The lessons of Caroline's tragedy

Caroline Beale was the victim of mental illness and a system that put politics ahead of justice
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If the tragic case of Caroline Beale illustrates one thing, it is how little we know about mental disease and how easy it is for psychiatric illness to be misrepresented as evil intent. And that is doubly true of such illnesses during pregnancy.

Caroline Beale returns home tomorrow without having to face a further stretch in jail but she carries the stigma of a felon. To secure her release she had to plead guilty to manslaughter despite the expert diagnoses of world-renowned psychiatrists who said she was very sick when her new-born baby died in a New York hotel room. She was arrested in September 1994 as she boarded a plane bound for the UK. The dead baby's body was inside a shoulder bag. Two days later she was charged with murder. She spent eight months on remand in Rikers Island Penitentiary, and a further eight on bail living with a church family in the New York borough of Queens.

When I first met Caroline Beale, now 31, she was in jail and clearly suffering from a severe mental disorder. She shivered and cried. She could barely form whole sentences and when she tried to talk about her dead baby she was reduced to incoherent stammering. People like Caroline Beale are cursed twice. They have a crippling disease but they must also contend with society's belief that they are faking, that the gruesome performance of twitches and wild looks is a charade.

That is how Caroline Beale was treated by the American authorities. Throughout her gruelling interrogation, without a lawyer present, she was addressed as though anything she said was a lie. Maybe the problem was that she wasn't crazy enough for the US authorities. If she had rolled her eyes and lolled her tongue she may have fitted more closely our picture of madness, but mental illness during pregnancy is so much more subtle than that.

Thousands of women every year suffer psychosis during pregnancy. Experts such as Professor Channi Kumar at the Maudsley Hospital, where Caroline will be treated, say post and antenatal depressions are the least understood of mental illnesses and often receive the least public sympathy.

Dr Margaret Spinelli agrees. An eminent New York psychiatrist, she has seen Caroline Beale twice a week since January 1995. She says society expects pregnant women to be happy and radiant. "Mental illness still carries a profound stigma and that is doubly so when the victim is a pregnant mother. Look at the images of motherhood in commercials and glossy magazines - we believe a woman should be delighted to be pregnant. When her pregnancy makes a women mentally ill our belief system cannot cope. We assume the mother is the definition of evil."

The New York prosecutors who handled Caroline Beale's case have got their pound of flesh, the district attorney will be able to add another guilty plea to his statistics. Yet both Kumar and Spinelli concluded that she was suffering from a major and significant psychiatric illness that meant she was not responsible for her actions. Their assessments were available more than a year ago. Why didn't Caroline Beale go free then?

"This was a political case as well," a source inside the DA's office told me. "We couldn't go too easy on her. She was white and middle class. We get baby-killing cases all the time but the perpetrators are usually black or Hispanic and we give them a really hard time. It would not have been politically acceptable to let Caroline walk without some kind of guilty plea."

So Caroline Beale was psychotic and white - what chance did she have that her case would be handled at face value in the US courts, where money and political calculation often outweigh justice? Of course, had Caroline Beale been black or Hispanic I doubt that she would have walked free. Her original court-appointed lawyer advised her to plead guilty and accept 15 years in jail. Without his replacement, the charismatic Mike Dowd, she would have had little media attention and she may now have been in prison.

Not that we have grounds to be smug. The consulate in New York was exemplary, giving genuine and effective help. But despite repeated pleas from her parents, the Foreign Office barely lifted a finger. Her parents, who financed her defence by using their life savings, wrote to the Prime Minister, the Foreign Secretary and local MPs, all of whom received summaries of psychiatric reports.

The replies were polite but useless, of the "we don't interfere in internal workings of other countries" type. How gutless. This was a British citizen in as much distress as the victim of a serious traffic accident or a mugging, yet nothing was done.

With more official assistance Caroline Beale, officially ill by any definition, may have avoided the need to plead guilty in open court to killing her baby.

Which leaves that other puzzle: why did nobody know that this woman was pregnant? Where were her friends and relatives when she needed them? This is an aspect of the case that Americans, especially women, find most puzzling. One explanation seems plausible. Above all, Caroline Beale and her baby were victims of "British reserve" - that insidious sickness which makes us all reluctant to intrude or even inquire about the emotions of others.

Caroline Beale's friends and relations all told me they had noticed changes in mood and behaviour during what we now know was her pregnancy. When asked why they didn't press her for explanations they almost all said: "I didn't like to pry" or "That's not the kind of thing you talk about." Yet unless the British learn to talk more about their emotions there will be other Caroline Beales and similar tragedies. Psychiatric illness has social as well as biological causes and the often suffocating nature of British relationships did much to trap Caroline Beale inside her own sickness.

Tomorrow Caroline Beale will arrive back in London accompanied by her lawyer and her New York psychiatrist. She will be taken directly to the Maudsley Hospital in south London for treatment. Her traumatic illness leaves a once-healthy baby dead and a young woman who has suffered damage, the scale of which is yet to be fully assessed.

Professor Kumar hopes that Caroline Beale's time at the Maudsley will teach us more about mental illness during pregnancy. That may be the only good thing to come out of this case.