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Who is Andrea Yates?: A short story about insanity
Author: Deborah W. Denno Date: Summer 2003 From: Duke Journal of Gender Law & Policy(Vol. 10) Publisher: Duke University, School of Law Document Type: Article Length: 68,869 words Content Level: (Level 5) Full Text:
INTRODUCTION

We all know by now the story of Andrea Yates. Or, at least we think we do. Andrea Yates, high school valedictorian, swim team champion, college graduate, and registered nurse married Russell ("Rusty") Yates in 1993 after a four-year courtship. Both were twenty-eight. (1) Over the next seven years, Andrea (2) gave birth to five children and suffered one miscarriage, all the while plunging deeper into mental illness. (3) Then on June 20, 2001, in less than an hour, Andrea drowned all of her children in the bathtub, one by one. (4) Months later, she was convicted of capital murder in Harris County, Texas, (5) where she now serves a life sentence. (6)

Some may think that a mentally ill mother who committed such an act should be judged insane. Yet, news accounts and court records suggest that Andrea impaired her attorneys' efforts to plead insanity. (7) Such defense plans were already encumbered by the unusually strict Texas insanity standard (8) and the state's renowned retributive culture. (9) After a jury found Andrea competent to stand trial, (10) she resented the efforts that her attorneys mounted on her behalf (11) even as she faced possible execution. (12) Andrea insisted there was nothing wrong with her mind (13) and that she deserved to die. (14) She seemed to be awaiting punishment for her sins.

To those closest to Andrea, this self-blaming reaction came as no surprise. They could testify that Andrea had been tormented by bouts of mental illness, (15) and, in fact, both the prosecution and defense agreed that she was mentally ill. (16) Andrea's life was also distinguished by religious obsession and a steadfast devotion to tales of sin and Scripture, (17) a "repent-or-burn zeal" (18) that led her to believe she was a bad mother with ruined offspring. (19) According to Andrea, she killed her children to save them from Satan and her own evil maternal influences, (20) delusions that did little to help Andrea's defense because they fueled her own desire for punishment.

Public opinion on the Yates killings helps explain some of the more contradictory themes in the case. On the one hand, the public had much sympathy for Andrea and the life that she led. (21) Yet, her composed behavior on the day she killed her children stirred a strong retributive response. (22) Many were unable to comprehend such violence except by declaring it intentional and evil. (23) According to this view, it could be said that Andrea was supremely sane--her acts rational and premeditated (24)--despite her unquestioned history of postpartum psychosis. (25) Andrea propelled this account, spurring the public, her "jury," to see her as the Satanic mother she believed herself to be. (26)

These complex and conflicting aspects of the Yates case fed into the prosecution's depiction of Andrea's mental state on the day she killed her children. But, one psychiatrist's testimony seemed to have a greater impact than the others on the case's outcome. (27) The prosecution's star expert, Park Dietz, (28) appeared particularly adept at persuading the jury to accept the prosecution's assertion that Andrea was sane and acting intentionally when she killed her children. (29) Because the Yates case is on appeal, many of the court records are not available. (30) In addition, the defense team still lacks funds to pay for the entire trial transcript (31) so it too cannot be examined. Park Dietz's testimony, however, is now accessible (32) and it warrants a thorough analysis in its own right.

What is most striking about Dietz's testimony is how his opinions about Andrea's mental state could carry so much authority with the jury. Criminal trials commonly involve different sides presenting competing legal "stories" about their version of the facts. (33) The law's role is to ensure that just verdicts result from these conflicting representations. Courts must be perceived "as fair and disinterested, capable of rising above the self-serving and adversarial narratives by which cases are presented." (34) While the law provides evidentiary standards and procedures to oversee what information is released in court and how, (35) an immense amount of discretion exists nonetheless in the ways stories can be told. It remains unclear who is to police these narratives--beyond the structures already in place--or whether such oversight is even needed.

In the Yates case, the defense claimed that Andrea's mental illness caused her to believe that killing her children was the right course of action. Although Andrea's attorneys called a number of experts to prove their argument, each expert had a different twist on this central viewpoint. (36) Therefore, the defense's story about Andrea, while emphasizing her insanity, was still somewhat muddled. In contrast, the prosecution's story about Andrea's sanity was clearer and also apparently consistent with the cultural norms of Harris County, Texas. The prosecution argued that Andrea may have been gripped by her belief in some demonic command, but she was still fully capable of knowing she was doing something wrong. (37) And Andrea seemed to concur, damningly perhaps. Her story was congruent with the prosecution's. She had sinned and deserved punishment for acting out the devil's dictates. (38) In all likelihood, however, Andrea's own story was indicative of her mental illness, (39) not evidence of the disposition she felt she most deserved. Nonetheless, both her narrative and the prosecution's were accentuated by courtroom storyteller, Park Dietz.

This Article analyzes the problematic aspects of Dietz's testimony in an effort to contribute some balance to the Andrea Yates story. While Dietz's comments may have confirmed the Harris County jury's preconceptions, they were virtually unsubstantiated. Dietz also has no significant expertise in postpartum depression or psychosis even though both sides agreed that Andrea severely suffered from the disorders and that they significantly affected her conduct.

Of course, expert witnesses are routinely used in litigation. (40) Dietz is simply one of the more prominent and prolific examples of what the criminal justice system seeks. (41) Despite the long history of expert witnesses in criminal trials, the justice system should question the fairness and efficacy of such an unregulated storytelling process. The potential for inequity is all the more pronounced in a case where the prosecution's story lacks factual justification, both sides agree the defendant is mentally ill, and the death penalty is at stake.

Part I of this Article briefly discusses Andrea's life up to her marriage to Rusty as well as the outcome of her trial. Part II provides an overview of the insanity defense and the strict Texas insanity standard. Part III examines Dietz's background, his reputation, and his psychiatric philosophy, in addition to his proclivity to testify for the prosecution. Part IV describes Andrea's history of mental illness, especially her postpartum psychosis that started with the birth of her first child and ended with a severe psychotic episode. Part V focuses on Dietz's testimony in the Yates trial, beginning with his pre-trial interview with Andrea and ending with an analysis of his conclusions. The discussion emphasizes the speculative nature of many of Dietz's statements and their lack of connection to Andrea's history of mental illness. Part VI presents the other perspectives and experts in the Yates case, and considers how the case might have reached a different result with a more consistent defense strategy or a less rigid insanity standard.

The Andrea Yates case is a vast, book-length, narrative. This commentary covers just a part of the trial. It is beyond this Article's scope, for example, to scrutinize the general role of psychiatric experts in the criminal justice system (42) or to review the research on postpartum depression and postpartum psychosis, which is available elsewhere. (43) Nonetheless, examining one piece of the Yates story can be enlightening. "Narrative, we are finally coming to realize, is indeed serious business--whether in law, in literature, or in life." (44)

I. THE EARLY LIFE AND TRIAL OF ANDREA YATES

A. Meet the Yates Family

Andrea Yates was raised in the Houston area. Her family background appeared to be middle-American and middle-class. (45) Her father was a retired auto shop teacher who died of Alzheimer's disease shortly before the killings. (46) Her mother, Jutta Karin, was a homemaker. (47) Andrea, the youngest of five, was expected to be a high achiever (48) and, in high school, she succeeded: she was captain of the swim team, a National Honor Society member, and valedictorian (49) of her 1982 graduating class. Upon completing a two-year pre-nursing program at the University of Houston, she went on to the University of Texas School of Nursing in Houston, graduating in 1986. From 1986 to 1994, she was employed as a registered nurse at the University of Texas M.D. Anderson Cancer Center. (50) Andrea's nursing career ceased entirely, however, soon after her marriage to Rusty. (51)

Andrea and Rusty first met in 1989 at the Houston apartment complex where they both resided. Both were twenty-five at the time. (52) Rusty, "a popular jock" in high school and a summa cum laude graduate of Auburn University, was designing computer systems for NASA. (53) Andrea approached him first in conversation--an uncharacteristically bold move for her, Rusty would later reveal. (54) Only after Andrea's arrest would Rusty learn that she had never dated until she had turned twenty-three, that she was recuperating from a romantic break-up at the time they met, and that her directness in initiating contact with him was prompted by intense loneliness and, perhaps, depression. (55) Andrea and Rusty spent the next few years becoming acquainted, "living together, reading the Bible, and praying." (56)

Their April 17, 1993 wedding ceremony was small and simple. Surprisingly, it was also nondenominational, (57) perhaps because of the influence of Rusty's spiritual mentor, Michael Woroniecki, from whom "[h]e had learned the faults of organized religion." (58) The couple confidently announced to wedding guests that they would not use birth control--they wanted as many children as nature would provide. (59) Their desire for children was immediately fulfilled. Within three months, Andrea was pregnant (60) with the first of five children. Eight years later she would kill them all. (61)

B. The Yates Trial

On July 30, 2001, Andrea was indicted on two counts of capital murder for the deaths of Noah (seven), John (five), and Mary (six months), (62) but not for the deaths of her other two children, Luke (three) and Paul (two). (63) All of the indictments were for capital murder because they involved more than one person and victims less than six years old. (64) On the same day, Andrea's attorneys, George Parnham and Wendell Odom, filed a "notice of intent to offer evidence of the insanity defense," based upon the testimony of two psychiatrists claiming that Andrea was, at the time of the killings, "mentally insane" as defined by the Texas Penal Code. (65)

The insanity defense for Andrea would ultimately dissolve. (66) Within eight months following her indictment, one jury decided that Andrea was sufficiently competent to stand trial for killing her children (67) and another refused her insanity plea. (68) Although this second jury declined to impose the death penalty, (69) Andrea received a mandatory life sentence for the killings. (70) Under the Texas capital felony statute, an inmate must serve forty years in prison before becoming eligible for parole. (71) The case is currently on appeal. (72)

Many theories could explain Andrea's conviction. Of course, the primary theory would speculate that the jury was so horrified by Andrea's acts that any psychiatric evidence offered on her behalf paled in comparison. Yet, the continuing controversy and debate over Andrea's conviction (73) suggest that there may be other, more complex, explanations.

