The Psychology of Female Violence: Crimes Against the Body

This excellent book draws our attention to the problem of women who engage in serious violence. Despite advances in gender equality, contemporary society still evidences denial of female violence. For example, in infanticide cases, society often wants to believe that mothers who kill are mad (insane), while their counterpart fathers are bad. Harming one's children goes against traditional notions of femininity, and men are more harshly punished for the act. Yet, dating back to mythology, Medea killed her children for reasons unrelated to mental illness.

Anna Motz is a forensic and clinical psychologist in the United Kingdom who has served as president of the International Association for Forensic Psychotherapy. She focuses on explicating the inner world of female offenders, something forensic readers may not be used to. Challenging the denial of female violence is her primary goal. This is critical in objective forensic evaluations. Psychiatrists should strive not to be fettered by unconscious expectations of the mother role.

The book is divided into four sections: Violence Against Children, Violence Against the Self, Violence Against Others, and Clinical Applications. Motz discusses taboo topics, including physical and sexual abuse by mothers, mothers who fabricate a child's illness, and infanticide. Violence against self, explains Motz, includes deliberate, self-injurious behavior and anorexia nervosa. She also examines the controversial topic of battered women who kill. She uses detailed case examples; several, disturbingly though brilliantly, help the reader appreciate the complex dynamics associated with these women and their offenses.

Women's violence occurs mostly at home, in private, compared to men's more public violence. Motz asserts that society's tendency to deny the existence of female violence and to idealize motherhood can present difficulties in violence prevention and prosecution. She uses a psychodynamic context to examine underlying functions of the violence and discusses implications for treatment of various types of violent behavior. For example, in an infanticide case study, she explains the mother's motivations for the offense, which include annihilation of hated parts of herself, revenge, symbolic ownership of the infant, and a mechanism to draw attention to her despair.

Recent media frenzy has occurred around abuse of children by breastfeeding them through latency age. Motz says that “there can be a powerful narcissistic element to breastfeeding, which may become an intoxicating experience for a mother to the extent that she continues to suckle her child for her own gratification” (p 38). She provides a thoughtful psychodynamic model for understanding child physical and sexual abuse by a mother, who, due to perceived rejection, uses the child as a “receptacle for her own unacceptable feelings of hopelessness and deprivation” (p 55). She cautions readers about Munchausen's syndrome by proxy, which is often overlooked because of professional and societal blind spots, resulting in denial of the danger a mother may present to her child, even when there is clear evidence to the contrary. Treatment and dispositional decisions should be based on understanding the nature of women's violence, as the author offers, not preconceptions.

Motz considers various functions that self-harm may have, from feeling real, to distraction, to communicative function, to displacement of anger, to assertion of control. She posits that women who engage in self-injurious behavior may be symbolically attacking their own mothers. The author asserts that the woman's body is “her most powerful means of communication and her greatest weapon” (p 1).

In her discussion of battered women who kill, Motz reviews learned helplessness and describes a model of violent relationships. She covers difficulties in leaving relationships, psychological effects of victimization, and victim blaming. However, there is danger in conceptualizing all domestic violence relationships in this way because intimate partner violence can be bidirectional. Battered women who kill may do so rationally, and the author makes an intriguing comparison to society's perception of cuckolded husbands who kill. She aptly discusses and critiques the legal points that arise in the battered-woman defense in the courtroom.

Managing transference, countertransference, boundaries, and splitting when working with violent women is not often addressed in the forensic literature. Motz's discussion of stressors encountered by professionals who work in an inpatient unit for women with severe personality disorders is useful for clinicians and for the hospital administrator who may be reconsidering the unit's design. There is also thoughtful discussion of the concerns of expert witnesses, including those faced by Sir Roy Meadow in the United Kingdom, and an in-depth discussion of the Victoria Climbie inquiry report, a highly publicized case of an eight-year-old girl who was systematically tortured and killed by her aunt and her aunt's boyfriend.

Motz emphasizes that a woman's status as both victim and perpetrator must be contemplated when assessing risk. Professionals involved in treatment, evaluation, and decision-making related to violent women must come to terms with women as offenders; otherwise, children will be put at further risk. Those of us who work in this area can find it difficult to persuade others of the possible depravity of women, especially when child abuse or Munchausen's syndrome by proxy is involved. It would be far better to feel disturbed when reading this book than to be shocked when evaluating a defendant.

This sophisticated book is recommended to forensic psychiatrists, psychologists, and nurses working with women who have offended. Readers in the United States will find Motz's style a substantial departure from that of other books on the topic because of the psychodynamic bent, which is not often found in the American courtroom. However, it may help U.S. clinicians to obtain a fuller understanding of violent female offenders, their situations, and motives.

• © 2012 American Academy of Psychiatry and the Law