Login
By Roger McFillin, Psy.D.
Four months, seven prescribers, 13 drugs and not a single medical test. Three children are dead, and the profession that did this calls itself healthcare.
I have been called extreme for my views on psychiatry. Radical. Bellicose. Irresponsible. A psychologist who is going to scare people away from getting help.
So let us establish what the word means.
Is it extreme to sit across from a sleep-deprived mother of three children under the age of 5, whose complaint is anxiety and insomnia, and recommend a class of drug that carries a black box warning for emergent suicidality? A drug with poor efficacy and a range of adverse health effects?
Is it extreme to recommend an SSRI to a woman who is breastfeeding?
That these chemical compounds pass into milk is not in dispute. And we are not without data on what that means for an infant: serotonin acts as a growth factor in the developing brain, governing how neurons migrate and how circuits form, while nursing infants exposed this way have been reported to show irritability, poor feeding and disrupted sleep.
What we do not have, after 40 years of prescribing to nursing mothers, is a single study following those children into adolescence. She raised the objection herself, twice, and she was right both times.
Is it extreme to put that drug in her body without ever establishing whether she can metabolize it? The test is a cheek swab. The genetic differences that govern how a person metabolizes these drugs are common, and the consequences of getting it wrong can be fatal.
The forensic literature documents patients who metabolized these drugs slowly, developed severe akathisia on ordinary doses, and went on to suicide and to homicide.
Is it extreme to give that woman 13 psychiatric drugs in four months, and run more than 30 prescriptions through her body without ordering any medical tests?
Is it extreme to stop an SSRI cold after an adverse reaction left her awake for 48 hours straight, then hand her a second drug from the same class four weeks later, only to stop that one abruptly as well? And then, in a single afternoon, to start three new drugs on top of a taper she never finished?
Psychiatry is not a branch of medicine in the traditional sense. It wears the coat, and it uses the vocabulary, and it bills the codes, but it does not perform like other branches of medicine. It does not identify any physical abnormality, confirm it with a test, correct it, and measure whether the correction worked.
What it does instead is administer powerful chemical compounds that alter mood, cognition and perception, in combinations no one has studied, at doses whose biological effect no one has measured, to bodies whose capacity to process them no one has evaluated, and then attribute whatever follows to the patient’s illness.
They are drug dealers in the literal sense.
I have spent my career watching this. I am writing about it now because the record of Lindsay Clancy’s care is public, sworn and being read aloud in a courtroom in Plymouth, Massachusetts, while a jury decides whether she dies in prison for killing her three children.
Cora was 5. Dawson was 3. Callan was 8 months old.
In the four months before that afternoon, seven prescribers gave her 13 drugs across more than 30 prescriptions. She got worse on nearly every one of them, and she told them so. That is not a scandal within psychiatry.
That is psychiatry.
Nothing about this was mysterious. Follow it one appointment at a time, and the outcome is not only explicable, it was foreseeable from the second week. Let’s follow the record, and you draw your own conclusions.
1. The first appointment was not a medical examination.
Sept. 15, 2022. Lindsay Clancy meets a psychiatrist for the first time, over video. Nobody takes her pulse or her blood pressure. Nobody weighs her. Nobody looks at her.
No one draws blood, orders a thyroid panel, checks iron or B12 or vitamin D, or asks what she is eating while breastfeeding an infant. There is no physical examination of any kind, because there is no physical examination in this specialty, and the format of the appointment makes one impossible.
Hold that against the word doctor. Every other physician she could have seen that day would have begun with her body. This one began with a questionnaire.
2. The medicalization of human struggle.
She scores 23 on the Edinburgh Postnatal Depression Scale. The cutoff for probable depression is 13. Understand what that instrument is. Ten questions about the past week, each answered on a four-point scale, added together.
A woman indicates whether she has been able to laugh, whether she has blamed herself, whether she has been anxious or worried, whether things have been getting on top of her, whether unhappiness has made it hard to sleep. She circles 10 answers. The answers are summed.
