STATE OF TEXAS
v.
ANDREA YATES
Exhibits to the testimony of
Park Dietz, MD, PhD
SPECIALIZED
EXPERIENCE
Experience in the Forensic Evaluation of
Criminal Responsibility

Hundreds of evaluations of this issue since
1977, for courts, defense attorneys, and
prosecutors

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

Wrote reports about 30 other defendants
pleading insanity since 1994

Found 9 of 30 insane (30%)

Retained by prosecution in 7 of the 9
cases found insane
Maternal Filicide Forensic Experience

Evaluated 14 cases from 1996-2006

Reached opinions about criminal
responsibility in 7 cases: 3 sane, 4
insane

Working for prosecution in all 7
Research on Maternal Filicide

FBI research project

175 mothers who killed their
children
Retention

Contacted July 6, 2001 (16 days after
drownings)

Requested all records and exam ASAP

Notified September 26, 2001, that Court
had authorized exam
SOURCES OF
INFORMATION
Interviews

Mrs. Andrea Yates, 11/6/01 and 11/7/01
(videotaped and audio taped)

Melissa Ferguson, M.D., 11/6/01

Debra M. Osterman, M.D., 11/7/01

Mr. and Mrs. Robert Holmes, 11/8/01

Mr. Russell Yates: requested but refused

Mrs. Dora Yates: requested but refused
Videotaped Interviews by Others

Interview of Russell Yates, 6/21/02,
Channel 13

Recorded portion of the examination by
Phillip Resnick, M.D., 7/14/01

Recorded portion of the examination by
Lucy J. Puryear, M.D., 7/27/01

Recorded portion of the examination by
Lucy J. Puryear, M.D., 8/10/01
Cont.
Videotaped Interviews by Others (cont.)

Examination by Phillip Resnick, M.D.,
11/3/01

Excerpts of an interview of Russell
Yates, undated, broadcast on 60
Minutes, 12/9/01

Examination by Lucy J. Puryear, M.D.,
2/4/02
Videotaped Interviews by Others (cont.)

Birthday party

Examination by Michael Welner, M.D.,
5/3/06 and 5/4/06
Testimony from Prior Proceedings

Mohammad A. Saeed, M.D.

Phillip J. Resnick, M.D.

Lucy J. Puryear, M.D.

Melissa A. Ferguson, M.D.

Steven Rosenblatt, M.D.
Testimony from Prior Proceedings

Ellen Allbritton, M.D.

Earline Willcott, LMSW

Harry Wilson, M.D.

Park Dietz, M.D., Ph.D.
Educational Records re. Defendant

Transcript from Houston Independent
School District

Milby High School Yearbook, 1982

University of Houston records

University of Texas Health Science
Center at Houston records
Employment Records re. Defendant

Employment records, M.D. Anderson
Hospital and Tumor Institute
Social Service Records re. Defendant

Harris County Child Protective Services
records re. Andrea Yates
Medical Records re. Defendant

Ben Taub Hospital Emergency
Room, 6/17/99

Methodist Hospital, 6/18/99 – 6/24/99

James P. Thompson, Ph.D.

Starbranch Psychiatry Associates,
7/1/99 – 4/3/01
Cont.
Medical Records re. Defendant (cont.)

Spring Shadows Glen Hospital, 7/21/998/10/99

Samaritan Center for Counseling and
Education, 8/26/99-2/24/00

Earline Willcott, LMSW, 5/16/00 – 03/06/01

Devereux Texas Treatment Network,
3/31/01–4/12/01
Cont.
Medical Records re. Defendant (cont.)

Devereux Texas Treatment Network,
5/04/01–5/22/01

Mohammad A. Saeed, M.D., 4/19/01 –
6/21/01

Harris County Jail medical records,
6/20/01 – 12/19/01

Portions of the medical and psychiatric
treatment records from 2002-2006
Investigative Reports

Complete Houston Police Department
investigative file

Tape of 911 call by Andrea Yates

Police crime scene photos

Crime scene videotape
Statements

Statement of Andrea Yates, 6/20/01 (tape
and transcript)

Statement of Russell Edison Yates,
6/20/01 (tape and transcript)

Statement of Dora Yates, 6/20/01 (tape
and transcript)
Medical Examiner’s Office Investigation

Medical Examiner’s Office crime scene photos

Autopsy report re. Mary Deborah Yates, age 6
months, by Patricia J. Moore, D.O.

Autopsy photographs of Mary Deborah Yates

Autopsy report re. Luke David Yates, age 2, by
Harminder S. Narula, M.D.

