The ideal mother has no interests of her own.
ALICE BALIN, psychoanalyst, 1974
Powerless women have always used mothering as a channel—narrow but deep—for their own human will to power.
ADRIENNE RICH, 1975
When the paramedics arrived, the child had been dead for some time. A delicate girl, four months old, with bright clowns on her sleeper and a wisp of blond hair, she lay on the living room floor of her parents’ apartment among the unwrapped Christmas gifts. The room filled with a sting of winter air and the clamor of panic as adults rushed in and tripped over each other, shouting and muttering, reaching down to Tami Lynne to blow breath into her small blue mouth. It was December 20, 1985, nearly two in the morning in the manufacturing town of Schenectady, New York, twenty miles north of Albany.
Night sinks deeply in Schenectady in winter. The roads are poorly lit; they wind past shuttered houses and run-down malls. An ambulance siren keens through the somnolent quiet. Forty-two-year-old Marybeth Tinning was familiar with the sound of that siren. Over the years she had rushed her children to the emergency room at Saint Clare Hospital many times. Marybeth and her husband, Joe, were strong people, robust, rarely ill. But their children …
The Tinnings’ neighbor Cynthia Walter lingered with them in the hospital waiting room, stunned with fatigue, high on adrenaline, until the last thread of hope had unraveled and snapped. She didn’t want to let go of Tami Lynne, couldn’t believe the girl had simply “stopped breathing,” wouldn’t see her Christmas presents, would be covered with earth like a stone. She was grief-struck, like a mother, and although she didn’t know it, she was not the first to feel that hollow sorrow on the Tinnings’ behalf. She was, in fact, the last in a long line of wrenched souls—neighbors, relatives, friends, the withdrawn and devastated father—to watch Tinning children die.
Marybeth Tinning, an expansive, handsome woman with too-bright eyes, began a round of announcing phone calls at 8:00 A.M. It was presumed that Tami Lynne had succumbed to sudden infant death syndrome. She called her sister-in-law, who sank to the floor. She called a friend who worked in a children’s clothing shop and requested a bonnet to match Tami Lynne’s Christmas dress, which would be her funeral attire. Then she and Joe went home, and she set to work packing up her daughter’s clothes and toys in boxes. Two days later, the funeral, and the mother standing above her infant’s grave, citing a prayer in a whisper: “Now I lay me down to sleep, I pray the Lord my soul to keep. If I should die before I wake, I pray the Lord my soul to take.”
There were many troubled mourners at the funeral of Tami Lynne Tinning that morning two days before Christmas. People there who felt more than grief, who felt the leaden weight of realized dread. They knew this would happen, they should have done something, they didn’t. Now they were watching the last rites administered to the ninth dead Tinning child. This time, the Schenectady child abuse hotline flashed with calls. For the first time, the police department got involved. It would take investigators several weeks, but they would gradually assemble enough information to provide a grim retrospective on the maternal career of this ostensibly ordinary American housewife.
Over the course of fourteen years, police suspected, she had deliberately harmed, hospitalized, and murdered eight of her nine children, ranging in age from one week to five years. On February 18, 1986, Tinning confessed to the New York State police to killing three of her children. Ultimately there would be enough forensic evidence to convict her for the murder of Tami Lynne.
In psychiatric parlance, Marybeth Tinning seems to have had Munchausen syndrome by proxy. The phrase describes a condition that is a spin-off from Munchausen syndrome, in which a person self-inflicts injuries or invents symptoms in an unceasing quest for attention from family and doctors. Unlike the expressive self-destruction of angry women, Munchausen syndrome is “instrumental” aggression, meaning that it’s calculated, strategic—a deliberate and manipulative deception. In Munchausen syndrome by proxy, a person inflicts injuries on someone else—specifically, a child.
MSBP is almost exclusively the province of women who find themselves in maternal roles, either as biological or adoptive mothers or as babysitters or caretakers. They are very often nurses or are married to doctors. They have an expert grasp of medicine and a keen sense of medicine’s power. They know that if they do certain things, or administer particular drugs, they can elicit seizures, respiratory arrest, or stomach problems that will enable them to rush their children to hospitals, enacting a dramatic last-minute rescue on a brightly lit stage. The psychiatrists Herbert Schreier and Judith Libow describe MSBP as “a ‘career’ pursued by ostensibly wonderful mothers who repeatedly offer their children’s bodies to entice and simultaneously control their powerful, professional victims.” Their victims—the targets of their power plays—are doctors. Their children are pawns. Although some of them kill their children (the death rate ranges from 10 to 30 percent), most keep them alive through careful dosing, tossing them with stunning cruelty into constant states of peril.
In 1991, Schreier and Libow sent out questionnaires about MSBP to all 870 pediatric neurologists in the United States. Of the 190 responses they got back, 107 doctors reported 89 confirmed cases and 198 suspected cases. Pediatric gastroenterologists responding to the same questionnaire reported 267 cases of the syndrome. Though there is still no accurate tally in the United States of how common this phenomenon is (estimates run to about 500 new cases a year) “we can safely say that the disorder is far from rare, and that it is frequently missed.” In 1995, the FBI issued a report on MSBP to police investigators, citing “a growing list of cases” being brought to their attention by medical personnel. “This disorder represents a substantial challenge to the criminal justice system,” the report cautioned. MSBP women are such effective liars that police officers have to pursue their suspicions with a firm handle on the complexity of the suspect.
