Book Review: Are You There Alone? The Unspeakable Crime of Andrea Yates by Suzanne O’Malley

Are You There Alone? is written by Suzanne O’Malley, an investigative reporter. She followed the tragedy in real time. She was present through Andrea Yates’ 5 weeks of court proceedings. To write this book, she read all of the transcribed trial testimony, 2000 pages of Andrea Yates’ medical records and interviewed nearly 100 people, including Ms. Andrea Yates and Mr. Rusty Yates, her ex-husband, to write this book.

Personal Note: I often review books written by persons who suffer from severe and persistent mental illness. I do this to honor the people involved and to give their lives meaning by providing others information about mental health. I am not judging the people involved or direspecting them. These books usually aren’t easy to read. The material can be upsetting to some and triggering to others.

Some of my other reviews:

Electroboy: A Memoir of Mania By Andy Behrman

Birth of a New Brain by Dyane Harwood

The River of Forgetting: A Memoir of Healing from Sexual Abuse by Jane Rowan

This is an important book. It is the true account of Andrea Yates. The true account of a woman who has a very serious mental illness coupled with psychotic features. We, as a society, need to face these stories and learn to be more compassionate and more educated and more effective in the face of mental illness.

The story of Andrea Yates is the story of unmedicated psychosis in mental illness. The devastation of improperly medicated mental illness needs to be in the public discourse.

The story of Andrea Yates is also the story of a shocking disregard for the reality of human limitations.

Ms. Yates is a woman who was not treated with proper medication nor who followed the strict lifestyle adjustments needed to manage a mental illness with psychosis. Lifestyle adjustments include acceptance of the illness as real and treatable, committing to adherence to medication and other treatment protocols and strict adherence to a lifestyle management that promotes mental health stability and overall stress reduction. These are not simple goals but they are medically part of treating severe mental illness.

I read this book as a perinatal mental health specialist. I wanted information about these horrific murders. For years, I was unable to face Ms. Yates’ story. I was repelled by the idea of reading this story. It is horrifying to imagine 5 children killed. But then to imagine 5 children killed by their mother’s own hand. My stomach churns as I write this sentence.

Yet, I believed I needed to read this material as a perinatal mental health professional.

I downloaded and read the book in 2012. It took me seven years, until 2019, to write a book review about it. I was repelled, angry and mesmerized all at once. I think about the Yates family often.

It is the story of a complete disregard for basic lifestyle management skills that support physical and mental health.

This personal devastation did not have to happen. It could have been prevented. This makes me angry, shocked, outraged and grief stricken.

I am not being judgmental. I am being scientific and factual. Facts matter. Untreated, unmedicated psychosis is tragic. Poorly managed lifestyle choices are tragic. These are medical facts, not personal opinions.

From the facts in the book, I will just lay out the timeline of Ms. Yates’ life. It is shocking.

April 17, 1993 – Married

1999 – In SIX years, by 1999, Ms. Yates had five pregnancies, resulting in one miscarriage and four children. During this time, it was noted by family and friends that she was behaving in peculiar ways. She did not explicitly speak about her frightening imagery and her feelings of being an utter failure of a mother, but there were signals. Plus, there was a pervasive preoccupation with strict religiosity that runs throughout her own and her family’s psychology.

Mental Health Fact: Women are most at risk for an acute episode of mental illness during the hormonal fluctuations of pregnancy and childbirth. If a woman had a pervious episode of depression or anxiety or psychosis or bipolar disorder during her lifetime, then after childbirth, she has a higher risk of a re-occurence.

1998 – Moved from Houston to Tampa, and started living in a 350 square foot trailer, with four boys. They bought the trailer from their pastor, Mr. Woroniecki and his wife. He preached a particular fire and brimstone sort of religion.

Ms. Yates was constantly pregnant and breastfeeding. The family also chose to homeschool. She was not getting much sleep, caring for infants constantly.

Pastor and Mrs. Woroniecki’s advice was to exhort Ms. Yates to divest of their house in Houston and worldly possessions and thus not “…put off hope of being truly saved…” (p. 32). Ms. Yates preoccupation with religiosity, a symptom of major mental illness, was re-enforced by their teachings. She isolated herself and read her Bible.

Mental Health Fact: It is possible to be religious and also make healthy lifestyle choices. Some pastors and churches promote a healthy balance between being a spiritual person and the reality of being a human being with limitations and others do not.

In 1999, she tries to kill herself twice.

