Complexities of Filicide

Giovana Levin, MD, FRCPC Forensic Psychiatrist University of Western Ontario November 22, 2019

Objectives

• Know the definition and types of filicide

• Learn about the psychiatrist’s role in the assessment of cases of filicide

• Understand the repercussion (familial and societal) of filicide

Outline

• Historical background

• Mothers vs fathers

• Risk factors (parents and children)

• Legal ramifications: NCR/NGRI

• Psychiatric assessment and follow-up

• Conclusion

Background

• In 2001, Andrea Yates drowned her five children (6 mo to 7 y-o) In a bathtub in her home;

• Four previous admission to psych, catatonic and mute in one;

• “Bad mother”, drowned them to save them from eternal damnation

• Found guilty in 2002, reversed/NGRI in 2006

Background

• In ancient Greco-Roman times, a father was allowed to kill his children without any legal repercussions;

• Mostly perpetrated by the mother;

• “suffocated in bed”

Background

• Filicide: 1 y -18y-o

• : up to 1 y-0

• Neonaticide: first 24 hs.

• Most of the literature is on children killed by their mothers

• May occur in the context of (entire family is killed) Background

• First 24 hs.: young, immature mothers, illegitimate child OR History of antisocial/little ethical restraint (1957)

• Resnick (131 cases) types of filicide*: • Altruistic (49%) • Acute psychotic • Unwanted child • Accidental • Spousal revenge (2%) *1969 • For children murdered under the age of 5, 30% were killed by mothers and 31% by fathers (1976-2004).

• Fathers are more likely to kill sons, mothers are more likely to kill daughters

• In studies, strongest risk factor: depression/psychosis/SI

• Still, extreme rare event but has devastating consequences

Risk Factors: mothers

• Depression, psychosis, lack of resources, illegitimacy

• Severe (, bipolar)

• Other risk factors: social isolation, sole care provider, victims of violence themselves (mothers)

• Unemployment, substance use disorder, limited supports, concealment of pregnancy, none to poor pre-natal care

Risk Factors: mothers

• Strongest risk factor: risk of depression/psychosis/SI

• Even in accidental cases, the death is usually caused by abuse or extreme neglect

• Drowning, strangulation, asphyxiation, head trauma

• Repeated cases: higher prevalence of personality disorders

• Low awareness/denial of pregnancy even in repeated cases

• Munchausen by proxy Risk Factors: infant

• Children under 5: 60% are killed by the parents

• Baby with colic: 70% of mothers had aggressive thoughts

• Gender

• Disability

• Illness

• High percentage of infants were not born in a hospital

Risk Factors: infant

• Rare genetic disorders may be associated with infant death and become “suspicious” (43 identified as associated with SID Inborn Errors of metabolism)

• Sudden Infant Death Syndrome

Extended suicide

• 16-29 % of filicidal women complete suicide (extended suicide)

• 40-60% males: attempted or completed suicide

• Previous suicide attempts and mental health encounters represent elevated risk*

• Nihilistic view of the world, post-event realization of their actions

*Bradford et al, Canadian Journal of Psychiatry, April 1, 1990

Society’s views

• Polarized: justice must be done vs. something must be wrong with a parent who kills their own child

• The vast majority of parents know the legal wrongfulness

• Most have an overriding moral justification for their actions based on psychosis to commit altruistic homicide

• Father who kill their children are more likely to be convicted and sent to prison (in the USA, death penalty) Fathers who kill their children

• Rarely neonaticide

• Children are typically older

• Fathers typically in the late 20s

Fathers who kill their children

• Psychosis is also common in fathers, altruistic motive is the Most common both in mothers and fathers who kill their children

• Association with killing of the spouse

• 40-60%: attempted/completed suicide

Step-parents who kill their children

• More common than biological parents who kill their children

• Men: 8X, Women: 3X more than biological parents

• More violent methods

The psychiatrist’s role

• Awareness and increased frequency of contact pre- and post-partum

• Assess for depression, psychosis, personality disorders, support system, father/intimate partner in her life

• Denial of pregnancy

• ASK THE QUESTION about thoughts of harming the child

• Preparations for the arrival of the child

The psychiatrist’s role

• “lack of memory for the event”: malingering? Dissociation?

• Attempt to hide the body?

• Move on with their lives as if nothing happened…

The psychiatrist’s role

• False expectation that the parents should feel “happy and fulfilled” may hinder proper assessment

• Thoughts of suicide in the parent: even more imperative to inquire about thoughts of harming the baby

• Family doctors should also be aware of first-episode psychosis during the post-partum period

• Nihilistic view of the world

• “my child would be better off…”. Think extended suicide

Criminal Code of Canada and Infanticide

• 233 A female person commits infanticide when by a wilful act or omission she causes the death of her newly-born child, if at the time of the act or omission she is not fully recovered from the effects of giving birth to the child and by reason thereof or of the effect of lactation consequent on the birth of the child her mind is then disturbed.

Criminal Code of Canada and Infanticide

• Maximum sentence: 5 years

• The term “disturbed” in the definition in the CCC has • Been criticized as vague and non-specific Attempts to decrease infanticide

• Safe Haven Laws (45/50 states)

• Baby hatches (Europe)

• In Canada: child abandonment is illegal, but Vancouver and Edmonton have locations where you can leave a newborn The aftermath of filicide

• Rare, devastating event for the perpetrator and the entire family

• Stigma, depression, guilt, isolation

• Self-hatred

• Vivid memories, avoidance The aftermath of filicide

• In follow-up: mothers values support from family

• In follow-up: mother values relationship with other children

• Regaining the role of mother is important for recovery