Strain Theory and Postpartum Psychosis

Strain Theory and Postpartum Psychosis Free Online Research Papers Strain theory is based on the concept anomie. Anomie first defined by Emile Durkhiem (1858-1917) and means the state of normlessness. The basic concepts suggest that when social norms become disorganized an increase in deviant behavior will occur as a reaction to the loss of a social cohesion. It is believed that once success is lost whether by choice or due to any other action, severe problems can occur. (Cullen 2006) On the morning of June 20, 2001, Andrea Yates, 36 years old, systematically drowned her five children, one-by one, in her upstairs bathtub (Feldman, 2001). Born on July 2, 1964, the youngest of five, Andrea grew up, reportedly, in a normal, church-going family (Feldman, 2001). While attending high school, she was captain of the swim team and graduated valedictorian of her class (Feldman, 2001). After graduating high school, Andrea attended the University of Texas School of Nursing at Houston and became a registered nurse (Feldman, 2001). She practiced nursing from 1986 to 1994 at the University of Texas M.D. Anderson Cancer Center (Bernstein, 2001). In April of 1993, Andrea married her boyfriend of four years, Russell Yates, a NASA computer engineer (Bernstein, 2001). Ten months after their wedding, Andrea gave birth to their first child, Noah, left the nursing profession, and became a full time mom (Bernstein, 2001). Friends report that Russell Yates insisted that his wife stay home after giving birth to their first child (Bernstein, 2001). Evidently, Andrea did not complain and agreed to quit her job and give up her career, to stay at home with her son (Feldman 2001). Her mother states that she supported her daughter’s decision to stay at home, especially since her daughter and son-in-law planned to have as many children as God would allow (Feldman 2001). Within 4 years, Andrea had two more children, John and Paul. By all reports, Andrea, Russell, and the three boys were a happy, healthy family (Teachey 2001). Friends state that they saw no signs of depression in Andrea during this period, and described Andrea as â€Å"a model of mental stability and patience as she reared her children† (Bernstein, 2001, p. 5). It was not until the birth of her fourth child, Luke in 1999, that Andrea began to exhibit symptoms of depression. It was soon after Luke’s birth that Andrea first attempted suicide. A few months later, after the death of her father and her second unsuccessful suicide attempt, she was hospitalized (Feldman 2001). Her mother describes her as being overextended and being unable to handle the job of raising her family (Feldman, 2001). During her hospitalization, her doctor, Dr. Eileen Starbranch, diagnosed her as â€Å"having major depression with severe, recurrent psychotic features† (Teachey, 2001b, p. 4). Dr. Starbranch further cautioned that Andrea’s condition could â€Å"spiral downward†¦[and] surely guarantee future psychotic depression† (Teachey, 2001b, p. 4) if she were to have more children. Andrea told her psychiatrist that she had been having homicidal thoughts since the birth of her first child and that her suicide attempt was to  "prevent herself harming others† (Teachey, 2001b, p. 3). However, her mother stated that although she was not back to normal, the hospital stay and the anti-psychotic medication ameliorated Andrea’s mental condition (Feldman, 2001). Less then 2 years later, Andrea once again gave birth, this time to a girl, Mary (Teachey, 2001b). Four months later, in April of this year, Andrea was again admitted to a mental hospital for depression, and then again in May. Her husband acknowledged that she had become â€Å"paranoid, withdrawn, and emotionally numb† (Teachey, 2001, p. 4). After a 10-day hospital stay in May, Andrea was declared not to be suicidal and was released (Teachey, 2001a). Continuing an outpatient program until May 22, Andrea appeared to have improved with the help of the anti-psychotic drug Haldol and anti-depressant drugs (Teachey, 2001a; Colb, 2001). However, her husband asserts that she had begun to deteriorate again right before the murders, after she had been taken off the anti-psychotic drugs (Teachey, 2001a). Her family declared that they were worried she may harm herself but never contemplated that she would harm the children (Feldman, 2001). After months of thinking about killing her children, on