The public debate over Lindsay Clancy has exposed something larger than disagreement over one criminal case: how little tolerance we have for the contradictions, uncertainty and frightening realities of serious mental illness.
I am not a psychiatrist.
My father is. He has practiced psychiatry for over half a century, which means I have spent a lifetime absorbing some of the language and thinking of psychiatry without possessing his training or expertise. If anything, growing up around a psychiatrist has taught me how much I do not know.
Psychiatric diagnosis can be difficult. Symptoms overlap. Patients can have more than one condition simultaneously. Diagnoses evolve as clinicians obtain more information. Medications can help, fail, cause adverse effects or complicate an already confusing presentation. Patients do not always understand what is happening to them. They do not always communicate it accurately. And two clinicians looking at the same patient may not reach precisely the same conclusion.
This does not qualify me to diagnose Lindsay Clancy.
It does make me deeply uncomfortable with the extraordinary confidence with which people who have never examined her have done exactly that.
Or, more accurately, have diagnosed her as sane.
Clancy is accused of killing her three children — Cora, 5, Dawson, 3, and Callan, 8 months — in their Duxbury, Massachusetts home in January 2023. She then attempted to kill herself by jumping from a window and survived with injuries that left her paralyzed. Her defense does not dispute that she killed the children. It argues that severe mental illness, including psychosis, rendered her not criminally responsible. Prosecutors argue that she was mentally ill but nevertheless retained substantial capacity to appreciate the wrongfulness of what she was doing and to conform her conduct to the law. That distinction is the heart of the case.
The trial was enormous: more than 80 witnesses and hundreds of exhibits. After seven days of deliberations, the jury remained unable to reach a unanimous verdict, leading the judge to declare a mistrial.
Yet outside the courtroom, people routinely resolve the question with a sentence.
She Googled things.
She sent her husband out.
She waited until she was alone with the children.
She planned it.
Therefore, she could not have been psychotic.
That reasoning bothers me because it rests on a fundamental misconception:
Planning is evidence of planning. It is not, by itself, evidence of sanity.
Psychosis does not necessarily eliminate the ability to plan.
There is a popular conception of psychosis in which a person must be completely detached from ordinary functioning — incoherent, visibly hallucinating, unable to make decisions or perform sequential tasks.
That is not the only way severe mental illness can present.
A person can perform organized actions based upon a profoundly disordered understanding of reality. Someone acting under a delusion can make plans in furtherance of that delusion. Someone experiencing hallucinations can still use a telephone. Someone whose perception of reality is seriously impaired can understand physical cause and effect.
This matters enormously in the Clancy case because the prosecution has argued that evidence of preparation demonstrates criminal responsibility. It may certainly be relevant evidence. But there is an additional inference being made when members of the public say that planning proves she was not psychotic.
It doesn’t.
The relevant question is not merely whether the person planned.
It is: What was happening in the mind doing the planning?
The defense says Clancy was experiencing psychosis and command hallucinations. Prosecutors reject that account and contend that she deliberately killed her children because she believed they would suffer without her. Experts testified on both sides.
I don’t know which explanation is correct.
That is the point.
Neither does someone who watched a TikTok clip and decided that a Google search settles the matter.
Mental illness does not owe us consistency
Another argument against Clancy’s illness is built around apparent contradictions in her behavior.
She sought psychiatric help, yet she did not always follow treatment in an orderly fashion.
She wanted medications changed.
She worried about side effects and dependency.
She saw multiple providers.
She sometimes reported severe symptoms and at other times denied symptoms that would have indicated greater immediate danger.
She reportedly disclosed suicidal thoughts and thoughts involving harm to her children, yet when her husband asked whether she needed to be kept away from them, she said no.
People look at these contradictions and see deception, manipulation or evidence that she was fundamentally in control.
I see a much more complicated question:
Why are we expecting a severely psychiatrically ill person to manage her psychiatric illness like a perfectly rational case manager?
Clancy was prescribed 13 psychiatric medications during approximately four months preceding the deaths. Court-record reporting found more than 30 prescriptions involving multiple providers, including psychiatrists, psychiatric nurse practitioners, emergency physicians and inpatient psychiatric staff. The medications crossed several classes, and dosages were repeatedly changed as clinicians attempted to manage her symptoms. It is not clear that she was taking all of those medications simultaneously, and medication adjustment itself is not unusual in psychiatric practice.
That qualification matters. “Thirteen medications” should not become another simplistic slogan.
But neither should the treatment history be dismissed as irrelevant.
It describes an extraordinarily complicated clinical course.
Different psychiatric medications also have different timelines. Some adverse effects appear quickly; some symptoms require urgent intervention; some therapeutic effects take weeks; and different drug classes work differently.
But psychiatric treatment often requires time, observation and titration.
If the clinical picture is changing while medications are being added, discontinued and adjusted — and while different clinicians are encountering different pieces of the story — determining what is illness, what is medication effect, what is sleep deprivation and what is a newly emerging symptom can become more difficult.
That doesn’t prove anyone treated Clancy negligently.
It means complexity matters.
A difficult case is not the same thing as a difficult patient
Clancy seems to have been difficult to treat.
I don’t mean that pejoratively.
She appears to have been a complicated patient whose illness was difficult to understand and stabilize.
She sometimes wanted treatment changed quickly. She worried that medications were making things worse. She reportedly worried about becoming dependent on Ativan. She didn’t necessarily disclose every symptom consistently to every provider. The day after agreeing to one treatment plan, she contacted her provider wanting medication changes.