June 16, 1999 – Ms. Yates has a “nervous breakdown…” (O’Malley, 2004, p. 33). Mr. Yates tries to help her by coming home and helping her with the family.

June 17, 1999 First suicide attempt by overdose.

In June, 1999, one of her mental health therapists recognized there was something very, very wrong. Not being a doctor, she wasn’t able to diagnose the severity of Ms. Yates’ illness. But she recognized that living in a crowded trailer home with four small children is a strain that can heighten mental illness. A call to Houston’s Child Protection Services was put in, however, there was no neglect found. There was nothing to be done about it.

Living in tight quarters, homeschooling, being isolated and constantly being pregnant and breastfeeding is a major lifestyle stressor for anyone, and even more so for someone with a serious mental illness.

After the first suicide attempt, she becomes sicker. She does not interact with the children much and resists feeding Luke, the baby. In fact, her brother, her husband and her mother usually fed Luke. She had begun scratching her head, spot where she believed there was the mark of the devil. She flushed the medications prescribed for her down the toilet. She had performed self-mutilation with a knife. These are obvious signs of psychosis. I don’t expect the family to realize this is psychotic behavior, but it is past depressive symptomology. The woman needs psychiatric help.

After her first suicide attempt, insurance rules restrict the amount of time Ms. Yates could spend in inpatient treatment. She is put on medications and discharged and noted as “quite depressed.” (O’Malley, 2004, p. 37).

Around this time, Mr. Yates sells the trailer and buys a house so as to help the family living situation.

July 21, 1999 – Second suicide attempt by attempting to slit her throat. She is evaluated by the psychiatrist Dr. Eileen Starbranch. She is actively mute, suicidal and psychotic.

Late July – Mid August 1999 – Dr. Starbranch successfully treats Ms. Yates using injectable Haldol. Ms. Yates is non-compliant with her medication, so injectable medication is a practical way to manage her mental illness.

Dr. Starbranch says, “It doesn’t matter whether she is schizophrenic, schizoaffective, bipolar or depressed…all of those conditions can lead to catatonia, not eating, not sleeping, not taking in any fluids…(which are) …life threatening conditions….(therefore) you consider ECT.” (O’Malley, 2004, p. 177).

Dr. Starbranch recommends electroconvulsive treatment (ECT) evaluations by ECT specialists, Dr. James P. Thompson and Dr. Arturo Rios. Ms. Yates tells them of obsessive thoughts about her children and “how they’ll turn out…” (O’Malley, 2004, p. 39). She shares information about visual and auditory hallucinations she had after Luke was born that included being ordered to get a knife and then a vision of someone being stabbed and alot of blood. No one specifically is named as the victim.

Dr. James P. Thompson and Dr. Arturo Rios, both recommend ECT treatment.

Around this time, the insurance company says they will no longer pay for injectable Haldol treatments. But the Yates decide they do not want to use the injectable medication any longer, so this decision is not questioned. The Yates also choose to forego the ECT treatments.

In all of 1999, there is no other way to describe Andrea Yates but as a very ill psychiatric patient who needs lifelong monitoring and medication along with strict lifestyle management so as not to aggravate her mental illness. She is very, very ill. Haldol was sufficiently managed her illness. And she was the mother of four children under the age of 6. This is a very serious situation.

Mid – Late July, 1999 – Dr. Starbranch recommends ECT, but the Yates are against this treatment.

At this time, Mr. Yates feels that he has his wife back as Ms. Yates’ mental health is managed to an acceptable degree by the injectable Haldol. She graduates from inpatient care to partial hospitalization care and is sleeping at home, going to the hospital during the say.

Mental health fact: Research and clinical data finds this treatment to be effective for management of recurrent, serious mental illness with psychotic features, when used as part of a comprehensive treatment plan, including medications and strict lifestyle management.

August 16, 1999 – Amazingly enough, against Dr. Starbranch’s orders, the Yates decide that Ms. Yates is well enough to use oral medications. The patient is known to be non-compliant when taking medications voluntarily.

Even more amazingly, Mr. and Mrs. Yates also decide to not use birth control and to have another baby as soon as possible.

Dr. Starbranch cites in her notes: “They decide that they should have as many babies as nature will allow! This will surely guarantee future psychotic depression.” (O’Malley, 2004, p. 41)

January, 2000 – At this follow up visit with Dr. Starbranch, Ms. Yates admits she is off all medication as she is no longer symptomatic and her husband agrees with this decision. No other visits are noted with Dr. Starbranch after that date.