Marybeth Tinning began this strange dance in 1972, when she had her labor induced to make, of her third child, “a Christmas baby.” Newborn Jennifer died (naturally) of meningitis within days, and Tinning seems to have become abruptly fed up with the point of children, as if they no longer served a purpose. She was enraged by Jennifer’s dying, then depressed, and finally overwhelmed by the sympathy and adulation she received as a grieving mother. The funeral, some who attended remembered years later, seemed in an odd way to cheer her up. Events unfurled from there with lightning speed. Within a matter of weeks, Tinning burst through the doors of Saint Clare’s emergency room with Joe Jr. in her arms, the toddler gasping for breath as his mother screamed for help. Joe was admitted and recovered immediately. He went home. A few days later he was back. This time, the oxygen deprivation had gone on too long. By daybreak he was dead.
Two months went by, another funeral, and at the end of February, Tinning arrived at the emergency room with five-year-old Barbara in convulsions. The little girl was having seizures, bucking and writhing. She, too, was stabilized by hospital specialists. She, too, went home to recover and came back in the same state. By March, she, too, was dead. Marybeth Tinning had discovered in the ambulance siren her song, a triumphant cry to the world: I command your attention. I give life, and save it, and take it away.
The gap between what we assume of all mothers and what some of them actually feel was the space that Marybeth Tinning passed through. If Amy Ellwood committed her crime because her pregnancy had lost its meaning, Tinning suffocated her infant daughter because power was more important to her than love; ego gratification more compelling than toil. She was a predator. Had she been a man, she might have been a particularly ruthless entrepreneur, an organized criminal, a serial rapist. But she was a woman, and she located her well-spring of power in maternity. Not in the mundane, thankless mothering that most endure invisibly, without admiration, as our children flourish and grow. Tinning was drawn to the currency of motherhood, to the cultural prestige of pregnancy, the public admiration of a newborn, and the vast communal sympathy surrounding loss. Asked why she continued to get pregnant, given the alleged gene of death that seemed repeatedly to strike her, she replied: “Because I’m a woman, and that’s what women are supposed to do.”
When did people begin to suspect that something was amiss? Not after these first three children died; at that point, everyone was struck by the tragedy. How could a mother lose so much, so fast, and keep her wits about her? People pitied and admired Marybeth, which inspired her to do it again. A fourth child lived and died. Then a fifth. A sixth. Several nurses at Saint Clare were suspicious and called the child abuse hotline at various times, to no avail; Tinning’s pediatricians were stalwart in their support of her. As the sorrow of a mother is presumed, so is her tender protectiveness. The death of a healthy child must, by cultural dictate, be proclaimed a natural mystery. If a pattern emerges wherein nature strikes one family more times than the odds would allow, then suspicions are quickly quelled by the interplay in our culture between two icons: the saintly mother and godly doctor. Munchausen syndrome by proxy thrives in the context of medical arrogance, where doctors cannot admit to the failure of their expertise. They cannot admit to being mystified. They cannot say “I don’t know.”
Although there was never a clear cause of death in Marybeth Tinning’s children, the pathologists who examined each child resisted writing “Cause of Death: Unknown” on the death certificates. Barbara and Joseph and Timothy and Nathan and Michael and Mary Frances and Jonathan and Tami Lynne were listed, variously, as victims of SIDS, pneumonia, and Reye’s syndrome. In retrospect, it was apparent that none of these labels fit. What the children had in common when they died was signs of asphyxiation. They were smothered. Had the pathologists and pediatricians involved been less preoccupied with science, they might have thrown up their hands and so opened the door to an investigation. Still, one wonders if any serious investigating would have taken place. The culturally celebrated mother at the center of tragedy is one of our most potent symbols.
The name Munchausen syndrome by proxy was coined in 1977, around the same time as battered woman syndrome. The label is hugely misleading, insofar as it implies a treatable illness from which someone suffers, presumably without control, without the ability to make moral and rational choices. Many MSBP mothers suffered as children from neglect or abuse, but by the time they are adults, they are no more treatable than a serial killer like Paul Bernardo. Indeed, the psychiatrists Schreier and Libow contend that MSBP “may be a gender related form of psychopathy.” In a moral context, we might simply call it evil. The term psychopath was introduced in the late nineteenth century but is best described in a 1941 book called The Mask of Sanity, by American psychiatrist Hervey Cleckley. As Cleckley defined it, psychopathy covers a cast of characters whom we traditionally understand to be men and might recognize in a villain such as Bluebeard: people without conscience, who, in the clinical phrasing, lack “empathy” for and “insight” into other human beings. They are perfectly sane individuals, Cleckley argued, except for their inability to love. They are hollow.
