I write about politicians. I mock them. It is more or less my entire brand.

Not today.

Today you get the other two things I am, the medic and the science teacher, and I need you to set the pitchfork down for about ten minutes. Because I am going to walk you through some neuroendocrinology first, and only then tell you what it has to do with three dead children in Duxbury, Massachusetts.

I am doing it in that order on purpose. If I hand you the crime first, your brain locks and nothing after it gets in. Every one of us works that way. So we are going to start with the chemistry, and you are going to see where it goes.

— START WITH THE DRIP

Here is something almost nobody outside obstetrics or neuroscience knows.

Progesterone gets metabolized in the brain into a compound called ALLOPREGNANOLONE. Two enzymes do the work, 5-alpha-reductase and 3-alpha-hydroxysteroid dehydrogenase. What comes out the other end is what pharmacologists call a positive allosteric modulator of the GABA-A receptor.

Translation for my students: GABA is the brain’s brake pedal. Allopregnanolone does not press the brake itself. It makes the brake pedal MORE SENSITIVE. Same pressure, more stopping power.

Now here is the part that should make you sit forward. Allopregnanolone climbs steadily across all nine months of pregnancy and peaks right around labor. Then, within roughly forty-eight hours of delivery, it FALLS OFF A CLIFF.

Think about what that means mechanically. For nine months the brain has been running with an amplified brake system, and it adapts. It remodels the actual subunit composition of its GABA-A receptors to keep the network balanced against all that extra inhibition. Then the source vanishes overnight and the receptors have to remodel back, fast, in a body that is bleeding, hormonally scrambled, and not sleeping.

If that remodeling goes smoothly, you get a tired new mom.

If it does not, you get a brain in WITHDRAWAL.

And I mean that in the strict pharmacological sense. Benzodiazepines, Valium and Klonopin and Ativan, work on the very same receptor by the very same allosteric mechanism. So functionally, every woman who gives birth has been running a nine-month high-dose GABAergic drip and then had the line ripped out of her arm in a single afternoon. Nobody prescribed it. Nobody tapered it. Nobody warned her.

I have a daughter and three sons. All of my sons were born naturally, no epidural. I actually delivered all three (proud Dad and Medic). With all that pain being fully felt by my wife, the first thing she said when the baby was fully delivered was, “I want another one”. My wife is addicted.

Now back to science. You do not have to take my word that this mechanism is real, either. The FDA approved brexanolone, which is literally synthetic allopregnanolone given by IV, and later zuranolone in pill form, specifically for postpartum depression. You do not approve a drug that replaces a missing molecule unless the missing molecule is doing something.

Hold that thought about benzodiazepines. We are coming back to it, and it is going to hurt.

— THE OTHER THREE SYSTEMS GOING SIDEWAYS AT THE SAME TIME

The GABA story is only the first of four, and this is where postpartum psychosis separates itself from garden-variety exhaustion.

ESTROGEN AND DOPAMINE. Estrogen also crashes after delivery, and estrogen modulates the sensitivity of dopamine D2 receptors. That produced the dopamine supersensitivity hypothesis of puerperal psychosis, which is worth knowing precisely because dopamine excess is the pathway every antipsychotic drug we own is built to block. I will be honest with you, because I am not going to oversell my own argument: the challenge studies testing that hypothesis have come back mixed, and at least one of the best-known ones did not support it. It is a leading hypothesis, not settled science. But it is on the table for a reason.

THE IMMUNE SYSTEM. This is the one that stops people cold. Veerle Bergink and her colleagues have published repeatedly on immune dysregulation in first-onset postpartum psychosis, on elevated rates of autoimmune thyroid dysfunction in these women, and, in the American Journal of Psychiatry, on AUTOIMMUNE ENCEPHALITIS presenting as postpartum psychosis. Read that again. In some cases, what looks like a psychiatric break is the immune system physically inflaming the brain. Not a metaphor. Not a feeling. Swelling, in tissue, that you can treat with immunotherapy. A 2025 expert consensus review in Biological Psychiatry lays out the whole picture: the postpartum period involves profound endocrine, immune, neuroanatomical, and physiological change, and the tight timing of these episodes points hard at biology rather than character.

SLEEP. There is an entire literature on sleep loss as a trigger for postpartum psychosis, and it has been there since at least 2003. Sleep deprivation is the single best-documented precipitant of mania in the bipolar spectrum. In some patients one bad night does it. And the postpartum period is the closest thing our species runs to a controlled experiment in destroying a human being’s sleep architecture on purpose.

