Martha Burks v. State

• Court: Court of Appeals of Texas
• Decided: August 23, 2007
• Docket: 14-05-00921-CR
• Status: Published

Opinion

Affirmed and Memorandum Opinion filed August 23, 2007

Affirmed and Memorandum Opinion filed August 23, 2007.

In The

Fourteenth Court of Appeals

_______________

NO. 14-05-00921-CR

MARTHA BURKS, Appellant

V.

THE STATE OF TEXAS, Appellee

On Appeal from the 212th District Court

Galveston County, Texas

Trial Court Cause No. 03CR2734

M E M O R A N D U M   O P I N I O N

Appellant, Martha Burks, was charged with aggravated assault after she stabbed her five-year-old daughter.  A jury rejected appellant=s insanity defense, found her guilty, and sentenced her to twenty years= confinement.  In appellant=s sole issue, she contends the evidence is factually insufficient to support (1) the jury=s rejection of her insanity defense, and (2) the jury=s finding that she possessed the requisite culpable mental state.  Because all dispositive issues are clearly settled in law, we issue this memorandum opinion and affirm.  See Tex. R. App. P. 47.4.

I.  Background

Appellant does not dispute that she stabbed her five-year-old daughter, S.B., with a knife on September 6, 2003.  It is also undisputed that appellant has a history of mental illness.  Over the years, she has seen various professionals, been hospitalized numerous times, and intermittently taken medication.

At the time of the stabbing, appellant and David Burks had been married thirteen years, had three children, and lived in Texas City.  David testified regarding appellant=s mental problems and the incident at issue.  He first noticed appellant=s problems early in their marriage.  For many years, she alternated between normal and irrational behavior.  From 2001 to 2003, appellant was hospitalized several times.  In February 2003, her problems became more frequently manifested.  Appellant had recently returned to Texas City after temporarily living with her mother in Louisiana.  She obtained her own apartment, but David allowed her to visit the children, who had remained with him.  However, a court ordered a ninety-day commitment after appellant forcibly took S.B. and her twin brother from their babysitter.  Despite David=s objection, appellant=s psychiatrist released her early, and she returned to the family=s home in May 2003.

 Subsequently, consistent with a recurring pattern, appellant quit taking her medication, and her problems escalated.  She previously offered various excuses for her refusal to take medication.  But, this time, she informed David that Avoices@ told her to quit taking it.  When David insisted she take it, she claimed Jesus had healed her.  In late August 2003, she retrieved S.B.=s twin brother from school because the voices told her to go to Dallas.  However, she turned around upon realizing she knew no one in Dallas.

 In the days leading up to September 5, 2003, appellant exhibited additional strange and Amanic@ behaviors.  One evening, she showered fully-clothed and then lay on the kitchen floor.  On one occasion, she rolled in mud and excrement in the dog pen.  She also urged the children to kick the dog.  At one point, David found appellant sitting on the toilet, eating feces, and smearing it on her face because Athe voices@  told her to Aeat shit.@^[1]  Appellant spent considerable time reading her Bible and subsisted on cigarettes and coffee.  David estimated she did not sleep for nine or ten days before the stabbing.

On September 5, 2003, David took appellant to see her psychiatrist, Dr. George Sloganhoff.  After appellant=s examination, David relayed his concerns to the doctor.  David felt the doctor was dismissive towards appellant=s condition because the doctor did not order hospitalization.  Appellant became irritated that David spoke with the doctor and requested the keys to his truck, ostensibly to smoke a cigarette.  However, she left in the truck.  David took a taxi home and found appellant in the backyard staring at the sky.  That evening, she remained incoherent and unresponsive to her family.  She mostly smoked cigarettes, drank coffee, and read her Bible.  S.B. watched cartoons and colored.^[2]  David fell asleep while watching television in his bedroom. 

Shortly after midnight, David was awakened by screaming, followed by S.B.=s cries.  He ran to the living room where appellant was sitting on the couch, howling like a wolf, and holding a steak knife.  He knocked the knife from her hand, cuffed her mouth, and asked what she had done.  Appellant responded either, AWe have killed her. You can save her@ or AI have killed her.  Now you save her.@^[3]  David ran to S.B.=s bedroom.  She lay on the floor and was moaning, pale, bleeding, and entering a state of shock.  David summoned emergency personnel and applied pressure to one of S.B.=s wounds.  In the meantime, appellant had gone to the back yard, so David locked her out. 

Police officers eventually transported appellant to the Texas City jail.  S.B. sustained two stab wounds: to the back and chest.  She was hospitalized for four days, but fully recovered with no recollection of the incident. A court imposed a protective order precluding appellant from physical contact with the children, who continued to  live with David.

