Life Uncut - The Lindsay Clancy Case: Postpartum Psychosis & the Law Explained By A Forensic Psychiatrist

Starting point is 00:00:09 Hi guys and welcome back to another episode of Life Uncutt. I'm Laura and I'm Brittany. Now I know a lot of you have all been following the Lindsay Clancy trial and we've spoken about it quite a bit behind the scenes here at Life Uncutt. We didn't want to talk about it on one of the main episodes because we are not experienced enough in the world of mental health, in postpartum psychosis, in all of the intricacies of this trial to do it justice. However, we have been fascinated by it. We have been disturbed by it. We have felt and thought all the things that you guys are thinking and feeling as well. Well, it's sort of one of those things that I think, I mean, we don't talk about it just in terms

Starting point is 00:00:48 of, oh, should we cover it in terms of content? The world is hooked on this case because we've not really ever seen anything quite like it before. Yeah, and we put up a post in our Facebook discussion group a little while ago talking about whether or not you would be interested in an episode on postpartum psychosis with a bit of an unpack of the Lindsay Clancy trial. Now that is exactly what this episode is all about. This chat does discuss postpartum illnesses. It does discuss death and suicide. So please, if this is not the episode for you, we absolutely understand. And we will also share support services at the end of the show in the show notes.

Starting point is 00:01:21 Now, for anyone who missed it, Lindsay Clancy, she is a mum from Massachusetts who in January of 23 allegedly murdered her three young children, Cora, Dawson and Callan. Now, up until recent, this hasn't been a case around whether she did or didn't do it. It was more around whether she was responsible for it or whether or not she was so unwell after her birth of her third baby that the law shouldn't hold her accountable. A lot of questions were raised around postpartum psychosis, and this has turned into a worldwide discussion. Now, early this month, after five weeks of evidence and a week of deliberating, the jury could not agree. 11 jurors on one side and one on the other. The judge declared a mistrial, which left us with so many questions, what is postpartum psychosis really?

Starting point is 00:02:11 How do you prove what is going on in someone's mind on any specific day? And what does not guilty by reason of insanity actually mean? So we have found the perfect person to ask. Dr. Jackie Rakoff, she is a clinical forensic psychiatrist. She is based in Melbourne. She assesses people charged with very serious crimes, writes reports for the courts, and it also is cross-examined in the witness box on exactly these questions, whether someone is fit to stand trial or whether their mental illness means that they are not criminally responsible. She's also been writing very closely about the Lindsay Clancy trial on her substack. Now, I do want to note that there has been some updates in this trial with Lindsay Clancy's lawyer arguing that there simply isn't enough evidence

Starting point is 00:02:53 that she killed her three children. We are not here to discuss that today, but we are here to have a very honest discussion about the topic of postpartum psychosis. Jackie, welcome to life uncut. Thank you so much. Hey, Jackie, can we just kickstart by saying what is a forensic psychiatrist and how is it different to say just a clinical psychiatrist? Yes, great question. Well, all of us actually train as clinical psychiatrist first. I should probably go back and say we're all medical doctors, which is a bit of a difference between a psychologist and a psychiatrist. They're often muddled up.

Starting point is 00:03:25 So a psychiatrist is a doctor who specialises in mental illness where you can prescribe medication, diagnose mental health conditions, do treatment as well as talking therapy. Psychologists will have a different training pathway where they focus on the talking therapy parts. And then a forensic psychiatrist is a psychiatrist who's gone on to subspecialise in the intersection of psychiatry and the law. So there's a lot of myth about forensic psychiatrists showing up at crime scenes and looking at dead bodies. It's actually not what we do at all. That's definitely giving CSI. Yeah. Or SPU. Oh, yeah. Special victims. I do love that show.

Starting point is 00:04:01 Do you know, Jackie, this Lindsay Clancy trial has captured people online. I think it is certainly not every day where we see court cases where a mother has been the one to take the lives of her children or allegedly take the lives of her children. And this conversation around postpartum psychosis is such an unknown, I guess, like aspect of like what could entail as part of someone's postpartum journey. I mean, we talked a lot about sort of like postpartum depression, but not postpartum psychosis specifically. And when we were discussing, like, what was it that we wanted to talk about from this trial? That's one thing that so many of our listeners were like, there is just not enough

Starting point is 00:04:37 conversation around what postpartum psychosis is. Can you give us a little bit of a, I guess, an explainer of like what and how is postpartum psychosis diagnosed and what actually is it that people experience? Sure. So it's a psychosis in the postpartum or peripartum period. In general speaking, it's, you lose touch with reality, essentially, what you begin to believe differs from that what is actual. So there's diagnostic criteria, which can get a little bit technical. So you either have to have delusions, hallucinations, disorganized behavior, or the extreme version of catatonia. So not eating, not drinking, kind of zombie-like. It's as related to being pregnant or having a baby. What makes it postpartum? What actually causes it? Is it a huge crash of

