WEBVTT
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I've been thinking a lot about the Lindsay Clansey case.
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For anyone outside of the United States who may not know the story, Lindsay Clansey is a young mother from the state of Massachusetts in the U.S., who in January of 2023 was accused of killing her three children, five-year-old Cora, three-year-old Dawson, and eight-month-old Callan, before attempting to take her own life.
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She survived.
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Her children did not.
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The case has received enormous attention, particularly because Lindsay had been experiencing severe mental health problems after giving birth.
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Her husband had described changes in her behavior.
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She'd been seeing multiple mental health professionals.
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There were medications, appointments, and serious discussions about how she was doing.
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And still, three children died.
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It's heartbreaking.
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And if I'm being honest, it also makes me so angry.
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I don't quite know where to put all of that anger.
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I'm a mother myself.
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I know how quickly those first few months after having a baby can, you know, swallow you whole.
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How little sleep you get, how isolating it can feel, even when there are people around you.
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But there is a point where exhaustion and the upheaval of having a new baby become much more concerning.
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One of the illnesses that has entered the conversation around cases like Lindsay's is postpartum psychosis, a psychiatric emergency that can profoundly alter the way a mother experiences what is happening around her.
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Now, I want to be careful with Lindsay's case.
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Her trial is still unfolding, and I'm not going to tell you what was happening inside her mind or assign her a diagnosis that's not been established in court.
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But the questions raised by her case are difficult to ignore.
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And I started wondering about the women whose stories we hear less often.
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Women from immigrant families, women of color, Asian women.
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Women whose families have their own ideas about motherhood, mental illness, privacy, and reputation.
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For some Asian women, talking openly about psychiatric illness has also meant confronting the fear of being judged, of being seen as a bad mother, or of bringing a private family problem into the public.
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I wanted to know what one of those stories looked like.
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And that's how I found Dr.
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Daksha Emson.
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There's one photo of Daksha that I cannot get out of my head.
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She's sitting on a bench with her three-month-old daughter, Freya, in her arms.
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Daksha looks tired, but she's beaming.
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Both arms are wrapped tightly around Freya.
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Her cheek is almost touching her daughter's.
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Freya is pressed against her chest, held close with hardly any space between them.
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It's an incredibly intimate photograph.
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And it was taken twenty four hours before Daksha killed her daughter and attempted to take her own life.
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By then, she'd already bought the acetone she would use.
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She'd already made her plans.
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But in this photograph, there's no indication of any of that.
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There's just Daksha holding her baby, smiling straight into the camera.
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The next day, Freya would be dead.
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And Daksha would be found barely alive.
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You are listening to Missing Context.
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Stories from Asia and the Asian Diaspora.
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Daksha was born in Tanzania in 1966.
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Her parents were Gujarati with family roots in India, but by the time Daksha was born, East Africa had been home for decades.
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When Daksha was four, political upheaval forced the family to leave Tanzania.
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So they returned to Gujarat.
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Five years later, they left again.
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This time, they went to the UK.
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They arrived in London in the mid-1970s, during a period when immigration had become one of the country's most heated political debates.
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White supremacist parties were gaining support all over the country.
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Asian families faced racism in schools, housing, and employment, not to mention daily violence on the street.
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For Daksha's parents, starting again in London meant building a new life for their family from scratch.
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They'd already lost one home.
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Now they had to build another.
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At school, she had another set of things to deal with.
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She learned English.
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She worked on her accent.
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She carefully watched the way children spoke, dressed, joked, and interacted with each other.
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And then there were her studies.
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Daksha was exceptional.
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Her academic achievement was so remarkable that she became the first student from her school to attend medical school.
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In 1984, at 18, she entered the Royal London Hospital Medical School.
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A year later, she attempted to take her own life.
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She was admitted to a hospital and initially diagnosed with depression.
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After a later episode of mania, doctors diagnosed her with bipolar affective disorder.
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Over the years, there would be five psychiatric hospitalizations, three courses of electroconvulsive therapy.
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And between those episodes, Daksha kept going back to medical school.
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Her studies took a little longer, but she won scholarships.
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She received medals and academic awards.
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She continued to achieve at a level that would have been extraordinary, even without the hospitalizations or the medications or the illness constantly interrupting her life.
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Eventually, Daksha chose to study psychiatry.
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She wanted to understand her own bipolar affective disorder and help others who were going through it as well.
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Daksha understood bipolar affective disorder not just as a doctor, but as someone who'd lived through it herself.
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But she also wanted to understand what was happening biologically: the medications, their effects, their side effects, and what happened when treatment didn't work.
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That experience shaped the doctor she became.
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Her colleagues remembered her as incredibly kind, thorough, and empathetic.
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She listened to patients carefully and took them seriously.
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Daksha was good at what she did.
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Good enough that she was invited to teach other doctors.
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But there was another side to being a psychiatrist who had herself spent time in psychiatric hospitals.
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The medical world Daksha was entering was overwhelmingly white and male at the time, particularly at its senior levels.
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Daksha was a woman.
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She was Indian.
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She was the daughter of immigrants who had come to London and built a life above a grocery store.
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And she was working towards the highest level of her profession, where very few doctors looked like her.
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An inquiry after Daksha's death found that she went to considerable lengths to keep her psychiatric history hidden from supervisors.
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Daksha was open with occupational health, which is the UK's national service responsible for doctors' well-being, but received little support in terms of follow-ups or interventions or advice.
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By the 1990s, Daksha had entered a pretty long period of relative wellness.
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The medication lithium was part of her treatment, and she also took Prozac for some time.
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There was only one documented episode of mania during her residency and fellowship years, but otherwise, she remained well for about eight years.
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In 1991, while training in Ireland, she met David Emson, a soft-spoken radiologist.
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They fell in love.
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Daksha's family initially opposed the relationship, but the couple married in 1992 with both a civil ceremony and a Hindu wedding.
