Lindsay Clancy and postpartum psychosis

The trial around Lindsay Clancy may be over for now, but it still leaves us with questions. On today’s episode, we talk to psychiatrists and patients to answer them: What is postpartum psychosis, exactly? Why don’t we know more about it? And what can you do if you are worried about a postpartum loved one? Interested in more stories on mental health? Email us your question at [email protected] mailto:[email protected]. Support public media with NPR+ and enjoy perks for over 25 podcasts like this one. This show’s perks include sponsor-free listening. Learn more at plus.npr.org http://plus.npr.org. See pcm.adswizz.com https://pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences. NPR Privacy Policy https://www.npr.org/about-npr/179878450/privacy-policy

• 0:00Speaker 00

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• 0:23Speaker 01

  Hey, Short Wavers. It's Nate Rott, here with doctor and freelance science journalist Angela Zong.

• 0:28Speaker 02

  Hey, Nate. It's good to be here. So I have been really deep in the weeds on this Lindsay Clancy trial.

• 0:35Speaker 01

  Oh, yes. I have heard about it. But honestly, Angela, I've been kind of trying to avoid it because as a newish parent, it's really sad to read about because she was being tried for the murder of her three children, right?

• 0:46Speaker 02

  Yeah, it's this really horrible situation. And at the center of the case is this question. Was she sane when she strangled her children in the basement?

• 0:54Speaker 03

  This was not a woman in the throes of psychosis on January 24th, 2023. This was a woman who acted intentionally, rationally, and swiftly to accomplish a very specific goal: to kill.

• 1:08Speaker 02

  Or was she, as her defense argued, too mentally ill to be found guilty of murder?

• 1:13Speaker 04

  This is a woman that did not get the medication, did not get the medical treatment that she so deserved. This is a woman that was suffering from psychosis.

• 1:30Speaker 02

  It was a pretty contentious trial. And now this whole thing is being dragged out, and mistrial was declared last Friday when the jury was unable to come to a unanimous decision.

• 1:40Speaker 01

  Yeah, and to be clear, Angela, in this whole case and trial, we're talking about postpartum psychosis here, not postpartum depression or the baby blues, both of which are like far more common, right?

• 1:50Speaker 02

  Yeah, you're right. Postpartum psychosis is different. After giving birth, parents will have these really huge mood swings, so much bigger than in the classic, quote, "baby blues" many parents might have. They might be really irritated, or they might even have tons of energy, unlike in postpartum depression.

• 2:06Speaker 01

  I mean, it almost sounds more like bipolar disorder to me.

• 2:08Speaker 02

  Yes, it's much more similar to bipolar disorder. Also, the parent's sense of reality changes. They can have hallucinations, paranoia, among other things, and they're at risk for harming themselves or their kids.

• 2:20Speaker 01

  Ugh, it's sad.

• 2:22Speaker 02

  It is really sad. But that's usually all people know because this condition is so under-researched. I learned a little bit about postpartum psychosis in medical school, but not much, which is surprising because it's not particularly rare. It happens around one or two out of every 1,000 births, which is almost the same prevalence as something like multiple sclerosis in the US.

• 2:42Speaker 01

  Oh, wow.

• 2:43Speaker 02

  But some experts were not surprised when I mentioned how little I knew, like Verle Behink. She's a psychiatrist and director of the Women's Mental Health Center at Mount Sinai. She says that when she started taking care of patients with postpartum psychosis over 20 years ago now, there was really nothing in the literature. Patients had so many questions, and she just couldn't answer them.

• 3:04Speaker 05

  Why did I get so sick? We didn't see this coming. And what triggered it? How long should I continue this medication? And can I safely have a second baby? Am I at risk for severe mental illness?

• 3:18Speaker 02

  So really good questions. And to be honest, the questions that I had, too. So we're going to try to answer some of those today.

• 3:25Speaker 01

  Awesome. Okay, so today on the show, we do a deep dive into postpartum psychosis. Why does it happen? How do we treat it? And why don't we know more about it? I'm Nate Rott, and you're listening to Short Wave from NPR.

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• 5:06Speaker 01

  So Angela, right off the rip, why does postpartum psychosis happen?

• 5:10Speaker 02

  Well, the short of it is, we don't totally know, and we'll get more into why later. But what we do know is that it can happen really suddenly, like in the first few weeks or even days after giving birth. You can compare that to postpartum depression, which tends to happen more slowly. We also know that people are more likely to get postpartum psychosis if they had bipolar already or had psychosis in a previous pregnancy. But Verle Behink, the psychiatrist we heard from earlier, she says that doesn't mean that others aren't at risk.

• 5:39Speaker 05

  It doesn't matter if you're old or young, you're rich or poor, or higher educated or not, or the color of your skin, what kind of personality you have. It can happen to everyone, to you, to me.

• 5:50Speaker 01

  Oh, and what do people who have experienced say it's like?

• 5:53Speaker 02

  At first, one person I talked to said that she felt fine, honestly, even great.