June 19th, Andrea Yates decided it was time (Teachey, 2001b). The next morning, June 20, 2001, about an hour after her husband left for work, Andrea Yates began to mercilessly drown her children (Glenn, Rendon, Bernstein, 2001). The police report alleges that Noah walked in on his mother murdering his baby sister, that she turned toward her oldest son, and commanded him to â€Å"get in† the tub (Colb, 2001). Purportedly, Noah began to run; Andrea chased him down, struggled with her son, and finally, overpowered him and drowned him, as she had done with his four younger siblings (Colb, 2001). The police were summoned to the Yates’ home by Andrea Yates (Glenn et al., 2001). The caller only asked the police to come to her house but did not give the police any specifics as to why (Glenn et al., 2001). After the first phone call to the police, she called her husband at work and stated only that he had â€Å"better come home† (Glenn et al., 2001, p. 4). Described by police as wet and panicked, Andrea opened the door to the police, in a torn shirt, and stated, â€Å"I killed my kids† (Glenn et al., 2001, p. 1). Andrea led the police to an upstairs bedroom where they found John, 5, Paul, 3, Luke, 2, and Mary, 6 months, on a bed covered with a sheet. The eldest, Noah, 7, was discovered still floating, lifeless in the bathtub (Texas Woman†¦, 2001). Charged with five counts of capital murder, Andrea Yates was found competent to stand trail, and while sitting and waiting, under suicide watched in the psychiatric unit at the Harris County Jail, for her trial (Teachey, 2001b). Doctors had placed her on anti-psychotic drugs, and she reportedly came out of the comatose state she was in when she first arrived. According to the defense’s psychiatrist, Steven Rubenzer, Andrea believed she had â€Å"somehow damaged her children irreparably† (Colb, 2001, p. 2), and that she â€Å"wasn’t a good mother [and had] neglected them† (Teachey, 2001b). Dr. Rubenzer diagnosed Andrea with Postpartum Psychosis (Williams, 2001). A Houston jury of six men and six women found Andrea Yates not guilty of murder by reason of insanity after deliberating more than 12 hours over a three-day period. Yates was on trial for the drowning deaths of only three of her children Mary, 6 months; John, 5; and Noah, 7 at not for the deat hs of Luke, 2 and Paul, 3. This was her second trial for murder after her first murder conviction was overturned on appeal. (http://crime.about.com/b/2006/07/26/andrea-yates-not-guilty-by-reason-of-insanity.htm) What causes a mother to kill her children? There are several terms to describe these abhorrent acts: neonaticide, the killing of a child within the first 24 hours of life; infanticide, the killing of a child within the first 12 months of life, filicide; the killing of a child over 1 year-old by the child’s parent, also a general term used for killing one’s own child; and familial filicide, the mass murder of children by a blood relative (Sadoff-Rober, 1995; Guileyardo, Prahlow, Barnard, 1999). Regardless of terminology, filicide has been documented in every culture throughout history. During ancient civilizations, children with birth defects were killed due to the belief they were a bad omen. Some cultures have condoned the killing of children who were sick or weak because they were a drain on resources and finances. It is well documented that in Chinese and Japanese cultures parents have routinely killed female children due to the notion that having a female is shameful (Pitt Bale, 1995). In modern western cultures, due to the thought, that killing one’s own child is a horrific act, the killing of one’s children has been the focus of much research. The study of filicide has produced many classification systems to help identify, categorize, and understand child murder (Pitt et al., 1995; McKee Shea, 1998). Resnick proposed that to have an understanding of the women who commit these types of crimes; one must first differentiate between the offenders who commit neonaticide and those who commit filicide, a child over 1 day-old (Pitt et al., 1995). Mothers that commit neonaticide tend to be younger (late teens to early twenties), unmarried, immature, sexually submissive, and, although they rarely seek abortion, they make no plans for the birth and care of their child (Pitt et al., 1995). Fear and guilt are postulated to be the primary reasons for the killings (Pitt et al., 1995). The