Since Cleckley, various scholars have narrowed in on the telltale traits of the psychopath. Among the most consistent behaviors are pathological lying, short attention span, grandiosity, manipulativeness, recklessness, remorselessness, and an absence of fear. According to biocriminologists, psychopaths are physically incapable of getting nervous. They don’t experience the physiological arousal that goes with fear and anxiety, such as racing blood and sweaty palms. When people talk about “cold-blooded criminals,” they are intuitively describing a very real biological phenomenon. They may be referring to a lack of compassion, but they are also picking up on the lack of reaction. Psychopaths will as calmly murder a child as eat their supper. In fact, it is often remarked upon in accounts of serial killers that after the crime, they forget all about it and sit down to dine.
Dr. Robert Hare, of the University of British Columbia, has been analyzing psychopathic speech patterns, using functional magnetic resonance imaging scans to monitor brain wave activity. Theorizing that a vital link is missing between emotion and language in the neural structure of their brains, he shows psychopaths words, like “wood” or “hat” or “love” or “death,” to see if their brain waves distinguish emotionally resonant words from neutral ones. Most of us react differently to “love” than to “wood.” The psychopath does not.
“What is love?” a psychiatrist at the Penetanguishene Mental Health Center in Ontario asks a psychopath in a videotaped interview done in the 1980s.
“Having someone put dinner on the table,” the young man guesses.
“What is trust?”
This gives pause. “It’s just a word,” he replies, after mulling it over. “It doesn’t mean anything.”
The psychiatrist J. Reid Meloy compares the structure of the psychopath’s brain to a reptile’s. A cold-blooded animal like an alligator has a fixed set of instincts, “such as home site selection, establishment and defense of territories, hunting, feeding, mating, competition, dominance, aggression.” What a reptile doesn’t have “is a parental response to its offspring.” The analogy reveals why it’s so difficult for people to picture women as psychopathic predators. All women are presumed to have a parental response, even if it’s an anguished response or a crazy one. Even if a woman grows wild and furious with her child, that, at least, is engagement. But what if the child has no ability to affect her at all? That child is invisible, annihilated. The most painful cases of child abuse to read about are the ones in which a child was simply ignored. Nothing can be so threatening to one’s remembered childhood ego as the idea of maternal indifference. Yet neglect, not just by psychopaths, is one of the most common forms of maternal aggression. “Neglect is continual,” argues Dr. Mindy Rosenberg, a child psychologist in Oakland, California; “it’s pervasive, it’s chronic, it’s insidious. And it’s far more common than abuse.” The Swiss psychoanalyst Alice Miller has defined neglect as “soul murder.” Often, neglect is expressive of sublimated rage or depression, but it can also be instrumental. The starved, discarded child in the closet frequently has well cared-for siblings. The mother is using this one child for some other purpose: to punish the father, perhaps, or to disavow an aspect of herself. At any rate, her obliteration of the child is careful, considered, and prolonged. And so horrifying, we can barely even conceptualize it, which goes some way to explaining why the psychopathic mother is a type found virtually nowhere, in either literature or medicine.
What would a psychopathic mother look like? How would she talk and act? Meloy points out that psychopaths “share with the reptilian [brain] an inability to socialize in a consciously affectionate and genuinely expressive manner.” Because they cannot feel affectional emotions, only boredom, exhilaration, and rage, psychopaths become mimics of human behavior in order to fit in. This is what Cleckley meant in his title by “mask of sanity.” Through careful observation, psychopaths learn to appear to be loving, principled, and kind. They are predators in disguise. When Schreier and Libow describe Munchausen syndrome by proxy as “a form of mothering imposture,” they could be describing the mask that is donned by a female psychopath. If these women resemble anyone, if they summon any particular stereotype, it is that of the culturally celebrated mother.
There is a photo of Marybeth Tinning, taken perhaps in 1970, with her eldest daughter Barbara, who looks to be about four years old. The girl wears a perfectly pressed dress tied in the back with a bow. Her hair has been brushed until it gleams. Mother Marybeth sports an expression of cheerful concentration as she shows Barbara how to work a toy. Her own dark hair falls to the shoulder, then bounces with an insouciant flip, like Mary Tyler Moore’s in “The Dick Van Dyke Show.” Barbara would live for roughly one more year.
As if auditioning for parts in a play, Marybeth Tinning pursued roles that she identified with femininity and nurturance: She was the president of a girl’s club in her high school called Future Homemakers of America. She was a mother, nursing assistant, school bus driver, and volunteer ambulance attendant. One year, she got a job as a waitress and seemed to imitate the idea of waitress, painting on her eyebrows and dying her hair. She also engaged in a full repertoire of feminine self-denigrations, displaying tears, a chin cocked downward, a hope for approval. Yet, alone with Joe, she had a violent temper, once kicking her foot through their TV.
