MA v. Lindsay Clancy Day 19

Yes.

Jennifer Sprague (02:30:29):

You can finish.

Dr. Kirk Heilbrun (02:30:35):

So she was not going to remain in Women and Infants. And the next step that she took was hospitalization at McLean.

Jennifer Sprague (02:30:54):

And so if I could ask you a follow-up question now-

Dr. Kirk Heilbrun (02:30:55):

Yes.

Jennifer Sprague (02:30:56):

... before we go on to McLean-

Dr. Kirk Heilbrun (02:30:57):

Yes.

Jennifer Sprague (02:30:58):

... about Women and Infants. Were you able to review the Women and Infants records?

Dr. Kirk Heilbrun (02:31:02):

I was, yes.

Jennifer Sprague (02:31:03):

And looking at the Women and Infants records on page 9 I have here, it states that patient was offered several options for her, including inpatient treatment for medication management, a partial hospital program focused on general mental health or continued outpatient management. Patient plans to follow up with her outpatient provider for guidance. So even though they said she didn't necessarily fit into their postpartum program, they did offer her three other programs, correct?

Dr. Kirk Heilbrun (02:31:35):

They did, yes.

Jennifer Sprague (02:31:36):

And her response, Ms. Clancy's response, was that she was going to discuss that with her provider for guidance, correct?

Dr. Kirk Heilbrun (02:31:42):

Yes.

Jennifer Sprague (02:31:43):

And in reviewing the records of Dr. Tufts and Rebecca Jollotta, did you ever see any mention of the defendant actually following through with that and discussing with them those three options that were offered by Women and Infants?

Dr. Kirk Heilbrun (02:32:02):

No. What I saw is that they were back to being treated according to the plan and the medication and so on. But she was back to being treated, discussing with Dr. Tufts what the best implications were for treatment.

Jennifer Sprague (02:32:26):

Okay. And then you were about to talk about what happened at McLean. So if you could please tell us what you learned about McLean and how that was impactful to your analysis or your evaluation.

Dr. Kirk Heilbrun (02:32:37):

Yes. She was admitted to McLean on January 1st of 2023. And what got her there was suicidal thinking. That was very difficult for her. That was a very difficult time to experience that sort of thing. And so she went into McLean on January 1st and their admission documentation listed postpartum depression and major depressive disorder, which they described as recurrent and mild. While she was in McLean, what she reported as her primary concern was insomnia. And she said that while she was hospitalized, it actually made her more anxious than being at home. And when she was asked about the suicidal impulses and thoughts, she said that she would not commit suicide because of her children and her mother. So they asked about reasons for living among other things. And those were some of the ones that she cited.

Jennifer Sprague (02:33:45):

Doctor, would that be called a protective factor?

Dr. Kirk Heilbrun (02:33:49):

Yes. Sometimes it's called a protective factor.

Jennifer Sprague (02:33:51):

And that's something that protects you or prevents you from committing suicide?

Dr. Kirk Heilbrun (02:33:56):

Yes. Would keep you from doing something like that.

Jennifer Sprague (02:33:59):

And then what were your further findings?

Dr. Kirk Heilbrun (02:34:02):

So she stayed at McLean for five days. And she was documented as not having safety concerns and at minimal risk for returning to the community by January 3rd. She described her mood there as numb, but she denied things like delusions, or hallucinations, or suicidal thoughts that were continuing, or homicidal thinking. And at the time she was discharged on the 5th of January, she was described as cooperative and pleasant with no psychosis, no suicidal or homicidal thinking. And she said when I was asking her about it, that when she left McLean, she had what she described as a small shred of hope after discharge because she was off of medication Seroquel, which she thought was causing her a lot of trouble. But the intrusive suicidal thoughts returned, she said, within a week or so following her discharge from McLean.

Jennifer Sprague (02:35:16):

And would we be moving on now to number three on your PowerPoint?

Dr. Kirk Heilbrun (02:35:22):

Yes, we are.

Jennifer Sprague (02:35:22):

Symptoms following the beginning of medication. So what were your major findings in that area?

Dr. Kirk Heilbrun (02:35:28):

Well, I think I've combined two and three as I've talked about this. Because one of the things about this is after she started taking the medication in October, the Zoloft, the anxiety didn't get better. She had great difficulty with insomnia. And she said she was numb. She felt like a zombie. It wasn't something that she was able to see any improvement in. In fact, she thought it was getting a lot worse. And so basically what she thought is that the symptoms that she was experiencing following taking the medication that was prescribed beginning in October, she said the symptoms were getting worse, particularly a new symptom, which was insomnia.

Jennifer Sprague (02:36:34):

We can move on to the next slide. Doctor, and does that bring us to number four on your PowerPoint, the adverse response to medications, including bad insomnia?

Dr. Kirk Heilbrun (02:36:44):

Yes. And I won't take nearly as long in talking about that because one of the things that she thought was happening when she began taking that medication in October is that the medication itself was far from making the anxiety better. It was making it worse and keeping her from sleeping. And it was, she thought, making it difficult for her to... She thought that the medication was actually making it a real problem for her to sleep, to feel she felt emotionally numb and that sort of thing. And so accompanying the bad insomnia with the apparent adverse responses, producing the insomnia and other things was a real problem for her as she saw it. And it's one of the things that she continued to emphasize to providers, whether it was Dr. Tufts or Ms. Jollotta, a nurse practitioner. She said, basically, "I think these medications are making me worse."

(02:37:57)
But one of the things, moving on to number five there, one of the things she also said is that she was focusing on making the anxiety, helping the anxiety get better through medication. There was a little bit of counseling going on with Ms. Jollotta, but one of the things that she did not really have was say a cognitive behavioral therapist or something like that to help her work through the problems. She thought that medication was going to try to help. And it really did. It was something that she focused on a good deal.

Jennifer Sprague (02:38:44):

And when you say the defendant was focused on medication resolving her problems, would that include talking to doctors about different medications to try, researching medications on her own, asking friends and family for tips on medications, things like that?

Dr. Kirk Heilbrun (02:39:02):

Yes, all of those things.

Jennifer Sprague (02:39:05):

Okay. And then should we move on to number six, the mixed evidence about diagnosis and the nature of her problems?

