Bad Men Do What Good Men Dream: A Forensic Psychiatrist Illuminates the Darker Side of Human Behavior

by Robert I. Simon

  Donald Harvey, a nursing assistant known as the Angel of Death, may have killed as many as 100 victims in healthcare settings. He worked as a nursing assistant in various hospitals. He confessed to killing 15 patients at Marymount Hospital in London, Kentucky, and 15 more at the Cincinnati Veterans Administration Medical Center. While working at Drake Memorial Hospital from 1985 to 1987, when he was arrested, he allegedly killed 21 additional infirm and chronically ill patients.

  Harvey at first claimed that he was committing mercy killings, but his real motivation came out later as he told how he obtained great satisfaction from being able to fool “know-it-all” doctors who would assume that their patients had died from natural causes. Psychiatrists described Harvey as a compulsive man who murdered because it gave him a sense of power. He had also killed for revenge after having been homosexually raped. Harvey was not a subtle mercy killer, as his methods of murder also revealed. He thrust a straightened-out coat hanger into the abdomen of a restrained and confused old man, puncturing the man’s bowel and causing him to die of peritonitis two days later. For others, he cut off the oxygen supply, suffocated them with plastic bags and pillows, injected syringes full of air, and mixed arsenic and cyanide in patients’ food.

  Other so-called mercy killings have taken place with some frequency in hospitals, institutions, and nursing homes. Few of these murders have anything to do with compassion and pity for the victim. Most echo Harvey’s incentive to kill in order to exercise total power and control over the victim. Motives of nurse-killers or bedside-killers have included the thrill of creating medical emergencies, appearing heroic, enjoying watching patients as they die, and putting patients out of their misery. The most common method of killing is injecting a prescribed drug in amounts that are known to be lethal. Charles Cullen, a nurse, was charged with the murders of at least 40 seriously ill patients. He injected patients with drugs, mainly digoxin, used in cardiac care units, ostensibly to end their suffering. Similarly, Harold Shipman, a British physician, was convicted of killing 15 patients, although a government investigation concluded that he had killed at least 215, making him the most notorious of all medical serial killers.

  Patients in nursing homes are sometimes killed by physical abuse. It is my belief that some serial killers work in facilities that take care of the elderly and the very infirm—killers who change jobs frequently and whose crimes are only discovered in the wake of heightened patient mortality rates that are otherwise inexplicable.

  It was not until after the death of Dr. David J. Acer, a dentist practicing in Florida, that the workplace violence he allegedly committed was discovered. Dr. Acer had died of acquired immunodeficiency syndrome (AI DS). He had contracted the human immunodeficiency virus (H IV) years earlier but continued to practice dentistry—and did not inform his patients of his condition. The first of his patients to develop AI DS and die was young Kimberly Bergalis. Dr. Acer himself died before he could be questioned about Kimberly’s treatment. At least five other patients became infected. It was only possible to test 700 of Dr. Acer’s 2,000 patients for HIV. Questions have been raised about whether Dr. Acer might have deliberately infected his patients. His former lover has been quoted as saying that Dr. Acer did do so in an attempt to “prove” that AIDS was not just a disease limited to the population of homosexuals. If Dr. Acer did deliberately transmit the fatal disease to his patients, he would have to be considered a serial murderer. It may be years before the full extent of the damage he allegedly wrought can be tallied. I say allegedly because a new scientific study may cast doubt on the original findings that implicated Dr. Acer.

  Vigilante Justice in the Courts

  As the introductory vignette about Gian Luigi Ferri’s murderous assault on the law firm of Pettit and Martin makes clear, lawyers, law firms, and the courts are fast becoming targets of violence. Bad feelings toward lawyers and the court system are today epidemic and are reflected in the current abundance of uncomplimentary jokes about lawyers. Ferri was reported to have laughed himself to tears, a few weeks before the massacre, when told the following joke: “If you were locked into a room with Saddam Hussein, the Ayatollah Khomeini, and a lawyer, and you had a gun with two bullets in it, who would you shoot? The lawyer—twice.”

