The patient described in this example was a 34-year-old mentally ill woman who killed her children and attempted suicide. She killed in the context of a psychotic depression, when she was suffering from paranoid delusions, and she consequently developed features of an abnormal grief reaction. Negative life-events, namely the loss of her children and husband, prolonged her depression, so that she became, in effect, the perpetrator as well as the victim of her bereavement. Some of the issues raised by this case include the comorbity between depression and PTSD; the treatment of the core disease of schizoaffective disorder with medication which then enhanced her guilt feelings and precipitated a relapse into psychotic and PTSD symptoms; the benefits of grief therapy; and the question of transference and counter-transference among psychiatric staff. 34 references