Falling Into the Fire: A Psychiatrist's Encounters with the Mind in Crisis (18 page)

Resnick defined spouse-revenge cases as those in which parents deliberately kill their children in order to make their spouses suffer. The mythic Greek character Medea, who kills her two sons to avenge the infidelity of her husband, is the prototypical example within this category. Resnick found this type of filicide to be the least common, and subsequent research has supported that finding. Nonetheless, this motive is not a simply mythological one and might have been at play in the 2010 case of Theresa Riggi, who admitted to having stabbed to death her eight-year-old twin sons and their five-year-old sister in the midst of a custody battle with the children’s father.

Murders of unwanted children are more commonly infanticides, as was the case with Melissa Drexler, the highly publicized American “Prom Mom” who, in 1997, had concealed her pregnancy, gave birth to a baby in the bathroom at her high-school prom, disposed of the infant in the bathroom trash can, and rejoined her friends on the dance floor. However, this motive was also suspected in the equally high-profile case of Susan Smith, who buckled her one- and three-year-old sons into the backseat of her car and let it roll into a lake, where the boys drowned. Smith first achieved infamy because of the racism implied by the fact that she initially claimed “a black man” had taken her children in a carjacking. Later she was held in even greater derision when court proceedings revealed that one week prior to the incident Smith’s boyfriend had written her a letter saying that he liked Smith but did not believe he was suited to raising children.

Acutely psychotic infanticides occur when parents are hallucinating, delusional, or delirious and act out of the fear or anger brought about by their psychotic symptoms. In these situations, Resnick writes, an emotional impulse “is translated into a violent action.” A mother in this instance might push her son out the window, believing him to be an agent of Satan who intends to kill her. Alternatively, these crimes may be the result of confused, involuntary actions that occur during seizures, as when Resnick tells of an “epileptic mother who placed her baby on the fire and the kettle in her cradle.” In either scenario these are women whose minds are in the throes of a severely distorted reality.

Finally, and most interestingly, mothers who commit altruistic filicide believe that their actions are compassionate and driven by love. They kill in an attempt to alleviate their children’s suffering—be it real or imagined, present or future. A range of mothers fall within this category; for example, the mother of a neurologically devastated child who smothered him to put an end to his unceasing seizures, as well as the fifty-year-old paranoid widow who believed that an imaginary slavery ring was attempting to take her eleven-year-old daughter and so murdered her to save her from that fate. In testifying on Andrea Yates’s behalf at her jury trial, Resnick applied this category of altruistic filicide to Yates. In the midst of Yates’s psychosis, Resnick argued, her motivation for the murders was altruistic. Yates believed she was saving her children from a lifetime of hellfire and damnation by killing them before they were of an age to be held accountable for their sinful natures. This classification of altruistic filicide would also include mothers who are planning their own suicides and who kill their children so as not to abandon them, or to save them from the grief of their mothers’ deaths. This filicide-suicide subgroup is not insignificant. It represented an enormous 42 percent of the women in Resnick’s study population, a finding reinforced by the fact that we know approximately 5 percent of mothers who commit suicide also kill their young children.

My task, therefore, was to try to determine how likely Anna was to fall into one of these categories. In talking more with her over the days of her hospitalization, I was able to rule out certain of Resnick’s groups, even as Anna’s disturbing visions continued. Her son was not an unwanted child, Anna and her husband had been excited to become pregnant, and she continued to say she found joy and meaning in her identity as a mother. Anna’s marriage had its share of marital discord, which had been exacerbated by her husband’s inability to understand this sudden shift in his wife’s mental health, but there was no evidence of the kind of conflict that would lead her to kill her son out of spousal revenge. The child was not neglected or abused. The family confirmed that he had always been healthy, apart from some mild asthma, and I had seen him toddle around the unit one afternoon during visiting hours, chubby and beaming. More important, as Anna and I began to speak to her family members about her symptoms and treatment, every one of them attested to how well loved and well treated the boy was.

My central question, then, was whether Anna was psychotic and, if so, whether her psychosis could be deeply entrenched enough to have tragic consequences. Were the “visions and voices” she experienced in fact visual and auditory hallucinations that were commanding her to commit acts of violence against her son? Was she able to stay in touch with reality enough to know she should not harm him? Or, as was true for Andrea Yates, was there some secretly held delusional framework within Anna’s mind that had led her to believe that killing her son would somehow be an altruistic act of love and kindness?

