Return to Transcripts main page

CNN Talkback Live

Andrea Yates: Is Postpartum Psychosis to Blame?

Aired August 08, 2001 - 15:00   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
BOBBIE BATTISTA, HOST: Nancy Reagan calls her "a special spirit who shared her father's gift of communication and his love of politics." Maureen Reagan, dead at the age of 60.

Good afternoon, everyone. Maureen Reagan, the oldest daughter of Ronald Reagan and actress of Jane Wyman, passed away today. She had been battling malignant melanoma for five years now. Last month she was diagnosed with brain cancer.

Former First Lady Nancy Reagan released a statement saying, "Maureen had her father's gift of communication, his love of politics, and when she believed in a cause she was not afraid to fight hard for it." With us on the phone right now is Robert Dallek, a presidential historian and author of "Ronald Reagan: The Politics of Symbolism." He teaches at Boston University.

Also joining us here in our studios is CNN medical correspondent Dr. Sanjay Gupta. And Mr. Dallek, if we -- for the last several hours or so since she passed away, we've heard many people talk about Maureen Reagan and what a wonderful person she was, and the many hats that she wore during her career. If you could, tell us something that maybe we don't know.

ROBERT DALLEK, PRESIDENTIAL HISTORIAN: OK.

(LAUGHTER)

Well, you know, I'll try to put it in the perspective that a historian has, which is that she was clearly a presidential daughter. And presidential children have a difficult time. One can look at the history of presidential children in this century, and you don't see a long track record there of great accomplishment and exceptional achievement.

But she was really an impressive person, in the sense that she got along with her father. She was very much someone who reflected his point of view, and I think Mrs. Reagan is accurate in saying that she did have special communication skills and she herself might have had a very impressive political career if she hadn't been a presidential daughter.

What I'm saying, in a sense, is that there are drawbacks to being an offspring of a president. And I think she -- she took the best from it. But it was not easy for her, in the sense that I think she might have been a more independent spirit if she hadn't been, so to speak, in the eye of the media as the daughter of a president.

BATTISTA: As you say, she probably could have had a political career, had she really, really wanted it, or perhaps a little bit more disciplined in some ways.

DALLEK: Yeah.

BATTISTA: But it is interesting to note that she was Republican before her dad was, even.

DALLEK: Yeah.

BATTISTA: Yet she disagreed with him strongly on a number of issues.

DALLEK: Yes, she did. And also what's interesting to me is how warmly and strongly she spoke out in the closing months of her life in behalf of medical research on Alzheimer's, and of course on cancer. And I think this will be one of the things that she'll be remembered for, as an advocate of -- of more research, of people taking care of themselves with medical attention. It's a terrible disease which has afflicted the lives of so many people in this country.

BATTISTA: We've had questions from the audience about her family. On a personal level, what can you tell us about her husband and her daughter?

DALLEK: Well, I think they were a warm, close-knit family. I think that they expressed the values that Reagan himself often articulated in relation to family, and you know, these are -- these are sort of -- sometimes they are an expression of a kind of rhetoric that -- that politicians engage in. But I think for her and her family -- immediate family, they were something that they live by and was not -- was not something that was artificial.

BATTISTA: Let me take a question from the audience. Gary, go ahead.

UNIDENTIFIED MALE: How close were her and Nancy?

DALLEK: You're asking me?

BATTISTA: Yes.

DALLEK: Oh. Well, I think that she and Nancy got along, particularly after the onset of President Reagan's Alzheimer's. I think there were some tensions prior to that, because remember, she was not Nancy's daughter but Jane Wyman's daughter. But on the other hand, I think once this affliction struck Ronald Reagan, she and Nancy came together to really devote themselves to making his life as comfortable and as satisfactory as it could be with anyone with this terrible disease.

BATTISTA: As a matter of fact, you know what? I'm going to throw to a sound bite right now because it flows off of that and the last time that Maureen Reagan made an appearance on TALKBACK LIVE. It was about a year ago, and the show was about Alzheimer's. And we -- we spoke to her about what it was like to take care of a family member with that disease. Let's run that now.

(BEGIN VIDEO CLIP)

MAUREEN REAGAN, RONALD REAGAN'S DAUGHTER: When you have a diagnoses of Alzheimer's, you have a death sentence. And then you have to come back over 180 degrees around and live with the disease over a period of years. And some people have a great deal of trouble making that turn. I think the hardest thing has to be for a spouse. To watch the someone that you were going to sit in the rockers with, and recall your -- your golden years together suddenly lose those memories, lose that ability to inter -- to interact with you. And to have to watch them just disappear before your very eyes has to be the most difficult thing that anyone can go through.