That is the whole procedure. It is not a diagnostic test, and its own authors never claimed it was one. It is a screening questionnaire, designed by three researchers in the 1980s to help health visitors identify which new mothers might warrant an extended conversation and monitoring.
The cutoff of 13 is not some magical indication of a disease. It is a statistical tradeoff, chosen to catch as many affected women as possible while accepting a substantial number of false positives, and the numbers shift depending on which population you validate it in. Nothing in the body corresponds to a 13, or to a 23.
Now look at what a woman in her circumstances would score honestly. She has three children under 5 and an infant of 4 months. She is sleeping three hours a night. Her husband is working, and her parents have driven in from out of state because she needs hands in the house.
Ask her whether things have been getting on top of her. Ask her whether she has been anxious. Ask her whether she has slept badly. She answers truthfully, and the truthful answers generate a high score, because the questions are asking about her circumstances and the instrument has nowhere to record that her circumstances explain them.
An accurate description of an untenable situation goes in one end, and a number that means pathology comes out the other. The score cannot distinguish a woman with a disease from a woman with no sleep and no help, because it was never built to. It was built to start a conversation.
Nobody had that conversation. She was offered a drug at the first visit.
Zoloft is offered at that first visit. She declines. She is breastfeeding, and she wants to try therapy first.
3. Inexplicably prescribed a drug after reporting improvement.
On Sept. 30, she writes to that psychiatrist through the patient portal. The prosecution read the message to the jury.
She was not describing an illness. She wrote that she was not well enough to care for patients, that staying up all night on a hospital floor was not possible right now, and that she was just beginning to feel well enough to function without any drugs.
Read what she was actually saying. She was getting better. She had gone through this before, in 2019, when she declined the same drug for the same reason and the episode resolved on its own. Why? Because they almost always resolve on their own. This is called the human experience.
And her specific problem was not that she was experiencing a mysterious underlying “mental illness.” It was that a woman sleeping three hours a night cannot safely take responsibility for other people’s deliveries on a night shift. That is not a symptom of postpartum depression.
In the first week of October, she goes in to have her leave paperwork signed. There is no crisis in the record that week, no documented deterioration, no note explaining a change of mind. After that appointment, she starts the Zoloft. Why?
I stated on my most recent podcast episode that it is reasonable to conclude she took the drug in order to obtain the letter. There is no actual evidence for me to conclude that point other than I have seen this exact scenario throughout my career.
The clinician recommending the drug and the clinician certifying her unfitness for work are the same person. Leave certification rests on a diagnosis and a treatment plan. A patient who is “disabled” enough to be excused from work but is refusing the recommended treatment does not receive a medical leave from work.
That pressure exists whether or not any individual intends it, and it operates on every person in this country who needs a form signed by a medical professional who wants them medicated.
4. No tests were ordered to evaluate if she could safely metabolize the drug.
Roughly 2%-5% of people of European descent are poor metabolizers at CYP2C19, and 5%-10% are poor metabolizers at CYP2D6, the two enzyme systems used to process most of these drugs.
Although I would argue that you never prescribe these drugs to people with this profile, the Clinical Pharmacogenetics Implementation Consortium publishes dosing guidance for exactly this, recommending a reduced starting dose of sertraline in CYP2C19 poor metabolizers, and reduced dosing or avoidance of tricyclics in CYP2D6 poor metabolizers.
What happens when an impaired metabolizer is given a standard starting dose of an SSRI? We see an extremely dangerous adverse reaction, ones that are potentially fatal.
Sleep becomes a problem for many, and the clue is that her insomnia worsened after the drug was prescribed. Activation syndrome: racing thoughts, agitation, an inner restlessness that is frequently mistaken for mania and, in this field, recorded as one.
Akathisia, which is not restlessness in any ordinary sense but an unbearable internal agitation, a state patients consistently describe as intolerable and one long documented in the psychiatric literature as a driver of suicide.
Emotional blunting.
Dissociation, a sense that the world has gone unreal or distant.
Intrusive violent imagery.
Suicidal thinking arriving in a person who has never had it.
Hostility and aggression.
All of these are known adverse reactions to this particular drug. When she begins to experience exactly this … what happens?
