What the Lindsay Clancy Trial Still Isn’t Teaching Families About Postpartum Psychosis

Postpartum psychosis is real, terrifying and still wildly misunderstood. This week, we separate the diagnosis from the courtroom speculation—and ask why so many only hear about it after tragedy.

Three children are dead. Their mother’s criminal responsibility is for a jury to decide. But families should not have to encounter a postpartum psychiatric emergency for the first time through an unimaginable tragedy.

Welcome to a very different edition of After Bedtime, The Mother Chapter’s weekly late-night debrief. Tonight, we’re setting aside our usual mix of motherhood news, group-chat debates and things worth putting on your nightstand to talk about something every family should understand.

If this feels like your group chat, send it there. If someone sent it to you, subscribe for free and meet us back here next week.

This week looks different.

We told you we were going to talk about the Lindsay Clancy trial, but the more we thought about it, the more we realized we didn’t want to simply recap what happened in court—or add one more opinion to a conversation already full of them.

Instead, we wanted to ask a bigger question:

What should mothers, partners and families know about postpartum psychosis before they ever find themselves in a crisis? What should all of us have understood long before we knew the names Cora, Dawson and Callan Clancy?

An important note before we begin: This newsletter is intended to provide general education about postpartum psychosis. It is not medical advice. The clinicians and advocate interviewed here were asked to speak generally about the illness; their comments are not intended to diagnose Lindsay Clancy, evaluate the evidence in her case or offer an opinion about her criminal responsibility or trial.

The two truths we keep being told to choose between

The Lindsay Clancy trial began this week, and almost immediately, the public conversation split into two camps—as though we are incapable of holding two devastating truths at the same time:

Three children were killed.

And their mother may have been gravely ill.

Acknowledging one does not erase the other and holding space for both is not the same as reaching a conclusion about what happened.

Clancy’s defense says she was experiencing postpartum psychosis and was not criminally responsible when she killed her children. Prosecutors say her actions were deliberate and calculated. The jury has been asked to determine which account is supported by the evidence and whether Clancy was criminally responsible under Massachusetts law.

As this issue publishes Friday, the trial remains in its first week. Jurors are expected to visit the former Duxbury home where the children died before testimony resumes. Patrick Clancy and several first responders have already testified, while the prosecution and defense continue to offer profoundly different accounts of Lindsay Clancy’s mental state and actions.

We’re not going to reproduce the most graphic testimony here—the children’s deaths do not need to be made more horrifying to hold our attention. We’re also not going to pretend that a newsletter can diagnose a defendant or decide a legal case. A psychiatric diagnosis and the legal standard for criminal responsibility may overlap, but they are not the same thing. The jury will hear evidence and expert testimony the rest of us do not have. It will decide whether the Commonwealth has proven its case and whether Clancy was criminally responsible under the law.

What the trial cannot decide is whether postpartum psychosis is real. It absolutely is.

Postpartum psychosis affects approximately one to two people for every 1,000 births, although some estimates are slightly higher. It’s a full-blown psychiatric emergency that can involve delusions, hallucinations, mania, severe depression, mixed mood states, confusion, paranoia, severe agitation and a profound break with reality. It is not postpartum depression or ordinary maternal anxiety, and it is not another name for feeling angry, overwhelmed, resentful or unlike yourself after having a baby.

Aaisha Alvi, a postpartum-psychosis awareness advocate, writer and author of A Mom Like That: A Memoir of Postpartum Psychosis, vehemently objects to how casually the condition is dismissed as “rare.”

“Calling something rare ensures we don’t make space for it in our brains as members of the public and as healthcare providers,” she told us.

Whatever word we use to describe how often it happens, the number is not so small that pregnant women should be told nothing about it, partners should have no idea what to watch for or the doctors most likely to encounter a postpartum mother should be unprepared to recognize it.

Yet far too many women, and the village that’s meant to support them, first hear the term only after a mother and her children have become a national headline.

Psychosis does not have one recognizable costume

A lot of the public conversation around the Clancy case has focused on moments in which she reportedly appeared organized or capable of completing ordinary tasks.

She used her phone, kept notes, communicated clearly, knew where her husband was and completed ordinary tasks. Therefore, some argue, she couldn’t possibly have been psychotic. But those actions alone cannot establish that.

“Postpartum psychosis doesn’t have a single look, and that’s part of what makes it so easy to miss,” said Dr. Sarah Oreck, a reproductive psychiatrist and co-founder of Mavida Health. “Many mothers remain groomed, articulate and outwardly functional while experiencing delusions or hallucinations.”