(END VIDEO CLIP)

BATTISTA: And that is so sweetly ironic, now that her own family had to go through a similar thing with her disease. Let me bring in Dr. Gupta, as a matter of fact, to the tell us a little more about melanoma and how it got to her brain.

DR. SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: Right. Yeah. Well, first of all melanoma is a very common skin cancer. There's about a million cases of skin cancer, and about 51,000 of cases of melanoma here each year in the United States of those. Close to 10,000 of those folks died. So it can be pretty deadly. The good news is that if it's caught early, it can have up to a 96 percent survival rate. So it's important to catch it early and not let it spread. The first places that it'll spread, often, are the liver and the lungs, and by the time it spreads to the brain, the survival rate drops down, 10, 15 percent, certainly as we've seen in the case of Ms. Reagan.

BATTISTA: I sort of took Brad's question, did I -- or was it Kevin's -- of how it gets to the brain. But go ahead, Brad.

BRAD: I was just wondering whether it was kind of sudden or was it expected at all that the outcome would finally be death?

GUPTA: Well, after it has spread to the brain -- she actually had seizures as recently as July in this year and it had already spread to her brain by that time -- and it's a much different disease at that point, compared to the melanoma that is initially found. If you find the lesion on your skin and have that removed, your survival rate -- you can do very, very well from that.

Let me just point out as well, a couple of things, you know, a lot of people wonder who's at risk for melanoma. Folks who have white skin, and folks who have blue eyes -- you've probably heard all this -- folks who are out in the sun a lot. But it's also cumulative, meaning that if you used to get sunburned a lot as a kid and now are lathering up and being really cautious, you still need to be careful about any changing moles on your skin and have those checked out right away. Those are the ABCs of moles, Bobbie. They talk about the mole becoming asymmetric, A -- the borders changing and the color changing and the diameter changing, getting bigger. ABCD. If those things are changing, you probably need to see a doctor about it so you can catch it early.

BATTISTA: And we should say that Maureen Reagan was a great champion of that advice, by the way, after she was diagnosed too.

GUPTA: Right, right.

BATTISTA: Mr. Dallek, I did not know her personally. I only knew her professionally, as she made several appearances on our show. She always seemed like somebody that you wanted to know. I think you know what I mean. She was very warm and very genuine and outgoing. Is that accurate?

DALLEK: Well, I think so. I never met her and I didn't know her. But yeah, I've heard that myself, that she was someone who was very warm, an attractive personality. And in many ways, I think she was very much her father's daughter. Because this is what we know or remember Ronald Reagan so clearly for, being such a warm and a successful communicator. Someone who engaged with people in such an effective way. And I think she very much had those attributes.

BATTISTA: And another question from the audience. I think this one is for the doctor. Go ahead.

UNIDENTIFIED FEMALE: Yes, I would like to know: any type of medication that can be taken for that?

GUPTA: If you -- if it's actually diagnosed as melanoma, the best treatment really is to have surgery, and make sure that you have the melanoma completely removed. If the melanoma in fact has spread,oftentimes chemotherapy, radiation, and I think, Bobbie, you mentioned amino therapy which Maureen Reagan actually did go through. Those are more for cases that have already spread, but again, early detection, have it removed and that's oftentimes a cure. That's all that needs to be done.

BATTISTA: And a question from Mirabel?

MIRABEL: Yes, was she presently working at the time right before her death. What was her state of mind?

BATTISTA: Mr. Dallek, I don't if you can answer that or not. Was she...

DALLEK: I don't know. I don't know. I would, you know -- I'm sure the doctor could speak more clearly to that. At very end, I understand she was pretty ill, and I imagine it would have been pretty difficult for her to be fully engaged with any work.

BATTISTA: I think it's probably safe to say that, knowing the kind of person that she was, that she was probably working up till she couldn't.

DALLEK: Yeah. But wasn't it very recent that she spoke before a Congressional committee in support of research on Alzheimer's, as I recall.

BATTISTA: All right. One last question up here in the audience.

UNIDENTIFIED FEMALE: Yes, I have a question for the doctor. I want to know if too much sunlight would cause melanoma.

GUPTA: That is the biggest risk factor. Too much sun. Too much UV light, specifically. In folks, again, who are most at risk, light skin, blue eyes, blond hair and people who spend a lot of time in the sun. Those are people at risk. And people who have a lot of moles. If you have a lot of moles and they're changing, get them checked out.

