Hidden True Crime - Two Psychiatrists, Two VERY Different Conclusions About Lindsay Clancy | Trial Day 18

Episode Date: August 23, 2026

Lauren Matthias breaks down a pivotal Day 18 of the Lindsay Clancy trial as the defense and prosecution present sharply conflicting psychiatric opinions about Lindsay’s mental state on January 24, 2023. Renowned forensic psychiatrist Dr. Phillip Resnick — who testified in both Andrea Yates trials and has evaluated dozens of filicide cases — told jurors he believed Lindsay was suffering from bipolar II disorder, severe depression and postpartum psychosis, and that she was unable to conform her conduct to the law when she killed Cora, Dawson and Callan. On cross-examination, prosecutors challenged his conclusions using his own research on malingering and command hallucinations, then called rebuttal psychiatrist Dr. Avram Mack, who diagnosed major depression but rejected bipolar disorder and said he found no evidence of psychosis or mania in the relevant period. With the defense now rested, Lauren breaks down the expert battle over THE VOICE, criminal responsibility and the central question the jury will soon have to decide. Sponsor: Jones Road Beauty- Use code HIDDEN at https://jonesroadbeauty.com to get a Free Gift with your first purchase! About Hidden True Crime What started as a simple conversation at their dinner table became a captivating podcast. Join the dynamic duo of Dr. John Matthias, a criminal psychologist, and Lauren Matthias, an investigative journalist, as they delve into the psychological facets of unthinkable crimes every week. Their unique perspectives and in-depth analysis offer a fresh take on true crime storytelling. Thank you for your support through sponsorships, subscribing, listening, and becoming a Patreon member at⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Patreon.com/HiddenTrueCrime⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Learn more about your ad choices. Visit podcastchoices.com/adchoices

Hello, Hidden Jens. It is Friday or fray. We have a big day in the Clancy trial. I'll just say this. I won't bury the lead. The defense rested. They took, you know, a lot fewer days than the prosecution took. The defense rested.

Rebuttals from the prosecution has started. It is a big day. We're going to go over everything. I am curious, though, because I'm having some nostalgia. and I'm remembering when John and I used to go live every Friday night. That's how we started our YouTube channel. And I'm wondering who has been here since that time or if anybody remembers because that's what this Friday live is reminding me of.

And it's good to be with all of you. So thanks for being here, even though we are a little bit later than planned. Because we have so much to go over. First, the defense called their final witness today, Dr. Philip Resnick, and yes, Dr. Spinelli never did testify. And people happen pointing out, I'll just say this, and I've seen the post, that Dr. Spinelli has been sharing on Facebook her support of Lindsay Clancy. That's kind of a no-no if you're going to be an expert witness in a trial. I don't know if that's why she didn't testify. I can't confirm that. But Dr. Spinelli did not testify and she was supposed to be a key witness in this case. But instead, the defense landed on their final witness today, Dr. Philip Resnick. He's a forensic psychiatrist with decades of experience in both psychiatry and the legal system. And he actually recently had to undergo surgery. So he testified remotely over.

Zoom. Redington started by going through his background, as always, very impressive background. He earned his bachelor's degree in epidemiology and then his medical degree from Case Western Reserve University in Cleveland. After completing a brief military hospital internship, he returned to University Hospital in Cleveland, where he completed his psychiatry residency. He remained at Case Western throughout his career and eventually became a full professor. And his work increasingly focused on forensic psychiatry, which deals with psychiatric issues that intersect with the legal system. In 1979, Dr. Resnick started a forensic psychiatry fellowship and directed it for the next 40 years. He also served as director of the court psychiatric clinic in Cleveland for more than

four decades, board certified in psychiatry in 1971, forensic psychiatry in 1979, with additional qualifications and later recertifications in forensic psychiatry. He's also held around 14 visiting professorships. So then, Redington goes into one of the areas Dr. Resnick has become particularly known for, Philisach. Yeah, he's particularly known were philicide. Phylliside, as many of you know here, a hidden true crime is the killing of one's children.

He explained that that's what Philicide is, the killing of a child in the United States, by a parent. In the United States, it's relatively uncommon, even though it seems common because we cover them a lot, but they're relatively uncommon, and they occur between 400 and 500 times a year.

I'm going to ask whether he had, had more experience evaluating suicide cases than perhaps anyone else in the country, he paused, but said he believed that was true. Over the course of his career, he has been personally involved in approximately 80 cases in which he evaluates the mothers and fathers who have killed their children. His work has also taken him into some of the most high-profile criminal cases in the country, truly, truly some of the most high-profile. Listen to this list. he's consulted for the prosecution in the Jeffrey Dahmer case,

the Unabomber case, Ted Kaczynski, been part of that, Casey Anthony's case. He was a consultant, but the defense ultimately couldn't use him in the way they hoped. Andrea Yates, both trials of Andrea Yates helping the defense, a trial that's been compared to Lindsay Clancy's. He's also consulted for the prosecution in the Aurora movie theater shooting case and worked for the government in connection with the Oklahoma City bombing case. Beyond those specific cases, Dr. Resnick testified that he has worked on numerous homicide cases for both prosecutors and defense attorneys,

including many involving parents who had killed their children. Reddington then brought the discussion directly to Lindsay. Dr. Resnick, I've been contacted by the defense, asked to assist in the evaluation of Lindsay Clancy. He explained that approximately four months after the killings, he personally evaluated Lindsay and her parents. He spent about three hours interviewing Lindsay herself, an approximately an hour and 15 minutes interviewing third party contacts, those collateral interviews, including her parents. The evaluation happened in May, 23 at Tewkesbury Hospital. Ready to ask Dr. Resnick to describe Lindsay's physical and

emotional presentation during that interview without getting into anything that she actually told him. Can you describe for us without getting into any statements? that she made to you. Tell us about the circumstances. How did she appear to you physically? And how was she able to answer your questions? Just tell us what her appearance was. Her mood? Yes. Well, first of all, at the time, of course, she had suffered major injury and was paralyzed. So that was the setting. So during the examination, she did not have control of the lower part of her body.

During the interview, she appeared somewhat matter of fact, but at the time she was so grieving, the nurses told me that she was crying daily about the loss of her three children. and she was also medicated at that time. She was fully cooperative and gave me a detailed account of her recollections of the critical events.

Did you make an observation of her affect? Did she appear to have what you refer to as a flat effect? Yes, she did have or I would call it a blunted affect, that is her emotions were not, as you would expect, her feeling tone was muted. Muted? Is that what you said muted? Muted.

Okay. Yes. Now, doctor, in the course of evaluating this case, and again, in the interest of time, would you agree that you had a chance to review a number of items? to assist you in your evaluation. I reviewed extensive records in this case, both records referring to Ms. Clancy's mental illness, how it developed over-treaters were,

and then also I was able to evaluate records after her conduct. And that would include police reports. Extensive police reports, yes. Grand jury testimony? Yes. Photographs? Yes. Videos.

Yes. Medical records from health care providers such as Dr. Tufts, nurse practitioner, Jolada and McLean Hospital. Yes. We were aware that she had also contact. suspected suicide hotlines and went to a facility in Rhode Island, women and infants. Yes, I reviewed all those records. So with all of that information, Doctor, that you had access to,

did you also have the opportunity to review any records from, let's say, the government's doctors, Dr. Helburn, Dr. Sattorne, Dr. Sattof. Yes, after I prepared my report, I was aware that there are three experts employed by the prosecution, and I was able to review their reports from detail as you. So after Dr. Resnick had prepared his own report, he became aware of the three experts retained by the prosecution, was able to review their reports in detail. Reddington focused on the testing performed by one of those government experts, Dr. Halpern, One of the tests Dr. Halpern administered was the MMPI, the Minnesota multifacic personality inventory.

So Redington asked Dr. Resnick whether that testing showed evidence that Lindsay had been faking or exaggerating psychiatric symptoms. Dr. Resnick said it did not. He explained that. In fact, the results suggested Lindsay had a tendency to minimize rather than exaggerate her symptoms, which is something we have speculated on, right? Did she share everything with her doctors? There was no evidence of what is referred to as symptom faking. Dr. Resnick also explained that the MMPI was designed to assess symptoms and personality characteristics rather than determine if someone simply lying or telling the truth.

Still, the testing did not suggest that Lindsay was fabricating psychiatric symptoms. Reddington then asked about the case scale, sometimes referred to as a validity or lie scale, Dr. Resnick said that that scale was not evaluated. The questioning then turned to another major area of Dr. Resnick's professional expertise, malingering. Also known as lying or not completely telling the truth, malingering. He testified that determining whether people were faking or exaggerating psychiatric symptoms had been a major area of interest throughout his career. In fact, he'd written 46 articles or book chapters on the subject beginning in 1984. Dr. Resnick explained

that the psychiatric research has evolved. So he updated a chapter for a later edition of his book, incorporated some fresh research. The older publication he had written could, you know, be now added with new information. Redington brought that point back to Dr. Halpern's report. And Dr. Resnick testified that Halpern had cited some of his own research, but the research referenced by Dr. Halpern was a bit older.

Redington then returned to Lindsay's medical record. and the medications she had been prescribed during the period leading up to the killings. Well, Dr. Reznik confirmed that he had reviewed her psychopharmological pharmacology records, including the medications prescribed by Dr. Tufts, Nurse Jolada, and other providers we have heard from. His evaluation was not solely based on just the three hours he spent with Lindsay. He also considered that interview along with the extensive medical records. police material, the reports, other evidence, Lindsay's journal information documenting her thinking, her symptoms as of January 24, 2023 approached. And with that foundation, Reddington was ready to begin

getting into Dr. Resnick's actual conclusions about Lindsay's mental state. First, a ad from one of our wonderful trial sponsors who helped support our nightly lives and work. Take a listen. One thing I have learned with reporting and hit into crime is I need makeup that works fast because I can go from literally sitting and chilling at home to realizing, oh, we're going live in like five minutes. So I can't spend 30 minutes to get camera ready. And that is why I love Jones Road beauty. Their miracle ball has become one of my favorites because I can put it on with my fingers, no brush necessary. I immediately get this really super glowy and put together look. and it doesn't feel like I'm wearing layers of makeup. It's easy. It's natural, perfect for the days

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Reddington also established that Dr. Resnick was aware of Lindsay's cell phone activity during the months leading up to the killings, including her Google searches and searches for medications during October, November, December, and January. The questioning then moved to the central issue of Dr. Resnick's opinion, whether Lindsay was suffering from a mental disease or defect at the time of the killings that substantially impaired her ability to appreciate the wrongfulness of what she was doing or to conform her conduct to the requirements of the law. Dr. Resnick began with his diagnosis.

Well, sure. Let me begin with the issue of whether she had a mental disease or a defect. Ms. Clancy had a severe depression. There is a book called the DSM or Diagnostic Manual prepared by the American Psychiatric Association, which lists criteria for various diseases. So in the diagnostic angle, for example, there are one needs to have five out of nine symptoms to make a diagnosis of major depression.

And Ms. Clancy, as she approached the date of the crime, actually had seven of the nine symptoms and was severely depressed so that in addition to that, she had some earlier evidence of what's called a mild mania, and that sits together in what's called bipolar two. In other words, it's a type of bipolar illness where there is more, frank depression, severe depression, but the manic aspects are not as severe. So my final diagnosis of her was called bipolar 2 with a severe depression on January 24,

2003 and from reading your reports of all the experts that are that will be testifying that no one failed to diagnose a major mental disease on the day of the client. Now doctor in the course of that diagnosis have you considered the concept of postpartum depression and or postpartum psychosis? Yes. Can you tell the jurors how that... I'm sorry. Can you tell the jurors how that factors into your diagnosis and opinion?

Yes. Ms. Clancy had a history of anxiety and difficulty with each of her children. It was minor with her first child, more significant with her second child, and on the occasion of Callan's birth, things went well for the first three months. But then Ms. Clancy became very anxious and depressed, and it took quite a toil on her. And I believe the jury has heard from various treaters, such as Dr. Tufts and Nurse Delada and others, and her own anguish about how de crest she was, where she actually felt she couldn't function,

her brain was damaged, she would never be the same. So she definitely met the definition of a major depression as well as this bipolar phenomena. Now, with respect to the postpartum aspect, since this Crancy's symptoms began within three months of Callan's birth that would be considered a postpartum onset.

Then, of course, she had considerable difficulty over the next five months, and at the time of the crime itself on January 24, 2020, was Clancy was frankly psychotic. So in that sense, she had a postpartum psychosis. It's actually not frequent to have a postpartum psychosis eight months after a birth, but it does occasionally occur.

And so what I can say is whether it is a classic postpartum psychosis or not, With the postpartum onset and frank psychosis on the day of the killing, I would label that a postpartum psychosis in the sense that it was a postpartum onset and she was clearly psychotic on that day. And doctor, when a person is psychotic or involved in having a psychosis, in your opinion, Are they able to appear normal, quote-unquote, communicate with people, drive a car, things of that nature? Well, let me say there that Ms. Clancy herself did her best to not reveal the extent of her depression. She was frank with members of her own family, her sister, her mother, her mother-in-law,

were aware of how anguished and depressed she was, but with more casual friends, she tended not to show the extent of her depression. I'm not suggesting that she was, although psychosis can indeed wax and wing, for example, on the day of her crime, I'm not suggesting that she was frankly psychotic every minute. She was functioning.

In fact, she said she was having a better day than other days. And she actually went out and made a snowman with the kids, visited with Kora to a doctor for the fifth birthday checkup and was functioning at a level that was not frankly psychotic. until she had a command hallucination while her husband, Patrick, was out doing a couple of chores. And can you tell us, Doctor, in your opinion, what a command hallucination is and how it fits, if you will, in a diagnosis of psychosis?

