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[Legal protection of the fetal victim of injuries].
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[Clinical aspects of puerperal psychoses. Review with 3 case examples].
Psychic disturbances in the post-partum period are divided into the postpartum blues, postpartum depression, and postpartum psychoses. The latter are severe endogenous psychoses which mostly fulfill the diagnostic criteria for cycloid psychoses according to Leonhard. Based on three case reports, characteristic symptoms, the phasic clinical course with remissions, and distinct etiological, therapeutic, and forensic aspects of cycloid psychoses in the post-partum period are discussed. The high relapse rate of approximately 50% in patients at risk requires intensive psychiatric care in the peripartal period. In particular, the possibility of a prophylactic treatment of patients at risk with lithium immediately after delivery is emphasized. However, this sophisticated therapeutic strategy requires close cooperation between gynecologists and psychiatrists.
["I have killed my child". Experiences with severe depression in mothers after sudden infant death from the psychiatric and legal medicine viewpoint].
Grief and depressive syndrome belong to normal reaction by parents after a sudden infant death (SID). In the following we report on two cases from the point of view of psychiatry and forensic medicine in which, subsequent to SID, mothers reacted with extremely grave depression and accused themselves of having killed the child. Furthermore, some recommendations are given for the care of parents affected.
Munchausen syndrome by proxy and intra-alveolar haemosiderin.
Munchausen syndrome by proxy is characterised by the invention of a false history and/or the deliberate inducement of a factitious illness by parents in their child. First reported as a disorder of mothers, this syndrome is now recognised to have male perpetrators. One of the most common characteristic presentations is with the child allegedly suffering repeated apnoeic attacks. These are in fact deliberately induced episodes of upper airway obstruction. The children of these parents are at great risk of serious harm or death if not recognised. The identification of smothering at autopsy is fraught with difficulty and the presence of intra-alveolar haemosiderin has been claimed to be a marker of previous smothering. A case of Munchausen syndrome by proxy is presented where there were deliberate acts of repeated partial smothering and where the finding of intra-alveolar haemosiderin at autopsy provided additional supportive evidence of smothering.
Neonaticides may be more preventable and heterogeneous than previously thought - neonaticides in Finland 1980-2000.
Neonaticide is a sad and infrequent crime with possibly a high level of underreporting. The aim of this study was to examine the circumstances of neonaticide, and whether there are subtypes of offenders, or suggestions for prevention. The study was retrospective and register-based using comprehensive nation-wide material of all cases of suspected neonaticide during 1980-2000 in Finland. Out of the 50 suspected cases, 32 women were included in the final analyses as neonaticide offenders. Most women (91%) had concealed their pregnancy, which was not the first for 66%. Most (66%) were not quite sure why they had offended, and the most frequent (63%) method of operation was neglect. Four women were diagnosed psychotic and formed a specific group. We concluded that there might be specific subgroups of offenders - even though our small population limited conclusions. Furthermore, prevention might be heightened. We call for international joint projects for enlarged material to enable grouping, as well as education and discussion among the public and the professionals to prevent neonaticide, unify its jurisprudence and improve the treatment of the offenders.
Germany: a midwife's accusation.
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Child abuse before Kempe: an historical literature review.
This literature review traces the recognition of child abuse and ends where many texts begin with the publication of Henry Kempe's paper in 1962, where the term, "battered child syndrome," was used for the first time. Starting with the first known treatise in pediatrics, the review examines evidence produced throughout the centuries on the recognition of physical child abuse. Many of the references are medical and show how while the early physicians found it easy to accept that those caring for children might injure them, by the end of the 19th century, more obscure diagnoses were being sought to explain the lesions. However, even during the time some physicians were pursuing "scientific" etiologies, there are publications that demonstrate a continuing acknowledgment of the problem of child abuse. No review of this type can claim to be complete, and the author hopes others will be sufficiently interested to seek out further historical references.
Fatal maltreatment by mothers: a proposed framework.
This paper proposes a framework for understanding fatal maltreatment by mothers based on an in-depth study of incarcerated women. Despite its extreme outcome, fatal maltreatment is not homogeneous. While the specifics of each case varied, the circumstances leading to the fatality followed a similar progression. The framework is characterized by a recurrent pattern of abuse culminating in the fatality. All of the women had abused the deceased child prior to the fatality. The women provided warning signals to professionals and to members of their personal networks (kin, friends, neighbors) by alerting them to the abusive incidents. The fatal incident was not a one-time assault, but the exit point of a continuing pattern of abusive interactions that was maintained by the woman's ability to explain, rationalize, and minimize the abuse to herself and to her network. Future research efforts must be directed beyond the fatal incident to the circumstances leading up to it. Intervention and education must be aimed beyond biological parents to the wider network and community.