It is tempting to transform those facts into a moral judgment: She wouldn’t cooperate with treatment.
But psychiatric illness presents a peculiar problem.
The organ being relied upon to identify the illness, assess its severity, communicate it to clinicians and make rational decisions about its treatment is the same organ that is ill.
We ask psychiatric patients to notice their symptoms, interpret them accurately, decide which ones matter, describe them coherently, tolerate uncertainty, evaluate medication effects, comply with treatment, recognize deterioration and know when they have become dangerous.
Some psychiatric illnesses can interfere with exactly those capacities.
This does not mean patients have no agency. Nor does it mean clinicians can be expected to know information a patient has withheld.
It means that imperfect psychiatric self-management is not necessarily evidence against psychiatric illness. Sometimes it may be part of the clinical problem.
The diagnosis itself was moving
One of the most striking moments in the testimony occurred during Clancy’s treatment in December 2022.
Psychiatric nurse practitioner Rebecca Jollotta testified that Clancy had reported going approximately 48 hours without sleep after an increase in Zoloft and, significantly, that she had not felt tired. Combined with difficulty tolerating antidepressants and other symptoms, that caused Jollotta to consider whether an underlying bipolar disorder might be part of the clinical picture.
Clancy screened negative for bipolar disorder, had no known history of mania and did not, in Jollotta’s judgment, meet the criteria necessary for the diagnosis at that time.
Then Jollotta raised the possibility with Lindsay and Patrick Clancy.
Patrick reportedly responded:
“My wife is not bipolar.”
According to Jollotta, Lindsay looked at her and said nothing.
I keep returning to that exchange.
Not because I blame Patrick Clancy.
I don’t.
The evidence portrays a husband who knew that his wife was suffering, was concerned about what medications were doing to her and participated in efforts to obtain help. Jollotta herself characterized him as concerned.
But Patrick was also her husband.
He was not her psychiatrist.
Knowing someone intimately is not the same thing as knowing how a psychiatric disorder presents clinically.
It is entirely possible to be a loving spouse and sincerely believe, “My wife isn’t bipolar,” because the person you know does not resemble your understanding of what bipolar disorder looks like.
And that is where Lindsay Clancy’s case becomes about something much larger than Patrick Clancy.
We still don’t understand serious mental illness nearly as well as we think we do
Our culture has become substantially more comfortable talking about anxiety, depression, trauma and therapy. That is progress. But serious psychiatric diagnoses still carry enormous cultural baggage. Bipolar disorder, psychosis and schizophrenia can provoke reactions that depression and anxiety increasingly do not.
My father has practiced psychiatry for more than half a century, and one of his enduring frustrations is that psychiatric stigma remains. That stigma is not merely insensitive. It can affect whether people seek treatment, what they disclose, how families respond to a diagnosis and even how patients understand what is happening to them.
It also matters because psychiatric diagnosis is difficult. Trauma-related disorders, mood disorders and psychotic disorders can sometimes produce overlapping symptoms, particularly in patients with comorbid conditions. Different diagnoses may require very different treatment strategies.
Stigma can also influence healthcare interactions and diagnostic processes. Research has documented diagnostic bias and misattribution involving serious mental illness, while studies of early psychosis have found that emerging symptoms may initially be attributed to conditions such as anxiety or depression. That does not mean stigma explains any particular diagnosis in Clancy’s treatment history. It does mean that diagnosis does not occur in a cultural vacuum.
Stigma therefore enters an already complicated diagnostic environment. And diagnosis is only one part of the problem. The expertise available to make that diagnosis matters, too.
There is also something peculiar about the way we separate mental illness from the rest of medicine.
The brain is a human organ.
We readily accept that a heart can malfunction, a thyroid can malfunction, a liver can malfunction or a bone can break. We understand that disease or injury can change what those parts of the body are capable of doing.
But when the organ that becomes ill is the brain, our intuitions become much less reliable.
The brain produces thought, perception, judgment, emotion, memory and behavior. When those functions become disturbed, the symptoms can therefore look less like symptoms and more like the person herself: her choices, her beliefs, her personality, her morality.
That may be one reason serious mental illness frightens us in a way many physical illnesses do not. The distinction between the person and the illness becomes harder for us to see.
And our understanding remains limited. Psychiatry has made enormous progress, but the human brain is extraordinarily complex, and psychiatric diagnosis still depends heavily on patterns of symptoms, behavior, history and clinical judgment rather than the kinds of definitive tests available for many other diseases.
Human beings are uncomfortable with uncertainty. We are especially uncomfortable when that uncertainty concerns behavior that frightens us.
So we reach for explanations that restore a sense of order: she planned it, therefore she understood it; she could function, therefore she couldn’t have been that sick; she knew enough to seek help, therefore she knew exactly what was happening to her.
But a malfunctioning brain does not become less biological simply because its symptoms are expressed through behavior.
The brain can become sick.
And when it does, the manifestations of that illness may be precisely the thoughts, perceptions, judgments and behaviors we are most tempted to interpret as evidence that the illness isn’t real.
Not every psychiatrist is the same psychiatrist
There is another uncomfortable reality that we discuss readily in almost every medical specialty but seem reluctant to discuss in psychiatry:
Expertise exists on a gradient.
Having access to a psychiatrist is not necessarily the same thing as having access to the psychiatrist best equipped for a particular clinical problem.
That is not an insult to psychiatrists.
We understand this intuitively elsewhere in medicine. Nobody assumes that every cardiologist possesses identical expertise in congenital heart disease, electrophysiology and interventional cardiology merely because each is a cardiologist.