Dawn’s nursing notes reflected her own continued apprehension: “Patient reports that son and mother-in-law were here for visiting hours. Patient reports that she had homicidal feelings toward her son. Reports voices were telling her to see what it would feel like to stab him. Reports she couldn’t wait for the visit to end. This writer suggested patient tell her mother-in-law not to visit with the son. The patient watched football the rest of the afternoon.”

I sat down and talked with Anna again. “I’d like to talk some more about exactly what you’re seeing and hearing when you have these thoughts,” I told her. She nervously nodded her assent. For the first two days, I had treated Anna’s symptoms somewhat as I would have treated a trauma victim’s flashbacks. The prevailing psychological theories in trauma treatment historically endorsed repeated and detailed retelling of the trauma story by the victim, with the thought that the repetition would dilute the potency of the experience and eventually bring peace and healing. More recently (due in part to research that was conducted in the aftermath of the September 11 terrorist attacks), we have come to understand that retelling the story in a detailed way may in fact be akin to reexperiencing—and thereby deepening the damaging effect of—the trauma. Because I had understood how distressing it was for Anna to experience these visions and suggestions, I had resisted asking her to go over them with me again in detail. Yet Anna’s symptoms had not improved in the slightest, despite the fact that I had been giving her an antipsychotic medication for two days now. I was starting to worry that I was missing something.

“Well,” she began, “it’s almost always the same. I’m doing something normal, like laundry or brushing my teeth, and all of a sudden I see this horrible sequence, like a movie in my mind. I’m hurting my son. I . . . I . . . I kill him, either with a knife or by holding him underwater. I never see myself in that moment, only his body and what I’ve done to it. While I see this, there’s a voice—almost like a voice-over—saying, ‘Try it. Try it. Just see what it feels like.’”

“Then what happens?” I asked.

“Then I see myself bending over his body, so sad at what I’ve done.” She grew quiet. “It’s so awful to talk about. It’s like I’m a monster.”

“Is there ever anything after that?” I asked.

“Sometimes,” she replied. I stayed silent to allow her to continue. “Sometimes I see myself in jail because of what I’ve done.”

“Do you ever actually think that you
are
doing it?” I asked her. “Are you ever unsure as to whether what you’re seeing is happening or whether it’s only in your mind?”

“Oh, I know it’s in my mind,” Anna replied. “I’m just so scared that one day my mind will overpower my heart, you know? And that I’ll act out this film that has played in my head over and over again.”

“How often does it play?” I asked.

“I don’t know.” She paused to think. “Maybe once an hour. Maybe more. It’s been happening less since I’ve been in here, but when I’m around my son, it’s going all the time.”

As Anna was describing this personalized horror film looping endlessly in her mind, I began wondering whether these were true visions and voices in the form of command hallucinations or whether they were in fact obsessive thoughts. The difference is a critical one. Obsessions are involuntary, upsetting, persistent thoughts that cannot be reasoned away. Hallucinations are false sensory perceptions. In other words, was she
imagining
this scenario over and over or was she actually, physically
seeing
it?

This was not an issue of mere semantics; my working diagnosis would dictate Anna’s treatment, a course of action that, if I were wrong, could have catastrophic consequences. My two potential categories of diagnosis—psychotic versus obsessive-compulsive—called for opposite forms of treatment. If Anna was indeed having command hallucinations to kill her child, the risk that she could fall into Resnick’s category of psychotic filicide was a real one, and she should be kept away from her child in order to keep him safe. If, however, this troubling film in her mind was obsessive and not psychotic, then the treatment would call for her to spend
more
time with her son in increasingly distressing and anxiety-provoking settings. This would allow her to see that she would
not
harm him, no matter how strong her fears of doing so might be.

There were risks associated with either course of action. If I wrongly diagnosed Anna as psychotic and made her visits with her son fewer, further between, and more heavily supervised, I would be reinforcing her belief that she could not safely spend time with him. I would also rob Anna’s son of a critical relationship with a mother who was loving, albeit afraid. If, however, I incorrectly diagnosed Anna as obsessive and implemented a treatment plan in which she would spend unsupervised time with her son, I could be placing this much-loved toddler in a position of real peril.