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Daksha now had the life she'd once imagined from the small apartment above her parents' door: a medical career, a husband, and the prospect of a family of her own.
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Then she and David began thinking seriously about having a child.
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For Daksha, pregnancy required a great deal of preparation.
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She knew how serious her illness had been.
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She also knew what the medication had given her over the previous decade.
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Her health, a reputable medical career, and the ability to live life the way she wanted.
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Daksha and David talked a lot about what would happen if she came off her medication as they tried for a baby.
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What should they watch for?
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What changes in her mood or sleep should concern them?
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What would they do if her behavior changed?
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There was another pressure as well.
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Daksha was approaching the level of consultant psychiatrist.
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A consultant psychiatrist is the highest clinical grade in the UK's National Health Service or NHS when it comes to psychiatry.
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It meant leading teams, teaching younger doctors, and making major clinical decisions independently.
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Daksha had worked extraordinarily hard to get here.
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She was terrified that her psychiatric history could jeopardize it.
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So, the pregnancy was planned with extreme caution.
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Daksha stopped lithium while trying to conceive.
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Soon she became pregnant.
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David and Daksha were over the moon.
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But the pregnancy ended in a miscarriage.
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Daksha became pregnant the next month, but that pregnancy also didn't continue.
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Within three months, Daksha suffered three miscarriages, including the loss of twins.
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A few months later, Daksha became pregnant again.
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This pregnancy continued.
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David remembers Daksha smiling constantly as they moved from one milestone to the next.
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After three miscarriages, every week that passed brought another reason to believe they might finally bring this baby home.
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Freya, their healthy baby girl, was born in July of 2000.
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Daksha was elated.
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She finally had the baby she'd so desperately longed for.
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Daksha was also determined to breastfeed Freya.
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She saw it as one of the most important things she could give her daughter, the best possible start in life and part of being the mother she wanted to be.
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With her psychiatrist's agreement, she remained off lithium for another three months.
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During this time, she cared for Freya.
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She began doing some part-time work.
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She started preparing to return to psychiatry.
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The people around her were still turning to Daksha to tell them how she was doing.
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She'd lived with the illness for a long time.
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She understood the treatment and knew the warning signs better than anyone around her.
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David, I know my illness, she would tell her husband.
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So David and the doctors, who knew her history, trusted that knowledge.
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For years that trust had been justified.
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Then, as summer turned to fall, Daksha's sleep began to rapidly deteriorate.
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By September, Daksha was depressed and was barely sleeping.
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But she was still doing an incredible amount of work.
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Daksha was looking after Freya, keeping up with the demands of a new baby, all the while trying to return to work.
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She was also talking to her doctors.
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She was talking to family.
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From the outside, there was still plenty of evidence that she was functioning well.
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But functioning well is not the same thing as being well.
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Daksha's sleep was rapidly deteriorating.
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Her thoughts were becoming increasingly preoccupied with failure as a mother, as a wife, as a woman.
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She was writing about those fears in her diary while continuing to do the things everyone around her had come to expect from Daksha.
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And this is what is so heartbreaking when we look back at those weeks.
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The illness was there, the signs were there.
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But Daksha wasn't a woman lying in bed unable to care for her baby.
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She wasn't pushing Freya away.
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She was feeding her daughter, playing with her, showering her with hugs and kisses.
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She was laughing at David's jokes, answering the phone, going to the store, speaking to her doctors.
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All while her thoughts were taking her further and further from what was real.
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Postpartum psychosis is volatile.
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It moves quickly.
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And sometime during those final days, Daksha began to develop beliefs that were no longer grounded in reality.
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Freya became a part of those beliefs.
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Daksha became convinced that her baby was in grave danger from evil forces, that she needed to protect Freya at all costs.
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By the time this shift in thinking happened, Daksha was no longer simply watching for the signs of relapse.
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She was lying awake at night, caught in a thought spiral she just couldn't quiet, with her fears becoming harder and harder to separate from what was actually happening around her.
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Her illness was no longer something she was managing.
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It was beginning to dictate what she saw, what she believed, and what she feared.
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This is important because a symptom like deteriorating sleep can actually be an early warning sign of bipolar relapse.
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But in a new mother, poor sleep can look like part of the job.
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There's no routine screening test for postpartum psychosis that can simply tell a doctor whether a woman is developing it.
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Doctors and family have to recognize risk and changes in behavior.
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In Daksha's case, there were several things happening at once.
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Her worsening sleep, like I mentioned, was one of the clearest warning signs, but at the time, it was not being treated with the urgency we might place on it today.
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Daksha's doctors and David knew she was struggling with depression, with sleep, but they were also seeing a highly functional woman dealing with what could easily look like the exhaustion of new motherhood.
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What they could not see was where those symptoms were taking Daksha.
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Part of that was because Daksha's care was not happening in one place with one person.
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She'd chosen not to become a formal patient of the local community mental health team because of her fear that her psychiatric history would become known.
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Instead, she spoke to the people she trusted.
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A psychiatrist friend often visited Daksha at her house and they discussed her symptoms.
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She spoke with a few other trusted colleagues.
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She talked to David.
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These were people who knew Daksha and cared about her.
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But the issue was that they were not talking to one another about what Daksha was sharing.
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And there were very few and sporadic notes about these conversations.
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So there was no comprehensive assessment.
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Her care was pretty devoid of any context of her bipolar disorder, the recent birth, the lack of sleep, the depression, the fact that she was off medication, and finally the changes that people were beginning to notice in her behavior.
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Now, the other complication was Daksha was seen as a highly respected doctor first and foremost, rather than a vulnerable patient.
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That made it easier to believe that she would recognize when she needed help and just ask for it, that she didn't need the level of care and monitoring that a patient with her medical history might normally receive.
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But that assumption had a major flaw.
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Because the very illness Daksha's confidants were relying on her to recognize was beginning to affect her judgment severely.
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Daksha actually did tell her doctors that she was depressed.
