Andrea Yates: The Mother Who Went Too Far Pt. 1

On the surface, Andrea Yates was a former valedictorian, nurse, and a devout mother of five from Clear Lake, Texas. But deep down, Andrea was consumed by religious guilt, postpartum psychosis, and the manipulative teachings of a fringe preacher who convinced her that demons were pursuing her family. This episode traces her deteriorating mental health across nearly a decade of mismanaged care, isolation, and unchecked delusion that all came to a head in June of 2001. Join Crime House+ to binge a special limited series on Murder: True Crime Stories for America’s 250th: The Crimes That Built America. These are the cases that created the FBI, gave us Miranda rights, sparked criminal profiling, and gave us America’s Most Wanted. Join at crimehouseplus.com http://crimehouseplus.com or if you’re listening on Apple Podcasts, tap “Try Free” at the top of this show’s page. You’ll also get both parts to every Serial Killers & Murderous Minds case released at once ad-free. 🎧 Need More to Binge? Listen to other Crime House Originals Clues, Crimes Of…, Murder True Crime Stories, Crime House 24/7, and more wherever you get your podcasts! Follow me on Social Instagram: @Crimehouse https://www.instagram.com/crimehouse/TikTok: @Crimehouse https://www.tiktok.com/@crimehouseFacebook: @crimehousestudios https://www.facebook.com/crimehousestudiosYouTube: @crimehousestudios https://www.youtube.com/@crimehousestudios

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:01Vanessa Richardson?

  Hi, everyone. Before today's episode, there's another show I want to tell you about. It's called What the Fact with Connor Tomlinson from Netflix's Love on the Spectrum and Carter Roy. Every week, they take three unbelievable true facts from history and tell you the full story behind them. Plus, Connor's infectious energy that'll make you realize history is the most fascinating thing on earth. Follow What the Fact wherever you listen, or subscribe on YouTube at What the Fact Pod.

• 0:36Speaker 01

  This is Crime House.

• 0:42Vanessa Richardson?

  We've all experienced intrusive thoughts, like waking up in the middle of the night with the sudden fear that something terrible will happen to us, or the ones we love. Or worse, that we'll do something terrible to them. Usually, intrusive thoughts are manageable. We can cope with them through positive self-talk or seeking help from a professional, and hopefully, we can break out of it. But in some cases, dark thoughts are stronger than any coping mechanism. They may even be stronger than medication. And when that happens, nightmares can become reality. In the early 2000s, Andrea Yates suffered from thoughts and visions so horrific, they

• 1:23Vanessa Richardson?

  left her completely debilitated, until one day, when Andrea decided to do something about it. Unfortunately for her family, Andrea's way of addressing her demons was to do their bidding.

• 1:50Vanessa Richardson?

  The human mind is powerful. It shapes how we think, feel, love, and hate. But sometimes, it drives people to commit the unthinkable. This is Serial Killers and Murderous Minds, a Crime House original. I'm Vanessa Richardson.

• 2:06Tristin Engels?

  And I'm forensic psychologist Dr. Tristin Engels. Every Monday and Thursday, we uncover the darkest minds in history, analyzing what makes a killer.

• 2:15Vanessa Richardson?

  Crime House exists because of listeners like you. Want even more? Join Crime House Plus and get both parts of every story dropped on the same Monday, completely ad-free. No waiting three days for part two, plus Crime House bonus episodes every month. To join, go to crimehouseplus.com, or if you listen on Apple Podcasts, tap "Try Free" at the top of the Serial Killers and Murderous Minds page. Before we get started, be advised, this episode contains descriptions of severe mental health issues and self-harm, so please listen with care. Today, we begin our deep dive on Andrea Yates, a devout Christian and stay-at-home

• 2:55Vanessa Richardson?

  mother, whose one wish was for her family to make it to heaven one day. In Andrea's mind, the only thing holding them back from that dream was the literal demons surrounding them. As Andrea's mental health deteriorated over the years, she became convinced there was nowhere safe to run. And in the end, she decided the only way to protect her family was to remove them from this earth herself.

• 3:22Tristin Engels?

  As Vanessa goes through the story, I'll be talking about things like how extreme religious guilt can feed into delusions, how mounting stress can cause someone to break down, and how all of these issues can culminate into violence.

• 3:36Vanessa Richardson?

  And as always, we'll be asking the question, what makes a killer?

• 3:44Vanessa Richardson?

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• 4:59Vanessa Richardson?

  Andrea Yates was always up for a challenge. From the time she was born, hard work and discipline were in her blood. Her father was a soldier who was stationed in Germany after World War II as an Air Force B-24 navigator. At some point, he met Andrea's mother, and the two of them moved to Houston, Texas, where Andrea was born in July of 1964. She was the youngest of five children growing up in a strict Catholic household. As a teenager, Andrea had a quiet demeanor, but that didn't mean she didn't push herself. She excelled academically and athletically as a competitive swimmer, and she was a valedictorian in high school. Then she went to the University of Houston to study nursing.

• 5:44Vanessa Richardson?

  Nursing suited Andrea. It required precision, sticking to the rules, and keeping cool in difficult situations. It was right up her alley, and when she graduated, she was ready for the next challenge, working at the University of Texas Cancer Center. Most of her life revolved around her work. Outside of that, she had a small circle of friends, and in 1987, when she was 23 years old, she had her first serious relationship. All this time, Andrea clung to the beliefs she grew up with, including wanting to wait until marriage to have sex. And the following year, when it became clear she and her partner weren't aligned with these values, they broke up. Afterward, Andrea sank into a deep depression.

• 6:28Vanessa Richardson?

  Not only was she heartbroken, but it was possible she felt conflicted between her religious beliefs and the modern world she lived in.

• 6:36Tristin Engels?

