STATE OF TEXAS v ANDREA YATES Exhibits

STATE OF TEXAS v. ANDREA YATES • Exhibits to the testimony of • Park Dietz, MD, Ph. D

SPECIALIZED EXPERIENCE

Experience in the Forensic Evaluation of Criminal Responsibility q Hundreds of evaluations of this issue since 1977, for courts, defense attorneys, and prosecutors q Teaching and lecturing on techniques of evaluation at universities and professional conferences in the U. S. and other countries

Experience in the Forensic Evaluation of Criminal Responsibility q Wrote reports about 30 other defendants pleading insanity since 1994 q Found 9 of 30 insane (30%) q Retained by prosecution in 7 of the 9 cases found insane

Maternal Filicide Forensic Experience q Evaluated 14 cases from 1996 -2006 q Reached opinions about criminal responsibility in 7 cases: 3 sane, 4 insane q Working for prosecution in all 7

Research on Maternal Filicide q FBI research project q 175 mothers who killed their children

Retention q Contacted July 6, 2001 (16 days after drownings) q Requested all records and exam ASAP q Notified September 26, 2001, that Court had authorized exam

SOURCES OF INFORMATION

Interviews q Mrs. Andrea Yates, 11/6/01 and 11/7/01 (videotaped and audio taped) q Melissa Ferguson, M. D. , 11/6/01 q Debra M. Osterman, M. D. , 11/7/01 q Mr. and Mrs. Robert Holmes, 11/8/01 q Mr. Russell Yates: requested but refused q Mrs. Dora Yates: requested but refused

Videotaped Interviews by Others q Interview of Russell Yates, 6/21/02, Channel 13 q Recorded portion of the examination by Phillip Resnick, M. D. , 7/14/01 q Recorded portion of the examination by Lucy J. Puryear, M. D. , 7/27/01 q Recorded portion of the examination by Lucy J. Puryear, M. D. , 8/10/01 Cont.

Videotaped Interviews by Others (cont. ) q Examination by Phillip Resnick, M. D. , 11/3/01 q Excerpts of an interview of Russell Yates, undated, broadcast on 60 Minutes, 12/9/01 q Examination by Lucy J. Puryear, M. D. , 2/4/02

Videotaped Interviews by Others (cont. ) q Birthday party q Examination by Michael Welner, M. D. , 5/3/06 and 5/4/06

Testimony from Prior Proceedings q Mohammad A. Saeed, M. D. q Phillip J. Resnick, M. D. q Lucy J. Puryear, M. D. q Melissa A. Ferguson, M. D. q Steven Rosenblatt, M. D.

Testimony from Prior Proceedings q Ellen Allbritton, M. D. q Earline Willcott, LMSW q Harry Wilson, M. D. q Park Dietz, M. D. , Ph. D.

Educational Records re. Defendant q Transcript from Houston Independent School District q Milby High School Yearbook, 1982 q University of Houston records q University of Texas Health Science Center at Houston records

Employment Records re. Defendant q Employment records, M. D. Anderson Hospital and Tumor Institute

Social Service Records re. Defendant q Harris County Child Protective Services records re. Andrea Yates

Medical Records re. Defendant q Ben Taub Hospital Emergency Room, 6/17/99 q Methodist Hospital, 6/18/99 – 6/24/99 q James P. Thompson, Ph. D. q Starbranch Psychiatry Associates, 7/1/99 – 4/3/01 Cont.

Medical Records re. Defendant (cont. ) q Spring Shadows Glen Hospital, 7/21/998/10/99 q Samaritan Center for Counseling and Education, 8/26/99 -2/24/00 q Earline Willcott, LMSW, 5/16/00 – 03/06/01 q Devereux Texas Treatment Network, 3/31/01– 4/12/01 Cont.

