The Lindsay Clancy case is horrific. Three children are dead. A mother stands accused of killing them. A husband and father has lost his children and the life his family once had.
Examining the mental healthcare Lindsay received does not minimize any of that. It asks a different and necessary question: What happens when a psychiatric patient gets worse during treatment and the system keeps interpreting that deterioration primarily as evidence of worsening illness?
That is the question I keep coming back to as I have watched the testimony in this case.
Not whether psychiatry is good or bad. Not whether psychiatric medication is good or bad. And not whether we can retrospectively identify one medication, one diagnosis, one provider, or one moment and declare that we have solved an extraordinarily complicated tragedy.
We cannot.
What we can do is examine the thinking.
And the Lindsay Clancy case exposes serious problems in how we think about psychiatric patients once they enter the mental healthcare system.
When Everything Looks Like Illness
There is an old saying: if all you have is a hammer, everything starts looking like a nail.
Psychiatry has a hammer-and-nail problem.
A patient presents with anxiety, depression, insomnia, intrusive thoughts, agitation, or some combination of symptoms. Those symptoms are interpreted through a psychiatric framework. A diagnosis is made. Medication is prescribed.
Then the patient changes.
Now we have a much more complicated clinical picture because we no longer have only the original symptoms. We have the original symptoms plus the effects of treatment.
A medication has been introduced. Perhaps another is added. A dose is increased. Something else is stopped. Another medication is substituted. Sleep changes. Anxiety changes. Cognition changes. Behavior changes.
At that point, the original hypothesis should not automatically remain the dominant hypothesis.
Yet this is where hammer-and-nail psychiatry can become dangerous.
If the patient improves, the medication worked. If the patient deteriorates, the illness is worsening. If the patient becomes agitated, perhaps the disorder is more severe than initially thought. If the patient cannot sleep, perhaps another medication is needed. If the next intervention does not work, perhaps the diagnosis needs to change.
Eventually the patient can become a collection of diagnoses being treated by a collection of medications while everyone loses sight of a fundamental question:
What changed after treatment began?
That is not an anti-medication question.
It is basic clinical reasoning.
The Medication Timeline Matters
The number of psychiatric medications and medication changes discussed during the Lindsay Clancy case deserves scrutiny precisely because causation is uncertain.
Starting psychiatric medication can change symptoms. Increasing it can change symptoms. Decreasing it can change symptoms. Stopping it can change symptoms. Switching medications can change symptoms. Combining medications makes attribution even more difficult.
None of that proves medication caused Lindsay’s deterioration or what happened to her children.
But it means medication effects belong in the differential.
There is a profound difference between saying medication caused this and saying we have an obligation to investigate whether medication contributed to this.
I am arguing for the second.
When a patient’s presentation changes during a period of substantial psychiatric medication exposure and medication changes, multiple hypotheses should remain open. The underlying condition could be worsening. A medication could be ineffective. A medication could be producing an adverse effect. A medication change could be contributing to symptoms. Withdrawal or rebound phenomena could be involved. Sleep disruption, postpartum physiology, medical factors, psychological factors, and medication effects could all be interacting.
Real patients do not divide themselves neatly into diagnostic categories.
When multiple variables are changing simultaneously, certainty should decrease.
Instead, we often see the opposite.
Dr. Tufts and the “Lack of Insight” Double Bind
The testimony involving Dr. Tufts highlighted another problem that deserves far more attention: how the language of psychiatric “insight” can create a double bind for patients.
Clancy was documented as lacking insight when she hesitated to take psychiatric medication. Later, after taking medication and reporting that she believed it was making her feel worse, her insight was again questioned.
Think about the position that creates for the patient.
Hesitate to take the medication, and your hesitation may become evidence that you lack insight into your illness.
Take the medication, experience something you believe is worsening, and attribute that deterioration to the medication, and that interpretation may also become evidence that you lack insight.
So what exactly is the patient allowed to believe?
That is a double bind.
Compliance appears to demonstrate insight only as long as the patient also accepts the clinician’s interpretation of what the medication is doing.
That should concern anyone who cares about informed consent.
A patient saying, “I think this medication is making me worse,” does not prove the medication is responsible. Patients can misattribute symptoms. Clinicians can too.
The statement is data.
It should create clinical curiosity.
What changed? When did it change? What had recently been started, stopped, increased, or decreased? Were these symptoms present before treatment? Did their character or severity change afterward? Could an adverse effect, withdrawal phenomenon, rebound effect, sleep disruption, or interaction plausibly explain some portion of the presentation?
Those questions do not require the clinician to agree with the patient.
They require the clinician to keep more than one hypothesis alive.
Otherwise, psychiatry risks creating an unfalsifiable loop. The illness explains the original symptoms. The illness explains reluctance to accept treatment. The illness then explains the patient’s belief that treatment is making her worse.
