Publisher Health

DUXBURY, Mass. — Lindsay Clancy lay paralyzed in a hospital bed on Tuesday afternoon, occasionally blinking or shutting her eyes, unable to do anything but listen as lawyers told two narratives about how she had strangled her three children.

The prosecutor said it had been meticulously planned: She had concocted an errand that would keep her husband, Patrick, out of the house for about 25 minutes, just long enough so she could do it.

And she had then strangled each of her children with an exercise band, an act that would require holding each of them down for at least four minutes. Then she leapt from a second-story window, a fall that fractured her spine.

“The defendant stated that after he left the house that night, she killed the kids because she heard a voice, and had, quote unquote, a moment of psychosis,” Assistant District Attorney Jennifer Sprague said during a virtual arraignment via Zoom.

“She heard a man’s voice, telling her to kill the kids and kill herself because it was her last chance,” Ms. Sprague said.

The defense lawyer told a different story. Since the birth of her youngest child, eight months ago, he said, Ms. Clancy had repeatedly sought help for postpartum depression, eventually being prescribed 13 psychiatric medications in a four-month period. But suicidal thoughts kept surfacing, culminating in a break on Jan. 24.

“This is not a situation, your honor, that was planned by any means,” said Ms. Clancy’s lawyer, Kevin Reddington. “This is a situation that clearly was a product of mental illness.”

In the last two weeks, since Mr. Clancy arrived home to a horrific scene, this community has been trying to make sense of it. Ms. Clancy, 32, worked as a labor and delivery nurse. She was known as a generous friend and a doting mother. She had no criminal record, nor any reported history of abusing her children — Cora, 5; Dawson, 3; and the baby, Callan.

Ms. Clancy has received a good deal of sympathy, much of it from women who have experienced postpartum depression and psychosis. Online supporters have adopted the hashtag LAOL, which stands for Lindsay’s Army of Love. Mr. Clancy appealed to the public to “find it deep within yourselves to forgive Lindsay, as I have.”

But Tuesday’s arraignment made it clear how difficult it would be to untangle Ms. Clancy’s mental state from her actions.

The Plymouth County district attorney, Tim Cruz, is prosecuting Ms. Clancy on charges of first-degree murder, which carries the state’s maximum penalty, life imprisonment without the possibility of parole, as well as three counts of strangulation and three counts of assault and battery with a dangerous weapon.

Mr. Cruz, a rare Republican prosecutor in Massachusetts, is widely seen as uncompromising. He successfully pushed for two consecutive life sentences for Latarsha Sanders, who fatally stabbed her two sons in Brockton, Mass., despite her family’s insistence that she was psychotic and delusional.

The extent of Ms. Clancy’s mental illness is only gradually coming into view.

Prosecutors said on Tuesday that she had never reported psychosis to her husband and that a psychiatrist who evaluated her in December had concluded she was not suffering from postpartum depression. On Jan. 5, less than three weeks before the killings, she had been released from a five-day inpatient stay at McLean Hospital, a psychiatric hospital, without any warning that she posed a danger to herself or others.

The case is unfolding at a moment of rising awareness of mental illness and failures in the mental health system.

“If I were the D.A., I would be reticent to charge this as murder — it feels misaligned with our current understanding of mental health, and misaligned with the public reaction,” said Daniel Medwed, a professor of criminal law at Northeastern University.

“Society,” he added, “is way ahead of the law here.”

More than two dozen countries have laws decreasing penalties and providing psychiatric care for mothers who kill children under the age of 1. In 2018, Illinois was the first U.S. state to pass a law making postpartum illness a mitigating factor in sentencing.

Ms. Clancy posted frequently on social media, leaving behind a trail of family snapshots and updates on her mental health. In one post, last fall, she described an adverse reaction to Zoloft, a commonly prescribed antidepressant, which she wrote had left her with such “extreme insomnia” and lack of appetite that she stopped taking it.

Over the four months preceding the killings, Mr. Reddington said, she had been prescribed 13 psychiatric medications, an assortment of benzodiazepines, antidepressants, mood stabilizers and Ambien, which is used as a sleep aid.

“This continued even up until the week before when her husband went to the doctor and asked her for help and said, ‘Please, you’re turning her into a zombie,’” he said at a hearing last week. At Tuesday’s arraignment, he said she had been suffering from postpartum depression, “as well as a possibility of postpartum psychosis that is pretty much ignored.”

Prosecutors, meanwhile, cast the killings as carefully planned.