Medical Records re. Defendant (cont. ) q Devereux Texas Treatment Network, 5/04/01– 5/22/01 q Mohammad A. Saeed, M. D. , 4/19/01 – 6/21/01 q Harris County Jail medical records, 6/20/01 – 12/19/01 q Portions of the medical and psychiatric treatment records from 2002 -2006

Investigative Reports q Complete Houston Police Department investigative file q Tape of 911 call by Andrea Yates q Police crime scene photos q Crime scene videotape

Statements q Statement of Andrea Yates, 6/20/01 (tape and transcript) q Statement of Russell Edison Yates, 6/20/01 (tape and transcript) q Statement of Dora Yates, 6/20/01 (tape and transcript)

Medical Examiner’s Office Investigation q Medical Examiner’s Office crime scene photos q Autopsy report re. Mary Deborah Yates, age 6 months, by Patricia J. Moore, D. O. q Autopsy photographs of Mary Deborah Yates q Autopsy report re. Luke David Yates, age 2, by Harminder S. Narula, M. D. q Autopsy photographs of Luke David Yates Cont.

Medical Examiner’s Office Investigation (cont. ) q Autopsy report re. Paul Abraham Yates, age 3, by Harminder S. Narula, M. D. q Autopsy photographs of Paul Abraham Yates q Autopsy report re. John Samuel Yates, age 5, by Patricia J. Moore, D. O. q Autopsy photographs of John Samuel Yates q Autopsy report re. Noah Jack Yates, age 7, by Harminder S. Narula, M. D. q Autopsy photographs of Noah Jack Yates

Forensic Evaluation Records re. Defendant q Report by Steven Rosenblatt, M. D. , 6/25/01 q Report by George M. Ringholz, Ph. D. , M. D. , undated q Report by Phillip J. Resnick, M. D. , 02/27/02

Legal Documents q Texas Penal Code, Section 8. 01 re. Insanity q Notice of Intent to Offer Evidence of the Insanity Defense, 7/30/01 q Various Motions

Miscellaneous Documents q March – June 2001 Chronology prepared by Debbie Holmes q The Perilous Times, Series: 2000 -1 J q Various letters to and from Mrs. Yates q Scientific studies of maternal filicide, postpartum illness, haloperidol, and benzodiazepine-induced amnesia

REPORT

Report q Peer-reviewed by Daryl Matthews, M. D. , Ph. D. , Bennett Blum, M. D. , and Daniel Martell, Ph. D. q 103 pages (single spaced) + 144 pages of complete examination transcript (single spaced) q Submitted 2/25/02

REFERRAL QUESTIONS

Referral Questions q Did Andrea Yates have a mental disease or defect on June 20, 2001? q What was her mental state during the time she drowned her children? q During that time, did she know her conduct was wrong?

DID ANDREA YATES HAVE A MENTAL DISEASE OR DEFECT ON JUNE 20, 2001?

Various Doctors’ Diagnoses of Mrs. Yates at Her Worst q q q Major Depression with Psychotic Features Schizophrenia Schizoaffective Disorder Postpartum Psychosis Bipolar Disorder + Schizoid Personality Disorder Any of these can be a severe mental disease

Effects of These Mental Diseases q Any of these diseases may cause delusions, hallucinations, or some degree of cognitive impairment in some people, some of the time q People with a particular disease do not all have identical signs and symptoms q A person with a mental disease may have different signs and symptoms at different times

Effects of These Mental Diseases q Sometimes, individuals with each of these diseases kills someone q When someone with a mental disease kills another, it may or may not be at a time when because of delusions, hallucinations, or other psychotic symptoms, that person does not know that killing is wrong q No mental disease causes every killer with the disease to not know what he or she is doing is wrong

The Question of Postpartum Onset q DSM-IV-TR requires onset within 4 weeks of delivery q Some doctors believe the definition should be changed to 3 months or even one year q Changing the definition changes which cases are classified as postpartum onset

The Question of Postpartum Onset q DSM-IV-TR says the symptoms do not differ from those of mood disorders without postpartum onset q Some doctors believe there is a unique condition of postpartum psychosis with hormonal causes, additional symptoms, and faster recovery

The Question of Postpartum Onset q Whether onset was postpartum is not related to the severity of Mrs. Yates symptoms at the time she drowned her children q Whether onset was postpartum is not related to whether Mrs. Yates knew her conduct was wrong when she drowned her children

