The case of the mother who strangled her three children to death while her husband was away: A severe legal loophole regarding the ‘insanity defense’ has turned the case into absolute madness, leaving Lindsay Clancy at risk of becoming a victim in her own case.

The Lindsay Clancy trial has a really unusual twist that most people don’t know about. By the end of this video, you’ll understand this trial better than almost anyone else talking about it. First, the twist. Almost everywhere in America, if you claim insanity in your defense, you have to prove it.

 It’s your lawyer’s burden. But, in Massachusetts, it’s backwards. Once her defense raises it, the prosecution has to prove she was sane and beyond a reasonable doubt. That’s the highest bar in American law and it’s pointed at the state. If you haven’t followed the the case, here’s a quick 15-second recap. In January 2023 in Duxbury, Massachusetts, a 32-year-old labor and delivery nurse named Lindsay Clancy killed her three children and then tried to end her own life.

 She survived, but is paralyzed from the waist down. She admits she did it. Her lawyer says she was not in control of her mind. Her trial just started in July 2026 and is still ongoing. Three things I’m going to show you. One, the prosecution’s best evidence is that she checked how long her husband’s errand would take. I’ll show you why that might not decide anything.

 And there’s a clinical reason for that most people have never heard of. Two, more than 30 countries have a specific law for cases exactly like this. The United States has none. The reason goes back to a law from 1624 that presumed mothers were guilty of murder. Three, the screening test that nearly every new mother in America fills out cannot detect the illness at the center of this case. It was never built to.

And in between all this, there’s one warning sign that families miss both in new mothers and in aging parents for the exact same reason. So, if you’re caring for either one, that part alone is worth your time. Please send this video to someone else who needs to see it. I’m Neil K. Shah, a Johns Hopkins and NIH-funded caregiving researcher and the CEO of Caring IO.

I’ve helped thousands of families navigate aging, dementia, and serious illness. I’m not a clinician, but a leading researcher and innovator in caregiving. One more thing here before we start. Three children died here, Cora, Dawson, and Callan. Nothing here is a defense of that.

 This is about what the law is actually asking and what science can can and cannot tell us. So first, let’s talk about what is known. Lindsay Clancy was a maternity nurse. She was on leave from Massachusetts General Hospital, one of the best hospitals in the country. On January 24, 2023, her husband left to pick up food and a prescription.

 While he was gone, she killed their three children. Then she went out a second story window in a suicide attempt. She fell more than 20 ft. She lived, but she uses a wheelchair now. She has never said she didn’t do it. This is not a mystery about who did it. Her lawyer, Kevin Reddington, is arguing something the law calls lack of criminal responsibility.

 Most people just call it the insanity defense. The trial is in Plymouth Superior Court in front of Judge William Sullivan, and it just started in late July 2026. As I record this, there’s no verdict, but the law, the science, and the history I’m about to explain will give you real insights into into what’s going on here and why it’s so difficult.

First, Massachusetts doesn’t use the word insanity. It uses a test from a 1967 case called Commonwealth versus McCool. Picture two doors. The defense only has to go through one of them. Door one, at the time, did she lack the ability to understand what she was doing was wrong? Door two, even if she did understand it, that it was wrong, did she lack the ability to stop herself? So door one is about knowing, door two is about controlling, and they’re totally separate questions.

Almost every news story covers door one, but very few mention that door two exists, and I think door two is a big deal because most of America threw it out before. 40-something years ago, back in 1981, John Hinckley shot President Ronald Reagan. In 1982, a jury found him not guilty by reason of insanity.

 The entire country was absolutely furious. Two years later, Congress passed a law that deleted door two from all federal cases. A wave of states copied it within about two years. Four states, Kansas, Montana, Idaho, and Utah, even got rid of the insanity defense completely. But, Massachusetts kept both both doors. So, now look at the prosecution’s strongest evidence again.

 They say that she checked how long the husband’s errand would take. They say that proves planning and planning proves a working mind. But, here’s what I think almost nobody explains. In forensic psychiatry, there’s an idea sometimes called organized psychosis. A false belief sets the goal, but the ordinary machinery of the brain, like timing, sequence, and simple steps, can still keep running underneath it.

 Think about it like a car with a steering wheel that’s broken, but the engine’s still working fine. It still moves ahead and drives. It can still go fast. It just isn’t going where a healthy mind would want it to go. So, being able to just organize 20 minutes doesn’t prove she could stop herself. It’s a different legal question. Massachusetts law asks both.