Dr. Kirk Heilbrun (02:39:12):

Yes.

Jennifer Sprague (02:39:12):

And what were your major findings in that area?

Dr. Kirk Heilbrun (02:39:20):

Excuse me just a moment. Over the course of the time that she was going through these experiences between mid-October and late January, she'd had a lot of providers offer a lot of diagnoses and there were a lot of complicating considerations. So among some of the diagnoses that she'd been given were adjustment disorder with anxiety and depression, generalized anxiety disorder, major depressive disorder, bipolar disorder, bipolar disorder II, postpartum depression, postpartum psychosis, post-traumatic stress disorder. That last one was not before January of 2023, but it's something that she has right now. And in addition to those diagnoses, which sort of implies that she has a disorder and she has symptoms, there were complicating factors.

(02:40:49)
She had psychotropic medication with apparent adverse reaction. She had serious sleep deprivation over a three-month period. She had between five and eight months after the birth of her third child. She had anxiety about returning to work in the fall of '22. She was worried about leaving her baby for work and he was not taking the bottle. And the other thing which was important for her is she was always someone who was, she was into exercise. And she stopped exercising sometime in October when she started having these adverse reactions. But it's one of these things that it was a real difficult thing for her to handle when she couldn't do the running, or the yoga, or the Peloton, or other things that she used to keep her anxiety managed.

Jennifer Sprague (02:41:47):

Were you aware that she was able to return to exercising on several dates in December and in January going to the Kingsbury Club where she was a member?

Dr. Kirk Heilbrun (02:41:59):

Yes. She was trying that, yes.

Jennifer Sprague (02:42:00):

Yeah. And is that something that, as putting on your clinician hat for a moment, is that something that you would recommend to a patient in this situation that they try to do things like exercise to compliment medication and therapy?

Dr. Kirk Heilbrun (02:42:14):

Well, if it works, it does work for some people and they use it effectively over the course of their lives, particularly if they have some anxiety that might not fully need treatment, but it's something that might interfere with your life a little bit.

Jennifer Sprague (02:42:29):

And what were your next observations?

Dr. Kirk Heilbrun (02:42:34):

Well, if we could move on to the next slide, please.

Jennifer Sprague (02:42:40):

So here we have number seven, your diagnosis, bipolar II disorder. So was that your diagnosis of Ms. Clancy?

Dr. Kirk Heilbrun (02:42:47):

It was. And it was hard because of all the diagnoses in the records and all the symptoms that she experienced and so on. To make a diagnosis of bipolar disorder or bipolar II disorder, which is kind of a less serious way of experiencing bipolar disorder, you have to have identifiable mood swings. And one is a period of depression, which she certainly had, but a period of depression. And that was something that made a big difference over a certain period of time in depressed symptoms and sadness and not having much motivation and things like that. But you also, for a bipolar diagnosis, need something where you have an identifiable period where the mood is much greater. One of the things that I might say is that one feels during a manic period, sort of high, jumpy, decreased need for sleep, racing thoughts, sort of flight of ideas, thinking really fast, excessive appetites for different kinds of things, not getting tired, feeling important and powerful, and things like that.

(02:44:26)
And I was having a hard time finding something that looked like it was a manic episode. There were times when she felt, as she described it after the birth of different children, she felt good. She felt on top of the world. She felt really close to them, her husband and her kids and so on. But it's also something that it didn't look like a manic episode so much as it looked like she was really feeling good and getting back into exercise and things like that. So it's-

Dr. Kirk Heilbrun (02:45:00):

Exercise and things like that. So it's one of those considerations where the thing that sort of gave me pause for a while in diagnosing a bipolar disorder is that I didn't see that manic episode. But what really convinced me is that she's been at Tewksbury now for more than three and a half years. And the diagnosis of record at Tewksbury is bipolar disorder. And they are, as I read the records, very careful about what they prescribe and how much and various other kinds of considerations. And one of the things that the records reflect is that when she was on some medication that's prescribed to help stabilize her mood and it was discontinued for medical reasons, she had a kind of immediate response to that, which is to say she noticed it and that's a consideration as well. So I ended up with a diagnosis, making a diagnosis of bipolar two disorder, which is a slightly less... Not slightly, it's a less severe form of bipolar disorder.

Jennifer Sprague (02:46:21):

And Doctor, why did you diagnose with bipolar two and not bipolar?

Dr. Kirk Heilbrun (02:46:27):

Because bipolar, as I said, is a more severe kind of diagnosis. It's more noticeable. And if you had a bipolar diagnosis, then I would want to see something that clearly and definitely looks like a manic episode. And I did not see any evidence of that before January 24th of 2023.

Jennifer Sprague (02:46:53):

And there were some incidents that have been described by witnesses who have testified and in the medical records, things like the defendant cleaning out her garage with her husband at one point in time. Was that something that you did or did not see as manic and why?

Dr. Kirk Heilbrun (02:47:08):

Well, there was some indication in the records that some people thought it was manic. I did not see it that way. She did not describe when I asked her whether... She did not describe that as a manic episode. She didn't think it was. And when I talked to Patrick Clancy, he said he didn't think it was either. And basically it was cleaning out the garage and getting a lot of stuff into 20 trash bags and so on. But one of the things he said is they were both working hard, but it wasn't all her out there putting stuff in 20 trash bags and he wasn't a part of it. He said he was definitely a part of it.

Jennifer Sprague (02:47:51):

Okay. And would it be accurate that bipolar disorder requires that period of mania for, I believe it's seven days, where bipolar two requires hypomania for four days? Is that right?

Dr. Kirk Heilbrun (02:48:06):

Yes, that's right.

Jennifer Sprague (02:48:08):

And so did you see signs of hypomania?

Dr. Kirk Heilbrun (02:48:12):

Well, that's something where it's less clear that it's manic. And that's one of the things that inclined me toward bipolar two is I just did not see signs that were clearly manic episodes, but it looked like something that it possibly could have been a less serious or less severe manic episode.

Jennifer Sprague (02:48:35):

And in terms of this diagnosis, this bipolar two, is there a way to determine whether she always had this disorder or if it's something new, and if it's something new, when it appeared?

