Saturday, August 1, 2009

Doctor's Orders?

A couple of quasi-medical links worth noting...Karen Houppert in Salon considers the factors that may have led to a schizophrenic woman, Otty Sanchez, to not only kill but consume parts of her newborn baby. In accounting for why Sanchez reportedly was off of her meds (and according to the article claimed to have been hearing voices telling her to do the deed), Houppert suggested that a doctor probably told her to stop taking them due to breastfeeding. Say what?

It is not for me to comment on Sanchez's specific case beyond saying generally that it is overwhelmingly more likely that she was off of her meds because, in the case of schizophrenia and other severe and persistent mental illnesses, non-compliance is more the rule than the exception. When one considers that the disorders in question often involve poor self-insight, and that the medications are often extremely expensive and have significant side effects, non-compliance ceases to be surprising. I have no idea whether she was even in active treatment around the time of her pregnancy or delivery, but by the time the baby was born the only potentially life-saving intervention would have been social services intervention to ascertain her mental status and fitness for motherhood at the time.

Houppert commendably offers a view of "killer moms" as desperate and hopeless women rather than as amoral monsters. However, in our contemporary glorification of maternal instinct it is easy to overlook the fact that infanticide, far from being unnatural, has in fact been a routine practice in numerous "primitive" cultures in various times and places. While the practice seems to make no evolutionary sense at first blush, it actually does inasmuch as infanticide usually happens when a mother (often a particularly young one with poor social and financial support) feels overwhelmed and unable to raise the baby safely. In that case, it makes evolutionary sense for the mother to punt, so to speak, and preserve her own well-being as she can live on to reproduce again. This is obviously not to condone a heinous deed (murder and rape are "natural" as well), but it is to argue that it is not inherently psychologically puzzling.

In another vein of risky behavior, a local story looks at the persistent popularity of tanning beds despite new data suggesting that they dramatically increase the lifetime risk of skin cancer. However, a 78-year-old woman in the article justifies her habit (I have never had the pleasure of visiting a tanning salon, but I never would have expected to encounter the 70-and-over crowd there).

The reasons for this practice are interesting. Some just thumb their nose at medical recommendations, which is a useful reminder that there are values in life apart from cautious self-preservation. Tanning salon operators (who might be said to be biased) maintain that their services are actually healthful inasmuch as they provide vitamin D in a controlled fashion (according to the article some folks actually arrive with doctors' notes advising them to get more vitamin D).

There is also the fact that while skin cancer is common, and undoubtedly more common with tanning bed use, it is also an eminently treatable cancer in most cases when caught early. I don't mean to trivialize it, but apart from the rare melanoma, your average skin cancer is not, say, pancreatic or ovarian cancer.

In an overview of biotechnology's effects on the human body, William Saletan in the New York Times points out that many current and developing medical interventions seek to compensate for risky behaviors, from overeating to running on bad knees. So my inference is that advances in the diagnosis and treatment of skin cancer may have the eventual paradoxical effect of boosting tanning salon profits.


Retriever said...

Horrible story...Perhaps these killer moms so shock us because they are so much rarer than killer dads/stepfathers/boyfriends? And because of our cultural iconography sanctifying Mom?

On the moms,it should be added that the effects of pregnancy, post-partum shifts, and breastfeeding are wildly unpredictable. Vary with the individual, with different pregnancies, within diagnoses, and even within families.

One family member may have their initial manic break postpartum first child, and subsequently become suicidal after other kids. Another family member may be stabilized for first time in years by pregnancy, breastfeeding.

While people with severe mental illness may display apparently poor judgment about meds (by not complying with their physicians' directives), their decisions may be based on any of the following:

--love of their baby (not wanting to damage them in utero with drugs of untested or known deleterious effect on a fetus)

--a temporary euthymia during pregnancy or postpartum that makes them think themselves cured. Saved by love, having this precious child to take care of is worth staying well for

--intense dislike of a patronising or insulting shrink who brooks no discussion: going off meds is one way to say !@#$ you to such a one.

--pressure from well-meaning friends and relations who are either in denial about the seriousness of the mental condition of the mother, OR who say "You can't poison your baby"

--Denial, denial, denial

--woman's-magazine-syndrome, talk show idiocy, or the asinine anti-drug remarks of a fundy preacher, a recovered alcoholic who is against any drugs or a celebrity twit like TC. When pregnant and postpartum, women are often highly emotional (you think???) and a single remark can have a huge impact.

Dr X said...

The evolution angle is fascinating. Most often, I think of infanticide by males--the instinct to kill the competitor's offspring, but what you say makes sense.

But what about cannibalism? Here, I find explanations consistent with Kleinian notions of primitive object relations compelling. Processes of projection and reintrojection aren't typically expressed as vividly as they are expressed in canablism, but then again, babies being in peoples "stomachs" and feeding off the body of their mothers (along with all the biochemical changes that take place during pregnancy`and childbirth) might have a special way of bringing out the most primitive in a person.

