Filicide: from Medea to Mary

Abstracts

O filicídio é a manifestação extremada da violência doméstica contra a criança. Visando estudar o tema e chamar a atenção para a sua importância, os autores apresentam a descrição de uma perícia psiquiátrico-forense realizada no Instituto Psiquiátrico Forense Dr. Maurício Cardoso, de Porto Alegre, referente a um caso de duplo filicídio, seguido de tentativa de suicídio. O contexto jurídico em relação ao delito de filicídio é brevemente apresentado, assim como uma revisão de literatura do tema. É destacado o papel da doença mental grave como fator associado a certos casos de conduta filicida e sublinhada a relevância do diagnóstico precoce e da implementação de medidas terapêuticas adequadas. Os autores assinalam a necessidade do olhar atento dos agentes de saúde mental para a identificação de casos indicativos de violência contra a criança, uma vez já ser conhecida a tendência à subnotificação desses casos.

Psiquiatria forense; filicídio; infanticídio; homicídio; violência

CASE REPORT

Filicide: from Medea to Mary

Lisieux Elaine de Borba Telles^I; Paulo Soroka^II; Ruben de Souza Menezes^III

^IMSc. in Forensic Psychiatry, Universidad Nacional de La Plata, La Plata, Argentina. PhD student, Universidad Nacional de La Plata. Psychiatrist, Instituto Psiquiátrico Forense Maurício Cardoso, Porto Alegre, RS, Brazil

^IIPsychiatrist, Instituto Psiquiátrico Forense Maurício Cardoso

^IIIMSc. in Medicine and Medical Clinic, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil. Psychiatrist, Instituto Psiquiátrico Forense Maurício Cardoso e Centro Interdisciplinar de Saúde Mental (CISAME), Porto Alegre, RS, Brazil

Correspondence

ABSTRACT

Filicide is the extreme domestic violence against the child. To study the subject and draw attention to its importance, the authors present the description of a forensic-psychiatric investigation that was performed at Instituto Psiquiátrico Forense Dr. Maurício Cardoso, in Porto Alegre, Brazil. This investigation refers to a double filicide followed by a suicide attempt. The legal context and a literature review on the subject are briefly presented in this work. The role of severe mental disease is stressed as a factor associated with certain cases of filicide behavior. The authors report the importance of early diagnosis and the need to implement appropriate treatment. Attention by mental health professionals is necessary to identify likely cases of violence against the child, since these cases are known to be underreported.

Keywords: Forensic psychiatry, filicide, infanticide, homicide, violence.

Introduction

Mention to children's assassination may seem, at first sight, an exaggerated reference concerning exceptional facts. According to data from the Brazilian Department of Health, there were 211,918 deaths of children and adolescents caused by accidents and violence from 1990 to 2000. In the population aged 5-19 years, external causes are the main cause of death, surpassing even infectious and parasitical diseases.¹ In addition, reality shows that, in terms of child victims, aggressors are usually their own parents. Unfamiliar individuals account for most aggressions against adolescents and adults.^1-3

Idealization of mothers' love for their children and the underlying denial of aggressive aspects that, at different levels, are present in this relationship are factors that, due to defensive reasons, create obstacles to the full acknowledgment of repeated aggression against children both in its more silent expressions - abandonment and negligence - and in its most extreme manifestation: filicide.⁴ The latter acquires a wider expression, as outlined by Rascowsky, when claiming that society as a whole destroys, mutilates and mortifies young people, such as in war times.⁵

An important movement in the sense of progressive acknowledgement of domestic violence against children, in its full range of manifestations, occurred in the early 1960's, when Kempe described the battered-child syndrome, which included varied lesions caused by different types of blows, injuries and traumas, leading to the victim's death in 25% of cases.⁶ Known cases account for only 1/4 of cases occurring in communities; most of them do not receive proper follow-up because they are not reported. In addition, only a minority of women who commit infanticide are convicted, and sentences are usually mild.^7-9

However, the cultural opposition against accepting the reality of children's assassination is significant. This situation finds significant expression in semantics: until the mid-1970's, the term "filicide" was not included in important American publications, and "infanticide" was the closest term in meaning.⁵ This fact is in disagreement with denial and underreporting of domestic violence, under allegation of the "sacred family."¹⁰ Paradoxically, the parents' criminal attitude has a clear expression in mythology, where the assassination of the first born is recurrent, followed by threats or partial mutilation against the siblings. In the Greek tragedy, Medea kills their two children as retaliation against Jason, her betraying husband. In ancient Greece and Rome, the assassination of newborns was considered as a right of the family head, as a way to determine legal offspring.¹¹ In the Middle Ages this fact, although considered illegal, was tolerated, as a form of controlling family size.

