Psychosis Can Change the Beliefs That Govern Action
Psychiatrist Alok Kanojia argues that the Lindsay Clancy case cannot be understood through a model of ordinary judgment overwhelmed by weak impulse control. Drawing on his clinical experience and familiarity with the hospitals involved in her care, he says severe psychosis can alter what a person believes is real, so actions that appear incomprehensible from outside may follow from delusions or hallucinations experienced as fact. Kanojia’s account also frames postpartum psychosis as a rare but recurring clinical emergency that public discussion often confuses with more familiar forms of mental illness.
Psychosis changes the premises from which actions follow
Alok Kanojia describes psychosis as a break from reality in which perceptions or beliefs feel fully real to the person experiencing them. The central mistake, he argues, is to picture it as ordinary thinking overwhelmed by poor impulse control: someone knows what is true, recognizes an action as wrong, and simply fails to stop. In psychosis, the disruption can begin earlier. A person may come to believe something that is not real, and actions can then make internal sense within those altered beliefs.
That distinction is central to how Dr. K approaches the case of Lindsay Clancy, an obstetric nurse and mother of three. He says she had a history of psychiatric illness and experienced a decline after her third child, marked by outpatient treatment, a partial-hospitalization program, emergency-room and inpatient care, discharge, and treatment from seven psychiatric providers who prescribed 13 medications over time. He says Clancy killed her children, injured herself, and jumped from a window, leaving her paralyzed from the sternum down, to his understanding.
Dr. K says he trained at Massachusetts General Hospital, where Clancy went to the emergency room, and at McLean Hospital, where she was hospitalized; he knows people involved in her care. He has also read civil filings and researched postpartum psychosis. He notes that Clancy faces a Massachusetts criminal trial for the deaths of her three children, alongside a separate civil suit by Clancy and her former husband against mental-health providers over their duty of care.
For Dr. K, psychosis can involve hallucinations, delusions, or both. Hallucinations are not merely unwanted or intrusive thoughts. A person may see or hear something they take to be present in the external world. He asks the listener to imagine being inside a horror film in which a pursuing demon is not a cinematic device but an immediate reality. He recalls a patient who jumped from a third-story window because he believed a demon was chasing him, breaking both legs.
Delusions work differently but can be equally consequential. Dr. K recounts encountering an inpatient who repeatedly addressed him as her son and urged him to get a DNA test. Each time he denied the relationship, she took his resistance as something he would eventually overcome. The point was not that she was malicious or speaking metaphorically: she sincerely believed he was her child.
What people don't understand about psychosis is you take the things that you really believe, and then you just change them.
Chris Williamson frames the distinction as one in which an element of volition can remain, but action follows “deranged belief.” Dr. K agrees with the broad formulation while stressing that the beliefs themselves have broken from reality. What looks irrational from outside may be logical to someone whose premises have changed.
The picture becomes more complicated with command auditory hallucinations. Dr. K distinguishes them from persecutory hallucinations, which may involve a voice continuously abusing, criticizing, or threatening someone. He compares the latter to having the most toxic person one knows permanently speaking through AirPods and commenting on every action.
Command hallucinations issue instructions. Speaking generally about psychosis, Dr. K says some people feel compelled to obey; others may resist for a long time and comply in one moment, or follow a command because they have come to believe doing so is right. Williamson notes that Clancy reportedly said a man’s voice told her to kill her children.
Dr. K’s broader point is that severe psychosis is not interchangeable with stereotypes about sociopathy, feigned illness, or popular accounts of dissociation. In his clinical account, the relevant issue is often belief rather than everyday self-control. That is also why people can be hospitalized against their will: clinicians may conclude that a person experiences a dangerous falsehood, threat, or command as real.
He says other psychiatric diagnoses generally preserve some degree of agency, while psychosis can be different in kind. Though he is not a forensic psychiatrist, he says this is the sort of circumstance for which the “not guilty by reason of mental defect” exception exists.
Postpartum suffering can be far closer to the edge than outsiders recognize
The public argument around Clancy is not only about law or psychiatric diagnosis. Alok Kanojia says it has become a source of conflict within couples and between men and women. He mentions reports of people ending relationships over a partner’s support for Clancy, and he describes his own wife telling him she was disappointed in how he was approaching the case.
The reaction surprised him. He says he had taken paternity leave, changed diapers, supported women through pregnancy, seen postpartum psychosis clinically, and spent 10 to 15 hours reading into the case. He knew his wife did not consider him a bad husband, father, or psychiatrist. Yet she still felt disappointed. For him, that encounter showed how much emotional and moral weight people were placing on the case.
Some people, he says, are angry at women who support Clancy because they see that support as a failure to consider the children. Others are disturbed by support for a mother who killed her children regardless of that question. A partner may reason that if someone can sympathize with a person who killed her children, that sympathy itself makes them unsafe to be around.
Dr. K believes this response reflects both fear of child harm and a failure to grasp the severity of pregnancy and the postpartum period. Society often says pregnancy and early parenthood are hard, he says, but does not fully understand what that hardship can entail.
His explanation for why some women have rallied to Clancy is not that they endorse what happened. Rather, he says many have experienced postpartum suffering intensely enough to recognize its proximity. They may have struggled with thoughts of suicide, thoughts of killing their children, or the sense of fighting day after day against something that could destroy their family while they still deeply love their children. They may know the feeling of losing ground, not knowing what to do, and watching their lives seem to fall apart.
They have looked down from the cliff that she jumped off of.
Dr. K presents that as the basis of the identification he sees: not approval of Clancy’s actions, but recognition of a terrifying internal struggle that can coexist with love for one’s children. His account is that many people who have not experienced this kind of suffering cannot easily understand how devotion to a child can coexist with feeling endangered by one’s own mind.
An uncommon incidence can still mean recurring cases
Alok Kanojia cites an incidence of two to three cases of postpartum psychosis for every 10,000 live births. His point is that a rate expressed per birth can still translate into continuing cases across a country with many births.
Dr. K says he had tried to calculate the implication using a daily US birth figure of either 6,000 or 60,000, while explicitly acknowledging that he might have the figure wrong. His conclusion from that rough calculation was that a handful of people experience postpartum psychosis on a typical day in the United States. He presents it as a condition that clinicians encounter repeatedly, rather than an event confined to an exceptional case.
He distinguishes postpartum psychosis from postpartum depression, which he defines as a depressive episode occurring within 12 months after having a baby. The diagnostic criteria for postpartum depression, he says, are the same as for a regular depressive episode; its timing is what makes it postpartum. He also notes that not every depressive episode during that period is necessarily caused by pregnancy.
For Dr. K, mental-health awareness has risen without an equivalent rise in mental-health literacy. People may recognize terms such as depression, trauma, and mental illness, he says, while still not understanding what psychosis specifically does to perception, conviction, and agency. The Clancy case concentrates those misunderstandings in a setting of unusually high stakes: the deaths of children, Clancy’s reported self-inflicted injuries and jump from a window, and the legal question of responsibility.