  If Andrea grew up in a strict Catholic household, it's possible that she may have developed rigid beliefs about purity, marriage, and expectations. So when she entered into her first relationship, she likely was very rigid on following this specific moral framework. And so she was following the rule and the expectations perfectly, in her opinion. When this relationship ended, she may have viewed it as a spiritual, personal, and/or moral failure on her part. And that can create feelings of shame, which can be internalized as a belief something is wrong with her, or worse, that she failed God in some way, which can then turn into catastrophic beliefs about herself. And that can intensify depression, because it adds self-blame, isolation,

• 7:20Tristin Engels?

  and hopelessness on top of grief, and in some cases, religious-based fear, especially when you consider that she was conflicted between her religious beliefs and the modern world that she lived in. But it's important to also highlight that religion itself is not the problem. For many people, faith is protective. It provides meaning, structure, community, and comfort. But when someone's already vulnerable to depression, or rigid thinking, or fear-based interpretations of religion, then that can sometimes intensify guilt or self-blame and hopelessness.

• 7:55Vanessa Richardson?

  Andrea didn't seek formal treatment for what she was going through. She didn't seem to talk to her loved ones about it either. Instead, she internalized the pain. But a year later, in 1989, Andrea met someone new, 24-year-old Russell Yates, who went by Rusty. He was a NASA engineer who lived in the same apartment complex as Andrea in Houston. They chatted sometimes, and eventually, they realized how much they had in common. They were both Christian and shared traditional family values. Rusty hoped to provide for a family of his own one day, and he expected his future wife to stay home to take care of their kids, which was exactly what Andrea wanted. And as she and Rusty grew closer, and he introduced her to a more extreme version of Christianity,

• 8:40Vanessa Richardson?

  she embraced that, too. Rusty followed the teachings of a traveling preacher named Michael Peter Warnicki, who referred to himself as "an ambassador of Christ" and had amassed a small following across the country. Michael believed that people could only get into heaven if they followed a strict set of rules on earth. These involved following strict gender roles, having a lot of children, and living as frugally as possible. Michael also opposed institutionalized religion, schools, and medicine. In other words, he felt that true Christians relied on only themselves to lead virtuous lives, because in Michael's eyes, demons were always lurking.

• 9:22Vanessa Richardson?

  But by following his doctrine, his followers could avoid their clutches. Michael convinced his followers that he preached the Word of God directly "from God", so they did what he told them to. Rusty had met him when Michael visited his college campus. Now they stayed in touch through letters, as well as Michael's newsletter called "The Perilous Times." Soon Andrea formed a close relationship with Michael's wife, Rachel, as well, and she and Rusty completely bought into Michael's teachings. However, despite how aligned their beliefs were, Rusty also used Michael's teachings to manipulate Andrea. Andrea still felt it was wrong to live with a partner before marriage, but Rusty wanted

• 10:05Vanessa Richardson?

  to move in together, and he reminded her of a key aspect of Michael's doctrine: living sparsely. If they lived together, their lives would be less materialistic. Andrea was persuaded. In 1992, when they were both in their late twenties, they moved in together, and pretty soon Andrea's beliefs were tested again, when Rusty convinced her to have sex with him for the first time. Andrea had always planned to wait until she was married to have sex, but Rusty was assertive, and since he didn't feel it was wrong, Andrea didn't challenge him. Still, she couldn't help but feel a deep sense of guilt.

• 10:44Tristin Engels?

  Her guilt makes sense when you consider her beliefs around purity, marriage, and sex, and her concerns about the conflict of her beliefs in the modern world, and the fact that she met someone a year after her first breakup. That may have been something that she was feeling discouraged about. But in her previous failed relationship, she held firm to her beliefs. She waited to be intimate until marriage, and when she realized that she and her partner were not aligned on that, the relationship ended, and that resulted in her going into a deep depression. So it's possible that Andrea may have associated her boundaries to rejection, and that can create anxiety. And if so, that makes her more vulnerable to Rusty because now there is likely fear

• 11:25Tristin Engels?

  of losing this relationship, especially if it's tied to spiritual value or self-worth. So when he pushes her boundaries, saying no and sticking to her values means risking another rejection or perceived moral failure, and possibly falling into another deep depression. But conversely, violating her beliefs means experiencing guilt about that. And because Rusty is confident and convincing, and he's using the teachings of Michael, that can cause her to mistrust her own doubt about this, too. So Andrea may have gone along with something that she did not fully want because she was hopeful it could restore something she felt she needed to preserve, and that is an attachment to Rusty.

• 12:04Vanessa Richardson?

  In general, when someone's taught to see things in absolute terms like this, how can that affect the way they handle mistakes or regret? Does that possibly cause someone to internalize that stress?

• 12:15Tristin Engels?

  I think it makes it so much harder to process. There is less room for nuance, or repair, growth, or even context. Things can be seen in very black and white terms, or very rigid ways, and subsequently, that's how feelings like guilt can be turned into shame. And yes, that can absolutely cause someone to internalize stress because they blame themselves, or they'll ruminate, withdraw, or become more rigid to avoid making that same mistake again. But there's also more pressure because they're not really processing the conflict. With absolute thinking, people can start to interpret mistakes as who they are rather than something they did, something they can learn from, which I think Andrea is at risk for, given just her history here.

• 12:56Vanessa Richardson?

