MA - Lindsay Clancy, Strangled 3 Children in Murder/Suicide Attempt, Duxbury, Jan 2023

[azure]

My second scenario was based on a mother who did not have PPS, but killed her child out of pressure from poverty, secrecy, religion, addiction etc. Those people have terrible burdens but they live in this reality. In this reality, at least in the west, there are many options that do not involve murdering your children.

But certainly, broadly speaking, any mother who considers killing her child within a certain period of time after birth must at least be considered for a PPP diagnosis, right? And not being their doctor, I don't think you could say that they don't have PPP, even if they aren't as sympathetic of a character as this mother is?

I don't want to argue with you further but I can't imagine that a mother killing her child to save it from poverty (a situation brought up by you, as all of my hypotheticals were imagined to have PPP as well) can be automatically and categorically excluded from PPP. Just because she states a "reason", or leaves her child in a snowbank instead of strangling it to death, doesn't exempt her from PPP and make her culpable when this mother isn't. That was my point.

 

[Telltale]

But certainly, broadly speaking, any mother who considers killing her child within a certain period of time after birth must at least be considered for a PPP diagnosis, right? And not being their doctor, I don't think you could say that they don't have PPP, even if they aren't as sympathetic of a character as this mother is?

I don't want to argue with you further but I can't imagine that a mother killing her child to save it from poverty (a situation brought up by you, as all of my hypotheticals were imagined to have PPP as well) can be automatically and categorically excluded from PPP. Just because she states a "reason", or leaves her child in a snowbank instead of strangling it to death, doesn't exempt her from PPP and make her culpable when this mother isn't. That was my point.

I mean people kill their children to spite their ex. Infanticide was quite common before abortion and likely will become more common now that abortion is effectively unavailable to large swathes of Americas poorest and most vulnerable. It's not all PPS by a long way.


I don't really get your point. This mother has a clear well documented history of what (I am going to assume) is PPS which she was in intensive treatment for. She gets more sympathy because why she did this is basically not in question.

If some other hypothetical mother gives a reason based on her actual real circumstances, then she is not motivated by psychosis, it might be desperation, fear, shame, or even PPD but that is still making a choice based in reality. If found out years later, that usually means the crime was concealed, which is usually taken as an indicator that the mother knew what they were doing was wrong and an understanding of the consequences if found out. It's not impossible for it to be PPS, but your case for it is going to be a much harder sell

If it's a clear cut case of PPS. Yet the mother also has issues with drug use/ drink / mental health - or time has passed that can be prejudicial, but it is also a genuine complication in judging the motivation .

America has a bad track record for putting mothers like this in prison. It is likely that there are many mothers, especially marginalized or impoverished mothers who had PPS but were treated as cold blooded monsters. Then again America puts the profoundly mentally ill and children in jail so at least it's consistent.

 

[BeginnerSleuther]

I have empathy for women who, due to a hormone imbalance that cannot predict or control, so completely detach from reality that murder their loved children. Their brain turned on them utterly. Often their terrible actions are still driven by love, it has just been twisted by a completely real (to them) but alien reality. Could you kill your child so could be safe in heaven of you knew, absolutely knew, they would be endlessly tortured by demons if you didn't?

I do not think anybody should temper empathy for this family that due to this woman being a white apple pie American mum, just because another hypothetical woman might be hypothetically offered less.

If a woman operating in this reality, who has any alternative options at all (and in the west there are almost always alternatives.) Kills her child abandons it to die, or stuffs it in a shoebox or otherwise pays for her own convenience and comfort with a babies life. Yeah I don't have all that much sympathy. No matter how much she's struggling, she could rouse herself enough to hand the baby to literally anyone.

Exactly this. I love how you described what PPP does to one. It's honestly true of most mental illness. Any organic psychotic disorder will do the same to someone. Many fear those with schizophrenia, but if they met people living with this condition they'd understand that only a very small minority are violent. The rest are struggling with the same "betrayal of the brain" that you mention in this case. Their reality is turned upside down and they're tortured by their fear and inability to tell the difference between what's real and what's not.

 

[Ilex]

I won't swear to it either. If anyone has a MSM article that mentioned inpatient treatment, please let me know. One thing I will say is that generally with this illness, you do inpatient treatment first, then outpatient as a step down. Could she have only done outpatient? Maybe. I'd be surprised though, unless her working diagnosis was only PPD and not PPP.