After appellant=s arrest, pursuant to the trial court=s orders, she was evaluated by two psychiatrists relative to the insanity issue.  The doctors reported conflicting opinions on whether appellant was legally insane when she stabbed S.B.  At trial, the parties presented extensive evidence concerning appellant=s mental state at the time of the incident, including the testimony of both doctors.  The jury was instructed regarding the insanity defense and given the option to find appellant not guilty by reason of insanity.  However, the jury found appellant guilty of aggravated assault, thereby rejecting the insanity defense.

II.   Rejection of Insanity Defense

We will first consider appellant=s contention that the evidence is factually insufficient to support the jury=s rejection of her insanity defense.

A.        Standard of Review

A defendant bears the burden to prove the affirmative defense of insanity by a preponderance of the evidence.  See Tex. Pen. Code Ann. ' 8.01(a) (Vernon Supp. 2006); Tex. Code Crim. Proc. Ann. art. 46C.153(a)(2) (Vernon 2006);  Reyna v. State, 116 S.W.3d 362, 366 (Tex. App.CEl Paso 2003, no pet.) (citing Meraz v. State, 785 S.W.2d 146, 150 (Tex. Crim. App. 1990)).  The essential question is whether, at the time of the conduct charged, the defendant, as a result of severe mental disease or defect, did not know her conduct was wrong.  Tex. Pen. Code Ann. ' 8.01(a); Reyna, 116 S.W.3d at 367; Plough v. State, 725 S.W.2d 494, 500 (Tex. App.CCorpus Christi 1987, no pet.).

The insanity issue is not strictly medical but also invokes legal and ethical considerations.  Bigby v. State, 892 S.W.2d 864, 877 (Tex. Crim. App. 1994) (citing Graham v. State, 566 S.W.2d 941, 949 (Tex. Crim. App. 1978)); Reyna, 116 S.W.3d at 367.  Expert testimony may aid the jury in its determination of the ultimate issue, but does not dictate the result.  See Graham, 566 S.W.2d at 949; Reyna, 116 S.W.3d at 367.  Only the jury can join non‑medical components that must be considered in deciding the ultimate issue.  Bigby, 892 S.W.2d at 878 (citing Graham, 566 S.W.2d at 949); Reyna, 116 S.W.3d at 367.  Because circumstances of a crime are always important in determining the accused=s mental state at the time of the offense, the jury may consider such evidence as her demeanor before and after the offense, attempts to evade police, attempts to conceal incriminating evidence, expressions of regret or fear of the consequences of her action, other possible motives for the offense, and other explanations for her behavior.  See Graham, 566 S.W.2d at 951B52; Torres v. State, 976 S.W.2d 345, 347B48 (Tex. App.CCorpus Christi 1998, no pet.).

Ultimately, determination of the insanity issue lies within the province of the jury, as to credibility of witnesses and weight of the evidence, as well as the limits of the defense.  See Bigby, 892 S.W.2d at 878 (citing Graham, 566 S.W.2d at 952); Reyna, 116 S.W.3d at 367.  In examining factual sufficiency of the evidence to support a jury=s rejection of an insanity defense, we review all the evidence relevant to the issue to determine whether the judgment is so against the great weight and preponderance of the evidence that it is manifestly unjust.  Bigby, 892 S.W.2d at 875 (citing Meraz, 785 S.W.2d at 155); Reyna, 116 S.W.3d at 367.  We will overturn the jury=s decision only when insanity is undisputed or resolved to one end of the spectrum outside the realm of discretion.  Reyna, 116 S.W.3d at 367 (citing Bigby, 892 S.W.2d at 878).

B.        Expert Testimony

To support her factual-insufficiency challenge, appellant primarily cites the contrasting testimony of the experts who evaluated appellant.  As explained below, both doctors agreed that appellant suffered from a severe mental disease and heard voices which commanded her to slaughter S.B.  However, the doctors disagreed regarding the appropriate diagnosis and whether appellant knew at the time of the offense that stabbing S.B. was wrong.

1.         Dr. Michael Fuller

Appellant presented testimony from Dr. Michael Fuller, an associate professor of psychiatry at University of Texas Medical Branch in Galveston.  When appellant requested pre-trial evaluation by a psychiatrist, the trial court appointed Dr. Fuller.  He reviewed most of appellant=s medical records from previous hospitalizations and met with appellant, her mother, and David.

In October 2003, Dr. Fuller conducted four separate interviews of appellant, lasting about one hour each.  During the first interview, she expressed guilt and remorse about hurting S.B.  She recited a previous diagnosis of bipolar disorder.  Dr. Fuller testified bipolar disorder causes a person=s emotional state to alternate between severe depression and severe euphoric, delusional psychosis.  Appellant said she experienced a severe episode of mania and heard voices for three or four weeks before the stabbing and had not slept for many days.