  Well, despite all the mounting shame she was feeling, Andrea never opened up to Rusty about it. So their relationship kept moving forward. And on April 17, 1993, they got married. Andrea was thrilled. She was already thinking about their future together and told Rusty she wanted to renew their vows on their 20th wedding anniversary. He said they could do it, but only if she could still fit into her wedding dress. This didn't seem to bother Andrea, who believed it was her job to look and behave exactly the way her husband expected. And almost immediately after they were wed, Andrea quit her job and they started their family. Between 1994 and 1997,

• 13:38Vanessa Richardson?

  they had three children, Noah, John, and Paul. Andrea's dreams were coming true, but it came at a cost. She was thrilled to finally become a mother. However, she developed a deep and unshakable fear that her children may not get into heaven one day. She was willing to do anything to ensure they'd make it past the pearly gates. And that's where Michael's teachings came in. One day before Andrea gave birth to her first child, she received one of Michael's newsletters in the mail. She eagerly flipped through the pages and was pleasantly surprised at how relevant it was to what she was going through. In his writings, Michael taught that only "righteous women" could raise righteous children and that in order to gain God's approval,

• 14:23Vanessa Richardson?

  women had to abide by a strict standard of motherhood, including giving birth naturally. Once Andrea read this, she knew she had to do exactly as Michael said. She gave birth without any medication, which was extremely hard on her, but she committed to it each time.

• 14:42Tristin Engels?

  And that commitment tells us something important about how Michael's messaging may have landed for Andrea because she seemed to read it as instruction and a standard that she had to meet. That may be because his message spoke directly to fears that she already seemed to have about her worth, value, and spiritual standing. And this comes after a period where Andrea had already compromised on beliefs that were Very important to her with Rusty. She had wanted to wait until marriage. She had not wanted to live with Rusty before marriage. So if she was already carrying guilt around compromising on those choices and those beliefs, then Michael's message may have felt like a way to repair that guilt somehow. Like if she could become the right kind of wife and mother, then maybe she could make things right overall.

• 15:27Tristin Engels?

  But at the same time, his message tied her children's spiritual safety to her performance as a mother. And I think the pain medication during childbirth became a test of obedience, faith, and maternal worth. His message was giving her an impossible burden. It was telling her she needed to have what could arguably be a traumatic birth, but it was also not something that she wasn't already familiar with in her dynamic with Rusty either.

• 15:54Vanessa Richardson?

  It sounds like Andrea is experiencing religious OCD. Is that even a thing? And if she is experiencing something like that, how might that relate to the guilt and the symptoms of depression we've seen from her?

• 16:07Tristin Engels?

  Great question. So religious OCD usually involves intrusive fears about sin, morality, or spiritual failure, followed by repeated attempts to neutralize that fear, like excessive praying, for example, or confession, reassurance-seeking, or mentally reviewing whether or not you did something wrong. It's very similar to just regular OCD, but it's based around religious themes. And I do think there may be elements of intrusive religious fear here, but I do not know that we have enough to call it obsessive-compulsive disorder. For that, I would want to see a clear pattern of obsessions followed by compulsions or ritualized behavior. There needs to be that loop for it to qualify.

• 16:50Tristin Engels?

  Right now, what we see is a fear and her attempt at a solution, even though the solution looks extreme or irrational in hindsight. But her guilt does appear to be tied to religious rules and expectations that seem to have started young and then were reinforced by Michael and Rusty and their messages or teachings or beliefs. And remember, Rusty had been using that to his advantage, too. So her guilt, fear, and her rigid expectations were also being intensified by the people around her.

• 17:19Vanessa Richardson?

  It seems like Michael realized just how committed Andrea was to his form of Christianity. Because soon, his messages became even more urgent. He started sending her tape recordings of himself preaching about how women were inherently unrighteous and that Satan was within her. Michael said the only way to banish Satan was to follow his guidance to a T. And Andrea believed him. To Andrea and Rusty, these ideas seemed reasonable, but no one knew just how vulnerable she was to Michael's influence and just how dangerous Andrea's beliefs were becoming.

• 18:04Speaker 01

  Did you know the most feared pirate in the Atlantic, the man who terrorized an entire ocean for years, may never have actually killed anyone? Or that the real Golden Age of Pirates was the most democratic workplace in the Western world? I'm Connor Tomlinson from Love on the Spectrum, and history is my thing. And I'm Carter Roy, and this is What the Fact. Every week, we take the most unbelievable true things in history and tell you the whole story behind them. Carter sets the scene. Connor brings the facts, the deep cuts, and the genuine belief that this is the most interesting subject in the world. It is. This is the history lesson you actually wished you had in high school. New episodes every Wednesday.

• 18:46Speaker 01

  Follow What the Fact on Apple Podcasts, Spotify, Amazon Music, or subscribe on YouTube at What the Fact Pod.

• 18:58Vanessa Richardson?

  By 1997, 33-year-old Andrea Yates had three children. Once she finally became a mother, she also became consumed with fear over whether her kids would get into heaven one day. And because of Michael Warnakey's influence over her, Andrea believed that she had to lead a perfectly righteous life in order for her kids to be saved. Then in 1998, Andrea and her husband Rusty made even more sacrifices, inspired by Michael's teachings. That year, Rusty part- purchased a converted Greyhound bus from Michael. They tossed most of their belongings, sold their house, and started living in the bus. In addition to a few personal items, Andrea only kept her sewing machine and cookware.

• 19:42Vanessa Richardson?

  However, Rusty rented a storage shed for some of his things, but he left them behind as they embarked on a nomadic lifestyle, traveling to different trailer parks. Their life was now the most minimal and isolated it had ever been. But even though Andrea believed she was checking all the right boxes to earn her family their spots in heaven, the seclusion weighed on her, especially because she stayed home all day, homeschooling the kids. The importance of homeschooling was something else Michael preached, and since he and Rusty believed women should be solely responsible for childcare, Rusty played with the kids, but he never helped feed, bathe, or put them to bed.

• 20:23Vanessa Richardson?

  The sheer workload was beginning to weigh on Andrea, especially by 1999, when their fourth child, Luke, was born. But she kept her head down and did what she believed was her womanly duty.

• 20:37Tristin Engels?

