A Mother Charged with Killing Her Children: A Possible Explanation for the Unthinkable
A Mother Charged with Killing Her Children: A Possible Explanation for the Unthinkable
Q&A with a BMC nurse-midwife on the importance of recognizing and treating postpartum depression and psychosis
Editor’s note: On Friday, January 27, the third child in this incident, a 7-month old infant, also died, according to prosecutors.
To many people, it’s unthinkable. This week a Duxbury, Mass., mother allegedly killed two of her three children and seriously injured the third, a seven-month-old infant, then tried to kill herself by jumping out of a second-floor window.
People reacted to the tragedy with shock and grief, but many guessed a possible cause: postpartum psychosis, a rare and severe form of postpartum depression triggered by the massive hormonal changes experienced by new mothers.
No one knows if that’s what drove Lindsay Clancy, 32, who is in police custody in a Boston hospital, charged with strangling her five-year-old daughter and three-year-old son to death and injuring her seven-month-old son. But Clancy’s social media posts reportedly referenced postpartum issues after the birth of one of the older children.
“This is not the baby blues, this is a severe disease,” says Rosha Forman, an assistant professor of obstetrics and gynecology at the Aram V. Chobanian & Edward Avedisian School of Medicine and director of midwifery services at Boston Medical Center. “It’s very sad and very scary, and all we can do is try to keep close eyes on people and educate, educate, educate.”
In one more awful twist in the story, reportedly Clancy is a labor and delivery nurse at Massachusetts General Hospital and would have been familiar with the warning signs.
“What that would tell you is that nobody is immune, no matter how much education you have, no matter how much knowledge you have, these are things that are chemical,” Forman says. “But again, I don’t know what happened in this case.”
A midwife at BMC for 13 years, in her current role Forman sees 40 to 50 women a year through their pregnancy and beyond delivery. She says perhaps 20 percent have mild to moderate postpartum depression; she has seen only two patients with postpartum psychosis in her career.
We asked Forman about the causes, warning signs, and treatment of the condition. “I’m happy to use any opportunity to spread the word about postpartum depression and postpartum psychosis,” she says.
with Rosha Forman
BU Today: How does postpartum depression figure in your work?
Forman: Most of our care focuses on the care of the pregnant person through six weeks postpartum and beyond. And so a big part of our job is postpartum care and that transition to primary care. We do screenings for depression three times during the pregnancy and then at the two- and six-week postpartum visits, and mental health ends up being a lot of what we do. We do the screening and diagnosis, but not the therapy. And if we can build trusting relationships with our patients, which is our goal, and I think, our outcome, they’re more likely to disclose what they’re really truly feeling, and we’re more likely to be able to get them connected with the services that they need—psychiatric or behavioral health and mental health services.
BU Today: What causes postpartum depression?
Forman: The cause is multifactorial. I mean, like any disease, like cancer, you don’t know the exact cause. One thing that’s happening in the body is enormous: hormonal fluctuations that happen once the baby and the placenta leave the body. So estrogen and progesterone and testosterone levels—a lot of the hormones that control a lot of the reproductive life cycle—are flipping and flopping all over the place. That’s a higher risk factor for emotional and mental health. There are other risk factors that contribute: environmental exposures, lifestyle, those kinds of things.
It being your first baby is a risk factor for postpartum depression. Traumatic birth can be a risk factor for postpartum depression. Severe anemia can be a risk factor. So basically, if your physical body is not well and you’re coping with all of those changes, it’s more likely that your emotional state is not well. But there are plenty of people that have a traumatic birth or have an unhealthy body and don’t get depressed. It’s not causal, but it does increase your risk.
BU Today: How often do you see the far end of the spectrum, postpartum psychosis?
Forman: Not even once a year. Honestly, I have seen it in my career twice—neither one of which manifested in aggression towards their babies. But they manifested in hallucinations and hallucinatory thoughts, and they were both very striking in presentation. But I see postpartum depression a lot, you know. I think the statistics say, between 6 and 20 percent of people have postpartum depression. And I would say, I see closer to 20 percent.
BU Today: There’s a wide range of severity here?
