The doleful litany goes on and on. What can possibly explain such horrific acts? Increasingly, doctors and psychiatrists are pointing to temporary mental breakdown in the months after giving birth, postpartum disorders that can range from mild depression to full-blown psychosis. Medical experts have long known that though the year after the birth of a child may be one of the most joyful times in a woman's life, it is also among the most stressful. Between 50% and 80% of new mothers experience an emotional letdown, known as the "baby blues," and become sensitive, moody and tearful. Such feelings usually disappear within a couple of weeks.
However, about 8% to 12% of women who give birth suffer a blacker torment and become seriously depressed for months. They undergo mercurial mood swings, lose their appetite and go sleepless for nights on end. Plagued by thoughts of ; suicide or fantasies of killing their baby by dropping it down the stairs, burying it in the backyard or cutting it up with a kitchen knife. "These are invasive, terrifying ideas that can drive them crazy," says Psychiatrist Ricardo Fernandez, of Princeton, N.J. "A lot of women have a tremendous amount of guilt and shame because of these thoughts."
Most never act on the dark impulses, but a few new mothers -- less than 1% -- become psychotic. These may suffer extreme agitation, feel persecuted and begin hallucinating. Angela Thompson of Sacramento drowned her nine-month-old son in the bathtub after hearing the voice of God tell her the child was the devil. It has been five years since her son's death, but her recollection of her mental state is still vivid. "I thought if I killed the baby that my husband would raise him to life again in three days and that the world would know that my husband was Jesus Christ," she explains. "When he was dead, I thought his face was contorted like the devil's."
Postpartum mental disorders are so far poorly understood. Psychiatrists debate whether they are distinct forms of depression or psychosis. The Diagnostic and Statistical Manual of Mental Disorders (III), the profession's bible, does not list postpartum problems separately. No one is exactly sure what causes these mental conditions, but both physical and psychological explanations have been suggested. "A woman is undergoing a tremendous hormonal upheaval around the time of childbirth," says Nancy Reame, a women's health researcher at the University of Michigan. During pregnancy, estrogen and progesterone increase a thousandfold, then abruptly drop to normal or sometimes below normal after birth, which may precipitate sudden emotional disorders. Breast feeding is also accompanied by major hormonal changes.
Caring for a newborn is demanding physically and emotionally, a task that many women are ill prepared for. New mothers today often lack a support structure to relieve them of the added pressures and the continuing strains of everyday living.
Medical treatment for the entire gamut of postpartum disorders, from depression to psychotic episodes, has become quite effective. It may include medication, hospitalization, electroconvulsive therapy and counseling. Some women, including those who have experienced problem pregnancies or have a family history of mental illness, are thought to be at higher risk of developing postpartum trouble. Preventive injections of progesterone ; immediately after birth may be suggested for women who have suffered from depression after a previous birth.
Too often, though, the problem goes undetected. Women now leave hospitals within three days of delivery, well before most postpartum difficulty arises. Husbands and doctors frequently fail to appreciate the gravity of the illness. Sharon Comitz, a Pennsylvania pharmaceutical clerk who dropped her month-old son from a bridge into a mountain stream, had previously been hospitalized for depression after the birth of a daughter. Yet when she came home with her new son, her husband Glenn recalls, "I didn't realize it, but she was just going through the motions. She would bathe the baby in the kitchen but would have no towels, no diapers, no powder. Then she would get completely beside herself. I would tell her, 'You're just having a bad time.' "
Two years ago, Beverly Bartek of Lincoln, Neb., drowned her infant daughter in the kitchen sink two days after her physician told her that her moodiness and paranoia were the results of the baby blues. Angela Thompson had hallucinations after the birth of her first child, jumped off a bridge and was taken to a mental hospital. Still, when she became pregnant with her second child, she notes, "my doctor said, 'Just take it easy. I see no reason why it should happen again.' "
Despite their anguish, most husbands remain steadfastly supportive of their wives, regarding them as temporarily insane and not responsible for their actions. But as a legal defense, insanity as a result of postpartum mental illness is not a surefire success. While some women, including Thompson, Remington and Bartek, have received sympathetic hearings on such grounds and gone free, others have been sent to prison. Householder spent 22 months in jail; Comitz is now serving an eight-to-20-year sentence. Both women had told police complex kidnaping stories. Comitz had so completely convinced herself of the truth of her alibi that she passed two lie-detector tests. She revealed the truth only under hypnosis.
Prosecutors, however, tend to see elaborate fabrications as proof that the women are rational. Declares District Attorney Ray Gricar, who handled the Comitz case: "Obviously, Sharon was depressed and 'lost it,' but there's no way she was out of her mind. She had to know exactly what she was doing and had a clear head to do it." Criminologist Daniel Katkin of Pennsylvania State University sees a dangerous fallacy here. "The mistake is to think that ; insane people are incapable of making plans," he explains. "The reality is that crazy people also make plans, but they make crazy plans." Whether Lucrezia Gentile is prosecuted will be decided by a grand jury.
The key to preventing tragedies lies in the education of both the public and health-care professionals. Mothers who have experienced postpartum distress have started support groups; Depression after Delivery, based in Yardley, Pa., has 14 chapters around the country. Families that have suffered the most devastating loss are trying to contribute too. Thompson's husband Jeff is lobbying California legislators for a bill that will enable women accused of infanticide to remain in custody at a hospital. The couple has found the courage to go on and lead a normal life: in May 1987, four years after killing her baby, Thompson gave birth to another son.