Yes. If we take, first of all, the hallucination is simply hearing a, voice and the voice can be benign or it can be more malignant. So a voice may just simply say open the window. About one third of voices are called command hallucination. That is an instruction to do something. And the majority of those commands are benign. So it might be open a window, get a glass of water. It might be something much more ominous

such as to kill oneself or harm someone else. Those are dangerous command hallucinations. Now, in Ms. Clancy's case, she had not only a command hallucination

on the day that she killed her children. She had what is known as a delusion of influence. That is, not only did she hear a command, but she felt that her body was taken over by an external force where she was in a dream state and did not have control of her own body. It was almost like she was a puppet

and someone else was pulling the strings. Yeah, hold that second. Counsel? I want to give you an instruction at this point. I'm going to go into this also a little bit later when I give you the full instructions at the end of the case. But you would not to consider the defendant statements to any psychiatrist or psychologist as establishing the truth of any facts that are contained in that sense, in those statements. The defendant's statements to any psychiatrist or psychologist for purposes of evaluation, cannot be considered by you as evidence of premeditation, extreme atrocity, or cruelty, or specific intent to kill.

Such statements are admissible only as they relate to the basis for the doctor's opinion of the defendant's mental condition. All right. I'll go into that a little bit later. Okay. Go ahead. Mr. as it relates to the standard of a person being lacking criminal responsibility at the time of the commission of a crime in the Commonwealth of Massachusetts. Well, there are two arms to the test for criminal responsibility.

One has to do the defendant's ability to control their conduct, and the other has to do with their knowledge of the wrongfulness. of their acts. I'd like to address each of those separately, if I may. Sure. With her to my opinion, my opinion is that Ms. Clancy was due to her mental disease, unable to conform her conduct, was to the requirements of the law on the day that she took the lives of her children. And let me give you the basis of that opinion. First of all, she was hearing a voice, which was commanding her

to engage in the killing behavior. And she did not feel any sense of control. She felt that she had to obey the instructions she was, to evening. It was a matter where she was just following the command

rather than being able to make any decision to do it or not. And for example, I ask his plan says...

You can't say what you're doctor. You can't You cannot say what she told you, all right? Okay, all right. I will not do that. Let me just make sure I'm covering other aspects of her. The second evidence that she was lacking control is the fact that she made a severe suicide attempt, also based on the command hallucination that she heard that day so that she,

she not only cut her throat and jumped out of the window, she very much wanted to die. I thought that was so interesting how he explains it as she is a puppet, but not in control of the strings. Reddington then moved into Resnick's research, more specifically women, specifically women who kill. their children, mothers. He explained that he had divided the motives for philicide into five categories. The first was altruistic philicide. That refers to a parent killing a child out of what

the parent believes to be love and concern for the child's well-being rather than hostility towards the child. So he explained that that could occur when a parent develops a delusional belief that the child was going to suffer or be tortured or believes killing the child was. The child was actually in the child's best interest. It could also occur when a mother was planning to kill herself and because of severe depression or psychosis came to believe that her children would be better off dying with her than remaining alive without her.

In Lindsay's case, Dr. Resnick connected that category to what he described as her intense focus on caring for her children. He said she had consulted people at work because she wanted to make sure she was doing what was right for them. according to his opinion Lindsay had become convinced that if she died her children would be left in terrible circumstances

without her to care for them. Her thinking had become so distorted, he said, that she believed she was actually helping them by having them go to heaven with her rather than remain on earth without her. Reddington then asked him to identify the other four

categories without going into detail unless they applied to Lindsay. So the second category was acutely psychotic suicide that involves someone who was frankly psychotic and acting on delusions hallucinations rather than anything rational. So Dr. Resnick did explain that that category does apply to Lindsay, but the remaining three categories do not. In other words, child maltreatment involving an abusive parent who might kill a child through acts like shaking baby syndrome or throwing the child. another was unwanted child, where a parent kills a child because the child is viewed as a burden

or inconvenience. Final category was spouse, revenge, fill aside, where someone kills a child as a way of punishing or hurting their spouse. Dr. Resnick testified that none of those three categories fit Lindsay. He described her as someone who loved and respected her husband and had a good marriage, and he said there was no history of her spanking or abusing her children and all of the children had been wanted. In fact, he pointed out that Lindsay had planned to have a fourth child, which we heard about in her journal. Dr. Resnick then returned to the two categories he believed did apply. In the altruistic category, he said Lindsay's thinking had become distorted to the point

that she believed her children could not have a decent life without her. She believed that what she was doing was morally right for them, even though she understood that ordinarily killing a child was against the law. in the second category, psychotic suicide involved a command hallucination and delusion of influence. So Dr. Resnick's opinion was that Lindsay had been so deeply caught up in that psychotic state that she no longer had the capacity to make a rational decision about whether to comply with the law. Reddington then moved to another issue that had been raised during the trial, whether Lindsay had been forthcoming with her doctors about the effects she experienced from her medications.

Dr. Resnick said that based on his review of the medical records, Lindsay was actually a more sophisticated patient than most and was generally forthcoming about her symptoms. There was one significant exception. He said that she had not fully disclosed the thoughts or impulses she was experiencing about harming her children. The reason was that Lindsay had a rational fear that her children could be taken away from her by a social service agency. At the same time, he described another belief she had as irrational, the belief that simply entering a psychiatric hospital could result in her children being taken away. Redington then asked whether it was common for postpartum women experiencing intrusive or dark thoughts to be afraid to tell their health care providers because they feared losing their children. The judge stopped that question before Dr. Resnick could answer.

And so Reddington then addressed another issue that had come up during the trial. The fact that Lindsay had not killed herself while hospitalized at Tewksbury. It's also been mentioned here a couple of times that she hasn't killed herself yet, even though she's in the Tewksbury Hospital. Can you tell the jurors briefly, while she's in the Tewksbury Hospital, what are the circumstances of her confinement and what type of care is being provided to her? as it relates to whether or not she, why she hasn't killed herself yet. Well, let me see, indeed, there is evidence of her feeling suicidality

to such an extent that she is never allowed to be out of the presence of a staff member. Even when I conducted an examination of her and requested privacy, a staff member had to be present. So her ability to take her life in view of her purposes and observation is simply because, and she recognizes that so that the reality is no matter he does not want to live at any point,

she has no choice but first to live Edgaret's time. Thank you very much, doctor. You have to answer some questions from the DA. Well, after that, Sprague began cross-examination by addressing Dr. Resnick's credentials. She noted that the doctor had a 40-page resume and asked that it be submitted as an exhibit. There was no objection and the resume was marked. And from there, Sprigg focused on an area of Dr. Resnick's career that went beyond evaluating

psychiatric patients. Dr. Resnick had also taught courses to forensic psychiatrists and psychologists about testifying in court. Sprague asked whether those courses included instruction on how to answer questions, how to dress, and how to appear believable and trustworthy. Dr. Resnick agreed. Sprague then brought up one of Dr. Resnick's training materials called dues and don'ts of depositions. And in that material, Dr. Resnick had written that information beyond the question should not be volunteered because it could open up new areas of questioning, give the other side ammunition, eliminate the opportunity for surprise, and potentially prevent information from reaching the jury. Sprague asked whether that meant Dr. Resnick taught other psychologists how to hold back information during the discovery process

in order to surprise the opposing side. But Dr. Resnick rejected that characterization. The questioning then moved again to fill aside. Sprague established that a woman who kills her child could have more than one motive. Dr. Resnick agreed. He also agreed that the most common motive among women who killed their children was fatal maltreatment or child abuse, and he agreed that most women who kill their children do not do so because of mental illness.

But then Sprague got into Dr. Resnick's writings about what happens to parents emotionally after they kill their children. Dr. Resnick's written about this significant emotional devastation that could follow these killings, including the possibility that the event could prolong a parent's depression. Sprigg pointed out that birthdays, holidays, and anniversaries of the children's deaths could become painful reminders. Dr. Resnick agreed that those events could sometimes be upsetting.

As you know, what she's trying to do there, say, but she was eating dinner on those days with her parents. Well, the cross-examination then turned toward millingering, another subject Dr. Resnick had spent years researching. Sprague established that a person could have a genuine mental illness and still malinger by exaggerating symptoms and claiming to experience psychosis symptoms that weren't actually present. Dr. Resnick agreed. Sprague then brought up one of Dr. Resnick's articles faking it and a statement about command auditory hallucinations being easy to fabricate. The article also explained that people experiencing genuine command hallucinations did not always obey the voices, particularly when the commands were. were dangerous. Again, Dr. Resnick agreed. Sprague went through some of the advice Dr. Resnick

had given other practitioners for identifying possible malingering. And one thing doctors were told to look for was whether a person uses strategies to make the voices go away or reduce their intensity. I thought that was so interesting. She suggested that someone who heard a voice telling them to do something as horrific as killed their child would typically try to resist it, at least initially. Dr. Resnick pushed back slightly on that generalization. He explained that there was variability. Some people resisted. Some people did not. Sprig then brought up Andrea Yates, who Dr. Resnick had previously discussed during his direct testimony, helping her defense, both times, both trials. Yates had heard voices telling her to kill her children for months. She had committed

herself to psychiatric hospitals five times and attempted suicide twice while resisting those voices, or attempting to resist those voices. Dr. Resnick agreed that she had tried to resist until she eventually could not. Sprigg then compared that history with Lindsay's. According to the records and testimony, Lindsay heard the voice and immediately acted. Dr. Resnick responded that Lindsay had experienced impulses to harm her children before that and had resisted those impulses until the command hallucinations overwhelmed her. Sprague went back to the records. She pointed out that Lindsay had reported an impulse to harm her children on one occasion in December.

Dr. Resnick believed she had actually mentioned it to Patrick on two occasions. But after those occasions, Sprague noted that Lindsay did not report another impulse to harm her children until after the killings. Dr. Resnick acknowledged that she had only specifically mentioned the impulses to her husband twice, but he believed her references to those horrible impulses suggested they were something she was dealing with on an ongoing basis. Bragg then drew an important distinction between thoughts of harming the children and thoughts of killing them. That's true. Lindsay had told people about thoughts of harming her children, but she had never specifically told them she was thinking about killing them. Dr. Resnick agreed with that distinction.

Sprague then returned to Dr. Resnick's earlier testimony that Lindsay had been forthcoming with her medical providers. She pointed out that Lindsay had repeatedly been asked by her doctors whether she was experiencing homicidal thoughts, and she repeatedly denied it. Dr. Resnick agreed, but clarified that this was true during the earlier stages of her treatment, but by late December in January, she had developed the impulses and did not disclose them to her doctors. But what she told her doctors in December is that she had no homicidal ideation. She only reported suicidal ideation, correct? Yes. And as noted, that's very common because people fear their children will be taken away. So it's better to kill them than to have been taken away.

You know, it's not better to kill them. Go on that. Yeah, question, stricken, Eddie, it's restricted. Okay. You say that she was very forthcoming in her symptoms to her medical providers, but she never told those medical providers that she had an impulse to harm her children, correct? That's correct. You also, in teaching people about malingering, about faking hearing voices or being psychotic, you give pointers of what people should look for,

such as patient uses no strategies to diminish hallucinations. Patient states he obeys all commands, correct? Yes. You also, in a podcast, evidence entitled Identifying Malingering with Dr. Philip Reznik, you were asked about malingering. and you said, and asked about hearing voices, and you said, quote, so a common example I'll use in teaching is if you hear a voice out of the blue that says, kill your mother, your moral fiber would cause you to hesitate.

But if you have concurrent delusion that your mother is an evil wizard, you're more likely to act on that command to hallucination, correct? Correct. And there's no evidence in the records or in the testimony that we've had thus far that Ms. Clancy believed that our children were evil or that they were possessed or that there was any danger posed by them or to them by such forces, correct? Instead, Ms. Clancy had a yes or no question, doctor. Go ahead. You can answer to that. Instead, Ms. Clancy had the dichotic, distorted belief that her children would be better off in heaven,

rather than being motherless. But that was her psychotic distortion, coupled with the command hallucination. So she met the exact requirement you're referring to. And you believe that that was her psychotic delusion, that they would be better off without her, better off in heaven without her, because according to your report, you could figure out no rational,

non-psychotic motive for her to kill her children, correct? Yes. And so just because you can't figure out a motive or you don't know a motive or the person doesn't tell you a motive doesn't mean that there actually isn't a motive, correct? There was a motive. But that's not what I asked you. I did not ask you about Ms. Clancy. I said just because someone tells you that they don't have a motive or you can't figure out a motive doesn't mean they didn't actually have a motive, correct? That's possible, yes.

Sprague then moved to another point from Dr. Resnick's research on malingering. He had written that the rapid resolution of psychotic symptoms after medication could be a warning sign because genuine psychotic symptoms generally took longer to resolve. Dr. Resnick agreed. Sprague then turned to Lindsay's records from Tewksbury Hospital. She asked about a note stating that Lindsay had been clinically stable since her admission with no episodes of effective, cognitive, or behavioral instability. The same note stated.

that she had not demonstrated difficulty accepting or following the rules and standards of the hospital. Dr. Resnick said he was aware of that information. Sprague then referenced another section of the records in which Lindsay reportedly denied ever experiencing hallucinations before or after the event in which she killed her children. Dr. Resnick confirmed that he was aware of that note as well. Another Tewkesbury record described Lindsay as having intact reality testing and no observable symptoms of psychosis. It also noted that she was actively participating in treatment and was able to identify possible hopes for her future, including becoming an activist for postpartum psychosis awareness

and participating in a wheelchair marathon. Dr. Resnick acknowledged that he was aware of that information. Sprague moved to admit those three portions of the Tewkesbury Records as exhibits. The defense did not object and they were admitted. The questioning then returned to something Dr. Resnick had mentioned during his direct examination. He had testified that nurses told him Lindsay cried every day over the loss of her children. She mentioned that when you interviewed Ms. Clancy, you spoke to some nurses who told you she had been crying every day, correct? Yes. Are you aware that in the Tewksbury records, in the one-to-one notes of people who watched her every minute of every day.

There's no record of her crying every day. Well, when I saw her at four months, I'm not sure was she already, how long had she been at Tewsbury? I, well, I'm not aware of that note, but my recollection is that she was her crying. But there's no record of her crying at Tewksbury every day, correct?

I have no knowledge. And you mentioned that during the interview, not getting into anything that she said, but her affect, her expressions, her emotions, you said that they were flat and blunted, correct? Yes. Do you remember the portions of the video where she smiled and laughed? Are you talking about the video or not in the radio? What was that?

Are you talking about the videotape of my interview? Yes. Yes, at the end of the video, do you recall her smiling and laughing? Does that open up the video? This is affect and behavior. That's an issue we could talk about over here. It's probably something best raised on cross. Okay.

I mean, no, and redirect. I'm sorry. And just getting into her affect and behavior, doctor. Yeah. yeah, that's not inconsistent with her affect throughout the interview, especially, for example, in talking about how delighted she was. I'm not asking anything about what she talked about, just her expressions and her affect.

Now, you mentioned that the Commonwealth experts saw Ms. Plancy three years after you examined her, correct? I said it was three years after the time. And you're aware that the Commonwealth was not permitted to interview Ms. Clancy until after defense had filed a notice of their defense, and we'd been giving permission by the court to have our experts interview her, correct? Yes. And you're aware that did not occur until approximately two and a half years after the incident, correct? Yes. Now you mentioned that postpartum psychosis doesn't typically happen eight months after a child's

born, correct? Yes. In fact, typically it's within four weeks of a child being born, correct? Most often, yes. And you mentioned that her postpartum, Ms. Clancy's postpartum symptoms began within that three-month timeframe of postpartum. Do symptoms have to occur within that three-month period to be postpartum? Well, there's a wide range of definitions of postpartum.

Some scholars in the area make it the whole first year, others three months, others four weeks. And in fact, her seeking help from a psychiatrist happened in September, which would have been four months after she gave birth, correct? Correct. You mentioned that Ms. Clancy was able to hide her symptoms of depression from her friends, that she was open with some people, but she was able to hide those symptoms from friends and other people she interacted with, correct? Yes, hide the depth of her depression. And so she was able to control and conform her behavior to situations in which she did not want to show people,

how she was feeling, correct? Sure. Very common. Finally, Sprague addressed Lindsay's fear that her children would be taken away. Dr. Resnick had written in his report that Lindsay had paranoid beliefs that her children would be removed from her. If anyone learned what she was experiencing, Sprague challenged the use of the word paranoid, wasn't it actually rational for someone who believe they might harm their children to worry that the children could be taken away. Dr. Resnick responded to that, that the fear could be rational in some

circumstances, but in Lindsay's case, he considered the belief irrational. Sprague then told the court she had nothing further, and surprisingly, there was no redirect. And after that, the defense rested, done, dunzo, no Dr. Spinelli. The prosecutor. is going to have some witness that they're going to rebuttal. So up next, the Commonwealth called its first rebuttal witness because, you know, this is their trial. They get the last word. The prosecution does.

And they called Dr. Abram Mack, Dr. Mack, Buckingham was up this time. And Buckingham began by establishing Dr. Mack's background. Dr. Mack was a psychiatrist who had been practicing for 22 years after completing his training. He attended the University of Michigan for college and Cornell University for medical school. Very impressive medical school. He completed his psychiatry residence, residency at Brigham and Women's Hospital, followed by a child psychiatry fellowship at Columbia University and a one-year forensic psychiatry fellowship at New York University. He currently worked as a professor of psychiatry at Thomas Jefferson University in Philadelphia and also maintained a clinical

practice at a children's hospital and his work included both clinical psychiatry and forensic psychiatry. Dr. Mack was board certified in psychiatry, child and adolescent psychiatry, and forensic psychiatry. He had also previously been board certified in addiction medication, although he explained that the organization that provided that certification had since closed. His forensic work covered a broad range of issues. He had testified about matters involving capacity, contract, adoptions, competency, criminal responsibility. His work has taken him around the country.

He's been involved in reviewing and investigating cases in more than half of the state's impressive resume. And he is the prosecution's report. buttell witness. And so, Buckingham then asked him to explain what it meant to conduct a forensic psychiatric evaluation. Dr. Mack said it could mean different things depending on what question a court or other authority was asking. Sometimes the psychiatrist was required to answer a specific question laid out in a statute. Other times, particularly in civil cases, the psychiatrist might be asked to give an opinion about something like the degree of harm a person had experienced.

He had testified as a forensic psychiatrist in both civil and criminal matters. Buckingham also asked about the difference between a forensic psychiatry and forensic psychology. Dr. Mack explained that they were separate professions, although both involved mental health. They were different. They had different professional rules governing forensic psychologists in the way they carried out their work. The questioning then moved to Dr. Mack's experience with criminal responsibility. He had conducted evaluations and testified in cases involving criminal responsibility,

and he acknowledged that the legal standards could differ somewhat from state to state. And for this case, he had been asked by the Commonwealth to review the matter involving Lindsay Clancy. And as part of that evaluation, he reviewed the Massachusetts statutes concerning criminal responsibility. Buckingham asked how Dr. Mack became involved in the case. and he said he had been asked by the prosecutor's office to serve as a psychiatrist reviewing the matter. And that led to a discussion about the role of an expert who was retained by one side in a criminal case. Buckingham asked whether the expert's job was simply to advocate for the side that hired them or whether they were supposed to independently evaluate the evidence.

Dr. Mack explained that the goal was to provide an independent evaluation. He also described the role as providing clarity and explaining what could actually be said based on evidence. In some criminal matters, the question could have a relatively straightforward yes or no answer. In others, the issue wasn't necessarily that simple. Buckingham then asked how Dr. Mack approached a criminal responsibility evaluation. So he said he starts with the applicable statute and then gathered and reviewed the available information to understand the person's mental history, and mental state. The goal was to determine whether that information could be applied to the specific legal questions the court was asking. That meant psychiatric records were important. Dr. Mack said that ideally, the evaluator would also personally examine the individual.

That allowed the psychiatrist to gather historical information directly from the person while also conducting an examination of their current mental state. That real-time assessment was known as a status examination. Other records could be relevant to including medical records, educational records, and other documents that described the individual. And in a criminal case, Dr. Mech agreed that the evaluator would generally review the entire criminal file. Buckingham then asked whether an expert's opinion could be limited by the information at the time the evaluation was conducted. And Dr. Mack explained that an opinion was based on the totality of the information available to him. If additional information became available later, he was open to reviewing it and incorporating it into his understanding of the case.

The purpose of interviewing the defendant was also clarified. When Dr. Mack conducted a forensic interview, he wasn't there to provide treatment. The purpose was evaluation. Ultimately, his opinion would concern the defendant's mental state to the extent that mental state affected a specific legal question being considered. And when the issue was criminal responsibility, the person's mental state at the time of the alleged crime or offense is clearly the central issue. With the question of criminal responsibility, are you aware of what the standard is? Yes. And what is it?

Well, it uses particular language based on the common concept throughout the country called the McNaughton standard. And I could read to the specifics of the language, but, Effectively, it refers to two pieces, well, actually starts with three. One is, did the person have a mental disorder at the time of the event? And then secondly, the two prongs speak to specifics about the mental state at the time. One being, and I would want to refer to the actual statute. If we can, maybe we'll break that down for the jury. So the first part of this for criminal responsibility is the question of,

does the person suffer from a mental disease or defect, correct? Correct. Objection to the leading. Let's see if you know. If you just ask them. I can refresh it. If you want to refresh this memory, you can. Well, you've already testified the first part of the analysis.

I think you used the terminology mental disorder. Yes, I take. And you're aware that a mental disorder is a clinical term. Yes. I'm sorry, I didn't hear that. I apologize. What was that? A mental disorder is a clinical term.

The terminology, mental disease, or defect, are you aware that's a legal term? Okay. Okay. Well, so when you were conducting evaluations for criminal responsibility. Is that an answer? Yes. I'm sorry. Yes.

Yeah. All right. When you're conducting an evaluation for criminal responsibility and you're trying to determine whether a person suffers from a mental disease or defect, do you look to mental disorders to see if that means criteria? I would evaluate if the person has ever had a psychiatric or a mental disorder. And what kinds of tools do you have available to you to do that? Well, there are two tools. One is gathering of historical information, and the other is the information you gather from actually seeing the person face to face.

And as a psychiatrist, that's something you do in your clinical practice. practice all the time, right? Correct. Because one of the main things you're going to do is look to try to diagnose an individual. Correct. And so how do you go about determining that if a person has a mental disorder? In psychiatry, we make diagnoses in a descriptive manner. We look to see ways in which the individual has symptoms or signs of mental disorders or mental defects or psychiatric disorders. So in particular, one will start with trying to gather as much information as possible about what are the things that bother the individual. That may be their mood, that might be things that they get anxious about, that may be abnormal movements that they make.

And that will also be aligned with understanding their medical condition, any medications that they take, any substances that they use. There is an array of sets of information that one gathers in that portion where you ask questions. But effectively, you're asking questions about symptoms. And one is trying to understand not just symptoms, but the degree of impairment that symptoms might be causing an individual. And do you work with any sort of tools that help you identify particular characteristics of symptoms associated with? disorders in your field? Well, at times, individuals use scales or tests, which can be psychological tests or scales that ask particular questions.

Or other times, you might use tests that are biological tests like the person's brain waves called an EEG or laboratory tests. When you're talking about diagnosing an individual for any particular mental disorder, Are there specific criteria for different types of disorders? Yes, there are. And is there a source that you use as a psychiatrist in order to identify the criteria for different disorders? We use a text called the DSM, otherwise known as the Diagnostic and Statistical Manual. It's currently in its fifth edition, or actually a revision was made of its fifth edition.

And so that text, which is created and vetted by a large number of professionals, provides criteria for the different disorders, and these are known as operational criteria. In psychiatry, there aren't necessarily gold standards that you can use for diagnosis, like finding a bacterium or finding an anatomical tissue. So for the last 60 years, 70 years, psychiatry has turned to agreed upon definitions that are listed in the DSM. And you said it's not the end-all-be-all, right, of diagnosing. You use your training and experience as well, but it's a tool that you use.

Well, it is the, it is, they are the criteria that one uses to make the diagnosis. It is not a guidebook for how to gather that information. It's not a how-to, but it is the standard. Buckingham then brought the discussion back to the Massachusetts criminal responsibility standards. The first part involved the mental disorder, Dr. Mack explained the second part of the Massachusetts criminal responsibility standard. He said the next two criteria focused specifically on the person's mental state at the time of the crime. One asked whether the person had retained a substantial capacity to know the act was wrong or against the law. The other asked if the person had a capacity to control or conform to their behavior and the report.

requirements of the law. So while the evaluator needs to understand the person's overall psychiatric history, Dr. Mack emphasized that the ultimate opinion concerned the person's condition at the time of the crime, just the time of the crime. The history was important because it helped sort of establish the person's diagnosis and understand how their mental illness developed. So history is important for that reason. But the legal question, ultimately comes down to what is happening at the time of the killings. That's what criminal responsibility means. So history matters to understand.

But what happened at the time of the killings? Buckingham then went through the information Dr. Mack had received while evaluating Lindsay. That included the criminal file, along with medical and psychiatric records from the hospital where Lindsay was currently being treated, spalding rehabilitation. Hospital. Rigum and Women's Hospital, her outpatient providers, and McLean Hospital. He also reviewed pediatric records concerning some of the children and reports prepared by other psychiatrists and psychologists. And so Buckingham asked whether Dr. Mack had personally interviewed Lindsay. He said he had. Those interviews took place on April 10th and April 12th

of 26. Buckingham asked about Dr. Mack's first impressions of Lindsay, and he described her as friendly and cooperative. He explained that a mental status examination wasn't something that happened during one specific portion of an interview, right? It's something the psychiatrist was doing continuously while interacting with a patient. He was paying attention to things like the person's emotion, affect, speech, mood, thought process throughout the conversation. There could also be more specific portions where the doctor tested cognitive abilities such as attention, concentration, and executive functioning. But bunch of the mental status examination came from simply observing how the person presented

during the entire interaction. Dr. Max said Lindsay maintained eye contact while speaking with him. When it came to her overall emotional presentation, he did not see really any mini abnormalities. He explained that he looked at several components. He looked at her affect again, which that refers to her emotional expression, as well, as her mood, her speech. He considered whether her speech was unusually rapid or slowed, whether her thoughts were goal directed, and what type of content those thoughts contained. Overall, Dr. Mack said there were not any abnormalities or significant ones in any of those

areas. There was one point when Lindsay appeared distressed while discussing certain topics, and he believed that she became tearful. Otherwise, he described her mental status examination as unremarkable. Buckingham also asked about her physical presentation during the April interviews. Dr. Mack observed that Lindsay was using a wheelchair. He did not observe any unusual movements, and physically she appeared comfortable. She then asked about Lindsay's ability to navigate the room herself, but the defense objected that the question was leading.

The judge told Buckingham to just ask Dr. Mack, what had actually observed. He had actually observed. And so Dr. Mack explained that when they took a break and Lindsay went into the hallway, she was able to maneuver her wheelchair from one place to another on her own. The interviews also gave Dr. Mack an opportunity to ask Lindsay about daily life at Tewksbury Hospital. And so she described what a typical day in the life of Lindsay Clancy was like for her. And for the most part, she told him that she stayed in bed.

She kept to herself. She did not describe having much interaction with other patients. She did, however, describe interacting with staff members, including a therapist. She also talked about having worked with a physical therapist at some point. Belenzie told him she wasn't really particularly interested in the physical therapy she was receiving. She also wasn't interested in the food at Tewkesbury. She did have visitors on a fairly regular basis. and sometimes those visitors bought her food or drinks that she was able to have instead of the hospital food that she wasn't too interested in.

Most of her visitors were family members. She explained that she had visits from religious figures, including chaplains or priests. Dr. Mack was able to corroborate at least some of what Lindsay told him by reviewing her medical records. And the records confirmed that she, yes, she had visitors and interactions between Lindsay and hospital staff. and to some degree other patients. Buckingham then returned to Lindsay's comments about the food. Dr. Mack had observed her consuming beverages and snacks that she had with her. Now, did she indicate to you her level of attention to hygiene and grooming while at Cheeksbury? She did. She described that she wasn't very interested in her own hygiene and grooming.

And were you able to later in the conversation speak with her about her ability to take care of her own daily activities like grooming. For instance, showering. Was she able to do that on her own? Showering is embarrassing. It requires staff to help her. And that's one way in which she would rather not. It may also be that she described a lack of interest. So it's both components.

When you observed her, did she appear to be disheveled or not properly groomed in your meetings on April 10th and 12th? No, she appeared groomed sufficiently, and I believe her hair was combed and she was wearing neat clothing. No, did she describe to you her thoughts or feelings about her current situation? Yes. And what did she say about that? Well, she described feeling depressed, which she termed situational depression. She described feeling, I'm not sure the exact term she used, but feeling miserable, not wanting to be alive. And if he's finished, that's fine, but don't cut him off.

I'm sorry, doctor, are you done? Yes. Thank you. So when you were meeting with her, do you recall her indicating that she reported being devastated? Yes. That she was devastating, grieving by her current situation. Yes. Buckingham then asked about Lindsay's current treatment and medications. Dr. Mack had gone over her treatment regimen with her during the April interviews.

She was able to tell him what medication she's taking. He then compared what she told him with her medical. records confirmed it was accurate. So the main psychiatric medications he identified was olanzapine. And he also noted that Lindsay was taking several other medications for physical conditions, including medications related to her bladder and her gastrointestinal system. Right. She's in a wheelchair now. Buckingham then narrowed the questioning back to the psychiatric medications, not the ones for physical ailments. And so he explained that olanzapine was also known by the brand name Zyprexa. It was originally developed as an antipsychotic medication. It was used to treat

psychosis. Buckingham asked whether he was aware that Lindsay was prescribed zyprexa for bipolar disorder. Dr. Mack began explaining that it could also be used for mania. He clarified bipolar disorder involved epithelomania and that zyprexa could be used. in the treatment of bipolar disorder. Lindsay's dosage was 2.5 milligrams. Buckingham asked whether that was considered a significant dose. Dr. Mack said it was not. It was a relatively small dose.

He also identified several other psychiatric medications Lindsay was taking at Tewksbury. Those included Tresadone, Welbutrin, clonidine, and propranol. Well, well, butrin is an antidepressant. Clonidine can be used for anxiety or to help asleep. Propranolol, a beta blocker, could be also used to help with anxiety. So overall, Dr. Mack characterized the dosages of Lindsay's psychiatric medications

as being on the lower side. So then Buckingham returned to Lindsay's description of her depression as situational. She asked whether she had discussed the diagnosis she had received at Tewkesbury. Dr. Mack said that there had been times when Lindsay expressed doubt about whether she it actually had bipolar disorder? At one point, she made the statement that she wasn't convinced that she has bipolar or has had bipolar disorder. She describes situational depression in terms of feeling depressed about the several

stressors that she experiences today. And what are those stressors? Well, the remorse and sadness about the events that this case, is about her separation or estrangement from her then husband her being separated from the world her physical injury do you recall her actually using the term remorse or is that just your description of of her the conversation you had that's my summarization right here okay now when you were meeting with her did you talk to her about past medication regiments that she had had been on prior to the current regimen of the xyprixa and Wobutrin.

Yes. And so are you aware that she had previously been prescribed at some point lithium? Yes. And is that something that would be important to you to know when you were conducting your own evaluation for diagnosis of whether somebody was on lithium? It might help, but in psychiatry we don't make diagnoses based on medication response. And when it came to the report of the lithium, fair to say it was not something that was trialed for a very long period of time.

Yes, and let me correct that. It's not that we don't make diagnosis. We don't categorize or define disorders by medication response. So I heard the description of the trial of lithium. That was a short trial. Okay. The conversation then moved to Lindsay's physical injuries. Dr. Mack had discussed those injuries with her, asked about her understanding what happened to her physically.

Lindsay denied having suffered any head injury after January 24th. She was aware of the extent of her spinal injury. She was able to explain where the injuries had occurred. Buckingham then asked about Lindsay's psychiatric history before 2022. Dr. Mack said that prior to 2022, she did not have any significant psychiatric. psychiatric history. He described her as someone who had generally been very driven. She tended to become anxious, but that anxiety had often pushed her to accomplish things and work hard. There had been two shorter periods of depression or anxiety during her life. One occurred while

she was in nursing school. We know about that. And then the other happened after the birth of her second child Dawson. So then during one of those periods, she had been prescribed in antidepressant roughly two years before 2022, but she never actually took it. After the birth of her second child, she was again prescribed medication for anxiety, but she didn't take that medication either. Instead, Lindsay had generally dealt with periods of anxiety or depression through exercise and working hard. Buckingham also asked about Lindsay's family psychiatric history. Dr. Mack found no reported family history of mental illness. There was no known family history of bipolar disorder or prior depression. She then asked about Lindsay's work history and whether Dr. Mack had looked into potentially

traumatic or otherwise adverse events in her past. He had asked Lindsay about those experiences and it also reviewed her records to see whether there was evidence of significant adverse events. So then the questioning, it got more specific and narrowed in on the period beginning in the fall of and continuing through January 24th, 2023. Dr. Mack had reviewed Lindsay's medication history during those months. There had been a substantial number of medications prescribed for different symptoms, but he cautioned that the records did not establish that Lindsay actually took every medication she was prescribed or that she necessarily took some of them more than once

or twice. Her first medication prescription came in September 2022, but she did not begin taking the searcherlene until October. Later, she's prescribed Prozac, along with all those various medications we've learned about that were intended to help her sleep. Then there was a several week period where she took Syriquil, also known as quixapine. Buckingham asked Dr. Mack about Syracquil because it had several different uses. The initial dose, Lindsay, was prescribed with 25 milligrams. Dr. Mack explained that Syracquil was commonly used at low doses to help people sleep, but it was also an antipsychotic medication. It's used to treat psychosis,

depression, and other symptoms. Buckingham asked whether the amount of time Lindsay took syracoyle could have caused any lasting biological effects on her brain or body. Dr. Mack said there was no long-term biological effects from that amount, and there could have been temporary effects while she was taking it, including effects of her functioning and psychological experience, one possible temporary effect involved cognition. Therich will could make it harder for someone to think clearly, pay attention, concentrate, or remember things. But those cognitive effects were expected to resolve after the medication was discontinued.

Buckingham asked whether Syriquil lingered in the body for an extended period. Dr. Max said, not substantially. He contrasted it with medications such as diazepam or Valium. which could remain in the body longer. Different benzodiazepines also had different durations in the body, with diazepam lasting longer than lorazepam. As for syracquil, once someone stopped taking it,

any negative effects would eventually resolve. Buckingham then moved to the medications, Lindsay, had been taking immediately before January 24th. The medications listed in the records included melatonin, larazepam, trazidone, and amatryptylene. The amatryptylene dosage had, been increased to 20 milligrams on January 23rd the day before the killing. And before that,

she had been taking 10 milligrams for several days. Well, Dr. Mack described both dosages as small. He said the usual starting dose for an adult was around 150 milligrams. The questioning then returned to the symptoms Lindsay had been reporting during the months where all of these medications were being prescribed. Are you aware of what the chief complaints or problems that the defendant had been reporting at the time when these medications were all being prescribed to her in 2022? Well, it's a several-month period, but it started in September with September of 2022 with complaints of anxiety and depression. And fair to say in reviewing all the records and with your conversation, that sleep also was a main issue or a complaint. Yes, that's right.

And in some of the medications that you reviewed is sleep, could the medications themselves affect a person's sleep? Yes, searchly and can. Now, as far as past diagnosis of this defendant, you were able to review overall in all the records that were available to you, what different providers had given as far as past diagnoses, correct? Yes. And as far as your overall evaluation in determining criminal responsibility, where you have to answer, that question of mental disease or defect, do you rely on those prior diagnosis or do you come to your own conclusions? I come to my own conclusions.

Are the fact that there were past diagnosis something that you consider? Yes, especially to the extent that they highlighted the basis for those prior diagnoses. I don't necessarily have to agree with the diagnoses, but I'm interested in what was observer. in terms of coming to those diagnoses. And when you're doing these types of evaluations for criminal responsibility, why do you not rely on a past diagnosis? Why do you come to your own conclusion? Well, that's part of being an independent evaluator where in your mind you're able to collate the information and make your own diagnosis. As far as kind of before you move on to your actual diagnosis,

In addition to the interview that you had with the defendant over those two days, reviewing all the records, did you attempt to speak with what are called collaterals? I did not. Is that something that you sometimes do in these evaluations? Sometimes. Fair to say in this particular case, you did have a significant amount of information from people that were close to the defendant, right? That was my view, yes. And after speaking with the defendant, did she identify to you some people that maybe you could talk to? I don't remember who she said, but I think she suggested perhaps her husband or then husband.

But you yourself didn't have an interview with Patrick Clancy, did you? No. But you were able to review his grand jury testimony and interviews he's given with the police in the past, right? Yes, I did. And CPS. And as far as speaking with the defendant's parents or her sister, you aware that attempts were made or requests were made to speak with them, but they didn't respond. I wasn't aware of that. I was not.

So based on everything that you reviewed in this case, were you able to come to a conclusion about diagnosis? Yes, I did. And at the time that you conducted this evaluation, what is your opinion about diagnosis? My opinion about her diagnosis in the span from 2022 to 2023 is that she suffered from what's called a major depressive episode. That probably is a part of what's called a major depressive disorder, but the important point about it is a major depressive episode. What made you come to that conclusion based on her presentation? The information about her feelings and the progression of her illness highlighted that it was best represented by a major depressive episode. It's a condition defined in DSM-5 where an individual displays problems with mood, problems with feeling pleasure, feelings of guilt or worthlessness, problems with appetite, problems with sleep.

of preoccupation with death or suicide, poor concentration, poor energy, perhaps also what's called psychomotor agitation or retardation. So one doesn't necessarily need to show all of those, but as it is in the DSM criteria sets, one needs to have a certain threshold. and her history and her description of her experience, in my view, that matched a major depressive episode. Okay. And you indicated that it was kind of a progressive thing from the fall into January of 2024, right? Yes. And in addition to the low moose,

were you able to identify that she presented with anxiety at various points? Yes, very much. And did you also make observations of obsessive thinking? Yes, obsessive thinking is a kind of anxiety where you repeatedly think about a topic, maybe that you're asking what if, what if, what if? And it's the kind of form of anxiety that you frequently see in an anxiety disorder called generalized anxiety disorder. I think it's possible she also had generalized anxiety disorder, but that is sort of secondary to the major depressive episode. I think it's possible. That was

interesting. I think it's possible she could have that. Maybe, maybe not. Eat, Prey Crimes says, I need Dr. John to walk me through the difference between these two experts. I agree. We'll get them on. Don't you worry. All right. All right. Buckingham then focus specifically on the period closest to January 24th. Dr. Mack had examined all of the available information to determine what Lindsay's mental state appeared to be during that time. She asked whether he found any indication that Lindsay had been experiencing mania or hypomania at any point during the period from 2022 through 2023.

Dr. Mack's answer was no. He said there was never any indication of mania or hypomania during that period. Buckingham clarified a point for the jury. Major depressive disorder was itself an established psychiatric disorder listed in the DSM. Dr. Mack confirmed that's true. She then asked Dr. Mack to explain what exactly psychiatrists meant when they used the term mania. So Dr. Mack explains that mania is a mood state. It's similar to a major depressive episode.

These mood states where the building blocks used to, to diagnose mood disorders, such as bipolar and major depressive disorder. Mania was also defined by specific criteria in the DSM. A manic episode generally required symptoms to persist for at least seven days with the symptoms present most of the day, nearly every day. And those symptoms could include distractibility, what's known as flight of ideas, grandiosity, excessive goal-directed activity, pressure, or unusually rapid speech, a decreased need for sleep, and engaging in activities that might

feel pleasurable, but carried high potential for painful consequences. In other words, forget the consequences. And if it's pleasurable, then, you know, hey. So a person had to meet the required symptom threshold and experience clinically significant impairment or distress. hypomania was a less severe form of mania. The time frame was shorter, generally at least four days, and the symptom threshold was lower. Buckingham then brought that definition back to Lindsay. Dr. Mack had reviewed the period from September 2022 through January, 2023. He said he could not find any behavior or thinking during that time that corresponded with the symptoms required for either mania or hypomania.

The same was true in that period immediately following the killings. Dr. Mack had reviewed Lindsay's records for Brigham and Women's Hospital and he didn't find evidence of mania or hypomania there either. In fact, he found portions of the records that showed the opposite. And after Lindsay was taken off, Dex Metatomedean, did I do that okay? Forgive all of the medical professionals in chat. Dex Metatomidine, a medication that had been keeping her sedated and intentionally asleep, she woke up and was able to think coherently. Her thoughts were described in the records as linear and goal directed.

The mental status examinations performed by doctors at Brigham and Women's were generally normal. So then Dr. Mack pointed to one particular evaluation in which doctors were assessing whether Lindsay had the ability to make an important health care decision. The medical team examined her closely, determined that she had decision-making capacity. That evaluation was significant to Dr. Mack because it occurred relatively close in time to the killings. Then he reviewed records from Dr. Tuths concerning an appointment with Lindsay the day before the killings, right? The day before she met with Dr. Tuffs. Again, no evidence of mania or hypomania.

Buckingham asked whether he had found any evidence of psychosis during the peer. period he had reviewed. He said he had not. He then explained what psychosis meant. Psychosis was disorganized thinking and in some cases a loss of what psychiatrists call reality testing. That meant a person could have difficulty determining whether a belief or experience was actually real. That's interesting, whether a belief or an experience is actually real. Psychosis could present in several different ways. One example was a delusion. which Dr. Mack described as a fixed false belief that persisted even when the person was confronted with information showing that the belief wasn't true.

Hallucinations were another possible manifestation. A hallucination involved experiencing something that wasn't actually present in the environment. That could include hearing something, seeing something, smelling or tasting something, or feeling something on the body. Sometimes a person experiencing hallucinations might physically respond to something they believe was happening around them. But psychosis could also involve a person's inability to behave or think in an organized way. So Buckingham asked whether someone experiencing psychosis could still function normally in certain areas of life. And Dr. Mac explained that it depended on the type

or the severity of the psychosis. So maybe, maybe not. Someone with a delusional disorder might have a significant false belief affecting one specific or particular area in their life, while continuing to function relatively normal in other areas. Hallucinations, same zies, same same. Could be similar. Some people experienced hallucinations regularly without significant negative effect on their functioning. So for someone whose hallucinations were part of a psychotic, bipolar or mood disorder,

the person's ability to cope with those experiences could vary, right? So then Buckingham asked whether someone experiencing delusions or hallucinations could still function in society and follow rules. Dr. Mack said that some people could, depending on the particular delusion or hallucination. Buckingham then asked an important legal question. Could someone experiencing psychosis still know the difference between right and wrong? person does have some form of psychosis or has delusions or hallucinations. They could still manage in society by following the rules, right? Like I said, it depends on which delusion or which hallucination, but there are individuals.

And it may be who can, and there may also be people who can on a stable basis, but there are also individuals. Next question. As far as a person who might be suffering from psychosis, can they appreciate or do they know right from wrong? There's no reason that psychosis in of itself inhibits a person's ability to know right from wrong. Now, as far as in this case with this particular defendant, you have identified that you believe it's a major depressive disorder, right? Did you consider other diagnosis? Yes.

What about bipolar? Did you consider bipolar? I weighed whether there might have been bipolar disorder. And so why not for this defendant? Well, to be diagnosed with bipolar disorder, you need to have had a manic episode. That's at least for bipolar type one. For bipolar type two, you need to have had a hypomanic episode. And there's no information in the available record that display is either of those.

So you can't diagnose bipolar disorder. Did you consider the fact that this defendant or that there's been some indication of postpartum for the defendant? Yes. And did that affect your opinions about diagnosis? As I said before, in psychiatry, we diagnose based on the symptoms that the individual presents with. So in the DSM, in our manner of diagnosing, when you have discerned what is the prominent symptom that the individual is suffering from, that becomes the disorder that carries your diagnosis. There are times that you can designate that it has occurred in the postpartum period.

DSM states that that would be within four weeks of birth. It also allows for the symptoms to have occurred before birth. So that is the standard that we utilize when we choose to add on that designation of something being postpartum. I object it doesn't matter what we do. It's what he does. All right. Next question. So as far as consideration of postpartum, do you rely on the DSM-5 in your diagnostic criteria? I do.

You're aware that there are other, that it's not universal across the world and that there are other opinions about the postpartum period, right? I'm aware that there are psychiatrists and others who have asked to make a specific diagnosis that relates to psychiatric problems in the postpartum state. That has been studied over the years. At this point, that has been suggested to the makers of the DSM and has been rejected. So I guess my question is more, based on your overall view of our review of this particular defendant,

onset of symptoms, when did they occur in this postpartum period? Or did they? The distress that we're talking about began in September, which is about four months after the birth of the most recent child. And so if you're relying on the DSM as four weeks postpartum for a lot of these illnesses, mental illnesses, then the defendant was well outside that period, right? Correct. And as far as for the the last child, when the killings occurred, that would have been eight months after the postpartum period, correct? Roughly, yes.

Buckingham then turned to several behaviors and thought that had been characterized as potentially psychotic. Dr. Mack considered those a part of his evaluation. And one example involved Lindsay's concern that child protective services or another child welfare agency might take her children away. Dr. Mack said he didn't necessarily consider that belief psychotic. He could understand why someone experiencing severe distress might fear that child welfare authorities could become involved and remove their children.

Another concern involved Lindsay's belief that medications had permanently damaged her. Dr. Max said that he could understand that she had experienced side effects and felt changed by the medications that she had taken. But he didn't necessarily consider the belief that the medications had caused permanent damage to be psychotic either. Buckingham asked about another incident, Lindsay asking whether someone could hear her thoughts. Dr. Mack had reviewed an episode in which Lindsay apparently asked her mother whether she could hear what Lindsay was thinking. Her mother told her no. Dr. Mack acknowledged that there was a form of psychosis known as thought broadcasting, where someone, so in thought

broadcasting, someone believes their thoughts are being transmitted or made accessible to other people. Isn't that crazy? Thought broadcasting. So to other people, but he did not believe that was what Lindsay was experiencing. In his interpretation, Lindsay was not expressing a fixed belief that she was broadcasting her thoughts. Instead, she asked the question and then engaged in reality testing when her mother told her that she could not hear them. So Dr. Mack viewed that as more consistent with the distress and intrusive thoughts Lindsay was experiencing rather than with psychosis. So then Buckingham confirmed that the issue of thought broadcasting, the idea that other people can hear your thoughts had also been discussed directly with Dr. Mack during his

interview with Lindsay. And Dr. Max said, yeah, we discussed it. Buckingham asked Dr. Mack about the episode in which Lindsay had asked her mother whether she could hear her thoughts. Dr. Mack had been able to ask Lindsay questions about that incident during his own interview. So he said that based on that conversation, he did not believe that Lindsay, again, was experiencing thought broadcasting. You're aware that concerns that were voiced by her, that there was other things wrong with her body, not just damage from medication, right? Yes. Did you consider that to determine whether that was a psychotic feature for this defendant? Yes.

So an example was her worry that she had ketoacidosis. I didn't necessarily think that that was psychotic. It may have been wrong, but it wasn't necessarily psychotic. She had been given a medication, Syracquel, where one of the side effects is that it negatively interferes with your glucose system. And ketoacidosis is the worst-case scenario when you have glucose, poor control of your glucose. So I don't know that she had a fixed false belief that she had ketoacidosis, but she was worried about having ketoacidosis. So when you say that you considered these things and you didn't believe them to be psychotic,

are you talking about them in the realm of, were they delusional, were they fixed false beliefs, or something else. Right. So I used that term specifically, as I said before, a delusion, which is a form of psychosis, is a fixed false belief, which is really immutable. You can't be convinced otherwise. But these were not fixed false beliefs. These were concerns.

And did you find that the concerns were rational based on your overall view of everything? Right. Not only were they concerns, but they aligned with the realities that she had experienced. Now, what about the idea of these intrusive thoughts? You reviewed the records to know that was a common report of her that she had intrusive thoughts, correct? Yes. And that at various points she did identify that she did want to die. Yes.

Is being suicidal a form of psychosis? No. What, if anything, does the idea of suicide? I'd tell you about this defendant or about her situation. Well, it tells me that she was suffering and that it was a part of, in my view, it was a part of a major depressive episode. You know, 10 to 15 percent of women in the postpartum period have depressive disorders. And it can be very serious and it can lead to suicidality or the need for hospitalization or other interventions. So the records show in my interviews that I gathered information that she was suffering and

suicidality is a form of suffering. Now, when you talk about suicidality, does it have to make sense why the person is suicidal? No. Suicidality occurs, but it doesn't always make sense. Sometimes there might be places where we're. one might say, well, why was that person suicidal? They had only good things in life, speaking hypothetically. But especially when individual has depression, it just occurs.

Now, when you're talking about people that have suicidal ideation, are there certain things known as protective factors? Yes. And did you identify in your view of this case in the records, whether the defendant presented with any protective factors when it comes to suicidality? Well, are you asking, did Ms. Clancy identify protective factors?

Yeah, at some point, it's fair to say she did identify protective factors. She did. And what were the protective factors? Mainly her mother and her children. That is to say, sorry, that is to say, she wanted to, her urges or her interest in suiciding was something that she chose not to do

because of the worry that she would hurt them by suiciding. And your review of the records from McLean Hospital, fair to say that one of the reasons for discharge was that she herself identified that she wouldn't have commit the act because of her kids. That was one of the factors. When we make decisions, when I make decisions, to allow somebody to be discharged.

It's an overall weighing of risk factors and protective factors. After lunch, Buckingham asked about the events of January 24th. Dr. Mack was aware that Lindsay had later reported that a voice told her that she needed to kill her children so that she could then kill herself. And that occurred. On that same day, she attempted to take her own life. She then brought up something that could seem contradictory. Earlier that day, Lindsay had reportedly described the day as a good one, right?

Dr. Matt confirmed that Lindsay herself had described the day as fun and productive, including spending time with her children, right, making a snowman. There were also reports from other people that she appeared to be having a good day. Patrick, for example, had reportedly told the child welfare agency that it was the best day Lindsay had in a long time. Buckingham asked whether having a lot of. a good day was inconsistent with attempting self-harm. Dr. Mack said it wasn't. It was also not consistent with having a depressive disorder. He explained that major depressive episodes could

begin to improve after several months, and as someone begins moving out of the worst part of a depressive episode, they can sometimes regain enough energy and ability to act on those self-harming thoughts. So positive feelings immediately before a suicide attempt could occur even while the person remained severely depressed. Buckingham, then turned to Dr. Max's interview with Lindsay about that date, January 24th, 2023. That terrible day. And during that interview, Lindsay asked, was asked to describe the day in order chronologically, beginning with the morning, continuing through the last thing she could remember. She was asked to tell the story in reverse. Dr. Mack said she was able to recount the same basic story in both directions. That's important. She could remember certain

details of the day while having gaps in her memory about other portions. Buckingham then asked about the voice Lindsay reported hearing. She described the voices male and loud. The message was essentially that she shouldn't kill the children because it was her last chance to then kill herself. After hearing the voice, Lindsay went on to kill her children, all three. She engaged in the activity of taking her children's lives. And she was able to describe to you how she did that, correct? And she first stated that she took Dawson down to the basement. Yes.

And then wrapped the exercise band around his neck and strangled him. Yes. And what did she say that she said, when she did that. She described that while that was happening, she was saying out loud, go to God. And did she describe the same for both Cora and then Callin? Essentially, yes.

And the voice that she said she heard, was it one time or more than one time she heard the voice? Multiple times is what she described. And after the kids, after she had killed the kids, Did the voice continue in her report? I don't remember that it did. It may have. I don't remember. And then after the kids were gone,

she then made an effort to take her own life, correct? And how did she do that? Right. So she did. She described that she went ahead to take her life or attempt to take her life with multiple steps. She went to her room upstairs in the house and took the various medications that were present. She cut at her wrists and at her neck,

and then she caused herself to fall from the window. Okay. And as far as going out the window, did she tell you whether she had to do anything with the screen? She described to me that she cut the screen. And then she dove out the window. Well, objection, that's not what you said. Well, what did she do after she cut the screen?

screen. She fell from the window. Buckingham also asked about the phone call Lindsay received from Patrick. His recollection was that the call occurred somewhere around 18 to 20 minutes into the series of events. Buckingham asked whether Dr. Mack remembered where the voice fit into that timeline. He said that Lindsay experienced the voice shortly after Patrick left the house. She then asked whether everything Lindsay told Dr. Mack during the interview matched the other evidence in the case. He discussed there were two inconsistencies that he had identified between Lindsay's account and other evidence. To regarding the bedroom door, Lindsay told Dr. Mack that she had not locked it.

That's interesting, right? Because based on the information Dr. Mack reviewed from Patrick and all the other records, his understanding was that the door had been locked. Second issue involved the window screen. So Dr. Mack recalled that there had been a question about whether the screen had actually been cut with a sharp object, which differed from what Lindsay had reported to him. Buckingham also confirmed that Lindsay had not suffered a head injury when she went out the window. She had sustained a spinal injury, including a C1 injury, but no head injury. Buckingham brought up a phone call from Patrick to Lindsay. Lindsay had told Dr. Mack that when Patrick called, she believed she had the in her hand and was doing something like taking food out of the refrigerator or preparing food for the children. And Dr. Mack remembered that. He was also aware of crime scene photographs showing the children's bowls in the living room. She then moved into the broader question

of Lindsay's ability to function normally in the hours and days surrounding the killings. Dr. Mack pointed to Lindsay's interactions with people in the community, including a restaurant where she had ordered food, right, 3V, CVS, where she had been getting Miralax for Cora. Those interactions didn't show any obvious departures from her normal behavior. He considered her ability to drive and follow the rules and expectations of the community. In Dr. Mack's view, she had continued to function within those expectations. So, Dr. Mack, based on your review of this case, Were you able to come to an opinion to a degree of medical certainty about whether this defendant was suffering from a mental disease or defect on January 24th of 2023?

Yes, I did. And what is that opinion? Yes, she was suffering from a mental disease or defect, namely major depressive episode as a part of major depressive disorder. And as far as the substantial capacity to appreciate wrongfulness or criminality of conduct, were you able to be able to. to come into an opinion to a reasonable degree of medical certainty about that? Yes. And what's your opinion regarding that?

That she had retained that capacity. And what information do you rely upon to come to that conclusion? The first point is that this was a continuation. Her mental state at that time was a continuation of the mental state she had had for months. And it was a mental state that included the capacity to control her behavior and also to be able to conform her conduct to standards

of law. So in that sense, first of all, there is not an indication to me that there was something that changed the overall capacity in that regard. Secondly, to the extent we are talking about the ability to conform to conduct to the law, one can analyze her actions and her behaviors and her thoughts on that day or as close as possible to the moments of the deaths. And that includes taking one of her children to a pediatrician that day, engaging in fun activities around the house that day, having gone to a, having engaged with one of her children's teachers the day before, having engaged. engaged in normal conversations with the restaurant that she ordered food from, 3V, and then also interactions with the pharmacy, CVS, where she was getting the Miralax from.

So in all these places, there was the ability to act normally. There doesn't seem to be any deviation from where she had been all along, which included this capacity. Furthermore, I would add that as a part of her interactions with the community or in driving, she had abided by law and abided by standards of the community at all those times. So there isn't necessarily to me any way in which that deviated that afternoon. So you're speaking about her ability to conform conduct, which is one of the one of the things we're talking about here. But I want to go back to the appreciation for wrongfulness or criminality. As far as that goes, were you able to form an opinion about that?

Yes. Sorry about that. That's okay. So what's your opinion about her ability to substantially conform, or excuse me, her substantial capacity to appreciate the wrongfulness or criminality of her conduct? So I again would go to thinking about what had been her state of mind for at least the months prior, the several months prior. And in all that time, there wasn't any feature that indicated that she didn't have that capacity. But furthermore, when there were moments when she thought about harming the children, when she had the thoughts about that, she was aware in those moments beforehand that that was wrong or against the law and that she could be punished for such an act.

you're referring to the December conversation with her husband and her mom? Yes, and her thoughts about the idea that if anyone knew what I was thinking, the children might be taken away from me. And also, the fact that she hadn't had any significant medication changes during that time period, does that also inform your opinion about that? Well, as that that aligns with what I was saying before about how while depressed, her mental state was relatively stable. It was perhaps improving, I'm not sure about that, but it was stable. There won't strike them.

He's not sure about it. That answer is stricken. Right. So the fact that she hadn't undergone any more significant medical. or medication changes, I should say, did that signify to you that she had been in the same kind of state she had in the months before? Yes. Now, what about the interaction with Dr. Tufts on January 23rd? Did anything about that suggest that there were any concerns or distress that would have changed her ability to appreciate wrongfulness of her conduct?

No, in that interaction she displayed normal thinking and the ability to think ahead and to navigate the world. And what about the statements that she referred to when she was killing the kids, the go-to-god? Does that inform your opinion? It does. And why? My understanding is that the sentiment, Go to God, is a way of bestowing or thinking about the children as innocence, as ones who hadn't done wrong, while what she was doing was the opposite, was wrong, or could be construed as wrong. And so go to God, not only was a hope for the children, but also a description of the situation. Okay. And what about the report from her that the voice was telling her, this is your last chance?

Is that significant to identify whether she would have had some knowledge or known that it was something that was wrong? Well, to the extent that it was seen as her last chance, yes, because there was an awareness that it was something that would be disallowed by their father. And as far as after the incident, when she woke up at the Bergammon Women Hospital, you're aware that she reported to the staff there that she was horrified, correct? Yes. And so the fact that she immediately afterwards identified that she was horrified, does that go to her capacity to appreciate the wrongfulness of her conduct?

Yes. One may, one can consider that her mental state, once she was removed from the Dex Metatomodon, was similar to what it had been on January 24th. And in that regard, the feeling of horror, the feeling of shame that comes from being horrified, indicates that she was aware that it had been the wrong thing to do. And then finally, just to go back to the substantial capacity to conform conduct, You've told us a little bit about that, about the fact that her condition hadn't really changed all that much. You outlined what she did that day.

But is there anything else to consider, based on everything that you reviewed, that would indicate to you that she did maintain the substantial capacity to conform or conduct to the requirements of the law? I think that in the household, she was engaging this activity methodically, which highlights to me that there was an ability to conform her behavior to expectations of living in a household. What do you mean methodically? As I understand the deaths, they were done methodically, and I think you asked me about that, earlier, one by one, in a way that was organized and that was intended to achieve a particular goal. Similarly, her attempt at suicide was organized and thoughtful in a sense that it included as many possible methods as possible.

And as far as the killings of the children methodically, did she report to you? in any way that she was given direction by this voice on how to complete the act and what exactly to do? No, she did not. And what about the call with Patrick? Is there anything about that that indicates that she maintains some control or the ability to control herself where she did engage in a short conversation with him? Well, that aligns with what we were talking about before in terms of not, in terms of being aware that he would disapprove or disallow this. And yet she didn't say anything.

She didn't say help or she didn't say, I'm having these thoughts. So it wasn't stated. So again, as far as your overall evaluation of this defendant, Lindsay Clancy, regarding the events of January 24, 2023, what ultimately is your opinion to a degree of medical certainty regarding criminal responsibility? My opinion is that she retained the capacity that were required for having criminal responsibility for these actions. Thank you.

And I would just like to admit Dr. Max, CV is the next. Any objection that may be admitted? Well, look, that concluded, obviously Buckingham's direct examination, but that doesn't mean Reddington's not going to do a cross-examination of Dr. Mac. So don't you worry, because this may be one of the most intense cross exams Reddington has done so far. IMO, in my opinion, you guys tell me. I'll just show you how it started so you can get a feel for how it was going to go. Dr. Mack, part of your evaluation would be an intent to investigate the person that you're being asked to evaluate for purposes of an opinion regarding criminal responsibility or lack thereof for the district attorney's office, correct?

What do you mean by investigate? You don't know what investigate means? You want me to explain that to you? You might. You're a psychiatrist that's employed by the district attorney, right? Retained by, yes. Okay, so we're going to talk semantics. Isn't employed by, retained by, mean that you get money from it, right?

I'm paid for my time, yes. Exactly. And normally, I don't even go there. Every one of us are getting paid for our time. Jurors not so much, but nevertheless, you get paid for your time, right? Correct. I get paid for my time.

The judge, Chrissy, Don, everybody gets paid for their time, right? I imagine, yes. So when you are retained by the district attorney's office, you are to evaluate an individual, right? Yes. And the individual in this case is Lindsay Clancy, correct? Yes.

And you recognize her. Do you not? I do. And you actually had a chance to meet with her and do your evaluation, right? Yes. And part of your evaluation you had to investigate into who she was. For example, her education, what she did for work, friends, family, right?

I asked her about her life, and I reviewed records to learn about her life, yes. Okay. So you're in a mental institution investigating or questioning a woman who's on medication, who is there because she's suicidal and under 101, 24-7 observation. Would you agree with that? Yes. And you get the history from her? Yes.

So did you talk to an? any collateral contacts? No. So how is it that you can tell this jury what her life story is? Did you get it from her? I got it from her. To the extent that, I'm sorry,

can you say you're never mind looking at the judge. What did she tell you about the education? Wait, listen, you look over there and listen to the question and answer the question. Can you say the question, please? Let me answer the question.

What does she? tell you about, I'm sorry. Ask the question. What did she tell you? What did she tell you? What did she tell you about her education? She described her education in terms of being a hard worker through high school and college. I want to keep going.

Do you just want to keep going? I mean, that was like, that was, yeah. It was through Partners Healthcare, I think, at the MCH. And do you recall what the nature of. the nursing was? Well, she had always wanted to be a labor and delivery nurse, and she was able to achieve that. So she worked as a labor and delivery nurse?

That's my understanding, yes. For a period of time? For several years, yes. Nine years, seven years? I'm not sure exactly. Did you talk to any of the nurses that she worked with? I mean, was she respected? Would she had work, or was somebody that was ducking out early,

didn't want to work? I didn't talk to any of her colleagues. I'm aware that she had been there for some time, and I did not hear about any aspects in which her work was deleterious. Who would you hear from them? Well, one might have heard it from the notes from her spouse. I might have heard it from the 10-bend-de-self. Let's talk about one might have heard it.

Is the one you, you're testified. Yes. Did you hear about it through the notes of the spouse? No, I didn't hear about any way in which her work. Okay, so what did you tell me that? Why are you saying one might occur about it through the notes of the spouse? Well, I think your question was, how would one learn about any deleterious acts or components of the person's work? So I didn't hear about any way in which she wasn't working hard and retained as a nurse at an excellent institution.

So basically, you don't know, is what you tell me. You don't know what her reputation for work ethic was. You don't know what her reputation in her work community was. You just don't know. Isn't that right? Combined with the records and also the report from Dr. Krasnick, who described her own view of herself as being a hard worker, I don't know further than that. So in addition to being a labor and delivery nurse at Mass General Hospital for a number of years, you knew that she asked, obviously was married, right?

Yes. And her husband was Patrick, right? Yes. You know how many years she was married, right? I do. How many? I don't know it offhand, but I believe I understand or knew the date when they were married, which may have been

2013. So the fact that she was married, you know, did she want to have kids or did she find them to be at birth? She very much wanted to have children. She described that that was her life. with long interest. Okay.

Had one child, Cora, right? She, say, I can't hear you. The first child was Cora, right? Yes. Did she have any delivery issues with Cora? Not that I recall. How about the second child? What was the second child's name?

Dawson. How old was Dawson at the time of the incident, as we say? I think he was around four. And did she have any issues with his name? any issues with his delivery. Do you mean the delivery or in the postpartum period? I mean the delivery. If I recall, I think she had a tear, which is called an apotheomy, and that was something she was unhappy about. Sure. Did she have medication prescribed to her after Do you mean psychiatric medication?

Sure. At some point, I think she was prescribed an antidepressant medication in that period. What was it? I think it was searchling. And do you know whether she took it? She has told us so she did not. And when she went home, after having the baby, Johnson, she then came home to a little daughter, obviously, Cora.

obviously Cora, had Dawson as an infant, correct? Yes. And was she living in a town or was she living, where was she living when she had these two kids? I think she was living in the same house in Duxbury. She was living in Wainmouth? She may have been. Sorry, I don't know.

That's right. So at some point she moves to Duxbury. She's with her husband and she goes back to work, does she? Yes. You didn't make any in your investigation. You didn't come across any information. that she didn't want to go back to work because she was lazy or just didn't want to work, right? No, I think she always wanted to work.

Does she have anxiety about going back to work after Callan, the third child? After Callum? Yeah, Callum. It's Call. CAA. Yes. Yes, she wanted to go back. As August and September arrived, she was hopeful to go back to work, but, she became anxious about working. There were other factors, too. She became anxious.

We'll get to the other factors. Why was she anxious about going back to work? I was about to say. She was anxious about the well-being and nurturance of her children as she went back to work. One being that the baby was not taking a bottle. Another, that in that span between the point that her husband went back to work and she was expected to go back to work, it was overwhelming to have three young children that she was caring for all by herself. As time went on, she was ambivalent about hiring somebody to help, hiring a nanny, and that was another area of anxiety.

So there were several areas of anxiety, and as we've discussed earlier today, anxiety was something that she had had throughout her life. I'm going to pull you in, okay? This is a cross-examination, sir. All right. Just ask the next question. So when you say that she had anxiety and the anxiety was about having her youngest child, Callan, correct? Yes. She was anxious about going back to work, correct?

Yes. But you also, as you were waxing eloquently, indicated that she was having anxiety about having a nanny. Yes. What was she anxious about the name? In my understanding, tell the jury what you investigated about her anxiety with the nanny. So through my evaluation, what I understood was that there was ambivalence about having a nanny, that is to say having somebody who helped.

There was some degree of wanting to be able to handle the children on her own. The other part of it is some ambivalence about other people, other than herself or perhaps her mother, caring for the children. Because I know that my evaluation discerned that she felt very positively about her ability to take care of her children, but also some ambivalence about other people taking care of the children. What time frame are we talking about? Summertime, fall? The end of summer, late August, early September.

Isn't it true that in the summer, she and Patrick, the kids felt that they were on top of the world, having a great summer, right? Well, that's what she said. That's her quote. Okay. And then come the fall, towards the end of September, that's when she started to have symptoms of anxiety, right? Yes. But to this point in your investigation, you have a young woman who was a nurse for a number of years, we assume from your investigation, a good reputation, a good reputation as a hard worker, right? I can't hear you. I'm sorry.

Yeah, one of the things that you had mentioned is that she was, how about exercise? Does she like to do exercise? Yes, in the past, exercise was else, right? Yes. Can you repeat the question? Sure, I can repeat the question. I ask you, sir. I'm objecting because he's interrupting the witness and not letting him answer the question.

The question called for yes or no answer. All right. And so go ahead. Go ahead. Can you state the question, please? Sure. You mentioned in direct examination for the DA that she was like to do exercise, correct? Yes. And would you consider a person who is an exercise aficionado, especially a woman who, for example, runs, let's say, a 5K or a 5-1 road race within about a couple of weeks after having a date? Is that hyper-exercise?

Is that hypomanic? Okay. In of itself, it's not hypomanic, no. Well, that led Reddington into one of the areas. He was clearly testing, right? Whether Lindsay's exercise and other behavior could have represented hypomania. So he asked, he asked that just then, is someone who is heavily into exercise, including a woman who ran a 5K or 5 mile road race shortly after giving birth?

Would that be considered hypomanic? you just heard his answer. It was no. And actually, that kind of frustrates me because as someone who's had a newborn, I don't think I was even able to walk out of my house. I know that every birth is different. So, you know, some people are able to exercise right after. But if someone, a new mother, is obsessed with exercising, it could certainly be manic, just saying. And he was. quick to say no. Anyway, Reddington then added other behaviors, such as an unusual increase. By the way, that was my confirmation bias working there. I'm not a psychiatrist, nor am I an expert witness. But Reddington then added other behaviors, such as the unusual increase in exercise combined

with the decluttering. Remember the garage that they quickly decluttered, removing personal belongings from the home and cleaning things out. Could that combination represent hypomania? Again, Dr. Max said not by itself. Well, then Redington clarified that he was talking specifically about the period after Callan's birth in 2022. And then he returned to the timing of Dr. Max's involvement in the case. Dr. Max said he was retained by the district attorney's office in early 2025. Running the road race after Callan. Okay?

With me? Yes, I am. So would you suggest, sir, that that is something that one would at least anticipate, consider, or investigate as being this manic or hypomanic that you're talking about? No. So, by the way, one of the questions that you were asked, sir, is that when you got involved with investigating this case, do you recall that from the DA? So do you recall that from the DA? the term investigate, if it's okay, I'll use the term evaluate. When you got appointed or retained by the DA.

So, and your question is? My question is, when were you retained by the district attorney, the prosecutors? It was sometime in early 2025. Early 2025. So like what? February, January? I think. I think the reach out had occurred in maybe December of 2024, and I think that the retention was early in 2025.

What's a reachout? Well, the communication, the reaching out. From the district attorney's office. Okay. And then when you were asked that question, you indicated that you had to wait for a motion to be filed or something with the court. Do you recall answering that question? No. Well, if I suggest to you, sir, it was in December of 20.

24 that a notice of lack of criminal responsibility was filed. Does that seem to fit with the reach out? Jackson, can we approach? Sure. So your understanding of the procedure is that a notice has to be given to the court that a person, like Lindsay, is raising the issue of criminal responsibility, correct? I imagine that's the case.

but I don't know the procedure here in Massachusetts in that regard. Okay, you don't know the procedure? The procedure for making notice? Right. No, I am, I do not. If I tell you, sir, that the notice is filed in December of 24, when was it that you had the reach-out? The first communication about the case was in, as I said, a few minutes ago, in late 2024.

And do you recall the circumstances of that communication? D.A. call you a letter or what? No, I was contacted through a retention firm called Park Dietz and Associates. Eats? He's a psychiatrist, isn't he? It sounds like you know him. I do know him. And actually, Park Deets is a rather famous psychiatrist, is he not?