That’s the first thing the coverage is is missing. Here’s the even bigger one. Most of us assume that if you claim insanity, you have to prove it. In federal court, that’s true. The defendant has to prove it. But, Massachusetts flips it. Once a defense shows enough evidence to raise a real question about mental illness, the burden of proof moves to the prosecution.

 The state then has to prove that she was in control beyond a reasonable doubt. Think about how hard that is. They have to prove beyond a reasonable doubt what was happening inside a person’s mind during a moment that nobody witnessed. Now, let me fix two things that almost everybody believes. First belief, people think that the insanity defense is a loophole that accused criminals use all the time.

 It isn’t. In a major eight-state study by Callahan and colleagues, it was raised in about 1% of felony cases and it succeeded in about a quarter of those. So, that’s roughly one in 400 cases. Second belief, being found not guilty by reason of insanity doesn’t mean you go home. It just doesn’t.

 In Massachusetts, that verdict sends you to a locked psychiatric hospital. There’s an evaluation period, then a 6-month order, then renewable 1-year orders. You get out only if a court decides you’re no longer mentally ill and you’re no longer dangerous. There’s no end date. Research has found that people found not guilty in this way are often locked up as long as or even longer than people who are convicted the regular way.

 Nobody just walks out. That’s not how it works. It’s just how television says it works. So, where did this whole idea come from? A shooting in London back in 1843. A Scottish woodworker named Daniel M’Naghten believed the British government was hunting him. He went to Whitehall to kill the Prime Minister Robert Peel. But, he shot the wrong man, Edward Drummond, Peel’s secretary.

 Drummond died 5 days later. M’Naghten was found not guilty by reason of insanity and the country lost its mind. Queen Victoria was especially angry and she had personal reason to be so. Someone had already shot at her. In 1840, a teenager named Edward Oxford fired at her carriage and he had also been found insane.

 So, Queen Victoria wrote to Peel, the Prime Minister, and demanded to know about this law. So, the House of Lords called in the judges of England and made them explain themselves. Their answers became the M’Naghten Rules. Those rules shaped the insanity defense across the English-speaking world for the next 150 years. Now, here’s the punchline.

Look what’s in those rules. Only door one, only whether the person knew it was wrong. The door two that exists in Massachusetts isn’t there. The part about did the person lack the ability to control themselves? One furious queen in 1843 helped set a legal test that most of the United States still uses today, but Massachusetts is one of the few places that decided that was too narrow.

Now, the medical part, and this is where I think the news coverage completely falls apart. People mix up three totally different things. One, the baby blues. Up to 80% of new mothers have this. Crying, mood swings, usually goes away in 2 weeks. Two, postpartum depression. 10 to 15% of mothers experience this.

 Deep sadness, exhaustion, no joy in anything. Three, postpartum psychosis. About one or two births out of 1,000. This is like an emergency. Things like false beliefs, hearing things, confusion, and it comes and goes hour by hour. A lot of new mothers get what are called intrusive thoughts. Sudden, awful flashes of something happening something bad happening to the baby.

 And the key part is normally those thoughts horrify the mother. They feel totally foreign, like they’re not even her own thoughts. Mothers who have them usually work extra hard to keep the baby safe because the thoughts scares them so much. That’s the common version, and it’s often treatable. It does not mean she’s dangerous.

But, in a psychotic episode, something can completely flip. The thought stops feeling foreign and starts feeling true. She stops fighting it. And in postpartum psychosis, it often shows up as a rescue idea. Not I want to hurt my child, but almost closer to thinking, I have to save my child from something worse.

Same kind of thought, but completely opposite relation to it. And from the outside, like in a text message or in a 15-minute appointment, those two states can look almost the same. Court testimony has established that in late 2022, Lindsay Clancy contacted a psychiatric provider about intrusive thoughts, brain fog, and bad anxiety.

She was told that intrusive thoughts are common in postpartum depression and anxiety. That is true. It’s genuinely true and usually the right thing to say. So, we can’t necessarily say that the provider did something wrong here. There may be lawsuits to settle that matter. But, what we can say is that this call is genuinely hard and the tools that we hand clinicians to make the call are worse than you’d guess.

The standard screening form used across America, like in maternity care, is the Edinburgh Postnatal Depression Scale. It’s a good form. It screens for depression. It does not screen for psychosis and it does not screen for bipolar disorder. That last one matters enormously because postpartum psychosis is closely tied to bipolar disorder.