Additional rationales primarily point to the retributive aspects of Texas law and culture. As one Harris County resident explained, "There's the rule of law, and there's the rule of law in Texas.... The rule of law in Texas is kind of cowboy law." (74) For example, Texas consistently executes more individuals than any other state; (75) annually it accounts for one-third of all executions in the country, (76) a pattern that conflicts with both national and international abolitionist trends. Harris County in particular is responsible for over one-third of the state's death row inmates, making it the harshest death penalty jurisdiction in the country (77) and one of the most punitive in the Western world. (78) If Harris County were considered a state, it would follow only two other states (Texas and Virginia) in its number of executions since 1977. (79)

Because the Yates prosecution sought the death penalty, Andrea's jury was "death qualified." In other words, the prosecution could exclude potential jurors for cause if their negative views toward the death penalty were so strong they "would 'prevent or substantially impair the performance of [their] duties as [jurors]'" (80) and therefore render them "unable to faithfully and impartially apply the law." (81) Research shows that death qualified juries are more anti-civil libertarian in attitude, particularly with respect to such principles as presumption of innocence and burden of proof, and they are significantly more likely to convict than juries that are not death qualified. (82) Presumably, then, Andrea's jury was far less able to "comprehend the inconceivable" (83) in evaluating an insanity defense relative to a jury that had not been death qualified.

The Texas insanity standard is a comparably strict rule of law; in the eyes of one legal commentator, it is "one of the most stringent" in the United States. (84) The Yates jury judged psychiatric testimony not only by Texas culture but also by that culture's narrow legal view of what constitutes insanity.

II. THE INSANITY DEFENSE

A. A Brief Overview of the Insanity Defense

Part II explores only the very basics of the insanity defense and how it is applied in the state of Texas. (85) The insanity defense is considered one of the most controversial criminal law doctrines, not only because of intense debate over how "insanity" should be defined, but also because of increasing conflict over whether the defense should exist in any form. (86) Statistics show that insanity pleas are seldom raised or successful in states throughout the country, (87) including Texas. (88) Nonetheless, the defense rankles social and community tensions over two conflicting goals: the desire to punish the horrendous, highly publicized crimes that the public typically hears about versus the need to understand that some mentally ill people should not be held responsible for what they do. (89)

1. The Major Legal Standards for Insanity

The legal standard for insanity varies across the fifty states. (90) The first and strictest insanity test of modern usage was introduced in 1843 by the English House of Lords in the M'Naghten case. (91) Under M'Naghten, a person is insane if, because of a "disease of the mind" at the time she committed the act, she (1) did not know the "nature and quality of the act" that she was performing; or (2) if she was aware of the act, she did not know that what she "was doing was wrong," that is, she did not know the difference between right and wrong. (92) The M'Naghten rule, which soon became the most widely accepted insanity test in the United States, (93) considers only cognitive ability and not volitional conduct. (94)

Concern over the narrowness of the M'Naghten test prompted attempts over the years to replace it. (95) The most successful attempt was the American Law Institute (ALI)'s 1962 insanity test which rapidly gained support from legislatures and courts; by the 1980s, the ALI standard was adopted nearly unanimously by the federal circuit courts and over one-half of the states. (96) Under the ALI test, an individual is not responsible for her criminal conduct if, because of mental disease or defect, she either lacked "substantial capacity" to appreciate the "criminality" (or, at the opting of the state legislature, the "wrongfulness") of her conduct, or she failed to "conform" her conduct "to the requirements of law." (97)

The differences between the ALI and M'Naghten tests are striking. For example, the ALI test accepts both cognitive and volitional impairment as an excuse. In other words, the test considers a defendant's cognitive ability to "appreciate" the criminality or wrongfulness of her conduct as well as her ability to "conform" her conduct to the law. (98) This added "conform" requirement is often characterized as a "lack-of-control defense," pertaining to those individuals whose mental disease or defect leads them to lose control over theft actions at the time they commit an offense. (99)

The ALI and M'Naghten standards vary in other important ways. The ALI test requires only that defendants "lack substantial capacity," not total capacity. (100) In turn, the ALI applies the broader term "appreciate" rather than "know" when specifying the type of cognitive impairment that leads to insanity; hence, the defendant's lack of emotional understanding can be incorporated into the defense. (101) The ALI test also allows the state legislature to consider "wrongfulness" rather than "criminality." This choice enables a finding of insanity if the accused does not know the act was illegal and also if she believes the act was "morally justified" according to community standards. (102) At the same time, both the ALI and M'Naghten tests skirt any set definition of the term "mental disease or defect." (103) According to the ALI, such an open-ended approach allows the term "to accommodate developing medical understanding" (104) and therefore avoid the constraints of old science.

The popularity of the ALI test dwindled in 1981 when a jury found John Hinckley not guilty by reason of insanity, based on an ALI standard, for his attempted assassination of Ronald Reagan. (105) The effects of the public furor over Hinckley's acquittal were immediate: (106) the federal government and several of the ALI test states abolished the volitional component of the test entirely and imposed other limits, in some cases reverting back to a M'Naghten-type standard. (107) According to a 1995 survey of insanity laws, about twenty states still use the ALI test while nearly half of the states apply "Home variation of the M'Naghten/cognitive impairment-only test." (108) A handful of states have abolished the insanity defense entirely. (109)

2. Modern Problems with the M'Naghten Insanity Standard

The return to a M'Naghten-type standard spotlights the problems that the test has always had and why there have been continuing efforts to change it. For example, the word "know" and the phrase "nature and quality of the act" can be defined either very broadly or narrowly. (110) Such vagueness gives legal actors little guidance for interpreting the test and heightens the chance that they will apply it inconsistently across different cases. Likewise, it is not clear whether the "wrong" in the right-and-wrong prong pertains to legal or moral wrongdoing because the language in M'Naghten itself could bolster either approach. (111) England has since established that the right-and-wrong element represents the defendant's recognition that an act is legally wrong. (112) Yet, American law sides in the opposite direction. (113) Most American courts have interpreted the word "wrong" to mean "moral wrong," not "legal wrong." (114) This issue was important in the Yates case because Texas law does not specify a particular approach (115) and a moral wrong approach would have benefited Andrea. According to some defense experts, Andrea knew that her acts were illegal but she believed they were morally right, given the context of her delusional circumstances." (116)

In American states that apply the moral right-and-wrong test, questions typically concern whether the defendant knowingly transgressed society's standards of morality, not whether the defendant personally perceived her acts to be morally acceptable. In other words, even if a defendant is mentally ill and, as a result, commits an offense that she believes is morally correct, she is considered sane if she is aware that her conduct is condemned by society. (117) As one commentator notes, however, this difference can "be blurred to near extinction" depending on how the particular circumstances in a case are pitched. (118) For example, a mentally ill individual "is apt to know that society considers it morally wrong to kill, but if she is acting pursuant to a delusionary belief that God wants her to kill, she might now believe that society would agree with her God-endorsed actions." (119)

Interpretation of the moral-right-and-wrong standard can vary somewhat in the few M'Naghten jurisdictions that have a "deific decree doctrine," in other words, a rule that allows a mentally disordered defendant to be judged legally insane if she believes that she is acting under the direct command of God (for example, a belief that God commanded the defendant to kill someone. (120) Two primary rationales explain the origins of the deific decree doctrine. First, the doctrine "was merely a logical extension of the Judeo-Christian belief that God would not order a person to kill another" because the Sixth Commandment prohibits murder. (121) Therefore, a person thinking that God is commanding her to kill is entertaining a false belief and thus should not be held accountable. Likewise, nineteenth-century courts and juries would not grant the insanity defense to individuals contending that they acted under the command of the Devil or some other religiously corrupt figure because people accepted only "the One True God." (122) Second, the doctrine may have been a vehicle for inserting a volitional component exception to the cognitive-only limitations of the M'Naghten rule so that M'Naghten could incorporate at least a narrow category of uncontrolled individuals. (123)

The exceptions and qualifications for the deific decree doctrine apparently still apply today for defendants experiencing such "command hallucinations." (124) The doctrine presumes that the defendant's behavior results from a delusion (a "false belief based on incorrect inference about external reality"), (125) and not from a religious conviction, (126) although determining the difference between the two can be very difficult. (127) While some jurisdictions treat the deific decree rule as an exception to the general insanity standard, other jurisdictions view it as a major factor in assessing an individual's capability to tell right from wrong. (128) Irrespective of a jurisdiction's particular approach, these right-wrong issues were key in the Andrea Yates case. Andrea's command hallucinations were a focus of the expert testimony and what was supposed to be considered "wrong" was neither specified, nor constrained, in the jury charge. (129)

B. The Texas Insanity Standard

In 1973, Texas joined the ranks of other states and adopted the more lenient ALI definition of insanity. (130) A decade later, however, the state returned to a M'Naghten type standard, partly in response to developments surrounding the Hinckley verdict. (131) Yet, a critical feature of the Texas test (132) is that it is even narrower than M'Naghten, although comparably confusing. The typical M'Naghten standard refers to two parts: the defendant's ability to know (1) the "nature and quality of the act committed" or (2) whether the act was "right or wrong." (133) The Texas standard, however, eliminates the first part and refers only to the second, that is, whether the defendant knew the act was right or wrong. (134) Texas also limits the defense to cases of severe mental illness and puts the burden of proving insanity on defendants. (135) As legal commentators rightly contend, the Texas standard "could hardly be narrower" (136) or more "impossible to meet." (137)

Similar to the M'Naghten standard, defining the terms "right" and "wrong" is a problem. (138) For example, the Texas insanity statute does not clarify whether "wrong" should be considered from a legal or a moral standpoint. (139) This ambiguity was a key issue in the Yates case, both for the law and the psychiatric profession. As one psychiatric expert commenting on the case said, there is still no "test" available to determine who is genuinely controlled by command hallucinations; rather, psychiatrists must rely on "a certain degree of approximation[]" in their assessments. (140) Likewise, the Yates jury charge did not specify what "wrong" should mean and expert testimony did not seem to restrict the definition of "wrongfulness." (141) The Yates jury was free to use the term's "common and ordinary meaning" (142) and apply "the statutory language to the facts as it saw fit." (143)

Such a legally muddled circumstance prompted conflicting approaches to interpreting the Texas insanity standard. As the Yates case evolved, for example, it became clear that both the prosecution and the defense would define the legal-or-moral wrong issue because of the statute's silence. Both sides agreed that Andrea was mentally ill and, in general, that she knew her actions were legally wrong. (144) The issue of whether Andrea's mental illness rendered her unable to control her actions, although hotly debated, was moot under the narrow confines of the Texas insanity statute. (145) Thus, only one significant question was left for the jury to resolve: Did Andrea know that her actions were morally wrong?

