Advocating for Women with Postpartum Psychosis takes the reader into the world of one of the most misunderstood mental illnesses. Affecting 1 to 2 out of 1,000 childbearing women a year in the United States, postpartum psychosis creates hallucinations and delusions, which, if untreated, can lead to infanticide and subsequently imprisonment or death for the mother. While other parts in the world, particularly the United Kingdom have more sympathetic laws, in the United States, women with postpartum psychosis are often stigmatized as "baby killers", and face the ultimate penalty. Through this book, though, authors Feingold and Lewis humanize the mother's experience to promote understanding and compassion. Beginning with an overview of the mental health and legal facets surrounding postpartum psychosis, the authors then provide vital resources and tools for mental health practitioners and legal professionals to enact change in their practices and communities. Complete with case studies and the authors' experiences in changing the law in their own state of Illinois, this book is a necessary resource for furthering dialogue and action around maternal mental illness.
PrefacePrologue (Barry)Introduction (Susan): Explains the importance of understanding postpartum disorders and postpartum psychosis in order to change laws and transform the national climate Part I: Understanding and Treating Women with Postpartum PsychosisChapter 1: Perinatal Mental Illness is a Serious Risk to Women and Families (Susan)Differentiation between postpartum depression and the rare, most serious form of the illness, postpartum psychosis (PPP). An explanation of the signs and symptoms, risk factors and prevalence of various postpartum disorders from the mildest baby blues to postpartum depression and the most severe, postpartum psychosis. Includes information distinguishing the various subtypes of postpartum mood disorders, the most common complication of childbirth, affecting nearly a million sufferers each year. While PPP is less common than postpartum depression, it accounts for hundreds of infanticides and suicides, many of them notorious. Many are the result of ""altruistic infanticides"" or ""command hallucinations"" and there is an urgency to treat this illness as a crisis and an emergency situation to prevent possible dreadful outcomes.Finally give the case in my practice where a phone call by a husband, and my quick response averted a potential tragedy. Chapter 2: The Silence and Stigma that is a Deadly Combination for those with Postpartum Psychosis (Susan)Education and early intervention are critical to prevent catastrophic outcomes. Conversely the caveat in order to have this happen is for the woman and family to disclose signs and symptoms to both healthcare and mental health professionals. Yet the stigma of serious mental health problems and fear of being regarded as a ""bad mother"" leads to silence which often does not encourage openness but rather a wall of silence and shame. Discuss the poignant story of Cynthia Wachenheim. This chapter is planned to include an interview with her sister, Karen who became an Advocate for PPP and Board Member of Postpartum Support, International. This is a great case to de-stigmatize women who get PPP, as Cynthia was a brilliant attorney and well-respected lawyer in NYC, who wrote position papers for judges, yet left an incoherent suicide note. Tragically, she strapped her infant child to her chest and jumped from her 8th floor apartment to their mutual intended death. This was to protect her child from a lifetime of suffering from what she believed were his disabilities. These disabilities existed only in her delusional mind. She landed on her back, dead, and the child protected by her mother's dead body suffered only mild injuries. If Cynthia's family had only understood what was happening to her, that she was having psychotic delusional thoughts about her son, they might have been able to save her by having her hospitalized. Legally, it is also an example of a case that could have been tried in the courts had Cynthia survived and the infant died instead. With the present laws it is likely she would have been charged with murder and spent years or a lifetime in prison.