BATTISTA: All right. Dr. Sanjay Gupta, thank you very much for the advice.

GUPTA: Thank you.

BATTISTA: And Robert Dallek, thank you. We appreciate your insight into Maureen Reagan and we send our sympathies to her family and we'll miss her. She was a great guest on this show and I wish that I had known her.

In a moment, Andrea Yates pleas insanity. Will it work, and what role will postpartum depression play in her defense? We'll continue on here. Stay with us.

(COMMERCIAL BREAK)

(BEGIN VIDEO CLIP)

UNIDENTIFIED MALE: This case has insanity, which is different from competency, written all over it.

(END VIDEO CLIP)

BATTISTA: Was confessed killer Andrea Yates insane when she drowned her five children in a bathtub?

(BEGIN VIDEO CLIP)

DICK DEGUERIN, DEFENSE ATTORNEY: I think that they'll try to show her history. Both of her mental problems, and her descent into what is obviously madness.

(END VIDEO CLIP)

BATTISTA: Yates has in pled innocent by reason of insanity in the deaths of her three children. Her attorneys say she is not fit to stand trial. But will a history of mental illness and postpartum depression protect her from the courts or from the death penalty?

(BEGIN VIDEO CLIP)

RUSTY HARDIN, FORMER PROSECUTOR: The prosecution's problem is -- is that though it's very difficult to imagine a jury giving her the death penalty, my guess is the state is going to want a jury to decide that.

(END VIDEO CLIP)

BATTISTA: Should Andrea Yates stand trial? And can her crime be blamed on postpartum psychosis?

Welcome back. It has been nearly two months since Andrea Yates called her husband and police and told them that she killed her five children. Today, her attorney said that she is not mentally fit to stand trial. She is pleading insanity. Her family has said that Yates suffered with postpartum psychosis. Joining us to dissect this kind of defense is Skip Simpson, a Dallas civil litigator who specializes in psychiatric malpractice cases. He represents a woman in a civil suit now who drowned her 4-year-old twins. Simpson won that -- or rather, the criminal lawyers won that case using the insanity plea. Unfortunately, though, Skip, you are under a gag order and cannot talk about that case specifically.

SKIP SIMPSON, CIVIL LITIGATION ATTORNEY: I can't even talk about whether there was a case or not.

BATTISTA: We understand. So, we won't go there.

SIMPSON: All right.

BATTISTA: Also with us is former Texas prosecutor Nelda Luce Blair. She's a regular on "Power of Attorney." Nelda, nice to see you.

NELDA LUCE BLAIR, FORMER TEXAS PROSECUTOR: Thank you.

BATTISTA: Skip, let me ask you this, then, just in generic terms, or in reference to the Yates case. How do you go about proving that this woman, who seemed lucid enough to call her the police and her husband after these murders -- how do you go about proving that she was insane at time of those murders?

SIMPSON: Well, what you do first of all is you look at all of her conduct prior to the event and then you look at her conduct subsequent to the events. And as I understand it, in this case, she had a psychiatric history. She -- as I also understand it -- she very much loved her children, her husband is supportive. And this was something that was very, very unusual.

And most people who are considering suicide, are considering homicide under these kinds of conditions. 95 percent of those people are psychiatrically ill. So that if have you someone that is -- like a young mother who is thinking of killing herself, one of the questions that's mandated by the standard of care in psychiatry is to ask if she would be considering killing anyone else, like the children, because that's not an unusual event. So what you do is, you look at behavior before, look at the behavior afterwards.

BATTISTA: What I think will be difficult is, you know, her mother said in the last day or so that she was beginning to understand what it is that she did and to recognize what she did. Which sort of leads us to assume that she's becoming more lucid now or more sane, if you will, so you have to then go back and prove that she was insane just a couple of months ago.

SIMPSON: No, actually. What you have to prove in a criminal context is that the moment of the act, was she -- did she have the criminal intent? Did she have an evil heart at that moment, when she was involved in the killings? And if, at that moment, she was doing it for an altruistic reason or if she was psychotic, it's at that very moment that you consider.

So in order to have a crime, you have to have first an act, and second the mental element. And if she doesn't have the mental element, there is no crime. It's really that simple. It maybe doesn't seem that simple when you're looking at it in the media after the event and all the other kinds of things that you look at, but that's where you're looking. And what happens, incidentally, is once the killings begin for a mother, that there's often a relief that comes afterwards.

BATTISTA: Oops, we're having trouble from our line from Dallas. We'll try to bring Skip back. Meanwhile, Nelda, we have to consider that this is the state of Texas. What is the definition of the insanity defense in Texas?