  Lawyers are advocates who work within an adversarial system, one that leads directly to the polarization of positions and to the evocation of strong emotions. The courts deal with difficult, contentious, and momentous decisions, sometimes of life and death; stresses on litigants, lawyers, judges, and juries can be extremely high. Letter bombs have been sent to lawyers and judges, injuring some recipients, killing others. Gun-wielding litigants seeking their own immediate brand of justice have killed several lawyers and judges. In one notable rampage, Kenneth Baumrock brought two handguns into a divorce hearing in a Clayton, Missouri, courtroom and killed his wife and wounded four court officials. On the same day in Grand Forks, South Dakota, a similar event occurred in a family court, in which a gunman severely wounded the family court judge.

  Lawyers can turn lethal as well. Attorney George Lott began a shooting rampage in a court, killing a defense lawyer and a prosecutor, and injuring two appeals judges. Lott’s complaint was that a family court justice had improperly favored his former wife in a child custody hearing. Violent outcomes are not unusual in divorce and custody actions because the litigation process fans intense hatreds.

  Death in Familiar Places

  Restaurants and financial institutions are increasingly becoming venues for violence as a result of revenge motives acted out in locations where many people are likely to be present. Only a few of the locations have been specifically connected to the perpetrators’ grudges against society. In one of the most awful incidents, George Hennard crashed his truck through the front window of Luby’s Cafeteria in Killeen, Texas, injuring several customers in his path. Hennard then jumped out of the truck with a gun in his hand and systematically killed 23 lunch customers and employees. Hennard killed mostly women, especially those who had made eye contact with him. He wounded 22 others and then took his own life. It was the nation’s worst firearms massacre. Hennard had fired a total of 96 bullets in a few minutes. Of the 136 survivors who were psychologically examined after the rampage, 20% of the men and 36% of the women were found to have posttraumatic stress disorder.

  Hennard had no real connection with Luby’s Cafeteria, but many other mass killers have targeted restaurants because they once worked in those particular locations or because they believed they had been insulted there. There is a high turnover of employees in the restaurant industry, and often robberies are executed by former employees of a restaurant who are familiar with its operation. In Queens, New York, two men entered a Wendy’s restaurant, displayed their guns, took 7 employees, 3 of them known to one perpetrator, into a basement freezer, and shot them in order to rob the eatery of $3,200. Two of the 7 who were shot survived and identified the killers.

  Workers at financial institutions are also at risk during robberies. Furthermore, they are targets for disgruntled employees and customers, especially during hard financial times. A disgruntled former employee of the Firemen’s Fund, 33-year-old Paul Calden, went to the Island Center Building in Tampa, Florida, killed three of the Fund’s supervisors while they were eating lunch, and injured two women. He then drove away and was found later in his car, 12 miles from the site, dead of a self-inflicted gunshot wound. It was learned that he had been dismissed from a job with Firemen’s Fund 8 months earlier and that he had been mentally disturbed, troubled by a preoccupation with extraterrestrial contacts.

  The General Motors Acceptance Corporation office in Jacksonville, Florida, repossessed a two-year-old Pontiac Grand Am from James Edward Pough, 42, a few months after Pough’s wife had left him. He could not pay the debt of $6,394 out of his low hourly laborer’s wages. Six months later, Pough walked into the office, killed eight people, wounded four others, then ended his own life with a .38-caliber revolver.

 
A disgruntled, disabled electrician named Jim H. Forrester drove his Chevrolet Suburban into the office of the State Industrial Insurance System in Las Vegas and went on a shooting rampage through the first floor of the building. In this incident, although no one was killed, about 25 employees later filed claims for stress and for injuries, and many of the 400 employees later received individual and group therapy.