Even so, I'm not sure it would have made any difference. The main point you made is right, she was receiving care and being evaluated by professionals who concluded she wasn't a risk to herself. Minus a crystal ball... We certainly don't want to start mandating inpatient treatment for every post-partum mother. I've thought for years that perhaps the reduction in the hospital stay isn't doing anyone any favors (try to do all you need to do with a pt in a 23 hour stay, it's brutal) but with PPP it can happen at any time within the first year so doubtful anything would be observed in even a few days of a stay.
Do they still do the program where a nurse goes in and rechecks the mother/child in the first few months? We did that in rural health facilities in the late 80's, but I'm not sure if that's still done. That gave us an opportunity to see how things were going in the home.

 

[Trebor5591]

I find myself very conflicted about this case. On one hand, I am pleased that empathy is being offered to a perpetrator who was clearly in the throes of mental illness. I'm grateful that PPP is being thoughtfully destigmatized by many professionals and people who have gone through it themselves.

On the other hand, I'm left wondering who 'deserves' a near-unanimous display of empathy and support after murdering three children. Would a murderer who isn't a perfect example of what present-day American society typifies as ideal receive less empathy? Would there be universal support for a murderer who was nonwhite, who was poor, who was a single mother with no husband stridently defending her in the press, who, instead of working in a caregiving job, was perhaps a sex worker? What about an illegal immigrant? You may say it's a moot point because that isn't the case being discussed, or that I can't predict how people would react in another scenario. But I've rarely seen any empathy for women who kill and discard their infants, who lay unidentified for years. When the infants are identified and the mothers arrested, there is celebration, not mourning. But who knows if in addition to PPP, those mothers weren't experiencing homelessness, abuse, or many other traumas.

I hope that the empathy offered to this woman is carefully considered, and that everyone so readily offering it explores their beliefs on when matricide is a 'tragedy' and when it's a crime.

I agree 100%.

 

[BeginnerSleuther]

Even so, I'm not sure it would have made any difference. The main point you made is right, she was receiving care and being evaluated by professionals who concluded she wasn't a risk to herself. Minus a crystal ball... We certainly don't want to start mandating inpatient treatment for every post-partum mother. I've thought for years that perhaps the reduction in the hospital stay isn't doing anyone any favors (try to do all you need to do with a pt in a 23 hour stay, it's brutal) but with PPP it can happen at any time within the first year so doubtful anything would be observed in even a few days of a stay.
Do they still do the program where a nurse goes in and rechecks the mother/child in the first few months? We did that in rural health facilities in the late 80's, but I'm not sure if that's still done. That gave us an opportunity to see how things were going in the home.

No, I haven't heard of nurses going in and re-checking. Home-based psychiatric care does exist and in those cases, a nurse may go, but most women with PPP don't need that. Generally, what happens is an inpatient stay (generally 5 - 11 days, but can be much longer if necessary), followed by partial/intensive outpatient 5 days a week for both medication management and therapy for another couple of weeks or longer.

In my experience, I haven't heard of a 23-hour stay for PPP. These patients are usually very, very ill and we have no trouble getting insurance to cover for at least 5 days. The larger healthcare systems will eat the cost if they're turned down after that.

Agree that we can't start mandating inpatient treatment for every woman in the postpartum period who may have mood fluctuations. That would actually do much more harm than good. For one, women wouldn't admit what they're feeling for fear of hospitalization. Second, the trauma of involuntary hospitalization is, on its own, a deterrent to ever seek healthcare again - any type of care, not just psychiatric. Third, you run the risk of ruining someone's life with an involuntary hospitalization. This is something that's used against the patient in divorce battles, custody fights, on admission paperwork for certain fields of study, on licensing applications for professionals, for apartment rentals, and a host of other things. You might as well stamp a Scarlet Letter on them. It's crucial that involuntary hospitalization be used only for situations in which the patient is an acute danger to themselves or others, not just because they may be struggling with PPD or other mental illness.

 

[Trebor5591]

I mean people kill their children to spite their ex. Infanticide was quite common before abortion and likely will become more common now that abortion is effectively unavailable to large swathes of Americas poorest and most vulnerable. It's not all PPS by a long way.


I don't really get your point. This mother has a clear well documented history of what (I am going to assume) is PPS which she was in intensive treatment for. She gets more sympathy because why she did this is basically not in question.

If some other hypothetical mother gives a reason based on her actual real circumstances, then she is not motivated by psychosis, it might be desperation, fear, shame, or even PPD but that is still making a choice based in reality. If found out years later, that usually means the crime was concealed, which is usually taken as an indicator that the mother knew what they were doing was wrong and an understanding of the consequences if found out. It's not impossible for it to be PPS, but your case for it is going to be a much harder sell

If it's a clear cut case of PPS. Yet the mother also has issues with drug use/ drink / mental health - or time has passed that can be prejudicial, but it is also a genuine complication in judging the motivation .