Dr. Esther Rollhaus, a double board-certified psychiatrist and owner of Child and Family Psychiatry, described the illness as having a “waxing and waning” presentation. A person may appear composed, organized and lucid during one period, then become paranoid, delusional or hallucinatory during another.

Dr. Emily Guarnotta, a clinical psychologist, certified perinatal mental-health specialist and founder of Phoenix Health, agreed.

“A mother can go from appearing disorganized or incoherent to communicating clearly and functioning,” she said. In other words, one calm or seemingly ordinary hour can’t tell us what was happening during another, prove a diagnosis, rule one out or tell us exactly what someone understood at the moment something occurred.

That’s a hard reality for people to swallow because, as humans, we so desperately want severe mental illness to be obvious. We want psychosis to announce itself in a way that no loving partner, relative or doctor could possibly miss. We want a clean line between the mother who loves her children and the mother who may be dangerous, between illness and responsibility, between a preventable tragedy and a deliberate crime.

But real psychiatric illness rarely behaves as neatly as the people watching it would like it to.

Alvi knows how misleading appearances can be. During her own experience with postpartum psychosis, she could arrive at appointments looking groomed and speaking clearly. She could explain that she was terrified by what was happening to her. Her medical records repeatedly treated those qualities as evidence that she was doing well.

What those notes didn’t show was that her family had pushed her to shower and get ready because she was struggling to care for herself—and appearing composed didn’t erase what she was explicitly telling her doctors: She was hearing voices, seeing things other people could not see and feeling commanded to do things she desperately did not want to do.

“I never felt disconnected from reality,” Alvi said. “It just felt like I was privy to things others weren’t.”

When she saw and heard the Devil, she didn’t experience it as a hallucination caused by an illness. To her, it was actually happening.

“They were hallucinations,” she said, “but for me, at that time, they were real.”

Believing a hallucination is not the same as wanting it

This is where the conversation can become especially confusing for new moms and the people who love them: How is psychosis different from the frightening intrusive thoughts that many women experience after having a baby?

Intrusive thoughts can be graphic, vivid and horrifying. A mother may suddenly imagine dropping the baby, see a disturbing mental image involving a kitchen knife or become terrified that she will lose control and cause harm.

When those thoughts are related to anxiety or postpartum OCD, the mother generally knows they’re thoughts—not instructions, predictions or reality. She doesn’t believe they show what she truly wants. Usually, the reason they upset her so deeply is that they are completely at odds with who she is and what she values.

Clinicians call this ego-dystonic: The thought feels alien, unwanted and inconsistent with the person’s identity.

Postpartum OCD can cause a mother to avoid certain objects or activities, check repeatedly that the baby is breathing or safe, or constantly ask other people to reassure her. It deserves real professional support—but an unwanted intrusive thought, without a loss of contact with reality, is not the same as postpartum psychosis.

Oreck said the most important distinction is something clinicians call reality testing. With an intrusive thought, a mother can generally recognize, even while terrified, “My brain produced this thought.” With a hallucination, she may hear a voice as clearly as though someone is standing beside her. With a delusion, she may believe something that is not based in reality and begin making decisions inside the world that belief has created.

There’s another misconception worth clearing up: A mother experiencing psychosis will not necessarily welcome, agree with or feel comfortable with a harmful command.

Guarnotta emphasized that people experiencing postpartum psychosis may also be horrified by what they are hearing, seeing or believing. Rollhaus explained that harmful thoughts can sometimes become consistent with a person’s delusional belief system in that particular moment, but Alvi’s experience demonstrates that this is not universal.

“Believing something to be true or real does not mean you agree with it,” Alvi said. “That’s an important distinction people don’t get.” Alvi believed the Devil was speaking to her and controlling her actions. She did not agree with what she was hearing. She was terrified, repeatedly asked doctors for help and even begged to be admitted to the hospital.

Because she understood that the commands were horrifying, some providers treated her distress as evidence that she still had “insight,” but at the same time, she was telling them that she heard a voice she believed was real.

Both things can be true: A mother can be terrified by a perceived command and still be experiencing psychosis. The question is not simply whether what she hears or believes upsets her. The question is whether she understands that it is a symptom of an illness—or experiences it as reality.

What families may notice before they know what to call it

Most partners aren’t going to look at a new mother and confidently announce that she’s experiencing a delusion, hallucination or manic episode.

They may not know the clinical language or have ever been told that postpartum psychosis exists at all. What they may recognize, however, is something simpler but equally important: This person is suddenly behaving in a way that’s profoundly unlike her.