Autopsy photographs of Luke David Yates
Cont.
Medical Examiner’s Office Investigation (cont.)

Autopsy report re. Paul Abraham Yates, age 3,
by Harminder S. Narula, M.D.

Autopsy photographs of Paul Abraham Yates

Autopsy report re. John Samuel Yates, age 5, by
Patricia J. Moore, D.O.

Autopsy photographs of John Samuel Yates

Autopsy report re. Noah Jack Yates, age 7, by
Harminder S. Narula, M.D.

Autopsy photographs of Noah Jack Yates
Forensic Evaluation Records re. Defendant

Report by Steven Rosenblatt, M.D.,
6/25/01

Report by George M. Ringholz, Ph.D.,
M.D., undated

Report by Phillip J. Resnick, M.D.,
02/27/02
Legal Documents

Texas Penal Code, Section 8.01 re.
Insanity

Notice of Intent to Offer Evidence of the
Insanity Defense, 7/30/01

Various Motions
Miscellaneous Documents

March – June 2001 Chronology prepared
by Debbie Holmes

The Perilous Times, Series: 2000-1J

Various letters to and from Mrs. Yates

Scientific studies of maternal filicide,
postpartum illness, haloperidol, and
benzodiazepine-induced amnesia
REPORT
Report

Peer-reviewed by Daryl Matthews, M.D.,
Ph.D., Bennett Blum, M.D., and Daniel
Martell, Ph.D.

103 pages (single spaced) + 144 pages of
complete examination transcript (single
spaced)

Submitted 2/25/02
REFERRAL QUESTIONS
Referral Questions

Did Andrea Yates have a mental
disease or defect on June 20, 2001?

What was her mental state during
the time she drowned her children?

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





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

Any of these diseases may cause
delusions, hallucinations, or some
degree of cognitive impairment in some
people, some of the time

People with a particular disease do not
all have identical signs and symptoms

A person with a mental disease may have
different signs and symptoms at different
times
Effects of These Mental Diseases

Sometimes, individuals with each of these
diseases kills someone

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

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

DSM-IV-TR requires onset within 4
weeks of delivery

Some doctors believe the definition
should be changed to 3 months or
even one year

Changing the definition changes
which cases are classified as
postpartum onset
The Question of Postpartum Onset

DSM-IV-TR says the symptoms do
not differ from those of mood
disorders without postpartum onset

Some doctors believe there is a
unique condition of postpartum
psychosis with hormonal causes,
additional symptoms, and faster
recovery
The Question of Postpartum Onset

Whether onset was postpartum is
not related to the severity of Mrs.
Yates symptoms at the time she
drowned her children

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

Depression began 6-8 weeks after
Luke’s birth (2/15/99), while living in
the bus and home schooling

Psychosis was suspected in July
(Dr. Starbranch)

The first clear psychotic symptom
(delusion of cameras in the house)
was in August
Timing of Defendant’s Symptom Onset
After Mary’s Birth

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)

Unknown when delusions began

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

Mental disease: a serious mental
disorder with a known set of signs
and symptoms that may fluctuate in
severity over time

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
Cognitive functioning may vary
(e.g., consciousness, memory,
orientation)
Hallucinations may be present or
absent
Delusions may be present or absent
Some of the Factors Influencing Mental
State

Natural history of any mental disease

Life events (ordinary, stressful, and
traumatic)

Fatigue

Lack of sleep

Medications and other treatment
Some of the Life Events Affecting Mrs.
Yates Before Her 1999 Episode of Illness









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

Feeling depressed and overwhelmed, she asked
her husband for help, but got medical attention
only upon taking an overdose (June)

Flushed Zyprexa (July)

ECT recommended by Drs. Thompson and Rios;
Mr. and Mrs. Yates refused (August)

Against medical advice, secretly went off all
medication (November)
Medical Advice Disregarded in 2000

Against medical advice, became
pregnant (February)

Against medical advice, failed to
take medication during pregnancy

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





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







Mrs. Yates’ father fell (January) and
declined in health
Mrs. Yates’ father died (March 12th)
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

Dr. Saeed told Mr. Yates that someone must be
with his wife at all times (April)

Dr. Saeed recommended ECT; Mr. and Mrs.
Yates refused (May)

Mrs. Yates denied delusions or hallucinations
countless times when asked by MDs

Two delusions (cameras and television)—known
only to Mr. and Mrs. Yates—were kept secret
from all doctors (August 1999-June 2001)

Mrs. Yates was left alone with the children for an
hour (June 20, 2001)
Mrs. Yates’ Mental State
3/12/01 – 5/22/01

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

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.)