Forman: It goes from “baby blues,” which almost everyone experiences, which is just feeling tearful, kind of crying at the commercials. You hear your favorite song, and the tears flow. That’s not so worrisome. That’s really more of a part of what should be expected with that hormonal transition. And then in the middle, you have kind of a more severe postpartum depression that doesn’t clear up after two to six weeks. And then postpartum psychosis is the end of that spectrum of postpartum mood disorders.
BU Today: The more serious forms respond to treatment?
Forman: It generally requires medication and hospitalization while they stabilize, but absolutely it can be treated. Being diagnosed is really important, because with all mental health disorders, the longer something goes on, the harder it is to right the ship. So I think that early recognition and diagnosis is really essential.
People will say, “I started to feel like something was off, but I knew she was super tired,” and maybe don’t recognize the signs that things are turning into a really bad space early enough. This is not to place any blame on their support. But that’s one of the reasons I wanted to talk about this. I say to people, if you feel like she’s just not her normal self or she really doesn’t have that regular sparkle in her eye, or she’s saying anything that makes you feel worried, don’t wait. Just give us a call.
BU Today: What else do you look for?
Forman: The largest risk factor for postpartum depression is a history of depression. If a person has had a history of depression prior to their pregnancy or during their pregnancy, it is really important to talk to your provider about that, to disclose that information, and for some people I’ve started them on SSRIs [selective serotonin reuptake inhibitors, a class of antidepressants] about a month before birth, in preparation for that postpartum depression episode to occur.
If you had postpartum depression with your first baby, you’re more likely to have it with your second and third, absolutely. And people who we’ve seen that have had a really tough time, we make sure they’re seeing behavioral health providers during their pregnancy, even if they’re like, “I’m fine now.” I’m like, “No, no, no, so you need someone you trust that you have on your speed dial, that you can call when you are not feeling well this next time.” And some people don’t get depressed again. It’s certainly not like a curse that you will always be depressed, but they are the people we keep our eyes on, more to make sure that we can preempt a severe depressive episode.
BU Today: How do you diagnose this?
Forman: We use a postnatal screening tool called the Edinburgh Postnatal Depression Scale. It’s a little bit better than the tool called the PHQ-9 [patient health questionnaire], because the PHQ-9 asks questions like, Are you tired all the time? And everyone’s like, yesss. And, are you sleeping well? Nooo. This one is a little bit more targeted. And there’s a range, depending on your score. You get like a mild, medium, or severe, and so we would target our intervention to sort of how worried we are about the person. If anybody discloses any suicidal or homicidal thoughts or intentions, we have emergency behavioral health services that we’ll call in and do a warm handoff. If we think someone is just a little down, but very clearly not suicidal or homicidal, we might be able to put in a referral for a visit within a week or something.
The mental health services in this country right now are kind of in crisis, and there is way more demand than there is access, and I think something like postpartum care often will get bumped up in terms of priority, because it’s such a time-specific event. But I don’t want to paint too glossy a picture on this topic. There’s too much demand for quite a small system. I think we need more. We need more mental healthcare providers. We probably need better pay for mental healthcare providers. We need more people who specialize in caring for perinatal mental health disorders, so people can really get these services in a timely fashion.
BU Today: Are there warning signs that mothers should be aware of?
Forman: The phrasing we use is, if you have any thoughts of hurting yourself or hurting anyone else or you have disinterest in caring for your baby. I think that’s one of the real warning signs that I see for severe postpartum depression or postpartum psychosis. If a mom is so depressed that she is not interested in caring for her baby anymore, that to me is a warning sign. Way before thoughts of harming the baby. We want to make sure to promote maternal-infant bonding. And if that is not happening, that is a real, real danger.
BU Today: What else should we know about?
