The After Show: The Lindsay Clancy Trial

this episode is brought to you by nordstrom for 125 years nordstrom has been part of your story the stylist who found the perfect outfit for your big interview the first pair of walking shoes for your one-year-old the tomato soup you shared with your sister at the cafe these are the moments that make nordstrom nordstrom big or small we're here for all of it celebrating 125 years with new moments still add discover it all in nordstrom stores and at nordstrom.com hi everybody and welcome to 2020 the after show i'm deborah roberts and as always i'm so glad you're with us today those of you who follow us know that normally we take you behind the scenes and inside our latest 2020 episode that aired the friday before today we're going to take a little turn and take a look at a story that has just captivated this country grabbing headlines everywhere one that is sparking lots of social media debate and you know this case it is the one of lindsey clancy you have no doubt heard about this excruciatingly tragic case 36 year old clancy is accused of the unthinkable killing her three young children five-year-old cora three-year-old dawson and her eight-month-old infant son callan she also tried to take her own life on that day and this past august she pleaded not guilty we've watched emotional moments in the past and we've seen them in the past and we've seen them in the courtroom including clancy sobbing as medical examiners and doctors testified about her children's death we've also seen hundreds of women rallying outside the courtroom standing in solidarity with this mom arguing that it is a failure of the medical system that she was struggling with her mental health this trial has captured the public's attention as i said raising questions about the known mental health condition known as postpartum psychosis. Now, Lindsay's defense does not refute that she killed her children. That's so important here, but they do argue that she should not be held criminally responsible. The prosecution in this case is arguing that she was fully aware of her actions, methodically planning and carrying out these murders. So the big question is how to process these conflicting assessments of this case. Joining us now to help answer big questions about this case and also to understand more about mental illness, particularly amongst new mothers, is a friend of our show, emergency room psychiatrist, Dr. Ajua Smalls-Monte. Dr. Monte, good to have you as always. Thank you. You often bring such clarity to us when we talk about these cases and whether you've actually worked on them or not when it comes to stories. And in this case, we should make it very clear. You had no dealings with this case. You had no connection to Lindsay Clancy. You have not treated her or observed her. But clearly, you know a lot about moms dealing with mental health crisis after they've had children. So let's talk about what it's like for you to even just watch this case. I mean, as it sort of unfolded over the last couple of years. It is gut-wrenching what happened. Not only are three children gone, a father has lost his children. A mother has lost her children. And a woman is also harmed and paralyzed. That is so hard for me to see, especially when there are so many discussions on mental health in this case. But it truly is a tragedy. And I think we just all want to understand what is happening and what can we all do better to prevent things like this from happening again. And we want to talk to you about that. I remember, I mean, so many of us, who are old enough, remember the case of Andrea Yates in 2001. That's immediately what came to mind when I heard about this case. Tragically, a woman who drowned her five children in the bathtub and said that she was suffering from a mental health crisis and voices were in her head. Her conviction, she was actually convicted of capital murder in the very beginning. And then her conviction was overturned. She was found not guilty by reason of insanity. And she remains in a mental health facility. Let's talk a bit, that's what could possibly happen in this case. Lindsay could actually wind up going to prison for the rest of her life, or she could also be committed to a mental health facility. When we talk about postpartum psychosis, we know about postpartum depression, we know about anxiety, we know about all kinds of issues that new moms deal with. What is postpartum psychosis all about? So we're looking at two things. We're looking at psychosis in the postpartum time. So let's first talk about psychosis. With psychosis, you have a loss of touch with reality. So that loss of touch with reality can be due to delusions. Those are odd thoughts that you're having, things that are not true. But you believe it's true, even when anyone tells you that this is happening, that you're thinking is happening cannot happen. But with psychosis, you can also have hallucinations, whether you're hearing things, or seeing things that aren't there in her case, she said she was hearing voices, very, very common in psychosis. And people can also have disorganized thought, like they're not clear. And that disorganized thought can also make their behaviors just not seem put together, they can do odd things. So when you have all three of those, or even two of them, that is what we're calling psychosis. And then to have postpartum psychosis, we're usually talking about 12 weeks after a pregnancy. And when I say pregnancy, that can include whether you had a live birth, or even if you had a stillbirth, or a miscarriage, you can have postpartum psychosis happen in those instances as well. Postpartum psychosis is relatively rare, it's about one to two women experience it out of 1000 live births. So it is rare, it is pretty rare. So we don't see it often. I've seen it a few times in my practice in my career. But it is still something that now we have more heightened awareness of because of that. Because of this, is this typically? Does this typically happen amongst women who have already had some kind of mental health struggles? Or does this is it just triggered by childbirth? So for many women, they do have a history of having a bipolar disorder or a psychotic disorder before. But for 50% of people that have postpartum psychosis, that can be their first manifestation of a bipolar disorder that they might have. For the rest of their life or any psychotic disorder or even a depression with