Andrea Yates' Trial May Not Be Over

Andrea Yates, the Texas mother who killed her five children while in a delusional state of Postpartum Depression, has had her second trial verdict decided. She was found not guilty by reason of insanity and sent to a psychiatric hospital. The decision regarding when she may be released is being placed in the hands of the court and the mental health experts to whom they will go for guidance.

When I worked on a forensic unit at a psychiatric hospital, we had women who had killed their children and fathers who had murdered their entire families. All of them had been judged NGRI (not guilty by reason of insanity) and sent to the hospital for an indeterminate time. Some waited for 10 years, others were still there when I left because their delusions were more related to an underlying mental illness on top of their Postpartum Depression.

Some of them didn't want to leave because they couldn't face life in the community or what they had done. Now that they had regained their sanity, their deed was too much for them to even discuss with members of their treatment teams. It was always "the incident" or "it happened" and it was left to the mental health professionals to know what that was.

Postpartum Depression with Psychotic Features (Postpartum Psychosis) is not usually found in new mothers, although Postpartum Depression is found in anywhere from 50-80% of new moms, depending on where you get the statistics. Only about 1% of new moms experience the far-more-serious form that carries with it the possibility of harm to the mother and/or her children. In Andrea Yates' case, she believed that, in order to save her children, she had to kill them. She planned the murder and after it was over, she called her husband and the police. Some have said to me that that indicates she knew what she was doing.

Allow me a quick moment for some important mental health information:

Psychosis, the loss of the ability to know reality from delusion, does not carry with it an inability to plan and carry out something. People in this state of diminished capacity do, indeed, plan and carry out sometimes complex plans. They are still, however, delusional and not able to know they are deluded. To them, they are acting in the only way they know to save someone or stop something from happening. I once had a forensic patient who had a serious delusion about a government official who he planned to kill. He was caught in time before he could put his plan into action.

The one cruel twist in the Andrea Yates case has yet to be realized. The prosecutor only charged her with the murder of three, not five, of her children. I am guessing that this means he retains a means to prosecute her again, only this time for the murder of the other two.

Related Topics: Brooke Shields' Struggle With Postpartum Depression, Mom's Antidepressants are Safe for Nursing Infants

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Aging Gracefully: My Neighbor

I have a wonderful neighbor whose name I don't even know, but each time our paths cross, he smiles broadly, asks how I am and I return the pleasantry. We live just two floors apart in an apartment building, but we've never been into each other's apartments, nor have we sat on the porch to just talk about nothing in particular.

From what I've seen, he's incredibly productive, goes shopping each day, cooks for himself and I've never seen him either grouchy or curt. I wish I could say the same for me. I am a grouch sometimes.

My neighbor also has an incredible talent - he repairs violins, cellos and violas. Small children go with their parents to his studio apartment where he listens thoughtfully to their playing and then offers some suggestions about the instrument or the tuning. In the warmer weather he leaves the door open so I've taken a peek or two.

I've never seen anyone approach that door with anything but a sense of reverence. It's almost as though they are approaching a very special place, a Mount Olympus on the East Coast of the United States.

He is so pleasant, so content and I would love to talk to him about his philosophy of life. When he's not repairing violins or giving small lessons, he hops on the bus to Manhattan and returns in the evening with a small bulging shopping bag. He never seems to find his osteoporosis bothersome, even though it makes him walk with his head somewhat down. His beret is always jauntily tilted on his head and he walks up the stairs rather than taking the elevator to his apartment.

What's so special about this man? He's around 80 and he never lets that get him down from my observation. There isn't a hint of dementia. If 60 is the new 40 for our President, I guess 80 is the new 35 for this man. Just goes to prove that we are only as old as we tell ourselves and that we are the ones who keep us from being active. I guess he learned that lesson eight decades ago when he was born in China long before any of us knew of Positive Psychology.

Related Topics: Aging Bonus: Increased Happiness, WebMD Video: Seniors Kick Butt with Kickboxing

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The Kindness of Strangers

Tennessee Williams had Blanche Dubois deliver that famous line in "A Streetcar Named Desire" where she says something like, "I've always depended on the kindness of strangers."

Today, I saw that kindness in action and it was truly touching. An elderly woman, somewhat disheveled and with missing front teeth, fumbled with her large shopping bag at the counter of a well-known coffee shop. It was obvious to anyone that, as she took napkins and tucked them into her bag, she didn't have money for coffee, but she couldn't ask for anyone's help. She was dependent on the kindness of strangers and, as I watched, I knew I was going to step in.

