Women who kill their newborns usually claim to have been in denial about their pregnancies. Can you carry a child to term without realizing it? And if you do, how responsible are you for your actions?

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One summer morning in 2006, Jean-Louis Courjault found two dead babies in his freezer. The 40-year-old was trying to find space for some mackerel when he opened a drawer and saw something unusual wrapped in a towel. “I open it,” he later recounted in court. “I see a hand.” In the next drawer there was a second bundle: “I open it and I see that it is also a baby.”

Courjault retreated to the living room in shock. He and his family had moved from France to Seoul, the South Korean capital, four years earlier. As an engineer, Courjault was often away for months on business while his wife, Veronique, 38, looked after their two sons and volunteered at a local kindergarten. That summer, Veronique had taken the boys to France, and Jean-Louis was left alone. “I have to call the police but I do not know their number,” he later remembered. “I can barely say my address, I do not know how to say baby, I do not know how to say freezer.” Jean-Louis phoned a Korean colleague who contacted the police.

The case was shocking, but what followed made it a national sensation in France. DNA tests found that the dead infants belonged to the Courjaults. Jean-Louis and Veronique held hands during a press conference and denied all responsibility, but after further tests confirmed the results the couple was arrested, and Veronique confessed. She had concealed both pregnancies from her husband. Each time she had labored alone in a bathroom and then suffocated the child before hiding it in the freezer. A third baby had been born, she added, while the couple was still in France in 1999—Veronique burned the body in the fireplace. The “affaire des bébés congelés,” or “freezer babies affair,” gripped France for months.

VERONIQUE COURJAULT SEEMED TO fit the image of an ideal mother: a caring Frenchwoman in a stable and affluent marriage with no demanding career to distract from her family. Members of the press were baffled. During the eight days that followed the discovery, Courjault's life was closely scrutinized. What emerged were anecdotes from friends and family about her pleasantness and passivity. “My mother always told me, ‘You give way too much!,’” she said in passing during her trial.

Lindsey Lowe, a 25-year-old children's dental assistant, gave birth to twins in a toilet in her parents' home. Sometime later she emerged from the bathroom with two dead infants. She placed them in a laundry basket in her room, where they remained until her father found one a few days later.

Had Courjault not wanted more children there were options available to her. Abortion is freely available in France during the first trimester. And though it remains officially illegal in South Korea, authorities usually look the other way.

“Regarding abortion, the issue did not really arise,” Courjault explained during her trial, “because in my head, I was not really pregnant.” Courjault claimed that although she had at times been conscious of the fact that she was carrying, she had also experienced a strong feeling of denial. In her words: “There was no rapport between my body and my mind.” She had worn loose clothing to conceal her shape from her husband but was paralyzed from taking any further action. The French psychiatrist, Michel Dubec, described what Courjault did as a “mental abortion.” It might sound “absurd,” Courjault conceded, but “it is the truth.”

THE QUESTION OF GUILT sits at the heart of this story. Is a woman who kills her newborn a cruel Medea, acting out of selfish motives, or does she resemble the other ancient model of neonaticide—the victim of insanity? Euripides' chorus contrasts Medea with Ino, who killed her sons after being “driven to madness by the gods.” This question raises a related concern: Should we punish all perpetrators of neonaticide with the full weight of the law, or treat them for mental illness?

The problem isn't theoretical; Courjault's case is far from unique. Between 2006 and 2013, at least 12 more freezers in France and Germany yielded the bodies of babies. All had been killed by their mothers soon after birth. When confronted, almost all of the mothers claimed to have been gripped by a similar state of pregnancy denial.

And neonaticide is not just a European problem. The Centers for Disease Control and Prevention estimates that a baby born in the United States in recent decades was 10 times more likely to be killed during its first day than at any other time of life. And for the first week, a baby's killer is overwhelmingly likely to be its own mother. The vast majority of these women claim to have been in denial about their pregnancies.

THERE ARE STRIKING SIMILARITIES between high-profile cases of neonaticide. In 2011 Lindsey Lowe, a 25-year-old children's dental assistant, gave birth to twins in a toilet in her parents' home. Sometime later she emerged from the bathroom with two dead infants. She placed them in a laundry basket in her room, where they remained until her father found one a few days later. Lowe was promptly arrested. She eventually told police that she had placed her hands over the babies’ mouths in a panic, to stop their cries from being heard by her parents.