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She did seek help.
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And that makes these final weeks extremely painful for us to go through and look back on.
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Because she was reaching out, she was telling people she wasn't well.
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There were people around her who knew she was struggling.
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But she was still keeping the worst of it to herself.
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Daksha was lying awake into the early morning hours, her thoughts churning.
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She was frightened and vulnerable.
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She was beginning to believe she was failing the people who depended on her: Freya, David, her patients.
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On October 5th, Daksha met with her psychiatrist friend.
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She told him about her depression and talked about the pressures at work and the demands of caring for Freya.
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Her psychiatrist recommended that she restart her medication and consider weaning Freya.
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Daksha reluctantly agreed.
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She would stop breastfeeding.
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She would begin taking the medication.
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Her psychiatrist wrote out the prescription.
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Daksha was due to start her medicine on October 10th, five days away.
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The next evening, Daksha and David were supposed to go to a concert.
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Her sister-in-law was going to look after Freya.
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But that afternoon, Daksha changed her mind.
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She told David to go on without her.
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The following morning, Freya woke early for a feed.
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Daksha was already awake.
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She fed the baby and brought her into bed with her and David.
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The couple had a small argument about who should go to the grocery store.
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They needed groceries.
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They also needed baby formula.
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David wanted Daksha to begin weaning Freya so she could restart her medication that week.
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Eventually, Laksha got dressed and went to the store.
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The inquiry that I mentioned earlier records that she left around 8:30 or 9 that morning.
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It is possible she bought the acetone she would later use that day during this same trip.
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But what she was definitely buying was formula for her baby.
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Later that morning, Daksha's mother called.
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She offered to come over with Daksha's sister.
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Daksha said no.
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She didn't want them to visit.
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Now, on its own, that might not have seemed alarming at all.
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A tired new mom declining a family visit isn't really that unusual.
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But by then, Daksha was withdrawing.
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And her thoughts about Freya were becoming more concerning.
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She'd become convinced that her daughter needed protection from evil forces.
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She hinted at this to David over the next couple of days.
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On the morning of October 9th, David kissed Daksha and Freya before leaving for work.
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He didn't know that this would be the last morning he would see his wife and daughter alive together.
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That afternoon, when David returned from work, he expected the usual sounds of home.
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His wife talking to the baby, Freya making those little three-month-old noises babies make, gurgling, cooing, answering Daksha's voice with a sound of her own.
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He called out for his wife, for his daughter.
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Nothing.
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Then he smelled smoke.
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It was coming from upstairs.
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On the kitchen table was a note from Daksha.
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The writing was in capital letters.
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Daksha wrote that Freya was in danger from something really bad, that she loved her daughter and had to protect her.
00:24:16.960 --> 00:24:19.279
David ran upstairs.
00:24:19.599 --> 00:24:24.160
The smell of smoke and burning became stronger as he reached the bedroom.
00:24:25.039 --> 00:24:28.960
Freya was dead, lying on the bed.
00:24:29.759 --> 00:24:31.359
She'd been stabbed.
00:24:32.319 --> 00:24:38.079
Daksha was lying on the floor, badly burnt, one eye open.
00:24:39.359 --> 00:24:41.680
David called to her in panic.
00:24:42.799 --> 00:24:45.759
She looked at him and said his name.
00:24:46.640 --> 00:24:49.680
Then she lost consciousness.
00:24:51.440 --> 00:24:54.640
Daksha would die three weeks later.
00:24:55.119 --> 00:24:57.599
She was thirty-four years old.
00:24:58.960 --> 00:25:03.920
The police initially arrested David in connection with his wife's death.
00:25:04.240 --> 00:25:06.799
He was released a few weeks later.
00:25:07.359 --> 00:25:12.160
But the question that remained was not simply what had happened in that bedroom.
00:25:12.640 --> 00:25:23.359
It was how Daksha had reached that point, while doctors, her husband, and the people who knew her well were all aware that she was becoming unwell.
00:25:24.400 --> 00:25:28.240
The inquiry would spend years examining that question.
00:25:30.640 --> 00:25:36.319
There was one place where Daksha had been putting some of her feelings into words.
00:25:36.640 --> 00:25:37.599
Her diary.
00:25:38.480 --> 00:25:44.880
Her diary actually gives us a much clearer picture of how badly Daksha was struggling.
00:25:45.519 --> 00:25:48.720
She was increasingly preoccupied with failure.
00:25:49.039 --> 00:25:56.319
At work, she was still pushing herself to prove that she belonged in a senior, overwhelmingly white male position.
00:25:56.640 --> 00:26:01.359
There was little room in her mind to let anyone see her falter.
00:26:02.640 --> 00:26:20.720
And beneath all of it, of course, was the fear that if people discovered how unwell Daksha had once been, how unwell she felt now, she could completely lose the career she'd fought so hard to establish, and perhaps even lose Freya.
00:26:22.319 --> 00:26:30.319
Those fears began to converge until failure itself became a recurring theme in the way Daksha saw herself.
00:26:31.680 --> 00:26:37.680
She wrote, I feel useless as a mother, as a wife, as a woman.
00:26:37.920 --> 00:26:40.640
I see no hope for the future.
00:26:41.039 --> 00:26:47.440
In another entry, she described sleep that left her feeling no better than before.
00:26:47.680 --> 00:26:53.119
She wrote about forcing herself to eat because Freya needed the nourishment.
00:26:53.920 --> 00:26:57.599
She worried that everyone could see she was failing.
00:26:58.319 --> 00:27:02.480
And then the language in the diary begins to change.
00:27:03.119 --> 00:27:07.440
Daksha began to question her own worth, her own character.
00:27:08.720 --> 00:27:11.440
Am I bad and wicked?
00:27:11.920 --> 00:27:14.160
Do I deserve good things?
00:27:14.799 --> 00:27:18.720
Is there really any hope for the future?
