OUSTON, Sept. 7 — She picked at her head until she scratched bald spots on her scalp. Her blackest depressions left her mute and catatonic, unable to recognize any semblance of hope. She tried to commit suicide in June 1999 and berated herself for failing. She thought, as a nurse, she should at least know how to kill herself.
And barely a month after that first suicide attempt, Andrea Yates tried to slash her own throat before her husband grabbed the knife.
Later, she admitted: "I had a fear I would hurt somebody. I thought it better to end my own life and prevent it. There was a voice, then an image of the knife. I had a vision in my mind, get a knife, get a knife."
These details of a woman tormented by periods of psychosis and depression emerge in more than 1,000 pages of medical records recently filed in court by lawyers for Mrs. Yates, the mother who has admitted drowning her five young children one by one in a bathtub in their home in the Clear Lake section of Houston. Mrs. Yates, 37, has inspired both outrage and pity in a case that has resonated so deeply across the country that the National Organization for Women has condemned the decision by the local district attorney to pursue the death penalty.
The medical records — written observations from doctors, psychiatrists, nurses and social workers during and after her hospitalizations since 1999 — portray a shy woman bereft of self-esteem, overwhelmed by raising her five children with little help, yet unable to admit her frustrations or ask for help. Her two suicide attempts in 1999 followed the birth of her fourth child, Luke, when she was diagnosed with postpartum psychosis, and she fell into another bout of depression and psychosis this year after her fifth child, Mary, was born.
The records also seem to provide a grim foreshadowing. when barely two months before the death of her children, Mrs. Yates was found staring at a bathtub filled with water. Her husband believed she intended to kill herself and sought medical help.
Her husband, Russell Yates, a NASA engineer who eulogized his five children at their funeral and who has expressed support for his wife, is depicted in the records as sympathetic and loving during her hospitalizations. Yet he is also described by one doctor as controlling.
In one group therapy session, Mrs. Yates said her husband allowed her two hours a week of personal time.
A psychiatrist fretted that the couple's determination to have a big family was putting a severe strain on Mrs. Yates, who home schooled the children. "Apparently Pt. and husband plan to have as many babies as nature will allow!" the psychiatrist, Dr. Eileen K. Starbranch, wrote in 1999, using the abbreviation of "patient" for Mrs. Yates. "This will surely guarantee future psychosis and depression."
The release of the medical records, which were filed in court last week, comes as prosecutors and defense lawyers are preparing for a hearing next week to determine whether Mrs. Yates is competent to stand trial. State District Court Judge Belinda Hill has prohibited lawyers and others, including Mr. Yates, from discussing the case, but Mrs. Yates's family has said to the local news media that they think she may be found competent because she has improved since taking medication in jail. Mrs. Yates's lawyers have already entered pleas of not guilty by reason of insanity to the murder charges.
According to the medical records, Mrs. Yates had never been treated for mental illness before her first suicide attempt in June 1999, roughly six months after the birth of her fourth child, Luke. Doctors diagnosed her with postpartum psychosis and depression after she attempted to overdose on her father's prescription medicine. Her father, according to some of the records, had a history of depression, while two of her brothers and a sister also had suffered different degrees of mental illness.
Mr. Yates said his wife also faced additional stress from helping to take care of her father, who had Alzheimer's Disease.
"She states that she just wanted to sleep forever," one record said of Mrs. Yates's first suicide attempt.
Mrs. Yates spent the next week at a local hospital, where she was prescribed Zoloft for depression. At the time, the Yates family was living in a converted Greyhound bus, and Mr. Yates told a hospital social worker that he was training his sons, including the 3-year-old, to use power drills, because they enjoyed woodworking. The social worker filed a complaint with Children's Protective Services, but the state agency ultimately declined to pursue it.
One record said Mrs. Yates was discharged after seven days because of insurance restrictions. Records described her as "quite depressed" upon her discharge but no longer suicidal. But on July 21, less than a month later, Mr. Yates found his wife holding a knife to her neck. He admitted her to another hospital, and doctors learned that she had stopped taking her medications.
Mrs. Yates described hearing voices and having a vision about getting the knife. She said that she had first had such a vision after the birth of her first child.
Asked what may be missing in her life, Mrs. Yates told the social worker that "she spends all her time in child care, has been living in a motor home part time and with her elderly, medically frail parents part time.
"Pt. agrees she needs more help with child and home responsibility, needs some activities only for her."
She remained hospitalized for 19 days and began attending group therapy sessions. She was also prescribed the anti-psychotic drug, Haldol, and began to improve.
Near the end of the stay, Mr. Yates became "very eager" for his wife to be discharged and "is putting some pressure on her" to leave the hospital, a psychologist wrote, noting that Mrs. Yates would continue outpatient therapy.
"He reports Pt. is 90-95 percent back to normal; she reports it's more like 70-75 percent," the psychologist wrote. She noted that Mr. Yates planned to work half-days at home and that the family had moved into a new house.
"Nevertheless, stress level will remain high," the psychologist continued. "This couple plans to have Pt. home school their children. They also hope to have additional kids. Suggested they consider Pt.'s best interest in making these decisions."
The birth of her fifth and final child, Mary, prompted another bout of depression and psychosis in Mrs. Yates earlier this year, according to records. Her father had also died a few weeks earlier. Between March and May, she spent four stints at a psychiatric hospital. In April, her physician, Dr. Mohammed Saeed, sought a court order to have her committed, noting that she was catatonic and had scratched bald spots onto her head. He dropped the proceeding after Mrs. Yates voluntarily agreed to sign in.
On her last day at the hospital, May 14, records indicated that Mrs. Yates was still depressed and had suicidal impulses. She asked to go home and start outpatient treatment, records show. Dr. Saeed agreed and discharged her for the last time.