A young man dressed in casual clothes, sandals on his feet and with a book bag slung across his shoulder, stepped out of line and asked, "Would you like something? Some coffee or something to eat?" She looked at him, not seeming to understand. This fellow was someone not of her race and, in fact, he looked Middle-Eastern. She hesitated and he asked again in a low, pleasant voice.

'Yes, I'd like coffee and maybe..." and her voice trailed off almost as though she didn't want to ask for too much. "Yes," he said, "and a bagel or something?" She spoke just above a whisper and indicated that she'd like a bagel with butter. He told her not to worry, that he would get it for her and she continued shuffling her bag on the floor, uncomfortable as any of us would be if we were in her position. A seemingly broken woman, she still clung to some sense of self-esteem. I didn't detect any hint of a "user" about her.

I looked at the guy and I said, "That was very nice of you." He replied, "I can't see someone like that, especially a woman. It's not right. We never know if we'll be in that place some day. Life is so uncertain."

Recently, we heard a great deal about how a new study showed that we are more alone and lonely, more disconnected from each other than ever before. The study also seemed to imply that this disconnection had made us lose some of that "social glue" we used to hear about. We had become impersonal and self-absorbed and lonely as a result, it concluded.

I think the researchers need to look at this simple vignette that involved only two strangers but was evidence that we do care for each others, we may not show it as we did before.

Related Topics: The Science of Good Deeds, Elders Reveal Keys to Healthy Aging

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The Ogre in the Office

Work is something we do for a variety of reasons, It provides us with a sense of purpose, gives us an opportunity to increase our skills or view of the world, helps pay the bills and can mean fulfillment of goals we've set for yourself. One thing work really shouldn't be is a place where you are bullied, denigrated or made to feel less competent. Unfortunately, the bullies of the school yard of years gone by are now lurking in our offices, so we need to learn how to handle them.

Sometimes bullying involves invading your personal space so that you feel a sense of threat or you are verbally abused. I heard of one surgeon who bullied the nurses in the OR and actually barricaded one in the OR because the surgeon "didn't like the nurse's attitude." Is this behavior acceptable for someone who holds a scalpel in their hand on a regular basis and has the power of life and death? It doesn't sound reasonable or professional. No action was taken against the surgeon who was told to transfer to a different hospital or service.

I once had a landlord try to bully me into not going to college at night because he thought I was too old. I avoided him whenever possible and once told him that his daughter was just a few years young than me and she was going to medical school. No answer from him.

A young, petite medical intern had a similar instance of bullying. She needed a small stool so that she could observe the surgery. The surgeon in charge, who didn't think women belonged in surgery unless they were nurses, whirled around and kicked the stool across the room. She ultimately became a dermatologist.

Bullying can also include excluding you from important meetings or communications, and one survey found that 24% of the companies surveyed indicated bullying in their facilities. The recourse, of course, is through the chain of command in the company and then, if that doesn't work out, legal action can be taken.

Does bullying cause you damage? Yes, because it can increase the stress in your life to the point that it damages your health and, certainly, your mental health is affected.

The message here? Bullying isn't to be tolerated, you do have rights and there are people who will stand by you.

Related Topics: Fight Stress and Find Life Balance, Work Stress May Hurt the Heart

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Postpartum Depression: A Grim Disorder

Andrea Yates murdered her five young children in 2001 and she did it while in a psychotic state of Postpartum Depression, a disorder that too few women and healthcare workers know about. This lack of information leaves a woman, her family and even her community at risk if the disorder reaches the proportion that it had in Ms. Yates' case.

Before I outline the symptoms, first let me give you some background on the case because Andrea Yates is on trial, for a second time, for the murder of these children. In the first trial, a prosecution witness, a very well-known psychiatrist, gave inaccurate testimony that could have tainted the jury decision against this woman.

Andrea Yates had five children in eight years of marriage and she turned from an outgoing, intelligent woman into someone wracked by guilt, depression and increasingly delusional behavior. She tried to commit suicide twice, was hospitalized and then began mutilating herself, stopped eating, had no interest in maintaining her personal hygiene and became convinced that her children needed to die in order to escape a worse fate. A psychiatrist had warned after, I believe, the birth of her third child, that, if she continued to have children, her Postpartum Depression would worsen with each birth.

Antipsychotic medication had been prescribed for Yates, but it was in the form of pills and she stopped taking them. No one, seemingly, was either supervising her medication or thought to provide something other than pills. In my professional experience with potentially dangerous patients, this medication would have been provided to them in an IM (intramuscular) formulation for their own protection and that of others. This was not done in this case.

Yates has admitted the crime and for the rest of her life she will suffer the guilt of those deaths, even though she wasn't truly responsible. Psychosis takes away the ability to think clearly and to control dangerous actions and that happened in Ms. Yates' case. She was the victim of her biology having gone berserk.