America has a bad track record for putting mothers like this in prison. It is likely that there are many mothers, especially marginalized or impoverished mothers who had PPS but were treated as cold blooded monsters. Then again America puts the profoundly mentally ill and children in jail so at least it's consistent.

I wonder what the statistics are of mothers who murder their own children? I am aware of Andrea Yates. Diane Downs. Susan Smith. Lori Vallow. Now Lindsay Clancy.

The term for parents who murder their children is "fiacide". A study by Brown University says that parents murder their own children about 500 times per year. That's more than a murder per day. Fathers (57%) were slightly more likely to kill their own children than mothers. From the study:

"Close to three-quarters (72 percent) of the children killed were age 6 or younger. One-third were infants (children less than 1 year of age). Only about 10 percent of children killed were between ages 7 and 18.... Male children were more likely to be killed (58.3 percent) than female children. About 11 percent of victims were stepchildren...

Among offenders, while fathers were about equally likely to kill an infant, they were more likely to be the alleged murderer of children older than a year, especially when the children were adults (fathers were the offenders in 78.3 percent of those cases). Overall, fathers were the accused murderer 57.4 percent of the time.

The researchers found that the most common method of killing was with “personal weapons,” such as by the beating, choking, or drowning of victims. Parents used these means in 69 percent of murders of infants.

Analysis: 32 years of U.S. filicide arrests

Over the last three decades U.S. parents have committed filicide — the killing of one’s child — about 500 times every year. The horrifying instances are often poorly understood, but a recent study provides the first comprehensive statistical overview of the tragic phenomenon. The authors also...

news.brown.edu

 

[Ilex]

No, I haven't heard of nurses going in and re-checking. Home-based psychiatric care does exist and in those cases, a nurse may go, but most women with PPP don't need that. Generally, what happens is an inpatient stay (generally 5 - 11 days, but can be much longer if necessary), followed by partial/intensive outpatient 5 days a week for both medication management and therapy for another couple of weeks or longer.

In my experience, I haven't heard of a 23-hour stay for PPP. These patients are usually very, very ill and we have no trouble getting insurance to cover for at least 5 days. The larger healthcare systems will eat the cost if they're turned down after that.

Agree that we can't start mandating inpatient treatment for every woman in the postpartum period who may have mood fluctuations. That would actually do much more harm than good. For one, women wouldn't admit what they're feeling for fear of hospitalization. Second, the trauma of involuntary hospitalization is, on its own, a deterrent to ever seek healthcare again - any type of care, not just psychiatric. Third, you run the risk of ruining someone's life with an involuntary hospitalization. This is something that's used against the patient in divorce battles, custody fights, on admission paperwork for certain fields of study, on licensing applications for professionals, for apartment rentals, and a host of other things. You might as well stamp a Scarlet Letter on them. It's crucial that involuntary hospitalization be used only for situations in which the patient is an acute danger to themselves or others, not just because they may be struggling with PPD or other mental illness.

I was talking about post-natal care, not mental health care. By the time I left we were only doing 23 hours stays for most pts, barring any medical necessity. It didn't give us much ability to assess or educate, so at least in rural health settings where mothers might have an issue with getting to a medical facility we would provide home health assistance by going in at 3 weeks, 6 weeks and 3 months to not only help with any issues (i.e. latching, self care, etc) but also to assess the situation and get support available if needed. What we saw in the home was an invaluable tool to assess needs. I'm not sure if that's done outside of rural health or even if it's done at all. Again, not sure it would make a difference. I've seen psychosis and made the mistake of letting my guard down because the pt seemed normal and relaxed. It's amazing how quickly it can all change.

 

[BeginnerSleuther]

I wonder what the statistics are of mothers who murder their own children? I am aware of Andrea Yates. Diane Downs. Susan Smith. Lori Vallow. Now Lindsay Clancy.

I think it's wrong to lump those women together. Of the above, only Andrea Yates had PPP and now, reportedly Lindsay Clancy. The others were just criminals. It's not the same thing at all.

 

[BeginnerSleuther]

I was talking about post-natal care, not mental health care. By the time I left we were only doing 23 hours stays for most pts, barring any medical necessity. It didn't give us much ability to assess or educate, so at least in rural health settings where mothers might have an issue with getting to a medical facility we would provide home health assistance by going in at 3 weeks, 6 weeks and 3 months to not only help with any issues (i.e. latching, self care, etc) but also to assess the situation and get support available if needed. What we saw in the home was an invaluable tool to assess needs. I'm not sure if that's done outside of rural health or even if it's done at all. Again, not sure it would make a difference. I've seen psychosis and made the mistake of letting my guard down because the pt seemed normal and relaxed. It's amazing how quickly it can all change.

