As the only psychoanalyst participating in the trial of Andrea Yates, I had a unique perspective on the proceedings in the courtroom. I am an expert in women's psychiatric disorders, specifically postpartum depression; I was hired by the defense to address the issue of Yates' sanity at the time she drowned her five children.
My being in psychoanalytic training was never raised during the trial. The defense did not want to mention it; they feared that the jury would not understand and have a negative impression of me. The prosecution did not mention it on cross-examination. I was a “closet” analyst.
The prosecution's expert witness was a forensic psychiatrist, Park Dietz. He believes the forensic psychiatrist's task is to find “the truth.” This involves extensive review of all of the physical evidence, including autopsy pictures and crime scene photos. As recently quoted in a New York Times article, he mainly works for the prosecution, believing that only the state is bound by law to seek truth and justice. The defense bar is biased, as its mission is to help the defendant. Clinical psychiatrists who testify for the defense are also biased by their inherent interest in helping patients. Dietz believes that empathy and compassion make it difficult for the evaluating psychiatrist to see the truth.
Dietz looks at the concrete facts of the case. Forced to make a choice between interviewing a defendant and viewing crime scene physical evidence, he states he would forgo the interview. Dietz is a well-regarded forensic expert, but his way of understanding is antithetical to the way psychoanalysts think about the mind and human behavior. He looks at behavior to explain motivation and intent. A psychoanalyst tries to “get inside the mind” of a patient to understand his or her behavior.
I interviewed Andrea Yates several times before she was able to give me any information. Initially she was too psychotic to answer questions. She seemed lost in her own thoughts, and I spent several minutes in silence waiting for her to respond. Having spent two years as an attending on a psychiatric inpatient unit, I knew this wasn't mere reverie; she appeared to be responding to something to which I was not privy.
Lucy J. Puryear, M.D., is an advanced candidate at the Houston-Galveston Psychoanalytic Institute. She is on the clinical faculty at Baylor College of Medicine and has a private practice specializing in women's mental health.
I asked, “What is going on inside of you now?” After another long silence, she answered that someone or something was trying to put thoughts into her head. She believed it was Satan. That was very real and plausible to her, and it motivated her actions on the day of the drownings. She acted rationally and “volitionally” (albeit without the full benefit of reason), based on a fixed belief that Satan was trying to send her children to hell, and that she herself might be Satan or was Satan's agent. Her last loving act as a mother was to save her children and send them to heaven.
I had to look at the world from her point of view, something I have been training as an analyst to do. This doesn't mean that I forgive her behavior or condone her actions; that is not the meaning of empathy. Rather, I tried to see the world as she saw it on that fateful day. In this case, understanding was almost impossible; her beliefs were too bizarre.
Yates tried to reconstruct memories in a way that made sense to her, after she was on antipsychotic medication, from a time when her thoughts were disorganized and inconsistent. The further away she got from the day of the crime, the more her memories changed. Her delusion became less bizarre and more organized. By the time she was interviewed by the prosecution expert, many months later, she was unable to recall her thinking on the day of the crime. She presented reconstructions from what she vaguely remembered and what others had told her she said. It was hard to know what she truly remembered and what she had internalized as her own memories, taken from others' accounts.
It is frustrating that a psychoanalytic way of thinking is not more prevalent in society. People tend to believe what they can see. The idea of mental illness is hard to convey to someone who has not seen it or experienced it at first hand. It may be impossible to convince the guy on the street that what he can see with his eyes may not be the most accurate view of reality.
When the jury heard a forensic pathologist testify that Yates' behavior was organized and deliberate and that she knew what she was doing was wrong, they had the explanation that fit their world view. To the jury and the prosecution expert, her behavior “proved” that she was not insane. In truth, her behavior was intentional, but the motivation for her actions was delusional.
I feel like a bridge between two worlds. The world of the analyst is cut off from mainstream thought, even amongst my psychiatric colleagues.
It is a constant battle trying to live in the medical model and maintain credibility as a diagnostician and pharmacologist while also practicing psychoanalytic techniques. Some psychiatrists don't understand the usefulness of dynamic thinking and ridicule psychotherapy. Reading the APsaA's Open Line e-mail list after the trial, I realized there are still some analysts who don't understand the world of severe, persistent, and chronic psychotic illnesses.
I am speaking from the perspective of an M.D. and a psychoanalytic candidate. It has been important for me to maintain my identity as both. Being both a physician and a future psychoanalyst fits my way of thinking and being with my patients. In the Yates trial, I could talk about psychiatric illness and medications and also provide a perspective on the accused's inner world.
In dealing with mothers with postpartum illness, I can understand the hormonal changes affecting their mood and the intrapsychic conflicts that inevitably occur when a new baby is born. Both perspectives make me a better healer. I was deeply saddened by the outcome of this trial, but I am further convinced of the value of psychoanalytic thought and its place in our society.