These are the facts that no one disputes: On January 24, 2023, Lindsay Clancy strangled her three young children to death, then she attempted suicide by cutting her wrists and neck and jumping out of a second-story window in her Massachusetts home, which left her paralyzed from the waist down. The point of contention, as her trial has progressed, is whether Clancy should be held criminally responsible for her actions.
Clancy has entered a plea of not guilty by reason of insanity. A jury will soon decide whether she was sufficiently mentally ill at the time of the murders to spare her a mandatory sentence of life without parole in a state prison. The problem for Clancy and her defense team is that although she appears to have been extremely sick in the months leading up to the tragedy, the jury may still find her legally sane. This is because the legal standard for insanity diverges from the clinical understanding of mental illness.
Insanity defenses, which are premised on the idea that people are not fully blameworthy for criminal acts that could be seen as outside their control, have existed since ancient Greece and Rome and have been a feature of jurisprudence for hundreds of years. The legal definition of guilt typically requires both action and intention, which means committing a crime while in a reckless, negligent, purposeful, or knowing state of mind. An insanity plea is premised on the assumption that people who are insane at the time of their crimes do not have the capacity for criminal intent, so they cannot be considered entirely guilty.
Christopher Slobogin, a professor of law and psychiatry at Vanderbilt Law School, told me that courts have applied different tests for establishing insanity over time, though none has overlapped fully with clinical descriptions of mental illness. In the Victorian era, courts seeking to determine whether a defendant could be excused from criminal liability by reason of insanity began relying on something called the M’Naghten rule, named for Daniel M’Naghten, a Scottish artisan whose paranoid delusions about a grand conspiracy moved him to shoot and kill a senior British civil servant in 1843. M’Naghten’s case inspired a rule that designated defendants legally insane if they did not understand the nature of their criminal acts or that their actions were wrong. This rule remains in use in roughly half of the United States.
[Norm Ornstein and Steve Leifman: Locking people up is no way to treat mental illness]
According to Michael Perlin, an attorney and a professor emeritus at New York Law School, the insanity defense became controversial in the United States after the acquittal of John Hinckley Jr., whose defense attorneys had argued that his attempted assassination of President Ronald Reagan in 1981 was a consequence of his schizophrenia and delusional obsession with the actress Jodie Foster, whom he wanted to impress. Outrage swiftly followed the 1982 verdict, stoked by politicians who called trial-jury members before a Senate subcommittee to interrogate them about their decision. Idaho’s legislature promptly eliminated the insanity defense that year, followed by Utah in 1983 and Kansas in 1995. Congress passed the Insanity Defense Reform Act in 1984, which narrowed the application of insanity defenses in federal cases.
In states that kept the insanity defense, views on how to apply it have continued to evolve. The closures of mental-health institutions across the country in the 1960s and ’70s increased the number of mentally ill people in the criminal-justice system, which created some urgency for establishing an adequate standard for legal insanity.
By defining insanity in terms of what a defendant knew at the time of the crime, the M’Naghten rule excluded defendants who had understood their conduct was wrong but nonetheless had been unable to resist or control their impulses. Some states addressed that limitation by expanding insanity defenses to include defendants who had acted under an irresistible impulse caused by mental illness or who had been otherwise unable to abide by the law. In Massachusetts, defendants may be found not criminally responsible if a mental illness left them unable to appreciate the wrongfulness of their conduct or unable to conform their conduct to the requirements of law.
In the months prior to what Clancy’s defense team has described as a psychotic break, she had repeatedly sought psychiatric help. She was briefly hospitalized and had prescriptions for 13 medications to treat her intense anxiety, depression, racing thoughts, insomnia, and confusion. Her lawyers have argued that she was suffering from postpartum psychosis, a psychiatric condition that occurs after 0.1 to 0.2 percent of deliveries in women who don’t have a history of mental illness. At the time of their death, her children were eight months to 5 years old.
According to Veerle Bergink, the director of Mount Sinai’s Women’s Mental Health Center, postpartum psychosis is an acute episode of psychosis, mania, or psychotic depression in the months following childbirth. Symptoms include severe mood disturbances, delusions, hallucinations, confusion, and catatonia, and patients generally lose touch with reality. Bergink told me that a woman may come to believe that all the wars in the world are her fault, or that her child is possessed by an evil spirit. Because mothers diagnosed with postpartum psychosis are at heightened risk of suicide and infanticide, the condition is considered a psychiatric emergency.
