The Dangers of Medicalizing Evil: When Does an Explanation Become an Excuse?
When a mother kills her own children, society naturally searches for an explanation. Was she mentally ill? Did postpartum psychosis cause her to lose touch with reality? Did medication contribute to her actions? Did doctors fail to recognize the seriousness of her condition?
These initial inquiries are legitimate and must be investigated carefully. However, there is a growing danger in allowing a medical explanation to become a substitute for personal responsibility, moral judgment, and justice.
Explanation, Not Automatic Excuse
Mental illness exists as part of the human condition, and some forms of mental illness can profoundly affect a person’s ability to understand reality, make decisions, and/or control behavior. Postpartum psychosis is becoming recognized as one such serious psychiatric condition [1], and women who experience it need immediate and appropriate medical attention.
Doctors and other medical professionals have an obligation to recognize dangerous psychiatric conditions and provide competent treatment. When they fail to meet that obligation, their actions should be examined and, when appropriate, held accountable.
However, acknowledging the existence of mental illness does not require society to conclude that every terrible act committed by a mentally ill person was caused by the illness or that the person therefore bears no responsibility for the consequences.
The case of Lindsay Clancy illustrates the difficulty of drawing that line. Clancy, a Massachusetts mother, is accused of killing her three young children, Cora, Dawson, and Callan, in January 2023. Her defense has argued that she was suffering from severe postpartum psychosis and therefore should not be held criminally responsible for their deaths.
The prosecution has challenged that explanation and presented evidence concerning her mental state, her actions, and her understanding of what she was doing. Her case raises an important question that extends far beyond one courtroom: At what point does explaining a person’s conduct become an excuse for that conduct?
That question does not require us to deny mental illness, minimize postpartum psychosis, or ignore possible failures within the medical profession. Nor does it require us to assume that every person who commits a horrific act while suffering from a psychiatric disorder is simply evil and therefore undeserving of compassion.
The issue is more fundamental: specialists in medicine can help explain what may have happened inside a person’s mind, but they cannot alone determine the moral value of an action or automatically remove personal responsibility for that action.
Those questions belong not only to medicine, but also to the law, to morality, and to society. The distinction is especially important when the victims are children. When a mother kills her own children, public attention can quickly become centered on her diagnosis, her medications, her doctors, and her psychiatric history. Those subjects may be important, but the children must not disappear from the discussion.
Cora was five years old, Dawson was three, and Callan was eight months old when they were murdered. Their deaths were not merely symptoms of a psychiatric disorder or consequences of a medical treatment controversy. They were the deaths of three innocent children, and their lives and deaths must remain at the center of any honest examination of what happened.
The danger of medicalizing evil is therefore not the recognition of mental illness. The danger is allowing a medical diagnosis to become the final explanation for conduct that also demands moral and legal examination. A person may be mentally ill and still understand the difference between right and wrong. A person may receive psychiatric treatment and still make deliberate decisions.
A doctor may make a serious mistake without becoming responsible for every subsequent action of a patient. Conversely, a person may suffer such a profound psychiatric break with reality that the law determines she cannot be held criminally responsible. The challenge is not to choose between compassion and accountability, but to determine honestly when each applies.
The cases of Lindsay Clancy and Andrea Yates demonstrate why this distinction matters. Both cases involve mothers who killed their children and whose mental health became central to the legal proceedings. Both cases raise legitimate questions about postpartum psychiatric illness and medical treatment. Yet neither case can be understood simply by attaching a diagnosis to the defendant.
The facts, the medical evidence, the testimony of experts, the defendant’s actions, and the applicable law must all be considered. Otherwise, society risks replacing one kind of injustice with another: excusing conduct that should be examined carefully while, at the same time, reinforcing the false notion that mentally ill people are inherently dangerous.
The purpose of examining the medicalization of evil is not to condemn those who suffer from mental illness; it is to insist that explanations be supported by evidence and that compassion not become moral confusion. Mental illness deserves understanding and treatment.
