Lindsay Clancy Is on Trial. So Is Postpartum Psychosis.

From the New York Times, I'm Natalie Kietrow-F. This is the Daily. The trial of Lindsay Clancy, a mother who killed her three children, has captivated the country for weeks, not just because of the horrific nature of the crime, but because of the difficult questions it's raised about how we treat or fail to treat postpartum women who are in crisis. As of Thursday afternoon, Clancy's fate is in the hands of a jury, which is expected to deliver a verdict in the coming days. Today, my colleague Ellen Berry takes us inside the courtroom to understand the stakes of the outcome. It's Friday, August 28th. Ellen, welcome back to the Daily. Thank you for having me. So you have been in the courtroom, I understand, for every day of the Lindsay Clancy trial. Just talk about why. What drew you to this case initially? Well, I cover mental health for the times, and I had the feeling when I read about the crime that it was going to end up revolving around a psychiatric disorder. This happened in January of 2023 in Duxbury, Massachusetts. I lived not far away, and I drove over to the house where the family lived, where the crime occurred. What I found, as one often finds, after there's been a terrible loss of life, is that the neighbors had created a kind of a shrine outside this house. They had left squishmallows and Thomas the Tank engines and toys for the kids, teddy bears. But what I sort of didn't expect to find is that people were leaving cards and flowers for Lindsay Clancy as well as if she were another victim in this crime. And it made me wonder whether maybe we are changing sort of in the way we look at mental illness, and in particular, the most part of mental illness in the society. Alright, I want to talk about the response to this case, but first, can you help us just establish the basic facts of the crime? Tell us who Lindsay Clancy is and what she's accused of doing. Right, so Lindsay Clancy is a labor and delivery nurse. She lived in Duxbury, this town on the south shore of Massachusetts, with her husband and her three children, Korra, Dawson, and Callan. About three, four months after the birth of her third child, she went to a psychiatrist complaining of symptoms like insomnia and anxiety and depression and started taking an antidepressant in hopes that it would help her get through this period. But over the next three months, despite a long series of prescriptions and seeing quite a few mental health providers, her condition seemed to get worse and worse. And one night at the end of January in 2023, she asked her husband to go out and pick up takeout for them for dinner. And she strangled all three of her children. They were three and five and eight months. And then she went upstairs and tried to die by suicide. She survived although she is paralyzed, but the kids did not. And she was charged with three counts of first-degree murder. It's just so terrible. It's hard to imagine a more tragic thing than a mother killing her three children. It's hard to even think about. Yeah, I think that feeling has really permeated the whole trial. Helen, we should say that those facts, they're not in dispute because Clancy and her lawyers admit that she did this, that she strangled her children. She has not disputed committing the crime. She has pleaded not guilty by reason of insanity. And her defense has been consistently that she committed these actions in a state of psychosis because she heard a voice telling her to do it. So that's what this trial is about. That's what this trial hinges on. Correct. The jury will ultimately have to determine whether they believe that she did this in psychosis or whether she knew what she was doing. And if she's found guilty of first-degree murder, then she will be sentenced to life without parole, probably in a medical unit. If she is found not guilty by reason of insanity, she will remain where she is at a forensics psychiatric hospital for an undefined period of time. It's also possible that the jury could take a different route and still find her guilty but of a lesser charge, second-degree murder or manslaughter. All right. Let's go back to the opening days of this trial. What was the scene inside the courtroom and what did it feel like? Yeah. So from the very beginning, there was a sense that this was not going to be an ordinary trial. It was really hard to pick a jury. There are quite a few jurors who, when they came up to talk to the judge about this, some of them burst into tears. But the courtroom wasn't fall. There were just a handful of people who would show up every day in support of Miss Clancy, her parents, who I think haven't missed even part of even one day of trial, her parish priest, father Bob, who shows up fairly regularly, but there weren't spectators. There weren't strangers. And how did things unfold in the courtroom? The prosecution made its case first, correct? Morning, ladies and gentlemen. That's right. And their case argued that Lindsey Clancy was not psychotic when she killed her children. Throughout the evidence in this trial, you will learn about the defendant being the classic overachiever in school and a personal life in her nursing career. Instead, they sort of painted a picture of a woman who was exceptionally perfectionist and patrolling about managing her children's health and their lives. Food was planned carefully. Sleep was scheduled to the minute. And he found herself unable to maintain those standards as her family grew and as she prepared to go back to her job as a nurse and who sort of snapped under all that pressure. This was a woman who no longer liked the life she thought she wanted. It was getting harder and harder to control. According to this line of argument, Shannon Buckingham, the assistant district attorney said she didn't want the life she thought she wanted. So having decided to die of suicide, she essentially brought her children with her. This was not a woman in the throws of psychosis on January 24th, 2023. This was a woman who acted intentionally, rationally, and swiftly to accomplish a very specific goal. The prosecution is essentially arguing that this woman was in her right mind and she made a conscious decision to