The Hidden Fallout From the Clancy Mistrial: Fear Could Make the Postpartum Crisis Worse

A Plymouth County jury spent seven days locked in a room, trying to decide whether Lindsay Clancy was guilty of murdering her three children or whether the Duxbury, Massachusetts, mother was instead in the throes of postpartum psychosis. Eleven jurors opted for not guilty while one held out, forcing Judge William Sullivan to declare a mistrial earlier this month.Ms. Clancy next appears in court on September 29 with the case facing an unknown future, but its ripple effects are already being felt far and wide.“There is no question that press coverage of famous, controversial cases can cause seismic shifts in what happens afterward,” a professor at New York Law School, Michael Perlin, tells The New York Sun. He points to the aftermath of John Hinckley Jr.’s attempted assassination of President Reagan as the clearest historical parallel.Mr. Hinckley’s 1982 acquittal by reason of insanity set off a wave of state-level reforms that tightened the insanity defense nationwide and led Congress to shift the burden of proof onto defendants in federal cases through the Insanity Defense Reform Act of 1984.After the Clancy case, medical experts warn, there’s a real and growing risk of a mother who admits to intrusive thoughts or a dark moment ending up in a hospital bed she didn’t ask for; losing her newborn to child protective service; or even facing legal action. That fear is already taking hold in exam rooms far from Plymouth County.The Fear of OvertreatingAt the trial, much of Ms. Clancy’s defense was aimed squarely her doctors. In his closing argument, the lead defense attorney, Kevin Reddington ,argued that the health care system had doped her up on more than a dozen medications for generalized anxiety disorder, postpartum depression, a major depressive episode and insomnia, without properly treating what was underneath. He told the jury it was that overmedication, not premeditation, that triggered the killings.In an essay for STAT News, two psychiatrists say that approach could make psychiatrists more reluctant to treat mothers with mental illness at all, given that only around 500 reproductive psychiatrists practice nationwide. The writers are a forensic psychiatrist at Boston and the president-elect of the American Academy of Psychiatry and the Law, Renee Sorrentino, and a forensic and reproductive psychiatrist at Case Western Reserve University, Susan Hatters Friedman.Clinicians who are afraid of liability, they wrote, may respond to ordinary reports of intrusive thoughts by over-hospitalizing patients or making unwarranted referrals to child protective services.Dr. Hatters Friedman, reached separately by the Sun, sees a version of that danger already taking shape among the next generation of doctors.“One of the worries is that if doctors practice very conservatively and hospitalize mothers who have any slight increase in risk, or report mothers with any slight increase in risk, mothers could be inappropriately hospitalized or CPS cases opened,” Dr. Hatters Friedman tells the Sun. “I’m also worried about whether we will see physicians just not offering care to pregnant or postpartum mothers because they are afraid of working with this population at risk.”A professor at the University of Texas School of Law, Rachel Rebouché, anticipates that the same liability calculation could play out beyond psychiatry.Ms. Rebouché tells the Sun that trainees are “already voicing concern about future practice” and that the likely response cuts two ways. On the one hand, it could lead to more testing and more referrals to specialists. On the other, it could prompt more reluctance to prescribe medication at all. Providers who fear being blamed the way Ms. Clancy’s clinicians have been could escalate some forms of care while quietly withholding others. Separations from newborns and involuntary psychiatric holds — brief hospital commitments made without a patient’s consent — can themselves worsen a mother’s mental health, she highlights. This could further deter future help-seeking, hitting hardest at mothers who are already hesitant to disclose.Not every forensic expert agrees that the picture will shift much.An American forensic psychiatrist and the chairman of The Forensic Panel, Michael Welner, has examined defendants in some of the country’s most closely watched filicide cases, including Andrea Yates, the Texas mother who drowned her five children in 2001; and Lori Vallow, the Idaho mother convicted in the so-called doomsday-cult killings of her two children.He tells the Sun that mothers with anxiety or confusion do not kill children. Rather, in his view, it is mothers harboring homicidal fantasies beforehand who do, and those thoughts arise far more often than they are acted on. Through Dr. Welner’s lens, mothers concealing a plan already have every reason to stay silent long before a case like Ms. Clancy’s makes headlines, and no amount of press coverage changes that calculation.“So long as the focus is on actuarial risk management and not on children’s rights to live in their parents’ home in safety, there will be no creative solution, only management of optics,” he observes. For Dr. Welner, the deeper failure is a story with no advocate for its youngest characters.“Children never asked to be born in a particular home, only to be loved where they were born, and to be safe. And no one, no one speaks for the children,” he says. When Disclosure Becomes the DangerPart of what makes postpartum psychosis so difficult clinically, however, is that it barely exists on paper in the United States. The illness is not recognized as its own diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, the standard reference used across American medicine, meaning many doctors are never specifically trained to identify it.Yet it affects an estimated one to two births per thousand. Mothers experiencing it often hide symptoms out of shame or fear that admitting confusion or intrusive thoughts will be used against them by a judge, a caseworker or an insurer.A licensed clinical psychologist and perinatal legal advocate, Susan Benjamin Feingold, points to arguments that Mr. Reddington made during the trial that Ms. Clancy was failed by a health care system that overmedicated her without properly addressing her mental health needs. She emphasizes that this is a lesson worth salvaging regardless of how any retrial ends.“We need to create a system in which women and their families feel safe coming forward when something is wrong, and in which doctors feel equipped and supported to recognize postpartum psychosis and respond appropriately, rather than fearing the consequences of asking questions or intervening,” Ms. Feingold tells the Sun. “Postpartum psychosis is a psychiatric emergency, but it is also temporary and treatable.”Some in the field do not see the case as a step backward. Since the underlying message about the illness is ultimately that it can be treated, there is also hope if the attention pushes obstetricians and pediatricians toward better screening rather than away from treatment entirely.“The postpartum year is the time in a woman’s life when she is at greatest risk of developing mental health symptoms,” Dr. Hatters Friedman says, “and postpartum mental illnesses are very treatable, and with treatment mothers and families can lead better lives, with decreased risk.”Ms. Clancy’s case may be retried, which will likely keep the country’s attention for months. The more pressing question for psychiatrists and legal scholars is not how the next Plymouth County jury ends up ruling, but whether women feel secure enough to speak up in obstetrics offices across the country.“The answer cannot be for mothers to be afraid to disclose symptoms or for clinicians to become reluctant to intervene,” Ms. Feingold says. “We need greater awareness, earlier identification, appropriate treatment, and a system that makes it easier, not harder, for women to get the help they desperately need.”

The Hidden Fallout From the Clancy Mistrial: Fear Could Make the Postpartum Crisis Worse

The Hidden Fallout From the Clancy Mistrial: Fear Could Make the Postpartum Crisis Worse

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