02:05
What is postpartum psychosis? Inside the Lindsay Clancy case
00:0000:00
The ongoing murder trial of Lindsay Clancy, the mother who in 2023 killed her three children in Massachusetts, has catapulted into the spotlight the severe mental health condition known as postpartum psychosis. It’s left many parents and concerned loved ones to wonder what causes the medical emergency and when to seek help
The trial, which is expected to take several weeks, centers around Clancy’s mental state and whether she should be held criminally responsible for her children’s <a href="https://healthylife7.com/glp-1s-could-be-linked-to-more-than-150-deaths/” title=”GLP-1s could be linked to more than 150 deaths”>deaths. The prosecution has argued that the 35-year-old intentionally and knowingly attacked her children. Her defense team does not dispute the fact that she killed her children, but has argued that she was consumed by the rare mental health condition. And because of it, her defense has said, she was not responsible for her actions.
So what exactly is postpartum psychosis?
TODAY.com spoke to clinical psychologists and psychiatrists about the dangerous psychiatric condition, which can alter an individual’s sense of reality. It’s also far less well-known than other mental health disorders, like postpartum depression, a different condition that causes mood swings and extreme sadness. The experts say the case has laid bare the critical need for more research, education, awareness and empathy around perinatal mental health issues
“There’s a lot that we can learn from this tragic case that needs to happen in order to improve our systems of care for birthing persons across the board,” says Tracy Vozar, Ph.D., a clinical psychologist and director of the Perinatal Wellness Program at Endeavor Health
The Lindsay Clancy Case and Her Mental Health History
The crux of Clancy’s defense hinges on the argument that she had been suffering from postpartum psychosis when she killed her children — Cora, 5, Dawson, 3, and Callan, 8 months — at her home in the suburbs of Boston
That night in 2023, she sent her then-husband Patrick Clancy out on errands before strangling her children, according to court documents. Afterward, she jumped out of a window on the second floor of her home. She was left paralyzed from the waist-down as a result of the suicide attempt, her attorneys have said
During the trial, Lindsay Clancy’s attorneys told the court that on the day of the killings, she heard voices instructing her to harm the children
“This is your last chance,” Clancy’s lawyers said she heard the voices say. “Kill the children so you can kill yourself.”
Lindsay Clancy, who was diagnosed with bipolar disorder after the killings, was not formally diagnosed with postpartum psychosis, according to court documents and clinicians’ testimony
But testimony from her ex-husband — in addition to her previous diary entries and two medical malpractice lawsuits filed by Patrick and Lindsay Clancy individually — details her multiple attempts to seek help for her increasingly deteriorating mental health following the birth of her third child
Before Clancy was scheduled to return to her work as a labor and delivery nurse at Massachusetts General Hospital, she sought care from several clinicians in the fall of 2022, according to Patrick Clancy’s medical malpractice lawsuit
She was diagnosed with generalized anxiety disorder and prescribed a long list of medications, from anti-depressants to sleep aids, to treat her worsening symptoms, the suit said. One of the medications, Seroquel, was an antipsychotic to which Clancy reported having experienced suicidal ideation since starting the drug, according to the suit
As the weeks went by, Lindsay Clancy’s mental health declined, Patrick Clancy’s medical malpractice suit said. At one point, she was getting roughly three hours of sleep a night, according to the complaint. By December, Clancy admitted herself into a hospital day program for patients with postpartum depression, reporting that she was “(w)orried that she (wa)s ‘messed up beyond repair,’” the suit said. Not long afterward, she checked herself into a psychiatric hospital and was released a few days later.
Nineteen days after her release from the psychiatric hospital, Clancy attacked her children. Her medical malpractice lawsuit argues that the providers named “each failed to properly diagnose Lindsay’s bipolar disorder with postpartum onset and instead subjected her to a disorganized, uncoordinated course of polypharmacy that exacerbated her condition and precipitated a severe psychotic break.”
The providers who have responded thus far have denied the allegations
Alia Goodheart, a psychiatrist who treated Clancy during her in-patient stay at McLean Hospital, a psychiatric facility named in Lindsay Clancy’s lawsuit, testified on Aug. 7 that she did not observe any signs of psychosis, saying she was a low-level risk patient
“I did not have any concerns about her safety or a risk for anybody else,” Goodheart told the court about discharging Clancy after five days. “She had never stated that she had any thoughts of harming anybody else.”
What Is Postpartum Psychosis, and What Are the Symptoms?
Experts stress that postpartum psychosis is quite rare. Unlike postpartum depression, a type of depression following childbirth that impacts one in seven women, postpartum psychosis is a medical emergency that impacts between 1-2 per 1,000 women. Though it’s much less common than other mental health conditions during the perinatal time period, Vozar underscores that it’s “also the most concerning and most severe.”
Vozar explains that those who are experiencing psychosis in the postpartum period generally lose the ability to distinguish delusions from reality. Individuals may hear voices or experience hallucinations, the clinician says
“These are voices or commands that feel very real — as real to them as a conversation with a loved one is to you or I,” Vozar says. “Because they believe it to be true … the concern is that folks with postpartum psychosis may act on these beliefs, these thoughts and these voices.”
In addition to psychotic symptoms, the condition can also involve mood symptoms, from depression to mania, as well as confusion, says Dr. Jennifer Payne, a reproductive psychiatrist and the director of the University of Virginia’s Reproductive Psychiatry Research Program
“These patients often appear somewhat disorganized or confused, or they complain of brain fog, so they’re not thinking correctly,” Payne tells TODAY.com
She adds that there’s a “spectrum” of illness when it comes to postpartum psychosis. While the most severe cases can appear obvious, the less severe cases may not be immediately apparent to a clinician, she says
“It has this kind of waxing and waning course,” Payne says. “So a patient may look fine on exam one moment and a few hours later be very ill.”
