OBJECTION: Massachusetts Has To Prove She Was Sane

Three days after his three children were killed, Patrick Clancy wrote something on a GoFundMe page that most people in his position never write. He said the real Lindsay was generously loving and caring, that what he wished for her was that she could somehow find peace, and he asked the people reading it to forgive her the way he had. A year and a half later, he told the New Yorker that he hadn’t been married to a monster; he’d been married to someone who got sick.

He has since divorced her, remarried, and moved to New York. He testified for the prosecution last week. He is also expected to testify for the defense, and he is separately suing the doctors and nurse practitioner who treated his ex-wife in the months before she killed their children.

Her trial began July 27th in Plymouth Superior Court, in front of Judge William F. Sullivan. It’s expected to run six to eight weeks. District Attorney Timothy Cruz’s office is prosecuting three counts of first-degree murder, and a conviction on any one of them carries a mandatory sentence of life without the possibility of parole. There is no lesser sentence available, no mitigation a judge can apply, nothing anyone in that courtroom can do about it if the verdict comes back that way.

Her lawyers have already conceded that she killed them. That part is not in dispute and has not been in dispute for a long time.

Cora was five. Dawson was three. Callan was eight months old. They died on January 24th, 2023, in Duxbury, and nothing in the rest of this post makes that any smaller.

Almost every account of this trial I’ve read describes it as an insanity defense, which is close enough for a headline and wrong in a way that matters.

Massachusetts doesn’t use the word insanity. The doctrine is called lack of criminal responsibility, and it comes out of Commonwealth v. McHoul, 352 Mass. 544 (1967), which adopted the Model Penal Code formulation:

A person is not responsible for criminal conduct if at the time of such conduct as a result of mental disease or defect he lacks substantial capacity either to appreciate the criminality [wrongfulness] of his conduct or to conform his conduct to the requirements of law.

Read the second half of that. There are two independent ways to satisfy the test. The first is cognitive, whether you could appreciate that what you were doing was wrong. The second is volitional, whether you could conform your conduct to the law. A person can understand perfectly well that killing is wrong, can articulate it, can know it the way anyone knows it, and still meet the standard if the illness took away the capacity to stop.

Federal law used to work that way too. Congress removed the volitional prong in the Insanity Defense Reform Act of 1984, passed in the wake of John Hinckley’s acquittal, when the national mood held that the defense had become too easy to win. The federal test today, at 18 U.S.C. § 17, is cognitive only. Massachusetts never followed, and the volitional prong is still good law there.

Lindsay Clancy does not have to prove she was mentally ill. She does not have to prove anything.

Once lack of criminal responsibility is fairly raised, which happens through credible evidence and generally means expert testimony, the burden shifts entirely to the Commonwealth. The prosecution then has to prove she was criminally responsible, and it has to do it beyond a reasonable doubt. That rule goes back to Commonwealth v. Johnson, 188 Mass. 382, and was reaffirmed in Commonwealth v. Clark, 292 Mass. 409.

The state has to prove she was sane. To the highest standard the law has. That is a minority position in this country, and it is a structural fact about this case that changes how you should read every piece of coverage you see.

Compare it to almost anywhere else. In federal court, insanity is an affirmative defense and the defendant carries it by clear and convincing evidence. In most states, the defendant carries it as well, usually by a preponderance or by clear and convincing evidence. In Idaho, Kansas, Montana, and Utah, the affirmative insanity defense has effectively been abolished.

This is also why the defense conceding the killings isn’t the capitulation it looks like from outside. Admitting the act and contesting responsibility is ordinary, coherent trial strategy, and in Massachusetts it puts the hardest burden in criminal law on the state. Andrea Yates, whose case everyone reaches for as the comparison, was tried in Texas under M’Naghten with the burden on her own lawyers. Clancy is being tried under a materially more favorable rule.

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The public understanding of an insanity verdict is that the defendant walks out of the courthouse. That has never been true, and it is emphatically not true in Massachusetts.

Under G.L. c. 123 § 16, a verdict of not guilty by reason of lack of criminal responsibility starts a sixty-day window in which the district attorney, the superintendent of the facility, or the medical director at Bridgewater can petition to commit her on a showing of mental illness and dangerousness. Commitment is then reviewed at six months and annually after that, indefinitely, with the person able to petition for discharge and the state able to keep opposing it. In practice, people committed after an NGRI verdict are frequently held longer than they would have served on a sentence.

Yates was found not guilty by reason of insanity in 2006. She has been in a Texas state hospital ever since.

Massachusetts, to its credit, lets the jury be told this. Under Commonwealth v. Mutina, 366 Mass. 810, a defendant who fairly raises the defense is entitled on request to an instruction explaining what an NGRI verdict actually means. Most states don’t allow that, which is one reason juries elsewhere convict out of a fear of release that has no basis in how the system works.

Lindsay Clancy was a labor and delivery nurse at Massachusetts General Hospital. She spent her working life getting other women through childbirth.

