QUESTION 16Justice & EthicsAugust 9, 2026

Lindsay Clancy Trial: The Insanity Defense, Postpartum Psychosis and Criminal Responsibility

When mental illness changes legal blame—and why an insanity acquittal is not the same as forgiveness

Beginning with the Lindsay Clancy trial, this article asks why a defendant who was severely mentally disordered at the time of an offense may be acquitted or receive a reduced sentence. It traces the history and global varieties of criminal responsibility, then uses seven philosophers to explain both doors: the exit from punishment and the entrance into medical confinement.

The trial of Lindsay Clancy is continuing in Massachusetts.

On January 24, 2023, her three children—five-year-old Cora, three-year-old Dawson and eight-month-old Callan—died at the family home in Duxbury. Clancy does not dispute that her actions caused their deaths. The central question is whether, at the time, she was in a mental condition that allowed her to bear criminal responsibility for those actions.

The defense argues that she had experienced severe mental distress after the birth of her third child and that postpartum psychosis and related illness had severed her contact with reality when the acts occurred. The prosecution does not deny that she had mental-health problems. It argues, however, that facts such as sending her husband on an errand and checking how long it would take show planning and an understanding that what she was doing was wrong.

The trial began on July 27, 2026, and testimony from relatives, friends and medical professionals has continued. As of August 9, no verdict has been returned. This article therefore does not conclude that Clancy had postpartum psychosis, lacked criminal responsibility or committed a calculated murder. Those are disputed propositions for the jury to decide after hearing the evidence.

Yet the question raised by the case extends far beyond one American courtroom.

A body that caused deaths stands before us.

But if the mind moving that body was not connected to the same reality, the same reasons and the same prohibition—“you must not do this”—that the rest of us inhabit, to whom is punishment addressed?

Hearing the words “not guilty by reason of insanity” can sound as though the harm has been erased and the defendant forgiven. Others may feel that imprisoning a seriously ill person is itself cruel.

That binary is inadequate.

The law of criminal responsibility contains two doors.

The first takes a person who could not bear responsibility out of punishment.

The second may place that person inside confinement, under the names of treatment and public safety, for a period whose end is difficult to predict.

An insanity acquittal can be an exit into freedom and, at the same time, an entrance into medical control.

Unless we look at both doors, we cannot understand either the mercy or the danger of the institution.

Begin by separating three questions: diagnosis, criminal responsibility and competence to stand trial

The greatest source of confusion is that medicine and law ask different questions.

Question	What is being decided?	Relevant time
Medical diagnosis	What symptoms or disorder does the person have?	During examination and over the course of illness
Criminal responsibility	Could the person understand the act and its wrongfulness and control their conduct?	At the time of the offense
Competence to stand trial	Can the person understand the proceedings and consult with counsel?	At the time of trial

Postpartum psychosis is a severe condition that may involve hallucinations, delusions, mania or profound depression. The United Kingdom’s NHS treats it as a medical emergency. It is not the same as postpartum depression or the temporary mood changes commonly called the “baby blues.”

But a diagnosis does not automatically produce an acquittal.

Two people with the same diagnosis may differ in their ability to perceive reality or control their actions, and those abilities can change over time. Conversely, the legal judgment that a person lacked responsibility is not determined solely by the diagnostic label written in a medical record.

The court is not merely asking, “Was this person ill?”

It is asking: At that very moment, and in relation to that very act, what did the illness take away from the person’s ability to understand, choose and stop?

A person who lacked responsibility at the time of an offense may later recover enough to understand a trial. A person who was responsible when an offense occurred may later become too unwell to participate in proceedings.

Responsibility looks backward to the moment of action. Competence to stand trial concerns the person’s ability to participate now.

This is not a technical distinction for lawyers alone.

It is the first barrier against locking a person into the single word “patient” or “criminal.” It forces us to ask which capacity was absent, to what degree and at what time.

In this article, “insanity” is used as a broad legal and historical term, not as a medical diagnosis. Massachusetts often speaks instead of “lack of criminal responsibility.” That wording narrows the inquiry to legal capacity at the time of the offense rather than branding every person with mental illness as “insane.”

