What the Lindsay Clancy trial reveals about postpartum psychosis

The trial of Lindsay Clancy has brought renewed attention to postpartum psychosis, a rare but potentially devastating psychiatric condition that can emerge after childbirth.

Clancy has pleaded not guilty to three counts of first-degree murder in the deaths of her three children. Her defense argues that she was suffering from postpartum psychosis at the time of the killings, placing her mental state at the centre of a case that has drawn widespread attention in the United States.

But as The Guardian reported, the trial has also opened a broader conversation about a condition that remains poorly understood, difficult to identify and, in many places, inadequately treated.


For women who have survived postpartum psychosis and the specialists who treat it, the public focus on the Clancy case could offer an opportunity to improve awareness of a medical emergency that affects roughly one to two women in every 1,000 births.

“Women deserve better access to care, and they deserve experts who really understand what’s going on,” Crystal Schiller, a clinical psychologist and director of the University of North Carolina at Chapel Hill Center for Women’s Mood Disorders, told The Guardian.

Lindsay Clancy case puts postpartum psychosis in the spotlight

The Lindsay Clancy case has become one of the most closely watched trials involving questions of maternal mental health in recent years.

According to The Guardian, Clancy's defence has argued that postpartum psychosis played a critical role in the deaths of her three children. Prosecutors and defence lawyers are expected to present competing interpretations of her mental condition, making psychiatric evidence central to the proceedings.

The case has also generated difficult conversations about the difference between postpartum depression and the far rarer condition of postpartum psychosis.

While the circumstances surrounding the Clancy case are exceptional, mental health experts say the attention surrounding it may help people recognise warning signs earlier and understand that severe psychiatric illness can sometimes emerge rapidly after childbirth, The Guardian reported.

What exactly is postpartum psychosis?

Postpartum psychosis is a severe mood disorder involving psychotic symptoms. It is considered a psychiatric emergency because symptoms can intensify quickly and may place both the mother and others at serious risk.

According to experts cited by The Guardian, the illness can involve hallucinations, delusions, severe confusion, insomnia and dramatic changes in mood. A person may move between depression, agitation and manic symptoms, sometimes developing beliefs that are disconnected from reality.

The condition usually appears soon after childbirth, often within the first two weeks, although symptoms can occasionally begin later.

One of the challenges is that symptoms may fluctuate. A mother may appear relatively normal during one interaction and severely unwell hours later, making the illness difficult to detect during brief medical appointments, The Guardian reported.

Although postpartum psychosis is rare, it is associated with an elevated risk of suicide and infanticide, which is why experts stress that immediate medical intervention is essential.

Why does postpartum psychosis happen?

Scientists still do not have a complete answer.

Researchers believe postpartum psychosis may develop through a combination of biological vulnerability and major changes surrounding pregnancy and childbirth. Hormonal shifts, severe sleep disruption and changes in the immune system may all play a role.

A family history of bipolar disorder or postpartum psychosis can increase the risk. Women with bipolar disorder are also considered more vulnerable to developing postpartum psychosis.

Recent research has strengthened the argument that postpartum psychosis may be closely linked to the bipolar spectrum, The Guardian reported.

Yet risk prediction remains imperfect. Schiller told The Guardian that in about 40% of cases, doctors are unable to identify known risk factors beforehand.

That means a woman can experience postpartum psychosis even without a previous psychiatric diagnosis or an obvious warning sign.

Early warning signs can escalate rapidly

Postpartum psychosis does not always begin with dramatic hallucinations or delusions.

Early changes may include severe insomnia, unusual irritability, racing thoughts, heightened energy or sudden and extreme shifts in mood. In some cases, these symptoms can rapidly progress into confusion, paranoia, false beliefs or hallucinations.

Dr Soudabeh Givrad of Stanford Medicine told The Guardian that the condition can move quickly from mood disturbances to a state in which a person's beliefs become detached from reality.

That rapid progression is one reason families and healthcare professionals are encouraged to take sudden behavioural changes seriously.

Experts say mothers experiencing symptoms should be evaluated by medical professionals immediately. Emergency services, crisis support or an emergency department may be necessary when there is an immediate risk of harm.

Postpartum psychosis is treatable

Despite the severity of the illness, recovery is possible.