Dr. Kirk Heilbrun (02:48:54):

It's a disorder that typically comes on in adulthood. It's not something that you have as a kid or even for the most part as an adolescent. It's something that you start to show the signs of when you are in your 20s or 30s.

Jennifer Sprague (02:49:15):

Okay. And so at this point, would it be time to move on to number eight on your PowerPoint?

Dr. Kirk Heilbrun (02:49:20):

Yes.

Jennifer Sprague (02:49:21):

Which would be criminal responsibility evaluation. So mental state and legal standard are relevant. So what were your findings on number eight?

Dr. Kirk Heilbrun (02:49:30):

Well, one of the things that I wanted to say about number eight is that I wasn't called up here just to make a diagnosis or talk about symptoms. This is a criminal responsibility evaluation. And one of the things that I take a look at very carefully when I'm doing something like this is what's the standard for criminal responsibility in the jurisdiction? Now, I'm aware that the court will instruct the jury about the standard and how you apply it and so on, but my understanding of the standard for criminal responsibility in Massachusetts is that a person is not criminally responsible if at the time of the offense they suffered from a mental disease or defect, and as a result lacked substantial capacity either to appreciate the criminality or wrongfulness of their conduct, or to conform their conduct to the requirements of the law.

(02:50:35)
So there were really three parts. There really are three parts to that criminal responsibility standard. The first is mental disease or defect, and that's one of the reasons why I've paid so much attention to the symptoms and when they began and things like that. But the other thing that I try to do is take those symptoms and see how they affect somebody, in this case Ms. Clancy's capacity for knowing that something like this was illegal or wrong, or how they affected her capacity for conforming her conduct to the requirements of the law, which I think of as kind of controlling her behavior.

Jennifer Sprague (02:51:24):

Is that something that... Those three elements, are those things that you kept in mind throughout your evaluation of the records and your interview of the defendant and the psychological testing that you did?

Dr. Kirk Heilbrun (02:51:35):

It is, yes. And it's something that I put on page one of my report because I always try to do that to try to make it as clear as I can that this is something I'm paying attention to throughout the entire evaluation.

Jennifer Sprague (02:51:48):

So that's your mindset when approaching the evaluation of Ms. Clancy?

Dr. Kirk Heilbrun (02:51:52):

It is, yes.

Jennifer Sprague (02:51:54):

Okay. And so what types of psychological testing did you do with Ms. Clancy?

Dr. Kirk Heilbrun (02:52:14):

There were several reasons why I wanted to do psychological testing. One is what we call response style. In a matter like this, somebody like Ms. Clancy during an interview could respond what we call reliably, which is within the limits of her memory as accurately as she possibly can. But there are other response styles. One is that somebody could do what we call exaggeration or even fabrication. Sometimes that's called malingering, which is they distort or they take the kind of report that they do and they exaggerate or even fabricate the severity of what they are experiencing. And then the other kind of response style is to under report. Basically to say, I'm going to minimize or even deny things that I actually experienced. So response style is always important in doing a forensic evaluation like this, and I paid attention to it. And one of the psychological tests that I administered, something called the Minnesota Multiphasic Personality Inventory, has scales that allow me to look and say, is she being kind of reliable or is she exaggerating or fabricating? Or is she minimizing or denying?

(02:53:44)
So that was one of the reasons that I wanted to do these tests. The second is I wanted to pay attention to possible symptoms of what we call severe mental illness, things like hallucinations or delusions or mental disorganization. They can't really kind of focus on what's being discussed so much as you tend to get off track or have tangential speech, which is kind of running off the topic and going to different ways and so on. Cognitive disorganization is another speech. There's also review of her reported symptoms around January 24th of 2023, and I wanted to ask her questions in a fairly comprehensive way about that. There are other symptoms that she was experiencing reportedly, depression in particular, and I wanted to know how depressed she was feeling. And so that was something that I could also measure with these psychological tests. And then finally, suicidal thinking was quite important. And I wanted to ask her questions about her thinking and feeling and behavior related to suicide kind of leading up to January 24th and then around that time. So these are all reasons why I gave her psychological tests.

Jennifer Sprague (02:55:17):

Can I have you pause there for just for a moment?

Dr. Kirk Heilbrun (02:55:19):

Yes.

Jennifer Sprague (02:55:19):

I'm not sure if it's a good time to break.

Judge William Sullivan (02:55:22):

It's a good time to break. All right. Why don't we do that? Thank you. All right. So members of the jury, we're going to take the afternoon recess at this point. You know my instructions, so they're going to be the same. Don't talk about this case. Don't do any research about this case. Don't listen to anything about it. Don't read anything about it. Have a nice break and we'll have you come back here about two o'clock. Okay?

Prosecution (02:55:44):

Court, all rise. All rise please. Jury, close your notebooks. Place them on your chair. [inaudible 02:55:58].

Judge William Sullivan (02:56:23):

All right, Doc, you may step down. All right. Anything we need to address before two o'clock?

Jennifer Sprague (02:56:30):

No, Your Honor.

Judge William Sullivan (02:56:30):

All right. So we'll be in recess until approximately two o'clock.

Speaker 6 (02:56:39):

This court is back in session. You may be seated. All rise.

Speaker 7 (02:56:43):

[inaudible 02:56:43] return back to the trial [inaudible 02:56:44].

Clerk (02:56:45):

Commonwealth versus Lindsay Clancy. All parties are present, excluding the jury.

Judge William Sullivan (02:56:47):

All right. Counsel, we all set for the jury?

Council (02:56:49):

Yes, Your Honor.

Judge William Sullivan (02:56:50):

All right. Yeah, bring them in.

Prosecution (02:57:43):

Court all rise. Jurors entering. This court is now in session. Please be seated.

Clerk (02:57:45):

Your Honor, for the purpose of the record, we return back to the trial. Commonwealth versus Lindsey Clancy. All parties are present, including the defendant and including the 18 jurors.

Judge William Sullivan (02:57:53):

All right. Thank you, Madam Clerk. Members of the jury, we're going to return now to the direct exam of this witness. All right. Counsel?

Jennifer Sprague (02:58:00):

Thank you, Your Honor. Doctor, before we broke, you were describing the various psychological tests that you conducted on Ms. Clancy. Can you tell us the results of those tests?

