Published August 14, 2026
In a courtroom at Plymouth Superior Court, one of the most closely watched criminal trials in recent Massachusetts history is moving toward its midpoint. Lindsay Clancy, a former labor and delivery nurse, faces three counts of first degree murder in the January 2023 deaths of her children, Cora, 5, Dawson, 3, and Callan, 8 months, at the family’s home in Duxbury. She has admitted the acts. The trial, before Judge William Sullivan, is about a single question: was she criminally responsible when she committed them?
Since jury selection began on July 20, the Commonwealth has been presenting its case in chief, and that presentation is now well advanced. The defense, led by Kevin Reddington, has told jurors that Clancy was in the grip of postpartum psychosis and a cascade of psychiatric medications when the killings occurred. What is unfolding in Plymouth is a working demonstration of how an insanity defense is actually fought in a Massachusetts courtroom, and it looks very different from how most people imagine it.
What the Jury Has Seen So Far
Early in the trial, jurors were taken to view the former Clancy home in Duxbury, a step Massachusetts practice permits so that the panel can orient itself to the physical space where the events occurred. A view is not evidence in itself, but it gives jurors a frame for everything that follows: the layout of the house, the basement, the distances involved.
The testimony that followed has been, by all accounts, grueling. Jurors heard the 911 call Patrick Clancy placed after returning home and discovering his children, a recording the court has treated as too disturbing for public release. Patrick Clancy himself testified in the trial’s opening days, walking the jury through the months after Callan’s birth, his wife’s deteriorating mental state, and the day of the killings. The Commonwealth has also called first responders who went to the Duxbury home that night, state medical examiners, the family’s former nanny, friends and coworkers, and a series of healthcare workers and psychiatric clinicians who treated Clancy in the months before January 24, 2023.
That witness list tells you something about strategy. The prosecution’s theory, as stated in its opening, is that Clancy acted deliberately, with premeditation, intending to take her children with her in a planned suicide attempt. Every category of witness serves that theory: the responders and medical examiners establish what happened and how; the husband, nanny, and coworkers establish what Clancy said and did in the weeks beforehand; the treating clinicians establish what she reported, and did not report, to the people responsible for her care.
Facts First, Psychiatry Later
Observers sometimes expect an insanity trial to open with dueling psychiatrists. It almost never does. Under Massachusetts law, once a defendant raises lack of criminal responsibility, the Commonwealth bears the burden of proving beyond a reasonable doubt that the defendant was criminally responsible. The governing standard comes from Commonwealth v. McHoul: a defendant is not responsible if, as a result of mental disease or defect, she lacked substantial capacity either to appreciate the wrongfulness of her conduct or to conform her conduct to the requirements of law.
Prosecutors meet that burden the same way they build any murder case: with conduct. Planning evidence, timing, opportunity, statements before and after the act, and any behavior suggesting awareness that the conduct was wrong all become circumstantial proof of a functioning, choosing mind. That is why the Commonwealth’s case has been built witness by witness around the ordinary texture of Clancy’s life in late 2022 and early 2023, and around the specific choreography of January 24: when Patrick Clancy left the house, what errands he was sent on, and what happened in the window while he was gone. Timing is not a detail in this trial. If jurors conclude the killings were arranged around the husband’s absence, prosecutors will argue that is planning, and planning is the signature of a mind that understood what it was doing and that others would stop it.
The treating clinicians serve a second purpose. Medical records introduced through them document therapy, psychiatric visits, a hospitalization, and a long list of prescribed medications. The Commonwealth will use those same records to argue that Clancy was assessed repeatedly by professionals in the relevant window and that the record reflects depression and anxiety rather than psychosis. The defense will use them to argue the opposite: that the system saw a drowning woman and responded with an escalating stack of prescriptions.
The Defense Case Being Fought on Cross
Because the defense has not yet called a witness, its case so far exists entirely in cross-examination, and Reddington has used it to plant themes the jury will hear again. With clinicians, the cross has pressed on what was prescribed, when, and with what monitoring. With lay witnesses, it has drawn out the moments that do not fit a portrait of cold calculation: the pleas for help, the fear, the strangeness. A defense in this posture is not trying to win points witness by witness. It is assembling, in fragments, the narrative its own experts will later make explicit.
