The Psyche of Women Committing Neonaticide A Psychological Study of Women who kili their Newborn Children
K.J. de Wijs-HeijIaerts,A.J. Verheugt, T.I. Oei
Introduction
Neonaticide is the biological mother talcingthe life of the newborn child within 24 hours of its birth. Severaltimes a year in the Netherlands there is an uproar in societywhen the dead body of a newbom baby is found, wrapped up in a plastic bag, rolled in a towel, sometimes complete with umbilical cord and afterbirth, found under shrubbery, in a park or street, or in a house, in the attic, a bedroom or the basement. 1fthe biologicalmother is found, she may sometimes say that she kept the pregnancy a secret from her environment, that she gave birth alone and that she suhsequently took the life of the child, either passively or actively.Very frequently her environment was unaware of the biologicalmot}ier’spregnancy, or of the baby’s existence. In this day and age, when contraceptives and abortion are available,such a crime provokesnot onlyrevulsion and indignation in society,but it also calls forth incomprehension and raises many questions. There are questions about the personality of the culprit, her background, her environment, a possible motive and whether these kind of cases can be prevented. In this chapter we willtry to find answers to three essential questions: i What is the personahty of the person committing neonaticid& 2 What induced her to commit neonaticide
3. What can be done to prevent neonaticide?
In order to find these answers in this chapter the most important findings in available scientific psychological and psychiatnc hteratuie on neonaticide are outlined Then the resuits of this study are reviewed and recommendations for further research presented.
Review of literature
In order to present a picture of available hterature on neonaticide we searched three databases namely Psycinfo PubMed and Embase We used the foflowing keywords neonaticide mmdci or kiP oi homicide newhorn or baby/babies 01
435
Cronos
mythological
newborn
deformed
abandoned. whether
mean
extreme childrenE
earth
Short
Neonaticide
concealment
ments),
smoking),
other
care,
animal
concerned, Those with
cide
after
the
excluding
the
of
with
and
pregnancy,
not
of
only
the
articles which
neonate/infant,
PROGRESSION
A
the
newborn
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keywords
same
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psychopathology
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in
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or
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to
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dead
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employed mainly
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proved immediately
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ignorance
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England
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PSYCHIATRY
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available
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says:
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as
or
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This
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Infanticide
maximum
by
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compared
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who
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spirit
pregnancy
child it
dealing
their
‘The
manslaughter
guilty 287
These
(young)
conditions
was Act
was
These
takes
in
of
and,
brought
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of
of This
in
child
of
was
the
murder
as
for
was
mother mothers
and
discovery
older
from
to
bom,
six
countries
law
of 1922
the
child
sections
a
of
of
in
motherhood
her
with
become
Act
to
a
delivery,
Dutch
are
women
terminate
law
result
years’.
widely
when
maximum
pul
infant
20 289
(through
many
dealing
a
preceding
times,
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than
child’s
about
was
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the
of
in
has
sections
decision
who,
instead
women
years
or
who
and
respectively)
Penal
of
and
the
the
she
seem
through
widened
12
countries
Infanticide
temporarily
Section
not
(among
manslaughter,
criticised,
have
if
deliberately in
which
by
with
life
operating
hornicide
to
had
for
months,
contraceptives,
found
the
care
from
had
which
not,
women
been
and
of
the times,
of
Code
manslaughter,
who
290
to
changed
immediately
made
manslaugh
nine
not
neonaticide pregnancy
not
infanticide,
of
the
291
have
abortion)
there
as
effects
which
to
the
changed
guilty
also
there
and
kili
dealing
a
yet
because
is
yet
Act
balance
in years’.
or inciude
much
of under
insane third
in
(often while
takes
same
found
been
legal,
are
who fully
their
the
fully
291
the
on
the
was
be
is
of
of
are :1 THE PSYCHE OF WOMEN CQMMITTINC NEONATICIDE party (bymeans of adoption), it is true that killing newborns is less frequent than in the past, but has not (yet)ieR society altogether. The literature review’s resuits which follow relate to the woman committing neonaticide in our time.