So line them up. Neurosteroid withdrawal. Dopaminergic instability. Immune activation. Circadian demolition. All four, in the same brain, in the same weeks.

That is not a mood. That is a system under load from four directions at once.

— THE NUMBERS THAT SEPARATE THE TWO CONDITIONS

I have watched several hundred people online confidently analyze this case using the phrase “postpartum depression.” Please stop.

Postpartum depression affects somewhere around one in eight new mothers. Real, common, treatable, and here is the defining feature: the woman experiencing it STAYS TETHERED TO REALITY. She is flattened. She is frightened. She is not hallucinating.

Postpartum psychosis affects roughly one or two women per THOUSAND births. Mania, mixed states, or depression with psychotic features. Hallucinations, delusions, agitation, and what the literature calls cognitive clouding.

Now the risk numbers, which are the part that matters for this case. In a woman with known bipolar disorder, the risk of postpartum psychosis runs somewhere around twenty to thirty percent. With a first-degree family history of postpartum psychosis on top of that, published figures climb toward seventy-four percent. After one episode, recurrence risk exceeds fifty percent.

Those are not “she was stressed” numbers. Those are numbers you would act on immediately in any other organ system. If a patient walked into my ER with a family history that conferred a seventy-four percent risk of a lethal cardiac event, nobody would send her home with a follow-up appointment and a pamphlet.

Two more clinical points people keep tripping over.

FIRST, this illness WAXES AND WANES. Clear hours. Good afternoons. Whole days where she looks and sounds like herself and reassures everyone who loves her. That is not recovery. That is the disease inhaling.

SECOND, intrusive thoughts are not command hallucinations. Nearly every new parent gets an ugly flash, “what if I dropped him on the stairs,” and recoils. That thought is ego-dystonic and recognized as SELF-GENERATED. That is a normal brain running a threat simulation, and it means nothing. A command hallucination is experienced as coming from OUTSIDE the self, with authority. Those are different phenomena from different machinery. If you had the first one, thank God, and understand that you did not have the second.

— NOW DUXBURY

Cora was five. Dawson was three. Callan was eight months old.

On January 24, 2023, their mother killed all three of them and then tried to end her own life. She survived. Her spine did not. Lindsay Clancy is a paraplegic now, and she is sitting in a wheelchair in Plymouth Superior Court, in front of Judge William Sullivan, watching her own murder trial.

Her attorney never argued she did not do it. He conceded it in opening statements. Nobody in that room is arguing about WHAT happened.

The entire case is about what was happening inside her skull while it happened.

Those three children are the victims. Full stop. If you came here hoping I would soften that, close the tab, I am not your guy.

But “who is the victim” and “what is the defendant criminally responsible for” are two different questions, and only the second one is on trial.

— THIRTEEN PRESCRIPTIONS. FOUR MONTHS. AND BENZODIAZEPINES ON A RECEPTOR SYSTEM ALREADY IN WITHDRAWAL.

Told you we were coming back.

Per a Boston Globe review of the court records, Lindsay Clancy was prescribed THIRTEEN different psychiatric medications between October 2022 and January 2023. Four months.

They did not come from one physician. They came from psychiatrists, nurse practitioners, emergency department doctors, and an inpatient psychiatric program.

Multiple prescribers. Nobody holding the whole picture.

Every medic in America just felt their stomach drop, and here is why. When I get to a patient, one of the first things I want is the med list, because half the time the med list IS the differential. And what I am reading for is never a single drug. It is what the drugs are doing TO EACH OTHER.

Look at what was on hers. Antidepressants. An antipsychotic. Benzodiazepines. Diphenhydramine. A mood stabilizer.

Now overlay the biology from the top of this article.

Her GABA-A receptors were already mid-remodel from neurosteroid withdrawal. And onto that unstable receptor population we layered exogenous benzodiazepines, which bind that same receptor, and which in a subset of patients produce PARADOXICAL DISINHIBITION rather than sedation. The drug prescribed to calm a person occasionally does the reverse. Then add diphenhydramine to a sleep-starved brain and you have opened the door to anticholinergic delirium, which every ER nurse in this country has seen and almost nobody outside medicine ever mentions.

And then the biggest one. If a patient sits on the bipolar spectrum and NOBODY HAS DIAGNOSED IT YET, and you give her SSRIs, you can flip her into mania or a mixed state. Antidepressant-induced mania is not a theory a defense lawyer invented. It is in the prescribing information. It is the entire reason “have you ever had a manic episode” is a screening question before that prescription gets written.

