It has been a struggle for me to understand postpartum psychosis, particularly while following the Lindsay Clancy case. One difficult reality I keep thinking about is that there are likely other women in the United States and around the world who have experienced postpartum psychosis but did not have the financial resources or opportunity to obtain a highly experienced private criminal defense attorney.
Lindsay’s attorney is clearly passionate about defending her. I can appreciate the empathy behind that commitment. At the same time, there are moments when, in my personal opinion, his questioning of witnesses appears unnecessarily harsh. That creates a contradiction for me. If we are advocating for greater compassion and understanding toward people experiencing serious mental illness, I believe that compassion should also extend to the other people involved in the process, including witnesses and professionals whose perspectives may differ from those of the defense.
I do not question that Lindsay may have experienced psychosis. What I continue to struggle with is the relationship between psychosis, awareness, and legal responsibility. She has reported experiencing a voice telling her that this was her “last chance” and instructing her to kill her children and then herself. What did she understand that “last chance” to mean? Did she understand the nature and consequences of what she was about to do? Did she understand that killing her children was wrong? To me, these are important questions. Experiencing psychosis does not automatically answer the legal question of criminal responsibility. The question also involves whether, because of a mental illness, a person lacked the substantial capacity to appreciate the criminality or wrongfulness of their conduct or to conform their conduct to the requirements of the law.
I believe it is possible to recognize the seriousness of a psychiatric illness while also discussing accountability and public safety. In my view, if someone is found to have committed such devastating acts while severely mentally ill, that person should receive intensive psychiatric treatment in a secure setting where their condition can be continuously evaluated and where they cannot harm themselves or others. Compassion and accountability do not necessarily have to be opposing ideas.
I also see responsibility as complicated and potentially shared across multiple parts of the mental health system. Psychiatric providers must evaluate symptoms carefully, ask appropriate questions, monitor medication responses, recognize warning signs, and respond appropriately when risk becomes apparent. However, I sometimes question whether the depression screening tools commonly used in clinics are sufficient on their own. Some forms ask direct questions about thoughts of self-harm or suicide. While those questions are important, I doubt that every patient will feel comfortable answering them honestly, particularly when speaking with someone they are meeting for the first time. A patient may feel ashamed, afraid of being judged, concerned about hospitalization, or simply unable to explain what they are experiencing.
At the same time, psychiatric treatment depends heavily on what a patient reports and what clinicians are able to observe. A provider cannot automatically know about hallucinations, intrusive thoughts, suicidal thoughts, or other internal experiences if those symptoms are not disclosed and are not otherwise observable. Some psychiatric symptoms may also require repeated assessment or observation over time before their severity becomes apparent. For that reason, mental health evaluations should involve more than a single questionnaire. They should include thoughtful conversations, follow-up assessments, attention to changes in behavior, and opportunities for patients to disclose symptoms gradually as trust develops.
This case has strengthened my belief that mental health should be treated as an essential part of healthcare rather than something addressed only after a crisis occurs. Organizations routinely require annual physical examinations, yet psychological and psychiatric well-being often receives far less systematic attention. I believe we need stronger systems for routine mental health screening, early identification of serious symptoms, access to treatment, and appropriate follow-up when concerns are identified.
I have often said that the weapon itself is not the entire problem. We also have to look at the person who has access to that weapon. A weapon becomes especially dangerous when it is in the hands of someone who is psychologically vulnerable, severely mentally ill, experiencing a crisis, or unable to exercise safe judgment. This does not mean that access to weapons should be ignored. In fact, restricting access to lethal means when someone is experiencing a serious mental health crisis can save lives. But prevention cannot stop there. We must also identify and support the person who may be at risk of harming themselves or others.
Organizations routinely request annual physical examinations, and I believe we should place similar importance on routine mental health screening and assessment. Mental health should not become a priority only after someone reaches a crisis point. We need earlier identification, better access to psychiatric services, continued follow-up, and greater education for families about warning signs.
Ultimately, I do not believe this conversation has to be reduced to choosing between mental illness and accountability, or between weapons and mental health. These issues can exist together. A person can be profoundly mentally ill and deserving of compassion and psychiatric treatment, while society can still have legitimate questions about awareness, responsibility, and safety.
It is not one person who needs to own the blame. This is part of the evolution of the science of psychology. Ultimately, it is the vulnerable human mind that needs understanding and support.