Lindsay Clancy does not dispute killing her three children aged eight months, three and and five years. The former labour and delivery room nurse who lived in Duxbury, Massachusetts with her family was in the grip of postpartum psychosis following the birth of her third child.
She knew something was horribly wrong and had sought help. Multiple outpatient providers prescribed a cocktail of drugs. She called a suicide hotline, checked into a residential psychiatric hospital and sought treatment at a hospital-based, full-day treatment programme for women with postpartum mental health problems.
She told her family she had thoughts of harming her children. She heard a male voice in her head telling her to do so.
In court, her former mother-in-law—Lindsay’s husband Patrick has since divorced her and remarried—testified that she was a “wonderful mother” who loved her children. Her mother, sister, a former nanny, friends and co-workers have all testified that they knew she was struggling with her mental health after the birth of her youngest child.
So, how did her condition continue to worsen, culminating in that horrific day in January 2023 when she killed her children before attempting to take her own life, an attempt that has left her paralysed?
{{/usCountry}}So, how did her condition continue to worsen, culminating in that horrific day in January 2023 when she killed her children before attempting to take her own life, an attempt that has left her paralysed?
{{/usCountry}}The trial is now in the hands of a jury. Both sides have concluded closing arguments. Prosecutors have argued that Lindsay understood what she was doing and acted intentionally. If convicted, she faces life in prison without parole. If found not guilty by reason of lack of criminal responsibility, she could be committed to a state mental health facility.
For the hundreds of women who have been showing up outside the courtroom in solidarity with Lindsay Clancy, the tragedy is indicative of how American society fails at maternal mental health and the care of new mothers. Some women, reports The New York Times, are there because they themselves have suffered pregnancy-related mental health issues and have been left to deal with them on their own. Others feel: “This could have been me.”
What should postpartum care look like in one of the world’s richest economies where Republicans are urging women to have more children, where abortion rights have been rolled back and where childcare is prohibitively expensive. The US is the only wealthy nation in the world that still does not have a national law that mandates paid maternity leave.
If it takes a village to raise a child, then where was that village when Lindsay Clancy was literally begging for help?
A motherhood story
Shreya Mitra remembers what it was like to be a new mother: Exhausted, sleep deprived and finding it hard to bond with her baby. Twenty days after her delivery she had her first anxiety attack. Her hands were shaking and she had palpitations that made her feel like she was having a heart attack.
She had a hands-on husband, supportive in-laws and parents happy to help. But her symptoms only worsened. Consultations with a cardiologist, a general physician and two gynaecologists led to a battery of tests, but no diagnosis. She tried homeopathy for eight months; she kept losing weight.
Then, a neurologist in Chennai dropped the words that changed everything: Postpartum depression. “I had never even heard that term,” she said. He suggested some medication and within days, the fog lifted.
“Nobody could understand what I was going through,” said Mitra. She would post pictures of a seemingly happy family on her social media and get a host of compliments about her “picture-perfect” family. Later, she reposted the same photograph of herself, her husband and the baby with the caption: “This is what postpartum depression looks like.”
The period before, during and immediately after birth known as the perinatal period can be fraught for some. Perinatal mental health is a spectrum that can range from feeling blue to, in very extreme and rare cases, psychosis, said Mumbai-based consultant psychiatrist and therapist Parul Tank. About 40% of women experience the blues, a transient phase of feeling low and overwhelmed brought on by hormonal upheaval, being a new mother, breastfeeding and sleep deprivation. This, she said, usually passes in a few weeks.
Postpartum depression is characterised by an intense low mood, a lack of interest and constant worry: Am I doing the right thing? This phase usually requires medical intervention; either just therapy or medication or both.
At the most extreme end of the spectrum is postpartum psychosis that affects around one in 1,000 mothers. This is a distinct psychiatric emergency that could occur with or without postpartum depression. It’s where a mother might start hearing voices and hallucinating. This, said Tank, definitely requires medical intervention.
[What is postpartum psychosis, how to spot the symptoms, and how is it treated? The Guardian has an explainer here]
Unchartered waters
Right up to the birth of a child, a pregnant woman will have scheduled meetings with her doctor once a month, with visits increasing to every two weeks and finally every week until the baby is born. After that she will make a single follow up visit usually at six weeks. “New mothers are just left in unchartered waters that they have to navigate on their own,” said Uma Ram, director and obstetrics and gynaecology lead at Seethapathy Clinic and Hospital, Chennai.
High-income countries have a prevalence of 13% of postnatal depressive disorders, a 2020 study found. It is significantly higher in low and middle income countries at 19.8%. The greatest pregnancy-related mental health burden was borne by the least well-resourced women with the least access to health services.
In a culture where motherhood is eulogised, there is very little acknowledgment, leave alone awareness, of postpartum mental health issues. In the popular culture new mothers are expected to be beatific, not confused and sad.
“There are simply not enough referrals from gynaecologists and therefore not enough treatment,” said Tank. Families still stigmatise mental health, especially in new mothers. “The mother-in-law will say, ‘but we had five kids’ or ‘we also went through this, you need to toughen up’.”
Most postpartum mental health issues are, fortunately, mild and can be treated. One in five women will experience some kind of mood-related problem, said Ram: “But you need screening to identify the problem.” Left untreated, symptoms could worsen, impacting not just the health of the mother but also the child. The World Health Organisation has asked for perinatal mental health to be integrated with maternal and child health services.
There are slow but unmistakable signs of change. In Telangana, Kerala and Tamil Nadu, hospitals are asking mothers questions about their mental health in their antenatal clinics, said Ram.
Yet, said Parikshit Tank, deputy secretary general of the Federation of Obstetrics and Gynaecological Societies of India: “We need a more structured response.” Manyata for Mothers is a certification programme developed to improve quality of maternity and newborn care services in private facilities by training doctors, nurses and administrative staff on essential clinical, facility and patient care protocols. And, yes, training medical professionals to spot mental health issues and report on them is part of that protocol.
Shreya Mitra is glad she didn’t give up, despite the initial lack of diagnosis. The problem she sees is the lack of community. “If we had space for new mothers, a lot of them would have a better postpartum journey,” she said. A lawyer by training, she is now a full-time content creator advocating for maternal mental health through her Instagram handle, Raising_shaan.
Reacting to the Lindsay Clancy tragedy she posted: “It’s time we create more noise around postpartum mental health so that it’s identified before it’s too late. Moms need more support, and lesser judgement. Just because it didn’t happen to you doesn’t mean it doesn’t exist.”
[If you or someone you know needs help, please reach out to:
Manas: a national tele-mental health initiative of the ministry of health and family welfare. Toll-free numbers: 14416 or 1-800-891-4416; https://telemanas.mohfw.gov.in/home
Sumaitri: crisis centre for depressed and suicidal people. Call 011-46018404/ 9315767849, 7 days a week, 12.30 pm to 5 pm.
https://www.sumaitri.net/
Sanjivini: non-profit that addresses mental health needs. Call 011-40769002/41092787/ 9871346488, Monday-Friday, 10 am to 5.30 pm.
https://www.sanjivinisociety.org/]