00:27:20.559 --> 00:27:26.000
And there was another line in the diary that is particularly painful to read.
00:27:26.400 --> 00:27:30.880
Daksha wrote that she was finding it difficult to hang on to reality.
00:27:32.960 --> 00:27:35.920
Yes, Daksha knew her illness.
00:27:36.640 --> 00:27:40.960
But by this time, her illness was progressing too rapidly.
00:27:41.200 --> 00:27:45.839
It was changing how she saw herself and everyone around her.
00:27:46.160 --> 00:27:51.359
And that made it harder for her to recognize how urgently she needed help.
00:27:51.759 --> 00:27:55.599
By the time help came, it was too late.
00:28:01.039 --> 00:28:05.039
I began this episode thinking about Lindsay Clancy.
00:28:05.440 --> 00:28:07.759
I was angry, I still am.
00:28:08.720 --> 00:28:17.279
But I also know enough about postpartum mental illness to know that anger and empathy can actually exist together.
00:28:18.079 --> 00:28:28.400
I don't know what Lindsay understood about her own condition, what she believed was happening to her, or what her state of mind was like at the time.
00:28:28.880 --> 00:28:30.960
Her case is still being decided.
00:28:31.039 --> 00:28:33.440
There's still deliberations happening.
00:28:34.720 --> 00:28:37.599
What I do know is what happened to Daksha.
00:28:38.960 --> 00:28:44.160
Despite the illness taking hold, Daksha seemed to know she was worsening.
00:28:44.319 --> 00:28:45.920
She sought help.
00:28:46.480 --> 00:28:55.359
But she was also trying to protect her career, her privacy, and her family from the consequences of anyone knowing just how unwell she'd become.
00:28:56.240 --> 00:29:02.880
And much of that responsibility for deciding when she needed more help still rested with her.
00:29:04.960 --> 00:29:10.559
Daksha was asking for help while trying to hide how much she needed it.
00:29:11.039 --> 00:29:19.200
And the system struggled to recognize vulnerability in a woman who had become exceptionally good at appearing capable.
00:29:21.440 --> 00:29:31.599
The inquiry after Daksha and Freya's deaths condemned the UK's NHS for severe neglect, for being complicit in the tragedy.
00:29:32.319 --> 00:29:48.559
Doctors did not warn David or Daksha's family of the rapid onset of postpartum psychosis, how it can trigger a complete detachment from reality in a matter of hours, how Daksha was extremely vulnerable.
00:29:49.519 --> 00:30:02.000
The inquiry also made several recommendations about communication between professionals, perinatal mental health care, recognizing risk, and supporting doctors with mental illness.
00:30:03.839 --> 00:30:10.000
But Daksha's story also leaves us with a human question.
00:30:11.119 --> 00:30:20.160
How many women are trying desperately to remain the person everyone knows them to be while secretly becoming more and more sick?
00:30:21.119 --> 00:30:33.440
For women from immigrant and minority communities, that struggle can come with the added fear of shame, stigma, judgment, and losing the life they'd worked so hard to protect.
00:30:35.039 --> 00:30:39.920
Baksha was not just the woman in that bedroom on October 9th.
00:30:40.559 --> 00:30:57.039
She was also the little girl who arrived in the UK speaking very little English, the brilliant medical student who fought a serious illness, the gifted and empathetic psychiatrist, and the mother who held her baby close.
00:30:58.319 --> 00:31:01.039
All of those women were Daksha.
00:31:05.680 --> 00:31:11.920
You are listening to Missing Context Stories from Asia and the Asian diaspora.
00:00:09.679 --> 00:00:14.320
I've been thinking a lot about the Lindsay Clansey case.
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For anyone outside of the United States who may not know the story, Lindsay Clansey is a young mother from the state of Massachusetts in the U.S., who in January of 2023 was accused of killing her three children, five-year-old Cora, three-year-old Dawson, and eight-month-old Callan, before attempting to take her own life.
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She survived.
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Her children did not.
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The case has received enormous attention, particularly because Lindsay had been experiencing severe mental health problems after giving birth.
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Her husband had described changes in her behavior.
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She'd been seeing multiple mental health professionals.
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There were medications, appointments, and serious discussions about how she was doing.
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And still, three children died.
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It's heartbreaking.
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And if I'm being honest, it also makes me so angry.
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I don't quite know where to put all of that anger.
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I'm a mother myself.
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I know how quickly those first few months after having a baby can, you know, swallow you whole.
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How little sleep you get, how isolating it can feel, even when there are people around you.
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But there is a point where exhaustion and the upheaval of having a new baby become much more concerning.
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One of the illnesses that has entered the conversation around cases like Lindsay's is postpartum psychosis, a psychiatric emergency that can profoundly alter the way a mother experiences what is happening around her.
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Now, I want to be careful with Lindsay's case.
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Her trial is still unfolding, and I'm not going to tell you what was happening inside her mind or assign her a diagnosis that's not been established in court.
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But the questions raised by her case are difficult to ignore.
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And I started wondering about the women whose stories we hear less often.
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Women from immigrant families, women of color, Asian women.
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Women whose families have their own ideas about motherhood, mental illness, privacy, and reputation.
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For some Asian women, talking openly about psychiatric illness has also meant confronting the fear of being judged, of being seen as a bad mother, or of bringing a private family problem into the public.
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I wanted to know what one of those stories looked like.
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And that's how I found Dr.
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Daksha Emson.
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There's one photo of Daksha that I cannot get out of my head.
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She's sitting on a bench with her three-month-old daughter, Freya, in her arms.
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Daksha looks tired, but she's beaming.
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Both arms are wrapped tightly around Freya.
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Her cheek is almost touching her daughter's.
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Freya is pressed against her chest, held close with hardly any space between them.
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It's an incredibly intimate photograph.
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And it was taken twenty four hours before Daksha killed her daughter and attempted to take her own life.
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By then, she'd already bought the acetone she would use.
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She'd already made her plans.
