Opinion: I’m a reproductive psychiatrist. The Lindsay Clancy trial will cause terrible damage to my field

OpinionFirst Opinion I’m a reproductive psychiatrist. The Lindsay Clancy trial will cause terrible damage to my field Rather than prompting a renaissance in treating postpartum mental illness, the trial will make things worse Manage alerts for this article Email this article Share this article By Jennifer Adaeze OkwerekwuSept. 1, 2026 Okwerekwu is a reproductive psychiatrist in private practice.

Jennifer Adaeze OkwerekwuJennifer Adaeze Okwerekwu is a psychiatrist and was a columnist for STAT. After a grueling five-week trial, the Massachusetts jury attempting to determine whether Lindsay Clancy is criminally responsible for killing her three children is deadlocked. Her defense argued that the health care system failed her.

The prosecution argued that the murders were premeditated. For now, the judge has asked the jury to keep deliberating. But whatever happens, psychiatry has been changed.

I specialize in caring for women’s mental health issues during pregnancy and the postpartum period. I do not know Ms. Clancy, nor have I ever been involved in any element of her care, so I cannot say what mental health condition she was plagued with or where her care may have gone awry.

Nor do I care to opine on her guilt or innocence.Advertisement All I know for sure is that something terrible has happened, and the fallout will be ugly. This trial has done serious damage that will cost the patients who need help the most. In an effort to provide a robust defense, Ms.

Clancy’s attorney has, in effect, put psychiatry on trial, no matter the broader emotional or moral costs. The trial and the discourse around it have flattened the whole of my field into a single lazy question: Did the health care system fail her? I understand the impulse to pinpoint exactly went wrong and identify a clear bogeyman to blame.

I, too, have struggled with the impulse to point the finger at something, anything, when trying to make sense of traumatic patient losses.Advertisement But the question mistakes the way psychiatry works — and its limitations. We can try our best, do everything right with the tools and resources reasonably available to us, and things can still go catastrophically wrong. Psychiatry is the work of building the airplane while flying it carefully, collaboratively, and compassionately, as conditions may change midair.

In the subspecialty of reproductive psychiatry, we must understand how multiple moving parts interact: fluctuating hormones, the menstrual cycle, fertility treatment, pregnancy, postpartum recovery, parenting, perimenopause, medical conditions, trauma, sleep, relationships, and the crushing demands of daily life. The defense has portrayed psychiatrists as spending too little time with patients, not listening, trying too many drugs. In many situations, it has egged on popular misunderstandings of psychiatry.

What does help look like? Consider a night that has stayed with me. It was just past 3 a.m.

when I was called to evaluate a patient in the emergency room. She was a middle-aged woman struggling with depression and thoughts of suicide. I patiently listened to her story, tried to understand her symptoms, and sat with her in her suffering.

“I was here a few weeks ago,” the patient explained, “and they just discharged me. No one helped me.” Her care, she implied, was callous and dismissive. Perhaps in the fogginess of the early-morning exhaustion, she didn’t recognize me.

I was the psychiatrist who evaluated her at that time and cleared her for discharge. But I did not just discharge her, as she accused me of doing. I cared for her during that overnight shift and spoke with her extensively about her suffering and her symptoms, the various medication options and treatments available to her.

I coordinated with our social work staff to obtain information from her family about how she was doing and what care she was already plugged into in the community. This woman also struggled with alcohol use disorder. We reflected together about how she may be self-medicating underlying depression with alcohol, and that medication may help to address her mood.

I offered her a voluntary psychiatric hospitalization, where she would be evaluated for medication. Perhaps with her depression and anxiety more under control, she would have an easier time engaging in her substance abuse treatment programs. She declined my offer.Advertisement She was able to engage in robust safety planning — discussing with me warning signs of worsening mental health, outlining her coping skills and support system, and discussing reasons for returning to the ER.

She told me her preference was to enroll in a detox program she had already signed up for. She said she was no longer feeling suicidal, was engaged in her care, and had a solid follow-up plan. We were both hopeful.

It was only then, after a thorough assessment and collaborative treatment planning, that I cleared her for discharge. When she returned a few weeks later, I told her I was sorry she was still having a hard time. You might not recognize me, I said, but I was the psychiatrist in the ER a few weeks ago.

I opened up my note in the medical record and walked her through the plan we had constructed together. I reminded her that I offered her admission and that she declined in favor of the detox program. I asked her what went awry and what she felt she needed going forward.

“I just need help,” she said. This time, I arranged for her to be voluntarily admitted to the hospital. When the patient told me that no one had helped her when she begged for it, I wondered for a moment if I had failed her.

But medicine does not worship at the altar of binary thinking. I held both truths at once: Her suffering was real, and so was the care she had received. Her discharge was the result of a thorough assessment ending in a collaborative plan she chose.