What the Massachusetts jury must decide

Massachusetts generally uses the phrase lack of criminal responsibility rather than the more familiar “insanity defense.”

Under its test, a defendant is not criminally responsible if, because of mental disease or defect, the defendant substantially lacked either of two capacities:

the capacity to appreciate that the conduct was criminally wrong;
the capacity to conform the conduct to the requirements of law.

Once evidence properly raises the issue, the prosecution must prove beyond a reasonable doubt that the defendant was criminally responsible. That differs from federal law and the law of many states, where the defendant bears the burden of establishing the defense.

This is why the prosecution in Clancy’s case emphasizes planning and the defense emphasizes her perception of reality and experiences of voices: they are contesting those two capacities.

But planning and an accurate moral or legal understanding are not identical.

A person can plan means and sequence actions within a delusion. It is theoretically possible to organize conduct while believing, falsely, that the conduct will “save” children from an imaginary threat. It is also possible to have a mental disorder and still plan a self-interested act while knowing that it is wrong.

The jury therefore cannot decide the case on a single axis of “planned” versus “impulsive.” It must ask within what perceived reality, and within what world of reasons, the plan was made.

That is what makes the case difficult.

External conduct can be recorded.

The world in which that conduct made sense cannot. A court must reconstruct a past mental state from fragments: diaries, searches, statements, treatment records, conduct before and after the event, and expert evaluations.

A courtroom cannot enter a mind.

A criminal-responsibility trial is an attempt to reconstruct an invisible past mind from the traces it left behind.

Aristotle: Is a moving body the same thing as a person acting?

An early guide to the history of responsibility appears in Aristotle.

In the Nicomachean Ethics, he argues that praise and blame are directed primarily at voluntary action. Put simply, voluntary action has two conditions:

its origin lies within the agent;
the agent knows the particular circumstances of what they are doing.

If a gale throws someone into another person, the first person’s body may knock the second down, but the movement did not originate in a choice. If someone hands over poison while reasonably believing it to be medicine, the physical act is intentional, but the death is not what the person knowingly chose.

We cannot simply transplant this account into modern criminal law. Aristotle knew neither postpartum psychosis nor contemporary legal doctrine.

His distinction nevertheless remains important:

Being the physical cause of a bodily movement is not always the same as being the author of a meaningful action.

In cases involving psychotic delusions, there may be no doubt that the defendant’s body caused the result. The dispute is whether the reasons moving that body arose from the person’s ordinary beliefs, desires and values, or from an illness that radically altered the person’s grasp of reality.

The word “author” is not a device for evading accountability.

Punishment should not be a system that merely sends pain back toward the body that caused a result. If punishment expresses blame, it must be addressed to an agent who could understand the question, “Why did you do this?”

Kant: Punishment must answer a rational agent

The eighteenth-century philosopher Immanuel Kant understood human beings as autonomous agents capable of grasping and following moral law.

“Autonomy” does not mean doing whatever one wants.

It means stepping back from desire to ask whether one’s maxim could be a rule for everyone and whether one is treating another person merely as a means. An autonomous person can discipline action through such reasons.

Kant was a strict retributivist about punishment. A wrongdoer should not be punished merely as an example to frighten others, he argued, but because that person committed the crime as a responsible agent.

Applied to criminal responsibility, this severity produces an unexpected conclusion.

To punish strictly, we must first establish that the person was capable of rational agency.

If a severe mental disorder destroyed the person’s ability to understand reality or respond to moral reasons, punishing that person merely to deter others would turn the person into an instrument.

That does not mean Kant himself designed the modern insanity defense. It is an implication that can be drawn from his account of autonomy.

Respecting a person does not always mean assigning more responsibility. When the conditions of responsibility were absent, withholding blame can itself be a form of respect.

That is how an acquittal can be something other than leniency.

Bentham: Punishment that cannot be understood becomes additional suffering

Jeremy Bentham’s utilitarian approach stands in sharp contrast to Kant’s.