Chapter 3: The Legal Implications of Postpartum Illness in the Criminal Justice System (Barry)The risk of neonaticide and infanticide, although only a small number of those with PPP, are dealt with in the justice system. These women though treated like any other homicide in the U.S. are different, as they are suffering from a severe mental illness that is unique to childbirth. In the UK there have been infanticide laws since 1938, and similar laws exist in 30 other countries. A brief history of the law and the limitations of current laws regarding insanity and PPD/PPP. A discussion of the law of murder, and the limitations of current laws regarding the insanity defense and postpartum disorders like severe postpartum psychosis. A particular fact of importance to the legal system is how the psychosis waxes and wanes, and can appear suddenly. This can have tremendous effects on the outcome in the legal system, and makes this illness unique and difficult to defend. The law is inconsistent in the U.S. and varies from state to state and cases are treated differently in different parts of the country. Some women have been given probation whereas there are states where a woman may be given life in prison without the possibility of parole or even the death penalty. Discuss the case of Andrea Yates of Texas. Yates drowned her five children, as a result of her delusional religious beliefs and ""command"" hallucinations. Andrea had been a valedictorian of her high school, had a career in nursing which she ultimately gave up as a deeply religious person to raise and home school her five children. This case is cited as a successful use of the insanity defense. However, it was only possible to establish that defense after a retrial occasioned by the discovery of false, possibly perjurious, testimony at the first trial. Many Texans were outraged by the outcome and called for the death penalty for Andrea. The issue of ""knowing"" right from wrong is critical. While the witness for the prosecution testified that Yates was responsible for the deaths of her children because she knew right from wrong at the time of the act (Grinfield 2002), the expert for the defense testified, ""even though she knew it was against the law, she did what she thought was right in the world she perceived through her psychotic eyes at the time"" (Spinelli, 2003). Yates motivation was to kill the children before they would reach the age where they could, and would, be sent to hell for eternity; an example of what is known as ""altruistic filicide"" where a mentally ill mother kills her children ultimately to save them.
Chapter 4: Laws of Neonaticide and Infanticide in Countries outside the U.S (Barry) Discussion of the UK's British Infanticide Law of 1922 and how this evolved into The Infanticide Act of 1938. Discussion of postpartum criminal laws of infanticide in 30 other countries. How in 2009 Texas tried to introduce legislation similar to the British Infanticide Law but failed to gain any traction and was defeated. Discuss the case of Carol Coronado of California. She stabbed her three children to death, and tried to kill herself. Coronado spent a lifetime suffering from mental illness. The day of the murders her behavior was bizarre. The prosecution's first hired gun refused to find her sane, and opined in fact she was insane. The prosecution's second hire testified she may have been ""mildly depressed"" at times. A criminal court judge found her sane and sentenced her to three consecutive life terms plus three years, saying she needs mental health treatment--she can get that in the penitentiary. Had Carol lived in the UK or 30 other countries, she would have likely been charged with a misdemeanor and served 6 or less years in the penitentiary or she might have been sent to a mental health facility instead for psychiatric treatment instead of a life in prison. Part II: Advocating for Women with Postpartum PsychosisChapter 5: PA 100-0574 Illinois' New Postpartum Law and our Role in the Process (Susan) Discuss how it all started with Bill Ryan and HB1764 to eventually become the first law in the nation identifying PPD and PPP as ""mitigating factors"" in sentencing. How we got involved and why we had to persist to usher the legislation each step of the way to become a law on June 1st 2018. Also, discuss what the new Illinois law, PA100-0574: what it is, what it does and does not accomplish. Until the passage of PA100-0574, only executive clemency and a pardon from the Governor was available to incarcerated women in IL who had long or life-time sentences. An example of an IL woman who was granted executive clemency is included in this chapter. It is the story of Debra Gindorf, who attempted suicide and killed her two children in 1985, an example of ""altruistic filicide"" during an episode of postpartum psychosis. Susan served as an expert witness who testified before the prison review board in 2002. Gindorf was finally released with a pardon from the Governor in 2009.
Chapter 6: Letters from Illinois Prisoners: Assistance toward Re-sentencing (Susan and Barry) We have received letters from about 10 women in Logan Correctional Center thanking us and hoping for release following decades of incarceration. This is a first step toward a more responsible set of laws which would consider this a disease, exemplified by the British Infanticide Act. The 10 women incarcerated in IL who have contacted us, plan to file for re-sentencing hearings since PA 100-0574 passed. This chapter may tell the story of one or two of these women, and may include interviews with a few of these incarcerated women.
Chapter 7: The Steps for Professionals to Advocate and Enact Legal Change (Susan and Barry) This chapter will provide a specific set of steps to pass postpartum and other legislation. We are currently consulting with advocates and legislators in MA who are planning to be roll out PPP legislation in 2019. Our goal with PA100-0574 was to start with Illinois, but continue this endeavor with legislation throughout the nation. There is discussion of the importance of the correct name for legislation to garner a law the public will support. Discussion will include ways to appeal to mental health professionals as well as defense attorneys to sponsor legislation and promote change through legal advocacy. This chapter is planned to include interviews with the state sponsors of IL PA 100-0574, Representative Linda Chapa LaVia and Senator Toi Hutchinson.