The same duality surfaced in her mothering. A telling detail in the short life of Tami Lynne was that she was always beautifully attired, according to the family, but the doctors who examined her on the night that she died found severe, untended diaper rash. “In Marybeth’s mind,” writes the journalist Joyce Egginton, “a baby was an extension of herself, and when the infant was admired it was she who received the compliments.” But what others didn’t see need not be done. Tinning showered her babies with store-wrapped gifts but often left their bottles out on the counter for a day or two, until the milk grew sour. When attention wandered from her, she upstaged other people’s events. She announced her eighth pregnancy, for example, at a christening party for her seven-year-old niece, effectively usurping the mood by casting a pall over everyone’s day. Even her murder trial, an event of justice sought for her children, became an opportunity for self-promotion. Tinning was delighted by the media. “You could paper the walls with all my photographs,” she bragged to a staffer in the courthouse cafeteria, according to Joyce Egginton.
Some cultures invoke the belief that if you photograph a person, you steal their soul. According to J. Reid Meloy, the relationship of the psychopath to those around her is somewhat akin to the process of a body in search of a soul. People become “projective containers,” alternately idealized and devalued to sustain the fragile structure of the psychopath’s “grandiose self.” Even in death, Tinning’s children were mirrors, reflecting back a confirmation of her own importance. Tinning’s behavior at her trial was reminiscent of that of an Oregon woman named Diane Downs, whose three children got in the way (as she saw it) of her infatuation with a married man. Having showily lavished attention on them throughout their young lives, she now unhesitatingly shot them—at close range with a Colt.45—in an act of premeditated mayhem that was made to look like a carjacking. One of her children survived and eventually summoned the courage to tell investigators what happened, which led to Downs’s arrest. In 1983, Downs appeared at her murder trial pregnant and smiling serenely, having conceived a new child on a one-night stand so that she could project an aura of maternal grace to her jury. Like Tinning, she didn’t understand that her femininity had lost its currency the night she fired her gun.
Eventually, female psychopaths unmask themselves this way. They reveal a fundamental failure to get the point about love or mothering. Even so, it takes much longer for people to see the mask slip on a woman than on a man. Marybeth Tinning confounded observers because she seemed so genuinely torn up by her losses. Emotion in predators often trips us up because we don’t expect them to be able to show it. “I’ve seen psychopaths cry like a baby,” says Dr. Bill Tillier, a forensic psychologist in Edmonton, Alberta. “But it’s the focus of the emotion you have to look for. Their emotion is flowing through an egocentric filter.” They cry in self-pity, not grief. If the difference is only remotely evident in men (Paul Bernardo sobbed hysterically the night Tammy Homolka died), it is extremely obscure in women because it plays so directly into feminine stereotypes. The people around Marybeth Tinning saw her as “childlike,” “needy,” “craving affection,” “insecure.” Add to this their preconceptions about motherhood, and a lack of suspicion turns into outright protectiveness. Even when she gave her confession, the state police investigator, William Barnes, led her to answer questions that he hoped would win her forgiveness at trial, “doing his best to elicit a confession … which might be the basis of a plea of temporary insanity.”
The idea that Tinning was temporarily insane on eight different occasions (some suggest she had postpartum psychosis) was somewhat belied by her attempt to kill Joe, after an argument over money, which she spent copiously and recklessly. In the spring of 1974, according to Joyce Egginton, she appears to have poisoned her husband with seventy capsules of phenobarbital, a drug her nephew took to prevent seizures. Far from being suspected of attempted murder, she won pity for the fact that her husband “had tried to commit suicide”—a scenario that Joe didn’t oppose because he couldn’t remember what happened. Tinning came close to being charged with arson when, at her insistance, Joe bought and renovated a trailer that she decided she didn’t want, at which point it mysteriously burned to the ground.
Over the years between 1972 and 1985, Tinning hinted to people that she might harm their children—or may have killed her own. She placed these warnings in the mouths of third parties, as if commenting on unfounded accusations against her. Her favorite book was Where Are the Children? by Mary Higgins Clark, in which the heroine is falsely accused of killing her children and must keep on the run from police sirens, fugitive-style. Joyce Egginton interprets these dark insinuations to be her cry for help. But do people who want help indulge in multiple murder as a means to that end? Psychopaths don’t want help, they want power. One suspects, instead, that Tinning was flexing her muscle—boasting, as nearly as she could without getting caught, of her magnificent accomplishment. What could ever be so potent as to kill?
When Medea used her children as pawns in her war with Jason, she became one of the last figures in Western culture to mirror the truth that women can be strategically aggressive toward children, that their violence isn’t always personal, private, or impulsive, that sometimes it is expressly political—a means of making a public statement, furthering an ambition, punishing a man. Greek and Roman mythology is fairly plain on this point, with an abundance of wrathful godesses and heroines who imperil children in pursuit of some other goal. The fate of the child is irrelevant to the mother. The child is a vehicle for her own empowerment. Yet if all this was quite explicit in early Western mythology, it has since disappeared. Apart from the wicked stepmother, who is not biologically related to the child, one searches literature in vain for an archetype of instrumental maternal aggression.