  That phrase, "womanly duty," says a lot about Andrea's exhaustion, because, again, she likely heard that and believed that being tired, overwhelmed, or emotionally deteriorating was something that she was supposed to endure. That is dangerous, because if it's true of her, that she truly did believe that, she's more likely to ignore any warning signs, or signs that she needs a break, signs that she needs help, because she believes that she's not supposed to have help to begin with. And it's already weighing on her as it is. She's taking on a lot of the physical and emotional labor, after having just given birth, no less, and that can be so exhausting in every possible way. And sleep deprivation alone can seriously affect mood, concentration, emotional regulation,

• 21:23Tristin Engels?

  and reality testing, especially in the postpartum period. On top of that, she's the only parent providing childcare and now is living in isolation, so her mind and body may never have had a real chance to recover from that. And the isolation also reduced the chances that someone could help with childcare, someone in her family, some neighbor, anyone, or someone who could recognize how badly she was deteriorating. This is a very risky situation that she is in when you really break it down.

• 21:54Vanessa Richardson?

  What are some of the early signs that someone might be suffering mentally, even if on the outside they're managing their day-to-day responsibilities?

• 22:02Tristin Engels?

  Yeah, like you said, it's not a one-size-fits-all. Some people you can see are visibly struggling, but the reality is a lot of people hide struggle well on the outside, but internally are quietly deteriorating. But that said, commonly, what we often see are changes in sleep, appetite, energy, concentration, or emotional regulation. They may seem more irritable, more withdrawn, more tearful, more anxious, or more flat emotionally than usual, like they have a harder time experiencing pleasure or joy. Another sign is when everyday tasks start taking much more effort. The person may still be functioning, but everything is more taxing for them. And sometimes the biggest sign is disconnection.

• 22:46Tristin Engels?

  They stop reaching out, they stop enjoying things, like anhedonia, stop laughing, or might be physically present but are emotionally somewhere else. These are signs to check in with that person and ask them how they're really doing, listen more than you talk, and offer practical support. And if at any point someone indicates that they're in immediate danger, call emergency services. And here in the US, we have a crisis line, it's 988.

• 23:13Vanessa Richardson?

  About halfway through 1999, Andrea reached a breaking point. If looking after the children wasn't already challenging enough, Andrea was also caring for her father. A few years earlier, he'd been diagnosed with Alzheimer's. And as a former nurse, Andrea helped manage his treatment as his condition worsened. There was a lot of pressure mounting on Andrea. It was becoming too much for one person to handle. And on June 16, 1999, she felt herself start to break down. That day, while home with the kids, Andrea suddenly burst into uncontrollable tears. Feeling scared and alone, she called Rusty at work. He rushed to the bus to check on her.

• 23:56Vanessa Richardson?

  And when Rusty got there, Andrea was sitting in an armchair, bent over. She was unable to speak and was shaking uncontrollably.

• 24:06Tristin Engels?

  It can't be overstated how stressful it is to be a caregiver in general. And we're talking, you know, a mom or, you know, just a caregiver in general, but let alone a caregiver to someone diagnosed with Alzheimer's disease or any kind of disabling condition. That is mentally and physically demanding, but we're adding it on top of our own household demands. So with that, it's likely that Andrea has met her emotional threshold. And when someone's been under sustained stress, exhaustion and sleep deprivation, the brain can reach a point where it can no longer keep compensating for that anymore. Her body has likely been accumulating stress hormones like cortisol, and now her body needs a release and a reset. And sometimes that can look like panic.

• 24:50Tristin Engels?

  Sometimes it looks like a breakdown. Sometimes it looks like dissociation, where the person seems disconnected, shut down, or not fully present. Dissociation can be a way the mind copes with stress that feels like too much to process. So when Andrea is sitting there, shaking, crying and unable to speak, I would see that as a serious warning sign. Her system was overwhelmed. She was no longer just tired or stressed. Her mind and body were showing that the demands on her had exceeded her capacity to keep functioning safely at this level.

• 25:23Vanessa Richardson?

  We see what's coming. I mean, this is so much stress. So she doesn't have any freedom and really no ability to self advocate here. How would you recommend someone handle the early signs of this level of stress to hopefully avoid reaching this point?

• 25:38Tristin Engels?

  Yeah, before I get into that, for clarity, this is educational information. I'm not acting in place of a therapist or provider for anyone listening. But ideally, you learn to respond before your body forces a shutdown like this. And the first step is understanding your limits and then setting them. Recognize the moments when you're pushing past what you can realistically sustain and push back or delegate where you can. Set boundaries when appropriate, reduce demands when possible, and ask for help before you are completely depleted. And secondly, be honest about how you're really doing, not just with people when they check in, but with yourself. Too, that's so important. But if you're saying, I'm fine, but you're crying more, you're sleeping less,

• 26:21Tristin Engels?

  you're feeling numb, you're panicking, you're irritable, hopeless, or you're feeling disconnected. That's information, and that's information you should take seriously. And third, learn relaxation, grounding, and stress reduction skills before you desperately need them. Use them regularly, like tune-ups, not just when everything's already unmanageable. And if symptoms are escalating, especially if you are feeling unsafe or detached from reality, and you're unable to sleep, or you're having thoughts of harming yourself or someone else, that is the point where you need immediate professional support, not later, not after you push through, or get your daily workload done, or your household chores, or whatever the case may be. It's now. Your care matters just as much, too.

• 27:06Vanessa Richardson?

  Unfortunately, Rusty had no idea what to do. He eventually convinced Andrea to go for a walk along the beach with him. It seemed to help at first, but the next day Andrea's mental state deteriorated even more. That day, the Yates family visited Andrea's parents at their home. At some point, Rusty went out to run an errand, and when no one else was paying attention to what Andrea was doing, she took a heavy dose of her father's sedative pills. Shortly after, her mother found her unresponsive and called an ambulance. At the hospital, doctors determined that Andrea could have died, but thankfully, they stabilized her and she was admitted for psychiatric care. During that time, doctors documented severe depressive symptoms.

• 27:51Vanessa Richardson?

