (e.g., age 3 and adolescence) inhibit brain development via the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system outflow involved in the stress-brain response (Chase et al. 2019; Read et al. 2014; Ruby et al. 2014; Schalinski et al. 2018).
The traumagenic neurodevelopmental model of psychosis (see Read et al. 2014) suggests a graded relationship between the number of ACEs and later-life psychosis. In addition, higher numbers of ACEs have an enduring effect. One generation of specific childhood adversities impacts well-being in future generations because ACEs impede parental capacity to foster optimum environments for their offspring (Hughes et al. 2016; Read and Bentall 2012).
Currently, research directly linking ACEs to PPP has been amassed yet remains controversial in the psychiatric community. One study in the United Kingdom involving 208 mothers with previous PPP did not associate it with high ACEs scores (Perry et al. 2016). One of the largest population-based cohort studies to date confirmed a dose-response relationship between ACEs and development of postpartum psychiatric episodes (Meltzer-Brody et al. 2018) but did not find this to be true for the development of PPP. Researchers were limited in differentiating the specific types of postpartum psychiatric episodes, namely PPP, given the low prevalence rate. In this study (Meltzer-Brody et al. 2018), childhood physical and sexual abuse—identified as strong risk factors for psychosis and schizophrenia in adulthood (Varese et al. 2012)—were not among the eight ACEs assessed. Such research variables may have skewed the findings of association between ACEs and PPP.
In addition, the study by Meltzer-Brody et al. (2018) did not account for attachment-related childhood traumas, identified by Barone et al. (2014) as pervasive among filicidal women. In their European study of 121 women (normative group n = 61; maternal mental illness group n = 37; and filicide group n = 23), they found that early traumatic experiences, low socioeconomic status, and mental illness did not increase relative risk to filicide, but that attachment styles were significant. That is, although ACEs absent of attachment traumas did not yield significant difference between the filicide and maternal mental illness groups, a hostile-hopeless attachment pattern involving unresolved traumatic attachment experiences differentiated the filicide group from the others. As such, attachment variables must be further investigated and considered for their role in the collection of risk factors linking ACEs to PPP and maternal filicide.
Impetus for This Book
This book pays homage to George Parnham, J.D., and honors the legacy of his work—fighting for, giving voice to, and supporting mothers who take the lives of their children whilst in the throes of maternal mental illness. Outstanding in his profession, with 50 years of legal practice, George is honored in this book for his contribution, service, and social justice advocacy on behalf of mothers who are thrust into the criminal justice system as a result of taking the lives of their children, when these mothers are as much a victim to their mental disturbance as their children. George is heralded and revered for his courage and the impact he has made on the lives of so many. The role of mental illness in maternal filicide was less understood before the Andrea Yates case in 2001, which George successfully defended. From public disdain for Andrea after she drowned her five children to mobilized understanding of the impact of maternal mental illness, namely PPP, the world caught a glimpse of the life of a mentally ill mother, and many cultivated compassion for her, the likes of which had not been experienced before. Given this, our book is also a tribute to Andrea Yates.
George Parnham: A Man of Scruples
I feel you whisperingacross my heart todayreminding me thatyou’re still thereholding my fractured pieceslovingly in your little hands.
My (G. P.) life as a criminal lawyer, a defender of the underdog, had its genesis and evolution in my seminary experiences. My folks were strongly bonded by a deep love for each other and for their children. They enrolled me in parochial school when I was young, which was where I quickly gravitated to Catholicism and the priesthood. On Sundays, I would pretend to be a priest, setting up an altar in my room and, with prayer book in hand, saying Mass.
At the ripe age of 13, I said goodbye to my parents and joined the seminary. There, we had no contact from regular civilization and were self-sufficient. Located far in the Alabama Piney Woods, we grew our own crops and built much of the infrastructure with our bare hands. We enjoyed a beautiful baseball field and basketball gym, but, above all, I rejoiced in the chapel, where a large percentage of each day was spent in prayer. One day, after 7 years, I was stunned and bewildered when Father Doyle told me I was to leave the seminary because of my extreme scrupulosity. My mentors saw my rigidity to the church and believed that my fear of doing wrong in the eyes of God would thwart me from becoming the man I could be. The next day, the priests, chaplain, and my fellow seminarians lined up in a tearful goodbye, and I was set out into the real world. It was only in later years that I could understand and appreciate why I was asked to leave.
