The Lindsay Clancy case has become one of the most painful and polarizing stories in recent American memory. At its center are the unimaginable deaths of three young children and a mother whose mental state has become the subject of intense legal, medical, and public scrutiny. The criminal justice system will determine legal responsibility, but regardless of the trial’s outcome, the case exposes a larger and uncomfortable truth: Our understanding and treatment of postpartum psychiatric illnesses remain profoundly inadequate.

For many observers, the debate has become a binary one. Either Clancy was suffering from a severe postpartum psychiatric disorder, or she was not. Either she is guilty of murder or she is not. Either the system failed her or it did not. And, despite numerous attempts to seek medical care, she was either inappropriately medicated or not.

The truth is likely not that simple. Even if the system worked perfectly — and it rarely does, especially with complicated cases — there are limitations in what we can currently offer women experiencing postpartum mental illness. This case exposes the gaps in current diagnostic and therapeutic systems and the challenges of identifying which women are at greatest risk, predicting who will respond to treatment, and recognizing early when a patient is deteriorating despite receiving care. We are reproductive psychiatrists and neuroscientists who have not treated Clancy, but this case is a painful reflection of what we already knew: We need better options for patients suffering from postpartum mental health issues.

Postpartum depression affects roughly one in seven to one in eight women after childbirth, making it among the most common complications of pregnancy. Yet diagnosis remains largely dependent on self-reported symptoms and clinical interviews rather than objective biological tests. Clinicians often rely on screening questionnaires, which are valuable but imperfect. A woman may minimize or hide symptoms out of shame, fear of losing her child, or concern that she will be judged as a bad mother. Others may present with atypical symptoms that do not fit neatly into diagnostic categories. In contrast to postpartum depression, postpartum psychosis is extremely rare and has a “waxing and waning” course, meaning that a woman can appear to be OK at one moment and extremely ill at another point in time. This makes postpartum psychosis challenging even for experienced clinicians to diagnose. By the time severe illness becomes obvious, opportunities for prevention may already have been lost and tragedy may have already struck.

Treatment options, while helpful for many patients, have significant limitations. Standard antidepressants such as selective serotonin reuptake inhibitors (SSRIs) are frequently used because they are familiar, widely available, and well tolerated. However, they generally require weeks to become fully effective, do not work for everyone, and may even be contraindicated depending on the exact diagnosis.

Recent advances offer some hope. Newer medications have demonstrated more rapid symptom improvement than traditional antidepressants but still do not work for everyone. In addition, these newer therapies also underscore additional limitations of our current system, which include inequities in access due in part to the high cost. Unfortunately, determining which medication will help a specific patient often still involves a frustrating process of trial and error.

The Clancy case also highlights another challenge: Postpartum depression, postpartum psychosis, anxiety disorders, and bipolar-spectrum illness can present with overlapping symptoms. Distinguishing among them is often extraordinarily difficult, even for experts. In many areas of medicine, physicians can order laboratory tests, imaging studies, or genetic analyses to help guide diagnosis. In postpartum psychiatry, clinicians usually must make critical decisions without comparable objective tools.

This is why the search for predictive biomarkers deserves far greater attention and investment. Imagine if obstetricians could identify during pregnancy which women were at high risk for severe postpartum depression. Imagine if a blood test could predict who would respond to a specific therapy, who required more intensive monitoring, or who was at risk of progressing toward a psychiatric emergency.

Such advances would not eliminate tragedy completely, but they could dramatically improve outcomes. Promising research already exists. Investigators have identified epigenetic signatures and other biological markers that may predict postpartum depression risk before symptoms emerge.

The broader lesson from the Lindsay Clancy case is not that medicine failed because it lacked compassion. Rather, it may have failed because it lacked precision.

Jamie Maguire, Ph.D., is a professor of neuroscience at Tufts University School of Medicine. Lauren M. Osborne, M.D., is an associate professor of obstetrics and gynecology and psychiatry and a reproductive psychiatrist at NewYork-Presbyterian and Weill Cornell Medicine. Jennifer Payne, M.D., is vice chair of research and a professor at the University of Virginia in the Department of Psychiatry and Neurobehavioral Sciences, as well as the director of the Reproductive Psychiatry Research Program, UVA Health. Disclosure: Maguire is a named inventor on a pending U.S. patent application related to a biomarker approach for psychiatry. The application is pending and no patent has been granted. She receives no personal financial benefit from the patent.