Chapter 8: Working with Local Issues, State and Federal Laws for Change (Barry and Susan) This chapter will discuss ideas for getting involved with change on a local level, as well as how to enact legislative changes on the state and federal level. Discussion of advocacy training will be included, such as provided by Restore Justice, an Illinois group that has decades of experience educating and leading criminal justice reform work in Illinois.
Chapter 9: How to Partner and Work with Influential Organizations (Susan and Barry) This chapter will focus on garnering support from influential organizations and like-minded individuals to support and implement your proposed legislation. In the case of PA 100-0574, The Center on Wrongful Convictions at Northwestern School of Law, 2020Mom and Postpartum Support, International have assisted. Whatever legislation you are working on, you cannot do it alone! We need to get other influential organizations and individuals involved. This is the true meaning of, ""It takes a village.""
Chapter 10: Fostering New Initiatives Nationwide (Susan) The new IL law PA 100-0574 has helped to promote new programs and renew interest in postpartum psychosis. Postpartum Support, International has created a task force to address issues and encourage research in postpartum psychosis. This task force will help to further the cause of education, promoting early mental health intervention and de-stigmatize this disorder so that women and families aren't suffering in silence or ignoring signs and symptoms that lead to catastrophic outcomes.
Chapter 11: Networking and Support for Postpartum Psychosis: Help from Our Friends (Susan and Barry) The secretiveness and stigma of PPP has encouraged sufferers to develop online support and affiliation through Facebook Closed Groups and sub-groups within organizations such as Postpartum Support, International and the Marce Society of North America. Discussion of the case of Heather and how talking to friends for support averted a tragic outcome. Heather had planned to commit suicide and to take the life of the child she thought could not survive without her. In her psychotic mind, she enlisted a friend to help her, who ultimately saved her life and the life of her child by having her hospitalized.
Chapter 12: Conclusions and the Case for Reduced Infant Mortality Linked to Postpartum Psychosis (Susan and Barry) Infant mortality rates in IL have recently been published to meet the Healthy People 2020 objective of 6.0 deaths per 1,000 live births. How many of these deaths are connected to a mother who has a mental illness like postpartum psychosis? Greater awareness and prompt treatment of PPP will likely lower mortality rates. Our hope for the future is there will be less catastrophic outcomes when women experience postpartum psychosis. Destigmatizing postpartum disorders and more education will encourage more openness and promote prompter and successful treatment. Yet, in those cases when the worst tragedy ensues, new state laws as Illinois PA 100-0574 will lead to better outcomes. Our goal is having more understanding to foster humane laws throughout the nation.
PrefacePrologue (Barry)Introduction (Susan): Explains the importance of understanding postpartum disorders and postpartum psychosis in order to change laws and transform the national climate Part I: Understanding and Treating Women with Postpartum PsychosisChapter 1: Perinatal Mental Illness is a Serious Risk to Women and Families (Susan)Differentiation between postpartum depression and the rare, most serious form of the illness, postpartum psychosis (PPP). An explanation of the signs and symptoms, risk factors and prevalence of various postpartum disorders from the mildest baby blues to postpartum depression and the most severe, postpartum psychosis. Includes information distinguishing the various subtypes of postpartum mood disorders, the most common complication of childbirth, affecting nearly a million sufferers each year. While PPP is less common than postpartum depression, it accounts for hundreds of infanticides and suicides, many of them notorious. Many are the result of "altruistic infanticides" or "command hallucinations" and there is an urgency to treat this illness as a crisis and an emergency situation to prevent possible dreadful outcomes.Finally give the case in my practice where a phone call by a husband, and my quick response averted a potential tragedy. Chapter 2: The Silence and Stigma that is a Deadly Combination for those with Postpartum Psychosis (Susan)Education and early intervention are critical to prevent catastrophic outcomes. Conversely the caveat in order to have this happen is for the woman and family to disclose signs and symptoms to both healthcare and mental health professionals. Yet the stigma of serious mental health problems and fear of being regarded as a "bad mother" leads to silence which often does not encourage openness but rather a wall of silence and shame. Discuss the poignant story of Cynthia Wachenheim. This chapter is planned to include an interview with her sister, Karen who became an Advocate for PPP and Board Member of Postpartum Support, International. This is a great case to de-stigmatize women who get PPP, as Cynthia was a brilliant attorney and