Woman may face death penalty in postnatal depression case

A US organisation has called for more research into postpartum depression and better services for women affected by the disorder, as the trial of a mother charged with capital murder for drowning her five children reached its final stages this week.

A Texas jury has been hearing final arguments in the case of a woman who has admitted drowning her five children, who ranged in age from 6 months to 7 years, on 20 June 2001. Despite a history of severe mental illness dating back to 1999, former nurse Andrea Yates, aged 37, living with her husband in Houston, Texas, could face the death penalty if she is found guilty.

“It is horrific and barbaric,” said Sonia Murdock, president of Postpartum Support International, which provides support and information for women with the condition and carries out research. “We are totally against the execution of mentally ill mothers,” she said, admitting, “We are so much further behind [in the United States] than in the United Kingdom.”

Her organisation is fighting for better provision for women with the condition and has the backing of Congressional representative Bobby Rush, who is supporting the Melanie Stokes Postpartum Bill. The bill, named after a woman who killed herself four months after the birth of her child while suffering postpartum psychosis, calls for more research and better services for women with postpartum mood disorders and depression.

In the United Kingdom, parliament introduced the Infanticide Act in 1922, which reduced the crime automatically from murder to manslaughter on the basis of insanity if a mother “had not fully recovered from the effect of giving birth to such child, but by reason thereof the balance of her mind was then disturbed.” This would enable her to receive treatment in a special hospital rather than being imprisoned.

Some US states, such as Hawaii, have far more lenient laws than Texas in such cases and would allow treatment rather than a prison sentence or death penalty. But only last year a woman in Arkansas was executed after a similar case, said Ms Murdock.

In the current trial the state of Texas has charged Yates with capital murder, after her full videotaped confession. Defence lawyers for Yates offered a plea of insanity to the jury, invoking the 19th century McNaughton rule.

This states that in order to prove insanity the person must be shown to have been so ill as either not to know what they were doing or, if they did know, that they did not know it was wrong.

The defence had submitted much evidence to show that Yates had suffered from mental illness for at least two years before she drowned her children. Psychiatrist Dr Eileen Starbranch warned Andrea Yates and her husband against having more children after she treated Andrea in 1999 for postpartum depression that had resulted in two hospitalisations and two suicide attempts.

But Dr Starbranch testified, “Rusty Yates and Andrea wanted as many children as nature would allow.”

Three months before she drowned her children, Andrea Yates was admitted to Devereux Texas Treatment Center, and psychiatrist Dr Ellen Allbritton said she immediately recognised her as someone who required inpatient treatment. Dr Allbritton described Yates to defence lawyer George Parnham as “someone who had declined to the point of nonfunction, just there, a shell.”

Yates improved during her two week stay at Devereux, where she was treated with haloperidol, an antipsychotic. However, she was returned to the facility for additional care on 4 May, after she filled the family's bath with water a day earlier. Dr Mohammed Saeed, her treating psychiatrist, said, “We hospitalised her [again] because I thought filling the bathtub was an indication she might be suicidal.” Yates was released on 14 May.

Dr Saeed, who examined Yates again on 18 June, two days before she drowned her children, said he saw no evidence of psychosis then. Defence lawyers called Dr Phillip Resnick, a leading forensic psychiatrist, as their expert witness. In a videotaped interview made three weeks after the 20 June drownings, Yates explained that Satan was telling her she was such a bad mother that she had to kill her children to keep them from going to hell. She believed the state would execute her, Satan would be eliminated from the world, and her children would be saved if she killed them. “These were their innocent years,” she said on tape. “God would take them up.”

Dr Resnick said, “In my opinion, even though she knew it was against the law, she did what she thought was right in the world she perceived through her psychotic eyes at the time.” He told jurors that Yates suffers from schizophrenia and major depression that impaired her behaviour and thinking and resulted in delusions, hallucinations, and social withdrawal. He said Yates began having delusions after the birth of her fourth child in 1999 and attempted suicide twice that year. The voices and delusions again grew more intense after her fifth child's birth in November 2000.

Dr Resnick said that, from his two interviews with Yates and a review of police and medical records, he concluded that she knew the drownings were illegal but not wrong. “A person can do an act that is illegal, but still believe the act is right,” he said.

Dr Park Dietz, a psychiatrist called by the state of Texas as a rebuttal witness, said Andrea Yates suffered from a severe mental illness at the time she drowned her five children last year but knew her actions were wrong. She told Dr Dietz in a videotaped interview conducted on 7 November 2001 that she decided to kill the children the night before the 20 June drownings. Dr Dietz said Yates became confused and sometimes changed her story during the interview. He thought the changes occurred because Yates was still depressed and probably suffers from schizophrenia.

Dr Dietz surprised the court in the second day of rebuttal testimony when he said that Yates knew her actions were wrong in the eyes of the law, society, and God, but he would not give an opinion on whether she met the Texas definition of legal insanity.

Figure.

AP PHOTO/STEVE UECKERT

Andrea Yates, who began having delusions after the birth of her fourth child in 1999