Perhaps one reason for the absence is that maternal aggression isn’t always physically explicit; the injury is less visible than Medea’s slaughter of her sons. Instead, it takes the form of pushing or forcing children to behave a certain way. Sons throughout history have been pushed into wars and other conflicts by their mothers, for the sake of her honor or aggrandizement, only to lose their limbs or their lives. In her book about the history of motherhood, Shari Thurer comments that “the Roman mother’s use of her own sons toward the attainment of power was elevated to a high art.” The same could be said of several other epochs and cultures. Adrienne Rich understood this in terms of sublimation of forbidden emotion: “A woman whose rage is under wraps may well foster a masculine aggressiveness in her son.” But less purely emotional motives come into play as well. Women use children to express their will to power.
One of the most influential explanations for crime in the twentieth century is anomie theory, which holds that criminality is a response to frustrated ambition. Men who hope to achieve success will turn to crime if no other route is available. At the same time, anomie theory has been used to explain why women do not commit crime: Since their ambitions are to marry and raise children, “extremely accessible” goals, they are less likely to be frustrated in their aspirations. Applied this way, anomie theory becomes the economic version of the psychological theory of relationalism—women’s point of reference is the family and the home; therefore, they are less inclined to be antisocial and destructive. Both theories miss the point. Social and economic arrangements do not, in themselves, erase a woman’s will to power. What they do is shape her concept of empowerment and redirect her efforts.
Is there a connection between the ambitious woman who endangers the life of her child to enhance her own prestige and the MSBP mother? It’s important to make the distinction between two bids for power: One aims for vicarious access to the masculine world, such as the mother who pushes her son into war, politics, or sport because she cannot pursue power directly. The other bid is to project feminine power into the masculine world—to remind men, as it were, that women have control over life and death itself. This was Medea’s strategy, and it is the far more fearsome of the two, for the power is more potent and the tactic more ruthless. Unconscious of her mythic ancestress and, perhaps, of her own motive, a woman like Marybeth Tinning promotes herself in much the same way. Working within the conventional boundaries of femininity, a psychopathic woman who is searching for an arena in which to aggrandize herself may well be attracted to the grandiosity of the medical establishment because it has become the locus of power and prestige for the traditional maternal role.
The rise of MSBP coincides with the ascendance of medical control over motherhood and the rise of so-called scientific mothering. Before this century, women largely raised their children through a combination of experience, common sense, and collective wisdom. By the time Marybeth Tinning joined the Future Homemakers of America in high school, male doctors’ influence was paramount. Women were responsible for children, but they were not in control. Motherhood was a career, for which they had to train, in perpetual apprenticeship to doctors.
The anthropologist Rima Apple has unearthed magazine advertisements from the twenties, thirties, and forties that encapsulate the paradox. In one ad, dating from 1938, a woman is portrayed at a table flipping through an expert’s child-rearing text. She is telling her daughter, “I wish I’d had this manual when you were born!” Beneath the tableau runs the caption: “Add science to love and be a ‘perfect mother.’ “Apple cites an advice columnist who tells her women readers, “Ideal motherhood, you see, is the work not of instinct, but of enlightened knowledge conscientiously acquired and carefully digested. If maternity is an instinct, motherhood is a profession.”
Psychopathic women might be attracted to the concept of scientific mothering because of its assumption that maternal behavior isn’t instinctive but is, instead, something they could train for. They might also calculate its power-play potential: If maternity in the guise of medical knowledge is prestigious, they can appropriate that knowledge and empower themselves in a male world. They can win, all at once, the adulation of the feminine and the power of the masculine, usurping both control and prestige. There is an intriguing overlap in the behavior of mothers with Munchausen syndrome by proxy and nurses who commit multiple homicides and are known, euphemistically, as angels of death: Both pursue acts of feminine nurturance, a role that, if disconnected from true or spontaneous compassion, has the appearance of compassion, and more than that, the prospect of heroism—the potential for the caregiver to be adored and respected for the rescue of life itself.
Take a tour of a hospital pediatrics ward, and you begin to see the discrepancy in status between nurses and mothers, on the one hand, and doctors, on the other. So it seemed one afternoon at The Hospital for Sick Children, in downtown Toronto, which had its own brush with an angel of death. Sick Kids, as it’s known, is a light, airy, plant-filled oasis for ill and wounded children from around the world. Their dramatic tales often get newspaper play: the South Asian Siamese twins who were successfully separated; the Ghanaian boy who recovered from a rare cancer. On 7D, the general pediatrics ward, the doctors make their early morning rounds through the white corridors, pushing a computer on a trolley past posters of Babar and Winnie-the-Pooh. They are accompanied by two junior residents, an intern, and a visiting doctor from Poland. Everyone is well dressed beneath their white coats, young urban professionals whose identical stethoscopes mark them as members of the medical elite.
Every few feet, the group pauses to discuss the patients whose names they see slotted into plates beside each doorway. One doctor pulls up the relevant file on her computer, and the group debates diagnoses. Could five-year-old Brian indeed have cystic fibrosis, as “Chest” insists? A second doctor feels the child also suffers “clinical malnutrition.” Were the liver biopsy results back from G.I.? The junior resident notes that Brian hasn’t been “tolerating his feeds.” The first doctor worries about that, tapping at her keyboard, “We need him to be optimized for his operation.”
