Byline: M. Manjula, C. Chandrashekar
The tragedy of maternal filicide and extended suicides has occurred throughout history. Maternal filicide-suicide perpetrators most often suffer from depression, suicidality, or psychosis. Interventions in such cases are not commonly reported in the psychiatric settings, and the components of psychotherapeutic approach and its efficacy are also not known. Here we present a long-term therapy carried out with a 36-year-old married lady, with the complaints of low mood, suicidal ideation, severe guilt feelings, and depressive cognitions. There was positive family history of depression, past history of dysthymia, suicidal attempt, and severe marital discord. Therapy was carried out for a period of 9 months with follow-up for 4 years and addressed existential issues and grief with the components of existential therapy, grief therapy, narratives, religious beliefs, and interpersonal acceptance. The case highlights the need for blending of multiple approaches to meet the challenges such cases can pose.
Maternal filicide is defined as child murder by the mother. Reasons for maternal filicide may be altruistic motives, acute psychosis in mother, birth of an unwanted child, fatal maltreatment of the child or spouse revenge. [sup] The mothers often face multiple psychosocial stressors such as financial problems/unemployment, social isolation, full time care giver status, being victims of domestic violence, or have other relationship problems like conflict with family members, ongoing abusive adult relationships, and lack of social support. [sup], A significant proportion (16-29%) of filicides end in completed suicide by the mother. [sup]
Bourget and Bradford (1990) [sup] noted that 31% of parents who committed filicide had a diagnosis of major depression, compared with none of the perpetrators of nonparental homicide. A recent review of 85 filicide cases in Turkey [sup] showed that nearly half of the perpetrators had been diagnosed of psychiatric disturbances, including schizophrenia (61%) and major depression (22%). Most frequently, these mothers had altruistic motives. Spouse revenge filicide is difficult to prevent because there is usually little warning. This behavior most often occurs after learning of spousal infidelity or in the course of child custody disputes. [sup]
The intervention with the survivors often includes addressing bereavement, trauma, guilt, and existential issues. The interventions with survivors indicate that participants experienced high levels of psychological distress, including elevated symptoms of depression, guilt, anxiety, and trauma. They experienced substantial difficulties in the social arena (e.g., talking with others about the suicide). Majority of them viewed professional help as beneficial, although many informal sources of support were also valued (e.g., one-to-one contact with other survivors). Depression and lack of information about where to find help served as barriers to help-seeking behaviors. Higher levels of functional impairments were associated with higher levels of psychological distress, social isolation, and barriers for seeking help. [sup] However, there is very little research on intervention with the survivors of filicide and there is a need for evidence-based interventions.
The case is presented in the background of lack of literature on intervention with such cases, and also to highlight the need for integration of various techniques in therapy, and therapist's unique therapeutic experience.
Mrs. N., a 36-year-old married lady working as a nurse, was brought from central prison with the complaints of low mood, severe guilt feelings, depressive cognitions, suicidal ideas, and crying spells. She had charges of attempted suicide and homicide of her two children.
The patient was unconscious for 2 days after the attempt and was referred to NIMHANS for high suicidal risk. …