- Published: November 28, 2012
During the postpartum period, the time immediately after a woman gives birth, the mother is at the greatest risk of developing a mental illness. Arguably the most severe of these mental illnesses is postpartum psychosis, defined as an “extended period of loss of contact with reality that may include auditory or visual hallucinations, delusions, or rapid mood swings. The auditory and visual hallucinations may focus on violence toward self or the infant"(Nau et al. 2012). 4% of women with postpartum psychosis commit infanticide (kill their children of less than one year of age).
There are two standards that the legal system uses to determine the defendant’s sentence, depending on the state. First, the M’Naughten standard serves to show that the defendant understood the difference between right and wrong during the commission of the crime. The second standard is the Model Penal Code (MPC). In addition to having a cognitive test to show that the defendant understood right from wrong, there is also an irresistible-impulse test that says the defendant had the capability to behave according to the law.
The authors of the article “Postpartum Psychosis and the Courts” (2012) conducted a literature review of 34 postpartum psychosis cases to see if the outcomes of these women’s trials differed depending on the type of standard. In states that used the M’Naughten standard, the results were as follows: in 46% of cases, defendants were found not guilty by reason of insanity (NGRI), 46% were convicted, and 7% were found guilty but mentally ill. In states that sued the MPC standard, 43% of cases were found NGRI, 43% were convicted, and 14% were guilty but mentally ill. Therefore, there does not seem to be a large difference in outcome of trials based on the type of standard used. The insanity defense is fairly successful in postpartum psychosis cases, and the outcomes appear uniform across different jurisdictions, which is fortunate.
Nau et al. found that defendants who successfully plead NGRI had acute psychosis and major severe depression. One example of this is Andrea Yates, who was found NGRI in a retrial on the basis that she did not know that what she did was wrong. One major problem with the law’s understanding of postpartum psychosis is that cognitive changes can occur rapidly. The reason that Andrea Yates was found guilty in the first trial was that she reported the murders to the police, therefore seeming to understand the difference between right and wrong. Nau et. al explain that “[b]ecause fluctuating mental status is a common attribute of postpartum psychosis, some have argued that a mother’s efforts to contact the police after the killing should not be admissible as evidence of knowledge of right and wrong at the time of the killing” (p. 322). This element of postpartum psychosis should be clearly explained to the jury to avoid further confusion.
In the future, there is a possibility of having more concrete scientific evidence (e.g. biomarkers) that could help make the case that a woman presents with postpartum illness. The authors write that federal courts might require a test that shows serotonin or norepinephrine imbalances. Unfortunately, these chemical tests could fluctuate rapidly, so the likelihood of this evidence being successfully admitted is slim.
Nau, Melissa L., Dale E. McNiel, and Renée L. Binder. 2012. “Postpartum Psychosis and the Courts.” Journal of the American Academy of Psychiatry and the Law Online 40(3):318–325. Assessed from < http://www.jaapl.org/content/40/3/318.full.pdf+html>.