 A landmark 2001 study by Jones and Craddock found something really startling. Among women with bipolar disorder who also had a close relative who had postpartum psychosis, the risk of them having it was about 74%. Think about how high that is. So, a woman can fill out her form, pass that test honestly, and still be sitting on the single biggest known risk factor for an illness that nobody has screened her for.

Now, I want to relate this to the caregivers watching. You know, the defining feature of postpartum psychosis is that it comes and goes. Someone can be perfectly clear at 2:00 in the afternoon and deeply confused by it at night, then clear again in the morning. If you’ve cared for an older adult, you may already have seen this pattern.

There it’s called delirium and it’s extremely common, especially in hospitalized older adults. It also gets missed constantly. And people miss it for one specific reason. They say, “She seemed fine an hour ago.” I think that sentence is a trap. In both of these conditions, the good hours are not proof that the person is okay.

 The coming and going is the illness. Being normal part of the time is a symptom, but it’s not reassurance. So, here’s what to actually do. And it works for a a new mother and for an 80-year-old facing delirium. Don’t just judge by one moment. Write things down over several days and write down the time. If someone is sharp in the morning and confused at night, that swing is what to report to the doctor, not just the good hours, not just the bad hours, but the on and off pattern.

And if someone tells you about a thought that frightens them, the most important question isn’t what the thought was, it’s whether it still frightens them. When a person stops being scared of a thought like that, get help immediately. That is the greatest moment of risk. Please share this part with others.

 Most people have never heard it, and I think it could be genuinely useful. Now to the part that the defense has built its case on. Over about 4 months, from roughly September 2022 to January 2023, Clancy was prescribed a long list of psychiatric medications, antidepressants, and antipsychotics, several anxiety medications, sleep medications, and older drug called a tricyclic.

The Boston Globe reported 13, a court filing said nine over slightly different window window, a TV analyst said 15. It’s hard to give a precise number because these sources disagree, but let’s estimate it at around a dozen different drugs over 4 months from several different prescribers. Really, I think the who matters more than the count of drugs itself.

 Court testimony describes outpatient providers, emergency room visits, and an inpatient stay at McLean Hospital with clinicians often unable to see each other’s records. That’s the failure at the center of this. Nobody seeing her was truly understanding the whole picture. Everyone was just seeing a piece of the puzzle.

The defense has two medical arguments, and let me give you both, and then also let me present the other side. One, akathisia. This is real. It’s a side effect usually from antipsychotics, sometimes from antidepressants. It’s not ordinary restlessness. It’s a severe physical inside your skin type agitations.

 Patients often describe it as unbearable, and it gets mistaken for anxiety all the time. Two, the mood switch. There’s a well-known worry that giving antidepressants to someone with undiagnosed bipolar disorder without a mood stabilizer can tip them into a manic or mixed state. No sleep, agitation, and sometimes even psychosis. Both of those are real things.

But now here’s the other side. The link between akathisia and violence is weaker than the internet claims. A 2021 review by Cal Nienus and colleagues looked at whether akathisia is linked to suicide behavior. They found only four usable studies. Two showed a weak link, two didn’t even support it. Their conclusion was that it can’t be reliably linked.

If the suicide link is that shaky, then the violence towards others link, which rests mostly on individual case reports, is even shakier. No psychiatric medication in America carries a warning about homicide, not one. Antidepressants carry warning added in 2004 and widened in 2007 about suicidal thinking in people under 25.

Ambien even got one in 2019 about sleepwalking and sleep driving. Anxiety medications got theirs updated in 2020. And proving that a drug caused one specific act in one specific person is close to impossible. To do it, you’d have to rule out the illness, but the illness is why the drug was prescribed in the first place.

 Usually, you can’t separate the two factors. So, what’s the scorecard here? That postpartum psychosis is real, dangerous, and badly under detected. That a dozen different medications from completely uncoordinated prescribers is just bad health care. The claim that akathisia causes violence, that’s weaker. And that any specific drug caused what happened that day, no one can know.

Which brings us to the evidence that I think has been read most strongly. Two days later, a psychiatrist examined Clancey in the intensive care unit. She had a breathing tube. She answered in writing. The exam reportedly find her alert, thinking in a straight line with no obvious signs of active psychosis. The prosecution has leaned on that hard.

“See, she wasn’t psychotic.” they say. Three problems here. First, what kind of exam it was? A bedside hospital consult usually answers a very narrow question. Is the patient safe? Can she agree to medical procedure? In her case, final surgery. Deciding whether someone can consent to an operation is completely different job from reconstructing her mind two days earlier.