Dr. Kirk Heilbrun (02:58:10):

Yes, I can. On the MMPI, which I spoke about first, and this was, of course, three and a half years after the alleged offense, so much of it is going to describe her thinking and feeling and behavior in April of 2026 rather than January of 2023. But it's something that's always a challenge when you try to reconstruct what happened some time ago. And so some of these tests were administered from the standpoint of what was it like for you back then? But the MMPI was delivered in terms of how you're doing right now. And she, on the response style scales that I talked about earlier, she showed a slight tendency to under-report, to deny unusual experiences. Although she did that in a way that was pretty sophisticated. She's a bright woman. And so given this, we kind of take into account a little bit the fact that she might be under-reporting a little bit in terms of what's really wrong with her.

(02:59:37)
However, there are a number of what we call clinical scales on this test, and she was not elevated on any of them, meaning that she's not actively symptomatic in many areas or in great distress in certain ways. But there was one scale that is elevated, and that is the suicide and death ideation scale, thinking about suicide and death. And I should say that Ms. Clancy has been on one-to-one suicide precautions, which is the highest level of precautions that a hospital can take since she came to Tewksbury. This is a very long time to be on that kind of precautions. And what it says to me is that she was at risk for suicide. She remains at risk for suicide. And so she still is. The Adverse Childhood Experience Questionnaire I mentioned earlier, basically it's a measure of whether somebody is reporting experiencing as a child or adolescent adverse or traumatic events. And she was not. So she had a zero on that.

(03:00:57)
There were two measures of suicide intent. One is called Beck's Suicide Intent Scale, and the other is called the Columbia Suicide Severity Rating Scale. And I can sum up those results very quickly by saying that when she responded to one of them as she would have if she'd been filling it out in January of 2023, what it suggested is that this was a very serious suicide attempt at that time. And when she responded to both of them as she feels right now, she also was indicating that she remains at high risk for suicide, and hence the one-to-one supervision for three and a half years.

(03:01:57)
The brief symptom inventory is something where you ask people about a number of possible symptoms that they've been experiencing within the last month or so. Gave it to her under two circumstances. One is how are you doing right now? That is around April of this year. And the other was, how were you doing in January of 2023? Her description of how she was doing in January of 2023 is that she endorsed feeling blue, still extremely depressed, feeling no interest in things, thoughts of death or dying, feeling hopeless about the future, feeling very self-conscious with others, and the idea that something is wrong with her mind. She thought depression, suspiciousness, memory problems, problems with attention and concentration and things like she was having trouble concentrating so she'd be cooking, for instance, and she'd forget what steps she was on. So most of these are consistent with symptoms of depression. And so I thought that they were good indications that she was endorsing feelings of depression, although she was improving somewhat from her December feelings.

(03:03:28)
Something called the obsessional beliefs questionnaire has three scales. One scale is kind of responsibility threat estimation, which is a belief about your personal responsibility and overestimation of threats. She was not elevated on that. A second was perfectionism and certainty. She was not elevated on that either, although she works hard and so on, but she was not elevated on the perfectionist aspect of this test right now. However, she was elevated on something called importance and control of thoughts, meaning that for her, it's always been important to be able to work hard and control what's going on with her mind and her life. And one of the things that I'm going to talk about in a few minutes that I think was making her depressed and hopeless and sad and so on is that she had been trying very hard since October to basically control the problems that she was having and it wasn't working. It was not succeeding for her.

(03:04:47)
Okay. And then there was something called the Lahoney Slade Hallucination Scale. And so she endorsed the following things. Sometimes a passing thought will seem so real, it frightens me. Sometimes I get distracted trying to concentrate on my work. That was something she endorsed back in '22 and '23. In the past, I've had the experience of hearing a person's voice and then found there was no one there. That was only on January 24th. I often hear a voice speaking my thoughts aloud again, only on January 24th. I've been troubled by hearing voices in my head again only on January 2024th. All right. So those were the psychological testing results. And I'm going to move to the last item on the PowerPoint here, which is why it was important for me to consider her motivation for killing her children. And this is something that if you look at Lindsay Clancy would be described as so out of character that I'd just like to know what could possibly have been going on.

(03:06:13)
Because for instance, when I talked to her and talked to her husband as well about how do you discipline your kids? It was never spanking. It was never hands-on. It was never anything like that. They both felt bad when they yelled at the kids. So it was one of those things that to imagine her doing something like this really seems so out of character that I thought it was very important to try to figure out why it might have happened. So this is how I approached it. The other thing about the why question is it could well be something that is valuable to know when we're thinking about whether she understood that something was wrong or when she was thinking about whether she could conform her conduct to the requirements of the law or control herself. The why question seemed important. So if I could have the next slide.

Jennifer Sprague (03:07:20):

Sure. And in evaluating the why, did you come up with two possible explanations?

Dr. Kirk Heilbrun (03:07:29):

I did, yes, which is on this slide.

Jennifer Sprague (03:07:31):

And so can you explain that please?

Dr. Kirk Heilbrun (03:07:32):

I can, yes. There are a number of reasons in my experience why people harm one another, why people kill one another. And most of these reasons ended up not applying to Ms. Clancy. I mean, it wasn't job related. She wasn't in the military. Didn't have to do with money or property or fame or anger or being callous or abusive or being afraid or doing... None of those there was any evidence for. But there were a couple of things that started to have some evidence for, and this is what it looked like. One is the psychosis, the possibility that she had a severe mental illness experiencing hallucinations, delusions, that sort of thing. And as part of that on January 24th, experienced those symptoms that we're going to talk about in a minute. And I'm calling that the first bullet point there, acute psychosis with command hallucinations.

(03:08:40)
The second possible explanation was as part of an attempt to take one's own life as part of a suicide, one might harm one's children if you thought that would prevent them from suffering. And let me see if I can give you an example of that. If one of us were to learn and we had no doubt in our mind that the Holocaust was coming tomorrow, and we thought that was going to be awful and I can't live through that and so I'm going to take my own life. If I had children, the question might come up, do I take them with me? Do I take their lives as well? Now, I'm not saying that I would definitely do that, but what I'm saying is that it would come up as a possibility in what I thought about. And so there ended up being, in my mind, two possible explanations for why she did what she did.