  Andrea was largely non-verbal, withdrawn, and at times appeared almost catatonic. When hospital staff asked her why she'd taken the pills, Andrea said she just wanted to stop the intense emotional pain she'd been living with. She was officially diagnosed with major depressive disorder and prescribed antidepressant medication, which Andrea wasn't thrilled about. After all, remember, her religious beliefs forbade medication. Still, it seems like her symptoms improved, because after seven days in the hospital, she was discharged and sent home.

• 28:26Tristin Engels?

  Let's talk about major depressive disorder because it's more than just sadness. It's a mood disorder where a person experiences a sustained period of depressed mood, typically lasting at least two weeks, loss of interest, low energy, changes in sleep or appetite, difficulty concentrating, guilt or worthlessness, and sometimes thoughts of death or suicide. It affects how a person thinks, feels, functions, and interprets themselves. And it can range from mild to severe, with some individuals experiencing psychotic symptoms. Major depression can show up at many points in life, but it often begins in adolescence or adulthood. And for women, risk can increase during pregnancy and postpartum.

• 29:09Tristin Engels?

  Perinatal depression includes depression during pregnancy and after childbirth, and symptoms also range from mild to severe. And for Andrea, the timing makes clinical sense. Her most severe symptoms appeared after multiple stressors stacked on top of each other. She had repeated pregnancies, postpartum hormonal shifts, sleep deprivation, four young children, isolation, she was caregiving for her disabled father, and she had intense religious pressure, especially around motherhood. And just to clarify, what was commonly known as postpartum depression back then is actually now known as major depressive disorder with peri-partum onset.

• 29:49Vanessa Richardson?

  After something like this, what are the signs that someone isn't actually out of the danger zone yet, that they're still in it? What does stabilization actually look like?

• 29:59Tristin Engels?

  Andrea was psychiatrically hospitalized following a suicide attempt. So that's acute inpatient. And in an acute psychiatric setting, treatment typically includes psychiatric medication, psychoeducation about their diagnostic condition, and individual and group therapy. Providers are also observing the person's behavior. They're monitoring their mental status, and they're documenting whether their symptoms are improving or worsening. In that setting, stabilization means is the person sleeping, eating, thinking more clearly, and able to participate in basic decision-making with the introduction of treatment. And it also means they're not Actively suicidal, homicidal, psychotic, or impaired, so much so that they can't care for their basic needs.

• 30:43Tristin Engels?

  There's also a realistic safety plan, professional follow-up, medication, or other treatment if needed, which most of the time there is. Reduced demands at home is recommended, and other adults actively helping. So if someone meets those stabilization requirements, they may be discharged. But being discharged just means that the immediate crisis, what brought them in to that level of care, has reduced enough that they no longer require that level of care. They still require ongoing treatment. And for Andrea, there are still continued risks here. Because first, she was already apprehensive about medication. And given the severity of her deterioration, medication likely played an important role in getting her stabilized.

• 31:27Tristin Engels?

  If she stopped taking it, the risk of relapse would remain very serious for her. Second, she was likely returning to the same level of stress to her environment that contributed to her acute mental health emergency in the first place. It's unlikely that Michael or Rusty's religious messaging would suddenly change to accommodate Andrea when she returned. But more importantly, Andrea seemed to want to believe in their messaging because it offered her hope and structure, or a possible solution to her fears. So instead of recognizing the demands as part of the problem, the demands at home specifically, she might have interpreted again that her breakdown was proof that she needed to become even more obedient, or more righteous, or more self-sacrificing when she came home.

• 32:12Tristin Engels?

  Which is clinically concerning to me because if she believes suffering is part of her duty, then rest, medication, outside help, or fewer demands aren't going to feel like appropriate treatments to her, even if they are provider-recommended, even if they are medically appropriate. So she is likely to be discharged into the same pressure system she was in with the same expectations. And that, alongside of medication-compliance issues, is a high-risk situation for her.

• 32:45Vanessa Richardson?

  So from a clinical standpoint, Andrea had been stabilized, but that didn't mean her underlying condition had been resolved. It only meant she was no longer in immediate crisis. Following her discharge, Andrea's symptoms seemed to improve, but unfortunately, this was short-lived. Because about a month later, on July 21st, she attempted to take her own life again, this time with a knife. Rusty intervened, but Andrea begged him to let her go forward with it. Fortunately, Rusty pulled the knife away and immediately brought Andrea to the emergency room. At the hospital, it became clear that Andrea hadn't been taking her medication as directed. And on top of that, a nurse discovered several self-inflicted wounds,

• 33:30Vanessa Richardson?

  which showed the doctors how much her condition had worsened. But even that was just the tip of the iceberg, because Andrea was harboring dark secrets. And her demons were becoming impossible to control.

• 33:52Vanessa Richardson?

  In the summer of 1999, 35-year-old Andrea Yates attempted to take her own life twice. She'd been officially diagnosed with major depressive disorder, but refused to take her prescribed medication. Then during her second hospital stay, Andrea described some troubling symptoms she'd never mentioned before. Apparently, she'd been experiencing vivid intrusive thoughts for some time, including visions of a violent knife attack. She told her doctors she didn't know how to stop it, and soon they realized there was another layer to these thoughts. Andrea also told them she believed she was evil and had been overtaken by Satan himself. She said he was in control of her thoughts and actions.

• 34:37Vanessa Richardson?

  The doctors had no way of knowing that Michael Warnicki had planted these ideas in Andrea's mind. Regardless, they knew Andrea was experiencing more than depression alone. Based on her uncontrollable, distorted thoughts, they diagnosed her with postpartum psychosis.

• 34:55Tristin Engels?