Oreck described the warning sign as “a genuine break from who that person has always been.” That break may look like:

• A sudden, unmistakable change in her usual personality

• Confusion about who people are, what time it is or what is happening

• Extreme agitation or moods that change very quickly

• Intense paranoia that has no clear explanation

• Saying things or expressing beliefs that seem bizarre or impossible

• Seeing or hearing things nobody else can

• Feeling watched, controlled, chosen, persecuted or personally sent a special message

• Talking much faster than usual, seeming intensely energized or becoming impossible to settle

• Doing things the people closest to her cannot explain as ordinary stress or exhaustion

• Talking about harming herself, the baby or someone else

• Sleeping very little without seeming tired or being unable to sleep despite feeling severely exhausted

Sleep deserves special attention because almost every family with a newborn expects the mom to be exhausted. A sleep-deprived new mother usually wants to sleep but may not be able to because the baby keeps waking, anxiety has put her body on high alert or her mind will not shut off. Even so, she knows she’s tired.

During a manic presentation of postpartum psychosis, Oreck explained, a mother may sleep very little for several days and not feel tired at all. She may stay energized, wired or unable to settle even when someone else has the baby and she has a real opportunity to rest.

But postpartum psychosis does not always present with mania or heightened energy. During a severe depressive or mixed episode, a mother may feel profoundly exhausted yet remain unable to sleep, even when she has the opportunity. Because many people associate postpartum psychosis primarily with mania, these depressive and mixed presentations may be more easily overlooked or dismissed.

In other words: The warning sign is not simply, “She isn’t sleeping.”

It’s: Her sleep has changed dramatically from her normal pattern. She may not feel tired despite sleeping very little—or she may be desperately exhausted but unable to sleep even when given the chance—and she is behaving noticeably differently from herself.

Alvi encourages families to pay attention to a phrase that doesn’t require a medical degree: bizarre behavior.

Her relatives wouldn’t necessarily have known to describe her as hallucinating or delusional, but they could see her running with her fingers in her ears to block out voices, screaming things they did not understand and fighting against people or forces nobody else could see.

At first, some of those changes were blamed on exhaustion. But as her behavior escalated, her family knew something was seriously wrong and brought her to doctor after doctor. They recognized that something was off—and were repeatedly told not to trust what they were seeing.

“Speak up” cannot be the whole safety plan

Mothers are told over and over again to just ask for help: Tell someone if you don’t feel like yourself, answer the screening questions honestly, call your doctor, speak up.

But postpartum psychosis can interfere with the exact insight and judgment a mother would need to recognize that she is sick and explain what is happening.

Some mothers, like Alvi, do retain enough awareness to ask for help, especially early in the illness or during clearer periods. Others do not. And because symptoms can come and go, a mother may understand that something’s wrong during one hour and completely lose that understanding during the next.

“In the beginning of the illness, a mother may have some insight that ‘something is not right,’ and often that insight waxes and wanes,” Rollhaus explained. “Once the illness progresses, the mother often loses the capacity for insight and the delusions and hallucinations feel real to her.”

Guarnotta said this is precisely why families can’t simply wait for a mother to accurately identify and report the illness herself. “Some mothers with postpartum psychosis do recognize that they need help, but others may not,” she said. “This is why it’s so important for her support system to step in if something seems wrong.”

We cannot build a maternal-mental-health safety system that depends entirely on the sickest person in the room correctly identifying her own emergency.

Partners and relatives need to know what to watch for, obstetricians, midwives, pediatricians, primary-care doctors, therapists and emergency clinicians need to take abrupt postpartum behavior changes seriously, and when a family says, “This is not her,” those words should be treated as important medical information—not dismissed as an anxious relative overreacting.

Alvi believes she survived because the sixth doctor she saw understood postpartum psychosis, listened to what she was saying and gave her the appropriate treatment.

She stabilized within roughly a week and a half of reaching the right antipsychotic dose. Within three months, she had weaned from the medication. She has not experienced those symptoms again outside the postpartum periods in which they occurred.

One provider who understood the illness changed the future of her entire family.

If you think this is happening, do not wait for her to ask for help

Postpartum psychosis is a medical emergency. ACOG recommends immediate medical attention, and treatment commonly requires hospitalization for stabilization and safety.

If you suspect postpartum psychosis:

Stay with her. Do not leave her alone while arranging care.

Make sure another trusted adult is caring for the baby and any other children.

Call 911 or go to the nearest emergency department. Say the concern plainly: “She recently gave birth, and I’m concerned she may be experiencing postpartum psychosis.”

