Progressive postpartum depression is one of the least recognized diseases suffered by young mothers despite the fact that almost 80% of women who give birth experience some form of postpartum upset. Although this symptom picture is well described in the research literature, postpartum depression is not recognized in the mental health professional's legal "bible," the Diagnostic Statistical Manual of Mental Disorders, fourth edition ("DSM IV").  The symptoms of postpartum depression may masquerade as manic-depression (bipolar disorder). Periods of euphoria, agitation, sleeplessness, sexual promiscuity, and hyperactivity characterize the manic symptoms. Poor judgment is a result. 
Progressive Postpartum Depression and Psychosis
A common misperception is that the postpartum depression is nothing more than the "baby blues" and will disappear on its own shortly after childbirth.  However, if untreated, the disease can develop into a more severe form, progressive postpartum depression or even psychosis. When this happens, the mother suffers from continued episodes of mania or depression, each one progressively worse than the last. Rejections, separations, and losses often trigger subsequent recurrent episodes. Because of the episodic nature, the woman is often untreated or undiagnosed until a tragedy occurs.
Despite the common misconception that only newborns are at risk from this disease, mothers suffering from the more severe form kill older children. The case of Andrea Yates more than amply illustrates this point.
The Andrea Yates Case
Andrea Yates suffered from postpartum depression, which progressively deepened with each child she had. Andrea cared for her three young boys while her husband worked to support the family. Her husband became involved in a fundamentalist religious group and eschewed material possession, downsizing their home to a mobile home and then a bus. After the birth of her fourth son, she attempted suicide twice before being hospitalized. The birth of her fifth child, a daughter, caused her to become severely depressed and delusional. She was hospitalized and medicated, but Andrea hid her delusions from her doctors and family. She was having conversations with Satan and feared punishment if she told anyone.
On June 20, 2001, Andrea drowned all five of her children to save them from Satan while they were still innocent. She called 911 and then her husband, who had just left for work an hour before. Andrea told him all the children were hurt, and he needed to come home. When Andrea confessed to the murders, she said she loved her children, but not in the "right" way. Andrea thought she was a bad mother because her children were not developing in an academic or righteous sense.
Andrea Yates was charged with capital murder with possible penalty of death. Whether Yates believed she was saving her children from Satan or she was simply overwhelmed with caring for them, the jury found her guilty of murder after deliberating for three and a half hours. The prosecution then sought the death penalty. After only 35 minutes of deliberation, the jury elected a prison sentence for life. 
Continued, in part 4 ....
This four-part series of posts "Filicide is Different" continues next Friday, as part of Friday's In Depth Look / Friday's Legal Memo. The final part of the series discusses mothers who don't want their children, the Susan Smith case, and the overall treatment of maternal filicide by the American Justice system.
 Oberman, supra at 71.
 Husman, supra, at 41-42.
 Margaret G. Spinneli, Maternal Infanticide Associated With Mental Illness, 161 Am. J. Psychiatry 1548, 1548 (2004).