III. PARK DIETZ'S EXPERTISE AND PSYCHIATRIC PHILOSOPHY

There was little legal or psychiatric clarity guiding the determinations to be made in the Yates case. For this reason, the opinions of expert witnesses were especially important. According to a synopsis of the ethical guidelines established by the American Academy of Psychiatry and the Law, "the medical expert is expected to provide a clinical evaluation and a review of the applicable data in light of the legal question posed and in the spirit of honesty and striving for objectivity--the expert's ethical and professional obligation." (146) The Academy specifies that such an obligation "includes a thorough, fair, and impartial review and should not exclude any relevant information in order to create a view favoring either the plaintiff or the defendant." (147)

According to some legal commentators, Park Dietz's expert testimony was considered "crucial" (148) for the conviction of Andrea Yates--the "defining moment" of the trial. (149) Part III examines Dietz's background, experience, and psychiatric philosophy in an effort to explain why Dietz's story about Andrea seemed so much more compelling than the other stories experts had to offer. Notably, much of the information about Dietz derives from interviews with Dietz himself, or from his supporters, in magazines and newspapers. Dietz is commendably forthright about his views in general and was immediately open to commenting on the Yates case as soon as Andrea was sentenced. (150) What becomes apparent is how his own self-described, pro-prosecution leanings could mesh so well with a death qualified, Harris County jury.

A. Dietz's Background and Reputation

Park Dietz is considered one of the most "prominent and provocative" psychiatric expert witnesses in the country. (151) In one professional capacity or another, he has been involved with a long list of famous homicide defendants: John Hinckley, Jr., Jeffrey Dahmer, Susan Smith, Melissa Drexler, the Menendez brothers, O.J. Simpson (in the civil case), and Ted Kaczynski, to name a few. (152) He can now add Andrea Yates to that list. As the prosecution's star witness in the Yates case, (153) he both interviewed and videotaped Andrea, (154) and he subsequently testified in court about his evaluation. (155)

Dietz also has extensive professional credentials. He acquired a B.A. from Cornell in biology and psychology, an M.D. from Johns Hopkins School of Medicine, and a Masters in Public Health and Ph.D. in sociology, both from Johns Hopkins. He has held academic posts at Johns Hopkins, the University of Pennsylvania, Harvard, and the University of Virginia. (156) His professional experience is substantial, including consulting positions with the Department of Justice and the Federal Bureau of Investigation. (157) In addition, Dietz has over one hundred publications, "nearly all" of which concern violent or injurious behavior, (158) and he has examined "thousands" of criminal defendants for forensic psychiatric purposes, including sanity determinations. (159)

Currently (and at the time he testified in the Yates trial), Dietz runs two businesses in Newport Beach, California. He is the president and founder of Park Dietz & Associates, Inc., forensic consultants in medicine and the behavioral sciences, as well as president and founder of Threat Assessment Group, Inc. (TAG), which specializes in the prevention of workplace violence. (160) Before arriving in Houston to testify in the Yates case, Dietz mailed his business brochure (describing his companies and the types of cases on which they work) to a wide range of members of Houston's legal community--prosecutors, defense attorneys, attorneys specializing in premises liability for violent crime, and lawyers representing elder abuse victims. (161) Although the Yates defense brought forth evidence of Dietz's brochure distribution during cross-examination in an effort to portray Dietz as a "professional testifier," (162) Dietz did not seem apologetic. (163) Nor did such a revelation appear to dent the perceived validity of his testimony.

1. A Desire to Emphasize "Facts"

Media articles about Dietz claim he is known for emphasizing "facts" rather than "theoretical conjecture" when evaluating a case. (164) Indeed, both Dr. Jonas Rappeport, a renowned professor of Dietz's at Johns Hopkins Medical School, (165) as well as Roger Adelman, one of the prosecutors in the Hinckley case, (166) credit Dietz's precision and "focus on the facts" as major contributions Dietz has brought to modernizing the field of forensic psychiatry.

In line with this facts-driven orientation, Dietz seems to be more concerned with the physical evidence linked to a crime than with the defendant's history that can be acquired in an interview. (167) According to Dietz, for example, interviews with defendants have typically "been the linchpin of forensic assessments"; yet, there are "serious risks" associated with them because the "[n]atural human techniques for gaining information from an interview unthinkingly cut corners by suggesting answers or guessing at the answer or offering multiple choices." (168) Such leading or suggestive procedures are comparable to crime scene evidence that has been contaminated or corrupted. (169) Dietz favors instead the second source of mental evidence, which includes examining the crime scene, analyzing autopsies and weapons, and interviewing witnesses to the crime. (170) Although "the ideal" would be to have both types of evidence when making an evaluation, Dietz has stated that, "[i]f I had to choose between the interview [with the defendant] only or everything except the interview as a means of getting to the truth, I'd prefer everything except the interview because it would get me to the truth more often." (171)

Dietz's apparent stress on facts, (172) combined with what even Rappeport views as a "rigid" approach towards defendants, (173) has prompted criticism. According to an article about Dietz in Johns Hopkins Magazine, "[s]ome forensic psychiatrists" have accused him of presenting "mere informed opinion as solid fact, and [complain] that his standard of criminal responsibility is harsh and unforgiving of mentally ill defendants." (174) For example, during his testimony in the Yates case, Dietz indicated that because Andrea claimed that Satan, rather than God, told her to kill her children, she knew her actions were wrong. (175) Andrea also failed to act in a way a loving mother would if she really thought she was saving her children from hell by killing them. As Dietz stated, "I would expect her to comfort the children, telling them they are going to be with Jesus or be with God, but she does not offer words of comfort to the children." (176) However, there appears to be no empirical support for this kind of interpretation of the deific decree doctrine, if in fact that is what Dietz was referencing. (177) Rather, if Dietz's explanation has any source at all, it seems to derive from the centuries-old, Judeo-Christian origins of the doctrine itself. (178) As one legal critic asked in response to Dietz's comments, "Is one to infer that it is somehow more loving to invoke the name of Jesus while you drown your children than to drown them without any religious commentary?" (179) In other words, Dietz appears to be stressing religion, not facts, a focus more aligned with Southern Bible belt culture (180) rather than with a medical assessment of Andrea's mental state.

Even Dietz's supporters have admitted that his inflexible approach may prevent him from being able (or willing) to comprehend "some of the psychological nuances of human behavior." (181) According to Rappeport, a strong advocate, (182) Dietz has the capability to understand and apply knowledge of human behavior, he simply chooses not to. (183) As Rappeport explained, "I have a suspicion he may not like to do that. So he may find himself more frequently on the side of the prosecutor, who doesn't like to do those things either." (184) Such an omission is a troubling handicap in a field where "[f]ifty percent or more of medicine is emotional." (185) It is particularly problematic given that the cases that typically involve Dietz's testimony often turn on the very "nuances" that Dietz discounts.

Indeed, in media interviews (186) and his testimony in the Yates case, (187) Dietz has made clear that he does not treat patients in a psychiatry practice. This lack of engagement with patients is "rare" among medical expert witnesses. (188) Rather, Dietz opts to concentrate on research and one-time interviews with criminal defendants. (189) Yet, such a view of the psychiatric world is distorted. For example, it is difficult to comprehend how Dietz can evaluate an individual's normality or abnormality if he only engages in short-term interviews with highly abnormal people. By encountering briefly only the most extreme criminal cases, all Dietz sees is pathology. He has no "control group" as a comparison, no in-depth evaluations of individuals from whom he can learn nuances. Such an approach may explain additional criticisms concerning where Dietz draws the line for distinguishing sanity from insanity. According to Fred S. Berlin, associate professor of psychiatry at Johns Hopkins and one of the defense's psychiatric experts in the Jeffrey Dahmer case, Dietz's line is too stringent. "He has a high threshold for evidence that tends to suggest impairment. A narrow range for what he defines as psychiatric disorder." (190)

Consistent with this view, in the Yates case Dietz minimized the defense expert witnesses' testimony that Andrea had suffered years of delusions, auditory hallucinations, and visions of violence. (191) Instead, Dietz claimed that Andrea had, at most, experienced "obsessional intrusive thoughts." (192) Yet, contrary to other high profile defendants pleading insanity, Andrea had a substantial and documented history of mental illness before she killed her children. (193) Not only had she twice attempted suicide, she had also been hospitalized and prescribed anti-psychotic drugs after the birth of her fourth and fifth children. (194) The defense could call experts who had actually treated Andrea, some repeatedly, (195) in sharp contrast to Dietz's relatively brief interview. As one scholar on expert testimony emphasizes, "[t]he legal system assumes that the treating doctor is more credible than a nontreating doctor"; therefore, the treating physician "is frequently sought to provide expert testimony." (196)

Nonetheless, Dietz's effectiveness as a witness appears to be due to his alleged emphasis on fact. Because jurors received conflicting expert testimony during the Yates trial, minimal statutory guidance, and unclear stories from both the prosecution and defense, they were left with little to rely on other than the supposed "facts." (197) Compounding this dilemma, the multiple defense psychiatrists gave somewhat contradictory analyses of Andrea's mental state, (198) presumably in part because she had been treated or assessed by a number of them during different stages of her illness. Such a multiple-theory defense narrative contrasted with the more uniform "factual" narrative presented by Dietz. Given a choice, Dietz's story may have been the preferred alternative; the jury could base a decision on something tangible--"facts"--rather than confusion.

2. A Prosecutorial Bent

Almost immediately, Dietz's testimony and post-trial commentary about the Yates case sparked notoriety for the views he expressed both inside and outside the courtroom. In an interview with the New York Times six weeks after his trial testimony, Dietz stressed that his involvement in the Yates case was "troubling," both "professionally and personally." (199) As he explained, "[i]t was obvious where public opinion lay, it was obvious she was mentally ill, it was obvious where professional organizations would like the case to go." (200) Therefore, while "[i]t would have been the easier course of action to distort the law a little, ignore the evidence a little, and pretend she didn't know what she did was wrong," it also would have been "wrong ... to stretch the truth and try to engineer the outcome" in that way. (201)

Dietz also tried to justify his career-long tendency to appear primarily for the prosecution. According to Dietz, prosecutors, like good forensic psychiatrists, strive "to seek truth and justice" and therefore to make available all the information important in a case. (202) In contrast, defense attorneys attempt to help their clients--a goal that conflicts with a thorough search for data. "[O]ften there are pieces of evidence that are not in their client's interest to have disclosed or produced." (203) Of course, Dietz's statements imply that defense attorneys and their witnesses want to distort information in some way and shield the truth. (204)

The irony of Dietz's points, however, were spotlighted a week later by Andrea's attorneys. They discovered a factual error that Dietz had made during cross-examination. As the next section discusses, their research showed that Dietz had testified incorrectly about the existence of a television episode about postpartum depression that never aired. (205)

3. A Mistake in Testimony

Dietz is a technical advisor to two television shows: Law & Order and Law & Order Criminal Intent. In his advisory capacity, he has viewed nearly three hundred episodes of both shows. (206) During the Yates trial, Dietz mistakenly testified that, shortly before Andrea killed her children, Law & Order aired an episode involving a postpartum depressed mother who successfully won an insanity appeal after drowning her children in a bathtub. (207) The episode never existed. (208) When Dietz learned of his error, he wrote prosecutors Joe Owmby and Kaylynn Williford and informed them that he had confused the insanity episode he testified about with other Law & Order episodes and infanticide cases. Dietz's mistake about such a fact, however, may be part of the grounds for Yates's appeal. (209) It is not a stretch to think the jury may have been affected by Dietz's implication that Andrea was somehow influenced by the show.

