Insanity defense hard to use, Md. experts say

Yates verdict shows lack of understanding about mental illness, doctor says

March 14, 2002|By Patricia Meisol | Patricia Meisol,SUN STAFF

In the two decades since John Hinckley was acquitted by reason of insanity in the shooting of President Ronald Reagan, Texas and many other states have made it almost impossible for criminal defendants to be acquitted because of mental illness.

In a case that shocked the nation, Andrea Yates was found guilty Tuesday of drowning her five children by a Houston jury that rejected her claim that she was insane at the time of the killings. The sentencing phase of her trial begins today. She could be sentenced to death.

Jurors took less than four hours to find her guilty.

"If you have a heinous crime and a defendant who is not an empathetic figure, no matter what the facts are, the jury just finds them guilty," said Will Carpenter, an expert on schizophrenia and professor of psychiatry at the University of Maryland School of Medicine.

He was among the doctors at the Hinckley trial in 1982 who testified that the man suffered from a chronic illness and could not appreciate right and wrong. Public furor over the verdict led many states to change laws to make it harder to use the insanity defense.

To Carpenter, such changes are ridiculous. "It's not a safety issue," he said, pointing out that had Hinckley been found guilty he would be out of prison by now instead of continuing to receive treatment at a hospital for the mentally ill.

Maryland's definition of insanity is broader than the one used in Texas, but an insanity acquittal is still rare.

A study a decade ago in Baltimore showed that insanity defense is infrequently used and almost never successful. Of the 60,432 criminal cases in Maryland in 1991, only 120 employed the defense. Of those, only eight were successful. Jeffrey Janofsky, a forensic psychiatrist at the Johns Hopkins School of Medicine who wrote the study, said that the insanity defense is usually successful only when defense and prosecution agree before trial. "Contested insanity case are extraordinarily rare," he said.

The Texas case turned on the legal definition of knowing right from wrong and almost no one ever meets it, he said. "Does it mean moral wrongfulness or legal wrongfulness?"

While experts testified that Yates seemed to know what she did was legally wrong, she told doctors that she needed to kill her children so God would take them to heaven and they would be spared eternal damnation.

In Maryland, at least five women diagnosed with similar severe psychoses who killed their babies are being treated at Clifton T. Perkins hospital after being found not criminally responsible, Janofsky said. Most had psychotic depression, the most severe form of depression, and became delusional, he said. The delusions were typically of a religious nature, usually horrible things happening to their children, he said.

Sheppard Pratt psychiatrist Neil Sandson said the Yates verdict revealed a tragic lack of understanding about mental illness.

"If you believe her delusion, then the deliberateness of her acts - hiding some children under sheets so older ones wouldn't see - are inconsequential," said Sandson. "She was guided by choosing the lesser of two evils.

"Even the statement she made about what she was doing was wrong, any sophisticated look at the situation [would show] she believed she was caught between thinking they were going to heaven via her killing them and them going to hell if she didn't. If that was her moral yardstick, clearly she didn't know right from wrong."

People were bothered that she could commit a heinous crime and "get away with it," he said. Unfortunately, he said, the jury wasn't told that there were options other than prison or freedom. But Yates is less likely to receive comprehensive treatment in prison than she would in a state hospital for the criminally insane.

Yates' disease was extreme, doctors testified, and she had been diagnosed with a chronic illness. Depression in the year after childbirth is common.

About 15 percent of women who deliver babies report symptoms of depression, said Jill RachBeisel, associate professor of psychiatry at the University of Maryland School of Medicine.

Unfortunately, most new mothers are ashamed to admit they are depressed and their illness worsens and can reach a point of psychosis, she said. The biggest predictor is a history of depression, she said. "The majority of disorders are very treatable," she said. Such patients need to be followed closely during pregnancy, and they need good social support and aggressive treatment after delivery.

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