Not to beat this horse to death, but here’s Megan McArdle’s take on the verdict in the Yates case (under “comments”):
I think it’s a tragedy. But I think that this woman’s life is completely over no matter what we do to her. And I think that there is a danger in presenting to others that they can get off from killing their kids by pleading insanity.
Ah, there’s the rub — and the cause of such cautious debate over this case in Blogdom, I suspect. Should Andrea Yates bear the burden of people’s concern that her case may set some sort of troubling precedent? I don’t think so.
Listen: I don’t want to see anyone “get of from killing their kids.” But the question here is whether or not Yates herself was insane at the time of her actions (clearly I think she was — or rather, that Texas law unreasonably suffocates the question), not whether someone in the future may use a “not guilty by reason of mental defect” verdict as a justification for his/her own (hypothetical) actions.
Why, in this case, is prison or death more appropriate than institutionalization and — yes! — rehabilitation (and ultimately release, if medically warranted)? By all medical accounts I’ve read (including testimony offered by witnesses for the state of Texas), Yates is a different human being altogether when on her anti-psychotic medication.
Are we no longer serious about rehabilitation? If so, fine. But let’s at least articulate what it is we’re hoping to achieve by way of our criminal justice system.
[related: “Mother Who Drowned Children Is Found Guilty of Capital Murder,” The New York Times; “Texas Mother Convicted Of Murder,” The Washington Post
Also, check out John Cole, Alex Knapp, Matthew Edgar, Glenn Kinen, Glenn Reynolds, Damian Penny, et al. — most of whom think I’ve lost my mind.]
The thing is, of course, is that prison is <em>supposed</em> to be about instuitionalization and rehabilitation. That’s part of the point. (Not all, but certainly a large point.) If prison is not about rehabilitation at all… well that would be a symptom of a large problem with prisons. (And certainly California Democrats joking about prison rape doesn’t help.)
Hmmm….add me to the list of those who believe you’ve slipped your moorings on this one. Rarifed air, pleasant surroundings, jovial companions, whatever the reason, academics do have a blind spot when it comes to evil. And the usefulness of retribution for the remainder of the tribe. Cementing mores and the like.
I never said you lost your mind, I said you are being corrupted by the humanities department. Over Spring Break take a week to recover and then all will be well.
Well, Don, I appreciate the feedback—but I think I’ve been pretty consistent to date about where I stand on “evil.” I have no problem calling a spade a spade, and as a rule I feel no need to “problematize” black-n-white issues until they devolve into a murkier grey.
In this case, though, I’m troubled by the <i>source</i> of the “evil”; that is, should Yates be found guilty of murder, or should she be found guilty of killing her children because something misfired in her brain—something that can be corrected (and by all accounts has been) by anti-psychotic medication.
“The usefulness of retribution for the remainder of the tribe” is fine as a philosophy for treating criminal behavior, so far as we’re clear on what it is we’re doing when we administer justice.
Since I haven’t been following the Yates case, I can hardly claim to be knowledgeable about the facts. OTOH, I am (presumably) that rarity that lawyers and judges assiduously seek, an unbiased mind.
That Yates’ anti-psychotic medication removes all traces of her affliction I will accept, at least for purposes of discussion. It seems evident, however, that it was NOT being administered properly (if at all) at the time that she killed her children.
Those things being the case, who will see to it that Yates DOES take her medication, and what penalties (if any) would be appropriate for that person or institution if she commits further violent acts?
I see where you’re trying to take this, John, but I’m not going to let you get there so easily. Yates was <i>taken off</i> her anti-psychotic medicine by her doctor a week or so before she committed the crime. There’s no evidence that I know of that she “forgot” to take her medicine and in so doing became a potential danger to society—one tethered legally (albeit tenuously) to those who provided her with the drugs.
As I said, I haven’t been following the case. Among those who have, though, who can tell me (and, perhaps, others) WHY her doctor took her off her meds?
Here’s a bit from an AP story:<blockquote>Andrea Yates visited her psychiatrist just two days before the June 20 attacks in a follow-up visit after her release from a mental health treatment center in May.
