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

[infinit]

Timeline of Duxbury killings: Prosecutor lays out case against Lindsay Clancy

Plymouth officials presented investigators' timeline of events at Lindsay Clancy's arraignment on Tuesday.

www.masslive.com

Timeline. It notes that Patrick said her wounds were no longer bleeding when he found her; I wonder if that means they weren’t as deep as she had wanted them to be. I don’t know how long it takes wounds to stop bleeding. I think she intended to die; I wonder why she couldn’t do it? Is it just that thing where you can’t make the psychological jump to end your life? Maybe throwing herself out the window was the thing that was her last chance?

Cedars raises a good point but another potential consideration - Just speculating but I wonder if the pain is a factor. Not saying those poor babies didn't suffer, but that's not something the person carrying out the act experiences. Cutting yourself hurts, if you want to do it particularly deeply it hurts - a lot. The actual act of jumping doesn't hurt, until you hit the ground, by which point it's out of your hands.

I have no statistics but I would expect a lot of people who manage to kill themselves via cutting have taken a substantial quantity of alcohol or other substance.

JMO.

 

[spicyrock]

I could really only see it if she was experiencing a psychotic break of the sort where delusions replace your reality and you end up in the hospital yelling about nazis psychically invading your mind and astral projecting into the bodies of the hospital staff. That’s what it looks like for me.

And it’s definitely worth remembering that extreme anxiety can cause psychosis, too. I’m not sure what that looks like.

Sadly though, to me she’s sounding lucid. Doesn’t mean she is! But so far I don’t see anything in those moments to suggest she’s not, except that she killed her children.

She’s not the only person to have done that, and usually parents who kill their children don’t get cut too much slack. I think we have a mental health crisis in this country and I think we have a childcare crisis too, and a criminal justice system that leaves a lot to be desired. I think many people commit crimes out of desperation. But I don’t think it’s right to say we’ll look at her differently than poor, marginalized mothers who do this. That bothers me. I can’t help it because I feel empathy with desperate mothers generally in this society. I think in a way it’s worse that she had so much help, if others had her level of support they might have made different choices.

I don’t know, I really don’t. I wouldn’t want to punish someone for having advantages. I just wish more people had them. She has so much support that I am minorly afraid to say these things.

I still feel for her. But those children break my heart.

 

[infinit]

I could really only see it if she was experiencing a psychotic break of the sort where delusions replace your reality and you end up in the hospital yelling about nazis psychically invading your mind and astral projecting into the bodies of the hospital staff. That’s what it looks like for me.

And it’s definitely worth remembering that extreme anxiety can cause psychosis, too. I’m not sure what that looks like.

Sadly though, to me she’s sounding lucid. Doesn’t mean she is! But so far I don’t see anything in those moments to suggest she’s not, except that she killed her children.

She’s not the only person to have done that, and usually parents who kill their children don’t get cut too much slack. I think we have a mental health crisis in this country and I think we have a childcare crisis too, and a criminal justice system that leaves a lot to be desired. I think many people commit crimes out of desperation. But I don’t think it’s right to say we’ll look at her differently than poor, marginalized mothers who do this. That bothers me. I can’t help it because I feel empathy with desperate mothers generally in this society. I think in a way it’s worse that she had so much help, if others had her level of support they might have made different choices.

I don’t know, I really don’t. I wouldn’t want to punish someone for having advantages. I just wish more people had them. She has so much support that I am minorly afraid to say these things.

I still feel for her. But those children break my heart.

I don't think it's an unfair viewpoint you're putting forward. The problem with mental health conditions unlike most physical health ones is you can't just run a scan or a blood test to definitively diagnose it. Hopefully that will change one day.

It's basically impossible without knowing having all her medical records and a detailed accounting of how she was acting in the lead up, subsequently and detailed sessions with her for even an experienced Psychiatrist to be able to give a qualified opinion of what she could have been suffering with, if anything at the time, and even then different ones might give different opinions so we have absolutely no hope.