The woman committing neonaticide in present times
Demographic chciracteristics Neonaticide is a crime that is almost exclusively committed by women and in which the perpetrator in practically all cases is the biological mother.’ Neonaticide committed hy the father is extremely rare. In the Netherlands”8 on average four dead bodies of newborn babies are discovered per 2year. Resnick to describe the phenomenon of neonaticide,° and he was one of the first descrihed, as the typical perpetrator of neonaticide, a generally young (sometimes even underage) woman, who is not in a steady relationship, still lives in the house of her parents, still goes to school, who does not ask for any prenatal assistance and who keeps the pregnancy concealed from her environment. In most cases the victim is the perpetrator’s first child. However, in recent years it neonaticide also occurs among married women who2 are already the emerged that mothers of a number of children. Both the single, young’ women and the 223 women who are in relationships and/or have already had children, generally commit one singular neonaticide, in which one baby is killed before they end up in the hands of justice. There are, however, also cases in which the woman once more becomes pregnant after the first neonaticide and acts in the same fashion as with her first neonaticide.24252 Perpetrators of27 neonaticide generally speaking have no judiciafy record252 and in those cases6 where they have been in trouble with the law, this6 concerns relatively minor offences and only in rare cases acts of violence. Compared to women who kill older children this category is younger, more frequently single, and suffers less from mental 23disorders.
As regards the pregviancy It is mostly stated of the pregnancy that it is unplanned and unwanted and concealed from the environment for the entire gravidity. When a third party inquires after the possibility of a pregnancy, this is actively denied.22930 A number of women claim not to have heen aware of the pregnancy, but in most cases they did know and the pregnancy was concealed from the outside world. In many cases the motive that is produced for the concealment of the pregnancy is the fear of discovery of the pregnancy, because — perhaps only in their own minds — this pregnancy would not be acceptable to their immediate environ 33ment. Both during the pregnancy and during the delivery no third party
439 PROGRESSION IN FORENSIC PSYCHIATRY
assistance of any kind is asked for. The delivery takes place in absolute isolation, but often in relative proximity to others, who may sometimes even be in the next room.2 6 After its birth the baby is killed, mostly fairly rapidly, but in any case within 24 hours, either actively or pas sively, and the death is caused by the mother’s inactivity rather than by her activity. When the child bas passed away the dead body is as it were laid aside and’3 in many cases wrapped in several layers (of clothing and/or plastic), and kept in the woman’s bedroom, or in an attic, in a basement or storage space. Afterwards no one is informed of the child’s birth (and demise) and everyday life is resumed as if nothing has happened. One striking aspect is that some women, when they move home, move the dead body with them into the new 31abode.2 In other cases the child is put with the garbage or abandoned post mortem8 in a nature reserve or 32elsewhere. And then they turn to the order of the day, as if the pregnancy never took place.
Denial and concealmentofpregnancy in a general sense Concealment and denial of the pregnancy is not something that is exclusively found in neonaticide. The literature concerning this subject consists, for the larger part, of descriptions of case studies and has only a few studies of large groups of women who have denied their pregnancies. Denial of pregnancy is mostly defined as “a woman’s subjective lack of awareness of being preg 3334nant”. A distinction is made between the denial of the pregnancy and its concealment, as in the latter case there is an awareness of the pregnancy (often already’ at an early moment in the pregnancy), but in which the woman telis no one about it and wants to keep the pregnancy hidden to the outside world at all costs. Beier et al. suggest in this case to use the term ‘negated pregnancy’, as an8 umbrella term for both denying and concealing the pregnancy. A review ’ in Berlin shows that denial of pregnancy after more than 208 weeks’ gestation occurs once in 475 pregnancies (o.21%).36 One in 2500 women (0.04%) keeps up this negation right up to the 37delivery, a ratio equal to that of eclampsia (a form of toxaemia) during pregnancy.3 It is an interesting fact that 8% of the women who had kept their pregnancy8 hidden had earlier already denied a pregnancy in the way. same 4L Denial of pregnancy is linked to potential risks, such as the absence of pre-natal care, ill-treatment of the unborn child in the sense of exposing it to harmful substances during pregnancy, postpartum psychiatric problems in the mother as a reaction to being taken by surprise by the confinement (without any assistance), as well as the risk of neonaticide. A review by Wessel et al. of 69 newborns where the pregnancies39 had been denied by their mothers shows that compared to a group of children4 whose pregnancies had not been denied, they ran a greater risk ° of premature’ birth, lower birth weight, would lag behind in growth for the duration of the pregnancy and would have to stay in a neonatal intensive care 37unit. As a possible motive for denying c.q. concealing the pregnancy Nirmal et al. mention the conflict between the desire to have a child and the fear of losing it to
440 THE PSYCHE OF WOMEN COMMITTING NEONATICIDE the Child Protection Services. In addition to that an earlier history of substance abuse, early sexual trauma,4 being of a very tender age, extemal stressors and an earlier psychiatric history’ might also be risk factors. Beier et al., however, that in their review group of 66 women4 who had denied their maintain ’ pregnancy and twelve women who had kept their pregnancies hidden, the risk factors of low socio-economic status, tender age, low intelligence and naivety as regards sexuality and bodily flanctions do not apply. This last factor is seen as 8 only possibly contributory to the occurrence of the denial of pregnancy, but not women that go through their first pregnancy may deny the pregnancy.