Psychiatry has subspecialization and differences in clinical experience, too.
A clinician who has spent years treating complicated perinatal mood disorders may recognize patterns that another competent clinician encounters rarely. Someone specializing in bipolar-spectrum disorders may ask different questions. Someone experienced with first-episode psychosis may notice something another clinician reasonably interprets differently.
And experience itself matters.
One manifestation of expertise is not magically knowing the correct diagnosis on the first visit. It may instead be recognizing:
Something here does not fit.
That ability to remain uncertain — to resist prematurely forcing a complicated patient into a familiar diagnostic category — can be extraordinarily important.
Clancy’s history raises a question that is broader than whether she technically had access to psychiatric care:
Did she have access to the right expertise, at the right level of care, at the right moment?
I am asking the question because I think it needs to be asked.
Nor does asking it mean that one of her clinicians was incompetent.
Misdiagnosis does not automatically mean malpractice. Sometimes illnesses evolve. Sometimes crucial symptoms haven’t appeared yet. Sometimes a patient doesn’t disclose them. Sometimes one diagnosis genuinely looks more likely until the longitudinal picture becomes clearer.
But saying “she had psychiatrists” does not resolve the question of whether she was receiving the treatment appropriate for the illness she actually had.
Available care and appropriate care are not necessarily synonymous.
Bipolar disorder complicates the story further
Clancy has subsequently been diagnosed with bipolar disorder, including by forensic psychologist Kirk Heilbrun, a prosecution rebuttal witness who diagnosed bipolar II disorder. Other experts, including prosecution psychiatrist Avram Mack, disagreed with that diagnosis. The defense presented expert testimony that Clancy had bipolar disorder and that her illness ultimately spiraled into postpartum psychosis. A 2026 expert consensus statement in Biological Psychiatry describes postpartum psychosis as closely associated with the bipolar spectrum and notes that, in some women, a first postpartum psychotic episode can also represent the first recognized onset of bipolar disorder. Prosecutors and their experts dispute important aspects of that interpretation.
What makes the bipolar question particularly significant is that it did not emerge only after the killings. A provider was considering bipolar disorder before January 24, based in part on Clancy’s response to antidepressants and her unusual sleep history. That does not settle what diagnosis was correct at the time, but it demonstrates how complicated the clinical picture had already become. ACOG recommends screening for bipolar disorder before initiating pharmacotherapy for perinatal depression or anxiety when bipolar disorder has not already been assessed.
Bipolar-spectrum illness can also be difficult for family members — and sometimes patients themselves — to recognize when their understanding of the disorder is shaped by its most dramatic presentations. Clancy had reportedly functioned at a high level for much of her life. She was a labor-and-delivery nurse, wife and mother.
But functioning does not exclude psychiatric illness.
A person does not have to resemble the cultural caricature of “bipolar” to have a bipolar-spectrum disorder. Particularly outside a full manic episode, people with mood disorders can work, parent, maintain relationships and appear entirely ordinary to people around them.
This returns us to Patrick’s statement.
“My wife is not bipolar” may simply have meant:
The woman I know does not look like what I believe bipolar disorder looks like.
That is a very human response.
And it is precisely why public understanding of serious mental illness matters.
It also makes one feature of Clancy’s history especially important: sleep.
Sleep cannot be treated as a footnote
The available evidence does not establish precisely which shifts she worked during the relevant months, so the relationship between her work schedule and her sleep problems remains unclear.
But sleep disturbance itself is firmly part of the clinical history.
Clancy repeatedly reported insomnia. Her reported period of going approximately 48 hours without sleep while not feeling tired was one of the facts that caused Jollotta to consider bipolar disorder. By December, Clancy was contacting her provider after terrible nights saying she was desperate for help.
Sleep deprivation can worsen psychiatric symptoms, and abnormalities in sleep can themselves be clinically significant in mood disorders.
So consider the accumulating picture.
A postpartum woman.
Three young children.
Severe depression and anxiety.
Persistent sleep disturbance.
Suicidal thinking.
Intrusive thoughts.
Possible bipolar-spectrum illness.
Unusual responses to medications.
Repeated medication changes.
Multiple clinicians.
A brief psychiatric hospitalization.
Questions about whether she needed a higher level of care.
And, according to the defense, eventual psychosis.
No single item explains January 24.
The accumulation is the story.
“Why didn’t she just tell someone?”
This may be one of the most deceptively simple questions surrounding the case.
Clancy was telling people that something was wrong.
But apparently she did not always disclose everything consistently.
That creates a legitimate clinical problem. Doctors cannot respond appropriately to information they do not have.
But before converting nondisclosure into evidence of rational manipulation, consider what we ask a mother to admit.
I’m thinking about suicide.
I’m having thoughts about harming my children.
I’m hearing something nobody else can hear.
I’m afraid I’m losing control of my mind.
Now imagine what a frightened mother may believe those disclosures could cost her.
Will someone take my children?
Will my husband trust me alone with them?
Will I be hospitalized?
Will everyone think I’m dangerous?
Will my husband still see me the same way?
I am not claiming Lindsay Clancy had those thoughts. We don’t know.
But these are precisely the kinds of fears that make stigma clinically relevant.
And that is where the gendered component of this case becomes impossible for me to ignore.
The patriarchy here is bigger than one husband
It would be easy — and unfair — to turn Patrick Clancy’s “my wife is not bipolar” statement into an indictment of Patrick Clancy.
That isn’t my argument.