Timing of Defendant’s Symptom Onset After Luke’s Birth q Depression began 6 -8 weeks after Luke’s birth (2/15/99), while living in the bus and home schooling q Psychosis was suspected in July (Dr. Starbranch) q The first clear psychotic symptom (delusion of cameras in the house) was in August

Timing of Defendant’s Symptom Onset After Mary’s Birth q By most accounts, Mrs. Yates’ depression began more than 3 months after Mary’s birth (11/30/00) and after Mrs. Yates’ father’s death (3/12/01) q Unknown when delusions began q Floridly psychotic only after she was in jail

WHAT WAS MRS. YATES’ MENTAL STATE DURING THE TIME SHE DROWNED HER CHILDREN?

Mental Disease vs. Mental State q Mental disease: a serious mental disorder with a known set of signs and symptoms that may fluctuate in severity over time q Mental state: the condition of a person’s mind at a particular time, such as the time of the drownings

Signs and Symptoms Change as Mental State Changes Mood, affect, energy, and appetite may vary q Cognitive functioning may vary (e. g. , consciousness, memory, orientation) q Hallucinations may be present or absent q Delusions may be present or absent q

Some of the Factors Influencing Mental State q Natural history of any mental disease q Life events (ordinary, stressful, and traumatic) q Fatigue q Lack of sleep q Medications and other treatment

Some of the Life Events Affecting Mrs. Yates Before Her 1999 Episode of Illness q q q q q Giving up her career Giving up her possessions Changing her faith Giving up her identity (according to others) Allowing her husband to make all decisions Relative social isolation Five pregnancies (four births and a miscarriage) Living in an RV and a bus Home schooling her children

Treatment Delayed and Refused in 1999 q Feeling depressed and overwhelmed, she asked her husband for help, but got medical attention only upon taking an overdose (June) q Flushed Zyprexa (July) q ECT recommended by Drs. Thompson and Rios; Mr. and Mrs. Yates refused (August) q Against medical advice, secretly went off all medication (November)

Medical Advice Disregarded in 2000 q Against medical advice, became pregnant (February) q Against medical advice, failed to take medication during pregnancy q Against medical advice, failed to take medication after Mary’s birth (November 30)

Evidence of Mrs. Yates’ Mental State 11/30/00 – 3/12/01 q q q Mrs. Yates said she had a reasonably normal Christmas Resumed fitness routine of morning swim for 2 -3 months According to Mr. Yates, she “was fine” According to Ms. Willicott, she was not psychotic but rather a devoted, perfectionistic mother worried about her father’s declining health in early March Kept a detailed journal of home schooling until 3/12/01

New Stressors in 2001 q q q q Mrs. Yates’ father fell (January) and declined in health Mrs. Yates’ father died (March 12 th) Felt guilty about not doing enough for her father Separation from her family during admissions to Devereux (March and May) Felt guilty about not attending to her children as she wished Worried about her children bonding with Dora and not coming to her Worried about her children being taken away

Medical Advice Ignored and Delusions Hidden in 2001 q Dr. Saeed told Mr. Yates that someone must be with his wife at all times (April) q Dr. Saeed recommended ECT; Mr. and Mrs. Yates refused (May) q Mrs. Yates denied delusions or hallucinations countless times when asked by MDs q Two delusions (cameras and television)—known only to Mr. and Mrs. Yates—were kept secret from all doctors (August 1999 -June 2001) q Mrs. Yates was left alone with the children for an hour (June 20, 2001)

Mrs. Yates’ Mental State 3/12/01 – 5/22/01 q According to Mrs. Yates, after her father’s death, she began to withdraw, wasn’t eating well, continued to have difficulty sleeping, and began to have thoughts about being a bad mother q Repeated thoughts about the boys (but not Mary) not being righteous returned in March 2001, but she did not have images of the children being stabbed in 2001