Intra- and extrafamilial child homicide in Sweden 1971-1980.
Over the 10-year period studied, a total of 96 children under 15 years of age were killed in Sweden. This number constituted an average annual rate of 0.6 per 100,000 children. The violence, most frequently involving strangulation, shooting, and stabbing, was largely directed at young children. The pattern of child homicide was mainly characterized by intrafamilial violence, especially in connection with the suicide of a parent-perpetrator. Extrafamilial homicides were rare and only committed by male perpetrators. Cases of child abuse by a parent and cases of sexual abuse were infrequent. By psychiatric examination after the crime, only 10 perpetrators out of 47 examined were found not mentally ill.
Adoption at birth: prevention against abandonment or neonaticide.
A study was carried out between 1987 and 1989 to try to understand why women choose to give their infants up for adoption at birth and the psychodynamics of this decision. The interviews of 22 female subjects were based on psychoanalytic methodology. They revealed that the motives behind such a choice arose from a specific set of symptoms: The denial of pregnancy and fantasies of violence towards the fetus. These symptoms were the result of psychological and sexual traumas that the subjects experienced during their childhood in negligent or incestuous families. Eighteen of the subjects were able to take advantage of the French law permitting anonymous and cost-free delivery, then the adoption of the baby. However, four of the subjects denied their pregnancies so efficiently that childbirth took them by surprise. The sudden discovery of the reality of the newborn led them to neonaticide. This study clarifies the confusion that exists between the abandonment of a child in a public place, and the choice of adoption at birth, the aim of which is to protect the infant from the risk of violence or future neglect.
Child abuse and neglect in Japan: coin-operated-locker babies.
The coin-operated-locker baby is a type of child abuse that may be unique to Japan. The term refers to newborns who are placed, while alive or dead, in coin-operated lockers. This practice has been decreased by specific measures. It is likely that social and economic variables in Japan account for differences in the frequency and types of child abuse cases when compared to American or European societies as social conditions in Japan change the reported incidence of child abuse may increase in the future. Recently, the government of Osaka organized a group specifically designed to deal with the detection and protection of abused and neglected children. In 1993, they published a manual on how to deal with child abuse, but the Japanese judicial administration still uses old laws for abuse cases. The development of new laws is occurring in parts of the country now. This paper introduces the present status of coping with child abuse and neglect in Japan.
Fatalities assessed by the Orange County child death review team, 1989 to 1991.
Interagency child death review teams have emerged in response to the increasing awareness of severe violence perpetrated against children in the United States. Child death review involves a systematic, multidisciplinary, and multiagency process to coordinate data and resources from the coroner, law enforcement, the courts, child protective services, and health care providers. The Orange County, CA team reviews all coroner's cases (unattended death or questionable cause of death) for children 12 years old and younger. This paper describes the interagency review in Orange County and provides data on the demographics of cases reviewed by the team (N = 637) compared to unreviewed deaths (N = 1,463) for the period 1989 to 1991. Trends were analyzed to assess differences in: (1) age distribution; (2) gender; (3) ethnicity; (4) cause of death (non-SIDS natural; non-natural including traffic deaths, SIDS, other injuries; homicide; and undetermined); and (5) cause of death by age, gender, and ethnicity. Implications of the data for other jurisdictions with child death review teams are discussed.
Maternal filicide: a preliminary examination of culture and victim sex.
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Why are potential women being killed?
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Sex selection and reproductive freedom.
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Why solutions continue to elude us.
Three issues addressed in Robert Weir's book Selective Nontreatment of Handicapped Newborns raise important questions about the social and political context of moral judgment, and the relation of moral judgment to moral theory. Arguments to the effect that infants are not moral "persons" as we normally understand the concept of personhood, illuminate the dialectical relationship between sound, confident moral judgments and moral theories. The way we describe and label decisions to offer or not to offer particular treatments to specific individuals has political and moral consequences. In general, we should opt for descriptions that display, rather than conceal, the problematic and controversial aspects of our decisions. The active killing of patients can only be defended from the narrowest viewpoint of minimizing that individual's suffering. It ignores the requirements made of other moral actors, and it fails to acknowledge a number of important facts about social institutions. Workable solutions must be attentive to the political and social context of moral dilemmas.
A histological study to determine aeration of the lungs of newborn infants in cases of mummification.
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