  Postpartum psychosis is a rare but severe psychiatric emergency that can occur after childbirth. It involves poor reality testing, delusions, hallucinations, paranoia, confusion, disoriented thinking, severe agitation, insomnia, or rapidly shifting mood. It requires immediate treatment. And one important distinction is that intrusive thoughts are not automatically concerned for psychosis. A person can have a terrifying unwanted thought or image, like a violent image flashing into their mind, and be horrified by it. That's a common symptom of certain anxiety disorders, for example. But a hallucination is very different. It's a perceptual experience without an external stimulus, like hearing a voice or seeing

• 35:40Tristin Engels?

  something others do not. Auditory and visual hallucinations are the ones people tend to think of first, but hallucinations can also involve smell, taste, or touch as well because they affect the senses. A delusion is also different from an intrusive thought or hallucination. That is a fixed false belief that is not easily changed by the evidence. So when Andrea says she's evil, or that Satan's taken her over, and that he's controlling her thoughts and actions, that is where the shift from concerns regarding depression turned into psychosis. Now we're talking about a belief that may be detached from reality and organized around religious themes. Her prior mental health history raises her risk as well, which, if you recall, did not

• 36:24Tristin Engels?

  seem to start with her hospitalization, her first one. Andrea experienced a significant depressive episode after her first serious relationship loss, but she didn't seek treatment at that time. So by the time she was hospitalized the first time, this may not have been a brand-new vulnerability for her, at least it doesn't appear to have been. It may have been a longstanding susceptibility to depression that became much more severe under the weight of postpartum changes, sleep deprivation, isolation, caregiving demands, and that religious pressure, which shows you just how important your environment is and other stressors. And that is often how severe symptoms develop. It's not one single cause. It's vulnerability plus stressors, which Andrea had multiple of in addition to isolation.

• 37:11Vanessa Richardson?

  Through a more modern lens, would you agree with Andrea's diagnosis?

• 37:15Tristin Engels?

  Yes, I would agree with this, obviously having not met her. But from what you've shared and what we have here, I would. But one important clarification is that postpartum psychosis is actually not a standalone diagnosis in the Diagnostic and Statistical Manual of Mental Disorders and never has been. For Andrea, given her history of depression and past psychiatric hospitalization, it would likely have actually been diagnosed as major depressive disorder, recurrent, severe with psychotic features with peri-partum onset. But that's just based on the information we have, again, for educational purposes only. I've never evaluated her, but it could also have been brief psychotic episode, another severe mood disorder, or a different psychotic disorder that's starting to present itself as well.

• 38:00Tristin Engels?

  But that's part of the diagnostic process. We start with our first diagnostic impression, and then we update as we get more information. We see them over time. We see how long, like a brief psychotic episode generally lasts a month. Is this lasting longer? We do testing, we get observation, and then we make a change.

• 38:19Vanessa Richardson?

  Now that doctors felt they had a better understanding of what Andrea was going through, they added a new medication to her treatment regimen. In addition to antidepressants, they introduced an antipsychotic called Haldal to target her hallucinations and delusions. They also kept her in the hospital for a while to monitor her progress, and they made sure she got her meds. At first, it seemed like they were working. Andrea regained her ability to think clearly and hold conversations. She no longer spoke of Satan controlling her. Rusty felt relieved, as did Andrea's doctors. Andrea wasn't as optimistic, though. She didn't want to be on medication. Not only was it against her beliefs, but she was afraid she'd become dependent on it, which scared her.

• 39:05Vanessa Richardson?

  It was hard for her doctors to persuade her to take her meds, but eventually they saw enough improvement to transfer her to outpatient care. And eventually, she was released from that program and went back to her normal life. By this point, the Yates's had moved back into an actual house in Clear Lake, Texas. Rusty thought having some more space could create a more stable environment as Andrea recovered. From the outside, it seemed like everything was back to normal. But at a routine doctor's visit in early 2000, Andrea admitted to her provider that since returning home, she hadn't been taking her medication, a decision Rusty had agreed with.

• 39:45Tristin Engels?

  We've already seen the risk of Andrea discontinuing medication. When she stopped the first time, she attempted to take her life again and significantly decompensated, which led to a new diagnosis and a new medication. At this point, she is taking medication to treat both depression and psychosis, so stopping them means risking a relapse of both depressive and psychotic symptoms. I think we have a good idea why Andrea is hesitant to take her medication. She had already verbalized it, but I think there may have been, possibly, a deeper belief underneath that that's worth exploring that's independent of Rusty's reinforcement of her not taking the medication. It's possible she believed that if she needed medication in order to function as a wife

• 40:27Tristin Engels?

  and mother, then that means that she's not righteous enough. And if she was not righteous enough, then maybe her children would not be righteous enough either. That would feed directly into her deepest fear that her children might not get to heaven. And imagine what that belief would do to her delusions or hallucinations if those are active. So the medication also may have represented failure, weakness, or inadequacy. And Michael and Rusty's teachings were just reinforcing that rigid thinking.

• 40:57Vanessa Richardson?

  It's not clear whether Andrea's medication was tapered off, or if she stopped taking it cold turkey. Still, at the time Andrea seemed to be functioning well. She cared for her children and did all the housework. To Rusty and Michael, that was all that mattered. Unfortunately, even though Andrea seemed okay, she was still battling dark thoughts. She told her friend Debbie that she still believed Satan possessed her. Debbie was a Bible teacher, and she read Andrea passages to try and help her overcome her fear of Satan and demons. It seemed to work well enough that Andrea soon told Debbie she wanted to get pregnant again. However, both Debbie and Andrea's doctors warned her that if she had another child,

• 41:40Vanessa Richardson?

  she'd be at risk of another mental health crisis. But Andrea was determined. She and Rusty decided the risk was worth it. After all, based on their religious beliefs, bringing a lot of children into the world was one of their top priorities. And Rusty seemed to think that Andrea's mental health issues had only been temporary. So in March of 2000, Andrea became pregnant again. Her mental health seemed stable throughout her pregnancy. And that November, she and Rusty welcomed their fifth child, a little girl named Mary. But the joy was short-lived. Because in March 2001, tragedy struck when Andrea's father succumbed to his Alzheimer's.

