A Massachusetts jury heard opening statements in a murder trial against 35-year-old Lindsay Clancy on Monday morning. That jury will soon be asked to decide if she is criminally responsible for killing her three children in January 2023, or not culpable of this heinous act because she was in the throes of postpartum psychosis.
By all accounts, the Clancys were a typical family raising three small children in a Boston suburb. Lindsay worked as a labor and delivery nurse, and Patrick, her husband at the time, worked at Microsoft. In 2022, after Lindsay Clancy’s third pregnancy, she began experiencing severe insomnia, depression and suicidal ideation. In response to those symptoms, she did exactly what society encourages struggling mothers to do: She asked for help. She saw psychiatrists, she extended her maternity leave, she connected with a specialized perinatal behavioral health program, and she voluntarily admitted herself to inpatient care.
She did exactly what society encourages struggling mothers to do: She asked for help.
Medical personnel treated her throughout, prescribing her 13 medications over four months, including eight in a single three-week span. Lindsay Clancy saw one of her providers the day before she says she heard a male voice ordering her to strangle her children and kill herself by jumping from the second-story window of their home. Her jump left her paralyzed from the waist down.
Postpartum depression is the most common psychological condition following childbirth and affects up to 20% of new mothers. Postpartum psychosis is much rarer, and it is not recognized by the Diagnostic and Statistical Manual (DSM-5), the mainstream guide doctors use to code mental health diseases and medical conditions for insurance purposes. However, there is a growing number of experts who argue that a recognition of postpartum psychosis in the DSM-5 would be the first step toward destigmatization. Unlike postpartum depression, postpartum psychosis is often accompanied by hallucinations, delusions, mania and other erratic experiences.
Lindsay Clancy’s defense team will almost certainly argue that the misdiagnosis and mistreatment of her mental illness should be on trial, not her. But the single greatest limitation of the American criminal legal system is that it functions to convict people, not systems. Just as we lock up people who steal baby formula instead of reckoning with the poverty driving their behavior, we consistently focus on punishing those who commit crimes of violence due to mental illness when we could be addressing the obstacles to them getting care. The criminal prosecution of acts stemming from postpartum mental illness only further reinforces the notion that it is a shameful moral failure rather than a clinical diagnosis.
Lindsay Clancy was an upper-middle-class white woman working inside the healthcare system. If a woman with her level of access and privilege can still fall through the cracks, then low-income mothers of color with mental health issues are sure to experience the same mistreatment — or worse. The Clancys are suing Lindsay’s medical providers for medical malpractice and wrongful death, and a civil jury may eventually assign some blame to the professionals who appear to have failed her. But in criminal court, she sits alone as the defendant.
In Massachusetts and many other states, a verdict of not guilty by reason of insanity requires a finding that a defendant lacked the substantial capacity to appreciate the wrongfulness or criminality of her conduct and conform her behavior to the law.
Prosecutors plan to argue that sending her husband out on errands before she killed their children proves that Lindsay Clancy knew her actions were wrong. In her opening statement Monday morning, prosecutor Shanan Buckingham said that Clancy “was not a woman in the throes of psychosis” when she killed her children and that she acted “intentionally, rationally and swiftly.” Yet an insanity standard that places emphasis on whether she appreciated the wrongfulness of her conduct overlooks the unpredictable and highly personalized nature of mental illness.
Defense attorney Kevin Reddington told told the jury that the case is about “women’s health and postpartum psychosis” and criticized Plymouth District Attorney Timothy Cruz for charging the mother with murder.
Defense attorney Kevin Reddington told the jury that the case is about “women’s health and postpartum psychosis” and criticized Plymouth County District Attorney Timothy Cruz for charging the mother with murder.
Manufactured legal formulas like Massachusetts’ insanity standard assign binary, standardized logic to amorphous concepts like blameworthiness and morality. But few cases are ever truly “one size fits all” or fit squarely within this framework. That means mentally ill defendants who mount this defense are set up for failure far more often than not. It is possible that in Lindsay Clancy’s mind, she knew what she was doing was socially unacceptable and wrong and still had crippling delusions that made her somehow believe she was doing right by her children.
Andrea Yates’ murder trials show how arbitrary the law’s insanity standard can be in practice. In 2001, after years of mental illness stemming from her pregnancies, Yates drowned her five children in the bathtub. She reported hearing Satan’s voice telling her that the only way for her children to go to heaven was for her to kill them. A jury heard evidence about the deliberateness of her actions (including that she waited for her husband to leave the house before the killings) and convicted her. As may happen with Lindsay Clancy’s case, they reasoned that this kind of planning reflected consciousness of guilt.
That conviction was later overturned on appeal, and at Yates’ retrial, a second jury heard largely the same facts and found that Yates believed what she was doing was right in the context of her delusions and could not be culpable. The 12 people hearing the case against Lindsay Clancy will enter the courtroom with 25 years’ more research and education on postpartum illnesses. If, and how, that affects their verdict remains to be seen. Yet being found not guilty by reason of insanity is hardly a “get out of jail free” card. Yates, for example, has spent nearly two decades committed to a state psychiatric hospital, and Clancy would likely face a similar outcome if she were acquitted.
Notably, Lindsay Clancy’s case is moving forward over Patrick’s objections as the surviving spokesperson of their three children. He has stated publicly that his former wife is not a “monster” who deserves prison but “someone who got sick.” He is expected to cooperate with the defense and has appealed to the judge to limit the graphic evidence displayed for the public. Yates’ husband similarly advocated against criminal prosecution.
Prosecuting Lindsay Clancy over the objections of those most closely affected raises the uncomfortable but fundamental question: What is this prosecution actually meant to achieve? It won’t deter mothers in deep psychosis, who are hardly capable of the rational thought that deterrence requires. It won’t serve as a cautionary tale about getting help when you need it, as she did get help and it still wasn’t enough. And as Patrick Clancy has implied, his former wife’s incarceration won’t offer peace to a family that lost its loved ones. While there is no more heart-wrenching tragedy than three children being killed by their mother, it is worth asking ourselves if retribution alone should justify locking away a woman whose illness and the system meant to treat it may have led her there.
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