Insanity Trials and The Court of Popular Opinion

High-profile cases involving the insanity plea have always caught people’s attention. With Lindsay Clancy’s trial currently underway, we are seeing in real time how increased access to information through social media, live streaming, and various online communities can impact public involvement, perception, and opinion. This trial underscores both the importance of understanding the insanity plea and the educative role of psychiatrists.

At its core, the purpose of an insanity defense is that we, as a civilized society, do not punish someone who did not mean to do wrong.^1,2

The M’Naghten Standard

In modern history, in 1843 London, Daniel M’Naghten shot and killed Edward Drummond. M’Naghten had mistaken Drummond for his target, Prime Minister Robert Peel. M’Naghten had paranoid and persecutory delusions. M’Naghten’s acquittal by reason of insanity resulted in intense public backlash, prompting the creation of a new insanity standard known as the M’Naghten standard.³

The M’Naghten standard considers that someone is insane, if by a “defect of reason” caused by a “disease of the mind,” the person did not know the “nature and quality” of the act or its wrongfulness.⁴ This new standard emphasized the power of public opinion in shaping jurisprudence. It has been argued that had the M’Naghten standard been applied to M’Naghten’s own case, he likely would have been found guilty.³

Hinckley Trial (1982)

More than a century later, in 1982, John Hinckley’s trial was a high-profile not guilty by reason of insanity (NGRI) case in the United States. In an attempt to gain the attention of actress Jodie Foster, Hinckley shot President Ronald Reagan and 3 other people in the District of Columbia. Hinckley was tried under a relatively lenient standard for insanity, referred to as the Model Penal Code standard. In addition to the wrongfulness component that the M’Naghten standard considers, the Model Penal Code also considers the defendant’s volitional capacity (to conform his conduct to the requirements of the law) at the time of the offense. Under this standard, Hinckley, who was represented by a top-notch defense team hired by his family, was found NGRI.⁵

Again, the public backlash from the Hinckley decision was tremendous, as many people were skeptical of Hinckley’s schizophrenia diagnosis. People were also misinformed about the frequency and success of the insanity defense, thinking of it as a “get out of jail free” card. The public was also skeptical about whether the expert witnesses were “for hire” and if the field of psychiatry was too imprecise to rely on for such critical cases.⁵ Following the trial, Congress passed the Insanity Defense Reform Act of 1984, which raised the bar for insanity by eliminating the volitional component of the law, shifting the burden of proof for insanity from the prosecution to the defense, raising the standard of proof, and preventing expert opinion testimony about the ultimate issue.⁵ The high-profile Hinckley case then, similarly to the M’Naghten case, demonstrated society’s mistrust in psychiatric diagnosis, with misunderstandings about the defense and leading to more stringent criteria for a successful insanity defense federally. (Most states similarly have M’Naghten standards.) Another case 2 decades later would have a different trajectory.

Yates Trials (2002 and 2006)

In 2001, in Texas, Andrea Yates drowned and killed her 5 children. Texas had a M’Naghten style NGRI statute. She had a long history of serious mental illness, including postpartum psychosis, and killed her children while she was acutely psychotic. Though she pled NGRI in her first trial, the jury rejected the defense and found her to be guilty. However, at her retrial, Yates again utilized the insanity defense, and this time was found NGRI.⁶

The Yates case put a spotlight on maternal mental illness.^7,8 In distinction to the Hinckley case, in the Yates case, forensic psychiatrists called by both sides agreed that she suffered from a mental illness at the time of the offense⁶; the disagreement between experts instead focused on whether or not she understood the wrongfulness of her acts at the time.

Clancy Trial (2026)

Now 2 decades later, the public is following another high-profile murder case involving a postpartum mother. Lindsay Clancy is a former labor and delivery nurse who is currently on trial for killing her 3 children in Massachusetts, a state famous for its very public trials involving women from the Salem Witch trials,⁹ to the more recent high-profile case of Karen Read.¹⁰ Massachusetts’s sanity law contains both the cognitive M’Naghten arm and the volitional component (similar to the law Hinckley was tried under). New in the high-profile Clancy trial, in comparison to the Hinckley and Yates trials, is the role of technology. Increased public access to the details of the case through livestreaming has resulted in millions of viewers across the days of the trial.

Social media has also expanded public awareness of this case and increased the discussion around various psychiatric topics, including postpartum psychosis,¹¹ suicide, and difficulties with accessing psychiatric care. While a greater understanding of mental health can be seen as a win for psychiatry, this conversation must be thoughtful. The public is learning about mental illness through the lens of a murder trial, thus potentially linking mental illness and homicide in the public eye. This is despite the actual data that people with mental illness are more likely to be victims of violence rather than perpetrators.¹² Social media also has the potential to amplify false narratives.¹³ Increased interest in “forensic fandoms” where internet sleuths examine evidence independently and present their own interpretations and theories¹⁴—with the potential to further distort information on psychiatric illnesses and treatment.

Finally, the Lindsay Clancy trial has highlighted an important issue in psychiatry and the law: the potential for gender and racial biases.^15,16 Not all defendants who kill their children, and not even all defendants with suspected psychosis, are treated equally. In 2022, Latarsha Sanders, a Black woman, was found guilty of killing her children in the same Massachusetts county. Her trial was not high profile and she did not have a GoFundMe. The same presiding judge as viewers watch in the Clancy case did not allow the defendant to submit her medical records containing details of her mental illness. During the Clancy trial, the Massachusetts Supreme Judicial Court ordered a retrial for Sanders, as the decision impeded her ability to use the NGRI defense.¹⁷

Concluding Thoughts

Public opinion has the potential to sway case outcomes. Public impression can lead to scrutiny and reconsideration of the legal standard for NGRI. The high-profile nature of the Clancy trial should remind psychiatrists about our role in public discussion. First, it is important to recognize that psychiatric illness is not synonymous with an insanity verdict. Psychiatrists should recall that a trial is a basic part of the justice system, existing for a reason—rather than asserting that certain defendants should not have to stand trial.