do this, to kill her children and to kill herself. Yes. A major part of this argument has been that she actually planned the killings meticulously that she checked Apple Maps to see how long it would take her husband to go out to the restaurant and pick up the food and that she had enough rationality to plan these actions. And what did the witnesses that they called actually say? So the prosecution called many, many more witnesses than the defense and there was a lot of overlap between the two sides on who they wanted to call. But it did emerge sort of gradually as we began to hear from people who knew the family and who knew Ms. Clancy, that a lot of that testimony ended up being somewhat supportive of the defense in the sense that pretty universally, the people who are called to the stand, who knew Lindsay Clancy described her as a really devoted mother who had never laid a hand on her children. I observed a wonderful mom who loved her kids. She was very concerned with their safety. She was very concerned with cowlons eating and sleeping. She was a wonderful mother. We heard that from the family's nanny, Elaine Rossi, she's very dedicated. She did everything. And we heard it from Lindsay's now ex-husband and the father of the children, Patrick Clancy. She made up so. for them. I remember she used to make green eggs and ham for Acora because she liked that book. And it's also true that as we began to hear from the medical personnel who had seen her in the months before she killed the children, they also sort of painted a picture of a woman who seemed to be very sincerely trying to get help. Explain that. Well, one thing that came through is that as she saw a progression of different psychiatrists and psychologists, it seemed like it was a little bit difficult for any of them to determine exactly what her underlying problem was. So she got diagnosed initially with generalized anxiety disorder, and then subsequently someone diagnosed her as presenting bipolar and perhaps having bipolar too. And after that, as she was getting more severely ill and suicidal, she was diagnosed with severe depression and passive suicidal ideation, the other thing that was going on during that time is that there was just a cascade of prescriptions that were all trying to handle her various symptoms. So over that period of, I guess, four months, she was trialled on 13 different medications of different classes. Wow. That's a lot, Ellen. Yeah. Her doctors were trying to address the symptoms, but it seemed like they were just getting worse and worse. This sounds like the portrait of a woman who knows something's deeply wrong is trying to do something about it. I guess I'm wondering why would the prosecution go into this level of detail if they're trying to show that she's of sound mind and in control? I think the prosecution wanted to show that these doctors and nurses and psychologists who saw Lindsay Clancy before the crime had examined her and asked her a lot of questions. And none of them concluded that she was manic or that she was psychotic. And none of them believed that she was so severely ill that she posed a danger to herself or her children. They're essentially arguing that she received solid care and that the providers that assessed her, which were many, didn't think that she was in the grips of psychosis. Not only that, they sort of described her as like an unusually sophisticated consumer of medical care who was doing her own research on medications and on underlying diagnoses and had her own opinions about what was going on. It didn't always follow what the doctor had prescribed. But I do think that we went very systematically, very slowly through the weeks of medical care that she got as she was deteriorating. And it also emerged from listening to all these various providers that the right hand didn't know what the left hand was doing. She had way too many providers who didn't have access to her entire medical records. There was no case manager except for Lindsey Clancy herself. So it sounds like that's what you meant when you were saying that there were parts of the prosecution's case that ended up helping the defense. Yeah. And there were other examples of that as well. I mean, I think for the prosecutors, the centerpiece of this case has always been to focus on the three children and to dwell on their deaths and what they suffered. But in court, part of the way this played out is that as the prosecution was making its case, Lindsey Clancy's demeanor changed quite a lot. In the beginning, she seemed to be kind of impassive or remote. But as we got farther into the evidence, particularly evidence about her children and how they died. And what about she was just inconsolably crying to the extent that a couple times the judge cleared the courtroom so that she would have time to sort of gather herself back together. Literally had to pause the proceedings. Yes. You know, I've been following this case as well, not from the courthouse, but in the headlines and the coverage on social media. And it's clear that those moments in the trial have made a really big impact from the outside as well. You've seen this response kind of build over time. Did you feel that inside the courtroom? Yeah, I would say the third week is when that began to change. That week and then the following week as the defense began to present its case every day, the gallery was full. Often when the courthouse opened, there were long lines sneaking outside. And people were coming from other states just to sit there and watch testimony. It became a different scene all together. We'll be right back. Ellen, you've described these long lines forming outside the courthouse as the defense gets underway. And I want to talk about those people that are in line and why they're showing up. But first, what exactly is the defense's argument? What is the case that Clancy's lawyers are making here? Sure. So from the beginning, this is a woman that did not get a medical treatment that she so deserved. Clancy's attorney, Kevin Reddington, has really made this into or endeavored to make it into a trial that looks at the quality of mental health care as it is provided to Americans. The government says that this is a situation. It's