The ongoing Lindsay Clancy murder trial is understandably receiving enormous attention in Massachusetts and across the country. The prosecution has charged Clancy with first-degree murder in the tragic deaths of her three children. The defense does not appear to seriously contest that she caused their deaths. Instead, it has raised what most people call the “insanity defense,” arguing that Lindsay Clancy was suffering from severe postpartum psychosis and was grossly overmedicated at the time
In Massachusetts, however, “insanity defense” is not really the terminology we use. The defense is called lack of criminal responsibility, or LCR. While insanity defenses are difficult everywhere, Massachusetts makes an already difficult defense even harder.
That is important to understand when evaluating the Lindsay Clancy case. The obstacles facing her defense are real and considerable. But they do not make the defense impossible. In fact, some of the very features that make Massachusetts lack-of-criminal-responsibility cases so difficult can, in the hands of experienced counsel and the right experts, sometimes be turned to the defense’s advantage.
What Is Lack of Criminal Responsibility in Massachusetts?
Once lack of criminal responsibility has been properly raised, the burden is on the prosecution to establish to a “moral certainty” that the accused was criminally responsible, or “sane,” at the time of the alleged offense. The Massachusetts standard is narrow.
The focus is on whether, at the time of the offense conduct, as a result of a mental disease or defect, the defendant was unable to differentiate between right and wrong or unable to conform his or her conduct to the dictates of the law.
That temporal limitation is critical. It is not enough to show generally that somebody suffered from depression, anxiety, psychosis, or another serious mental illness. An experienced Massachusetts criminal defense lawyer presenting an LCR defense has to connect the psychiatric evidence to the defendant’s condition at the precise time of the alleged crime. That is one of the reasons these cases are so difficult to try.
Why a Massachusetts Insanity Defense Is Particularly Difficult
Massachusetts defendants face obstacles beyond those encountered in many other states. First, Massachusetts does not employ the type of bifurcated procedure used in many jurisdictions, involving a guilt phase followed by the insanity phase, where a jury first decides whether the defendant committed the crime and only then separately considers insanity. Here, everything is effectively tried together.
As a practical matter, in many Massachusetts LCR cases, the defense begins trial having effectively conceded the conduct itself, even though the Commonwealth technically retains its burden of proof. The defense therefore gives up an obstacle the prosecution would ordinarily have to overcome and asks the jury to focus instead on the far less familiar question of criminal responsibility. That is no small thing. Second, the Massachusetts LCR standard confines the inquiry to a narrow legal question tied to the defendant’s mental state at the time of the offense. Third, Massachusetts defense lawyers still have to deal with all of the same prejudices surrounding an insanity defense that exist everywhere else.
The more horrible the alleged crime, the more difficult it can be for a juror to accept that a defendant may someday, following successful psychiatric treatment, regain his or her freedom, even after treatment in a secure psychiatric facility.
There is also a fundamental misunderstanding among many people about what serious mental illness looks like. Jurors see a defendant sitting calmly beside counsel and think: “She looks fine.” They expect someone who was genuinely insane to be hiding beneath the counsel table, talking to people who are not there, swatting at imaginary objects, or mumbling incoherently. But that confuses competency now with criminal responsibility then. Someone can be fully competent to sit in a courtroom today and still have been profoundly mentally ill, psychotic, delusional, or detached from reality at the exact moment an offense occurred. That distinction seems simple on paper. It is much harder to teach to twelve jurors in a murder trial.
This Is Why Experience Actually Matters in an LCR Case
It is relatively easy to read the Massachusetts lack-of-criminal-responsibility standard and repeat it. Trying the case is something entirely different. An experienced lawyer has to know how to identify jurors who simply will never accept an insanity defense, no matter what the evidence shows. Skillful voir dire can root out those skeptics and identify jurors who are capable of understanding that mental illness is real, complicated, and not always outwardly visible.
Then comes the expert testimony. Virtually every serious insanity or LCR case eventually becomes a battle of the experts. The Commonwealth is permitted to, and invariably will, retain its own expert to evaluate the defendant. That means defense counsel must not only present a persuasive expert of its own, but be prepared to attack the assumptions, methodology, experience, history, and potential biases of the prosecution’s expert.
If a prosecution expert is repeatedly retained by prosecutors and repeatedly reaches the same conclusion, that can matter. If the expert has never meaningfully dealt with the particular psychiatric condition being offered by the defense, that can matter. If the expert can describe diagnostic terminology but cannot persuasively explain why the defendant was criminally responsible at the precise moment that matters, that can matter too.
An LCR trial is not won simply by putting a psychiatrist on the stand. Counsel has to understand the medicine well enough to present it, challenge the Commonwealth’s expert, connect the mental-health evidence to the Massachusetts legal standard, and teach the jury why a person can move in and out of periods of lucidity. That last point may be especially significant in the Lindsay Clancy trial.
