The Dallas Morning News

A good mother swaddles her child in a sturdy weave of love and care. But mothers with severe mental illness might offer only a threadbare cover.

Frayed by psychosis or a profound depression, the fabric of these mothers’ minds can, in rare instances, leave their babes dangerously exposed. Such women often struggle mightily to be good mothers, research suggests. And in many ways, they would succeed - if they didn’t kill their children.

Motherhood is considered a sacred duty. So last June, when Andrea Pia Yates drowned little Noah, John, Paul, Luke and Mary, people wondered exactly what evil had possessed her.

For any individual, science can’t answer that question. But scientific studies can help define differences among mothers who kill. In fact, research dating back three decades has outlined several categories of such mothers, with some overlap.

“Women who kill their children as a group are going to be just as disparate as any other population,” says Carol Holden, a forensic psychologist and researcher at the University of Michigan.

Some mothers fatally beat their children but don’t mean to kill them. Mothers also kill to spare a child some real or imagined suffering. They kill for revenge on their partners. They kill children they no longer want - or didn’t want to begin with.

“You have everyone from a terrified 13-year-old who doesn’t even realize she’s going to give birth and doesn’t know what to do and smothers the newborn, to someone who cold-heartedly decides children are too much trouble,” Dr. Holden says.

Mothers also kill because their minds have wrung reality into a bizarre new form. Such killings, and the women who commit them, tend to be distinct from the others, psychological studies show.

Overall, “these mentally ill mothers … look quite different than the non-mentally ill mothers,” Dr. Holden says. On the other hand, “that’s not to say that anyone who looks like that is definitely mentally ill.”

Statistics on child murders in the United States show just how vulnerable the youngest children are. Among preschoolers, the younger the child, the greater the risk of being a homicide victim.

Victims of filicide - the term used when a parent kills a child - also tend to be very young. Of the U.S. children in one maternal filicide study, “we didn’t find a single child killed … who was over age 12, and almost all of them - 85 percent - were under age 5,” says forensic psychologist Geoffrey McKee.

Matching threads weave through much of the research on filicidal mothers. Compared with other such mothers, those who are severely disturbed are more likely to be older. They are more likely to be married. They tend not to conceal their act. They more often try to kill themselves at the same time. And they are more likely than other such mothers - who kill during abuse or moments after childbirth - to murder more than one child.

Such threads connect even mothers of different nations - at least in some English-speaking cultures, says Dr. McKee, a clinical professor at the University of South Carolina School of Medicine. He and colleague Steven Shea have compared 20 U.S. women accused of killing their children with earlier studies of such women from Britain, Canada and a multinational sample.

The women in the U.S. group had been referred to a psychiatric hospital for pretrial evaluation, and thus were more likely to be mentally ill than, say, the broader group of women in the English study. Still, the research noted a “consistency of characteristics across countries.”

The cross-cultural comparison suggests that women who kill their children typically “are nonaddicted, married, low-income, mentally ill, new or recent mothers under 30 who, acting alone and without weapons, kill only one of their children, likely of preschool age,” the scientists wrote.

“In our study, only 15 percent had more than one victim,” Dr. McKee says. “However, when there is more than one child who’s killed, typically all the children are killed.”

In his clinical and research experience, he adds, “if there are multiple children who die, the mother is mentally ill.”

Dr. Holden and her colleagues have detected similar strands. They studied 28 Michigan women who had pursued the insanity defense for killing their children. Eight of the women had been held criminally responsible for their killings; 20 had been found not guilty by reason of insanity. Those in the latter group were more likely to have had a history of psychiatric illness, and less likely to have held a job - “which is a good measure of … adjustment” psychologically, Dr. Holden notes.

Among those found not guilty by reason of insanity, 60 percent had been diagnosed with schizophrenia (a brain disorder characterized by strange thinking, feelings and behavior) and 35 percent with a mood disorder - most often severe depression with psychotic symptoms.

A history of suicide attempts, psychiatric hospitalizations and being abused is not uncommon. “When we’re talking about mentally ill mothers, we’re talking not just of psychotic mothers,” Dr. McKee says, but also mothers with a history of major depression or clinical depression.

