Are You There Alone? The Unspeakable Crime of Andrea Yates
by Suzanne O'Malley. New York, Simon & Schuster, 2004, 281 pp., $25.00.
When a mother kills her children, how much does mental illness matter
when the mother's guilt is judged in the courtroom? The case of Andrea
Yates, who drowned her five children on June 21, 2001, suggests that
in some cases the verdict falls before the trial starts. Although abundant
evidence exists to prove that Ms. Yates suffered severe mental illness
in the 2 years before and at the time of the tragedy, psychosis and delusional
hopelessness were not enough for her to be judged not guilty by reason
of insanity in court.
The case took an unexpected turn recently when the trial court's verdict
was overturned on appeal. Although the appeals court's reasoning focused
on an error by the testifying forensic psychiatrist, it is a reasonable
inference that the judge's ruling was based on the assumption that, other
things being equal, the jury was at a tipping point. Given the facts
presented, for the jury to have been at a tipping point can be understood
as a reflection of a folk psychology whereby people are predisposed by
the horror of an act itself to use judgmental heuristics. It is thus
no wonder that Andrea Yates's acts are understood more easily as bad
rather than mad, regardless of the fact pattern.
The puzzling story of Andrea Yates has now received a much needed recounting
from journalist Suzanne O'Malley. Are You There Alone? is
a heartfelt account of the events that led to the tragic deaths of Noah,
John, Paul, Luke, and Mary Yates. O'Malley argues that psychosis with
manic features, combined with medical mismanagement, stressful circumstances,
and religious obsessions masking delusions, resulted in the tragedy.
Her reading of the health records presents Andrea Yates's treatment as
a litany of misdiagnoses, poor treatment, wrong medications, and the
role of the health insurance company rather than the clinician as the
key decision maker in care. Nonetheless, despite being fragmented and
confusing, the medical records documented that Andrea Yates suffered
serious psychotic illness and delusions before and after she drowned
her children. Mentally ill or not, however, she appeared to admit to
knowing that what she did was legally wrong in videotaped interviews
shown in court, and the death-qualified jury found her guilty and sane
according to Texas laws.
The verdict will continue toward further appeal and a potential retrial
or plea bargain. O'Malley's account gives rise to questions on which
a potential appeal ruling or any retrial could turn. One such question
is, How valid are videotaped interviews for forensic purposes with psychotic
individuals? Especially when the psychoses of those individuals before
they committed the acts in question included that they were being videotaped!
Moreover, by the time the videos were shot, Andrea Yates had already
been repeatedly interviewed. In her aloneness with the terror of psychosis,
with her delusions masking guilt and grief over her abhorrent deed and
unimaginable loss, might she not seek nonverbal cues and guidance for
how to maintain connection? We do not read that there was any serious
exploration as to whether, in her suffering, she might have had a natural
need to turn her interviewers into unwitting directors to absolve her
of an otherwise unbearable confrontation with the horror.
Although forensic psychiatrists are trained to examine accused persons
such as Andrea Yates for feigning madness, it is far more difficult to
detect the accused feigning badness or filling in the blanks as we might
expect them to. Some accused would rather present themselves as bad than
mad, more terrified of the aloneness of the latter than the legal consequences
of the former. In this instance, if a trained, thoughtful, and experienced
forensic psychiatrist could, as any human being might, become confused
in the heat of cross-examination between what he was told and his observations,
then is it not as likely that Andrea Yates, in the midst of the unbearable
grief that the death of her children brought to the surface, might have
become confused between what she imagined she was supposed by society
to say to the videotape-directing interviewer and what she actually remembered?
O'Malley succeeds in providing detailed, memorable descriptions of the
horror, and she explicates formerly mysterious issues of the religious
influences of Mr. Woroniecki, the role of Randy Yates, and the political
and financial aspects of the trial. Psychiatric ethics courses can use Are
You There Alone? to raise haunting questions regarding the injustice
of a social and medical system where psychotic patients feel they need
to present themselves as bad rather than mad.
HAROLD J. BURSZTAJN, M.D.