BLAIR: Well, Skip was talking about her having an evil heart. But let's get more to the real details of what the law says. The reason that insanity plea -- defense is going to be very difficult to prove is because the definition is that Andrea Yates, because of a mental disease or defect at the time of the conduct, did not know what she was doing was wrong. And that is exactly what the law says. Not whether she was a psychotic, as her attorney has even told here on CNN. Not whether she'd been depressed for years. But if at that the time she knew it was wrong.

BATTISTA: And how hard is that?

BLAIR: Well, considering she picked up the phone and called police and her husband immediately afterward, I would suggest it's going to be a very difficult road.

BATTISTA: Why did she only plea to three of the murders, rather than all five?

BLAIR: Well, there's two capital murder charges right now. The first is for the 5-year-old and the 7 year old boys. And that is because she's charged under a statute that says capital murder, if you kill more than one person in more than one action, in one set of conduct. And the second one, Mary, the 6-month-old is the second charge, and that is the charge of killing anyone under 6 years old. So her 7-year-old didn't qualify by himself as a capital murder charge. Therefore, they've -- they've combined the two, 5 and 7-year- old for one charge and the 6-month-old for another charge. I would guess that Attorney Rosenthal, the District Attorney, is probably not filing the other two capital murder charges now in the event that he decides to do it later. BATTISTA: All right. We've got to take a quick break here. Still ahead, the charges against her could carry the death penalty. Do you think that prosecutors should seek the death penalty for Andrea Yates? Take the TALKBACK LIVE online viewer vote at cnn.com/talkback. AOL keyword: CNN. While there, check out my notes and send us an e- mail and we'll be back right after this.

(COMMERCIAL BREAK)

BATTISTA: All new mothers in Britain are evaluated for postpartum depression before they leave the hospital after giving birth. Nurses make at least two mandatory house calls to check for symptoms within 40 days of birth. In the U.S., New York and New Jersey are the only states that require hospitals to give new mothers information on postpartum depression.

And postpartum depression is at the core of her insanity defense. We have a question from Chandra in the audience about that. Go ahead, Chandra?

CHANDRA: Yes, I was wondering, has there been any case where a woman has used insanity as her defense?

BATTISTA: You mean postpartum depression?

CHANDRA: Yeah, postpartum depression.

BATTISTA: As an insanity defense in the state of Texas?

CHANDRA: Just ever. Have we ever heard of a case like this?

BATTISTA: Well, Skip. Yeah, you can't talk about that case, but...

SIMPSON: I can't talk about that case, but I can tell you that absolutely, that has been used as a defense in the past. And it has been successful. It's very unlikely that, if the prosecution brings this case, that they'll obtain a conviction.

BATTISTA: And Nelda, it has even been successful in the state of Texas, correct?

BLAIR: That's right, it has been successful. Actually, it's pretty unusual in the state of Texas. But it has been successful in the case back in '98 where the woman killed children and pled insanity based on postpartum and other things.

BATTISTA: Do you think that the D.A. will go after the death penalty in this case?

BLAIR: Well, what we have to consider is -- were you asking me?

BATTISTA: Yes.

BLAIR: What you have to consider is that first of all the grand jury has indicted this woman. Another jury most likely is going to decide whether she's competent to stand trial and can assist in her defense. And then, yet another jury will find her guilty and if they find that her insanity defense is not valid -- in other words, that she did commit capital murder -- what other case should the highest penalty be applied to, if not this one? I think that the D.A. has every reason in the world to seek it.

BATTISTA: Skip?

SIMPSON: I think it's a total mistake for the D.A. to even attempt a capital murder case in this -- in this instance. We're involved in a killing machine, almost, in Texas. And what we need to do in -- incidentally I am in favor of the death penalty as a general rule, and I'm an ex-federal, state, military prosecutor and feel strongly about those issues.

But in this particular case, just because this mother has killed these children, doesn't mean that we go up now and kill some mother because of that. What it has to be is a very careful analysis of what the facts were, looking at the very instant that those deaths occurred. Was there a mental element there? Before this -- these killings ever occurred, there should have been a complete suicide assessment, assessment done to determine whether or not if there was homicidal thinking and then preventative action before this ever occurred.

BATTISTA: So that would be the civil suit later, is what you're saying.

SIMPSON: Well, no, that's also a part of the criminal case.

BATTISTA: Uh-huh.