• 5:59Speaker 07

  After I gave birth, I felt incredible. I felt euphoric. I felt like the life of the party, like the funniest person in the group chat. Like, I was just like on top of the world.

• 6:10Speaker 02

  This is Ayana Lage. I talked to her while reporting the story. Ayana says that her husband noticed she was acting more animated than usual, but chalked it up to having just given birth. After all, they were first-time parents, and it's so hard to know what to expect after such a life-changing experience, as I'm sure you're aware, Nate.

• 6:28Speaker 01

  For sure. Uh-huh.

• 6:29Speaker 02

  But then she started to have these different, even scarier thoughts.

• 6:33Speaker 07

  I start to feel paranoid and think that no one is safe for my baby but me. Like, I can't trust anyone with her, no one can hold her, no one can feed her. I just want to be around her. And I just kind of had a thought of like, this is how moms feel toward their children. Like, it's supposed to be animalistic, it's supposed to be primal.

• 6:50Speaker 02

  And her husband started to get really worried about Ayana's behavior. She was lashing out at her family and being so protective of her baby in a way that just didn't seem normal. And then she started hearing voices.

• 7:02Speaker 07

  I heard what I called the voice of God and told my husband that we were going to start a church, that my daughter was Jesus, that I was a special prophet.

• 7:11Speaker 01

  Oh, wow. So things took a turn.

• 7:13Speaker 02

  Yeah. And before her pregnancy, Ayana was already seeing a psychiatrist for depression. So her husband called the psychiatrist, and they advised him to take her to the emergency room.

• 7:26Speaker 02

  By this point, her symptoms were so bad that she was seeing things that weren't there, she even thought that her daughter was a figment of her imagination. So Ayana ended up hospitalized for 17 days in a psychiatric ward.

• 7:42Speaker 01

  This just sounds like such an overwhelming experience, especially as a new parent where everything is a little overwhelming.

• 7:50Speaker 01

  Like, how do you treat postpartum psychosis if that's what you get diagnosed with?

• 7:54Speaker 02

  Well, the good news is, is that postpartum psychosis can actually be pretty easy to treat. We have great medications for it. Remember, it's similar to bipolar disorder. Here's Verle again.

• 8:06Speaker 05

  The best treatment is lithium, often combined with antipsychotics. And we see, you know, in some women, the psychotic and manic symptoms disappearing within days, others within weeks. So that is really optimistic message.

• 8:20Speaker 01

  Yeah, it is.

• 8:21Speaker 02

  Yeah, and getting better means that the parents can get back to bonding with and parenting their baby. Verle has actually studied this bond and what that means for the baby. She says that when the parent is treated successfully, their attachment to their child is the same as parents who didn't experience postpartum psychosis. And, good news, the kids grew up to do just fine.

• 8:40Speaker 01

  Ugh, that is a relief to hear. Is that what ended up happening with Ayana? Did she go on to have any more kids?

• 8:47Speaker 02

  Yeah, so thankfully, Ayana was treated successfully and recovered, although she says it probably took up to a year to feel totally herself again.

• 8:55Speaker 01

  Yeah.

• 8:55Speaker 02

  But she had another baby four years later.

• 8:58Speaker 07

  I'd prepared as much as I could mentally, but I also knew if this happens again, everyone in my life knows the warning signs. Like, they're watching me like a hawk. It will be caught within literal minutes if I start to act bizarrely or not like myself, and my psychiatrist will be, you know, on speed dial.

• 9:14Speaker 02

  And so with all of this, Ayana did well with her second baby and didn't have any psychosis.

• 9:18Speaker 01

  Oh, I'm so glad to hear that she was able to experience parenthood again without having that cloud over her. Sounds like she also had a really good team in her corner.

• 9:28Speaker 02

  Yeah, that's really important. In some ways, Ayana's case was the best-case scenario. She had an extremely attentive partner and family who sought medical attention as soon as they realized something was wrong. She had a pre-existing psychiatrist who actually called ahead to the hospital and prepared them for her arrival. Ayana is Black, and we know that Black women experience racism in medicine. But having people advocating for her, Ayana says that made a huge difference.

• 9:55Speaker 01

  I'm curious, what are some of the barriers to treating postpartum psychosis effectively? I mean, it sounds like not every case turns out as well as Ayana's did.

• 10:04Speaker 02

  Yeah, some barriers are around early and accurate diagnosis. Parents may not know about postpartum psychosis or know how to get help. And even if they do, they may not be able to see a mental health provider. They may not even want to because they're scared of being judged or separated from their baby. And patients with postpartum psychosis encounter doctors from all specialties, not just psychiatrists. So it's important that all types of doctors know more about it.

• 10:30Speaker 01

  OK, so if a parent does get to the doctor, they are diagnosed quickly, then are there still barriers?

• 10:37Speaker 02

  Unfortunately, so. Verily mentioned that lithium is one of the best treatments for postpartum psychosis. But there's been a big decline in lithium prescriptions for many reasons.