The Boston Globe reviewed the court records and found that in the four months before the killings, she was prescribed thirteen psychiatric medications: antidepressants including Zoloft and Prozac, the antipsychotic Seroquel, sedatives, three separate benzodiazepines, and the mood stabilizer Lamictal, among others. The civil complaint alleges that eight of them were prescribed inside a three-week stretch between mid-November and early December of 2022. She went through an outpatient day program. She was an inpatient at McLean Hospital in early January and left a day early to be at her daughter’s birthday party.

She told people she was having thoughts of hurting herself. She told people she was having thoughts of hurting her children. Saying that out loud is precisely what everyone is instructed to do, and it is supposed to be the thing that makes the system respond.

The malpractice suit her ex-husband filed in January alleges that her providers failed to diagnose bipolar disorder with postpartum onset and instead subjected her to what the complaint calls a disorganized, uncoordinated course of polypharmacy that made her condition worse and precipitated a severe psychotic break. The underlying clinical concern is well documented: antidepressants can trigger mania in a patient with an undiagnosed bipolar predisposition. It’s worth remembering who is making that argument in court. It’s the father of the three dead children.

Assistant District Attorney Shanan Buckingham’s position is that Clancy was not in the throes of psychosis and acted deliberately, and the evidence she’s marshaling is not weak.

Clancy allegedly sent her husband to a restaurant farther from the house than usual and to a CVS, and searched how long that would take him, which the state characterizes as engineering a window. Investigators found searches they’ve described as concerning ways to kill, though the defense insists those were suicide-method searches and has moved to keep the phrase out. On the day itself, she took one of the children to a doctor’s appointment and built a snowman in the yard, and a CVS manager and a restaurant hostess who spoke with her by phone that evening both noticed nothing wrong. The prosecution displayed nine prescription bottles that still had pills in them to push back on the overmedication narrative. And they’ve made a point of the timing of the command hallucination Clancy described, a man’s voice telling her that if she didn’t act then she would lose her chance, which she reported only after the killings and after she had met with her lawyer and a defense expert.

Some of that is genuinely difficult for the defense. But the appearance of normal functioning hours before a catastrophic act is not the contradiction it sounds like. Postpartum psychosis occurs in one to two of every thousand births, comes on rapidly, and characteristically waxes and wanes, which means a mother can be lucid at noon and psychotic by evening. Clinicians who treat this illness describe that pattern as typical rather than exculpatory-sounding spin.

England and Wales have had the Infanticide Act since 1938. Where a mother kills her child under twelve months old while the balance of her mind is disturbed by the effects of giving birth, the offense is not murder. It’s treated as something closer to manslaughter, and the outcomes are overwhelmingly psychiatric treatment rather than prison. Canada has a version in section 233 of its Criminal Code. Australia and New Zealand have their own. Roughly two dozen countries have something.

The United States has nothing. Not federally and not in forty-nine states. Illinois, since 2018, allows postpartum illness to be considered in mitigation at sentencing after a finding of guilt, and that is the entirety of American law on this subject.

Massachusetts had a chance to change that. SD1643 would create postpartum mitigation and resentencing provisions and guarantee a psychiatric evaluation for any birth mother charged with a crime committed within twelve months of childbirth. It was sent to a study order. In that legislature, a study order is how a bill is killed without anyone having to be recorded voting against it, and this one is not expected to advance this session. Advocates plan to refile.

I’ll give you the limit of my own argument here, though. An infanticide statute of the English kind would not have covered Cora or Dawson. Both were older than twelve months, and only Callan’s death would have fallen inside it. So even the reform I’m arguing Massachusetts should have passed would have left two of these three counts exactly where they are. That tells you how narrow the proposal is, and how far this country is from having a serious answer to a psychiatric emergency that is well described in the medical literature and almost entirely unaccounted for in our criminal law.

The expert psychiatric testimony hasn’t begun. That’s the real fight, and the defense has Phillip Resnick, who consulted on Yates, and Margaret Spinelli, who is one of the leading authorities on postpartum psychosis in the country. The prosecution has its own bench, including Park Dietz’s shop.

After that comes the charge, when Judge Sullivan reads the McHoul standard to the jury. Ninety seconds of instruction that will decide whether a woman spends the rest of her life in a prison or the rest of it in a hospital. I’ll break down the actual instruction language when it happens.

And behind all of it, SD1643 sits in a drawer.

Three children are dead. A system that had at least thirteen documented chances to see it coming did not, and a prosecutor is now asking for the maximum punishment the Commonwealth can impose. Both of those things are true at once, and I’d be careful with anyone who needs you to pick one.

I'll be covering the expert testimony and the jury charge in this case as they happen, along with whether anyone in Massachusetts refiles SD1643. Subscribe if you want that when it lands. Nothing here is ever behind a paywall, but if you can upgrade to become a paid subscriber to support my work, I’d be so grateful.

If you or someone you know is struggling after childbirth, the National Maternal Mental Health Hotline is 1-833-852-6262. It’s free, confidential, and staffed around the clock.