She was acquitted, but her enormous guilt over her denial remains. She worries every day that she might be pregnant, and concealing it from herself again.

Like Courjault, Lowe had no criminal history and was known for her willingness to oblige others. Her father described her in court as a “model daughter.” She was engaged to her college sweetheart and had spent the preceding months caring for her mother, who had brain cancer. Like Courjault, Lowe also claimed to have known on some level that she was pregnant—but, in the words of her lawyer, “her mind refused to accept it. She literally, on a day-to-day basis, did not realize she was pregnant.”

Two weeks after Lowe's arrest in 2011, callers to the HLN talk show Dr. Drew on Call argued that she was either “mad” or “bad.” “She had it all planned out and murdered two innocent, helpless baby boys,” said one caller, asking why Lowe hadn't taken advantage of Tennessee's safe haven laws for unwanted babies. Speaking on the show, clinical psychologist Lisa Boesky drew a clear dividing line between complete insanity and absolute culpability, arguing that if there was no evidence of serious mental illness like psychosis, “we need to send a message to the young women out there....”

The trouble is that most women who experience pregnancy denial—including the small fraction who go on to commit neonaticide—are not what you or I might call “insane,” or “mad.” Out of the 32 women charged with neonaticide in Finland between 1980 and 2000, for example, just four suffered from psychosis—and they had pre-existing conditions such as schizophrenia. Some psychotic neonaticide offenders report delusions of being influenced by the devil. By contrast, Lowe, Courjault, and most other neonaticide offenders suffer from no diagnosable long-term mental illness. Both women even said that they had, to an extent, been aware of their pregnancies. This narrative of conscious denial is not uncommon. The amplified version of this, in women who never even become consciously aware of their pregnancy, is often known as unconscious denial. A surprising number of pregnant women—about 1 in 2,500—maintain this until birth. These women often turn up at the hospital with labor pains that they describe as nothing more than excruciating stomach cramps.

But despite their lack of psychosis, neither Lowe's nor Courjault's actions seem entirely sane. Neither a laundry basket nor a freezer are sensible places to dump a body. It might not be a coincidence that both are storage areas—a place to put something away for the time being. In a 2001 study of 16 neonaticide cases, women were found to have engaged in similarly bizarre actions, including “returning to bed with the infant's corpse and keeping it under clothes or in a knapsack.” Dr. Margaret Spinelli, the Columbia professor who led the research, says that “one woman put the corpse in a filing cabinet in a shared office. That's pretty impressive.”

Most recognize that there is a difference between killing your own newborn out of cold, calculated self-interest, and doing the same thing in a fog of delusional psychosis. The grey area between responsibility and absolution stretches just as wide. Lowe and Courjault's stories outline a shared syndrome—but like all mental illness it exists on a spectrum, with absolute “madness” or “badness” applying only to the extreme outliers.

But although many neonaticide offenders tell similar stories, the differences in treatment are enormous. Courjault was sentenced in France to eight years in prison for the murders of three minors. She served just under four years and was released on parole in 2010, while continuing to receive psychiatric treatment. By contrast, Lowe was sentenced to a minimum of 51 years in prison for two counts of first-degree murder, first-degree pre-meditated murder, and aggravated child abuse. She will be 77 before she is eligible for parole.

NO SINGLE TYPE OF woman experiences pregnancy denial or commits neonaticide—but many women are repeat offenders. They come from a range of ethnicities, social backgrounds and ages. Demographically, they reflect the full range of motherhood: around 80 percent have completed their education, more than half are married or living with a close partner, and around halfalready have children.

Our thoughts and feelings can trigger any number of physical responses—from deliberately catching a ball to involuntarily blushing from embarrassment. It shouldn't be surprising that extreme denial can have equally tangible effects on our bodies.

Women with denial often have something to be anxious about: Courjault hinted at her fear that she could not be an adequate mother to more children; Lowe's twins were the product of a brief affair she wanted to keep from her fiancé. But no external reason quite explains the lengths to which women with denial go, or the similarities between their stories. The seed of similarity between these women lies buried in their psychology. Each one has a story that reaches back long before their pregnancy. The rate of infanticide mirrors the rate of adult suicide—not adult homicide. It is associated with self-destructive rather than murderous impulses. A history of abuse plays a part in pregnancy denial for significant numbers of women, but not all. “To understand it, you have to be specific,” says Dr. Jens Wessel, who conducted the first large-scale study of the syndrome. “Why this woman, with this partner, at this time denied this pregnancy.”

