In all my years working in the medical field, I have personally encountered postpartum psychosis only twice, and I will never forget either case. It is terrifying. One of those women had driven off a bridge with her baby strapped into the car seat in the back. When she came into the ER, she simply told us what she had done. There was no visible guilt, horror, or emotional reaction. It was almost completely matter-of-fact: “I drove off the bridge.” She seemed able to tell us the facts, but she did not seem to comprehend the meaning or consequence of what she had done. That was what was so disturbing about it. The baby, thankfully, was fine, and she was physically able to talk to us, but mentally she seemed profoundly disconnected from the reality of what had just happened. The other woman was hospitalized because the people around her could clearly see that something was terribly wrong. So I am not someone who doubts that postpartum psychosis is real. I have seen it with my own eyes, and it is frightening. That is exactly why the Lindsay Clancy case is so difficult for me to reconcile. If the evidence shows that she deliberately arranged for her husband to leave the house because she already knew what she intended to do, then that appears to involve planning: anticipating an opportunity, creating that opportunity, waiting until he was gone, and then carrying out the acts. So where, exactly, does the psychosis enter into that sequence? Was she lucid while planning it and sending him away, and then suddenly psychotic once the door closed? Premeditation first and psychosis second? That is the part that simply does not make sense to me. And then there were three children. Even if I accept that she could have been profoundly psychotic with the first, I struggle to understand how the reality of what she had just done—seeing her own child, experiencing the physical act, and then moving on to another child and then another—never produced even one moment of recognition or insight. Then she went to the window and jumped. I do not think that act alone proves lucidity; a profoundly mentally ill person can attempt suicide. But taken together with the apparent planning and the sequence of events, it leaves me with serious questions about how impaired her awareness actually was throughout the entire episode. I have seen postpartum psychosis. I know how devastating and real it can be. And what I witnessed looked very different: a woman could tell us what she had done, yet seemed completely disconnected from the emotional and moral reality of it. That is where I remain stuck with this case. She may absolutely have suffered from postpartum psychosis. But if she could formulate a plan, create the opportunity to carry it out, act against three children, and then attempt to take her own life afterward, I have a very difficult time understanding how there could have been no meaningful awareness of what she was doing from beginning to end. The result: three children are dead at the hands of their mother. There have to be consequences as severe as the horrific act.