Medical professionals deserve fair examination when their decisions are questioned. Defendants deserve due process. But innocent victims deserve justice as well. Understanding why something happened is important; determining who is responsible for what happened is equally important. One should never automatically replace the other.
Lindsay Clancy and the Search for Someone Else to Blame
On January 24, 2023, Lindsay Clancy killed her three children in the family home in Duxbury, Massachusetts. Cora was five years old, Dawson was three, and Callan was eight months old. After killing the children, Clancy attempted suicide by jumping from a second-story window and suffering severe injuries that left her paralyzed.
The basic fact that the children died at their mother’s hands was never disputed at trial. What was disputed was whether Clancy was criminally responsible for those deaths or whether severe postpartum psychosis had rendered her legally incapable of understanding or controlling what she was doing.
Clancy’s legal defense argued that she was suffering from severe postpartum psychosis and therefore was not criminally responsible for the killings. Prosecutors presented a very different interpretation. They argued that Clancy understood what she was doing and that the killings were deliberate.
Thus the central question was not simply whether Clancy had a mental illness. The question was whether that illness had reached the level required by Massachusetts law to relieve her of criminal responsibility for the deaths of her children. That distinction is enormous.
A psychiatric diagnosis does not, by itself, answer a legal question. A person can be severely depressed without being incapable of making decisions. A person can experience psychiatric symptoms without losing all understanding of right and wrong.
Furthermore, a person can receive psychiatric treatment without becoming a puppet of the medical system. And a person can suffer from a serious mental illness while still possessing some degree of personal agency. These distinctions are essential if society is going to discuss mental illness honestly without confusing a medical explanation with an automatic excuse for criminal conduct.
The trial lasted nearly six weeks, and the jury deliberated for approximately seven days before the judge declared a mistrial [2] on September 4, 2026. The jurors were unable to reach the unanimous verdict required under Massachusetts law.
Reports indicated that eleven jurors were prepared to acquit Clancy on the ground of lack of criminal responsibility while one juror would not agree, although accounts of the deliberations differed in important respects. Because the jury did not reach a unanimous verdict, Clancy was neither convicted nor found not criminally responsible. Her criminal case therefore remains unresolved, and prosecutors must decide whether to pursue another trial.
The unresolved nature of the case is important. Society should be equally cautious about declaring that Clancy was simply an evil woman who deliberately chose to murder her children and about declaring that psychiatric illness completely explains what happened.
The evidence presented at trial must be considered carefully, and allegations must remain allegations until established through the appropriate legal process. The jury’s inability to reach a unanimous verdict does not prove that the defense was right, nor does it prove that the prosecution was right. It demonstrates something else: determining the relationship between mental illness and criminal responsibility can be extraordinarily difficult.
The Difference between Illness and Responsibility
One of the greatest dangers in discussing cases such as Clancy’s is falling into one of two extremes. One extreme is cruelty—the belief that mental illness is merely an excuse and that psychiatric evidence should simply be ignored.
The opposite extreme is equally dangerous—the belief that once mental illness has been identified, personal responsibility automatically disappears. Neither position is reasonable. Mental illness can profoundly affect human behavior, but the existence of mental illness does not automatically settle the question of responsibility.
Postpartum psychosis is a particularly serious psychiatric condition. A person experiencing psychosis may hear voices, suffer delusions, or lose an ordinary understanding of reality. Such a condition can require immediate psychiatric intervention.
It is not imaginary, and it should never be treated as a character defect or dismissed as ordinary depression. Recognizing the seriousness of postpartum psychosis, however, does not mean that every criminal act committed by a person experiencing psychiatric symptoms is automatically the product of psychosis or automatically excused by it.
This principle is not unique to psychiatry. If a person has epilepsy, investigators must still determine what happened during a particular event. If a person has diabetes, the diagnosis does not automatically explain every decision that person makes.