Starting point is 00:05:24 hormones with some kind of wiring chemistry, miscommunication? Like, what is putting somebody into that psychosis? We don't actually know. We don't know that about any psychosis, frankly. There are certainly risk factors which can predispose you. So if you already have a diagnosis of a serious mental illness, such as bipolar effective disorder or schizoaffective disorder, schizophrenia, we know that you can absolutely be at heightened risk if you're carrying a pregnancy. And that would mean that your treating team needs to keep a close eye during that period. Make sure your mental state doesn't deteriorate. Is it possible for someone who has, hasn't had any sort of clinical diagnosis of any other mental health disorders previously

Starting point is 00:06:04 to end up having something like postpartum psychosis, or is that quite rare? Well, postpartum psychosis is actually very rare, including for those who've had a pre-existing mental health condition. It's about one or two per thousand live births. So there are so many things that can go awry in pregnancy that you can't be discussing absolutely everything with your specialist. You know, the minute you hear the heartbaden, off you go. Obviously, there's now the screeners that obstetricians and midwives do for your mental health. So any changes or deviations should get picked up pretty early. But I don't think we need to alarm people walking around thinking, I am at risk of a postpartum psychosis because I'm pregnant.

Starting point is 00:06:41 I also, obviously, I'm not a statistician, but I would have said that wanting to two in a thousand isn't that rare. Like wanting two per thousand to me sounds like more than I probably thought it would be. Is that classified as rare? It's definitely classified as rare, especially as compared to, postpartum depression or postpartum anxiety, which we have a lot more of prevalence. What is it specifically around this case that has, I guess, like, piqued your interest? Because you have been following this closely and speaking about it. What is it not just around the postpartum psychosis part, but the Lindsay Clancy trial in total that I guess has gotten you really invested?

Starting point is 00:07:17 Do you know, I actually have a confession to make I'm really bad at following true crime. And it wasn't until my, like a mum friend actually asked me. me on a number of occasions. Like, what do you think about Lindsay Clancy? What's going on? I think I try and avoid it because I know, and we might get into that later, like how much can be augmented by the media. And so I decided to have a look for myself, which is why I went into that sort of rabbit hole and sat there watching hours of expert testimony, because I wanted to have an actually informed opinion as opposed to two or three minutes on a TikTok video. Yeah. I think, look, obviously the interest came from fellow mums in terms of how I'm

Starting point is 00:07:56 I found out about it, and then obviously it was unavoidable in terms of headlines. I think this is particularly confronting for people because it's quite impossible to reconcile. So you have a mother who's admitted to killing her three children, but you're also asked to entertain that she's psychiatrically really unwell. And I think it's human nature for people to want them to be mutually exclusive. You know, everything about motherhood is so fiercely about protecting and caring for and doing it at all costs. So either she's a monster or she's.

Starting point is 00:08:26 She's just a loving mother who became terribly ill. And I think we're really uncomfortable with the possibility that it might be more complicated than that sort of binary. When you just said you're hyper aware of how things can be augmented on the internet, someone in your position that has the background that you do, does a study and the due diligence that you do, what do you want to scream at the internet when you see cases like this? Because you said, you know, I don't want to get my information from a three-minute TikTok. Unfortunately, that's where, like, I would say 80% of the population is getting their information.

Starting point is 00:08:55 and obviously we know that's why there's so much misinformation. What are you wanting to tell people? I think, well, it sounds a little bit obvious, but don't believe everything you hear because it's a lot more nuanced and complicated. And I think even when you're in the witness box, it's so important to understand the nuance and that not everything has a really tidy formulation or explanation. I think also just because someone has a TikTok account, it doesn't make them an expert. I think we conflate expertise and authority.

Starting point is 00:09:24 I also think that what a lay audience, which is essentially a jury, sees in an expert is different to how I'd be analyzing an expert. And I appreciate that that's a particular lens. I've been very careful not to comment about any diagnosis, Lindsay may have had or has, because I haven't assessed her. And I think there's an ethos in psychiatry. I think the American psychiatric organisation actually has a rule called the Goldenwater Rule. It came out very prominent around the time a psychiatrist said that. Trump was a psychopath and said, you really can't be going around diagnosing someone you haven't assessed for yourself. So it's sort of an ethical moral stance that we have where we don't

Starting point is 00:10:02 just slap around saying, oh yeah, she was nuts or she was just trying to get off on mental impairment. But I think there's a lot of interesting stuff to unpack around it, you know, the expert testimony and the what is the psychosis, as you say, people hadn't heard of it much until this came to light. We've had a number of filicide cases in Australia. They just haven't been, like, televised. So. Yeah. Why? Is that? I have no idea why. I mean, I think America has a lot of theater about it anyway. I don't know why they choose to do that. I guess they don't have any concerns about jury finding out or watching, I think, expecting a jury to keep a cleansed.