COLLEEN BROGAN (NOT HER real name) was 17 when she discovered that she was pregnant. Like Courjault and Lowe she had a reputation—in her own words—for being a “good girl.” "I was very into pleasing," she says of her childhood in Ireland. "Making beautiful cakes, helping my mum with the house—I just loved helping." Colleen was shy: she and her boyfriend had waited two years to have sex. When she missed her period, she told him immediately.

It isn't uncommon for younger women with pregnancy denial to have a “good girl” reputation for being dependable and high achieving. Many also come from families where problems are rarely discussed openly. “It's taken me years to learn that if something isn't dealt with, it doesn't just disappear,” Brogan says. “When my mum was dying of cancer nobody told us. We had a suspicion, but we didn't know.”

Brogan began to struggle with the prospect of telling her parents. “I couldn't bear to see them cry or be upset,” she says. She began to deny her pregnancy to the outside world and then to herself. After a week she told her boyfriend that she wasn't pregnant after all. This began as a tactic to give herself time to figure things out, but “the time kept extending and extending.”

Brogan fell into complete denial. She began to wear loose clothing and spent more time alone. “I thought maybe something might happen that would mean I wouldn't have to deal with it—like I might get attacked and die,” she says. “I used to go out late at night hoping that something would happen.” Over time her denial deepened; she ate little and put on less weight than expected. “I remember lying on my back and touching my belly and thinking: ‘Maybe there isn't anything in there. Maybe it's just my imagination,’” she says.

Despite the changes in her behavior, none of Brogan’s family, friends, or colleagues seemed to pick up anything different. One of the most perplexing elements of pregnancy denial is the way that others seem to participate in it. “Even if they're in bathing suits!” Spinelli exclaims. “People around them don't realize that they're pregnant.” Courjault used to attend yoga classes with her friend Sabine while she was pregnant, and often stripped to her underwear in the locker room. “I never noticed anything,” Sabine later said. “I never imagined that she was pregnant.” Two days before Lowe gave birth she wore a bridesmaid's dress that had been fitted six months earlier. Her sister Lacey testified that Lowe had changed her clothes in front of other women that week without anyone suspecting that she was pregnant. Even sexual partners can remain in the dark: each of the 16 neonaticide offenders in Finland who were in relationships during their denied pregnancy had regularly slept with their partner. Denial can even fool doctors.

Over time her denial deepened; she ate little and put on less weight than expected. "I remember lying on my back and touching my belly and thinking: 'Maybe there isn't anything in there. Maybe it's just my imagination.'"

“I will tell you a very amusing story,” says Dr. Peter Husslein, the head of the obstetrics department at the Medical University of Vienna, when I ask about his first experience with pregnancy denial. “It was my first week in obstetrics. I was called to deal with a woman in deep pain. I felt the abdomen and it was very hard. I recalled from surgical cases that this was often a sign of a rupture of the stomach so I was on the point of sending her for surgical intervention. But then I said to myself, ‘Well, I should examine her vaginally.’” He paused for effect. “I felt the hard head. It was the baby very shortly before delivery. And the woman completely denied, even with those pains—it was a complete shock to her that she was pregnant.”

Our thoughts and feelings can trigger any number of physical responses—from deliberately catching a ball to involuntarily blushing from embarrassment. It shouldn't be surprising that extreme denial can have equally tangible effects on our bodies. In women with pregnancy denial the enlarged stomach is often absent. One theory is that the fetus is positioned vertically within the womb rather than horizontally. More than half of women with denial continue to notice menstruation-like bleeding or spotting. Denial is the mirror image of hysterical pregnancy. Women who are convinced that they are pregnant can develop distended abdomens and unusually high levels of the hormone prolactin, which produces milk from their breasts. In the same way, the body of a woman in denial about her pregnancy often conspires with her unconscious. “Is it just: ‘Oh, I'm going to make-believe that I'm pregnant or not pregnant?’” Spinelli says. “Or is there something genuinely going on between the endocrine system and the central nervous system?”