not a referendum on women's having babies and having post-partum psychosis, post-partum depression, but it sure as hell is. He's argued that this is a case about post-partum psychosis, which is what exactly? Post-partum psychosis occurs in about one or two of every thousand births, so it's not common. Okay. It's a disorder that often occurs in women who have no history of severe mental illness, but who in the weeks after giving birth are seized by paranoia or hallucinations or delusions. Women with this disorder describe really terrifying thoughts about harming their children. And it is associated with an elevated risk of both infanticide and suicide. And I should say that this is a disorder that hasn't been systematically studied and isn't well understood. It's not included in the DSM, which is the manual that psychiatrists use to diagnose and treat mental health disorders. In part, because psychiatrists haven't ever been sure exactly how to classify it. It can look like mania or depression or it can look like hallucinations and delusions. It waxes in wanes, so a woman can present as normal and then experience a rapid change. And there's growing evidence that post-partum psychosis most often occurs in women with vulnerability to bipolar disorder, which is one of the diagnoses that Lindsay Clancy received. But this is not very common to be clear. And Reddington is saying this is one of those cases. How does he go about proving that Clancy was in the grips of that level of a crisis? So, largely, we heard from forensic experts who had interviewed Lindsay Clancy herself. We heard Ed Link from Dr. Paul Seizel, a forensic psychologist, and notably from Phil Resnick, who is a psychiatrist and really kind of a giant in the field of forensics. And those experts relayed what Clancy herself has said, which is that she on the night of the killings heard a voice that she could not but follow, that she felt like someone else took over her autonomy and took over her body. And I think the way she described it as like that she was a puppet and someone else was pulling the strings. And what is the testimony saying that the voice told her to do or what did it say? She has said that the voice told her, this is your last chance, kill the children so you can kill yourself. There is some support for this because we also heard from a chaplain who spoke with Lindsay after she was extubated while she was recovering from her injuries. Lindsay told her that she had heard a voice, a commanding voice, which instructed her to kill the children. And the voice, according to Lindsay, told her that if she did not follow the command, neither she nor her. - Her children would be safe. - And the Chaplin testified that the first thing that Ms. Clancy said to her on waking up was she said to me as I hold her hand to comfort her. I'm so glad my children are safe. - I am so glad my children are safe. - I mean, this testimony was clearly intended to show us that she was not in her right mind. - Did people in Clancy's life know about these voices before the crime actually happened? Was there any warning about that? - She didn't tell anyone she was hearing voices, no. And something that the prosecution's experts have underlined is that it would be very, very unusual for a person to hear a voice only once, coinciding with the violent crime and not hear it again. What we do know is that she told people in her life, her husband and her mother that she was having intrusive troubling thoughts of hurting her children. Now they ask, does that mean that you're dangerous? Should we keep you away from the kids? And she said she didn't think so, but she did share that piece of information which was an indicator of risk. - And if that level of risk was known to the people around her, how was she just left to still be with her kids? - Well, there are very specific triggers for involuntary treatment in our legal system. And her main symptomology is that she was having thoughts of suicide. That was known, I think, to a wide circle of people including her clinicians. But when she was asked about it, she would routinely say that she was having these troubling thoughts. They were disturbing, they were intrusive, but she didn't have a plan to carry them out. And as a result, several times when she went to an emergency room or called a suicide hotline, she was told that she didn't rise to the level of acuity that would have resulted in hospitalization. - Okay, so that's the defense. Now, can you just tell us about those crowds that are showing up outside the courthouse as Reddington is making this case? Who are they, and what do we know about why they're there? - Well, they're showing up here. Can I ask your name? - Margaret. - Well, the vast majority of people who began to show up at the trial as spectators were women. - Live in Long Widow, Massachusetts. - Okay. - And you drove here yesterday from Buffalo? - Yes, I've been glued to it every day. - When crowds began to come, I would speak to them. - Tell me what brought you here today. - And often, the response I would get is that they had had some kind of experience with postpartum disorders or postpartum psychosis. - So when my son was born 13 years ago, two children aged 11 and 15. - And I have to give him a birth to my son 21 years ago. - Did struggle with anxiety and depression and all. - I remember the doctor telling me I had postpartum depression, and I thought they were crazy. There's not a lot of information, and they had no resources for me. No like support groups, no here. - A lot of them described experiences that they had had 8, 10, 15 years ago when they had a child. And something happened that they really didn't have the words to describe. - Very dark, dark, dark symptoms that. - Like paranoia or fear of leaving the house or sort of unwelcome intrusive thoughts about different terrible things that could happen to their child. - Currently at night, I was always so paranoid. Something was going to happen to her. I remember that. - I remember hiding under my cellar stairs so that nobody would find me. Like I'm just sitting there and crying, crying, crying. I just was scared that I was gonna break it. - They were all in one way or another saying we just