When Psychiatry Fails Women: Lessons from the Lindsay Clancy Trial
Lindsay Clancy is a former labor and delivery nurse who is on trial for the January 24, 2023 strangulation deaths of her three children. Clancy did not have a documented significant psychiatric history, but over a four-month period at the end of 2022, she developed significant depression, anxiety, insomnia, and suicidal ideation. She sought help multiple times through psychiatrists, mental health providers, hospitalizations, calls to suicide hotlines, and was prescribed over a dozen psychiatric medications during that period. Her condition worsened and culminated in the deaths of her children and a suicide attempt that left her paralyzed. Her defense argues that she was suffering from undiagnosed bipolar disorder, postpartum depression, and postpartum psychosis when she killed her children.
Postpartum psychosis is a rare but severe psychiatric condition associated with childbirth. It can involve mania, severe depression, delusions, hallucinations, confusion, agitation, and rapidly changing mental states. Recent expert consensus estimates that it occurs after roughly 0.1–0.2% of deliveries among women without a prior psychiatric history. Postpartum depression affects many more women: 1 in 7.
During the trial, Clancy’s defense attorney Kevin Reddington asked a psychiatrist a deceptively simple question:
Is postpartum psychosis in the DSM?
The exchanges were striking. Dr. Alia Goodheart, a psychiatrist who had treated Clancy at McLean Hospital, testified that she did not know exactly where postpartum psychosis appeared in the DSM-5. Asked whether she had ever seen it there, she said she did not recall paying attention to where it was categorized.
Later in the trial, psychiatrist Dr. Donald Condie was questioned about the same manual. Asked what a reader would find by looking for postpartum psychosis, he testified that there was “one mention on page 148.”
Then, on Day 18 of the trial, psychiatrist Dr. Avram Mack (testifying for the prosecution) explained that postpartum psychosis is not a standalone disorder found in the DSM-5. Instead, clinicians generally diagnose an underlying psychiatric disorder and, where appropriate, use a “with peripartum onset” specifier.
Attorney Reddington goes straight at this omission: “Are you aware, sir, that postpartum psychosis and postpartum depression are pretty much virtually not even mentioned in your DSM-5-TR?…It’s a paragraph. Out of a thousand pages, it’s a paragraph.”
Whatever conclusions one reaches about Clancy’s mental state or criminal responsibility, these exchanges expose a question that extends far beyond one defendant and one courtroom:
Does our psychiatric vocabulary adequately describe what can happen to women after childbirth?
The answer is less straightforward than patients—or perhaps even many clinicians—might reasonably expect. Postpartum depression and postpartum psychosis are disorders that are commonly talked about, but the DSM does not independently diagnose. It is true that they can be classified as a sub-species of major depressive disorder or psychosis (via a specifier of peripartum onset), but they do not exist as standalone diagnoses. That distinction may sound technical. But diagnostic categories shape what clinicians are trained to recognize, what researchers study, what patients are told to watch for, and what symptoms are likely to be understood as part of a coherent syndrome. Classification affects visibility. And visibility matters. Clancy sought help from at least six different mental health providers, visited an emergency room, requested care at a women’s and infants’ hospital, checked herself into an inpatient stay voluntarily, called suicide hotlines twice, and received over 32 prescriptions—all in the span of 4 months. Not one of these encounters offered Clancy an accurate diagnosis or relief from her reported symptoms.
The four-week problem
There’s another problem that may have played a role in Clancy not receiving a diagnosis of postpartum psychosis and/or depression: DSM’s peripartum-onset specifier has traditionally applied when onset occurs during pregnancy or within four weeks after childbirth.
Four weeks.
That means a qualifying mood episode beginning 27 days after delivery may formally receive a peripartum specifier, while a comparable episode beginning later may not. Clancy’s last delivery had been roughly 5 months prior (baby Callen was 8 months old at the time of his death and her older children were 3 and 5 years old), not four weeks.
Reddington read the DSM’s peripartum-onset specifier out load to Dr. Mack during his testimony: it applies to mood episodes beginning during pregnancy or within four weeks after delivery. Dr. Mack confirmed, “That’s the four-week cutoff that’s on that specifier.” Reddington immediately responded sarcastically, “When was this last amended? 1958?”
The DSM’s approach becomes especially striking when compared with contemporary obstetric guidance. The American College of Obstetricians and Gynecologists addresses mental health conditions that may first arise during pregnancy or during the first year postpartum, and its clinical guidance explicitly includes postpartum psychosis.
Diagnostic categories are choices, not discoveries: other systems made a different choice
The DSM (published by the American Psychiatric Association) is not the only way to organize psychiatric illness.
The World Health Organization’s ICD-11 (used more outside of the U.S.) handles things differently. It has an explicit category called “Mental or behavioural disorders associated with pregnancy, childbirth or the puerperium, with psychotic symptoms” (6E21), alongside a corresponding category without psychotic symptoms (6E20). WHO’s 2024 CDDR is intended precisely as clinical diagnostic guidance, not merely a statistical coding manual.
A major comparison of ICD-11 and DSM-5 explains these differences. The ICD framework reflects, in part, the language used by obstetricians and other clinicians who commonly describe conditions as postpartum depression or postpartum psychosis, while the DSM tradition has emphasized the underlying psychiatric syndrome.
But their disagreement reveals something important: diagnostic manuals do not merely discover categories that exist in nature. Human beings decide how illness should be divided, named, and recognized.
Those choices have consequences.
A patient herself does not experience disciplinary or geographic boundaries. She experiences symptoms. A healthcare system should make those symptoms easier to understand, not harder.
Psychiatry itself is reconsidering the question
This concern is not an argument invented by attorneys in a criminal trial. Researchers are actively debating it.
A recent international expert consensus statement argues that postpartum psychosis has a sufficiently distinctive timing, presentation, prognosis, treatment response, and relationship to bipolar-spectrum illness to justify clearer classification. The authors recommend recognizing postpartum psychosis as a distinct diagnostic category and propose an onset window of up to 12 weeks after childbirth.
That proposal is not yet the DSM standard. But its existence should make us ask whether our current categories are doing enough. As I write this, the next version of the DSM (DSM-6) is in development, which presents an opportunity for revisions.
The Clancy case should not define postpartum psychosis
There is an important ethical danger here. Postpartum psychosis should not become publicly synonymous with infanticide or filicide. The Clancy case presents extraordinary and contested facts. Diagnosis and criminal responsibility are different questions, and experts may disagree about both.
If the only time Americans hear the term “postpartum psychosis” is after a horrific tragedy, increased awareness could easily become increased stigma. Women should not need a catastrophe before medicine examines its categories.
We need better research, clearer communication between obstetrics and psychiatry, more education for families and frontline clinicians, and diagnostic systems willing to evolve when their categories no longer serve patients well.
Jennifer Blumenthal-Barby, PhD, MA
AI statement: I used ChatGPT to go back and forth on blog post content, but all ideas, arguments, and writing of final draft in this blog post are mine.
All views expressed in this essay are entirely those of the authors and not those of any of the author’s affiliations