Maternal infanticide associated with mental illness: prevention and the promise of saved lives.
OBJECTIVE
Although maternal infanticide is a rare event, a high proportion of cases occurs in the context of postpartum mental illness. The author reviews historical, legislative, and contemporary psychiatric perspectives on infanticide and discusses ways in which the psychiatric community can improve prevention of infanticide and promote appropriate treatment of mentally ill women who commit infanticide.


METHODS
The case of Texas v. Andrea Yates, involving a mother with mental illness who drowned her five children, is used to illustrate society's complicated reactions to infanticide in the context of postpartum mental illness.


RESULTS
In the United States, the complexity of the response to infanticide is demonstrated by the judicial system's reaction to such cases. Whereas England's Infanticide Law provides probation and mandates psychiatric treatment for mothers with mental illness who commit infanticide, "killer mothers" may face the death penalty in the United States. Contemporary neuroscientific findings support the position that a woman with postpartum psychosis who commits infanticide needs treatment rather than punishment and that appropriate treatment will deter her from killing again. Psychiatrists have a vital role in recognizing the signs and symptoms of peripartum psychiatric disorders, particularly postpartum psychosis, and in early identification of and intervention with at-risk mothers.


CONCLUSIONS
The absence of formal DSM-IV diagnostic criteria for postpartum psychiatric disorders promotes disparate treatment under the law. The psychiatric community should develop guidelines for the treatment of postpartum disorders, foster sharing of knowledge between psychiatry and the law, and do more to enlighten society about the effects of mental illness on thought and behavior so that decisions about the treatment and punishment of mentally ill persons will not be left exclusively in the hands of the judicial system.
Spinelli
Margaret G
MG
College of Physicians and Surgeons of Columbia University, New York State Psychiatric Institute, 1051 Riverside Dr., Unit 123, New York, NY 10032, USA. mgs8@columbia.edu
D000367:Age Factors; D002203:Capital Punishment / Q000331:legislation & jurisprudence; D002648:Child; D002649:Child Abuse / Q000331:legislation & jurisprudence; D016241:Child of Impaired Parents; D002675:Child, Preschool; D019052:Depression, Postpartum / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology*; D004739:England / Q000453:epidemiology; D005260:Female; D005555:Forensic Psychiatry / Q000331:legislation & jurisprudence; D049672:History, 19th Century; D049673:History, 20th Century; D049674:History, 21st Century; D049690:History, Ancient; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007237:Infanticide / Q000266:history / Q000331:legislation & jurisprudence / Q000517:prevention & control*; D007298:Insanity Defense; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology*; D009035:Mothers / Q000523:psychology* / Q000706:statistics & numerical data; D011644:Puerperal Disorders / Q000453:epidemiology / Q000266:history / Q000523:psychology*; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data; D013781:Texas / Q000453:epidemiology; D014481:United States / Q000453:epidemiology