Clancy Trial Exposes Gaps in Postpartum Psychosis Care

The murder trial of Lindsay Clancy, a 36-year-old former labor and delivery nurse from Duxbury, Massachusetts, has thrust postpartum psychosis into the national spotlight, with women who have experienced the condition calling for more research and better medical training. The prosecution rested its case on Monday after more than 70 witnesses testified across four weeks, and the defense has begun calling witnesses including Clancy’s mother and sister, according to NPR.

Clancy is charged with three counts of first-degree murder in the January 2023 strangulation deaths of her three children: Cora, 5, Dawson, 3, and Callan, 8 months. Her defense team admits to the killings but argues she is not criminally responsible due to severe postpartum psychosis, using what is legally known as a lack of criminal responsibility defense in Massachusetts. Prosecutors, however, contend Clancy deliberately planned the killings by sending her husband out of the house on errands.

A Rare but Severe Condition

Postpartum psychosis affects an estimated 1-2 out of every 1,000 births, making it uncommon compared to postpartum depression, which affects about 10% of mothers. Yet it is a severe psychiatric emergency that can cause hallucinations, paranoid delusions, and a break from reality. The Boston Globe reports that when properly diagnosed, the condition is highly treatable, with studies suggesting lithium and other medications ease symptoms for 98% of patients.

One major obstacle to diagnosis is that postpartum psychosis is not listed as a distinct diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the main handbook used to identify mental health conditions. Dr. Susan Hatters Friedman, a reproductive and forensic psychiatrist at Case Western Reserve University, told NPR: “This is the scariest mental illness that I know of. You have these symptoms happening rapidly, you may or may not have any mental health history or any mental health literacy, and you’ve got this dependent little person with you — and it’s not listed in the DSM. So doctors might not recognize what’s going on.”

A Pattern of Missed Diagnoses

Clancy’s medical history reveals a troubling pattern. Between September 2022 and January 2023, she was prescribed 30 prescriptions for 13 different psychiatric medications from at least six providers. She was hospitalized at least three times, including a five-day stay at McLean Hospital. Dr. Veerle Bergink, a psychiatrist and director of the Women’s Mental Health Center at Icahn School of Medicine at Mount Sinai, who has treated hundreds of women with postpartum psychosis, said Clancy’s case follows a familiar trajectory.

“She was manic after delivery and it was not treated, and medication made it worse,” Bergink told NPR. “For me, it’s a very classical, typical story of a woman with postpartum psychosis not being diagnosed, not being treated.”

Dr. Uruj Kamal Haider, a perinatal psychiatrist and medical director of Massachusetts Psychiatry Access Program for Moms, emphasized to WBUR that psychosis doesn’t always present with obvious hallucinations. “There does not have to be full blown auditory or visual hallucinations for a mom to be psychotic,” she said. “The mom may just present as paranoid or confused or just very irritable and that can escalate very quickly especially with intense sleep deprivation.”

Conspiracy Theories Threaten Awareness

While the trial has drawn national attention to postpartum psychosis, it has also spawned a wave of conspiracy theories on social media. Amateur sleuths on TikTok have promoted unfounded claims that Clancy’s ex-husband, Patrick Clancy, actually murdered the children and framed her, despite surveillance footage and phone records corroborating his alibi. The Guardian reports that experts call this phenomenon “forensic fandom,” where people engage with real-life cases like fictional shows.

Katy Coduto, an assistant professor of media science at Boston University, told The Guardian that “crime cases don’t follow a clean narrative, even though viewers and listeners really want them to. It’s hard to accept that someone could do something terrible, so citizen sleuths are really trying to make anti-normative behaviors make sense and fit into a logical pattern.”

Andrea Clark, deputy CEO at Postpartum Support International, warned that denying postpartum psychosis may have played a role in the killings threatens to entrench stigma around the condition, creating a “chilling effect” on women coming forward to get treatment.

A Call for Change

Advocates and medical experts say the case underscores urgent gaps in the mental health care system for new mothers. Psychiatry residents are not currently trained on postpartum psychosis, and the U.S. lacks the infrastructure to study new moms and infants simultaneously, unlike countries such as the U.K. that have dedicated “mother and baby units.”

Meghan Cliffel, a postpartum psychosis survivor and mental health advocate, told Boston.com that the media’s intense focus on the trial feels disproportionate. “It feels heartbreaking to have the media kind of so unrelentingly focused on this story at this moment, after not really digging in and caring about this issue outside of that for the past however many 100 years,” she said.

Two decades after the Andrea Yates case brought postpartum psychosis to national attention, experts say change has been slow. But high-profile trials like Clancy’s may increase awareness about postpartum mental health, even as the legal proceedings continue. The trial, which began July 27 in Plymouth County Superior Court, is expected to continue for several more weeks as the defense presents its case.

If you or someone you know is in crisis, please call, text or chat with the Suicide and Crisis Lifeline at 988, or contact the Crisis Text Line by texting TALK to 741741.