Dietz's statements about the "truth seeking" differences between the prosecution and the defense were also problematic in other ways totally beyond his control and, presumably, his awareness. For example, trial testimony revealed that the defense was not able to acquire copies of particular documents, including Andrea's police offense report. George Parnham, Andrea's attorney, was allowed only to read her police report but not to photocopy it. (210) Therefore, Parnham resorted to taking notes on the report, based only on what he could remember of it. As one defense expert later revealed, having only Parnham's notes on Andrea's report put the expert "at a real disadvantage." (211)

Dietz also claimed that the defense experts asked "shocking examples of leading questions" of Andrea and provided only partial, and biased, videotapes of their interviews with her. (212) Predictably, his accusation prompted a response. According to Lucy Puryear, a Houston psychiatrist who testified for Andrea's defense, Dietz did the same. (213) Puryear added that Dietz edited his eight hours of videotaped interviews with Andrea and only "showed the jury portions that supported his testimony." (214)

Such media debates simply seem to accentuate the general problems associated with incorporating psychiatric testimony in an adversarial process, as well as the weaknesses of the profession itself. Legal commentators emphasized the extent to which both sides in the Yates case differed in their conclusions about Andrea's mental state given that they were purportedly examining the same evidence. (215) As the following sections suggest, however, the backgrounds of the experts appeared to have an impact on what kind of evidence they believed was most significant and why.

B. Dietz's Limitations in Expertise and Investigation

This section examines the extent of Park Dietz's background and experience for testifying in a case involving a defendant with an undisputed history of postpartum depression and postpartum psychosis. As one scholar on expert witnesses has emphasized, "[m]edical professionals who undertake the role of expert witnesses are generally expected ... to be knowledgeable and experienced in the area in which they are functioning as a medical expert." (216)

1. Postpartum Depression and Postpartum Psychosis

The Yates trial revealed the degree to which Dietz was unfamiliar with patients diagnosed with postpartum depression or postpartum psychosis and his admitted void in treating patients. (217) This observation is not meant to elevate the psychiatric classification of postpartum disorders to a level of scientific precision and sophistication that it does not deserve. (218) Rather, this section makes clear that there is still much to be learned about postpartum disorders and how much they can justifiably mitigate criminal culpability, if at all. At the same time, what is known medically about the disorders especially their neurobiological aspects--should not be ignored. Two postpartum experts highlighted the problem of such informational inadequacy specifically with respect to the prosecution's approach in the Yates case: "The real challenge for psychiatry is to educate the legal profession and juries about the physiological underpinnings of postpartum disorders and other psychoses ... and, ultimately, to encourage verdicts based on facts." (219)

Of course, Park Dietz was not responsible for such a lack of education. It is not the role of the expert witness to provide answers to questions that are never asked or to draw conclusions without a foundation. Andrea's defense attorneys could have more aggressively revealed Dietz's gaps and confronted him with the history of Andrea's illnesses that Dietz bypassed in his evaluations. Nonetheless, without a fuller expertise on postpartum issues, Dietz's story about Andrea offered a much simpler mental landscape and a greater level of speculation--than may have been warranted given her background.

Direct and cross examinations in the Yates trial made clear that Dietz has been asked to consult on an "unusually high proportion" of cases concerning mothers who kill their children. (220) Yet, according to his testimony, the last time he ever treated a female patient with postpartum depression was twenty-five years ago (in 1977). (221) Nor was Dietz "sure" that he ever treated a patient for postpartum depression with "psychotic features." (222) Dietz conceded that he stopped treating patients totally "many many years ago," in "1981 or 1982" (223) and that he has no expertise in women's mental health. (224) Dietz's error concerning the showing of a Law & Order episode on postpartum depression (225) came about when Parnham was cross-examining him to assess two issues: the sources of Dietz's income, but also whether Dietz had any more expertise in postpartum disorders, even at the level of consulting for television shows, than what he indicated in his testimony on direct examination. (226) It appears Dietz did not have more background because he did not offer any information other than his consultancy on a nonexistent show. Such inexperience does not comport with accepted diagnostic principles of psychiatry. (227)

Dietz's lack of expertise in postpartum depression and postpartum psychosis is striking given the psychiatric community's recognition of postpartum disorders (228) and the acceptance by both sides that Andrea was afflicted with one. (229) The disorders are included in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association, and now in its fourth (text revised) edition (DSM-IV-TR). (230) As courts and professionals have noted, "[t]he DSM is often referred to as 'the psychiatric profession's diagnostic Bible.'"(231) DSM-IV-TR also clearly recognizes the link between postpartum-related mental disorder and infanticide in the context of delusions. (232) Notably, however, postpartum psychosis is not presently treated as an individual diagnostic classification in the DSM-IV-TR. Rather, the symptoms are categorized according to the established criteria used to diagnose psychosis (for example, major depressive, manic, or mixed episode). The "postpartum onset specifier" applies if symptoms occur within four weeks after childbirth. (233)

2. Andrea's Postpartum Risk Factors and Life Stressors

It appears that Dietz never really adequately investigated or acknowledged AndreWs postpartum risk factors--most particularly in the context of the postpartum period's "unique ... degree of neuroendocrine alterations and psychosocial adjustments," which the DSM emphasizes. (234) In other words, the medical literature stresses that the risk factors for postpartum disorders cover a broad scope of biological, psychological, and social influences. These factors include an individual's personal and family history of depression, biochemical imbalances, recent stressful events, marital conflict, and perceived lack of support from the partner, family, or friends. (235)

Andrea experienced all of the postpartum risk factors that the DSM mentions. (236) She was also subject to a host of family and environmental life stressors shown to be linked to postpartum depression and postpartum psychosis. (237) Dietz only occasionally alluded to these stressors if he mentioned them at all in his testimony. Even if it could be argued that the direct and cross examinations of Dietz did not prompt further references to Andrea's disorders, it would be expected that they would be part of Dietz's evaluation of Andrea independent of his courtroom testimony.

Andrea's stressors were numerous. First, over the course of her marriage to Rusty (during which she was nearly always either pregnant or breastfeeding), Andrea consistently demonstrated DSM-listed criteria for postpartum mood disorder: "fluctuations in mood, mood lability, and preoccupation with infant well-being." (238) Like the DSM specification, these feelings "ranged from overconcern to frank delusions" (239) and they also took the form of suicide attempts related to the other circumstances in Andrea's life uprooted living conditions and transiency, home schooling her five children, her father's death, depressive illnesses throughout her family, Rusty's own bizarre behavior and pressure for more children, as well as Andrea's increasing obsession with religious doctrine, particularly as it was pitched by Michael Woroniecki and his wife, Rachel. (240) As the DSM notes, "[t]he presence of severe ruminations or delusional thoughts about the infant is associated with a significantly increased risk of harm to the infant." (241) Part IV considers in further detail how Andrea wove such delusional thoughts into a highly stressed life that seemed to spur the thoughts all the more.

IV. ANDREA YATES'S HISTORY OF POSTPARTUM DISORDERS

A. The Early Years of Andrea's Marriage

Andrea's postpartum difficulties appeared with her first pregnancy. Soon after Noah's birth in 1994, (242) for example, Andrea experienced hallucinations--a striking vision of a knife and her stabbing someone. She dismissed the image and never revealed it to anyone (243) until after her arrest, when she told Rusty. (244) As research shows, postpartum depressed or psychotic women often feel ashamed or embarrassed to admit to others their thoughts about harming their infants. (245)

When Andrea became pregnant a second time in 1995 (with John), she gave up swimming and jogging and also saw less of her friends. (246) Her lifestyle switched yet again in 1996, when Rusty was offered work on a six-month NASA-related project in Florida--an event that prompted the leasing of their four-bedroom suburban house and a drive to Florida in a thirty-eight foot trailer. (247) That trailer would become their "home" in a recreational-vehicle community where Andrea would care for Noah and John while Rusty worked. (248) In Florida, Andrea miscarried but then became pregnant a third time just when Rusty had completed his job and was ready to move back to Houston. (249)

The return to Houston did not mean re-inhabiting their house even though in 1997 Andrea gave birth to a third child, Paul. (250) Rusty had other ideas. In an effort to live "light" and "easy," the Yateses rented a lot for their trailer. (251) By 1998, after several months of trailer living, Rusty's "easy living" philosophy took a new twist. He learned that a traveling evangelist, Michael Woroniecki, whose advice had inspired Rusty In college, was selling a motor home that Woroniecki had converted from a 1978 Greyhound bus. (252) Woroniecki, his wife Rachel, and their children had used the 350-square feet of bus for home and travel for their mobile lifestyle. (253) Because Andrea and Noah preferred the bus to the trailer, Rusty bought it. Noah and John slept in the luggage compartment, while Andrea, Rusty, Paul, and now, Luke, who was born in 1999, slept in the cabin. (254)

While her brood expanded, Andrea also became devoted to helping her father, who now had Alzheimer's disease. This task was overwhelming for Andrea. (255) At the same time, Andrea became further isolated from everyone. When she did choose to see people, she always visited them, never reciprocating by inviting them to the trailer. (256)

Rusty's role in Andrea's increasing aloneness, oddity of lifestyle, religious obsession, and continual state of pregnancy should not be downplayed with respect to any facet of Andrea's behavior. (257) And it may never be known to what extent Andrea's pregnancies were based on a mutual decision with Rusty or primarily a product of Rusty's desire for a large family. A number of people, including Andrea's mother and her friend Debbie Holmes, suggested Rusty was a dominating force in the Yates family, including the decision to have babies. (258)

B. The Start of Andrea's Breakdown

On June 16, 1999, Andrea called Rusty at work, sobbing and hysterical. He returned to find her shaking uncontrollably and biting her fingers. (259) His efforts to calm her to no avail, Rusty took Andrea to her parents' home that evening. (260) The next day, while Andrea's mother was napping and Rusty was out doing errands, the full force of Andrea's troubles became unmistakably clear. She attempted suicide by taking forty pills of her mother's antidepressant medication. (261) An unconscious Andrea was rushed by ambulance to Methodist Hospital, with Rusty following behind. (262)