Oh sorry, I misunderstood.

 

[Ilex]

I wonder what the statistics are of mothers who murder their own children? I am aware of Andrea Yates. Diane Downs. Susan Smith. Lori Vallow. Now Lindsay Clancy.

The term for parents who murder their children is "fiacide". A study by Brown University says that parents murder their own children about 500 times per year. That's more than a murder per day. Fathers (57%) were slightly more likely to kill their own children than mothers. From the study:

"Close to three-quarters (72 percent) of the children killed were age 6 or younger. One-third were infants (children less than 1 year of age). Only about 10 percent of children killed were between ages 7 and 18.... Male children were more likely to be killed (58.3 percent) than female children. About 11 percent of victims were stepchildren...

Among offenders, while fathers were about equally likely to kill an infant, they were more likely to be the alleged murderer of children older than a year, especially when the children were adults (fathers were the offenders in 78.3 percent of those cases). Overall, fathers were the accused murderer 57.4 percent of the time.

The researchers found that the most common method of killing was with “personal weapons,” such as by the beating, choking, or drowning of victims. Parents used these means in 69 percent of murders of infants.

Analysis: 32 years of U.S. filicide arrests

Over the last three decades U.S. parents have committed filicide — the killing of one’s child — about 500 times every year. The horrifying instances are often poorly understood, but a recent study provides the first comprehensive statistical overview of the tragic phenomenon. The authors also...

news.brown.edu

Even for women suffering from PPP, only 4% of those who are untreated will murder their child.

Postpartum psychosis: Strategies to protect infant and mother from harm

Counsel at-risk women before delivery, and be alert for rapid symptom onset

www.mdedge.com

IMO it's why we are so shocked when something like this happens because it's so rare. When I went out and read up more last night about this I was shocked. Think about it, only 4% of untreated PPP mothers kill their children. Untreated. So how low is that percentage for mothers receiving treatment? My question is, are the treatment modalities making a difference? Are mothers who are receiving treatment less of a risk to themselves and their children?

 

[iamshadow21]

Even for women suffering from PPP, only 4% of those who are untreated will murder their child.

Postpartum psychosis: Strategies to protect infant and mother from harm

Counsel at-risk women before delivery, and be alert for rapid symptom onset

www.mdedge.com

IMO it's why we are so shocked when something like this happens because it's so rare. When I went out and read up more last night about this I was shocked. Think about it, only 4% of untreated PPP mothers kill their children. Untreated. So how low is that percentage for mothers receiving treatment? My question is, are the treatment modalities making a difference? Are mothers who are receiving treatment less of a risk to themselves and their children?

I though 4% sounded low until I realised that's one in twenty five. It's strange how just putting the same data in a different form makes it sound so much worse.

EDIT: I should say, this wasn't intended to comment on the mothers who endure this or the treatment programs that attempt to treat this, just that it's a terrible, terrible disease that causes pain and heartbreak to so many families.

 

[Ilex]

On a side note, I hope PC extends forgiveness to himself. I can't imagine how hard it must have been for him and to leave to pick up food and come back to this devastation. Along with the professionals working with Lindsay, I sincerely hope PC realizes he didn't do anything wrong and is able to forgive himself for any misguided guilt.

 

[BeginnerSleuther]

Even for women suffering from PPP, only 4% of those who are untreated will murder their child.

Postpartum psychosis: Strategies to protect infant and mother from harm

Counsel at-risk women before delivery, and be alert for rapid symptom onset

www.mdedge.com

IMO it's why we are so shocked when something like this happens because it's so rare. When I went out and read up more last night about this I was shocked. Think about it, only 4% of untreated PPP mothers kill their children. Untreated. So how low is that percentage for mothers receiving treatment? My question is, are the treatment modalities making a difference? Are mothers who are receiving treatment less of a risk to themselves and their children?

Yes. Women who receive treatment for PPP are at less risk. The highest risk is the untreated because they're suffering from acute psychosis. Inpatient hospitalization provides containment until symptoms improve. If the psychosis is treated effectively and/or they're in intensive outpatient treatment with daily check-ins, there's a safeguard and thus, less risk.

 

[Erutan]

I think Lindsay was fine when her husband left to get the meal, and the PPD or PPS kicked in suddenly and severely, overwhelming her and causing her to take those those lives.
I've had to do a 180 ∘ about this case.
My first thought was that Lindsay needed locking away for good ?

It's easy to condemn a person but without having experienced the PPD she was suffering, I can't judge.
There are posts here saying that Lindsay is also a victim.
Imo.