Jurors have heard that her doctors did consider whether she had bipolar disorder. She has since filed a civil suit against five providers alleging exactly this failure: nobody coordinated, nobody assembled the warning signs, nobody recognized what was in front of them. Her attorney has called the medication picture horrific and says her husband went to a doctor the week before and said the drugs were “turning her into a zombie”.

I do not know how a jury weighs that. I know precisely what it looks like from the back of an ambulance. It looks like a patient treated by everybody and cared for by nobody.

— NOW LET ME MAKE THE PROSECUTION’S CASE, BECAUSE IT IS STRONGER THAN MY SIDE OF THE INTERNET ADMITS

If I only tell you the half that helps my thesis, I am doing to you exactly what I spend my life yelling at cable news for doing. So here it is straight.

She never told a single provider she was hearing voices until AFTER the children were dead. Her own defense expert conceded that on the stand.

Multiple treating clinicians testified they observed no psychosis. Testimony to this point has included no contemporaneous diagnosis of it.

Weeks before, she admitted herself to McLean Hospital for five days, and a psychiatrist there testified she asked to be weaned OFF an antipsychotic because she was having trouble sleeping.

Prosecutors walked jurors through nine pill bottles that still held plenty of pills. Testimony indicates she sometimes skipped doses or asked to change her regimen, and prosecutors have suggested she moved between providers to get the treatments she wanted.

The state’s theory is that she sent her husband out on an errand to create a window, and that the killings were deliberate and meticulous. Their prosecutor told jurors flatly that this ”was not a woman in the throes of psychosis”. And the prosecution pressed the defense’s forensic psychiatrist hard on how much of his affidavit leaned on a magazine article rather than his own work.

Anyone telling you this is an easy case is selling you something.

— AND HERE IS THE CLINICAL ANSWER TO EVERY ONE OF THOSE POINTS

Now let me tell you what a medic hears in that same list.

ON NOT REPORTING THE VOICES. Ask yourself who this woman was. A LABOR AND DELIVERY NURSE. A licensed clinician who knows, to the letter, what happens the moment she says “I am hearing a voice telling me to hurt my children” inside a Massachusetts hospital. She knows about involuntary holds. She knows about mandated reporters. She knows about her nursing license. She knows about her kids. The single population on earth most likely to conceal psychotic symptoms from a psychiatric intake is health care workers, because they are the only patients who can accurately predict the consequences of full disclosure. Her silence is not evidence of a quiet mind. It is evidence of a professional who understood exactly what she was risking. And note what she DID say out loud, in December, to her husband and her mother: that she was having thoughts of harming the children. She got as close to the fire alarm as her terror allowed.

ON WANTING OFF THE ANTIPSYCHOTIC. Psychiatry has a word for the impaired self-assessment of a deteriorating patient. ANOSOGNOSIA. The organ evaluating whether treatment is working is the same organ that is failing. A patient in a destabilizing mood state steering her own medication regimen is a RED FLAG, not a reassurance. That testimony does not show a well woman making a sound call. It shows a sick woman being allowed to captain a ship she could no longer read the instruments on.

ON THE FULL PILL BOTTLES. This one, I think, cuts the other way entirely. Leftover pills do not prove undermedication. They prove the dosing was IRREGULAR. And irregular is not some gentle middle ground between medicated and unmedicated. Irregular is its own hazard. Starting and stopping psychotropics, cross-tapering, going up on one agent while coming down on another, missing doses of a mood stabilizer while the antidepressant keeps running, all of it inside a brain already destabilizing on its own. That is not less pharmacology. That is chaos with a prescription number stapled to it.

ON THE STAGED SUICIDE ARGUMENT. This is the one where I stop being polite, because this is my actual lane.

A forensic pathologist testified this week that when Lindsay Clancy was found on the frozen ground outside her home, her body temperature had dropped to EIGHTY-TWO DEGREES FAHRENHEIT.

Let me tell you what eighty-two means to anyone who has ever worked a code.

Normal is ninety-eight point six. Below ninety-five you are hypothermic. Below eighty-six you are in SEVERE hypothermia, the range where patients are typically unresponsive, where reflexes disappear, where the pupils can go fixed and dilated, and where the heart will drop into ventricular fibrillation on its own without asking anyone’s permission. Eighty-two is the temperature at which a paramedic looks at a patient and cannot tell by looking whether that patient is alive. It is why we teach that nobody is dead until they are WARM and dead.

