Falling Into the Fire: A Psychiatrist's Encounters with the Mind in Crisis (19 page)

•   •   •

T
hinking about Anna, I felt the memories of these thoughts resurface. I remembered the boat’s edge, the glint of evening on the black lake, and I remembered having felt the steep pitch of fear. But as I remembered those moments, I felt only reflective. Analytical. Calm and secure. I did not
feel
the fear. I only recalled it.

I wonder whether the difference in these situations between someone like me, who happens to be wired on the less nervous side of things, and someone like Anna, who had told me that she had been an anxious person well before she was a mother, is attributable in large part to the persistence of the fear. I was rattled—deeply, but briefly—by isolated thoughts that I could be responsible for the deaths of my children. Anna’s violent thoughts might have been of this exact nature. Worst-case imaginings. Devastating what-ifs. And yet, unlike mine, her mind held fast to what was meant to be fleeting. She was unable to let the images go. She became haunted by the thoughts, reliving not only their content but also the terror they fueled. Anna began to believe that she was bound to carry them out if she were not somehow prevented from doing so.

It was not a coincidence that some of my most anxious moments occurred when I was a new mother. In a blog piece for
Scientific American,
the primatologist Eric Michael Johnson points out that the stress hormone cortisol increases in animals (humans included) during pregnancy and in the postpartum period. This underscores what any parent knows: that new motherhood is a stressful time. But it also means that our bodies are operating at a heightened level of vigilance. Johnson argues that increased anxiety in mothers is evolutionarily beneficial. “Natural selection,” he explains, “has provided mothers with an early warning system, one that can alert them to danger before others are even aware of the risk.”

Whether it was cortisol, or breast-feeding, or any number of other aspects of my physical and hormonal tumult, there is no question in my mind that I have never felt more like an animal than I did in my early postpartum days. I wanted to comfort my infant daughter so fully that her cry was physically painful to me. The smallest signal of her unease would send me rising from much-needed sleep, hoisting my birth-wounded body out of bed and lifting her to me to nurse. Going to her was arduous, but it was nothing compared to the discomfort I felt from her small cry.

The eeriest and most powerful example of primitive postpartum instincts I have ever observed came from Deborah, a mere eight hours after she delivered our son. Worn out from nineteen hours of labor without a wink of sleep, Deborah was finally sleeping soundly in the hospital bed. I was napping fitfully on an awkward recliner beside her when her voice awakened me.

“Christine!” she called urgently. Still primed from the excitement and fear and helplessness of Deborah’s labor, I felt a surge of adrenaline rush through my body. I leaped up to her, catastrophizing. Was she bleeding? Was she in pain? Was she safe? “That’s our son,” she said.

“What?” I asked, confused. Our baby boy had been taken to the nursery for routine testing more than an hour earlier. I had no idea what she meant.

“That’s him. He’s crying. Can you go to him?” Faintly, above the hum of the fan in our window, I heard a baby’s cry.

“Sweetheart,” I said, “get some sleep. There are a million babies on this floor. Half of them are in the nursery. I’m sure it’s not our baby.”

And here she grew more urgent—angry, even. “It’s
our son,
” she insisted. Her tired eyes brimmed with tears. She could not yet get out of bed as her body recovered from the delivery. “
Go
to him.” As any nonbirthing parent will likely understand, when my partner had endured hours of pain and the associated rigors of childbirth to bring us a child, I would have been inclined to do anything she asked of me. Still, as I padded down the long hallway to the nursery, I thought that this request—and the prospect that Deborah had identified the distant cry as our child’s—was ridiculous. After all, our son had cried for a minute at most when he was born. In the subsequent hours in which we held him, wept over him, kissed every centimeter of his perfect form, we had heard nothing more from him than sleepy snuffles.

As I approached the nursery, the cry grew louder but still, to my ear, no less indistinct. I knocked on the door and entered, only to find a swaying nurse shushing our wailing son, who was protesting mightily after his heel had been pricked for a bilirubin test.

I took him from the nurse, swaddled him, and sang to him, and he settled. I wheeled his little plastic bassinet over to our room, where Deborah had fallen back asleep. I held our boy and sat down on her bedside, nudging her awake.

