At first glance, this may seem like an unimaginable crime, one that must invite the harshest punishment. After all, how can a mother kill her own children? But the Lindsay Clancy case has deep and disturbing layers and those layers have sparked a wider conversation around crime, accountability and a woman’s mental and physical health after childbirth.

For those who are unaware, Lindsay was a labour-and-delivery nurse from Duxbury, Massachusetts, and was on maternity leave when the incident occurred. She has been accused of planning to keep her husband busy with an errand to keep him out of the house for about 25 minutes, the time she took to kill their children. But the story is not that simple.

Lindsay was suffering from postpartum psychosis, according to her defence. She had repeatedly reached out to medical professionals for help. Each time, she was prescribed medication and sent back home. She had also told her husband that she was having thoughts of harming herself and did not feel okay. Yet, according to the defence, her treatment repeatedly involved medication adjustments and higher doses rather than recognising the severity of what was happening to her. Now, as the trial unfolds, people are watching closely.

What began as the story of a ‘killer mother’ sitting in court with a straight, almost non-blinking face has gradually become something more complicated. Mothers from around the world have begun sharing their own experiences with postpartum depression and intrusive thoughts. Some have spoken about having thoughts of harming themselves, harming their children or simply wanting everything to end and many of these women say there was someone who intervened. A husband, mother, sister or a friend. Someone who noticed that something was wrong, stayed with them, helped them seek treatment and simply refused to leave them alone during the darkest phase.

The question that keeps emerging is: who was there to rescue Lindsay? Her personal diaries reveal notes documenting disturbing and intrusive thoughts. Her defence lawyer has argued that Lindsay was severely mentally ill, was overmedicated and was hearing voices that instructed her to kill herself and her children. People close to the couple described Lindsay as a normal, happy suburban mother in the weeks before the killings. And that perhaps opens another uncomfortable conversation: how often severe mental illness remain invisible to the people around us. Depression, anxiety and other postpartum mental-health conditions do not always look like someone visibly falling apart. A woman can smile, feed her baby, attend appointments, speak to friends, post photographs and appear to be functioning while internally she may be struggling simply to get through the next hour.

Lindsay had reportedly experienced anxiety after the births of her first two children. But after the birth of her third child in 2022, her symptoms returned and became significantly worse, particularly as she prepared to return to work. According to the defence, psychiatrists and clinicians failed to recognise the severity of her condition. She was prescribed medications including Ambien, Klonopin, Valium, Prozac, Ativan, Zoloft and Seroquel as her insomnia, anxiety and depression worsened. By December that year, she was reportedly experiencing panic, numbness, suicidal thoughts and a growing fear that something terrible was going to happen.

She spent five days at McLean Hospital, a psychiatric facility near Boston. Her defence has said that she described hearing a male voice telling her that she should die and that her children would suffer if she were gone. On the day of the killings, Patrick returned home to find Lindsay on the ground after she had apparently jumped from a second-storey window. Her defence says she suffered spinal-cord injuries and was left paralysed.

Patrick has continued to ask people to show empathy towards Lindsay and has described her as a good mother but at the same time, he has faced public criticism and accusations that he did not support her enough and even made money from her condition. Patrick has now remarried and has a baby with his new wife.

But perhaps the most important conversation emerging from this heartbreaking case is not about whether motherhood can ever coexist with thoughts that seem completely incompatible with motherhood. It is about what happens when a woman becomes mentally unwell after childbirth and nobody recognises just how unwell she has become.

Around one in seven women experience postpartum depression, although the causes of postpartum mental-health conditions are still not fully understood. Postpartum psychosis is far less common but much more severe. It can involve hallucinations, delusions, extreme confusion, paranoia, mania and a loss of connection with reality. It is a psychiatric emergency because the risk of suicide and in some cases, harm to the baby can become extremely high. And yet postpartum mental health remains deeply misunderstood.

We have created such a powerful cultural image of motherhood, that a mother should be overwhelmed with love the moment her baby is born, that motherhood should automatically bring happiness and fulfilment, that a mother should instinctively know what to do and that admitting otherwise can feel like admitting failure. A woman feels guilty if she says, “I don’t feel connected to my baby.” She fear judgement if she says, “I am scared to be alone with my baby.” Now imagine a woman who says, “I am having thoughts of harming my baby,” may be so terrified of the consequences of telling someone that she chooses silence instead and that silence can be dangerous.

One mother, speaking on condition of anonymity, described how she believes she might have killed herself and her baby had her husband not recognised how serious her condition had become. He stayed home, took a break from work and helped her through the phase and treatment. Her story raises an important distinction: intrusive thoughts are not the same thing as intent. New mothers can experience frightening, unwanted thoughts about something terrible happening to their baby. What matters is recognising when these thoughts are becoming persistent, overwhelming, frightening or accompanied by other symptoms of serious mental illness and ensuring that the woman gets immediate, appropriate professional help. And Lindsay Clancy case becomes so uncomfortable here.

Many people are asking: if Lindsay was so unwell, why was she left alone with the children? If her husband knew she was struggling, why wasn’t she under closer supervision? And if he genuinely did not understand the severity of what was happening, why did nobody around her? These are questions that the trial will have to grapple with but beyond assigning individual blame, there is a larger question for society: do we know what severe postpartum mental illness actually looks like? Because perhaps we don’t.

We know how to celebrate a new mother. We know how to congratulate her, send flowers, bring food, buy clothes for the baby and ask whether the baby is sleeping. But how often do we ask the mother: Are you sleeping? Are you eating? Are you scared? Are you having thoughts that frighten you? Do you feel like yourself? Do you feel safe? And, importantly, how often do we take her answer seriously?

Postpartum depression is not simply ‘baby blues’ and postpartum psychosis is worse. It is not simply a mother being exhausted or overwhelmed. These are medical conditions that can require urgent psychiatric intervention.

The Lindsay Clancy case is particularly heartbreaking because, according to the defence, Lindsay did ask for help. She spoke about her deteriorating mental state. She sought medical treatment and was hospitalised. She described frightening thoughts and voices, yet somehow, the system failed to prevent a catastrophe. That does not erase the deaths of three innocent children. It does not make their loss any less devastating but it does force us to ask a harder question: what if the warning signs of a mother in crisis are recognised only after something irreversible has happened?

Perhaps that is why this trial has resonated with so many mothers. Not because they identify with what Lindsay did, but because they recognise the frightening vulnerability of the postpartum period. Some remember feeling like strangers to themselves, like feeling intrusive thoughts they were too ashamed to discuss. Some remember the terror of being alone with a newborn and there are also those who remember that the only thing that got them through was another person who noticed – that may be a husband, parent, sibling, friend, doctor or neighbour but someone has to notice.

We need to make it normal for mothers to say, “I am not okay.”

We need families to listen without judgement, we also need healthcare professionals to screen seriously for postpartum mental-health conditions and not just say this feeling will go. They should also be capable to recognise when symptoms are escalating. And we need women to know that having a frightening thought does not automatically make them a bad mother but it is a reason to speak to someone, particularly when the thoughts become persistent, distressing or accompanied by hallucinations, paranoia, severe confusion or thoughts of suicide or harm. The saddest part of the Lindsay Clancy trial may ultimately be that there are no winners here. A mother is permanently disabled and her children are dead but if anything meaningful can emerge from this tragedy, it is a willingness to talk about the invisible side of motherhood, because sometimes the mother who looks perfectly fine is the one silently screaming for help.