The After Show: The Lindsay Clancy Trial

0:00This is the way. Hi, I'm John Favreau. We are launching the all-new Star Wars, the Mandalorian and Grogu official podcast. I'm sorry, I can't focus at the moment. We're going behind the scenes, but the cast and crew sharing stories from the set, creative insights, and a few surprises from across the galaxy. I think he's earned a little snack. Watch and listen to Star Wars, the Mandalorian and Grogu official podcast, now streaming on Disney Plus or wherever you get your podcasts, and catch Star Wars, the Mandalorian and Grogu now streaming on Disney Plus, terms apply. Hi everybody and welcome to 2020 The After Show. I'm Debra Roberts and as always, I'm so glad you're with us today. Those of you who follow us know that normally we take you behind the scenes and inside our latest 2020 episode that aired the Friday before. Today we're going to take a little turn and take a look at a story that has just captivated this country, grabbing headlines everywhere. One that is sparking lots of social media debate and you know this case, it is the one of

1:03Lindsey Clancy. You have no doubt heard about this excruciatingly tragic case. 36 year old Clancy is accused of the unthinkable, killing her three young children, five year old Korra, three year old Dawson, and her eight month old infant son, Callan. She also tried to take her own life on that day and this past August, she pleaded not guilty. We've watched emotional moments in the courtroom, including Clancy sobbing as medical examiners and doctors testified about her children's death. We've also seen hundreds of women rallying outside the courtroom, standing in solidarity with this mom, arguing that it is a failure of the medical system that she was struggling with her mental health. This trial has captured the public's attention, as I said, raising questions about the prosecution of mothers with mental illness and putting a spotlight on a lesser known mental health condition known as postpartum psychosis.

2:04Now Lindsey's defense does not refute that she killed her children. That's so important here, but they do argue that she should not be held criminally responsible. The prosecution in this case is arguing that she was fully aware of her actions, methodically planning and carrying out these murders. So the big question is how to process these conflicting assessments of this case. Joining us now to help answer big questions about this case and also to understand more about mental illness, particularly amongst new mothers, is a friend of our show, Emergency Room Psychiatrist Dr. Aja was small as Monty. Dr. Monty, good to have you. As always, thank you. You often bring such clarity to us when we talk about these cases and whether you've actually worked on them or not when it comes to stories. And in this case, we should make it very clear you had no dealings with this case. You had no connection to Lindsey Clancy. You have not treated her, observed her, but clearly you know a lot about moms dealing

3:07with mental health crisis after they've had children. So let's talk about what it's like for you to even just watch this case. I mean, is it sort of unfolded over the last couple of years? It is gut wrenching what happened. Not only are three children gone, a father has lost his children, a mother has lost her children, and a woman is also harmed and paralyzed. That is so hard for me to see, especially when there are so many discussions on mental health in this case, but it truly is a tragedy. And I think we just all want to understand what is happening and what can we all do better to prevent things like this from happening again. And we want to talk to you about that. I remember, I mean, so many of us who are old enough remember the case of Andrea Yates in 2001. That's immediately what came to mind when I heard about this case, tragically a woman who drowned her five children in the bathtub and said that she was suffering from a mental

4:09health crisis and voices were in her head. Her conviction, she was actually convicted of capital murder in the very beginning, and then her conviction was overturned. She was found not guilty by reason of insanity, and she remains in a mental health facility. Let's talk a big, that's what could possibly happen in this case. Lindsay could actually wind up going to prison for the rest of her life, or she could also be committed to a mental health facility. When we talk about postpartum psychosis, we know about postpartum depression, we know about anxiety, we know about all kinds of issues that new moms deal with. What is postpartum psychosis all about? So we're looking at two things. We're looking at psychosis in the postpartum time. So let's first talk about psychosis. With psychosis, you have a loss of touch with reality. So that loss of touch with reality can be due to delusions. Those are odd thoughts that you're having, things that are not true, but you believe

5:10it's true, even when that anyone tells you that this is happening, that your thinking is happening cannot happen. But with psychosis, you can also have hallucinations, whether you're hearing things or seeing things that aren't there. In her case, she said she was hearing voices. Very, very common in psychosis. And people can also have disorganized thought. Like they're not clear, and that disorganized thought can also make their behaviors just not seem put together. They can do odd things. So when you have all three of those, or even two of them, that is what we're calling psychosis. And then to have postpartum psychosis, we're usually talking about 12 weeks after a pregnancy. And when I say pregnancy, that can include whether you had a live birth, or even if you had a still birth or a miscarriage, you can have postpartum psychosis happen in those instances as well. That's what the postpartum psychosis is relatively rare. It's about one to two women experience it out of a thousand live births.