Mr. Yates observed she was pacing with Mary
and not breastfeeding, and he took her to
Devereaux

Admitted to Devereaux twice with many signs
and symptoms of depression; history of onset
2-3 weeks before March 31st; psychotic
symptoms suspected, but no supporting data
given

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

In June, she heard a conversation
between Rusty and Dora about Dora
leaving in a few weeks (reported to
Dr. Welner)

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.)

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]

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)









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
Picking at her scalp
Biting her lip [W-7]
All of these signs may occur with or
without psychosis; they do not
prove psychosis
DSM-IV-TR Definition of Obsession

“Obsessions are persistent ideas,
thoughts, impulses, or images that are
experienced as intrusive and
inappropriate and that cause marked
anxiety or distress.”

A common obsession is the impulse to
harm one’s own child

Obsessions are a symptom of anxiety;
they are not delusions and are not
psychotic
Obsessions

When occurring in a major
depressive episode, obsessions do
not receive a separate diagnosis

Like other symptoms of anxiety,
obsessions are common in major
depressive episodes
Mrs. Yates had Obsessions

A repetitive image of Noah being stabbed
in 1999 (Example: at time of overdose)
[A]

The exaggerated concern that her
children were not developing properly

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

The fear that her children might
someday become criminals or a
burden on society

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








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








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
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
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:
Oh! Brother Where Art Thou?
Cast Away
A cartoon character talking about candy
Cartoon Christmas carols
A game show
MTV
None the morning of the drownings
Andrea Yates Had Two Kinds of Delusions
Before the Drownings

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

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]

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

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]

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

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]

Mrs. Yates told Dr. Welner she took exception to
false reports in the press that she had killed her
children on orders from Satan

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
Impairment in cognitive functioning
may vary from insignificant to
extremely severe
Mrs. Yates had No Significant Cognitive
Impairment During the Drownings








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

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

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







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









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





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

Traumatic experience (70%, in one
study)

Sleep deprivation

Solitary confinement

Anxiety
Possible Causes of Mrs. Yates’ Amnesia
for Certain Statements in Jail

Psychosis with disorganized
thinking

Lorazepam (Ativan)
Lorazepam (Ativan)



Lorazepam (Ativan) is a highpotency benzodiazepine
Benzodiazepines induce amnesia
for information learned after the
drug is taken
Research suggests that
benzodiazepines preserve the
memory of recent events before the
drug is administered
Lorazepam (Ativan)

Ativan is similar to Rohypnol, the
“date-rape drug”
DID MRS. YATES KNOW
HER CONDUCT WAS
WRONG IN DROWNING
HER CHILDREN?
Before the Drownings

Mrs. Yates considered her obsessive thoughts
of and impulses to harm her children “bad
thoughts,” for which she blamed Satan

For weeks, she concealed from everyone her
thoughts of harming the children and her plan
to drown the children

She made up her mind the evening of June 19th
to drown the children the next day [D]

She had no “visions” of drowning the children;
she agreed it was just an idea [W-4]
Cont.
Before the Drownings (cont.)

She tried to behave as normally as possible so
Rusty wouldn’t know anything unusual was
happening

She waited for an opportunity when no one was
home so that she would not be stopped from
drowning the children

She believed that killing the children would be
sinful and would be the last of the Seven Deadly
Sins for her to commit

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.)

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]

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

Knew she would be arrested and put
in jail

Knew her conduct was illegal

Knew society would judge her
conduct as “bad” [F]

Believed God would judge her
conduct as “bad”
Cont.
During the Drownings

Felt “the presence” of Satan during the
drownings, but did not think he was “in
her” until after her arrest [G]

Anticipated being punished by the state
[W-3]

Acted with determination to accomplish
her plan of drowning each child before
Dora arrived
Cont.
During the Drownings (cont.)

Found it most difficult to drown
Paul and Noah and “tried to numb
myself to it” [W-9]

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

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

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”

Told Sgt. Mehl she was prepared to go to
hell for what she had done
Cont.
After the Drownings (cont.)

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

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:

Mrs. Yates knew that her conduct
was wrong in the eyes of the law

Mrs. Yates knew that her conduct
was wrong in the eyes of society

Mrs. Yates believed that her
conduct was wrong in the eyes of
God
At the Time of Drowning Each Child:

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)