(03:09:51)
The first being the acute psychosis with command hallucinations. And the second being this was a serious suicide attempt and she wanted the children to be with her so she wouldn't be separated from them and so they wouldn't have to suffer after she was gone. Now in a minute, I'm going to talk about the evidence that I saw supporting each of those. But I will tell you right now in advance of talking about that, that most of the evidence that I saw supported the second one and not the first.

Jennifer Sprague (03:10:26):

And so doctor, if we could go to the next slide and you could talk to us, tell us what evidence you saw for acute psychosis with command hallucinations.

Dr. Kirk Heilbrun (03:10:38):

Yes. The first was that's what she said. I asked her that question and that's the way she explained it happened. She said sometime on the afternoon of January 24th, 2023, that she heard a voice and the voice said, "This is your last chance. You have to kill the kids so you can kill yourself." If she actually heard a voice like that, that would be evidence of psychosis being experienced and what we call command hallucinations where the voice is instructing her to do something. There were some other possible things that made me think that it could be a severe mental illness that she was experiencing and two in particular. One was thinking that others might know her thoughts. Now, this is something that is a symptom of psychosis called thought broadcasting if it's experienced in a certain way. In thought broadcasting, if I'm experiencing that, I literally have the idea that if I'm thinking it, you can hear what I'm saying just as if I were putting it on the television or a podcast or a movie or whatever. It's just coming out that way.

(03:12:17)
I asked her about that and other people ask her about that too and she said it was not thought broadcasting, but these were very vivid thoughts. And she thought that it might be that people could hear them as vivid and strong as they were. The second possible symptom is that thinking police might take her children. Now, in some of the records I saw people saying, well, this looks like a paranoid delusion to me. And I will tell you that it didn't look either paranoid or like a delusion to me. And here's why. I'm a healthcare professional. And that means that in Pennsylvania and every other state I know, I'm a mandated reporter. If someone tells me in therapy or in an assessment that they think that a child is going to be injured or severely hurt or that might happen, then I'm required by law to contact child line in Pennsylvania. Ms. Clancy is a labor and delivery nurse. She's a healthcare professional as well. And so it's one of those things where if she had said to a psychiatrist, psychologist, anyone providing treatment that she thought she was experiencing ideas like she might harm her kids, she would know as a mandated reporter that they were legally required to report that. Now that might not mean that the police would literally come and take her kids away, but it would mean that there would be an investigation. She would have to answer questions. And it might be that for a period of time she would be separated from the children.

Jennifer Sprague (03:14:12):

And doctor, is it-

Speaker 8 (03:14:13):

Well, can-

Jennifer Sprague (03:14:15):

I thought he was done.

Judge William Sullivan (03:14:16):

I don't know. Well, we'll find out. Were you done?

Jennifer Sprague (03:14:23):

I just want to ask a follow-up question about your last point. Is that okay?

Dr. Kirk Heilbrun (03:14:26):

Yes, that's okay.

Jennifer Sprague (03:14:28):

And so you mentioned you didn't think it was a delusion. Is it true that a delusion is a fixed false belief?

Dr. Kirk Heilbrun (03:14:36):

Yes, that's the way it's defined.

Jennifer Sprague (03:14:38):

And so Ms. Clancy, thinking that if someone knew she thought of harming her kids, her kids might be taken away, that's not a false belief, correct?

Dr. Kirk Heilbrun (03:14:49):

Well, that was what I was trying to say is that it is not a false belief. It's quite possible that it could come to pass.

Jennifer Sprague (03:14:56):

Okay. And if you could continue with your discussion of the evidence you saw for acute psychosis.

Dr. Kirk Heilbrun (03:15:03):

Yes. The other point there at the bottom is that it's appealing as an explanation because it could explain acts that seem so out of character for her. You don't have to get complicated at all. It's just, I had a psychotic episode, I heard a voice, voice told me to do something terrible, I did it.

Jennifer Sprague (03:15:27):

And after considering the evidence for acute psychosis command hallucinations, did you then consider evidence against acute psychosis with command hallucinations?

Dr. Kirk Heilbrun (03:15:40):

I did, yes.

Jennifer Sprague (03:15:41):

And what did you see?

Dr. Kirk Heilbrun (03:15:43):

One of the reasons, well, the first bullet point here is that the way she described this as happening is that she heard a voice that she'd never heard before, experienced an hallucination. And she's never experienced it since, but she only experienced it for the 18 minutes or so that it took to kill the children. And to put it mildly, that would be a very, very unusual pattern or manifestation of how this kind of thing comes about. Very unusual. I've been doing this kind of evaluation for many, many years and I'm always very careful when someone tells me that they experienced a symptom only during the course of committing an offense.

Jennifer Sprague (03:16:40):

Why is that, doctor? Why are you careful when someone tells you that they only experience this voice during a criminal offense?

Dr. Kirk Heilbrun (03:16:51):

Well, because it provides a convenient way of lessening your own culpability. I mean, it's always possible, but as I said, I find it very, very rare. Whereas an explanation for why somebody did something, somebody might look at that and say, it's a convenient way of somebody looks at me and I don't have the same culpability that I would otherwise.

Jennifer Sprague (03:17:26):

And what was the next part of evidence that you saw against acute psychosis?

Dr. Kirk Heilbrun (03:17:32):

There was some discussion of whether this was postpartum. And so she was about eight months away from having given birth to Cowan, her youngest child. And most of the explanations or most of the sources of authority like DSM-5 or the Cleveland Clinic will point to maybe one month after birth or two months after birth or something like that. But the...

Dr. Kirk Heilbrun (03:18:00):

Birth or two months after birth or something like that. But the farther away you get time-wise from the birth, the less likely it is under those kinds of authority to be postpartum. Now it could be something else. And there were certainly some things that I saw that were symptoms of depression and other sorts of things that she experienced in January, but it was given the time, it was less likely, I thought, to be postpartum. Then the next bullet was inconsistencies in her account. To me, when asked about this, she said the voice said, "This is your last chance. You have to kill the kids so you can kill yourself." And it just kept repeating that. And only that, and only that for about 18 minutes or the duration of the time it took to do this.