women who commit filicide are quite different. They are older (late twenties or older) and quite often married (Pitt, 1995). Psychologically they tend to be more depressed, psychotic, have high suicide ideations, and have a higher suicide attempt rate compared to neonacidal mothers (Pitt et al., 1995). In 1969, Resnick studied 88 cases of maternal filicide and classified them into 5 categories according to apparent motive; altruistic filicide, acutely psychotic filicide, unwanted child filicide, accidental filicide, and spouse revenge filicide (Pitt et al., 1995; Haapasalo et al., 1999). Resnick found the majority of mothers killed for altruistic reasons, meaning they felt the need to kill their child to save them from a real or imagined inescapable doom (Pitt et al., 1995; Haapasalo et al., 1999). Scott developed a similar classification system in 1973, which listed 5 categories based on the impulse to kill. These included elimination of unwanted children, mercy killing, gross mental pathology, stimulus arising outside the victim, and stimulus arising from the victim. In 1979, D’Orban, established his classification system, which is very similar to Resnick and Scott’s. His system classified maternal filicide into: battering mothers, mentally ill mothers, neonati cide, retaliating mothers, mothers who killed unwanted children, and mercy killings. Lastly, Guilryardo et al., (1999) developed a 16-item subtype scale, which included altruism, psychosis, and postpartum depression (Guilryardo et al., 1999). One common category throughout all the classification systems is that of pathological filicide, or rather, filicide committed during some type of psychological disturbance. As in the case of Andrea Yates, Resnick found that in persons who commit filicide, 75% had â€Å"psychiatric symptoms prior to committing† the murderous act (Guileyardo et al., 1999 p. 291). Another study by Silverman and Kennedy (1998), found 67% of mothers who commit filicide to be mentally ill (Haapasalo Petaja, 1999). Additionally, mothers who kill children over the age of 1 year-old tend to have â€Å"severe depression† (Haapasalo et al., 1999). It is reported that 70-80% of women experience â€Å"baby blues† after giving birth. Baby blues is marked by mood swings and a mild depression and that lasts no longer then two weeks (Oglesby, 2001). A more severe form of depression that occurs with childbirth is postpartum depression. This form develops in 10% to 20 % of new mothers. This more chronic form of depression lasts longer then two weeks but usually not more then a year, and is treatable with anti-depressants. Postpartum psychosis, which is the mo st serious form of depression developed after childbirth, is only diagnosed in about 1 out of 1,000 women (Oglesby, 2001). Notably, women who experience postpartum depression have a 50% chance of redeveloping depression again in a subsequent birth (Oglesby, 2001). According to the Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DSM-IV) Postpartum Mental Disorder, a metal disorder related to pregnancy, can induce â€Å"a major depressive disorder†¦to a brief psychotic disorder† (Guileyardo et al., 1999 p. 288). This disorder can cause a severe depression without psychotic features, involve command hallucinations to kill a child, or entail obsessive thoughts regarding killing or harming the child (Guileyardo et al., 1999). While the concept of postpartum depression and /or psychosis, explains the mental state of an offender, what motivates these individuals to kill? Obviously, a large majority of the women that develop the rarest form of postpartum depression, that of postpartum psychosis, do not kill their children. Back in 1960, Satten, Menninger, Rosen, and Mayman researched murder without apparent reason in an attempt to explain â€Å"rational, coherent, and controlled†¦ [yet] senseless† (p. 48) murders perpetrated by â€Å"sane† individuals. They postulated that the individuals who committed these types of murders suffered from a specific syndrome in which they were â€Å"predisposed to lapses of ego control† (Satten, et al., 1960, p. 48). The unstable ego defense system allows for â€Å"periodic breakthrough of intense aggressive impulses† (Satten et al., 1960, p. 52). In other words, because the individual does not have a well-developed defense system, they are unable to deal with stress and attacks on past unconscious traumatic events. Therefore, when