The Panagram scan (far from totally accurate, I know) claims it’s 100% AI assisted. It is a shame and it lacks integrity. Not sure why the commenter below thinks that’s funny.
The thing is, having dealt with severe mental illness and psychosis directly, so much of Clancy’s “normalizing” behavior is predictable. It’s amazing how sane and stable a person can present when they desperately want to go home and not end up cold and terrified in a psych hold, when they are seeking safety and comfort and warmth, when they know if they tell the whole truth they will lose every last bit of agency, when they know if they tell the truth the will be prevented from the one thing they believe they must do to find peace (suicide). I don’t know what happened in this case— way above my pay grade. But her behaviors are telling if you know the upside down world of psychosis
I wonder if that’s why she kept begging for help cause she knew she needed help and nobody exactly helped her and if you’re a loving caring husband, why are you leaving her alone With the children all the time what the heck and a girlfriend on the side,
As a retired RN of 49 years, I have many thoughts about this case , but the one that troubles me the most is how quickly her husband divorced her, got remarried and had another child.
And how quickly he “forgave” her! There is a lot to work through before reaching genuine forgiveness. It is so puzzling that he made it his starting point.
A very impressive essay! People wanting blood of someone in healthcare for what nobody can be held liable for is a sight to behold.
We have a patient now whose daughter does not feel comfortable taking her mother home because her mother’s heart stopped in the past and she had a hard time breathing. We are held almost at gunpoint to do we don’t know what to make sure that “I don’t want to go back to the doctor when we get home”.
We have no means to treat past or future changes in the patient state. We have no means to prevent cosmic events, personal tragedies, and “feelings”.
being a witness in a murder trial is no doubt stressful, and i’m not about to defend commentary on… well pretty much anything. however, everything else here seems to be show the legal system working properly.
take the comma issue. there is contemporaneous documentation. the medical professional gives an account of what they meant when they wrote it. the defence challenges them on it. they stand firm, a point which won’t be lost on the jury. it is just one of likely hundreds of data points underpinning the jury’s consideration. let’s say however that they were demolished on the stand, came across as an unreliable witness, other rogue commas were brought up. couldn’t have gone worse! they don’t get sent to jail, they go home and have a bad night’s sleep. they are not on trial.
on the reasonableness point and the jurisprudence referenced. i’m going to go out on a limb and guess this related to the reasonableness of actions by a police officer on trial for a homicide. this is the key matter being adjudicated, in an entirely different category to a high pressure clinical assessment. the actual question in this trial is ‘was clancy experiencing psychosis when she killed her children’, not ‘was it reasonable for this clinician to make this assessment at that time’ - the latter is just one piece of evidence informing the former, and doesn’t have to be determined in the binary.
I agree. This piece opened by reminding readers that this is a murder trial, but what followed in the essay did not relate to the question to be decided, namely was the accused suffering from psychosis at the time of the killings. Instead it speculated about a future malpractice trial.
In the murder trial, what the doctors observed and failed to observe, and whether they were paying close attention, are highly relevant in deciding whether and how to take away the accused's freedom, possibly for the rest of her life. In my view, worries about a potential malpractice suit should be furthest from those witnesses' minds in testifying about their observations of their patient, to whom they owe a duty of care.
I can understand that it is scary for a doctor to imagine being sued, but that's what liability insurance is for. The medical profession is not on trial here. A patient is on trial. The author doesn't believe that doctors should be held responsible for patient outcomes yet appears to blame the patient -- who is actually on trial -- for the outcome: the author called out the patient for not taking all her pills and for not being forthcoming about all her symptoms. But it seems to me that both of those issues can be symptoms of mania. So I did not find that to be useful or constructive.
I have seen postpartum psychosis. To all except those who knew her best, the sufferer seemed to be behaving normally. Eventually she went completely off the rails and it became obvious. But at both stages she refused medical treatment and professed to be fine.
The author also suggested that the patient, as a nurse, would have "understood the medications, the programs, and the words in her own chart." I found that to be a remarkable statement. Nurses generally can't prescribe medications. I doubt she saw her chart during treatment. She was a labour and deliver nurse, not a psychiatric expert.