Mrs. Yates’ Mental State 3/12/01 – 5/22/01 (cont. ) q Mr. Yates observed she was pacing with Mary and not breastfeeding, and he took her to Devereaux q Admitted to Devereaux twice with many signs and symptoms of depression; history of onset 2 -3 weeks before March 31 st; psychotic symptoms suspected, but no supporting data given q After coming home from Devereaux, she noticed that the children were bonding with Dora and not coming to her, and she held Mary to keep her close (reported to Dr. Welner)

New Stressors, 5/23/01 – 6/19/01 q In June, she heard a conversation between Rusty and Dora about Dora leaving in a few weeks (reported to Dr. Welner) q In June, she noticed that the children were becoming more attached to Dora, especially Noah and Luke (reported to Dr. Welner)

New Stressors, 5/23/01 – 6/19/01 (cont. ) q She declined Rusty’s offer to make an appointment for her with Ms. Willcott in the summer of 2001 because “I wasn’t really willing to talk about it” and was concerned she would lose the children to the foster care system [W-8] q She was hearing about drownings from the flood caused by Tropical Storm Allison around the time she began to think of drowning the children (June 10, 2001) (reported to Dr. Welner)

Non-Specific Signs of Severe Depression (and Other Conditions) q q q q q Disheveled Poor hygiene Matted hair Slow speech Being nearly mute Staring at ceiling or into space Looking frightened Not wanting to eat Being passive

Non-Specific Signs of Severe Depression and Other Conditions Appearing very sick Not holding or making eye contact with her baby q Picking at her scalp q Biting her lip [W-7] q q All of these signs may occur with or without psychosis; they do not prove psychosis

DSM-IV-TR Definition of Obsession q “Obsessions are persistent ideas, thoughts, impulses, or images that are experienced as intrusive and inappropriate and that cause marked anxiety or distress. ” q A common obsession is the impulse to harm one’s own child q Obsessions are a symptom of anxiety; they are not delusions and are not psychotic

Obsessions q When occurring in a major depressive episode, obsessions do not receive a separate diagnosis q Like other symptoms of anxiety, obsessions are common in major depressive episodes

Mrs. Yates had Obsessions q A repetitive image of Noah being stabbed in 1999 (Example: at time of overdose) [A] q The exaggerated concern that her children were not developing properly q The fear that her children were not on the path of righteousness (as evidenced by disobedience and rebelliousness) because of her failings as a mother

Mrs. Yates had Obsessions q The fear that her children might someday become criminals or a burden on society q The fear that she might seriously harm the children (Example: at time she filled the tub in May 2001) [B]

DSM-IV-TR Definition of Delusion “A false belief based on incorrect inference about external reality that is firmly sustained despite what almost everyone else believes and despite what constitutes incontrovertible and obvious proof or evidence to the contrary. The belief is not one ordinarily accepted by other members of the person’s culture or subculture (e. g. , it is not an article of religious faith). ”

Articles of Faith Shared by Warnecki Followers Are Not Delusions q q q q The husband is head of the household A woman is servant to the man and obeys him God prefers natural childbirth (“Eve’s curse”) Children who rebel or disobey should be spanked A woman who disobeys her husband or fails to discipline her children is a witch Children are unaccountable until age 10 or 12 Satan becomes more influential on children who are not well disciplined Satan deceives and tempts people

Articles of Faith Shared by Warnecki Followers Are Not Delusions q q q q Satan speaks lies into people’s minds If you say your thoughts aloud, Satan will hear them and use them against you Satan preys on the weak Satan rules the world and is alive and active now He who falls from righteousness can never be saved The unrighteous go to hell Those who are righteous and saved go to heaven Those who die before the age of accountability go to heaven

Mrs. Yates’ Belief She Was Inadequate as a Mother in June 2001 Was Not a Delusion Mothers with depressive symptoms have significantly reduced odds of continuing breastfeeding, showing books, playing with the infant, talking to the infant, and following routines q A delusion must be a false belief, but it was true that despite her very best efforts, Mrs. Yates was unable to function well as a mother q

