by Cina, Joshua A. Perper, Stephen J. ; Cina, Joshua A. Perper, Stephen J.
On the other hand, “organized” serial killers are almost the inverse image of the disorganized killers and are much more consistent with the profile of doctors involved in such crimes. They have an above average IQ of 105–120 or more, are socially adequate, frequently live with a partner, had a stable father figure, have a history of harsh physical family abuse, are geographically and occupationally mobile, follow the news media, often have a college degree or higher education, have good hygiene and housekeeping skills, do not usually keep a hiding place, have diurnal habits, drive flashy cars, and are interested in police activities (sometimes becoming police groupies or “wannabes”). John Wayne Gacy, Thomas Neill Cream, and Ted Bundy fit this profile. In regards to the methodology of crime, organized serial killers usually attack using seduction followed by restraint. They routinely kill at one site and dispose of bodies at another. Occasionally they will dismember the body and they generally leave a controlled crime scene that contains little physical evidence. As to post-crime behavior, organized murderers need to return to the crime scene to see what the police have done, usually contact the police to play games, and respond best to direct interviews.
Although many physicians perpetrating serial murders display general traits common amongst organized serial killers, others showed mixed-type features.
These killers may have done poorly in school at times, had trouble holding down jobs, come from markedly unstable families, may have been neglected or abandoned by their fathers and raised by domineering mothers, or have been abused psychologically, physically or sexually. These killers may harbor deep feelings of 52
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hatred towards their parents and often have a history of psychiatric problems requiring treatment or hospitalization, an interest in sadomasochistic pornography, fascination with fire, and a propensity to enjoy hurting or killing small animals. These latter characteristics are shared by some of the more widely known, non-physician serial killers. These disturbed individuals commonly evolve into sexual sadists and commit the most horrific of crimes.
The motivation of serial killers may be classified as being either “Act Focused”
(quick kills) or “Process Focused” (prolonged kills). The Act Focused murderer includes two subcategories:
1. The Visionary often hallucinates and hears voices or sees visions that order them to kill (classic psychotic features). The voices, usually coming from God or the devil, legitimize the violence and
2. The Missionary who has been placed on earth to eradicate a group of people (prostitutes, gays, minorities, etc.) because the perpetrator sees them as social pollution or enemies
In contrast, the Process Focused serial killer includes four subcategories: 1. The comfort-oriented hedonist that takes pleasure from killing, but also gets some profit or personal gain from it. This variety of killer is more common among females
2. The lust-oriented hedonist who associates sexual pleasure with murder. Sex while killing and necrophilia are viewed as eroticized experiences 3. The thrill-oriented hedonist who gets a “rush” or “high” from killing and feels euphoric at the victim’s anguish and suffering, and
4. The power/control freaks that take pleasure from manipulation and domination of another human being (a true sociopath) and experiences a “rush” or “high”
from the victim’s misery
The motivation of the perpetrators of medical homicide is often complex and multifactorial. Some are Act Focused “missionaries” whereas others are “control freaks” best fitting the Process Focused model. Physician killers tend to be self-centered sociopaths disdaining or indifferent to other people’s suffering.
They are often narcissistic, arrogant and patronizing to both their victims and the police. In his book “The Psychopathology of Serial Murder: A Theory of Violence”
Stephen Giannangelo discusses the characteristics of serial murderers that kill simply for the joy of killing. Their hallmark is “the ultimate control of another human being and the accompanying catharsis” and a narcissistic personality is at the core of their psyche. Freud’s designation of narcissism is based on a pathological self-love as exemplified by the legend of Narcissus. According to myth, Narcissus, a young Greek, was so unusually handsome that everyone he met fell in love with him. Echo, a beautiful nymph fell under his charms but was cruelly ignored by him, breaking her heart. As a punishment the God of Revenge, Nemesis, put a curse on him that caused Narcissus to fall in love with his own reflection in a pool of water. He stayed mesmerized by his own reflection until he died and was then turned into a flower by the gods. It logically follows that Nature or Nurture?
