PLYMOUTH, Mass. (AP) — In the months after the birth of her third child, Lindsay Clancy 's mental health collapsed. Manic, unable to sleep and stricken with thoughts of harming herself, she sought care from experts in postpregnancy mood disorders, was put on multiple psychiatric medications, and when nothing worked, checked in to a psychiatric hospital.

Nineteen days after she was discharged, she strangled her three children at their Massachusetts home.

A jury heard opening statements Monday in Clancy’s murder trial, which is expected to feature dueling views about her mental state. Both sides agree she killed her children. They disagree over whether she should be held criminally responsible for their deaths.

The first witness was Patrick Clancy, her former husband, who found the children's bodies after returning home on the day of the killings in January 2023. He has said in interviews that he forgives his wife, and will testify for both the prosecution and the defense.

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EDITOR’S NOTE: This story includes discussion of suicide. If you or someone you know needs help, the national suicide and crisis lifeline in the U.S. is available by calling or texting 988.

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He told prosecutors on Monday that a month before the killings, his wife began to describe suicidal and intrusive thoughts of harming the children, but denied having plans to hurt them or herself. He said the situation was “very confusing” because moments later, she would be making the children lunch or playing with them.

“I never saw Lindsay harm the kids,” he told jurors.

Despite around four months of psychiatric care, changing medications and new providers, her condition continued to get worse, he said. She became increasingly depressed, struggled to sleep and lost weight.

Prosecutors say Clancy strangled her children — Cora, 5, Dawson, 3, and Callan, 8 months — after sending her husband out to do some errands. She then used multiple methods to try to end her own life. She remains paralyzed from the waist down after jumping from the home’s second-story window.

Clancy, seated in a wheelchair, wiped her eyes with a tissue at times as lawyers discussed her children.

Competing narratives in the Lindsay Clancy trial

Defense lawyer Kevin Reddington said Clancy, a former labor and delivery nurse at Massachusetts General Hospital, was suffering from postpartum psychosis. The rare mental illness is linked to the stress, sleep deprivation and hormonal changes that follow childbirth. He argued she had bipolar disorder and that antidepressants prescribed after the birth of her third child worsened her condition.

“She loved those children right up to the time of their death,” he told jurors, saying they would hear from family, friends, neighbors and teachers about her devotion.

Prosecutor Shanan Buckingham argued Clancy “acted intentionally, rationally and swiftly” and bears full responsibility for the deaths.

“This was not a woman in the throes of psychosis," Buckingham said. “This is not a public debate about women’s mental health and how the medical system treats women. This case is about this defendant, Lindsay Clancy.”

Lindsay and Patrick Clancy have filed lawsuits accusing her medical providers of failing to properly diagnose and treat her condition.

If convicted of murder, Clancy faces life in prison without parole. If found not guilty due to a lack of criminal responsibility, she would be committed to a state mental health facility.

The trial will hinge on Clancy's mental state

Elyse Hershon, a Boston criminal defense attorney and legal analyst, said the verdict will likely depend on how the jury views Clancy’s “intent and mental capacity.”

“Whenever there are deaths of children, it rattles emotions,” Hershon said. “Some people naturally will identify and sympathize with Clancy and her postpartum depression, and others will not be able to understand how one could end their children’s lives, and demand responsibility.”

While postpartum depression is fairly common among women who have given birth, postpartum psychosis is estimated to afflict only 1 to 2 per 1,000 women after delivery. Symptoms include hallucinations, delusions, paranoia, mood changes and thoughts of harming yourself or others. Most women who have the condition, however, do not wind up harming their children.

On the day of the killings, Clancy said she heard voices telling her, “This is your last chance. Kill the children so you can kill yourself,” according to her lawyer.

Similar cases have led to insanity verdicts

The case has parallels to several other mothers accused of killing their children.

Possibly the most well-known is Andrea Yates, who drowned her five children in a bathtub in 2001. Her attorneys said she suffered from severe postpartum psychosis, believed Satan was inside her and that killing them would save them from hell.

Her initial murder conviction was overturned, and in a retrial she was found not guilty by reason of insanity and committed to a state mental hospital.

Another Texas mother, Dena Schlosser, was found not guilty by reason of insanity in 2006 after she killed her 10-month-old daughter by cutting off her arms.

Dr. Nicole Cirino, the director of the division of reproductive psychiatry at Baylor College of Medicine, who has testified in infanticide cases, said many of the women in the grip of postpartum psychosis often believe their actions are helping the child.

In their own minds, “they may be saving their children from damnation,” Cirino said.

Experts say postpartum psychosis is still poorly understood in the legal system

Awareness of postpartum psychosis has grown since the Yates case, but Cirino and other maternal mental health advocates said it's rarely considered in criminal prosecutions. Illinois is the only state with a law allowing for undiagnosed or untreated postpartum depression or postpartum psychosis to be a mitigating factor in sentencing.

“To me it’s ‘illness until proven otherwise,’” said Dr. Catherine Birndorf, the CEO and founder of The Motherhood Center in New York City, which treats mothers with perinatal mood and anxiety disorders. “The fact that we consider it ‘criminal until proven otherwise’ is problematic.”

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Associated Press writer Leah Willingham contributed from Boston.