  The annals of workplace killers are heavily weighted toward lowerrank former employees, but one of the first such killers to come to the public’s attention was a former IB M executive and engineer, Edward Thomas Mann. He had resigned, rather than be fired, after his performance ratings had slipped. Mann charged that he was a victim of racial discrimination. He traded in his white shirt and other appurtenances of IB M life and donned an olive-drab fatigue jacket and ski mask. Then, in pseudocommando style, Mann crashed his bronze Lincoln Continental into the lobby of an IB M office building in Rockville, Maryland. He leaped out of the car with two loaded rifles, a shotgun, and a pistol, using these to kill two people and wound seven more in a long siege, at the end of which he surrendered to police. Two years later, in prison, he hanged himself.

  Most perpetrators of workplace violence are white men, but occasionally they are women. In every setting except where women are acutely psychotic, men have a higher incidence of violent behavior. Gail Levine, age 62, was convicted of sabotage against the Pepsi-Cola company by a federal jury in Denver. She had placed a syringe in a Diet Pepsi can during the tampering scare—as delayed vengeance against the company that had fired her husband 18 years earlier. In a rare case of workplace violence perpetrated by a woman, 30-year-old industrial engineer Elizabeth A. Teague attempted to set the Eveready Battery plant in Bennington, Vermont, on fire by detonating several homemade black powder and gasoline bombs. Before the bombs went off, she shot and killed the plant manager and wounded two coworkers at the plant where she had worked. Captured, she complained to the FB I of racial harassment at Eveready, that her home phone had been tapped by the company, and that coworkers had stolen and sold company secrets. Police also found at her home some media accounts that had fueled her vengeful feelings: stories about the Luby’s Cafeteria massacre and about Anita Hill’s sexual harassment charges against Supreme Court nominee Clarence Thomas.

  A Behavioral Profile of the Workplace Killer

  There are millions of unhappy workers in the workplace, but only a few of them reach the point of acting out their unhappiness in violence against others. Although the behavioral characteristics of the person who commits workplace mayhem is rather stereotypical, the psychological motivation can be extremely complex and, often, undiscoverable. Typically, the worker is disgruntled and has troubled work relationships, but this is not enough to trigger violence. In general, ordinary occupational unhappiness does not play a significant part in the motivation of workplace violence, although it is often cited as a “cause.” Situations, context, genetic makeup, psychological development, physical and mental disorders, cultural and social influences, and many other factors enter into the lethal mix. Even trained professionals are frequently unable to detect a potential murderer. John Merlin Taylor, whose career in the postal service had lasted 27 years, had paranoid ideas about being set up to take a fall. He imagined that he would find money on his route and that this would be used as a way to discipline or fire him. Such a delusion did not, in itself, signal the murderous violence he later wreaked. Taylor gave no warning that he would explode.

  Profiling of potential perpetrators of workplace violence is an inexact exercise; it should be viewed as a rough assessment tool that can raise the consciousness of management personnel toward the possible prevention of outbreaks of violence in their workplaces.

  The following 10-dimensional behavioral profile (summarized in Table 6–1) characterizes many perpetrators of workplace violence:

  TABLE 6–1. A behavioral profile of the workplace killer

  1. Disgruntled

  2. Disturbed

  3. Determined

  4. Deviant

  5. Distant

  6. Dangerous

  7. Disrupted relationships

  8. Dyscontrol

  9. Drugs and alcohol

  10. Down and out

  1. Disgruntled

  Virtually all persons who commit workplace violence have major, unrequited grievances against their employers. Often, the employee feels he or she has been “screwed over,” used, abused, and discarded like a piece of trash. Frequent absences occur. Usually, disciplinary actions have been taken against the employee in the past. A documented record of escalating labor-management disputes often is found after a violent incident has occurred. Complaints of work stress commonly precede the outbreak of violence. Disgruntled employees or exemployees whose lives are consumed by pursuing their grievances can turn lethal. For example, James Huberty was described as a bitter man. A 42-year-old unemployed security guard, Huberty lost his job after 13 years of hard work when his employers shut down their plant. He was emotionally cold and had a violent temper; he struck his children and engaged in physical fights with his wife. He was fascinated with weapons, mercenary literature, and army clothing. On July 18, 1984, at 4 p.m., Huberty dressed in camouflage clothing, armed himself, and told his wife, “I’m going hunting humans!” He entered the nearest McDonald’s and sprayed the restaurant with an Uzi semiautomatic weapon and a 12-gauge shotgun. Twenty-one people were killed and 15 were wounded. Huberty was shot through the heart by a SWAT team. A number of mass murderers attack in pseudocommando style. Their interest in weapons, mercenary magazines, and the military are often an attempt to cover up deep feelings of inadequacy, as well as to express intense bitterness and hatred toward others and themselves, given that they often also die.

  2. Disturbed

  Many perpetrators of workplace violence experience some sort of mental disturbance. Some have been diagnosed; others commit their violence and are judged as disordered well after the fact. The patient who killed psychiatrist Wayne S. Fenton was reported to be a paranoid psychotic. Edward Mann, who rammed his car into the IB M offices and was captured after killing two people, was later diagnosed for the first time as suffering from major depression and a delusional disorder. Many workplace killers commit suicide after their rampages and can only be diagnosed in retrospect, and even then without great certainty.

  One particular form of mental disorder, erotomania, was implicated in a case in California’s Silicon Valley. In erotomania, the person feels absolutely convinced that the object of his or her affections feels the same way, even if there is evidence to the contrary. Software engineer Richard Farley met Laura Black, an electrical engineer, at the defense contractor ESL, Inc. When she spurned his advances, he stalked her. Four years after Farley had met Black, he stormed ESL, killed seven employees, and gravely wounded Black. Farley wanted to spill his blood on Laura Black so she would never forget him. From prison, Farley continued to write to Black as she lay in a hospital bed with her survival in doubt. Even though his violence had been acted out, his delusion and disorder continued.

  The vast majority of people who are mentally disturbed are no more violent than the population in general. There is no research support for the strong connection the public assumes exists between mental disorder and violence. In fact, a previous history of violence and current alcohol and drug abuse are much more accurate indicators of the risk of violence. Mental disorder represents only a modest risk of violence compared with other risk factors such as male gender, young age, and lower socioeconomic status. Mental disorders, however, can interfere with work performance. A vicious cycle may develop in which declining performance brings managerial criticism, which produces further anger and deterioration in work. The worker’s mental disturbance is overlooked, and an opportunity to intervene therapeutically is lost. When mentally disturbed workers are subjected to these downward cyclical stresses, they may be more likely to become violent. Prior brain injuries, posttraumatic stress disorder, dep
ression, mania, substance abuse, personality disorders, chronic pain—any of these, or a combination of them, may, but not necessarily do, form the backdrop for violence. When Texas tower killer Charles Whitman was autopsied, he was found to have had a brain tumor the size of a pecan. The pathologist was uncertain of the role that tumor might have played in Whitman’s murderous rampage, but it was learned that Whitman had complained of severe headaches.

  3. Determined

  Frequently, among survivors of workplace violence, one hears the description of the killer as acting like an automaton—mechanically, coldly, and emotionlessly going about his killing. Gian Luigi Ferri was described as displaying a blank expression while murdering people at the law firm of Pettit and Martin. This observation is counterintuitive, because we would expect peak expressions of strong emotion during the act of killing, such as hate and rage.

  It is my impression that many workplace killers commit violence in a mentally-split state. Most workplace killings are planned. Once a plan is hatched, the person is determined to see it through. Perpetrators generally are familiar with weapons, have a military background, and attack the workplace in a pseudocommando fashion. Much like men preparing to go into battle, they are determined and prepare themselves mentally. Part of that preparation is to consciously split off thoughts and feelings that might produce fear or otherwise interfere with the mission.