psychosis. So while definitely having a mental health disorder can raise your susceptibility to this happening, because pregnancy is a very stressful time for your body, you're having a lot of hormonal spikes, changes happen. Yes, definitely. This can be the first occurrence for somebody and their mental health. When talking about someone like Lindsay Clancy, three children, and by all accounts, people said that, you know, she said, she's a nurse, she seemed to love her children, help us understand how someone could love their children, but yet do something that is just so unthinkable. So unthinkable. And when I see patients that mentioned that they want to hurt themselves, or that they're even having the urge to hurt somebody else, what I often hear is that they have to do that in order to protect themselves, or to protect who they are. They're not even thinking in that rational way you would think. And so I think that's the only way that they can protect themselves. And so while it is unimaginable that someone could hurt someone that they love, sometimes it's because they don't recognize a person as being someone that they really know and love, or they think they are killing somebody out of benevolence. Well, one of the most devastating moments in this trial was one that I think a lot of people clued in on, was when the hospital chaplain testified that Lindsay Clancy said she allegedly heard a voice that told her to kill her children, and then she said now they were safe. She felt she was making her children safe by taking their lives. As a psychiatrist, how do you react to that? Is that something you've heard before? It is. And that's the very scary thing for anyone to hear. But unfortunately, in my line of work in the emergency room, I have encountered people that have hurt other people, but they thought they were doing it to protect that other person or to protect that themselves because the other person was a threat. And so that is a psychosis. You're not in touch with reality. You don't really recognize what's going on. Your mind is playing tricks on you. The one thing that so many people feel that this case is highlighting is not only the mental health crises, but the medicines that people are taking, the medications. Clancy, by all accounts, had been having problems for a while. Her husband had even talked about that and testified. She has sought help from a number of therapists, and many of them had been telehealth visits that she had had. She'd been taking a number of medications, even sought help at a psychiatric hospital. What we like to hear with regards to anyone that's experienced seeing a mental health disorder is that they are willing to go and get help. And so that's the good thing. But there are so many other things. that we're learning about going to see a number of different providers, going to taking a lot of different medications. And sometimes when there are too many cooks in the kitchen, sometimes things can get a little bit jumbled. One person doesn't know what another doctor has prescribed. You might be prescribed one medication from a doctor and then get another medication that can actually exacerbate a condition that you have. And are you disclosing everything that you're experiencing to your doctor? The one thing about psychiatry that makes it a little bit more difficult than other fields of medicine and making a diagnosis is a lot of it is relying on the report of the patient or somebody close to them. There's not too many blood tests that are going to give us obvious answers. And so we really rely on that disclosure on everything that's happening, but seeing you over a course of time so that we can really see your behaviors and understand what's happening. And if someone is going and seeing a lot of doctors, it makes it harder for one person to get the whole picture. So whenever people are seeking psychiatric care, we really implore them to stick with one provider, unless you have a very clear plan of transitioning to somebody else, or at least two providers are talking about what is happening so things don't get confused. Many see this as a symptom of a broken system. I mean, people are pointing to the fact that she was crying for help and had seen multiple experts and sought help many times. I mean, do you see it as a system that is broken? Well, I do want to acknowledge that there are many parts of the healthcare system that is broken. I don't want to say whether this, in this case, the system was broken, because we do understand that there were many opportunities to get help. But the confusing, the hard part is if that care is fragmented. And whether it's fragmented from the patient going around to a lot of people, or even as doctors, sometimes we're saying, see that specialist, that specialist, that specialist, but you need one person looking at the picture completely. Another complicating factor here is that if you're taking a lot of medications, are you taking them for the full course that you're supposed to take? If you're not taking it all the time consistently, then you're not possibly getting the benefit. And one might supplement the medications that we're giving them with over the counter supplements, even with recreational drugs, and all those things can come into play and interact with how with someone's mental health. And so I don't want to say that the, in this case, the system was broken. But I do think it points out that fragmented care is not optimal, which is why I think it has captivated so many people. There's a lot of talk about this case out there online, particularly on social media, which is one of the reasons this case, I think, has just captivated so many people. And there's a lot more for us to talk about. So don't go anywhere. We're going to take a quick break. When we come back, we're going to talk to Dr. Smalls-Montein and weigh in on what is being said out there. or somebody saying you need to go get help for that because that isn't normal. - And sometimes they're embarrassed They don't want to say that. They don't want to sound like terrible parents, mothers. Yes. And that is the key thing that I think with this case, and as we're discussing Hayden Panettiere, that when more people are talking about what they're experiencing, they're normalizing that this is an experience that many people have. And also that you can seek treatment for it, that you can get help. Just last year, Jennifer Lawrence disclosed that she had taken a medication