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Mental Disorders

by Suzanne O'Malley
Simon & Schuster Audio, 2004
Review by Christian Perring, Ph.D. on Jun 4th 2004

"Are You There Alone?" is a remarkable account of the mental illness of Andrea Yates and her subsequent trial for the murder of her five young children.  As Suzanne O'Malley relates the facts of the case, there is no doubt that Yates had a major mental illness.  She had been hospitalized many times, had attempted suicide, and had been on a long list of psychiatric drugs.  While O'Malley herself remains neutral about the values inherent in the Texas legal system that would allow the death penalty for Yates' crime, the facts she provides leave almost no room for any decent person to believe it could be reasonable to execute her, even for such a terrible action.  O'Malley's book provides strong grounds for the utter condemnation of the policy allowing the capital punishment of people with severe mental illness.  It is a powerful book and essential reading for those interested in the intersection of psychiatry and the law. 

Andrea Yates had firm religious convictions not untypical of those in the Bible Belt, with belief in the literal truth of the Old Testament and maybe even more troubling, the prophetic parts of the New Testament, including the reality of Heaven, Hell, and Satan.  These clearly played a role in her motivation for killing her children, since she seemed to believe that they needed to die in order to be saved from Satan.  From the transcribed interviews with psychiatrists, it appears that she believed if she killed them, then they would go to Heaven, but otherwise they would be at risk from Satan.  More mundanely, she seemed to worry that her children were not normal and that they were not developing properly.  It is also possible that Yates was relying on getting the death penalty for killing her children, since she believed that she was not a good mother and deserved punishment.  She was often suicidal and had been unsuccessful at committing suicide, so killing her children may have been an attempt for her to bring about her own death.  It was clear that her murders were premeditated and deliberate and that she knew that she would be punished for them, and according to Texas law, that was sufficient for her to be fully legally responsible for her crime. 

Some speculate that Yates' motive in killing her children was nothing to do with their spiritual well-being, but rather revenge against her husband Rusty Yates.  For example, that was the view of religious zealot Michael Woroniecki who Andrea and her husband become involved with; in fact, she was strongly influenced by his extreme doctrines.  Judging from O'Malley's account, Woroniecki's theories lack all credibility, and could have been motivated by a wish to escape blame for his role in leading to her crime. 

One of the other elements of the book that will be shocking to many, but unfortunately only too familiar to others, is the inadequate mental health care Andrea Yates received in the years before her crime.  She had symptoms of psychosis and depression, and had received a variety of diagnoses.  She had received a variety of treatments, some of them demonstrably inappropriate.  For example, in hospital, she was made to watch videos about substance abuse, when she did not even drink.  There was a failure of communication among mental health professionals, and her in-patient care was frequently limited by her HMO plan so she had to leave hospital when she was not ready to do so.  Some of her psychiatrists seem to be simply incompetent.  Given the seriousness of her mental illness, it is not clear whether her descent into such severe psychosis could have been prevented, but it is clear that professionals could have done to spot the danger she presented to her children. 

"Are You There Alone?" is an alarming book because the failures of the legal and psychiatric system that it demonstrates do not seem special cases, but rather are just particular horrific examples of the failures that happen every day. 

Becky Ann Baker reads an abridged version for the audiobook with energy and variety of intonation, making it all the more absorbing.

 

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© 2004 Christian Perring. All rights reserved.

 

Christian Perring, Ph.D., is Academic Chair of the Arts & Humanities Division and Chair of the Philosophy Department at Dowling College, Long Island. He is also editor of Metapsychology Online Review.  His main research is on philosophical issues in medicine, psychiatry and psychology.