SIMPSON: In other words, we're looking again at that moment, what was going on in her mind. And if -- if before that time, this was something that would be very unusual for this lady, and then after that time, you look at those -- those matters also. And -- but what I'm saying is that very shortly after the deaths occurred, then she would be able to act like a normal person, so to speak, for a certain period of time.

BATTISTA: Well, I think we need to probably get more information here on postpartum psychosis. So let me bring in Dr. Nada Stotland who is a psychiatrist and a specialist in women's mental health at Rush Medical College in Chicago. And Nancy Pfotenhauer is also with us today. She is president and CEO of the Independent Women's forum. Dr. Stotland, let me start with you, because there is confusion here, I think, about what is postpartum blues, depression, psychosis.

DR. NADA STOTLAND, WOMEN'S HEALTH PSYCHIATRIST: There's sort of a spectrum. Postpartum 'baby blues' is something that nearly everybody has. It comes on soon after you have the baby, within a day or two. You feel everything very intensely. You may cry. It's not really depression. OK, it goes away by itself.

Postpartum depression is something that about 10 percent of new mothers have. It can take some weeks to set in. And that's why you're out of the hospital, you're not in immediate medical care. That's a problem. Nobody expert is watching you. And then postpartum psychosis is even more serious and even more rare. That's well less than 1 percent of new mothers. And that's being psychotic. Being out of touch with reality.

BATTISTA: Can it be used as a defense for murder?

STOTLAND: Well, it certainly has been. You've got lawyers with you. But it certainly has been. Many of the women who in this kind of state -- and I'm not speaking about a particular patient, because I haven't seen her myself -- have various kinds of delusions. OK. They either -- once in a while they think that the baby or the child is Satan, is evil. More often, they feel bad. They feel bad about themselves. So they think that they can't take proper care of their children. I mean, we're talking about to a psychotic degree, now.

As one of the lawyers mentioned, they don't think they deserve to be on earth, and they don't want to leave that child or those little children behind them. They want all of them to be together and have it -- they don't want to leave them unprotected. So that's the kind of delusions that somebody has when she has a postpartum psychosis.

BATTISTA: Nancy, I just think to most sane people, the whole idea of killing your children is -- I may not be under the definition of law -- but it's insane.

NANCY PFOTENHAUER, PRESIDENT & CEO, INDEPENDENT WOMEN'S FORUM: Well, so far as I can -- as I can tell, what we've got here is a situation where a woman was mentally ill and was suffering from psychosis. Having said that, I guess I just don't buy that she should be unaccountable totally for her actions. And my guess is that she should be brought before a jury or a series of juries, and that they should make up their mind about to what extent she should -- she should have to pay some price for hunting down and drowning five innocent children. I mean, the two older boys, she -- I mean, she chased 7-year-old Noah and held him under water and killed him.

BATTISTA: I don't -- and I'll check with Skip here, but I don't think anybody anywhere was ever advocating that this woman not be held accountable for her actions in some way.

PFOTENHAUER: Well, maybe it's a series of degrees then. One thing that I think that matters a lot to those of us who are moms is this -- is that there's a little bit of a perception that every woman has at some point or every mother has at some point looked at her children and -- and understood the murderous impulse. In fact, Anna Quindlen wrote in a column that when she talked about women -- talked to women about this, that she sees that kind of recognition in their eyes. And as the mother of five myself, I just tell you that I -- I have never found that.

BATTISTA: I'm sorry, you guys. I have to take a quick break here and then I'll get to the audience also and some e-mails, and we'll continue here in just a moment. We'll also talk to a person who has suffered from postpartum depression. Stay with us.

(COMMERCIAL BREAK)

BATTISTA: Welcome back. A couple of e-mails here. Nancy in Missoula, Montana says: "As someone who suffers treatment-resistant clinical depression, I know that there are not words to describe how I feel. For Andrea Yates to do what she did, her pain took her into another dimension. No one who has not suffered the same has the right to pass judgment."

Larry in New York says: "This mother showed a deliberate, methodical plan by drowning her children one after the other. I've suffered from depression myself, and any thoughts of causing injury were to myself, not others. She deserves nothing less than the death penalty."

We -- I want to bring in another guest now. Pam Hainlin is with us. She's a mother of three, and she is in treatment for postpartum depression. She's also president of Mothers and More, a support group for women who have left the work force to stay home with their children.

Pam, thanks very much for joining us.

PAM HAINLIN, POSTPARTUM DEPRESSION PATIENT: Thank you.

BATTISTA: Tell us, if you will, a little bit about your experience with postpartum. When did you first notice you had a problem?