well-respected lawyer in NYC, who wrote position papers for judges, yet left an incoherent suicide note. Tragically, she strapped her infant child to her chest and jumped from her 8th floor apartment to their mutual intended death. This was to protect her child from a lifetime of suffering from what she believed were his disabilities. These disabilities existed only in her delusional mind. She landed on her back, dead, and the child protected by her mother's dead body suffered only mild injuries. If Cynthia's family had only understood what was happening to her, that she was having psychotic delusional thoughts about her son, they might have been able to save her by having her hospitalized. Legally, it is also an example of a case that could have been tried in the courts had Cynthia survived and the infant died instead. With the present laws it is likely she would have been charged with murder and spent years or a lifetime in prison. Chapter 3: The Legal Implications of Postpartum Illness in the Criminal Justice System (Barry)The risk of neonaticide and infanticide, although only a small number of those with PPP, are dealt with in the justice system. These women though treated like any other homicide in the U.S. are different, as they are suffering from a severe mental illness that is unique to childbirth. In the UK there have been infanticide laws since 1938, and similar laws exist in 30 other countries. A brief history of the law and the limitations of current laws regarding insanity and PPD/PPP. A discussion of the law of murder, and the limitations of current laws regarding the insanity defense and postpartum disorders like severe postpartum psychosis. A particular fact of importance to the legal system is how the psychosis waxes and wanes, and can appear suddenly. This can have tremendous effects on the outcome in the legal system, and makes this illness unique and difficult to defend. The law is inconsistent in the U.S. and varies from state to state and cases are treated differently in different parts of the country. Some women have been given probation whereas there are states where a woman may be given life in prison without the possibility of parole or even the death penalty. Discuss the case of Andrea Yates of Texas. Yates drowned her five children, as a result of her delusional religious beliefs and "command" hallucinations. Andrea had been a valedictorian of her high school, had a career in nursing which she ultimately gave up as a deeply religious person to raise and home school her five children. This case is cited as a successful use of the insanity defense. However, it was only possible to establish that defense after a retrial occasioned by the discovery of false, possibly perjurious, testimony at the first trial. Many Texans were outraged by the outcome and called for the death penalty for Andrea. The issue of "knowing" right from wrong is critical. While the witness for the prosecution testified that Yates was responsible for the deaths of her children because she knew right from wrong at the time of the act (Grinfield 2002), the expert for the defense testified, "even though she knew it was against the law, she did what she thought was right in the world she perceived through her psychotic eyes at the time" (Spinelli, 2003). Yates motivation was to kill the children before they would reach the age where they could, and would, be sent to hell for eternity; an example of what is known as "altruistic filicide" where a mentally ill mother kills her children ultimately to save them. Chapter 4: Laws of Neonaticide and Infanticide in Countries outside the U.S (Barry) Discussion of the UK's British Infanticide Law of 1922 and how this evolved into The Infanticide Act of 1938. Discussion of postpartum criminal laws of infanticide in 30 other countries. How in 2009 Texas tried to introduce legislation similar to the British Infanticide Law but failed to gain any traction and was defeated. Discuss the case of Carol Coronado of California. She stabbed her three children to death, and tried to kill herself. Coronado spent a lifetime suffering from mental illness. The day of the murders her behavior was bizarre. The prosecution's first hired gun refused to find her sane, and opined in fact she was insane. The prosecution's second hire testified she may have been "mildly depressed" at times. A criminal court judge found her sane and sentenced her to three consecutive life terms plus three years, saying she needs mental health treatment--she can get that in the penitentiary. Had Carol lived in the UK or 30 other countries, she would have likely been charged with a misdemeanor and served 6 or less years in the penitentiary or she might have been sent to a mental health facility instead for psychiatric treatment instead of a life in prison. Part II: Advocating for Women with Postpartum PsychosisChapter 5: PA 100-0574 Illinois' New Postpartum Law and our Role in the Process (Susan) Discuss how it all started with Bill Ryan and HB1764 to eventually become the first law in the nation identifying PPD and PPP as "mitigating factors" in sentencing. How we got involved and why we had to persist to usher the legislation each step of the way to become a law on June 1st 2018. Also, discuss what the new Illinois