Over time, my scrupulosity to religious scriptures subsided. Nevertheless, as a criminal defense lawyer, I became scrupulous in my dedication to and pursuit of defending those accused of some of the most heinous crimes. Although the road from extreme religious scrupulosity to defending murderers is seemingly unbidden and inconceivable, it was most fortuitous and natural for me. I had been denied the priesthood due to my overzealous adherence to rules, but my calling to attend to those who might feel lost and in pain remained strong. Certainly, they could be viewed as allegedly doing wrong in the eyes of God, and defending them was—and is—my priesthood. My involvement in the legal defense of mothers who take the lives of their children has been the most challenging among all the cases in my many years of practice. However, bringing about education and awareness, and a changing attitude for the better, in the area of maternal mental health has been one of the most rewarding aspects of my career.
Gina Wong: Forging Ahead
Memories saturate my heart and the story of you spills from my eyes.Andren 2018, p. 11
In 2003, as a young psychologist and early academic, I (G. W.) continued seeing perinatal and postpartum women in clinical practice. I trained with Postpartum Support International (PSI) to diagnose and treat women experiencing perinatal mood and anxiety disorders. My publications in motherhood scholarship focused on deconstructing the damaging cultural ideologies and institutions that regulate mothers’ lives. Many women struggle with mental illness and personalize issues to themselves, remaining silent and internalizing societal madness rather than locating it in the systems, cultural beliefs and practices, institutions, and ideologies of mothers within our society.
My foray into the role of perinatal expert witness in maternal filicide cases in Canada began in 2017 when I was called to a case in which a young mother had stabbed her three children and herself. As a psychologist who specialized in maternal mental health, assessing and working with mothers was in concert with my training; however, I languished in my knowledge of the legal ramifications of maternal filicide and my understanding of criminal processes involved in court cases. As a fledgling expert witness in Canada, I recognized a dearth of understanding surrounding maternal filicide and of dialogue, training, and community resources. I sought to highlight wisdom gleaned from the veteran experts in the field with whom I met in my quest to successfully fulfill the role. I felt profound meaning in this work, and the impetus to bring together a collection that would serve as a training resource was born.
Wendy Davis, executive director of PSI, connected me with veterans in the field, specifically Diana Barnes, who became my greatest mentor and has met with me over the years and provided insight and guidance as well as friendship. I also spoke often with Margaret Spinelli, who graciously gave her time. I consulted with George Parnham regarding legal understanding of maternal filicide cases. He mentored me and unequivocally offered his expertise. George and I delivered key conference presentations together that inspired our recognition that a book in the field of maternal mental health forensics was urgently needed.
Available Resources
Several publications about mental health and the criminal justice system are available. Notably, Experts in Court: Reconciling Law, Science, and Professional Knowledge by Sales and Shuman (2005) examines the use of expert testimony across the legal system, including the pitfalls and the possible perception of mental health expert testimony as nonobjective. The Psychiatrist as Expert Witness, edited by Gutheil (2009), is another well-used resource in psychiatry training programs. Likewise, Psychological Evaluation for the Courts: A Handbook for Mental Health Professionals and Lawyers by Melton et al. (2018) is a compendium that guides readers through many contradictory perspectives in translating clinical expertise for applicability within criminal justice. Although these books inform expert witnesses, they do not focus explicitly on maternal mental health experts in maternal filicide court cases. Books such as Models of Madness: Psychological, Social and Biological Approaches to Psychosis, edited by Read and Dillon (2013), and Psychosis, Trauma and Dissociation: Emerging Perspectives on Severe Psychopathology, edited by Moskowitz et al. (2008), address childhood adversity and trauma. However, few books specifically address trauma and attachment as they relate to perinatal mood and anxiety disorders—and more specifically PPP—in infanticide and filicide cases. This is a gap that our book begins to fill, with several chapters elucidating these perspectives.
The most resounding publication our book aims to complement is Infanticide: Psychosocial and Legal Perspectives on Mothers Who Kill, edited by Spinelli (2003). It is the most authoritative resource examining the legal, medical, and psychosocial aspects of mothers who take the lives of their infants. A chapter by Macfarlane describes criminal defense theories of diminished capacity, involuntary acts, and insanity pleas in relation to infanticide, filicide, and neonaticide (Spinelli 2003). The book addresses criminal defense in infanticide and neonaticide and the medical, biological, and legal determinants of postpartum psychiatric disorders and offers discussion of treatment, prevention, and rehabilitation. Our book underscores and extends Spinelli’s ideas by including deeper discussion surrounding ACEs and trauma related to perinatal mental health outcomes. Spinelli’s book informs our understanding of filicide and the pivotal dimensions of a woman’s psychological state of mind that contribute to enacting filicide.
