Both lay dabblers and scholars of history repeatedly admonish us that history repeats itself. Historical context can help us understand and grapple with issues that have plagued and continue to plague humankind.

The United States is not alone in having a dubious record of misogyny and glaring inequities in the treatment of women and people of color. In recent decades, people have re-examined historical teachings through the lens of human rights, leading to a 21st-century reassessment of past events like the Salem witch trials. These trials, which took place in the late 1600s, resulted in the execution and torture of women accused of witchcraft. Our current consumption of “true crime” and all things sensational keeps people hooked on the events of hundreds of years ago that occurred in a small town in Massachusetts. It has it all: women behaving “badly,” “hysteria,” courtroom drama, all set in a quaint New England town. Feminist scholars and writers have offered opinions and perspectives on the trial, which predominantly accused women and people of color of witchcraft, potentially having been a way of stifling a burgeoning independence of women in a time of Puritanical values.

These Massachusetts trials demonstrably affected courtroom practices in Massachusetts and the nation concerning due process, insanity pleas, and the legal framework for mental illness. The trials influenced the Massachusetts legislature to codify in its constitution protections in Massachusetts courtrooms, sometimes beyond federal protections. The Mass.gov website highlights this. The state bears the burden of proving that the defendant was criminally responsible and did not lack the capacity to understand the legal wrongfulness of their actions at the time of the offense because of mental illness. In many other states, the burden of proof lies on the defense, from which one could extrapolate that this is an extra protection for defendants, one that Massachusetts perhaps felt necessary based on its history of the witch trials.

Now let’s fast forward to a modern-day Massachusetts courtroom where a mother, Lindsay Clancy, sits facing murder charges. By all accounts, she was a former labor and delivery nurse whom coworkers well liked. She was also a loving mother, friend, and spouse. The perpetrator of the children’s killing is not disputed. Her mental state at the time of the incident and in the months preceding and after is. After strangling the children, she took pills, cut her neck, and jumped out the window, sustaining injuries resulting in paralysis from the waist down. She currently resides in a psychiatric hospital in Massachusetts.

As a psychiatrist, I have been watching closely. I have not examined the defendant, so I cannot opine on her diagnosis or state at the time of the crime. I can discuss some nuances that are being lost in some discussions I have heard about the case. Like in the times of the Salem witch trials, the behavior of women and people of color has a particular way of being interpreted in often biased manners. Sometimes, to an untrained eye, this can be difficult to detect. Society’s expectations often influence how people judge another’s behavior when it deviates significantly from what society expects.

One can assume that the defense may suggest that Lindsay suffered from postpartum depression and/or postpartum psychosis. Clinicians have widened the term and call it peripartum because it more fully represents that mood issues can occur in the months prior to birth and up to one year after birth. While most people are at least peripherally aware of peripartum depression, fewer are aware of peripartum psychosis because it is much rarer. There is immense nuance in the presentation of perinatal psychosis, which I will leave to the perinatal psychiatrist to explain. There are psychiatrists who have additional training and predominantly treat peripartum psychiatric disorders.

What I am more interested in is how society and human beings conceptualize horrific events when mental health diagnoses of female individuals may be involved. I am increasingly convinced that human beings’ love of binary and dichotomous structures may be our downfall. We want simple answers: yes/no, good/bad, easy/hard, witch/saint. Dichotomies help us attempt to make sense of the world, especially when faced with information that we cannot understand and is far outside the realm of normal human behavior. If we can convince ourselves that a person who kills their children is a monster, or a person experiencing “hysteria” is a witch, we can also convince ourselves that we are not those things so the tragedy will not befall us or people we are close to. We feel the need to reassure ourselves that we are safe because we are different from the people to whom the tragedy occurred. The task requires us to identify and highlight the monster or witch, potentially by labeling the perpetrator as such or by considering treatment providers as embodying this role. We need to believe that if we or our family were sick that we would find the right treatment providers who would do all the right things to tame the witch or monster. This is such a fragilely constructed story, but it often works to allay some of our fears. What we need is distance; we need to believe we are not like them. The truth is much scarier: People suffer from mental illness, diagnosis and treatment of such illnesses depend somewhat on the information given to the treatment providers, and sometimes the treatment algorithm fails.

That mental illness could cause a person to do something previously unimaginable is too scary, and even scarier if by a mother. We hold mothers to a high standard. Mothers are not supposed to get sick; they are supposed to take care of the sick. I have seen this bias in the reporting of social services issues. People strongly judge a mother for whom poverty makes it difficult to meet a child’s needs. Then, they pat a father on the back for making a sacrifice far less than their female counterpart has made.

The handling of mental illness in court cases proceduralizes the attempt to determine guilt or innocence. From listening to the early testimony, it appears to include combing through seemingly innocuous events of the days and months prior to the incident. It appears the defendant was a well-liked colleague and a caring mother, so how do we make sense of this? I think when women and mental illnesses are involved, we often jump to the monster/witch issue, telling ourselves that the perpetrator is one or the other and explaining away a previously normal existence before they suffered mental illness. It has to be the devil, the witch, the monster, the bad entity that caused the tragedy because sitting with the truth that something that is a well-recognized aspect of the human experience, mental illness, could contribute to the act is far too unpalatable.

I think this is quite similar to the Salem witch trials in that there was behavior that was not understood, and societally we needed to explain it in a way that distanced ourselves and our families from the destruction. The Salem trials of the past have influenced how Massachusetts constitutionally legislates the insanity defense, requiring the state to prove its case, and this decision will determine whether Lindsay Clancy will be placed in jail or a psychiatric hospital for the rest of her life, which is already shortened by her paraplegia according to life expectancy data.

I suppose we are all left to decide whether she is a monster or a mentally ill mother. I have seen mental illness up close and chosen a career in the diagnosis and treatment of mental illness. I have seen the consequences of mania and psychosis. This has influenced my understanding and ability to tolerate the idea that at any time someone I love or myself may need treatment for mental illness. I am not sure how far we have come societally in the acceptance of mental illness, especially in women and mothers, and sometimes Salem feels not so far from today. I hope that as the trial proceeds, people will be open to learning about perinatal mood disorders and recognizing symptoms in the mothers in their lives.Maternal mental illness is still judged like witchcraft

Courtney Markham-Abedi is a psychiatrist in Lexington, Kentucky. She has written widely about physician suicide and other psychiatric topics for online publications and has appeared on several podcasts, work that led feedspot.com to name her one of the 1,000 best health care journalists and editors.

Her peer-reviewed work centers on the metabolic and neurologic effects of antipsychotic medications, including case reports on a probable association between ziprasidone and worsening hypertension, ziprasidone-induced catatonic symptoms, and hypertriglyceridemia tied to the direct effects of olanzapine rather than to weight gain.

She has also written a novel, Unlocking Lakin, set in a psychiatric hospital in her hometown. The manuscript won first place for full-length prose from West Virginia Writers, and she is currently seeking an agent to represent it.