Starting point is 00:10:42 Yeah. Profaner about the case is really hard in the age of social media and the internet. You really can't control what someone does in their hotel room after you go home for the day. I don't know the motivations why this trial was televised and why others wouldn't be. It's been something that I've seen quite a bit of online and speaking about the two-minute TikToks, but people talking about how is it possible for someone to admit guilt to something when they don't remember doing it? And with this whole conversation around postpartum psychosis and having a affected memory around

Starting point is 00:11:15 what it is that's reality or not reality, is it possible for someone to take full responsibility for something that they don't have full cognition that they've done? You can. Again, that's really complicated and would require the assessment, not to just be cross-sectional about the time of the alleged offending. You need to know what they were like before. You need to know what they were like after. Absolutely blanket rule, it's very hard to lay down memories

Starting point is 00:11:41 when you're acutely psychotic or acutely unwell. So that's not surprising that there can make difficulties in recall. I think also people take advice from their legal counts, about whether they're going to plead what we call a Victorian mental impairment or, I guess, insanity in the States, because the consequences of those are quite markedly different. So you either end up in a forensic hospital, so like a hospital with secure walls, or you end up in jail if you go down the trial route, or if you plead not guilty, or if you accept the charges and plead guilty. So there's usually consultation with your lawyer about your outcomes. I had a, I guess,

Starting point is 00:12:20 off-duty judge tell me off the record. You'd have to be effing mad to take a mental impairment if you're looking at under 20 years because in Victoria, where I practice, nominal term for murder would be 25 years. And so you might get less if you plead guilty and end up in prison. But if you pursue a mental impairment defence and end up in a forensic hospital, that's what you're looking at, 25 years under an order, whether it's custodial or supervised in the community. So it's all jargon, really, but it's essentially like there's consequences to which avenue you take in the courtroom. How hard is it to prove mental impairment or mental illness in a criminal court case? And I guess I say that because if the Lindsay Clancy trial does come off and they do say it was

Starting point is 00:13:04 a mental illness, how much room for error is there in that? Like how much of an uproar will there be from us, the public, saying, oh, you could have got it wrong? I guess like what is the percentage of accuracy on your end? I think in terms of medical specialties, we have the smallest provable accuracy because we don't have any tests. We can't measure a blood test and say you've got this much serum psychosis. But what we do take is expert opinion and people with experience.

Starting point is 00:13:33 And what's interesting is, ideally, you shouldn't be able to tell who's footing the bill when an expert gets in the witness box. And I think that that, unfortunately, was really obvious, and particularly some of the experts in this trial where you would have a psychiatrist saying, you know, I really cared for her, or the psychologist, I really cared for her. You're not there to be an advocate to a party. You're there to your duties to the court. And so it's very common, in my experience, to have contested mental impairment hearing.

Starting point is 00:14:01 So you have an expert witness for the defence. You have an expert witness for the prosecution. You've come to different conclusions about the person's mental health and culpability. And then you go to court. You present your evidence. You're not there to win or lose per se. and then the jury will decide if they accept your evidence or not and that moving forward. You said something just before, Jackie, and I found it fascinating.

Starting point is 00:14:21 I wonder if it's the same in the States that, like, you'd have to be actually insane to go down the route of wanting to plead insanity because the punishment is just as, you know, the punishment is still what it is. It's still. Almost equivalent. Yeah, you're still spending time, but in an institution, I think that maybe, and I say this for myself, like, the way. that the Lindsay Clancy case has been framed is that for a lot of people viewing it from the outset,

Starting point is 00:14:48 that if she's found that it was postpartum psychosis, that she won't stand punishment in terms of like, oh, that's something I was going through. Now I'm not. I'm fine. I'm healed. Therefore, there's no punishment or like it's going to be far less. Is it the same in the States that if you were to be convicted but convicted on the grounds with, you know, some sort of insanity or like, you know, post-partner, whatever it looks like, would the punishment still be quite similar in terms of being put into a psychiatric ward instead of a prison? Two things. I think it's interesting that your or the public perception is that it's punishment. So if you're found here, not guilty by reason and mental impairment, but still deemed too unsafe to go back to the community, you would be

Starting point is 00:15:33 under a supervised treatment order and you would get treated in hospital. So the justice system doesn't view that as a punishment. Well, I appreciate the public is maybe relieved that that person's not roaming the streets. It's considered rehabilitation and treatment rather than punishment. My understanding is Lindsay's in hospital, and that's where she was attending court from. She's currently in a psychiatric hospital rather than a prison. So whether there's, I don't know exactly in Massachusetts, whether they have temporary supervision orders for restoration of mental health and then you'll return to custody. But absolutely, if you're found not guilty by reason of insanity, you may be then compelled to spend time in a forensic hospital.

Starting point is 00:16:13 But if you spend time in a forensic hospital, is there an amount of time that is... Yeah, like, so for example, if you're found guilty on orders of insanity, whatever is the terminology for it, do they say you're going to spend minimum 10 years in this hospital or a minimum 25 years? In which case, I would say, yes, there's treatment, but like you can't foresee how long treatment should be until that person's treated. So if you put a minimum of 25 years in there, kind of is a punishment as well. And they're better after three years. Yeah, do you know what I mean?

Starting point is 00:16:42 No, it's a great question. I think so the nominal term that you're compelled to be supervised is 25 years, but not all of that time might be spent in the hospital. So again, I only have worked in Victoria. So we have a hospital where you progress from acute wards to subacute wards to rehabilitation wards. When you're residing on those rehab wards, you might be going to TAFE, you might be engaging in employment. So you're not confined to four walls anymore, but you're under heavy supervision.

Starting point is 00:17:12 So there's forensic leave panels. You go to the Supreme Court to look at supervision orders and on extended leave orders. So if, say, after eight years, you've been consistent with your psychosis treatment, you have great insight, you understand, or you've conveyed that you have great insight, you understand the role of a need for treatment. That can be conveyed to the Supreme Court. You've got all the stakeholders present, including the treating. service and you explain, this person's done really well, we think they don't pose a risk to the

Starting point is 00:17:41 community, et cetera, et cetera. So while it does sound huge, it's, it's very heavily scrutinized on the way. Understand. So no one falls through the cracks whilst they're under that order. And Jackie, can you talk us through what usually happens in a criminal case? So when you're brought on to assess somebody, are you the first point of call? Like when this case is going to court, they're like, okay, we can't do anything until we've assessed them. Do you get like a nominal amount of time that you have to complete your assessment by, if you say, I need six months, do you get to take six months? And are there multiple assessments of people in your position? Or does it fall on just the one person? That's a great question. Say someone is arrested. It's front page news.

Starting point is 00:18:21 They're remanded into custody. Depending on the skills of their lawyer, their criminal lawyer, is how quickly they will realize there's a mental health issue, whether it's about an impairment defense or otherwise, like fitness to stand trial or if there are just fact of mental health involved. They will quickly get onto a forensic psychiatrist or psychologist because they want the mental state assessed as contemporaneously as possible to the time the offence took place as opposed to a year later. Because people are on remand for ages. So I meet someone a year later. I have no idea really what they were like when they're alleged to have done XYZ. So a really good lawyer will get onto that really quickly. Having said that, wait times for us

Starting point is 00:19:04 might be a little while, so it may not be that quick. But again, if you're looking at something that is going to make your work clearer, it's to your advantage to reshuffle and prioritize that. So particularly a series of bending like homicides or significant violence. Well, I imagine it's hard enough to assess someone the week after something has happened, let alone a year later when they may have come out of a psychosis or they may be in a different mental, to be like, hey, trust me, I can't remember what I did. It seems. like an impossible job for you to be doing? We rely really heavily on collateral information. So there'll be notes from the forensic medical officer who's there at the time of the arrest

Starting point is 00:19:43 and just says they're fit for police into or not. There's notes from the clinical notes from prison, which are remarkably hard to come by, but nevertheless we persevere because there's nurses and GPs, occasionally psychiatrists who are commenting all along the way. And so that's what I think is really important. What I mentioned earlier is having that longer tunal view of someone, than just the cross section the day you meet them because it might be a totally different person. Specifically with this case, there's been a real kind of push and pull between the prosecution and the defence between focusing on the planning aspects of the murders. Premeditation. Yeah, yeah, that there is actually like thought that's been put into it.

Starting point is 00:20:25 And then in the defense is really focused on the psychosis aspect of it. Is it possible for two things to be true? Can you plan if you're in psychosis? You absolutely can. And I think that's what makes people so uncomfortable because it's almost ununderstandable because the psychosis is about your beliefs, not your behavior. Again, I don't know, I didn't assess Lindsay. I don't know exactly what her thought processes were. But say, you know, I've had before someone's killed a relative because they had voices, auditory hallucinations telling them that they had to kill this relative in order for

Starting point is 00:21:00 them to save the world from the Illuminati. Wow. That was one of your cases, was it? Yeah. Wow. I mean, that's common. In terms of a bona fide psychotic homicide, there's some what might be considered bizarre beliefs that are real to them. And you would need to figure out exactly what they were thinking and the lead up.

Starting point is 00:21:20 And that might have involved a lot of planning because they need to have access to the victim. They need the weapon or the mode. But again, it's all predicated on that belief that is totally bizarre to us. I guess similarly on that, people are saying, well, she was so happy. in the day. It was a normal day. She was playing outside with her kids that morning. Can that be true? Can you have that switch like that? Can you be like, I'm going to play on like happy families now knowing what I'm going to do later? Absolutely. Look, I don't know her mental state on the day and I'll keep repeating that. Of course. I know, for example, people who complete suicide finally make a decision and

Starting point is 00:21:57 they become very at peace with that decision and they might have a day that completely blinds their family and loved ones because they're at peace, they're calm, they have an out, there's, you know, a light at the end of the tunnel for them because they've decided. Again, I don't, I don't know the particulars of this case, but it is very common for the mental state and the decision making to be hard to reconcile for someone who's not in that frame of mind. You know, we haven't even really said it, but it is just so devastatingly sad. Like, there is no aspect of this trial that isn't just the saddest, the saddest, the saddest tragedy. And I think like online has become so consumed with the conspiracy theories of it.

Starting point is 00:22:38 In your experience in these trials, and obviously I know you can't speak to Lindsay Clancy in itself, what are your thoughts of those conspiracy theories? What are your thoughts of people's, I guess, like assumptions that are made on TikTok? I think everyone wants to talk about something that makes sense to them, that's understandable to them. And a lot of this doesn't make sense. So it would make sense if there's some plot twist or really obvious conspiracy or ulterior motive. I mean, it doesn't, what are you going to make a TikTok about? It's really sad that another case of severe mental illness went untreated and unnoticed at a tragedy befell the family.

Starting point is 00:23:18 There's no jeopardy. There's no cliques. There's no, yeah. It's also, I think for a lot of people, it's incomprehensible to imagine a mum doing that. And so therefore, like, we're trying to fill the gaps in with there being another perpetrator. Because it is often, more often than not it is the dad. Like, it is very rare that we hear about moms having such a severe mental break that they kill their children.

Starting point is 00:23:39 It is an incomprehensible thing that has happened. Yeah. I mean, as I said earlier, motherhood is so deeply associated with protection that it really sort of violates our fundamental expectation of human behavior. What I have felt interesting in the few matters I've done with, the mother has committed the act. And I've had sort of shaken babies or abetting. and babies. I think the biggest punishment has already happened outside the criminal justice

Starting point is 00:24:05 system. I think they're no longer with a child or the child is civilly disabled and they have to live with that reality. And I'm not saying that the justice system shouldn't go ahead, but having sat with these people for hours, you can see that the worst punishment you could possibly land them with has already occurred in the act itself. I get asked a lot as a forensic psychiatrist, but as a mother, how can you see this person or how could you do-da-da-da-da. And I think, oh, well, I think boundaries are so important in our line of work. And I think that, again, you have to remember what your duties are to the court. Like, I'm not there as a vigilante mom trying to lock everyone away who's ever harmed a child.

Starting point is 00:24:44 I also think that someone maybe who's either born witness to someone having children or had children themselves has a little bit more insight into context. So I was actually talking with a fellow female forensic psychiatrist who is a mum. And she was telling me about the expert on the other side who didn't even mention in their report that this female offender was three months postpartum, which is quite relevant in a timeline. But a male without children may have had a different lens or a different style of asking questions. Because if you think back to three months postpartum, maybe things are a little different to how they are in your everyday sort of professional or personal life.

Starting point is 00:25:24 Not to say that you can't write a perfectly good assessment with no lived experience of motherhood. But do you think it changes because you had kids? Do you think your outlook would be different? I say that because for me, a big part of my history, I was heavily involved in postmortems on children that had passed away in my specialty, which was medical radiation science. So I would be involved in trying to figure out what had happened. And people used to say, how can you do that?

Starting point is 00:25:50 How can you hold a child a dead child? How can you do that day in and day out? And for me, I could separate it as a job. But the number of people that said to me, wait until you become a parent, you won't be able to do that anymore. Like the impact of having that lived experience. So maybe it would change. But I wonder how much you think actually having that lived experience maybe changes the way that you approach the situation. So I don't think it's become any harder or easier as a result of whatever's happened in my personal life. I might have my own thoughts on a subject or offending, but they're completely unrelated to my professional assessment. And as you say, it's a job. It's a job I love and it's very consuming, but it's still a job.

Starting point is 00:26:34 And if you are so easily swayed, I think, look, we're mandated to have peer supervision, like a peer group that you meet with and discuss cases and encouraged to have private supervision. And I think you should be addressing things you find challenging. I know a lot of colleagues, they don't want to work with people charged with sexual offending, for example. Find it too confronting. That's fine. Again, you just need to know your own limits and not try and overcome them despite some really harsh pull either way.

Starting point is 00:27:05 Yeah. Has there been, and I guess what's the line between baby blues, postnatal depression, postnatal psychosis? Have you ever experienced a case where it? it hasn't been psychosis, but it's extreme postnatal depression where a child has been injured and or murdered, that postnatal depression alone has stood up in court? Like, how do you define that line of crossing over? Look, depression is a mental illness and considered a disease of the mind in terms of by the judicial college. I haven't been involved in a matter where a child has

Starting point is 00:27:40 died and the mother has been depressed. I've had other outcomes for the children and absolutely the diagnosis of depression or PTSD in abused women has absolutely been taken seriously by the court and considered in their determinations. Can you talk us through a little bit as well? What's the gap between someone who has been diagnosed as mentally ill and someone who is found like criminally not responsible for what they've done because of their mental illness? I guess it's is there correlation or causation? So does one drive the other? Were they laboring under a belief system at the time that caused them to behave in the way

Starting point is 00:28:19 that is deemed to reduce their culpability? Or did the mental illness just happen alongside? So again, in Victoria, we have a particular consideration that say someone is determined to have committed the act, whatever it is, but they have this very significant mental illness. At the time of sentencing, so they've been found guilty for having done the thing, you have to take into account, was the mental illness operative at time of offending? Will time in prison make their mental illness worse? Will their time in prison be difficult because of the mental illness, etc? So those factors are always considered and you have to really disentangle. You can see

Starting point is 00:28:55 how complicated it gets. You have to disentangle, was it the driver or just the passenger? That's so, I actually, and especially when it comes to a decision that's based on a jury, people who have to sit there and listen through all these details and are not the experts. I mean, for anyone who's been following the Lindsay Clancy case, you would know that there was one hung juror. There was one person who went against the rest. What happens in these situations where there's, you know, you hear all the facts. Majority people say one thing and then there's one person who turns around and says, whatever the rationale is, I can't get on board with it. I guess, well, I think they now have to determine whether it's going to be retried or a plea

Starting point is 00:29:38 is agreed upon. It's never happened in my experience. Again, I'm only limited to mine or colleagues where I've had that outcome. But I guess with our retrospectoscope on, would you think maybe the evidence that was presented was not compelling enough, whichever way they were leaning? I mean, I also think that people have very extreme views and latch on to this. Again, that's the problem with people on the internet. And the problem with people on the internet is that those people on the internet become people on the jury.

Starting point is 00:30:10 That's the thing about jury. You're entitled to have your opinion. So it's as valid as the next persons. It's crazy to think how much depends on a jury. I know that's literally their job. But like your outcome is dependent on who gets plucked from the general public. And I've never really thought about it the way you just said it, where it's like the crazy theories are going on tick.

Starting point is 00:30:29 TikTok, that person could end up being the person that is literally deciding the fate of the rest of your life, which seems like an insane thing to put your, like, hang your life on. I actually wrote about juries on a, like a little substack essay because I think, look, I don't know that we have a better solution. I just don't think it's a very good one. Which is a fair assumption, I guess I would say. You've worked inside prisons, which I imagine is a whole other kettle of fish. What do you think would surprise people about mental illness of people that are already inside the prison?

Starting point is 00:31:02 I think two things would probably be surprising. One, to learn that prisons are actually our nation's biggest mental health care providers. So it's tragically common for someone's mental health to become known as an issue the minute they're involved in the criminal justice system. So they've been falling through the cracks or they've been turned away by services or they've turned to maybe less helpful routes, substance use, et cetera. So there are a lot of people of mental health issues in custody. And the other thing that I think might surprise people is just how normal people in prison are and how sometimes it was just the matter of you had a better launching pad than they did or you had more opportunities than they did. I mean, the tragic story is just, you know, this is obviously unidentifiable, but I remember

Starting point is 00:31:47 meeting a guy whose mum used to inject him with heroin to shut him up as a child. Wow. Oh my gosh. She can get on with her day. And I think, well, what kind of launching pad is that for someone's life? Or, you know, young men who stroll into a petrol station and hold up a butter knife because they know a charge of armed robbery is going to get them three hot meals and a roof over their head, which is more than they've got at the moment. Yeah. Some people feel it's inevitable to turn to crime, I think.