The underlying psychopathology in women denying their pregnancies may be diverse. In many articles a distinction is made between a psychotic and a non psychotic variant. Psychotic denial frequently occurs with chronically 111424341 (often schizophrenic) women who may experience the physical mentaily symptoms of pregnancy but attribute them to delusional 43causes. The denial of the pregnancy’ may be so persistent that in a number of cases it continues to exist, even after the birth of the child as ‘most persuasive proof’ has taken 43place. Families of psychotic deniers are often aware of the pregnancy, as the patient does not take any trouble whatsoever to conceal her 47pregnancy. Non-psychotic denial of pregnancy may be divided into three categories: pervasivedenial, in which not only the emotional meaning but also the entire existence of the pregnancy remains outside the consciousness, affectivedenial, in which the woman is intellectually aware of the pregnancy, but makes oniy few emotional or physical preparations for the birth, and persistent denial, when the woman becomes aware of the pregnancy for the first time in the third trimester, but does not seek out any pre-natal 44care. For some considerable time now there have been people advocating the denial of pregnancy to be included as a special category within DSM and ICD classifications. Strauss et al. argued already in 1990 that denial of pregnancy should be considered as an adaptive disorder and should also be classified 45thus. At the time the suggestion was to refer to this as a ‘maladaptive denial of physical disorder’ classification within the adaptive disorders in the DSM. Miller made a further differentiation by suggesting that it should be referred to as a ‘condition’ instead of a ‘disorder’, because strictly speaking a pregnancy is a physical condition and not a disorder. At the same time6 it was advised to specifically include pregnancy in the description of this afiliction. It would be regarded as separate from the psychotic fonns of denial and of the forms of concealment of pregnancy, in which the pregnancy is not denied by the woman herself This description of the denial of a physical condition as an adaptive disorder°5 was not included in DSM-IV.Beier et al. suggest regarding the denial of pregnancy as a reproductive dysfunction which is not brought about by an organic disorder or illness and to incorporate it in the chapter ‘sexualand gender identity disorders’ of the 8DSM. Stil, it is questionable
44’
mictio. 44 pregnancy
and perception the
nancy. 354 °
pregnancy. their
denial neither
lit-tle
in
solution have
suppose emotional
environment, develops. 52
woman
prominent
conformity their
neonaticide
have unpleasant
further
who
personality found
the
Varying
correct for
observation
group
Psychopctthology
deny perception. whether so
PROCRESSION
some
much
Though
few
pregnancy
all
offence
as
any
are
situation.
own
stated
their
by
women. 39
that
in
for
characterized
possible. 35
picture other
who
(for
resuits
that
the
psychiatric
the
in
the
women
these
immaturity
there
responsibility.