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But in this photograph, there's no indication of any of that.
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There's just Daksha holding her baby, smiling straight into the camera.
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The next day, Freya would be dead.
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And Daksha would be found barely alive.
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You are listening to Missing Context.
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Stories from Asia and the Asian Diaspora.
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Daksha was born in Tanzania in 1966.
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Her parents were Gujarati with family roots in India, but by the time Daksha was born, East Africa had been home for decades.
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When Daksha was four, political upheaval forced the family to leave Tanzania.
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So they returned to Gujarat.
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Five years later, they left again.
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This time, they went to the UK.
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They arrived in London in the mid-1970s, during a period when immigration had become one of the country's most heated political debates.
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White supremacist parties were gaining support all over the country.
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Asian families faced racism in schools, housing, and employment, not to mention daily violence on the street.
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For Daksha's parents, starting again in London meant building a new life for their family from scratch.
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They'd already lost one home.
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Now they had to build another.
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At school, she had another set of things to deal with.
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She learned English.
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She worked on her accent.
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She carefully watched the way children spoke, dressed, joked, and interacted with each other.
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And then there were her studies.
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Daksha was exceptional.
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Her academic achievement was so remarkable that she became the first student from her school to attend medical school.
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In 1984, at 18, she entered the Royal London Hospital Medical School.
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A year later, she attempted to take her own life.
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She was admitted to a hospital and initially diagnosed with depression.
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After a later episode of mania, doctors diagnosed her with bipolar affective disorder.
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Over the years, there would be five psychiatric hospitalizations, three courses of electroconvulsive therapy.
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And between those episodes, Daksha kept going back to medical school.
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Her studies took a little longer, but she won scholarships.
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She received medals and academic awards.
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She continued to achieve at a level that would have been extraordinary, even without the hospitalizations or the medications or the illness constantly interrupting her life.
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Eventually, Daksha chose to study psychiatry.
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She wanted to understand her own bipolar affective disorder and help others who were going through it as well.
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Daksha understood bipolar affective disorder not just as a doctor, but as someone who'd lived through it herself.
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But she also wanted to understand what was happening biologically: the medications, their effects, their side effects, and what happened when treatment didn't work.
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That experience shaped the doctor she became.
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Her colleagues remembered her as incredibly kind, thorough, and empathetic.
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She listened to patients carefully and took them seriously.
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Daksha was good at what she did.
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Good enough that she was invited to teach other doctors.
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But there was another side to being a psychiatrist who had herself spent time in psychiatric hospitals.
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The medical world Daksha was entering was overwhelmingly white and male at the time, particularly at its senior levels.
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Daksha was a woman.
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She was Indian.
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She was the daughter of immigrants who had come to London and built a life above a grocery store.
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And she was working towards the highest level of her profession, where very few doctors looked like her.
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An inquiry after Daksha's death found that she went to considerable lengths to keep her psychiatric history hidden from supervisors.
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Daksha was open with occupational health, which is the UK's national service responsible for doctors' well-being, but received little support in terms of follow-ups or interventions or advice.
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By the 1990s, Daksha had entered a pretty long period of relative wellness.
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The medication lithium was part of her treatment, and she also took Prozac for some time.
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There was only one documented episode of mania during her residency and fellowship years, but otherwise, she remained well for about eight years.
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In 1991, while training in Ireland, she met David Emson, a soft-spoken radiologist.
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They fell in love.
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Daksha's family initially opposed the relationship, but the couple married in 1992 with both a civil ceremony and a Hindu wedding.
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Daksha now had the life she'd once imagined from the small apartment above her parents' door: a medical career, a husband, and the prospect of a family of her own.
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Then she and David began thinking seriously about having a child.
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For Daksha, pregnancy required a great deal of preparation.
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She knew how serious her illness had been.
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She also knew what the medication had given her over the previous decade.
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Her health, a reputable medical career, and the ability to live life the way she wanted.
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Daksha and David talked a lot about what would happen if she came off her medication as they tried for a baby.
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What should they watch for?
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What changes in her mood or sleep should concern them?
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What would they do if her behavior changed?
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There was another pressure as well.
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Daksha was approaching the level of consultant psychiatrist.
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A consultant psychiatrist is the highest clinical grade in the UK's National Health Service or NHS when it comes to psychiatry.
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It meant leading teams, teaching younger doctors, and making major clinical decisions independently.
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Daksha had worked extraordinarily hard to get here.
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She was terrified that her psychiatric history could jeopardize it.
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So, the pregnancy was planned with extreme caution.
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Daksha stopped lithium while trying to conceive.
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Soon she became pregnant.
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David and Daksha were over the moon.
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But the pregnancy ended in a miscarriage.
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Daksha became pregnant the next month, but that pregnancy also didn't continue.
00:12:23.120 --> 00:12:29.679
Within three months, Daksha suffered three miscarriages, including the loss of twins.
00:12:31.120 --> 00:12:35.200
A few months later, Daksha became pregnant again.
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This pregnancy continued.
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David remembers Daksha smiling constantly as they moved from one milestone to the next.
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After three miscarriages, every week that passed brought another reason to believe they might finally bring this baby home.
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Freya, their healthy baby girl, was born in July of 2000.
00:13:00.639 --> 00:13:02.639
Daksha was elated.
00:13:03.360 --> 00:13:07.440
She finally had the baby she'd so desperately longed for.
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Daksha was also determined to breastfeed Freya.
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She saw it as one of the most important things she could give her daughter, the best possible start in life and part of being the mother she wanted to be.
00:13:23.919 --> 00:13:29.679
With her psychiatrist's agreement, she remained off lithium for another three months.
00:13:30.080 --> 00:13:32.799
During this time, she cared for Freya.
00:13:33.360 --> 00:13:35.840
She began doing some part-time work.
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She started preparing to return to psychiatry.
00:13:40.480 --> 00:13:46.000
The people around her were still turning to Daksha to tell them how she was doing.