Dawn of New Hope
The timeliness of this book comes from a recognition that we are entering a new dawn in time, an era of hope in the United States and internationally for mothers and for postpartum mental illness–related filicide. Twenty years after the Andrea Yates tragedy, we continue addressing maternal mental illness and its intersection with criminal justice in ways far greater than before. We stand at the precipice of change that will have lasting impact, in which maternal mental health forensics is underscored as an essential subspecialty area.
The first revelation toward a new dawn of hope is the understanding that childhood adversity relates to adult psychopathology and greater risk for psychosis-related mental illness. Although some controversy exists regarding the association of ACEs with PPP, a convincing body of research is developing. Continued research examining attachment-related childhood trauma, specifically the hostile-hopeless attachment pattern characterized by unresolved attachment injuries, will further understanding of the types of childhood adversities that increase the risk of PPP and elevate the risk of filicide. Furthermore, research including childhood physical or sexual abuse as variables of ACEs, as well as research noting the impact of ACEs on developing parts of the brain at discrete developmental stages in childhood, is needed.
Such awareness will galvanize intervention efforts aimed to support families at risk by reducing specific types of child adversities at critical neurological brain development periods. Furthermore, a life course perspective (Hughes et al. 2016) applied to understanding maternal filicide is needed to advance our ability to see the evolution of postpartum mental illness relative to childhood (and intergenerational) experiences. A life course framework can elicit in-depth understanding of the intergenerational effects of childhood adversity and improve outcomes for future generations. The World Health Organization’s (2013) Comprehensive Mental Health Action Plan 2013–2020 underscores the need to focus on mental well-being as part of its overarching goal and advocates a life course approach empowering early intervention in adverse childhood circumstances.
The second major shift comes with the possible inclusion of PPP in the next edition of DSM, with Spinelli’s involvement advocating PPP as a distinct classification. Such a shift would provide legitimacy to a PPP diagnosis in the courtroom and could save the lives of countless women. The third indicator of change was the passage of a postpartum law in Illinois in 2018, which is a seismic shift in the United States regarding harsh laws for maternal filicide acts. In Chapter 3, the authors detail their successful advocacy work lobbying for the Illinois postpartum law to pass in the state senate. Feingold and Lewis (2020) wrote about how this postpartum law amends the Criminal Code of Corrections to consider postpartum depression and PPP as “mitigating factors” in sentencing when women commit offenses whilst gripped with postpartum mental illness. They also advanced HD 1736 in Massachusetts in 2019; however, it has not yet passed legislation.
Chapters in This Book
This collection brings together a cadre of esteemed professionals to advance the field of maternal mental health forensics in light of a new dawn of hope and to provide an educational and training resource with scholarly underpinnings. We approach maternal mental health forensics based on the four foundations upon which the book is structured. Case illustrations are offered throughout the book. Each chapter culminates with a didactic section wherein main clinical/legal and cultural points and practice and discussion questions for professionals are offered. In Chapters 16 and 17, two additional clinical presentations of maternal infanticide are provided that illustrate application of foundations and practical considerations. A glossary at the end of the book contains key terms and concepts discussed throughout the chapters.
The first part of the book, “Foundation I: Legal Aspects Surrounding Maternal Infanticide and Filicide,” begins with an anchoring chapter. I (G. P.) reflect upon the Andrea Yates case and my involvement as a criminal defense attorney in Chapter 1, “Honoring the Legacy of the Andrea Yates Case.” Chapter 2, “Becoming a Legal Expert in Infanticide and Filicide Cases in the United States,” delineates my work defending mothers whose mental illness has resulted in the commission of the filicidal act. Having been involved in nearly a dozen maternal filicide cases in my 50 years as a defense attorney, I draw on the need to legitimize maternal mental disorders in these cases and give shape to the necessary understanding for successful criminal defense of these mothers. Furthermore, the chapter explicitly speaks to the dire need for more compassionate laws in the United States.
In Chapter 3, “A Groundbreaking Illinois Postpartum Law Brings Hope for Change in the United States,” Susan Feingold, a licensed psychologist, and Barry Lewis, an attorney at law, who together published Advocating for Women With Postpartum Mental Illness: A Guide to Changing the Law and the National Climate (Feingold and Lewis 2020), discuss their involvement in passing the postpartum law PA 100-0574 in Illinois in 2018. PA 100-0574 is groundbreaking because it is the first postpartum criminal legislation in the United States, and Illinois is the first state to recognize the role of perinatal mental illness in maternal filicide. Overall, this chapter addresses legal considerations in maternal filicide in the United States and the need to continue this advocacy in all states.