As the highly clinical medical scrum goes on, nurses in sweatpants and running shoes squeeze by with muttered “excuse me’s” to get into the patients’ rooms. They carry Monopoly boards and teddy bears, bottles of juice, packs of crayons. They sit the children on their knees, cradle them in their arms, and, when the children vomit or soil themselves, the nurses roll up their sleeves and clean it all away. The contrast is striking: Authority and respect is on the doctor’s side, toil and sentiment on the nurse’s. It runs parallel to the division of esteem in the traditional home.
In 1979, the Hospital for Sick Children was plunged into crisis. Twenty babies died in a handful of months, apparently from overdoses of a heart medicine called Digoxin. For a time, code blues were sounding almost every day. Ultimately, a nurse was charged, but was released for lack of evidence; the deaths were never solved.
In 1981, officials at Bexar County Hospital in San Antonio, Texas, telephoned the Hospital for Sick Children for advice when a large numbers of children in their ICU began perishing unexpectedly as well. Usually, the pediatrics unit had two or three code blue resuscitations in a month. In August of 1981, they had nine; in September, thirteen. The children were hemorrhaging internally or dying of cardiac arrest. Without exception, the dramatic emergencies took place on a shift under the supervision of a nurse named Genene Jones, who appeared to be flourishing in her role at the center of crisis.
The parallels of character between Jones and Tinning are striking. Genene Jones was a “charming and manipulative” liar, who, like Marybeth Tinning, “told colorful stories about her life and exaggerated illnesses to her friends and children.” In Jones’s first two years as a pediatric nurse, she proved unreliable and arrogant, making several serious nursing errors, showing up for her shift drunk, swanning dramatically off to Bexar County’s outpatient clinic and emergency room a total of thirty times for mysterious ailments, and presiding with operatic flair over the children on the unit. At one point, presumably for thrills, she announced to a mother and father that their child had died when he hadn’t.
Everything about Genene Jones’s behavior should have sounded alarms when the code blues sprang up on her shift, but at the same time, it seemed implausible that a woman who so clearly relished the rescue of children could be causing them harm. Eventually, hospital administrators agreed that Jones was too strong a suspect to ignore. Doubtless armed with words of caution from the Hospital for Sick Children in Toronto about pegging the wrong person, Bexar County fired all of the nurses in the ICU rather than risk litigation for firing Genene Jones alone. Within weeks, she’d moved to a private pediatrics clinic in a small town, hired by one of Bexar County’s former residents, who was apparently unaware of, or who dismissed as unfounded, suspicions about her conduct. In less than a month, four little patients went into respiratory arrest, exactly the type of code blue that had occurred at the hospital. Then a girl who was tagging along with her mother to the doctor’s office suddenly developed breathing difficulties after sitting on Jones’s lap alone in the waiting room. The doctor sent the girl to San Antonio for investigation, and on the trip, accompanied solely by Jones, she had a heart attack and died.
The parents took out an ad in the local paper thanking the doctor and her nurse, Genene Jones. The local medical community responded differently. They forced the head of the clinic to investigate her nurse. The doctor found vials of Anectine, a drug that causes muscle paralysis and respiratory arrest, and Jones was charged with two counts of murder. Shortly after her conviction, a Texas Department of Corrections official wrote to the Bexar County Hospital District to ask if there was any problem with inmate Jones being assigned to the hospital dispensary.
Mothering, whether in the home or on the hospital floor, is a much more common route to power for psychopathic women than is commerce or sex. That route should be clear. That it’s so veiled is less a comment on the cunning of the women themselves than on the prejudices of our culture. As Schreier and Libow wrote about MSBP, “That we have so much difficulty seeing these mothers as charades says as much about our wishes and needs as it does about the women themselves.”
In recent years, academics have tried to uncover MSBP rates by tracking cases of confirmed abuse or death in children and then researching the fates of their sisters and brothers. Dr. Roy Meadow, a professor of pediatrics at St. James University Hospital, Leeds, England, who coined the phrase Munchausen syndrome by proxy, reported in 1990 that of twenty-seven children who had been suffocated by their mothers, he’d found eighteen siblings who had died “suddenly and unexpectedly in early life.” Three similar studies found high rates of unexplained sibling demise. Chicago, which has one of the highest unexpected infant death rates in the world, was the subject of a 1985 study by the Committee to Prevent Child Abuse. Twenty-two percent of the crib deaths recorded in a two-year period, the committee found, “were related to suspected child abuse and neglect.” Though not all of the suspicious Chicago cases were the result of Munchausen syndrome by proxy, the data reveal how easy it is to harm children, and particularly babies, without falling under suspicion.
According to Dr. John Emery, testifying at Marybeth Tinning’s trial, the term sudden infant death syndrome was coined at the turn of the century in the state of Washington. “As deaths due to what you might call classic disease such as pneumonia disappeared,” Emery explained, “relatively larger numbers of children died unexpectedly … at home instead of at hospital.” Without any obvious or medically understood cause of death, parents became suspects in neglect, either for “sleeping on top of them, or being drunk or disorderly.” A group of Seattle doctors “said let us, as it were, invent a term which could be used to describe babies that are found unexpectedly dead, and we will say that this is a natural cause of death so these parents shall not be harassed. Eventually they called it sudden infant death syndrome, and this had a very fine effect.”