Patient autonomy is one of the principles of ethical medical practice. It teaches us to respect the right of capable people to make their own life choices. That capacity is the ability to understand the situation and how the risks involved may impact you, and to explain how your choice to accept a medical treatment or not aligned with your priorities.

Doctors must honor capable refusals of care, even when we may disagree with the choice. Patients exercise autonomy when they choose to take medication or not, involve family in their care or not, or in the case of my ER patient, accept a voluntary admission or not.Advertisement An incomplete picture We also act on the best information available at the moment we have it, which is rarely all of it. Sometimes prior records are simply unreachable.

I recently tried to request my own records from a large Boston-area organization and, after several attempts, managed only to leave a message after the voicemail recording advising me that requests take up to seven business days. Sometimes patients honestly forget parts of their medical history. Sometimes they withhold information, for reasons that are sympathetic and risky all the same.

One patient told me that when she was telling the ER team about her medications, she halved the dose of her antidepressant because “I didn’t want them to feel like I was sick.” Another disclosed that, while completing mental health intake paperwork for a family member, they had omitted a family history of bipolar disorder and suicide out of shame. Sometimes patients minimize their symptoms and hide the full extent of what they experience. Other times people use globally hyperbolic language to communicate their distress.

Teasing all of this apart is the work. Clancy’s legal team has cast brief follow-up visits as inherently inadequate and templated documentation as evidence of impersonal care. That is at best a superficial understanding of the work involved in psychiatric treatment and the substantial labor that occurs outside the appointment itself.

This past week, for example, I spent 45 minutes face-to-face with a patient. I spent an additional hour of my personal time completing prior-authorization paperwork for a medication on which she had become stable. Her new insurer denied the request, not because the medication was ineffective or unsafe for her, but because it wanted her to first try and fail other medications.

I then spent another hour writing a detailed appeal explaining why disrupting a hard-won treatment plan could jeopardize her recovery from postpartum depression. None of that advocacy — the review of her history, the paperwork, the appeal, the clinical reasoning, or the time spent trying to preserve stability — is fully visible in a medication list or a short clinical note. Yet it is part of the care.Advertisement I resent the narrative that psychiatric medications corrupt the mind.

Our medication is an easy villain — concrete, nameable, and easy to blame. That discourse is deadly. Many patients arrive understandably afraid of psychiatric medication.

I spend a great deal of my workday discussing what medication can and cannot do, addressing concerns, correcting stigma-laden myths, and helping patients make decisions that fit their goals and values. The limits of possible care Several years ago I cared for a postpartum patient with a trauma history who was living with severe anxiety and overwhelm. She had not slept, felt desperate and depleted, and was struggling to feed her baby, who would not take a bottle.

When she logged in to one of our telehealth visits, she was crying and hiding beneath a table after her partner had threatened her life. Throughout our work together, she had chosen not to take medication for her symptoms. At each visit, I tried to meet her where she was — reviewing options, discussing the potential benefits and risks of treatment, and respecting her autonomy while remaining attentive to her needs.

But the hospital system was already overburdened. Social-work referrals I had placed weeks earlier had not yet led to meaningful support. As the urgency of her situation became clearer, I found myself trying to assemble safety resources in real time: talking through protective orders, exploring shelter options, submitting additional referrals, and searching for some way to make help arrive sooner.

I remember shaking as I reached out to my supervisors for support. I felt overwhelmed not only by what I was witnessing, but by the realization that everyone involved was working hard and it may never be enough. I am usually steady and measured in a crisis.

That day brought me to my knees. Afterward, I cried too. Long-term consequences for psychiatry Ms.

Clancy’s suffering has been examined from every angle. But the insidious harm that moves in the other direction — from illness, through a patient, into the person treating her — has no forum at all. This is where the biggest threat to my profession lies.

It is not a threat to our feelings. It is a threat to our supply.Advertisement From moments of terror and grief to violence and loss, as frontline workers we care for patients through the lowest of lows. Even when the trauma is not ours, bearing witness to it repeatedly can affect us.

Patients can also harm their clinicians through retaliatory filings of complaints. Clinicians who have been harmed may withdraw from the field, or at least from the most challenging patients. This feeling, or tendency toward avoidance of complex patients, was captured in a 2005 study published in JAMA.

In the survey, 42% of physicians said they had started restricting their scope of practice in medicine, including caring for complicated patients, due to the liabilities involved. Women bear the brunt of that calculation. It is not uncommon for radiologists to decline to interpret mammograms as part of their practice due to the fear of litigation.

Maternity deserts also exist, in part, due to the risk of obstetric litigation. Many OB-GYNs mitigate this by avoiding high-risk patients or dropping the practice of obstetrics all together. Of all the potential complications of childbirth, maternal mental health conditions are the most common complications associated with childbirth.

