The murder trial of Lindsay Clancy — a Massachusetts nurse charged with killing her three children in January 2023 — has put a rare and severe postpartum illness under sustained national attention in a way that medical experts say is long overdue.
Clancy's defense says she was in the grip of postpartum psychosis, a condition that can cause hallucinations, delusions, and a complete break from reality. Prosecutors argue she acted with intention and full awareness. The medical experts PBS NewsHour consulted for its reporting are not taking sides in that legal argument. But they are emphatic about one thing: postpartum psychosis is real, it is treatable, and it is severely underrecognized.
What Postpartum Psychosis Actually Is
Postpartum psychosis is not postpartum depression. The two are frequently confused, but they are categorically different conditions — different in their symptoms, their severity, their timeline, and their treatment.
Postpartum depression is relatively common — affecting roughly 10 to 15 percent of new mothers — and involves persistent sadness, fatigue, difficulty bonding, and anxiety. It is serious and requires treatment, but it does not typically distort a person's grip on reality.
Postpartum psychosis is far rarer and far more severe, affecting approximately 1 to 2 women per 1,000 who give birth. Its symptoms include hallucinations (seeing or hearing things that aren't there), delusions (fixed false beliefs), paranoia, extreme and rapid mood swings, disorganized thinking, and in some cases, mania. A person experiencing a full psychotic episode may have no insight into the fact that something is wrong — their perception of reality has changed, and from inside that changed reality, their behavior makes a different kind of sense.
The condition typically appears within the first two weeks after childbirth, though it can occur up to three months postpartum. The rapid hormonal shifts, sleep deprivation, and psychological stress of new parenthood are all implicated in its development.
Why It Gets Missed
The condition is rare enough that many primary care providers and even some obstetric clinicians have limited familiarity with it. Its early symptoms — unusual behavior, agitation, not sleeping even when the baby sleeps, talking quickly or strangely — can be easy to attribute to new-parent exhaustion or to the more commonly recognized postpartum depression.
"What I also want people to know is that these are treatable illnesses," says Dr. Julia Riddle, a psychiatrist at the University of North Carolina who spoke to PBS NewsHour during the trial. "Whether it's postpartum depression, postpartum anxiety and OCD, or postpartum psychosis — there are treatments, and people do get better."
That last sentence is the part that tends to get lost when cases like Clancy's dominate the coverage. Postpartum psychosis is not a life sentence. It is not a reliable predictor of future episodes for most people. When it is caught and treated quickly, the outcomes can be excellent. The tragedy in many documented cases — including some raised in the Clancy litigation — is that the illness wasn't caught and treated quickly.
Risk Factors and Warning Signs
Certain factors substantially increase the risk of developing postpartum psychosis. A personal or family history of bipolar disorder is the strongest risk factor — researchers estimate that approximately 25 to 50 percent of women with bipolar disorder will experience postpartum psychosis after delivery. A prior episode of postpartum psychosis dramatically increases risk in subsequent pregnancies.
Other risk factors include schizophrenia or schizoaffective disorder, being a first-time parent, sleep deprivation, and — in some research — stopping psychiatric medication during pregnancy.
The warning signs to watch for in a new parent, according to the American Psychological Association: sudden changes in mood, speech, or behavior; not sleeping at all even when the baby allows it; expressing strange or frightening beliefs; appearing confused or disoriented; and, most critically, any mention of hearing voices or seeing things.
Any of these signs in a new parent — or in yourself — warrant an immediate call to a medical provider. Postpartum psychosis is a psychiatric emergency. It moves fast, and early intervention is the factor that most reliably determines outcomes.
What the Research Shows About Recovery
Psychiatric care for postpartum psychosis typically involves inpatient hospitalization, which may be voluntary or involuntary depending on the severity of the episode. Treatment includes antipsychotic medications and sometimes mood stabilizers. For some patients, electroconvulsive therapy — done under anesthesia, and highly effective for certain psychiatric conditions — is part of the treatment protocol.
The recovery data is, genuinely, mostly good. Most people who receive appropriate care recover fully. The majority do not experience another episode if risk factors are managed in subsequent pregnancies, often with preventive medication started immediately after delivery.
What doesn't recover is the harm done when the condition isn't recognized. That's the conversation the Clancy trial is forcing — about what happens when a severe psychiatric emergency isn't caught, isn't treated, and isn't understood until something irreversible has happened.