HAINLIN: Well, I have three young children and I had depression, some depression, after the birth of my first, but I didn't recognize it as postpartum. After the birth of my second, it was worse. I actually got help through my obstetrician, got pregnant with my third, and had it much worse then, and actually was referred to a psychiatrist who specialized in postpartum depression for the medical treatment.

BATTISTA: And what kind of symptoms were you having, what kind of thoughts were going through your head?

HAINLIN: It's extreme sadness, devastation, despair. You don't have anything to look forward to. I personally did not have bad thoughts toward my children. I did have bad thoughts toward myself, really more along the lines of I'm not a very good mother, I should just walk off into the sunset because they would do -- be better off without me. Really almost incapacitating.

BATTISTA: And when you received treatment for this, was it almost just instantaneous, the change? I mean, were you just suddenly back to being yourself?

HAINLIN: Well, I think it depends on the treatment. The medication that worked for me took about a week to work. I think it varies depending on the medication. A week later, though, yes, there was a noticeable difference.

BATTISTA: And how do you feel about the Andrea Yates case? Can you imagine someone being that sick and going that far with those thoughts?

HAINLIN: As a mother, I can never imagine anybody killing a child. Having had depression, though, and after the birth of my third, it was quite severe. I had never gone into a psychosis, but I can see where I was very close. I do think it conceivable that somebody could get into a psychotic state because of postpartum depression. What they do in that state, though, you know, I couldn't give a guess.

BATTISTA: Let me bring Shirley -- is it Shirley in the audience in, also? -- because you, too, say that you suffered from postpartum depression. Was it depression? Or it was more than baby blues?

SHIRLEY: I think it probably -- it probably fell somewhere between baby blues and postpartum. As I listen to the experts discuss, you know, this condition, I know I never felt like hurting my children, but I felt this enormous sense of helplessness and inability to protect my children. I was almost obsessed with doing everything for them myself, because I was sure that if I didn't something would happen to them. And that's what I remember most.

It was a long time ago, because my children are adults now.

BATTISTA: Well, Dr. Stotland, what sends somebody just over the edge then?

STOTLAND: Well, we don't really know what causes psychosis. Certainly, hormonal changes are part of what precipitates the depression. What makes that depression -- the depressions, usually, just the way Pam said, get worse and worse after each baby. But what makes it go all the way, we do not know.

PFOTENHAUER: You know, Bobbie, it strikes me that one important role here that maybe we should spend time addressing is -- is the role played by family members who are in a position to observe the gradual deterioration of their loved-one and the potential risk that the children might be exposed to.

BATTISTA: I think there's not enough education about that also, but I want to ask Pam quickly if her family was supportive of her when she was going through all this, or did they just think you were in a foreign land somewhere?

HAINLIN: Oh, no, they were extremely supportive. And they knew me very well. And my actions and my thoughts when I was depressed were so different than how I usually am that they -- that it was noticeable. I do have to say, though, that I think maybe even more important is the support from the medical community. Having -- I had an obstetrician that was excellent, was right on top of it. But I do have friends who went through this whose obstetricians were not as quick to identify postpartum depression. And it's still really not discussed.

It wasn't discussed while I was pregnant. I didn't know what to expect. I didn't know to recognize it. My obstetrician helped me with that, but I felt very alone. STOTLAND: I want to agree with that. It's very important to have shows like this so pregnant women understand about this disorder. But it's hard to hear. When you're pregnant and you're happy, it's hard to hear: People don't hear thing about having to have caesarean sections. They don't hear things. It doesn't sink in.

Families are extremely important, and they can be a problem in the sense that doctors and families may say: You're supposed to be tired, no wonder you're having trouble concentrating, no wonder you can't eat, because you have a new baby. That's how all, you know, new mothers are. But if you can't sleep even when the baby is sleeping, that's a problem.

The other thing families -- the other mistake families can make is to say: This is the happiest time of your life. How you can be sad? And it makes the woman feel even worse.

HAINLIN: If you're yelled at because you're sad when you're sad I can't see how that can be a good thing.

BATTISTA: I have to take a quick break here, and Pam Hainlin, we say thanks to you. We appreciate you joining us today and sharing your experience. We'll be back in just a moment.

(COMMERCIAL BREAK)

BATTISTA: A couple of more e-mails here. "I feel that in this society today we're too quick to make excuses for bad behavior, and until we take the tough approach and stop letting mature adults get away with murder, that this behavior will continue to increase."

Meredith in Virginia Beach says: "I feel so sorry for this woman. I experienced this type of depression 32 years ago. Nothing could be more painful or more of a living hell. I also wanted to kill my son and commit suicide."