Why the Massachusetts Standard Can Also Help the Defense
Ironically, one of the features that makes Massachusetts LCR law so restrictive can also help the defense. Because criminal responsibility is determined by the defendant’s mental condition at the time of the offense, the law necessarily permits a defense based on a severe but temporary psychiatric condition. A person does not have to be continuously psychotic.
A person suffering from serious mental illness can move in and out of lucidity. Medication can matter. Going off medication can matter. Being overmedicated can matter. Someone may appear rational shortly before an alleged crime, or again afterward, without answering the central question of what was happening in that person's mind at the exact time of the offense.
That is why the defendant’s broader psychiatric history can become so important.
The Massachusetts Supreme Judicial Court reinforced this principle in Commonwealth v. Sanders. Although the disease or defect must have affected the accused at the time of the alleged offense, the defense may introduce relevant evidence concerning the accused’s mental-health history before and after the crime, and defense experts may rely upon that history in reaching their conclusions. That gives experienced defense counsel something important to work with.
The Commonwealth may want the jury staring at one terrible moment. The defense can show the jury the psychiatric history necessary to understand how the defendant arrived at that moment.
Why the Lindsay Clancy Insanity Defense Can Still Win
None of this means the Lindsay Clancy defense faces an easy road. It plainly does not. However, difficult is not the same thing as impossible. Good jury selection can eliminate jurors who categorically reject an insanity defense. Strong experts can explain mental illness in terms ordinary people actually understand. Effective cross-examination can expose weaknesses in the Commonwealth’s psychiatric opinions. And sometimes the alleged conduct itself is so incomprehensible that jurors begin with a question the defense needs them to ask.
Here, a mother is accused of taking the lives of all three of her young children and then making a serious attempt to take her own life, leaving herself paralyzed after jumping from a window. A juror may understandably ask: Could a mother in her right mind really do this?
That question does not prove lack of criminal responsibility. But it can open the door to understanding it. And once that door is open, the quality and experience of the lawyers and experts presenting the psychiatric evidence can become decisive.
Lindsay Clancy and Postpartum Psychosis: Massachusetts Should Be Paying Attention
The Lindsay Clancy case also involves something larger than one murder trial. Postpartum psychosis is real. Yet it remains shockingly and, in my view, shamefully under researched and poorly understood. Approximately one in a thousand new mothers reportedly experiences it. Women have been dealing with postpartum psychoses for millennia. There is even anecdotal evidence that women exhibiting symptoms may have been hanged as “witches” in the 17th century. And still, in 2026, most people know very little about postpartum psychosis. That should be particularly embarrassing in Massachusetts. We routinely hold ourselves out as one of the leading medical and psychiatric centers in the world. We have internationally recognized hospitals, medical schools, universities, psychiatrists, and researchers.
Yet an extraordinarily serious illness capable of producing a profound detachment from reality remains poorly understood, insufficiently discussed, and unfamiliar to much of the public.
The Lindsay Clancy trial provides an opportunity to change at least some of that. Her lawyers have an opportunity not only to educate the jury and challenge the prosecution’s expert, but perhaps to educate the broader medical community and the public about a dangerous condition deserving far more research, funding, attention, and understanding.
Whatever someone believes the ultimate verdict should be, acknowledging the reality of postpartum psychosis should not be controversial. The three children who died in this case cannot be brought back. Nothing about a lack-of-criminal-responsibility defense minimizes that tragedy.
But if the Lindsay Clancy case causes Massachusetts doctors, hospitals, mental-health providers, families, husbands, partners, and new mothers to better recognize postpartum psychosis and take its warning signs seriously, the trial may educate all of us in a way that is long overdue.
Massachusetts Lack of Criminal Responsibility Cases Require Experience
The Lindsay Clancy trial shows why a Massachusetts insanity defense is unlike an ordinary criminal defense. The law is narrow. The public skepticism is real. The expert issues are complicated. The jury must be taught to distinguish present competency from criminal responsibility at an entirely different point in time. And the defense must sometimes persuade jurors to look beyond horrific conduct and seriously examine the psychiatric explanation for it.
Those are not issues learned simply by reading the legal standard. They are issues learned by litigating serious criminal cases involving mental illness, preparing and cross-examining psychiatric experts, selecting juries, and understanding how the Massachusetts lack-of-criminal-responsibility standard actually operates in a courtroom.
The lawyers at Brad Bailey Law, P.C. have experience successfully raising and defending lack-of-criminal-responsibility and insanity cases in Massachusetts.
If you or a loved one is facing serious criminal charges in Massachusetts where mental illness, psychosis, psychiatric medication, competency, or lack of criminal responsibility may be an issue, contact our team to discuss the case.