00:13:46.240 --> 00:13:49.039
She'd lived with the illness for a long time.
00:13:49.360 --> 00:13:54.639
She understood the treatment and knew the warning signs better than anyone around her.
00:13:55.519 --> 00:14:00.240
David, I know my illness, she would tell her husband.
00:14:00.720 --> 00:14:05.519
So David and the doctors, who knew her history, trusted that knowledge.
00:14:05.840 --> 00:14:08.799
For years that trust had been justified.
00:14:09.759 --> 00:14:17.039
Then, as summer turned to fall, Daksha's sleep began to rapidly deteriorate.
00:14:19.279 --> 00:14:24.159
By September, Daksha was depressed and was barely sleeping.
00:14:24.960 --> 00:14:28.240
But she was still doing an incredible amount of work.
00:14:28.559 --> 00:14:35.519
Daksha was looking after Freya, keeping up with the demands of a new baby, all the while trying to return to work.
00:14:35.840 --> 00:14:38.159
She was also talking to her doctors.
00:14:38.320 --> 00:14:39.919
She was talking to family.
00:14:40.320 --> 00:14:45.759
From the outside, there was still plenty of evidence that she was functioning well.
00:14:46.720 --> 00:14:52.240
But functioning well is not the same thing as being well.
00:14:52.879 --> 00:14:55.759
Daksha's sleep was rapidly deteriorating.
00:14:55.919 --> 00:15:02.480
Her thoughts were becoming increasingly preoccupied with failure as a mother, as a wife, as a woman.
00:15:03.120 --> 00:15:11.440
She was writing about those fears in her diary while continuing to do the things everyone around her had come to expect from Daksha.
00:15:12.720 --> 00:15:16.720
And this is what is so heartbreaking when we look back at those weeks.
00:15:16.960 --> 00:15:20.000
The illness was there, the signs were there.
00:15:20.240 --> 00:15:24.879
But Daksha wasn't a woman lying in bed unable to care for her baby.
00:15:25.120 --> 00:15:27.679
She wasn't pushing Freya away.
00:15:27.919 --> 00:15:33.039
She was feeding her daughter, playing with her, showering her with hugs and kisses.
00:15:33.360 --> 00:15:39.919
She was laughing at David's jokes, answering the phone, going to the store, speaking to her doctors.
00:15:40.480 --> 00:15:46.480
All while her thoughts were taking her further and further from what was real.
00:15:50.000 --> 00:15:53.279
Postpartum psychosis is volatile.
00:15:53.440 --> 00:15:55.039
It moves quickly.
00:15:55.279 --> 00:16:03.279
And sometime during those final days, Daksha began to develop beliefs that were no longer grounded in reality.
00:16:03.840 --> 00:16:06.399
Freya became a part of those beliefs.
00:16:06.720 --> 00:16:16.559
Daksha became convinced that her baby was in grave danger from evil forces, that she needed to protect Freya at all costs.
00:16:18.000 --> 00:16:26.000
By the time this shift in thinking happened, Daksha was no longer simply watching for the signs of relapse.
00:16:26.720 --> 00:16:39.679
She was lying awake at night, caught in a thought spiral she just couldn't quiet, with her fears becoming harder and harder to separate from what was actually happening around her.
00:16:40.720 --> 00:16:44.480
Her illness was no longer something she was managing.
00:16:44.720 --> 00:16:50.080
It was beginning to dictate what she saw, what she believed, and what she feared.
00:16:52.399 --> 00:17:01.759
This is important because a symptom like deteriorating sleep can actually be an early warning sign of bipolar relapse.
00:17:02.080 --> 00:17:07.440
But in a new mother, poor sleep can look like part of the job.
00:17:07.920 --> 00:17:15.599
There's no routine screening test for postpartum psychosis that can simply tell a doctor whether a woman is developing it.
00:17:15.839 --> 00:17:20.799
Doctors and family have to recognize risk and changes in behavior.
00:17:22.079 --> 00:17:26.160
In Daksha's case, there were several things happening at once.
00:17:26.400 --> 00:17:36.079
Her worsening sleep, like I mentioned, was one of the clearest warning signs, but at the time, it was not being treated with the urgency we might place on it today.
00:17:36.559 --> 00:17:51.759
Daksha's doctors and David knew she was struggling with depression, with sleep, but they were also seeing a highly functional woman dealing with what could easily look like the exhaustion of new motherhood.
00:17:53.440 --> 00:17:58.720
What they could not see was where those symptoms were taking Daksha.
00:17:59.599 --> 00:18:05.279
Part of that was because Daksha's care was not happening in one place with one person.
00:18:06.559 --> 00:18:16.960
She'd chosen not to become a formal patient of the local community mental health team because of her fear that her psychiatric history would become known.
00:18:17.599 --> 00:18:20.880
Instead, she spoke to the people she trusted.
00:18:21.119 --> 00:18:27.039
A psychiatrist friend often visited Daksha at her house and they discussed her symptoms.
00:18:27.359 --> 00:18:30.079
She spoke with a few other trusted colleagues.
00:18:30.319 --> 00:18:31.839
She talked to David.
00:18:32.559 --> 00:18:36.720
These were people who knew Daksha and cared about her.
00:18:37.599 --> 00:18:44.079
But the issue was that they were not talking to one another about what Daksha was sharing.
00:18:44.480 --> 00:18:48.799
And there were very few and sporadic notes about these conversations.
00:18:50.079 --> 00:18:53.599
So there was no comprehensive assessment.
00:18:53.920 --> 00:19:11.839
Her care was pretty devoid of any context of her bipolar disorder, the recent birth, the lack of sleep, the depression, the fact that she was off medication, and finally the changes that people were beginning to notice in her behavior.
00:19:13.759 --> 00:19:24.079
Now, the other complication was Daksha was seen as a highly respected doctor first and foremost, rather than a vulnerable patient.