Andrea told the staff at Methodist Hospital that she had consumed the pills to "sleep forever," but afterwards she felt guilty because she had her "family to live for." (263) At the same time, her recovery was slow. According to notes taken by a hospital psychiatrist and a social worker, Andrea was evasive about the reasons for her suicide attempt and deflected questions. (264) Although Andrea was still depressed, the hospital discharged her for "insurance reasons," the explanation written on her medical chart. The psychiatrist prescribed Zoloft, an antidepressant, and Rusty took Andrea back to her parents" home to rest. (265)

Andrea did not like taking the medication, however, and her condition only worsened. (266) She would stay in bed all day and self-mutilate. At one point, she scratched four bald patches on her scalp, picked sores in her nose, and obsessively scraped "score marks" on her legs and arms. (267) Later, she would tell psychiatrists that during this time, she saw visions and heard voices, telling her to get a knife. She also watched a person being stabbed, although she would not identify the victim. (268) At the same time, Andrea refused to feed her children or nurse her baby Luke, claiming that they were "all eating too much." (269) Such delusions and thoughts about her children are consistent with the criteria listed for postpartum disorders in the DSM. (270)

It was only after Andrea's attempted suicide that her relatives discovered the extent of her family history of mental illness: Andrea's brother and sister had ongoing treatment for depression, another brother was bipolar, and in hindsight, her father also suffered from depression. (271) According to the DSM, this family history of mental disorder (particularly bipolar disorder), (272) along with Andrea's pre- and post-pregnancy experiences with depression, (273) are all factors that would heighten the likelihood of postpartum psychotic features. As the DSM explains, "[o]nce a woman has had a postpartum episode with psychotic features, the risk of recurrence with each subsequent delivery is between 30% and 50%." (274)

At different times, Andrea also experienced bizarre delusions and hallucinations. She believed that there were video cameras in the ceilings watching her in various rooms in the house and that television characters were communicating with her. She told Rusty of these hallucinations; however, neither of them informed Andrea's doctors, even though Andrea was continually asked whether she had hallucinations. (275)

Of all of her family members, Andrea seemed to suffer the most and her condition continued to deteriorate. The day before she had an appointment with one of her psychiatrists, Eileen Starbranch, Rusty found Andrea in the bathroom looking at the mirror with a knife at her throat. Rusty had to grab the knife away. (276) When Rusty told Starbranch of the incident, she insisted that Andrea be hospitalized again, this time at Memorial Spring Shadows Glen, a private facility in Houston. (277)

The initial results of this hospitalization were disastrous. Andrea was virtually catatonic for ten days. (278) According to clinicians, catatonia is an objective sign of mental disorder whether or not an individual reveals what he or she is thinking. (279) It was also only during Andrea's stay at Memorial Spring Shadows Glen that there would ever be any record suggesting that she experienced hallucinations. (280) This record was based on a doctor's report and observations by the doctor's assistant. (281)

Starbranch gave Andrea a multi-drug injection that immediately improved Andrea's behavior, according to Rusty. (282) After a sound sleep, Andrea seemed much more like the person he had first met and they had in the evening what he thought was one of their best conversations. (283) Only later did Andrea assert that she considered the injection a "truth serum" that led her to lose self-control in a way she abhorred. (284) Andrea's view of the injection as a "truth serum" could be considered yet one more bizarre delusion on her part. (285)

When Andrea returned to her family after treatment, "home" was neither her parents' house (which was too small) nor the bus, which her parents considered unhealthy for her and the children. With her parents' urging, Rusty, a well-salaried ($80,000 a year) project manager at NASA, bought a three-bedroom, two-bath house in a tree-lined, residential neighborhood. (286) The house even had a place to park the bus, which was still very important to Rusty. In the more serene surroundings, Andrea apparently prospered--swimming laps at dawn, baking and sewing, playing with her children, and fostering an environment for home schooling, (287) which Rusty encouraged despite the past stress on Andrea. (288) At this point, Andrea admitted to Rusty that she had "failed" at their life in the bus; this new phase in their life was a chance to succeed. (289)

During this period, the family was engaging in three nights per week of Bible study in the living room because Rusty did not like any of the churches in their area. Again, the views of the bus-selling traveling minister Michael Woroniecki would come to have a profound effect on the lives of Andrea and Rusty. (290) Through Woroniecki, Rusty came to doubt organized religion, even though Rusty was not in complete agreement with Woroniecki's views. (291) Andrea was another story, however. Woroniecki's "repent-or-burn zeal" (292) captivated her and she corresponded with Woroniecki and his wife for years after she and Rusty bought their bus. (293) Indeed, at times, the Yates family seemed to imitate the Woronieckis--a bus-living, home-schooling, Bible-reading brood relishing the isolation of itinerancy. (294) According to Woroniecki, "the role of woman is derived ... from the sin of Eve." (295) Likewise, he thought that "bad mothers" create "bad children." (296) There came a time when Woroniecki's "hell burning" influence on Andrea was so great, it distressed both her parents and even Rusty. (297)

By the spring of 2000, Andrea became pregnant again, a decision seemingly made with Rusty when Andrea started to improve so markedly. (298) Yet, the news greatly alarmed Starbranch, who had warned that Andrea's problems could be far more serious if they returned, (299) as well as Andrea's mother, who had believed all along that Rusty's demands prompted Andrea's breakdown. (300) Debbie Holmes, a former nursing colleague of Andrea's, echoed this view of Rusty, claiming that Andrea continually depicted Rusty as manipulative and controlling and that Rusty pushed her to have the fifth baby. (301)

C. Andrea's Plunge into Mental Illness

Starbranch's predictions rang true. Andrea's pregnancy was met by another downward dive into mental illness, this time precipitated by the death of Andrea's father. (302) Andrea also became more absorbed with the teachings of the Bible. (303) The effects of the traumatic circumstances surrounding her father's death were obvious: Andrea stopped talking; she would continually hold Mary but not feed her; she would not drink liquids; she scratched and picked at her scalp until she started to become bald again. (304)

On March 31, 2001, four months after Mary's birth, (305) Rusty sought to re-hospitalize Andrea, with Starbranch's urging. This time, Rusty took Andrea to the Devereux Texas Treatment Center Network, (306) a trip that Andrea adamantly resisted. (307) Only with much prodding from Rusty and her brother did Andrea finally agree to go to the hospital. Once there, she refused to sign forms admitting herself. Because he thought Andrea's condition was dangerous, her attending psychiatrist, Mohammed Saeed, (308) initiated the process of requesting that a state judge confine Andrea to Austin State Hospital. (309) Only after Rusty's continual pleading did Andrea finally agree to sign the forms admitting herself to Devereux. (310)

Saeed's account of Andrea's condition appeared to be based entirely on Rusty's description rather than from Andrea's treating psychiatrists or from Andrea herself who, Saeed said, rarely spoke. (311) When Rusty insisted that Saeed put Andrea on Haldol," (312) a drug that had been helpful to her in the past, Saeed complied. (313) Saeed discontinued the treatment shortly thereafter because, he said, her "flat face" seemed to be a side effect. (314) Later, Saeed would testify that, based on the little Andrea said, she did not seem psychotic, never described the torment she was going through, and denied experiencing hallucinations and delusions. (315)

After ten days at Devereux, Andrea finally started feeding herself again--a behavioral improvement which, in Saeed's opinion, justified discharging her even though her medication regime was still not stable. (316) Also, Andrea wanted to go home and Saeed thought that Rusty could take care of her. (317)

When Andrea returned home, Rusty's mother, Dora, visited from Tennessee to help out during the day while she stayed at a motel in the evenings. (318) Yet, there were clear signals of Andrea's desperate mental state. On May 3, for example, after Andrea and Dora returned from taking the children for a walk, Noah told Dora that he saw Andrea filling up the bathtub with water. (319) When Dora turned the water off and asked Andrea why she was running the water, Andrea replied only, "[j]ust in case I need it." (320) Presumably, Andrea's behavior must have been quite unusual for such an (otherwise) innocuous event to have garnered so much notice from Noah and Dora. (321) Andrea also would not allow her friend Debbie Holmes inside the house when Debbie stopped by to leave food that afternoon. Later, Holmes stated that she thought Andrea had been repossessed by the Devil, an issue that both she and Andrea had discussed after Andrea's illness in 1999. (322) This time, however, Debbie thought the "the demons had returned a hundredfold." (323)

Based upon what was happening, Andrea returned to Devereux for rehospitalization. Again, Saeed was her chief caretaker. (324) During her entire stay at Devereux, Andrea was almost completely silent and lethargic, particularly around Rusty. Apparently, in group sessions, Rusty dominated discussions and always answered questions asked of Andrea, who would not even nod her head. (325) While on a combination of Haldol and antidepressants, Andrea stayed in her room most of the time on fifteen-minute suicide checks. (326) By May 14, Saeed suggested that she could go home. Although Andrea was still depressed and basically mute (apart from responding with her name when asked), her sleeping and eating had greatly improved and she was no longer expressing suicidal thoughts. (327)

On June 18, a month after Andrea's release from Devereux and after six days of outpatient therapy, Rusty and Andrea met with Saeed. (328) Andrea's mental state was sharply declining. (329) At that point, Andrea was off Haldol and Saeed was experimenting with other drug combinations. (330) As usual, Rusty answered most of the questions addressed to Andrea, but he expressed deep concern. Andrea was getting worse and was now having nightmares. (331) Rusty asked that Saeed reconsider applying shock therapy, a strategy Saeed declined, saying it was for far more serious disorders. (332) Also, Saeed did not want to re-prescribe Haldol. (333) Instead, he readjusted Andrea's level of antidepressants, suggested that she see a psychologist, rather than a psychiatrist, and, perhaps most strikingly, "think positive thoughts." (334)

The next afternoon, Andrea watched cartoons on television and then joined Rusty and Noah for a quick round of basketball in the garage. (335) Yet, moments later, she returned inside and went to bed without changing her clothes. (336) She slept until the next morning, June 20, but had a nightmare during the night. (337) She would not tell Rusty what the nightmare was about. (338) That morning, while Andrea set out cereal bowls and milk for breakfast, Rusty made sure that she had swallowed her dose of antidepressants before he left for work. (339) According to Rusty, his last picture prior to the killings was one of seeing Andrea eating cereal from a box. (340)

D. Andrea's Killings and The Aftermath

1. Andrea Drowns Her Children

From all accounts, Andrea started the drownings nearly as soon as Rusty left because her children were still having breakfast. (341) First, she selected "Perfect Paul," then three-years-old, apparently her greatest joy (and the "least trouble") of the five. (342) Paul's death took only seconds. She tucked his body in her bed and laid his head on the pillow. Next came Luke (age two), John (age five), and then Mary (age six months), who was nursing a bottle while Andrea was drowning the others. Andrea left Mary in the tub. (343)