stress does occur, they become unstable and act out violently (Satten et al., 1960). After the attacks the offenders rarely remember the details and describe themselves as being in a dissociate state (Satten et al., 1960). While this accounted for impulsive, seemingly unprovoked attacks on relative strangers, it does not explain maternal filicide. To achieve a better understanding of this phenomenon, one must evaluate the concept of the Catathymic Process on a motivational spectrum. Schlesinger developed a motivational spectrum to classify all types of crime (Schlesinger, 2001). This spectrum utilizes a continuum from â€Å"external motivations for crime† to â€Å"internal motivations for crime† being on opposite ends, with situational, impulsive, and catathymic motivations situated between them. For example, a contract killer’s motivation is external, usually monetary. There is no mental illness or an internal stimulus that is â€Å"compelling† him to kill. On the other end of the spectrum, internal motivation is an individual whose motivation to commit a certain crime is overwhelmingly internal. They may feel a compulsion to commit the crime, as a sexual sadistic murderer does, with little or no external motivations (Schlesinger, 2001). Catathymic motivation, according to the spectrum, is m ostly internal with external stimuli playing a minor role. The term catathymia, from the classical Greek dictionary means â€Å"in accordance with emotions† (Schlesinger, 1996). In 1912, the concept of catathymic behavior was first introduced by Maier, however, it was Wertham who first utilized the idea in the forensic setting (Wertham, 1978). His five stages of the catathymic crisis are: 1. An initial thinking disorder, which follows an original precipitating (or traumatic) circumstance. 2. Crystallization of a plan, when the idea of a violent act emerges into consciousness. The violent act is seen as the only way out. Emotional tension becomes extreme, and thinking becomes more and more egocentric. 3. Extreme emotional tension culminating in the violent crisis, in which a violent act against oneself or others is attempted or carried out. 4. Superficial normality, beginning with a period of lifting of tension and calmness immediately after the violent act. This period is of varying length, usually several months. 5. Insight and recovery, with the reestablishment of an inner equilibrium. Wertham believed that catathymic crisis â€Å"is indispensable for an understanding of certain forms of violent behavior† (Wertham, 1978). Catathymic motivations represent crimes that seem relatively unmotivated (Schlesinger, 2000). It is postulated that a catathymic crisis is a psychological process that is activated by an emotional situation that is connected to underlying ideas (Schlesinger, 1996). In other words, the individual has underlying unresolved conflicts, ranging from self-perceived inadequacies to attachment disorders. When an emotional situation occurs, it â€Å"produces extreme emotional tension† (Schlesinger, 1996) inside the future offender. Their underlying unresolved conflicts are ignited by the emotional event that has occurred and the future offender forms a rigid, delusional idea that they must act out violently to resolve the inner turmoil (Schlesinger, 1996). The essential feature of this crisis is the idea and the urge that they must act out violently to resolve the inner conflict (Schleslinger, 1996). In the context of familicidal murder, there are two types of offenders, accusatory and despondent (Schlesinger, 2000). The accusatory individual usually suspects a loved one of cheating or has a partner who is trying to end their relationship and they act out of jealousy and anger (Schlesinger, 2000). This type of offender is sexually motivated by sexual inadequacies and may have a history of violence (Schlesinger, 2000; Schlesinger, 2001). They strike out at the object of their jealously (Schlesinger, 2001). Conversely, the despondent type is severely depressed and â€Å"view themselves as failures† (Schlesinger, 2000, p. 200) and generally does not show hostility toward their attended victim before the attack (Schlesinger, 2000). It is within the context of the catathymic process that one can begin to understand why it is that these individuals resort to violence. Revich and Schlesinger, influenced by Wertham’s concept of catathymic crisis, developed their own catathymic process model (Schleslinger, 1996). They postulated that the catathymic process could be broken down between chronic and acute types (Schlesinger, 1996). In both types, there seems to be a transformation in thought pattern that influences the future offender to act. The acute type occurs when an offender’s underlying emotional conflicts are triggered by a situation and the offender reacts almost immediately with violence. For the acute catathymic process, the incubation period of emotions can be several seconds or longer, and then the individual acts out to resolve their inner conflict. The acute offenders experience a flattening of emotions after acting out. The victim is usually a stranger and, afterwards, it is common for the offender to have only partial memory of the act itself (Schlesinger, 1996). Schlesinger differentiates the acute catathymic viole nt act from â€Å"situational acts of violence and from assaults committed [because of] anger, fear, and jealousy or under the influence of paranoid delusions, drugs, or alcohol† (Schlesinger, 1996). Rather, a deep underlying conflict has been triggered by emotional tension that causes theses individuals to act violently (Schlesinger, 1996; Schlesinger, 2000). The chronic catathymic type exemplifies the type seen in despondent familicidal offenders, and is divided into three stages, incubation, violent act, and relief (Schlesinger, 1996). During the first stage, there is also a marked change in the individuals thinking process, usually accompanied by depression. This is triggered by â€Å"a build up of tension, a feeling of frustration, depression, and helplessness† (Schlesinger, 1996). The future offender begins to believe the only way out of their situation is to kill, either themselves or others (Schlesinger, 2001). Initially, the future offender is resistant to the idea of killing. The individual may seek help from outside sources, clergy, friends, a psychological counselor, and even tell the future victims themselves. However, they are often ignored. Despite the reluctance at first to accept the impulse to kill, the individual begins to believe that this is the only way out of their horrific, inescapable situation (Schle singer, 2000). The urge to carry out the plan to kill is all consuming. This incubation period can last from days up to a year before the offender acts out (Schlesinger, 1996). The second stage is the violent act itself. The victim of the attack is usually someone that the offender has had an interpersonal relationship with, or is an actual family member (Schlesinger, 1996). The third stage, relief, usually is comprised of the offender feeling an overwhelming sense of calm after committing the violent act. In addition, their homicidal thinking dissipates (Schlesinger, 2001). The â€Å"catathymic tension† is released with the murder (Schlesinger, 2000). Normally, the victims are remembered with sympathy, demonstrating that the violent act was a â€Å"means of securing liberation† (Schlesinger, 1996) for the victim not an act of anger or hate. Wertham believes that if the stage of relief is not met, then there is great risk that the offender will return to the belief that violence is the only way to resolve their inner conflict (Wertham, 1978). Filicide is a crime that leaves people angry, horrified, and predominantly mystified. In the case of Andrea Yates, adding to the mystery is the fact that the offender is a well-educated, middle class woman, who seemed to have all the family support and love ones needed to raise a healthy family. While the diagnosis of postpartum psychosis is being used to defend Andrea Yates’ actions, it does not explain why and how she was able to kill her children. The concept of chronic catathymic process does explain the mental process that could have attributed to Andrea’s mass murder. During the incubation stage, depression is the most prominent feature present. Accordingly, there is irreparable evidence that Andrea had been suffering from depression since the birth of her fourth child two years prior. This depression intensified with the birth of her fifth child. The development of postpartum depression, perhaps, was the emotional tension that triggered some sort of unresolved inner conflict within Andrea. The depressive state broke down her defensives and she became riddled with self-doubt and insecurity regarding her abilities to mother. Andrea began to feel helpless. She started