Even as a neurologist, I couldn’t recognize postpartum psychosis in myself. Recovery in the U.S. depends too much on geography, timing and chance. That shouldn’t be the backbone of a health system.
Lindsay Clancy case raises questions about postpartum psychosis
The Lindsay Clancy murder case is drawing attention to postpartum psychosis and the challenges of diagnosis and treatment.
My story was silent until a scream in the middle of the night.
Two months after I delivered my daughter, I stopped trusting the world around me – and then my own mind. I was afraid to say it out loud. I am a neurologist, but illness does not spare those who study it.
Today, I feel like I’m still screaming, not for myself this time, but for other mothers.
In a Massachusetts courtroom, a jury must decide whether postpartum psychosis overtook Lindsay Clancy’s mind when her three children were killed in 2023. But the deeper question extends far beyond this verdict.
Clancy’s defense rests on postpartum psychosis, yet the diagnostic manual that American psychiatry relies upon does not recognize it as its own diagnosis. Instead, it remains folded into broader mood disorders despite growing evidence that it is biologically distinct.
She sought care repeatedly. She saw multiple clinicians. She was prescribed more than a dozen medications.
The system failed Lindsay Clancy long before trial
That failure is not because postpartum psychosis is controversial. It is because our diagnostic framework has not kept pace with the science.
Many of the world’s leading experts recently argued in the scientific journal Biological Psychiatry that postpartum psychosis is one of psychiatry’s most biologically distinct illnesses. They called for it to become its own diagnosis. They also noted that, ironically, an insanity defense often depends on a formal diagnosis, while postpartum psychosis still lacks one.
A diagnosis is more than a label. It determines what physicians are taught to recognize, what researchers study, what insurers cover and how quickly patients receive treatment.
Postpartum psychosis can ignite within days of birth, though not every mother follows the textbook timeline. When it strikes, it is a medical emergency. Too often it is misdiagnosed and mismanaged. Our health system cannot reliably recognize an illness that our diagnostic system still fails to distinguish.
Language cannot capture what this illness feels like. Imagine the child you wanted most in the world. Then imagine that weeks after she arrives, you look at her and cannot tell whether she is real or an object.
This is not weakness, nor evil. It is an illness in the brain. The woman this happens to is someone’s daughter, someone’s sister, someone’s mother. She could be someone you love.
Postpartum psychosis is rare. Maternal mental illness is not.
I nearly died giving birth to my second daughter, and was eventually diagnosed with postpartum obsessive-compulsive disorder and psychosis.
I’m a neurologist married to a neurosurgeon, but even as a physician, I could not recognize it in myself.
What saved me wasn’t insight. It was access. Recovery in this country depends too much on geography, timing and chance. Chance should not be the backbone of a health system.
Postpartum psychosis may be rare, but untreated maternal mental illness is not.
About 1 in 5 mothers experience a perinatal mood or anxiety disorder, making these conditions the most common complication of childbirth.
Mental illness is now the leading cause of maternal death in the first year after pregnancy, and most of those deaths are preventable.
Now ask where a mother in crisis can actually go. Fewer than 40 intensive perinatal psychiatric programs exist nationwide, and almost no hospital can admit a mother with her baby together.
For most families, specialized care is hours away, or nowhere at all.
The program that treated me shows a better future is possible. We know what works: Recognize postpartum psychosis as its own diagnosis. Screen mothers throughout the first postpartum year, not only at the six-week visit. Expand specialized mother-baby treatment programs so recovery depends on care rather than luck.
Something in me breaks when I know three children are gone, and nothing will soften that. Still, it breaks again for their mother, and for every woman carrying this illness in silence. A court will decide innocence or guilt. What the rest of us owe is compassion.
I am not here because I was stronger than any other mother. I am here because someone recognized what I could not, while there was still time. Every mother deserves that chance. Until our diagnostic system catches up with the science and our health system learns to recognize this illness before tragedy, we will keep screaming.
Dr. Barbara “Bobbie” Decker is an adult epileptologist at Mary Washington Healthcare in Fredericksburg, Virginia. Her work focuses on women’s neurology across the reproductive lifespan.