A survey performed by the Brazilian Multiprofessional Association of Childhood and Adolescence Protection (ABRAPIA) found that 44.3% of homicides against children occur in the domestic context, and their parents are responsible in 34.4% of cases.¹ The assassination of infants in the first 24 hours of life is almost always committed by their own mothers, and there is no difference as to the victim's gender.¹²

Resnick reviewed the scientific literature on the assassination of children by their parents from 1751 through 1967, dividing aggressors into two groups:

- Neonaticides: those who killed their child in the first 24 hours of life. There was no prevalence of psychotic disorders in this group, but of undesired pregnancy due to illegitimacy, rape or because the pregnancy is experienced as an obstacle to the parents' ambition.

- Filicides: those who killed their child after 24 hours. The author subdivided this group into altruistic filicide, psychotic filicide, unwanted child filicide, fatal maltreatment, and filicide motivated by spouse revenge (Medea).^13,14

In Brazil, Mendlowicz et al. studied the population of women who killed their child in the first 24 hours in the city of Rio de Janeiro from 1900 to 1995. Although there was a report of psychiatric complaints, only one of the accused women was diagnosed with mental retardation; the others were considered sane from the psychiatric perspective.^7,11

The importance of mental disease as a determinant of filicide has been stressed by several authors.^13,15-18 Castaño-Henao, in a study performed on the filicide population of Colombia from 1998 through 2003, found prevalence of mothers as violence agents and presence of chronic maltreatment as a risk factor for this crime. The researcher outlined mental disease, followed by fatal maltreatment as causes of this conduct. Psychotic filicide mothers used guns more frequently, were older and killed older children compared with the group of nonpsychotic mothers.¹⁹

Menezes stressed that, regarding mental patients, there is a delusional distortion of thought, and filicide conduct is an expression of delusional ideation. The author reports a case that occurred at the Instituto Psiquiátrico Forense (IPF): the mother tried to kill her child under the influence of mystic ideation, according to which she believed that the family would be saved from demonic influences by sacrificing her child.¹⁶

This study aims at presenting a psychiatric-forensic report of legal accountability at the IPF in which the crime was a filicide, drawing attention to the vicissitudes of family violence in its varied manifestations, in addition to stressing the association between untreated severe mental disease and violent conduct. It is known that these phenomena, when properly diagnosed and treated, can be avoided or minimized. The forensic expert signed an informed consent form after agreeing to participate in the case study.

Legal Context

The assassination of children by their mothers can be classified by the Brazilian Penal Code (in effect since 1940) according to the situation:²⁰

- Article 123 - filicide, i.e., "killing one's own child under the influence of puerperal psychosis during delivery or soon after."

- Article 121 - homicide.

In the Brazilian penal system, the crime of filicide has a lower sentence than that predicted for homicides. For that, it is necessary to have a confirmation by forensic-psychiatric investigation of the existence of "puerperal psychosis" and also presence of causal relation with the crime. This examination can be performed during inquisition, aiming at a closer temporal proximity with the facts.

A causal relation must be present because, although filicide is often described as being cause by a puerperal transient phenomenon, it is believed that it can be more related to other factors, such as previous psychopathology.²¹

In cases of homicide in which there is doubt as to the mother's mental integrity, based on Article 149 of the Brazilian Penal Code, an incident of mental insanity can be established, suspending the process until receiving the report of the Penal Imputability Exam.²²

In the State of Rio Grande do Sul, the IPF is responsible for forensic investigations and for the treatment of defendants that are punished with a criminal commitment for being considered unimputable due to mental disease.

Summary of forensic-psychiatric report

M., 26 years old, separated, housewife. She was referred for assessment as a convict defendant who avowed committing crime of homicide against her two daughters. Personal history showed two previous hospitalizations. Suicidal ideation and hearing hallucinations were present in the first; and tachylalia, euphoria, insomnia, and delusions of grandeur were reported in the second. There was also a previous attempt of filicide. Diagnostic hypothesis came to be bipolar affective disorder.

Her history shows her parents' separation and a first crisis in adolescence, including hospitalization. She met her partner when she was 19, and they went to live together after knowing she was pregnant. They had two daughters. The partner, who was jealous, used to attack her physically. There were frequent fights, in which both lost control, breaking objects at home. One year before the crime, after a violent fight, her partner wanted to separate. At that time, M. started having religious interests. When her partner wanted to come back home, after ending a new relationship he had started, she perceived herself as "paranoid," in her own words: "he treated me as if I were a prostitute, did everything in bed, and I hated him for that. Then, when I wanted to be with him, he didn't want it anymore: he wanted to be with other women." She was experiencing a conflict between religious interests and her partner's sexual demands at that time.