If a person takes a prescription drug, the fact that the drug has possible side effects does not automatically establish that the drug caused a particular action. Likewise, a psychiatric diagnosis does not automatically establish that a defendant was incapable of understanding or controlling a criminal act. The relevant question remains what the evidence demonstrates about the person’s mental state at the time of the conduct.
There is another important reason to resist careless medicalization: it can harm people who suffer from mental illness. The American Psychiatric Association has emphasized that most people with mental illness are not violent and that people with mental illness are frequently victims of violence themselves [3].
When society begins treating mental illness as synonymous with dangerousness, innocent people who need treatment may become afraid of being judged, hospitalized, or stigmatized.
Mental illness deserves treatment and compassion. But mental illness should not become a universal explanation for human evil. To do so weakens moral reasoning while simultaneously reinforcing false stereotypes about millions of people who have never harmed anyone.
Compassion for those who suffer from mental illness requires that society understand the disease accurately. It does not require abandoning the concept of individual responsibility whenever a psychiatric diagnosis is present.
Andrea Yates: A Case That Changed the Conversation
The Andrea Yates case provides an important historical comparison. On June 20, 2001, Yates drowned her five children in the bathtub of her Houston-area home. The children were Noah, seven; John, five; Paul, three; Luke, two; and Mary, six months old.
Yates had a significant history of severe psychiatric illness, including hospitalizations and suicide attempts. Her legal defense argued that she was suffering from severe postpartum psychosis and was living in a delusional world in which she believed she was saving her children from Satan [4].
The horror of those killings and the seriousness of Yates’ mental illness existed simultaneously. One fact did not cancel out the other. Five children were dead, and their mother had committed the killings.
At the same time, the evidence concerning Yates’s psychiatric condition was extraordinarily significant to the question of whether she could legally be held responsible for those deaths.
Yates was initially convicted of murder, but that conviction was later overturned. The appellate court concluded that false testimony from prosecution psychiatrist Park Dietz concerning a nonexistent Law & Order television episode could have affected the jury’s decision.
Dietz had testified about an episode supposedly involving a woman who drowned her children, was diagnosed with postpartum depression, and was found not guilty by reason of insanity. The Texas Court of Appeals determined that the testimony was material to the case and that the conviction could not stand [5].
This history matters because it demonstrates how enormously influential psychiatric testimony can become in a criminal trial. Expert testimony can help a jury understand complicated medical conditions, but expert testimony must also be examined carefully. A person’s testimony does not become correct merely because he or she possesses medical credentials. Evidence must still be accurate, relevant, and subject to scrutiny.
At Yates’ second trial in 2006, the jury found her not guilty by reason of insanity. Her attorneys never disputed that she had killed the five children. Instead, they argued that her severe mental illness meant that she could not be held criminally responsible under the applicable legal standard.
The jury accepted that argument, and Yates was committed to Kerrville State Hospital, a state psychiatric hospital, where she currently still remains—apparently choosing to remain under care instead being released into the community.
That result illustrates an important principle that is frequently misunderstood. A finding of legal insanity does not mean that nothing terrible happened. It does not mean that the victims cease to matter. It does not mean that drowning five children becomes morally acceptable. It means that the jury determined that the defendant’s mental condition met the legal standard for avoiding criminal responsibility.
That determination is very different from saying, “She was sick, therefore nothing she did matters.” Everything she did mattered. Five children died. Their lives were destroyed. Their family was devastated.
The legal question was whether the law should hold their mother criminally responsible given the condition of her mind at the time of the killings. That distinction must remain clear whenever society discusses medical explanations for horrific behavior.
When the Victims Disappear
Perhaps the greatest danger of medicalizing evil is that the victims can gradually disappear from the story. The discussion becomes focused on diagnoses: Was it postpartum psychosis? Was it depression? Was it bipolar disorder? Was the medication appropriate? Should the hospital have admitted her? Did the psychiatrist miss warning signs? Those questions may all be important, but they are not the only questions.
