Sebolelo Seape responds to an opinion article written by Nthabi Nhlapo about the Lauren Dickason case, writing postnatal depression is both a public health problem and a personal suffering.

A recent opinion piece by Nthabi Nhlapo entitled Lauren Dickason: Justifying killing children at mental health alter demonstrates the strong need for psychoeducation among the public (media personnel in particular) around many issues pertaining to mental health, including stigma and depression. While the forensic psychiatric issues have been dealt with, noting a finding of fitness and responsibility despite the presence of mental illness, it would be prudent not to cast any comments on this, as: 

1) We have not conducted a forensic psychiatric observation (in South Africa Lauren Dickason would have been referred for this in terms of the criminal procedures act (CPA), as amended to establish fitness and responsibility) 

2) We really only have media reports, so whatever opinions are held would be based on a psychological autopsy at best and 

3) Laws pertaining to infanticide differ across countries (SA does not have an infanticide law as such; women that commit filicide would be charged with murder. New Zealand has a trial by jury, SA does not. It is unclear whether the concept of diminished capacity exists in New Zealand).

Noting there are reasons why a woman might commit filicide, with severe mental illness at the time of the offence, the South African Society of Psychiatrists holds the view that all cases, regardless of outcome, must be treated with respect and sensitivity to the issues at hand. Where perpetrators of violent acts have a history of mental illness, responsible journalism should always be adhered to.

The opinion article perpetuates the idea of the concept of a “bad” mother when referring to a woman who is coping with motherhood. It also stigmatises and demonises women with depression. 

There is no doubt that it is a tragedy when a mother kills a child. The jury found that she was not mentally ill sufficient to meet their understanding of their legal definition of infanticide. This can indeed happen. The writer considers certain responses to the verdict from the public as "justifying murder." For psychiatrists and psychologists working in the field of maternal mental health, this is a blatant undoing of many years of work towards destigmatising mental illness. From the case itself, all the experts, for the crown and the defence agreed that there was evidence for mental illness.

A further notion in the article that financially well-off people or healthcare practitioners can and do access adequate mental health treatment when they need it, is steeped in ignorance. Women of all sections of society struggle to access care for depression and postnatal depression, either because care is not available (in the private or public sector due to a critical shortage of psychiatrists and mental health practitioners) or due to stigma – the fear that they will be seen as being "mad", "crazy", "a bad mother", preventing them from accessing care.

Postnatal depression affects as many as 33% of South African women of all races and socioeconomic strata. Being a doctor does not protect you from postnatal depression or from depression. Yes, as a doctor you may theoretically have more resources to treat your depression, but the complex interplay of why women do not access resources is a field of scientific study in perinatal psychiatry. In many instances, if there is no support to access those resources, you will remain ill. 

Suicide in the context of severe depression and other psychiatric disorders is a serious problem worldwide, and South Africa is not immune. The World Health Organisation has declared it a global health concern. The author's statement that "Suicide and euthanasia………. one thing we have always agreed on ….is inexcusable until now" suggests that we now excuse the killing of a child warrants attention too.

Forensic psychiatrists generally interrogate whether any behaviour excuses a criminal act, versus explaining it. It is this "explanation" aspect that psychiatrists would hope is dealt with sensitively and in a manner that offers a way of making things better, not worse, for people struggling with perinatal mental health issues, and indeed any mental health issue.

Avertible filicide should be a focus in women with depression and anxiety, i.e., assessing risk factors for it and managing symptoms as they arise. To this end, clinics are developing protocols. Responsible journalism would certainly aid in this effort.

In the medical profession, especially post Covid-19, medical practitioners have high rates of depression, and a number die by suicide. Try to find a psychiatrist and see how long you have to wait to get an appointment. We have a mental health crisis in this country, post the pandemic, which mirrors a worldwide phenomenon.

Many psychiatrists and patients who have had mental illness have been deeply distressed by the tragedy that has befallen the Dickason family. Some families survive depression and postnatal depression; some families do not.