00:19:24.480 --> 00:19:39.119
That made it easier to believe that she would recognize when she needed help and just ask for it, that she didn't need the level of care and monitoring that a patient with her medical history might normally receive.
00:19:40.000 --> 00:19:43.279
But that assumption had a major flaw.
00:19:44.240 --> 00:19:52.799
Because the very illness Daksha's confidants were relying on her to recognize was beginning to affect her judgment severely.
00:19:53.759 --> 00:19:57.839
Daksha actually did tell her doctors that she was depressed.
00:19:58.079 --> 00:19:59.839
She did seek help.
00:20:00.400 --> 00:20:06.960
And that makes these final weeks extremely painful for us to go through and look back on.
00:20:07.200 --> 00:20:11.680
Because she was reaching out, she was telling people she wasn't well.
00:20:12.640 --> 00:20:16.559
There were people around her who knew she was struggling.
00:20:17.119 --> 00:20:21.039
But she was still keeping the worst of it to herself.
00:20:22.240 --> 00:20:27.039
Daksha was lying awake into the early morning hours, her thoughts churning.
00:20:27.279 --> 00:20:29.519
She was frightened and vulnerable.
00:20:29.759 --> 00:20:36.319
She was beginning to believe she was failing the people who depended on her: Freya, David, her patients.
00:20:39.039 --> 00:20:43.200
On October 5th, Daksha met with her psychiatrist friend.
00:20:43.440 --> 00:20:49.680
She told him about her depression and talked about the pressures at work and the demands of caring for Freya.
00:20:50.880 --> 00:20:56.240
Her psychiatrist recommended that she restart her medication and consider weaning Freya.
00:20:57.119 --> 00:21:00.319
Daksha reluctantly agreed.
00:21:03.039 --> 00:21:05.200
She would stop breastfeeding.
00:21:05.920 --> 00:21:08.319
She would begin taking the medication.
00:21:08.559 --> 00:21:11.279
Her psychiatrist wrote out the prescription.
00:21:11.599 --> 00:21:17.920
Daksha was due to start her medicine on October 10th, five days away.
00:21:19.920 --> 00:21:24.079
The next evening, Daksha and David were supposed to go to a concert.
00:21:24.319 --> 00:21:26.720
Her sister-in-law was going to look after Freya.
00:21:27.839 --> 00:21:31.200
But that afternoon, Daksha changed her mind.
00:21:31.440 --> 00:21:34.240
She told David to go on without her.
00:21:35.119 --> 00:21:38.559
The following morning, Freya woke early for a feed.
00:21:38.720 --> 00:21:40.799
Daksha was already awake.
00:21:41.039 --> 00:21:44.720
She fed the baby and brought her into bed with her and David.
00:21:45.359 --> 00:21:50.240
The couple had a small argument about who should go to the grocery store.
00:21:50.480 --> 00:21:51.839
They needed groceries.
00:21:52.079 --> 00:21:54.480
They also needed baby formula.
00:21:54.720 --> 00:21:59.759
David wanted Daksha to begin weaning Freya so she could restart her medication that week.
00:22:01.359 --> 00:22:05.279
Eventually, Laksha got dressed and went to the store.
00:22:06.000 --> 00:22:13.680
The inquiry that I mentioned earlier records that she left around 8:30 or 9 that morning.
00:22:15.039 --> 00:22:22.720
It is possible she bought the acetone she would later use that day during this same trip.
00:22:24.400 --> 00:22:28.880
But what she was definitely buying was formula for her baby.
00:22:30.000 --> 00:22:32.799
Later that morning, Daksha's mother called.
00:22:32.960 --> 00:22:35.599
She offered to come over with Daksha's sister.
00:22:36.000 --> 00:22:37.920
Daksha said no.
00:22:38.319 --> 00:22:40.640
She didn't want them to visit.
00:22:41.599 --> 00:22:46.400
Now, on its own, that might not have seemed alarming at all.
00:22:46.799 --> 00:22:52.000
A tired new mom declining a family visit isn't really that unusual.
00:22:53.279 --> 00:22:56.720
But by then, Daksha was withdrawing.
00:22:56.960 --> 00:23:00.960
And her thoughts about Freya were becoming more concerning.
00:23:01.920 --> 00:23:06.559
She'd become convinced that her daughter needed protection from evil forces.
00:23:06.799 --> 00:23:10.720
She hinted at this to David over the next couple of days.
00:23:12.240 --> 00:23:18.319
On the morning of October 9th, David kissed Daksha and Freya before leaving for work.
00:23:20.079 --> 00:23:26.880
He didn't know that this would be the last morning he would see his wife and daughter alive together.
00:23:30.240 --> 00:23:36.720
That afternoon, when David returned from work, he expected the usual sounds of home.
00:23:37.039 --> 00:23:47.920
His wife talking to the baby, Freya making those little three-month-old noises babies make, gurgling, cooing, answering Daksha's voice with a sound of her own.
00:23:48.319 --> 00:23:51.519
He called out for his wife, for his daughter.
00:23:52.240 --> 00:23:53.200
Nothing.
00:23:54.000 --> 00:23:56.799
Then he smelled smoke.
00:23:57.119 --> 00:23:59.359
It was coming from upstairs.
00:24:00.160 --> 00:24:03.200
On the kitchen table was a note from Daksha.
00:24:04.079 --> 00:24:06.480
The writing was in capital letters.
00:24:07.119 --> 00:24:16.319
Daksha wrote that Freya was in danger from something really bad, that she loved her daughter and had to protect her.
00:24:16.960 --> 00:24:19.279
David ran upstairs.
00:24:19.599 --> 00:24:24.160
The smell of smoke and burning became stronger as he reached the bedroom.
00:24:25.039 --> 00:24:28.960
Freya was dead, lying on the bed.
00:24:29.759 --> 00:24:31.359
She'd been stabbed.
00:24:32.319 --> 00:24:38.079
Daksha was lying on the floor, badly burnt, one eye open.