My argument is about the society in which both Patrick and Lindsay were operating — and about how that society shapes what women understand about mental illness, what their families understand about it, what women are willing to disclose, and what we expect mothers to manage for themselves.
Patrick may have known his wife extraordinarily well. But he was not a medical professional. He could not know simply from loving and living with Lindsay whether she had bipolar disorder. And like the rest of us, his understanding of what “bipolar” looked like may have been informed by whatever cultural images of the illness he had encountered.
Perhaps the Lindsay he knew simply didn’t resemble them.
That would not make him uncaring. It would make him human.
And that is precisely the problem.
Mental-health stigma does not require a cruel husband telling his wife that mental illness is shameful. It can operate far more subtly than that. A loving spouse can reject the possibility of a diagnosis because it seems incompatible with the competent, accomplished person he knows. A patient can hear that reaction and absorb something from it. A family can sincerely want someone to get better while still finding some psychiatric diagnoses much harder to accept than others.
There is another reason a family member’s response to a possible diagnosis matters. In serious psychiatric illness, the people closest to a patient may become an important part of the safety net precisely when the patient’s own insight is deteriorating. If those people understand bipolar disorder, mania or psychosis primarily through cultural stereotypes, they may sincerely love the person in front of them while failing to recognize the illness developing in that same person. A trusted family member’s rejection of a diagnosis may also influence how the patient understands or responds to that possibility herself. None of this makes the family member responsible for the illness. It means that mental-health literacy among the people surrounding a patient can become part of the environment in which that illness is recognized and treated.
We don’t know what Patrick meant beyond the words he spoke, and we certainly don’t know what Lindsay thought when she heard them.
But we do know the cultural environment in which those words were spoken.
Women have historically occupied a particularly fraught position within psychiatry. Their distress has at different times been pathologized, trivialized, attributed to hormones, dismissed as emotionality, or explained through diagnoses reflecting the assumptions of the era. At the same time, genuinely serious psychiatric illnesses affecting women — including those associated with pregnancy and childbirth — have not always been recognized or understood adequately.
That history doesn’t disappear simply because we now talk more openly about mental health.
Today, postpartum depression has finally become part of mainstream conversation. Women are routinely told to watch for it. Partners are told to watch for it. Obstetric practices screen for it. Celebrities talk about experiencing it.
That is real progress.
But our cultural acceptance of maternal mental illness still has boundaries.
We are relatively comfortable with the image of a postpartum mother who is sad, exhausted, overwhelmed and tearful.
What happens when she says:
I think I might be bipolar.
Or:
I’m hearing voices.
Or:
I’m having thoughts about hurting my baby.
Or:
I’m frightened by what is happening inside my own mind.
The reaction changes.
Suddenly we are no longer talking about the sympathetic version of maternal mental illness. We are talking about symptoms that frighten people.
And motherhood makes that fear uniquely consequential.
A woman experiencing psychiatric deterioration is not simply being asked to tell a doctor what she feels. She may understand — correctly or incorrectly — that what she says could change how her husband sees her, whether people trust her with her children, whether she can continue working, whether she will be hospitalized, and whether somebody might decide that her children are safer without her.
Those fears don’t have to be objectively justified to influence what someone says.
And I am not claiming that Lindsay Clancy personally had each of those fears. We cannot know that.
But we cannot have a serious conversation about maternal psychiatric care without acknowledging why a mother might hesitate before saying the most frightening thing happening inside her head.
That creates a cruel paradox.
Tell us everything so we can keep you and your children safe.
But also:
Know that certain things you tell us may fundamentally change the way other people see you as a mother.
And then we place another extraordinary responsibility upon women: we expect them to recognize when their own psychiatric illness has become dangerous.
Think about what that actually requires.
A postpartum woman experiencing severe psychiatric symptoms may be expected to recognize that her thoughts are no longer ordinary anxiety. She must distinguish intrusive thoughts from something more dangerous. She must recognize abnormal sleep. She must notice changes in her own thinking. She must decide whether a medication is helping or making things worse. She must accurately communicate all of this to clinicians. She must navigate appointments and different providers. She must tolerate medication changes and side effects. She must know when outpatient treatment is no longer enough. And, ultimately, she may be expected to determine whether she can safely remain alone with her own children.
All while the illness being evaluated may itself be affecting sleep, cognition, judgment, perception and insight.
There is something fundamentally backwards about making the deteriorating patient the primary detection system for her own deterioration.
Families become the backup detection system. But spouses are not psychiatrists either.
Patrick’s question to Lindsay about whether she needed to be kept away from the children illustrates this painfully.
She said no.
Knowing what eventually happened, it is almost impossible to read that answer without wanting somebody to have overruled it.
But Patrick had no access to January 24. He had a wife who had disclosed frightening thoughts but who told him she did not need to be separated from their children. He also knew a woman he had presumably watched mother those children without harming them.
What exactly are we expecting an untrained spouse to do with that information?
And what exactly are we expecting a psychiatrically deteriorating mother to know about herself?
This is where reducing the story to individual choices misses something much larger.
A system that depends heavily upon a sick woman recognizing the precise nature of her own illness, communicating it completely, advocating for the correct treatment, knowing when that treatment is failing, overcoming whatever stigma she or her family associates with more serious diagnoses, and correctly assessing her own dangerousness is placing an enormous burden on the person whose judgment may be becoming less reliable.
That doesn’t absolve patients of responsibility for participating in treatment.
It doesn’t mean families are powerless.
And it doesn’t mean clinicians should hospitalize every postpartum woman who reports an intrusive thought. Intrusive thoughts are not synonymous with homicidal intent, and indiscriminate hospitalization would create its own harms — including giving mothers even more reason to conceal symptoms.