I don't know about in the US so perhaps someone can explain it to me, but in the UK where I am from the bar for an insanity defence is you have to have had an abnormality of the mind so significant you either a) Didn't understand what you were doing or b) Didn't understand what you were doing was wrong. If you manage to meet that bar that's a very different proposition to say being poor (which has its own complexities.)

 

[Zella]

I don't know about in the US so perhaps someone can explain it to me, but in the UK where I am from the bar for an insanity defence is you have to have had an abnormality of the mind so significant you either a) Didn't understand what you were doing or b) Didn't understand what you were doing was wrong. If you manage to meet that bar that's a very different proposition to say being poor (which has its own complexities.)

It varies by state here, truthfully. Whether or not the person is capable of understanding what they did is wrong is often a key part of it, but you can still be substantially mentally ill and still not be able to meet the requirements of an insanity defense if you knew what you were doing was wrong. MOO

I've linked something that is a helpful overview of how it differs by jurisdiction here (though I'm not sure how current it is). It seems that MA follows the less restrictive model of determining insanity in defendants.

A Crime Of Insanity - Insanity On Trial | FRONTLINE | PBS

www.pbs.org

 

[rkendmar]

I don't think it's an unfair viewpoint you're putting forward. The problem with mental health conditions unlike most physical health ones is you can't just run a scan or a blood test to definitively diagnose it. Hopefully that will change one day.

It's basically impossible without knowing having all her medical records and a detailed accounting of how she was acting in the lead up, subsequently and detailed sessions with her for even an experienced Psychiatrist to be able to give a qualified opinion of what she could have been suffering with, if anything at the time, and even then different ones might give different opinions so we have absolutely no hope.

I don't know about in the US so perhaps someone can explain it to me, but in the UK where I am from the bar for an insanity defence is you have to have had an abnormality of the mind so significant you either a) Didn't understand what you were doing or b) Didn't understand what you were doing was wrong. If you manage to meet that bar that's a very different proposition to say being poor (which has its own complexities.)

In the UK, the availability of treatment and the legal view regarding infanticide is quite different from the US:
"The United Kingdom’s Infanticide Act of 1938, for example, limits the charge against a postpartum mother to manslaughter if the killing occurred while the mother’s mind “was disturbed by reason of her not having fully recovered from the effect of giving birth to the child.” In such a situation, a manslaughter charge could lead to life in prison. But in the past few decades almost all UK women convicted of infanticide are given hospital orders, probation, or supervision."

When Giving Birth Leads to Psychosis, Then to Infanticide

Mothers suffering from postpartum psychosis sometimes hurt or kill their children, but the law isn't sure how to separate illness from intent.

www.theatlantic.com

 

[BeginnerSleuther]

I'm not sure that's an apples to apples comparison. But for the sake of discussion, let's go with it. What does palliative care look like for a "terminal" mental health diagnosis? TIA

Per the medical literature:

Palliative Care in Severe and Persistent Mental Illness: A Systematic Review - PubMed

Severe and persistent mental illnesses refer to a group of psychiatric disorders causing severe dysfunction in patients and include diagnoses such as schizophrenia, bipolar disorder, and major depression. Patients with severe and persistent mental illnesses have a complex symptomatology and face...

pubmed.ncbi.nlm.nih.gov

Palliative psychiatry for severe persistent mental illness as a new approach to psychiatry? Definition, scope, benefits, and risks - BMC Psychiatry

Background As a significant proportion of patients receiving palliative care suffer from states of anxiety, depression, delirium, or other mental symptoms, psychiatry and palliative care already collaborate closely in the palliative care of medical conditions. Despite this well-established...

bmcpsychiatry.biomedcentral.com

Palliative psychiatry in a narrow and in a broad sense: A concept clarification - PubMed

Even with optimal treatment, some persons with severe and persistent mental illness do not achieve a level of mental health, psychosocial functioning and quality of life that is acceptable to them. With each unsuccessful treatment attempt, the probability of achieving symptom reduction declines...

pubmed.ncbi.nlm.nih.gov

And for people who may not have experience with palliative care in medical illness and the role of mental health experts:

Palliative Care Psychiatry: Update on an Emerging Dimension of Psychiatric Practice

