The trial of American mother Lindsay Clancy, accused of killing her three children, has brought postpartum psychosis into the spotlight and raised the issue of its absence from the DSM-5. This was reported by Qazaqyia.kz citing BBC News.
A month before Clancy killed her children, she told her mother and then-husband that she had "thoughts of harming the children". Her mother, Paula Musgrove, testified this week that Lindsay would say: "This isn't me, I've never been like this before." Musgrove added: "And I would agree, because she wasn't."
Clancy is not disputing that she carried out the killings, but has pleaded not guilty to murder charges. Her defence argues that she was suffering from postpartum psychosis when she took her children's lives. Symptoms included hallucinations and delusions that began after the birth of her third child.
"She was unable to conform her behavior to the rule of law and she had no appreciation for the wrongfulness of her act," clinical and forensic psychologist Paul Zeizel said on the stand on Wednesday. Prosecutors, meanwhile, alleged she made a calculated decision to intentionally kill her children - Cora, five, Dawson, three, and Callan, who was eight months.
Postpartum psychosis, considered a medical emergency, can involve mania, depression, or a mixture of both. Patients also endure psychotic symptoms, such as hearing voices that aren't there. In rare, severe cases, they may harm or kill themselves or other people. Experts told the BBC it is among the most serious illnesses a woman can experience after giving birth, but it remains unclassified in medicine's encyclopaedia of psychiatry.
The illness is gaining more attention as Clancy's trial approaches the one-month mark, and has opened up a dialogue about mental health complications women can experience after giving birth. Postpartum psychosis often presents with mood symptoms such as irritability, mood swings, insomnia, and a delirium-like state, Susan Hatters-Friedman, forensic psychiatry professor at Case Western Reserve University, told the BBC. "Psychosis in general as a term means that the person's out of touch with reality, and that often includes hallucinations, hearing things, seeing things that aren't there, delusions, which are fixed false beliefs that are not consistent with your culture," Hatters-Friedman said.
Meghan Cliffel was eight months postpartum from the birth of her second daughter when she began hallucinating. It was a Friday in 2015, and she had just finished her workday in New York City. She became convinced that people were following her, that she was being recruited for a cult, and that the world - including her husband - was out to get her and her two daughters. Some 24 hours later, she was handcuffed to a gurney and taken to a psychiatric hospital. She would go on to spend the next 12 days there receiving treatment for postpartum psychosis.
Psychiatric symptoms, like the ones Cliffel experienced, can appear rapidly, Hatters-Friedman said. That is why it needs to be treated as a medical emergency, experts say. A person can be fine and then suddenly lose touch with reality. On the day Clancy killed her children, she played with them outside building a snowman, her former husband, Patrick Clancy, said. "She was having one of her best days," he told the court during the trial. Clancy had previously told her then-husband she was having thoughts of suicide or harming the children, but on that day everything seemed better, he testified. When evening came that January 2023, he went out to grab dinner for the family of five. When he returned, he found his children dead and Clancy injured from a suicide attempt.
That contrast demonstrates the light-switch - or waxing and waning effect - that can be postpartum psychosis, experts told the BBC. "A woman can appear fine one minute and be really ill a little bit later," said Jennifer Payne, a reproductive psychiatry expert at the University of Virginia. Experts say it's not entirely clear what causes postpartum psychosis. It could be related to hormonal changes and stress after giving birth, and there seems to be a link between previous mental health challenges and developing the illness while postpartum.
There is one major barrier standing in the way of awareness and better treatment of postpartum psychosis, experts and Cliffel agreed - it needs to be formally included in the Diagnostic and Statistical Manual of Mental Disorders, commonly referred to as the DSM-5. It's the mental health handbook published by the American Psychiatric Association. Veerle Bergink, a professor of psychiatry and the director of the Mount Sinai Women's Mental Health Center, is among the people working diligently to get postpartum psychosis included in the DSM-5. Without a mention there, the illness does not get discussed in medical school textbooks; students do not learn about it, and people do not talk about it much. Its addition is essential, she said. "You can only investigate and talk about the disease if you give the disease a name, and if it has criteria," Bergink said. "So you don't get research funded, there is no money, there is no care system, there is no insurance code." For people like Cliffel, who experienced the illness first-hand, the lack of mention in the DSM-5 is "bananas". "It feels like an erasure," she said. "I know how healing it is to have somebody finally name what you have."