6:12So it is rare. It is pretty rare. So we don't see it often. I've seen it a few times in my practice, in my career. But it is still something that now we have more heightened awareness of because of this. Is this typically, does this typically happen amongst women who have already had some kind of mental health struggles, or is it just triggered by a childbirth? So for many women, they do have a history of having a bipolar disorder or a psychotic disorder before. But for 50% of people that have postpartum psychosis, that can be their first manifestation of a bipolar disorder that they might have for the rest of their life, or any psychotic disorder, or even a depression with psychosis. So while definitely having a mental health disorder can raise your susceptibility to this happening because pregnancy is a very stressful time for your body. You're having a lot of hormone changes. Hormoneal spikes changes happen.

7:13Yes. Definitely, this can be the first occurrence for somebody and their mental health. When talking about someone like Lindsey Clancy, three children, and by all accounts, people said that she's a nurse. She seemed to love her children. Help us understand how someone could love their children, but yet do something that is just so unthinkable. So unthinkable. And when I see patients that mention that they want to hurt themselves, or that they're even having the urge to hurt somebody else, what I often hear is that they have to do that in order to protect themselves, or to protect whoever that they think that they have to hurt. Some might say they're imposterous, they're aliens, they're spies that are after them, and that's the only way that they can protect themselves. And so while it is unimaginable that someone could hurt someone that they love, sometimes it's because they don't recognize a person as being someone that they really know and love,

8:16or they think they are killing somebody out of benevolence. They're not even thinking in that rational way you would think. Well, one of the most devastating moments in this trial was one that I think a lot of people clued in on was when the hospital chaplain testified that Lindsey Clancy said she allegedly heard a voice that told her to kill her children, and then she said now they were safe. She felt she was making her children safe by taking their lives. As a psychiatrist, how do you react to that? Is that something you've heard before? It is. And that's the very scary thing for anyone to hear, but unfortunately in my line of work in the emergency room, I have encountered people that have heard other people, but they thought they were doing it to protect that other person or to protect themselves because the other person was at the right. And so that is the psychosis. You're not in touch with reality. You don't really recognize what's going on. Your mind is playing tricks on you.

9:18The one thing that so many people feel that this is, this case is highlighting is not only the mental health crises, but the medicines that people are taking, the medications. Clancy, by all accounts, had been having problems for a while. Her husband had even talked about that and testified. She has sought help from a number of therapists, and many of them had been telehealth visits that she had had. She had been taking a number of medications, even sought help at a psychiatric hospital. What we like to hear with regards to anyone that's experiencing a mental health disorder is that they are willing to go and get help. And so that's the good thing, but there are so many other things that we're learning about going to see a number of different providers going to taking a lot of different medications. And sometimes when there are too many cooks in the kitchen, sometimes things can get a little bit jumbled. One person doesn't know what another doctor has prescribed. You might be prescribed one medication from a doctor and then get another medication that

10:22can actually exacerbate a condition that you have and are you disclosing everything that you're experiencing to your doctor. The one thing about psychiatry that makes it a little bit more difficult in other fields of medicine and making a diagnosis is a lot of it is relying on the report of the patient. Or somebody close to them. There's not too many blood tests that are going to give us obvious answers. And so we really rely on that disclosure on everything that's happening, but seeing you over a course of time so that we can really see our behaviors and understand what's happening. And if someone is going and seeing a lot of doctors, it makes it harder for one person to get the whole picture. So whenever people are seeking psychiatric care, we really implore them to stick with one provider unless you have a very clear plan of transitioning to somebody else or at least two providers are talking about what is happening so things don't get confused. Many see this as a symptom of a broken system.