Palliative care psychiatry is an emerging subspecialty field at the intersection of Palliative Medicine and Psychiatry. The discipline brings expertise in understanding the psychosocial dimensions of human experience to the care of dying patients and ...

www.ncbi.nlm.nih.gov

 

[spicyrock]

In the UK, the availability of treatment and the legal view regarding infanticide is quite different from the US:
"The United Kingdom’s Infanticide Act of 1938, for example, limits the charge against a postpartum mother to manslaughter if the killing occurred while the mother’s mind “was disturbed by reason of her not having fully recovered from the effect of giving birth to the child.” In such a situation, a manslaughter charge could lead to life in prison. But in the past few decades almost all UK women convicted of infanticide are given hospital orders, probation, or supervision."

When Giving Birth Leads to Psychosis, Then to Infanticide

Mothers suffering from postpartum psychosis sometimes hurt or kill their children, but the law isn't sure how to separate illness from intent.

www.theatlantic.com

I just read the article. I can get behind something like this- for postpartum psychosis. I don’t know what I would want it to look like. Probation and house orders feels too risky, risky to the patient too. But I can definitely get behind changing the way we look at postpartum psychosis and treat those crimes.

But- that’s psychosis. The women discussed in the article don’t really sound like LC’s case to me.

 

[BeginnerSleuther]

And it’s definitely worth remembering that extreme anxiety can cause psychosis, too. I’m not sure what that looks like.

No, anxiety doesn't cause psychosis. Anxiety can cause symptoms that look psychotic, but the person isn't actually psychotic.

 

[BeginnerSleuther]

RBBM
Respectfully, if you have no history of mental illness then suddenly having psychosis as you describe would be very rare in my unprofessional opinion. There are warning signs.

Psychosis isn’t a condition unto itself. It’s a symptom of an underlying health problem. While it’s most commonly a feature of a mental illness like schizophrenia, bipolar disorder, or major depression, psychosis can also be triggered by trauma, substance abuse, brain disease or injury, and even extreme sleep deprivation.
7 Warning Signs of a Psychotic Episode: EXIS Recovery Inc.: Substance Abuse and Trauma Treatment Facilities

JMO

You can have a quick switch like that, but that's usually not a psychotic disorder. That's usually psychotic symptoms due to substance use (THC in those under the age of 25), stroke, brain tumor, delirium, or some other acute medical problem. Psychotic symptoms that are psychiatric either are co-morbid as you said or they generally have a prodrome.

 

[spicyrock]

No, anxiety doesn't cause psychosis. Anxiety can cause symptoms that look psychotic, but the person isn't actually psychotic.

What is the difference between symptoms and state, as it relates to the mindset of a person committing a violent act?

I really appreciate your expertise, thank you.

 

[BeginnerSleuther]

What is the difference between symptoms and state, as it relates to the mindset of a person committing a violent act?

I really appreciate your expertise, thank you.

That's a good question. Let's take something like OCD (which used to be categorized under anxiety disorders until it got its own category). In OCD, one can have obsessions and compulsions. In some (most) cases, these obsessions and compulsions are caused by faulty beliefs. For instance, a belief that if they don't count backwards from 30 every night, they will die. Some may call that a delusion (which is a symptom of psychosis). By strict non-psychiatric definition, it may be a delusion. But the person isn't actually delusional. That's because a delusional person truly believes the delusion and has no insight into the fact that it's not real. Simply, they've lost touch with reality. The person with OCD is driven by anxiety, but at their core, they know their obsessional thought isn't true. It's the anxiety of "what if" that drives them to do it. That insight is very important because it's the lack of insight that makes psychotic disorders and truly psychotic symptoms so difficult to treat.

With regard to this case and someone committing a violent act, if your violent act is driven by anxiety, you really can't claim you didn't know what you were doing. Your insight should be preserved and while you may panic, you have not lost touch with right and wrong. Someone with anxiety killing the kids are doing it because they're anxious about the kids, not under the belief that the child is the devil sent here to kill the rest of the world, for example.

