What Lindsay Clancy's Trial Is Teaching Us

Dear friends,

As I send this, a jury in Plymouth, Massachusetts is still deliberating in the trial of Lindsay Clancy — the mother who killed her three young children in 2023, in the grip of postpartum psychosis. I don't know what they'll decide. I do know this: the case has cracked open a conversation I've been having quietly, in my office, for more than 20 years.

Postpartum psychosis barely exists on paper.

Here's something that surprises almost everyone I tell it to: postpartum psychosis is not its own diagnosis in the DSM-5. There is no code for it. It shows up only as a "with peripartum onset" specifier, tacked onto bipolar disorder or brief psychotic disorder — a footnote to other illnesses, not the fast-moving, high-stakes emergency it actually is. Women's mental health experts have been petitioning the APA since 2020 to change this. It's rare, roughly one to two women in a thousand, but when it happens, it happens fast, and it is a true emergency. We still don't have a stable, agreed-upon language for it. That gap has consequences. It shapes how quickly a woman is believed when she says something is wrong. It shapes how a jury is asked to think about "knowing right from wrong." It shapes research funding, because you cannot easily study, or bill insurance for, or build treatment protocols around a condition that doesn't have its own diagnostic home.

This is part of a much bigger pattern.

Women's health and women's mental health are chronically understudied and underfunded, full stop. Care for new mothers is fractured by design. An OB who sees you for six weeks and releases you. A pediatrician focused entirely on the baby. A primary care doctor who may never ask how you're sleeping, or what's moving through your mind at 3 a.m. A mental health system disconnected from all of it. This is exactly why I don't work in isolation — I collaborate closely with a trusted prescriber, so therapy and medication management are never two separate conversations about the same person. It shouldn't be unusual for a therapist and a prescriber to actually talk to each other. It should be the standard. It rarely is.

The fracture is architectural too, not just a metaphor. Only a handful of hospitals in this entire country have an inpatient unit for perinatal psychiatric care. Most states have none. And even where a unit exists, we have no true mother-baby units here — places where a mother is hospitalized together with her infant, so treatment doesn't require severing the bond at the exact moment it may matter most. The UK has more than twenty of these units. France has over a dozen. Belgium, New Zealand, too. Here, when a mother is hospitalized for postpartum psychosis, her baby goes home without her. That single design choice tells you where maternal psychiatric care sits on the list.

The people closest to her often see it first.

Postpartum psychosis moves fast, usually within the first two to four weeks, and it can erode a woman's insight into her own state even as it's happening. She may not be the one who notices. This is why I talk to partners and families too, not just my patients — about what to watch for. Rapid, dramatic mood swings. Disorganized or racing thoughts. Refusing sleep even to the point of exhaustion. Strange, fixed beliefs about the baby, or about being watched or in danger. And sleep deprivation isn't just a symptom here, it's an accelerant. In a woman already vulnerable, severe sleep loss can help tip her into a manic or psychotic episode outright. I've said it before: sleep is queen. Here, it can be the difference between catching something in time and not.

Something has shifted in how we're responding.

I've been struck by how different the public response to Lindsay Clancy has been compared to Andrea Yates. I remember the Yates coverage well — horror, mostly, and not much cultural literacy about what postpartum psychosis even is. This time is different. More women are saying, out loud, "I see myself in her." Not because they've done what she did. Because they recognize the terrain. The sleeplessness. The fear of not being taken seriously. The terrifying sense of losing your own mind while everyone around you thinks you're just tired and stressed. And underneath all of it, something less visible but just as exhausting: the work of advocating for your own care when this isn't your area of expertise. You don't know if the medication combination you've been handed makes sense. You don't know if the provider in front of you actually understands what's happening to you, or is just moving you through a fifteen-minute visit. You're depleted, likely frightened, maybe already losing your grip on what's real — and you're still expected to be the one who catches the error, asks the sharper question, pushes for the referral. That's an unreasonable thing to ask of anyone. It's an impossible thing to ask of a woman who may not be well enough to ask it of herself.

A caution, though, as this story permeates the zeitgeist. If you've had a scary, unwanted thought about your baby,  most mothers have — that is not this. Intrusive thoughts that horrify you, that you would never act on, that make you recoil from yourself, are common, they are treatable, and they are a different category entirely from psychosis, which is a break from reality itself. If you're afraid you're "like her" because of a thought that scared you, hear me clearly: being afraid of the thought is itself evidence you're not in psychosis. Please still tell someone. Please don't spiral alone. But please don't borrow a fear that isn't yours.