It means the system has to be sophisticated enough to operate in the space between those extremes.
And it means our public understanding of mental illness matters more than we sometimes acknowledge.
We have spent years telling people to “end the stigma” around mental health. But much of that destigmatization has occurred around the illnesses and experiences we find easiest to assimilate.
Depression.
Anxiety.
Trauma.
Therapy.
Burnout.
We have become considerably better at saying, It’s okay not to be okay.
We are much less comfortable saying:
It’s possible to be a loving mother and experience psychosis.
It’s possible to be an accomplished professional and have bipolar disorder.
It’s possible to hear voices without becoming the caricature of a “crazy person.”
It’s possible to experience horrifying thoughts and be terrified by them.
It’s possible for someone you know intimately to have a serious psychiatric illness you don’t recognize.
If our compassion disappears when mental illness becomes frightening, then we have not actually eliminated psychiatric stigma.
We have merely drawn a new boundary around which illnesses are socially acceptable.
And for postpartum women, that boundary may have consequences.
Because the symptoms a mother is most frightened to disclose may be precisely the symptoms her clinicians most urgently need to know.
This is why I cannot separate the Clancy case entirely from patriarchy — not because I believe a husband caused his wife’s illness, and not because I believe men are uniquely capable of stigmatizing mental illness.
It is because motherhood itself carries an enormous set of gendered expectations.
A good mother knows her children.
A good mother protects her children.
A good mother knows when something is wrong.
A good mother asks for help.
A good mother follows the doctor’s instructions.
A good mother would never hurt her children.
And when psychiatric illness collides with those expectations, we can end up demanding something impossible: that a woman prove she is a good mother by accurately identifying and reporting the deterioration of the very mind she is relying upon to make that judgment.
Then, if catastrophe occurs, we work backward.
Why didn’t she tell somebody?
Why didn’t she recognize what was happening?
Why didn’t she stay away from the children?
Why didn’t she take the right medication?
Why didn’t she insist upon hospitalization?
Why didn’t her husband know?
Those are reasonable questions.
But they are not self-answering indictments.
Sometimes they reveal something else: how much of our mental-health system still depends upon patients and families possessing knowledge, insight and confidence that we have never adequately given them.
Patrick’s “my wife is not bipolar” therefore matters to me without making Patrick culpable.
It captures, in a single exchange, the distance between knowing a person and knowing an illness.
A clinician saw something that made her consider bipolar disorder.
A husband saw a wife who did not fit his understanding of bipolar disorder.
And Lindsay sat between them.
We cannot know what that silence meant.
But a society genuinely committed to maternal mental health should be asking what it would take for a woman sitting in that chair to feel completely safe saying whatever came next.
Intrusive thoughts are not the same thing as psychosis
There is another distinction that the public discussion sometimes erases.
Such thoughts can be ego-dystonic: deeply unwanted, frightening and inconsistent with the person’s desires.
Nor does it necessarily prove that she secretly wanted to kill them.
Her earlier symptoms should not be retrospectively converted into psychosis merely because we know what happened later.
The defense’s contention is essentially one of deterioration: that her condition eventually progressed into psychosis.
The prosecution disputes that.
That distinction matters.
And it brings us to perhaps the greatest cognitive trap in this entire case.
Hindsight makes everything look obvious
We know what happened on January 24, 2023.
Her clinicians in October, November and December 2022 did not.
Patrick didn’t.
Lindsay didn’t know what the future held either.
When we now read that Lindsay had thoughts about harming the children, we read the statement knowing that she eventually killed them.
That knowledge transforms how the earlier statement feels.
A clinician hearing an exhausted, severely depressed postpartum woman describe an unwanted intrusive thought has to assess the risk without knowing the ending.
Likewise, we now hear Patrick say, “My wife is not bipolar,” knowing that Lindsay subsequently received a bipolar diagnosis.
Patrick did not possess that information in December 2022.
We see the medication changes knowing what happened weeks later.
Her prescribers didn’t.
Hindsight bias creates the illusion that clues were predictions.
But hindsight can distort the story in the opposite direction, too.
Because something catastrophic eventually happened, we cannot simply declare that every earlier symptom was an obvious sign of impending psychosis and that every clinician should have known.
That would be equally simplistic.
Some warnings become warnings only after we know the outcome.
The responsible question is harder:
Given only what was reasonably knowable at that particular moment, what conclusions should have been drawn?
That is a very different question from the one being answered on social media.
She was hospitalized. That doesn’t end the inquiry either.
Another shortcut goes something like this:
She had access to care. She had doctors. She was hospitalized. What else could anyone have done?
Clancy did receive substantial psychiatric care. She sought a higher level of treatment and ultimately had an inpatient psychiatric admission shortly before the killings. She was subsequently discharged after clinicians assessed her condition and risk. Her treatment history included emergency evaluation and recommendations for partial hospitalization.
That makes the case harder, not easier.
There is an uncomfortable space in psychiatric medicine between someone who is clearly well enough for routine outpatient management and someone who obviously meets the threshold for continued inpatient confinement.
People can move through that space.
They can deteriorate.
They can appear substantially better during one evaluation.
They can deny intent.
They can genuinely believe they are safe.
They can become worse afterward.
A person can need more intensive treatment without presenting at every evaluation in a manner that makes the need obvious.
That doesn’t mean clinicians necessarily made the wrong decision.
It means “she was evaluated” is not synonymous with “therefore she could not subsequently have become catastrophically ill.”