As with postpartum psychosis, SIDS is not always the wrong conclusion to draw, insofar as there quite clearly are breathing and metabolic disorders in some infants that cause sudden death. In some cases, the problem may be a subtle neurological malformation affecting respiratory control; in others, a respiratory infection. Smoking during pregnancy increases the risk of SIDS. So does premature birth. Babies are also vulnerable to suffocation when lying facedown on bunched bed clothes, because they don’t have the strength to lift their faces. The peak risk age is between two and four months, with 90 percent of SIDS deaths taking place before six months. Natural infant deaths are not a fiction. SIDS itself is not necessarily a misnomer. The problem is that it’s become a catch-all explanation, used when autopsies show no clear cause of death. Coroners tend to apply the label indiscriminately. In 1995, two babies in the Boston area who suffocated in battery-operated cradles were listed as SIDS cases without death scene investigations. Another eight babies died before any connection was made to the design of the cradle.
Death by smothering is virtually indistinguishable from SIDS at autopsy. If medical examiners don’t seek out clues at the death scene, as they do for all suspicious adult deaths, then it’s not difficult to see how infanticides by smothering are overlooked. Police investigators and academics guess that 10 to 20 percent of the six thousand to eight thousand SIDS cases reported each year in the United States conceal accidental or deliberate suffocation. “I remember handling all the deaths, and you’d get a lot of crib deaths,” recalls detective Leroy Orozco. “We had one where one gal’s baby died, then several months later, another one. We thought, this gal could suffocate her kids and we’d never know it.”
Karisa Santiago, of Yonkers, New York, was charged with murdering her five-month-old daughter, Maria Lisa Ruiz, in 1994 after two of her other children died of SIDS—Mildred, eight months, on March 25, 1994, and Benjamin, two and a half, on November 18. Although the New York City Medical Examiner had found Benjamin’s death “suspicious” because of bruises on his nostrils, not to mention the fact that he was too old to be dying of SIDS, his case was listed as SIDS due to “insufficient evidence.” Only when Maria died were the earlier two cases reopened. Karisa Santiago pled guilty to one count of manslaughter in November 1995. “The only way you can prove [smothering],” according to Dr. J. M. DiMaio, a coroner in San Antonio, Texas, “is to show a pattern of behavior.”
DiMaio worked on the case of Martha Woods, which set a precedent for introducing patterns of behavior in infanticide in 1973. Woods was the wife of an army officer who had harmed nine children and caused seven to die (only three were her own) over twenty-three years. In each case, she rushed the baby or toddler to the hospital in a state of oxygen deprivation, doctors performed extensive tests, found nothing wrong, the child recovered and after repeated episodes, finally died. In one instance, a doctor cited the cause of death as “status lymphaticus,” a condition that doesn’t exist. In another, a physician cited the cause of death suggested to him by Martha Woods rather than performing an autopsy. Woods eluded detection from 1946 to 1973, in part because she and her husband were moving around. Marybeth Tinning, on the other hand, was not moving around. She stayed in one place in full view of her community. “A lot of doctors,” notes Dr. DiMaio, “are very naive about these cases.… they think that all mothers care about their children and find it very hard to believe that some mothers don’t.”
One such doctor seems to have been Alfred Steinschneider. In 1972, the pediatrician published an article in Pediatrics magazine announcing that multiple deaths in one family probably had a genetic or inheritable component—the gene of death that Joe Tinning thought he and Marybeth were carrying. SIDS, the doctor claimed, ran in families. Twenty-two years later, Dr. Steinschneider’s case study for this article, a New York State housewife named Waneta Hoyt, confessed to smothering all five of her children.
In the meantime, however, Steinschneider’s article was widely influential, preventing coroners and doctors across North America from entertaining suspicions when multiple babies perished in a family. After a Chicago woman named Deborah Gedzius lost her fifth child, a healthy two-year-old, to mysterious causes in 1979, her husband requested an investigation. Their pediatrician, Dr. Eugene Diamond, phoned Steinschneider, confirmed that SIDS ran in families, ruled that all five toddlers had died naturally (in spite of the fact that they were well beyond the SIDS age bracket), and published his own journal article about it. Then a sixth child died, and Deborah Gedzius’s husband, who in grief and disgust was planning to divorce her, was shot in the head while he slept. Gedzius collected one hundred thousand dollars in life insurance. She wasn’t charged with the crime. Nor would the attorney general’s office prosecute her in connection with the deaths of her six children. Their reasoning? They’d heard expert testimony at a preliminary hearing (which determines whether there is sufficient cause to go ahead with a criminal charge) that was based on Steinschneider’s article.
If Marybeth Tinning was able to get away with murder for so long, the SIDS-in-families theory was certainly one of the culprits. It wasn’t the only one, of course. The child welfare system failed the Tinning children by repeatedly erasing its records of abuse calls, creating for itself a continuous tabula rasa about her behavior. Given the virtually invisible nature of certain forms of female-perpetrated abuse, the mistake is perhaps unsurprising.
