The ongoing murder trial of Lindsay Clancy has drawn attention to a rare but severe psychiatric condition that can emerge after childbirth: postpartum psychosis. Defense attorneys for the Massachusetts labour and delivery nurse do not dispute that Clancy strangled her three children — Cora, 5; Dawson, 3; and Callan, 8 months — before jumping from a second-story window of her home in 2023. But they argue that she was not criminally responsible because she was experiencing postpartum psychosis.
According to testimony in the case, Clancy had taken medication for mental health problems after Callan’s birth and had sought help from several mental health professionals. Prosecutors, meanwhile, have pointed to descriptions of the incident as evidence of “deliberate premeditation, extreme atrocity or cruelty, and the state of mind of the defendant,” according to a CNN report. The trial has therefore placed a complex medical condition alongside difficult questions about responsibility and severe mental illness.
DISCLAIMER: This article is based on information from the public domain and/or the experts we spoke to. Always consult your health practitioner before starting any routine.
Postpartum psychosis is among the rarest and most serious psychiatric disorders associated with childbirth. The report also mentions that mental health problems are among the most common complications associated with pregnancy and parenting, affecting as many as one in five women in the US during pregnancy and the year after birth.
Understanding postpartum psychosis is important not only because of its potential severity but also because early recognition and treatment can make a significant difference. Experts explain how the condition differs from postpartum depression and other post-birth mental health problems, who may be at risk, and what families should watch for.
What is postpartum psychosis and who is vulnerable?
Dr Jagadish Hiremath, a Public Health Intellectual, tells indianexpress.com, “Postpartum psychosis is a rare but severe psychiatric condition in which a woman loses contact with reality, typically developing symptoms such as hallucinations, delusions, paranoia, severe confusion or marked changes in mood and behaviour. It is estimated to occur in around 1 to 3 women per 1,000 births.”
Neha Cadabam, Senior Psychologist and Executive Director, Cadabam’s Hospitals, adds, “The exact cause is not fully understood, but postpartum psychosis appears to involve a complex interaction of biological vulnerability, rapid hormonal changes, sleep disruption and underlying psychiatric risk. Women with a personal or family history of bipolar disorder or psychosis, or a previous episode of postpartum psychosis, are particularly vulnerable. However, it is important not to assume that the absence of a psychiatric history means someone is not at risk. It can occur unexpectedly after childbirth.”
This is very different from baby blues, Dr Hiremath notes, which are common, mild mood changes that usually peak within the first few days after delivery and resolve within about two weeks. “Postpartum depression and anxiety can cause persistent sadness, excessive worry, guilt, fatigue and difficulty functioning, but the person generally remains in touch with reality. In postpartum psychosis, that connection with reality can be significantly impaired,” he stresses.
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What symptoms should families and healthcare providers watch for?
The early warning signs can sometimes look like extreme exhaustion or an unusually intense emotional reaction to childbirth, Cadabam says, so families need to pay attention to sudden and significant changes in behaviour. “A woman may go for prolonged periods with little or no sleep, become unusually agitated or energised, speak rapidly, behave in a disorganised manner, or appear markedly confused. She may hear or see things that are not there, develop fixed beliefs that others cannot share, become intensely suspicious, or believe that the baby or family members are in danger. There may also be abrupt shifts between manic, depressive and confused states. Importantly, she may genuinely believe these experiences are real and may not recognise that she is unwell.”
From a medical perspective, Dr Hiremath says that severe or rapidly worsening insomnia “is an important warning sign, particularly when it occurs alongside confusion, unusual behaviour or changes in perception.” He suggests that families should not dismiss these changes as simply being part of new motherhood. Postpartum psychosis commonly has a sudden onset, often within the first few weeks after delivery, and the situation can deteriorate quickly. A new mother who suddenly seems disconnected from reality needs an urgent psychiatric assessment rather than routine postpartum reassurance.
How is postpartum psychosis treated and why is it an emergency?
“Postpartum psychosis is considered a psychiatric emergency because impaired judgement and loss of contact with reality can place both the mother and baby at immediate risk,” says Dr Hiremath, adding that treatment generally requires urgent psychiatric intervention and often hospitalisation, with medication used to control psychotic and mood symptoms. “The exact treatment plan depends on the clinical presentation and may involve antipsychotic medication and, where appropriate, mood-stabilising treatment. Early intervention is critical because psychosis can escalate rapidly, but recovery is possible with appropriate treatment.d or unreported cases.”
Cadabam shares, “If a woman is hallucinating, expressing frightening or bizarre beliefs, behaving in a severely confused or unpredictable manner, or talking about harming herself or the baby, the family should treat it as an emergency rather than trying to reason with her or manage the situation at home. She should not be left alone, and the baby should be kept with a safe, trusted adult while urgent medical help is arranged. The priority is immediate assessment by a psychiatric or emergency medical team. Families should also avoid confrontation or arguing about the reality of her beliefs, because during psychosis she may genuinely be unable to distinguish those beliefs from reality.”
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DISCLAIMER: This article is based on information from the public domain and/or the experts we spoke to. Always consult your health practitioner before starting any routine.