Citing his wife’s deteriorating mental condition, Russell Yates said he wanted the doctor to resume anti-psychotic medication for Andrea Yates, who had been weaned from it earlier that month.
‘She would stand still, hold the baby and stare blankly ahead,’ Russell Yates said. ‘She would speak only when spoken to and when she did speak it was in one- or two-word answers.’
However, the doctor declined Russell Yates’ request.</blockquote>
Here’s a more complete background to the case from <i>USA Today</I>: <a href=”http://www.usatoday.com/usatonline/20010911/3618026s.htm”>’Psychotic,’ but is Andrea Yates legally insane? Houston mom who drowned her 5 kids will find it tough to prove<a/>.
Question, Jeff –
You want her to be hospitalized and treated for her condition. But it’s obvious that she *was* hospitalized. And after that, she committed her crime. What end would hospitalizing her again serve?
Actually, Alex, I’m not certain I’d want her hospitalized, either (though others who believe Yates was insane have spoken of lengthy incarcerations in mental health facilities). My point—difficult as it is for me to adopt—is that Yates, for all intents and purposes, is unpunishable. To wit, her doctor <i>took her off</i> the anti-psychotics; when <i>on</i> the anti-psychotics, she poses no danger to anyone. Hospitalizing her is an excuse for incarcerating someone for whom incarceration would serve no purpose.
This is a fascinating case: essentially, if you believe that Yates’ schizophrenia rendered her incapable of reasonable judgment (as I do), then it stands to reason that she is not guilty of murder. Her treatment—anti-pyschotic medication—has already proven itself to be an effective way to control her malady.
So what’s left to do?
Frame it this way: Were Yates an epileptic rather than a schizophrenic, and had her sickness (say, a seizure) led to the death of her 5 children, what would we recommend be done with her once we corrected her seizure medication?
The appearance of “calculation” here on Yates’ part is a product of the way the disease manifests itself. Are we willing to equate a disease like epilepsy with a disease like schizophrenia? I don’t know.
I’m thankful I don’t have to make the call, quite frankly.
The AP stringer doesn’t seem to answer the question “why”?
Rather than take up more of your comment, I think that I’ll work something for my own blog.
Okay. But it seems to be a case of simple misdiagnosis. The doctor felt that Yates’ condition was controllable without the antipsychotic drugs (whose side effects can be severe at times).
Jeff-
You identify the problem of insanity involved in the court cases in your 4:16 post. This is what I was trying to argue last night – that insanity leads to a conclusion that they cannot be considered guilty. They are just victims of insanity. This is why the insanity laws are just so dumb is that they allow people who murdered out. Furthermore, I do not think that incarceration in a booby hatch is a good plan. Those should be intended only for people who are in there for a time to recover and be treated. Murderers do not deserve that treatment – they deserve to suffer.
Emphasized point: if insanity can lead to not guilty then any person convicted of murder to war crimes can claim insanity and try to get off the charges and walk away a free man. Just stupid…
Matthew—
“Murder” assumes intent;I’m all for locking up murderers. What I don’t support, however, is convicting someone of murder if what they’ve done is not “murder,” strictly speaking (because the conditions necessary to form reasonable intent are lacking as a result of mental defect).
There’s a point about Andrea Yates that I haven’t seen anywhere, and I think it’s relevant. When I was in college, I worked at a mental hospital where all patients were on medication of some sort. A few were on Haldol, the drug Yates was on until a 13 days before she killed the children. Haldol, as I recall, causes liver damage if taken over the long term, so doctors would switch patients off it to something else, like Thorazine, after some time. It could be that this was what Yates’ doctor was doing, and he followed the normal practice of letting it flush out of the system before starting the new drug in order to prevent combination effects that would make correct dosing impossible.
So let’s assume that the best medicine has to offer to people like Yates is temporary fits of relief from their illness, punctuated by periods when they’re extremely dangerous to the community.
Do you want such people walking around?
No. Obviously, having such people wandering around is troubling, to say the least. But Yates <i>tried</i> to get herself treatment over and over. She was begging to be institutionalized, it seems to me.
