We Are Lindsay Clancy and What You Really Need to Know About Postpartum Psychosis

Like many people across the world, the Clancy trial has been permeating my social feed, and I have found myself unwittingly transfixed, moved, and horrified by the trial. I have also, like many mothers, seen shadows of my postpartum self in her journal accounts. 

"I'm so desperate to get a mental break from taking care of everyone that my mind is trying to find something physically wrong with me," she wrote in one journal entry. She described feeling anxious and overwhelmed, caring for three young children, including a baby who kept getting sick from viruses brought home by the older two young children. Her impending return to work was increasing her sense of stress, guilt, and overwhelm, impacting her breastfeeding journey, and she found herself feeling "incredibly sad and guilty". 

As a perinatal therapist and mother of three myself, I can speak to how common these sentiments are for mothers in North America. The demands of motherhood, coupled with intense sleep deprivation and hormonal changes that occur around the first year following birth, as well as a too-soon return to work, all contribute to mothers feeling overwhelmed and struggles with mental health. This is why the Clancy trial speaks to so many of us. We can see our own struggles in Lindsay’s struggle.  For some mothers, these circumstances, coupled with a genetic predisposition towards mental health challenges, can lead to the diagnosis of a mental health disorder. The postpartum period (roughly the first year after giving birth) is considered an at-risk time in a woman’s life for mental illness, even for those who have never experienced one before.

In Lindsay’s case, it seems that she may have been tragically misdiagnosed or that the psychotic features of her illness were missed despite seeking support from multiple practitioners (this is the basis of the case that her defense team is making, that she was good mother, reaching out for support and unable to get the help that she needed). 

So how is it that her providers could have missed the psychosis? 

The fact that postpartum psychosis is rare, affecting 1-2 women out of every 1000 live births, can contribute to it being overlooked and misdiagnosed, as well as the fact that psychosis can manifest itself differently in every person - with some people behaving in a manic or agitated manner and others in a depressive or withdrawn state. 

Confounding things further, postpartum psychosis can be inherently illusive, with psychotic symptoms waxing and waning, which explains why she could seem lucid and stable at times. Many women, and possibly for Lindsay as well, don’t report all of their symptoms to their providers out of fear that this will cause their children to be separated from them.

What actually is postpartum psychosis? 

Postpartum psychosis is not a standalone diagnosis in the DSM-5-TR, the manual used to diagnose mental health disorders across North America. Instead, it is diagnosed through an underlying disorder like bipolar disorder, major depressive disorder with psychotic features (yes, this can happen with very severe postpartum depression, though rare), or with a psychotic disorder. 

Like other perinatal mood and anxiety disorders, sufferers experience intrusive thoughts, but unlike other disorders where the person is horrified by those thoughts, in the case of psychosis the person typically doesn't experience these thoughts as disturbing (though this is not always the case). Other features can include delusions, hallucinations, severe mood disturbances, impaired insight, and disorganized thoughts and behaviour. The sufferer will experience a break from reality, marked by poor reality testing, confusion and disorientation. 

Lack of recognition and misdiagnosis

A few years back I was speaking to a group of family doctors about maternal mental health, specifically, how to recognize the signs and symptoms of perinatal mood and anxiety disorders. 

I was stunned to encounter not just a lack of understanding and knowledge regarding identifying potential signs of psychosis in a postpartum mother but a sense of over confidence from one of the doctors in particular while sharing of a story of a mother she had treated some years back. When describing the woman’s symptoms, to me she sounded clearly like someone who had been experiencing psychosis but whose symptoms had been missed with the doctor confidently diagnosing her with postpartum depression. Luckily, in that case, unlike for Lindsay, things did not end with such devastation. 

But the Clancy trial sheds light on the fact that it could have, and what mental health providers specializing in the perinatal period have been trying to shed light on for years: that postpartum psychosis is always considered a medical emergency, and that, however rare, it must be screened for, properly identified, and when identified, the woman must be given immediate intensive care. We also need to destigmatize the diagnosis for women so that they feel safe to come forward and share their symptoms honestly without a fear of judgment.

With the right support, there is hope for those suffering with postpartum psychosis. The story of Aaisha Alvi, a Canadian mother who experienced psychosis and went on to publish a beautiful and inspiring book about her experience, ‘A Mom Like That’, offers an insightful account of a firsthand experience where someone is (finally) able to access support, get better, and help others. That should have been Lindsay’s experience. Instead, she was failed by the system and society. 

We need to do better for all mothers so that no one else suffers the same horrific fate as the Clancys. 

If you are struggling, please reach out for support and know that with the right support, you will get better. 

At MamaCare, we offer specialized support for expectant and new parents including free services through MamaCare Community.