• 42:24Vanessa Richardson?

  The day he died, her mother called her to come help. And when Andrea got into their house, she was met with her father's lifeless body. This experience seemed to trigger something within Andrea, and it was only a matter of days until her own condition deteriorated rapidly. For days, Andrea refused to eat or drink, and she barely uttered a word. She couldn't sleep, staying up all night, sitting in an armchair, tapping her foot against the floor, or pacing around the house in fixed patterns. Not only that, but Andrea refused to let go of her baby Mary out of fear that something would happen to her.

• 43:04Tristin Engels?

  Andrea's response to her father's death is a good indication that this is not ordinary grief, but rather, her system already appeared extremely fragile. And this loss may have overwhelmed whatever stability she had left. Grief alone can destabilize someone, but in Andrea's case, this was layered on top of severe depression, prior psychosis that may or may not have returned, sleep disruption, chronic stress, she's still postpartum and healing, and ongoing religious fears. And the circumstances of the death actually matter here, too, because she walked into the home and encountered his body herself. That can be distressing and traumatic, especially for someone whose mental health is already

• 43:45Tristin Engels?

  fragile. But her deterioration after suggests another significant psychiatric decompensation, which isn't unusual for someone like Andrea who is not compliant with medication. The lack of sleep is especially concerning because sleep deprivation can worsen depression, like we talked about. It can impair reality testing, increase anxiety, and intensify psychotic symptoms. So, once someone enters that cycle where they're no longer sleeping and their thinking becomes more rigid or fearful, symptoms will escalate very quickly. And stress can have a significant impact on your mental health as well. Andrea already has a number of stressors, and this experience was a significant stressor for Andrea, whether

• 44:26Tristin Engels?

  he was living or after he passed. And it may have been the final stressor to overwhelm her system.

• 44:32Vanessa Richardson?

  Do you think Andrea's behavior could be considered normal if those symptoms, those behaviors, hadn't persisted for so long?

• 44:39Tristin Engels?

  Some of Andrea's reactions in isolation could absolutely occur in a normal grief or acute stress experience. But it becomes concerning when the intensity, duration, and level of impairment. When symptoms persist, escalate, or interfere with a person's functioning or their ability to care for themselves, or safely reality tests, that goes beyond what we would typically consider an expected grief response.

• 45:07Vanessa Richardson?

  After a while, Rusty feared Andrea would harm herself again. So he started searching for an inpatient facility for Andrea. By the end of the month, he found a place that was able to treat her. However, Andrea didn't want to go. Rusty and Andrea's brother had to wrestle her into the car. Once they arrived, Rusty told the staff that Andrea wouldn't have survived another night at home without professional care. Inside, clinicians were met with the same nearly catatonic state Andrea had been exhibiting at home, clear signs that she was, once again, in the middle of a severe mental health crisis. This time Andrea was under the care of a new psychiatrist, Dr. Mohammed Said.

• 45:48Vanessa Richardson?

  At that point, Dr. Said hadn't gotten Andrea's records from her previous psychiatrist yet, but he arrived at a similar conclusion as Andrea's past doctors, that she was clinically depressed, unable to make rational decisions about her own care, and posed a danger to herself. However, Dr. Said and his team didn't provide an evaluation as to whether Andrea posed a threat to others, a decision that would later come under significant scrutiny.

• 46:16Tristin Engels?

  The fact that Rusty believed that she would not survive another night at home tells you just how severe this had become. And that said, there's a lot that stands out about this. Firstly, there's a noticeable pattern that we can see in hindsight, which is Andrea improves in a structured setting, but when she returns home to the same stressors, she stops medication, deteriorates again, and then re-enters a crisis. That revolving door pattern is very concerning because it suggests the underlying risk factors were never fully stabilized long-term, which is exactly what I highlighted as the major risk for her earlier in our discussion. And unfortunately, that's not isolated to Andrea's case. It's something that we frequently see a lot of the time, especially if someone's unhoused and we have to discharge them.

• 47:01Tristin Engels?

  Where do they continue their treatment? Where do they continue getting their medication to stay stabilized? It's an ongoing issue. Unfortunately, once someone is discharged from acute inpatient care to a lower level of care, we just can't continue monitoring them 24/7. Hours a day to make sure they're taking their medication or getting their medication. And the medication issue is especially important here because Andrea had already shown significant fear and resistance towards psychiatric medication and Rusty appeared to support discontinuing it. But when someone has severe depression with psychotic features, stopping treatment can dramatically increase the risk of relapse. And once psychosis worsens, insight often worsens too, meaning the person may not recognize

• 47:45Tristin Engels?

  they're becoming ill again. And given that this is now her third psychiatric hospitalization in a short period with two suicide attempts, both with high lethality potential and poor medication adherence history, my question is, why wasn't an involuntary medication order considered for her? It's a very high threshold to meet to get one granted, and it requires a judge's order. But in my opinion, it was worth exploring for her. Those orders can begin during an acute hospitalization and, in some cases, continue during outpatient treatment under court oversight. Refusals are documented, and courts may become involved when noncompliance repeatedly results in dangerous decompensation like this.

• 48:29Tristin Engels?

  So at least there would be some level of monitoring outside of Rusty. As far as Dr. Said's assessment, I think it's important to be fair and careful, at least in hindsight, because based on what he reportedly observed and the fact they didn't have all of her records, concluding that Andrea was severely depressed and determining that she was a danger to herself and gravely disabled seemed clinically reasonable. But there was no documented assessment regarding danger to others. Today, in acute crisis, assessing for danger to self, danger to others, and grave disability are generally done for admission purposes and risk. But clinicians are assessing risk in real time, often with incomplete records and limited information.

• 49:12Tristin Engels?