Starting point is 00:32:13 We fail them at some point earlier in their life. Had they been born in our family, they might have had a very different trajectory. Having said that, plenty of people who have great launching. pads suffer civil mental illness and end up facing the justice system. But I think it's not a big us and them divide, not as big as you think it is. Jackie, what's your professional opinion on the Lindsay Clancy trial? Like when you have gone through all the information that you've gone through and you look at it from the perspective of an expert, what do you think that either us as the public are missing or what do you land on in terms of how you think this court case has unfolded?

Starting point is 00:32:50 I focus mostly on the expert testimony and there was a lot of that. And I really think that it was like, a better word, sloppy. I think this is crime of the decade in this jurisdiction, presumably. And you want to have read everything and you want to be internally consistent with your information that you're providing to the jury. You want to be clear that you don't have bias to the prosecution or the defense. You want to be understandable for the jury. These people speak late English. They don't speak psychobabble. And really, I just, oh, some of the, remembering some of the testimonians just cringe, like people getting very defensive about their qualifications or, you know, again, as I mentioned, very biased about Lindsay and how much they

Starting point is 00:33:35 care for her and how they feel for her. And so I think, like, it's a great example for me to take to trainees about what not to do when you're in the witness box. Yeah. What do you think specifically about her psychologist? I was thinking the young woman, for, me, I forget her name, but I was thinking about one of the testimonies I saw. She was sort of on trial for saying she'd never dealt with, she was quite newly qualified, she'd never dealt with psychosis before. The psychiatrist, the training psychiatrist. Do you think that's reason to accuse her of getting it wrong because she hadn't ever successfully diagnosed psychosis before? Or do you think the fact that she has fresh out of training is enough? Because I guess they were

Starting point is 00:34:13 trying to use it and like, well, you've never diagnosed anyone before. So it's your fault, basically. I really feel for her because she had newly been board certified and no one wants to be a household name in their first year of practice. For that too. Yeah, I think we all have to start somewhere. There was always a time where all of us didn't have a case of postnatal psychosis, perinatal psychosis under our belts. And to be honest, again, I don't know about her training, but I never did a perinatal term exclusively. So the first time I encountered pregnant or postpartum patients was in my private practice once I'd already qualified. The principles still apply in how to diagnose and how to treat, how to assess.

Starting point is 00:34:56 But it's very reasonable that you can come out on the other end of training and not have seen certain cases. One of the things that was a bit of a theme of the Lindsay Clancy trial was she was going from one doctor to another doctor. So she'd been to different psychiatrists, psychologists, she was getting different prescriptions. Is this something that can be common within Australia? Is that a normal part of like the mental health journey in terms of the failures that there are to be able to get a consistent health care for people as well? Absolutely.

Starting point is 00:35:26 Who's the short answer? I think particularly public services are so overstretched. I don't think that's where Lindsay was looking though. I know that you have to be really sick to get in the door of a public service now. I think, you know, they just don't have the resources to manage like a plum, low risk depression, even if they don't have the funds for private treatment. I think really psychosis refusing treatment requiring assertive care, that's sort of where our public sector is relying on, which is actually crazy because if you think about any other health condition,

Starting point is 00:35:56 say you've got heart failure, you would never be denied cardiology, cardiological care because you didn't have enough heart failure. Yeah. Like it's not quite grade three, four, you're still mild, like go get like see a GP. Yeah, we'll wait until it's really bad. And and then we'll see you, but we won't prevent it from getting super bad. Until you need resuscitation. Until you do something horrific and then we'll help you. Yeah. And that's like, this is such a, you know, sweeping subject, but like this is what, it's not

Starting point is 00:36:23 sexy. Mental illness isn't sexy. It's like dirty, depraved. It's very stigmatized, et cetera, you know, in terms of politics and election promises. And we never hear what's going to be done. And I think at some point, you're going to have to care because it could be your family member, it could be your next door neighbor who's paranoid and violent. at some point something's going to give. And I'm just wondering, like, how many deaths is it going to take?