During a subsequent visit, Dr. Fuller also recognized symptoms of a previously undiagnosed Adissociative disorder,@ which occurs when one has learned as a child to mentally separate from overwhelming trauma.  During a prior hospitalization as a teenager, appellant  recalled she was raped at age seven or eight by her older brother, and her mother beat her when she mentioned the rape.  Dr.  Fuller found her recollection was credible.  Appellant, her mother, and David told him that appellant had a history of sexual promiscuityCbehavior consistent with sexual abuse as a child, bipolar disorder, and borderline personality disorder, which is associated with a dissociative disorder.  Further, David reported appellant once curled up in a ball saying, Amommy, don=t hit me@ after he yelled at herCan incident highly suggestive of dissociative disorder.

Over the course of the four interviews, Dr. Fuller obtained information from appellant regarding the Avoices.@  During the first meeting, appellant reported the voices claimed her torment would cease if she complied with their commands to stab S.B.  When Dr. Fuller asked if S.B. was an intentional victim, appellant responded Ano, she was just there.@  Appellant was unable to clarify the origin of the voices.

During the second visit, appellant reported that the voices waged a battle between good and evil within her, and she feverishly read the Bible to find answers to these torments.  Several days before the stabbing, the voices told her she was Alower than dirt@ and instructed her to eat dirt and feces.  Dr. Fuller believed appellant ate feces because David also mentioned the incident.  Dr. Fuller testified that eating one=s own feces is caused exclusively by profound psychosis or brain damage because that act is incomprehensible in every culture.  Dr. Fuller described the last few minutes of this interview as Achilling.@  Appellant relayed that Satan told her she is a star and must slaughter her children to resume her destiny in the heavens.^[4]

During the third meeting, appellant assured Dr. Fuller she had literally been a star in earthling form.  In the heavens, other stars denigrated her because they were required to skin their children alive to resume their place in the heavens while she was compelled to only sacrifice her child.  In addition, appellant repeated psychotic statements involving Aclang like associations,@ such as Alame@ and Alamb@ and Ababy alone@ and ABabylon.@  She interjected that God created her as a vessel to capture demons.

By the last visit, appellant=s thoughts had changed into perceptions with a Christian background.  She expressed she had been chosen by God, and the voices at the time of the stabbing originated from God.  She again referenced her notion that God used her as a vessel to store demons and prevent them from injuring other people.

Dr. Fuller ultimately concluded that, on the night appellant stabbed S.B., she was extremely psychotic as a result of uncontrolled bipolar disorder, which had driven her to absolute mental and physical exhaustion.  She believed the war between good and evil transpired within her, and God commanded her to slaughter S.B. to fulfill appellant=s destiny.  Until the moments surrounding the stabbing, she had known right from wrong and resisted commands to harm her child.  However, in the moments surrounding the stabbing, a combination of the severe psychotic state and a dissociative episode separated her from the act she was commanded to perform and she could not discern right from wrong.  In short, she Asnapped.@  Her howl after stabbing S.B. most likely reflected an end to the dissociative state and realization of what she had done.  Accordingly, Dr. Fuller opined that appellant was legally insane when she stabbed S.B.

2.         Dr. Victor Scarano

The State presented testimony from Dr. Victor Scarano, who is assistant professor and chief of forensic psychiatry services at Baylor College of Medicine Department of Psychiatry and also an attorney.  After Dr. Fuller rendered his report, at the State=s request, the trial court appointed Dr. Scarano to evaluate appellant.  Dr. Scarano met with appellant and reviewed some of her medical records, a statement given by David, a police-department tape recorded at the Burks= home, a videotape of appellant=s Abooking@ into the Texas City jail, a recording of appellant=s transportation between the Texas City and Galveston County jails, appellant=s letters to family members, and Dr. Fuller=s report.^[5]

Dr. Scarano testified that he evaluated appellant for four hours on November 24, 2003.^[6]  Appellant told Dr. Scarano about her previously Arecovered memory@ of sexual abuse as a young child by her brother.  Dr. Scarano implied that he was skeptical of this claim based primarily on the lack of corroboration.  Appellant told Dr. Scarano she did not eat or sleep for a week before the stabbing and had eaten dirt and feces.  However, Dr. Scarano doubted she ate feces for several reasons.  He found inconsistencies in appellant=s and David=s recitations regarding this incident.^[7]  Moreover, Dr. Scarano explained that a person who would eat feces must be so Aterribly demented@ or Aabsolutely totally psychotic@ as to require hospitalization.  Such person would be unable to function and could not drive a car, make coffee, act guarded with a doctor to avoid hospitalization,^[8] or engage in lucid conversation just hours after stabbing her daughter^[9]Cactions appellant performed around the time she allegedly ate feces.

