The Lindsay Clancy murder trial has captured national attention. When a mother in suburban Duxbury, Massachusetts, seemingly picture-perfect with three young children, strangles her three children (ages 8 months, 3, and 5), the question arises: Could this happen to anyone, anywhere?
As a reproductive psychiatrist with over two decades of experience, I have treated more than a thousand women with postpartum depression and anxiety, and fewer than twenty with postpartum psychosis. The condition is rare, occurring in 1–2 per 1,000 postpartum women, but devastating. Postpartum psychosis typically presents with fluctuating symptoms: mood disturbance (depression, elevated or irritable mood), psychotic features (delusions, hallucinations, illogical thoughts), and sometimes bizarre behavior. In most cases, it represents a bipolar-spectrum mood disorder rather than a primary psychotic illness.
The Challenge of Recognition
In my clinical practice, I have encountered subtle presentations of postpartum psychosis. Women may appear sad, depressed, anxious, or agitated, often with severe sleep disturbance. When sleep deprivation persists and antidepressants fail to help, symptoms can worsen. In a subset of women with underlying postpartum psychosis, antidepressants may actually exacerbate the presentation, triggering irritability, agitation, and worsening insomnia.
Patients frequently use socially acceptable language: “I’m so anxious,” “I’m exhausted.” They rarely volunteer paranoid ideation or auditory hallucinations. Intrusive thoughts about wanting to die, or distressing images of harm to the baby, can occur in both postpartum psychosis and postpartum OCD. Distinguishing whether a postpartum woman with intrusive thoughts is at risk for harming herself or her infant is one of the most challenging aspects of our work. Clinical textbooks suggest that if a woman has no intent to act on suicidal or frightening thoughts, she more likely has postpartum OCD. However, the reality in clinical practice is that postpartum psychosis can wax and wane; a woman may appear stable for part of the day, then experience a surge of symptoms.
My colleagues and I, with over sixty years of collective experience, regularly present challenging cases in peer supervision. We review postpartum depression, postpartum OCD, and occasionally postpartum psychosis to ensure we are not “missing something” and to discuss the most effective treatments for complicated patients.
The Lindsay Clancy Case: A Familiar Presentation
Lindsay Clancy reported symptoms consistent with postpartum anxiety: stress, anxiety, difficulty sleeping, feeling overwhelmed at the prospect of returning to work as a labor and delivery nurse and leaving her young children. I have treated countless postpartum women with similar complaints. The differential diagnosis is broad: postpartum depression, postpartum OCD, postpartum psychosis, and postpartum PTSD.
Telehealth has become standard in mental health care. Many clinicians gave up office space during the pandemic and moved fully virtual. In my practice, approximately 20% of patients see me in person; the majority prefer telehealth. For clinical reasons, I request in-person visits when puzzled by a presentation. Office appointments can reveal information that telehealth cannot capture—a paranoid patient might hesitate to disclose concerns that her apartment is bugged by the CIA through a screen, but might open up about psychotic symptoms in person.
Medicine, Law, and Language
Our legal system operates in black and white, good versus evil, while medicine, and psychiatry specifically, focuses on symptoms, treatments, and treatment response. We speak different languages. We live in a litigious society: when tragedy strikes, lawyers are hired, courts convene, and the goal becomes holding someone responsible. In this case, Lindsay Clancy’s attorney has focused on psychiatric medications as one culprit, and the prescribers as another. The attorney repeatedly refers to SSRIs as “strong chemicals that change the brain.” He has also emphasized her outpatient psychiatrist’s limited experience, noting she had graduated from residency only months before joining a group practice and beginning telehealth treatment with Clancy.
Raising Awareness
The Lindsay Clancy murder trial is raising awareness of perinatal mental illness. News outlets are interviewing experts to differentiate postpartum depression from postpartum psychosis. Hopefully, this will lead family members, friends, and physicians to consider postpartum psychosis on their differential when a loved one or patient reports severe symptoms unresponsive to “usual treatments” for postpartum depression or anxiety.
Greater awareness should lead to more women receiving appropriate treatment. Postpartum Support International, a nonprofit organization, offers free virtual support groups for pregnant and postpartum women in the United States. PSI also has regional coordinators worldwide who help connect pregnant and postpartum women to clinicians specializing in women’s mental health. Additionally, PSI has a team of reproductive psychiatrists who provide expert consultation to attorneys representing women with legal issues related to perinatal mental health conditions.
Postpartum Psychosis Essential Reads
A “Bad Disease”
My husband is an oncologist. Throughout his training and career, he often referred to certain cancer diagnoses as “bad disease,” an informal term used when standard treatments were insufficient to prevent progression and death. In reproductive psychiatry, postpartum psychosis is a “bad disease.” It can masquerade as anxiety or depression, worsen with “usual treatments,” and ultimately carries risk of suicide and infanticide.
Lindsay Clancy’s clinical course, worsening symptoms over several months, two emergency department visits, an evaluation at a specialized women’s mental health day hospital program, and an inpatient admission to McLean Hospital, suggests that the “usual treatments” were insufficient to stabilize her.
Would a longer inpatient stay at McLean have made a difference? Would consistent engagement with the Women & Infants day hospital program have changed the outcome? If Lindsay Clancy had consistently taken her prescribed psychiatric medications, would her three children be alive today? These questions are unanswerable.
Regardless of the legal outcome, the tragic deaths of Cora, Callen, and Dawson will profoundly affect everyone who knew the Clancy family and all who have followed this case for years to come.
