The trial of Lindsay Clancy entered another pivotal stage this week as the psychiatrist who treated her before the deaths of her three young children faced hours of questioning about the care she provided — and what warning signs may or may not have been visible at the time.

Dr. Jennifer Tufts treated Clancy beginning in September 2022, several months before the January 2023 events at the family’s Duxbury, Massachusetts, home.

On the witness stand, Tufts said that although Clancy was struggling with depression, anxiety, insomnia and difficulties associated with motherhood, she did not observe symptoms that led her to believe Clancy was psychotic.

That distinction has become central to the case.

Clancy has pleaded not guilty to three murder charges. Her defense maintains that she was suffering from severe postpartum mental illness and was not criminally responsible for her actions, while prosecutors dispute that characterization.

During cross-examination, defense attorney Kevin Reddington turned his attention to Tufts’ experience and the circumstances under which she treated Clancy.

One major issue was that their appointments were conducted remotely.

Tufts acknowledged that she never met Clancy in person during the months she provided psychiatric treatment.

The defense also questioned the extent of Tufts’ specialized experience with postpartum psychiatric conditions and whether she had access to all of Clancy’s medical information when making treatment decisions.

Tufts acknowledged that she did not have access to Clancy’s complete medical record.

The questioning highlighted another complicated aspect of Clancy’s treatment: medication.

Jurors have heard that Clancy received numerous psychiatric prescriptions as she moved between doctors and sought relief from worsening symptoms.

Tufts testified that Clancy sometimes believed medication was contributing to how poorly she felt. According to the psychiatrist, however, she believed Clancy’s underlying depression — rather than simply the medications — was responsible for many of those struggles.

Clancy had also reported troubling symptoms during the months before the events at the center of the case, including severe anxiety, insomnia and periods of feeling emotionally disconnected.

Yet Tufts maintained that Clancy remained coherent during their appointments and did not display the symptoms she would normally associate with psychosis.

That testimony presents jurors with one of the most difficult questions in the trial:

Could a patient appear organized and capable during psychiatric appointments while experiencing a much more serious deterioration outside them?

The defense is attempting to show that Clancy’s mental condition was more severe than her providers recognized and that opportunities to identify the seriousness of her postpartum illness may have been missed.

Prosecutors, meanwhile, have elicited testimony from mental-health professionals who treated Clancy and said they did not see evidence of psychosis before the children’s deaths.

The timeline immediately before January 24, 2023, has become particularly significant.

Tufts saw Clancy remotely the day before the incident.

During that appointment, according to testimony, Clancy did not report suicidal or homicidal thoughts and did not appear psychotic to her psychiatrist.

Less than 24 hours later, everything changed.

Clancy’s three children — Cora, Dawson and Callan — suffered fatal injuries inside the family home. Clancy survived a fall from an upstairs window and was left paralyzed.

The prosecution and defense agree on many of the basic events that occurred.

Where they sharply disagree is over Clancy’s state of mind and whether she was legally criminally responsible at the time.

That is why testimony from the professionals who treated her beforehand has become so important.

Each appointment, prescription, medical note and reported symptom is being examined retrospectively for clues about a mental state that both sides interpret very differently.

The defense’s questioning of Tufts does not itself establish that her treatment caused what happened or that Clancy was experiencing psychosis. Instead, it challenges whether the care she received was based on a sufficiently complete picture of her condition.

Tufts, for her part, continued to defend her assessment.

Her testimony leaves jurors with a striking contrast: a patient experiencing significant psychological distress, yet one whom her psychiatrist says did not exhibit psychosis during treatment.

Resolving that contradiction may ultimately become one of the most consequential tasks facing the jury.

As the trial continues, the focus is increasingly moving beyond the question of what happened inside the Clancy home.

The courtroom is now confronting the far more complicated question at the heart of the case:

What was happening inside Lindsay Clancy’s mind?

Main Sources: Associated Press, CBS News Boston, ABC News, Boston.com