Cora Clancy was five years old. Dawson Clancy was three. Callan Clancy was eight months old. Noah Yates was seven. John Yates was five. Paul Yates was three. Luke Yates was two. Mary Yates was six months old. They were not psychiatric case studies.
They were children. They had names, families, personalities, futures, and relationships. Their lives had value apart from whatever diagnosis, treatment history, or legal argument later became part of the story.
Their deaths should not become merely illustrations in a debate about psychiatric diagnosis. A society that values compassion must have compassion for innocent victims as well as suffering defendants. That does not require hatred of the defendant, and it does not require denying mental illness. It simply requires remembering that an explanation for an action is not the same thing as a moral evaluation of that action.
Two things can be true at the same time: a person can be desperately ill, and an innocent person can be deliberately killed. The difficult task is determining how the first fact affected responsibility for the second. Refusing to acknowledge one fact does not make the other fact disappear.
When the victim is a child, this moral distinction becomes even more important. Children have no ability to choose their parents, control their circumstances, or protect themselves from the decisions of adults.
They depend upon adults precisely because adults are expected to exercise judgment on their behalf. When that protection fails catastrophically, society has a duty to remember the children rather than allowing the entire public conversation to revolve around the suffering of the accused.
Compassion for a defendant and compassion for the victims are not competing moral obligations. A mature, well-functioning society must be capable of extending both. To remember the victims is not cruelty. To insist upon personal responsibility is not hatred. To recognize mental illness is not surrender. These principles can and should exist together.
The Temptation to Blame the Medical Profession
Another danger of medicalizing evil is the temptation to transfer responsibility entirely to doctors, psychiatrists, hospitals, or medications. Doctors should absolutely be held accountable when they commit malpractice.
If a physician fails to recognize a dangerous psychiatric condition, that failure should be investigated. If a hospital ignores warning signs, that should be investigated. If medication is prescribed negligently, that should be investigated. Medical professionals deal with human lives and should be held to high standards.
But there is a critical difference between medical negligence and responsibility for a crime. The Clancy case illustrates this distinction particularly well because the medical care she received before the killings has become a major part of the public discussion.
Her civil attorney has alleged that healthcare providers failed her, including claims involving diagnosis and psychiatric treatment. Those allegations are serious, but they remain allegations in a separate civil proceeding.
The proper response to those allegations is to examine medical records, treatment decisions, professional standards, and expert testimony. If negligence is established, the responsible parties should be held accountable. But the existence of a malpractice allegation does not, by itself, prove that medical providers caused the deaths of the children [6].
There is a profound difference between saying, “The medical system should have done more,” and saying, “The medical system caused these murders.” The first statement might ultimately be proven by evidence. The second requires a much stronger demonstration of causation.
A physician cannot control every thought or action of a patient. Psychiatric treatment is not mathematics. Doctors work with incomplete information, changing symptoms, uncertain diagnoses, and patients whose conditions can improve or deteriorate rapidly.
The medical profession should be accountable for negligence when negligence occurs. But accountability must be based upon evidence rather than upon the understandable human desire to find someone else to blame after an unimaginable event. The fact that a terrible outcome occurred does not establish that any person who interacted with the defendant beforehand caused that outcome.
Hindsight Is Not Proof
Horrific acts create an extraordinary temptation to look backward and assume that the warning signs were obvious. After a crime occurs, every earlier symptom can suddenly appear significant. A doctor’s appointment becomes a warning. A medication becomes a clue. A strange statement becomes evidence. A missed diagnosis becomes the turning point. But people make decisions without knowing the future.
Doctors diagnose patients with incomplete information, and psychiatric symptoms can be ambiguous. A medical professional can make a terrible mistake without intending harm, just as a patient can make a terrible decision without being completely controlled by illness. This situation remains the reason that malpractice claims are judged according to evidence and professional standards rather than simply by the terrible outcome.
The same principle should apply when the question is criminal responsibility. A terrible outcome does not automatically prove that a particular earlier decision caused it. Otherwise, every tragedy would become proof of someone’s negligence.