You do not arrive at eighty-two degrees by hopping out a window for effect and then getting up. You arrive at eighty-two degrees by going out that window and STAYING DOWN, unconscious and unmoving, on frozen January ground, for a long time, with a broken back, bleeding.

Whatever else that was, it was not theater.

— TWO PRONGS, TWO BRAIN SYSTEMS, ONE QUESTION

Here is the piece that almost every take on this case misses, and it is the reason all of the above actually matters legally.

Massachusetts insanity law does not ask one question. It asks TWO. A defendant lacks criminal responsibility if, because 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.

Appreciate. Or conform. Either one.

And those two prongs are not lawyer poetry. They map onto genuinely different neural machinery.

Knowing that killing is wrong is stored semantic and moral knowledge. It is durable. It survives sleep deprivation, mania, and most drug states largely intact. That is the first prong, and it is the harder one for any defense to win.

CONFORMING YOUR CONDUCT is a completely different job, run largely by top-down inhibitory control out of the prefrontal cortex and anterior cingulate. That is the braking system. And that braking system is exactly what sleep deprivation degrades, what mania overruns, what benzodiazepine disinhibition unhitches, and what a GABA-A receptor population in mid-remodel cannot properly support.

Which is why the law, written by people who had never heard of allopregnanolone, still got the architecture right. You can KNOW a thing is wrong and still have nothing left to stop yourself with. The knowledge lives in one place. The brake lives in another. Sever the second and the first just watches.

And the burden here does not sit where most people assume. The prosecution must prove beyond a reasonable doubt that she was NOT in that state. Not the reverse. That is a wall, and it was built that way on purpose, long before any of us were arguing about it online.

I am not on that jury. Neither are you. But I would not want to be the one climbing it.

— NOW PUT YOURSELF IN HER SHOES

You cannot. I want to be honest about that before we start. Nobody reading this actually gets there.

Try anyway.

Try to imagine that the voice generating sentences inside your head, the one that has been YOU your whole life, starts producing content you did not author, about the three people you would step in front of a truck for without breaking stride.

Try to imagine being a labor and delivery nurse, a woman whose entire working life has been placing newborns into their mothers’ arms, and hearing that.

Try to imagine telling your husband and your mother anyway, in December, that you were having thoughts about hurting your kids. Try to imagine checking yourself into a psychiatric hospital because you have become afraid of your own mind, and getting discharged in five days because you presented well.

She told people. In advance. That is not how someone builds an alibi. That is how someone screams into a system that was not built to catch her.

And then try to imagine waking up.

Not in a cell. In a hospital bed. Legs that will not answer. And the memory walking in the door.

That is the part I cannot get past as a medic. There is no morphine for that. There is no protocol, no algorithm, nothing on any drug box in this country for a woman who has to wake up every morning for the rest of her natural life and remember what her broken brain made her hands do to her babies.

— THE SENTENCE STARTED LONG BEFORE THE TRIAL DID

Whatever twelve people in Plymouth decide, understand what is already permanent.

She is paralyzed. That is not improving. Spinal cords do not knit themselves back together because a verdict came back favorable.

Her children are gone, and she is the reason they are gone.

Her marriage is over. He is her EX-husband now, and sit with what that actually means. There is no future in which that man looks across a room and sees the woman he married. Every time he sees her face, he sees the last day of his children’s lives. He does not get a version of her that exists apart from that. Neither does she. That door is welded shut from both sides.

She has not been walking around free. She has been held for court-ordered treatment.

And then the one nobody puts on a chyron. She has to live knowing her own mind failed at the most fundamental biological imperative that exists. Not a moral failure. Not a character failure. A HARDWARE failure, in the one organ that was supposed to protect those children and instead turned on them. The parental instinct is supposed to be more reliable than a heartbeat. Hers stopped firing.

There is no prison in Massachusetts worse than the one she wakes up in.

— THE BRAVEST MAN IN THIS ENTIRE STORY

Patrick Clancy lost all three of his children in a single evening, and the person responsible is the woman he married.

He would have been entitled to burn the world down. Not one human being on this planet would have judged him.

Instead, days after it happened, he publicly asked people to show his wife compassion. He said the Lindsay he knew was loving and that what he wanted for her now was peace. He has since said he ”wasn’t married to a monster” but to someone who got sick.

Twenty-three years in uniform, plus the ambulance years, plus the classroom. I have been in a lot of rooms with a lot of people on the worst day of their lives.