Starting point is 00:36:46 We've seen Bondi Junction. We've seen in Victoria, we had Burke Street. Like, it is enough enough. What's it going to take? But I mean, how long's a piece of string? Because look at what we've been through and it hasn't changed. Yeah. And I think it's a bipartisan issue. That's not a comment on any particular sitting government. It's just, I don't want people to notice after it's too late. Yeah. What are some warning signs for people that might be experiencing postpartum depression that could be teetering onto a psychosis and the warning signs for family members who think something is not right with their partner. Well, I think it's important to appreciate depression and psychosis aren't necessarily a spectrum, so you don't morph from one into the other. But irrespective, I think it's all the regular

Starting point is 00:37:30 milestones that you'd be looking for. So how is your sleep, how's your mood, how's you're bonding with your baby, how are you behaving on the day to day, are you able to self-care? I think you've got your GP, your six-week check-up, your maternal child health nurse. All of those sort of checkpoints can determine whether things are going well or not. Interesting that you just said that. So postpartum depression isn't a prerequisite for psychosis. You can just go from, I've been absolutely fine to a psychosis without going through the depression system. There are elements of psychotic illnesses that involve mood, but it's not a prerequisite for diagnosis, no. It may be that you have a negative syndrome or you're very unmotivated, lethargic, etc, but it's not

Starting point is 00:38:16 because you had depression first. It's such a fascinating one. I mean, in my whole life, I've known one person who went through postpartum psychosis, and she had mental health issues beforehand. It was really tragic because I remember having a conversation with her pre-her having her baby when she was pregnant. She was like, I feel so good because I've done all the preparation work. And then several months after she'd had her baby, I knew that some stuff was going on, but it was just like, it was so not her. She was going through abandonment. So she kept on leaving her baby. Like on a time. Running away, basically. But, and it's just like an incredibly sad thing to experience as a mother because it's so misunderstood. There is so little, you know, I think we've become as, and I mean,

Starting point is 00:39:02 as friends and family, like we've started to. really understand postpartum depression a little bit more. But psychosis, I think because, as you say, it is rare. It doesn't happen very often. Most people don't have someone that they can call up and go, oh, I experience this too. It's so isolating. And it goes against everything that we've been led to believe you should do as a mother. Like, you should everything, once you give birth, every fiber of your being should be around protecting and keeping safe this little human. And if you're going through something like postpartum psychosis, those rules don't apply. Yeah. that they do and that's where you get into trouble.

Starting point is 00:39:36 Yeah. Yeah. Well, there you go. Question that's a little bit different here. I don't know if you follow all the cases and the glamorization of like Jeffrey Dahmer and the Ryan Murphy Monster's creation for Netflix. It's almost like takes these horrific crimes and horrific people and makes it. They retell the story, but they Hollywoodize it. I mean, what's your take on shows like that that almost glamorize it? Do you think that almost provides inspiration to some people?

Starting point is 00:40:00 Well, I think on the real margins of society, you do get people who write manifestos that are inspired by other manifestos. I suspect those people would have already been susceptible or vulnerable to that sort of influence. And I think the internet's been wild and that it's unleashed access for that. I actually just wrote about Unabomber, which came out on Netflix over the weekend. I didn't really think it was a good film because it was kind of boring in that it sort of passively blamed a psychologist he bumped into when he was at college. But someone like that today on the internet, imagine the fandom because he was anti-establishment, anti-climate change.

Starting point is 00:40:42 And like, we see that. You know, you've got young people who are protesting and making it their whole identity. And I think some of these really notorious criminals or mentally ill criminals would be inspiring to people who are vulnerable, maybe are misfits in their sort of lives and are looking for somewhere to belong, somewhere where there's an ideal. that accepts them and they accept. And yeah, I think we see a lot of that radicalisation that's very influential. I think a good example of that is that Luigi Maggioni guy who shot the healthcare CEO and everyone online was like, you're a hero. Yeah.

Starting point is 00:41:21 And clearly, it is crazy how people are able to separate the crime from the person and the action because of what they think on social media it represents. Or a moral belief. Yeah, absolutely. Jackie, thank you so much for your time. And we absolutely understand your separation from the Lindsay Clancy case. But I think, like, we asked our Life Uncutt community, you know, their interest in having a discussion around postpartum psychosis. And so many people have been following or tapping in and out of this case and their interest in it. And it was something that so many people had written

Starting point is 00:41:56 saying that they wanted to hear more about. And thank you so much for sharing and for your insights in what is an incredibly difficult topic. Thank you. so much for having me. Thank you so much, Jackie. If this episode has raised anything for you or you're worried about a new parent, Panda, which is capital P-A-N-D-A, which is the perinatal anxiety and depression Australia, that number is 1-300-726306. Of course, there is always lifeline, which is 13, 11-14. If someone is in immediate danger, call triple zero. Postpartum psychosis is a medical emergency, so go to your nearest emergency department.

Life Uncut - The Lindsay Clancy Case: Postpartum Psychosis & the Law Explained By A Forensic Psychiatrist

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