An Overvalued Desire for Motherhood Leads to Homicide

In 2004, Bobbie Jo Stinnett was found stabbed to death at her home in a small Missouri town. A 911 call from her mother described the scene, "She is lying on the floor with blood everywhere. She was pregnant. It’s like her guts have exploded or something." Stinnett was pregnant and her infant was now missing. In a high-profile federal case, the death penalty was given to Lisa Marie Montgomery after she was convicted of murdering Stinnett and taking the newborn. Only three other women have been executed by the U.S. federal government. The list includes Mary Surratt (Lincoln assassination), Ethel Rosenberg (espionage), and Bonnie Heady (murder of a 6-year-old boy). Nearly 70 years after Heady’s execution, Montgomery was given a lethal injection for her depraved acts. Montgomery’s defense team argued that Montgomery had a psychotic mental disorder in which she had lost touch with reality. She was perhaps motivated by an extreme overvalued belief and not a delusion.

Fantasizing Pregnancy
Stinnett raised puppies and sold them online, while also sharing the news of her pregnancy with others. This caught the eye of Montgomery in Kansas who, having fantasized about motherhood, relished the opportunity to abduct this baby. Montgomery lied to her husband, stating she was pregnant and wore maternity clothes. Using a false name, she contacted Stinnett via messaging online.

Fetal Abduction
Montgomery had a deceptive plan—steal the unborn child and pass it off as her own. Montgomery planned this by bringing along a knife, a cord, and a baby car seat. She strangled but did not kill Stinnett with the cord and then cut into her abdomen. After a struggle, Montgomery had to strangle her again, finally killing her. She extracted the baby girl from Stinnett’s body, cut the umbilical cord, and kidnapped the infant. Montgomery drove off while holding the infant and pinching the umbilical cord. She clamped the cord, suctioned the newborn’s mouth, and strapped her into an infant carrier seat. She then drove back to Kansas and called her husband to announce “the birth” of their daughter. The police issued an amber alert and traced her through her computer. She confessed to murder and child abduction.

Delusion or Extreme Overvalued Belief?
Since the case involved kidnapping across state lines, Montgomery was federally charged. An indictment alleged that Montgomery willfully and unlawfully kidnapped, abducted, and carried away the infant resulting in the death of Stinnett. Defense experts argued that Montgomery suffered from “severe pseudocyesis delusion” and was in a “dissociative state" during the offenses.

The Rebuttal
According to the prosecution, two historically described phenomena have been called pseudocyesis. One is when a woman has an abnormal personality and believes she is pregnant, but is not delusional. The belief ends when the woman is confronted with evidence that she is not pregnant. The second involves a severe mental illness (for example, schizophrenia), with a delusion of pregnancy. A prosecution expert opined that at the time of the offenses, Montgomery did not suffer from any mental disorder or defect that affected her ability to appreciate the nature and quality of the wrongfulness of her acts.

Extreme Overvalued Beliefs
Various terms such as false pregnancy (or fausse grossesse), hysterical pregnancy, and imagined pregnancy (grossesse par illusion motivee) as well as phantom pregnancy (grossesse fantome) have been described in the literature. Some texts consider the beliefs to be due to overvalued ideas. An extreme overvalued belief is shared by others in a person's cultural, religious, or subcultural group. The belief is often relished, amplified, and defended by the possessor of the belief and should be differentiated from a delusion or obsession. Over time, the belief grows more dominant, more refined, and more resistant to challenge. The individual has an intense emotional commitment to the belief and may carry out violent behavior in its service. The belief becomes increasingly binary, simplistic, and absolute. For review, other extreme subcultures include:

“I am too fat, and I need to lose more weight.” (Anorexia nervosa)
“That company is evil to its customers.” (Paranoid litigious state)
“That actor is in love with me.” (Erotomania)
“All abortion doctors are murderers.” (Political or religious)
“It is the duty of every Muslim to liberate the al-Aqsa Mosque in Jerusalem.” (Al-Qaeda)
“We are the army of the truth. Where we go one, we go all.” (Q-Anon)
"Trump won the election. Biden is a communist. Hang Mike Pence." (US Capitol Attack)

DSM-5 Diagnostic Considerations

Montgomery’s case was characterized not by the appearance of cardinal symptoms of psychosis (for example, delusions, grossly disorganized speech, or hallucinations), but by the excess of an emotional-behavioral state. Overvalued beliefs often involve emotions of anger, jealousy, envy, sexual gratification, moral outrage, greed, or ideological framing. Montgomery’s beliefs and desires are often shared by others because motherhood is an archetype that is revered universally. Many women can’t get pregnant and desire a child of their own, making Montgomery’s beliefs relatable to others, but relished and amplified by her to an overvalued degree—not just to simply steal a baby, but to have an entire fantasized pregnancy experience. Her beliefs are best described utilizing dimensional personality models (borderline personality) and cultural formulation sections of the DSM-5. This can be done through an analysis of Montgomery’s life story, one with a long history of maladaptive attachment issues.

Psychodynamics
The term object means person in the psychoanalytic tradition. Drives such as sexuality and aggression are primary, whereas relationships between people are secondary. Infant-mother and other dyads are critical to understanding later adult relationships. Poor parenting skills as well as neglect or abuse serve as the prototype for future dysfunctional relationships. Psychoanalyst Melanie Klein described how positive (gratifying) and negative (frustrating) encounters during an infant’s early upbringing help form a personality as an adult. Psychoanalyst Otto F. Kernberg developed the now well-established theory of borderline personality organization in which a child has difficulty integrating helpful and harmful relationships. If a caregiver neglects a child’s needs or deliberately harms them, an imbalance in the positive and negative encounters causes an inability to recognize that the same person can be good or bad. They then split these two poles of love and hate for others in dysfunctional ways. Modern biological models have also found that traumatic experiences alter genetic expression and brain function.

Forensic Psychology Essential Reads

Assassins and Their Fixations

The Psychology of Public Humiliation

Violent Attachments
For Montgomery, primitive modes of thinking formed her abnormal personality self-structure. Her capacity for forging normal attachments and relating to people in relationships was seriously impaired, as evidenced by failures to sustain meaningful relationships, which were largely narcissistically driven. As scholar and forensic psychologist Reid Meloy has described in similar cases, Stinnett's self-image was fueled by omnipotent and grandiose fantasies in which she viewed other people as objects to be denigrated or destroyed. These are rooted in primitive internal fantasy worlds in which part object relations predominated. Thus, primitive affects such as shame, excitement, envy, rage, contempt, and disgust predominated over more mature affects (for example, guilt, fear, depression, remorse, empathy, humor, or joy), which involve an appreciation of whole objects and a capacity for actual bonding, but in her case was grossly impaired. Could Montgomery's attack on Stinnett have been prevented? That is difficult to say. However, it is critical for forensic psychiatrists to properly identify an individual's cognitive driver as a delusion or an extreme overvalued belief.