This being Sunday, I'm reminded of just how compelling Kleinian formulations are. Think about the Catholic Mass and the Eucharist. Jesus is murdered in connection with human redemption--he dies as a surrogate for human evil--an external container of the evil in all of us. But he doesn't really die. He lives on and, in Catholicism, is literally consumed as the Eucharist during the Mass. It's very powerful for people and it is not considered symbolic. It is treated as actually consuming the body and blood of Christ.

Evil is projected into the container, destroyed, and the goodness of the container is reintrojected where it lives on.

Anonymous said...

I think the most disturbing thing is that she has made manifest - in the most explicitly extreme way possible - a latent primal urge existent in all humans which is ordinarily suppressed - especially in nurturing mothers. But there is a certain logic to 'protective slaughter', however morally repugnant it seems. Looking into an inverted black mirror of our apparent essential goodness is not an exactly edifying experience.

Actually, if we take the extremity of this act a few notches back into the morally acceptable (albeit squeamishly so) realm of ritualistic placenta consumption, then outright human cannibalism becomes even more reasonably explicable - it's just a little further on that continuum of perverted logic.

Human physiology, psychology, etc is eminently warpable. It may only take the naturalest of human behaviours to instigate an avalanche of evolutionary regression on a devastating micro scale.

Retriever said...

Great comments on Klein and the Mass, Dr. X!

On the evolutionary regression mentioned by Anonymous, I have never forgotten the rat experiments we heard about in college (Skinner and rats were the main thing in our psych dept then, so I didn't want any part of it).

Anyway, the rats: when overcrowded, they became homicidal, ganged up on each other, didn't eat right, or ate each other, a higher percentage acted homosexually (how to refer to a gay rat without anthropomorphism?) than when the population was less dense. They committed infanticide, etc.

Years later when a tender hearted kid of mine bought a rat to keep it from becoming python dinner, I was forced to admit that they are very intelligent (albeit filthy) animals. Our "Ratty" was affectionate, would beg for food, and would follow conversations with every appearance of understanding tone of voice and emotions. She would dance charmingly to get our attention, climb up the bars of her cage and shake it like a monkey to get our attention. Would nuzzle her owner. But when forgetful child would not feed or water or clean her cage quickly enough, she could become quite snappy and alarming.

My point is that if a creature like a rat, with a complicated repertoire of behaviors and feelings and habitual responses can change into a fairly savage beast under stress or physical duress, how much more so a human?

Every mother knows how kids will fight before supper. Partly overstimulated, tired unwinding from the day (why colicky babies are worst in the early evening). But also just savage with hunger at times. The recovery movement warns of the dangers of being hungry, angry,lonely and tired. ALtho devised to warn alcoholics in recovery of situations that might induce relapse, the HALT combination is relevant to those suffering severe mental illness as well. By definition, many mothers of infants are hungry, are often angry (at how demanding a baby is, how their partners may have responded to the child and them, often lonely trapped in a room with a screaming infant 24/7, and ALWAYS tired.

But I still don't get the cannibalism, the infanticide, the destruction of children. I can understand it intellectually, but still have my evolutionary buttons pushed at the sight of little kids and can't understand the impulse to hurt them. Or how anyone can call it "natural" to hurt a kid.

Is it perhaps sometimes a mother who hates herself, and lashes out at what's there to get rid of the demon?

Or is it like borderline cutting, that is so heartbreaking to see and scars so, but that induces a terrible calm and temporary release in the suffering cutter? We talk about someone being drunk with anger. Are there some positive physiological feedbacks to a person being violent, so that they temporarily feel better after hitting or silencing another? This might explain why certain people keep on hitting others, not just that they are angry, but that their bodies get used to a kind of rush?

I am not trying to absolve anyone of moral responsibility for their actions. But, for example, it's a cliche that reproduction works best if sex is pleasurable, so perhaps violence is also physiologically pleasurable (to encourage a person to hunt or kill that sabre tooth tiger or marauding band from the next cave?)

A mystery to me.

Anonymous said...

I have a buddy whose wife runs away
when her role as Mother becomes too much for her to bear especially thinking of the many years more she has to do her job as Mother.
She is bi-polar and may or may not take her medicines which at best
do almost nothing for her anxiety or depression as she has been on these pills for many years.

Her husband and sh
is now exploring ECT at a $35.000.00 cost for a block of these treatments for her with a specialist Psychiatrist in manic disorders. Wow thats a lot on moolah and sadly out of pocket cost
with no certain outcome.

All I wish
to say is that we all hope down the road that we have better treatments
then what DR's. use today.

As a Neurologist said to me "We must first understand how the wiring in the brain works and why
it becomes haywire for some ,we still don't know much about the brain and it's cell function and
how this all affects not only
Neurology but Psychiatry".
I wish myself to be around in 100 years to see what treatment will be like for the mentally ill.