•   •   •

M
y own daughter is seven weeks old when I first take her to our family’s Michigan lake cottage. She is a lovely pudge of a baby with a few soft threads of hair, deep cobalt eyes, and a new smile that thrills me whenever it breaks across her face. The May lake is freezing cold, and Deborah and I are wearing jeans and sweaters. But I (who always leap from the car and run down the dock every time I arrive and lift the clear water to my lips the very last moment right before I leave) am determined to introduce my baby to the lake and it to her.

I put her in shorts and a little shirt, slip my hands beneath her armpits, and dip her tiny toes into the green water. A kind of baptism. Her face grows stern and perplexed, as if to ask,
What is this sudden shock of chill?
She pulls her thick, bowed legs up to her belly. I dip her again, then once more, all the while singing gleeful nonsense to her. Smiling broadly, Deborah snaps pictures. Half a moment later, our baby girl threatens to cry, and I concede, cradling her to me and pulling the base of my sweater up around her diapered bottom, her blanched and dripping legs.

That evening my mother pulls the cover off the old motorboat and we decide to take a sunset ride. I swaddle our baby in a beach towel. As I step into the boat with her in my arms, my father holds tight to my elbow, protective, steadying us until I sit down on the bench seat in the bow. My mother walks the boat out to a depth where we can start it without having the prop dig in the sand. Evening’s slant of light turns the lake’s surface reflective—a metallic, mirrored gray. If I lean a bit over the boat’s edge, my head and shoulders cast a shadow that lets me peer into the water, its clarity giving an unobscured view of the sandy lake bottom with its occasional rock, clamshell, furrowed path left by a freshwater snail.

Eventually my mother clambers aboard, revs the motor, and buzzes us around the lake’s periphery. With the engine’s hum, our baby sleeps soundly; the warmth of her little body against me seeps across my abdomen—the place where she has so recently been inside. In the big end of the lake, the sun begins to dip beneath the tree line, and my mother cuts the motor. We drift to a stop. The water beneath the boat is more than two hundred feet deep, and so even in brightest daytime it is dark and bottomless-appearing. In this half-light of dusk, the water is impenetrably black.

I stand up in the boat’s gently rocking bow to take it all in—the quiet, the soft breeze, the sky beginning to burst into a reckless orange glow. As I do, a flash. No other way to describe it. A sure knowledge that if I were to drop my baby overboard, she would sink like a stone and be gone. Fear rises in me, a heartbeat pounding in my throat as I clutch her to me and sit back down. Still, the uncertainty will not relent. Can I keep this small being safe? Can I hold her tightly enough to thwart the peril just beyond the boat’s edge? The world; this holy lake; we parents and grandparents of this child, capable swimmers who would instinctively risk our own lives to save her—suddenly none of it steadies or offers protection. There are only my untrustworthy arms, this fragile infant, and these encircling, fathomless depths.

The image of her falling from me is not a wish or an intent. It is a fear. But the fear is such a terrible one that it feels as though
thinking
it might make it so. Between the thought
(I could drop my baby overboard)
and the rational, instinctive reassurance
(But she is safe, and I would never do that)
must be a sliver of a second. What if, during that split second, some motor impulse were to act on the fearsome thought? Some senseless, wild, physical reflex of obedience—unmanaged by reason or love?

I am not by nature an anxious soul. Beyond a ride or two in careening airplanes or the moments in which I received news of serious diagnoses in loved ones, I have never before felt this degree of unremitting fear that makes me tremble, unable to breathe adequately. Never from just a thought, never without real, justifiable external cause. Never since. Back on land, the moment passes. It never returns with that degree of intensity, but similar scenarios resurrect the fear, even if its return is more muted. On a ferry ride from Vancouver to Nanaimo when our daughter is nearly one, I hold her close to me as we look over the rail at the vast expanse of mountains and sea. My heart skips, and I have to step back five feet, then ten from the railing. A year and a half later: At the height of the London Eye, safely encapsulated in our glassy pod, I hold our six-month-old son snugly in a sling. As the space opens beneath our feet, again the catastrophic—and impossible—flash that I might drop him.