Andrea Yates Had Two Kinds of Delusions Before the Drownings Delusions of reference on approximately six occasions between May 24 and June 19, 2001, that movies and television were targeting her family: q Oh! Brother Where Art Thou? q Cast Away q A cartoon character talking about candy q Cartoon Christmas carols q A game show q MTV None the morning of the drownings

Andrea Yates Had Two Kinds of Delusions Before the Drownings q Ongoing delusion that cameras had been placed in the ceiling of the house to monitor whether she was a good enough mother or would hurt the children (at various points she suspected Dr. Starbranch, CPS, Dora, or Rusty were involved in this)

DSM-IV-TR Definition of Hallucination “A sensory perception that has the compelling sense of reality of a true perception but that occurs without external stimulation of the relevant sensory organ. Hallucinations should be distinguished from illusions, in which an actual external stimulus is misperceived or misinterpreted. . The term hallucination is not ordinarily applied to the false perceptions that occur during dreaming, while falling asleep (hypnagogic), or when awakening (hypnopomic). Transient hallucinatory experiences may occur in people without a mental disorder. ”

Andrea Yates Had No Hallucinations Before or During the Drownings q On one occasion in 1999, Mrs. Yates thought she heard voices from the wall say in a growl, “Andrea, come here” while awakening from a nap in the hospital—a hypnopompic experience, not a true hallucination [H] q In Dr. Resnick’s interview, Mrs. Yates denied that Satan had ever told her to “grab the knife”

Andrea Yates Had No Hallucinations Before or During the Drownings q In Dr. Welner’s interview, Mrs. Yates said that a few months after Noah’s birth in 1994, she had a “fleeting thought” to get a knife, and in 1999 she had obsessive images of Noah being stabbed [W-1] q Mrs. Yates said little about these experiences because of what Mr. Warnekci had told her, and out of concern the children would be taken away [W-2]

Andrea Yates Had No Hallucinations Before or During the Drownings q In Dr. Welner’s interview, Mrs. Yates indicated that she did not hear any voices of any kind the morning of the drownings [W-5] q Mrs. Yates told Dr. Welner she took exception to false reports in the press that she had killed her children on orders from Satan q In my interview, Dr. Welner’s interview, and a letter she wrote to a penpal, Mrs. Yates indicated that new symptoms began after she was arrested and began to reflect on what had happened [W-6]

Cognitive Functioning Components include level of consciousness, motor behavior, use of language, memory, concentration, orientation, attention, ability to think abstractly, plan, and organize q Impairment in cognitive functioning may vary from insignificant to extremely severe q

Mrs. Yates had No Significant Cognitive Impairment During the Drownings q q q q She was able to dress herself that morning She awakened the children to say “goodbye” to Rusty, as usual She remembered who each of her children was She was able to stick to the task of drowning all five children She was attentive to completing her task before Dora arrived She remembered to call the police so they would be there before Dora arrived She was able to call 911 and provide accurate information She was able to dial her husband’s phone number

Andrea Yates Had Thoughts about Satan Before the Drownings q In the weeks before the drownings, Mrs. Yates felt tormented by her “bad thoughts, ” delusions of reference, delusion about cameras in the house, fears that the children would be ruined, and impulses to harm the children q Medically, these would all be seen as symptoms of her illness, but Mrs. Yates blamed her symptoms on Satan and even wondered if Satan might be inside her giving her directions [C]

Andrea Yates’ Mental State at the Time of the Drownings on June 20, 2001 q q q q No hallucinations Recent delusions of receiving messages from the television and movies, but none that day Recent delusion about cameras in the house, but no thoughts about this at the time of the drownings Obsessions that her children could grow up unrighteous and that she was a bad mother Worry that her children could be taken away Minimal or mild cognitive impairment, if any Faith-based beliefs that by drowning her children, she could send them to heaven and save them from possible unrighteousness on earth

Factors Changing Mental State Between the Drownings and June 21, 2001 q q q q q Hearing Rusty’s and Dora’s grief Being arrested Hearing a radio commentator say he’d kill her himself Being booked Being interrogated by the police Beginning to contemplate what had happened Being stripped of her clothing Being placed in solitary with no bedding and no clothes Being given lorazepam (Ativan)