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characteristics of narcissistic personality disorder include a grandiose sense of self-importance; preoccupation with fantasies of unlimited success, power, brilliance, beauty or ideal love; a firm belief that she or he is “special” and unique and can only be understood by other special or high-status people; a need for excessive admiration; a sense of entitlement; a decided lack of empathy; intense envy of others while believing that others are envious of him or her; and consistent arrogant, haughty behavior. Some of these traits are common among physicians who don’t kill their patients as well as those who do.
Lawrence Miller, a police psychologist, contends that predatory killing is linked to the typical hunting behavior of males, pathological only in terms of degree.
Serial murderers feel intoxicated by their power over helpless victims and crave this
“high” just as males in battle or in athletics pursue the adrenaline rush that has been called “the thrill of victory.” They eventually become addicted to the psychologically rewarding homicide, a powerful addiction similar to that of gambling, BASE
jumping, and other potentially harmful, obsessive behaviors. Furthermore, their initial capability to avoid apprehension by the authorities is also a thrill which prompts them to take progressively more and more risks to maintain their “buzz.”
This escalating athrill-seeking behavior ultimately gets some serial killers arrested.
In the end, it almost seems that they wanted to be caught.
Nature or Nurture?
As with any severely aberrant behavior there is a deeper question behind the stereotypical motivations and behavior of serial killers – are serial murderers born or made? Are they the product of an inborn genetic defect or of some deep-seated emotional trauma inflicted during an impressionable period? Some experts such as Helen Morrison, an American forensic psychiatrist, believe in a very strong genetic influence; others disagree and emphasize early adverse environmental factors. To date, no familial cases of serial murderers have been reported and no “killer” gene has been discovered, but absence of evidence is not evidence of absence. The psychiatric environmentalists point to the very troubled childhood and adolescence experiences of several serial murderers.
However, traumatic personal events, some very severe, are common in the lives of many individuals and very, very few turn into serial killers. The truth is that nobody knows what triggers the killing behavior in some individuals but not in others. No one knows what experiential catastrophic event or events amalgamate with an inborn susceptibility to reach a critical mass that releases powerful demons locked in the unconscious mind. Once the emotional avalanche begins, however, the most basic feelings of compassion and respect for human life are eradicated and a monster is born.
It seems likely that the creation of a serial murderer is akin to the development of cancer. In both cases, there is an underlying genetic problem that either encourages abnormal development or fails to inhibit abnormal growth (this may be applied to 54
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cells or personality traits). An external factor in the environment, such as cigarettes (or a physically abusive father), can then mutate the cells making up the lining of the to create a benign tumor stomach (or foster an interest in sadistic pornography
by a 10-year-old). A third environmental insult, such as nitrates in hot dogs (or an overly domineering mother) results in the transformation of the benign tumor into cancer (or leads to a teenager setting fire to puppies). Any additional biochemical insult to the cancer cell (or emotional trauma to the incipient serial murderer) can result in an aggressive malignancy capable of killing.
The majority of serial killers does not fulfill the legal definition of insanity as they fully appreciate the criminality of their acts and plan their actions very carefully. This is particularly true of the organized killers. However, to the average person the behavior of serial killers is light-years away from any resemblance of sanity. The repulsive nature of the gruesome attacks, especially those accompanied by mutilation or disemboweling of the victims, protracted torture, and the consumption of body parts is way outside of society’s norms.
How Do You Catch Them?
The type of victim selected by a medical murderer serves as a marker of how their crimes and their psychological profile are likely to resemble or differ from other serial killers. Physician serial killers that murder strangers fit the profile of non-medical, organized serial killers and the crimes can be investigated in an identical manner. However, doctors that murder their own patients may show significant deviations from the common pattern of serial killers in general. The investigation of their crimes and their eventual conviction is much more complex and challenging compared to the investigation of other murderers.
