What the Lindsay Clancy Trial Can Teach Us About Postpartum Mental Health
I’VE BEEN GLUED TO THE LINDSAY CLANCY TRIAL.
“A woman can look functional on the outside while completely unraveling on the inside.” — Shelby Castile, LMFT
As a therapist who has spent years working with anxiety, trauma, women and families, I’ve found myself watching the testimony with a mixture of professional curiosity, heartbreak and a lot of questions. This case raises difficult questions about postpartum mental health, how we recognize psychiatric emergencies, our mental-health system, motherhood and the assumptions we make about women who are struggling.
I also want to be careful about something from the outset: I wasn’t there, I haven’t treated Lindsay, and I don’t know what was happening inside her mind. The trial is still unfolding, and ultimately, the court; not a therapist writing a blog; is responsible for determining the legal questions surrounding her actions.
But I do think there is an important conversation for mental-health professionals, mothers, partners and families to have.
Because underneath the headlines and courtroom arguments is a question that deserves much more attention:
What happens when a woman’s mental health deteriorates after childbirth… and the people around her don't recognize just how serious it has become?
The trial is examining whether Lindsay Clancy was suffering from a severe mental illness, including postpartum psychosis, at the time her children died in January 2023. Her defense is arguing that she was not criminally responsible because of her mental state, while prosecutors are challenging that interpretation. Her psychiatric treatment, diagnoses and medications have become central issues in the courtroom.
And that is where I want to start.
“We cannot wait until someone looks completely incapacitated before we take psychiatric deterioration seriously.” — Shelby Castile, LMFT
Postpartum depression and postpartum psychosis are not the same thing
One of the things that concerns me when cases like this become national news is how easily the public conversation collapses every postpartum mental-health condition into “postpartum depression.”
They are not interchangeable.
Postpartum depression can involve profound sadness, anxiety, hopelessness, guilt, irritability, emotional numbness, difficulty bonding, intrusive thoughts, and feeling overwhelmed.
Postpartum anxiety can be equally debilitating. A woman may become consumed by fears that something terrible will happen to her baby, obsessively check breathing or feeding, or become unable to sleep because her nervous system is constantly on high alert.
Postpartum psychosis is different.
It is a psychiatric emergency involving a loss of contact with reality. Symptoms can include delusions, hallucinations, severe confusion, paranoia, disorganized thinking, extreme agitation, or dramatically altered beliefs about oneself or one's baby.
And perhaps most importantly:
A person experiencing psychosis may not understand that they are psychotic.
That distinction matters enormously.
The Part That Scares Me Most: Someone Can Look “Functional” While Falling Apart
One of the most dangerous misconceptions about mental illness is that someone has to look completely incapacitated before we recognize that something is seriously wrong.
That isn't always how psychiatric deterioration works.
A person can shower, answer texts, make dinner, care for their children, go to appointments, and appear articulate and capable—and still be experiencing a rapidly deteriorating psychiatric condition.
This is particularly important for women who have been socialized to perform competence at almost any cost.
The woman who says, “I'm fine.”
The woman who doesn't want to bother anyone.
The woman who feels guilty asking for help.
The woman who is terrified that admitting she is struggling will make people question whether she is a good mother.
The woman who is desperately trying to hold everything together while internally unraveling.
We need to pay attention to what is happening behind the functioning.
If you recognize yourself or someone you love in these warning signs, you don't have to wait for things to become a crisis to ask for help.
Intrusive thoughts are not the same thing as intent
This is another area where I hope this trial encourages more nuanced public education.
Many new mothers experience intrusive thoughts. A mother may suddenly imagine dropping her baby, picture accidentally driving off the road, or have an image of something terrible happening to her child—and then feel horrified by the thought.
That thought alone does not mean she wants to act on it.
In fact, intrusive thoughts are often deeply inconsistent with a person's values, which is precisely why they can be so distressing.
The clinical questions become:
Is this an unwanted intrusive thought?
Does the person recognize it as irrational or unwanted?
Is there intent behind it?
Is there a plan?
Is the person losing touch with reality?
Are there delusions or hallucinations?
Can they recognize that something is wrong?
Those distinctions matter. A lot.
We also need to talk about medication without turning medication into the villain
Another major issue emerging in this trial is psychiatric medication management.
There is a legitimate conversation to be had about whether medications were appropriately prescribed, monitored, adjusted, and coordinated with the severity of the symptoms being reported.
But I would caution against turning this case into “psychiatric medication is dangerous.”
That is far too simplistic.
Medication helps many people. At the same time, medication management should never happen in a vacuum—particularly when someone is experiencing rapidly changing symptoms, severe anxiety, insomnia, agitation, intrusive thoughts, or possible psychosis.
Treatment requires ongoing assessment, communication between providers, monitoring, and a willingness to reconsider the plan when the clinical picture changes.
Sometimes the most important clinical information isn't what a patient looked like two weeks ago.
It's what has changed since then.
“Sometimes the most dangerous assumption we can make is that someone is okay because they are still functioning.” — Shelby Castile, LMFT
Sleep deprivation deserves more attention than it gets
I also think we underestimate the psychiatric impact of severe sleep deprivation.