 

[spicyrock]

That's a good question. Let's take something like OCD (which used to be categorized under anxiety disorders until it got its own category). In OCD, one can have obsessions and compulsions. In some (most) cases, these obsessions and compulsions are caused by faulty beliefs. For instance, a belief that if they don't count backwards from 30 every night, they will die. Some may call that a delusion (which is a symptom of psychosis). By strict non-psychiatric definition, it may be a delusion. But the person isn't actually delusional. That's because a delusional person truly believes the delusion and has no insight into the fact that it's not real. Simply, they've lost touch with reality. The person with OCD is driven by anxiety, but at their core, they know their obsessional thought isn't true. It's the anxiety of "what if" that drives them to do it. That insight is very important because it's the lack of insight that makes psychotic disorders and truly psychotic symptoms so difficult to treat.

With regard to this case and someone committing a violent act, if your violent act is driven by anxiety, you really can't claim you didn't know what you were doing. Your insight should be preserved and while you may panic, you have not lost touch with right and wrong. Someone with anxiety killing the kids are doing it because they're anxious about the kids, not under the belief that the child is the devil sent here to kill the rest of the world, for example.

That makes sense to me and I appreciate your answer.

With LC, she said in the hospital that she had psychosis, and that has stuck with me bc I think of the adage widespread among some patients- if you think you’re psychotic, you’re not. Which may not be strictly accurate but, do you think a person could come out of psychosis so quickly?

Who knows if she was led to say that- but if she said it unprompted, would that demonstrate insight?

That’s my last question, I promise!

 

[BeginnerSleuther]

That makes sense to me and I appreciate your answer.

With LC, she said in the hospital that she had psychosis, and that has stuck with me bc I think of the adage widespread among some patients- if you think you’re psychotic, you’re not. Which may not be strictly accurate but, do you think a person could come out of psychosis so quickly?

Who knows if she was led to say that- but if she said it unprompted, would that demonstrate insight?

That’s my last question, I promise!

It depends. People who've been psychotic before may know they're starting to decompensate or may know after they start to improve. That's a good prognostic feature in schizophrenia, for example. Harder to say in LC's case. As for whether she came out of it or not, that's hard to say too without knowing what meds they gave her. Psychosis can improve in a few days in people with postpartum psychosis if they're on the right med (or if it's substance induced, if the substance is taken away). Depends on the cause and the medication used to treat it.

 

[Litig8r]

With LC, she said in the hospital that she had psychosis, and that has stuck with me bc I think of the adage widespread among some patients- if you think you’re psychotic, you’re not. Which may not be strictly accurate but, do you think a person could come out of psychosis so quickly?

I have been wondering about this as well. It seems rather convenient that she wasn’t psychotic just before the killings and is no longer psychotic right after. Who would actually say, “I had a touch of psychosis”? It just seems very coincidental to me. As a L&D RN she would surely be familiar with PPP.

 

[SpideySense]

No, anxiety doesn't cause psychosis. Anxiety can cause symptoms that look psychotic, but the person isn't actually psychotic.

This study appears to conclude that anxiety does cause psychosis in patients who have no comorbid psychotic disorders.

Evidence That Psychotic Symptoms Are Prevalent in Disorders of Anxiety and Depression, Impacting on Illness Onset, Risk, and Severity

From the study:

“BACKGROUND: It is commonly assumed that there are clear lines of demarcation between anxiety and depressive disorders on the one hand and psychosis on the other. Recent evidence, however, suggests that this principle may be in need of updating.”

“CONCLUSION: Copresence of psychotic symptomatology in disorders of anxiety and depression is common and a functionally and etiologically highly relevant feature, reinforcing the view that psychopathology is represented by a network of overlapping and reciprocally impacting dimensional liabilities.”

BBM

I guess my question to you as a physician is, what does a diagnosis of “Anxiety Disorder with Psychotic Features” mean?

 

[BeginnerSleuther]

This study appears to conclude that anxiety does cause psychosis in patients who have no comorbid psychotic disorders.

Evidence That Psychotic Symptoms Are Prevalent in Disorders of Anxiety and Depression, Impacting on Illness Onset, Risk, and Severity

From the study:

“BACKGROUND: It is commonly assumed that there are clear lines of demarcation between anxiety and depressive disorders on the one hand and psychosis on the other. Recent evidence, however, suggests that this principle may be in need of updating.”