5. Adverse drug reaction recorded as worsening mental illness.
And when Lindsay Clancy experienced 48 hours without sleep on 50 milligrams, it was written into her chart as anxiety. Ten days in, and one night after the dose was doubled, she does not sleep for 48 hours.
She reports the rest of it on Oct. 20 and her prescriber reads it back from the chart on the stand: she felt awful, insomnia worsening with the dose increase, no appetite, diarrhea, food unappealing, crying all day, which the note itself records as not normal for her, mental fog, racing thoughts overnight, and in her own words, paranoid of getting suicidal thoughts, something bad happening, does not want to be alone.
These are known adverse drug reactions! Agitation, insomnia, racing thoughts and emergent suicidal thinking following the initiation or increase of a serotonergic drug. It is the recognized precursor to the outcome the black box warning describes, and in a patient who may have a genetic vulnerability, evidence of iatrogenic harm.
At that moment, the correct clinical judgment was available and obvious. This woman was reacting badly to this class of drug, and the compound should have been identified as the cause of her decline.
I made the point on my podcast that a room of middle school children could work this out. Tell a 13-year-old that a woman was given a drug acting on a particular chemical in her brain and stopped sleeping for two days.
Tell her the drug was withdrawn and a second drug acting on the same chemical was given weeks later, and she got worse again. Ask what is causing it. A hand goes up, and the answer is the drug. Every time.
The child gets it right for one reason. Nobody has trained her out of it. She has not been taught that these compounds are medicine treating an underlying disease, so she has no reason to exempt them from suspicion. She has not learned the move where deterioration on a treatment becomes evidence of the illness the treatment was for.
She does not yet possess the vocabulary that lets a clinician write poor insight when a patient says a drug is hurting her.
That is the part people misunderstand about this profession. The training is not what allows a psychiatrist to see the problem here. The training is what prevents it. You do not need a medical degree to understand what happened to Lindsay Clancy. You need to not have one.
Now remember, no medical test has been ordered. No plasma level, no gene testing, no test of any kind. The reaction was written into the chart as anxiety, and with that single entry, the most important piece of information anyone would ever have about her nervous system disappeared from her record.
Explain to me how this is medicine?
6. Then she was given the same class of drug again.
Nov. 21. A nurse practitioner opens her chart, sees a woman with anxiety and insomnia, and prescribes Prozac.
This is the failure that every other branch of medicine is built to prevent. You do not reexpose a patient to a drug class that has already injured her. It is the entire reason adverse reactions are documented. And it happened here for one reason: the reaction had been recorded as a symptom, so the chart contained no injury to avoid.
Four days later, the insomnia intensifies and the Prozac is stopped abruptly.
7. Drugs abruptly discontinued, new drugs added, and a hospital warning that changed nothing.
On Nov. 25, four days after starting Prozac, the drug is stopped abruptly. The same day, three new drugs are started at once: Ambien, Remeron and Klonopin, on top of a benzodiazepine taper she has not completed.
Understand what abrupt discontinuation does. The brain immediately begins adapting to a drug’s presence by changing receptor number and sensitivity. Remove the drug and every one of those adaptations is left unopposed, producing a withdrawal state with its own timeline and its own symptoms, which look almost identical to the complaints that brought her in.
Start new drugs on top of it the same day, and no one can distinguish drug effect from withdrawal effect from underlying distress, because four variables have been changed in a single afternoon.
The next day she cannot tell what is real. She reports it immediately: the world unreal, distorted and distant, herself disoriented, forgetful, disconnected from her own body, unable to drive or be left alone.
Days later an antipsychotic is added. By Dec. 6 her husband is in the appointment saying she is 10,000 times worse since the drugs began, and the Seroquel is increased toward 400 milligrams a day.
On Dec. 21, she admits herself to the partial hospitalization program at Women and Infants Hospital in Providence, a specialty perinatal service, which is exactly where a postpartum woman in crisis is supposed to end up.
They do not admit her. According to her civil complaint, the clinical team concluded that her symptoms were more pharmacologically induced than depressive, that she was overmedicated, and that their program was not appropriate for her, because what she had was not postpartum depression.