Severity of illness is a crucial distinction, notes Dr. Josephine Stanton, a New Zealand clinical psychiatrist. Dr. Stanton and colleagues have conducted detailed interviews with six mentally ill mothers who killed their children. Most of her subjects had schizophrenia or schizo-affective disorder (schizophrenia symptoms accompanied by a major depression or manic episode). One had major depression and anxiety.

Thirty percent of people have some sort of mental disorder, Dr. Stanton says, but illness that severe occurs in only about 1 percent. “So we’re not talking about someone with a mild depression.”

Scientists are instead talking about someone who probably has hallucinations (imaginary sensory perceptions) or delusions (false, irrational beliefs). Among women acquitted for reasons of insanity in Dr. Holden’s study, hallucinations and delusions were common.

The delusions included such notions as the child “was defective or monstrous, possessed by Satan - something is seriously wrong with them,” Dr. Holden says. “Or there was some sort of delusional disaster that was going to befall the children, and the mothers were saving them.”

For the mothers hobbled by depression and psychosis, she says, the delusions “were very much in line with depression - these horrible senses of what was going to happen.”

The mothers Dr. Stanton studied also had stitched crazy quilts of false ideas. For one set of mothers, wild fantasy governed decision-making. One woman had persecutory delusions “where a whole group of people were running her life,” Dr. Stanton says. “According to her delusions she had to do all sorts of things to save the world, and she couldn’t.” She also couldn’t leave her child behind.

For the other mothers, “life was absolutely terrible and they couldn’t leave their children in such an awful world,” Dr. Stanton says. “It’s not bizarre, but the intensity of it is delusional.”

Suicidal mothers may decide to kill so their children won’t have to grow up without a mother, Dr. McKee says. Psychotic mothers may be trying to save a child from a lifetime of psychosis.

“So they have a very altruistic reason for killing their child, even though it’s pure delusion,” he says. In their minds, they are good mothers.

And by some measures, they can be good mothers.

“Most are women who really care a lot about being mothers,” Dr. Stanton, of the University of Auckland, found. “It’s very important to them … and I think that’s partly why, when they develop the illness, the delusional stuff tends to relate to their children.”

Some of the women showed Dr. Stanton pictures of their children and talked of them lovingly. One of the mothers spoke of feeling guilty because she had carted her daughter around shopping. Another described mincing steak herself, rather than buying mince that would have contained ingredients other than beef.

“They would take a lot of trouble to make sure things were done really well,” says Dr. Stanton. “I think in some ways that increased the burden of parenting for them; it was harder because they thought they had to be perfect.”

Other burdens can consume anyone with a grave mental illness.

Certainly for the mothers who are psychotic, says Dr. McKee, mental distortions disrupt sleep and intrude on the ability to think.

“Delusions and hallucinations are very emotionally draining, especially if these are new-onset symptoms” - such as those that, in rare cases, arise just after childbirth. For some, the symptoms persist, evolving into a more chronic psychosis, such as schizophrenia.

Some women experience severe depression after the birth of one child but not another, Dr. Holden says. Others suffer depression or psychosis after each child is born. The biological swing that can follow childbirth could cause anything from a mild case of the blues in a number of women, to serious depression in a smaller group, and psychosis in a fraction.

Many recent mothers who develop mental problems aren’t sure how to mend their minds. “There are lots of women who don’t seek treatment,” Dr. Holden says, “because they get told everybody gets the blues.”

Meanwhile, routine pressures mount. “Someone who’s been mentally ill for a while is going to have the difficulties that go along with mental illness - impaired social and work relationships,” Dr. Holden says. It’s hard to relate to people whose reality is distorted, adds Dr. Stanton, because their behavior can be so odd. “They’re quite difficult to get close to.”

Each individual case of filicide, however, is not cut from the same cloth. “That’s part of the reason why … [scientists] are looking for commonalities,” Dr. Holden says.

Among the mothers with severe mental illness, the decision to kill a child can arise abruptly. But then, so can the mental problems.

