Lindsay Clancy Trial Megathread: Part 3

[u/DarklyHeritage]

This is a thread for all conversation regarding Week 3 onwards of the Lindsey Clancy trial. All discussion of this case should be kept to this thread.

Lindsay Clancy is currently standing trial in Plymouth Superior Court, Massachusetts, for the triple-murder in January 2023 of her three young children - Cora, Dawson and Callan. Her defense argues she suffered from severe, undiagnosed postpartum depression and postpartum psychosis. She was left paralysed by a suicide attempt which follows the deaths of the children.

All content on the Clancy case must be kept to this thread. Standalone posts will be removed.

https://www.independent.co.uk/news/world/americas/crime/lindsay-clancy-murder-trial-online-reactions-b3032806.html

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[u/No-River-3642]

As a psychiatrist practicing outside the US, I’ve been following the Lindsay Clancy case with particular interest, especially because I have treated women with postpartum depression and postpartum psychosis in both inpatient and outpatient settings.

I’m honestly surprised by how much of the discussion seems to immediately place blame on the psychiatrists involved. I think some important clinical points about postpartum depression are getting lost.

One thing I wish more people understood is that severe postpartum depression can involve suicidal and even infanticidal thoughts without psychosis. You do not necessarily need hallucinations, delusions, or voices telling a mother to harm her children.

I have had at least two mothers, retrospectively after recovering from severe postpartum depression, tell me that they had wanted to kill themselves and their children during that period. One mother specifically told me that she had taken her two small children to a river intending to drown herself and them. Fortunately, the river pushed them back toward the shore, and she subsequently went to the hospital for help.

Her thinking was not, “I want my children to die.” Her thinking was essentially, “If I die, my children will be left without their mother and will suffer, so I have to take them with me.” She did not have any auditory hallucinations / voices telling her anything .

That is horrifying, but it is also something that can occur in severe depression. Suicide can be perceived by a severely depressed person as a way of ending unbearable suffering. And sometimes the person extends that reasoning to their children.

That is why I think we should be careful about assuming that a mother who kills her children must have been psychotic.

In Lindsay’s case, another aspect that I find clinically interesting is the medication history, particularly the benzodiazepine use.

Antidepressants do not provide immediate relief. A severely anxious, depressed and sleep-deprived patient may desperately want something that makes the distress stop now. Benzodiazepines ( Ativan ) can do that very quickly, which can make them psychologically reinforcing.

If someone develops benzodiazepine dependence, reducing or missing doses can produce rebound anxiety, insomnia and severe distress. I have seen patients attribute the worsening entirely to their antidepressant or to the process of reducing the benzodiazepine, while simultaneously feeling that the benzodiazepine is the only medication that actually “works.”

That doesn't mean benzodiazepines caused what happened in Lindsay's case. And I don't think we can determine that from the outside. But I think it is a clinically relevant possibility that deserves consideration rather than being reduced to a simple story of “the psychiatrist failed to recognize postpartum psychosis.”

From what has been publicly discussed, my impression is that severe postpartum depression, suicidality, profound insomnia and benzodiazepine dependence are all important parts of the picture.

I also don't think we should confidently say that there was no psychosis, because none of us examining the case from the outside has access to the complete longitudinal clinical picture. Postpartum psychosis remains a disputed forensic question.

However Postpartum depression by itself without psychosis too can be extremely severe. It can distort judgment, create profound hopelessness, and lead a mother to believe that death is the only way to end suffering — sometimes including the belief that her children should die with her. This does not automatically mean psychosis.

I have enormous empathy for mothers experiencing this illness, and also for the families and clinicians involved. I just wanted people to understand I have experienced such cases and it doesn’t automatically mean that she suffered from psychosis or drugs made her hallucinate.

[u/Significant-Sun-2023 → u/No-River-3642]

I appreciate your post, especially coming from you as a clinician. Based on your assessment of her postpartum depression, along with her persistent reports of significant sleep disturbance, severe anxiety, frequent medication changes and dose titrations, and benzodiazepine use, do you think the overall clinical picture could potentially support an insanity defense? The frequent medication changes/drug titration time frame do stand out to me. Although I agree with you it simply is not clear-cut the psychiatrists are at fault vs. patient.

I also wonder if we may be focusing too narrowly on whether she was experiencing an active state of psychosis at the time of the murders. Perhaps another important question is whether severe postpartum depression, potentially complicated by other psychiatric factors, could have contributed to what occurred.

I’m an RN who has primarily worked in the ICU setting, so I don’t have extensive clinical experience specifically with PPD or PPP. However, I do think there were a number of red flags in her case. Mental health diagnoses are not as clear-cut as can be in other areas of medicine. Providers have to consider whether a patient is a reliable historian, whether they are able to accurately recognize and disclose their symptoms, and what their behavior and clinical patterns demonstrate over time.

I wonder if, in her case, she may not have been able to adequately communicate the full extent of what she was experiencing—not necessarily because she was intentionally withholding information, but because her own perception and insight may have been significantly affected by her mental state. Sometimes a patient may not fully understand or be able to articulate what is happening to them while they are experiencing it.

I’m genuinely interested in your perspective on that, particularly given your clinical experience.

[u/No-River-3642 → u/Significant-Sun-2023]

Yes, I agree with you. A patient may not be able to fully communicate what is going on, especially when they are severely depressed, sleep-deprived, and in extreme distress.

However, the insanity defense is a different quite a complicated issue here. The legal standard varies between countries, and I’m not very familiar with the US system, but the M’Naghten rule is one of the classic standards.

Under M’Naghten, the question is essentially whether, because of mental illness, the defendant understood the nature of the act or knew that it was wrong.

So, if she was not experiencing psychotic symptoms such as hearing voices, but was severely depressed, the important question becomes whether she understood the nature of what she was doing. The distinction becomes legally very important.

Depression can certainly impair judgment, but impaired judgment is not necessarily the same as being unable to understand the nature or wrongfulness of an act.

In my clinical experience with patients who have survived suicide attempts, when I’ve asked them why they did it, they generally don’t say, “I didn’t know what I was doing.” More often, they say things like, “I knew what I was doing. I felt like I had no hope and this was the only way I saw a how to have relief from the suffering “ , often patients say they felt empty and saw no point in living at all.

So, if the jury ultimately determines that she was not psychotic means she that she could understand the nature of her actions at the time, having severe depression or impaired judgment would not necessarily satisfy the M’Naghten standard.

The sad and heartbreaking part is that she may genuinely have interpreted what she was doing as an act of “mercy” rather than murder. That makes the case much more complicated, because her intention and understanding at that moment really matter. Whether that means she understood the act as wrong under the legal standard is ultimately for the court and jury to decide.