• 10:47Speaker 05

  Lithium is a very cheap treatment. It's the salt, so there is no money to be made there.

• 10:52Speaker 02

  Lithium can't be patented, so pharmaceutical companies aren't going to spend money to advertise it. So it usually gets looked over in favor of other newer drugs. And lithium can have a lot of side effects. So there's some issues with the medication. And then there's also issues with how we care for these patients in the hospital. We're verily trained in Europe. She took care of patients postpartum psychosis who could actually keep their baby with them under tight supervision. Here in the US, we don't really have those types of units.

• 11:19Speaker 05

  And that is a problem. If mothers cannot be admitted together with their baby, because as soon as they can, they want to go home. So they're doctors. They feel the pressure to treat them very fast. And what I see happening a lot that women get a lot of medication, like really in a few days, all kinds of combinations.

• 11:40Speaker 01

  Really?

• 11:41Speaker 02

  Yeah, so the parents really want to go home. And then our psychiatric system is overwhelmed. And so between all of that, sometimes the parents go home when they're safe but not totally better. And of course, the fear is they're still at risk for harming themselves or their baby.

• 11:55Speaker 01

  Yeah, like what we've been hearing about with the Lindsay Clancy trial in case.

• 11:58Speaker 02

  Mm hmm, exactly. And so what's so interesting about the Lindsay Clancy trial is that now a lot of people want to know more about postpartum psychosis.

• 12:07Speaker 05

  People are talking about it, and that is understandable because it's so horrible.

• 12:11Speaker 02

  But Verily thinks that some of the attention is harmful misinformation, too.

• 12:15Speaker 05

  We should also realize that it's really rare. Even in the US, with not good diagnostic system or care system, the actual risk of women actually, you know, harming their child, that is extremely rare. Unfortunately, the risk of women losing their own life is not so rare. And that happens a lot as well. But that doesn't make it into, you know, the front pages of the news.

• 12:42Speaker 01

  Ugh, that's hard to hear. But it's also interesting because this isn't the first time postpartum psychosis has really been in the limelight, right?

• 12:51Speaker 02

  Yeah, so that's another thing. The more I researched this case in postpartum depression, the more I was pulled into another trial from 25 years ago. In Texas in 2001, there was a similar case with a woman named Andrea Yates, who drowned her five kids in a bathtub at their home after months of hearing voices. And she thought doing so would save them from Satan. I brought this case up to Verily, and she pointed out that across all that time.

• 13:16Speaker 05

  There is no progress. There has been zero progress with regards to postpartum psychosis. It's scandalous.

• 13:22Speaker 02

  And, you know, it's maybe not surprising because there's still a huge stigma around mental health. A lot of people judge Lindsay and Andrea because they think it could never happen to them or someone they know. At the same time, there's also been no progress on how much we know about postpartum psychosis or even how many people are getting sick from it. Postpartum psychosis isn't even defined in the DSM-5.

• 13:44Speaker 01

  Which, for those of us that aren't doctors, is what?

• 13:47Speaker 02

  Yeah, so the DSM-5 is this psychiatric dictionary of sorts that helps people have a standardized definition. It helps you, you know, know what you're taking care of and know how to research it.

• 13:57Speaker 01

  OK, so Angela, what can we do about this going forward?

• 14:00Speaker 02

  Verily says that having a formal definition of postpartum psychosis would really help researchers. It could also help doctors make guidelines about how best to diagnose and treat it. She's hopeful that if we do this, we can make the same kind of progress we made of postpartum depression. So with postpartum depression, there's actually formal screening tools. And interesting fact, I actually used them a lot during my newborn visits when I was a pediatric resident. And I was able to get a lot of parents' mental health resources just by asking them the questions.

• 14:28Speaker 01

  Yeah.

• 14:29Speaker 02

  And so one lesson here is doctors should ask their patients about any symptoms of mania or psychosis.

• 14:34Speaker 01

  I mean, that's great if people can get care at the doctor or their doctor asks them questions about their psychological well-being. But what about, you know, like husbands, like me, or non-doctor friends or family? Is there anything that we can do to help people out?

• 14:48Speaker 02

  Yeah, so in some ways, the people that are around the parent are the most important ones you could pay attention to and support the postpartum parents in your life. If you notice that a new parent is acting just really different from their normal self, Verily recommends taking some extra precautions. So maybe you don't let the new parent be alone with themselves or the children. Or if you're really worried, like in Ayana's case, maybe you call their doctor or take them to the emergency room to get help.

• 15:12Speaker 01

  That is great advice, Angela. Thank you so much for talking to us about this trial and this case and this condition.

• 15:19Speaker 02

  Yeah, thanks, Nate, for having this really important conversation with me.

• 15:25Speaker 01

  This episode was produced by Aru Nayar and edited by Rebecca Ramirez. Tyler Jones checked the facts. Robert Rodriguez was the audio engineer. I'm Nate Rot. Thanks for listening to Short Wave from NPR.

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