Dr. Scarano and appellant also discussed the Avoices.@  She reported that evil voices said she must kill her children to shine like a star.  She initially resisted, knowing it was wrong to hurt her children.  However, she ultimately stabbed S.B. in the abdomen and back and yelled, AI did it.  I did it.@  Appellant stated she was Acrushed@ because she knew this act was wrong.

Dr. Scarano believed appellant heard voices.  However, he found inconsistencies in appellant=s and David=s various statements regarding the time-frame for the voices.  Further, he questioned appellant=s accounts to Dr. Fuller regarding the source of the voices for several reasons: a psychotic person hears one voiceCnot a morass of different voices; voices are usually derogatory; ordinarily, the origin of voices does not change from evil to God; and a voice from God does not command a person to commit an act, such as kill her child, and promise a reward.  Moreover, appellant told Dr. Scarano the voices were evil and specifically denied they originated from God, as she had eventually relayed to Dr. Fuller.  Dr. Scarano suggested that appellant changed her description to Dr. Fuller of the voices from evil to God to help her insanity defense. 

Additionally, Dr. Fuller had asked why appellant did not report such terrible commands to David or her doctor before the stabbing.  She replied that they did not ask the right questions.  Notably, several hours after the stabbing, appellant was transported from the Texas City jail to the Galveston County jail and then returned to the Texas City jail.  When Dr. Fuller asked why, she replied AI don=t know.  I guess I just didn=t give them the right answers to their questions.@  Dr. Scarano testified that appellant=s twice making a similar statement demonstrated an attempt at manipulationCnot florid psychosis.

Dr. Scarano also testified concerning appellant=s use of the terms Alamb@ and ABabylon@ in her meetings with Dr. Fuller.  Because appellant had focused on reading the New Testament book, Revelation, Dr. Scarano looked for references to Babylon in that book.  Appellant=s statement that she was a vessel for storing evil and her description of the war between the lamb and anti-Christ mirrored two chapters of Revelation.  According to Dr. Scarano, these chapters discuss Babylon as the repository of evil and predict a final battle between the lamb and anti-Christ to remove this evil spirit.  Dr. Scarano suggested that appellant obtained some descriptions of the voices from RevelationCnot from her mental state when she stabbed S.B.^[10]

Dr. Scarano also explained the significance of the following items he reviewed:

Appellant=s Letters

On November 1, 2003 (about two months after the stabbing), appellant wrote a letter to her mother stating,

I=m all for divorcing David and getting one third of his retirement.  I can=t wait to move into the cabin.  The Lord doesn=t want me with David this much.  He has shown me.  I=m not worried one single bit.  I=ll be out of here before you know it.  I=m thinking a few months and then maybe the state school.

However, four days letter, she wrote to David, stating she loved him and  was sorry for her actions.^[11]  According to Dr. Scarano, the letters were indicative of a person trying to plan her futureCnot a floridly psychotic or demented person.

Tape of Appellant=s Transportation Between Jails

Approximately six hours after appellant stabbed S.B., Texas City police officer Earl Mendenhoff transported her from the Texas City jail to the Galveston County jail.  Dr. Scarano listened to a police-department tape of their conversation during the ride.  He testified that appellant=s voice was calm and goal-directed, her thought processes were goal-directed and  logical, and she gave appropriate responses to questions.  She did not exhibit psychotic-type behavior or symptoms of mania, such as pressured speech and hyperactivity.  In short, she spoke in a Atotally normal manner.@

Jail Videotape

Dr. Scarano also viewed a videotape from the Texas City jail recorded shortly after the stabbing.^[12]  During cross-examination, appellant focused on Dr. Scarano=s written report that no Abizarre behavior was noted@ on the tape, despite the following actions:  appellant undressed and then put her clothes back on; she lay on the floor when she heard an inmate scream in an adjacent cell; and she urinated and defecated in the corner of her cell.  However, Dr. Scarano explained the reasons for his notation.  When undressing, appellant kept her back to the camera and thus consciously retained a degree of modesty.  Further, it is not unusual for a person to become frightened upon hearing an inmate scream in an adjacent cell.  Moreover, appellant had not relieved herself for a long time and was Avery careful@ to urinate and defecate in a corner.  Then she moved her mattress to prevent urine from flowing onto it.  Dr. Scarano opined appellant was already attempting to bolster her insanity claim.

