Lindsay Clancy tragedy exposes blind spot in modern psychiatry

In the four months leading up to the deaths of her three children, Lindsay Clancy was prescribed 13 different psychiatric medications through more than 30 prescriptions. Of those 13 medications, only four fell within Massachusetts’s prescription monitoring program, while the remaining nine, including antidepressants, an antipsychotic, and a mood stabilizer, were outside its routine reporting requirements. Equally troubling, testimony during her trial revealed she attended only two dedicated psychotherapy appointments at one mental health clinic, despite recommendations for weekly therapy.These facts raise two concerning questions. First, how can physicians effectively combat psychiatric polypharmacy when most state prescription drug monitoring programs exclude most psychiatric medications? More importantly, has modern psychiatry become so focused on pharmacologic management that it has neglected its most fundamental tool for understanding patients — meaningful conversation? Recommended Stories In my practice of internal medicine, I have stopped routinely referring patients to psychiatry after repeatedly witnessing their encounters reduced to completing a symptom questionnaire, receiving a diagnosis, and leaving with a prescription and “follow-up” appointment — all without meaningfully exploring what is happening in the patient’s life, whether it be an abusive relationship, financial hardship, or unresolved trauma. Rather than identifying and confronting these underlying problems, their psychiatric care seemingly devolved into self-perpetuating cycles of medicating symptoms while neglecting their underlying causes. Research in the field of psychiatry suggests this pattern extends well beyond my own clinical observations. A study published in the American Journal of Psychiatry found that the proportion of outpatient psychiatric visits involving psychotherapy fell from 44.4% in 1996-1997 to just 21.6% in 2015-2016. An earlier landmark study documented a substantial rise in psychiatric polypharmacy, with the proportion of visits involving multiple psychiatric medications increasing by more than 40% over a decade.Patients themselves have voiced similar concerns. A 2024 study of 510 former psychiatric inpatients documented recurring complaints of impersonal treatment, inadequate communication, and clinicians failing to consider patients’ individual circumstances. Another 2021 qualitative survey found that while patients valued lasting therapeutic relationships and meaningful physician involvement in their care, psychiatrists placed greater emphasis on medication-related decisions, often viewing ongoing therapeutic relationships as outside their primary role.While psychiatrists cannot be expected to provide ongoing psychotherapy to every patient, they should still make meaningful efforts to understand what drives their patients’ suffering and challenge destructive patterns of thinking, rather than confine their role to prescribing medications and adjusting doses based on symptoms. Psychiatry must reclaim its psychotherapeutic roots and restore inquisitive questioning and a holistic understanding of the patient to the center of care. Proactive deprescribing should be prioritized, while further pharmacologic escalation should be contingent on concurrent psychotherapy, which has demonstrated superior long-term outcomes for certain psychiatric conditions compared to medications alone.THE LINDSAY CLANCY TRIAL JUST EXPOSED A MAJOR PRO-LIFE BLIND SPOTThe first step in identifying overprescription is for state governments to equip psychiatrists, internists, and family medicine physicians with prescription monitoring programs that also track noncontrolled medications that act on the central nervous system. This would include antidepressants, anxiolytics, antipsychotics, mood stabilizers, and other centrally acting psychoactive drugs. Tracking these medications would allow clinicians to identify overlapping prescriptions and potentially dangerous drug combinations. This tool is evidence-based. A 2020 systematic review found that nearly 70% of studies examining opioid prescribing behavior reported reductions associated with these programs.To be clear, neither Clancy’s psychiatric care nor limited drug monitoring programs can be presumed to have caused the deaths of her children. Severe postpartum psychiatric illnesses can be extraordinarily difficult to diagnose and manage, even for the most experienced clinicians, and a tragic outcome does not necessarily reflect a failure of medical care. Nonetheless, with over 30 prescriptions written for 13 different drugs by multiple providers over a period of just four months for only one patient, it is reasonable to ask whether a medical field so adept at writing prescriptions is equally adept at recognizing when pharmacologic escalation may not be working.Alexander Herbert is a board-certified internal medicine physician practicing as a hospitalist and concierge physician, with graduate training in bioethics and experience working with an AI-driven healthcare company. His writing has been published by the American College of Physicians, the Federalist, and Doximity, where he has contributed case reports and opinion pieces on contemporary issues in medicine.