But denial is hidden by its very nature—by the time it is discovered, any physical evidence has vanished. Skepticism about pregnancy denial prevails among judges and juries. While sentencing Lowe, Judge Dee David Gay stated that her account of denial was “not credible.” The jurors agreed. When a defendant claims to have been in denial, the prosecution looks for evidence that they were aware of the pregnancy. And in cases of conscious denial they often find it. Lowe had used her iPhone to search for information on how to induce labor, and for pornography involving pregnant women. For Gay this, together with her affair, showed that her priorities were ultimately “selfish.”

Like Lowe, Brogan was aware of her pregnancy early on. “It was very odd,” she says, “very childish, very immature, very not dealing with the facts of life.” But she is equally certain that she was not fully in control of her mind. Over time, her denial became more unconscious. Even when the baby grew and began to kick, “there was no conscious thought like: ‘Just don't think about it!’” she says. “I just didn't think about it.” She struggles for a metaphor. “It's like when you watch TV. You're really not thinking, you're just watching. I was totally detached. I was outside myself.”

Cancer patients sometimes display an intermittent awareness of their illness that is similar to Brogan’s approach to her pregnancy. It is known as middle knowledge. Though these patients have been told of their diagnosis they might occasionally deny symptoms—insisting, for example, that a lump is the result of a mild injury that will soon heal. In more extreme cases they refuse to see their doctor or to tell their families, or turn down treatment altogether. Cancer patients and pregnant women with denial are drawing on the same primitive defense mechanisms to cope with a situation that feels threatening. But, like all weapons, denial can backfire.

Even when the baby grew and began to kick, "there was no conscious thought like: 'Just don't think about it!'" she says. "I just didn't think about it." She struggles for a metaphor. "It's like when you watch TV. You're really not thinking, you're just watching. I was totally detached. I was outside myself."

Brogan’s denial paralyzed her. After several months of pregnancy she began to have rushes of high blood pressure. These were early signs that she was at risk of eclampsia—a condition that causes seizures during labor and is fatal without treatment. “I was aware of them because they're massive,” she says, “but my twisted state of mind was—it wouldn't have bothered me if I'd died.” At about 36 weeks, Brogan went into labor alone in her bedroom and began having loud fits and drifting in and out of consciousness. “I remember my mum screaming to my dad: ‘There's a baby, there's a baby!’” she says. Her son had been born, but in the ambulance her heart stopped beating. She was resuscitated and spent several days in a coma.

For most women with denial, feelings of dissociation peak during labor. Women describe “watching” themselves, and often report that the pain was “not bad” or deny having any pain altogether. They make little noise—there are usually other people nearby who never realize what is happening. Many women with denial are unable to think of the baby as an individual. During her trial Courjault said: “It was a part of myself, an extension of myself that I was killing.” Brogan eerily echoes those words: “The baby I was carrying didn't seem like a person—it was a part of me. It wasn't something else, it was me,” she says. “I guess that's what happens when somebody murders somebody. They're not connected to them as a person.”

Brogan is now 46. When she woke from her coma all those years ago, she no longer had any sense of denial. “At that point everything was out,” she says. “The first thing I wanted to do was to see the baby.” Today, her son is 28, and has a child of his own.

It is impossible to say what Brogan might have done had she been conscious. For Husslein of the Medical University of Vienna, neonaticide is sometimes the rational consequence of an irrational situation. “I don't think a mother sits there and says: ‘Well, I have the following options, let's balance things out, I think the best thing to do is to kill the baby.’ She is in shock, she is panicking. The only way to continue on a path of denial is to put the baby away.”

Most neonaticides happen in just this way—by putting the baby to one side rather than taking any direct action to cause death. It is important to distinguish passive neonaticide from active neonaticide. In the late 1980s Dr. Catherine Bonnet interviewed two French women who were in such extreme denial that, she writes, they did not recognize their newborns as babies. One of the babies died from head injuries caused by falling onto the ground during labor, while the other drowned after falling into a toilet. “These women, in fact, did not exercise physical violence on the person of the baby,” Bonnet pointed out, adding that amnesia often followed.

Neglect played a part in another story I encountered. Christine Bernard (not her real name) was 27 and already a mother when she was charged with the murder of her newborn in France. She agreed to speak to me only by email. She told me that she had experienced what is often termed unconscious denial for the full duration of her pregnancy. “I had no symptoms,” she writes. “To give an idea of my ‘form,’ I biked with my son on the luggage rack a few hours before giving birth.”