to help with her postpartum anxiety. And I'm so happy that we have new advancements in medications to treat this particular condition. Definitely this case and all of the women that are talking about their experience has brought it just more to the forefront of all physicians to think about it, to scream for it more, to keep it on your differential of things that could be happening to a mom. So while it is very tragic, the situations that we're experiencing, that we're dealing with now, the increased awareness, I think will definitely be the benefit to society. If nothing else, we will be talking about a subject that is no longer taboo. You often offer advice and we want to get some advice from you. So don't go anywhere because we want to come back and hopefully you can offer some help to women out there who may be suffering or someone in your life who may be suffering. So stay with us. We'll be right back. This episode is brought to you by Nordstrom. For 125 years, Nordstrom has been part of your story. The stylist who found the perfect outfit for your big interview. The first pair of walking shoes for your one-year-old. The tomato soup you shared with your sister at the cafe. These are the moments that make Nordstrom, Nordstrom. Big or small, we're here for all of it. Celebrating 125 years with new moments still ahead. Discover it all in Nordstrom stores and at Nordstrom.com. Welcome back to 2020 The After Show. I'm sitting here with Dr. Ajua Smalls-Monte discussing the devastating case of Lindsay Clancy, that mom in Massachusetts who admitted to killing her three young children, but also saying that she was suffering from a mental health crisis. Let's talk about warning signs. There's a big difference between having the blues and having postpartum depression and having a real psychosis, which can be a real problem. And I'm going to talk about what the warning signs are. So first, we'll talk about that a lot of times we have fleeting bad thoughts in our head. And I think that is the scariest thing for people to admit. But if the thought is fleeting, you recognize what is happening, you can still bring that up to somebody and say, but I'm able to control my actions. But if they're very, very dark, they are troubling to you. And if you even hear somebody else mention that, you're going to be in a lot of trouble. You're going to be in a lot of trouble. You're going to something that is very alarming to you. That is when you should seek help. That is when you should seek emergency help. Emergency room, emergency, not just a call to the OBGYN. If the person is in good control, they're able to do what they have to do, whether it's taking care of themselves and taking care of their baby. They're not having thoughts of I want to hurt this baby, I feel like I'm not in control of my actions. That's a huge thing. If they feel like I can't control myself, that raises alarm bells. And that is when they should go to the emergency room. If someone has a fleeting thought, I hate to say it, but many times I do see people, it's a fleeting thought. They're like, I would never do anything to hurt somebody. I'm just like, so mad. I'm so stressed. I'm overwhelmed. And I want moms to know that it's common. It really is. I had fleeting thoughts when my children were born, sure. Definitely. But you recognize like, I would never do this. I have so much love. I'm in control. I just needed to take a break a minute. I'm all right. I'm fine. But when you are feeling compelled, a lot of times people that do things will almost describe retroactively, they feel like a puppet almost, like their actions are being controlled. Like they can, even though whatever they're thinking, they don't want to do, they cannot control it. But also if a voice is compelling you to do things, if you're not sleeping, if you're feeling like you're dissociating, like you're out of your body, you're kind of. On the outside looking in, those are all really serious warning signs. And that is when I would seek the emergency room as opposed to, oh, I'm having some thoughts. I'm not sleeping well a little bit. I'm still able to do things. It's a little bit slower than I would like to. Then maybe you can talk to your obstetrician, your pediatrician for the child, but really the obstetrician for the mother. And then you can also try to find a psychiatrist. But let's be honest, the wait to get a psychiatrist is pretty long nowadays. And so sometimes going to the emergency room can get you a little faster access. You mentioned earlier that one, if there's any little glimmer of hope that comes out of this horrible case, is that we're talking now about mental health and mental health amongst moms and hopefully helping moms who are out there who are struggling. You mentioned that this is shining a light on a problem that is not talked about all the time. Is your hope that in the middle of this tragic, horrible case, that that might be the lasting impact that we continue to support and talk about moms who are dealing with mental health issues? It certainly is. And as you said, this is a complete tragedy. But I do hope that people feel more comfortable with talking about their symptoms if they're experiencing any type of psychotic symptoms. If you were even experiencing any type of psychotic symptoms, if you were even experiencing depression or anxiety associated with the postpartum period, or even if you're not postpartum, if you're just a person going through life, and you're experiencing this feeling more empowered to go and seek help, because there is help available. And it can be wonderful. It can work well for many, many people. Well, let's hope so. Let's hope that people will definitely think about seeking help before the worst happens. And we should also add that if you or someone who's someone you know is struggling with thoughts of suicide, free confidential help is available 24 hours a day, seven days a week. You can call or text the National Lifeline at 988. Dr. Smalls Monte, you are always such a help. Thanks so much for being here with us. And we thank you, our listeners, for choosing to spend some time with us today. And of course, you can find 2020 on Friday nights on ABC, and you can stream episodes anytime on Disney Plus and Hulu. Thanks so much for being here. Thanks for being with us, and we wish you all a good day. Wayfair has pieces for every style and budget. Shop Wayfair's Labor Day clearance now through September 7th at Wayfair.com.