Knowing something is wrong is not the same as knowing what is wrong
Another public shortcut is:
She knew she needed psychiatric help. Therefore she had insight. Therefore she knew what she was doing.
But insight isn’t binary.
A person can recognize:
Something is terribly wrong with me.
without accurately recognizing:
I have bipolar disorder.
or:
I’m becoming psychotic.
or:
That voice isn’t real.
or:
I am capable of hurting someone.
or:
I cannot safely be alone with my children.
Help-seeking proves that someone recognizes distress.
It does not necessarily establish intact insight into the nature, severity or consequences of the underlying illness.
She said no.
Knowing what eventually happened makes that answer horrifying.
But several possibilities remain.
Perhaps she was minimizing symptoms.
Perhaps she was afraid of what would happen if she said yes.
Perhaps she genuinely believed she would never hurt them.
Perhaps the thoughts were intrusive and unwanted rather than homicidal at that point.
Perhaps her condition later deteriorated dramatically.
Perhaps something else was happening entirely.
We don’t know.
“She said no” does not tell us why she said no.
Remorse does not have to look the way spectators expect
The public has also scrutinized Clancy’s face in court.
Some observers have interpreted her expressions as evidence that she lacks remorse.
Clinicians who treated or evaluated her after the killings have testified to expressions of horror, remorse or ongoing grief, and Patrick Clancy has publicly described her as ill rather than evil and has forgiven her.
Again, none of that establishes legal insanity.
But neither does a courtroom photograph establish absence of remorse.
If Clancy genuinely believes that she loved her children and would never have killed them but for catastrophic mental illness, the psychological task confronting her is almost impossible to comprehend.
I killed my children.
and
I loved my children.
and
I do not recognize the mind that could have done this.
could all coexist.
We don’t have to resolve that contradiction for her.
Three children are dead
Any discussion of Lindsay Clancy’s mental illness must continually return to Cora, Dawson and Callan.
They cannot become abstractions in an argument about psychiatric care.
Three children suffered horrifying deaths.
Nothing about psychiatric nuance changes that.
But neither should caring about those children require us to simplify their mother’s mental state into evil.
That binary impoverishes our understanding of what happened and, more importantly, does nothing to prevent something similar from happening again.
Understanding is not exoneration.
Explanation is not excuse.
Compassion is not a verdict.
And acknowledging catastrophic mental illness does not make the lives of the victims matter less.
In fact, taking severe maternal mental illness seriously is partly about protecting children.
That point deserves far more attention than it usually receives.
Maternal mental health is often discussed as though it were principally a quality-of-life issue for mothers: whether a woman is coping, whether she feels bonded to her baby, whether she is sleeping, whether she is enjoying motherhood, whether she is depressed.
All of those things matter enormously.
But severe maternal psychiatric illness can also become a child-safety issue.
A mother who is profoundly depressed, severely sleep-deprived, manic, psychotic, suicidal, cognitively disorganized or losing insight may have difficulty safely caring for herself and, depending on the severity and nature of the illness, may also have difficulty safely caring for children.
That does not mean mentally ill mothers are inherently dangerous.
Most are not.
It does mean that maternal psychiatric care should not be treated as an optional add-on to obstetric care or as something that becomes urgent only once a woman says the exact words that trigger an emergency response.
The healthier and more accurately treated the mother is, the safer and more stable the environment around the children is likely to be.
That sounds obvious when written plainly.
Yet culturally, we often treat maternal mental health as though the stakes belong almost entirely to the woman.
They do not.
Children depend on the adults around them for regulation, supervision, judgment, routine and safety. When one of those adults is becoming psychiatrically unstable, the entire family system can be affected.
That is why early recognition matters.
Accurate diagnosis matters.
Sleep matters.
Continuity of care matters.
Specialized expertise matters.
Honest disclosure matters.
And families understanding what serious psychiatric symptoms can look like matters.
This is also why stigma is not merely cruel.
It can become dangerous.
If a mother is afraid to say that she is hearing voices because she fears losing her children, that fear can interfere with the very disclosure that might help keep those children safe.
If a spouse rejects the possibility of bipolar disorder because the diagnosis sounds too frightening or doesn’t match a stereotype, that may unintentionally make it harder to recognize deterioration.
If clinicians, families or patients themselves are more comfortable calling something anxiety or depression when the presentation is becoming more complicated, important changes can be missed.
Again, none of those propositions tells us exactly what happened in Lindsay Clancy’s case.
But they tell us why the questions matter.
There is a strange contradiction in the way society talks about motherhood.
We place enormous responsibility on mothers for children’s safety, development and emotional well-being.
But maternal psychiatric illness is still too often treated as a secondary concern — something to address once the baby’s physical health has been checked, once feeding is established, once everyone has gone home.
That hierarchy makes little sense.
A baby’s environment includes the mother’s mind.
A child’s safety depends partly on the mental functioning of the adults caring for that child.
That does not mean surveilling mothers or treating every disclosure of distress as evidence of danger.
In fact, doing that would likely make mothers less willing to disclose what they are experiencing.
It means building systems in which women can say frightening things without immediately being reduced to frightening people.
It means distinguishing intrusive thoughts from intent.
It means distinguishing depression from bipolar illness.
It means recognizing psychosis early.
It means taking profound sleep disturbance seriously.
It means giving families enough education to know when symptoms have moved beyond ordinary postpartum distress.
And it means creating pathways to higher levels of care before the situation becomes catastrophic.
If society genuinely cares about protecting children, then maternal mental health cannot be treated as separate from child welfare.