The the
characteristic
of
does
The matters
problems.
with
of pregnancy,
as
For
a certainly
IN
of
term
to
instance
mother
reproductive
pregnancy
the
and
mental
is
the
women
childish childbirth,
PORENSIC
completely
the
of
This
have
strong
are
women
was
of
pregnancy
not
example
pregnant-
Beier the
‘reproductive
pregnancy
the
also
environment,
wonzen
after
individual
Because
found
and
history
display continued
may
passivity
been
a by
situation
in
sense
in
underlying
The
committing
of
denial PSYCHIATRY
et
and
number
these
to
indecisiveness,
characteristics
the are
confrontation
their
during
Spinelli
al.
being
be
nor
committing
in
there
system
deny
denied
majority
with
fearful
is
preceding of
no
an
emphasize
relatively
form
characterized
so
the
will
presenting
for
personality
may
women,
generally
this
also
dysfunction’
in
monthly
unambiguous powerful
abandoned
of
the
inner
the
a
literature
is
which
the
describes
magically
individual
certain
of
of
which
and
similarities
neonaticide,
no
of
also
leads
existence
pregnancy
a
of
the
abortion,
killing
neonciticide 442
healthy,
the
number
reactions
action
bonding
women
concealed
such
first
with
therefore
emotional
lessen
felt
loss
goes
woman
this that
gives
belle
the to
offence.2 6 47
about
by
by
is
the
of
disappear
to
and
as
pathology. 5
no
of
is
phenomenon, it
of
their woman
an
along
passivity,
indfterence, mental
or
their
can
the
is
who
rise
nausea
the
be
who
also
blood,
but
of
undertaken personality
problems. 8
preparation
with
that
to
adequate
the
that
foremost,
adoption
the
from
immaturity
child.
unwanted
he
cases
to
physical
generally
their
unwanted
seems
parents
at
killed
mental
in
breaks importance
—
a
dynamism
found
finds
the
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is a THE PSYCHE OF WOMEN COMMITTING NEONATICIDE
During the pregnancy no third party assistance is sought, neither as regards the pregnancy in the form of pre-natal assistance, nor as regards their own mental wellbeing in the sense of mental health care. In labour the approaching confmnementbecomes an ever increasing reality and many perpetrators of neonaticide become dissociated, and display symptoms of depersonalization and have the feeling that they are in a trance. Some women stated that they had the sensation of watching themselves from a distance, which are also known as autoscopic experiences. Related to this Nesca and Dalhy6 provided the option that characteristics of a post traumatic stress disorder should also he taken in consideration on account of the dissociative elements at the time of the traumatic conflnement, but further study into this has not yet heen carried °5out. Apart from these dissociative phenomena there is frequently no serious psychopathology in a narrower 32sense, although some studies also mention psychotic phenomena.253 There 5is generally no question of suicidality nor of suicidal intent,202 not in the earlier history,’ and nor immediately after the offence. delivery After6 the 6 everydaylife is once more resumed and even then the pregnancy or the birth of the child does not play a role of any significance in the mother’s perception of the world.
Motives In most studies the motive for neonaticide is ordinarily classifled as that of the ‘unwanted child’.253252 The child being “unwanted” might for instance be based on the fact that it was illegitimately fathered, or hecause of economic condi 23tions, at the same time suggesting that getting rid of the pregnancy (or its result) might be the only motive. However, this does not explain why they did not resort to abortion at an earlier moment or why some women keep the body close to them for such a long time and, in doing so, seemingly cannot abandon the child post mortem. In the case of these women Oberman also refers to a certain ambivalence about their pregnancies, which contributes to their indecisiveness in 53action. They live by the day and do not rnalceplans towards the inescapable birth of the child. Pitt & Bale suggest a motive to be found in their relationships, namely that the fear of rejection by the parents or the partner should also be viewed as an important 53factor. Quite a few perpetrators of neonaticide claim they were unaware of the pregnancy and were completely taken hy surprise when childbirth occurred, but according to Porter & Gavin this does not tally with the behaviour during 32childbirth. For assistance is not called in, not even when the child is stillborn, whereas also then the normal reaction would be to calI in assistance and not to push the child aside or to put it in the biri and to proceed with the order of the day. Putkonen et al. studied 32 cases of neonaticide in Finland over a period of 20 years (1980-2000) and apart from the child being unwanted found other motives: a panic situation, fear of desertion, and an inahility to deal with the 33child. In 66% of the cases the motive was unclear, however. They conclude that
