WARNING: This article contains details about violence against children and suicide.
The murder trial of Massachusetts mom Lindsay Clancy has forced a spotlight on maternal mental health that some medical experts say may be the only positive outcome in the tragic case.
Clancy’s defence doesn’t dispute that she strangled and killed her three children in 2023 while her then-husband was running an errand, and then attempted to kill herself. But they argue she isn’t criminally responsible because she had bipolar disorder and was suffering from postpartum psychosis, a rare and little-understood mental health condition that can affect a new mom’s sense of reality.
Postpartum psychosis — the sudden onset of psychotic symptoms after childbirth — is much more serious than postpartum depression. Researchers estimate that the condition afflicts one to two women per 1,000 after delivery.
The trial has sparked wide-ranging conversations about maternal mental health, and rallies in support of Clancy calling for mental health reform.
These conversations are critical because suicide is still one of the leading causes of maternal mortality in the period of time around giving birth, Dr. Nicholas Leyland, the president of The Society of Obstetricians and Gynaecologists of Canada (SOGC), told CBC News.
However, he says only about one in five patients are ever even asked about their mental health during this perinatal period. And he suggests work needs to be done to help health-care providers and patients differentiate between postpartum depression and psychosis.
“Postpartum psychosis is uncommon, but can be extremely devastating to families and mothers and, of course, the children,” Leyland said.
“Unfortunately, with such a tragic case, it does help us get the message across that these are really important areas to deal with.”
Who is Lindsay Clancy?
Lindsay Clancy, 36, is on trial for killing her three children: Cora, 5; Dawson, 3; and 8-month-old Callan.
On Friday, the defence rested its case in the trial, which began on July 27 in Plymouth County Superior Court in Plymouth, Mass. Closing arguments are expected next week.
Jurors have heard that Clancy strangled the children with exercise bands in the basement of their home in the Boston suburb of Duxbury before attempting to take her own life by jumping out of a second-floor window, which left her paralyzed.
Jurors have also heard that Clancy suffered from hallucinations and delusions that started after her third child was born. On the day of the killings, Clancy said she heard a voice telling her, “This is your last chance. Kill the children so you can kill yourself,” according to her lawyer.
Prosecutors argue Clancy is guilty of three counts of first-degree murder, having plotted to get her husband out of the house so she could carry out the murders. She faces life in prison without parole if convicted. If she’s found not guilty due to lack of criminal responsibility, or by reason of insanity, she would be committed to a state psychiatric hospital.
“The Lindsay Clancy case has become one of the most painful and polarizing stories in recent American memory,” three medical experts noted in an op-ed on the health and medicine news site Stat News.
“Regardless of the trial’s outcome, the case exposes a larger and uncomfortable truth: Our understanding and treatment of postpartum psychiatric illnesses remain profoundly inadequate.”
What is postpartum psychosis?
Postpartum psychosis is a perinatal mental health disorder — one of several types of mental health conditions that can affect mothers during pregnancy and after childbirth. Postpartum depression and anxiety are the most common, affecting about one-quarter of mothers who recently gave birth, according to 2019 Statistics Canada data.
A recent study published in medical journal JAMA found that mothers with diagnosed perinatal depression were three times more likely to be at risk of suicidal behaviour compared with mothers without perinatal depression.
Postpartum psychosis is the most severe postpartum psychiatric illness. The major difference between postpartum psychosis and postpartum depression is that those suffering from psychosis can suddenly lose touch with reality, according to Leyland, the SOGC president.
It can cause extreme mood swings, delusions and confusion, according to the SOGC. Symptoms can also include hallucinations, disturbing thoughts, disorganized thinking or behaviour, paranoia, confusion, mania or depression, racing thoughts, insomnia, irritability or agitation.
An example of a hallucination could be hearing a voice instructing the mother to harm herself or her child, Leyland said.
“These patients are very ill and this is the psychiatric emergency where they need to be hospitalized and managed appropriately by a psychiatrist.”
What are the risks of harm?
A 2023 clinical review published in the journal Medical Science Monitor explains that symptoms can evolve rapidly and differ from psychotic episodes that are unrelated to pregnancy. The condition usually appears in the first two weeks after birth and progresses quickly. There’s an increased risk for suicide and self-harm, the review notes.
“Suicide is a huge risk in these patients,” Leyland said.
Then there’s the risk of harm to the children. According to a 2024 research paper published in the Archives of Women’s Mental Health, untreated postpartum psychosis is associated with an infanticide rate of about four per cent.
Leyland says it’s difficult to get the kind data to really understand the nature of the risk, “but the risk is there.”
“We need to be able to intervene on these cases quickly with appropriate treatment to prevent that from happening … because it is just so devastating and it will have intergenerational effects,” he said.
WARNING: Video contains discusssion of suicide | Health Canada has approved the first drug meant to specifically treat postpartum depression. The medication is designed to treat moderate to severe cases and can help relieve symptoms in as few as three days.
Experts caution that it’s problematic to have messaging that only focuses on the risk of violence, rather than identification and treatment. Leyland says postpartum psychosis is treatable, often with aggressive use of antipsychotic medications, mood stabilizers and sometimes electroconvulsive therapy.
“If the message is only about risk, we worry about women who are experiencing symptoms not seeking treatment because of stigma and because of fears of losing custody of their kids,” forensic and reproductive psychiatrist Susan Hatters Friedman told the Psychiatric Times earlier this month.
Experts say getting help early increases the odds of a good outcome.
Was Clancy diagnosed with postpartum psychosis?
A forensic psychiatrist diagnosed Clancy with bipolar disorder and postpartum psychosis after the killings. Clancy’s lawyers are seeking to prove she had postpartum psychosis at the time she killed her children.
Clancy and her ex-husband, Patrick Clancy, have also filed lawsuits accusing her medical providers of failing to properly diagnose and treat her condition. Several of those providers have testified in Clancy’s trial.
Jurors have heard that Clancy was prescribed 13 different psychiatric medications across different providers, and her attorneys say Clancy did everything she could to seek help, including going to the emergency room, calling a suicide hotline and checking herself into a psychiatric hospital.
“She was begging for help,” Clancy’s mother-in-law, Susan Clancy, testified at the trial this week.
Her lawyers argue that antidepressants prescribed after the birth of her third child worsened her bipolar disorder.
Earlier this week, court heard that Clancy, a former nurse, conducted online searches concerning depression, suicidal ideation and “symptoms of postpartum psychosis” in the days before the killings.
On Friday, Dr. Phillip Resnick, a forensic psychiatrist and expert in the killing of a child by a parent, testified that Clancy was “clearly psychotic” on the day she killed her children and was not in control of her actions.
“It was almost like she was a puppet and someone else was pulling the strings,” said Resnick, who also testified for the defence in the 2006 trial of Andrea Yates, the Texas mother who drowned her five children in 2001 and was found not guilty by reason of insanity.
Regardless of the trial’s outcome, Leyland says health-care providers need to do more to help patients with postpartum psychosis get proper screening, diagnosis and care.
“People are afraid to come forward to talk about these things because they feel that it’s a failure on their part,” he said.
“But if you got cancer, it’s not a failure on your part. It’s just a disease, a serious one. And mental health is exactly the same. It’s a serious illness that can be treated.”
If you or someone you know is struggling, here’s where to look for help:
