There is a TWIST in the Lindsay Clancy trial that almost no one has mentioned: in Massachusetts, she doesn't have to prove she was insane. The state has to prove she was SANE, beyond a reasonable doubt. That detail changes how you should watch every day of this trial.
In this video I walk through the law, the science, and the 400 years of history behind one of the most misunderstood trials in America — and one warning sign that matters just as much if you're caring for an aging parent as it does for a new mother.
Three children died here: Cora, Dawson, and Callan. Nothing in this video is a defense of that. This is about what the law is actually asking, and what science can and cannot tell us.
What you'll learn:
— Why Massachusetts uses a two-part test (Commonwealth v. McHoul, 1967) while most of America deleted half of it after John Hinckley shot President Reagan
— What forensic psychiatry calls organized psychosis, and why being able to time a 20-minute errand does not prove someone could stop themselves
— Why the burden of proof flips to the prosecution once the defense raises criminal responsibility
— The difference between baby blues (up to 80% of new mothers), postpartum depression (10–15%), and postpartum psychosis (1–2 per 1,000 births)
— Why intrusive thoughts usually horrify a mother, and the specific moment that pattern flips into danger
— Why the Edinburgh Postnatal Depression Scale, the standard screening form used across American maternity care, cannot detect psychosis or bipolar disorder — and why that matters when a 2001 Jones & Craddock study found roughly 74% risk in women with bipolar disorder and a first-degree relative who had postpartum psychosis
— The one warning sign families miss in new mothers and aging parents for the exact same reason
— Why a dozen medications from uncoordinated prescribers who couldn't see each other's records is the failure at the center of this case
— Where the akathisia argument is strong and where the research is genuinely weak
— Why more than 30 countries have an infanticide law and the United States has none, going back to a 1624 English law that presumed mothers guilty
CHAPTERS
0:00 The twist almost no one is reporting
0:35 The case in 60 seconds
3:06 Two doors: how Massachusetts defines insanity
4:16 Why "planning" doesn't prove control
5:01 Why the state has to prove she was sane
6:35 1843: the furious queen behind American law
8:00 Baby blues vs. depression vs. psychosis
8:33 Intrusive thoughts and the moment everything flips
10:00 The screening test that cannot catch this
10:47 For caregivers: the "she seemed fine" trap
12:16 A dozen medications, no shared chart
13:15 Akathisia and the mood switch: both sides
15:22 The ICU exam everyone misreads
16:48 30 countries have a law. America has none.
20:57 Where to get help
QUESTIONS PEOPLE ARE ASKING
Who has to prove insanity in Massachusetts?
The prosecution. Once the defense raises lack of criminal responsibility with enough evidence, the Commonwealth must prove sanity beyond a reasonable doubt — the opposite of federal court.
What is the Massachusetts insanity test?
The McHoul standard asks two separate questions: did the person lack substantial capacity to appreciate the wrongfulness of the act, OR lack substantial capacity to conform their conduct to the law. Either one is enough.
Does not guilty by reason of insanity mean going home?
No. In Massachusetts it means commitment to a locked psychiatric hospital under renewable court orders with no end date. Research finds these stays are often as long as or longer than prison sentences.
How common is the insanity defense?
Rare. An eight-state study by Callahan and colleagues found it raised in roughly 1% of felony cases and successful in about a quarter of those — around 1 in 400.
What is postpartum psychosis?
A psychiatric emergency affecting roughly 1–2 in 1,000 births, involving delusions, hallucinations, and confusion that fluctuates hour by hour. It is closely tied to bipolar disorder and is not the same as postpartum depression.
GET HELP
988 Suicide & Crisis Lifeline — call or text 988
Postpartum Support International — 1-800-944-4773
National Maternal Mental Health Hotline — 1-833-852-6262 (free, 24/7)
ABOUT
Neal K. Shah is a Johns Hopkins- and NIH-funded caregiving researcher and CEO of CareYaya, and has helped thousands of families navigate aging, dementia, and serious illness. This channel breaks down the health and caregiving news that actually affects older adults and the people who care for them.
DISCLAIMER
This video is for education and general information only. I am a researcher and innovator in caregiving, not a clinician or an attorney. Nothing here is medical, mental health, or legal advice, and nothing here is a defense of what happened. Court proceedings are ongoing and details may change. Please consult qualified professionals about your own situation.
#PostpartumPsychosis #LindsayClancy #MaternalMentalHealth 
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