443 t44. PROCRESSION IN FORENSIC PSYCI-IIATRy in a prosperous country such as Finland the traditional stigma and economic reasons behind neonaticide are not the prime motives, but suggest that the background reasons are rather to be found in the perpetrator’s psychology. Oberman also describes that women feel isolated from their environment and are fearful that they will be deserted when their pregnancy becomes known, whereas afterwards no such fear was 57justified. Study in the Nethericinds In the Netherlands the most recent study (2007) of neonaticide was carried out by Verheugt as part of his review of parents who kill their own 34children. Covering a period of ten years (1994-2003) all cases of neonaticide were reviewed in which the mental faculties of the women involved were examined. Verheugt arrived at the following profile of the perpetrator of neonaticide: the woman who commits neonaticide is generally young, of indigenous origin, is single or has only incidental partner contacts and has very little involvement in intimate relationships with others. Regarding the dynamism the perpetrators of neona ticide display a strong ambivalence: the pregnancy must remain concealed at all costs (often for fear of losing the love of a partner or of the parents) and at the same time there is a strong wish that the pregnancy does get noticed, that searching questions are asked, but when this actually happens, everything is done to deny the pregnancy to the outside world. Verheugt also indicates that the dynamism of becoming pregnant in the testing of mental faculties is often omitted. Generally speaking, at any rate on superficial examination, the women who commit neonaticide function adequately and are mostly not suicidal. The (psychiatric) disorders that exist tend to develop especially in the mn-up to the killing. Verheugt’s review also indicates that a third of the entire group of parents who kill their own child lost a loved one who was stil a child, so a little brother or sister, a (previous) child or a brother or sister of their 34parents. The statistics for women who commit neonaticide are still to he researched. -t,
Condusion from literature review ‘l
Neonaticide is taking the life of newhorns by their biological mothers, within 24 hours after childbirth. It is practised in all eras and in all cultures, mostly because of either harsh living conditions, such as poverty and scarcity of food, or in order to get rid of unwanted (deformed, illegitimate or female) newborns. In this day and age neonaticide is committed by relatively young, emotionally somewhat childish women and is characterized by keeping the pregnancy hidden for the environment, for fear of discovery, and after delivering the child taking its life either actively or passively. Then the mother continues with everyday life.
Denial and concealment of pregnancy are phenomena which — quite apart from neonaticide — more frequently occur in the case of women who are in some
444 THE PSYCHE OF WOMEN COMMITTJNG NEONATICIDE
cases already suffering from a psychiatric disorder. The personality problems found in women who commit neonaticide are characterized by passivity, the tendency to suppress difficult maffers and to deny the existence of problems. On top of that indecisiveness, emotional immaturity and also an absence of a suitable affect regarding the pregnancy are also frequently identified. No bonding with the as yet unbom child develops and it is sometimes thought that the pregriancy will magically disappear if as linie as possible thought is spent on it. During the birth of the child, which takes place in absolute isolation, to a greater or lesser extent dissociative symptoms develop in the mother. In the literature the stock motive for committing neonaticide is mostly given as that of the unwanted child, on account of the illegitimacy of the child or because of economic circumstances. Some studies, however, mention a few other possible motives, such as the fear of desertion, being in a panic situation and an inability ‘5 to cope with the child. It is suggested to find the background motives in the :e perpetrator’s psychology, rather than in environmental conditions.
Discussion
The available literature conceming neonaticide presents a picture of the demo graphic and social data of the women who resort to neonaticide, and also the characteristics of the crime and of the historical context of this phenomenon. This sheds a fair amount of light on the ‘outside’ of the phenomenon of neonaticide, but the present studies stiJl shed too linie light on the ‘inside’ of the perpetrator of neonaticide. Several 3354studies suggest that new research should focus on the psychology of the offender, rather than on the (socio economic) circumstances of the women who commit this crime. In a time when there are many possibilities to prevent pregnancy, and there are also all kinds of alternative solutions available to deal with an unwanted pregnancy, it is most certainly of great importance to determine why a small number of women when confronted with an unwanted pregnancy nevertheless resort to keeping the pregnancy completely hidden from their environment and ultimately to take the life of the newborn child.