Bentham did not regard punishment as good in itself. Because punishment inflicts suffering, it is an evil that can be justified only when it prevents a greater evil.

For a threatened penalty to deter, an agent must at least be able to connect the following steps:

If I do this, I will be punished.
Therefore I should not do it.

If a delusion has displaced reality, and the command of a god, demon or persecutor is experienced as more immediate than the law, the law’s warning may never reach the person’s deliberation.

Making an undelivered warning louder does not create deterrence.

Suffering imposed afterward cannot travel back in time and penetrate the delusional world at the moment of action.

From a Benthamite perspective, when punishment could not have prevented the act, it risks becoming merely added pain. Treatment, relapse prevention and intervention in dangerous circumstances may do more than vengeance.

Utilitarianism also carries a danger.

If public safety alone is maximized, a person can be confined not for a culpable act but because experts predict that the person might be dangerous in the future.

Kant warns against using an unresponsible person as a warning to others.

Bentham warns against suffering that achieves no preventive purpose.

Both approaches cast doubt on retributive punishment when responsibility is absent. Yet Benthamite concern for safety can also open the second door: preventive confinement.

H. L. A. Hart: Responsibility requires capacity and a fair opportunity

The twentieth-century legal philosopher H. L. A. Hart emphasized ordinary capacities to understand, reason and control conduct, together with a fair opportunity to exercise them.

An everyday promise makes the point clear.

When a friend misses an appointment, we ordinarily assume that the friend could remember the promise, understand the time and choose to attend. If we learn that the friend was unconscious after an accident, we react differently to the same absence.

Law works in a similar way.

When it says “you must not,” it presupposes that the person can understand the demand, weigh reasons and alter conduct.

The insanity defense identifies exceptional cases in which that presupposition fails.

One advantage of this view is that we need not solve the cosmic question of whether free will ultimately exists.

Even if human conduct is influenced by genes, environment, the brain and past experience, people ordinarily retain practical capacities to understand reasons, receive criticism and revise conduct. Criminal law can operate on those capacities.

If a severe mental disorder temporarily destroyed that circuit, responsibility cannot remain unchanged.

Responsibility is not a label pasted onto a bad result. It is a relationship with a person who could receive the law’s reasons and choose otherwise.

Strawson: We become angry because we see another person’s will in the deed

The philosopher P. F. Strawson approached responsibility not by proving an abstract freedom of the will, but through the emotions of human relationships.

When someone deliberately injures us, we feel resentment. We read an attitude into the act: “You regarded me as unimportant,” or “You did not care whether I suffered.”

Strawson called emotions of this kind “reactive attitudes.”

When we discover that the other person was a young child, could not understand reality because of severe mental disorder, or caused the harm accidentally, our anger may not disappear. But its direction changes.

We move from asking the other person, “Why did you treat me this way?” to asking, “What happened, how can it be treated, and how can it be prevented?”

This helps explain the emotional meaning of an insanity acquittal.

It does not minimize the result.

It asks whether that result may properly be returned to the defendant as the expression of ordinary malice or indifference.

Strawson’s view also reveals a danger.

The moment we suspend blame, we may stop treating the person as a participant in dialogue and begin treating them as an object to be observed, treated and managed.

Removal from the community of blame must not become removal from the human community.

Reducing responsibility is not the same as reducing a person’s voice, dignity or legal protection.

Susan Wolf: “I truly wanted it” is not enough for responsibility

The contemporary philosopher Susan Wolf argues that responsibility requires a condition of sanity.

Her famous thought experiment concerns JoJo, the son of a cruel dictator. From childhood, JoJo is taught only his father’s values and comes sincerely to regard cruelty as admirable. He does not act reluctantly; he commits cruelty exactly as he wishes.

Should we blame him in precisely the same way as an ordinary wrongdoer?

Wolf’s answer is cautious.

Acting from one’s own desires is not sufficient for full responsibility. A person must have an adequate grasp of reality and an ability to recognize reasons about what is good and bad.

This prevents us from treating psychosis as simply an unusual desire.

A deluded person may not merely want to do wrong. The person may not inhabit the same factual world that we do.

If a safe home appears to be “possessed by demons,” and injury appears to be “rescue,” desire and conduct may align while the capacity to apprehend reality and moral reasons has broken down.

The point is not that every strange belief cancels responsibility.

The state must not classify minority religious, political or cultural views as insanity. The relevant question is not whether someone agrees with the majority. It is whether the person could understand evidence, recognize the existence and rights of others, and respond to reasons about the meaning of the act.

Wolf’s view can be condensed for a beginner into one sentence:

It is not enough that an act came from your “true self.” That self must have been formed in a condition capable of touching reality and reasons.

“Not guilty” does not mean “nothing happened”

Insanity acquittals provoke fierce resistance partly because the words “not guilty” can sound as though they deny the harm itself.

Law must, however, separate at least three questions:

The act—whose body did what?
Criminal blame—may the act be condemned as a responsible choice?
What follows—are treatment or protective measures now necessary?

A finding that a defendant lacked criminal responsibility does not erase the first fact. It does not restore the people who died or diminish a family’s loss.

What it denies is the second relationship: punishment as a response to a culpable will.

The third question remains.

If we refuse this distinction and measure respect for victims only through “guilty” versus “not guilty,” a court can recognize harm only by demanding the heaviest punishment.

But the depth of harm and the defendant’s lack of responsibility can both be true.

The loss can be irreversible.

At the same time, in a particular case, the person who acted may not have possessed the capacities required for responsibility.

There is no contradiction in saying both.

The ethical maturity required of justice lies precisely in enduring both truths without erasing either one.

How did the law of criminal responsibility develop?

The distinction between mental disorder and crime was not suddenly invented by modern medicine. Its rationale and institutional form have changed over time.

1. Antiquity and the Middle Ages: The thought that guilt requires a blameworthy mind

Roman law contained ideas excluding people in severe states of mental disturbance from criminal responsibility, and these ideas influenced later medieval law. Medieval jurists sometimes placed a person experiencing insanity alongside an infant as someone lacking the judgment necessary for guilt.

The period also used degrading metaphors that treated mentally disabled people as close to animals. Modern society should not inherit that view of humanity.

Even so, we can see an early form of a principle that remains central: a bad result alone does not constitute a crime; there must also be a mind that can be blamed.

2. The Arnold case of 1724: The narrow test of knowing nothing “like a wild beast”

In the English case of Rex v. Arnold, exemption was said to apply only when a defendant understood almost nothing of what he was doing, like an infant or a wild beast.

This barely recognized degrees of impaired responsibility. It created an exception only for the most extreme and total loss of understanding.

3. The Hadfield case of 1800: Acquittal becomes linked to confinement

James Hadfield attempted to shoot the king while under the influence of delusions and was acquitted on grounds of insanity.

Fear that he might simply be released prompted Parliament to hurry through legislation allowing people acquitted by reason of insanity to be confined. Hadfield remained in custody for many years.

The two doors that persist today were institutionalized:

there is no responsibility that justifies punishment;
yet the person may be confined for as long as the person is considered dangerous.

From an early stage, the law joined compassion and preventive detention in the same structure.

4. The M'Naghten case of 1843: What did the person do, and did the person know it was wrong?

Daniel M'Naghten, acting within a delusion that the government was persecuting him, targeted the British prime minister and shot another man. His insanity acquittal triggered widespread outrage, and the House of Lords asked judges to state the governing rule.

The resulting M'Naghten rule exempted a defendant who, because of a disease of the mind, did not know the nature and quality of the act or did not know that the act was wrong.

The test focuses on cognition.

Its clarity is attractive, but it prompted a criticism: it does not adequately address someone who understood that an act was wrong yet could not stop because of illness.

5. The twentieth century: From cognition to the capacity for control

Tests of “irresistible impulse” later developed in the United States and elsewhere, bringing self-control as well as understanding into the inquiry.

The Durham rule of 1954 denied responsibility when an unlawful act was the “product” of mental disease or defect. It made psychiatric knowledge easier to incorporate, but critics said it transferred too much of the legal judgment to experts.

