Curious Femme

Well, it finally happened. I got booted from one of those Facebook groups where apparently “accountability” means diagnosing women from your sofa and becoming furious when someone introduces evidence.

The subject was Lindsay Clancy.

The discussion began with the usual certainty. She is evil. She’s a sociopath. Postpartum psychosis is an excuse. Anyone discussing her mental state is “defending a child killer”.

Then things got… educational.

I pointed out that postpartum psychosis is a recognised psychiatric emergency involving symptoms including delusions, hallucinations, paranoia, confusion and severely impaired contact with reality.

Apparently this was controversial.

Then came the amateur psychiatrists.

One diagnosed Clancy as a “sociopath”.

Another informed me that “real men” don’t experience psychosis like women do.

Someone called me a “femnazi”.

Another suggested women should never have been given the vote.

One charming gentleman managed “grab her by the pussy”.

You know, just a completely normal, evidence based discussion about protecting children.

But my favourite moment came when I introduced THE FACEBOOK FORENSIC PSYCHIATRY EXAM. 😂

This is the part of the Lindsay Clancy case that I think deserves considerably more attention.

In approximately four months, Lindsay was reportedly prescribed more than 30 prescriptions involving around 13 different psychiatric medications, across several different drug classes and involving multiple healthcare providers.

Just read that again.

Four months.

Around 13 psychiatric medications.

More than 30 prescriptions.

The list reportedly included:

Sertraline, Zoloft, SSRI antidepressant
Fluoxetine, Prozac, SSRI antidepressant
Mirtazapine, Remeron, antidepressant
Trazodone, antidepressant, also commonly used for insomnia
Amitriptyline, tricyclic antidepressant
Lorazepam, Ativan, benzodiazepine
Clonazepam, Klonopin, benzodiazepine
Diazepam, Valium, benzodiazepine
Zolpidem, Ambien, hypnotic
Quetiapine, Seroquel, antipsychotic
Lamotrigine, Lamictal, mood stabiliser
Buspirone, anxiolytic
Diphenhydramine, Benadryl, sedating antihistamine

This does not mean she swallowed 13 different drugs simultaneously. Some were stopped, others started, doses were increased and decreased, and medications were substituted.

But that is precisely why the history matters.

These are not Smarties.

Some can cause sedation, cognitive impairment, agitation, restlessness or confusion. Some have recognised rare neuropsychiatric adverse effects, including hallucinations or unusual behaviour. Benzodiazepines carry dependence and withdrawal risks. Several medications depress the central nervous system. Several affect serotonin. Antidepressants can also precipitate mania or hypomania in susceptible people with bipolar disorder.

And Lindsay’s defence argues that an underlying bipolar disorder had not been recognised.

None of this means “the medication made her kill her children”.

That would be an extraordinary causal claim and the evidence does not establish it.

But neither is it intellectually credible to pretend the medication history is irrelevant.

When somebody’s mental health is deteriorating while clinicians repeatedly start, stop, switch and alter doses of psychotropic medication, you have to consider adverse effects, interactions, withdrawal phenomena, treatment response and the underlying illness.

That is basic clinical reasoning.

And there is something else worth knowing.

NICE guidance for perinatal mental health says that when psychotropic medication is used during pregnancy or the postnatal period, clinicians should seek specialist advice where appropriate, use the lowest effective dose and:

“use a single drug, if possible, in preference to 2 or more drugs.”

NICE also advises that benzodiazepines should not routinely be offered during pregnancy and the postnatal period except for the short-term treatment of severe anxiety and agitation.

That does not tell us that Lindsay’s American clinicians breached British NICE guidance. Obviously, they were practising in Massachusetts, not Manchester.

But it demonstrates something important about contemporary perinatal psychiatry:

Polypharmacy, switching and withdrawal are not trivial matters.

Meanwhile, Lindsay was reportedly experiencing severe insomnia, depression, anxiety, cognitive “brain fog”, intrusive thoughts and progressive deterioration.

She was eventually admitted voluntarily to psychiatric hospital.

Then discharged.

Then the medication changes continued.

So when I see people on social media confidently declaring that her psychiatric treatment is irrelevant because “evil is evil”, I have questions.

Quite a lot of them.

Was there one clinician overseeing the entire medication regime?

Did every prescriber know exactly what the others had prescribed?

Were adverse effects systematically assessed?

Were medication interactions reviewed?

Were discontinuation and withdrawal effects considered?

Was emerging bipolar disorder adequately considered?

Was her profound insomnia treated as a symptom, or recognised as a possible warning sign of serious perinatal psychiatric deterioration?

Was specialist perinatal psychiatry involved?

And what safety information was given to Patrick and the wider family?

Those are not excuses for killing children.

They are clinical governance questions.

In fact, Patrick Clancy has now filed a separate wrongful death medical malpractice action concerning the treatment his former wife received. Lindsay has also brought civil proceedings. The allegations include failures to monitor her adequately, coordinate her treatment and appropriately manage the numerous psychiatric medications she was receiving.

The healthcare providers deny malpractice. But remember Purdue Pharma?

Those civil cases will therefore have to examine questions that Facebook’s newly qualified forensic psychiatrists appear remarkably keen to skip.

And this is why I created my little Facebook Pharmacology Exam.

If you’re confident enough to announce that medication, psychosis, bipolar disorder and postpartum mental illness are all irrelevant “excuses”, you should surely be able to explain what these medications actually do.

So:

What are the recognised effects of benzodiazepine withdrawal?

What can zolpidem do to behaviour and memory?

What happens when several CNS depressants overlap?

Why do clinicians monitor antidepressants for activation in somebody potentially vulnerable to bipolar disorder?

Why does serotonergic polypharmacy require consideration?

Why does NICE prefer a single psychotropic drug where possible during the perinatal period?

And why might profound insomnia be clinically significant in somebody developing severe postpartum mental illness?

You don’t have to know the answers.

“I don’t know” is a perfectly respectable answer.

In fact, one man in the group who said he had some pharmacology knowledge actually attempted my quiz. He got several answers right and openly admitted when he didn’t know something.

I respected him enormously more for that.

Because the problem isn’t ignorance.

We are all ignorant about subjects outside our expertise.

The problem is ignorance accompanied by absolute certainty.

The medication history does not prove Lindsay Clancy was legally insane.

It does not prove that her doctors caused what happened.

It does not prove that medication caused the deaths of those three children.

But 13 psychiatric medications, more than 30 prescriptions, multiple providers, repeated medication changes, and a deteriorating postpartum patient absolutely belong in the clinical and forensic analysis.

Pretending otherwise isn’t accountability.

It’s refusing to examine inconvenient evidence.