11:24I mean, people are pointing to the fact that she was crying for help and it's seen multiple experts and sought help many times. I mean, do you see it as a system that is broken? I do want to acknowledge that there are many parts of the health care system that is broken. I don't want to say whether this in this case the system was broken because we do understand that there were many opportunities to get help, but the confusion, the hard part is if that care is fragmented. And whether it's fragmented from the patient going around to a lot of people or even as doctors, sometimes we're saying see that specialist, that specialist, that specialist, but you need one person looking at the picture completely. Another complicating factor here is that if you're taking a lot of medications, are you taking them for the full course that you're supposed to take? If you're not taking it all the time consistently, then you're not possibly getting the benefit. And one thing that a lot of patients actually do is they might supplement the medications

12:27that we're getting them with over the counter supplements, even with recreational drugs. And all those things can come into play and interact with how, with someone's mental health. And so I don't want to say that the, in this case, the system was broken, but I do think it points out that fragmented care is not optimal. Which is why I think it has captivated so many people. There's a lot of talk about this case out there online, particularly on social media, which is one of the reasons this case, I think, is just captivated so many people. And there's a lot more for us to talk about, so don't go anywhere. We're going to take a quick break. When we come back, we're going to talk to Dr. Smalls Monti, and weigh in on what is being said out there, so don't go anywhere. Today I want to tell you about an exciting new deal from our friends at Cozy Earth. Take a moment and close your eyes, and think back to the best night of sleep you ever

13:29had. Did it feel like you'd never sleep that well again? Well, good news. You can give yourself an amazing night of sleep every night by upgrading your bedding to Cozy Earth. Cozy Earth offers luxury bedding at an incredible price. Their ultra soft, temperature-regulating sheets, coverlets, and duvet covers are the perfect companion for a night of uninterrupted relaxation. Their sheets come in all different colors and stripes, so there's something for everyone, whether you're doing a big fall refresh of your master bedroom, or updating a guest room in time for the holidays. And as comfy as they are on day one, they only get better from there, because they're designed to get softer with every wash. Best of all, with our limited time deal, the already great prices are even better. You can get 50% off of a wide assortment of bedding options by going to our unique link. That's right, 50% off. But hurry, this deal is only for a very limited time. Get yourself the bedding of your dreams. Right now, go to abcsecretsavings.com slash 2020 for 50% off the best bedding you'll ever sleep on. That's abcsecretsavings.com slash 2020.

14:31I want to hire a private investigator. Some folks in the best. ABC September 15, TV's hottest PI is back. Are you sure you're ready to take on a serial killer? It's like a dozen more likely explanations other than serial killer. All right, maybe none of it does. The main Florida crime has no offseason. I just heard you were shot at today with a rocket launcher. Well missed. RJ Decker from R.J. Tuesday, September 15, 109th Central, next day on Hulu. Welcome back to 2020 The After Show. I am sitting with Dr. Small's Montet discussing the case of Lindsey Clancy. So Dr. Montet, let's talk about postpartum psychosis. Folks on TikTok are talking about it. And women are relating to Clancy because they feel like they really understand what women suffer with. Armchair, shrinks, diagnosing her coming up with their own theories.

15:34How can all of this conversation and speculation impact not just what people are thinking about this trial, but also going forward just the conversation around mental health? It certainly is bringing maternal mental health to the forefront of the conversation to our thought. I think in the past 20 years, but definitely in the past 10 years, people have been talking about mental health. But in the past few years, we've heard more women talking about their postpartum struggles. And I think that's very important. It's so hard to say that another person should have seen the signs. We should have been able to recognize because psychosis can happen just like that. So I really think that we have to be aware you cannot blame other people for what has happened. In some ways, this case has been a case of dual-linked experts. We've heard from medical experts throughout this trial talking about Clancy's situation about the medicines that she was taking.

16:34According to court records, she was prescribed medications for anxiety and insomnia, mood stabilization. There were times where supposedly she had not slept in 24 hours or 48 hours because of what she was dealing with. Prosecutors argue that Clancy jumped between medical providers and medications. They argue that she had the means, the access, the mental health support that most people don't, and that she chose to deal with her mental health issues in the worst way. In other words, they say that she's culpable. Her defense lawyers argue that she was prescribed more than a dozen psychiatric medications in four months. That medical professionals did not communicate with each other, which you say is so very important. And her lawyer also argued that the SSRIs that she was prescribed were making her symptoms worse. Now, you are in practice and you get a chance to know a lot about these medications. Talk to us a little bit about how someone should be reassessed if they're taking these kinds of medications.