The American Law Institute’s 1962 Model Penal Code denied responsibility when, because of mental disease or defect, a person lacked substantial capacity either to appreciate the criminality of the conduct or to conform the conduct to law. Massachusetts’s present approach belongs to this lineage, which considers both cognition and control.

6. After 1982: The backlash against the idea of an “easy escape”

John Hinckley Jr. shot President Ronald Reagan in 1981. When Hinckley was found not guilty by reason of insanity the following year, the United States saw an intense backlash.

The federal reforms of 1984 narrowed the defense to a severe mental disease or defect that left the defendant unable to appreciate the nature and quality or wrongfulness of the act. They removed impaired control as an independent basis and placed on the defendant the burden of proving insanity by clear and convincing evidence. Some states also narrowed or abolished an independent insanity defense.

In 2020, the US Supreme Court held in Kahler v. Kansas that the Constitution does not require states to adopt one particular form of insanity defense.

This history shows that doctrine does not evolve through medical knowledge alone.

Public anger after famous cases, fear of release, trust and distrust of experts, attitudes toward disability, and competing ideas of punishment have all moved the legal boundary.

How do legal systems distinguish “no responsibility” from “reduced responsibility”?

The same diagnosis does not lead to the same result everywhere. A comparison reveals at least three broad forms of institutional design.

Country or jurisdiction	Test for excluding responsibility	Reduced responsibility	Distinctive feature
Massachusetts, United States	Mental disease or defect substantially eliminates capacity to appreciate wrongfulness or conform conduct to law	Addressed through other doctrines depending on charge and case	Once properly raised, prosecution proves responsibility beyond a reasonable doubt
US federal law	Severe mental disease or defect makes defendant unable to appreciate the nature, quality or wrongfulness of the act	Loss of behavioral control is not an independent basis for the defense	Defendant proves insanity by clear and convincing evidence
England and Wales	Special verdict under the M'Naghten rules	In murder, substantial impairment of understanding, rational judgment or self-control may reduce murder to manslaughter	Separates complete exculpation from diminished responsibility
Germany	Criminal Code §20: specified disorder eliminates capacity to appreciate wrongfulness or act in accordance with that appreciation	§21: punishment may be mitigated when capacity was substantially diminished	Treats capacity in degrees
Japan	Penal Code Article 39(1): an act committed while “insane” is not punishable	Article 39(2): punishment must be reduced for “diminished capacity”	Two levels: absent or seriously diminished capacity
Canada	Mental disorder leaves person incapable of appreciating the nature and quality of the act or knowing it was wrong	Mental condition may also be relevant at sentencing	Separate infanticide provision for a biological mother whose mind was disturbed by childbirth or lactation

Japan’s Penal Code Article 39 states briefly that an act committed by a person who is “insane” is not punishable and that the punishment of a person with “diminished capacity” must be reduced. These are legal concepts, not diagnoses. They concern whether a person could distinguish right from wrong and act in accordance with that judgment.

German law likewise separates incapacity from substantially diminished capacity.

England and Wales recognize diminished responsibility for murder. A recognized medical condition must have substantially impaired the defendant’s ability to understand the nature of conduct, form a rational judgment or exercise self-control, and it must provide an explanation for the killing. A successful plea changes murder to manslaughter.

The United Kingdom’s Infanticide Act 1938 concerns a biological mother who kills her child under twelve months while the balance of her mind is disturbed by childbirth or lactation. Canada’s Criminal Code has a provision concerning the death of a “newly-born child” in comparable circumstances.

These provisions attempt to take the effects of childbirth on responsibility into account more broadly than a general insanity test might. They have also been criticized for drawing lines around mothers alone and children of a specified age, for relying on dated medical language, and for excluding fathers and adoptive parents.

Clancy is being tried under Massachusetts law, and the children’s ages and circumstances differ. The British and Canadian infanticide provisions do not directly govern her case.

The purpose of comparison is not to declare that another country would necessarily have reduced the charge or sentence.