Forman: One thing I didn’t mention that’s another piece of the spectrum is severe postpartum anxiety, which generally doesn’t lead into psychosis and hurting people, but can be very detrimental to health, and I think it’s probably underdiagnosed. The anxiety would be particularly about caring for your baby, keeping your baby safe, your baby breathing. It can get a little bit irrational. People can be not able to sleep because they need to watch their baby breathe. All the time. They don’t want anyone to touch their baby. We use the same interventions as depression. Anxiety is not a fun feeling, and it can get very intense in that postpartum period, when you are tasked with caring for the person you love more than anyone in the whole world. And they’re very vulnerable. And you have huge hormonal transitions, and you’ve never done this before. It’s a big deal.
If you or someone you know has thoughts of harming themselves, Call 988 or go to 988lifeline.org to chat with someone at the Suicide and Crisis Lifeline. Call 1-833-943-5746 (1-833-9-HELP4MOMS) to contact the National Maternal Mental Health Hotline.
I think this article only touches the surface. There is research on this going on in England that is very interesting and also speaks to potential that there are other issues that can make the mother at risk including premorbid presence of the bipolar although women can have it who have no prior history of bipolar. They also speak to cases of men displaying it. I think the real issue here is whether or not she had had treatment and support groups for it, did she have it with the other children or only with this one and did it sneak up on her. This is not only about educate, educate, educate. It is about screening for predisposition, follow-up, being as interested in the mothers’ health as the newborn’s health. It is also about the stigma related to psychosing symptoms which can scare a parent into not divulging that they are having psychotic episodes, nightmares and hallucination. She could fear losing her children, losing her job, especially given what she does for a living. We have no idea how much sleep this mother was getting given the age of the baby as well as the stress in managing the other children, not to mention any premorbid bipolar history. In England, one mother who had this was craving chocolate and fizzy drinks, psychosing and her husband found her hiding in the garage. He got her to the E.R. This is a tragedy; for the kids, the father AND the mother. We have no idea what her present mental health condition is, but if and when she realizes what she has done, the self judgment will be far worse than any court’s. https://www.youtube.com/watch?v=fA2ug9EDs3k
Thank you for presenting a very informative piece on this under discussed illness.
I hope it serves to help someone dealing with depression in their life
Thank you for increasing awareness through this excellent Q&A. As an opportunity to be more inclusive, could we use “they/them” pronouns and “mother” with “birthing person”?
This is a serious subject, and your first thoughts are use of pronouns? Really?
Thank you! My thoughts exactly!
Please let’s keep our eye on the ball here. Two children were murdered. The third child, a baby, is in critical condition. First responders from my hometown, and from surrounding towns where I have also resided, responded, and said, this is the worst thing they have ever seen. Our town manager was in tears on Wednesday night speaking about this. The world, and especially, my hometown is reeling from this sad, tragic news. Yes, it is important to use inclusive language. Maybe when we a further out from the night when this occurred, folks will be more cognizant of those chosen words. But for now, and at the speed at which people are being asked to respond to the news, please be gentle around issues of inclusion. Everyone will come around.
So erase women altogether? Great.
SSRIs caused me psychosis after the birth of my child I wonder if she was taking a SSRI?
She spoke of ppd and anxiety in her social media posts. She was in a PPD program at MGH. She was probably taking at least one psychiatric medication. I experienced psychosis from an anti-anxiety drug. I was given a high dose for sleep by an osteopath at the Merino Center in Cambridge, MA. On top of that I was then given two SSRIs. This prescribing of medication cocktails is rampant. I wish she would get a lawyer to pursue a wrongful death suit. She should be given a sentence of involuntary manslaughter, a functional medicine doctor, and a trauma informed therapist. That’s probably Utopia. She will go to prison and her son will grow up and find out what happened. All women need to get their hormones checked and all women need to learn about bio-identical hormones (not HRT). If you are a woman over 30 get your levels checked NOW. Find a functional medicine doctor and prepare for childbirth (if applicable), Perimenopause and menopause. Be very careful with meds. Many people have adverse reactions.
Exactly, I was going to say, it is a poor recommendation to give postpartum mothers if in fact she was already taking an antidepressant or antipsychotic that is linked to causing psychosis (as many are, especially if it was a first time use). Antipsychotics and antidepressants can cause otherwise perfectly normal individuals to commit some atrocious crimes and morbid suicide. Could be dangerous to use these drugs on postpartum women who already have an overload of certain hormones and brain chemicals (including seratonin)…
Thought article very informative. This Professional stated the facts, which we all need to hear & try to understand.