At some point we have to ask a much harder question:
What evidence would cause us to reconsider the treatment hypothesis?
If nothing the patient says can do that, then we have moved beyond a disagreement about insight. We have created a structural problem in psychiatric decision-making.
Informed Consent Requires the Ability to Question Treatment
This double bind connects directly to informed consent.
Informed consent is not merely permission to prescribe. A patient agreeing to swallow a pill does not tell us whether she understood the decision she was making.
Meaningful psychiatric informed consent requires discussion about expected benefits, meaningful risks, alternatives, uncertainty, what to watch for, and what happens if symptoms change.
It also requires something even more fundamental: the patient has to be allowed to change her mind about what she is experiencing.
A patient must be able to hesitate before taking medication without that hesitation automatically being pathologized. She must be able to take medication and later say she believes something has changed. She must be able to question whether the treatment is helping.
The clinician does not have to agree.
But informed consent becomes difficult to defend if questioning treatment itself can be interpreted as evidence of illness.
That is not shared decision-making.
It is a closed loop.
Therapists Cannot Be Psych-Med Illiterate
The Clancy case has also exposed another professional contradiction that mental health clinicians need to confront: psychiatric medication literacy among therapists.
I have heard some version of the same argument repeatedly: “I’m a therapist. I don’t prescribe. Medication is outside my scope.”
Prescribing is outside the scope of most therapists.
Understanding psychiatric medication is not the same thing as prescribing it.
Therapists diagnose mental disorders. We assess mood, anxiety, sleep, cognition, behavior, suicidality, functioning, substance use, risk, and changes in presentation. We routinely work with clients taking psychiatric medication. We hear when clients say they feel worse. We refer people to prescribers. We suggest that clients speak with prescribers when something changes. And in many cases, the therapist spends considerably more time with the patient than the prescriber does.
The DSM itself recognizes substance/medication-induced psychiatric disorders.
So how exactly are therapists supposed to assess those possibilities while simultaneously declaring psychiatric medication knowledge outside their professional concern?
We cannot.
You cannot assess what you do not understand.
Psych-med literacy does not mean telling clients to start medication. It does not mean telling them to stop medication. It does not mean changing doses or pretending to be a prescriber.
It means understanding enough to recognize when the clinical picture may have changed following a medication intervention. It means understanding that physiological dependence and addiction are not synonymous. It means knowing that withdrawal can resemble psychiatric illness. It means recognizing medication-induced presentations. It means understanding why timing matters when symptoms emerge after something has been started, stopped, increased, decreased, or switched.
A therapist does not need prescribing authority to notice:
Something changed here. We need to understand what.
Hiding behind scope does not solve the problem.
It creates a blind spot.
Fragmented Care Can Produce Fragmented Thinking
Another striking feature of the Clancy case is how many people and systems touched her care.
There were therapists, prescribers, hospital clinicians, outpatient services, assessments, medication decisions, referrals, and transitions between levels of care.
That can look like a tremendous amount of healthcare.
But quantity of care is not continuity of care.
A patient can have many professionals involved and still have nobody holding the entire clinical story.
The therapist sees one piece. The psychiatrist sees another. The hospital assesses immediate safety. The outpatient provider resumes care. Someone evaluates medication. Someone else evaluates symptoms. Everyone documents what happened inside their own encounter.
Each professional may be able to say, “I did what someone in my role typically does.”
But who is asking whether all those individual pieces make sense together?
That is where fragmented care becomes more than an administrative inconvenience. It becomes a clinical reasoning problem.
Everyone can stay in their lane while the patient disappears between the lanes.
Where Was the Longitudinal Story?
Psychiatric appointments capture moments.
Deterioration happens across time.
That makes the longitudinal story extraordinarily important.
Who was Lindsay before this began? What changed first? What happened after treatment started? What happened after medication changes? When did sleep deteriorate? When did intrusive thoughts change? What did her husband observe? What did her therapist see? What was different from baseline?
These are not peripheral questions.
They are clinical data.
Collateral information matters because the patient sitting in front of a clinician during a short appointment is only one snapshot of the person being treated.
Privacy matters. Patient autonomy matters. But privacy should not become synonymous with clinical isolation.
The Clancy testimony should force us to examine whether our system has normalized treating increasingly complicated psychiatric presentations while simultaneously accepting increasingly fragmented information about the person experiencing them.
“Standard of Care” Does Not Mean the Standard Is Good Enough
One of the recurring defenses surrounding cases like this is that what occurred was standard.
Short psychiatric appointments are standard. Limited collateral information is common. Fragmented treatment is common. Inpatient units focus on stabilization. Therapists defer medication questions to prescribers. Prescribers have limited time.
