The recent case of Lindsay Clancy has weighed heavily on my heart over the past several days. According to her husband, she was a young mother who was suffering from postpartum depression or psychosis and receiving treatment in an intensive outpatient program. She allegedly took her children’s lives and tried to end her own life.
The DSM 5-TR nomenclature for this condition is peripartum onset, referring to mood onset during pregnancy or within four weeks of delivery. However, I will use the term “postpartum depression/mental illness” throughout as it is more widely recognized, and there is an appreciation that during the strict criteria state onset within four weeks, there are many variable presentations.
Her husband, Patrick, made a statement asking for forgiveness and spoke about each of his children’s amazing attributes. His plea will likely face resistance in a society that is often unforgiving of mothers who suffer, especially from mental illness. It often takes personal experience or that of a loved one to understand the ramifications of postpartum depression, which affects 10 to 15 percent of women after birth and can occur up to a year later. Postpartum psychosis is much rarer, at 0.1 to 0.2 percent. Those who have treated individuals with psychosis understand that the individual experiences the thoughts, often persecutory in nature, as real. Postpartum anxiety and obsessive-compulsive disorders are often associated with depression and sometimes psychosis and are characterized by intrusive thoughts. Intrusive thoughts are uncontrollable and mostly unwanted thoughts, such as experiencing scary images or thoughts, like seeing blood on the walls of the nursery. Practitioners attempt to determine the potential danger of these thoughts, but it’s not always clear or predictable.
Mothers suffering from postpartum depression, and especially psychosis, are often confused, embarrassed, and ashamed, which sometimes keeps them from seeking help. Mothers who commit filicide often believe that evil forces are after their children and that taking extreme measures is the only way to protect them. This is very upsetting and unthinkable to most people. Still, we must remember that individuals with postpartum psychosis suffer from a break from reality, and their brains are not functioning in a way that makes sense to them.
I have suffered from postpartum depression and had intrusive thoughts, and I can’t imagine what her husband, family, and friends are going through. I hope people will learn more about this illness and what to look for. She was getting treatment, and she and her husband were doing everything right, but the outcome was still unthinkable. I hope that those of us in health care will do our best to raise awareness of postpartum mental illnesses and heed her husband’s call to view this tragedy with empathy.
Courtney Markham-Abedi is a psychiatrist.