When Marybeth Tinning began to kill, infanticide and child abuse had not yet come to the fore of American social politics. By the time she was arrested, questions about how citizens treated their children were urgently being posed. Reports of child abuse increased 50 percent nationwide between 1986 and 1992, with a total of 1,160,400 children confirmed as abused by investigators—a 10 percent increase over 1991 alone. In terms of fatal child abuse, a 1993 Department of Justice report, “Murder in Families,” states that mothers were more likely than fathers to be the perpetrators of child homicide. Smaller samples by scholars show conflicting results, concerning nonfatal abuse, with men found to be more responsible for “shaken baby syndrome,” while mothers more commonly commit general assaults—or vice versa, depending on the research. Women appear to be more responsible for the severe physical abuse of American children, with sons being more frequent targets than daughters. Female involvement in sexual abuse, virtually ignored in the discourse, is more common than previously believed. A number of new studies have focused on female child molestors, though the incidence rate remains controversial—ranging upward to 25 percent of all cases.
There is a marked tendency to preface the admission that women abuse children with a reminder that they spend more time with them. This is akin to insisting that men are more violent in war only because they are the ones to be drafted. It is hardly an explanation. We obscure the role of women in child abuse and neglect because it doesn’t fit well with current rhetoric on violence. “Women are linked more intimately into networks of interpersonal ties, and their moral decisions are more influenced by an ethic of caring that inhibits criminal activities that hurt others,” noted two crime scholars in 1993, echoing the thinking first elucidated by Harvard psychologist Carol Gilligan. Crime runs contrary to “the values of womanhood.” Anyone who has been physically or sexually assaulted by her mother or a female caretaker knows that this truism has too many exceptions to hold.
There are compelling reasons to resist an exclusive emphasis on maternal child abuse. Freud began a long tradition of blaming everything that went wrong in human development on Mom. But what is vitally important about acknowledging female contributions to family violence is that mothers can act as powerful forces of socialization, either teaching a child through the trauma she inflicts how to behave in the wider world, or compelling that child, who is damaged, to wreak destruction in turn. Alice Miller has traced the links between child abuse and violence particularly eloquently. “When a person cannot talk about the cruelty endured as a child,” she writes, “then he or she must demonstrate cruelty.” Miller cites the case of an eleven-year-old Newcastle girl named Mary Bell, who strangled two small boys, aged three and four, and left their small bodies amidst litter in a junkyard. Her mother had given birth to her at seventeen and immediately rejected her, shouting “Take it away” when the baby was brought to her in the hospital. Several times she left her small girl in adoption offices, simply walking out. The child was returned to her repeatedly, and ultimately she tried to kill her. Strikingly young, Mary Bell began to kill in turn. “A child who has been mistreated at such an early age,” Miller wrote, “must be able to tell in some way or another about the wrong that has been done her, about the murder perpetrated on her.”
A recent study of rapists and child molestors found that fully 62 percent of them had been sexually abused when they were young, by female caretakers as well as male. Studies of wife-assaulters frequently reveal a majority who were abused as children—as often, if not more often, by mothers than fathers. Research on the relation between child abuse or neglect and female criminality shows that twice as many girls who were mistreated were later arrested for adult crime. Men and women who were abused themselves are far more likely to fatally assault or neglect their own children. It is not that bad men are the fault of evil women, but to separate one sex from the other as virtuous or blameworthy is to follow a false trail in understanding the causes of violence. If a man learned physical or sexual violence from his mother, how useful is it for us to blame it on his maleness, to educate him about not being sexist, to decry “violence against women,” as if women weren’t contributors to the trajectory of his rage? If we are to understand his crimes, we might just as well understand his models. “Only the last murder,” writes Alice Miller, “the final act in a very long chain of events, is punishable by the court.” The first, the neglect or abuse of the child, goes unremarked, and “spreads over the world like a plague.”
If the formation of the child—morally, emotionally, and socially—is a more plausible cause of violent behavior than testosterone, say, or patriarchy, how much weight should we lend a child’s abuse in our perception of the adult offender? It depends on the point of the perception: prevention or justice. Where prevention is concerned, we must obviously assign it a lot of weight. Justice is more problematic. Maltreatment teaches, but it does not decree. Millions of battered children grow up to be compassionate adults, and if their relationships are difficult, they have nevertheless chosen to try to construct for themselves loving and ethical lives. Abuse interacts with a number of other factors, both external to the growing child and intrinsic to her personality, which complicate cause and effect. In describing MSBP mothers as once-neglected children who are “hurting for love,” Schreier and Libow assign to these women a childlike innocence that the criminal justice system cannot, as a matter of principle, concede. Childhood is no longer the sum of who adult offenders are. The court could no more exonerate Marybeth Tinning than the court in Canada could acquit Paul Bernardo. Their deeds may have been only the last in a long chain of events, as Miller says, but they must be punishable. Otherwise, the chain extends, unbroken, through a long line of harmed and harming souls.