The woman described herself as a careful mother who liked her daughters very much. J., the ex-partner, said that M. had periods of insomnia, loss of initiative, mutism. In those occasions she was careless with her daughters. There was also reference to periods of agitation, irritability, aggressiveness, "accelerated" conduct, ideas of grandeur, and violence. She once set fire to her house, placing her daughters and herself at risk. She had mystic ideas, in which she referred to her partner as "Judas," or alternatively as "the Devil."

The women described her crime as follows:

"I killed my little girls, one was 3 and other was 5, and then I wanted to kill myself: I slit my wrists and throat, but I couldn't do it. I hadn't slept for 2 weeks, I was taking chlorpromazine and imipramine for 3 years, but it was not having any result. I got nervous. My ex-husband was with me and with other women. I did it as a revenge. I was nervous and nobody was there to help me. I wondered if this feeling would go away, if I would go back to sleep. I couldn't do anything right. I had already tried it, but I set fire to my house and wanted to drown the little one in the bathtub. At that time, this happened because he wasn't working. If the neighbors hadn't helped me, the gas tank would have exploded. This happened 3 years ago. Since then I've been under treatment. At that time, I used to listen to voices, it seemed as if the TV was on inside my mind."

On mental health examination when the crime was committed she had hearing hallucinations. Her memory had no changes. Her conscience was lucid. Her thought was predominantly magical, with delusive jealousy and suicide ideation and of a mystic nature. Tachylalia was present in her language, alternating with mutism. Intelligence, untested on clinical assessment, is median. Jealousy and mistrust were present in affection, with periods of depressive mood, alternating with periods of irritability. Her behavior was marked by homicide crimes, her daughters being the victims. She reported previous periods of insomnia, inappetence, isolationism, hypoactivity, suicide attempts, aggressiveness, and withdrawal periods. There was incendiary conduct and previous attempt of filicide.

Collected data indicated the woman had a bipolar affective disorder, in which periods of mania - irritability, tachylalia, aggressiveness, mystic interests - are typically alternated with depressive episodes (withdrawal, hypoactivity, mutism, carelessness about usual interests). Her disorder was manifested as severe manic and psychotic symptoms.

Legal medical comments stress that the diagnosis of bipolar affective disorder corresponds to what the lay postulates as mental disease, in which there is rupture of the contact with reality, including its ethic and normative aspects. Both her judgment and ability of self-determination were compromised, and her criminal conduct was determined by delusional stimuli to the detriment of considering the objective reality. Once the causal relation between mental disease and crime is established, the defendant is characterized as unimputable, and is protected by the Article 26 caption of the Brazilian Penal Code.

This expert opinion was accepted by the judge, leading M. to a not guilty verdict. She was given a criminal commitment for 3 years.

Final considerations

This brief literature review, illustrated with the report of an expert investigation performed at the IPF, aimed at drawing attention to two aspects: dangerousness of patients with untreated severe mental disease and the crime of filicide, herein understood as the extreme expression of a wide range of manifestations of violence against children, especially in home settings.

Remembering that multifactorial dimension of family violence against children, in which the social issue stands out in Brazil and in other emerging countries, severe mental disease plays a major role as the triggering factor of certain cases of filicide conduct. Hence, early diagnosis and implementation of proper therapeutic measures are relevant to minimize occurrence of violence, either domestic or in the mental health context, in its varied manifestations. In the present case, for example, personal history reveals past filicide attempt.

At time when it is so important to maintain mental patients with their families, it is relevant to stress the importance of assessing risk of violent conduct in severe mental patients with history of comorbid conditions, fragile adherence to previous therapeutic measures and without proper family support. Therapeutic measures maybe need for these cases, including hospitalization, as an opportune resource to prevent severe offenses.

References

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• 14. Resnick PJ. Murder of the newborn: a psychiatric review of neonaticide. Am J Psychiatry. 1970;126(10):1414-20.
• 15. Bourget D, Gagné P. Paternal filicide in Québec. J Am Acad Psychiatry Law. 2005;33(3):354-60.
• 16. Menezes R. Esquizofrenia e liberdade. Reforma psiquiátrica, manicômio judicial e a era da saúde mental. Porto Alegre: Armazém Digital; 2005.
• 17. Nogueira JA. Atuação homicida contra os filhos: estudo clínico-dinâmico de 14 casos [trabalho de conclusão de curso de especialização em psiquiatria]. Porto Alegre: UFRGS; 1976.
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"

Medea, pointing to her dead children.

They no longer exist. You shall suffer for that, Jason."

^*

Publication Dates

• Publication in this collection
  01 Dec 2008
• Date of issue
  Apr 2008

History

• Accepted
  11 Mar 2008
• Received
  25 Aug 2007