 

[Erutan]

On a side note, I hope PC extends forgiveness to himself. I can't imagine how hard it must have been for him and to leave to pick up food and come back to this devastation. Along with the professionals working with Lindsay, I sincerely hope PC realizes he didn't do anything wrong and is able to forgive himself for any misguided guilt.

I think he has been gracious to his wife in his grief !
If he can already forgive Lindsay and does not harbor anger, that's showing (imo) a family that had trouble but also a great deal of love.
Pretty amazing of him.

 

[annemc2]

Even so, I'm not sure it would have made any difference. The main point you made is right, she was receiving care and being evaluated by professionals who concluded she wasn't a risk to herself. Minus a crystal ball... We certainly don't want to start mandating inpatient treatment for every post-partum mother. I've thought for years that perhaps the reduction in the hospital stay isn't doing anyone any favors (try to do all you need to do with a pt in a 23 hour stay, it's brutal) but with PPP it can happen at any time within the first year so doubtful anything would be observed in even a few days of a stay.
Do they still do the program where a nurse goes in and rechecks the mother/child in the first few months? We did that in rural health facilities in the late 80's, but I'm not sure if that's still done. That gave us an opportunity to see how things were going in the home.

Way back in the 90s, I had a job (state-funded) where any at-risk mother/baby was flagged and I did screenings to see who needed/wanted to be followed with in-home case management. Our clinic was mostly recent immigrants with poor access to available services. I usually ended up staying longer with the teen moms and with those whose child(ren) had chronic medical conditions. The criteria were pretty loose so it was great to be able to offer services to just about anyone who wanted them. I'd drive all over a large metropolitan area to make visits and in some cases try and track down people whose charts came across my desk. Sometimes it was frustrating (and sad) but also very rewarding.

I myself got a nurse home visit when my 2nd child was (2009) born with meconium aspiration - I think it was maybe 48 hours after discharge. Everything was fine but my gosh, it was so reassuring to know that someone was just checking and making sure that we were okay. It just seems to make so much sense (ethically and likely financially in the long run) to have even a professional support person pop by, make sure everything is okay, and refer to services if needed. The US is so behind on this compared to many places, and our maternal morbidity/mortality rates are shockingly high.

 

[Cloudydiamond]

No, it wasn't. Mentally ill people who are more likely to be the VICTIMS of crime than perpetrators. Those of us who are not mentally ill should be thanking whatever god, faith, or whatever we believe in because it could just as easily have been us or our loved ones who suffered from these afflictions and we/they shouldn't have their civil rights stripped from them due society's ignorance of their illness.

Disagree to disagree.
"Many times individuals who really do require intensive psychiatric care find themselves homeless or more and more in prison," Sisti says. "Much of our mental health care now for individuals with serious mental illness has been shifted to correctional facilities."
https://www.npr.org/2017/11/30/5674...atric-hospitals-led-to-a-mental-health-crisis

 

[Keane]

I used to work for the healthcare system that MGH is a part of and if their insurance is still the same, it's self-funded, with 3 very affordable plans through Blue Cross Blue Shield of MA and Neighborhood Health Plan.

Assuming that Lindsay and family were covered under one of the MGH plans, in my opinion and in my experience as a former employee whose role dealt with the health insurance plans (trying not to doxx myself!), there would have been very little chance that the services provided to Lindsay were not covered.

 

[BeginnerSleuther]

Disagree to disagree.
"Many times individuals who really do require intensive psychiatric care find themselves homeless or more and more in prison," Sisti says. "Much of our mental health care now for individuals with serious mental illness has been shifted to correctional facilities."
https://www.npr.org/2017/11/30/5674...atric-hospitals-led-to-a-mental-health-crisis

I believe you may be misunderstanding the article you posted. That article is about the shortage of psychiatric hospital beds, which I fully 100% agree with. And yes, most people who need the help are unable to get it. But that has very, very little to do with deinstitutionalization, which was a policy that stated psych patients who were STABLE (as in did not need the help) could not legally be hospitalized against their will just because they had a mental illness. Institutionalization was about keeping them out of community and stripping them of their rights, even if they didn't need care because they were mentally ill.

You're arguing two different things.

From your article:
"State hospitals began to realize that individuals who were there probably could do well in the community," he tells Here & Now's Jeremy Hobson. "It was well-intended, but what I believe happened over the past 50 years is that there's been such an evaporation of psychiatric therapeutic spaces that now we lack a sufficient number of psychiatric beds."

Yes, I agree 100%. We need the beds for those who need care. But people who are not a danger to self or others should NOT be hospitalized against their will just because they have a mental health condition (which is what deinstitutionalization was about).