Lindsay Clancy, a 35-year-old former nurse, is on trial in Massachusetts for the murder of her three young children in 2023. The details of the case are disturbing—according to court records, Clancy strangled her children, aged five years, three years and eight months, to death before she attempted to take her own life. Clancy has pled not guilty to the murder charges on the basis that she suffered from a mental health disorder called postpartum psychosis.
During this episode, Clancy’s lawyers have said, she was convinced by voices in her head to kill her children and herself. The prosecution has argued the killings were premeditated.
The ongoing, high-profile trial has thrust the topic of maternal mental health—and postpartum psychosis in particular—into the national spotlight. But behind the headlines, maternal mental health experts say the disorder is nuanced, understudied and, importantly, treatable.
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What is postpartum psychosis?
Postpartum psychosis is a rare and severe mental disorder that occurs in people who have given birth. It occurs after about one to two of every 1,000 live births, explains Khatiya Moon, an assistant professor of psychiatry at the Zucker School of Medicine at Hofstra/Northwell. It’s different from postpartum depression—the onset of depression following childbirth—which is more common and can affect around one in five to 10 people who have given birth.
The symptoms of postpartum psychosis are “variable,” Moon says, but may include delusions, paranoia, purposeless or repetitive behavior, as well as hallucinations—hearing voices, seeing things or even feeling sensations on the skin that aren’t there.
Other symptoms might include difficulty sleeping and eating or maintaining personal hygiene. “Obviously, when you become very preoccupied by various delusions, it can be hard to think about anything else,” Moon says.
Psychosis patients in general also tend to lose what doctors refer to as “insight”—the ability to recognize that your experiences need medical attention. “They can tell that something's off, but they may not really understand what exactly is happening,” Moon says.
What causes postpartum psychosis?
Researchers haven’t identified a singular cause for postpartum psychosis—or any psychiatric disorder, for that matter—says Veerle Bergink, director of the Women’s Mental Health Center at Mount Sinai. But scientists think it may be related to the “hormonal roller-coaster” associated with pregnancy or possibly changes to patients’ immune systems after delivery, she says.
Studying the disorder can be challenging for a few reasons: Postpartum psychosis is rare and has not been formally recognized as a disease, making it difficult to raise money to research the condition, Bergink says. When the disorder arises, it’s considered a medical emergency, so running blood tests, measuring hormone levels or getting a patient into a magnetic resonance imaging (MRI) machine for tests isn’t always feasible. Symptoms may also shift from day to day, making it difficult for health care providers to identify the condition.
Postpartum psychosis can happen to anyone, but certain populations may be at an elevated risk, Bergink says. People with bipolar disorder, for instance, have about a one-in-six estimated risk of postpartum psychosis. “For all my patients that have a known bipolar disorder, and they’re going into a pregnancy, I always talk to them about the risk of postpartum psychosis,” Moon says.
How can it be treated?
There are currently no treatments specifically for this disorder that have been approved by the U.S. Food and Drug Administration. But, Moon says, treatments that doctors rely on to help people with postpartum psychosis may be similar to those used for other kinds of psychosis. They may include antipsychotic drugs, benzodiazepines, which can be used for aiding sleep and easing anxiety, and lithium, a common treatment for bipolar disorder. Some research shows electroconvulsive therapy (ECT), or short electric shocks to the brain, may also help.
Recognizing postpartum psychosis quickly is important because people who have it are at a higher risk of suicide, Bergink says. Cases of infanticide may get a lot of attention, but they are extremely rare, even among patients with postpartum psychosis. “The way more prevalent catastrophic event is suicide,” she says.
With the right treatment, however, many patients do recover. “It is a very, very treatable condition,” Bergink says. “There are women who have this as a single episode in their lives. They get severely ill—and never again.”