It is to see where each system draws its boundary:

no responsibility if reality could not be understood;
no responsibility if wrongfulness could not be understood;
no responsibility if the person understood but could not stop;
reduced responsibility when capacity was seriously impaired;
separate consideration of the postpartum condition.

Natural science cannot select one boundary by itself.

Each is a moral line through which a society decides how much capacity a person must possess before the state may condemn that person through punishment.

Foucault: When the “unresponsible person” becomes the “dangerous person”

Michel Foucault analyzed how the encounter between modern criminal law and psychiatry produced a new object: the “dangerous individual.”

Older criminal law asks, “How responsible was this person for the past act?” Modern psychiatry can add a different question: “What might this person do in the future?”

A person found not criminally responsible escapes punishment.

At that instant, however, the person may be transformed from a defendant blamed for a past act into a patient whose future dangerousness must be predicted.

A prison sentence ordinarily has a maximum term.

“Dangerousness” has no obvious expiration date.

For that reason, someone acquitted by reason of insanity can conceivably remain confined longer than someone convicted of the same offense.

In Massachusetts, a finding of lack of criminal responsibility does not necessarily produce immediate freedom. State law permits an initial observation period of up to forty days. If further requirements are met, commitment may then begin for six months and may continue through annual court review.

The first and second doors now come into view:

You were not responsible.
Therefore we will not punish you.
But we do not know when you will be safe.
Therefore we will manage you without a fixed end date.

This is not simple mercy.

Changing the institution’s name from prison to hospital does not remove the power to take liberty. Treatment may be necessary, but without respect for the patient’s will, a right to challenge confinement, periodic independent review and the least restrictive conditions, medical care can become a form of detention less visible than punishment.

Foucault’s warning is not that psychiatry is false.

It is that medical knowledge can become a power that does more than heal: it can decide whom society calls dangerous and how much liberty may be taken away.

The disability-rights objection: Is exemption really equality?

The insanity defense has usually been understood as protection against unjust punishment for people with mental disabilities.

Disability-rights theory also raises an objection from the opposite direction.

Article 12 of the UN Convention on the Rights of Persons with Disabilities requires recognition that persons with disabilities enjoy legal capacity on an equal basis with others. Work by the Office of the UN High Commissioner for Human Rights and the Committee on the Rights of Persons with Disabilities has raised a difficult question: does declaring a person “incapable of responsibility” because of mental disability, then channeling the person into special confinement, deprive that person of standing as a legal subject?

In simple terms, the criticism is this:

The protection “you need not bear responsibility because you are ill”
can become the exclusion “you are not a full legal person.”

An insanity acquittal may also be followed by involuntary treatment and confinement with no readily predictable endpoint. Formally it is an acquittal; substantively it can produce a uniquely burdensome loss of liberty.

Some scholars therefore propose abolishing diagnosis-based defenses and applying “disability-neutral” doctrines—intent, mistake, duress or necessity—to everyone in the same way.

That proposal faces a serious objection of its own.

Giving formally identical responsibility to someone whose reality was fundamentally altered by psychosis may send the person to prison in the name of equality. Even without using a diagnosis, a court still has to ask what the person understood and to which reasons the person could respond.

We need to distinguish “treating everyone identically” from “treating everyone as an equal person.”

Equal respect does not require mechanically imposing the same sentence.

It can require an individualized, evidence-based assessment of different capacities, together with support and rigorous procedure.

At a minimum, a rights-respecting system of criminal responsibility should:

assess concrete capacities at the time of the act, not rely on diagnosis alone;
make the assessment temporary and act-specific, rather than labeling the whole person “dangerous”;
support the defendant’s understanding and participation in proceedings;
provide independent review, regular reconsideration and a right to challenge therapeutic confinement;
end confinement when risk has sufficiently declined rather than continuing it solely because of the past act;
provide victims and families with explanation, support and public remembrance that do not depend entirely on sentence severity.

Recognizing reduced responsibility and taking away a person’s voice as a legal subject must never become the same thing.

When we say “mental illness did it,” whose responsibility disappears?

Clancy’s own criminal responsibility is the central issue at trial.