Dr. Scarano ultimately concluded that appellant suffered a mental disease when she stabbed S.B., but he could not clearly define the defect.  The voices may have been caused by borderline personality disorder so manifest that she was psychotic.  Alternatively, she may have been so depressed due to bipolar disorder that she became psychotic.  Dr. Scarano disagreed that appellant was in a manic state or experienced dissociation when she stabbed S.B.  However, he concluded that, even if she experienced dissociation, she did not lose the ability to discern right from wrong.  Dr. Scarano further disagreed with Dr. Fuller=s suggestion that a person can enter a state of legal insanity at the moment she commits a crime and then suddenly return to a state of sanity.  Instead, Dr. Scarano opined the voices commanded appellant to perform an act she knew was wrong, but she could not resist.  By subsequently yelling AI did it,@ she effectively told the voices, Aall right, already, now leave me alone.  I did do it.  I did it.@  Thus, the statement was consistent with awareness that stabbing S.B. was wrong but inability to resist the command.  Consequently, Dr. Scarano opined that appellant was not legally insane when she stabbed S.B.

C.        Analysis of Experts= Opinions

Appellant contends the Aextraordinary contrast@ between the experts= analyses renders the evidence factually insufficient to support the jury=s rejection of  her insanity defense.  She argues that Dr. Fuller=s analysis was thorough and Adiligently researched@ while Dr. Scarano=s approach was cursory.  However, after reviewing the testimony of both doctors, we cannot say that Dr. Scarano=s analysis was so cursory compared to Dr. Fuller=s evaluation that the evidence is factually insufficient to support the verdict.  Dr. Scarano explained the reasons for his opinion at length and negated many of the factors relied on by Dr. Fuller.  Further, each party thoroughly cross-examined the expert presented by the other party to ferret out purported inadequacies in the doctors= respective opinions.

Appellant emphasizes that Dr. Scarano reviewed relevant records after interviewing appellant, did not review all her medical records, and failed to interview David regarding purported inconsistencies in his accounts of appellant=s behavior, particularly the feces-eating incident.  However, Dr. Scarano explained he prefers to conduct an interview before reviewing records to prevent a Apre conditioned idea of what is going on.@  Following the interview, he read a Atremendous@ number of records before rendering his opinion.  Further, Dr. Scarano found that appellant=s statements after the stabbing were more pertinent to her state of mind at the time of the offense than previous medical records.  Dr. Scarano also testified he had sufficient information to understand David=s position.  Moreover, because David  testified, the jury had the opportunity to evaluate his credibility and decide whether to believe his statements regarding appellant=s behavior.

In addition, Dr. Scarano compared both doctors= qualifications and methodology. Although Dr. Fuller regularly conducts forensic psychiatric evaluations, he is not board-certified in forensic psychiatry, whereas Dr. Scarano is board-certified in forensic psychiatry.^[13]  Dr. Scarano explained that doctors who are considered Aforensic psychiatrists@ are board-certified.  Also, Dr. Fuller found that several examinations were necessary to obtain sufficient information to render an opinion.  However,  Dr. Scarano preferred his method of conducting one longer interview because an examinee becomes less guarded as time progresses.  Further, at one meeting, Dr. Fuller discovered appellant had been writing.  He encouraged her to continue writing and bring her notes to their next visit.  Dr. Scarano was quite critical of this request because appellant would be influenced to record thoughts helpful to her case.

 Appellant also contends Dr. Scarano=s approach was Aadversarial@ and calculated to dismantle Dr. Fuller=s opinion.  Appellant asserts Dr. Scarano focused on cataloging inconsistencies in appellant=s reports regarding the voices.  However, Dr. Scarano explained that a forensic psychiatrist should critique any previous reports on the examinee as part of the overall evaluation.  He also indicated that analyzing inconsistencies is an important aspect of a forensic evaluation, particularly when the subject stands accused of a felony.  Moreover, considering the voices were central to appellant=s insanity defense, the jury was entitled to assign great weight to the inconsistencies.  Based on the inconsistencies, the jury could rationally infer that appellant made some statements to doctors to support her insanity defense.  Appellant further claims Dr. Scarano=s refusal to acknowledge that appellant=s behavior at the jail was bizarre undermines the credibility of his opinions.  Although Dr. Fuller characterized her behavior as Aabsolutely abnormal,@ the jury was free to believe Dr. Scarano=s explanation that appellant=s actions were deliberate.

D.        Other Evidence of Appellant=s Mental State

Although appellant focuses on the contrasting expert opinions, the State presented other evidence supporting the jury=s rejection of her insanity defense.