Second, the coming and going problem, the exact thing we just covered. Being totally clear on Thursday tells you very little about the mental state on Tuesday in an illness that’s defined by its fluctuations. And third, this is barely discussed. Her body was not the same body. At the hospital, she had survived a fall of more than 20 ft, a spinal cord injury, heavy blood loss, and a cardiac arrest.

 She’d been given emergency trauma drugs, and her entire psychiatric medication routine had likely been stopped cold. So, whatever her brain chemistry was on January 24th, it was not that on January 26th. By the way, that’s not proof that she was psychotic, but it means that the exam at the hospital is weaker evidence than it’s been sold as in both directions.

Now the part I’ve been saving since the first minute. More than 30 countries have a specific law for the situation. England’s Infanticide Act, passed in 1922, widened in 1938, allows a charge more like manslaughter, you know, more than murder, when a mother’s mind was disturbed after childbirth. Canada has one.

 Australia, Ireland, around 21 other European countries have versions. The United States has nothing, not even one state. And the reason England passed theirs is really remarkable. Murder meant a mandatory death sentence. So, juries would just refuse to convict mothers. They’d let women go free rather than hang them.

 Judges would formally sentence a woman to death knowing full well the home secretary would cancel it within days. The judges themselves came to talk about this ritual with open disgust. No woman had actually been executed in England for a killing an infant since 1849. So, Parliament finally wrote a law to match what juries had already decided on their own.

If you go back in history further, it gets even darker. In 1624, England passed a law about bastard children. If an unmarried woman hid the death of her infant, she was presumed guilty of murder. She had to produce a witness to prove the baby was born dead. That’s the opposite of innocent until proven guilty.

 One of the few times in English law that it was ever flipped. Historians found prosecutions jumped about fourfold afterwards. And it stayed on the book on the books for nearly 200 years until 1803. So, for 400 years, the West has swung back and forth, presume these mothers are murderers, then write special laws to protect them.

 America is the one that never wrote a law. One more name because he deserves it. In 1858, a French doctor named Louis Victor Marcé wrote one of the first medical books devoted specifically to mental illness after childbirth. The International Society for Maternal Mental Health is named after him today. We’ve known this was an illness for more than a century and a half, which makes where we are now harder to defend.

 In the UK, France, and Australia, a mother in severe crisis after birth usually goes to a special unit where she and her baby are treated together. In the US, she goes to a regular adult psychiatric ward, and she’s separated from her baby. For an illness whose false beliefs usually center around the baby, that separation is its own kind of harm.

 We have almost none of those units here. And this isn’t rare. CDC review data shows mental health conditions, suicide, and an are a leading cause of pregnancy-related death in our country. In 2021, close to one in four. Two last things. The coverage of this case has been shaped by money. True crime rewards a simple story, monster or victim.

 Both sides get pushed into a cartoon. But a person can be seriously ill and also have done something unbearable. Those don’t cancel each other out. The legal question isn’t whether Lindsay Clancy is a good person. It’s narrow, technical, and about mental capacity. And look who gets the airtime. A study of 94,000 arrests across 32 years of FBI data found that fathers were the accused parent in about 57% of cases.

 Fathers killed their children slightly more often than mothers do. But you would never guess that from watching the TV news. There’s one more detail I can’t shake. Lindsay Clancy was a labor and delivery nurse. She spent her career inside the exact system that was supposed to catch this. And there’s a solid research study, a 2021 study in JAMA Psychiatry, finding that female nurses have roughly double the suicide risk of women in the general population, 17 per 100,000 against about nine.

So, the people who care for us most closely during our worst health moments are statistically amongst the least likely to be helped themselves. I started out by telling you the state has to prove that she was sane. So, picture that. A woman who spent years walking other mothers through their hardest hours of their lives, sending a message to say something was wrong in her head, and being told correctly and kindly that this is common.

And then the system that told her that had no way to see the whole chart, no form that screened for what she actually had, and nowhere to send her that would have actually kept her safe. Whatever that jury decides, that part isn’t going to be in dispute. If you know someone out there that is struggling, please remember 988.

 Call or text anytime. Postpartum Support International is a valuable service. 1-800-944-4773. The National Maternal Mental Health Hotline is free. 1-833-852-6262. It’s available 24/7. Please send this video to someone out there that’s caregiving right now and under a lot of stress. Whether it’s a new parent or someone caring for an aging parent, I think the lesson is the same for both.

I’m Neil K. Shah and let’s take care of each other. I’ll see you in the next one.