Central to that narrative is medication. Clancy’s attorneys have said she was prescribed roughly a dozen psychiatric medications, reported as 13 in a span of about four months, including drugs for anxiety, depression, and insomnia. Whatever the final tally established at trial, the medication timeline matters to both sides. For the defense, rapid polypharmacy is evidence both of how sick she was and of a possible contributing cause: abrupt starts, stops, and combinations that can destabilize a fragile patient. For the Commonwealth, the same records show engagement with treatment, accurate self-reporting, and clinicians who repeatedly evaluated her without documenting psychosis. One set of documents, two opposed readings. Juries decide between them.
What Forensic Psychiatrists Actually Do
When the defense case opens, expert testimony will move to the center, so it is worth being precise about what a forensic evaluation is. A forensic psychiatrist or psychologist retained in a criminal responsibility case does three things. First, a records review: medical charts, prescription histories, police reports, witness statements, texts, and anything else that documents the defendant’s functioning over time. Second, direct interviews with the defendant, often many hours across multiple sessions, probing memory, symptoms, and mental state at the time of the offense. Third, a retrospective reconstruction: an opinion about the defendant’s capacity at a specific moment in the past, using the McHoul framework.
That third step is where the real fight lives. No expert examined Lindsay Clancy on January 24, 2023. Every opinion offered in this trial is an inference backward from records and later interviews to a mental state on a single afternoon more than three years ago. Cross-examination of experts in these cases follows a predictable path: how many hours with the defendant, how long after the offense, how much the opinion depends on the defendant’s own account, and whether the defendant had reasons to shape that account. Both sides’ experts face the same structural limits. The question for jurors becomes whose reconstruction better fits the contemporaneous record.
Postpartum Psychosis, Briefly and Clinically
The clinical backdrop deserves care, because public discussion tends to blur it. Postpartum psychosis is rare, occurring after roughly one to two of every 1,000 deliveries according to the psychiatric literature. It is categorically different from postpartum depression, which affects a meaningful share of new mothers and does not involve a break from reality. Psychosis involves hallucinations, delusions, disorganized thinking, and rapid mood swings, often with onset in the days or weeks after delivery, and it is treated as a psychiatric emergency precisely because of the risk of harm to mother or infant. The defense contends Clancy experienced command hallucinations, a voice ordering her to kill the children. The Commonwealth contends the treatment record shows depression and anxiety, not psychosis. Where the diagnosis lands, and when any psychotic symptoms began, will be the load-bearing dispute of the expert phase.
How Juries Weigh Dueling Experts
Research on juror decision-making, and the accumulated experience of trial lawyers, points to a consistent pattern: jurors rarely resolve a battle of experts on credentials alone. Both sides will field qualified professionals. Jurors instead attend to three things. Basis: which expert’s opinion is anchored in the documented record rather than in the defendant’s later account. Coherence: which story of January 24 explains more of the undisputed facts, including the ones that cut against it. Demeanor: which witness teaches rather than advocates, concedes what should be conceded, and survives cross without visible strain. In criminal responsibility trials, jurors also bring a durable skepticism toward the defense itself; national experience suggests insanity verdicts are uncommon even where mental illness is undisputed. The defense’s task is not to prove Clancy was ill. It is to persuade jurors that her illness reached the specific severity McHoul requires, at the specific hour that matters.
What to Watch Next
The Commonwealth’s case is expected to conclude soon, and the trial’s second act will begin. Watch for several things. First, the composition of the defense witness list: family members who observed Clancy’s decline can supply the lived texture that records cannot, before the experts translate it into diagnosis. Second, the specificity of the defense experts’ timeline: an opinion that psychosis was present on January 24 will be tested against every normal-seeming text and appointment in the surrounding days. Third, whether the Commonwealth answers with rebuttal experts of its own, which would set up the direct clash jurors have been waiting for. Finally, the jury instructions: if the case reaches them in this posture, Judge Sullivan will tell jurors that the Commonwealth must prove criminal responsibility beyond a reasonable doubt, and that a verdict of not guilty by reason of lack of criminal responsibility results in commitment proceedings, not release.
Three children died in Duxbury, and nothing in the mechanics of trial practice should obscure that. What the next weeks will test is whether the Commonwealth’s account of a planned act, built patiently through fact witnesses before a single psychiatrist took the stand, can withstand the clinical narrative the defense is about to present.