1.         Dr. George Sloganhoff=s Testimony

Dr. Sloganhoff testified that, during appellant=s appointment the day before the stabbing, she was alert, oriented, and aware of her surroundings, although she was very guarded and vague and apparently preferred to be elsewhere.  She denied hearing voices and having suicidal or homicidal thoughts.  She did not exhibit any behavior indicating hospitalization was required.^[14]  Dr. Sloganhoff agreed appellant may have tried to mask her symptoms to avoid hospitalization.  Regardless, the jury could infer that she was sufficiently mentally conscious to mask her symptoms.  Further, she was sufficiently cognizant of her surroundings to request David=s keys and leave in his truck when she became irritated he spoke with the doctor.

2.         Officer Felix Flores=s Testimony and Tape

Officer Felix Flores, who initially responded to the call from the Burks= home, testified at trial.  An audio-tape of his conversations at the home was also admitted.^[15]  Thus, the jury could evaluate firsthand appellant=s statements and demeanor shortly after the stabbing.  After Officer Flores allowed emergency personnel into the home, he focused on appellant, who was in the backyard pacing and talking to herself.  When he opened the door, she said AI did it.@  The jury could reasonably conclude appellant knew stabbing S.B. was wrong, considering she made this statement immediately when confronted by a police officer.  Further, appellant was sufficiently lucid to respond ANo, I don=t@ when Officer Flores asked if she had any knives.  In addition, Officer Flores testified appellant understood his instructions to come to the front of the house and get in the police car, although she was unresponsive to his repeated questions regarding the incident.

3.         Officer Mendenhoff=s Testimony and Tape

 The jury also heard the taped conversation between Officer Mendenhoff and appellant approximately six hours after the stabbing, as well as the officer=s testimony.^[16]  Even without Dr. Scarano=s observations concerning the tape, the jury could reasonably draw several conclusions from the conversation.  During the ride between jails, Officer Mendenhoff asked if apellant was alright.  Appellant initially said Ayes,@ but then said Ano@ and volunteered, AWhat I did tonight was a bad, horrible thing.@  This statement indicates she knew stabbing S.B. was wrong.  Further, appellant inquired about S.B.=s condition, and Officer Mendenhoff testified she seemed concerned about S.B. and remorseful about the incident.  They also discussed whether appellant could obtain information about S.B.=s condition and other matters.  The jury heard for itself that appellant engaged in lucid conversation several hours after the stabbing.^[17]  Finally, Officer Mendenhoff testified appellant knew she was returned to the Texas City jail due to improper documentation.  Thus, he contradicted appellant=s statement to Dr. Fuller that she was returned to the jail because she answered questions incorrectly.

4.         Appellant=s Letters

The jury could also draw several conclusions from appellant=s dramatically conflicting letters to her mother and David.  Although Dr. Scarano testified the letters were indicative of a person attempting to plan her future, the jury could reach that conclusion on its own.  Moreover, based on the contrasting letters, the jury could question the credibility of appellant=s statements to various witnesses, including Dr. Fuller.  The jury could also view appellant as manipulative and willing to make the statements necessary to obtain support during her prosecution.

In sum, the jury heard substantial evidence concerning whether appellant=s mental disease rendered her legally insane when she stabbed S.B.  After reviewing all the evidence, we conclude the jury=s rejection of appellant=s insanity defense is not so contrary to the great weight and preponderance of the evidence that it is manifestly unjust.

III.   Culpable Mental State

Appellant also contends the evidence is factually insufficient to support the jury=s finding that she possessed the requisite culpable mental state.

Appellant was charged with committing aggravated assault by intentionally, knowingly, or recklessly causing bodily injury to S.B. by stabbing or cutting her with a deadly weaponCa knife.  See Tex. Pen. Code Ann. '' 22.01(a)(1); 22.02(a)(2) (Vernon Supp. 2006).  Assault by causing bodily injury under Penal Code section 22.01(a)(1) is a result-oriented offense.  Ford v. State, 38 S.W.3d 836, 844 (Tex. App.CHouston [14th Dist.] 2001, pet. ref=d).  Therefore, the State must prove the defendant caused the result with the requisite culpable mental state.  See id. (citing Cook v. State, 884 S.W.2d 485, 490 (Tex. Crim. App. 1994)).  AA person acts intentionally, or with intent, with respect to . . . a result of [her] conduct when it is [her] conscious objective or desire to . . . cause the result.@  Tex. Pen. Code Ann. ' 6.03(a) (Vernon 2003).  AA person acts knowingly, or with knowledge, with respect to a result of [her] conduct when [she] is aware that [her] conduct is reasonably certain to cause the result.@  Tex. Pen. Code Ann. ' 6.03 (b) (Vernon 2003).^[18]  A culpable mental state may be inferred from circumstantial evidence such as acts, words, and conduct of the defendant and surrounding circumstances.  See Guevara v. State, 152 S.W.3d 45, 50 (Tex. Crim. App. 2004); see Stadt v. State, 120 S.W.3d 428, 438 (Tex. App.CHouston [14th Dist.] 2003), aff=d, 182 S.W.3d 360 (Tex. Crim. App. 2005).