Seven-year-old Noah was still eating his cereal when Andrea asked him to the bathroom. (344) When he "saw his sister facedown in the water, he asked, 'What happened to Mary?'" (345) Noah then tried to run away. But, Andrea ran after him, dragging him back to the tub--struggling to drown him while he came up twice for air. Afterwards, Andrea put Mary in the bed with her brothers, ensuring that their arms were wrapped around their little sister. (346) She left Noah in the tub. (347)

2. Andrea's Confession

Andrea immediately dialed 911. (348) While speaking "unemotionally" (349) and hesitating in response to questions, Andrea finally requested police and an ambulance. (350) When the dispatcher asked Andrea if she was ill, she said that she was. When he asked her if she was "sure" she was alone, Andrea responded that her sister was with her when, in fact, she was alone. (351) After Andrea called 911, she called Rusty. "It's time. I finally did it," was her first statement to him. (352) Then she told him to come home and hung up. Rusty called back, alarmed by her tone of voice, and asked Andrea if anyone was hurt. "It's the kids," Andrea said. He inquired which one. She said, "All of them." (353)

The police officers who arrived described Andrea as "composed." She showed them where they could get clean glasses for a drink of water in the kitchen, for example, and keys to unlock the back door. (354)

But it was Andrea's seventeen-minute (355) confession to Houston Police Sargent Eric Mehl that was to have one of the biggest impacts on the jury. During the jury's brief forty minutes (356) of deliberation, they had requested the audiotape of Andrea's account of what had transpired when she killed her children. (357) To the jurors, it appeared as though Andrea's "plan" to kill her children was cold and methodical. (358) Nearly all of Andrea's answers to questions were monosyllabic and the way that Mehl questioned her fostered the impression of matter-of-fact indifference to the killing. "No," she did not hate her children. "No," she was not mad at them. She had, however, considered the prospect of killing them for two years. (359) She realized that she was not being a good mother to them and "they weren't developing correctly," either in their learning or their behavior. (360) She also "realized that it was time to be punished" and, in response to Mehl's question, she wanted the criminal justice system to punish her. (361) She added that she had thought of drowning the children two months earlier (362)--and filled the tub with water--but she "[j]ust didn't do it at that time" and also believed that Rusty would have stopped her. (363)

To those who did not "know" Andrea Yates, her attitude would, no doubt, appear indifferent and her behavior calculated. But, as two postpartum specialists have noted with respect to the Yates case, organic psychosis involves a "waxing and waning" of sensation and mood. (364) Simply because Andrea called her husband and the police after the killings does not necessarily mean she was experiencing a "normal mental status" and could tell the difference between right and wrong at the time of the killings. (365) That kind of analysis suggests that "we extrapolate backward then 'predict' that she had an intact thought process." (366) Another expert honed the key issue: Crimes based on "deluded moral reasoning" can be "well planned, carefully executed, and ... have evidenced high degrees of behavioral control." (367) As Part V discusses, Dietz's perspective on Andrea's mental state was entirely different.

V. PARK DIETZ'S INTERVIEW AND TESTIMONY IN THE ANDREA YATES CASE

Park Dietz's interview with Andrea Yates and his trial testimony provide additional evidence for assessing how Dietz appeared to influence jurors. Part V explores one particularly striking feature of Dietz's testimony: Even though both sides agreed that Andrea severely suffered from postpartum depression and psychosis and that it significantly affected her conduct, neither side seriously questioned Dietz's statements or his knowledge.

A. Dietz's Interview with Andrea

Dietz interviewed Andrea for two days in November 2001, (368) nearly five months after the killings and four months after Phillip Resnick, the defense's primary psychiatric expert, interviewed Andrea. (369) Over the months after the killings, Andrea showed substantial progress due to a regimen of antipsychotic medication. Other professionals estimated that by August, Andrea's psychosis seemed under control (370) and by September, a jury found her competent to stand trial. (371)

According to Dietz, Andrea was grossly psychotic the day after the killings (372) and was suffering from schizophrenia when he met her in November 2001. (373) He still believed, however, that she knew the difference between right and wrong at the time she killed her children. (374) This conclusion, of course, stemmed in part from the November interview he conducted with her and the questions he asked about how and why she planned to kill her children.

In response to Dietz's questions, Andrea explained that she did not want her children "tormented by Satan" as she was. (375) She noted that Satan had been conveying "bad thoughts" through the television and the cameras in her homed. (376) She was also "afraid Satan would lure [her] children to himself--and maybe that [she] had some Satan in [her]." (377) She believed Satan was "inside [her] giving [her] directions ... about harming the children ... about a way out--to drown them." (378) According to Andrea, the drowning would be "a way out" because the children "would go up to heaven and be with God, be safe." (379) Basically, "at the time" Andrea thought "this was a good idea" because she "didn't want [her children] ruined--[she] was afraid they would continue to go downhill--and [she] thought [she] should save them before that happened." (380) Andrea believed "the children were in torment" from Satan because they were exhibiting relatively "more strife and disobedience"; however, she did not think that Dora, her mother-in-law, was in such torment nor Rusty, who she believed was a "good man." (381) In Andrea's mind, Satan had selected her children because of Andrea's own personal "weaknesses"; in fact, she had stopped reading the Bible close to the time of the killings because she "felt like Satan was nearby." (382)

Andrea seemed to have been markedly influenced by the 1995 movie "Seven," (383) a crime thriller about two homicide detectives who strive to solve a series of mysterious murders patterned on the seven deadly sins: gluttony, greed, sloth, pride, lust, envy, and wrath. (384) Andrea told Dietz that because "[she] felt [she] had done all the other sins" but murder, she believed that the drowning would constitute her seventh, and last, sin. (385) She claimed that she was thinking of the movie on the day she killed her children--"about what [she] was about to do, and how it fit in there--the deadly sins--and how [she had] done all of them after [she] drowned the children." (386) She "saw [the drowning] as a sin that [she was] going to commit." Although the act of drowning would "condemn" her, it would save the children. (387)

While Andrea had ruminated about the seven deadly sins a week before she killed her children, she picked the specific date she was going to drown them only the night before. (388) She did not tell Rusty her thoughts about the deadly sins or of her plans to kill because, in response to Dietz's question, she believed Rusty would interfere. (389) As Andrea explained, if she had been stopped, "the children would still be alive" and she "would still worry about their soul with Satan around." (390) On the morning of the killings, she tried to act as normally as possible so Rusty would not be alarmed. (391)

Despite Andrea's claims of careful planning, however, on the day of the killings, she did not close the blinds or the curtains or take the phone off the hook (the door had already been locked the night before and Rusty left through the garage exit). (392) She also remembers taking her medication. (393) In answer to Dietz's questions, she said she felt "the presence of Satan that morning ... just helping [her] fill up the tub, and getting ready." (394) Yet, she believed she would be punished ("jail") and she knew the act was illegal. (395) It seemed as though Andrea viewed the killing as a balancing test: "Doing it, [the children would] go to heaven; not doing it, there's the risk of Satan messing them up.... Probably if I did it, I'd get in trouble." (396)

Notably, in his court testimony, Dietz conceded that he did not interview either Rusty or Dora, both of whom refused to see him. (397) Dietz also stated that Andrea had difficulty being viewed by others as mentally ill and that her attitude hindered her recovery. For example, after her first suicide attempt, Andrea refused to take the antipsychotic medication prescribed to her and flushed it down the toilet. (398) As Dietz emphasized, "the most consistent story she's indicated is that she didn't think she was psychotic, didn't want to be thought of that way and resented someone calling her that." (399) However, a key issue that was not brought out in Dietz's testimony, either in direct or cross, is that Andrea, like many psychotic people, was wrong about her mental status. (400)

B. Dietz's Empirically Unsupported Conclusions

Dietz's testimony about Andrea's condition is full of troubling speculations that sound authoritative but have no empirical support. Of course, the field of psychiatry in general is vulnerable to such criticisms. (401) As the following analysis suggests, however, in a number of instances, Dietz's accounts give Andrea's actions a degree of intentionality and manipulation that seem to derive only from Dietz's interpretations and no other source.

1. Andrea's Suicide Attempts

Dietz testified that when Andrea attempted suicide the first time using pills, she got a "week away from the stressors, only with an overdose," when she was hospitalized (her admission to Methodist Hospital's psychiatric unit). (402) In other words, the idea conveyed was that with "only" an overdose, Andrea could get a substantial break from taking care of the kids and the house. After her week-long stay at Methodist, however, Andrea came back to the same stressful environment in the cramped bus. (403) For that reason, according to Dietz, the second time Andrea attempted to commit suicide, she "upped the ante" by using a knife. (404) Presumably, by employing a more certain and serious instrument of death, Andrea could acquire even more help and a bigger break than she got the first time by "only" ingesting pills. Dietz indicated that Andrea was successful with this approach. (405) While she was hospitalized the second time, her parents insisted to Rusty that Andrea could no longer stay in the bus because it was not healthy for her or the children. (406) As a result, Rusty purchased a nice new house, which was all ready for Andrea to live in when she returned from the hospital. (407) In Dietz's eyes, a new home was the reward that Andrea was seeking: "[T]his time, [the suicide attempt] not only got her hospitalized, it got her a house." (408)

The implication, of course, is that Andrea somehow realized that she would get both a long break and material benefit--"a house"--for her more dramatic second suicide attempt. But, that view contradicts everything we know of Andrea: that she hated to be hospitalized, that she continually resisted psychiatric help, that she resented any kind of psychiatric label. Indeed, Andrea was so opposed to being re-hospitalized at Devereux Texas Treatment Center on March 31, 2001, that Saeed had to start the process of involuntarily committing her to a state hospital. (409) For Dietz to suggest, even indirectly, that Andrea's suicide attempts were strategic efforts to gain a better home derides the reality of Andrea's psychosis and the severity of her postpartum disorders. As the defense noted, Andrea "never told any doctor that, 'I wanted a new house.'" (410) Andrea's marital history suggests just the reverse--that Andrea was enamored (perhaps even more than Rusty) with the Woronieckis' bus-living existence and later apologized to Rusty for not being able to handle it. (411)

It is also questionable even by Dietz's own account whether Andrea was in fact "upping the ante" (412) by using a knife rather than pills. Only moments before making that statement, Dietz claimed that it was unclear what level of severity Andrea's knife-using episode entailed ("varying degrees of intent"); in contrast, her ingestion of pills would most likely have resulted in her death if her mother had not awakened her. (413) Most importantly, as Dietz conceded on cross-examination, Andrea's overdose and knife threat could be "interpreted by medical experts as an alternative to hurting her children." (414) Psychological research suggests that "aggression against others and aggression against self frequently co-occur" and that "[r]isk assessment for suicide and homicide should go hand in hand." (415) Andrea's psychiatric history and her final act of killing her children support, rather than contradict, this suicide-homicide relationship.

