“Did you hear what I told you? I said I thought about putting my baby in a blender.”

Those words, from a desperate mother terrified that she was going to brutally murder her baby, are nearly a decade old. They still haunt me. They arrived in a phone call on a helpline for Postpartum Support International (PSI), the United States-based advocacy organization for pregnant and postpartum women struggling with their mental health. 

I am a medical anthropologist who has studied experiences of postpartum mental illness in the U.S. and China over the past decade, but I was volunteering for PSI on a sabbatical in the 2017-18 academic year. At that moment, I could hear the terror in the mother’s voice. Thankfully, I had been trained on the field’s best practices on how to respond. My certification program to become a postpartum doula, education in maternal mental health, and PSI volunteer training all had taught me the same thing.

You are not going to hurt your baby, I told her.

I explained that what she was experiencing was called an “intrusive thought.” Postpartum intrusive thoughts are not indicative of a danger to one’s baby, I had learned. In fact, quite the opposite: According to my training, mothers who have scary intrusive thoughts are often more cautious and more attentive with their babies than other mothers. 

They are, statistically speaking, no more likely to harm their babies than mothers who never had such thoughts. In their desperation to keep their babies safe from what they fear is their own murderous potential, mothers may instead enter a spiral of self-loathing, debilitating anxiety, and obsessive-compulsive behaviors. 

Perinatal mental health experts had found that it was only women who did not feel that fear, who did not see the wrongness of this act, who thought murdering their children was the virtuous thing to do actually constituted an infanticide risk. These women were psychotic, meaning they had delusions, hallucinations, or disorganized thinking that detached them from reality. 

The woman on the other end of the phone clearly understood the wrongness of the thing that she saw in her head, and she was terrified. She needed help from a specialist. She was mentally unwell — but I felt fairly confident she was not a threat to her baby.

What Lindsay Clancy Taught Us

We cannot, unfortunately, say the same about Lindsay Clancy, the Duxbury, Massachusetts mother whose trial ended in a mistrial last month, more than three years after she strangled all three of her children with exercise bands on January 24, 2023.

I do not know the content of Clancy’s intrusive thoughts. But anyone who watched the trial knows that she reported them repeatedly to family and mental health providers over the course of her months-long battle with mental illness, and that she thought they meant she was a danger to her children 

What we do know is that whatever thoughts Clancy was having, they terrified her.

How did she fear she was going to do it? Did she see visions of blenders, hammers, or knives, like the women I interviewed as part of my long-term ethnographic study of women with postpartum mental illness in the U.S. and China? Was it the exercise bands she dreamt of? 

We do not know the answers to these questions. What we do know is that whatever thoughts Clancy was having, they terrified her. She repeatedly reported them to the mental health professionals she saw. She reported them to her husband and her mother. She begged her mother to stay with her so that her children would be safe. 

But prior to her children’s deaths, her practitioners never saw signs of psychosis. She knew the thoughts were wrong, and they scared her. So Clancy seemed to be just another anxious mother, afraid she might do something terrible to her children that she was never going to do. 

If Clancy had called the helpline, I likely would have told her that she was not a threat to her baby.

Karen Kleiman, the clinical psychologist who wrote the bestselling book Good Moms Have Scary Thoughts, which investigators found in Clancy’s home, acknowledged in a recent New York Times story that perinatal mental health specialists may have been overly simplistic in their previous understanding of intrusive thoughts. 

She seemed to be a good mother, and good mothers did not kill their children. 

“What we’re really learning is how much we don’t know,” Kleiman told the Times. Apparently, the line between postpartum obsessive-compulsive disorder or anxiety, and postpartum psychosis, is not as firm as perinatal mental health specialists had thought. 

I should not have been surprised. Anthropologists have long argued that mental illness diagnoses are slippery and imprecise, and they rarely adequately describe the full breadth or variation in real people’s experiences of mental distress. 

Diagnostic categories are manmade boundaries that rarely completely account for the messiness or broad range of lived experience. But I adhered closely to that distinction in my volunteer work, because I wanted to believe that these women were safe. The woman would not put her baby in the blender. Scary thoughts did not make bad moms.

Bad Moms and Legal Arguments

It is the so-called bad mom part of this story that has formed the crux of why her defenders insisted that Clancy must have been psychotic — because she seemed to be a good mother, and good mothers did not kill their children. 