Clancy’s desperate diary entries dated from the days and weeks before the murders recount such symptoms. She described feeling “incredibly sad and guilty” about not breastfeeding and suffering from “crazy brain fog.” She wrote that she was living “moment to moment waiting for the next nap time,” terrified that her infant son was becoming overtired, “because I feel I can’t help him.” She admitted to contemplating suicide. “I feel like I’m drowning every day,” she wrote. She told medical staffers that she was suffering from “intrusive thoughts,” and she checked herself into a psychiatric hospital on New Year’s Eve and spent several days there before being discharged.
Clancy, her ex-husband, and their attorneys have filed a medical-malpractice lawsuit against the psychiatrists who treated her during the months she spent spiraling. But regardless of whether a timely and accurate diagnosis could have saved Clancy and her children, she was plainly suffering from severe mental illness at the time of her crimes. Still, the jury may deny her insanity plea because the clinical understanding of postpartum psychosis—like those of a host of disorders—does not fit squarely within the legal definition of insanity.
Massachusetts prosecutors have argued that Clancy acted rationally and with clear intent, noting that she seemed organized, reasonable, and communicative in the days leading up to the murders, according to witnesses. Clancy’s diary entries and help-seeking indicate that she knew that her desire to harm herself and others was wrong, yet on the day that she apparently intended to kill her children, Clancy asked her then-husband to run an errand that would keep him out of the house. But the symptoms of postpartum psychosis, like those of bipolar disorder and schizoaffective disorder, are known to involve sudden and dramatic fluctuations, meaning that Clancy’s moods and cognition could have changed rapidly in the run-up to the murders—in defiance of most legal tests of insanity.
Regardless of the evidence, judges and juries regularly treat such defenses with skepticism. Although lawyers present this defense in only 1 percent of felony cases, Perlin told me that many people assume insanity defenses are overused—and suspect that defendants who plead insanity are faking their illnesses. Some are certainly trying to sell a story, but studies have found evidence that defendants falsified mental illness in fewer than 10 percent of cases.
For this reason and others, claims of mental illness at trial can be a “double-edged sword,” Slobogin, the professor at Vanderbilt, told me. He explained that juries regularly treat evidence of insanity as a sign that a defendant is inherently dangerous, best managed by being locked away—or put to death. In 1995, Scott Panetti was put on trial for the 1992 murders of his in-laws in Texas and was allowed to represent himself despite his history of schizophrenia. Panetti conducted his trial defense in a cowboy outfit and attempted to call more than 200 witnesses, including the pope, John F. Kennedy, and Jesus Christ. Nevertheless, Panetti’s jury found him guilty and sentenced him to death.
[Elizabeth Bruenig: The dishonesty of true crime]
Panetti remained on death row until he died from natural causes in 2025, about two years after a U.S. District Court judge ruled that Panetti “lacks a rational understanding of the connection between his offense and his sentence of death and that his execution would therefore violate the Eighth Amendment’s prohibition on cruel and unusual punishment.” Yet his case and others have made defense attorneys wary of touting a client’s mental illness, even when it is overwhelmingly obvious and crucial to making sense of their crimes.
Another problem with an insanity plea is that many jurors are under the mistaken impression that the penalties for such verdicts are too soft. If Clancy is found guilty of murdering her children, she faces a mandatory sentence of life without parole. If she is found not criminally responsible, she will be admitted to a state psychiatric facility for observation, after which state officials can petition for her continued commitment, subject to periodic review. But this does not mean that Clancy will eventually be freed: Andrea Yates, a Texas mother who drowned her children while suffering from postpartum psychosis, was found not guilty by reason of insanity and remains in a state psychiatric facility to this day. (She received this verdict after a retrial was prompted by the discovery that the prosecution’s psychiatric expert had provided false testimony in her original trial.) Perlin told me that, in general, people who successfully plea insanity spend more time in state custody than if they had been found guilty.
Whether Clancy is committed to a psychiatric hospital or locked up in prison, her story is harrowing not only because of the abject horror of her actions, but also because of the eerie familiarity of her struggle with new motherhood. I can remember my earliest days with my second child—the restless hours, the boundless needs, the sudden doubling of diapers, the endless laundry rotation in our small apartment, the struggle to care for both a toddler and a newborn. But I also remember the sunshine, my daughter’s delight in her brand-new baby sister, the newborn’s tiny arms in a triumphant stretch fresh out of the swaddle, those first precious smiles.
Clancy’s illness caused her to drown in the overwhelming chaos of mothering, beyond the reach of such buoying joys. Although she survived her suicide attempt, her life was in many ways already over. Regardless of what the jury decides, she is already in hell, and has been for some time.
The post Lindsay Clancy Was Mentally Ill. But Was She Legally Insane? appeared first on The Atlantic.