Haldol (Haloperidol) comes in a couple of different forms, Haloperidol is given orally. Haloperidol Lactate is given orally, via IM, or via IV injection or infusion. Haloperidol Decanoate is given via IM. I can’t say for sure, of course, but my assumption is that Mrs. Yates would have been taking an oral as the IM seems mostly to be used in cases of noncompliance (very long half-life – about three weeks) and the IV in emergencies.
In some instances Haldol can cause impaired liver function and/or obstructive jaundice, although those two fall into the “rare or very rare” category. The pharmacology information I could dig up was somewhat sketchy (not uncommon, we’re really unsure of how a lot of these drugs work exactly), but based on basic hepatic physiology (specifically the first pass effect) my assumption would be that the risk of that is higher – probably substantially – with the oral form than it would be with IM. It may be dose dependant (probably is) but it doesn’t appear to be a long-term issue. Somewhat to my surprise, hepatoxicity is *not* a known adverse reaction. Not that it much matters, but some recent studies indicate that Silymarin would probably counteract the negative liver effects, not that her doctors probably knew that.
Looking at the adverse effects list it seems pretty clear that the major negative effects of Haldol fall into two categories – CNS (unsurprising) and endocrine (also unsurprising).
The potential CNS adverse effects can include severe parkinsons, severe hallucinations, and neuroleptic malignant syndrome, among others – NMS can be fatal. Tardive Dyskinesia and Tardive Dystonia can occur, the risk appears to be dose and duration dependant, and can be irreversible and even fatal.
On the endocrine side, looking at the list I’d guess that most of it is caused by a large increase in prolactin caused by the drug. Prolactin is tied in an inverse loop to dopamine (likely explaining the prolactin increase as, among other things, Haldol acts as a dopamine receptor antagonist), but it is also tied indirectly to estrogens and progestogens as well as IGF. Those are in turn tied to the LH/FSH axis, SHBG levels, and a host of other feedback loops. In other words, effect one and you have a kind of cascade effect the severity of which is going to vary. Among other things, gynocomastia (presumably in men), breast engorgement/lactation/pain, various forms of menstrual changes, skin photosensitivity, and various forms of libido changes have all been reported. There is some debate about an increase of breast cancer risk, though apparently no hard data. In the absence of data to the contrary it’s probably safer to assume there is, given that most breast cancers are hormonally dependant. While not mentioned, many doctors seem to feel that a sustained increase in prolactin levels increases the chance of a prolactinoma. I’ve my doubts, seems to me that’s backwards (high prolactin levels area symptom, yes, but probably not a cause), but it can’t be discounted entirely.
There’s some discussion of potential cardiovascular and hematologic effects, but those appear to be mostly dose dependant and/or mostly transient.
Looking at the adverse effects list I don’t see anything that would indicate long term hepatic damage as a major risk. Doesn’t mean it isn’t, just that it apparently isn’t a generally accepted risk factor. However this drug is certainly not something you’d want to be taking long term if you can at all avoid it. Any drug of this type is going to be fairly nasty on the bod, it’s the nature of the beast, and this one is a lot more mild than some of the ones I’ve looked at, but still. Further, titrating drug type and dose is a common practise, as is trying to get someone off of a drug like this if you feel they’re manageable.
That she was taken off of it just doesn’t surprise me that much, nor does it seem certain that the temporal connection implies causality. If she was on the IM there certainly would not be a connection – again the half-life is 3 weeks. For the oral I didn’t see a half-life given, but it would be present in detectable amounts at least 28 days later. You don’t just stop a drug like this and have its effects go away the next day – ain’t how it works.
Myria
Thanks for that exposition, Myra. I looked up Haldol too, and was most struck by the warnings associated with long-term use: one said that damage to the brain and the eyesight was more-or-kess certain, another that Haldol shouldn’t be prescribed except as a last resort, and another said that withdrawl symptoms are extremely severe. I misremembered the liver damage part.
Given the severity of the withrawl symptoms, I wonder if it’s considered good clinical practice to have a patient kick Haldol in an outpatient mode; it appears that a radical increase in psychotic fantasies would be predictable. While I’m dubious about the widespread use of the insanity plea by women who commit violent crimes, this Haldol withdrawl thing is a red flag that has me believing that there was a basis for an insanity plea in this case after all.