In certain respects, what happened after Andrea Yates killed her five children last June was no different from what happens in any other murder case. Once her husband left for work, according to her confession taped by police, she methodically drowned her four sons and one daughter, ranging in age from 6 months to 7 years, by placing them one-by-one into the filled bathtub in her home in a Houston suburb. Those acts were followed by the predictable tragic aftermath of sorrow, pain, confusion and bewilderment, and then by the legal system stepping in to bring justice and, finally, retribution.

What it did not do, like every other similar mass murder that came before it, was resolve the seemingly age-old conundrum of criminal responsibility for acts committed while insane. Once again, media pundits raised troubling questions: Was the insanity defense implemented either too harshly or too leniently? Was mental illness treated too aggressively with myriad medications of limited value, or too haphazardly with a startling lack of collaboration among physicians?

The Yates murder case also raised gender issues. Feminist groups rallied around Andrea and her misunderstood postpartum depression, while men's rights groups railed against critics of her husband, Rusty, who was accused of a lackadaisical response to his wife's illness.

Although not in time for the Yates case, these issues may be resolved soon. The American Academy of Psychiatry and the Law (AAPL) is scheduled to release its practice guidelines this summer, a first-ever effort to bring some consistency to forensic evaluations of mentally ill individuals accused of crimes. Two years in the making, the Practice Guidelines for Forensic Psychiatric Evaluation of Defendants Raising the Insanity Defense will catalogue accepted methods for handling such cases, Howard V. Zonana, M.D., told Psychiatric Times. Zonana is AAPL's medical director and professor of psychiatry at Yale University School of Medicine.

"People have argued for hundreds of years about what the appropriate test for insanity is, and there's always a great deal of distress there," Zonana said. "There are a lot of myths about the insanity defense, [such as] how frequently it's used."

That passage of time, even though it has seen major advances in the understanding and treatment of mental illness, still has not resulted in forensic psychiatrists knowing any more about what makes people respond to the symptoms of their disease in certain ways.

"There are a lot of people who hear command hallucinations, but not everybody listens to the commands," Zonana told PT. "You can't just say because someone has command hallucinations that they had to follow those commands. But we don't have any test to know which people do, can or can't follow those things. We are still left to sort of dealing with a certain degree of approximations in those answers." He continued, "Most schizophrenics stop at red lights. Just the fact that you have a disorder doesn't get you over the hump."