In the press, we heard much about infanticide laws in the United Kingdom and other countries in Europe that held mothers who killed their children within a year of giving birth to different standards than others who committed the same crimes. We heard legal arguments about how much Clancy loved her children — as if love never shared space with violence. 

There are many contexts and scenarios in which people, because they are not well, do terrible things. Most of these cases lead to convictions rather than mental health treatment.

And we heard repeated commentary about the need for more resources, more understanding, and more support for postpartum mental illness. This latter phenomenon has had real results: In the weeks since Clancy’s trial began, Massachusetts governor Maura Healey has taken action to increase screening, treatment, and other resources for postpartum mothers in response to concerns raised by the trial about postpartum care in the state. Several other states may follow suit.

And yet even if Clancy were psychotic, it is not at all clear that her psychosis was related to her having given birth eight months earlier. Most cases of postpartum psychosis occur within the first weeks after giving birth, and non-postpartum moms also kill their children. 

Earlier this year, just 45 miles from Duxbury, 49-year-old Wellesley mother Jeannette MacAusland killed her two school-age children, ages 6 and 7. MacAusland’s lawyers are also arguing that she should be found not guilty by reason of insanity. In some ways her case was more cut and dry, since she exhibited bizarre behavior in front of witnesses shortly after the killings. 

But infanticide laws and postpartum mental illness screenings would not have helped MacAusland, because the parties in question were neither infants nor postpartum. 

And what about Christopher Evans, Curtis Jenkins, and Misael Lopez Gomez — all of whom are fathers charged in recent months with killing their infants? Where are their special laws or protections?

Herein lies the problem with making a special case out of postpartum mothers who commit crimes: There are many contexts and scenarios in which people, because they are not well, do terrible things. Most of these cases lead to convictions rather than mental health treatment. Most are never broadcast on TV. Most do not turn out crowds dressed in pink, carrying signs in support of the accused murderer. 

And most are not pretty, middle-class, white mothers living in idyllic beach towns like Duxbury.

How Race Plays A Critical Role in Clancy’s Case

Less well-known outside of Massachusetts was another story about a psychotic mother murdering her children that reentered the local Boston-area news at the same time that Clancy was on trial. 

Latarsha Sanders, a Black woman living in the high-poverty city of Brockton, killed her children, Marlon, age 8, and La’Son, age 5, in 2018. This was after years of floridly psychotic behavior that resulted in her later being diagnosed with paranoid schizophrenia. 

Sanders was convicted of first-degree murder and sentenced to two consecutive life sentences without the possibility of parole, after the judge on her trial refused to admit psychiatric evidence. 

The Clancy trial was tried by the very same judge who tried Sanders. It was only during the Clancy trial that the Supreme Judicial Court of Massachusetts finally recognized an injustice had occurred and vacated the conviction for Sanders.

The unthinkability of a crime committed by a middle-class white mother against a baby has produced a unique amalgam of horror and sympathy that is not extended to crimes committed by mothers of color, fathers, or even mothers of older children.

Clancy might still get justice. After her trial ended in a mistrial, many expect the local district attorney to charge her with lesser crimes than first-degree murder, in recognition of her postpartum mental illness. In the meantime, many promises have been made around the country to do something about the epidemic of postpartum mental illness in the U.S. 

Doing something about postpartum mental illness in the U.S. is certainly a very good thing. While postpartum psychosis is relatively rare, affecting only one or two in a thousand birthing women, postpartum depression is one of the most common complications of childbirth, affecting, by some estimates, 20% of mothers globally in the first year after birth. 

And it is deadly: In the U.S., mental illness is the leading cause of preventable maternal death during the perinatal period. It accounts for more deaths during this time than hemorrhage, preeclampsia, infection, or cardiovascular complications. Clearly it is a cause worth investing in.

And yet as an anthropologist of postpartum mental illness, I find the outpouring of support for the postpartum cause in the wake of the Clancy tragedy to also be strangely troubling. The unthinkability of a crime committed by a middle-class white mother against a baby has produced a unique amalgam of horror and sympathy that is not extended to crimes committed by mothers of color, fathers, or even mothers of older children. 

Why is it only mothers like Clancy who are offered sympathy instead of retribution when they commit a heinous crime? Why should mothers who kill infants get special legal consideration that fathers and parents of older children do not? Many perinatal specialists and advocates are arguing that they should. 

