In an unexplained development expert witness, Dr Avram Mack resigned from his role as a psychiatrist at Nemours Children’s Health in Delaware, hours after taking the stand. He has been a key expert witness in the Lindsay Clancy trial.
The murder trial of Lindsay Clancy has placed competing psychiatric opinions at the centre of a difficult question for the jury: was the Massachusetts mother legally responsible for killing her three children, or was she so severely affected by postpartum psychosis that she could not distinguish right from wrong or control her actions?
Clancy has admitted killing her children but pleaded not guilty by reason of insanity. Her defence maintains that she was suffering from postpartum psychosis when she killed Cora, five, Dawson, three, and Callan, eight months, on January 24, 2023, before attempting to take her own life.
The prosecution and defence called psychiatrists whose conclusions could not have been have been further apart. Dr Avram Mack, a psychiatrist hired by the prosecution, reviewed Clancy’s medical records and interviewed her twice, including interviews conducted at Tewksbury Hospital earlier this year. Mack concluded that Clancy was suffering from a major depressive episode but did not have psychosis. He also inherently rejected the suggestion that she was experiencing mania.
His testimony presented the killings as deliberate and organised rather than the product of a psychotic break.
“I understand the deaths, they were done methodically … one by one, in a way that was organized and that was intended to achieve a particular goal,” Mack testified.
“Similarly, her attempt at suicide was organized and thoughtful in a sense that it included as many possible methods as possible.”
Mack also described what he said Clancy had told him about the events. According to his testimony, she reported hearing a “male” voice during the killings and described it as “loud.”
“The voice said [something] to the effect of, ‘You should kill the kids. This is your last chance, so that you can kill yourself,'” Mack testified. “She [said] that while that was happening, she was saying out loud, ‘Go to God.'”
For the prosecution, the importance of Mack’s evidence was apparent. The existence of a voice alone does not necessarily establish psychosis, and Mack’s assessment was that the wider clinical picture did not demonstrate a psychotic disorder. His interpretation of the sequence of events was also a key factor in his opinion on criminal responsibility.
The defence, however, offered a fundamentally different psychiatric interpretation.
Forensic psychiatrist Dr Phillip Resnick testified after reviewing Clancy’s medical records and evaluating her several months after the killings. Resnick concluded that she had been experiencing postpartum psychosis at the time of the offences.
His credentials brought considerable forensic experience to the defence case. Resnick is a professor of psychiatry who has researched postpartum psychosis and previously testified as a key expert in the trial of Andrea Yates, the Texas mother accused of drowning her five children in 2001. His professional biography also records consultancy involvement in cases including those of Jeffrey Dahmer, Timothy McVeigh, Theodore Kaczynski, Scott Peterson and Casey Anthony.
Resnick said to jurors that, in his opinion, Clancy was unable to distinguish right from wrong and lacked control at the time of the killings.
The inherent difference between the experts therefore went beyond a disagreement about diagnosis. Their testimony went directly to the legal issue the jury must ultimately determine: whether Clancy possessed the mental capacity required for criminal responsibility when the children died.
Mack’s evidence was subjected to a robust cross-examination by defence attorney Kevin Reddington. At one point, Reddington challenged Mack’s professional experience.
“Your area of interest is in adolescents who like to smoke weed and drink, isn’t it?”
“No,” the psychiatrist responded.
Reddington then pressed him on his experience with women, asking whether he had “ever come within breathing distance of a pregnant woman.” He also questioned how many women Mack had treated before asking:
“What, are you making this up?”
The defence lawyer further suggested that Mack might have suffered from confirmatory bias because the state had approached him as part of its effort to rebut the insanity defence. Mack denied that suggestion. Reddington also questioned the amount Mack earns as an expert witness, placing his financial interest in forensic testimony before the jury.
The most heated exchange concerned postpartum psychosis and the diagnostic framework contained in the DSM-5, the standard reference used by mental health professionals.
When Mack described postpartum psychosis as a “proposed” symptom or disease, Reddington challenged him directly.
“Are you telling me you don’t believe or buy postpartum psychosis?”
“I’m not saying that at all,” Mack replied.
The exchange eventually drew an intervention from Judge William Sullivan. When Mack appeared to respond to questions by questioning Reddington rather than answering directly, the judge reminded him of his role as an expert witness.
“Doctor, hold on. Here’s the way this works. You don’t really ask a lot of questions, you answer the questions.”
Sullivan continued: “I told you before, if you can’t answer a question the way it is framed, just let me know and I’ll tell counsel to frame it in a different way.”
The exchange illustrates one of the recurring difficulties in psychiatric expert evidence: the distinction between a clinical diagnosis and the legal conclusion the court must reach. An expert may offer an opinion on diagnosis, symptoms, mental state and capacity, but the ultimate determination of criminal responsibility belongs to the fact-finder.
The competing testimony also demonstrates why expert witnesses can become pivotal in insanity cases. Mack’s opinion relied substantially on the absence of psychosis in the clinical picture and his interpretation of the organisation of the killings and suicide attempt. Resnick, by contrast, brought extensive specialist and forensic experience in postpartum psychosis and interpreted Clancy’s mental state through that lens.
The jury began deliberating on Thursday and had not reached a verdict by the end of Friday.
Whatever conclusion it ultimately reaches, the Clancy trial provides a striking illustration of the weight placed upon psychiatric evidence when a defendant admits the physical acts alleged but disputes the mental state required for murder. The case turns not simply on what happened, but on what the competing experts say was happening inside the defendant’s mind when it happened.
By Edward Price