In Chapter 4, “Delineating the Meaning of Disturbance of Mind in Canadian Infanticide Law,” Kirsten Kramar, a criminologist and sociolegal studies scholar in Canada and author of Unwilling Mothers, Unwanted Babies: Infanticide in Canada (Kramar 2005), describes the evolution of the Canadian Infanticide Law and offers an authoritative perspective on related and relevant legal issues. Kramar cites Canadian case law and summarizes what lawyers and perinatal expert witnesses need to know about its current application in the criminal justice system in Canada.
Chapter 5, “Fathers and Filicide: Mental Illness and Outcomes,” is authored by Susan Hatters Friedman, a renowned perinatal forensic psychiatrist in the United States who edited Family Murder: Pathologies of Love and Hate (2018). Her chapter here elucidates paternal filicide and highlights the gender disparities in legal outcomes for male perpetrators with mental illness. She also integrates research results identifying the profiles of men who commit filicide. Hatters Friedman invites discernment as well as recognition of the similarities between the genders when it comes to evaluation and criminal justice.
These chapters are followed by “Foundation II: The Impact of Perinatal Psychiatric Complications in Maternal Infanticide and Filicide.” In Chapter 6, “Role of Perinatal Psychiatric Complications in Infanticide and Filicide,” Kimberly Brandt, a perinatal psychiatrist, and Amanda Kingston, a forensic psychiatrist, both in the United States, relay the perinatal mental illnesses commonly identified in maternal infanticide and filicide and present three cases to illustrate best practices in forensic assessment and differentiate between potentially confusing mental illness presentation in mothers.
Chapter 7, “Altruistic Filicide: A Trauma Informed Perspective” is authored by Diana Barnes, an award-winning perinatal psychologist in the United States and the editor of Women’s Reproductive Mental Health Across the Lifespan (2014). Barnes examines the impact of childhood trauma on a mother’s sense of safety and protection for her own children, which may lead to altruistic filicide and a subsequent charge of murder. She advances a biopsychosocial perspective that is exemplified in clinical cases from her work as a perinatal expert witness. Barnes also co-authors Chapter 8, “Understanding the Mysteries of Pregnancy Denial,” with Anne Buist, a psychiatrist and professor of women’s health in Australia. They explore clinical presentations of neonaticide and the psychological underpinnings of pregnancy denial. Barnes’ examples from her case files, coupled with Buist’s 30-year understanding of neonaticide in Australia, amplify similarities and differences between the United States and Australia in cultural perspectives as well as legal outcomes of maternal filicide cases. Together, they examine sociocultural, medical, psychological, and psychiatric considerations to inform lawyers and expert witnesses relative to pregnancy denial and neonaticide.
“Foundation III: The Role of the Expert Witness in Maternal Infanticide and Filicide Cases,” begins with a chapter by Phillip Resnick, who is a renowned forensic psychiatrist and forefather in the field, with more than 50 years of expertise progressing the field of filicide. Resnick poignantly articulates his foray into the role of an expert witness in the Andrea Yates case in Chapter 9, “Reflections of an Expert Witness in the Andrea Yates Case.” He reveals his strategy, thoughts, and opinions for both trials, which occurred in 2002 and 2006. He presents and expounds upon his early writings on the topic of filicide, particularly outlining the five typologies of apparent motives behind why mothers kill their children (Resnick 1969, 1970, 2016).
This is followed by Chapter 10, “Becoming an Expert Witness in Maternal Filicide Cases,” wherein Canadian researcher Kathryn Bell and I (G. W.) present a research study funded through the Social Sciences and Humanities Council of Canada. We elucidate our research involving six novice and four veteran expert witnesses, each of whom were involved in at least 1 or as many as 60 maternal filicide cases in the United States or Canada. Three domains of competencies are identified as essential to the role of the expert witness. We reveal how experts gained these competencies, their initiation to their first case, necessary supports to this role, and the meaning derived from working as expert witnesses. This research will inform the development of competency-based curriculum for becoming a maternal mental health expert witness and may support guidelines developed to establish the high level of professional competence this role necessitates.