Her defense attorney, Kevin Reddington, has done something that matters regardless of the verdict: he has insisted on her humanity. His argument has centered on the fact that Lindsay Clancy loved her children — that in the delusion of her psychosis, she believed she was protecting them, not harming them. That distinction is everything. It's the difference between monstrousness and illness. And it's the exact distinction postpartum psychosis scrambles for the person living inside it.

Some testimony described her as experiencing a command hallucination, and a delusion of influence — the sense that someone else was controlling her own body. Other experts disagreed. One didn't think she was psychotic at all. That disagreement, among trained clinicians looking at the same woman, tells you something on its own: this territory is genuinely hard to diagnose, even up close. That's the jury's job to weigh, not mine. But you don't need a verdict to sit with what it would mean if true — a mind so overtaken it no longer was her own.

A hospital chaplain testified that when she visited Clancy about a week after the killings, Clancy took her hand and said, unprompted, that she was so glad her children were safe. The chaplain told her, gently, that they were safe in heaven. Clancy reportedly said a voice had warned her that if she didn't act, neither she nor her children would be safe. I share this not to make a legal point. It's the clearest window I've seen into what delusion can feel like from the inside — not confusion about right and wrong, but a completely rearranged sense of what was true. In her mind, in that moment, she hadn't taken her children's safety away. She believed she'd secured it.

Postpartum psychosis does not always look like what people imagine. A woman in the middle of it can still get dressed, hold a conversation, show up to an appointment, and look, to someone glancing at her, entirely fine. Dr. Phillip Resnick, the defense's forensic psychiatrist, put a name to this in his testimony: psychosis "can indeed wax and wane," he said, and he wasn't suggesting Clancy was frankly psychotic every single minute, even on the day of the crime. That's consistent with what I've seen clinically. I've sat with patients whose internal world had become almost unrecognizable to them while their outward presentation stayed composed enough that no one around them clocked how much danger they were in. That gap, between how a woman looks and what's happening inside her mind, is exactly why we can't rely on appearances. It's why the smaller signs matter as much as they do.

And by every account, Lindsay Clancy was asking for help. Her husband reportedly went to her doctor the week before the killings, worried about how heavily medicated and altered she'd become. She was on multiple psychiatric medications at once. Whatever the jury decides about criminal responsibility, this part deserves to sit on its own: a mother reaching for help, repeatedly, inside a system that wasn't built to hear her clearly or fast enough.

The legal system, like the DSM, was never really built to hold something like postpartum psychosis. A jury gets handed a small set of boxes — guilty, not guilty, not guilty by reason of a lack of criminal responsibility — that force an illness with blurred edges into a binary the law can process. That's not a flaw unique to this trial. It's the same category problem, showing up in a different building.

There is so much more work to do.

In my practice, I've assessed and hospitalized women in the throes of postpartum psychosis. I want to say that plainly, because I think honest statements from clinicians on the front line of care matter right now. It is one of the most frightening presentations I've witnessed in this work — for the patient, for their partner, for everyone standing nearby trying to figure out what is happening and how fast they need to move. It is also, with the right recognition and the right collaborative care, treatable. Women recover. Families rebuild. But that recovery depends entirely on the system around a woman recognizing what's happening in time, and right now, too much of that recognition is left to chance — to whether a partner speaks up, whether a provider asks the right question, whether anyone is looking closely enough.

This case will end with a verdict — guilty, or not guilty by reason of a lack of criminal responsibility. But I don't think either outcome hands Lindsay Clancy her old life back. Whatever the jury decides, she is very unlikely to simply walk free; she's far more likely facing years, maybe a lifetime, in psychiatric custody either way. That matters, because so much of the public conversation defaults to a binary — innocent or guilty, free or locked away. The reality here is neither.

It will not end the reckoning this case started, either. Maternal mental health needs better research, a clearer diagnostic home, care that doesn't leave a mother's mind out of the conversation about her body, and a public that keeps learning, the way it seems to be learning right now, to meet these stories with recognition instead of reflexive horror. Cases like this one sometimes become the catalyst that legislation needs — better postpartum screening mandates, insurance requirements for thorough psychotherapy and psychiatric follow-up, not just a six-week checkup and a pamphlet. I hope this is one of those cases.

One more thing, gently. If you're pregnant or postpartum right now, you have my explicit permission to look away from this trial's coverage if it's too much. You don't owe anyone your attention to graphic detail in order to care about this issue, or this mother. Protecting your own nervous system is not avoidance. It's wisdom.

If you or someone you love is struggling with your mental health during pregnancy or postpartum, please reach out. You can call or text the National Maternal Mental Health Hotline at 1-833-TLC-MAMA, any time, for free and confidential support. You can also call or text the Postpartum Support International HelpLine at 1-800-944-4773, in English or Spanish. And as always, our door at 67 Byberry is open if expert and humane care it what you need right now.