Postpartum Mental Illness and Criminal Responsibility

Postpartum mental illness becomes a question of criminal responsibility in Alice Espanet’s case, where the defense argues that psychosis deprived her of the capacity to understand or govern her actions when she killed her infant twins. The book places that claim at the intersection of psychiatric diagnosis, legal standards, and cultural expectations of motherhood. Its account neither treats maternal distress as proof of illness nor makes a diagnosis self-evident from the crime: it follows a contested process in which Alice’s behavior, her own account, expert testimony, and the law acquire different kinds of authority.

Medical distinctions and the limits of diagnosis

At Alice’s initial hospital admission, psychiatrists recorded disorientation and shock, and left open the possibility of dissociative amnesia. She spoke very little, sometimes asking where the children were and whether they were all right. When asked her name, she said Jade, confusing the doctors. The next morning, after a forensic examination, she began asking about her children; when told what had happened, she cried out that it was impossible, then moved between wailing, silence, and renewed trembling. These observations established an acute state of distress, but the book distinguishes them from a settled diagnosis of postpartum psychosis.

At trial, Dr. Leclercq, the psychiatrist who had treated Alice throughout the preceding year, explained the diagnostic spectrum. Baby blues, he said, affects about 80 percent of mothers after birth; hormonal changes, exhaustion, and sleeplessness can produce sadness, anxiety, crying, and guilt, but the condition generally passes within weeks. If symptoms persist or worsen after two or three months, clinicians should investigate postpartum depression, including the mother’s history and social circumstances and possible physical causes. Treatment may combine medication and psychotherapy, and recovery can take years. In some cases the condition progresses to postpartum psychosis, which can involve a loss of contact with reality and an immediate risk that the mother may harm herself or her baby, sometimes requiring round-the-clock hospitalization.

Dr. Leclercq stressed that the distinction is not simply between having a harmful thought and acting on it. In depression, a thought of harming a baby may be egodystonic: it conflicts with the mother’s values and can bring guilt and shame. In psychosis, he explained, such a thought may instead feel consistent with what the person believes must be done, making action more likely during an acute episode. He judged Alice’s case to be psychosis and said her account described an impulse she had not resisted. Yet the evidentiary basis for that conclusion remained important: the diagnosis rested on Alice’s behavior and her own account, not on an official diagnosis made before the crime.

Competing accounts in court

The prosecution drew attention to the absence of a psychiatric history. Dr. Leclercq acknowledged that Alice had no such history and no bipolar disorder, although he maintained his diagnosis. He also conceded that nothing independently documented Alice’s account; his assessment matched his recent evaluations of her. When the prosecutor made explicit that the diagnosis depended on the defendant’s conduct and testimony, most jurors appeared to nod in agreement with the psychiatrist’s answer. The book thus shows how a patient’s testimony can become a central component of a medical judgment even as its evidentiary limits are exposed in court.

The prosecution then called two court-appointed psychiatrists who had examined Alice soon after the deaths. They had found neither postpartum psychosis nor depression. In their view, postpartum psychosis occurred in the weeks immediately following childbirth, not ten months later, as in Alice’s case. They contrasted her timing with other infanticide cases in which psychosis had been certified, including mothers who killed very young babies. Their testimony did not merely dispute one expert’s conclusion; it presented timing as a test of whether the proposed illness could plausibly explain Alice’s actions.

Mélanie, the au pair, offered another kind of evidence. She had worked in Alice and Ritxi’s home from the time the twins were a month old until the deaths. Testifying behind a screen, she described a mother whose conduct could be difficult to predict. At times Alice supervised every movement, advising her on how to hold or change the babies and apply cream. At others, Alice said she was going to paint and left Mélanie to care for them. When Alice remained close, Mélanie recalled criticism and shifting worries: the babies might not be gaining enough weight, might be too heavy, might not sleep enough, or might be sleeping too long and be ill. Such testimony suggested instability and distress, but it did not by itself settle the clinical question of how far illness could explain or excuse the crime.

Criminal law, motherhood, and unequal histories

The defense’s legal argument centered on Article 20.1 of the Spanish Criminal Code. As Carmela Basaguren reminded the investigating judge, the provision exempts a person from criminal responsibility if, because of a psychological abnormality or disturbance at the time of the offense, that person could not understand that the act was unlawful or act in accordance with that understanding. The defense therefore framed Alice’s mental state not as a denial that the deaths occurred, but as a reason she should not be held criminally responsible in the ordinary way.

The book sets this provision beside the changing legal treatment of infanticide. In Victorian London, domestic servants could lose their jobs after becoming pregnant by men who had seduced them, leaving some abandoned, publicly shamed, and without resources. Queen Victoria intervened so that women in such circumstances would not automatically face the death penalty for infanticide. The narrative connects this history to the idea that a mother’s killing of a newborn has sometimes been treated as a distinct offense from homicide, an exception shaped by both maternal status and social conditions.