Do not assume everything is fine because she becomes calm, answers questions clearly or looks put together.

Tell the medical team exactly what’s changed. Share specific examples of what she has said, believed, heard, seen or done. Explain how much she has been sleeping and whether she can sleep when given the opportunity.

If she is frightened, speak slowly and calmly. Stay physically close if she’s comfortable with that.

Do not aggressively argue with her about whether what she believes is real. You do not need to convince her that she’s psychotic before getting her medical care.

Do not shame her, threaten her or treat the illness like a moral failure.

Do not wait until Monday to call her usual therapist.

And do not let one dismissive evaluation outweigh a clear and escalating change in the person you know. If you remain concerned, keep advocating for an emergency psychiatric assessment.

The goal is not to figure out how to manage postpartum psychosis at home. The goal is to get the mother, baby and rest of the family safely into the care of people trained to treat it.

Recovery should not be treated like a footnote

Stories about postpartum psychosis often begin with the most catastrophic cases—and end before anyone talks about the mothers who recover.

That creates a deeply distorted connection between postpartum psychosis and violence. The illness can carry serious risks and requires emergency care, but most people who experience it don’t harm themselves or anyone else—and with appropriate treatment, most recover.

“Although postpartum psychosis constitutes a psychiatric emergency, it’s highly treatable,” Oreck said. “These moms often go on to be safe, loving and capable parents.”

Guarnotta wishes every story made clear that the illness has nothing to do with a mother’s character or love for her baby. “It is a real mental-health condition, not a character defect or flaw,” she said. “With the right treatment, mothers recover and go on to have very meaningful relationships with their children.”

Recovery can involve hospitalization, medication, ongoing psychiatric care, therapy, hands-on family support and time and it may not be immediate or perfectly linear. Some mothers experience depression, grief or trauma after the psychosis lifts and they begin to understand and process what happened to them.

But Rollhaus has also watched women rebuild full and meaningful lives, return to caring for their children and resume their work, responsibilities and relationships. Some eventually experience what she calls post-traumatic growth: a greater appreciation for life, deeper empathy for other people and a new understanding of their own strength. Families need to hear that part too.

When postpartum psychosis is discussed only in connection with tragedy, a newly diagnosed mother may assume she’s permanently dangerous. Her partner may fear that the person they knew is gone forever. Women may hide early symptoms because they are terrified of what the diagnosis could mean, while relatives may hesitate to seek care because they fear judgment, hospitalization or separation.

Treatment is not what makes a woman unsafe. Treatment is what protects her and her family.

“This illness is frightening because of the tragedies associated with it when it’s not properly diagnosed and treated,” Alvi said. “However, nobody needs to fear it because it is temporary and so easily treatable when properly recognized for what it is.”

What families deserve to know now

The Lindsay Clancy trial will eventually produce a verdict about one woman, under one state’s laws, based on one specific body of evidence.

It will not tell us that every mother who experiences postpartum psychosis behaves the same way.

It will not prove that a person who can use a phone, keep notes or hold an ordinary conversation cannot also be psychotic.

It will not mean that someone who’s horrified by a hallucination didn’t believe it was real.

It will not mean every woman experiencing psychosis will recognize what’s happening and ask for help.

And it should not distract us from a healthcare system that still allows mothers and their families to learn about this diagnosis only after they are already in danger.

Cora, Dawson and Callan should not become merely evidence in a public argument about their mother and postpartum psychosis should not be understood only through the worst thing that can happen when it goes unrecognized or untreated.

Families deserve both truths: a clear understanding of how serious the illness can be and an equally clear understanding that treatment works.

Most of all, they deserve this information before they’re standing in an emergency department, desperately trying to convince someone that the woman they love is no longer acting like herself—not after she becomes a headline.

Save these numbers somewhere you can find them

For an active psychiatric emergency or immediate danger: Call 911 or go to the nearest emergency department.

988 Suicide & Crisis Lifeline: Call or text 988.

National Maternal Mental Health Hotline: Call or text 1-833-TLC-MAMA (1-833-852-6262) for free, confidential support 24 hours a day, seven days a week in the United States.

Postpartum Support International HelpLine: Call 1-800-944-4773 and select 1 for Spanish or 2 for English. You can also text “HELP” to 800-944-4773 in English or 971-203-7773 in Spanish. The PSI HelpLine provides information, support and referrals but is not an emergency crisis line.

Lastly, please send this issue to the partner, sister, friend, grandparent or provider who should know these signs too. Postpartum safety cannot become one more thing we expect mothers to handle by themselves.