The trial of a Massachusetts woman accused of strangling her three young children to death has captured the public’s attention, raising questions around the prosecution of mothers with mental illness and putting a spotlight on a lesser known mental health condition known as postpartum psychosis.

Lindsay Clancy has pleaded not guilty to three murder charges in connection with the deaths of her 5-year-old daughter Cora, 3-year-old son Dawson and infant son Callan at her family’s home in Duxbury, a Boston suburb, on Jan. 24, 2023.

According to prosecutors, the former nurse attempted suicide on the night of her children’s deaths, leaving her paralyzed and in a wheelchair. She is currently being held at a state hospital.

In opening statements, Clancy’s defense attorney said Clancy, now 35, was suffering from “psychosis” at the time of her children’s deaths, arguing that she “did not get the medication, did not get the medical treatment that she so deserved.”

“Every one of these doctors and nurses knew that she was suffering from postpartum, and now it’s turning into psychosis,” said attorney Kevin Reddington, who alleges that Lindsay Clancy was overmedicated at the time of the killings.

Prosecutors in the case argue that Clancy is “criminally responsible” for the deaths of her children.

“People with mental illness commit crimes everyday and are responsible for them,” Plymouth County assistant district attorney Shanan Buckingham said in opening statements. “The fact that someone may suffer or have a mental illness, a mental disease or defect is not the end of the inquiry when it comes to guilt or innocence.”

Ex-husband takes the stand

Patrick Clancy, Lindsay Clancy’s former husband and the father of their three children, was the trial’s first witness, taking the stand on July 27.

Patrick Clancy, who has since remarried, testified about returning home from picking up takeout dinner on the night of Jan. 24, 2023, and finding his then-wife on the ground outside a window of their two-story home, and later finding his three children in the basement.

Patrick Clancy also testified about Lindsay Clancy’s mental health, saying she experienced mental health issues after the births of their children, including indicating that at one point she was suicidal and had thoughts about harming their kids. He said his then-wife struggled with anxiety, medication changes and sleep deprivation, according to ABC Boston affiliate WCVB-TV.

Patrick Clancy said though that on the day of the murders, Lindsay Clancy was “having one of her best days.” He testified that they exchanged photos of their children making snowmen, doing crafts, and attending a doctor’s appointment.

Shortly after his children’s deaths in 2023, Patrick Clancy said that he forgave Lindsay Clancy, writing in a statement, “My family was the best thing that ever happened to me. I took so much pride in being Lindsay’s husband and a dad to Cora, Dawson and Callan.”

“Our marriage was wonderful and diametrically grew stronger as her condition rapidly worsened,” he wrote, without sharing further details on Lindsay Clancy’s “condition.” “I took as much pride in being her husband as I did in being a father and felt persistently lucky to have her in my life.”

What is postpartum psychosis?

The trial has drawn attention to the distinction between postpartum psychosis and the more common postpartum depression.

What is the difference between postpartum depression and postpartum psychosis?

Postpartum depression — a depression that occurs after having a baby — affects as many as 1 in 8 women who give birth, according to the U.S. Centers for Disease Control and Prevention.

Postpartum psychosis is far less common than postpartum depression. It affects roughly 1 to 2 mothers per 1,000 childbirths, according to estimates from a 2017 systematic review in the journal BMC Psychiatry.

What are the symptoms of postpartum depression and postpartum psychosis?

Symptoms of postpartum depression include withdrawing from loved ones, crying more than usual, feeling worried or overly anxious, feeling anger, doubting your ability to take care of your baby and thinking about harming yourself or your baby, according to the CDC. The symptoms may last for weeks or months after giving birth, and are more intense and longer lasting than the “baby blues” that women may experience after giving birth.

Symptoms of postpartum psychosis can include delusions or hallucinations that can prompt suicidal or homicidal action, according to the American College of Obstetricians and Gynecologists.

How long after birth can postpartum depression and postpartum psychosis be diagnosed?

Symptoms of both postpartum depression and postpartum psychosis typically begin days to weeks after giving birth, but can last months to a year, according to MedlinePlus, an online health resource run by the National Library of Medicine, and and StatPearls, an online library available through the National Library of Medicine.

How are postpartum depression and postpartum psychosis treated?

Postpartum psychosis is considered a psychiatric emergency, according to ACOG. It is a major safety risk for both mother and child, and it requires hospitalization to ensure safety. Treatment includes medications such as mood stabilizers and antipsychotics.

Treatment options for postpartum depression and psychosis will differ based on severity and type of symptoms and may include medication options, psychotherapy and/or support groups.

In 2019, a drug called Zulresso was approved by the U.S. Food and Drug Administration as the first-ever medication made specifically for women suffering from postpartum depression.

Who else is expected to testify?

So far, in addition to Patrick Clancy, witnesses called to testify have included first responders who responded to the Clancy home on the night of Lindsay Clancy’s suicide attempt, the night the children were killed, as well as people who interacted with Lindsay Clancy earlier that day, including a CVS Pharmacy employee and a local restaurant hostess.

The witness list presented at the start of the trial contained more than 200 names, according to WCVB.

The trial is expected to last six to eight weeks. The jury is composed of 12 women and six men.

What sentence does Lindsay Clancy face?

If she is found guilty of first-degree murder, Lindsay Clancy faces life in prison without parole, according to The Associated Press.

If found not criminally responsible for the three murder charges, Lindsay Clancy will be sent to a state mental health facility.

If you or someone you know is struggling with thoughts of suicide, call or text 988 or chat 988lifeline.org. Free, confidential help is available 24 hours a day, 7 days a week. You are not on your own.