The Lindsay Clancy trial has raised a popular concern surrounding the notion of mothers having “intrusive thoughts” after delivery, specifically dangerous ones that, as in this case, may even be related to the murders of Lindsay Clancy’s three young children. However, “intrusive thoughts” are common after delivery and show up in many different ways in psychiatry, most of which are not dangerous. For example, one common and very scary thought that happens after delivery is the continuous suggestion that the mother may harm or even kill her infant. In fact, most mothers having such intrusive thoughts do not actually act upon the thoughts. With that said, this does not change that the distress these thoughts bring is understandably tremendous and should be treated very seriously.
In Lindsay Clancy’s case, it was postpartum psychosis that was allegedly related to her “intrusive thoughts.” This is a condition in which it becomes difficult for the person to understand and connect with the reality around them. In psychosis, patients may believe that others are out to hurt them, that there are hidden messages on the walls or in reading material specifically directing threats to their own safety.
In postpartum psychosis, it is rare, but unfortunately more likely than in other psychiatric conditions, that an intrusive thought can lead the person to go through with the action suggested by the thought, even as far as killing their children. Again, the rate of postpartum psychosis is so small, affecting between 1 and 2.6 mothers for every 1,000 new births, that postpartum psychosis ends up being the exceptional case rather than the rule. Additionally, the number of postpartum psychosis cases that lead to tragedies like this is all the more exceptional, being extremely few and far between, at approximately 1 percent to 4.5 percent of all postpartum psychoses. Therefore, the vast majority of mothers should not fear that their “intrusive thoughts” will devolve into something as tragic as the situation in the Clancy case. There is a larger space for hope and treatment for every patient, and one highly publicized case does not change that reality.
Instead, mothers entering the postpartum period who have a new onset of “intrusive thoughts” should let their obstetricians know about it so that immediate help can be sought to address symptoms early. Mothers should also maintain regular follow-up with their doctor and therapist. Discussing such emergency situations and making preparations with one’s spouse is also an important part of ensuring treatment is started promptly. Having a plan in place beforehand is important, since it can be difficult to make clear decisions in the moment that one is having such “intrusive thoughts.”
It is important to remember that most mothers entering the postpartum period who have new “intrusive thoughts” do not act on them. Instead, they are more likely to be diagnosed with other conditions, specifically postpartum depression (without psychosis), anxiety, and occasionally obsessive-compulsive disorder (OCD), all of which can include intrusive thoughts that mothers find particularly scary and stressful but which they are not known to act upon.
Have a plan to get help if such symptoms are to arise after your delivery. Being a new mother is already really difficult; don’t let a scary, sensationalized case add to that stress and take away from your special moments with your newborn.
Zane Kaleem is a forensic psychiatry fellow. Dallas Hamlin is a psychiatrist.