They are connected.
Taking a mother’s psychiatric deterioration seriously is not choosing her over her children.
Sometimes it is one of the most important ways of protecting them.
What does a mother have to look like before we believe she is seriously ill?
Perhaps this is the question underneath all the others.
Apparently she cannot be too organized.
She cannot Google.
She cannot make plans.
She cannot work.
She cannot care for her children sometimes.
She cannot recognize that she needs help.
She cannot disagree with a doctor.
She cannot change her mind about medication.
She cannot withhold symptoms.
She cannot appear normal between crises.
She cannot tell her husband she is safe and later become unsafe.
If she does those things, people point to them as evidence that she couldn’t really have been severely ill.
But what kind of mental illness are we leaving room for?
Only the version that is unmistakable to everyone around the patient?
Only the patient who behaves consistently with our expectations?
Only the person whose illness announces itself so dramatically that a layperson recognizes it immediately?
Real psychiatric illness does not have to perform itself for us.
The lesson is epistemic humility
There is a word for what I think is missing from much of the conversation around Lindsay Clancy:
humility.
Not moral relativism.
Not an unwillingness to judge evidence.
Epistemic humility: recognizing the limits of what we know.
Lindsay knew things about her internal experience that Patrick could not know.
Patrick knew things about the woman he lived with that a clinician seeing her for an appointment could not know.
Individual clinicians possessed expertise Patrick didn’t have, but each may have seen only part of a changing longitudinal picture.
A clinician with deep expertise in one psychiatric subspecialty might recognize patterns another competent clinician would interpret differently.
Experts examining the case retrospectively can see a chronology that none of the people living through it possessed prospectively.
And a jury sitting through weeks of testimony has vastly more evidence than somebody watching selected clips online.
Even those jurors, after hearing more than 80 witnesses and reviewing a record containing hundreds of exhibits, have struggled to agree.
That should tell us something.
Not that there is no truth.
Not that expertise doesn’t matter.
Not that every interpretation deserves equal weight.
It should tell us that confidence ought to be proportional to knowledge.
I don’t know whether Lindsay Clancy was legally criminally responsible when she killed Cora, Dawson and Callan.
I don’t know whether another psychiatrist would have diagnosed her differently months earlier.
I don’t know whether a different medication regimen would have changed the outcome.
I don’t know whether longer hospitalization would have prevented it.
I don’t know what Lindsay thought when Patrick said, “My wife is not bipolar.”
I don’t know what she withheld, what she misunderstood, what she feared or precisely when her perception of reality may have changed.
Neither does almost anyone arguing about her on the internet.
And perhaps the most useful thing this terrible case can teach the rest of us is to become more comfortable saying those three words:
I don’t know.
Because “I don’t know” does not mean we stop asking questions.
It means we ask better ones.
Instead of asking why a psychotic person could make a plan, ask whether planning and psychosis can coexist.
Instead of asking why a sick patient didn’t manage her treatment better, ask how psychiatric illness can affect the very insight and judgment required to manage it.
Instead of asking why she didn’t tell everyone everything, ask what makes patients — and mothers in particular — afraid to disclose the symptoms that frighten them most.
Instead of saying she had doctors, ask whether complicated psychiatric illness sometimes requires not merely access to care, but access to the right expertise and the right level of care at the right moment.
Instead of deciding that a loving husband must know whether his wife is bipolar, recognize the difference between knowing a person and diagnosing an illness — and ask whether we have given families enough understanding of serious mental illness to recognize what they may be seeing.
Instead of expecting a psychiatrically deteriorating mother to know precisely when she has become unsafe, ask how much of our maternal mental-health system depends upon the sick person successfully detecting and reporting the deterioration of her own mind.
Instead of treating postpartum mental health as synonymous with postpartum depression, become willing to talk about bipolar disorder, mania, psychosis, intrusive thoughts and the symptoms that still frighten us.
Instead of treating concern for a mother’s psychiatric illness as somehow separate from concern for her children, recognize that the two can be inseparable. Taking severe maternal mental illness seriously is not choosing mothers over children. Sometimes it is how we protect both.
And instead of looking backward from three dead children and convincing ourselves that everything should have been obvious, remember that nobody living through those months knew how the story ended.
Mental illness does not owe us a clean narrative.
It does not have to progress logically.
It does not have to produce consistent behavior.
It does not have to conform to the stereotypes held by spouses, strangers or even patients themselves.
And a person does not have to stop functioning completely before her mind can become dangerously ill.
The deaths of Cora, Dawson and Callan demand accountability to the truth of what happened. But truth is not served by flattening complexity until the story becomes emotionally satisfying.
If anything, their deaths demand that we tolerate the complexity long enough to learn from it.
That means taking frightening maternal psychiatric symptoms seriously before catastrophe makes their significance obvious. It means creating a culture in which a mother can disclose those symptoms without being reduced to them. It means giving families better tools to recognize serious illness, and ensuring that access to mental-health care includes pathways to specialized expertise and higher levels of care when ordinary treatment is no longer enough.
And it means understanding that protecting a psychiatrically ill mother and protecting her children are not competing objectives.
They are often the same one.
Because if the only serious mental illness we are willing to recognize is the kind that already looks unmistakably like serious mental illness, we will continue to recognize some people far too late.
And sometimes, far too late is irreversible.
Update, September 7, 2026: This essay has been expanded to include a discussion of the way we conceptualize illness of the brain differently from illness or injury elsewhere in the body, and how that distinction may contribute to our difficulty understanding serious mental illness. The central argument of the essay is unchanged.
