Postpartum Psychosis and Criminal Responsibility

Postpartum psychosis and criminal responsibility form one of the book’s central legal and ethical disputes: whether a mother’s mental state at the time of a crime can alter her responsibility, and how that state can be established when experts disagree. Through Alice Espanet’s trial, the narrative sets psychiatric evidence against legal standards, the details of childbirth and early separation, and the pressure to treat motherhood as either proof of devotion or an explanation for violence.

Legal categories and historical context

The defense’s legal argument rests on Article 20.1 of the Spanish Criminal Code, which exempts a person from criminal responsibility when a mental anomaly or disturbance prevents them from understanding the unlawfulness of an act or acting in accordance with that understanding. Carmela Basaguren invoked the provision in seeking Alice Espanet’s acquittal on grounds of mental incapacity. The issue was not simply whether Alice had suffered distress, but whether her condition had impaired her ability to comprehend or control her conduct when the crime occurred.

The book places this question against a history in which the law treated infanticide by mothers as a distinct category. In Victorian London, servants who became pregnant after being seduced by their employers could be dismissed and left without support; Queen Victoria intervened so that women who killed newborns would not receive the death penalty. In Spain, infanticide remained a separate offense from homicide from 1822 until 1995. The former provision tied the offense to a mother’s effort to conceal dishonor, and later reform proposals substituted emotional pressures associated with childbirth and the puerperium. When the separate offense disappeared from the 1995 Criminal Code, a mother who killed her baby could be convicted of murder. The narrative uses this history to show that legal definitions have repeatedly made judgments about what forms of maternal distress count, and what they mean for punishment.

It also contrasts Spain’s approach with Canada’s provision, under which killing a child under one year old in a mental state altered by pregnancy, childbirth, or lactation could be treated as infanticide and exempted from punishment if mental disturbance were proved. The book highlights the controversy in the proof: the fact that a mother killed her child could itself be used to support the inference that she was disturbed. This account is presented as a contested legal arrangement, not as a medical conclusion. Across these examples, the question of responsibility is inseparable from the law’s changing ideas about motherhood, childbirth, and mental illness.

Psychiatric testimony at Alice Espanet’s trial

The trial makes the uncertainty concrete. A Belgian psychiatrist testified that Alice Espanet’s account of her past included symptoms of bulimia and depression. Those earlier conditions had not received an official diagnosis, but he said they corresponded with his recent evaluations. Under cross-examination, he confirmed that his diagnosis of postpartum psychosis relied on Alice’s behavior and her own account. When challenged about the basis for that judgment, he maintained that these were the available kinds of evidence. Several jurors visibly responded to his answer, suggesting that his willingness to acknowledge the limits of diagnosis also made his testimony persuasive.

The prosecution’s experts offered a sharply different assessment. The psychiatrists who had examined Alice at the investigating judge’s request said they had found neither postpartum psychosis nor depression. They emphasized timing: in their view, postpartum psychosis occurred in the weeks immediately after birth, whereas Alice’s alleged condition arose ten months later. Their testimony included accounts of other infanticide cases in which psychosis had been certified, followed by references to the Beck Depression Inventory and the Edinburgh Postnatal Depression Scale. They also read out a list of traits attributed to Alice, including narcissism, histrionic tendencies, low empathy, and a tendency to idealize some people while despising others.

The presentation failed to hold the jury’s attention. One expert then departed from the prepared account, saying that the issue was less a disorder than Alice’s way of being: she could do evil, as almost anyone could, but could then live with it. That statement shifted the dispute from diagnosis toward character and moral blame. The book does not make the competing expert accounts equivalent or settle the clinical question; it shows how different forms of evidence—self-report, observed conduct, timing, tests, and judgments of personality—can lead to opposing interpretations of the same defendant.

