This Is Insane!

The case of Andrea Yates, the Houston mother who drowned her five children in the family bathtub, has spurred public debate about methods of prosecuting the mentally ill, the dangers of postpartum depression, sanity, and the appropriate use of the death penalty. The Yates case was chronicled in more than 1,150 published articles nationally in the first 4 weeks after police discovered the children (Gamiz, 2002). The prosecution presented an unrelenting case that Yates deserved to be punished: that she deliberately, premeditatedly, and methodically murdered her children. The defense lawyers had little trouble convincing jurors that Yates was mentally ill. They presented testimony demonstrating Yates's mental illness, suicide attempts, depression, and history of hospitalization. There was evidence that Yates was overmedicated, prematurely discharged from the hospital, given inappropriate drugs, and had her medication stopped 2 days before the killings. So why did the jury find Andrea Yates guilty of murder? What can we, as advanced practice mental health nurses, learn from this case? How can we work to prevent this type of injustice happening again? Two main issues affected the outcome of this trial. First was the problem with the meaning of "insanity," and second, what this conviction meant to the jurors. Insanity is a legal term with a very narrow definition: Was the person able to discern right from wrong at the time of the crime? Just because Yates was mentally ill doesn't mean she was insane. The insanity defense was established through centuries of English law to excuse people afflicted with mental problems from criminal responsibility. The modern formulation of the insanity defense derives from the M'Naghten Rules established in 1943. John Hinckley, who shot President Reagan, was found not guilty by reason of insanity, and 20 years later is still confined to a psychiatric institute. Public outrage over the Hinckley verdict led to sweeping legal changes that all but eliminated insanity as a defense. "In the history of English and American law, there has probably never been so dramatic and rapid a shift in legal doctrine," says George Dix, a law professor at the University of Texas (Parker, 2002, p. 1). If Hinckley's verdict can change the law so dramatically, is it possible the Yates verdict also can be a catalyst for the more humane treatment of the mentally ill? Several activist groups, including the National Organization of Women, have rallied to Yates's aid. Our national and international psychiatric nurses organizations also could lend support and lobby for legislative changes that would make it possible to protect those who are mentally ill and vulnerable, rather than condemn them to prison or death. Society would be protected from those who suffer mental illness when these people are institutionalized until deemed safe to be discharged. Criminal law is embedded in antiquated laws directed toward punishment. The issue of right or wrong should not be the guiding principle to determine sanity. We need to go beyond the concrete, black-and-white, narrow definition of insanity that makes no allowance for the complexity of mental illness. A person can be totally psychotic and still, in that world, know right from wrong. We have a noneducated public that is ignorant about mental illness and the purpose of punishment, particularly for someone like Yates. In a stunningly fast review of weeks of complex psychiatric testimony, the jury rejected Yates's insanity claims in less than 4 hours and pronounced her guilty after 35 minutes of deliberation. Executing Yates would imply that her crime had no context. In fact, her mental illness was inextricably entwined with her decision to hold her five children under water until they drowned. Mental illness and criminal behavior do not emerge suddenly from a vacuum. Courts need to give different instructions to the jury regarding the consequences of finding a person not guilty for reasons of insanity. …