In Spain, infanticide remained a separate offense from homicide from 1822 until 1995. The earlier provision tied the offense to a mother’s attempt to conceal her dishonor, and also applied to maternal grandparents who killed a child to conceal that dishonor. Later reform proposals shifted the rationale toward emotional strain associated with childbirth and the puerperium. The 1995 Criminal Code abolished the separate offense, so a mother who kills a baby in Spain today may be convicted of murder. The comparison with Canada is deliberately sharp: Canadian law, as described in the book, still treats the killing of a child under one year old as infanticide when it results from a mental disturbance connected to pregnancy, childbirth, or lactation. The author highlights the possibility that proof of disturbance may be inferred from the killing itself, a circularity criticized by opponents of the law.

These legal histories make clear that criminal responsibility is not assessed in a cultural vacuum. The categories available to a court have changed over time, and the law has alternately emphasized concealment of sexual shame, the physiological and emotional effects of childbirth, and general mental incapacity. The case asks how those frameworks shape judgments of the mother, while also exposing how rarely the ideal of maternal happiness makes room for mental illness or ambivalence.

Stigma and the pressures of care

Dr. Leclercq testified that only about 15 percent of mothers experiencing postpartum depression seek help. He described the condition as taboo: mothers may find it difficult to acknowledge to themselves, their families, and doctors that motherhood has not made them happy and has instead left them deeply distressed. His account connects an individual failure to obtain care with a wider social pressure, without establishing exactly why Alice did not seek treatment. The gap between symptoms and help-seeking matters in the case because the defense must explain a severe crisis despite the absence of a prior psychiatric record.

The Narrator’s reflections on motherhood supply a parallel account of how care can crowd out other parts of a person’s life, but they are not evidence of Alice’s diagnosis. After becoming a mother, The Narrator describes feeling incomplete when walking alone, as if passersby could not understand her unless they knew she was a mother. Even solitary walks did not free her from responsibility: she still carried the baby on her conscience. After three months without more than three consecutive hours of sleep, repeated weight checks, and close attention to the baby’s bodily symptoms, she felt that motherhood had displaced her former identities as writer, worker, wife, and daughter.

The book also gives the daily work of care its own weight. Feeding, changing diapers, doing laundry, settling a crying baby, and checking whether the child is breathing can fill hours that seem gray and shapeless, while the rest of the world continues at its ordinary pace. The Narrator’s account resists the assumption that exhaustion is the only difficulty: boredom, isolation, and the expectation of constant self-giving also belong to the experience. At the same time, her reunion with Erik at nursery is filled with tenderness. He notices her, crawls toward her, and reaches out; she loves his body and wonders whether such closeness to life should appear in her writing. The affection does not cancel the frustration, nor does frustration erase the affection.

This contrast sharpens the book’s critique of any simple equation between maternal feeling and moral or medical status. The Narrator remembers initially resenting Niclas for the pregnancy, then accepting the coming child and wanting him. Later, she describes how vulnerable motherhood can make her: she wants to protect Erik fiercely but knows that love cannot prevent accidents, illness, or other dangers. Niclas comforts her during Erik’s medical examination and says they are doing well; privately, The Narrator admits that she means to do better herself. These scenes show how care can involve love, fear, exhaustion, self-reproach, and unequal responsibility at once. They illuminate the social expectations surrounding maternal care, but do not make those ordinary contradictions equivalent to Alice’s alleged psychosis or the crime.

Judgment and treatment

The case began with a defense request to apply the mental-incapacity provision and ultimately led to a jury decision followed by the court’s replacement of imprisonment with outpatient psychiatric treatment. Alice would not be sent to a psychiatric institution. The legal outcome therefore treated mental illness as relevant to criminal responsibility while leaving the response to the case within a criminal-justice framework rather than imposing ordinary imprisonment.

The book also records an argument about the practical consequences of that choice. The decision was praised on the grounds that Spain had only two prison psychiatric hospitals, in Alicante and Seville, both far from Alice’s family. Outpatient care was presented as viable because of Alice’s financial circumstances and her husband’s commitment, with institutions expected to monitor treatment and rehabilitation. The account raises, without resolving, the concern that social standing may have influenced the favorable arrangement. Thus the legal question does not end with whether illness is recognized: it extends to where treatment takes place, who can sustain it, and whether comparable options are available to defendants in different circumstances.

Across medical testimony, historical law, and domestic experience, postpartum mental illness and criminal responsibility remain related but distinct questions. A diagnosis may explain a loss of contact with reality; it does not erase the need to assess evidence, timing, and legal capacity. Conversely, the absence of a prior diagnosis does not by itself settle what occurred during a crisis. By setting expert disagreement beside the silences and demands of motherhood, the book presents responsibility not as an abstract verdict alone, but as a judgment formed through contested accounts of illness, care, and the social conditions under which mothers are expected to endure.