Years ago, one of the steadiest people on my team came back from maternity leave changed: irritable, quick to complain, sharp with colleagues for no reason any of us could see.
uncertain
any → come → us
I had no name for it.
asserted
I → have → it
Only later did I understand I had probably watched perinatal depression unfold, and that nobody around her, including me, knew what to look for.
asserted
nobody → understand → what
Since then, with one daughter a psychiatrist and the other a psychotherapist, I have had an unusual education in the subject at my own dinner table.
asserted
I → have → table
That is the lens I bring to the case of Lindsay Clancy.
asserted
I → bring → Clancy
On Sept. 4, a Massachusetts judge declared a mistrial after the jury in Clancy’s murder case deadlocked, with 11 of 12 jurors reportedly ready to find her not criminally responsible for strangling her three children in January 2023.
uncertain
her → declare → January
At the first hearing since, on Sept. 29, prosecutors said they had not decided whether to retry her, her lawyer argued the evidence was insufficient, and the judge set another hearing for Nov. 2.
asserted
judge → say → Nov.
The trial has become a Rorschach test.
asserted
trial → become → ?
Prosecutors see intent.
asserted
Prosecutors → see → intent
The defense sees postpartum psychosis.
asserted
defense → see → psychosis
Critics of psychiatry see “polypharmacy on trial.”
asserted
Critics → see → trial
The medical record supports none of these tidy stories, and it points to a more useful lesson.
asserted
it → support → lesson
Two questions in two languages
As the neurosurgeon Marc Arginteanu wrote, the law asks whether she knew the act was wrong and could stop herself, while medicine asks whether her grip on reality had slipped so far that ordinary judgment no longer applied.
uncertain
judgment → write → reality
He also flagged the prosecution’s strongest point.
asserted
He → flag → point
Postpartum psychosis is rare, with one or two cases per 1,000 births, and usually strikes within weeks of delivery.
asserted
psychosis → strike → delivery
That makes a psychosis defense harder to prove, but not biologically impossible — the literature documents late-onset cases, and the diagnostic manual still gives the condition no standalone entry.
asserted
manual → make → entry
What the record shows
A Boston Globe timeline drawn from court records shows Clancy was prescribed 13 psychiatric drugs, across more than 30 prescriptions, in about four months: antidepressants, an antipsychotic, three benzodiazepines, a mood stabilizer, and sedatives, from an outpatient psychiatrist, a nurse practitioner, two inpatient programs, and several emergency physicians.
asserted
Clancy → show → psychiatrist
Her own civil complaint alleges that clinicians missed a bipolar vulnerability and that “polypharmacy and the involvement of multiple prescribers” obscured an accurate diagnosis.
asserted
polypharmacy → allege → diagnosis
Postpartum psychosis is closely tied to bipolar disorder, and an antidepressant alone can destabilize a patient with unrecognized bipolar vulnerability.
asserted
antidepressant → tie → vulnerability
That is why the obstetricians’ 2023 guideline calls for bipolar screening before medication is started.
asserted
medication → call → screening
The clinicians who treated her testified that they saw no psychosis, including her outpatient psychiatrist, across 14 telehealth visits.
asserted
they → treat → visits
That is exactly the pattern specialists warn about: a condition one leading researcher calls “massively missed” because few doctors are trained to spot it.
asserted
doctors → warn → it
Once recognized, postpartum psychosis is highly treatable.
asserted
psychosis → recognize → ?
In a Dutch study of 64 women, a stepwise protocol ending in lithium brought 98% into complete remission.
asserted
protocol → end → remission
What fails is rarely the drug.
asserted
fails → fail → ?
Where the pill skeptics have a point
None of this makes psychiatric medication the villain.
asserted
medication → make → this
Once psychosis appears, withholding treatment is dangerous.
asserted
withholding → appear → treatment
But the critics are right that a regimen assembled piecemeal by several prescribers, none of whom sees the whole picture, is a hazard in any branch of medicine.
asserted
none → assemble → medicine
We would not accept it for blood thinners or chemotherapy.
asserted
We → accept → thinners
We should not accept it for a sleep-deprived mother cycling through thirteen psychoactive drugs in four months.
asserted
We → accept → months
What Would Actually Help
Pharmacogenomic testing is often proposed as the answer, but a 2025 review found its benefits modest and short-lived, and no gene panel can detect an unrecognized bipolar history.
asserted
panel → help → history
Every perinatal patient on psychiatric medication should have one accountable prescriber and one reconciled medication list.
asserted
patient → have → prescriber
For the far more common cases of mild-to-moderate depression and anxiety, which go untreated about three-quarters of the time, I believe psychotherapy should be the first rung, as the U.S. Preventive Services Task Force’s counseling recommendation supports; psychosis is different and demands prompt medication.
asserted
psychosis → go → medication
And the country needs beds.
asserted
country → need → beds
The United Kingdom runs 22 mother and baby units that admit mother and infant together.
asserted
that → run → mother
The United States has five perinatal psychiatric units, and none keep the baby overnight.
asserted
none → have → baby
The law will settle its own question about Lindsay Clancy.
asserted
law → settle → Clancy
Medicine should settle ours.
asserted
Medicine → settle → ours
A country with about 3.6 million births a year has no psychiatric unit built to keep a mother in crisis together with her baby.
asserted
country → have → baby
It is a verdict on how seriously we take it.
asserted
we → take → it
…and 4 more, not listed.
The Aporia