Andrea Yates’ Mental State at the Time of Dr. Ferguson’s Exam. on June 21, 2001 q q q Visual illusions and possible hallucinations in her cell A new urge to “figure out Satanic things” in her cell “Very distraught and anxious” New delusions about a werewolf, the Mark of the Beast (“ 666”), a prophecy, Satan being inside her, and the state destroying Satan Inaccuracies in reporting her history (e. g. , the Matrix, a voice telling her to grab the knife, recent growling noises)

Known Triggers to Auditory Hallucinations q Traumatic experience (70%, in one study) q Sleep deprivation q Solitary confinement q Anxiety

Possible Causes of Mrs. Yates’ Amnesia for Certain Statements in Jail q Psychosis with disorganized thinking q Lorazepam (Ativan)

Lorazepam (Ativan) is a highpotency benzodiazepine q Benzodiazepines induce amnesia for information learned after the drug is taken q Research suggests that benzodiazepines preserve the memory of recent events before the drug is administered q

Lorazepam (Ativan) q Ativan is similar to Rohypnol, the “date-rape drug”

DID MRS. YATES KNOW HER CONDUCT WAS WRONG IN DROWNING HER CHILDREN?

Before the Drownings q Mrs. Yates considered her obsessive thoughts of and impulses to harm her children “bad thoughts, ” for which she blamed Satan q For weeks, she concealed from everyone her thoughts of harming the children and her plan to drown the children q She made up her mind the evening of June 19 th to drown the children the next day [D] q She had no “visions” of drowning the children; she agreed it was just an idea [W-4] Cont.

Before the Drownings (cont. ) q She tried to behave as normally as possible so Rusty wouldn’t know anything unusual was happening q She waited for an opportunity when no one was home so that she would not be stopped from drowning the children q She believed that killing the children would be sinful and would be the last of the Seven Deadly Sins for her to commit q She believed she was not raising the children properly, did not pay enough attention to them, and that they might get in trouble Cont.

Before the Drownings (cont. ) q She believed that killing the children would guarantee that they go to heaven and prevent them from one day becoming unrighteous, criminal, a burden on the state, or vulnerable to Satan, and for these reasons thought it was right for the children [E] q She did not believe that the children were already suffering at the hands of Satan but rather from lack of guidance (reported to Dr. Resnick)

During the Drownings q Knew she would be arrested and put in jail q Knew her conduct was illegal q Knew society would judge her conduct as “bad” [F] q Believed God would judge her conduct as “bad” Cont.

During the Drownings q Felt “the presence” of Satan during the drownings, but did not think he was “in her” until after her arrest [G] q Anticipated being punished by the state [W-3] q Acted with determination to accomplish her plan of drowning each child before Dora arrived Cont.

During the Drownings (cont. ) q Found it most difficult to drown Paul and Noah and “tried to numb myself to it” [W-9] q At the time of the drownings, she had doubt whether killing her children was the right thing for them (reported to Dr. Resnick 7/14/01).

After the Drownings q Called 911 and asked for the police because “that’s who you call. . . when you’ve done something wrong, ” and she thought she had done something wrong q Called the police quickly because she wanted them to arrive before Dora did “because I didn’t want her to see what I had done” q Told Sgt. Mehl she was prepared to go to hell for what she had done Cont.

After the Drownings (cont. ) q Told Sgt. Mehl she wanted to be punished by the criminal justice system for what she had done and asked when her trial would be q After her psychosis worsened in solitary confinement in jail, Mrs. Yates for a time believed her execution would kill Satan and that the killings had something to do with a prophecy

Opinions

At the Time of Drowning Each Child: q Mrs. Yates knew that her conduct was wrong in the eyes of the law q Mrs. Yates knew that her conduct was wrong in the eyes of society q Mrs. Yates believed that her conduct was wrong in the eyes of God

At the Time of Drowning Each Child: q Mrs. Yates thought, with some doubt, that the killings were in the best interests of the children and that the ends (saving the children’s souls) justified the means (her conduct in wrongly and illegally killing them)