The trial shaking the USA: Why did Lindsay Clancy murder her children?

"She had no reason to kill these three lovely children. So why did she do it? Why?", this question was asked by Kevin Reddington, the defense attorney in the trial of Lindsay Clancy from Massachusetts, USA. Clancy murdered her children by strangling them with exercise bands and then stabbed herself in the neck, cut her veins, and jumped out of a window. She was left paralyzed from the waist down and is now on trial for her actions. Reddington claims she did it because of postpartum psychosis.

Clancy's trial is attracting a lot of attention in the USA. Not everyone believes that the 35-year-old mother, formerly a midwife nurse at Mass General Hospital, was in a state of insanity when she committed the act. They point out that her youngest son, Callan, was already eight months old, supposedly long after the hormonal storm that childbirth brings with it. The prosecution presented evidence that Clancy sent her husband to pick up an order from a restaurant and buy medicine at a pharmacy, and checked on Google how long the round trip would take, evidence that she planned the move, premeditated murder.

But the husband, now divorced, actually supports the defense's line and claims that Clancy suffered from a severe mental crisis and was not responsible for her actions. She was indeed hospitalized due to mental illness until a few weeks prior, and after she was released, her parents and husband tried to keep the children under her supervision as little as possible. Clancy herself claims that she heard voices in her head calling on her to kill the children and herself.

In parallel to the trial against Clancy, her ex-husband is suing the hospital and the medical staff who treated her in a civil lawsuit, who, according to him, did not diagnose her properly and released her from hospitalization too early. In the criminal trial, defense attorney Reddington claims that regardless of the illness and her diagnosis, Clancy was treated with an excessive amount of medication, 13 different drugs for sedation, anxiety treatment, depression treatment, and also for psychosis, over four months. He wonders if perhaps the multiple medications and her many transitions between doctors, each of whom tried something new, were what caused her condition to deteriorate into a murderous and suicidal reaction.

One in 500 mothers may suffer from psychosis

The diagnosis of postpartum psychosis seems "convenient" for a person accused of such a crime. Not only can Clancy claim insanity and replace detention with hospitalization, she will also be able to say later that her condition has improved, and the conditions that caused it have passed. But then the question asked by the defense attorney arises: if not for this reason, then why?

The period after childbirth is recognized as one of the most sensitive periods for women's mental health. Postpartum depression affects about 10%-15% of mothers, and gradually postpartum anxiety (not the normal fear for the baby's future in a cruel world, but paralyzing anxiety) is also becoming more recognized. Postpartum psychosis is also a condition that medical literature recognizes today.

It is estimated that one in 500 mothers will suffer from the phenomenon. That is, in Israel, this will happen to only 360 women a year. These are considered low morbidity rates, and yet - 360 women a year. It is important to note that the vast majority of them will not resort to violence: the rates of attempting to harm the baby are about 4% of those suffering from the phenomenon, and there is a bias in this figure because many of those who did not try to harm the baby will not receive the diagnosis of psychosis, even if that is indeed their condition. However, they may harm themselves or certainly suffer greatly. Awareness of the phenomenon is low, but efforts are being made today to increase it, because there is something to do and how to treat it.

Postpartum psychosis does not look like stereotypical 'madness'. Only in about 49% of those diagnosed does it include hearing voices or seeing visions that are not realistic. It is often characterized by delusional thoughts around the baby. For example, a woman who stares out the window all night because she is sure that someone is about to arrive to take her child. One can understand how in our unstable world, the environment would perceive this as normal concern and would not identify it with psychosis. Another type of delusional thought can be that messages from the television or billboards are actually specific messages intended for the woman or her baby, delusional thoughts that the baby is very sick or even that he is already dead, fears that the baby is not really theirs, or delusional thoughts that she is pregnant again. Other symptoms are a sharp decrease in the need to sleep - it is very difficult to diagnose this in a woman who has no time to sleep anyway, as well as severe confusion or catatonia - for example, a woman who reported that she arrived at a cafe and could not place the order.

In 2001, a woman from Houston named Andrea Yates drowned her five children in the bathtub. She explained that under the influence of psychosis, she believed that if she killed them, she could save them from hell, and if she committed suicide, the evil of Satan would disappear from the world. In her first trial, the jury decided that despite these delusional thoughts, she knew during the act that it was illegal, and therefore she has criminal responsibility. But Yates appealed and was eventually released.

Carol Coronado from California murdered her three daughters by stabbing. Investigators found her lying next to them naked, digging into their wounds, and according to her, afterwards she had no memory of the events. She was actually convicted, on the grounds that she was sane and only depressed.

How can it be treated?

Since this is a turbulent period in the life of the woman, the family, and the immediate environment, it is very difficult, as mentioned, to separate strange but expected phenomena at this stage from psychosis. Clancy herself wrote in her diary: "It's like I want to take a break from taking care of them so much that my brain is trying to make itself sick on purpose". But it is not on purpose. It is a product of powerful hormonal and emotional changes, realistic anxiety, and lack of sleep, which cause the outbreak of a disease to which the patient probably had a genetic predisposition.

It should be distinguished that many women suffer from obsessive thoughts or a feeling of alienation from themselves and from their baby, and this is not psychosis. Many women even report that they experience thoughts of violence towards the children, for example, they imagine that they are throwing the child out the window or crushing him. In fact, these thoughts most often do not stem at all from the desire to harm the child, but probably constitute a defense and warning mechanism of the brain against risks. They are similar to thoughts that people of both sexes and all ages sometimes have about jumping off a cliff or throwing their cell phone, and the accepted explanation is that our brain explains the risk to us so that we will be more careful.

If a suspicion of psychosis is identified, the treatment will usually be pharmacological, while during the treatment the woman will usually be under close supervision to prevent her from harming herself or the children. Most cases of postpartum psychosis will be treated successfully, and there is more chance that the phenomenon will not develop into a chronic mental illness than in psychosis attacks that are not related to childbirth. That is, women with such psychosis have a very good chance of returning to a normal life.