http://www.stuff.co.nz/sunday-star-times/news/2756497/Love-and-death

Love and death

Sunday Star Times

THE day after the bodies of Kathleen Flowers and her son Dominic, eight, were found in their Auckland home on July 17, a neighbour was telling reporters how the 47-year-old was "a really good mum" who adored her children. At the double funeral of his brother and mother, Flowers' older son Alex said: "My mother was amazing. She would do whatever it took to make me happy..." But mourners also heard from celebrant Sally Avison that Flowers had been severely depressed and had attempted suicide twice before; that she took her own life that day while her husband James was at work; and that Dominic "did not choose his death". "We understand," said Avison, "the nature of his death was peaceful and gentle." The words are soothing; the reality brutal. Sometimes "good" mothers kill their children. Melissa Dorward was a "good" mother too. A friend told the Dominion Post newspaper that the 31-year-old, who was found dead on July 12 at her Hawke's Bay home alongside the bodies of her two young daughters, Keira, four, and Ellah, two, was "a good lady and a very, very good mum very involved with her children, especially sports clubs and other bits and pieces". Dorward was pregnant when she died, and had two older children, both sons. Professor Sandy Simpson is clinical director of the Auckland Regional Forensic Psychiatry Service. While he has no special knowledge of circumstances behind the Flowers and Dorward deaths, he says it is not out of the ordinary for mothers who kill while mentally ill which is the case in roughly a third of cases to be described as model parents. "For some, they're suicidal and deluded and come to feel they must kill themselves because of how bad the world is and they take the child with them because they believe to leave the child would be a horrendous thing... the symptoms of illness envelop the child and themselves."The ironic thing to get your head around is that the woman's judgement is so seriously troubled by illness that she thinks she's doing the right thing even though she's doing a horrendous thing." In 2000, Simpson was co-author of a study in which he and colleagues interviewed six women who had killed their child or children while mentally ill. Most of the women had been found not guilty on the grounds of insanity, and none had previously been child abusers; there was no history of repeated abuse, and all had a clear intent to kill. As the women recalled the circumstances leading up to the homicides, the theme of trying to be an ideal parent was common. They talked of the special efforts they made for their children, such as mincing steak instead of buying mince, putting aside time to play with their child to make up for taking them shopping, or of choosing to stay home with the children rather than working. "You know, I've always sort of wanted to be the perfect mother," said one interview subject. CHILD HOMICIDE IS rare, especially in developed countries, and homicide by mothers rarer still, with an average of around two cases per year in New Zealand. Between 1991 and 2000, 91 children in New Zealand died at the hands of 101 perpetrators. According to analysis by the government's chief social worker, Marie Connolly, 30% of killers were fathers, 24% were mothers, 18% were de facto parents, 18% were relatives or others known to the victims, and 10% were strangers or unknown killers. The most dangerous time for a child is its first 24 hours, during which time homicides are almost always at the hands of mothers. The risk of being killed diminishes steadily with age. Simpson says women who kill their children fall into three main groups (though there is some overlap between them). The largest group (over a third of cases) is women who are child abusers and end up killing a child without necessarily having wished them dead. This encompasses such sensational and appalling cases as the 1991 death of Delcelia Witika, two, at the hands of her mother Tania and Tania's partner Eddi Smith, or the fatal beating of three-year-old Ngatikaura Ngati in 2006 by his mother Maine Ngati and her partner Teusila Fa'asisila. All four perpetrators were found guilty of manslaughter. This kind of killing, says Simpson, is "really the tip of a rather large iceberg" of family violence. And while they attract most public outrage, they are in the sense the least mysterious. "Most parents know that there are moments when we all feel at the limits of our capacity to cope. [But] most parents of any wisdom put the child down gently and walk away until they regain their composure... The question is, what undermines people's ability to walk away?" The answers are familiar and gloomy: the more isolated a mother is, the poorer the parenting she received, the fewer emotional, personal and social resources she has, the greater the odds she will do the wrong thing. Such women, while probably stressed or even slightly depressed, are not typically mentally ill. A second, slightly smaller, category is "neonaticide", where a mother, usually a woman in her teens or early 20s, kills her baby in the hours after birth. "It's usually a concealed or denied pregnancy of a younger, quite isolated women who may be naive, often from strict religious background, who shouldn't have had sex and wound up pregnant," says Simpson. A recent example to receive media attention was that of the Pacific island student at Otago University who in May 2006 gave birth to a healthy baby girl in the toilet of her hall of residence, then placed the infant in a plastic bag and dropped it from a hostel window. She pleaded guilty to infanticide, a charge that recognises diminished intent due to psychological problems, and was sentenced to community work and supervision, which was later cancelled. And then there are the women suffering from major mental illness who make a clear if deluded decision to end their child's life. This makes up another third of maternal homicides. These women are likely to be older, to be married, and to have already had other children. They are also particularly likely to attempt an "extended suicide" killing themselves but first killing their child, "not out of anger or rage", as Simpson describes it, "but out of desperation and love". Particularly awful is the thought they may have wrestled with themselves for some time before killing. "It's usually been a build-up of desperation and feeling that's there's no other way," says Simpson. "Not uncommonly those thoughts were there for some days or weeks; and they were struggling to cope with it or to put them out of their mind." The danger sign, says Simpson, is the presence of psychosis. Psychotic symptoms where there are delusions or hallucinations and a sufferer loses contact with reality can arise from a range of disorders, including schizophrenia, manic episodes, or severe depression. "It doesn't matter necessarily which one of those diagnoses you have," says Simpson. "It's the delusions and hallucinations and disturbed emotional state that are the key bit, because they are the drivers for how you perceive the world and what you believe you must do." Many mothers struggle with stress or depression or even serious mental illness and psychosis, yet only the tiniest fraction of those will hurt their child. Is it possible to spot those women? Not exactly, says Simpson. Predicting an extremely rare event is usually impossible. "But what we do know is that if everybody with symptoms like this got the sort of care they should have, we will prevent many events." Effective treatments for psychotic depression start with medication, followed by talking therapies and the provision of broader support to the person and their family. "If we treated everyone who had major depression with psychotic symptoms, who is involved in a child-caring relationship, we wouldn't know which homicides we'd prevented, but we sure would do so." But there's the catch. When Simpson and colleagues interviewed New Zealand women who had killed children while mentally ill, they learnt that a number of them had been in touch with GPs or mental health services, but had felt unable to talk about their fear that they would harm their child. Others had discussed their fears but "the meaning of what they said wasn't fully understood". A wider US study of female fatal child abusers found some had expressed their fears but were told: "You're a good mother you wouldn't harm your child, would you?" The lesson, says Simpson, is that if a mother says she if fearful she will harm her child "it's a big deal". "A complaint like that isn't a sign that a child needs to be immediately uplifted; that's the thing that people fear and it's a big barrier to seeking the help that they need. "The best way to help is not to diminish that but to say, good on you for telling us how you feel, and let's see how we can support you."