That may accurately describe the system.
It does not vindicate it.
Standard tells us what commonly happens. It does not tell us whether what commonly happens is adequate.
If professionals do not have enough time to understand complicated patients, that is not a defense of the mental healthcare system.
That is a description of its weakness.
If nobody has enough time to reconstruct the medication timeline, examine competing explanations, gather collateral information, understand baseline functioning, and determine what changed after each intervention, then perhaps the most important question is not whether each individual provider met the minimum expectations of the system.
Perhaps we need to ask whether the expectations themselves are sufficient.
Medication Harm Has to Remain a Legitimate Hypothesis
There is a growing community of people who describe profound harm associated with psychiatric medication use, medication changes, and withdrawal.
Their experiences create an uncomfortable challenge for mental healthcare.
If every symptom that emerges during psychiatric treatment is attributed to psychiatric illness, medication harm becomes extraordinarily difficult to detect.
Withdrawal can be called relapse. Agitation can be interpreted as worsening illness. Emotional blunting can look like depression. Insomnia can become another symptom requiring treatment. New symptoms can produce new diagnoses. New diagnoses can justify additional medications.
A self-reinforcing loop can develop.
This does not mean medication is always responsible.
It means medication must remain one of the variables.
The intellectual error is certainty in either direction.
“Medication caused everything” is not rigorous thinking.
“The illness caused everything” is not rigorous thinking either.
The responsible position is to preserve competing hypotheses and investigate them.
What Did Treatment Change?
That may be the question I wish had been asked more often throughout this entire case.
Not simply: What diagnosis did Lindsay Clancy have?
Not simply: Was she mentally ill?
Not simply: Was she psychotic?
But:
What changed over time, and what happened immediately before those changes?
That question forces us to examine chronology instead of labels.
It forces us to look at the person before treatment, during treatment, after medication changes, during hospitalization, after discharge, and across different providers.
It forces psychiatry to consider something medicine sometimes struggles to consider:
The intervention itself may become part of the clinical picture.
That possibility should not threaten psychiatry.
It should strengthen it.
This Is Not an Anti-Medication Argument
I am not interested in replacing one simplistic narrative with another.
Psychiatric medication can help people. Psychotherapy can help people. Hospitalization can save lives. Skilled prescribers and therapists do important work every day.
The problem is not the existence of psychiatric treatment.
The problem is what happens when confidence in the treatment model becomes stronger than curiosity about the patient.
Hammer-and-nail psychiatry is not simply prescribing medication.
It is reaching for the hammer before adequately determining whether the problem is a nail.
It happens when worsening automatically means more illness. When another diagnosis becomes easier than reconsidering the previous intervention. When medication effects are treated as peripheral rather than potentially central to the differential. When a patient’s concern about medication becomes evidence of poor insight rather than a hypothesis worth examining.
And therapists contribute to the same system when they declare psychiatric medication outside their intellectual responsibility while assessing medicated patients every day.
We can do better than choosing between blind faith in psychiatry and wholesale rejection of it.
We can demand better thinking.
The Question the Lindsay Clancy Case Leaves Behind
I do not know that psychiatric medication caused Lindsay Clancy to kill her children.
That conclusion exceeds what the evidence can establish.
But I also reject the idea that asking serious questions about psychiatric medication, medication changes, fragmented care, informed consent, collateral information, and clinical decision-making somehow stigmatizes mental healthcare.
Questioning healthcare is how healthcare improves.
The Lindsay Clancy case should leave us asking whether our mental healthcare system is sufficiently capable of recognizing when treatment itself may be contributing to deterioration.
Can therapists recognize possible medication-induced presentations? Can prescribers reconsider the treatment hypothesis when a patient worsens? Can multiple providers construct one coherent longitudinal story? Can patients question medication without having their disagreement interpreted as pathology? Can clinicians distinguish illness from adverse effects, withdrawal, rebound, sleep deprivation, physiological factors, and the consequences of multiple simultaneous interventions?
And perhaps most importantly, can the system tolerate saying:
We don’t know yet.
Because uncertainty is not the failure.
Pretending uncertainty does not exist is.
The lesson from Lindsay Clancy should not be that medication is dangerous or psychiatry cannot be trusted.
It should be that when a person deteriorates during psychiatric treatment, we must be willing to examine both the patient and the treatment.
Instead of asking only:
“What was wrong with her?”
Mental healthcare also needs the intellectual discipline to ask:
“What happened to her — including after we started treating her?”
That is not anti-psychiatry.
That is what rigorous mental healthcare should look like.
Dr. Teralyn Sell, PhD writes about psychiatric medication decision-making, informed consent, deprescribing uncertainty, psych-med literacy, and clinical judgment when certainty exceeds the evidence.