| by Mary Paquette 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. The jury isn't told that if it finds the person insane, the person won't be released but sent to a psychiatric hospital until he or she is judged to be sane (in some instances this would be longer than a criminal sentence for a crime committed). No law prevents the jury from receiving this valuable and necessary information. Fearful Yates would be released, one juror was quoted as saying, "One of the reasons we convicted her ... is because she would walk if we found her insane" (Stack, 2002, p. A12). How is it going to help anyone to have her in jail? Some say this punishment will act as a deterrent to others. That reasoning doesn't demonstrate an understanding of mental illness. It implies that the person who is psychotic has control. A mentally ill person will walk into traffic, sometimes nude, during a psychotic episode. Does the possibility of injury or death deter this behavior? It doesn't appear so, because the psychotic person is incapable of assessing the consequences or choosing differently when voices insist on certain dangerous behavior. Yates resisted the voices and visions previously, but with additional strain and no medication she was unable to "do the right thing" on June 20, 2001. The science of mental health cannot reveal the precise degree to which insanity should mitigate responsibility for criminal behavior. Our laws concerning punishment for drunken drivers reflect an understanding that individuals who are intoxicated are not in control of their behavior. Yet the decision to drive while intoxicated is a decision made by a "sane" person who is temporarily affected by poor judgment and low impulse control. Punishment is commensurate with an understanding that this is a medical problem, and rehabilitation, not jail time, is the goal. We need to educate the public about the nature of psychosis and mental illness. The average person cannot comprehend mental illness as a reality that is different from his/her own. One of the major stumbling blocks to nursing students grasping the concepts of mental illness is to see the patient as ill. Often the bizarre behavior is judged as bad--the person needs to shape up and behave, and he/she has a choice regarding behavior. Comprehending mental illness, psychotic behavior, or someone being out of touch with or influenced by another reality is not easy for nursing students, let alone jurors. The public is fearful of mental illness. Jurors hate the insanity plea because they are afraid insane people will be set free. Punishing someone relieves you of the burden and provides relief from some horrific act--we are taking care of our children, and now we can sleep in peace. But in a humane society, Andrea Yates would not have gone to trial. Severe punishment--and possibly death--for an acute mental and medical problem such as this is not justice in any sense of the word, and especially not American justice. It is a major comment on our society in the age of knowledge. We must not turn our backs on the population we are committed to serve. We must provide treatment, support, and healing. As a professional group, advanced practice psychiatric/ mental health nurses can make a difference. Let's take up the challenge to change this barbaric response to mental illness. We can write letters to the editor, get involved with the court system to ensure that juries are educated about the consequences of an insanity verdict, lobby to change the narrow definition of "insane," and teach community courses where we invite the mentally ill to participate and interact with the public. It takes time, effort, and a commitment to patient advocacy to ensure the stigma and fear of mental illness are lessened in our society. | |
Mary Paquette, PhD, RN, CS
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| | References Gamiz, M. (2002, March 25). Two tragic cases show contrasts. Los Angeles Times, p. A2. Parker, L. (2002, May 16). `Psychotic,' but is Andrea Yates legally sane? USA Today, p, 1A. Stack, M.K. (2002, March 16). Yates draws life sentence. Los Angeles Times, p. A12. |
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