Justice cannot operate that way. It must distinguish between unfortunate circumstances, medical errors, genuine causation, and the independent decisions made by the person who ultimately committed the act.
Hindsight can also distort our understanding of psychiatric illness. Once we know that someone committed a terrible act, ordinary behavior before the crime may suddenly appear sinister. Yet families and doctors do not possess a crystal ball. A mother may be exhausted, depressed, anxious, or behaving unusually without anyone knowing that she will eventually become psychotic or violent.
It is precisely for these reasons that better research, screening, education, and treatment for postpartum psychiatric disorders are so important. The answer to uncertainty should be better medicine and better evidence—not the assumption that every unfortunate outcome proves that someone else was morally responsible.
Explanation Is Necessary—but Explanation Has Limits
Human beings naturally want causes. When something terrible happens, we ask why?That desire is understandable and necessary. Medical science advances by searching for causes.
Criminal investigations search for motives and circumstances. Courts examine mental states. Families search for explanations because accepting an apparently senseless tragedy is extraordinarily difficult. But there is a difference between finding a cause and fabricating an excuse.
A difficult childhood may help explain violence, but it does not automatically eliminate responsibility. Alcohol may help explain a person’s behavior, but intoxication does not automatically excuse a crime. A psychiatric diagnosis may explain unusual thoughts and behavior, but it does not automatically prove legal insanity.
The same principle applies to medication and medical treatment. A medication may influence a person’s condition, but it does not automatically establish that the medication caused a crime. Inadequate medical care may contribute to psychiatric deterioration, but it does not automatically establish that a doctor caused a murder. Each claim requires evidence.
These claims are not expressions of cruelty; they are expressions of intellectual honesty. If society cares about justice, it cannot decide that a diagnosis, a medication, or a doctor’s mistake must be the answer simply because that explanation makes a terrible event easier to understand.
There is also a danger in making the medical explanation too powerful. If society begins to assume that people who commit horrific acts are simply products of diseases, medications, childhood experiences, or healthcare failures, we may gradually weaken the concept of individual agency. Human beings are influenced by circumstances, but they are not merely collections of circumstances.
The law exists partly because society must distinguish between people who are genuinely incapable of understanding their actions and people who understand their actions but make terrible choices. That distinction is difficult, but difficulty does not make it unnecessary. In fact, the difficulty is precisely why the evidence must be examined so carefully.
Compassion without Moral Confusion
The strongest argument against medicalizing evil is not an argument for cruelty. It is an argument for moral clarity. We can say that a mentally ill mother deserves treatment. We can say that postpartum psychosis requires urgent medical attention. We can say that a negligent doctor should be held accountable. We can say that psychiatric patients deserve dignity and that families deserve support.
We can also say that killing innocent children is an act of such profound seriousness that neither the victims nor the question of responsibility should disappear beneath medical terminology. These ideas do not contradict one another. Compassion does not require confusion. In fact, genuine compassion requires us to face reality honestly.
If a defendant is truly insane under the law, justice requires recognition of that fact. But if a defendant is responsible for a deliberate crime, justice also requires that responsibility not automatically be transferred to a diagnosis, a prescription bottle, a psychiatrist, or a hospital. The law must examine the facts.
Medicine must examine the illness. Medical professionals must be held accountable when they truly fail their patients. And society must continue to ask moral questions that medicine alone cannot answer.
There is another reason moral clarity matters: the victims deserve it. When children are murdered, society should not speak of them only as symptoms of their mother’s psychiatric condition. They had names, personalities, potential futures, and relationships. Their lives had value independent of the medical or legal circumstances surrounding their deaths.
Whatever ultimately happens in the Clancy case, Cora, Dawson, and Callan should not become merely evidence supporting one side of a debate about postpartum psychosis. They were children whose lives ended violently. Remembering that fact is not a rejection of compassion for their mother; it is recognition that compassion must include the innocent.