17:35Because somebody has mania or a history of bipolar disorder, an SSRI could make that worse. It can bring on the mania or make your mania worse. And mania can have psychosis associated with it. Now, one doctor may not know that you were prescribed an SSRI. And it can be argued how do you not know very easily. When I'm sitting in the hospital, I can see on my electronic medical records, the medications that have been prescribed by doctors in that healthcare system. I can't see the medications that were prescribed by another medical system, by another doctor, unless a patient has given us access. And many times a patient may not remember all the medications that they are taking. They may not remember the doses. I spend time trying to follow up on that. But sometimes it's hard. Even today, I was trying to reach out to many different people trying to clarify some of

18:38these medications. I couldn't reach anyone. So even if you're doing your best, it's hard to do. For you to keep track of this. For you, for me as a doctor, to do that. And would it be great if everyone had their medications written down and came to you and these disclosed everything that they're taking? Yes. And it always happened. And it is to a certain extent the responsibility of the patient to disclose what they're taking so that a doctor can know everything. But sometimes that just isn't possible for many different reasons. Yeah. It's a lot to take on as a doctor when you're talking about a big, big situation. This case, I've heard so many people online even talking not only just about the importance of this case, but comparing it to another big case in the news, the case of the actress Hayden Pinnetere, who died in a very tragic way recently. She had spoken out about her postpartum issues. Candidly, she talked about postpartum depression, opioid addiction.

19:40Talk to us a little bit about the importance of monitoring the mental health of moms. And particularly the fact that she talked so openly about it and said that people almost didn't want to hear about these kinds of things. Talk to us a little bit about how important it is to try to monitor women who are suffering. It is very important. What is happening now is that gynecologists, obstetricians, even in your primary care office, a lot of times with every visit, they are screening for depression at those visits. But maybe not necessarily psychosis. And how do you screen for that? You might start asking the questions I ask as a psychiatrist. Are you hearing voices? Are you seeing things? Are you having any odd thoughts? A lot of people that have delusions are not going to say yes, I'm having an odd thought. That will be brought to the attention of a doctor usually by somebody else or somebody saying you need to go get help for that because that isn't normal. And sometimes they're embarrassed.

20:41They don't want to say that. They don't want to sound like terrible parents' mothers. Yes, and that is the key thing that I think with this case and as we're discussing a hate and penitentiary, that when more people are talking about what they're experiencing, they're normalizing that this is an experience that many people have. And also that you can seek treatment for it that you can get help. Just last year, Jennifer Lawrence disclosed that she had taken the medication to help with her postpartum anxiety. I'm so happy that we have new advancements and medications to treat this particular condition. Definitely this case and all of the women that are talking about their experience has brought it. Just more to the forefront of all physicians, to think about it, to scream for it more, to keep it on your differential of things that could be happening to a mom. So while it is very tragic, the situations that we're dealing with now, the increased awareness, I think will definitely be the benefit to society.

21:43If nothing else, we will be talking about a subject that is no longer taboo. You often offer advice and we want to get some advice from you, so don't go anywhere because we want to come back and hopefully you can offer some help to women out there who may be suffering or someone in your life who may be suffering. So stay with us, we'll be right back. We shop for everything at home now. Why can't we shop for blinds at home too? That's why I love 3-day blinds. Instead of wandering around a store, 3-day blinds sends a professional design consultant straight to you. They bring all the samples, help you see what actually works in your space, take expert measurements and even handle the installation. We've all bought something that looked great in a store and looked terrible once we got home. With 3-day blinds, you see everything in your actual light with your actual furniture before you commit. That's whether you're home or away, you can control your window treatments with the 3-day blinds app. So for a free, no charge, no obligation consultation, head to 3-dayblinds.com-safe50 for our By-1-Get-1-50

22:51percent off deal. That's the number 3, d-a-y-blinds.com-safe50. Welcome back to 2020 The Aftershow. I'm sitting here with Dr. Ajoa Smalls-Monti discussing the devastating case of Lindsay Clancy, that mom in Massachusetts who admitted to killing her 3 young children, but also saying that she was suffering from a mental health crisis. Let's talk about warning signs. There's a big difference between having the blues and having postpartum depression and having a real psychosis which can be dangerous. So help us know what the warning signs are. So first we'll talk about that a lot of times we have fleeting bad thoughts in our head and I think that is the scariest thing for people to admit. But if the thought is fleeting, you recognize what is happening, you can still bring that up to somebody and say, but I may little control my actions, but if they're very, very dark, they are troubling to you.

