Maternal Instinct Gone Awry : A Mother Who Kills Her Child Deserves Help, Not Prison, Psychologist Says

SAN DIEGO â€”  When people ask psychologist Susan Hickman why she doesn’t write about her work, she always has the same answer.

“I tell them I don’t need to write books. My mothers are my books,� she says.

Mothers like Sheryl Lynn Massip, the young Santa Ana mother who killed her 6-week-old son by running over him with her car.

Or San Diego mother Faye Foster, whose depression was so severe she was afraid she would harm her newborn daughter or kill herself, the way her own mother had done. And Lorenza Penguelly, who threw her 5-month-old daughter into the San Diego Bay.

All three mothers suffered a little understood psychiatric disorder called postpartum psychosis. Until recently, few families understood it, few doctors recognized it, and even fewer courts would accept it as a defense in cases of infanticide.

All that is changing--and Hickman can take a lot of credit for the change. For five years she has counseled women with postpartum depression, which usually affects about 10% of all new mothers, and the more serious postpartum psychosis, which occurs in about 1% of all those afflicted with the depression. She has lobbied anyone who will listen, from doctors to politicians to educators, for compassion and treatment for victims of this baffling illness.

A Legal Issue

And now she is taking her fight to the courts. In the past year she has testified as an expert witness on behalf of several women who have killed their children while under the effects of postpartum psychosis. Partly because of her testimony, most of those mothers have received treatment--not prison terms.

“Susan is enormously important in this field. She talks to these mothers, and she gets things done,� said Dr. James Hamilton, a San Francisco psychiatrist who is known for his work on postpartum disorders.

“She has a special feeling for women with postpartum depression. All of the women and their families sense her caring and her knowledge,� said

psychiatrist Namir Damluji of San Diego.

Damluji is clinical director of the Depression Treatment Program at Alvarado Parkway Institute, where Hickman’s weekly support group for postpartum mood disorders meets. Damluji says his treatment program is the only one in the nation that allows women to be admitted with their babies.

“I don’t know of any other units in the United States that do that. A lot of women won’t seek treatment because they don’t want to be separated from their babies,� he said.

Although postpartum mental illness is not new--Hippocrates first mentioned the condition in the 4th Century BC--confusion about it persists today. Doctors are uncertain what causes it. Some argue that the upheaval of birth reactivates previous mental disorders. Others insist that the hormonal changes of birth can trigger a separate illness, unconnected to any past trauma.

‘Biochemical Illness’

Hickman has no doubts.

“Postpartum psychosis is a biochemical illness precipitated by the hormonal upheaval with the loss of the placenta at delivery,� Hickman says. “The symptoms can start anytime during the first year.�

Psychosis symptoms include inability to sleep, extreme agitation, hearing voices and religious delusions. The illness affects about one in 1,000 mothers. A small number of women are so deeply disturbed that they kill themselves or their children.

To most people, it is unthinkable that a woman could kill her child, under any circumstance. Mothers are supposed to create and nourish life; the survival of the species depends on it. When a mother kills her child, it strikes society at a deep, dark level.

“Mothers just don’t kill their babies, so it’s obvious if a mother does kill her infant she has to be severely disturbed,� Hickman says. “These are not women with moral defects. These are highly functioning, normal, all-American girls who go crazy and harm their babies after they give birth.

“This is a serious illness that robs a mother of the joy of her new motherhood,� she adds.

Can Be Treated

And it’s a temporary illness that is treatable, usually with hospitalization and anti-depressant drugs. Once a woman is identified as being prone to the illness, her subsequent pregnancies can be carefully monitored.

Europe has offered more enlightened treatment programs for postpartum psychosis for years, Hickman says, including home health nurses who care for new mothers and psychiatric wards that allow mothers to keep their babies with them. She also points to England, where a woman can not be charged with the murder of her infant during the child’s first year of life, according to the Infanticide Act of 1938.

And then she points to the United States, where change is happening much more slowly. She recites a list of women in prison, mothers whom she believes were suffering from postpartum psychosis when they killed their infants. There’s Sharon Comitz, a Pennsylvania mother who dropped her 1-month-old infant off a bridge and is serving an eight- to 20-year prison sentence. She had suffered a postpartum psychosis after her first pregnancy that had gone untreated.

There’s Penguelly, the San Diego woman whom Hickman says had to set herself on fire when she was in San Diego County jail, which does not have a psychiatric facility for women, before she was given mental treatment at a state hospital. There are the unknown mothers who kill themselves, “who just drop off the planet,� as Hickman puts it, because of postpartum depression. And there are other women in prison who write Hickman with their stories.

Steps Being Taken

But Hickman also takes heart about some positive steps. She mentions the task force on postpartum disorders of state Sen. Robert Presley (D-Riverside), of which she is a member. She talks about the work of Angela Thompson, the Sacramento nurse acquitted by reason of insanity after drowning her baby in 1983. Thompson and her husband, Jeff, have established a statewide program to help law enforcement officials identify victims of postpartum psychosis.

And Hickman says she can see an end to the “awful silence� about the disease. The number of women coming to her support group is growing and can range from five to 20, she said. She also sees women through her private practice, Postpartum Mood Disorders Clinic, which she founded with her husband, Robert, also a psychologist.

A warm woman with an earthy sense of humor and a voice that trills up and then explodes in raucous laughter when she’s excited, Hickman has five children, ranging in age from 4 to 20. A longtime counselor in child-abuse cases, she says she sees no contradiction between defending a young victim of child abuse one week and testifying for a woman who killed her child the next.

“Makes sense to me,� she says, her face crinkling with humor. And then more seriously, “Each of them is a victim. My job is to identify which is caused by abuse and which is caused by a postpartum psychosis.�

Although she is frustrated by society’s attitude toward the women she counsels, Hickman seems undaunted by the vastness of her mission. For every mother in prison, she sees a woman who is receiving treatment. For every Lorenza Penguelly, she sees a Sheryl Massip.

Massip’s case in Santa Anna in December, 1988, was a triumph for Hickman. Despite Hickman’s testimony, and that of others, that the young mother killed her son while under postpartum psychosis, a jury convicted her of murder. But in a dramatic, unprecedented move, the judge overruled the jury, saying the illness was responsible. Massip is believed to be the first woman in Southern California to successfully use the postpartum defense.

Most women Hickman helps haven’t killed their babies. But, for the new mothers, a severe depression coming so soon after a joyous birth is crippling and bewildering.

Something Not Right

Not long after her daughter’s birth, Faye Foster felt something was not right. She veered between thoughts of suicide and thoughts of harming her baby.

“There were times I would literally pray I wouldn’t hurt my baby, that I would take my own life first,� she said 18 months later.

Foster had reason to fear. Her own mother suffered such deep postpartum depression that she committed suicide when Faye was 4 weeks old. The family never talked about it.

But Foster found help before she lost control. She was hospitalized for a week, and she called Hickman.

“Susan helped me feel not so guilty. She told me I was sick, but that I was a good mother, and I would get through this. I had an uplifted feeling every time I left her,� Foster says.

Hickman says she is able to help because she doesn’t judge her mothers.

“After talking to so many mothers, I realize they are so much like me. This could have happened to me. I don’t think of myself as (being able to kill) my children, but I can understand how something could take over my mind so I could do it,� Hickman said.

“But more than that even, I think of the sadness and the grief, the devastation when a mother realizes her own hands killed her child and she has to live with that the rest of her life,� she said. “All I can tell her is she didn’t kill her child, the illness did.