Childbirth and the meaning of clinical evidence

The defense also called Alice Espanet’s gynecologist, the midwives who attended her, and a perinatal psychiatrist. Alice had delivered by planned cesarean at 37 weeks because the girl was breech and the amniotic fluid was low. After the babies were delivered, they were taken away while Alice remained in recovery. Her blood pressure dropped; she trembled and could not move her hands because of the anesthesia. She did not know whether the babies were well and was too weak to ask. The boy was placed in an incubator with low birth weight, hypoglycemia, a low platelet count, and respiratory distress. The girl was well but spent the day in neonatal care as a precaution.

The perinatal psychiatrist argued that these first hours should not be dismissed. In her account, a scheduled cesarean bypassed a significant neurobiological process, including the surge of oxytocin, and separation disrupted hormonal imprinting and attachment. She suggested that such circumstances might have long-term effects, including a mother’s sense of estrangement from a baby. The Narrator, recalling her own separation from Erik after his birth, regarded this account as alarmist: once he left neonatal care, she felt an immediate bond. She also pointed to her own relationship with her mother, who had been with her from the beginning yet remained emotionally distant. The contrast does not disprove the expert’s claims, but it prevents a general theory of birth and attachment from serving as a ready-made explanation for an individual crime.

The testimony about Alice’s postpartum period also includes the difficulty of breastfeeding. Because the babies were separated from her, they did not stimulate milk production. A midwife repeatedly tried to express milk, sometimes by hand and sometimes with a machine, until Alice asked her to stop on the third day. These details place bodily distress, medical intervention, and separation in the record without establishing that any one of them caused the later events. Their significance in court depends on how experts and jurors interpret them.

Responsibility, verdict, and treatment

In her closing argument, Carmela Basaguren acknowledged the horror of what had happened and the vulnerability of the two children, but asked the jury to consider whether lifelong imprisonment of a broken and confused woman would serve justice. She recalled the circumstances the defense had advanced—depression, psychosis, hallucinations, paranoia, and sudden violent reactions—and argued that Alice had lacked control over her actions. The argument did not erase the crime; it asked whether punishment should be determined without regard to the particular condition in which it occurred.

The consequences extended beyond the verdict. The judge replaced imprisonment with outpatient psychiatric treatment, so Alice Espanet was not to be admitted even to a psychiatric hospital. A commentator interviewed after the decision praised outpatient care as appropriate in this case, citing Alice’s financial security, Ritxi’s commitment, and the prospect of institutional oversight. The interview also noted that Spain had only two prison psychiatric hospitals, both far away, in Alicante and Seville, and that confinement there would severely disrupt her family. The favorable outcome therefore appears not only as a judgment about illness and responsibility, but also as a decision shaped by available treatment and personal circumstances.

Motherhood, illness, and the book’s counterpoint

The Narrator’s reflections on her own motherhood sharpen the distinction between ordinary ambivalence and a psychiatric defense. She describes exhaustion and the monotonous labor of feeding, changing, and watching a baby, as well as the feeling that the identity of mother has displaced her former selves. When Erik greets her eagerly at daycare, she feels the force of their attachment and wonders whether that contact with life will enter her writing. Her account holds love, boredom, self-doubt, and the desire for time alone together; it does not present those feelings as evidence of psychosis or as an explanation for violence.

She also describes motherhood as a source of vulnerability. While some mothers online portray themselves as newly powerful protectors, she feels more exposed than ever to accidents and illness that she cannot prevent. When Erik undergoes a lumbar puncture and is diagnosed with viral meningitis, Niclas embraces her and says they are doing well; she replies that they will do better, privately recognizing that she means she must do better. This self-reproach contrasts with the courtroom’s attempt to decide how much control Alice had, and how much blame she could bear.

The book’s treatment of postpartum psychosis therefore remains deliberately unsettled. It distinguishes a possible mental disorder from the broad and socially expected contradictions of motherhood, while showing how difficult that distinction becomes in court. Diagnosis can depend on contested testimony; legal responsibility depends on a standard that must be applied to a particular person; and treatment after judgment is shaped by practical resources as well as principle. Rather than turning childbirth into either a universal excuse or irrelevant background, the narrative makes it part of the evidence whose meaning remains disputed.