The United States is already experiencing a mental health care provider shortage, and shorter still in those specialized in reproductive concerns. To practice medicine is to remain a student for life. The reality is that expertise in any field does not arrive fully formed; it begins as an interest held by someone with solid general training, and it takes years to grow.

My fear is that this trial is snuffing out that interest in maternal mental health before it can become expertise — in psychiatrists, and in psychologists, midwives, social workers, and nurses, too. Many physicians are leaving medicine not because they don’t care about patients, but because the work increasingly asks us to carry responsibility for things we cannot control. Of course, physicians are not beyond reproach and should be held accountable when care is careless, harmful, or below the standard our patients deserve.

But when painful outcomes follow thoughtful care, it can feel like a miscarriage of justice to have psychiatric treatment portrayed as inherently harmful.Advertisement Clinical documentation, the notes that record the course of a patient’s care, is one of the greatest sources of stress in modern clinical practice. It is an essential part of medicine, but it is also an administrative burden that can consume several hours each day, often well beyond scheduled patient visits. I have sought both coaching and therapy to manage the pressure of keeping up.

Part of that pressure comes from the standard I hold myself to: I want my notes to be excellent. I want them to accurately reflect the patient’s story, make my clinical reasoning clear, and withstand scrutiny if there is ever an audit, a complaint, or a situation in which another clinician needs to understand why I made a particular decision. The advice much more seasoned psychiatrists and physicians often give is simple: Make your notes good enough.

Do not aim for perfection. Most notes will never be revisited, they say, and when they are, they need only communicate enough to support billing, continuity of care, and sound clinical reasoning. I understand the wisdom in that advice.

But after watching a colleague on the witness stand in the Clancy trial be scrutinized — almost eviscerated — over the placement of a comma, “good enough” no longer feels simple. It is unsettling to realize how easily language intended to document care can be parsed, questioned, and used to reconstruct an entire clinical encounter. I spend a lot of time with my patients because time and attention are the highest form of care.

I have found myself wondering whether I should shorten patient visits and spend less time listening, thinking, and caring in order to ensure every note has flawless punctuation — even though I don’t think it will improve patient care. In the wake of this case, I have listened to colleagues trade risk-mitigation strategies, seek out documentation training, and revise their notes with legal defensibility in mind. That cost will not be paid out in malpractice claims.

It will be paid by a woman four months postpartum who cannot sleep and cannot stop crying, who calls six numbers and is offered a first appointment in seven weeks, and who decides somewhere around the fourth call that help does not exist. It will be paid by the women who absorb the harmful narrative surrounding this tragedy: that psychiatric medication is dangerous, that psychiatrists cannot be trusted, and that seeking help may make them less themselves. To see Clancy’s attorney, Kevin Reddington, hailed as a “feminist icon” and champion of postpartum mental health is jarring.

Save one, sacrifice the many.Advertisement My profession requires me to operate in imperfect systems of care. I’m always thinking about the one and the many. I recognize that medicine contains real imbalances of power, and that patients have good reason to be cautious within systems that have not always earned their trust.

I understand this deeply, not only as a Black woman, but also as a physician-mother who has dedicated my life to caring for women like Lindsay Clancy. Still, I wish there was more room to meet one another in good faith — to make it a prerequisite for both giving and receiving care. I wish patients did not have to keep their guard up in order to seek help, and clinicians did not have to keep theirs up in order to provide it.

I wish an insurance company could trust that, when I prescribe a medication, I have done so carefully and collaboratively. I wish people could be vulnerable about their mental health struggles without fearing that they will be seen as weak or less deserving of dignity. And I wish we could hold space for the painful truth that sometimes terrible, unimaginable things just happen.

As for my 3 a.m. ER patient, shortly before I ended my shift at 8:30 that morning, I received a call from the emergency room physician who had consulted me on her care. The patient did not want to be admitted to the hospital anymore.

Jennifer Okwerekwu, M.D., is a reproductive psychiatrist in private practice. Letter to the editor Have an opinion on this essay? Submit a letter to the editor.

legal, Mental Health, patients, reproductive health Submit a correction requestReprints Jennifer Adaeze Okwerekwu Former Columnist Jennifer Adaeze Okwerekwu is a psychiatrist and was a columnist for STAT. Newsletter The smartest thinkers in life sciences on what's happening — and what's to come Recommended First Opinion September 1, 2026 The Trump administration is burying science and health care in paperwork First Opinion August 31, 2026 The most shocking thing about the latest statistics on CTE in football is that we find them so shocking Advertisement First Opinion August 28, 2026 The unintended consequences of the Lindsay Clancy case First Opinion August 28, 2026 A billing code was supposed to incentivize relationship-based primary care for Medicare patients. It may not be working as hoped First Opinion August 28, 2026 We quit the CDC last year.

The problems we protested remain Subscriber Picks