Warning: Graphic content The most frightening thing about postpartum psychosis may not be what it looks like from the outside, but how easily its warning signs can be missed. That distinction is under intense scrutiny as the trial of Massachusetts mother Lindsay Clancy nears its conclusion. Clancy has admitted to killing her three children but has pleaded not guilty by reason of insanity, with her defence arguing she was suffering from postpartum psychosis at the time. Prosecutors have argued the killings were deliberate. During his testimony for the defence on Wednesday, Paul Zeizel, a forensic psychologist, said Clancy did not appreciate “the wrongfulness of her act” due to her mental health issues. The defence argues that Zeizel’s testimony provides strong evidence for their argument that Clancy was experiencing bipolar disorder and postpartum psychosis. Sheila Cavanaugh, a hospital chaplain at Brigham and Women’s Hospital in Boston who previously treated the defendant, testified Thursday that Clancy told her she had heard a male voice instructing her to kill her children and then herself. Prosecutors questioned why Cavanaugh’s notes did not document those alleged auditory hallucinations. Postpartum depression, psychosis not the same: psychiatrist For Dr. Shimi Kang, a psychiatrist and clinical associate professor at the University of British Columbia, the case offers an opportunity to explain a condition that remains poorly understood. “Postpartum psychosis is a legitimate, but rare psychiatric condition that can affect about 0.1 per cent of women. Postpartum depression is much more commonly heard of. That’s about 10 per cent,” she told CTVNews.ca. She described postpartum psychosis as a condition that is “extremely dramatic and very serious, often leading to harm to self or children or others.” Kang says it’s important to distinguish that postpartum depression and postpartum psychosis are fundamentally different conditions. “Postpartum depression is what we call a ‘mood disorder.’ We see dysregulation of sleep, energy, motivation, focus, concentration, sadness, or irritable mood. Maybe suicidal thoughts.” Postpartum psychosis, she says, involves something much more profound: a loss of contact with the real world. “Postpartum psychosis is very different. It is defined by being out of touch with reality, often having delusions, hearing voices, seeing things, paranoid thoughts with no insight,” she said. “Eventually ... that person is living in a different world, convinced of certain things.” Kang pointed to the case of Andrea Yates, the Texas mother who killed her five children in 2001 and was found not guilty by reason of insanity, as a well-known example of the devastating consequences psychosis can have when delusions and hallucinations become overwhelming. Patient can still appear functional Kang says psychosis does not necessarily mean someone will immediately appear disconnected from reality. “There is a phenomenon called sealing-over, where they don’t tell people and they can look quite functional,” Kang said. That can create a dangerous gap between what a person is experiencing internally, and what family members, friends or even health professionals, see externally. Kang says some people experiencing psychosis may recognize that something is wrong, but hesitate to disclose what they are experiencing because they fear consequences, including having their children taken away. “They keep it to themselves, really depending on what the voices are telling them to do or what’s happening inside their mind.” What does Canada take from the case? Kang cautions against directly applying the events inside the Massachusetts courtroom to Canada, where health care and legal systems operate differently across provinces. But she says the broader lesson is relevant. In Canada, there is an absolute need for “more awareness for all mental-health conditions,” particularly those affecting postpartum women, such as psychosis, Kang says. She points out that the issue is highly complex and that the Canadian system “has been orphaned in many ways underserved for decades.” While the country is finally “seeing better resources,” she notes that “we have a long way to go.” For Canadians, Kang says that means recognizing postpartum mental illness as more than a private struggle, and understanding that some of its most serious symptoms may not always be visible. The Clancy trial may ultimately turn on a legal question about criminal responsibility. But, for families and health-care providers, Kang says the larger question is whether warning signs can be recognized before a psychiatric crisis becomes a tragedy. If you or someone you know is in crisis or struggling with mental illness, here are some resources that are available. Canada Suicide Crisis Helpline (Call or text 988 or visit 988.ca) Centre for Addiction and Mental Health (1-800-463-2338) Kids Help Phone (1-800-668-6868) If you need immediate assistance call 911 or go to the nearest hospital.