 Appellant=s specific complaint is that her mental illness diminished her capacity to form a culpable mental state.  Under Texas law, diminished capacity is not recognized as an affirmative defense; i.e., a lesser form of the insanity defense. Jackson v. State, 160 S.W.3d 568, 573 (Tex. Crim. App. 2005).  However, diminished capacity is recognized as a simple failure‑of‑proof defense in which the defendant claims the State failed to prove she had the required state of mind at the time of the offense.  Id.  A defendant may present evidence, including her history of mental illness, to negate the mens rea element.  See id. at 574.

In this sub-issue, as opposed to the insanity defense, appellant challenges factual sufficiency of the evidence to support an element of the offense on which the State bore the burden of proof.  We must view all the evidence in a neutral light and set aside the verdict Aonly if it is so contrary to the overwhelming weight of the evidence as to be clearly wrong and unjust.@ Cain v. State, 958 S.W.2d 404, 407 (Tex. Crim. App. 1997) (quoting Clewis v. State, 922 S.W.2d 126, 129 (Tex. Crim. App. 1996)).  Before we may reverse for factual insufficiency, we must first be able to say, with some objective basis in the record, that the great weight and preponderance of the evidence contradicts the jury=s verdict.  Watson v. State, 204 S.W.3d 404, 417 (Tex. Crim. App. 2006).

B.        Analysis

Appellant relies on the same evidence to support this sub-issue that she cites relative to her insanity defense.  She contends that, even if she failed to prove legal insanity, her diminished capacity precluded her ability to form a culpable mental state.  We disagree. 

We have outlined Dr. Scarano=s testimony and other evidence showing appellant=s actions, statements, and demeanor around the time of the stabbing.  Based on this evidence, the jury could rationally infer that, despite her mental disease, appellant was sufficiently mentally conscious to form the intent to injure S.B.  Alternatively, the jury could rationally infer, at least, that appellant was sufficiently aware that stabbing S.B. would cause bodily injury.  In addition, the jury could rationally infer appellant intended to, or was aware she would, injure S.B. because she stated AWe have killed her@ or AI have killed her@ immediately after the stabbing.  Nonetheless, appellant argues that this circumstantial evidence, which might ordinarily establish a culpable mental state, is inapplicable because she experienced dissociation at the moment she stabbed S.B.  She argues the dissociative episode severed her ability to form a culpable mental state.  However, for the reasons we have discussed, the jury was free to believe Dr. Scarano=s opinion that appellant did not experience dissociation when she stabbed S.B.

Moreover, all the evidence, including Dr. Fuller=s testimony, indicates appellant=s mental disease actually provided the culpable mental state.  For example, in Jackson, the defendant killed his brother following a fight.  160 S.W.3d at 569B70.  The defendant presented evidence he suffered from paranoid schizophrenia and bipolar disorder.  See id. at 570B71.  The court considered whether evidence of a defendant=s mental illness may be used to show that his diminished capacity prevented ability to form a culpable mental state.  See id. at 572B75.  However, before addressing that issue, the court noted the evidence of mental illness in the case under review did not negate mens rea.  Id. at 572.  Rather, the evidence of mental illness demonstrated the defendant intended to cause serious bodily injury or death.  Id.  Specifically, the defendant killed his brother because his paranoia caused him to believe his brother was Aout to get him.@  Id.  Therefore, the paranoia simply provided a motive for the intentional act.  Id.

Similarly, in this case, the evidence of appellant=s mental illness demonstrated that appellant intentionally or knowingly caused bodily injury to S.B.  Dr. Fuller and Dr. Scarano both agreed that appellant heard voices commanding her to slaughter S.B. to resume her place in the heavens.  According to Dr. Fuller, based on her dissociative state, appellant lost the ability to discern right from wrong at the moment she stabbed S.B.  Whether appellant knew it was wrong to stab S.B., i.e. whether she was legally insane, was another question.  Nevertheless, she acted on the commands and attempted to slaughter S.B.  Therefore, her mental illnessCthe condition that caused her to hear voicesCprovided the motive to stab S.B.  Accordingly, the jury=s finding that appellant possessed the requisite culpable mental state is not contradicted by the great weight and preponderance of the evidence.^[19]

We overrule appellant=s sole issue and affirm the judgment of the trial court.