Whereas many studies regard neonaticide as a crime in reaction to an unwanted pregnancy, in our view neonaticide should sooner be considered as a ‘tragedyin four acts’:the first act is the (un)desired conception, the second the concealment of the pregnancy, the third the child’s birth in isolation and either actively or passively taking its life, and the fourth act concealing the dead body of the newborn child and sometimes keeping it close by. There is sometimes also an epilogue, when the neonaticide comes to light and leads to a court case, but in some cases this is where the tragedy ends and in other cases the tragedy is repeated, when we are dealing with multiple neonaticide. The psychological
445 PROGRESSION IN FORENSIC PSYCHIASRY
dynamism of each act should be examined, paying attention both to the speciflc dynamism of each individual act and to the psychological dynamism of the phenomenon as a whole. Also within the group of perpetrators of neonaticide attention should be paid to the fact that this need not be a homogenous group, as Putkonen et al. already 33suggested, which may be divided in a number of sub-groups. Especiallythe fact that there are women who are convicted after a single neonaticide and women who only after a series of killings of newborns have to answer for their crimes in court, raises the question whether in neonaticide we are always dealing with potential ‘serial killers’ or that there are rather two groups: women who do this once and women who will keep doing it unless they are stopped. There should be more longitudinal examination of this, especially with a view to prevention and risk assessment, of which as yet not much is known about this special group of women. Another element that should be further examined in additional research is the systemic aspect of neonaticide: the environment plays an important part in not noticing the pregnancy and in a number of cases also supplies an additional motive for the killing, namely that the mother’s perception is that she dare not make her pregnancy known to her environment. Some women also indicate that they would have liked third parties to ask searching questions when they denied being pregnant. Amon et al. emphasize also the role of the environment; they stress that this role is especially characterized by a certain lack of concern and indifference regarding the woman in questibn. What dynamism is at playhere? From what kind of families do these8women come? Is there a fear of losing a relationship with the parents or with a partner? Or is there after all (also) an aspect of revenge on the direct environment which insufficiently notices the pregnancy (and in so doing also the woman concerned)? Many questions regarding the systemic context of neonaticide still remain unanswered and should be more closely addressed in further research. In most studies of neonaticide the stock diagnosis of the motive for the offence is that of the unwanted child’. Although a number of studies also indicate that fear of desertion of a significant other (for instance parents or a partner) also plays a role, only occasionally a 33study suggests altemative motives for killing the newhorn child. The following motives are given: a panic situation, fear of desertion, and inability to cope with the child. Verheugt also mentions the fear of desertion by partner or parents as a possible motive for 34neonaticide. Fxtensive further research should be carried out into these alternative motives. For instance in no study up to now was any attention paid to the possibility that concealing the pregnancy and in so doing not acknowledging the life of the child to the outside world might he a motive in itself. In an unconcealed pregnancy the future mother shares the news of the approach of her babywith her environment and thus as it were already slightly detaches the baby from its symbiosis with herself. In this way the baby acquires a meaning also to others and then more
446
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Authors K.J. de Wijs-Heijlaerts, MA, psychologist, working at the NIFP (Netherlands Institute for Forensic Psychiatry and Psychology) in ‘s-Hertogenbosch. Since 2010 working on a thesis on neonaticide: the psyche of women who kili their newborn babies.
A.J. Verheugt, PhD, clinical psychologist/psychotherapist, working at the NIFP (Netherlands Institute for Forensic Psychiatry and Psychology), NRGD ‘1 (Netherlands Register for Court Experts), the Parole Appeals Division in t a Arnhem, and in own practice. Wrote thesis on parents who kili their own t children: ‘Moordouders. Een klinisch en forensisch psychologische studie naar de persoon van de kinderdoder’ (Murderous Parents. A Clinical and Forensic r Psychological Study of the Person of the Childkiller) (2007). S
1 T.I. (Karel) Oei, MD PhD, Professor emeritus of Forensic Psychiatry, Tilburg T Law School, Department of Criminal Law c
1: a c d c 0 ii
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