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

[PriorTheCreator]

I had the exact same thought! Why a psychologist?!

The next thing that went through my mind was: These are competent attorneys, familiar with the psychiatric issues in this case. They must have read the record and determined that a psychiatrist is unlikely support their anticipated defense, whether it’s about psychosis or medications or PPD. So they’re bringing in a psychologist who’ll testify more like a “mental health professional” who’s just a glorified, tangential layperson on the medical side of things.

You would know better than me, but I’m assuming it would be more difficult to find a psychiatrist who would testify that LC’s treating psychiatrist was wrong in determining she didn’t have PPD, or wrong in prescribing the medications she was given. A psychologist might be a bit more inclined to testify from a medication-skeptical, “let me tell you about PPD,” squishy sort of place.

Maybe to try to confuse the jury?

 

[SpideySense]

Maybe to try to confuse the jury?

Yep, blur the lines.

 

[Zella]

On the subject of LC's background as a nurse in relation to suicide, Andrea Yates was also a registered nurse, and she had multiple failed suicide attempts.

I don't think it's a given that a background in nursing or medicine makes one's attempts at suicide more successful than the average person's despite them having better anatomical knowledge than the average person.

That being said, the timeline laid out in that hearing was chilling. I'd wondered since the story first emerged whose idea it was for him to get takeout, whether it was his or hers.

MOO

 

[iamshadow21]

What is the defense thinking??? This guy is a psychologist? Why would they hire a psychologist to speak about this?

For reference, a psychologist -- NOT a medical doctor and does not prescribe meds.

Psychiatrist -- medical doctor who prescribes.

The defense hired the wrong specialist, IMO.

Perhaps this is just the first of several experts the defense is going to hire. A psychologist would be more than qualified to comment on her state of mind, right now, I would think. But I am not a lawyer, or a psych of any flavour, so MOO.

 

[SpideySense]

I've said earlier in the thread there's a very high overlap between bipolar I and postpartum psychosis. But it's also important to note that many women who experience postpartum psychosis don't know they have bipolar I. The reason for this is that they may have never had a manic episode (a diagnostic criteria for bipolar I) prior. Some have no psych history at all. That's because psych disorders like this can present in women in their 20s and 30s and women who have babies are also generally in their 20s and 30s, so they may have never had symptoms of bipolar or psychosis before and then suddenly, the hormones shift after delivery and this emerges.

Without knowing more about Lindsay, it's impossible for us to know what her diagnoses were/are, what her meds were used for, or what was happening at the time of this incident.

My admittedly nonprofessional understanding of the relationship between onset of Bipolar I and postpartum psychosis is that it’s only associated with primiparity, or first pregnancy/childbirth. But maybe I’m misreading these studies:

Mood disorders and parity – A clue to the aetiology of the postpartum trigger
From this study: “The results of our study indicate that in women with BD-I, episodes of postpartum psychosis are associated with first pregnancies.”

Birth order and postpartum psychiatric disorders
From this study: “The highest risk was found in primiparous mothers 10-19 days postpartum [relative risk (RR) = 8.65; 95% confidence interval (CI): 6.89-10.85]. After the second birth, the highest risk was at 60-89 days postpartum (RR = 2.01; 95% CI: 1.52-2.65), and there was no increased risk after the third birth.”

Callan was LC’s third child, so these studies seem to indicate her case wouldn’t be one of first onset of Bipolar Disorder I and associated psychosis. But again, maybe I’m reading them incorrectly or missing something.

 

[SpideySense]

That's not an accurate assumption. There are a (not small) number of nurses, doctors, and EMTs who attempt suicide and don't succeed. I've treated them and in most cases, they actually did want to die. There's any number of reasons someone's suicide attempt can fail, especially if they're acutely psychotic.

Totally agree that taking my statement alone, i.e. a nurse would be able to complete suicide if she wanted to, is a gross overstatement.

My point was about ALL that facts of that day taken together, particularly about the discrepancy between her methodical killing of her children in contrast to what we know of her selected methods of suicide attempt, taking into account her medical training.

 

[BeginnerSleuther]

My admittedly nonprofessional understanding of the relationship between onset of Bipolar I and postpartum psychosis is that it’s only associated with primiparity, or first pregnancy/childbirth. But maybe I’m misreading these studies:

Mood disorders and parity – A clue to the aetiology of the postpartum trigger
From this study: “The results of our study indicate that in women with BD-I, episodes of postpartum psychosis are associated with first pregnancies.”

Birth order and postpartum psychiatric disorders
From this study: “The highest risk was found in primiparous mothers 10-19 days postpartum [relative risk (RR) = 8.65; 95% confidence interval (CI): 6.89-10.85]. After the second birth, the highest risk was at 60-89 days postpartum (RR = 2.01; 95% CI: 1.52-2.65), and there was no increased risk after the third birth.”