Gladys is on the phone from Ontario. Gladys, go ahead.

GLADYS: Yes, I just wanted to say, too, how much it saddens me that people do not understand any type of mental illness, any type of psychosis. And they want -- I'm calling -- yeah, I'm calling from Ontario, Canada, and we have the same problems in Canada as the U.S. And people that need the help for mental illness do not get it. And I think part of Andrea's problem was that she felt she was a bad mother, so she wanted kill her children to get them out of the misery. That is part of the psychosis.

BATTISTA: You know, Skip is back with us now. I want to bring Nelda and Skip back in, too, and everybody else jump in when they want to, because we're getting a lot of -- a lot of e-mails like this one that says, you know: "Why did her husband leave her at home with these five children?" They knew about her history with this condition or diseases or whatever, and you know, the fact that she was on medication and was suicidal at one point. Why was he leaving her home alone with all these children? And should he be held partly to blame? SIMPSON: Let me address that if I can. I can say that I really agree with what the physician on this program has said. One of the things that you do is with patient information is that you bring the family in, and you explain to the husband and to all the family members, here's what our problems, here's what our concerns are, here's the clues that you need to watch out for. Here's what happens are thinking of suicidal, homicidal things. If anything like this happens, make sure you get us on the phone, take the lady or your wife to the emergency room or whatever.

Most likely, this man never got any kind of patient information like that. This is an issue of prevention. It's not Andrea's fault or the lady's fault that she got depression. That's something that came about. Then because of the depression, because of the psychotic break, being out of touch with reality, she killed the children. And now the state of Texas wants to kill her? Something's not working here. That's not the way we as a nation and as a state should react. And what we should do is be thoughtful, think about mental illness, and treat it the way it ought to be treated.

BLAIR: Now, remember, however, that Andrea Yates is going to have an opportunity to show through her attorneys that this disease was so bad that she didn't know that she was in a state, that she didn't know killing her children was wrong. And if they prove that, she will not be convicted of capital murder because her -- because of her mental state. But if she wasn't to a point that she didn't know it was wrong, if she killed her children in spite of the fact that she knew it was the wrong thing to do, then she should not simply go free.

Whether or not she should be put to death, or in Texas it's life imprisonment -- but it is not without parole, she will eventually get out -- is another question.

STOTLAND: Well, it's very hard for people to understand psychosis. They think if you're out of touch with reality, you shouldn't be able to breathe, eat, walk or do anything. You should just be raving. But it's not that way. It waxes and wanes, like heart disease. And you can carry out activities even though the reason in your mind is psychotic.

BLAIR: But where do you draw that line and where do you make that measurement for anyone who murders someone else?

PFOTENHAUER: Well, and one thing that I think it might, when we talk about prevention, it might be good for us to discuss here with this audience is many of us who have dealt with family members who have had problems -- whether it's alcoholism, eating disorders, or different or more serious kinds of mental illness -- there's almost a codependency that happens among the family members where you all passively agree not to acknowledge how bad the situation is. And that means that you don't get the treatment for the person that really needs to be retained or maintained so that they can keep from harming themselves and keep from harming their family members.

BATTISTA: I still don't understand sometimes the arbitrary nature, it seems, of the insanity defense, because I'm still getting over the fact that Jeffrey Dahmer was not found insane. I mean, the guy was a living Hannibal Lecter and he was not found to be insane. So I'm just not sure, you know, where -- you're right -- where the parameters are on that.

Let me go up here to a question from the audience.

UNIDENTIFIED MALE: Edward, go ahead.

EDWARD: Do you think that because of the brutality of this case, will it set women back from admitting that they have postpartum depression for fear that people will think they're monsters?

STOTLAND: Well, I think it will -- I think it scares people, because we have to remember that only a very small proportion of people who have depression go on to get psychotic. But I can imagine how scared those depressed mothers and those families are all over this country right now.

BLAIR: And in another vein, though, it might heighten awareness so that husbands and families might say, hey, maybe we should take this a little more seriously.

SIMPSON: I agree with that.

BATTISTA: Her medication also comes into question from this e- mail from Margaret in North Carolina, who says: "I'm greatly concerned that the drug Haldol, which had been prescribed for Andrea Yates, this drug was prescribed for my elderly mother, and I was horrified when she temporarily lost her mind, and I was unable to converse with her or reach her."

STOTLAND: Well, that's a problem that sometimes happens with elderly people, especially elderly people in an institution -- there has been a lot of work on that -- who are wandering or otherwise troublesome to the staff, who sometimes get overmedicated. And they need, when they take psychiatric medication, usually to take much less. But I think this is a different situation with a younger person.