(03:18:59)
There were other times though, for instance, when she was in the hospital after this happened and was talking to a psychiatric attending, when she said that the voice had said other things, for example, "The children will suffer without you or you have to take the kids with you," or things like that. So inconsistency is important because it suggests inaccuracy. In other words, which version is accurate? Is it the first? Is it the second? Is it neither? I mean, here it couldn't be both because she said, "I only heard this," to some people she said that. And then, "I heard this, plus this," to other people; she said that.

Jennifer Sprague (03:19:49):

And Doctor, if she had said to a third person that it was a different version, such as, "You have to kill the kids so you can kill yourself because there's a danger to you and the kids," would that be a further consideration of the inconsistencies?

Kevin Reddington (03:20:05):

Objection.

Judge William Sullivan (03:20:06):

Yeah. Overruled, defense.

Dr. Kirk Heilbrun (03:20:10):

The more inconsistency there is-

Kevin Reddington (03:20:13):

Can we have a basis for that at least?

Judge William Sullivan (03:20:16):

Go ahead. Was it asked as a hypothetical?

Jennifer Sprague (03:20:18):

Hypothetical, yes.

Judge William Sullivan (03:20:19):

I'll allow that.

Kevin Reddington (03:20:21):

So it's not based on evidence. It's a hypothetical.

Judge William Sullivan (03:20:23):

It's a hypothetical.

Dr. Kirk Heilbrun (03:20:27):

You might have to repeat the question.

Jennifer Sprague (03:20:29):

So if the person has a third version of what happened, what the voice said, and what the reasons the voice gave, would that be important in your assessment as well regarding inconsistency?

Kevin Reddington (03:20:42):

Objection. It's speculation. It's not based on evidence, and there's no foundation for a hypothetical question.

Judge William Sullivan (03:20:49):

Just ask it as the hypothetical. Assuming this and go that way.

Jennifer Sprague (03:20:55):

Doctor, a hypothetical question for you. Assuming that a person has already given two versions of a voice, what the voice said for them to do, and then gives a third version of what the voice told them to do, would that be significant to you in assessing the inconsistencies?

Kevin Reddington (03:21:13):

Objection for the record.

Judge William Sullivan (03:21:14):

Yeah. Overruled. Go ahead.

Dr. Kirk Heilbrun (03:21:16):

What I would say is the more inconsistency there is, the more problematic I find it to take any one particular account and say this is the accurate one.

Jennifer Sprague (03:21:28):

And then what other evidence did you find against acute psychosis?

Dr. Kirk Heilbrun (03:21:38):

There is some research that's been conducted on malingered hallucinations, which are counts of hallucinations that are exaggerated or fabricated. And I found it useful to look at that research and see what it suggested and kind of laid out there in terms of the way she described it. So some research suggests that one consideration is whether the voices are internal or external, whether they're coming from your own thoughts or whether they're coming from outside of your head. And Ms. Clancy perceived this voice as external, which is more consistent with genuine hallucinations. However, command hallucinations are often in about 88% of individuals reporting them by one account, accompanied by a related delusion.

(03:22:38)
Ms. Clancy did not report any accompanied delusions. So thus far you've got one point for genuine and one point for possible exaggerated. Then there's frequency and control. Genuine psychotic hallucinations are more often intermittent than constant. They'll come and they'll go. You'll hear it. Stop hearing it. You'll hear it again. Stop hearing it. And this can extend over a period of time. Ms. Clancy, in this instance, reported that the voice was constant for 18 to 20 minutes, and then it stopped. It had not been experienced before, and it has not been experienced since. And she also did not report having any control over the voice or over her actions in response to the voice.

(03:23:29)
Then the next item is content. So genuine hallucinations are often familiar, use both genders, and are clear rather than vague. Ms. Clancy described this voice as clear, but it was unfamiliar and it was a single male voice. So that was sort of mixed. I'm not counting it as one direction or another. And then finally, reaction and coping. Individuals who experience hallucinations like this often try to reduce their influence in different ways. Could be praying, could be listening to music. And while those who inaccurately report the experience of such hallucinations often do not describe coping mechanisms. And Ms. Clancy didn't report any attempt to stop the voice or distract herself from it or what have you. So there were about three points on which her account more closely resembled exaggerated or fabricated hallucinations. One where it looked more genuine and one that was kind of mixed.

Jennifer Sprague (03:24:37):

If I could ask you a question, you said that there were more points indicating malingering or exaggerating the existence of the voice. But earlier you testified about your psychological testing of Ms. Clancy, and it showed minimization, and it didn't show malingering. Could you explain how those two things could occur in the same person at the same time?

Dr. Kirk Heilbrun (03:25:00):

Yes. When we try to appraise through testing or specialized measures something that looks like malingering or exaggeration, the way we typically do it as psychologists who develop the measures is it looks like somebody who is going to take a shotgun approach. They're going to say unusual things are wrong and strange things are wrong and many things are wrong and things like that. If you do that, we're pretty good at picking up that shotgun approach to malingering. But if I ask you a bunch of questions and you answer them almost entirely in a genuine way, that you're being as accurate as you can, except with one exception, when I ask you about one experience or one symptom and you exaggerate or fabricate that, we can't pick that up through our testing. So what we have to do instead is we have to kind of develop our ideas about how it might have been experienced, what it was consistent with what the disorder is. We take a broader approach, which is what I've tried to do in talking about this.

Jennifer Sprague (03:26:13):

We'll go to the next slide, please. And was there further evidence against acute psychosis?

Dr. Kirk Heilbrun (03:26:25):

Yes. I'm going to start with the question of thoughts or hallucinations. I've already said that I found the account of hallucinations to be, as she described it, it would be very, very unusual to experience it that way. Never having not before, not since, constantly for 18 minutes. However, if this was a thought, an unwelcome, intrusive thought, but still a thought, that's basically, "This is your last chance. You have to kill the kids so you can kill yourself." Then that would be consistent with thoughts that she'd been experiencing for some time. She'd been having thoughts about harming herself, that it was going to be very difficult for her to do this in a way that made sense.

