“It’s easy to get swept up in the media circuses that surround these deaths, but without proper evaluations, complicated cases can be easily misunderstood.”

From rural South Carolina to suburban Boston, cases of alleged child murder by parents ― known as filicide ― have been top news stories in recent weeks.

Alex Murdaugh, the scion of a Lowcountry legal dynasty, is on trial for the double murder of his wife and young adult son. He faces the possibility of life in prison for their June 2021 slayings. Last week in Massachusetts, Lindsay Clancy — a labor and delivery nurse — was arraigned from a hospital bed over the deaths of her three children. Clancy allegedly strangled her infant son, her 3-year-old son and her 5-year-old daughter before jumping from a second-story window.

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As the only person in America who is a forensic psychiatrist, a reproductive psychiatrist and an academic whose research has focused on filicide for two decades, I always have a professional interest in these news stories and the effect they could have on public consciousness.

Too often, because of the way these cases are presented in the media ― and in popular films and TV shows like “Law & Order,” among others ― we may believe that those who commit filicide are mentally ill. However, the most important thing I want people to know is that there are multiple different reasons why parents kill their children, and mental illness may— or may not — have a role in individual cases.

It’s critical that we never presume why a parent killed. Lumping together mental illness and homicidality risks further stigmatizing many who have never been ― and will never be ― homicidal, and it can prevent people with mental health issues from getting the help they need. 

Working as a reproductive psychiatrist, I have treated many mothers and some fathers struggling with mental health during a pregnancy and the postpartum. Working as a forensic psychiatrist, I have conducted evaluations to understand the mental health and acts of parents who have killed their child, and to help courts ascertain their motives. I have also, in my roles, treated such parents after these tragedies in forensic hospitals and in correctional settings. I’ve led research studies related to parents who kill their children, considering dozens of cases of filicide and exploring mental health records, court reports by expert witnesses, coroner files and evidence from police investigations. 

One of the most important things to understand in filicide cases is that so much depends on the population studied. Mothers and fathers who kill their child and are subsequently imprisoned have different characteristics than those who commit suicide or who are treated in a forensic hospital. When my colleagues and I studied parents who committed filicide and suicide in a joint act, we found that twice as many fathers as mothers had done so. These parents often suffered from depression or psychosis.

When we studied the characteristics of mothers who were found not guilty by reason of insanity for killing their child, we found women with high rates of serious mental illness, who believed that they were doing what was morally right by killing their child or who were unable — because of their symptoms — to control their actions. This group of mothers found insane had, unsurprisingly, high rates of postpartum psychosis. It was not uncommon for these mothers to have planned suicide too. However, data about mothers who were found insane or who committed suicide can’t be generalized to all mothers who kill.

Filicide cases are often much more complex than they initially appear. As part of my work, I gather information from the parent after the homicide — about their life, their child’s life, their mental health and any substance abuse. Police reports and evidence are often crucial. Interviews, especially around the time of the killing, can be immensely helpful. Obstetric, pediatric and child protective services records provide clues. Any mental health records from before — and immediately after — the homicide can provide valuable insights into the parent’s state of mind. 

Anger, greed, hatred and revenge — feelings any one of us who has lived in a family might have experienced at some point — can be seen in various types of family murder.

In 1969, my mentor, Dr. Phillip Resnick (who testified in the Andrea Yates trial, which I accompanied him to) described five motives for child murder by parents — both fathers and mothers — after reviewing many cases described in the world literature. Today, those descriptions are commonly used by forensic psychiatrists around the globe who evaluate parents after such cases, and our own research in the past two decades has helped us further understand these motives. 

In cases of fatal maltreatment — the most common pattern — the child dies as the end result of abuse or neglect. Often, these children have experienced that treatment over a period of time, and one day their body cannot bounce back. Occasionally, however, their death occurs after a one-off instance of abuse or neglect. In these cases, mental illness or substance abuse may be involved, but so may personality disorders or parenting struggles.

Alternatively, in instances of “unwanted child” filicide, the parent’s needs or wants win out over the child’s life. This is a commonly described motive in neonaticide cases — in which an infant is killed at birth, often after a hidden pregnancy. But a child can be unwanted at any age and for a range of reasons, such as the parent desiring a child-free relationship. Here, the parent usually is not thinking of the child as their own person, but rather as someone whose fate the parent has ultimate control over.

In cases of partner revenge, a parent kills their child to get back at a partner (or an ex) and emotionally wound them. This may happen in a custody battle, for example. The mythological Medea killed her children in partner revenge.

In contrast to these first three motives, the much smaller populations of those found not guilty by reason of insanity and those who commit filicide-suicide tend to have altruistic or “acutely psychotic” motives.

In an altruistic filicide, a parent kills their child out of love. Our research further described that the mother or father may be psychotic — and out of touch with reality — or depressed at that time. If the parent is psychotic, they may be experiencing delusions that a fate worse than death is about to befall the child, and thus they believe they are sparing the child from that outcome by killing them “gently.” A parent who is severely depressed may plan their own suicide and not want to leave the child alone in this “cruel world.” (We also see altruistic motives in other types of family murder — such as one older adult killing a partner who is medically unwell or suffering from dementia.)

In the acutely psychotic cases, a parent kills with no rational reason. For example, they may hear the command of God in the context of a psychosis.

When the public reads the news and hears arguments from prosecutors and defense attorneys, it might seem simple to figure out the mental health issues that a defendant has (or doesn’t have) and their motive. However, this is almost always far from the truth.

Meanwhile, ethical psychiatrists bound by the so-called Goldwater rule should not share their hunches with the media about a defendant whom they have not evaluated. It’s easy to get swept up in the media circuses that surround these deaths, but without proper evaluations, complicated cases can be easily misunderstood — and mental illness and homicidality can become conflated, which is dangerous and unfair to people dealing with mental health conditions and challenges.

Media buzz about postpartum mental illness can shine a light on these issues, which may help to inform or even educate the public about this important (and often invisible) topic. But it’s crucial to remember that mental illness may or may not be relevant to an individual case. Health systems and human services need to screen for mental health, substance abuse and parenting difficulties — and from a public health perspective, the needed care should be funded appropriately.

As these cases continue to occur, we should keep in mind that there are various complex reasons why parents kill their children, and we should not make assumptions or correlations where they do not and should not exist. Most people with mental illness would never harm their child, and a great many parents who kill are not suffering from a mental illness.

Dr. Susan Hatters Friedman is a reproductive psychiatrist and the Phillip Resnick professor of forensic psychiatry at Ohio’s Case Western Reserve University. She edited the Guttmacher Award-winning book “Family Murder: Pathologies of Love and Hate,” and she has authored dozens of scientific articles on filicide and maternal mental health.

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