By Iris Hogan, MSW, LICSW
Over the past several weeks, the Lindsay Clancy trial has led to a cascade of conversations in my practice with women who are scared of their own thoughts and feelings.
A note before we go further:
I don’t know what was happening in Lindsay Clancy’s mind, and I’m not going to guess. The trial ended without a verdict. That question isn’t mine to answer, and it isn’t what this article is about.
What I do know is that many women are hearing the words “intrusive thoughts” attached to this case and wondering, with real fear, what that means about their own minds.
So that’s what I want to talk about. Not her case. Your thoughts.
More than one mother has told me that when she had an intrusive thought about harming her baby, she immediately handed the baby to her partner or put some distance between herself and the baby because she was terrified she might hurt them.
Mind you, she had no intention of hurting her baby and no plan to do so. She didn’t want the thought and certainly didn’t want what she imagined to happen. She was tortured by the possibility that having the thought might mean she could hurt the baby she loves more than anything.
As these conversations kept happening, I started thinking about all the women who weren’t having them. Women sitting at home with the same frightening thoughts, wondering if they are dangerous or losing their minds, but with no one to talk to about it.
I am not going to try to tell you what was happening in Ms. Clancy’s mind. At trial, the defense argued that she was legally insane at the time of the deaths because of severe postpartum psychiatric illness. Prosecutors argued that she retained an appreciation of the wrongfulness of her actions. The jury did not reach a unanimous verdict, and the trial ended in a mistrial.
We may never fully know what happened or what was happening in Ms. Clancy’s mind. What happened was a tragedy.
What I want to talk about is what intrusive thoughts are and what they are not. I worry that some women will hear the words intrusive thoughts in connection with this tragedy and begin to connect the two in their own minds.
If you have had frightening thoughts about harming your baby, the Lindsay Clancy tragedy does not tell us what your thoughts mean or what you might do. Your experience deserves to be understood on its own.
So I want to help separate these things. What are intrusive thoughts? Why can they feel so frightening? When can they become part of postpartum OCD? How are they different from postpartum psychosis? And, most importantly, when should you reach out for help?
If you are worried about immediate safety:
Seek emergency help if you want or intend to harm yourself or your baby, have a plan to do so, feel that you may act on what you are experiencing, are unable to keep yourself or your baby safe, are hearing or seeing things other people don’t, are severely confused or disconnected from reality, or aren’t sure whether you might act on what you are experiencing. In the United States, call or text 988, call 911, or go to the nearest emergency department.
When Your Mind Comes Up With the Worst Thing You Can Imagine
Women who have talked with me about these experiences describe thoughts and images that can have a nightmare quality to them, often involving the very person they love and feel most responsible for protecting.
The thoughts can feel so horrific and so completely out of character that a woman may begin to wonder what is wrong with her or even whether she is losing her mind.
A mother standing at the top of the stairs may suddenly picture dropping her baby. During bath time, she may have an image of the baby slipping underwater. She may be cooking and suddenly have a frightening image involving a knife. The thought can appear seemingly out of nowhere.
What can make this so difficult is what happens next. Instead of recognizing it as an unwanted thought, she may start asking herself why she had it.
What kind of mother thinks something like that? What if having the thought means some part of me wants to do it? What if I lose control?
I have heard women blame themselves for somehow manufacturing these thoughts and images, as though their minds couldn’t have produced them unless they meant something.
But having a thought is not the same as wanting something to happen. A thought is not the same as an intention, a plan or an action.
Our Minds Produce Thoughts We Didn’t Ask For
Years ago, while climbing in the Italian Dolomites, I looked down at clouds below me that appeared impossibly soft and suddenly had the thought: What if I jumped into them?
I didn’t want to jump. I didn’t believe the clouds would catch me, and I wasn’t worried that I was going to lose control and jump.
My brain had apparently offered a suggestion. I declined.
It was simply a thought my mind produced. I noticed it and kept climbing.
Here’s a small thought experiment you can try right now. Start gently moving your head from side to side, as though you are shaking your head no. While you continue moving your head, think to yourself, I’m not going to shake my head.
Chances are, you kept moving your head.
The point isn’t that people can’t control their actions. It’s that a sentence in your mind doesn’t automatically become an instruction you have to follow. And this little exercise certainly isn’t a test of whether someone is safe.
When the thought involves your baby, it can be much harder to trust that it is just a thought. You love your baby and need to know that your baby is safe. Even the smallest possibility that the thought could mean something can feel too important to ignore.
You don’t want the thought to be true, and you don’t want to take any chances with your baby’s safety. So you may start checking the thought, analyzing it, asking for reassurance or avoiding anything that brings it back.
And that is where the attempt to become absolutely certain can begin to keep the fear going.