“CONCLUSION: Copresence of psychotic symptomatology in disorders of anxiety and depression is common and a functionally and etiologically highly relevant feature, reinforcing the view that psychopathology is represented by a network of overlapping and reciprocally impacting dimensional liabilities.”

BBM

I guess my question to you as a physician is, what does a diagnosis of “Anxiety Disorder with Psychotic Features” mean?

There's no such thing as a diagnosis of anxiety disorder with psychotic features. It doesn't exist. Anxiety does not cause psychosis.

What you linked is talking about coPRESENCE. It doesn't say that anxiety caused psychosis. And if it did, I would refute the paper. Based on what we know about anxiety and psychosis, what is in all the major psychiatry textbooks and the DSM, and what is taught to medical students and psychiatry residents, there is no evidence that anxiety causes psychosis.

If LC tries this defense, she will probably lose before the trial starts because I can't imagine they'll find any psychiatrist to back up the claim that she became psychotic due to anxiety.

 

[spicyrock]

Family expressed concern about mother’s medication before prosecutor says she killed three children

Arguments at this week's arraignment made it clear that Lindsay Clancy's treatment for postpartum depression will play a role as she stands accused of killing her three children.

www.wbur.org

Her husband said she was addicted to benzos?

 

[SpideySense]

There's no such thing as a diagnosis of anxiety disorder with psychotic features. It doesn't exist. Anxiety does not cause psychosis.

What you linked is talking about coPRESENCE. It doesn't say that anxiety caused psychosis.

Maybe I’m not understanding how psychiatrists define these terms, or using “cause” incorrectly.

The study is saying that psychotic symptoms are prevalent in patients with anxiety and depression disorders who do not have co-morbid psychotic disorders, am I reading that right?

Per the study: “Individuals with a diagnosis of psychotic disorder at T2 or T3 (N = 21) or bipolar disorder (bipolar I or bipolar II) at any time point (N = 90) were excluded from analysis, as otherwise any differences between disorders of anxiety/depression with and without psychotic symptoms would be confounded by psychotic disorder.”

So, is it fair to say (instead of anxiety causes psychosis), people with anxiety disorders may experience psychotic symptoms without having a psychotic disorder or Bipolar disorder?

 

[BeginnerSleuther]

Maybe I’m getting not understanding how psychiatrists define these terms, or using “cause” incorrectly.

The study is saying that psychotic symptoms are prevalent in patients with anxiety and depression disorders who do not have co-morbid psychotic disorders, am I reading that right?

Per the study: “Individuals with a diagnosis of psychotic disorder at T2 or T3 (N = 21) or bipolar disorder (bipolar I or bipolar II) at any time point (N = 90) were excluded from analysis, as otherwise any differences between disorders of anxiety/depression with and without psychotic symptoms would be confounded by psychotic disorder.”

So, is it fair to say (instead of anxiety causes psychosis), people with anxiety disorders may experience psychotic symptoms without having a psychotic disorder or Bipolar disorder?

BBM. My professional opinion is that no, it isn't fair to draw that conclusion. But that is more accurate than previous post, though I still disagree with it. Based on what we know about anxiety disorders, they cause psychotic-like symptoms (as I was explaining with OCD), but I wouldn't really even call it psychotic symptoms because there are real differences between the perceptual disturbances in an anxiety disorder and true psychotic symptoms, primarily in detachment from reality and insight.

The biggest piece of evidence for that is that you don't treat the perceptual disturbance in anxiety disorders with an anti-psychotic medication.

 

[Zella]

Family expressed concern about mother’s medication before prosecutor says she killed three children

Arguments at this week's arraignment made it clear that Lindsay Clancy's treatment for postpartum depression will play a role as she stands accused of killing her three children.

www.wbur.org

Her husband said she was addicted to benzos?

Wondering if the RI hospitalization from last year was in October, based on how it's been clarified that she had been prescribed X number of medications from October to January. I'm still obsessed with determining the timeline of the hospital evaluations!