How Is Postpartum Psychosis Diagnosed?
Diagnosing postpartum psychosis can be tricky, Vozar explains. That’s because when a patient is in a state of psychosis, the individual isn’t always able to tell whether they’re in danger
“We have to rely, a lot of times, on what our patients are reporting to us. And unfortunately, if patients don’t tell us they’re exhibiting these symptoms, that they’re having these beliefs, they’re experiencing these hallucinations — it’s really hard to catch that this is happening,” Vozar says
And while about half of those who have experienced postpartum psychosis also have significant risk factors, such as bipolar disorder, the other half do not, Vozar says
“In half of folks who do end up with the diagnosis, we didn’t have any warning signs as professionals to be watching out for,” she explains
Apryl Alexander, a clinical and forensic psychologist, Psy.D., says the stigma tied to mental illness, particularly psychosis, can also make it difficult for those experiencing it to speak up
“Individuals with psychosis sometimes know that the voices or the things that they’re seeing … other people might think that those are ‘weird’, and so they might conceal them,” says Alexander, director of the UNC Charlotte Violence Prevention Center. “Sometimes, what happens with postpartum psychosis for folks is, ‘I’m hearing these things. Do I feel comfortable telling a clinician, telling my partner about what I’m hearing?’”
Often it’s up to loved ones, who’ve noticed stark changes in the individual’s behavior, to sound the alarm, Vozar says. A loved one might observe that the individual isn’t sleeping, or appears to be talking to someone who isn’t there or is abnormally agitated, she says. And that can help clinicians investigate further
Payne also notes that postpartum psychosis can be particularly difficult to diagnose in those who have depressive symptoms. She recalls some cases in her clinical experience in which she’s treated a patient with what appears to be postpartum depression. However, over time, she noticed that they’ve exhibited some confusion and other signs that are consistent with a milder version of postpartum psychosis, Payne says
“These were patients who were complaining of brain fog. They looked mildly confused on exam, but they weren’t out of control behaviorally,” Payne says. “When I said, ‘Yes, you’re presenting with depressive symptoms, but this seems to be a bit more. Let’s start some lithium,’ that reversed the course of the illness almost right away.”
Payne adds that those with postpartum psychosis often respond well to lithium as a form of treatment and management. And that positive response can be a “hallmark” of the condition itself, she says
What Can People Learn From Lindsay Clancy’s Case?
There’s still so much that is unknown about postpartum psychosis, Vozar says. Other mental health conditions like postpartum depression, for example, occur in a much larger sample, she explains. And that means there’s a much better shot at studying the issue comprehensively. However, postpartum psychosis is difficult to study longitudinally, she says. There simply isn’t enough research
“That’s one of the trickiest things about perinatal psychosis — because it’s so rare, and because when it occurs, it’s such an emergency, and it can occur quite suddenly, it’s very hard to study,” Vozar says
But questions and debates around Clancy’s case show just how little the general public is aware of mental health issues impacting birthing people more generally, experts say. Vozar believes that people should be stepping back from a focus on psychosis and instead advocating for more awareness around issues during pregnancy and the postpartum period
“We need to be better about supporting new parents, observing new parents, asking them meaningful questions about how they’re doing, really listening, really leaning in around how we can provide support,” Vozar says. “Rarely do I work with someone who says, ‘Nope, all of my needs are met. I’m doing great.’”
And though it’s easy to get fixated on some of the horrific aspects of the case, Alexander says it’s important to think about whether there are ways to reduce the likelihood that tragedies like this one happen again. Not only should people in society work to reduce the stigma tied to mental health help, physicians should also place a larger focus on evaluating patients’ mental wellbeing along with physical health, she says
“How are we assessing their mood and any other symptoms? Are we directly asking about it after a person has given birth?” Alexander says, calling on health care professionals to look into these issues with their patients. “Are we taking our due diligence and our time to be able to adequately assess and evaluate these women?”
She acknowledges, however, that the overburdened health care system in the U.S. doesn’t help. And that there needs to be more attention paid to the capacity of these systems
A 2023 survey from the American Psychological Association shows that the majority of psychologists reported an increase in symptom severity among their patients. And many reported that patients needed treatment for longer periods of time. Roughly one-third of psychologists reported that they were burned out, as well
“These findings demonstrate that psychologists are working at the limits of their capacity, and underscores the fact that some patients who need care are not able to access it quickly,” the survey said
Perinatal Mental Health Challenges Need More Empathy, Experts Stress
Alexander says that it’s also critical for people to reframe the existing, rather rosy ideas of parenthood and the perinatal stage. In reality, Alexander says, it’s a period of time that comes with a lot of stressors and big changes. Feelings of overwhelm and more are to be expected, she says
“A lot of the message that people get is, ‘This is supposed to be the most joyous part of your time,’” she says. “We have this idea of what giving birth to our child looks like and the aftermath, but it’s really hard and it’s really challenging. So sometimes we need to get rid of some of that ‘strong woman’ narrative that comes up for folks, and really think about what support that folks need after they’re having a child.”
Finally, Payne says, it’s time to have more empathy toward struggling parents with mental health issues
“Postpartum psychosis is like having a storm in your brain, and when one is psychotic, you are not acting the way you would normally, and you are not making decisions the way you would normally,” she says. “That really should drive compassion.”
She adds: “It is not something that someone chooses to have.”