to have obsessive thoughts that she was ruining her children’s’ lives. Ultimately, she developed the delusional thought pattern that, to save her children from herself, she must kill them. Initially, she fought against her drive to kill, evidenced by the fact that she sought help, and attempted suicide. In an attempt to save their lives, Andrea attempted to take her own life several times. As the research indicates, she reached out to mental health workers, telling them that she feared for her children’s’ lives. Neither her family nor her doctors believed that her children were in danger. However, her depression was not subsiding with medication and therapy and her obsessive thoughts began to make sense. It was then that Andrea Yates began to plan the murders. The catathymic tension could not be released without a violent act. As Wethram postulated, when her suicide attempt did not bring the relief she sought, she reverted to the planning stage or incubation stage of the catathymic process. She understood that the only way to relieve the pain that continually plagued her was to kill her children. Right after the killings, Andrea called the police and her husband. She had done what she needed to do, she saved them. Theoretically, Andrea Yates’ murderous acts were an expression of love. Being a new mother makes me want to know what drives someone to do something as cruel as to kill his or her own child or children, and get away with it. There have been many other cases since the case of Andrea Yates, but for some reason, this story was more compelling to research. Strain can cause someone to commit inhumane acts. Nevertheless, there should be stricter policies, for example, Yates not only should have been convicted of capital murder, but she should have received to death penalty, as soon as she was convicted. References Bernstein, A. (2001, June 27). Mom depicted as private, caring, burdened. HoustonChronicle.com, 1-6. Retrieved October 28, 2007 from chron.com/cs/CDA/story.hts/special/drownings/951166 Colb, S. F. (2001, July 4). Why Andrea Yates deserves compassion, not execution. FindLaw.com, 1-3, Retrieved November 3, 2007, from http://writ.news.findlaw.com/scpts/printer_friendly.pl?page=/colb/20010704.html Cullen, F. Agnew R. (2006) Criminological Theory Past To Present, Part V Feldman, C. (2001, July 5). Yates’ mother mystified by children’s drowning. HoustonChronicle.com, 1-5. Retrieved October 28, 2007, from chron.com/cs/CDA/story.hts/special/drownings/960277 Glenn, M., Rendon, R., Bernstien, A. (2001, June 27). Mom held in killing 5 kids: Children may have died in tub. 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(1960). Murder without apparent motive: A study in personality disorganization. American Journal of Psychiatry, 117, 48-53. Schlesinger, L. B. (1996). the catathymic crisis, 1912-Present: A review and clinical study. Aggression and Violent Behavior, 1 (4), 307-316. Schlesinger, L. B. (2000). Familicide, depression and catathymic process. Journal of Forensic Sciences, 45, 200-203. Teachey, L. (2001a, September 2). Release of Yates’ records a legal maneuver. HoustonChronicle.com, 1-5. Retrieved October, 28, 2007, from chron.com/cs/CDA/story.hts/special/drownings/1032138 Teachey, L. (2001b, September 21). Expert: Yates contemplated killing children for months. HoustonChronicle.com, 1-4. Retrieved October, 28 2007, from chron.com/cs/CDA/story.hts/special/drownings/1056637 Texas Mother charged with killing her 5 children. (2001, June 21). [On-Line], Retrieved October 28, 2007, from: http://www2.cnn.com/2001/US/06/20/children.killed Williams, D. (2001, August 8). Postpartum psychosis: A difficult defense. CNN.com, 1-2. Retrieved November 3, 2007, from http://www8.cnn.com/2001/%20-%20Postpartum%20psychosis%3A%20Adifficult%20 defense%20-11/3/01 Wertham, F. (1978). the catathymic crisis. In I.L. Kutash, S. B. Kutash, and L. B. Schlesinger (Eds). Violence: Perspectives on Murder and Aggression. (pp. 165-170). San Francisco: Jossy-Bass. Research Papers on Strain Theory and Postpartum PsychosisPersonal Experience with Teen PregnancyArguments for Physician-Assisted Suicide (PAS)Three Concepts of PsychodynamicTrailblazing by Eric AndersonEffects of Television Violence on ChildrenNever Been Kicked Out of a Place This NiceMarketing of Lifeboy Soap A Unilever ProductThe Relationship Between Delinquency and Drug UseDefinition of Export QuotasGenetic Engineering