Clancy Trial Forces Reckoning on Postpartum Psychosis
Clancy Trial Forces Reckoning on Postpartum Psychosis
The News
The murder trial of Lindsay Clancy, a 36-year-old labor and delivery nurse who says she strangled her three young children while suffering postpartum psychosis, has pushed maternal mental health into mainstream American conversation — and experts tell CNN the reckoning is decades overdue.
Clancy is standing trial in Plymouth Superior Court in Plymouth, Massachusetts. A central question is whether postpartum psychosis drove her to kill.
The trial, and the death of actress Hayden Panettiere at 36, have prompted women across the country to talk publicly about breakdowns they once hid.
The Numbers
Postpartum psychosis is rare. CNN reports it can affect up to 2 of every 1,000 women after childbirth; researchers cited by the Associated Press estimate 1 to 2 in 1,000.
Mental health problems overall — depression, anxiety or psychosis — affect as many as 1 in 5 women in the US during pregnancy and in the year after birth, according to CNN. Postpartum depression alone affects about 1 in 7 women after giving birth, the AP reports, and some research puts it higher.
Symptoms of postpartum psychosis include disorganized thinking, delusions, hallucinations, paranoia, agitation and mood changes. The risk is higher for women with conditions such as bipolar disorder. Most women who develop it do not harm their children, though severe cases may involve attempts to harm themselves or their children.
Timeline
Adrienne Griffen, now CEO of the Maternal Mental Health Leadership Alliance, sought help after her second child was born and says a doctor told her they were obligated to call Child Protective Services if she hurt her children, adding, "Well, we don't want another Andrea Yates" — a reference to the Texas mother who drowned her five children in a bathtub that same year. Griffen says it took another six months to get treatment.
Panettiere speaks about postpartum depression in a national TV interview on "Live with Kelly and Michael." She later said she was fired from a decade-plus brand deal with Neutrogena over it.
Bridget María Chesterton, a history professor outside Buffalo, New York, gives birth by C-section about two months early. Two weeks later her husband finds her on the bathroom floor, unable to remember basic details of her life. She is diagnosed with postpartum psychosis.
Panettiere tells a podcast interviewer: "There's a lot of stigma around postpartum, and there's a lot of misunderstanding. It's on a spectrum. It's on a scale, and fortunately, I never felt any hostility or negativity towards my child, thankfully, but I wasn't connecting with her the way that I knew I should be."
Jury selection in Clancy's triple murder trial reaches its third day before Judge William Sullivan, according to a Reuters photograph published by CNN.
Panettiere dies at 36. Days later, Neutrogena posts a statement on Instagram; the same day, hundreds of women dressed in bright pink gather outside the courthouse where Clancy is on trial.
Reactions
Neutrogena said it was deeply saddened by Panettiere's death. "We are proud to have partnered with her and understand that we made her feel unsupported during a very difficult time. This is not what Neutrogena stands for or who we want to be," the company said.
Griffen argues the system is built to overlook the mother. "In no other situation do we have one hospital patient, the mother, caring for another hospital patient, the baby," she told CNN. Care coordinators are routinely assigned to cancer patients, she said, but rarely to postpartum mothers.
Dr. Andrea Diaz Stransky, an assistant professor of psychiatry and behavioral sciences at Duke University, said maternal mental health conditions are more common than gestational diabetes but nowhere near as well managed. "Even though we have guidelines for how to screen for both conditions — gestational diabetes as well as perinatal mood and anxiety disorders — we don't have the same level of implementation," she said. Even a positive screen may go nowhere: "If I screen and it's positive, the waitlist for therapy is so long that this patient might not be able to access that soon enough."
Licensed clinical psychologist Dr. Noelle Santorelli told CNN's Sara Sidner that high-functioning women often mask what is happening, and that fear keeps them quiet. "Women get really afraid to be separated from their children, right? There's a fear that if they report what they're really experiencing, their children might be taken away," she said.
Chesterton, 52, bristles at online commenters who say postpartum psychosis is not real. "It's something that we do not talk about as a society," she said. "I'm not embarrassed about what happened. I want people to know about it."
What's Next
Clancy's trial is ongoing in Plymouth, Massachusetts, with her mental state at the center of the case.
In Washington, a federal bill under consideration would lower the out-of-pocket cost of perinatal care for mothers, according to the Policy Center for Maternal Mental Health, whose CEO Joy Burkhard says payment rules are part of the problem. Most obstetric providers "are paid one flat rate for all the care they provide, from when pregnancy is confirmed to six weeks postpartum, and this structure was created 30 years ago," she said. "There's been disincentives to address mental health, because mental health was never considered part of these bundled payments at the outset, 30 years ago."
The American College of Obstetricians and Gynecologists already has screening guidelines for pregnant and postpartum women, but Griffen says they have not been practically implemented across the US health system, and a lack of reporting requirements makes it hard to know how often they are followed.
Chesterton has a poem about her experience due to be published in a journal this fall.
More
Chesterton's case shows what recovery can look like when help arrives fast. Her daughter was in the neonatal intensive care unit; Chesterton was hospitalized at BryLin Hospital in Buffalo for about two weeks, released, then involuntarily committed for two more weeks after she deteriorated again. She credits antipsychotic medication, which she took for about a year, and her family — her husband James Fitzsimmons, her parents and a postpartum doula. By her daughter's first birthday, she was back to normal.
Dr. Emily Williams of Buffalo OB/GYN, one of her doctors, said the family acted quickly when symptoms appeared, and that relatives sometimes wave off warning signs as a need for more sleep. "The more hands on deck, the better," she said.
Diaz Stransky said untreated anxiety and depression are linked to increased risk of preeclampsia and preterm birth, and that partners and family need preparation too — partners can develop postpartum depression themselves. In North Carolina, where she practices, doctors can call a specialized phone line to consult a reproductive psychiatry expert.
If you or someone you know is struggling, the national suicide and crisis lifeline in the US is available by calling or texting 988.
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