Spring, 2005
By Margaret Spinelli, MD
Director, Maternal Mental Health Program Columbia University College of Physicians & Surgeons
In June 2001, the public was riveted by the news that Andrea Yates had drowned her five children in the bathtub of her Houston, Texas, home.1-4 Mrs. Yates, an exemplary nurse and mother, was an honor student, a jogger and a champion swimmer. She also had a history of mood swings. Andrea Yates was persistently pregnant or lactating from 1994 to 2001 and spiraled down into mental illness with the birth of each child. Mood states of high energy and a hyper-religious focus on Satan switched to worsening depression, psychosis, suicide attempts and four psychiatric hospitalizations in the years preceding the tragedy of the Yates children.5-6
Mrs. Yates’s fluctuating affect and disorganized, labile clinical picture lend support to the contemporary theory that women with postpartum psychosis have an underlying bipolar disorder diathesis.7
In the weeks before the tragedy, Mrs. Yates claimed she was directed by Satan to kill her children to save them from the fires of hell. Both the state and the defense agreed that she was floridly psychotic at the time of the crime.
Mrs. Yates was charged with capital murder with a possible penalty of death. After only three and one-half hours, the jury returned a guilty verdict. The prosecution sought the death penalty; the jury elected a prison sentence for life.3
The United Kingdom and 29 other European countries have laws that make infanticide a less severe crime with mandated sentences of probation and psychiatric treatment for mentally ill women who are found guilty. In contrast, in the United States, a woman convicted of infanticide may face a long prison sentence or even the death penalty. And yet, the prevalence of infanticide in countries where treatment is mandated is no different than that in countries where punishment is mandated.8 If the purpose of punishment is deterrence, then it is not working.
In Texas, the M’Naghten Test, or the “right and wrong test,” is used to determine the legal state of insanity.9 Derived from a landmark 1843 English case, it focuses on the cognitive aspects of behavior.
The M’Naghton formulation has inherent problems. The role of the expert psychiatric witness is to opine whether the mentally ill defendant “knew right from wrong” at the time of the crime. Cognitive capacity during most psychotic states remains unclear. The contemporary literature is filled with ongoing clinical research that queries the effect of psychoses on executive function, memory, cognitive capacity and attention. In fact, Wisner’s group, using objective neuropsychiatric testing, demonstrated cognitive impairment in women with childbearing-associated psychosis compared to those with non-child-bearing psychosis.10-11 This places into question the appropriateness of using a law based on cognition.
In light of 21st century neuroscience, it is questionable that a 160-year-old legal case can be applied for accurate determination of the state of insanity. Yet, we in psychiatry continue fruitless attempts to adapt our contemporary scientific knowledge to antiquated legislation. We endeavor to fit our current “square peg” into the obsolete “round hole” of the law.1
Andrea Yates pled innocent by reason of insanity to capital murder. But the prosecution’s expert asserted that she knew right from wrong at the time of the killings, because she knew Satan, who urged her to drown her children, only encourages evil.5
Such psychiatric testimony made the difference between this case and that of another mother who killed her children in Tyler, Texas.12 In 2002, Deanna Laney killed two of her children and tried to kill a third by bashing them with rocks because, she said, God ordered it. Andrea Yates and Deanna Laney both were loving mothers whose severe mental illness led them to kill their children. While Andrea Yates was found not legally insane, guilty of murder and sentenced to life imprisonment, Deanna Laney was acquitted by reason of insanity and remanded to a psychiatric facility.
The outcome and the difference in the expert testimony suggest that we can distinguish right from wrong based on the nature of the perceived authority directing one’s actions. Defendants with mental illness who face the criminal justice system have the right to a defense based on scientific fact, not whether God or Satan is a more appropriate moral authority. Such a defense is essential for equal representation under the law.1
The fact that the insanity defense is nonexistent in some states and extremely limited in others speaks to our society’s disregard for equal protection under the law for persons with mental illness.1 Until persons with mental illness are afforded the same legal and moral dignity given to other illnesses, the course will remain unchanged.
Footnotes
1Spinelli MG. Maternal infanticide associated with mental illness: prevention and the promise of saved lives. Am J Psych. 2004;161:1548–1557.
2Spinelli M. Infanticide: Psychosocial and Legal Perspectives on Mothers Who Kill. Washington, DC: American Psychiatric Press; 2002.
3CourtTV: Texas mom drowns kids. http://www.courttv.com/trials/yates
4Grinfield MJ. Mother’s murder conviction turns insanity defense suspect. Psychiatr Times.June 2002;1–5.
5Denno D. Who is Andrea Yates? A short story about insanity. Duke J Gend Law Policy.2003;10:61–75.
6O’Malley S. Are You There Alone? The Unspeakable Crime of Andrea Yates. New York: Simon and Schuster; 2004:1–41.
7Oosthuizen P, Russouw H, Roberts M: Is puerperal psychosis bipolar mood disorder? a phenomenological comparison. Compr Psychiatry. 1995;36:77–81
8Marks MN. Infanticide in Britain. In: Infanticide: Psychosocial and Legal Perspectives on Mothers Who Kill. Edited by Spinelli MG. Washington, DC: American Psychiatric Publishing; 2002:185–200.
9M’Naghten’s Case, 10 Clark and Finnelly 200 (1843).
10Wisner KL, Peindl KS, Hanusa BH. Symptomatology of affective and psychotic illnesses related to childbearing. J Affect Disord.1994;30:77–87.
11Wisner KL, Gracious BL, Piontek CM, PeindlK, Perel JM. Postpartum disorders: phenomenology, treatment approaches, and relationship to infanticide. In: Infanticide: Psychosocial andLegal Perspectives on Mothers Who Kill. Edited bySpinelli MG. Washington DC: American Psychiatric Publishing; 2002,36–60.
12Casey R. Devils: on the head of a pin. HoustonChronicle. April 7, 2004.
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Dartmouth-Hitchcock Medical Center
The opinions expressed in the journal, Lahey Clinic Medical Ethics,
belong to the individual contributors and do not represent the institutional position
of Lahey Clinic on any subject matters discussed.