Good moms have scary thoughts. Now we know that, very rarely, they may even act on them. Much more often they channel those scary thoughts into doing everything they can to protect and nurture their children. 

In the Clancy case, there were clear failures of her providers to adequately communicate with each other, monitor prescriptions, or assess changes in her condition. Yet, Clancy still had access to the kinds of mental health services and family support that most Americans can only dream of. Those resources are what allowed her to compile enough evidence to build a case for an insanity defense. But it does not mean that she is uniquely innocent.

In the U.S., 28 million people lack health insurance, including 4 million children. Even for those who are insured, mental health coverage is often limited to a small network of providers who are willing to accept the low reimbursement rates that insurance generally provides. 

Without access to proper mental health care, hundreds of thousands of people with severe mental illnesses reside in jail and prison facilities, with an estimated 25% of prison inmates in the U.S. suffering from a serious mental illness. We have long been criminalizing people who are mentally ill, and we have long remained willfully ignorant about just how many people who commit crimes are not mentally well. 

Clancy happened to have documented mental health records and a baby under the age of one. Does that mean she should be helped while others languish in prison?

Infanticide Is Rare, but Food Insecurity Is Not

There is another aspect of this case that troubles me too, and that is the way it has highlighted the role of intrusive thoughts in postpartum mental illness. In this case, the type of awareness being raised may well undermine the cause of supporting mothers.

Kleiman and colleagues estimate that 91% of mothers experience some sort of upsetting, obsessive (though not necessarily violent) intrusive thought at some point in pregnancy or early motherhood. 

For years, perinatal mental health practitioners have worked to dispel the myth that mothers who do have violent thoughts are at risk of hurting their children. Statistically, it remains the case that they are not. 

If we really want to save children’s lives and help struggling mothers, we must invest our money and energy in the things that make the biggest difference: providing the resources necessary to ensure that all families have access to the food, health care, security, and dignity that they deserve. 

Even among the one-in-a-thousand postpartum mothers who do develop psychosis, only 4% of psychotic postpartum mothers commit infanticide. On the other hand, the risk of reporting a violent intrusive thought to someone who may overestimate its real-world potential remains high – particularly for mothers of color. When it comes to Black mothers, the state often intervenes at the slightest hint of maternal failure, resulting in wildly disproportionate rates of child protective services involvement in Black families. 

Practitioners I interviewed as part of my research have told me that improperly trained clinicians in emergency rooms regularly report mothers confessing to scary thoughts to police or child protective services. These confessions too often result in unwarranted interventions, or even child removals, that may further endanger the mental health of both mothers and their children. They also noted that this tragic misreading of symptoms was much more likely to happen in the case of underinsured, low-income mothers and mothers of color. 

Now that we have a high-profile — if extremely rare — case of an intrusive thought turning into reality, I fear mothers experiencing such thoughts will be less likely to report them. Moreover, overreactions that end up harming both mothers and children may become more common — especially among the country’s most vulnerable families. A meaningful reduction in the already exceedingly low rate of infanticide by mothers is unlikely to follow.

In the wake of the spectacular tragedy of Clancy and her gruesome crimes, we must not lose sight of what really poses the most danger to mothers and children in our country: 3.3 million U.S. households with children were food insecure as of 2022, and 5.8% of all U.S. children do not have health insurance. In immigrant communities, children are losing their parents daily to arbitrary arrests, detentions, and deportations. And the U.S. still has by far the highest maternal and infant mortality rates among high-income countries. 

These burdens fall disproportionately on women and children of color who are living in poverty, without adequate resources and support. These are also the mothers struggling the most with their mental health. In the U.S. context, some studies suggest that nearly 40% or even 60% of mothers of color have a diagnosable perinatal mood or anxiety disorder. 

Good moms have scary thoughts. Now we know that, very rarely, they may even act on them. Much more often they channel those scary thoughts into doing everything they can to protect and nurture their children. 

As American mothers and fathers labor to do the hard, daily work of feeding, diapering, clothing, cleaning, comforting, and teaching their children with less and less help and more and more danger, we must not let the spectacular distract us from the mundane. 

The mother who thought of putting her baby in a blender still haunts me, but she does not keep me up at night. She almost certainly did not hurt her child. We cannot say the same for the policies and institutions of our country.

If we really want to save children’s lives and help struggling mothers, we must invest our money and energy in the things that make the biggest difference: providing the resources necessary to ensure that all families have access to the food, health care, security, and dignity that they deserve.