Clancy trial shines light on postpartum psychosis, a treatable psychiatric emergency

Lindsay Clancy told her mother and husband a month before it happened: she was having thoughts of harming her children. Her mother, Paula Musgrove, testified this week that Lindsay kept saying the same thing over and over—"This isn't me, I've never been like this before"—and her mother agreed. She wasn't herself. But by January 2023, when Clancy's then-husband Patrick came home from getting dinner for the family, he found their three children dead: Cora, five; Dawson, three; and Callan, eight months old. Clancy was injured from a suicide attempt. She is not disputing that she killed them. Her defense argues she was suffering from postpartum psychosis—a psychiatric emergency so sudden and severe that a person can appear fine one moment and lose touch with reality the next.

Postpartum psychosis is rare but devastating. It arrives with mood swings, insomnia, and a delirium-like state, but its defining feature is psychosis itself: hallucinations, delusions, the complete unmooring from what is real. A woman hears voices that aren't there. She believes things that contradict all evidence and her own culture. In severe cases—uncommon ones, experts stress—she may harm herself or others. On the day Clancy killed her children, her husband said she was having one of her best days. They built a snowman together. Everything seemed better. That sudden swing, that light-switch quality, is what makes the illness so dangerous and so hard to predict.

Meghan Cliffel was eight months postpartum when it happened to her. It was a Friday in 2015, and she had just finished work in New York City. She became convinced people were following her, that she was being recruited into a cult, that the world—including her own husband—was conspiring against her and her daughters. Within 24 hours, she was handcuffed to a gurney and admitted to a psychiatric hospital. She spent 12 days there. Susan Hatters-Friedman, a forensic psychiatry professor at Case Western Reserve University, explained to the BBC that psychiatric symptoms like Cliffel's can appear with terrifying speed. That is why it must be treated as a medical emergency. A person can be fine and then suddenly not be.

The condition is treatable. Lithium, a mood stabilizer, is commonly prescribed. Antipsychotic medications, electroconvulsive therapy, and hospitalization are also used depending on the patient. Cliffel went to therapy, underwent EMDR—a type of psychotherapy—and took lithium for a full year. She recovered. Research shows that between 1 and 4 percent of women with postpartum psychosis harm or kill children. Clancy's case is an outlier, experts said. Most women get better.

But there is a structural problem that may be making the illness harder to catch and treat. Postpartum psychosis is not formally classified in the DSM-5, the Diagnostic and Statistical Manual of Mental Disorders—the handbook that defines psychiatric illness for the American medical establishment. Without that classification, it does not appear in medical school textbooks. Students do not learn about it. Clinicians do not recognize it. Insurance does not code for it. Research does not get funded. Veerle Bergink, director of the Mount Sinai Women's Mental Health Center, is working to change that. "You can only investigate and talk about the disease if you give the disease a name, and if it has criteria," she said. "So you don't get research funded, there is no money, there is no care system, there is no insurance code."

Cliffel called the omission "bananas." It feels like an erasure, she said—the erasure of her own experience, and of countless others. She found her treatment by accident, fumbling in the dark. There was no ladder of care, no clear steps like there are for breast cancer or other serious illnesses. She had to piece it together herself. When she had a third child, she began taking lithium immediately after birth and continued for a full year, a precaution that worked. But she should not have had to discover that on her own.

The Clancy trial has brought postpartum psychosis into public view at last. Experts and survivors alike see it as a moment to push for formal recognition in the DSM-5, to educate clinicians and families, to build a real system of care. "Maternal mental health issues are the most common complication of childbirth," Cliffel said. The fact that one of the most serious of those complications remains unnamed in medicine's central diagnostic manual is, by any measure, a failure. The trial is approaching its one-month mark. The conversation about what postpartum psychosis is, and what it demands of us, is only beginning.