First, let me say that Postpartum Depression with Psychosis is rare and only affects about 1 out of 1000 births.

The symptoms of Postpartum Depression, which in its more common form, affects anywhere from 50-80% of women, include mood changes, insomnia, fear of harming your child, an overwhelming feeling of inability to cope, hopelessness and sadness, irritability and crying, fear of being alone, poor self-care, loss of interest in activities, social isolation, problems concentrating or thinking, decreased energy. For most women these will last a few days to a few weeks and, for some, as long as a year.

What to do? Talk to your doctor and understand that others are there to help and support you. This is biology, not you being a bad mother.

Related Topics: Postpartum Depression Checklist, Out of the Blue: Brooke Shields' Struggle with Postpartum Depression

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Heart Attack and Anxiety

The result of a 10-year study of 740 initially healthy men are now in and they indicate, according to a report in Clinical Psychiatry News (2006, vol. 34/6, p. 63), anxiety is a very strong predictor of future cardiac events such as Myocardial Infarction or sudden death.

A variety of psychological measures had been performed on the men in the study who were originally entered into the Veterans Administration Normative Aging Study in 1986. The average age of the men was 60 and they had neither diabetes nor a history of myocardial infarction (MI). While controlling for a variety of factors in their analysis, the researchers found that anxiety "was an independent and significant predictor of subsequent MI" in the sample.

Even after taking such factors as depression, anger, hostility, type A personality and perceived stress, the single most important predictive factor of MI remained anxiety. The underlying mechanism of just how anxiety may have brought this about is still unknown, but researchers see anxiety as having a possible association with triggering coronary events through plaque rupture, vasospasm, thrombosis and atherogenesis.

The implications of the study are evident in that controlling anxiety is not only good for your mental health and personal relationships, it is good for your physical health.

Related Topics: Enron's Ken Lay Dies: Was it Stress?, Phobias May Put Women's Hearts at Risk

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OCD and the Need to Hoard

The assumption has often been that only those with Obsessive-Compulsive Disorder are chronic hoarders, but the definition has been broadened to include significant clutter in the home as well as other behaviors which lead to impairment.  In order to explore hoarding and the groups in which it might be seen as a symptom of their anxiety disorder, Suzanne A. Meunier, PhD, studied 139 individuals who had either OCD, GAD, panic and/or agoraphobia, social anxiety disorder, or a specific phobia.   The diagnosis of an anxiety disorder was  found with comorbid depression in 20% of the subjects.

Participants in the study were rated on clutter scores, acquisition and difficulty discarding and those with panic or a specific phobia had no pathologic hoarding.  Eleven percent of individuals who had a diagnosis of OCD, 14% with social anxiety disorder, and 27% of those with GAD self-reported compulsive hoarding.  Both OCD and GAD patients had higher hoarding scores than the other groups.

Compulsive hoarding affects patients' work, family, and social life with families indicating the greatest problem. And it appeared to the researchers that there is a strong link to depression.  Other than this interesting finding, the researchers did not offer any indications as to why those with social anxiety or GAD engaged in hoarding.

If we consider that hoarding may be an indication of a need to protect from unforeseen calamities, it would stand to reason that both those with social anxiety or GAD would feel a need to hoard.  Individuals with GAD, perhaps, just like those with OCD may find the world an uncertain and unfriendly place where hoarding plays a role in providing protection from the whims of life.  

The study was reported at the 2006 annual convention of the Anxiety Disorders Association of America and also appeared in Clinical Psychiatry News, May 2006, 34(5), 33.

Related Topics: Bird Flu Over the Cuckoo's Nest, Clue to Obsessive-Compulsive Disorder?

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Babies and Maternal Stress

Everyone knows stress isn't good for you and pregnant women, in particular, need to be mindful of how their stress levels can affect the future life of their children, especially their daughters.  A new study presented at the International Congress of Neuroendocrinology (June 22, 2006) by Dr. Dirk Hellhammer and his associates look at 100 healthy females and 93 women with fibromyalgia found an astonishing association between fibromyalgia and their mothers' stress level during pregnancy.

All 93 of the fibromyalgia women told of their mothers having experienced significant stress during pregnancy.  Hellhammer believes that maternal stress leads to something he calls "prenatal programming" of the female fetus for the development of fibromyalgia.  The women with the disorder reported their mothers had profound levels of stress during pregnancy from partner loss, abuse/trauma, or lack of social support.  


Related Topics: Less Stress for Healthier Mom, Baby, Healthy Pregnancy Choices

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