Yes. He's testified in many cases, correct? Yes, but. No, overrule. I said Part Detes and associates. I didn't say Park Detes himself. Okay, well, you know Park Dix, I imagine, right? I do.

Yes. And you know that he's a guy that testified in a case and cited a Law and Order episode that didn't exist at the time he gave us a same. So is he still active? Objection. The state. Is he a psychiatrist now?

Yes, he's a psychiatrist. And on your letterhead, it says, Park Eats, D.I. ETZ and associates forensic experts, right? I can't see what you're looking at, but that's what the letterhead basically says. I am.

Okay, and this is your curriculum vitae, right? Yes. And big letters up above, it says Park beats and associates, right? Yes. Now, how does that work? You get a call from this retention group,

park, Dietz, and then you get assigned a case? When an attorney or a district attorney's office contacts them, they might think that it might be a case that I might want to be retained on. Okay. Do they, to your knowledge, try to get someone that's familiar with that particular topic or just anybody that has a random psychiatry degree? Well, there are only certain people that they think of or consider people that Dr. Deetz has thought of in terms of having a robust career. You have a robust career?

I've been active as a teacher and as a clinician over about 22 years, and I've been a full professor at Penn and Jefferson and Georgetown. So that's in your curriculum vitae, correct? the three professor level appointments? All of your stuff, the things you wrote, things that you're interested in, your fellowships, professorships, all that, right? Yes. Okay. And that's introduced into evidence by the DA, right?

Yes. So the jury's going to have it to look at, right? Okay. I didn't know that. Let's just take a look at it now. Is it your understanding that when you are, and I mean you individually, not practice associates, requested to look at and investigate into the lack of criminal responsibility of a individual charged with a crime that you've got to try to be independent.

Being independent is the expectation. The answer yes? You try to be independent? Yes, I do. Okay. Is it appropriate for you to evaluate an individual with another? Park Dietz associate guy? You're referring to Dr. Habran?

I am referring to Dr. Halper. He's another one of the DA's witnesses in this case, right? Correct. And you know, Habber, right? I had not met him until we jointly went to do the evaluation this April. Jointly went to do the evaluation? Yes. What did you do, both riding the same car over to Tewksbury to talk to her?

No. Did you have separate guys? We did. And then you met up beforehand and you went in to meet with Lindsay? Yes. Both of you together. Yes. So you were under the umbrella of Pacteats and Associates.

Halbrun, who's going to be testifying Monday for the government, works under the umbrella of Pacteats and Associates. And both of you interviewed her at the same time. Is what you telling this jury? Yes. In your opinion, is that appropriate, sir? Yes. Did you talk to Kirk about your opinion? We have talked about each other's opinion.

We have different opinions as far as I understand it. Did you talk to him about his report? No. I have not talked to him about his report. Have you talked to him about testifying here today? Not in terms of content. What does that mean? The other day he called me and said,

what day are you going up to Boston? Okay. Stripping up to Boston. Did you tell him? No, I wasn't sure what day I was going up to Boston. Okay. Did you review his report? I have reviewed his report.

All right. And has he reviewed your report? I don't know. All right. Park Deets. The Park Deets Deets Deets. I do have an interesting story. So who is Park Deets?

First, I'll explain that. Andrea Yates, another woman that this Lindsay Clancy trial has been very compared to. Andrea Yates killed her five children by drowning them in a bathtub. It was 2001, I believe. 2001. She had a trial. Her attorney's George Parnham. I just interviewed George Parnum just a couple weeks ago.

that interview is on our podcast. It's on YouTube. We'll post it in the description. Links are in comments. And during that interview with George Pardom, he explained, again, Park Deets and some more deets. We have some more info to show you how respected Park Deets is in the mental health community. So Park Deets is the reason the first Andrea Yates trial is overturned because what to Park Deeds do? He lied about a law and crime episode. He explained that there was a law and crime episode that Andrea Yates had watched in which they talked about postpartum psychosis. Thus, Andrea Yates was able to get the idea of postpartum psychosis as an excuse for killing her three children, or five children, excuse me, five, five children from this law and crime episode.

Andrew Yates has found guilty of murdering her five children. And her attorney, George Parnham, says, hold up. They discover that this law and crime episode isn't even a thing. Law and order. I keep saying law and crime. Sorry, law and crime. Sorry, law and crime. Law and order.

Law and crime didn't exist then. Law and order. This law and order episode wasn't even a thing. It was a lie. Park deeds lied and made up a law and order episode. on the stand. Her entire trial was overturned. They tried Andrea Yates again, and she was found insane. And she is still in a psychiatric, in a mental institution today. She doesn't want to leave. She could leave. George Parnham actually goes every couple of years to say she doesn't want to leave, let her stay.

She doesn't want to leave. George Parham, I have another story about Park Dietz. George Parham also said in this interview with me that he's in his 80s now. He considers Andrea Yates a daughter, that he talks to her all the time. He is following the Lindsay Clancy case very closely and talked to Andrea just hours before our interview. Andrea knew he was doing the interview and said she was grateful that George was doing the interview because she wants to bring her.

awareness to postpartum depression and psychosis and mental health. So now, something else, though, that George Partum told me is after the Andrea Yates trial and the second trial, he was asked to speak at a, I don't want to get it wrong. So I'm paraphrasing, go watch the interview with George for the exact name. But a large meeting with psychologists and psychiatrists, I don't know, an official, large meeting in California. He was flown out to speak. And in the speech, he admits to sort of shaming Park Dietz. And after his speech, he got a standing ovation. In other words, after that first trial of Andrew Yates was overturned, Park Deets was not very respected, is what I gathered,

what he was inferring in my interview with him. What I find interesting about this cross, I mean, whether or not the jurors are going to pick it up or not, there are jurors that are going to remember the Andrea Yates case, whether or not they remember Park Deetz is a whole other question, right? You can remember Andrea Yates, but you don't necessarily remember who Park Deets is. Well, I find it interesting in multiple reasons.

A, the prosecution is trying so hard to say, that this was premeditated murder with malice and cruelty. So I find it a little suspicious and interesting and odd that it would be the prosecution going to try to find an expert witness connected to Park Deats. I mean, it makes my spidey senses go up. Like, why are you, that's interesting to me. I'm not saying, so if the prosecution is saying that this has nothing to do with the Andrea Yates case, this is nothing like the Andrew Yates case. Why are they going and finding

an expert witness connected to Park Deets? Like, it's weird. It's not a good look. And they're also, it kind of makes me think that consciously or subconsciously, they are connecting the Lindley-Clancy case to the Andrea Yates case, something that they've tried to not do, right? This is not Andrea Yates, they say. But then they go find an expert witness connected to Andrea Yates. expert witness, infamous expert witness that had the entire trial overturned. So there you go. Those are my park deeds, deets, deets. Go watch the interview with George Parham. Fascinating. Again, what jurors are going to pick that up? I think a lot of the jurors, there were a lot of jurors that were my age, middle-aged, older that are going to remember the Andrea Yates case. They will.

And they're probably thinking about the Andrew Eates case. But whether or not they remember who Park Deetz is is to be determined, you know, some of you knew, some of you didn't. Who knows? Anyway, there you go. There you go. So from there, Reddington went through Dr. Max's curriculum vitae in considerable detail, right? And you know what? let's let's just watch some more

where in here does it say that you ever came within breathing distance of a pregnant woman and your practice in your interest in your writings so i remember being at the brigham uh as a resident and how long goes that give us a year well you asked me when so i'm starting when uh that was two the memory i have for that particular situation was 2001 2001 so 2001 so 25 years ago. Right.

And so since then, I went to the medical university of South Carolina, and then I went to Georgetown. And all that period up until 2015, I was doing general psychiatry work with areas of focus in peds or in addictions, but also with forensics as an area. I see myself as somebody who's generalist who happens to have a couple of areas of focus. In 2015, I did move from that generalist model. model to when I left Georgetown, I moved to the Children's Hospital Philadelphia and the University of Pennsylvania.

And in those years, since then, I've been working in pediatric hospitals, where at CHOP, Children's Hospital Philadelphia, the age is up to 24, and at the more is it's up to 21. So that is the overall area of adult and child psychiatry that I've been working in. Throughout the years at Georgetown, I would like to answer because I have more to tell you. So at Georgetown, certainly, that was all adult, and Georgetown has its own labor and delivery unit. And so that was plenty of engagement with women who were pregnant or who had just given birth. And then at both Children's Hospital Philadelphia and at the Moors, there are these special units that have been under design for the last several years of high-risk pregnancy units. So actually at CHOP, one of my first roles there was to develop the psychiatry services, coverage of the high-risk maternity unit there called the special delivery unit and I was the

co-leader and then the leader of the consultation service at shop and so I led the group of adult and child psychiatrists to tend to the psychiatric needs of that unit recently at Nemours the same unit was built and so yes in these pediatric hospitals there are actually are units of women who are about to have birth through just to have Well, I'm sure in these pediatric hospitals there are women about to have birth and have had birth, and I'm sure that there are competent doctors that treat that, correct? I agree with you. How about you? How many women with post-carbid psychosis have you treated?

Roughly 10 would be my estimate. Over what period since 2001? And when you would treat these women, you involved in, for example, testing them for their mental health? Well, usually the teaching has been that what was called postpartum psychosis is actually a form of bipolar disorder. So what is important is to say, let's do a full evaluation of the individual symptoms and signs, and then treat them and engage in treatment. And usually that's going to be a form of bipolar disorder treatment.

That's the teaching that is the general perspective. So with your wealth of knowledge on women that are pregnant and suffering from postpartum psychosis, do you know whether or not Lindsay was ever diagnosed with postpartum depression? I believe that the various notes from the clinicians over the year of 2022 or 2023 utilize the term unspecified mood disorder. Right. How about postpartum depression? I don't think that appellation was used. Okay.

So was she ever administered the EPDS? You mean the Edinburgh? Yeah. Was she ever administered that? I don't know if she was or wasn't. I don't remember. Isn't that something you were here testifying about this case? Wouldn't that be important to know that she was almost off the chat on the Edenberg scale for postnatal depression?

Well, I have said that she had depression. Well, postnatal depression for a woman who's pregnant or had a baby recently is a heck of a lot different than some guy who's just depressed about his job, right? I don't understand your question. Well, do you know what her readings were on the Edenberg test? Not to my memory at the moment, no. Why not? You read the medical records, didn't you? I mean, if you would like to show me, I don't want to show you anything. I'm asking you as a testifying witness to this jury.

Did you look at her medical records? I did. And the medical records pertained to her being a person that just had a baby, right? I'm not sure that which records you're talking about, but when I, can I finish? Can I finish? I'm not going to finish. 2022, obviously, because we already talked about the summit. She was trying.

When did she see Tufts? She started to see Dr. Tufts in 2022. When? I believe it was, well, she went to Dr. Tufts in September, and it was in October that she started taking the medication that Dr. Tufts had prescribed. Okay. And that was for what? You mean which medication or what was the purpose? medication

search link and otherwise known as Soloft and she took it after a while is that correct is that what you said a few weeks yes and the reason she didn't take it was what time as my evaluation hold that whole last thing back go ahead you want to re-ask that question

I'm okay okay so over time Ms. Clancy has avoided taking medications she's what avoided taking medications The description she gave me. She told you that? My awareness from my evaluation is that she resists taking medications. And for example...

No, no, no. Tell me what you mean by she resists taking medications. There are individuals in this world who do not want to take medications, and I think she described that she is one of them. You know what she saw Dr. Tofts because she apparently was anxious, right? Yes. Prior to that, other than having anxiety about public speaking as a nerve, from nursing school. And after she had one of her children, she didn't have any psychiatric

history of medications, right? She had not taken medications, but she had had a lifelong degree of anxiety. It hadn't been at the level of disorder, but she had a life. Life long. Yes. Okay. How about grandma school, high school, college? Did she have difficulty that she was anxious? So what I was saying is that anxiety can drive people. But she had a lot of of anxiety and she was hardworking and the anxiety helped her to be hardworking. But when it comes to medications, Mr. Regton, go ahead, doctor, finish the question. But when it comes to medications, she described that she didn't want to take medications. And an example was the time that after the birth of a second child that search lane had been

prescribed, but she chose to get through her anxiety and depression by exercising. And that is something that people do. But it also highlights that in this case, she didn't want to be taking medications. And I think that we also understand that in the fall of 2022, at this point, I'm going to stop. Next question. My question was, you said that she had a lifelong resistance to taking medication. That's what you said, right?

Yes. Yes. Then I asked you, run school, high school, college, did she have any right? any witnesses, any documents, that she had a resistance to taking medication? Only your description to me. She didn't tell you that she was resistant to medication in grammar school and high school and college?

What are you making this up? Yeah, sustained. Next question. She didn't tell you that. I understand her to have told me that generally she did not want to be taking medications. She didn't necessarily specify in grammar school, but that is her basic... Yes, I think that her description was

As an adolescent and as a young adult, she was not interested in taking medication. Do you really have that written that is something? I'm happy to be proven wrong, but I believe that that's what I understand it to me. You believe that's what it is. You don't know whether you haven't written that. Am I, can I refer to my report? Because it's not bad. Well, on page 8, what I had written was

Ms. Clancy's reluctance to take medication generally was accompanied by her concern, for medications entering her breast milk. So the general, she's pregnant. She's pregnant. Come on. That's the only time that she indicates that she did not want to take except for benzos medication because she was breastfeeding, right? I don't agree. I'm happy to be proven wrong. But my understanding is that she described that she generally did not want to take medication. Benzodiazepines included. Let's not guess. All right. Let's look at you. Let's look at Dr. Max report, okay? Medication history.

During the period before January 24, 23, she was taking several medications, and that would be tough, send her latter, and all the rest of them, right? Okay. Is that right? I didn't exactly hear your question. I'm sorry, can you repeat it? You said in your report, the defendant was taking several medications that had been prescribed for her, right?

In the fall in December of 2022, yes. So it's real easy. It's Pops and Gelada that were prescribing these meds, right? They were among the prescribers, yes. All right. And her reluctance to take medication was accompanied by her concern from medications entering her what? I believe it says breast milk. Breast milk. Okay. So other than her concerns as a mother about her breast milk and having these drugs get into an infant's body, When else did she tell you that she was resistant, as you just told this jury, to taking medication? Like she's somebody who doesn't want to take the medication, doesn't care to take the medication.

