Sept. 2, 2001, 2:00PM
Yates case proves we are still puritanical about brain diseasesBy DR. FRANK ADAMS
The terrifyingly Salem-like public discussions of the case of Andrea Pia Yates [accused of drowning her five children] underscores the disgusting state of affairs of the professions of psychiatry and psychology, the former of which is a medical specialty that practices little medicine, and the latter a liberal arts mutation whose members deceitfully act like doctors without having gone to medical school. Both these obsolete schools of thought about aberrant human behavior and, ultimately, brain diseases are shrouded in the mists of the Dark Ages.
The complicating factor, the one that prevents a rational and humane understanding of this tragic case is the unfortunate and continued adherence to such worthless concepts and phrases as "mental illness," "insanity" and "depression." These are meaningless labels that allow the primitive-minded to trivialize serious neurological conditions caused by broken and distempered brains. We have no trouble accepting that abnormal heartbeats, unusual urine output or labored breathing might be symptoms of something physically wrong. But our puritanical roots prevent us from appreciating that abnormal behavior might well be a symptom of serious medical illness. We prefer to believe that all deviant acts are deliberate and therefore require punishment, a mindset that excuses state murder as a redemptive act. It hasn't helped that the so-called mental health professions have provided a vocabulary drenched in the stench of Freudian voodoo, that the public eagerly parrots in its feverish desire to fix blame.
From the many press reports, but without the benefit of clinically examining her, it seems highly likely that Yates has a severe disturbance of brain function. Much time and effort will go into meaningless discussions about her "frame of mind" and "competency." However, it is more important that she be exhaustively examined by medical doctors qualified in the clinical cognitive neurosciences and, if clinically indicated, be investigated further with the finest available nuclear and magnetic brain scans. Positive findings, especially from the clinical examination, would indicate that the molecular environment of her brain is in a state of anarchic disarray, her puzzling and chilling behavior and pathological emotional state a direct reflection of highly abnormal brain activity, and not the product of festering psychological boils from some emotional trauma in her personal or marital life.
The issue then would not be is she competent, or did she know right from wrong? Rather, was she capable -- that is, did she have the capacity to oppose the gruesome directives of a pathologically functioning brain to which she was now both unwilling spectator and victim? It is important that those involved in her legal case, the public, Yates and her suffering family eventually realize that she was not the victim of her past, nor the handmaiden of evil influences, but the innocent victim of a neurological illness in which the brain gave rather than took directions, like the heart no longer keeping its regular beat or pumping the correct amount of blood. Both processes are independent of the person.
If the diagnosis is confirmed, then Yates was no more responsible for the deaths of her children than the person with a heart attack is responsible for chest pain, shortness of breath, sensations of impending doom and drenching sweats. Who blames the breast cancer patient for her tumor, or the Alzheimer's patient for urinating on the street, cursing in public, forgetting he was president of the United States? It is unthinkable in a civilized society that the medically ill would be held responsible for exhibiting the symptoms of their illnesses, and be executed for it.
There is no such thing as mental illness. This is the perpetuation of the stupid mind/body split which medicine, especially psychiatry and neurology has failed to address, and psychology shamelessly exploits. All sickness is physical, resulting from disease in some part of the body. Until this obvious fact is accepted, those diagnosed with abnormal behavioral or emotional conditions will continue to be stigmatized, treated as lepers, housed in prisons, put to death. By the same token, depression should no longer be referred to as a mental illness or even made a diagnosis. At the beginning of the last century, fever was a diagnosis, until medical science discovered that elevated temperature was a symptom of underlying disease, a useful warning signal that something was wrong somewhere in the body. Depression is the fever of the brain, a serious symptom of underlying brain disease. It serves only foul purposes to continue to focus exclusively on the behavior because it obscures the fact that the person is physically sick.
Unfortunately in these severe cases of emotional and behavioral disturbances, even with the best neuropharmacologic treatments, patients do not always recover fully, and can experience permanent and even disabling cognitive sequelae, such as short-term memory disorders and impairments of information processing. The outcome is further clouded by the frightening suspicion that brain disorders (depression), like traumatic brain injuries, predispose the individual to the eventual onset of Alzheimer's disease, an ultimate sentence of death.
This should satisfy even the most self-righteous neo-Salemites among us.
Adams is a neuropsychiatrist in private practice in Conroe and established the first section of neuropsychiatry at the University of Texas M.D. Anderson Cancer Center.
Copyright 2001 Houston Chronicle