I don't know whether the accused was suffering from psychosis or not. That's what the trial is for. That's why the doctors' testimony matters. The doctors should be asked and required to answer difficult questions in the pursuit of justice. Cross examination is not a pleasant experience but it is not grounds for outrage that a doctor is being asked questions about their treatment of a patient.
US culture currently has an obsession demonizing healthcare people. In almost 45 years in one part of healthcare or another, including clinical nursing and Pharma, I never ever met a person who shows up for work each day hoping to get rich harming someone, or who wouldn’t disclose an answer they knew for sure. Clinicians and the people who help them are overwhelmed. They are not to blame.
There are a lot of electronic records systems these days, and some of them don’t talk to each other. No one except the lawyers has access to all of it or time to sit with them, read through everyone’s documentation and piece a coherent time line.
I can’t separate that part from the desperation of a mother who has three kids in five years, a few months post-partum, experiencing anxiety, insomnia, and probably depression, along with the internal chaos of hormone imbalance, overwork, and situational sleep depravation. We want a primary care-giver, usually a woman, to be flawless in every way but we do exactly zero to make those years easier. She wasn’t homicidally overwhelmed until she was. No one could have documented what happened to her mind the hours before she killed her kids and tried to kill herself. She is not to blame. Her doctors are not to blame.
I liked the writing, if it is AI, it is a better specimen than most.
So I am not a medical professional, but I am a reasonably intelligent individual and know how to say what I need to appear a certain way in order to obtain the result I want. It’s not difficult. I wouldn’t even call it lying because I didn’t strictly lie. Persuade, let’s say. Doctors are people. They are not omniscient.
I appreciate your core argument, that physicians have no authority to prevent negative outcomes for patients and thus cannot be expected to achieve that for everyone. The legal system does not easily accept that sometimes rare cases occur and the system doesn’t need to change to prevent it in the future, it’s just a tragedy.
As someone who has actually made and continues to make the kind of decisions the mental health professionals in this case have made, thank you for your thorough analysis. I'm on the other side of the pond, but legislation here is comparable and the responses whenever things go wrong match my experience. If I would have been her doctor I would have probably made many of the same decisions, from medication regime to sending her home for the kid's birthday. As psychiatrists, we have very few diagnostical tools other than talking to people and using our clinical knowledge and experience. We don't have X-rays, blood tests or biopsies to determine a broken mind. We have our patient's story and that of the people close to them to go on, combined with our observational skills and clinical experience.
If someone is determined to not let us in on their thoughts and still sane enough to be able to behave like nothing serious is going on, we have very few options to force any treatment. When people are floridly psychotic or manic they usually can't keep their composure for more than a few minutes, so then we notice. Lindsay Clancy had been observed in an inpatient facility for multiple days and apparently even there she kept herself together well enough to be allowed to leave. If that's the case then there's unfortunately really nothing to justify involuntary treatment at that moment. Of course, given the outcome, it's wise to evaluate the course of action. But sometimes, unfortunately, there are no observable red flags before the fact. One could argue that post partum depression and/or psychosis is known for the risks of infanticide, but it's still really rare and if someone actively tells you they don't have thoughts about hurting their kids or themselves and doesn't display worrying symptoms then there's very little to act on.
The only people who had access to the entire treatment plan were Lindsay and Patrick. She was a nurse herself and would have known how to at least research and understand drug interactions. She had the wherewithal to send her husband out on some errands and go through with the murders. The only victims in this case are the children and the only criminal is the mother. Patrick I think could have maybe done better but as a spouse you tend to trust your partner.
A different discussion can be had on the eagerness of physicians to dispense mind-altering drugs. And really our medical system as a whole, and our culture at large. A godless society will behave in evil ways.
Very interesting essay but I feel like at least parts were written by AI, which is a shame. I hope you'll consider not doing that in future.
The Panagram scan (far from totally accurate, I know) claims it’s 100% AI assisted. It is a shame and it lacks integrity. Not sure why the commenter below thinks that’s funny.