I have never once seen that.

If the man who lost the most can get there, I am struggling to work out what excuse the rest of us are running with.

— WHY A MEDIC CARES ABOUT THIS FAR BEYOND ONE HOUSE IN DUXBURY

We have built a medical culture where a broken bone gets an X-ray and a broken brain gets a questionnaire. We image the femur. We survey the mind. And then we act astonished when psychiatry misses something.

That is not a shot at psychiatrists. Most of them are doing an impossible job with tools decades behind the rest of medicine. There is no glucometer for psychosis. There is no twelve-lead for a delusion. They diagnose by report and observation, and the patient in front of them is the least reliable narrator in the building precisely BECAUSE she is sick. That is not a character flaw in the patient. That is a SYMPTOM.

And I have watched this identical failure from a different angle for a long time.

I have watched us hand a soldier a stack of prescriptions from four different prescribers and call it a treatment plan. I have watched us take a man whose brain has been rattled by blast overpressure, starved of sleep for months, and marinated in adrenaline, and then act surprised when he does something the man he used to be would never have done. I have sat with families who said the exact sentence Lindsay Clancy’s family has been saying on the stand. That was not him.

Because it was not. The reason this breaks people is that we want moral agency to be a light switch. On or off. Guilty or monster.

Brains are not light switches. A brain is a dimmer with a short in the wiring, and when the short hits, the person you know is not driving.

If a soldier deserves our understanding when his damaged brain does the unthinkable, then so does a labor and delivery nurse in Duxbury. You do not get to apply that standard based on how sympathetic the defendant looks to you. That is not mercy. That is tribalism wearing mercy’s uniform.

— SO PRAY

Pray for Cora, Dawson, and Callan. They are with the Lord, and they are the only ones in this story who are genuinely at peace.

Pray for Patrick Clancy, who has to build an entire life out of rubble and has already shown more grace than most of us could successfully counterfeit.

Pray for both families, who lost grandchildren and a daughter in the same hour and now sit in the same courtroom.

Pray for those jurors, who got handed something no human being should have to carry home at night.

And yes. Pray for Lindsay Clancy. Not because she is innocent of the act. She is not, and she has never claimed to be. Pray for her because she is a human being who will spend the rest of her life in a wheelchair and inside her own memory, and because the God we claim to follow did not attach a list of exceptions when He told us who to pray for.

If your theology has a floor beneath which a person stops qualifying for prayer, I would gently suggest going back and checking whose theology that actually is. It is not the one in my Bible.

Mercy is not agreement. Mercy is not excuse. Mercy is not a verdict. Mercy costs you absolutely nothing, and it is the only thing left in this entire story that any of us still has to give.

— IF YOU ARE THE ONE WHO NEEDED TO READ THIS

If you are a new mother and something in your head is not right, and I do not mean sad, I mean NOT RIGHT, tell someone today. Today. Postpartum Support International runs a helpline at 1-800-944-4773, and 988 is answered around the clock.

And if the first door does not open, go kick the next one. Keep going until somebody actually listens to you. That is not weakness and it is not failure. That is the bravest thing a parent can do.

Also, husbands. Fathers. Look up from your phone. You live with her. You will see it before any fifteen-minute appointment ever will.

But what do I know. I am only a medic who has watched what a brain looks like when it stops taking orders from the person living inside it, and who learned a long time ago that it never once asks permission first.

IF THIS ARTICLE MADE YOU THINK:

LIKE this article so the algorithm shows it to people who need to read it. Some of them are new mothers who are frightened right now and have not told a soul.

SHARE this. Every share really helps get the word out. Use it.

COMMENT below with your take. Had you ever heard of allopregnanolone before today, and did anyone ever explain to you what actually happens to a woman’s brain chemistry in the forty-eight hours after she gives birth? Be honest. Tell me.

And if you want MORE of this, the data, the history, the science, the stories, JOIN Bski’s Classroom community or follow me on YouTube. Even better, subscribe to my account. It is about the cost of a cup of coffee per month. That is it. Your support keeps this classroom open.

Mike Borowski is a medically retired Army combat medic with 23 years of service, including a combat deployment to Iraq, and a high school Anatomy and Physics teacher at a high-need Career Technical district in Northeast Ohio — where he also wrote and published the textbooks for both courses. He runs “Bski’s Classroom,” a platform dedicated to cutting through political noise with data, history, and the kind of blunt honesty that comes from someone who has seen both war and the American classroom up close.

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