Spring, 2000 – Ms. Yates confides to a friend that she believes she is possessed by Satan. They consult the Bible, and tell their pastor, but no one thinks to consult with a psychiatrist. It is possible to be a religious person and to treat your mental illness. The Bible is a poor lifestyle choice to combat mental illness with psychosis. Her friend does urge her to not get pregnant again until she felt better. But Ms.Yates says she has been on “vacation” long enough (O’Malley, 2004, p. 43).

March, 2000 – Mr. and Mrs. Yates choose not to use birth control, for religious reasons. So, this very, very ill psychiatric patient becomes pregnant once again. She is homeschooling Noah at the kindergarten level and caring for three toddlers while she is pregnant.

I am not judging this decision or Mr. Yates. I am making an observation as a mental health professional. One can be a religious person and still make healthy lifestyle choices. In this case, having another baby was a tragic decision. I know that her husband has suffered greatly. However, Ms. Yates is the one who was put on trial and is in prison. I know he was overworked, caring and trying to care for tis family and his wife. However, he wasn’t psychotic or suicidal in 1999-2000. He made this decision with a mentally healthy mind.

November 20, 2000 – Gives birth to her fifth child.

This woman, with a history of severe and persistent mental illness, including psychosis, was home alone with 5 children under the age of 7 All. Day. Long. Unmedicated and untreated with poor lifestyle management.

February, 2001 – Ms. Yates’ father passes away. This is relevant as then her mother is unable to be physically present to help her, as she might have ben, as she is coping with the death of her husband. Ms. Yates, being mentally ill, takes on much guilt and blame for her father’s natural death.

Late March, 2001 – Ms. Yates is showing depressive symptoms. She is also actively psychotic once again. She is standing like a zombie and scratching at her forehead again, where she believes there is the mark of the devil. She stops eating, drinking and sleeping. Bizarrely, Andrea Yates repeatedly fills the bathtub with water.

Around March 31, 2001 – Mr. Yates, along with her brother, forcibly checks her into another psychiatric hospital. Ms. Yates refuses to stay, but she is eventually held involuntarily, as she is catatonic, refuses to eat, is suicidal, sits and stares, and refuses to eat.

April 1 – 12, 2001 – Dr. Mohammed Saeed takes over her psychiatric care. Sh is suicidal, staring, mute, dull, pacing out of control, refuses to eat. She is never given Haldol for her delusions, she is given Risperdal, another anti-psychotic, which does not control her symptoms adequately.

April 12, 2001 – She is released from inpatient care and given partial hospitalization care, although she is still showing signs of psychosis and severe depression.

May 4, 2001 – Dr. Saeed takes a while to retrieve the records from Dr. Starbranch regarding the use of Haldol. But Mr. Yates convinces him to use Haldol as Ms. Yates was still showing psychotic symptoms. She is readmitted to inpatient care.

June 4, 2001 – Released back home again, Dr. Saeed tapers Ms. Yates off of Haldol.

June 7, 2001 – A family friend sees the Yates family in the supermarket. He is shocked at Ms. Yates’ appearance and behaviors. He is frightened. He tells his wife to prepare for something awful to happen.

June 18, 2001 – At this follow up visit with Dr. Saeed, Mr. Yates asks him to put her back on Haldol. Dr. Saeed refuses. He adds a higher dose of Remeron to her medication protocol and cuts back on Effexor. This particular combination of medications have earned the slang name “California Rocket Fuel,” as their synergistic effects are super charged. This can be helpful for some people. But others can suffer with “serotonin syndrome,” which includes confusion and hallucination and physical symptoms such as extreme changes in blood pressure, increased heart rate, shivering, muscle stiffness and digestive problems.

June 20, 2001 – Ms. Yates murders her five children by drowning them in the bathtub.

June 27, 2001 – Mr. Yates holds a funeral service for all five of his children at Church of Christ, a welcoming Methodist Church only four blocks from his home. They are a supportive and warm church community. Andrea Yates was not interested in this local church community and chose to read the Bible in solitude.

This is truly a tragic and horrific event. And the timeline is truly tragic and horrific to read.

I pray that we can help others to avoid this awful outcome. Mental illness is real and needs treatment on multiple fronts: medication, ECT, familial support, community support, lifestyle management and mental health parity at the medical insurance level. I pray we all keep working towards this goal.

References

O’Malley, S. (2004). Here you there alone? The unspeakable crime of Andrea Yates. New York: Simon and Schuster.

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