MARY LOUISE KELLY, HOST:
We are still waiting on a verdict in the triple murder case against Lindsay Clancy. Clancy is accused of killing her three children back in 2023. And her case has resonated with many women who feel maternal mental health, particularly after giving birth, is not taken seriously enough. Dr. Julia Riddle is a reproductive psychiatrist and a professor at the University of North Carolina Chapel Hill Center for Women's Mood Disorders. Dr. Riddle, welcome to ALL THINGS CONSIDERED.
JULIA RIDDLE: Thank you for having me, Mary Louise.
KELLY: So Lindsay Clancy does not deny killing her children. She says she was suffering postpartum psychosis. And so I want to begin there just by defining that term. What is postpartum psychosis? What are the symptoms?
RIDDLE: Yeah, so postpartum psychosis, we - it's often a misnomer, which makes it hard out of the gate, but we talk about it as an affective illness, which means a mood disorder. It looks a lot like what we call a delirious mania, the delirious part meaning waxing and waning. So someone - a woman can look like herself and act like herself for a few hours and then the next minute, hour can be completely taken over by these psychotic and manic symptoms being delusions, so delusions being what we call fixed false beliefs - the world is not safe, something terrible is going to happen, something terrible is happening - as well as hallucinations. So those are the things - hearing things that other people can't hear, seeing things that people can't see.
But as well as the - that manic side of things, so often there's this activation - lack of sleep, kind of doing things that are very odd, often driven by delusions that women can't actually articulate to us and often can't remember once they get through an episode and get back from it. So it happens, epidemiologically, current estimates are around 1 to 2 in 1,000 births. We consider it a psychiatric emergency.
KELLY: A psychiatric emergency. That's helpful to just hear you walk us through it because it's - what you're describing sounds like an entirely different condition an order of magnitude from the feelings of, you know, exhaustion or being overwhelmed that so many new parents feel.
RIDDLE: Yeah, that's exactly right. And we talk a lot - and I think in what we do, and I think this resonates with women all the time, there's so much normalizing. Of course you're not sleeping. Of course you're overwhelmed. Of course you're, you know, kind of crying or maybe you get overwhelmed at times. And it - and I...
KELLY: Or scared that everything's going wrong because everything feels out of control.
RIDDLE: Scared that everything is going wrong, worried about your child's health. And so it can be really, really hard. You know, we know the data shows us that 50% of the time, it is missed. You're right, it's very different than just feeling a little down. It's very different than the baby blues. It's very different than just worrying if your baby's gotten enough milk and they're, you know, resting well. It's not that. It's a lot more of these really serious symptoms.
KELLY: You're also describing something that sounds very difficult to diagnose because, as you said, the symptoms can appear for a few hours and then the woman may feel like herself, may present as herself. That must be incredibly challenging for doctors trying to figure out what is going on.
RIDDLE: Yeah. And, I mean, what we do feels so high risk so often. And people, not just women, but people can pull up from quite a reserve in certain situations. So you can imagine if a woman comes to an ER and she's been displaying very odd symptoms at home, in that time when she's getting evaluated, she may be able to pull up enough reserve to hold herself together to say, oh, I'm just a little worried and not sleeping well. And so it does become, sort of in these cross-sectional examinations, hard to know without - we don't have those biomarkers. We don't have those tests to be able to say in this moment, OK, is this just a little bit of anxiety and sleep, or is this something bigger?
And we usually get at that by observation, by the pattern recognition of what we do and actually by talking to their community 'cause we will have someone in their family or their therapist or someone that knows them that says, this is not them. I know they're telling you that, but let me tell you how they're actually acting at home.
KELLY: Yeah. In your practice, what are you hearing from your patients? What are you hearing from colleagues who I imagine are watching this trial closely?
RIDDLE: You know, when this case first happened in 2023, I heard about it first, actually, from my patients. And really, this - it separates it a little bit. It's really my patients with OCD and with anxiety that are so scared. This is the scariest thing, I think, that any of us could ever imagine happening in our lives. And it's what makes it so hard to think about, to sit with, honestly, to watch, to have so pervasive in the media, that patients are so scared that's going to be them.
KELLY: Yeah.
RIDDLE: Right? And so I always do want to really articulate these are treatable illnesses, one. But two, having anxiety, having depression, having OCD does not mean you're going to have postpartum psychosis. And so you hear it from patients 'cause this is the scariest outcome they can ever imagine. And then from colleagues, I feel, you know, I'm very fortunate. I work in a training institution. I work with a lot of trainees. And many of my trainees are reaching out to me just to talk about it, to make sure that they're doing their gut check to think about, am I thinking through this right?
KELLY: I wonder, for all of the horror of this tragedy, what I'm hearing from you is at least the possibility that the spotlight could help change the national conversation. The healthcare conversation could maybe open up greater availability of resources to support women because, obviously, you know, nobody wants to see anything like this ever happen again.
RIDDLE: Yeah. And I would go even - you know, that is the hope. And I would go even further to just say that it - and the hope, the dream - if I can dream, and then I'll have my practical take on it. But my - the dream is that it inspires us to - you know, we always say it takes a village to raise a child, but it takes a village to take care of a mother and a family. And we have put that whole village often just on a woman and maybe on her partner. And how can we continue to expand that village? That's via paternity leave for all parents involved. That's via more community resources, via just more knowledge in this country of how to be family-friendly in ways that allow for a lot more kind of porous ways of being with each other and looking out for each other so that when things do happen or people do change or people are suffering, there's more people around to say, hey, we got to get you to health.
KELLY: Yeah.
RIDDLE: And then, absolutely, I hope that as this brings attention to A, how difficult it is in psychiatry to do the real research that we're not invested in enough and that we really can do - we can do a lot better. And I think that that is absolutely the pipe dream. Is the fear that when this ends, it's do we want it to end so badly? Because it's a lot to encounter this, I think, as a society. But is the fear that it becomes a flash in the pan, and we go back? I think that is a real fear. And I hope that this does inspire us to think about how are we investing? How are we thinking about risk assessment so that we can figure out who is at risk before the illness arrives so that we can get them into care so that we can expand where we're doing that? And we're thinking about that both in literal ways, how people are doing it, but also where we're investing our money and kind of that we're walking the walk as well.
KELLY: That's reproductive psychiatrist Dr. Julia Riddle. Dr. Riddle, thank you.
RIDDLE: Thank you, Mary Louise.
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