haven't paid enough attention. So there is definitely an element of women who just sympathize with Lindsay and among them, like quite a few who talk about postpartum, mental health disorders is something that they think is under-examined, under-treated, under-diagnosed. And it's become much more organized in the last week. - I'm gonna say something to all of you that are here. - So many of you. - Last Thursday, there was a crowd of maybe 300 or 400 people, women wearing pink shirts, signalling their support of Lindsay Clancy. - We did not come here to protest or to rally or to scream our opinions about what happened behind the walls of the Clancy home. We're here to send one message that it should not take tragedy for people to start paying attention to mental health. - And that was organized by a woman from Maine online who had been watching the trial. And she said that she had been inspired to plan it after watching Miss Clancy sort of collapse in tears in the courtroom. - I was still up at one o'clock in the morning thinking about her and I just felt like I had to do something. - So I put it out in the world. - I have to say, I think it's pretty remarkable that Lindsay Clancy is someone who's admitted to killing her children and there are all of these people, these women who identify enough with her to come out in support in really large numbers. How do you understand that based on your reporting in this case? - Well, I think that probably the key element that has drawn people behind her is the idea that she wouldn't have gotten as sick if her treatment had met the moment. Even women who haven't had the experience of postpartum psychosis something as severe as that could relate to the experience of trying to get care in a system that is often disjointed and where they didn't feel that they were being heard. - I also just think this is a, it's a very disturbing scene like we have seen Lindsay at trial inconsolably crying and her ex-husband Patrick as well. There is just enormous grief and it is, there's things I will never forget that I've heard at this trial. So I just think that's part of what is affecting people. So deeply. - It's also worth saying that not everyone is backing Lindsay Clancy here. There are many, many people who are extremely angry about the death of these children and believe that the focus should be on the three victims and that a guilty finding would be appropriate. - That's right, I met a woman outside the courthouse whose grandson went to school with Korra, one of the children. And she was complaining that it's the nature of these trials that the victims somehow disappear. They seem to get lost in all the testimony like they're forgotten. And she said, you know, Miss Clancy knew she was a danger and she didn't do the things that she needed to do to keep her children safe. - Ellen, at this point, the jury's deliberating. We expect a verdict any day now is my understanding. What are the implications of what the jury ultimately decides here guilty or not guilty on this larger conversation that's now happening? - Well, I think it's a little hard to know what the repercussions of a guilty verdict would be or in the event of a hung jury if this had to go to another trial, which also seems possible. What I hear from people who are primarily interested in postpartum mental health disorders is that if she is found guilty and sentenced to life and prison that it may drive women underground that they might be less likely to come forward about their symptoms if they feel like they could be demonized or or not treated with mercy. But if she is found not guilty by reason of insanity, people in the postpartum mental health world see it as a landmark event that might feed energy into building out systems to better protect women and their children in this situation. A few of the things that are under discussion is, you know, there is active movement within the American Psychiatric Association to expand its manual, the DSM, to include a chapter on postpartum disorders, you know, which would make it easier to identify and diagnose and treat them. There is a movement to get state laws that mitigate punishment in cases where a mother harms an infant in the postpartum period. And there is a long effort, really like a decade's long effort to create specialized units where mothers in crisis can stay in a hospital with their babies until the danger has passed. It sounds like perhaps another lasting impact of this trial, regardless of the verdict, is that this conversation has been activated. All of these people have been activated and are talking about this in a way that kind of seems irreversible. Yeah, I think that's right. I'm not sure you could put that genie back in the bottle. Well, Ellen, thank you so much. Thank you. (upbeat music) We'll be right back. Here's what else you need to know today. We're going to be changing the name of Lake Ontario, effective immediately to Lake America. On Thursday, President Trump followed through on his threat to change Lake Ontario's name to Lake America, a swipe at Canada and part of his escalating trade war against one of the United States' closest allies. The Canadian officials have treated us very badly. They're nasty people. During remarks at the Oval Office, Trump said that Canada was the worst to deal with on trade, and he re-upped a threat to slap steep tariffs on cars and trucks that are made there. And emergency workers and helicopter crews desperately searched the Himalayan valleys for survivors after devastating floods swept through Nepal and Tibet. Nepali officials reported at least 389 deaths, with more than 1400 still missing. Survivors who spoke to times reporters that traveled to the region described torrents of water that wiped out entire neighborhoods in a matter of seconds. ♪ ♪ Today's episode was produced by Alex Stern and Adrian Hurst, with help from Eric Krupke, Lexi Dio, and Ricky Novetski. It was edited by Annie Minoff, with help from Michael Benoit and Chris Haxel, and contains music by Leah Shaw Damarin, Marion Luzano, Pat McCusker, and Dan Powell. Our theme music is by Wonderly. This episode was engineered by Chris Wood. ♪ ♪ ♪ That's it for the Daily, I'm Natalie Kietroweth. See you on Sunday.