2. Andrea's Pregnancies

Dietz also portrayed Andrea as manipulative and controlling in her decision to discontinue medication and become pregnant again with Mary, her fifth child. (416) Initially, Dietz emphasized that Andrea did not want to admit her mental illness and therefore did not take her medication for that reason; (417) yet, he depicted her motives very differently when he discussed the medication issue in the context of Andrea and Rusty's apparent efforts to have another child. According to Dietz, Andrea's pregnancy was "one of the repeated examples of Mrs. Yates not following the advice of her doctor and thinking she knows best and maintaining control." (418) Dietz suggests that Andrea directed the entire decision to conceive: "She's the one deciding what to do. She will not take the medicine unless she wants it. She will get pregnant when she wants to. She's not taking the medicine during pregnancy." (419)

Dietz's analysis assumes realities of Andrea's life that did not exist. First, all accounts of Andrea and Rusty's marriage indicate that Rusty was the one in control, the one making decisions, and the one pushing for more children. (420) Second, testimony revealed that both Andrea and Rusty had been advised by multiple staff members "on the importance of staying on medications and on the importance of not having another pregnancy." (421) Dietz's conclusions suggest that Rusty had nothing to do with the decision. Indeed, Rusty continually joked (even at his children's funeral) that he always wanted enough boys "to make up a basketball team." (422) Likewise, Debbie Holmes testified that Andrea complained to her about the continual pregnancies. (423) Third, noncompliance with taking medication is the norm among psychiatric patients for a variety of reasons, but often because the mentally ill are paranoid or delusional about what doctors give them. (424) By his comments, Dietz implied that Andrea's behavior was anomalous and that her refusal of medication related to her need to "control." Yet, recent research suggests that "more serious mental illness is a cause not a consequence, of [a patient's] refusal of treatment" with antipsychotic medication. (425) In fact, when Andrea was being evaluated for her competency hearing, she expressed concern that her medication may be contributing to her psychotic episodes. Resisting medication was also a matter of pride. (426) Fourth, many women reject medication while they are pregnant; the DSM entry on postpartum disorders discusses this very issue and makes recommendations to medical personnel about how to counteract it. (427) Finally, Dietz never acknowledged that more than fifty percent of all pregnancies are unplanned, irrespective of what couples want or the decisions they make. (428) Throughout his testimony about Andrea's last pregnancy, Dietz attributes a level of intentionality to events that may well have simply been an accident.

3. Andrea's Knowledge of Right and Wrong

In an interview with Time Magazine on the day that Andrea was sentenced, Dietz stated that despite Andrea's mental illness, her "thought process" still permitted her to know right from wrong. (429) "Her mind recognized murder as wrong or she would not have sought the death penalty to get rid of her inner demons and protect her children from falling into [Satan's] grasp." (430) Also, "by wanting to dispose of Satan, she had to believe Satan had evil ideas. Therefore, she still comprehended evil to be wrong. She also 'knew that society and God would condemn her actions.'" (431) Of course, Dietz's analysis of Andrea, both in this interview and in court, presumes that Satan actually exists.

Frequently during his testimony, Dietz would strain the interpretation of an incident to support the view that Andrea knew the difference between right and wrong. For example, on May 3, when Andrea filled the home bathtub with water while Dora Yates was present, the incident was perceived to be so bizarre, it sent Andrea back to Devereux. (432) According to Dietz, Andrea "doesn't give a reasonable account of why she did that [fill the tub], and they [Devereux] take her back the next day or the day after." (433) But, in the months following the incident, Andrea gave several accounts of why she filled the tub that day, including what seemed to be the most reasonable (and defense-oriented) one--she had thoughts of drowning her children. (434) A portion of the direct examination of Dietz seemed to recognize that this explanation could support the defense's position. (435) If Andrea were contemplating drowning her children with Dora present, it would fuel the defense's argument that she may not have known that what she was doing was wrong. While this interpretation of Andrea's motives is purely speculative, it is the most rational account that Andrea herself provides. It is also congruent with the vague statement that Andrea made in response to Dora's question of why she was running the water, that is, "Just in case I need it." (436)

Indeed, at a later point in his testimony, Dietz downplayed the fact that Andrea told others that she was considering drowning her children while Dora was present. Dietz's story is intertwined with Andrea's own conflicting accounts. As Dietz explained, "[s]ometimes she told doctors that she was thinking of drowning the children then. Sometimes she said she thought she might drown the children then. Sometimes she said that she might need it [the tub water] because they might have their water cut off by the utility company; and at those times, she said that she wasn't thinking of drowning the children then." (437) However, the explanation that Andrea gave Dietz while he was interviewing her is the least reasonable one: "the utility company truck explanation rather than drowning the children." (438)

The more pointed question to ask is, why did Andrea tell Dietz the company truck answer when she told others she was thinking of drowning her children? Does it really make sense for a woman to fill her family tub in such an odd manner on May 3 because of a possible water shortage but then fill it again on June 20 to drown her children? It seems unlikely that Andrea's disruptive actions on May 3, which were sufficiently disturbing to hospitalize her again, appeared due to her concern over a water shortage, particularly in light of the other evidence.

In sum, Dietz's testimony was too focused on trying to explain Andrea's illogical thinking, which basically stemmed from her mental illness. His analysis was not based on "facts" but rather pure speculation about her delusional thought patterns. According to one legal scholar, "medical expert witnesses are not advocates for either side in the litigation, but may advocate their opinion." (439) Yet, there were a number of aspects of Dietz's testimony where his prosecutorial bent came through quite obviously. For example, despite his level of experience, Dietz repeatedly referred to the drownings as "homicides" (440) or "crimes," (441) even though at the time, Andrea had not been convicted of anything. Likewise, at certain points, it was Dietz who directly led the prosecution to a criminal conclusion about Andrea. For example: "Q. Now, you noted that--or Dr. Saeed told Mr. Yates that someone must be with his wife, but she was left alone; was that correct? A. Yes. And, of course, the significance of that is that it gives her the opportunity to commit the crimes." (442)

C. Dietz's Attempts to Give "Logic" to Andrea's Illogical Delusions

A major portion of Dietz's testimony was analyzing Andrea's "homicide" in three phases: (1) the pre-homicide phase, (2) the homicide phase, and (3) the post-homicide phase. The pre-homicide phase was key for Andrea's defense because it went to the issue of whether she knew the difference between right and wrong. Dietz conceded that Andrea told both Rusty and her friend Debbie Holmes about "her concerns for the presence of Satan, the influence of Satan." (443) Even in Dietz's opinion, Andrea was open about her fears and did not attempt to hide them.

What Dietz emphasizes, however, is that despite Andrea's openness about Satan, she concealed the thoughts of harming her children from other people. If, for example, she was concerned that by mentioning the harm to other people it would actually happen, Dietz responds that this fear would be even more reason for Andrea to talk about it. (444) Dietz's "legal-like" logic applied to the thinking of a mentally ill Andrea Yates goes as follows:

If it's true that she believed that killing the children would save
them, then why would she not want it to happen. She would want to
talk about it so it came true and the children would be saved. So,
I concluded at that point that she's keeping it secret, she knows
that other people are going to stop her, that it's wrong, that it's
a bad idea; and she admits as such. She admits that she knows
people will stop her. (445)
Yet, there is no factual support for anything Dietz says. Dietz also rather bizarrely analyzes Andrea's statements as real and "debates" her theories about Satan even though everyone agreed that Andrea was mentally ill and delusional. Delusions are by definition illogical. As a key text on delusional disorders emphasizes, "[i]n the delusional mode, thought form is relatively normal but the abnormal content predominates and is associated with profound, but focused illogicality." (446) Dietz's story is based on applying a logical analysis to Andrea's truly illogical ruminations. There is really no diagnostically acceptable point to it. Nor is it even clear that Andrea intended what Dietz said because she never articulated it, he did.

Perhaps anticipating this criticism, Dietz explained that he is entitled to apply such an inordinate amount of logic to the thinking of a mentally ill person because Andrea seemed to him to be "psychologically ready" to engage in the act of killing. (447) Yet again, Dietz does not provide any empirical support for this very vague explanation. Parenthetically, the field of psychiatry does not encourage members of its profession to engage in logic-applied analyses of the illogical ramblings of mentally ill people.

But, for Andrea, there was no escape from Dietz's testimony; he seemed to have cut off every avenue with some explanation based entirely on speculative presumptions. Dietz showed striking confidence in his conclusions, despite the conjecture. Comparably noteworthy was Dietz's complete disregard of the literature on postpartum depression, which indicates that women generally do not tell others that they are thinking about harming or killing their children; they are afraid and embarrassed and disturbed by such thoughts. (448) Dietz's sweeping generalizations about Andrea's mental state are consistent with his ignorance of the subject matter.

D. Dietz's Criticism of Andrea's Inability to Nurture Her Dead Children

Dietz also focused on the easiest emotional target of Andrea's illogicalities--how Andrea treated her children after she killed them. For example, Dietz queried why Andrea did not try to "comfort the children, telling them they are going to be with Jesus or be with God." (449) Again, however, such comments were guesswork on Dietz's part. In other words, is it typical for mentally ill people to give their children religious words of comfort before they kill them, particularly if they think Satan is their guide? (450)

While being cross-examined, Dietz acknowledged that Andrea had been nurturing toward her dead children. She had placed her children's heads on pillows, for example, with Mary's head "resting on her older brother's shoulder" and Mary's hand "cupped by her older brother's hands." (451) According to the police officers who arrived on the scene, the children's bodies appeared "posed," as though the "older brother were taking care of the younger sister." (452) Such arrangements are perhaps a more objective gauge of Andrea's thoughts than the speculative hindsight Dietz offered. At the very least, the way that Andrea situated her children suggested that she may have believed they were going to take care of one another; in contrast, Dietz had nothing to support his comments apart from sheer conjecture.