Callan was LC’s third child, so these studies seem to indicate her case wouldn’t be one of first onset of Bipolar Disorder I and associated psychosis. But again, maybe I’m reading them incorrectly or missing something.

You are less likely have to postpartum psychosis with second or third births if you didn't have them with your first, but less likely doesn't mean you won't.

"Interestingly, even though women with no history of perinatal mood episodes were less likely to have an episode in relation to the second pregnancy, 34% still developed a perinatal mood episode in the second perinatal period, which included 10% (22, 95% CI 4.0–16.2%) with affective psychosis and 24% (54, 95% CI 18.1–30.4%) with depression (Table 2)."

"We found in fact that, contrary to our expectations, the risk of having any form of perinatal recurrence was slightly higher in women with a history of non-psychotic perinatal depression than in those with a history of postpartum affective psychosis. Our results therefore emphasise the need in women with bipolar disorder to take into account all previous perinatal episodes, including depression and not to focus exclusively on the most severe episodes of illness. Although women with postpartum psychosis are at the highest risk of developing a further severe postpartum episode, women with bipolar disorder with a history of perinatal depression have in fact the highest rates of any form of recurrence."

"Although confirming the suspicion that these women were at lower risk, we found that the absence of mood episodes in or following the first pregnancy does not guarantee that women will not experience a perinatal episode of illness in relation to subsequent pregnancies. About a third of women will experience some form of perinatal episode in a second pregnancy even if they had no episode of illness following a first pregnancy."

Stratification of the risk of bipolar disorder recurrences in pregnancy and postpartum

Pregnancy and childbirth are a period of high risk for women with bipolar disorder and involve difficult decisions particularly about continuing or stopping medications.To explore what clinical predictors may help to individualise the risk of perinatal ...

www.ncbi.nlm.nih.gov

While I am not able to quickly find a study on third pregnancy, I will post if/when I have time to look later. But I can tell you that in clinical practice, any healthcare provider who doesn't account for the possibility that a woman with bipolar disorder will have postpartum psychosis (regardless of number of pregnancies and previous episodes) would very likely not win a malpractice suit as the standard of care is always to stratify the risk and I haven't yet seen anything that says "no risk" in these cases. With postpartum psychosis being so dangerous to both mom and baby, OBs and psychiatrists are trained to keep it in mind during exams and documentation. The patient should also be counseled on it during every single pregnancy AND during menopause as a similar hormonal shift can cause psychosis.

 

[BeginnerSleuther]

You would know better than me, but I’m assuming it would be more difficult to find a psychiatrist who would testify that LC’s treating psychiatrist was wrong in determining she didn’t have PPD, or wrong in prescribing the medications she was given. A psychologist might be a bit more inclined to testify from a medication-skeptical, “let me tell you about PPD,” squishy sort of place.

Hard to say without having access to the medical record. A psychiatrist certainly shouldn't lie, but depending on what the treating psychiatrist documented as symptoms at the time of LC's presentation (and McLean psychiatrists are some of the best in the world, IMO), they would be hard-pressed to find one. If the documentation is clear and did not show any psychotic symptoms, I don't see how a psychiatrist could say that, but I have no expert witness training besides what we get in residency.

 

[BeginnerSleuther]

Perhaps this is just the first of several experts the defense is going to hire. A psychologist would be more than qualified to comment on her state of mind, right now, I would think. But I am not a lawyer, or a psych of any flavour, so MOO.

I think it depends on what he does. Psychologists don't usually see people with acute psychosis. There are certain therapy modalities geared toward psychosis, but the patient generally has to be somewhat stable first as a patient with acute psychosis is usually too disorganized, delusional, and/or paranoid to engage. Definitely, a psychologist shouldn't be making inferences about her medications. While some psychologists will refer to psychiatry because they think a med is needed for a patient (and that's totally appropriate!), second-guessing a psychiatrist's medication regimen would awfully nervy considering they don't have experience prescribing and psychology training programs are somewhat inconsistent on the amount of medical background they get.

If a psychiatrist diagnosed, then you get a psychiatrist to refute the diagnosis. You always want a peer. It's the same for any specialty. If a surgeon did something wrong during surgery, you don't get an internal medicine doctor to testify to that. You get another surgeon.

 

[SpideySense]

But I can tell you that in clinical practice, any healthcare provider who doesn't account for the possibility that a woman with bipolar disorder will have postpartum psychosis (regardless of number of pregnancies and previous episodes) would very likely not win a malpractice suit as the standard of care is always to stratify the risk and I haven't yet seen anything that says "no risk" in these cases.

Maybe I misunderstood your post. I thought you were discussing LC as a possible case of first onset Bipolar Disorder I - postpartum psychosis, since we aren’t aware she has any prior history of BD. I thought your point was that this type of postpartum psychosis can strike out-of-the-blue in relation to BD onset being triggered by pregnancy/childbirth.

I would certainly agree with you that anyone with a pre-existing BD diagnosis is a different category altogether, and that every future pregnancy presents a risk for her and her child.