Using data from Ms. Clancy’s phone, Ms. Sprague described at length how Ms. Clancy had spent the afternoon of Jan. 24 — making a snowman with her children and taking photos that she sent to her mother and husband. Then, at 4:13 p.m., she searched for a restaurant to order takeout, using Apple maps to calculate how long it would take to drive to the restaurant and back.

At 4:53, she texted Mr. Clancy, who was working from a home office in the basement, and asked him to pick up the food — a Mediterranean power bowl for her, scallop and pork belly risotto for him. They had a 14-second call at 5:34 p.m., which Mr. Clancy described as unremarkable, though “she seemed like she was in the middle of something.”

When Mr. Clancy returned to the house, shortly after 6 p.m., he was confused to find it quiet, Ms. Sprague said. Setting down the containers and climbing up to the second floor, he forced open the door of the master bedroom to discover blood on the floor and an open window.

He ran down to the back yard, where his wife was lying, with cuts on her wrists and neck, and asked her where their children were. A recording of a 911 call captured the audio as Mr. Clancy climbed down the stairs to the basement. “At one point, he calls out, ‘Guys?’” Ms. Sprague said. “He can then be heard screaming in agony and shock as he found his children.”

All three had exercise bands tied around their necks. Cora, 5, and Dawson, 3, were pronounced dead at the hospital. Callan died three days later.

Maternal infanticide frequently takes place in the context of postpartum psychosis, a syndrome that occurs in one or two births per thousand and is characterized by delusions and hallucinations that can come on suddenly.

Courts and juries have responded to these cases in disparate ways. The best known is that of Andrea Yates, a Texas woman who was charged with murder in 2001, after she drowned her five children in a bathtub. She later said she had been following the commands of Satan, who had told her it would save them from hell.

In Ms. Yates’s first trial, in 2002, a jury found her guilty after just three and a half hours of deliberation. After that conviction was overturned, the jury in her second trial, in 2006, found her not guilty by reason of insanity.

It’s not unusual for doctors and family members to miss signs of postpartum psychosis in high-functioning women, according to Teresa Twomey, a lawyer and author of “Understanding Postpartum Psychosis: A Temporary Madness.”

Ms. Twomey, who said she had suffered a psychotic break after the birth of her daughter, remembered repeatedly calling her husband to warn him there were intruders in the house. He would drive home, reassure her there was no one in the house and leave again, figuring, as she put it, “maybe a squirrel got into the attic.”

Eventually, she said, she began to vividly visualize acts of violence against her baby, and was so fearful of her own potential actions that she collected the knives and scissors in the house and stowed them in the back of the closet.

In the case of a patient like Ms. Clancy, Ms. Twomey said, “we make the assumption that she would know, and could self-report.” But, she added, “if you’re high-functioning, and you’re paranoid, people are looking for reasons you wouldn’t have this illness.”

In a sermon last Sunday, the Rev. Robert Deehan, who had baptized the youngest of the Clancy children, asked parishioners to look more closely at their neighbors and family members, to consider, as he put it, “what burden the other person might be carrying.”

It had been a difficult week. The morning after the killings, Father Deehan sat with Mr. Clancy for an hour, praying. Later, he visited Ms. Clancy in her hospital room while she was still unconscious and delivered the sacrament of anointing of the sick, which is sometimes known as last rites. On Friday, at a funeral Mass for the children, he read the eulogy Mr. Clancy had written for them.

“Poor Pat kind of went off by himself because he’s still grieving, as you would imagine, and wanting to be apart and just alone, having some space,” he said. “So we gave him that space.”

In Duxbury, a seaside town settled in the 17th century, opinion was split, with some calling for draconian punishment and others, especially women, expressing sympathy.

“The first thing everybody did was look up her Facebook page, and on her Facebook page you can see literally how in love she was with her children,” said Julie Catineau, a psychiatric nurse who hosts a podcast, “Psychology Unplugged.”

“I believe in my heart that this woman was suffering,” she said. “That woman was out of her mind suffering.”

Ms. Clancy will remain in the hospital until she is cleared to be moved to a rehabilitation facility. A probable cause hearing in the case is set for May 2. Speaking to reporters last week, Mr. Reddington indicated that he planned to argue that she was not guilty by reason of insanity.

“The legal system is a heartless juggernaut that would not be affected by public opinion,” he said. “They will proceed as they deem appropriate. I hope they will temper justice with mercy, as they say. If they don’t, then it will be a trial.”