Jury selection began Monday in the trial of a Massachusetts mother who strangled her three children while undergoing medical treatment for psychiatric problems that developed after she gave birth.

The trial of Lindsay Clancy, which could take several weeks, is expected to explore the complicated and rare phenomenon of postpartum psychosis, which afflicts a very small percentage of women who develop delusions and sometimes hallucinations after childbirth.

Five jurors were selected Monday. A total of 18 jurors, including six alternates, will be chosen for the trial.

Clancy’s lawyers — and her husband — say she was not responsible for her actions. Defense attorney Kevin Reddington doesn’t dispute that she killed the children, but plans to raise an insanity defense.

“This whole case is an extreme tragedy,” he said.

Prosecutors say the killings were intentional and well planned, not the work of someone who had lost control.

Clancy, a former labor and delivery nurse at Massachusetts General Hospital, has pleaded not guilty to murder charges in the deaths of her children Cora, 5, Dawson, 3, and Callan, 8 months, when they were killed on Jan. 24, 2023.

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EDITOR’S NOTE: This story includes discussion of suicide. If you or someone you know needs help, the national suicide and crisis lifeline in the U.S. is available by calling or texting 988.

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On the day of the killings, Clancy, now 36, asked her husband Patrick Clancy to leave their home to get takeout food and to pick up something at a pharmacy. She strangled the children with exercise bands, then used multiple methods to try to end her own life.

She was paralyzed after falling from the home’s second-story window, and is being held at a state hospital.

Clancy’s husband is on the list of witnesses for both the prosecution and the defense. He has said in interviews that he forgives his wife.

Eighteen jurors, including six alternates, are expected to be chosen over several days for the trial in Plymouth, which is near the family’s home in Duxbury, an upscale coastal suburb about 30 miles (48 kilometers) south of Boston.

Clancy and her husband filed lawsuits earlier this year accusing her medical providers of failing to properly diagnose, treat and monitor her for a “severe postpartum psychiatric condition.” She spent several days at a psychiatric hospital weeks before the killings.

Lindsay Clancy’s lawsuit detailed how she was depressed, had trouble sleeping and repeatedly heard voices urging her to harm her children and herself.

“Lindsay Clancy did everything a mother in her situation could do,” the lawsuit said. “She recognized something was wrong with her. She sought medical treatment. She went to emergency rooms. She called crisis hotlines. She admitted herself to hospitals. She took the medication prescribed to her. She communicated her worsening symptoms to her providers. She told them the medications were making her worse.”

The day of the killings, Clancy said she heard voices saying, “This is your last chance. Kill the children so you can kill yourself.” A voice told her “that her children would suffer if she was gone,” according to the lawsuit filed by Patrick Clancy, citing medical records.

In a post on GoFundMe several days after the killings, Patrick Clancy wrote that the “shock and pain is excruciating and relentless,” but he urged the public to see Lindsay Clancy as he did before the killings.

“The real Lindsay was generously loving and caring toward everyone — me, our kids, family, friends, and her patients. The very fibers of her soul are loving. All I wish for her now is that she can somehow find peace,” it said.