It's genuinely an interesting point of view and topic too, I wish it wasn't tainted by AI
Lol 😂
The thing is, having dealt with severe mental illness and psychosis directly, so much of Clancy’s “normalizing” behavior is predictable. It’s amazing how sane and stable a person can present when they desperately want to go home and not end up cold and terrified in a psych hold, when they are seeking safety and comfort and warmth, when they know if they tell the whole truth they will lose every last bit of agency, when they know if they tell the truth the will be prevented from the one thing they believe they must do to find peace (suicide). I don’t know what happened in this case— way above my pay grade. But her behaviors are telling if you know the upside down world of psychosis
I wonder if that’s why she kept begging for help cause she knew she needed help and nobody exactly helped her and if you’re a loving caring husband, why are you leaving her alone With the children all the time what the heck and a girlfriend on the side,
Ok, so doctors should be able to slam people up if they think they’re lying, case closed!
Nobody said that
As a retired RN of 49 years, I have many thoughts about this case , but the one that troubles me the most is how quickly her husband divorced her, got remarried and had another child.
And how quickly he “forgave” her! There is a lot to work through before reaching genuine forgiveness. It is so puzzling that he made it his starting point.
Actually, I was mistaken. I don’t think he has any children with his new wife.
Wow...that was a lot. "You cannot design a system around the liberty of the ill and then indict the doctor for honoring it." Indeed.
A very impressive essay! People wanting blood of someone in healthcare for what nobody can be held liable for is a sight to behold.
We have a patient now whose daughter does not feel comfortable taking her mother home because her mother’s heart stopped in the past and she had a hard time breathing. We are held almost at gunpoint to do we don’t know what to make sure that “I don’t want to go back to the doctor when we get home”.
We have no means to treat past or future changes in the patient state. We have no means to prevent cosmic events, personal tragedies, and “feelings”.
being a witness in a murder trial is no doubt stressful, and i’m not about to defend commentary on… well pretty much anything. however, everything else here seems to be show the legal system working properly.
take the comma issue. there is contemporaneous documentation. the medical professional gives an account of what they meant when they wrote it. the defence challenges them on it. they stand firm, a point which won’t be lost on the jury. it is just one of likely hundreds of data points underpinning the jury’s consideration. let’s say however that they were demolished on the stand, came across as an unreliable witness, other rogue commas were brought up. couldn’t have gone worse! they don’t get sent to jail, they go home and have a bad night’s sleep. they are not on trial.
on the reasonableness point and the jurisprudence referenced. i’m going to go out on a limb and guess this related to the reasonableness of actions by a police officer on trial for a homicide. this is the key matter being adjudicated, in an entirely different category to a high pressure clinical assessment. the actual question in this trial is ‘was clancy experiencing psychosis when she killed her children’, not ‘was it reasonable for this clinician to make this assessment at that time’ - the latter is just one piece of evidence informing the former, and doesn’t have to be determined in the binary.
I agree. This piece opened by reminding readers that this is a murder trial, but what followed in the essay did not relate to the question to be decided, namely was the accused suffering from psychosis at the time of the killings. Instead it speculated about a future malpractice trial.
In the murder trial, what the doctors observed and failed to observe, and whether they were paying close attention, are highly relevant in deciding whether and how to take away the accused's freedom, possibly for the rest of her life. In my view, worries about a potential malpractice suit should be furthest from those witnesses' minds in testifying about their observations of their patient, to whom they owe a duty of care.
I can understand that it is scary for a doctor to imagine being sued, but that's what liability insurance is for. The medical profession is not on trial here. A patient is on trial. The author doesn't believe that doctors should be held responsible for patient outcomes yet appears to blame the patient -- who is actually on trial -- for the outcome: the author called out the patient for not taking all her pills and for not being forthcoming about all her symptoms. But it seems to me that both of those issues can be symptoms of mania. So I did not find that to be useful or constructive.
I have seen postpartum psychosis. To all except those who knew her best, the sufferer seemed to be behaving normally. Eventually she went completely off the rails and it became obvious. But at both stages she refused medical treatment and professed to be fine.