/s/        Charles W. Seymore

Justice

Judgment rendered and Memorandum Opinion filed August 23, 2007.

Panel consists of Justices Frost, Seymore, and Guzman.

Do Not Publish C Tex. R. App. P. 47.2(b).

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^[1]  As we will later discuss, one expert doubted that appellant ate feces.

^[2]   The couple=s oldest child was not home, and S.B.=s twin brother went to bed early.  

^[3]  David testified appellant responded, AWe have killed her. You can save her.@ However, within an hour and a half after the incident, David twice told police officers appellant responded, AI have killed her.  Now you save her.@

^[4]  Specifically, appellant stated, AI feel that I=m a conqueror for Christ.  Those with spirit will suffer.  They are testing me.  They tell me I=m of satan, that I=m the bride of Christ.  Do you really want to know what I was thinking?  I had to slaughter my children to resume my destiny.  My destiny is a star.  Female stars come to earth and give birth.  In order to return to the heavens and shine brightly once more they must sacrifice their children.  Satan tells me I=m one of them.@

^[5]  Dr. Scarano also reviewed records from Children=s Protective Services, but they were not admitted at trial, and Dr. Scarano did not testify regarding the contents.

^[6]  Appellant contends jail records for this day indicated the examination did not last four hours.  An entry shows appellant was checked out of her cell at A800@ and returned to her cell at A1040.@  However, the records do not indicate whether A1040@ meant a.m. or p.m.  The custodian of records testified that A1040@ did not necessarily mean a.m., and it was impossible to determine whether appellant was logged in at 10:40 a.m. or p.m.  The custodian agreed she could have been returned to the jail after her evaluation, but not placed in her cell until later that evening.  Accordingly, no evidence conclusively negated Dr. Scarano=s claim he evaluated appellant for four hours, and the jury was free to believe that testimony.

^[7]  Although Dr. Scarano=s testimony was not exactly clear, apparently, most of the inconsistencies concerned whether she first ate feces or dirt.

^[8]  Dr. Scarano had learned  that appellant acted guarded, presumably to avoid hospitalization, in her visit with Dr. Sloganhoff the day before the offense.

^[9]  As we will explain, Dr. Scarano reviewed a police tape indicating appellant engaged in lucid conversation with an officer about six hours after the stabbing.

^[10]  Although Dr. Scarano=s testimony is not exactly clear, he stated, AThat was the essence of what she was talking about when she says Revelations [sic] and talks about Babylon and the lamb, not about her daughter as she told, ask Dr. Fuller what she was talking about, but you have to go and read it.@

^[11]  These letters were not admitted at trial, but Dr. Scarano relayed the content.

^[12]  The tape was not admitted at trial; it could no longer be watched due to some change in the recording system.  However, Dr. Scarano was questioned about the tape based on the notes in his report.

^[13]  Both doctors explained that forensic psychiatry concerns the interface between psychiatric conditions and legal matters, including criminal responsibility. 

^[14]  In contrast, appellant presented testimony from Catherine Jones, an administrative staff member at the clinic.  She testified appellant seemed unaware of her surroundings at her appointment.  However, the jury was free to believe Dr. Sloganhoff=s testimony regarding appellant=s demeanor. 

^[15]  Officers= activities and conversations at the home were taped by equipment in the police car.  The  video portion of the tape contains no images pertinent to our review.

^[16]  On the tape, Officer Mendenhoff=s statements are not discernible, although appellant=s statements are clear.  However, he testified regarding the substance of the conversation.

^[17]  At one point, in response to appellant=s request, Officer Mendenhoff replied that  appellant  could not talk to S.B.=s doctors about S.B.=s condition.  Appellant then stated, AAnd, I=m sure you don=t care whether or not I know.@ At another point, she stated, AYou just know what I did.@  These statements sounded not only lucid, but confrontational.

^[18]  Because we conclude the evidence is factually sufficient to support a finding that appellant acted Aintentionally@ or Aknowingly,@ we need not discuss the definition of Arecklessly.@

^[19]  Appellant also cites a note from the jury to the trial court asking whether a defendant found not guilty by reason of insanity may Aautomatically resume a >normal= life without any court supervision or otherwise what may happen after the verdict.@  According to appellant, this question indicates at least one juror considered matters outside the evidence to reach the verdict.  However, the jury sent the note while the parties were presenting evidenceCnot during deliberations.  Subsequently, the trial court instructed the jury to consider only the evidence.  Absent indication to the contrary, we will presume the jury followed the trial court=s instructions.