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Wednesday, April 27, 2011

Guest Blogger Thomas L. Hafemeister: Postpartum Depression and Women Who Kill Their Children

Increasing attention is being given to the occurrence of postpartum depression and postpartum psychosis, driven by reports of women who have killed their infants a relatively short time after birth.  

 For example, in Lakeview, Illinois, a North Side neighborhood of Chicago, a thirty-year-old woman who was reportedly suffering from severe postpartum depression was charged this month with first-degree murder in the suffocation death of her eight-month-old son in February of this year.  The woman had a college degree, no prior criminal history, and the Illinois child protective services agency had apparently not received any prior reports of child abuse or neglect as it had no contact with the family preceding this incident.  Jason Meisner, Cops: Lakeview Woman Suffocated 8-month-old Son, Chic. Trib., Apr. 14, 2011.

Conjecture has also swirled about the mental state of Lashanda Armstrong, who drove her minivan off a boat ramp in Newburgh, New York, on April 12th, killing herself and three of her four children, ages five, two, and eleven months, with a ten-year-old child able to roll down a window as the vehicle hit the water and escape.  James Barron, Woman Tells of Boy’s Plea for Help After 4 Drownings, N.Y. Times, Apr. 13, 2011. This event has sparked a discussion of how often mothers kill their children, what causes it, and how it can be prevented.  For a widely circulated report, see Jocelyn Noveck, Moms Killing Kids Not Nearly as Rare as We Think, Assoc. Press, Apr. 16, 2011.  

Probably the most well-known related case involved Andrea Yates, who drowned her five young children, ages six months to seven years, in the bathtub of her suburban home outside Houston in 2001.  Yates had been suffering for years from very severe postpartum depression and psychosis, with a psychiatrist urging her after the birth of her fourth child not to have any more children.  Her initial conviction of capitol murder and a sentence of life imprisonment was overturned on appeal.  At her second trial, Yates was found not guilty by reason of insanity and committed to a state psychiatric facility, where she remains today.  Associated Press, Woman Not Guilty in Retrial in the Deaths of Her 5 Children, N.Y. Times, July 27, 2006.  See also Christine Michalopoulos, Filling in the Holes of the Insanity Defense: The Andrea Yates Case and the Need for a New Prong, 10 Va. J. Soc. Pol’y & L. 383 (2002-03; Kristine Esme Nelson, Postpartum Psychosis and Women Who Kill Their Children: Making the Punishment Fit the Crime, 23(2) Dev. Mental Health L. 23, 36 (2004) (“The American legal system as it currently exists is not equipped to respond in an appropriate fashion to these crimes.”).  

In 2010, as part of The Patient Protection and Affordable Care Act (PPACA), section 2952, entitled “Support, Education, and Research for Postpartum Depression,” was enacted.  This provision was based on the Melanie Blocker Stokes MOTHERS Act, a bill that had been stalled in Congress for a number of years, in part because of concerns that it would result in mandatory mental health screening for all new mothers.  As enacted, however, it has a much narrower scope.  This section encourages the Secretary of Health and Human services “to continue activities on postpartum depression or postpartum psychosis . . . , including research to expand the understanding of the causes of, and treatments for, postpartum conditions.”  Activities that are encouraged include “[t]he development of improved screening and diagnostic techniques” and “[i]nformation and education programs for health care professionals and the public.”  Congress authorized $3 million to support these activities for fiscal year 2010.  It also charged the Secretary to conduct a study on the benefits of screening for postpartum conditions and to submit a related report to Congress within two years of the enactment of this bill.  For the text of just this portion of the PPACA, see PerinatalPro.com, Melanie Blocker Stokes MOTHERS Act Signed Into Law!, Mar. 21, 2010.  For the PPACA in full, see here.  

An associated Congressional Report states, 

In the United States, there may be as many as 800,000 new cases of postpartum conditions each year. . . . Postpartum depression occurs after 10% to 15% of all deliveries and after 26% to 32% of all adolescent deliveries.  The majority of patients suffer from this illness for more than 6 months and, if untreated, 25% of patients are still depressed a year later. . . . The most severe postpartum condition is postpartum psychosis.  A comparatively rare disease, it complicates only 0.1% to 0.2% of deliveries. 

H.R. Rep. No. 111-48, at 4-5 (2009. 

This provision had been pursued in memory of Melanie Stokes, who committed suicide in 2001, three http://www.law.virginia.edu/lawweb/faculty.nsf/FHPbI/1169425months after giving birth to a daughter.  Stokes, in her late 30s, managed a sales team at a pharmaceutical company and was married to a urologic surgeon.  The couple had tried for several years to get pregnant and Stokes purportedly greeted the news with joy.  However, after giving birth to her child, she was unresponsive when the doctor told her that her new child was a girl and within days began talking of killing herself.  Hospitalized four times, she threw herself from the twelfth floor of a hotel a week after her last discharge.  Lisa Pevtzow, Law Gives $3 Million to Educate, Research Post-Partum Depression: Dedicated Mom Spent Nine Years Working to Pass ‘Melanie’s Law’, Chic. Trib., May 21, 2010.

Historically, a diagnosis of postpartum depression has received limited weight in conjunction with criminal justice proceedings.  A ruling by the Iowa Supreme Court suggests that courts may be changing their views somewhat.  The court noted that the defendant in this case, Heidi Anfinson, had told officers that she had left her two-week-old son alone in the bathtub so that she could use the telephone in another room.  When she returned, the baby had drowned.  Panicked, she took the body, drove it to a nearby lake, left it in the water, and drove home.  Anfinson pled not guilty to charges of first-degree murder and child endangerment.  Although her lawyer was aware that Anfinson probably suffered from postpartum depression following her son’s birth, the lawyer summarily dismissed the notion that this condition could http://www.law.virginia.edu/lawweb/faculty.nsf/FHPbI/1169425be used in her defense.  Further, he failed to investigate Anfinson’s medical history, or the extent of her symptoms and how they might otherwise explain behavior the jury might find unnatural or unforgiveable.  Although the first trial resulted in a mistrial as the jury was unable to reach a unanimous decision, the jury at a second trial convicted her of second-degree murder. 

On appeal, Anfinson argued that she had received ineffective assistance of counsel.  Upon reviewing the matter, the Iowa Supreme Court determined that Anfinson’s attorney was aware of the probability that she suffered from postpartum depression after her child’s birth, but “categorically rejected any suggestion that this condition be explored in her defense.”  The court acknowledged that the evidence of postpartum depression would not have qualified Anfinson for either an insanity or diminished responsibility defense in this particular instance, but determined that it likely would have affected the outcome of her case by bolstering her claim that the death was accidental and by explaining to the jury why a mother would neglect her newborn while it was in the bathtub, why she would irrationally bury the body in a lake following the drowning, and why she would appear emotionless about the ordeal when questioned later that day.  Courts are generally reluctant to find a lawyer’s assistance ineffective when it reflects a tactical decision; however, the court in this case determined that the lawyer’s decision to present no evidence of postpartum depression called into doubt the fairness of the outcome of Anfinson’s trial and remanded the case for a new trial.  Anfinson v. State, 758 N.W.2d 496 (Iowa 2008),

Anfinson ultimately entered into a plea in October of 2009, a week before her third trial was scheduled to begin.  Her original conviction carried a fifty-year mandatory sentence.  Under her plea, she received a fifty-year non-mandatory sentence.  With time already served, it was reported that she could be paroled within one to four years.  EveryPurpose.org, Plea Bargain Reached (Oct. 28, 2009).  This website also provides links to accounts by Anfinson’s husband, sister, and brother-in-law. 

--Thomas L. Hafemeister

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