Postpartum Psychosis and the Lindsay Clancy Case

This op-ed originally appeared in The Providence Journal.

Imagine a woman with Alzheimer’s gets into a car, drives, and strikes and kills several children. Or a man with AIDS dementia lights a cigarette, sets a house on fire, and kills everyone inside. Now imagine either of them on trial for murder.

How can you prosecute someone for acting on what their illness caused them to believe was true?

Consider Lindsay Clancy, the Duxbury, Massachusetts, mother who strangled her three children in January 2023, less than three weeks after discharge from a psychiatric hospital. She was tried in Plymouth Superior Court on three counts of first-degree murder. Her defense argued her actions were due to postpartum psychosis. The prosecution painted her as a woman who knew what she was doing and was hiding behind a phony story. On Friday, after seven days, the jury deadlocked and the judge declared a mistrial. Now the Plymouth County district attorney decides whether to do it all again. Postpartum psychosis is not exotic: published estimates put it at one to two cases per thousand births – several thousand American mothers every year.

For decades, I’ve argued that the way to see cases like this clearly is to compare them with other biological and neurological illnesses. We don’t blame people for the consequences of being ill. Except when the illness is a psychiatric one. I know this firsthand.

In 1986, I was a producer on the ABC-TV show “Jimmy Breslin’s People.” Over six weeks, I stopped sleeping, became confused, and grew suspicious of the people and events around me. I became convinced that Rudy Giuliani and other federal prosecutors were surveilling me day and night through the television in my New York apartment on West 77th Street.

One night, I carried my 13-inch Sony out to the balcony of my fourth-floor apartment and dropped it over the edge. I can still hear the pop and glass shatter when it hit the street. My goal: to tell those I believed were watching that I knew they were there – and to stop surveilling me. In that moment, my actions made total and rational sense to me.

That moment still haunts me – not for how irrational it was, but because if someone had stepped out of the doorway below at that instant, the television could easily have killed them. There but for the grace of God.

Soon after, my boss and then-girlfriend got me to St. Luke’s-Roosevelt Hospital, and my treatment began.

There was one funny moment. Breslin – who had just ended his ABC contract by buying an ad on the New York Times front page reading “Breslin to ABC: You’re fired” – heard I was in the ER and turned up. He said: I was worried when I heard you were in the emergency room, but then they told me you threw a TV set out the window, and I knew you’d be OK.

I would be, but it took time. It was months before I was diagnosed with manic depression – what we now call bipolar disorder. I got help, began the road to recovery and started producing documentaries about people living with mental illness – work that won a Peabody and led to two decades advising the Rosalynn Carter Fellowships for Mental Health Journalism.

A hallmark of that work is the insight that people with mental illness act rationally on irrational beliefs and information. If you believed your children were in mortal and spiritual danger and the only way to save them was to suffocate them, you might well do it. No matter how sick someone is, the person is still in there, fighting their way through the cognitive clutter. Those who emerge, emerge as whole reasoning people, with memories of the faulty decisions they made – and why.

How do you know it isn’t a ploy? The facts in the Clancy case cut the other way – the hospitalization, medical testimony, her own husband’s account of a months-long spiral. Everything points to a woman who was severely ill, living in an Alice in Wonderland reality.

Public attitudes toward AIDS, cancer and alcoholism have shifted dramatically. Attitudes about mental illness have not. Research we conducted at LCMedia for a New York City mental health anti-stigma campaign found the core fear is not violence – it’s unpredictability.

So if a person with dementia does something terrible, society pities and supports them and their family. If a person with a mental illness – equally a biological condition – does the same, the state prosecutes. I’m not saying mental illness exempts anyone from responsibility. But context has to be factored in.

We can only hope for the world Rosalynn Carter envisioned: one in which stigma no longer shapes who gets treatment, who recovers, and who faces discrimination. A world in which people like Lindsay Clancy get our sympathy and care rather than an indictment. That world starts with the decision the district attorney now has to make.

Bill Lichtenstein, a Brown University alumnus, is a Peabody Award-winning journalist and documentary producer in Cambridge who has written and produced extensively about people living with and recovering from mental illness. He has been in remission from bipolar disorder for 20 years.