When You Become Afraid of the Thought
Once your mind decides that the thought might mean something important, it can become remarkably persistent. You can examine it from every possible angle, replay exactly what you were feeling, ask yourself whether you secretly meant it, and then go through the whole thing again in case you missed something.
Unfortunately, anxious minds are not particularly impressed by thorough research.
You may also start changing what you do. The mother who had the thought on the stairs may stop carrying her baby downstairs. Someone frightened by an image during bath time may ask her partner to take over baths. A woman who had a frightening thought while cooking may avoid holding her baby in the kitchen.
These choices can feel completely reasonable. If avoiding the stairs makes the fear go away, why wouldn’t you avoid the stairs? If handing the baby to your partner makes you feel certain that nothing bad can happen, why wouldn’t you do that?
You may ask your partner, “You don’t think I would actually do that, right?”
Your partner reassures you. You feel better.
For about eleven minutes.
Then your mind comes back with: But what if I didn’t explain it correctly?
The problem is that the certainty doesn’t last. The thought comes back, or a new one takes its place, and once again you find yourself trying to prove that you would never act on it.
When OCD is part of what is happening, this can become a painful cycle.
How the Cycle Can Keep Going
As moms, one of our most basic jobs is to keep our babies safe.
So when your brain suddenly produces the worst possible thing you can imagine, responding with “Interesting thought, brain” and moving on is not exactly the natural first reaction.
You want certainty. Preferably 100 percent certainty, notarized and guaranteed for life.
So you check yourself, ask for reassurance, avoid certain situations, or work very hard not to have the thought at all.
The problem is that these things usually bring only temporary relief. The fear settles for a little while, but then the thought comes back, sometimes feeling even more important and frightening than before.
Intrusive thought → fear about what the thought means → checking, reassurance, or avoidance → temporary relief → the thought feels more important → more fear
Over time, a woman can find herself doing more and more to protect her baby from something she never wanted to do in the first place.
Postpartum anxiety does not always look like obvious anxiety. It can show up as checking, overthinking, difficulty trusting yourself, or a constant need to feel certain that everything is okay.
When Intrusive Thoughts Become Part of Postpartum OCD
Having an intrusive thought does not mean that you have OCD.
Research has found that unwanted thoughts about infant harm occur during the postpartum period, including among women without psychiatric disorders. These can include thoughts about accidental harm as well as unwanted thoughts or images of intentionally harming a baby.
One prospective study drew from a larger cohort of 763 women, with 388 providing data for the analysis of unwanted intrusive thoughts of intentionally harming an infant, OCD and self-reported maternal aggression.
Women who reported these unwanted thoughts were not more likely to report aggression toward their infants than women who did not, and the researchers found no evidence that OCD was associated with increased maternal aggression.
This research helps us separate the presence of an unwanted thought from what a woman actually intends to do.
It doesn’t mean that we can decide whether someone is safe based on one feature of her experience. We still need to understand what is actually happening.
If the thoughts keep returning, cause significant distress, or lead you to repeatedly check, seek reassurance, avoid situations, or stop doing ordinary caregiving tasks, it is worth speaking with a clinician who understands perinatal mental health and OCD.
Intrusive Thoughts and Postpartum Psychosis Are Different
This distinction is particularly important in the conversation surrounding the Lindsay Clancy case.
With OCD, intrusive thoughts are typically unwanted and distressing. Some of the women I have spoken with about their OCD describe spending hours every day battling their thoughts and trying to find some way to be 100 percent certain that their baby is safe.
There is an important paradox here. They aren’t spending those hours planning to harm their baby or fighting an intention to do so. They are spending them trying to convince themselves that the thought doesn’t mean they might harm their baby.
Postpartum psychosis is different. It is a rare but serious psychiatric condition that can involve significant changes in mood, thinking, behavior, and a person’s connection with reality.
Symptoms can include delusions, hallucinations, severe confusion or disorganization, paranoia, and symptoms of mania. Postpartum psychosis is a psychiatric emergency.
An unwanted thought or image that pops into your mind is also different from hearing a voice that other people don’t hear, believing that you are receiving instructions or messages, or developing beliefs that other people tell you aren’t based in reality.
But I don’t want women reading this to feel that they now have to diagnose themselves. If you don’t know what to make of what you are experiencing, reach out and tell someone what is actually happening.
You don’t need to know whether to call it an intrusive thought, OCD, depression or psychosis before asking for help.
What Should I Do If I’m Having Frightening Thoughts?
If you are worried that you or your baby may not be safe, follow the emergency guidance above and seek immediate help.
If there isn’t an immediate safety concern but the thoughts keep coming back, are causing significant distress, or are changing how you care for your baby, talk with a healthcare professional.
You can start with your OB/GYN, midwife, primary-care clinician, psychiatrist, therapist, or another clinician with experience in perinatal mental health.