The author also suggested that the patient, as a nurse, would have "understood the medications, the programs, and the words in her own chart." I found that to be a remarkable statement. Nurses generally can't prescribe medications. I doubt she saw her chart during treatment. She was a labour and deliver nurse, not a psychiatric expert.
I don't know whether the accused was suffering from psychosis or not. That's what the trial is for. That's why the doctors' testimony matters. The doctors should be asked and required to answer difficult questions in the pursuit of justice. Cross examination is not a pleasant experience but it is not grounds for outrage that a doctor is being asked questions about their treatment of a patient.
US culture currently has an obsession demonizing healthcare people. In almost 45 years in one part of healthcare or another, including clinical nursing and Pharma, I never ever met a person who shows up for work each day hoping to get rich harming someone, or who wouldn’t disclose an answer they knew for sure. Clinicians and the people who help them are overwhelmed. They are not to blame.
There are a lot of electronic records systems these days, and some of them don’t talk to each other. No one except the lawyers has access to all of it or time to sit with them, read through everyone’s documentation and piece a coherent time line.
I can’t separate that part from the desperation of a mother who has three kids in five years, a few months post-partum, experiencing anxiety, insomnia, and probably depression, along with the internal chaos of hormone imbalance, overwork, and situational sleep depravation. We want a primary care-giver, usually a woman, to be flawless in every way but we do exactly zero to make those years easier. She wasn’t homicidally overwhelmed until she was. No one could have documented what happened to her mind the hours before she killed her kids and tried to kill herself. She is not to blame. Her doctors are not to blame.
I liked the writing, if it is AI, it is a better specimen than most.
So I am not a medical professional, but I am a reasonably intelligent individual and know how to say what I need to appear a certain way in order to obtain the result I want. It’s not difficult. I wouldn’t even call it lying because I didn’t strictly lie. Persuade, let’s say. Doctors are people. They are not omniscient.
I appreciate your core argument, that physicians have no authority to prevent negative outcomes for patients and thus cannot be expected to achieve that for everyone. The legal system does not easily accept that sometimes rare cases occur and the system doesn’t need to change to prevent it in the future, it’s just a tragedy.
As someone who has actually made and continues to make the kind of decisions the mental health professionals in this case have made, thank you for your thorough analysis. I'm on the other side of the pond, but legislation here is comparable and the responses whenever things go wrong match my experience. If I would have been her doctor I would have probably made many of the same decisions, from medication regime to sending her home for the kid's birthday. As psychiatrists, we have very few diagnostical tools other than talking to people and using our clinical knowledge and experience. We don't have X-rays, blood tests or biopsies to determine a broken mind. We have our patient's story and that of the people close to them to go on, combined with our observational skills and clinical experience.
If someone is determined to not let us in on their thoughts and still sane enough to be able to behave like nothing serious is going on, we have very few options to force any treatment. When people are floridly psychotic or manic they usually can't keep their composure for more than a few minutes, so then we notice. Lindsay Clancy had been observed in an inpatient facility for multiple days and apparently even there she kept herself together well enough to be allowed to leave. If that's the case then there's unfortunately really nothing to justify involuntary treatment at that moment. Of course, given the outcome, it's wise to evaluate the course of action. But sometimes, unfortunately, there are no observable red flags before the fact. One could argue that post partum depression and/or psychosis is known for the risks of infanticide, but it's still really rare and if someone actively tells you they don't have thoughts about hurting their kids or themselves and doesn't display worrying symptoms then there's very little to act on.
The only people who had access to the entire treatment plan were Lindsay and Patrick. She was a nurse herself and would have known how to at least research and understand drug interactions. She had the wherewithal to send her husband out on some errands and go through with the murders. The only victims in this case are the children and the only criminal is the mother. Patrick I think could have maybe done better but as a spouse you tend to trust your partner.
A different discussion can be had on the eagerness of physicians to dispense mind-altering drugs. And really our medical system as a whole, and our culture at large. A godless society will behave in evil ways.
This analysis was extremely helpful to me. Thank you so much.