Chapter 11, “Writing the Maternal Filicide Report: Pearls of Wisdom for Expert Witnesses” offers practical considerations grounded in scholarship. Susan Hatters Friedman, along with Daniel Riordan, a forensic psychiatrist in New South Wales, Australia, and Jacqueline Short, a forensic psychiatrist in New Zealand, share their wisdom about the essentials for a forensic mental health professional who is inexperienced in filicide cases or a maternal mental health professional who is first venturing into the forensic arena. They present guidelines for conducting expert witness assessments and clinical interviews and provide excerpts redacted from real reports to illustrate key points.
The fourth part of the book, “Foundation IV: Sociocultural Considerations and Feminist Approaches to Prevention and Treatment,” begins with Chapter 12, “Maternal Filicide in Canadian News: A Decade in Review.” Canadian researchers Kimberly Rock, Amy Corkett, Nancy Shekarak Ghashghaei, and I (G. W.) delineate an ethnographic content analysis of 95 electronic news articles from the Toronto Star, Globe and Mail, and National Post encompassing a 10-year period between January 1, 2008 and April 26, 2018. We consider how Canadian media representations of mothers who kill their children impact, and are informed by, social and legal perspectives of the crime. We reveal what journalists most often report and focus on when writing about maternal filicide in Canadian news.
Chapter 13, “Trauma and Attachment: Preventing Maternal Filicide Through the Generations,” explores childhood trauma and attachment and how such foci contribute to maternal filicide prevention through understanding intergenerational patterns. Authors Nora Erickson and Megan Julian, clinical psychologists in the United States; Jonathan Handelzalts, a clinical psychologist in Israel; myself (G. W.), a psychologist and professor in Canada; and Maria Muzik, a psychiatrist and associate professor in the United States, write about the significance of secure-base attachment relationships in early life and childhood traumas that, when supported and processed effectively, safeguard against mental illness in adulthood. Fundamentally, we show the necessity of fortifying supportive caregiver relationships in childhood as fundamental to prevention of maternal filicide.
In Chapter 14, “Maternal Filicide in Malaysia: Structural Inequality and Cultural Disparity,” Salmi Razali, a psychiatrist and academic in Malaysia, and Jane Fisher and Maggie Kirkman, who are both psychologists and academics in Australia, share their pioneering research. They present secondary analysis of national data and qualitative interviews with women incarcerated for infanticide or filicide in Malaysia, as well as interviews with associated professionals in that country. They identify that Malay women are often punished for filicidal crimes for which they were not solely or, in some cases, at all responsible. In describing their results, they examine maternal filicide through the lenses of social contexts, structural and gender inequities, and human rights and present narratives of three mothers convicted of filicide in Malaysia.
Foundation IV concludes with Chapter 15, “Postpartum Support International: A Leading Resource Center for Maternal Filicide in the United States,” in which Jane Honikman, founder of Postpartum Support International (PSI); Tiffany Ross, social worker; and Wendy Davis, PSI executive director and psychologist, bring to light the evolution of one of the world’s largest nonprofit organization, which since 1987 has been dedicated to helping women and families experiencing perinatal mental health disorders. PSI has been advocating for greater understanding and compassion for maternal filicide across the globe. The PSI Justice and Advocacy Program offers recorded training materials and a Checklist for Attorneys and is developing further resources for maternal mental health specialists and legal experts involved in these cases.
my voice was silentbut my tears spoke eloquentlyeach quiet drop a story of you.Andren 2018, p. 23
The final part of the book, “Clinical Cases: Application of Foundations and Practical Considerations,” narrates the maternal filicide case of Greta in Chapter 16, “The Dark Side of Mother: A Clinical Case in Italy,” authored by Nicoletta Giacchetti, psychiatrist; Liliana Lorettu, assistant professor; Guido Maria Lattanzi, psychiatrist; and Franca Aceti, assistant professor, all from Rome, Italy. They share the results of their clinical interview and assessments, including evaluations of Greta’s early attachment and childhood traumas. Chapter 17, “Falling Between the Cracks of Medical Care: A Case of Maternal Infanticide in South Africa,” by Ugasvaree Subramaney, psychiatrist, and Daniel Hoffman, clinical psychologist, both from Johannesburg, South Africa, describes the case of MM, a young woman who presented to a psychiatric facility following a charge of first-degree murder. MM had committed infanticide and was assessed to be under the influence of a mood disorder and PPP at the time. The insanity defense was applied, and MM received psychiatric care, treatment, and rehabilitation under a section of the Mental Health Care Act. Both of these cases demonstrate compassion in countries where psychiatric treatment for mentally ill mothers is prioritized over punitive action and imprisonment.