If society looks only at that issue, however, other forms of responsibility can vanish from view.

How should severe postpartum symptoms be detected?

When a patient or family asks for help, can clinicians share and connect the relevant information?

How should sleep, medication, diagnosis and support after discharge be evaluated?

Did the community have a system capable of supporting a mother and children together?

These questions are distinct from Clancy’s legal responsibility. The public trial record as it now stands does not justify a conclusion that any particular clinician or institution was negligent.

Even so, a society that concentrates all responsibility in one person loses the questions needed for prevention.

The opposite reduction is also dangerous. If we say only “the system failed” or “the illness acted,” refusing to speak about the individual’s conduct at all, we obscure what happened to three children and how the defendant was connected to it.

Responsibility is not always zero or one hundred.

criminal responsibility for the act;
professional responsibility for medical judgments;
institutional responsibility to support a family;
social responsibility for resources devoted to postpartum mental health;
journalistic responsibility not to equate mental illness with violence.

These are different kinds of responsibility. Recognizing one does not erase the others.

A finding that the individual lacked criminal responsibility can coexist with a stronger social responsibility to prevent another tragedy.

The less adequately punishment explains an event, the more widely we must assume responsibility for preventing the next one.

The philosophical and ethical meaning of acquittal or mitigation for insanity

The discussion so far reveals five purposes of the law of criminal responsibility.

1. It separates causation from moral responsibility

The fact that a person’s body caused a result is separated from whether the person deserves blame for it. This does not deny the harm. It distinguishes punishment from revenge.

2. It makes punishment a message to someone who could answer reasons

If punishment is blame or warning, it must be addressed to a person who could understand it and could have chosen differently. When the circuit of understanding was absent, punishment can become pain without a message.

3. It recognizes degrees of responsibility

Mental condition is not painted in the two colors of perfect sanity and total insanity. Doctrines in Japan, Germany, and England and Wales recognize that responsibility and punishment may need to vary when the capacities for understanding or control were seriously diminished.

4. It redirects attention toward treatment and prevention

If illness decisively contributed to the act, stronger condemnation alone will not prevent recurrence. Earlier detection, access to care, family support and continuity of treatment matter.

5. It monitors the state’s power to confine indefinitely in the name of “danger”

Medical confinement after an acquittal must not be justified by the word compassion alone. The need for treatment and the need to restrict liberty must be separately established and periodically reviewed.

Without the fifth purpose, humanization can become nothing more than punishment translated into medical language.

What would a fairer system look like?

No legal test is perfect.

Define responsibility too narrowly, and people who could not grasp reality will be punished.

Define it too broadly, and responsible choices may be redescribed as symptoms, harming both justice for victims and confidence in law.

Give experts too much authority, and moral judgment by juries and society is replaced by medical vocabulary.

Distrust experts too deeply, and decisions rest on uninformed prejudice about psychosis.

Release everyone immediately after an acquittal, and genuine safety concerns may be ignored.

Confine people indefinitely, and an acquittal may take more liberty than a conviction.

What is needed is not one perfect line, but a procedure that guards against several different errors.

This article proposes four windows of responsibility:

The window of reality—could the person understand what was happening?
The window of norms—could the person understand why the act must not be done?
The window of control—could the person stop in accordance with that understanding?
The window of time—did the impairment exist at the time of the act, and does it continue now?

The first three look backward and address criminal responsibility.

The fourth governs present treatment and restrictions of liberty.

They must not be conflated.

Lack of responsibility at the time of the act does not automatically prove dangerousness now.

Stability now does not prove responsibility at the time of the act.

Past responsibility and present risk should be decided through different evidence, different procedures and different time limits.

That is the minimum condition for governing the two doors humanely.

Conclusion: Withholding responsibility is not taking a human being less seriously

We do not know what verdict the jury will return in Lindsay Clancy’s case.

Did the mental disorder alleged by the defense destroy her perception of reality or capacity for control at the time?

Does the planning emphasized by the prosecution demonstrate a responsible choice made with an understanding of wrongfulness?