Treatment can include antipsychotic medication, mood stabilisers such as lithium and, in some cases, antidepressants or electroconvulsive therapy. Cognitive behavioural therapy may also form part of recovery after acute symptoms improve.

“The majority of cases” can be successfully treated, Givrad told The Guardian, with many women eventually returning to their usual lives.

Recovery, however, is not identical for every patient.

Some women experience postpartum psychosis only once and never develop another major psychiatric illness. Others later receive a diagnosis of bipolar disorder, while a smaller number develop more persistent mental health conditions.

A study involving 106 women found that more than two-thirds did not experience major psychiatric episodes outside the postpartum period, while many of those who did later transitioned to a bipolar disorder diagnosis, according to research cited by The Guardian.

Experts say early treatment can significantly improve the chances of recovery.

A major gap in care for new mothers

One of the biggest problems is timing.

The weeks immediately after childbirth represent the period of greatest risk for postpartum psychosis. Yet the traditional postpartum medical checkup may not occur until around six weeks after delivery.

By then, a severe psychiatric episode may already have developed.

As The Guardian reported, this gap can leave family members, partners and even pediatricians in a position where they may be the first to notice that a new mother's mental health is deteriorating.

Schiller believes new mothers ideally should receive more frequent follow-up during the early weeks after childbirth.

However, awareness alone may not solve the problem. Healthcare professionals are not always trained to recognise or discuss postpartum psychosis, while women may be reluctant to disclose disturbing thoughts because of fear, shame or concern that their children could be taken away.

In some cases, the illness itself can prevent patients from recognising that they are becoming unwell.

Why specialised mother-and-baby care remains limited

Treatment systems also vary sharply between countries.

In the United States, mothers who require psychiatric hospitalisation are often separated from their babies, though visitation may be permitted depending on the circumstances.

In the UK and some other countries, specialist mother-and-baby units allow psychiatric treatment while keeping mothers and infants together where appropriate.

These units can help protect the mother-child bond and reduce the trauma associated with separation, The Guardian reported.

Such specialised programmes remain uncommon in the US. UNC, for example, operates a small inpatient programme for perinatal patients, but experts say demand for this type of specialised care far exceeds availability.

The lack of dedicated facilities can leave families struggling to find treatment specifically designed for severe psychiatric illness during pregnancy and after childbirth.

Can postpartum psychosis be prevented?

For women with known risk factors, prevention may be possible.

Those with a history of bipolar disorder or a previous episode of postpartum psychosis can work with doctors before and during pregnancy to develop a treatment and monitoring plan.

Preventive medication may sometimes be introduced late in pregnancy or immediately after delivery, depending on the patient's medical history and circumstances.

But prevention is more complicated for women with no known risk factors.

Unlike postpartum depression, there is currently no widely established screening tool designed specifically to identify postpartum psychosis before it develops, The Guardian reported.

That leaves doctors, family members and support networks heavily dependent on recognising behavioural changes and responding quickly.

Why experts want postpartum psychosis formally recognised

Another issue is how postpartum psychosis is classified within psychiatry.

The condition does not currently have a separate diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, or DSM, the guide widely used by healthcare professionals, researchers and insurers.

Experts argue that formal recognition could improve research, diagnosis and access to treatment.

A distinct classification could establish clearer diagnostic criteria, make it easier to identify suitable patients for research and potentially improve access to funding and insurance coverage.

Givrad told The Guardian that recognising postpartum psychosis as a distinct illness could help prevent vulnerable mothers from “falling through the cracks”.

The Lindsay Clancy trial

At the centre of the Lindsay Clancy trial is the question of her mental state when her three young children were killed at the family's home in Massachusetts in January 2023.

Clancy, a former labour and delivery nurse, has pleaded not guilty to three counts of first-degree murder. Her children — Cora, 5, Dawson, 3, and seven-month-old Callan — died after the incident. Clancy also suffered serious injuries in what prosecutors and court proceedings have described as an attempted suicide.

Her defence team argues that Clancy was suffering from severe postpartum mental illness, including postpartum psychosis, at the time of the killings and was unable to appreciate the nature or wrongfulness of her actions. The prosecution disputes that account, making her psychiatric condition and criminal responsibility central issues in the case.

The trial will ultimately turn on the evidence surrounding Clancy's mental state and the events that led to the deaths of her children. But the broader discussion has already extended far beyond the courtroom.