(03:27:29)
She was experiencing thoughts about hurting herself because her brain might have been damaged. She was experiencing thoughts about hurting the kids. She was experiencing all sorts of unwelcome thoughts. If that were the case on January 24th, if these were thoughts, then that would be consistent with what she'd been experiencing for months before. So that was something that made more sense to me: that rather than an auditory hallucination, it would have been an unwelcome, intrusive thought. The next bullet is her response to her husband's question, "What did you do?" So when he got home around 6:00 PM on January 24th and the house was quiet and he went in, thought people might've been playing hide-and-seek with him. Called downstairs, didn't get an answer. Called upstairs, didn't get an answer. Went upstairs, found the bedroom door locked, unlocked it with his key, went in, saw some blood there, saw the window was open, ran downstairs, and he saw his wife, Lindsay, lying there semi-conscious.

(03:28:55)
And he said his first question was, "What did you do?" And her response was, "I tried to kill myself." Now, I thought that if she had actually experienced this command hallucination, that she might've said something like, "I did what I had to do. I did what the voice said," or something like that. But no, she said, "I tried to kill myself." And this is consistent with my looking at this and starting from the perspective of this is a serious, highly lethal suicide attempt. And that's the way to understand it. And then the last bullet point has to do with the recovery of memories. So when she regained consciousness that night in the hospital, one of the things she said is that she wasn't able to remember what had happened. And she was informed of it. But if this had been genuine memory loss, then human memory is funny.

(03:30:08)
And one of the things that happens is that when you're trying to remember something that actually happened, things can interfere with that. Things that you read, things that you're told, other sorts of things like that. So it would have been hard to understand how she would recover that memory accurately, including the particular memory of the command auditory hallucination and what it said.

Jennifer Sprague (03:30:36):

And Doctor, did you already go over the first bullet point, the inconsistencies in her description of knowing wrongfulness?

Dr. Kirk Heilbrun (03:30:43):

Yeah. I'm going to pass on that one and go to the next slide.

Jennifer Sprague (03:30:46):

Okay. That's not a consideration?

Dr. Kirk Heilbrun (03:30:52):

Well, there were some additional inconsistencies in terms of whether she knew that... When I asked her whether she was aware that it was illegal or immoral, she said basically, "I wasn't thinking about this at all. No thoughts, no decisions, none of that. It was just all action." One of the things that Dr. Resnick wrote in his report is that she was intellectually aware that it was wrong or illegal but not morally. And what she said to me is that "I wasn't thinking about that at all. I didn't know any of that."

Jennifer Sprague (03:31:33):

Okay. And if we could go to the next slide, I think if you could describe for us the evidence that you saw for suicide combined with altruistic filicide.

Dr. Kirk Heilbrun (03:31:45):

Yeah. "Altruistic filicide" is a term that's used that means killing your kids out of love. Not because you're trying to be cruel or for material gain or because you want them out of your lives or any of that, but killing them out of love so that you could... Basically, they wouldn't have to suffer, so you could prevent their suffering. And what she did, I thought, was begin with what I said a minute ago was a highly lethal and very serious suicide attempt.

Jennifer Sprague (03:32:34):

And that was preceded by what?

Dr. Kirk Heilbrun (03:32:34):

It was preceded by months of thoughts and impulses about "You should harm yourself, you should kill yourself, your brain is damaged," that sort of thing. And that I think is the beginning of the way to understand what happened that day. The second point is that, as I've said before, she didn't like to leave her children. Whether that was for date night or school or going back to work or anything, she did not like to leave her children. And if she had taken her own life, then her children would have been without her, and she thought that they would suffer. And she'd been having these thoughts, both about herself and about her children, over a several-month period. And the other thing that I will say is that she was in pain. She was suffering. She was doing a little bit better than she had been before she went into McLean, but she was still in pain.

(03:33:43)
She was suffering. I think she was even desperate. And that is something that is often characterized as people who try to take their own life. They're in pain, they're suffering, and they're trying to put a stop to it. And I think when she decided at some point that she was going to put a stop to it, then she had to answer the question of what to do about the kids. And she didn't want to leave them. And she was convinced that they would suffer without her.

Jennifer Sprague (03:34:15):

Go to the next slide. And further evidence that you saw for the suicide combined with altruistic filicide?

Dr. Kirk Heilbrun (03:34:23):

There was. One of the things that she said when asked about what happened is that in the course of strangling each child, she said, "Go to God, baby. Go to God." And that was part of her expectation that she and the children would be together in heaven with God. She was raised as a Catholic. And this, as I understand, Catholic considerations; that's not necessarily what happens. But when I asked her about that, when I said, "Isn't suicide a mortal sin?"

Kevin Reddington (03:35:07):

I'm going to object at this point.

Judge William Sullivan (03:35:09):

Yeah. Can I see counsel over here? All right. And so I'm going to ask you to go back to the jury room and then we'll bring you back in a couple of minutes. All right?

Prosecution (03:35:25):

Court, all rise. Jurors [inaudible 03:36:03], please. This way.

(03:36:03)
Jurors are next to the court. This court's in session.

Judge William Sullivan (03:36:06):

All right. We'll be in a short recess, and I'll come out as soon as I can.

Prosecution (03:36:41):

Court, all rise.

(03:36:41)
This court is back in session. Please be seated.

Court Clerk (03:36:41):

Your Honor, for the purpose of the record, we return back to the trial of Commonwealth vs. Lindsay Clancy. All parties are present, excluding the jury.

Judge William Sullivan (03:36:47):

All right. After the following sidebar conference, I think the defendant made a motion. I'm going to allow an argument in regards to the motion. I'll hear first from the defendant, and then I will hear from the Commonwealth. Mr. Reddington.

Kevin Reddington (03:37:04):

Thank you, Judge. Your Honor, this has been obviously a long trial and a lot of work on the part of everybody involved, from the court to the staff, to the prosecutors, to myself. And needless to say, the strain on Lindsay Clancy. I have to move for a mistrial reluctantly. The reason is that this is intentional misconduct on the part of the prosecution. You know that this whole idea of injecting Roman Catholic faith, the concept of mortal sin, into this trial occurred, I don't even remember now, about a week ago. And I objected, but before I could get the objection out, Your Honor had us at the sidebar at the same time and very forcefully, in my opinion, indicated to the jurors that they should not consider that to any degree. At the time, I put on record the fact that I did not feel that...

