She was a nurse. The system still missed her.

If you've caught any headlines this week, you've seen the name Lindsay Clancy. She's the Massachusetts mother on trial for killing her three children in 2023, ages 5, 3, and 8 months. Her defense: postpartum psychosis.

I will tell you more about what that is in a moment.

I want to be careful with this one. This is a very sad story about three kids who died. Having young children myself close in age to hers, I would like to think about anything else than to imagine this tragedy happening to my children. 💔🖤

It's also, underneath the headlines, a story about a diagnosis most people have never heard of and a system that failed to catch it in someone who worked inside that same system every day.

The part that stopped me: Clancy was a labor and delivery nurse. At Massachusetts General Hospital. Trained to recognize exactly the kind of crisis she was living through. Journal entries read in court this week show her writing, “I'm completely overwhelmed trying to take care of the 3 kids. I feel like I'm drowning everyday.” Her own medical records described her as “critically ill” with postpartum psychosis. She still didn't get the help that could have changed the outcome.

If a trained nurse can fall through that gap, the gap is the story. 🩺

What postpartum psychosis actually is (and isn't):

• It occurs in roughly 1-2 out of every 1,000 births. Very Rare.

• It's not the same thing as postpartum depression, which affects up to 1 in 8 people who give birth and looks very different clinically.

• Symptoms of Postpartum Psychosis can include delusions, paranoia, hallucinations, and a break from reality that can escalate fast, sometimes within days of delivery.

• It's treatable. Early detection and treatment (often inpatient care, medication, etc.) lead to good outcomes.

Here's the part I need you to sit with: even in untreated cases, research puts the infanticide risk at around 4%. That means roughly 96 out of 100 mothers with this diagnosis never harm their child, and that number only improves with treatment. This diagnosis is already extremely rare, and the outcome everyone fears is the exception, not the rule. But every time a case like this makes national news, the disorder itself gets flattened into “the illness that makes mothers dangerous.” That's not accurate, and it's exactly the kind of headline that keeps the next mother from telling anyone what she's experiencing.

Stigma doesn't just hurt the person carrying the diagnosis. It hurts everyone who might need to say something before things escalate and now has one more reason to stay quiet.

What to actually do with this

• If you or someone you know had a baby recently and something feels “off” beyond exhaustion (racing thoughts, not sleeping even when the baby sleeps, hearing or seeing things, sudden paranoia), that's not something to wait out. Postpartum depression and even postpartum psychosis can move fast. It never hurts to express care or concern while providing a resource. Sometimes being “intrusive” can be the most helpful thing you can do.

• National Maternal Mental Health Hotline: call or text 1-833-TLC-MAMA. Free, confidential, 24/7.

• If you're a clinician, this is a good week to double check your postpartum screening protocols. Risk is dramatically elevated with a history of bipolar disorder, prior postpartum psychosis, or family history. That's worth flagging early, not after discharge.

• If you're reading this and just need to talk to someone, that's what 988 is for. Call or text 24 hours a day, 7 days a week.

Go deeper:

• PBS News: What to know about the Clancy trial and postpartum psychosis -- good, careful overview of the case and the clinical basics.

• Psychiatric Times: What the Clancy Case Can Teach Us -- if you want the clinical/forensic psychiatry perspective, including risk factors and detection gaps, this is the best resource I found. Worth bookmarking if you or someone you love is expecting.

• Postpartum Support Charleston: Postpartum Psychosis -- plain-language education on symptoms, risk, and treatment. Says it best: “Most women who experience postpartum psychosis do not harm themselves or anyone else.”

If you take one thing from this edition, let it be this: the diagnosis is not the danger. Silence is.

Thank you all for coming along this journey.

Until next time, come back…be here.

Keith