 

[spicyrock]

I feel like there’s something we’re not seeing. About getting the psychologist vs the psychiatrist. I keep thinking maybe they couldn’t. Could she have left a note? Maybe they couldn’t get a psychiatrist. Maybe she planned to kill herself, but she couldn’t fully do it.

Total, total speculation

Edit for typo

 

[BeginnerSleuther]

Maybe I misunderstood your post. I thought you were discussing LC as a possible case of first onset Bipolar Disorder I - postpartum psychosis, since we aren’t aware she has any prior history of BD. I thought your point was that this type of postpartum psychosis can strike out-of-the-blue in relation to BD onset being triggered by pregnancy/childbirth.

I would certainly agree with you that anyone with a pre-existing BD diagnosis is a different category altogether, and that every future pregnancy presents a risk for her and her child.

No, I'm not saying that pregnancy triggers bipolar onset. I'm saying the majority of cases of postpartum psychosis come from women who have bipolar disorder, but in some cases, the woman doesn't know she has it and/or has never had a documented manic or hypomanic episode so it was pretty much "evolving" in that case. So say we have a woman who has postpartum psychosis. She's never been diagnosed with bipolar disorder. But once she's stable, you do a full evaluation and she has had some hypomanic symptoms that were previously brushed off. Hypomania can look like a number of things, including personality disorders. Mania is more obvious, but can still go undiagnosed in some cases.

 

[Knox]

 

[spicyrock]

Another picture is starting to emerge in my head. A psychologist at least means the defense team doesn’t think psychiatry can help them rn. They’re trying to show something about her frame of mind, not her state of mind. So I start to think about a woman, a depressed and anxious but lucid woman, who is having anxiety about returning to work. Who spends a really nice day with her family and then ends their lives and tries to end her own.

I still have a picture of an insane woman in there, too. But the two images have definitely begun to compete.

 

[Zella]

about returning to work the next day

I'd missed this. So, was she scheduled to go into work for the first time since the hospitalization/treatment program on January 25th?

 

[spicyrock]

I'd missed this. So, was she scheduled to go into work for the first time since the hospitalization/treatment program on January 25th?

It’s actually phrased as the day before the killings she was anxious about returning to work. I’ll edit that.

Massachusetts mom was having ‘one of her best days’ before she allegedly strangled 3 children, husband told police

Prosecutors shared disturbing details of the killings at Lindsay Clancy's arraignment, where she appeared by video link.

www.nbcnews.com

 

[Zella]

It’s actually phrased as the day before the killings she was anxious about returning to work. I’ll edit that.

Massachusetts mom was having ‘one of her best days’ before she allegedly strangled 3 children, husband told police

Prosecutors shared disturbing details of the killings at Lindsay Clancy's arraignment, where she appeared by video link.

www.nbcnews.com

Thank you! That article had some stuff in it I'd not seen elsewhere, including the detail that she was hospitalized on New Year's Day specifically because she told her husband she was having thoughts about hurting the kids.

Edited: Also it seems like she'd had multiple evaluations at hospitals. "Last year," she was at one in Rhode Island that told her she didn't have postpartum depression and had generalized anxiety disorder instead. But the hospitalization New Year's Day was at a Massachusetts hospital and was this year a little over 3 weeks before she killed her children and tried to kill herself. I wonder if they agreed with the previous diagnosis or didn't and when she was evaluated in RI--was that in the spring or summer shortly after the youngest was born or was it later in the year and pretty close to the other hospitalization timeline-wise.

 

[iamshadow21]

Thank you! That article had some stuff in it I'd not seen elsewhere, including the detail that she was hospitalized on New Year's Day specifically because she told her husband she was having thoughts about hurting the kids.

Edited: Also it seems like she'd had multiple evaluations at hospitals. "Last year," she was at one in Rhode Island that told her she didn't have postpartum depression and had generalized anxiety disorder instead. But the hospitalization New Year's Day was at a Massachusetts hospital and was this year a little over 3 weeks before she killed her children and tried to kill herself. I wonder if they agreed with the previous diagnosis or didn't and when she was evaluated in RI--was that in the spring or summer shortly after the youngest was born or was it later in the year and pretty close to the other hospitalization timeline-wise.

So, she had homicidal thoughts in December, and told her husband, and sought treatment. That, to me, suggests she feared and tried to avoid this outcome.

 

[Zella]

So, she had homicidal thoughts in December, and told her husband, and sought treatment.

And depending on when the RI hospitalization was, she may well have been seeking treatment for months prior, even if that one wasn't specifically for concern about thinking about hurting the children.

 

[Tillyjames]

So, she had homicidal thoughts in December, and told her husband, and sought treatment. That, to me, suggests she feared and tried to avoid this outcome.

On New Year’s Day she had thoughts of harming kids and sought help! That’s a big deal. I wonder when she was discharged or details of that medically and her state of mind when she left.