We may never have an answer to this tragedy, but we must have “COMPASSION” for this troubled Mother.
I have no doubt she loved her children to no end.
Something in her brain ( Chemically) went array very, very suddenly. . No matter the legal status, she will never have a reason to live a nl life. She will always want to be with her Children, when reality becomes real.
If it does. These two Parents need all the LOVE & CARE , that society can provide. . Please everyone be KIND, esp in this matter. Thank You
I was depressed during pregnancy. I was aware of it and there was no medicine. What helped? To sleep more and put myself first.
I had not been sleeping enough. I was sleeping at 11 or 12 PM and waking up before sunrise to get ready for the day. No naps during the day because I either was in school in my final year with projects to finish or I was already taking care of my kids and couldn’t step away because they would otherwise get in trouble.
Why didn’t I ask my spouse to give me a break? Sadly, he was not understanding. He thought I could shake it off. I still remember when he told me his sister told him that I “was not sick”. He would be busy working or in school too.
Family? Nope. Lived far from family, and when I lived close enough to get sporadic help, I was encouraged to live for my husband and the family and the house, so I knew I wouldn’t be understood.
Friends? Nope. Lived “happy” in front of others and thought that if I claimed I didn’t have it together, others would be shocked and judge me. I was afraid to be judged.
Thank goodness for the stress evaluation at the gynecologist which brought me a counselor. I was in great emotional pain.
I actually thought I wouldn’t make it until someone came for support, but I’m here to tell the story.
I would tell any mother to take care of herself first, to simplify, to give herself a break.
Thanks to the counselor that helped me, I am a lot stronger mentally and emotionally. I learned to train my thinking patterns so that I could be aware and do something about it.
I remember the first time I went to bed and just left everyone in the living room. My husband was with the kids, and for the first time, I let him figure it out.
I had a good night’s rest and was ready for the next day.
I have since learned to stand up for myself and my needs. A lot has happened, but depression is a topic I take seriously. You can’t just shake it off.
You have to learn to rewire your brain, and change your assumptions, and take care of yourself.
For me, that took tremendous courage.
After my 3 month break from MGH with my 1st son I was driving him to my father-in-laws so I could go to work I had a massive anxiety attack. My husband had to leave work and take me to Urgent Care and they started me on Ativan and Sertraline. It saved my life. Then we went on to have 2 more children , so I had 3 kids under 5. The pressure and thoughts that go threw a woman’s mind and body during the postpartum is frightening. I was fortunate that I delivered my kids at MGH and was set up wi the great aftercare when I had the last son. My postpartum went from baby blues to depression and anxiety for years. I was fortunate to be able to recognize it and have people around me that recognize it as well. This is such a sad and horrible outcome is so under diagnosed. Every woman actually have a child should be set up with behavioral health even if it’s just for a week or two. It should be part of the postpartum treatment during the six weeks. I understand that staffing is short but it’s so essential this woman 32 years old went to the darkest place, and it was preventable. Sometimes we can have all the support at home but it’s not the right support. You need to be around people that understand what you’re going through and the main thing is medication. support groups are great but with very intensive postpartum depression there’s no support group in the world that’s gonna get you through that.
I like many women suffered from PPD. I actually suffered for years with Pms mood swings and when I got pregnant I felt like I had Pms through the whole pregnancy. It was horrible. I did bring my concerns during my pregnancy and was told due to my mental state to take medication. I took one pill and felt I just had to try without medication as I felt the medicine would harm the baby so I stopped. After my baby was born it was worse so I decided to take the advice of the doctors and try Zoloft . This is where the horror began . Starting the medication after a few days I became emotionless . I had intrusive thoughts of harm . I would struggle with these thoughts because that was no way in hell I thought . I can’t even put into words this was over 20 years ago . Those thoughts were scary like an urge . I immediately stopped the medication went bank to my regular PPD and I was ok with it dealt with it . That Zoloft was evil. I wonder if she was put on medication . My heart breaks for the whole family