That is the only correct assessment anyone made in four months, and it came from the one team that met her without a prescription pad already open. Their finding was not that she was too sick for the program. It was that she did not have the condition the program treats.
They then did what any competent service does. They called her prescriber. The complaint states the call was never returned.
Now follow the prescription record from there. The warning was delivered before Christmas. On Jan. 9, she was prescribed diazepam. On Jan. 12, trazodone. On Jan. 16, amitriptyline. On Jan. 23, the amitriptyline was doubled. Her children died the following afternoon.
A specialist team identified the cause in writing, weeks before anyone was dead, with no lawyer involved and nothing to gain by saying it. The information existed, it was documented, and it reached the edge of the system that could have acted on it.
Then the phone was not picked up, and the prescribing continued as before. That is what accountability amounts to in this field.
8. From there, the outcome was predictable.
Once you have a woman with a demonstrated severe reaction to a class of drug, the same class prescribed again, abrupt discontinuations, and multiple mind and mood-altering drugs started and stopped simultaneously, you have created severe disability.
Everything that follows gets read as her illness worsening, which produces more drugs, which produces more of what looks like illness.
This is standard psychiatry.
Every field of medicine makes mistakes. What sets this one apart is that it has arranged itself so that its mistakes cannot register as mistakes. She reported a severe drug reaction, and it was recorded as anxiety.
She said the antipsychotic was making her numb, and her psychiatrist testified that she lacked insight, on the simple fact that Clancy was worsening.
Her husband sat in the room and said she was “10,000 times worse,” after which the dose went up. As if more drugs would improve her situation. Make this make sense?
Understand, too, what these horrible drugs do at their best, which is the part nobody says out loud. They blunt emotional states. They restrict. Lindsay Clancy described it herself: she was numb, she could not feel love, she could not feel fear.
The treatment only makes sense if you believe her emotions were the problem, that a mother’s anxiety, worry and sleep difficulties are chemical malfunctions to be dulled rather than signals to be understood. Chemical sedation is not mental healthcare.
What you just read is not some outlier of poor psychiatric care. This is psychiatric care. Fifteen-minute appointments, a prescriber who never sat in a room with her, a benzodiazepine for anxiety, an antipsychotic for insomnia, and escalation whenever symptoms worsened. Drugs prescribed again and again after adverse reactions.
The only reason you are reading about this case at all is that three children are dead and the record became public. The rest of it never surfaces, whether that is the suicide recorded as death by mental illness, the withdrawal state logged as relapse, or the crisis that would have passed in six months turned instead into a lifelong prescription.
A courtroom in Plymouth is now arguing over whether Lindsay Clancy is criminally responsible, which is the wrong question, and it is wrong in a way that lets the rest of us off the hook.
The right question is how a profession that does not provide medical examinations, that rests on a claim about brain chemistry it has never been able to support, and whose history is a sequence of catastrophes, from the lobotomy to mass sterilization to drugging children, came to hold this much power over human beings.
She asked for help in September, followed the medical advice, and reported the adverse reactions to her providers. She went to emergency rooms, called crisis lines, and admitted herself twice, including to the most prestigious psychiatric hospital in the country.
She did every single thing a person is supposed to do, and she got worse at every step.
I want to leave you with one final thought.
This is the profession that could not recognize an adverse drug reaction in a woman who reported it to them for four months straight. This is the profession that wrote down poor insight after they harmed her with drugs. And this same profession holds the legal authority to declare you or me mentally ill and take away our freedom.
No medical examination is required to do it. No test confirms the label. No court sees you first. The judgment of the clinician in the room is sufficient, and you have just read what that judgment is worth. Do you trust their judgment?
They claim to be practicing medicine. They have never once had to prove it.
Cora. Dawson. Callan.
Our deepest condolences to the entire Clancy family.
AWAKEN
Originally published on Roger McFillin’s Radically Genuine Substack page.
Roger McFillin, Psy.D., is a clinical psychologist and host of the “Radically Genuine Podcast.”