It’s Crazy to Execute the Insane

The Wall Street Journal, March 14, 2002

By Sally Satel

It took a little under four hours for a Texas jury on Tuesday to find Andrea Yates guilty of capital murder in the drowning deaths of three of her children. Today the jury will decide whether she gets the death penalty.

The facts of her case have been headline news since June 2001, when Yates drowned all five of her children in the bathtub of their Houston home. Within an hour after placing the lifeless bodies on her bed, Yates called the police. In the years leading up to the drownings, Yates attempted suicide twice, suffered dark depressions after her children’s births, was hospitalized and treated with the anti-psychotic medication Haldol. These and other details strongly suggest that her behavior was the product of delusion — of postpartum psychosis, to be more precise.

Andrea Yates

Immediately after the killings, debate swirled around whether Yates was insane, evil or an everymother pushed to the brink by the combined demands of domesticity and child rearing. Over time, a consensus formed that she was mentally ill. Even most of those who want to see Yates on death row admit that she was profoundly sick when she killed.

Being psychotic at the time of her crime was not enough, however, for Yates to be found not guilty by reason of insanity. In Texas such a determination turns on whether the defendant knew at the time of the offense that her actions were wrong.

The prosecution argued that Yates was not insane because she made lots of choices. “She made the choice to fill the tub,” prosecutor Kaylynn Williford told the jury. Her calling the police was evidence of her awareness of wrongdoing. Yates was described as “rational” when the police came to her house the day of the crime; she told them where the keys to the backdoor could be found and directed them to clean glasses when they wanted a drink of water.

It is no surprise that an insane person could do these things. Just because someone is psychotic does not necessarily prevent him from doing everyday things well. I have had many patients who were very psychotic (paranoid, hearing voices, believed they were Joan of Arc) but who could still balance checkbooks and go shopping. One was very diligent at clipping and using Kmart coupons. Someone who has a very low IQ could probably not manage these things smoothly, and people who are demented (think of an advanced Alzheimer’s patient) or delirious (someone just coming out of a seizure, or heavily inebriated) cannot manage them at all.

Had Yates been retarded, demented or delirious, then it is possible she would have not realized she was committing murder. Instead she was psychotic. In my opinion, she knew exactly what she was doing, but — and this is vital to understanding her psychology — her purposeful actions were based on a deranged premise. Did she know it was wrong in this narrow sense? I suppose so, but that narrow legal sense is clinically and morally meaningless.

As she saw it, her choice was not to kill them or let them live happy lives. It was kill them or else subject them to horrifying damnation at the hands of Satan. She saw herself as a poisonous mother — in jail she wanted to shave her head to see if the 666 sign was still branded on her scalp — from whom her children should be protected. In this calculus of kill-them-to-save-them, Yates could justify her actions.

Her case is reminiscent of Russell Weston’s. Another high-profile psychotic, he burst into the U.S. Capitol building in 1998 and shot to death two guards. Weston “purposefully” traveled from Montana to Washington so he could dismantle the time-controlling satellite system housed in the Capitol and thus save the world from disaster. His actions flowed logically from his beliefs, but those beliefs were unhinged.

The law is impervious to these subtleties. The jury’s directive — to discern whether Yates knew that killing her children was wrong — applies a mistaken conceptual framework to the mindset of a psychotic.

For the promise of a resolution we should turn to the Supreme Court’s recent debate about whether the Constitution permits the execution of the mentally retarded. Of the 38 states with the death penalty, 18 prohibit the execution of the retarded. Last year alone five state legislatures outlawed the practice, and public sentiment is clearly shifting.

Mentally retarded individuals are considered “least culpable” because they cannot foresee the consequences of their deeds. In 1989 the court decided that executing the mentally retarded did not constitute cruel and unusual punishment. At that time only two states banned capital punishment for the retarded, prompting the court to say that there was not sufficient evidence of a “national consensus” that doing so violated the country’s “standard of decency.”

If so, standards should shift. States should not subject to the death penalty individuals like Andrea Yates who were deeply psychotic at the time they committed their crime. This is not to say they should be sent back to their homes. Here is an intriguing proposal put forth by mental health advocate D.J. Jaffe.

Sentence seriously mentally ill offenders to psychiatric treatment for the same length of time one would sentence any other offender. Half way through their sentence — which would be served in a forensic institution — they would be eligible for intensive supervised release. The supervision would almost surely include the requirement to take psychiatric medication. This would be especially valuable for individuals who, unlike Yates, did meet the standard for not guilty by reason of insanity and went on to be released from a mental hospital after only a few years without any treatment requirement.

The Supreme Court decides what is cruel and unusual based on evolving standards of decency as understood by society at large. If the Texas jury gives Yates a death sentence tomorrow, it will be a sure sign that those standards have not yet evolved as much as they should.