Second, psychiatrists should be cautious of biases, highlighting that every defendant should have equal access to the insanity defense when appropriate. High-profile cases also remind us that race, gender, and socioeconomic status may ultimately influence perceptions in NGRI cases.¹⁸

Finally, psychiatrists should remember that while our role as educators on psychiatric diagnoses and treatment is essential, we must maintain strict professional boundaries and adhere to the ethical principles underlying the Goldwater Rule by avoiding diagnostic commentary on public figures.¹⁹

Dr Shetty is a psychiatry resident at New York University Grossman School of Medicine.

Dr Hatters Friedman is the Phillip J. Resnick Professor of Forensic Psychiatry; professor of psychiatry, reproductive biology, and pediatrics; and adjunct professor of law at Case Western Reserve University in Cleveland, Ohio. She served as editor of the Group for the Advancement of Psychiatry volume Family Murder: Pathologies of Love and Hate, which won the Manfred S. Guttmacher Award.

References

1. The American Bar Association’s Criminal Justice Mental Health Standards. American Bar Association. August 2024. Accessed August 26, 2026. https://www.americanbar.org/content/dam/aba/publications/criminal_justice_standards/mental-health-standards-2016.pdf

2. Clark v. Arizona. American Psychological Association. January 2006. Accessed August 26, 2026. https://www.apa.org/about/offices/ogc/amicus/clark

3. Asokan TV. Daniel McNaughton (1813-1865). Indian J Psychiatry. 2007;49(3):223-224.

4. Kaplan J, Weisberg R, Binder G. Criminal Law: Cases and Materials. 7th ed. Wolters Kluwer Law & Business; 2012.

5. Newman AW. The Insanity Defense: United States v. Hinckley (1982). In: From courtroom to clinic: Legal cases that changed mental health treatment. Cambridge University Press; 2019:139-157.

6. Resnick PJ. The Andrea Yates Case: Insanity on Trial, 55 Clev. St. L. Rev. 147. 2007. Accessed August 26, 2026. https://engagedscholarship.csuohio.edu/clevstlrev/vol55/iss2/4

7. Levin A. Texas case awakens public to postpartum mental illness. Psychiatry News. December 16, 2016. Accessed August 26, 2026. https://psychiatryonline.org/doi/full/10.1176/appi.pn.2016.12b20

8. Moran M. Yates case puts mental illness in media spotlight. Psychiatric News. April 19, 2002. Accessed August 26, 2026. https://psychiatryonline.org/doi/full/10.1176/pn.37.8.0001a

9. Friedman SH, Howie A. Salem witchcraft and lessons for contemporary forensic psychiatry. J Am Acad Psychiatry Law. 2013;41(2):294-299.

10. Russell J. Karen Read found not guilty of murder in boyfriend’s death outside Boston. New York Times. June 18, 2025. Accessed August 26, 2026. https://www.nytimes.com/2025/06/18/us/karen-read-trial-verdict.html

11. Kuntz L, Friedman SH. Postpartum psychosis on trial: what the Lindsay Clancy Case can teach us. Psychiatric Times. August 3, 2026. https://www.psychiatrictimes.com/view/postpartum-psychosis-on-trial-what-the-lindsay-clancy-case-can-teach-us

12. Appelbaum PS. Public safety, mental disorders, and guns. JAMA Psychiatry. 2013;70(6):565-566.

13. Spatz E, Skene L. Conspiracy theories abound in the Lindsay Clancy Case: Why online observers are spreading baseless claims. Boston Globe. August 14, 2026. Accessed August 26, 2026. https://www.bostonglobe.com/2026/08/13/metro/lindsay-clancy-conspiracies/ 

14. Mathias C. How “forensic fandom” in Lindsay Clancy trial threaten postpartum psychosis awareness. The Guardian. August 17, 2026. Accessed August 26, 2026. https://www.theguardian.com/us-news/2026/aug/17/lindsay-clancy-trial-conspiracy-theories-postpartum-psychosis

15. Friedman SH. Searching for the whole truth: considering culture and gender in forensic psychiatric practice. J Am Acad Psychiatry Law. 2023;51(1):23-34.

16. Friedman SH. Realistic consideration of women and violence is critical. J Am Acad Psychiatry Law. 2015;43(3):273-276.

17. Russell J. Retrial ordered in child killing with parallels to Lindsay Clancy Case. New York Times. August 6, 2026. Accessed August 26, 2026. https://www.nytimes.com/2026/08/06/us/latarsha-sanders-lindsay-clancy-child-killings.html 

18. Friedman SH. What the tragic case of Lindsay Clancy teaches us about our own biased expectations of parenthood. MS NOW. August 23, 2026. Accessed August 26, 2026. https://www.ms.now/opinion/lindsay-clancy-murder-trial-psychosis-postpartum-motherhood-biases

19. Levin A. Goldwater rule’s origins based on long-ago controversy. Psychiatric News. August 25, 2016. Accessed August 26, 2026. https://psychiatryonline.org/doi/full/10.1176/appi.pn.2016.9a19