Sources and Further Reading
Law and the Lindsay Clancy case
Massachusetts Supreme Judicial Court. “Model Jury Instructions on Homicide: I. Criminal Responsibility.” Revised 2026.
Official Massachusetts instructions explaining the Commonwealth’s burden of proving criminal responsibility and the standards for determining whether a mental disease or defect deprived a defendant of substantial capacity to appreciate the criminality or wrongfulness of conduct or to conform conduct to the requirements of law.
Perinatal mental health, bipolar disorder and postpartum psychosis
American College of Obstetricians and Gynecologists (ACOG). “Screening and Diagnosis of Mental Health Conditions During Pregnancy and Postpartum.” ACOG Clinical Practice Guideline No. 4. Obstetrics & Gynecology 141, no. 6 (2023): 1232–1261.
Guidance addressing screening and diagnosis of perinatal depression, anxiety, bipolar disorder, suicidality and postpartum psychosis.
American College of Obstetricians and Gynecologists (ACOG). “Patient Screening: Perinatal Mental Health.”
Clinical guidance recommending bipolar-disorder screening before initiating pharmacotherapy for perinatal depression or anxiety when bipolar disorder has not previously been assessed, immediate assessment following affirmative self-harm responses, and immediate medical attention for postpartum psychosis.
Bergink, Veerle, Schahram Akbarian, Nancy Byatt, Prabha S. Chandra, Nicole Cirino, Paola Dazzan, Lot De Witte, et al. “Postpartum Psychosis and Bipolar Disorder: Review of Neurobiology and Expert Consensus Statement on Classification.” Biological Psychiatry 99, no. 9 (2026): 740–747.
Expert consensus review examining the relationship between postpartum psychosis and the bipolar spectrum and recommending that postpartum psychosis be classified within the bipolar-disorders chapter of the DSM.
Toor, Ramanpreet, Michelle Wiese, Carmen Croicu, and Amritha Bhat. “Postpartum Psychosis: A Preventable Psychiatric Emergency.” FOCUS 22, no. 1 (2024): 44–52.
Clinical review of the presentation, evaluation, treatment and prevention of postpartum psychosis, emphasizing its status as a psychiatric emergency requiring immediate medical attention and generally inpatient care.
Vigod, Simone N., Benicio N. Frey, Crystal T. Clark, Sophie Grigoriadis, Lucy C. Barker, Hilary K. Brown, Jaime Charlebois, et al. “Canadian Network for Mood and Anxiety Treatments 2024 Clinical Practice Guideline for the Management of Perinatal Mood, Anxiety, and Related Disorders.” The Canadian Journal of Psychiatry 70, no. 6 (2025): 429–489.
Comprehensive evidence-based guideline addressing perinatal depression, bipolar disorder, anxiety disorders, obsessive-compulsive disorder, post-traumatic stress disorder, high-risk clinical situations, treatment and organization of care.
Intrusive thoughts, stigma and barriers to care
Brok, Elke C., Patricia Lok, Desiree B. Oosterbaan, Aart H. Schene, Indira Tendolkar, and Philip F. van Eijndhoven. “Infant-Related Intrusive Thoughts of Harm in the Postpartum Period: A Critical Review.” The Journal of Clinical Psychiatry 78, no. 8 (2017): e913–e923.
Review of unwanted infant-related harm intrusions in the postpartum period and their distinction from actual intent to harm.
Lawrence, Peter J., Michelle G. Craske, Claire Kempton, Anne Stewart, and Alan Stein. “Intrusive Thoughts and Images of Intentional Harm to Infants in the Context of Maternal Postnatal Depression, Anxiety, and OCD.” British Journal of General Practice 67, no. 661 (2017): 376–377.
Clinical discussion of assessing infant-harm thoughts and distinguishing unwanted, ego-dystonic intrusive thoughts from situations involving intent or other indicators of risk.
Sambrook Smith, Megan, Vanessa Lawrence, Euan Sadler, and Abigail Easter. “Barriers to Accessing Mental Health Services for Women With Perinatal Mental Illness: Systematic Review and Meta-Synthesis of Qualitative Studies in the UK.” BMJ Open 9, no. 1 (2019): e024803.
Systematic review examining barriers to accessing perinatal mental-health services, including stigma, fear of judgment, concerns surrounding motherhood and difficulties navigating services.
Howard, Louise M., and Hind Khalifeh. “Perinatal Mental Health: A Review of Progress and Challenges.” World Psychiatry 19, no. 3 (2020): 313–327.
Broad review of the epidemiology, consequences, identification and treatment of perinatal mental disorders and continuing challenges in delivering effective care.
McCarthy, Megan, Catherine Houghton, and Karen Matvienko-Sikar. “Women’s Experiences and Perceptions of Anxiety and Stress During the Perinatal Period: A Systematic Review and Qualitative Evidence Synthesis.” BMC Pregnancy and Childbirth 21 (2021): 811.
Qualitative evidence synthesis examining women’s experiences of perinatal anxiety and stress, including social expectations, experiences with health care, social support and perceived expectations surrounding motherhood.
Daehn, Daria, Sophie Rudolf, Silke Pawils, and Babette Renneberg. “Perinatal Mental Health Literacy: Knowledge, Attitudes, and Help-Seeking Among Perinatal Women and the Public — A Systematic Review.” BMC Pregnancy and Childbirth 22 (2022): 574.
Systematic review examining knowledge and recognition of perinatal mental-health disorders, attitudes toward those disorders, stigma and factors influencing help-seeking.