Serial Killers and Serial Explanations
by Theodore Dalrymple (October 2014)
If the accused is found guilty, or rather if the accused actually committed the crimes with which he is charged (regrettably not always quite the same thing), he acted with an unusual degree of cunning, having left his defence many possible avenues of escape. He also seems not to have had any motive apart from such strange pleasure as he might have derived from the act of killing. Perhaps he was as disinterested in the pursuit of evil as Kant’ good person is in pursuit of good.
I have not had much to do personally with medical serial killers, either doctors or nurses, but shortly after the notorious case in England of a nurse called Beverley Allitt, who killed several babies by various means and was revealed later to have suffered herself from Munchausen syndrome, I was asked by the hospital in which I was working to examine a nurse working there who also suffered from, or perhaps I should say behaved as someone suffering from, Munchausen syndrome. (This is an extraordinary pattern of behaviour in which a person goes from hospital to hospital complaining of a variety of symptoms carefully chosen to signify possible serious underlying pathology, disprovable only by elaborate tests and procedures, and sometimes operations. Such a person may use up an immense quantity of medical time, energy and resources: the British Medical Journal once published a paper by a doctor who traced the path of a particularly prolific attender at public hospitals, and worked out that he had cost the taxpayer $17 million since he began what can only be called his career. More than once in my hospital I was able by detective work to uncover the identity of such a patient – they usually go under false names, they claim that their relatives are dead, to have just returned from abroad etc., so as to make themselves as untraceable as possible – and then, having been seriously incapacitated only moments before, rush out of the hospital when exposed as Munchausen patients, angrily swearing and cursing, sometimes threatening revenge, as if the exposure of their lies were an act of cruelty, as if their rights had been infringed. No wrongdoing is beyond the reach of self-righteousness.)
The hospital management was naturally anxious that it did not have another Beverley Allitt on its hands, and asked me to pronounce on this difficult matter. Was the nurse dangerous, or was she not? I could quite see why the hospital management was anxious about it, perhaps not so much for the safety of the patients as to avoid the vilification of themselves that would surely ensue if they permitted a serial killer to work in the hospital, a nurse known to have Munchausen syndrome. By asking me, moreover, they could deflect blame on to me if things went wrong. This is the great secret of the science of management.
The nurse, as far as anyone could tell, had done nothing wrong in the hospital – yet. My own view is that Munchausen syndrome is a form of fraud, for whatever strange compulsion the person with it may feel under, his behaviour in actually seeking admission to hospitals is perfectly conscious: he claims to have what he knows that he does not have. However, the nurse had been convicted of nothing, so could not be dismissed on grounds of criminal record. Moreover, there was a flaw in the logic which supposes that if all xs are ys, then all ys must be xs. So even if it were true that all serial killer nurses suffered from, or behaved like people with, Munchausen syndrome, it would not follow that all nurses who suffered from Munchausen syndrome were serial killers – unless there were a perfect overlap and coincidence between the two, which there is not.
Suppose (purely for the sake of argument) that half of nurses with Munchausen syndrome were serial killers of patients, what then? One can see that there would be a conflict between the rights of society and those of the individual. If the nurse were dismissed on the grounds of the high statistical risk that she posed, she might justly complain that she was being punished for what she had not done, for what she might do. She was still innocent both in law and in fact. But who would want to go, or want his loved ones to go, to a hospital where a nurse with a fifty per cent chance of becoming of becoming a serial killer was employed?
In preparation for my future attendance at the trial of the alleged serially-killing nurse, I decided to read about healthcare serial killers, and found a book by a forensic psychologist with the title Inside the Minds of Healthcare Serial Killers. For like almost everyone else, I am prey to the illusion that if only I study or read enough about a certain kind of behaviour, I will come to ‘understand’ it better. One might almost call this the mirage of understanding: it shimmers enticingly in the distance, but however far you go, it remains just as distant.
The book contains a brief historical survey of healthcare serial killers, starting in the mid-nineteenth century. Perhaps until then doctors and nurses killed their patients only by accident (George Washington perhaps among them), but as the pharmacopoeia expanded, so did opportunities to act upon dark desires. And the appetite grows with feeding.
Whether there are more healthcare serial killers than there were a few years or decades ago would, as usual, not be an easy question to answer. Publicity has given rise to awareness, the first step in detection, but it may also have given rise to emulation and even competition to be the worst of the worst. I have known people who, not having the talent to be the best at anything creditable, have settled on trying to be the worst at something discreditable: and that demand not so much talent as determination.
But even if there were, would it help us? Would we ever be able to say, ‘Ah, now at last I understand’?
His victims were mainly old, or oldish, ladies, most of them in good health for their age. Since he explained nothing himself, sifters in his biography sought explanations for themselves. One of the most commonly cited facts of his life is that he witnessed his mother die slowly and excruciatingly of cancer when he was 17 years old. A somewhat lonely young man, his mother was his main support and best friend. Here is what Katherine Ramsland has to say:
Harold Shipman took care of his mother as she died. It’s possible that as [he] began to kill patients, [he] found some measure of relief from anxiety when [he] exercised this form of control – not just over another person but also over their environments.
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