(03:38:10)
I felt that the court's instructions were sufficient. They were forceful. They were right on point. And we moved forward without a motion for a mistrial. I made a tactical decision. But unfortunately at this point, it's a concern I have because this is just over the top. It's the same thing again: talking about religion, talking about heaven, talking about killing people and the impact of the effect that it would have on Lindsay as well as her children. The fact that this is not the first time that it occurred during the trial and the prosecution has previously brought up the concept of mortal sin. Based on your ruling in the past, in conjunction with the fact that they brought it up again, I believe it was intentional misconduct. And I feel that the court should grant a motion for mistrial.

Judge William Sullivan (03:39:03):

All right. Thank you. Commonwealth.

Jennifer Sprague (03:39:04):

Thank you, Your Honor. The question I asked the witness did not ask for any testimony about religion, about Catholicism, about mortal sins or anything like that. And the slide is still up on the screen. There's nothing on the slide about Catholicism, about mortal sins, about any of that. The witness was explaining his reasoning. I don't think it was intentional on the part of the witness either. If we look at his interview of Ms. Clancy, one of the things that this witness has to do is determine whether the defendant knew the wrongfulness of her conduct. And that can be either that it was criminally wrong or morally wrong. And he explored that with her in the interview and asked her about whether she knew it was legally wrong. And she said she had no concept of legal consequences. And then he went on to ask her about moral wrongfulness and about her religion and whether she knew it was morally wrong.

(03:40:03)
And she did say that she had knowledge that suicide was considered sinful. So I believe that's where the witness was going in trying to explain his reasoning. I don't think he was intentionally trying to inflame the jury or cause an issue in this case. I know I certainly wasn't because I didn't ask a question about her religion or a question that would invoke that kind of response. I asked him to explain what was on the slides and that's not on the slides. So there was no intentional conduct by the Commonwealth. That was not where I intended to go with this questioning. And I don't think that the witness intended to do any harm either. He was just explaining his rationale. So I would ask that the jury be instructed to disregard the answer, and I can speak to the witness and tell him not to talk about that reasoning for behind his thoughts, that he can testify about his conclusions, but to leave that portion of his reasoning out of his testimony.

Judge William Sullivan (03:41:05):

All right. Well, here's a concern I have is what the witness did say in regards to... He said, "Go to God, baby. Go to God." That was statements that had been made in evidence already. And then he indicated that was part of her expectation that she and the children would be together in heaven with God. All right. Now we're getting a little closer to a problematic area. Then he testified, "She was raised as a Catholic. And as I understand Catholic considerations, that's not necessarily what happens." How is any of that proper at this point? But it was not...

(03:41:55)
I'm not going to declare a mistrial at this time. What I am going to do is I'm going to bring the jury in. I'm going to tell him to disregard it. I'm going to tell him that's an inappropriate area of inquiry and that this witness's understanding of Catholic dogma or Catholic teaching is irrelevant. There's no evidence of his background or training or having been to the seminary or any of that. And that's where he injected that. And so I am giving that, but the Commonwealth, I'm going to strongly, in perhaps the strongest language, talk to him and let him know that he can't go into that. And then my thought is we're going to bring the jury back in. I'm going to give him that instruction, and I'm going to send him home. I don't want them leaving here today with the last thing they heard was a discussion about this witness's understanding of the Catholic teaching.

(03:43:08)
That's not the last thing they're going to hear. And so my thought is that as best I can, is to address that and minimize the damage or prejudice because I do presume that this jury will be able to follow those instructions. And so that would be my thought. We'll come back. That will give the Commonwealth plenty of time to talk to this witness, to let him know the areas that he should and should not go into. And then we can come back tomorrow and we can resume his direct examination and cross-examination. All right. So that'd be my thought. We'll bring the jury in. I'll give him that instruction, and then we will recess until tomorrow. Okay?

Kevin Reddington (03:44:02):

Your Honor, just for the record, could I note that objection?

Judge William Sullivan (03:44:04):

Sure. Absolutely. All right. So are we ready for the jury? Yeah.

Prosecution (03:44:07):

Court, all rise. Jurors enter. This court's now in session. Please be seated.

Court Clerk (03:45:34):

Your Honor, for the purpose of the record, we return back to the trial of Commonwealth vs. Lindsay Clancy. All parties are present, including the defendant and including the 18 jurors.

Judge William Sullivan (03:45:38):

All right. All right. Well, members of the jury, just before we broke, there was some testimony from that last witness. And I just want to give you some instructions in regards to that testimony. And I just wanted to let... The religion that the defendant was raised with is absolutely an inappropriate area of testimony. It is to be stricken. It is not to be considered. I can't be any more clear of that. It cannot be considered. Secondly, the witness's understanding of Catholic teachings and considerations, again, is immaterial; it's irrelevant; it is to be disregarded based on that testimony. All right?

(03:46:26)
And so because we had a little bit of a delay due to this, what I'm going to do is I'm going to excuse you until tomorrow. All right? And so the thought is we'll come in; we'll finish up with this witness. I believe the Commonwealth has another witness at that point, and then we'll talk about where we go. I apologize for any kind of confusion or delay, but I just wanted to make sure you had those instructions with you when you left here today. All right? So I'm sorry, but so I'll see you tomorrow. Thank you.

Prosecution (03:46:57):

Court, all rise. Jurors, be kind and close your notebooks and place them on the chairs. This way, please.

Court Bailiff 2 (03:47:36):

Jurors have exited the courtroom. This court's in session. Please be seated.

Judge William Sullivan (03:47:41):

All right. Counsel, one more time. Can I see you at the sidebar?

(03:47:58)
All right. So we will be in recess until tomorrow. The anticipation is that the evidence will be done at some point tomorrow with the thought that most likely we'll have a charge conference sometime probably tomorrow afternoon, and arguments in charge would be on Wednesday. All right. Subject to change as they always are. So thank you, everybody, and we'll see you tomorrow morning. Thank you.

Jennifer Sprague (03:48:28):

Thank you.

Prosecution (03:48:29):

Court, all rise.

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