Those questions must be decided from the entire body of evidence presented at trial.

We can nevertheless say what the institution is for.

An acquittal or reduced sentence based on insanity does not approve the act.

It does not forget the victims.

It does not turn illness into an all-purpose excuse.

It requires the state, before inflicting suffering, to ask whether the person stood in a place that blame could reach.

When a person could understand reasons, perceive reality and control conduct, holding the person responsible can recognize that person as an agent.

When those capacities were absent, withholding blame can also show respect by refusing to make the person an object of revenge.

But that respect reverses itself if the acquitted person is then confined indefinitely under the description “dangerous patient.”

The first door is not enough.

The reason for taking someone out of punishment must be separated from the reason for entering medical confinement, and judicial light must continue to fall on the second door.

A civilized justice system does not prove itself by showing how forcefully it can punish. It proves itself, even in the cases that provoke the greatest anger, by distinguishing whom it may confine, for what reason and for how long.

The question

Is causing a terrible result enough to justify punishment?

Or must the person have understood the meaning and wrongfulness of the act and possessed the capacity to choose otherwise?

If an insanity acquittal leads to medical confinement with no predictable endpoint, is it truly an acquittal?

How can society honor victims other than through the severity of a sentence?

Can a system recognize lack of responsibility caused by illness without grouping people with mental disabilities together as dangerous?

And when support would prevent the next tragedy more effectively than punishment, where should society direct its resources?

FAQ

Has a verdict already been returned in the Lindsay Clancy trial?

No. The trial began at Plymouth Superior Court in Massachusetts on July 27, 2026, and remained in progress as of August 9. Clancy has pleaded not guilty to three counts of first-degree murder. The central dispute is not whether her actions caused the deaths but whether she was criminally responsible at the time.

Are postpartum psychosis and postpartum depression the same?

No. Postpartum psychosis is a rare and severe condition that may involve hallucinations, delusions, mania or profound depression and is treated as a medical emergency. A diagnosis and legal responsibility are nevertheless separate. A diagnosis of postpartum psychosis does not automatically produce an acquittal.

Does any mental illness eliminate responsibility for a crime?

No. Most mental-health conditions do not eliminate criminal responsibility. The legal question is how a disease or defect affected the defendant’s ability, at the time of the offense, to understand the nature or wrongfulness of conduct or to control that conduct.

Is a person acquitted by reason of insanity immediately released?

Not necessarily. In Massachusetts there can be an observation period followed by civil commitment proceedings and periodic court review. An insanity acquittal can therefore lead to confinement in a psychiatric facility rather than prison.

Does Japan have a comparable rule?

Yes. Article 39 of Japan’s Penal Code provides that an act committed by an “insane” person is not punishable and that the punishment of a person with “diminished capacity” must be reduced. These are legal judgments about the ability to distinguish right from wrong and act accordingly, not medical diagnoses.

Does an insanity acquittal disregard victims?

A lack-of-responsibility finding does not deny the act or the gravity of the harm. Law separates what happened, whether the defendant can be criminally blamed, and what treatment or safety measures are now justified. Support and remembrance for victims should not depend entirely on the severity of a sentence.

Is the insanity defense frequently abused?

A classic empirical study covering several US states found that the plea was raised in roughly one percent of felony cases and succeeded in about one quarter of those cases. It is an older American study and should not be generalized to the contemporary world. It does, however, challenge the popular image of a defense that anyone can invoke easily before walking free.

References

Lindsay Clancy trial and postpartum psychosis

Law and history

Philosophy and human rights

This article is based on public information available as of August 9, 2026. Lindsay Clancy’s criminal responsibility remains contested at trial. Neither the defense’s nor the prosecution’s account is presented here as an established fact.

It would be wrong to treat people with mental illness, including postpartum psychosis, as generally dangerous. Responsibility and safety risk must be evaluated from evidence specific to the person, time and act.

The philosophical theories have been summarized for beginners and applied to this problem. This does not mean that the philosophers themselves discussed the Lindsay Clancy case or modern criminal-responsibility law.

Carry the question into another conversation.

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