Similarly, Dietz noted that Andrea seemed to cover each of her children's heads and faces as she put them on the bed. (453) He suggested that she may have covered them so that the remaining children, who were still alive, would not discover the bodies. (454) Later in his testimony, however, Dietz stated that Andrea's covering of her children's faces was "an indication of her feeling guilt or shame." (455) Dietz's explanation for Andrea's behavior is perplexing; there is a social norm to cover the faces of the deceased for reasons of respect or reverence. It would have been just as reasonable for Dietz to have pitched Andrea's motives in an alternative way, in other words, to state that covering the children was Andrea's way of showing care and comfort to them, given that all of these explanations are speculative anyway. Nonetheless, Dietz did resist supporting one of the prosecution's more damning insinuations--that Andrea's decision to leave Noah in the bathtub after he died was cold hearted. Instead, Dietz noted that, at fifty pounds, Noah was too heavy for Yates to lift. (456) "Nurses know not to lift heavy weights." (457)

Lastly, Dietz explained that Andrea seemed "grossly psychotic" and mentally disturbed from June 21 to some period thereafter, so "very sick" that she was hearing "growls and voices" and seeing "teddy bears and ducks and marching soldiers" that she believed were satanic. (458) Yet, he claimed there was not "nearly as much evidence of that kind of extreme sickness or gross psychosis on June 20th as [there is] for the period beginning June 21st." (459) Dietz attributed his impression that Andrea was "different in a sicker way" to the rapid changes in Andrea's life after she was arrested. (460) However, there is an alternative explanation. Andrea did not receive nearly as much medical attention on June 20 as she did on June 21, when she became the object of intense evaluation. On June 20, she was with police for much of the day whereas on June 21, she was surrounded by psychiatrists who were able to assess her mental state. Given these day-to-day differences in the amount of time Andrea spent with medically trained professionals, Dietz's conclusions are unwarranted.

This analysis of Dietz's testimony could extend even further, continually assessing every word in the way that Dietz evaluated Andrea's every move. However, this Article is not intended to be an indictment of Dietz per se. Rather, it is a commentary on how swayed and fragile insanity determinations can be in the heat of litigation and how inadequate the criminal justice system is to handle them. Dietz did not create this situation; he merely responds to the many who want him to be part of it. As the following discussion makes clear, other aspects of the Yates trial as well as the law and culture of Harris County also appeared to be critical contributors to Andrea's conviction.

VI. OTHER VIEWPOINTS ON THE ANDREA YATES CASE

Up to this point, discussion of the Yates trial has focused on Park Dietz. Of course, there were other perspectives and experts involved in the case. Part VI examines briefly only a selected number of these additional people and issues to give a glimpse of a broader story about Andrea.

A. The Overall Defense and Prosecution Perspective

In general, the defense contended that Andrea's mental illness led her to believe she made the right choice when she killed her children. Andrea's long history of illness and her many visits to doctors (461) created a situation in which a number of defense experts were called to testify about her condition at the time they treated her or her mental state at the time she killed her children. (462) Yet, because of the numbers of medical specialists involved in the case who had evaluated Andrea at different times and for different purposes, some offered seemingly conflicting narratives of Andrea's perception of right and wrong. This range of opinion for the defense contrasted with the prosecution's more consistent argument that Andrea's acts were sane and intentional because the prosecution primarily relied only on Dietz's narrative.

Ironically, then, the severity and extent of Andrea's mental illness may have undercut her defense. There was one story of sanity from the prosecution and several stories of insanity from the defense. For example, Dr. Melissa Ferguson, a psychiatrist at the Harris County Jail, testified that Andrea told her in a post-arrest interview that drowning her children was "the right thing to do" since it saved them from a life of torment and eventual damnation in hell. (463) Defense expert Dr. Phillip Resnick testified that although Andrea knew her actions were illegal, "she did what she thought was right in the world she perceived through her psychotic eyes at the time." (464) Describing Andrea's motives as "altruistic," Resnick explained that she believed that she was sending her children to heaven and, in setting herself up for execution, ridding the world of Satan. (465) Another expert witness for the defense, Dr. George Ringholz, explained that in the midst of her "acute psychotic episode," Andrea "did not know the actions she took on that day were wrong." (466) Dr. Steve Rosenblatt further elaborated: "She was out of contact with reality, did not know right from wrong, and in my opinion, clearly was within what's considered the legal definition of insanity." (467)

Jurors struggling to make sense of it all would be additionally taxed by the open disagreement between Resnick and another defense expert, Dr. Lucy Puryear. According to Puryear, Andrea was too sick to know that her actions were wrong. In contrast, Resnick stated that Andrea knew her acts were illegal, but believed they were right because they saved her children from eternal damnation. (468) Granted, these two positions are not entirely mutually exclusive; however, Puryear acknowledged during cross-examination that there were conflicts between her testimony and Resnick's and stated merely that they had "differing opinions." (469)

Prosecutor Joseph Owmby claimed, on the other hand, that determining insanity did not come down to "a battle of the experts,'" but rather was "'a question of common sense[.]'" (470) According to Owmby, the experts simply "present the evidence from the medical side" while the jurors, though unable to diagnose mental illness, "can tell you whether they believe a person knew right from wrong at the time." (471) Similar to Dietz's testimony, the prosecution downplayed Andrea's history of mental illness as well as the neurobiological underpinnings of her disorder.

Yet, most of the expert testimony offered in the Yates case did little to abate the confusion surrounding Andrea's mental state. Not surprisingly, the testimony of expert witnesses for the prosecution directly clashed with the testimony of expert witnesses for the defense. As one psychiatric journalist explained, although prosecution expert Park Dietz and defense expert Phillip Resnick are well known in their mutual fields, they nonetheless viewed Andrea's insanity defense "in polar opposite ways." (472)

Overall, it appeared to be a tactical problem for the defense to deal with so many psychiatric experts. Their contrasting analyses blunted the defense's theory. Which story should the jurors choose? Assuming that Resnick was probably one of the stronger psychiatrists in terms of his demeanor and experience and was therefore more equal to Dietz, (473) the defense may have been better off presenting just Resnick (in addition to the psychiatrists who actually treated Andrea). With this approach, the defense would have had a clearer, more linear, story that Andrea was indeed insane. As it so happened, Dietz probably appeared better with his single theory in contrast to the defense's multiple theories concerning Andrea's mental state.

The defense also would have benefited from questioning Dietz more aggressively about the facts of Andrea's history of postpartum depression and psychosis. Such a "detailing to death" (474) tactic could have accomplished two goals: (1) it would have accentuated Dietz's lack of expertise in the area, and (2) it would have stressed the neurological and biological aspects of the disorders. The jury would perhaps more fully appreciate that insanity determinations are based on far more than just "common sense" or speculation. The jurors' own comments indicate that this kind of psychiatric evidence had little to no impact in their forty minutes of deliberation before deciding to convict Andrea.

B. The Jurors' Comments

The jurors' explanations for their verdict suggest that they were heavily swayed by the prosecution's presentation of the case. In their view, Andrea's manner of killing her children seemed "premeditated and methodical." (475) They cited Andrea's videotaped confession and the photographs of her children, alive and dead, as "the most compelling evidence" of their unequivocal belief that Andrea knew right from wrong. (476) According to one juror, for example, because Andrea called the police immediately after the killings and could converse with them and account for her behavior, "it seemed as if she was thinking pretty clearly." (477) Another juror emphasized that Andrea "was able to describe what she did.... I felt like she knew exactly what she was doing." (478) These "objective" actions of Andrea's are the kinds of factual evidence that Dietz stressed in his determination that Andrea was sane.

The jurors also appeared to take seriously the prosecution's depiction of Andrea's religiosity and her perception of her conduct as sinful. Indeed, religion was an important force throughout the trial in a number of different ways. For example, prosecutor Owmby claimed to have prayed before deciding to seek the death penalty for Andrea, (479) and he expressed his firm belief that she was aware that she had sinned. (480) He also elicited testimony from one of the defense's expert witnesses admitting that Andrea knew she had sinned. (481) Surely, Andrea's own statements supported that view. (482)

On the surface at least, the jury seemed predisposed to embrace such religious characterizations. In a television interview with four of the jurors conducted shortly after the Yates verdict, the jurors' comments indicated that they all shared some Christian convictions. (483) As the interviewer emphasized, "[i]n a case [the Yates jurors] found emotionally draining, they say prayer got them through." (484) According to one juror, for example, all the jurors "held hands and prayed ... [the] Lord's prayer, most mornings" and they "did the same thing before and after the verdict." (485) Another juror affirmed the prosecution's sentiment that Andrea "knew it was wrong in the eyes of God." (486) During the trial, there appeared to be little left for the defense to hold on to other than evidence of Andrea's mental illness, (487) and the nature and severity of her illness did not come across adequately.

Dietz also accentuated sin and religion generally throughout his testimony, far more than the "facts" of Andrea's mental history. (488) Of course, on the surface, Andrea's explanations for why she killed were laced with religion. Yet, given the severity of her mental illness, the religious aspects of her delusions were symptoms of her disorder, not a substantive issue for Dietz to "debate" with her. Delusions and hallucinations about the devil are not uncommon among women with postpartum psychosis and those who end up killing their children. (489) In turn, all mental illnesses are contextually based, reflecting the culture and day-to-day circumstances of the mentally ill person. (490) In other words, mental disability is interlinked with other influences in a person's life, including the community where that person lives.

C. Religion and Culture

Given Andrea and Rusty's intense interest in the Bible and the Woronieckis' lifestyle, it is understandable that such themes would provide the foundation for Andrea's delusional thoughts. While the Yateses were not affiliated with any church, (491) Rusty decided to hold the children's funeral close to their home at the Clear Lake Church of Christ, (492) which Rusty now regularly attends. (493) Over a two-century history, Churches of Christ have divided into eight primary branches, (494) now totaling nearly two million members worldwide. (495) The majority mainstream wing of the Churches of Christ is especially strong in the region of the United States spanning from Middle Tennessee to West Texas. (496) The tenets of this mainstream branch give some perspective on Rusty's current religious views and what he may have believed in the past.

Consistent with Rusty's prior distance from organized religion, (497) Churches of Christ purport to be nondenominational and therefore are not Catholic or Protestant. (498) Rather, followers of the Church simply call themselves "Christians." (499) Commonly, members contend "that they have restored the primitive church of the apostolic age and are therefore nothing more or less than the true, original church described in the New Testament." (500) Indeed, Churches of Christ have essentially "denied that they had a defining history other than the Bible itself" and many members have no knowledge of the Church's original founders. (501) "Biblical authority," therefore, is paramount (502) and Church members defy "hierarchy or headquarters or national program." (503) As a result, each congregation is an independent body (504) and "practices vary widely" among them. (505)

The Clear Lake Church of Christ has an extensive website, (506) which offers a range of lessons. (507) The Church also sponsors the White Stone Ministry, whose mission is in part to aid "those who do not know Christ" by introducing them to Jesus and the Bible's scriptures. (508) In addition to posting specific scriptures, the White Stone Ministry offers a number of instructive articles, which appear to focus on "sexual sin" (509) and the hazards of pornography, particularly in comparison to a good marriage. (510)

The importance of religion in the south and Harris County in particular should not be downplayed when analyzing the reasons for Andrea's conviction, especially since religious themes were highlighted by the prosecution. According to one legal scholar's analysis of the

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