  And the reality is, if Andrea denied thoughts of harming others, and there were no direct statements or behavior suggesting homicidal intent, then clinicians may not have had clear evidence that she did pose a danger to her children or anyone. But it wasn't documented, which I don't understand that. But most individuals with depression, even severe depression, do not become homicidal or violent either.

• 49:35Vanessa Richardson?

  If you encountered a case like this today, what would be some of your ideas for how to handle the patient's care?

• 49:42Tristin Engels?

  Okay, so first, I would want coordinated outpatient psychiatry, therapy, medication management, and regular assessment of that patient. In my experience, many individuals discharged from inpatient settings are given priority outpatient follow-up appointments where they may have a therapist, psychiatrist, and sometimes even a caseworker involved in their care. There are even outpatient settings where there's full-service partnerships, so that caseworker can transport them to and from appointments. Second, I would be extremely concerned about medication adherence. So psychoeducation for both Andrea and her family would be critical, including directly assessing those fears about medication, the religious concerns, maybe even bringing in a faith-based approach to that,

• 50:26Tristin Engels?

  relapse risk, and insight into her illness. I'd also want to have close communication with her psychiatrist, so the treatment team could regularly discuss presentation, functioning, compliance, and evolving risk factors. Typically, we do, we have interdisciplinary treatment teams. But for example, depending on the psychiatrist's assessment, I think a long-acting injectable antipsychotic may be considered if medication adherence continued to be a major concern, which I think it would have been. Those treatment decisions are ultimately up to psychiatry, of course, but it would have been something to talk about. And then, third, I would strongly recommend major environmental changes. Andrea appeared profoundly overwhelmed and isolated.

• 51:10Tristin Engels?

  So reducing childcare burden, increasing supervision and support, these are things we could use the caseworker for. And ensuring that she was not being left alone to manage multiple young children, while severely psychiatrically unstable to do so, would be very important. It would unfortunately have to involve outside parties to assist with that, but I would also likely recommend some form of home-based follow-up because so much of the risk appears tied to her home itself. Office visits only show a small snapshot of functioning. A home visit can provide a much clearer... Picture of stressors, support, supervision, childcare demands, medication adherence and overall safety.

• 51:51Tristin Engels?

  Again, another reason why case management services are so, so crucial. I would also want collateral information from all her prior providers, hospitals and outpatient records because cases like this often look very different over time than they do in a single interview. And then finally, depending on her level of insight, recurrent decompensation and refusal of treatment, I do think more intensive interventions need to be explored, including extended hospitalization, potential conservatorship or court involvement around treatment, at least in some jurisdictions. None of this guarantees a specific outcome would have been prevented. We're not fortune tellers. But today Andrea's presentation would be viewed

• 52:34Tristin Engels?

  as requiring long-term, high-intensity psychiatric management.

• 52:41Vanessa Richardson?

  Andrea stayed in the facility for almost two weeks. There were times when she seemed to improve. She'd eat and drink a little, especially if her family was there to visit. And sometimes she talked to staff members. By April 2001, that was enough for the facility to discharge her. Just like before, the plan was for Andrea to attend an outpatient program. Dr. Said also prescribed her antidepressants and antipsychotics. She'd taken the antipsychotic known as Haldal in the past. And while Dr. Said wanted to try a newer drug, Rusty insisted she take Haldal again. So Dr. Said did as Rusty asked and wrote her a prescription for it. It's not clear if Andrea actually took the medication.

• 53:24Vanessa Richardson?

  And while she did briefly attend the outpatient program, she eventually stopped going. Perhaps because of this, she didn't show much improvement. So eventually Rusty asked his mother, Dora, to come visit them for a while, partly to help keep an eye on Andrea and also to help out with the kids and other household duties. Rusty thought that would lessen the load on Andrea and help her get better. But no one realized what Andrea was truly battling, because while her doctors and family tried to stabilize her, someone else was whispering in her ear. Michael Warnicki had convinced Andrea that her problems would never go away. He told her that her suffering wasn't caused by mental health

• 54:08Vanessa Richardson?

  conditions, but by actual demons, and that those demons were coming after her kids. Eventually, Andrea decided to do something about it, and the consequences would be devastating.

• 54:35Vanessa Richardson?

  Thanks so much for listening. We'll be back next time as we conclude our deep dive into the mind of Andrea Yates.

• 54:42Tristin Engels?

  Serial Killers and Murderous Minds is a Crime House original powered by Pave Studios. Here at Crime House, we want to thank each and every one of you for your support. If you like what you heard today, reach out on all social media at @CrimeHouse. Don't forget to rate, review, and follow Serial Killers and Murderous Minds wherever you get your podcasts. Your feedback truly makes a difference.

• 55:05Vanessa Richardson?

  And to enhance your listening experience, join Crime House Plus and get both parts of every story dropped on the same Monday, completely ad-free. No waiting three days for part two, plus Crime House bonus episodes every month. To join, go to crimehouseplus.com, or if you listen on Apple Podcasts, tap "Try Free" at the top of the Serial Killers and Murderous Minds page.

• 55:31Vanessa Richardson?

  Serial Killers and Murderous Minds is hosted by me, Vanessa Richardson, and forensic psychologist Dr. Tristin Engels, and is a Crime House original powered by Pave Studios. This episode was brought to life by the Serial Killers and Murderous Minds team: Max Cutler, Ron Shapiro, Alex Benedon, Lori Marinelli, Natalie Pritzowski, Sarah Camp, Alyssa Fox, Ines Renike, Sarah Bachelor, Kaylee Pine, and Carrie Murphy. Thank you for listening.

• 56:07Vanessa Richardson?

  If you're looking for your next podcast, check out What the Fact with Connor Tomlinson from Netflix's Love on the Spectrum and Carter Roy. Every week, they take three unbelievable true facts from history and tell you the full story behind them. Follow What the Fact wherever you listen or subscribe on YouTube at What the Fact Pod.