Physicians Cannot Cure Evil
The medicalization of evil begins with a reasonable desire: the desire to understand why terrible things happen. Understanding is valuable. Medical science has an obligation to understand psychiatric disease, identify warning signs, develop effective treatments, and help families recognize when emergency intervention is necessary.
Mental illness is real. Postpartum psychosis is real. Psychiatric treatment can fail. Doctors can make mistakes. None of those truths should be denied. But neither should society deny another truth: human beings can be influenced by illness without necessarily being completely controlled by it.
The difficult task is determining where illness ends and responsibility begins. That determination cannot be made simply by attaching a diagnosis to a person after a terrible crime has occurred.
The Lindsay Clancy case forces Americans to confront that question. Clancy’s legal defense argued that postpartum psychosis made her not criminally responsible for the deaths of her three children.
Prosecutors challenged that account and presented evidence supporting their position that she understood what she was doing. After weeks of testimony, the jury could not reach a unanimous verdict, and the judge declared a mistrial. The case therefore remains unresolved.
Whatever happens in a future proceeding, the existence of a psychiatric defense should not cause the public to assume that medical illness automatically settles the question of responsibility. The law must determine responsibility according to the evidence and the applicable legal standard.
Andrea Yates’s case produced a different result. After her first conviction was overturned because of erroneous expert testimony, a second jury found her not guilty by reason of insanity, and she was committed to a psychiatric hospital. Her case demonstrates that the legal system can recognize profound mental illness while still treating the underlying conduct as an extraordinarily serious matter.
An insanity verdict does not mean that the children did not die. It does not mean that their deaths were unimportant. It means that the law reached a particular conclusion about the defendant’s mental state and criminal responsibility. That distinction must be preserved because without it, the words “mental illness,” “insanity,” “explanation,” and “excuse” begin to mean the same thing when they do not.
These cases do not teach us that mental illness is irrelevant. They teach us that mental illness and responsibility are difficult subjects that must be examined with extraordinary care.
We should reject the cruelty of blaming every mentally ill person for being dangerous. But we should also reject the opposite mistake: assuming that every terrible act committed by a mentally ill person is nothing more than a symptom of disease.
A diagnosis is not a verdict. A prescription is not a confession. A doctor’s mistake is not automatically the cause of a murder. And an explanation is not necessarily an excuse.
The children at the center of these tragedies deserve to be remembered not simply as evidence in a psychiatric debate, but as human beings whose lives were taken.
For those reasons, we must be careful about medicalizing evil. Medicine has an important role in explaining human suffering. It can diagnose disease, relieve pain, and sometimes save a person from the destruction caused by mental illness. But medicine cannot answer every question about right and wrong.
Those questions require moral judgment, personal responsibility, and justice. However complicated the medical evidence becomes, we must never allow the innocent victims to disappear. Understanding the reasons that a terrible act occurred is important.
Determining whether illness contributed to that act is important. Holding negligent professionals accountable, when the evidence establishes negligence, is important. But none of those responsibilities gives society permission to forget the most fundamental fact of all: innocent children died. An explanation may help us understand evil. It does not automatically excuse it.
Sources
[1] Alexandria Y. Alford, et al.“A systematic review of postpartum psychosis resulting in infanticide: missed opportunities in screening, diagnosis, and treatment.” PubMed — National Library of Medicine. September 2, 2024.
[2] Nate Raymond, et al. Reuters. “Lindsay Clancy Trial over Killing Her Children Ends in Mistrial.” Reuters. September 4, 2026.
[3] Tori DeAngelis. American Psychiatric Association. “Mental illness and violence: Debunking myths, addressing realities.” American Psychiatric Association. April 1, 2021.
[4] Editors. “Andrea Yates Found Not Guilty.” CBS News. July 26, 2006.
[5] Curators. Andrea Pia Yates v. The State of Texas. Texas First Court of Appeals decision January 6, 2005
[6]. Nicole Acosta and Elizabeth Rosner. “Lindsay Clancy’s Civil Lawyer Slams Medical Providers Over Children’s Killings.” People. September 9, 2026.
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