Future Directions
Although this book covers key foundations in maternal mental health forensics specifically addressing maternal infanticide and filicide, a call for further exploration of the topic is warranted. For instance, we advance discussions about ACEs, the neurobiology of trauma, and the importance of childhood attachments; however, the neurohormonal and biological bases of PPP, for example, are essential topics that should not be overlooked. Amplifying discussions of feminist and race deconstruction is the significant work of Razali, Fisher, and Kirkman (Chapter 14), who call attention to the structural inequities and cultural disparities in Malaysia. They delineate how gender inequality and rigid cultural and religious mores confine girls and women. Such oppression is essential to recognize in all parts of the world because it relates to the ways in which women’s lives are regulated. It is also critical not only to highlight how such oppression contributes to the psychological sequelae of a mother who enacts filicide but also to analyze how it contributes to inequities within criminal justice processes and decisions. Hatters Friedman lays groundwork in Chapter 5 for continued dialogue in this area. She underscores that the gender, race, and socioeconomic status of parents may unduly influence societal perspectives and court rulings of filicide. The need to focus on gender, cultural, and racial disparities in the area of maternal mental health forensics is imperative. In addition, it is crucial to examine the role of visible and invisible disabilities and limitations a mother may face concomitant to a perinatal psychiatric disturbance, when considering equity issues.
Finally, further expanding on this collection, the need for a trauma-informed framework and attachment-minded perspective in examining maternal mental illness within the criminal justice system is fundamental. As previously stated, research examining ACEs from a life-course perspective (Hughes et al. 2016) in maternal mental health and criminality is crucial to advance the field.
No Longer It “Depends”
Determining the criminal responsibility and the guilt or innocence of a woman who commits maternal infanticide or filicide depends. It depends because of the wide range of opinions, levels of understanding, and inconsistent practices. It behooves us to highlight and converge on foundations in maternal mental health forensics in filicide cases. Women’s and their families’ lives hang in the balance of, or are altered as a result of, conditions for which little variability should exist. Too often the outcome of a mother’s life
•
Depends on the country, region, or state relative to whether infanticide or postpartum laws exist and how they are applied;
•
Depends on the definition and cultural understanding of maternal filicide;
•
Depends on systemic, gender, ethnicity, and race issues;
•
Depends on the lawyers, defense teams, prosecutors, juries, expert witnesses, and judges involved, who are variable in their knowledge and insight into maternal filicide;
•
Depends on how many other cases have been tried around the same time, their outcome, and public perception of those cases;
•
Depends on societal compassion and a woman’s understanding of the crime and her culpability related to maternal mental health; and
•
Depends on her access to resources (e.g., criminal lawyer).
Keeping in mind that there will always be inconsistencies, it is prudent to mitigate what is within our control. Understanding, educating, recognizing commonalities; continuing to develop foundations of maternal mental health forensics along with standards, benchmarks, protocols, and assessments; and continually updating information based on evidence-based research are essential. Our book is a step in this direction.
An Invitation to Forge Ahead Together
We invite our readers into a mindset to “forge ahead together.” Such a framework underscores the need, despite inconsistencies, to move forward together in unity. Spinelli (2004) initiated this intent, stating the need for enhanced knowledge exchange between maternal mental health specialists and legal experts regarding mental illness in mothers that may lead to noxious acts such as filicide. Whether prosecution or defense, understanding maternal or paternal filicide and the multiple motivations, potential psychiatric underpinnings, and legal outcomes is essential to forge ahead together despite differences in opinions, theories, and conceptualizations. Maternal filicide may be an outcome not only of untreated perinatal mental illness but also of treated (albeit poorly) mental illness, as evidenced by many of the clinical cases presented in this volume. Maternal filicide is also a tragic symptom of systemic issues. Forging ahead together involves examining the ways that culture may impinge upon women and maternal well-being. In doing so, this book serves as a necessary step toward canonizing the field of maternal mental health forensics and toward continued understanding. As we reduce the circumstances for it depends, we do so entering this new dawn in time in which the field of maternal mental health forensics brings together essential knowledge and understanding to address, advance, and advocate on behalf of mothers, their children, their families, and the generations to come.
Oh, to be freelike the wildflowerto bask in surrenderunder the wide openforgiving skyAndren 2018, p. 170
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Infanticide and Filicide: Foundations in Maternal Mental Health Forensics
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Published in print: 9 December 2020
Published online: 5 December 2024
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