“You won’t believe this!” I crowed. “It
was
our son crying!”

She looked at me with incredulity. “That’s what I
told
you,” she said, reaching out to pull our baby toward her, and then, with him in the crook of her arm, sighed back into sleep.

•   •   •

I
f Anna’s thoughts were true obsessions, she was unlikely to harm her son. However, like many psychiatric symptoms, the manifestations of anxiety run a broad spectrum. And one of the things we
do
understand about mothers who kill their children is that before the murders they are often subjected to enormous amounts of stress.

According to Eric Michael Johnson, this effect may be demonstrated in part in nonhuman primates. He cites research by Dario Maestripieri on macaque monkeys. Maestripieri has shown that the increased cortisol levels in pregnancy are “directly related to protective behaviors that keep a mother’s infant from harm,” like when I rose from sleep to feed our hungry daughter or when Deborah sent me off to rescue our son from his blood test. Mothers who are vigilant about their infants’ risks and needs are more apt to have offspring that survive, thereby promoting this alertness via natural selection.

However, just as too little maternal cortisol might leave an infant in peril, too
much
maternal cortisol—brought about by prolonged periods of stress—carries with it its own dangers. Maestripieri explains, “A large body of evidence indicates that extremely high or chronically elevated cortisol levels due to stress can impair maternal motivation and result in maladaptive parenting behavior.” That is, mothers under too much strain may have difficulty as parents. Among Maestripieri’s macaques, mothers were sometimes noted to abuse their infants. Those episodes of abuse frequently followed periods of maternal social stress.

In her enthralling book
Mother Nature,
the anthropologist Sarah Blaffer Hrdy meticulously demonstrates that in many species—including humans—mothers kill their children much more routinely than we might imagine. Blaffer Hrdy suggests that animal mothers may eliminate their offspring in direct response to biological and social circumstances. There is, she writes, plentiful biological evidence that mother “beetles, spiders, fish, birds, mice, ground squirrels, prairie dogs, wolves, bears, lions, tigers, hippopotami, and wild dogs [in] a range of conditions . . . cull their litters and abandon or cannibalize young.”

We may be able to follow—and perhaps even accept—the grim logic by which a mother bird allows an older sibling to nudge a weaker, younger fledgling out of the nest to eliminate competition for food or by which a California mouse kills its pups if it finds itself without a mate to help raise them. Still, even if we accept the logic of survival in those examples, it is difficult if not impossible for most of us to consider human mothers as capable of any similar action. And yet they are.

In his piece for
Scientific American,
Eric Michael Johnson raises this question: Since humans can consciously decide between right and wrong and can “design political systems that protect the least among us,” shouldn’t humans be better at protecting our children from maternal infanticide than, for example, “our distant monkey cousins”?

“The answer to this couldn’t be more clear,” Johnson writes. In fact, “humans
are
very different [from our monkey cousins]. . . . We’re much worse.” Blaffer Hrdy concurs. As it turns out, our human infanticidal actions are not unique among animals, but they
are
unique among primates. Infanticide “is widely documented among primates, both human and nonhuman,” she writes in
Mother Nature.
“But in other primates, the killer is almost always an unrelated individual, never the mother. Even when nonhuman primate females are implicated in infanticide, mothers don’t harm their
own
infants, they kill someone else’s. Only under the direst circumstances does a mother cease to care for her infant or actually abandon it. . . . It is not that unusual for a mother monkey to treat her baby roughly, to briefly drag it, or even punish it with a slap or threaten it with a toothy grimace—especially when she is trying to wean. But no wild monkey or ape mother has ever been observed to deliberately harm her own baby.”

Though Blaffer Hrdy is talking about nonhuman primates, it is not hard to imagine the “direst circumstances” that might face human mothers, leading them to abandon or harm their children. A study published in the
American Journal of Psychiatry
that analyzed infanticide in seventeen countries emphasizes the contribution of stressful psychosocial factors. The study found an unambiguous “pattern of powerlessness, poverty, and alienation in the lives of the women” who had killed their children.