BATTISTA: A question from the audience. Is it Janika?

JANIKA: Janika.

BATTISTA: Janika.

JANIKA: I was just wondering what the history of the disease was, because lately in the media it seems to be popping up a lot, and I hadn't really heard much about it before now. So I was wondering if that's happened before.

STOTLAND: It's been known since before the birth of Christ, this disease.

SIMPSON: I can't speak to that, but it has been known for a long time, for sure.

BATTISTA: And is it something, doctor, that we've just kind of been sweeping under the rug or...

STOTLAND: Well, (UNINTELLIGIBLE) you're supposed to be happy. The psychiatric profession has known about it for a long time, but we haven't, obviously, gotten it out there enough to the public and to the obstetricians.

BATTISTA: Well, we should say, too, that -- what? -- how much, 1 or 2 percent of the women who reach the stage of psychosis. Correct? I mean...

STOTLAND: Or less.

BATTISTA: Just a very small amount.

(CROSSTALK)

PFOTENHAUER: It's 0.01. It's one out of every 1,000 women who have postpartum depression seem to -- you know, get caught in this downward spiral to postpartum psychosis.

SIMPSON: Well, one thing that we ought to look at, though, is that 20 percent of the United States at any one time is suffering from major depression. And so it may be postpartum depression, but just, if you look at major depression, that is a very serious illness, and people who are major depressed sometimes -- 30,000 people a year are committing suicide. So every one minute someone is thinking about it and every 15 minutes someone's doing it.

And if they're in that state and they're a young mother, they should also be asked by the psychiatrist or mental health provider, "Are you thinking about killing anyone else besides yourself?"

So we should be careful to not downplay this, because suicide, like I say, is now fortunately the 11th cause of -- leading cause of death in the United States. It was eight. Now it's 11. But a lot of those people are mothers, and those mothers need to be asked that question. That is the standard of care. And it has been since 1969.

BATTISTA: I've got to take another quick break here. We'll check the online viewer vote when we come back.

(COMMERCIAL BREAK)

BATTISTA: We're back, and I wanted to ask all of you from both a legal and medical standpoint why other countries, for example, consider infanticide different from other murders. It's treated differently. We certainly think of it as different. It's not like other murders. Should it be treated differently under the law and from a medical standpoint?

STOTLAND: I believe so. I think the other countries recognize that there are severe hormonal changes, and that people aren't, when they are that ill, are not totally accountable for what they're doing. That isn't to say nothing should happen to them.

BATTISTA: Nancy, on the other hand, you worry about others co- opting this defense, although wouldn't it be difficult?

PFOTENHAUER: Well, I just think -- I think that we have to be very careful here not to get overly casual with the idea that being depressed somehow excuses for your actions. If we were discussing, instead of this case today, a man who was depressed, drinking and beat his wife, and then said, let me explain, we wouldn't have very much sympathy.

I tend to think -- again, I'm biased, I'm the mother of five kids -- but I tend to think that if someone kills an infant, who is totally defenseless, that they should be held to a pretty high standard, that they should -- they should be accountable, if not as severely, more severely.

BLAIR: (UNINTELLIGIBLE) the state of Texas thinks that, too, because one of our levels of capital murder is children six or under. It's a special, special category of capital murder.

SIMPSON: Well, one of the things...

PFOTENHAUER: They're totally unprotected, they're totally vulnerable.

SIMPSON: One of the things we need to do is educate the lawyers and educate the judges and educate the judiciary on this, because we're not talking about just depression, we're talking about major depression, a psychiatric disorder. And we're talking about what happens at the time of the offense and whether or not the criminal intent is there with the act. If it's there, I put people in the penitentiary for doing that and would be glad to do it again. But if it's not there, you don't do it. You just have got to think these things through better than what we're doing right now.

BATTISTA: All right. A quick check of the online viewer vote. Should prosecutors seek the death penalty in the Yates case? 49 say yes, 51 say no.

Nelda Luce Blair, Skip Simpson, Dr. Nada Stotland, and Nancy Pfotenhauer, thank you all very much for joining us today.

SIMPSON: Thank you.

BLAIR: Thanks for having us.

BATTISTA: And thank you for joining us. We'll see you tomorrow for more TALKBACK LIVE.

TO ORDER A VIDEO OF THIS TRANSCRIPT, PLEASE CALL 800-CNN-NEWS OR USE OUR SECURE ONLINE ORDER FORM LOCATED AT www.fdch.com