Closing arguments are expected this week in the trial of Lindsay Clancy, the 36-year-old Massachusetts mother who strangled her three children in 2023 in their Duxbury home before jumping from a second-story window, a fall that left her paralyzed from the waist down. She has pleaded not guilty by reason of insanity to three counts of murder, and her defense is that she was in the grip of bipolar disorder and postpartum psychosis.

For most people watching, this is the first sustained exposure they have had to the illness, which is unfortunate, because the case is an extreme outlier of a condition that virtually never ends in violence toward anyone.

What Postpartum Psychosis Actually Is

The far more common problem is quieter and much more widespread. Postpartum psychosis is routinely missed in ordinary households, by attentive partners and parents who are watching closely and simply looking for the wrong thing.

What they are usually looking for is depression . When a new mother becomes seriously unwell in the first weeks after birth, families interpret it through the only framework most of them have, so they watch for sadness, withdrawal and a woman who seems to be sinking.

Postpartum psychosis does not fit that model. A woman in the middle of an episode is often not sad, and she may not look like she is sinking at all.

What tends to be visible instead is an unusual amount of energy. She may be talking faster than usual, awake and productive at hours when no one would expect her to be and in certain moments she may seem more like herself than she has since the delivery. Families read that as recovery, or as the ordinary strangeness of a house with a newborn in it.

The condition is rare. The consensus estimate in obstetric psychiatry is roughly one or two cases per thousand births, so most people will never encounter it. What makes it serious is not how often it occurs but how quickly it moves. Onset is usually within the first two weeks after delivery and sometimes within the first few days, and an episode can escalate over the course of a single day rather than over weeks.

A 2021 review published in Brain Sciences lays out what psychiatry now treats as settled: the condition sits on the bipolar spectrum rather than functioning as a mood disorder specific to pregnancy. The strongest known risk factor is a personal or family history of bipolar disorder, and childbirth appears to act as a trigger through some combination of abrupt hormonal change and the collapse of normal sleep and circadian rhythm. That same review found that more than 40% of affected women have no prior history of serious psychiatric illness, so its absence is not reassurance.

The clinical picture can include any combination of the following:

  • Mania — elevated or irritable mood, racing speech, a surge of energy
  • Depression with psychotic features, sometimes alongside the manic symptoms rather than instead of them
  • Delusions , often fixated on the baby
  • Hallucinations , most often auditory
  • Paranoia or a sense of being watched, judged or tested
  • Disorganization in thoughts or severely confused thinking
  • Rapid swings between euphoria and despair within the same day

No two episodes look identical, and a woman rarely has all of these at once. What ties them together, and what makes the illness so hard to catch in real time, is the last feature.

One other feature separates the condition from most psychiatric illness, and it is the feature that does the most damage to a family’s ability to see what is happening. The symptoms can fluctuate.

A 2017 study published in Bipolar Disorders followed 130 women hospitalized with the condition and found that a quarter showed a delirium-like profile marked by disturbed consciousness and disorientation, rather than a steady, easily narrated decline.

A mother can be disoriented in the middle of the night and entirely coherent by late morning, in the way a fever climbs and breaks and climbs again. Judging her condition by any single conversation is unreliable, and the calm conversations are the ones people tend to trust.

The 3 Postpartum Psychosis Symptoms Families Most Often Miss

None of this shows up the way a warning sign is supposed to. Each of the following is easy to mistake for something ordinary, or even something good, which is exactly why it gets missed:

  1. Sleeplessness that does not come with exhaustion. Every new parent is short on sleep, which is exactly why this sign hides so well. The thing to notice is not a mother who cannot sleep because the baby keeps waking her, but a mother who does not seem to need sleep. She is up through a second and third night, organizing and cleaning and messaging people, and she does not appear worn down by it the next day. A reduced need for sleep is a hallmark of mania, and a 2024 review published in Focus , the American Psychiatric Association’s clinical journal, names insomnia as consistently among the earliest signs in the weeks after birth.
  2. Confusion that comes and goes. Families expect a steady decline, so what they actually encounter is confusing in its own right. She briefly cannot say what day it is, seems unsure of where she is or loses the thread of a conversation, and then an hour later she is completely lucid. Those lucid stretches are genuinely reassuring, and that is the problem with them, because each one resets everyone’s sense of urgency.
  3. Unusual beliefs mentioned calmly. Psychotic thinking in this period tends to organize itself around the infant, often as a conviction that they are in danger, that something is wrong with them that no one else can perceive or that ordinary events carry a hidden meaning. These beliefs are rarely announced dramatically. More often one gets mentioned a single time in a flat, ordinary tone and is never raised again, sometimes because she has registered that it sounded strange and has decided to keep the rest to herself.

Why The Signs Of Postpartum Psychosis Slip Past

Some of it is cultural. New motherhood is one of the few states in which visible suffering is treated as normal and expected, so the sentence “she hasn’t been herself” gets said constantly and stops working as a signal.

The rest is fear, and it deserves to be understood rather than judged. Many mothers conceal what is happening to them, not primarily out of shame but out of a fairly rational calculation that describing frightening thoughts about her baby could cost her that baby.

As one qualitative study of mothers who’d avoided care, published in BJPsych Bulletin in 2025 found, fear of losing custody was one of the most persistent barriers to disclosure, leading many to minimize their symptoms in front of the clinicians meant to help them. Concealment is not evidence that she is unaware something is wrong. Usually it is evidence of the opposite.

The Clancy trial also illustrates something the coverage has largely skipped over, which is how contested these determinations are after the fact. Defense and prosecution experts examined the same woman and reached opposing conclusions about her mental state, with one prosecution psychologist arguing she was criminally responsible and describing the killings as an altruistic filicide rather than a hallucination-driven act. Retrospective diagnosis is genuinely difficult, which is an argument for recognizing the illness while it is happening rather than reconstructing it later.

How Postpartum Psychosis Should Be Handled

Postpartum psychosis is handled as a psychiatric emergency, closer in urgency to chest pain than to a difficult week. Standard guidance is to seek same-day evaluation through an emergency department or a maternal mental health line, and to make sure she is not left alone with the baby until she has been assessed. In the U.S., 988 reaches the Suicide and Crisis Lifeline. Postpartum Support International and Action on Postpartum Psychosis both keep plain-language material written for families trying to decide whether to make that call.

What gets lost in a case like this one is the prognosis, which is largely good. The condition responds well to treatment, and most women recover from the episode itself.

A 2021 study published in the International Journal of Bipolar Disorders , the only long-term follow-up of its kind, tracked 106 women for four years afterward and found that about a third went on to have a mood or psychotic episode later in life, typically tied to an underlying bipolar diagnosis. That is worth knowing, but it is a long way from the outcome this trial has put in the public’s head.

The reason the illness stays misunderstood is not that its symptoms are subtle. It is that they are the opposite of the ones we have been taught to watch for in a struggling new mother, and so families tend to be reassured by exactly the things that should worry them.

Postpartum psychosis hides behind moments that look like clarity, which is exactly why paying attention to your own well-being — not just how you’re coping on the surface — matters. See where yours actually stands with this science-inspired measure: Well-Being Index