In Dr. Stanton’s interviews, some women, draped with depression, had contemplated the killing for perhaps a week. For the others, blanketed in psychosis, the murder was an impulse.

But something had definitely snapped.

“They all had either a new illness that nobody knew about … or their illness changed,” Dr. Stanton says. “When you listen to these stories you can hear that they had signs and symptoms of illness, but they hadn’t been recognized.”

Among the symptoms: Thought becomes disorganized. Emotions may disappear - or escalate irrationally. Impulses are hard to control. Consequences aren’t clear.

“It makes people in that state very, very difficult to relate to and to have an idea of what’s going on,” Dr. Stanton says.

Despite the erratic nature of the illnesses, her research team was surprised at the mothers’ lack of premeditation. Especially among the psychotic women, she says, the killing was more the result of disorganized thinking.

“I think that’s the reality of the risk,” she says. “When you have someone who’s actively psychotic, they can do anything.”

After the mother’s arrest, treatment begins in earnest. And a tapestry of realization, despair and agony unfolds.

For the psychotic mothers, as delusions and hallucinations are tamed, a deep and lasting depression can ensue - one that stems from both the declining symptoms and a growing grasp of the horror of the crime, Dr. McKee says.

Remorse is great and suicide is a risk. When the psychotic reasoning subsides, Dr. Holden says, “they’re left with the fact that they killed their children.”

Furthermore, says Dr. McKee, “often they’re not viewed very sympathetically by others. … I’ve found few mothers or fathers who have much sympathy for a mother who kills her children.”

Experts are working to figure out just which mothers might someday kill their children - and how to get their mental illness treated.

Disturbed mothers may be contemplating killing themselves, says Dr. Stanton, “but suicide ideation is common - and killing children is uncommon. That’s one of the reasons it’s so difficult to do prevention.”

And since the crime is rare, science can’t really forecast which ill mothers might murder their child, Dr. Holden notes.

Because the few hundred U.S. filicides each year are spread across 50 states, just gathering subjects for a study can take a decade, Dr. McKee says. During that time, there may be changes in how diagnoses are made or how cases are prosecuted.

In addition, studies frequently focus on filicidal mothers who are mentally ill because those women are concentrated in psychiatric hospitals where researchers work. Other filicidal mothers, in jail or elsewhere, are a looser-knit group. Yet stopping fatal child abuse, and preventing overwrought teens from smothering their newborns, could save more lives.

Still, mentally ill mothers often can’t keep their troubles under wraps, providing some chance for prevention.

Dr. McKee cites a report that up to 75 percent of mothers who murdered their children had psychiatric symptoms before the killing, and up to 40 percent had been seen by a psychiatrist shortly before the killing.

“If a woman with children presents with depression, and with suicidal ideation, a question clinicians want to ask this person is, ‘What are your plans for the children?’ ” he says.

The question, originally posed by another researcher, allows the women to discuss their feelings about the children in relation to the suicide - “and perhaps allows them to talk about unthinkable topics, like killing your children.”

Watching for postpartum mental problems - those that follow childbirth - also deserves more emphasis, Dr. McKee says. He cites statistics showing that hospitalization for psychosis is 25 times higher among women in the first 30 days and 14 times higher in the first 90 days after childbirth.

Getting help for mothers before their minds unravel is not easy. In Dr. Stanton’s interviews, “a number of these women talked about people in their lives worrying about them, but the people didn’t quite know what to do with them,” she says.

Doctors and others need to work harder. “Sometimes I think it’s actually easy to get help to the people who are quite functional and who are able to ask and get help,” Dr. Stanton says. “We need to be more assertive about following up the people who need more help but don’t reach out.”

Maternal filicide has victims other than the slain children. The family that remains is shattered.

Take the siblings who survive. Researchers know little about them, Dr. McKee says.

“You can imagine the conflicts that they would have,” he says. Rage. Depression. Relief. Guilt. They may have witnessed the slaying. And they may miss mom.

The mothers themselves wear a mantle of guilt and grief for years. “When I interviewed these women,” Dr. Stanton recalls, “it was just so painful, still incredibly painful for them. It’s a terrible thing to have to live with.”