00:24:39.359 --> 00:24:41.680
David called to her in panic.
00:24:42.799 --> 00:24:45.759
She looked at him and said his name.
00:24:46.640 --> 00:24:49.680
Then she lost consciousness.
00:24:51.440 --> 00:24:54.640
Daksha would die three weeks later.
00:24:55.119 --> 00:24:57.599
She was thirty-four years old.
00:24:58.960 --> 00:25:03.920
The police initially arrested David in connection with his wife's death.
00:25:04.240 --> 00:25:06.799
He was released a few weeks later.
00:25:07.359 --> 00:25:12.160
But the question that remained was not simply what had happened in that bedroom.
00:25:12.640 --> 00:25:23.359
It was how Daksha had reached that point, while doctors, her husband, and the people who knew her well were all aware that she was becoming unwell.
00:25:24.400 --> 00:25:28.240
The inquiry would spend years examining that question.
00:25:30.640 --> 00:25:36.319
There was one place where Daksha had been putting some of her feelings into words.
00:25:36.640 --> 00:25:37.599
Her diary.
00:25:38.480 --> 00:25:44.880
Her diary actually gives us a much clearer picture of how badly Daksha was struggling.
00:25:45.519 --> 00:25:48.720
She was increasingly preoccupied with failure.
00:25:49.039 --> 00:25:56.319
At work, she was still pushing herself to prove that she belonged in a senior, overwhelmingly white male position.
00:25:56.640 --> 00:26:01.359
There was little room in her mind to let anyone see her falter.
00:26:02.640 --> 00:26:20.720
And beneath all of it, of course, was the fear that if people discovered how unwell Daksha had once been, how unwell she felt now, she could completely lose the career she'd fought so hard to establish, and perhaps even lose Freya.
00:26:22.319 --> 00:26:30.319
Those fears began to converge until failure itself became a recurring theme in the way Daksha saw herself.
00:26:31.680 --> 00:26:37.680
She wrote, I feel useless as a mother, as a wife, as a woman.
00:26:37.920 --> 00:26:40.640
I see no hope for the future.
00:26:41.039 --> 00:26:47.440
In another entry, she described sleep that left her feeling no better than before.
00:26:47.680 --> 00:26:53.119
She wrote about forcing herself to eat because Freya needed the nourishment.
00:26:53.920 --> 00:26:57.599
She worried that everyone could see she was failing.
00:26:58.319 --> 00:27:02.480
And then the language in the diary begins to change.
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Daksha began to question her own worth, her own character.
00:27:08.720 --> 00:27:11.440
Am I bad and wicked?
00:27:11.920 --> 00:27:14.160
Do I deserve good things?
00:27:14.799 --> 00:27:18.720
Is there really any hope for the future?
00:27:20.559 --> 00:27:26.000
And there was another line in the diary that is particularly painful to read.
00:27:26.400 --> 00:27:30.880
Daksha wrote that she was finding it difficult to hang on to reality.
00:27:32.960 --> 00:27:35.920
Yes, Daksha knew her illness.
00:27:36.640 --> 00:27:40.960
But by this time, her illness was progressing too rapidly.
00:27:41.200 --> 00:27:45.839
It was changing how she saw herself and everyone around her.
00:27:46.160 --> 00:27:51.359
And that made it harder for her to recognize how urgently she needed help.
00:27:51.759 --> 00:27:55.599
By the time help came, it was too late.
00:28:01.039 --> 00:28:05.039
I began this episode thinking about Lindsay Clancy.
00:28:05.440 --> 00:28:07.759
I was angry, I still am.
00:28:08.720 --> 00:28:17.279
But I also know enough about postpartum mental illness to know that anger and empathy can actually exist together.
00:28:18.079 --> 00:28:28.400
I don't know what Lindsay understood about her own condition, what she believed was happening to her, or what her state of mind was like at the time.
00:28:28.880 --> 00:28:30.960
Her case is still being decided.
00:28:31.039 --> 00:28:33.440
There's still deliberations happening.
00:28:34.720 --> 00:28:37.599
What I do know is what happened to Daksha.
00:28:38.960 --> 00:28:44.160
Despite the illness taking hold, Daksha seemed to know she was worsening.
00:28:44.319 --> 00:28:45.920
She sought help.
00:28:46.480 --> 00:28:55.359
But she was also trying to protect her career, her privacy, and her family from the consequences of anyone knowing just how unwell she'd become.
00:28:56.240 --> 00:29:02.880
And much of that responsibility for deciding when she needed more help still rested with her.
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Daksha was asking for help while trying to hide how much she needed it.
00:29:11.039 --> 00:29:19.200
And the system struggled to recognize vulnerability in a woman who had become exceptionally good at appearing capable.
00:29:21.440 --> 00:29:31.599
The inquiry after Daksha and Freya's deaths condemned the UK's NHS for severe neglect, for being complicit in the tragedy.
00:29:32.319 --> 00:29:48.559
Doctors did not warn David or Daksha's family of the rapid onset of postpartum psychosis, how it can trigger a complete detachment from reality in a matter of hours, how Daksha was extremely vulnerable.
00:29:49.519 --> 00:30:02.000
The inquiry also made several recommendations about communication between professionals, perinatal mental health care, recognizing risk, and supporting doctors with mental illness.
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But Daksha's story also leaves us with a human question.
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How many women are trying desperately to remain the person everyone knows them to be while secretly becoming more and more sick?
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For women from immigrant and minority communities, that struggle can come with the added fear of shame, stigma, judgment, and losing the life they'd worked so hard to protect.
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Baksha was not just the woman in that bedroom on October 9th.
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She was also the little girl who arrived in the UK speaking very little English, the brilliant medical student who fought a serious illness, the gifted and empathetic psychiatrist, and the mother who held her baby close.
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All of those women were Daksha.
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You are listening to Missing Context Stories from Asia and the Asian diaspora.