This narrative of conscious denial is not uncommon. The amplified version of this, in women who never even become consciously aware of their pregnancy, is often known as unconscious denial. A surprising number of pregnant women—about 1 in 2,500—maintain this until birth.

Bernard only became conscious of her pregnancy when she recognized the feeling of the contractions. She rushed to a nearby toilet and gave birth alone in the late afternoon. “The baby died,” she writes. “I was in full physical and mental distress, drained of blood, and I could not call for help and did not want to.” She left the baby in the bathroom, where it was found when help later arrived.

Bernard was arrested and spent a month in a psychiatric hospital before being transferred to prison for six months to await trial. It was only at this point that medical reports suggested that her baby had probably not been healthy enough to live outside the womb without aid. She was acquitted, but her enormous guilt over her denial remains. She worries every day that she might be pregnant, and concealing it from herself again.

WHAT IS THE RIGHT balance of treatment and punishment for women with pregnancy denial? And can anything be done to steer them away from the risk of neonaticide?

Countries such as England, Finland, Turkey, and Colombia use laws to distinguish maternal infanticide from murder. Sweden now asks a panel of doctors to judge such cases; Canadian offenders face a maximum sentence of five years. In America, states such as Kansas have chosen instead to abolish the insanity defense altogether.

“We're very skeptical about things like mental illness,” Spinelli says. “And a lot of that has to do with how the law treats insanity.” States that have kept the insanity defense rely on a legal test from over 150 years ago—the M'Naghten Rule. This rule, strictly imposed, has often favored punishment rather than treatment for delusional psychotics. Andrea Yates, for example, had struggled with psychotic episodes and suicide attempts for years before she drowned her children in 2001. She argued that she had acted to save them from Satan, who had sent her messages via popular movies. Yet the first jury she faced found her guilty, leaving her with a possible death sentence. “For me, when it's so degraded is in the case of women who are really psychotic,” Spinelli says.

Not all psychiatrists agree on how neonaticide offenders with pregnancy denial should be treated. The leading Finnish neonaticide researchers, Dr. Hanna Putkonen and Dr. Ghitta Weizmann-Henelius, argued that harsh punishments were useless: “Treatment is what we suggest.” They have a point: Even with her relatively light denial, Brogan was prepared to die of eclampsia to avoid having to face her pregnancy. The prospect of a harsh prison sentence would probably not have deterred her much.

In a 2001 study of 16 neonaticide cases, women were found to have engaged in similarly bizarre actions, including "returning to bed with the infant's corpse and keeping it under clothes or carrying it around in a knapsack."

But deterrence isn't the only reason for punishment. Spinelli argues that justice requires different mixtures of punishment and treatment for neonaticide offenders with different levels of denial. A woman whose baby dies after a labor that took her completely by surprise should not be held as responsible as a woman whose denial was lighter. But she also argues that even women with lighter forms of denial don't deserve life sentences. “It's actually pretty ludicrous,” she says, adding that probation might be one alternative.

America's second strategy for deterring neonaticide is the provision of anonymous hatches for abandoned babies. These were introduced by the Safe Haven laws that now cover the entire country. It's the same law that Lowe failed to make use of. She isn't alone—just 20 percent of abandoned babies were left in these incubators in the seven years after the law was first introduced in Texas. But in Austria the neonaticide rate more than halved after a different law was introduced to help women before they give birth—by offering anonymous delivery and adoption in hospitals under the country's largely free health care system. “It is the best alternative,” says Dr. Claudia Klier, a forensic psychiatrist who specializes in treating neonaticide offenders. “It avoids the most dangerous situation—when the mother has a secret, unaccompanied delivery.”

The best way to care for babies is to care for mothers—and this particularly goes for those who are at risk of harming their newborns. As we decide how much blame to assign any woman who denied her pregnancy and killed her own child, we must also face the reality of their condition, and the difference that the right measures could have made.

Neonaticide exposes human behavior at its most troubling, but it can also reveal us at our most empathetic. When Courjault was released in 2010 she was reunited with her husband and teenage sons, and welcomed back into the family. Jean-Louis spoke of his sadness about the “wasted lives” of the dead babies he never knew. But he had spent months speaking to other women who had experienced pregnancy denial, and to their partners. “I couldn't not make an effort to understand,” he concluded. “We are guilty of having seen nothing.”