23:54And if you even hear somebody else mentioning something that is very alarming to you, that is when you should seek help, that is when you should seek emergency help. Emergency room? Emergency room. Not just a call to the OBGYN. If the person is in good control, they're able to do what they have to do whether it's taking care of themselves and taking care of their baby, they're not having thoughts of, I want to hurt this baby. I feel like I'm not in control of my actions. That's a huge thing. If they feel like I can't control myself, that raises alarm bells and that is when they should go to the emergency room. If someone has a fleeting thought, I hate to say it, but many times I do see people. It's a fleeting thought they're like, I would never do anything to hurt somebody. I'm just like, so mad, I'm so stressed, I'm overwhelmed and I want moms to know that it's common. I had to get really thoughts when my children were born, sure. Definitely, but you recognize, I would never do this. I have so much love. I'm in control. I just need to take a break, a minute.

24:55I'm all right. I'm fine. But when you are feeling compelled, a lot of times people that do things will almost describe retroactively, they feel like a puppet almost. Their actions are being controlled. They can even know whatever they're thinking they don't want to do. They cannot control it. But also, if a voice is compelling you to do things, if you're not sleeping, if you're feeling like you're dissociating, like you're out of your body, you're kind of on the outside looking at. They're all really serious warning signs. And that is when I would seek the emergency room as opposed to, oh, I'm having some thoughts. I'm not sleeping well a little bit. I'm still able to do things. It's a little bit slower than I would like to. Then maybe you can talk to your obstetrician, your pediatrician for the child, but really the obstetrician for the mother. And then you can also try to find a psychiatrist. But let's be honest, the way to get a psychiatrist is pretty long nowadays. And so sometimes going to the emergency room can get you a little faster access.

25:58You mentioned earlier that one, if there's any little glimmer of hope that comes out of this horrible case, is that we're talking now about mental health and mental health among amongst moms and hopefully helping moms who are out there who are struggling. You mentioned that this is shining a light on a problem that is not talked about all the time. Is your hope that in the middle of this tragic horrible case that that might be the lasting impact that we continue to support and talk about moms who are dealing with mental health issues? It certainly is. And as you said, this is a complete tragedy, but I do hope that people feel more comfortable with talking about their symptoms. If they're experiencing any type of psychotic symptoms, if you are even experiencing depression or anxiety associated with the postpartum period, or even if you're not postpartum, if you're

26:58just a person going through life and you're experiencing this feeling more empowered to go and seek help because there is help available. And it can be wonderful. It can work well for many, many people. Well, let's hope so. Let's hope that people will definitely think about seeking help. And we should also add that if you or someone you know is struggling with thoughts of suicide, free confidential help is available 24 hours a day, seven days a week. You can call or text the National Lifeline at 988. Dr. Smalls Montey, you are always such a help. Thanks so much for being here with us. And we thank you, our listeners, for choosing to spend some time with us today. And of course, you can find 2020 on Friday nights on ABC and you can stream episodes any time on Disney plus and Hulu. Thanks so much for being with us and we wish you all a good day. A new podcast series from ABC Audio in 2020 goes inside a case that has captivated the

28:08nation. Many people Luigi Mangione is a modern day Robin Hood. People were cheering the demise of this person they'd never met. It was a father of two and a husband and had a life and was just doing a job. From the manhunt, ending in a McDonald's in Altoona, Pennsylvania, to what authorities are saying about a possible motive, I'm ABC News legal analyst Brian Buckmeyer. Listen to Burn in a Proof Luigi Mangione, wherever you get your podcasts. An all new season of the Hulu original series, The Secret Lives of Mormon Wives, is coming to Hulu and Hulu on Disney Plus of 10. Four years ago, we were just making TikToks, but it feels like there are no friendships left in mom talk. You act like you're better than everyone, you're not. I can't trust anyone in this group. She's just dead to me. There's so much the public doesn't know. Watch the new season of the Hulu original series, The Secret Lives of Mormon Wives, September 10th, streaming on Hulu and Hulu on Disney Plus for Bono subscribers, terms apply.