law, PA100-0574: what it is, what it does and does not accomplish. Until the passage of PA100-0574, only executive clemency and a pardon from the Governor was available to incarcerated women in IL who had long or life-time sentences. An example of an IL woman who was granted executive clemency is included in this chapter. It is the story of Debra Gindorf, who attempted suicide and killed her two children in 1985, an example of "altruistic filicide" during an episode of postpartum psychosis. Susan served as an expert witness who testified before the prison review board in 2002. Gindorf was finally released with a pardon from the Governor in 2009. Chapter 6: Letters from Illinois Prisoners: Assistance toward Re-sentencing (Susan and Barry) We have received letters from about 10 women in Logan Correctional Center thanking us and hoping for release following decades of incarceration. This is a first step toward a more responsible set of laws which would consider this a disease, exemplified by the British Infanticide Act. The 10 women incarcerated in IL who have contacted us, plan to file for re-sentencing hearings since PA 100-0574 passed. This chapter may tell the story of one or two of these women, and may include interviews with a few of these incarcerated women. Chapter 7: The Steps for Professionals to Advocate and Enact Legal Change (Susan and Barry) This chapter will provide a specific set of steps to pass postpartum and other legislation. We are currently consulting with advocates and legislators in MA who are planning to be roll out PPP legislation in 2019. Our goal with PA100-0574 was to start with Illinois, but continue this endeavor with legislation throughout the nation. There is discussion of the importance of the correct name for legislation to garner a law the public will support. Discussion will include ways to appeal to mental health professionals as well as defense attorneys to sponsor legislation and promote change through legal advocacy. This chapter is planned to include interviews with the state sponsors of IL PA 100-0574, Representative Linda Chapa LaVia and Senator Toi Hutchinson. Chapter 8: Working with Local Issues, State and Federal Laws for Change (Barry and Susan) This chapter will discuss ideas for getting involved with change on a local level, as well as how to enact legislative changes on the state and federal level. Discussion of advocacy training will be included, such as provided by Restore Justice, an Illinois group that has decades of experience educating and leading criminal justice reform work in Illinois. Chapter 9: How to Partner and Work with Influential Organizations (Susan and Barry) This chapter will focus on garnering support from influential organizations and like-minded individuals to support and implement your proposed legislation. In the case of PA 100-0574, The Center on Wrongful Convictions at Northwestern School of Law, 2020Mom and Postpartum Support, International have assisted. Whatever legislation you are working on, you cannot do it alone! We need to get other influential organizations and individuals involved. This is the true meaning of, "It takes a village." Chapter 10: Fostering New Initiatives Nationwide (Susan) The new IL law PA 100-0574 has helped to promote new programs and renew interest in postpartum psychosis. Postpartum Support, International has created a task force to address issues and encourage research in postpartum psychosis. This task force will help to further the cause of education, promoting early mental health intervention and de-stigmatize this disorder so that women and families aren't suffering in silence or ignoring signs and symptoms that lead to catastrophic outcomes. Chapter 11: Networking and Support for Postpartum Psychosis: Help from Our Friends (Susan and Barry) The secretiveness and stigma of PPP has encouraged sufferers to develop online support and affiliation through Facebook Closed Groups and sub-groups within organizations such as Postpartum Support, International and the Marce Society of North America. Discussion of the case of Heather and how talking to friends for support averted a tragic outcome. Heather had planned to commit suicide and to take the life of the child she thought could not survive without her. In her psychotic mind, she enlisted a friend to help her, who ultimately saved her life and the life of her child by having her hospitalized. Chapter 12: Conclusions and the Case for Reduced Infant Mortality Linked to Postpartum Psychosis (Susan and Barry) Infant mortality rates in IL have recently been published to meet the Healthy People 2020 objective of 6.0 deaths per 1,000 live births. How many of these deaths are connected to a mother who has a mental illness like postpartum psychosis? Greater awareness and prompt treatment of PPP will likely lower mortality rates. Our hope for the future is there will be less catastrophic outcomes when women experience postpartum psychosis. Destigmatizing postpartum disorders and more education will encourage more openness and promote prompter and successful treatment. Yet, in those cases when the worst tragedy ensues, new state laws as Illinois PA 100-0574 will lead to better outcomes. Our goal is having more understanding to foster humane laws throughout the nation.