New parenthood can involve fragmented sleep for months. For some women, the combination of hormonal changes, sleep disruption, anxiety, isolation, physical recovery, and overwhelming responsibility can create significant vulnerability.
Sleep deprivation doesn't automatically cause psychosis, but significant sleep disruption can worsen anxiety, depression, emotional regulation, and psychiatric symptoms—and in vulnerable individuals, it can become particularly concerning.
When a new mother says:
“I'm barely sleeping.”
“My thoughts won't shut off.”
“I'm terrified all the time.”
“I don't feel like myself.”
“Something is very wrong.”
Those statements deserve more than reassurance.
They deserve assessment.
We have to stop equating motherhood with self-sacrifice
There is another piece of this conversation that extends far beyond postpartum psychosis.
Women are still expected to absorb an extraordinary amount of responsibility quietly: be the mother, be the partner, keep the house running, manage everyone's emotions, remember every appointment, work, recover from childbirth, maintain relationships… and somehow be grateful while doing it.
There is a cultural script that says a “good mother” should be able to handle it.
I think that script is incredibly dangerous.
Being overwhelmed does not make someone a bad mother.
Asking for help does not make someone a bad mother.
Needing medication does not make someone a bad mother.
Going to therapy does not make someone a bad mother.
Saying, “I am not okay and I need someone to take over right now,” may actually be one of the healthiest things a mother can do.
“The goal isn't to become better at talking about tragedies after they happen. The goal is to recognize when someone is in trouble while there is still time to intervene.” — Shelby Castile, LMFT
The mental-health system also has to get better at connecting the dots
Another question this case raises is what happens when someone interacts with multiple providers and pieces of information remain fragmented.
One provider sees the anxiety. Another sees the depression. Someone else sees the insomnia. Another hears about medication side effects. A partner sees what is happening at home.
No one necessarily sees the entire picture.
This is where coordinated care matters.
Mental-health professionals need to be willing to ask difficult questions—not just, “How are you feeling?” but:
“Are you sleeping?”
“Are you having thoughts that frighten you?”
“Do you feel connected to reality?”
“Are you hearing or seeing things other people don't?”
“Do you believe something is happening that other people are telling you isn't happening?”
“Do you feel safe being alone with your baby?”
“Do you feel capable of keeping yourself and your baby safe?”
These questions are uncomfortable.
They are also necessary.
Compassion and accountability can exist at the same time
“Postpartum mental illness doesn't always announce itself in a way that makes everyone around the woman immediately recognize an emergency.” — Shelby Cstile, LMFT
Perhaps this is the hardest part of the entire conversation.
We desperately want simple categories:
Good person. Bad person.
Victim. Monster.
Sane. Insane.
Responsible. Not responsible.
But severe mental illness doesn't always fit neatly into those categories.
And neither does grief.
The children who died deserve to be remembered as children—not simply as evidence in a criminal case.
Their father and family deserve compassion.
And if Lindsay was experiencing a profound psychiatric illness, understanding that illness matters too.
Understanding is not the same thing as excusing.
Compassion is not the same thing as absolving.
Acknowledging the possibility of severe mental illness does not diminish the horror of what happened.
We can hold more than one truth at the same time.
What I hope comes from this trial
Regardless of the eventual verdict, I hope this case creates a much bigger conversation about postpartum mental health.
I hope partners learn to recognize warning signs. I hope mothers feel safer saying, “Something isn't right.” I hope physicians and therapists ask better questions. I hope psychiatric care becomes more coordinated. And I hope we stop treating maternal suffering as something women are simply supposed to push through.
Most of all, I hope we become much more comfortable talking about the darkest symptoms of mental illness before they become emergencies.
Because the goal isn't to become better at talking about tragedies after they happen.
The goal is to recognize when someone is in trouble while there is still time to intervene.
And sometimes the most important sentence a woman can say is also the simplest:
“I don't feel like myself. Something is wrong. I need help.”
We need to make sure she knows she can say it; and that when she does, someone is listening.
If you're struggling postpartum—or you're worried about someone who is… reach out.
Early support matters.
“Asking for help isn’t a sign that you’re failing. It’s a sign that you’re paying attention.” — Shelby Castile, LMFT
If You're Reading This and Something Feels Familiar
If you're a new or expecting mother reading this and thinking, “Some of this sounds like me,” please don't wait until things become unbearable to reach out.
You don't have to be in a full-blown crisis to deserve support. You don't have to have the right words. And you don't have to convince yourself that someone else has it worse.
Sometimes the most important first step is simply telling someone, “I don't feel like myself.”
If you're a partner, family member, or friend who is worried about a new mother, trust that concern. You don't have to diagnose what's happening. You can ask questions, listen without judgment, and help her connect with appropriate professional support.
And if there are concerns about psychosis, safety, or a mother or baby being in immediate danger, that is not a “wait and see” situation. Immediate professional or emergency support is warranted.
If You Need Support
I work with women navigating anxiety, trauma, perfectionism, relationship challenges, major life transitions, and the overwhelming pressure to hold everything together.
My approach is warm, practical, and focused on helping you understand what is happening beneath the symptoms—not simply teaching you how to function better while you're struggling.
If something in this article resonated with you, you don't have to figure it all out alone.
I offer a complimentary 15-minute consultation to talk about what you're experiencing and determine whether working together would be a good fit.