“Because killing one’s own infant is so abhorrent to us,” Blaffer Hrdy writes, “there is a tendency to compartmentalize the mother’s actions . . . to consider her behavior in isolation from her circumstances, even though they are functionally related.”

The laws in America regarding infanticide reflect this isolated abhorrence. England and at least twenty-one countries worldwide grant leniency to mothers who can demonstrate that they killed their children during a postpartum mental disturbance. These laws, based upon Britain’s Infanticide Act of 1922, adopt the premise that a woman who has committed infanticide may have done so because “the balance of her mind [was] disturbed by reason of her not having fully recovered from the effect of giving birth.” The result of this interpretation is that the maximum charge these women can face is not murder but rather manslaughter. The definition of “infanticide” varies from one country to the next, but in New Zealand the law applies to the murder of children who are as old as ten. America, in contrast, has no federal or state laws that specifically apply to infanticide. Not only may these women be tried for murder, but, as was the case for Andrea Yates, the prosecution may seek the death penalty.

Psychiatrists already know that intense stress increases a new mother’s risk for postpartum mood disorders. And social scientists have repeatedly demonstrated that increased parental stress is a risk factor for child abuse and neglect. Stress has also, in various forms, been correlated with a mother’s risk of killing her children.

Twenty-five-year-old Lashanda Armstrong had her own share of maternal stress when she drove her van into the frigid Hudson River in 2011, killing herself and three of her four children, ages five, two, and eleven months. The fourth child, her ten-year-old son, who was born when Lashanda was only fifteen, managed to slip out the van door and swim to safety. Though Armstrong was universally described by family and friends as a concerned and highly devoted mother, news reports revealed she was struggling amid difficult life circumstances. A supervisor at her children’s day care reported that Armstrong had recently described feeling “so alone.”

“She’s a single parent. She takes great care of her kids, goes to school and works,” said the supervisor. “She really needed a helping hand.” Armstrong’s son had revealed to a teacher that his mother and stepfather, Jean Pierre, were fighting frequently due to Pierre’s alleged infidelities. Armstrong was apparently trying to obtain a court order so that he could not have contact with the children. The last time she had left their two-year-old in his care overnight, the child was found by police wandering a city street, barefoot, in a wet sweat suit. The night that Armstrong drove her children into the river, her family had contacted police, fearing that Armstrong and Pierre were “tussling.” The police reported that the couple had previously had episodes of domestic problems and that an order of protection had been issued—and subsequently violated by Pierre—in the hours immediately prior to the tragedy.
Direst circumstances.

The forensic psychologist Geoffrey R. McKee created a “Maternal Filicide Risk Matrix” in an attempt to help clinicians further assess a mother’s risk of killing her child. The matrix identifies sources of maternal stress that might combine to make a mother vulnerable to thoughts of child harm. Notably, the presence of a psychiatric disorder is only one of many risk factors. Other potential risk factors that exacerbate the mother’s risk of filicide include the following:

teenage motherhood

below-average IQ

less than a twelfth-grade education

no prenatal care

history of trauma (including physical and sexual abuse as well as childhood loss of her own mother)

denial of pregnancy

negative attitude toward pregnancy

unassisted birth

nonhospital delivery

difficult birth

absent, abusive, mentally ill, addicted parents during her own childhood

violence in partnership

substance abuse in partner

divorce

single parenthood

financial instability

unemployment

relocations

low socioeconomic status

having two or more children if under age seventeen

many children in her care

child difficult to care for

lack of sleep

There is no shortage of anecdotes that highlight the danger in this perfect storm of stressors. Andrea Yates is surely the best-known example. In addition to her documented history of postpartum psychosis, she had for a time lived with her husband, Rusty, and their four children in a 360-square-foot bus. The family had moved into a house by the time Yates delivered her fifth child, but she was still expected to homeschool the older four in the bus while simultaneously caring for her newborn daughter. She had had a string of psychiatric hospitalizations from 1999 to 2001 and an overdose attempt in 1999 after she disclosed a thought of stabbing one of her children. During a period of inpatient hospitalization, she had been so profoundly impaired and unable to care for herself that she had to be spoon-fed.