You don’t have to find the right words before you tell someone. You can simply say what happened:
I had a frightening thought about my baby. I don’t want to hurt my baby, but the thought scared me, and I don’t know what it means.
If OCD is part of what is happening, cognitive behavioral therapy that includes exposure and response prevention, or ERP is a first-line treatment for OCD.
For non-emergency support in finding perinatal mental-health care, Postpartum Support International can help connect women and families with resources and clinicians trained in perinatal mental health through its provider directory.
Their HelpLine is not an emergency service.
Questions the Lindsay Clancy Case May Leave You With
Ms. Clancy reportedly experienced intrusive thoughts. I have intrusive thoughts. Should I be scared?
I really don’t know what Lindsay Clancy’s internal experience was like, and no one can say for sure.
What I can say is this: if you are having intrusive thoughts that frighten you, you deserve support. Tell someone what you are experiencing. You don’t have to figure out what the thoughts mean on your own.
If the thought horrifies me, does that mean I’m definitely safe?
If you are scared or horrified by your thoughts and wondering whether you are safe, I don’t want you to be alone in trying to figure this out.
Not because having a frightening thought means that you are dangerous, but because I don’t think anyone should have to make sense of something this frightening by themselves.
Tell someone what you are experiencing. A clinician who understands perinatal mental health can help you make sense of what is happening and figure out what kind of support you need.
If I tell my therapist or doctor that I imagined hurting my baby, will someone take my baby away?
I understand why women are afraid of this. For some women, the fear of what might happen if they tell someone is exactly what keeps them silent.
Clinicians who are trained in working with harm OCD know how to assess the difference between unwanted intrusive thoughts and actually wanting or planning to harm someone.
Having harm OCD is not the same as wanting, intending or planning to harm your baby. And having an unwanted frightening thought, by itself, is not the same as wanting, intending or planning to harm your baby.
I can’t promise what will happen in every situation. But this is one reason it can be so helpful to talk with someone who understands perinatal mental health and OCD and knows what questions to ask.
What if I don’t know whether what I’m experiencing is an intrusive thought?
Then you don’t need to figure it out by yourself.
Tell someone what you are experiencing, including the parts that are frightening or difficult to say out loud.
You don’t need to know whether what is happening is an intrusive thought, OCD, depression, psychosis or something else before you ask for help. That is something a qualified clinician can help you sort out.
If you don’t know what to make of what is happening in your mind, that is reason enough to reach out.
We Need Women to Be Able to Tell Us the Scary Thoughts
What I keep coming back to is the woman who is already afraid to tell anyone what is happening in her mind.
Many women suffer quietly with intrusive thoughts, often feeling ashamed of what they think of as “bad thoughts.” They may be afraid to speak about them, or do so with enormous trepidation, because they don’t know what the thoughts mean and because this is still something we don’t talk about very openly.
The publicity surrounding the Lindsay Clancy trial may have made that even harder.
Women have repeatedly heard the words intrusive thoughts in discussions of a mother accused of killing her children. I worry about what that association may mean for the woman who was already frightened by her own thoughts and unsure whether it was safe to tell anyone.
I don’t want the lesson she takes from that conversation to be: Don’t tell anyone.
We shouldn’t minimize frightening thoughts, but we also shouldn’t assume we know what they mean. We need to listen carefully enough to understand what a woman is actually experiencing.
If we can get to a place where a woman can say, My mind is showing me something horrible, and I’m scared. I can reach out to someone, without fear or shame; just think how much suffering we might prevent or reduce.
And I want someone to be there to listen.
Research & Resources
Postpartum intrusive thoughts and infant harm
Fairbrother N, Collardeau F, Woody SR, Wolfe DA, Fawcett JM. Postpartum Thoughts of Infant-Related Harm and Obsessive-Compulsive Disorder: Relation to Maternal Physical Aggression Toward the Infant. Journal of Clinical Psychiatry. 2022;83(2):21m14006.
Review of postpartum infant-harm intrusive thoughts
Brok EC, Lok P, Oosterbaan DB, Schene AH, Tendolkar I, van Eijndhoven PF. Infant-Related Intrusive Thoughts of Harm in the Postpartum Period: A Critical Review. Journal of Clinical Psychiatry. 2017;78(8):e913–e923.
Perinatal mental health assessment
American College of Obstetricians and Gynecologists (ACOG). Screening and Diagnosis of Mental Health Conditions During Pregnancy and Postpartum. Clinical Practice Guideline No. 4.
Postpartum psychosis and other perinatal mental health conditions
American College of Obstetricians and Gynecologists (ACOG). Summary of Perinatal Mental Health Conditions.
Perinatal OCD and treatment
International OCD Foundation. How Is Perinatal OCD Treated?
Finding perinatal mental health support
Postpartum Support International offers information, support, and a provider directory for pregnant and postpartum women and families. Their HelpLine is not an emergency service.