Twelve jurors in Massachusetts are confronting a question that reaches beyond the fate of Lindsay Clancy: What does justice require when the person who committed an unspeakable act may also have been overtaken by a profoundly disordered mind?

There is no dispute that Clancy killed her three young children, or that she had experienced serious psychiatric symptoms and repeatedly sought help. The prosecution contends that she acted deliberately. Her defense argues that postpartum psychosis destroyed her ability to appreciate or control her actions.

That conflict exposes a problem much larger than one criminal trial. Our legal system asks whether Clancy was a victim or a perpetrator when the painful answer may be that, in some circumstances, a person can be both. Yet, severe mental illness does not excuse violence. And, accountability should not require us to pretend that every human act originates in a rational mind.

Under Massachusetts law, it would appear that mental illness alone does not eliminate criminal responsibility. A defendant is not criminally responsible if she lacked the substantial capacity to appreciate the wrongfulness of her conduct or conform to the law. While the standard may appear straightforward, applying it is far harder.

The larger question is why the complete picture of a person’s deterioration is so often........

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