Where is it? No rule. Well, I didn't say that she didn't care. Okay. How about if she was resistant? My recollection, and I'm happy to, if you would like me to spend time finding it, I'd be happy to. What? Prove you wrong.

It's not in your report, though, is it? Okay. Yeah, that was the court reporter coughing there, which I, who I felt terrible. for that. It was a really tough job she had there right then, trying to transcribe and record all of that. So it makes sense that she started coughing. Anyway, eventually Reddington moved on. He returned to the DSM, the diagnostic and statistical manual used by psychiatrists when making diagnosis. Dr. Mack agreed that the DSM was standard use for psychiatric diagnoses. Reddington pointed out that one of the subjects relevant to Dr. Mack's testimony was postpartum mental illness, including

postpartum psychosis and postpartum depression. And then he challenged whether the DSM was really a sufficient standard for evaluating those conditions. Dr. Mack said it was the standard. Reddington brought up the ICD, the international classification of diseases, which is used internationally. Dr. Mack was familiar with it. Redington asked whether the ICD specifically classified postpartum psychosis. Dr. Mack said his recollection was that it did not. When asked about postpartum depression, under the ICD, he was not certain. Redington then returned to the DSM-5 TR that Dr. Mack had relied upon. He asked about the possibility that postpartum depression or postpartum psychosis could eventually be given a more specific classification in a future version of the DSM. Dr. Mack clarified

that there had been proposals for a distinct syndrome called postpartum psychosis, but had not been formally included in the DSM. He also said he wasn't aware that DSM 6 was currently moving forward in any active way. Dr. Mack then gave the jury some background on how the DSM had developed. He had actually written his college history thesis on the history of the DSMs. But for him, the first DSM was published in 1952, the second in 1968 and the third in 1980. A major change with the DSM 3 was the move toward a descriptive model of psychiatric diagnosis instead of classifying disorders primarily based on theories about what caused them. Psychiatrists began grouping disorders based on the symptoms they could actually observe. Dr. Mack explained that the same basic

approach continued through later editions. He also discussed the development of postpartum specifications within the DSM, beginning with the DSM for published in in 1994, literature reviews helped establish how postpartum timing should be handled. So rather than creating an entirely separate diagnosis for every postpartum condition, the DSM could add a specifier to an existing diagnosis. For example, a person could be diagnosed with depression and then have a specifier identifying that it occurred during the postpartum period. The limitation, though, according to Dr. Mack, was the four-week time.

frame under the DSM's current framework, the depressive episode occurring more than four weeks after childbirth would not receive that postpartum specifier. That's interesting, which would be why Lindsay didn't fit into that criteria. Reddington then returned to postpartum psychosis specifically. Dr. Mack explained that the concept of postpartum psychosis had been proposed as a distinct syndrome, potentially involving features associated with bipolar disorder. depression and even delirium. But because the DSM requires proposed disorders to be sufficiently distinguishable from existing diagnoses and useful for treatment, many proposed diagnoses never make it into the actual manual. According to Dr. Mack, postpartum psychosis was one of those proposed

syndromes that had not been formally approved. Redington then tried to summarize his position for the jury. Postpartum psychosis. and postpartum depression are pretty much virtually not even mentioned in your DSM-5 TR? I wouldn't agree with that. I was about to say. So you would not agree with it, right? Actually, I was about to get to that. Sure you were, but you would not agree with it, right? Is that correct?

I don't have a basis to say that. Okay. So looking at, and this is 1,050 pages of people putting together like a cookbook, fair to say, right? No, I wouldn't call it a cookbook. No? Would you agree, sir, that postpartum is referred to page 147 in sex and gender-related diagnostic issues. Would you agree with that, sir? Is that the introductory chapter?

This is the chapter, sir, that is pertinent to bipolar disorder. You're familiar with it. Okay, so it's the bipolar chapter. And referencing 147 sex and gender-related diagnostic issues. You're familiar with that, I imagine, right? That's a subset. I mean, that's a portion of the chapter, I imagine that describes the issue. It's a paragraph. It's a paragraph. Out of a thousand pages, it's a paragraph.

What's your question? Women may be more likely to experience rapid cycling and mixed states and to have patents of comorbidity that differ from those of men, including higher rates of lifetime eating disorders. Come on. This is what they talk about with postpartum, psychosis, and postpartum. depression, eating disorders, and the difference between women and men? Is that your question? I'm not sure I understand your question. No, you answer it, yeah. What's your question?

Postpartum disorders, sir, the difference between women and men, and they make reference to eating disorders? Well, I think the section header, if you don't mind reading it again, was aspects about gender. And so in that section, I imagine they're describing it. I didn't write the DSM, so I'm not here to represent it. Okay. I can just tell you about it.

All right. Okay, right here. Sex and gender related diagnostic issues, right? Would you agree that's under the bipolar and related disorder section? Yes. Yes. Okay. 8147. Talks about women, all life people experience, rapid cycling, and mixed states.

And we have patents of coerability that differ from those of men, including higher rates of lifetime eating disorders. Right? Did I read that right? That's all right. Okay. And then it goes on for the rest of the paragraph that women with bipolar 1 or 2 disorder are more likely to experience depressive symptoms than are men. I read that right? That they, meaning women apparently, have a higher lifetime risk of alcohol use disorder than men.

Really? Can I read that right? Yes. And that they also, and much greater likelihood of alcohol abuse disorder than women in the general population, some women with bipolar disorder experience exacerbation of mood symptoms during their pre-menstrual tank period. Right?

That's not that. Yeah. And that this has been associated with the worst course of illness. Many women with bipolar disorder also report severe emotional disturbances during perimenopause when estrogen levels are decreasing. I read that way.

Sorry. All of it. Sorry. It does say that. Okay. And that there does not appear to be an increase risk of mood. in pregnant women with bipolar disorder except for those who discontinue medications for pregnancy, right?

That what it says that in the DSM? Yes. So what does that tell you, your 25 words or less, sir, when that sentence, we were it talks about, there does not appear to be an increased risk of mood episodes in pregnant women with bipolar disorder except for those who discontinue medication for pregnancy. What does that mean? What it means is when thinking about women who have bipolar disorder who are pregnant, the risk of having either a manic episode or a hypomanic episode or a depressive episode generally stay stable compared to when the person is not pregnant, except in people who do not take medications for bipolar during the pregnancy. And then it goes on to read the specifier with periturnum process that should be used for mood,

episodes that begin during pregnancy or within four weeks of delivery. Is that the four week cut off? You tell them about that the four week cut off that's on that specifier. The Perryman, the Perry Party specifier. What was this last amendment? 1958? This one, well, you're talking about four week number? Yeah.

That was created in DSM. The index four in 1994. And how about the World Health Organization? What's their cut off using that term? I don't know. I can tell you that the proponents of postpartum psychosis illness utilize, I believe, 12 weeks, maybe six weeks, but not more than 12. How about the, what is it, IDC, ICD? The World Health Organization's International POSC.

If I tell you, it's a year, would that mean anything to you? It's about six, maybe 12. It's a year. Doesn't mean anything to me? Yeah, does it mean anything to you? With regard to what. It's a year. You're talking about four weeks, but they're referring to a year.

Well, the distinction between the ICD and the DSM is substantial. The DSM... All right. Is Ray? I'd just ask a question. By the way, I'm going to agree with this comment. The USA needs a year paid maternity leave. Amen.

Couldn't agree with that more. Reddington then brought up the World Health Organization and the ICD system. He wanted to know what time frame, the who, used for postpartum conditions. Dr. Mack wasn't certain of the exact time frame used by the ICD. He said proponents of a distinct postpartum psychosis diagnosis had discussed longer periods, possibly six or 12 weeks. Reddington told him that whose time frame was a year. Dr. Mack explained that the ICD and DSM were substantially different classification systems, but before he could elaborate, the judge redirected Reddington to ask his question, as you just saw there. And so

then Reddington argued that the way postpartum women were treated and classified in Europe was significantly different from the way they were treated in the United States. But that was objected and that objection was sustained. So then Reddington returned to the sex and gender section of the DSM and confirmed that it specifically mentioned the postpartum period. Then he moved to another section discussing the gender ratio for bipolar disorder. Dr. Mac agreed that bipolar 1 appeared to occur at roughly equal rates in men and women. Reddington then read language discussing bipolar 2, including the possibility that it could be more common in women. Dr. Mac explained that some of the differences could be related to the

fact that women experienced depression at higher rates, which could influence how bipolar 2 appears in clinical population. Redington continued through another passage describing differences between men and women in bipolar illness. The DSM noted that women were more likely to report hypomania and could experience mixed depressive features and rapid cycling. It also stated that childbirth could be a trigger for hypomanic episodes, particularly during the early postpartum period. Dr. Mack agreed that this was what the passage said.

The conversation then returned to the difference between the DSM and the Who's Classification. system, Dr. Mack said he was not prepared to confirm the exact 12-month time frame Reddington was attributing to the WHO, the WHO, the WHO, that he then explained an important distinction involving the proposed diagnosis of postpartum psychosis, according to Dr. Mack, proponents of recognizing postpartum psychosis, as its own disorder believed it was specifically connected to the physiological changes surrounding childbirth. And that was one reason they wanted the term postpartum rather than peripartum. The proposed condition was intended to focus on the period immediately following birth.

And Dr. Mack said that the literature describing postpartum psychosis generally portrayed it as a condition that could develop very quickly after childbirth and could require urgent intervention. So Redington asked what literature he was referring to. And then Dr. Mack explained that he was talking about published literature and the work of an expert consensus panel advocating for recognition of postpartum psychosis as a distinct syndrome. Redington suggested that these were the experts trying to get postpartum psychosis and postpartum depression added in the next edition of the DSM.

But Dr. Mack corrected him on postpartum depression. Postpartum depression didn't need to be added as a completely new diagnosis because the DSM already had a mechanism for identifying depression that began during the peripartum period. So then Reddington asked where that appeared. And so Dr. Mack said there was this specific specifier, right, for both bipolar disorder and depressive disorders that added peripartum onset. Redington asked him to find the section. Dr. Mack eventually located it.

Page 173, he explained that the section began several pages earlier and discussed different specifiers that could be attached to bipolar diagnoses. There were specifiers for such things as atypical features, rapid cycling, then there was a section addressing peripartum onset. So rather than reading the entire section, Reddington asked Dr. Mack to summarize it. And so what does Dr. Mack do? He explains, that the DSM provided a way to designate that a person's bipolar disorder or depressive disorder had begun during the peripartum period. The section also contained information about the typical course of these disorders.

And he explained that the DSM did not simply provide diagnostic criteria. It included information about how disorders developed over time, how common they were, and what kind of features were associated with them. Dr. Mack explained that similar sections existed within the depressive disorders chapters. Redington wanted to stay focused, though, on the bipolar section. So he then tried to connect the peripartum section to psychotic symptoms, such as delusions and hallucinations. Dr. Mack says, well, I would need to see a specific passage that Redington was reading

before agreeing with this. So then when Reddington points to him a section discussing peripartum on Dr. Mack explains what a specifier actually means. So the system has a way where we can emphasize features of a person's illness. Remember, as I said, the groupings in the DSM revolve around the major psychiatric symptoms. So this is the bipolar chapter, there's a depression chapter, there's an anxiety chapter. So here the specifier is our way of communicating that the person's problem, in this case, has peripartum onset. And if I could connect it all, the emphasis on the proposed postpartum psychosis disorder,

they object to it being parietardom. They would like it to be postpartum. And who's they? The authors of the expert consensus group that I referred to published a paper in biological psychiatry in the last year. About what? Psychiatry covers a life around. Yes. It's a paper that summarizes information about this proposed disorder,

highlights their assumption that it is actually a type of bipolar disorder. disorder. Can I just interrupt. What disorder are you referring to it? The proposed postpartum psychosis disorder. All right. So there is a group of people that are trying, to your knowledge, to get post-partum disorder in the next version of the Bible, right?

Effectively, yes, but I wouldn't use all those words, but yes. Okay. And then when you're referring to the peripatim onset, in one paragraph, you're talking about the specifier applied to current manic. Bipomanic or major depressive episode in bipolar one disorder, right? Did I read that right? Well, it's more than just one paragraph. It goes on to the next day.

Counsel, let me see counsel aside by here. Just some good scheduling. That's actually where court stopped for the day. Boom. The judge called the council, called that sidebar you just saw to discuss scheduling. Court recessed until Monday, where rebuttals will continue. And then actually the judge. said that closing arguments would be Wednesday, scheduled Wednesday?

Tuesday. Redington said outside of court that closing arguments would be Tuesday. So Monday, we conclude these rebuttals, Tuesday, being closing arguments, and then jury instructions, and then the jury deliberates. And yeah, you know, I'm sure that there were some jurors that were liking red in that fiery moment and others that didn't. but he's certainly fighting for his client, Lindsay Cam, Lindsay Clancy, that much is true.

All right, guys, I am going to take off. Whatever you believe about this case, I will say this. I'm a big believer in needing maternity leave and parental leave when children are born in the United States. Because those early months are so important for children, for mothers, for attachment, for fathers, it affects the entire future of the child, of the parents. And anyway, there's my soapbox as not to do about this case, but that's what I believe. All right. We'll see you guys this weekend.

There is more planned. Something is coming tomorrow. And then we've got a lot scheduled next week with hidden true crime. I'll just share that. There's a lot happening. And we're going to continue covering this as well as something else. So hit subscribe, hit notification, let your phone. friends know about us, and we're so grateful for all of you. Thanks for hanging out with us late this

Friday night. And we'll see you, well, for an interview that I have tomorrow and then a couple other things. So yeah, we'll be seeing you. Bye. At Cox, your internet and mobile price won't change for five years. That's five New Year celebrations. Five Valentine's days. Five Fourth of July's, five Halloweens, five Thanksgiving's, and five summers that go by too fast. Through it all, your price stays the same with our five-year price-lock guarantee. Cox, a step ahead. Requires two-gig speeds and gig unlimited mobile.

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