In the majority of serial killings done by non-physicians the major forensic questions that must be addressed involve the specific identification of the deceased, the circumstances of death, the scene characteristics, the survival time of the victim, the time of injury and death, the pattern and significance of injuries, and the commonalities of the dead person with other similar crime victims. The major and central goal is to identify the unknown assailant by integrating the facts of the investigation with physical evidence present on the victim’s body or at the scene (such as fingerprints, hair, DNA, etc.). A great deal of effort is directed at generating a “profile” of the murderer so he can be promptly identified and arrested prior to killing again. While this approach works well when it is obvious that people have been murdered, when doctors kill a series of patients it can be quite difficult to identify the victims because they blend in with the general patient population. Since sick people often die unexpectedly the murders may continue for years or decades before any crime is suspected. Discovery of the homicides may be triggered by a serendipitous observation of an abnormally high mortality rate in a certain physician’s practice (possible in small towns, very unlikely in larger cities), increasingly bold behavior on the part of the egotistical killer, or choosing the wrong victim at the How Do You Catch Them?
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wrong time. Once homicide is suspected, there is really no need for profiling since the suspect can usually be apprehended at his office or in the hospital or on the golf course without a struggle.
In non-medical serial murders, except in the case of some exotic modalities of death, an autopsy readily identifies the cause of death (e.g. blunt trauma, stabbing, gunshot wounds, etc.). Determination of the manner of death in these cases, homicide, also does not require Sherlock Holmes or Kay Scarpetta. In serial murders by non-physicians, once the murders are uncovered the case becomes a “Whodunnit” rather than a “How Did They Do It?” In contrast, since most murders of patients by physicians are done by poisons, excessive medications, or unwitnessed, inappropriate medical procedures (such as the injection of air into the bloodstream or disconnecting medical devices) substantiating both the cause and manner of death can be very difficult.
In these cases, if an autopsy is performed it may show significant natural disease, no evidence of trauma, and no indication of homicide. Only thorough toxicological analysis can detect the presence of toxins, poisons or excessive amounts of medications in the victim’s blood. In many jurisdictions, this exhaustive testing is not routinely performed on apparent natural deaths. In fact, most “natural” deaths never even come to the Medical Examiner’s Office for examination. For these reasons exhumation of potential victims may be required when a murderous physician is apprehended.
Some homicides can be missed even if the body is autopsied and appropriate toxicological tests are performed. Certain toxins are not detected in the blood unless highly sophisticated tests are ordered. Heavy metals (such as lead, mercury or thallium), a variety of poisons including arsenic, certain narcotics (such as
“China White”), and overdoses of naturally occurring substances (like insulin) will only be detected if someone tells the toxicologist to specifically look for them.
Even if homicide has been confirmed and the lethal substance is known postmortem artifacts including decomposition and embalming may affect the accuracy of the test or render any results inconclusive. In the absence of a confession, even if there is no doubt a murder was committed, there may be little or no physical evidence to link a doctor to his murdered patient. In democratic societies the conviction of serial killer physicians is fraught with difficulty and it may take years to develop an
“air tight” case.
Since murderous physicians tend to kill their own patients the best way to detect these killers is to monitor physician performance to detect any “red flags.” In our computerized era such monitoring is possible. Any given physician can be tracked by the number of death certificates they generate and the number of patients they send to the Medical Examiner or Coroner. The more difficult problem is the determination of the expected mortality rate for the patients of that physician taking into account the age of the patients, their medical conditions, the particular procedures performed by the doctor, and the medical specialty of the practitioner. It would be unfair to compare an oncologist’s patient death rate with that of a pediatrician (or at least one would hope so). Elaborate software could probably be developed to take into account all of these variables and develop a “most wanted doctor” list but this has not yet happened (at least we, as doctors, don’t know about it). Perhaps such a program will be a part of sweeping healthcare reform; there is no doubt that 56
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universal electronic medical records would make this approach easier. Until then patients may derive a degree of consolation in that murders by physicians, and in particular serial murders, are extremely rare and few are sadistic murders.
The ancient Greeks, aware of the spectrum of evil, believed that the Gods punished crimes in accordance with the degree of depravity involved. Some criminals were relegated to the regular abode of the dead (Hades) but others were sent to a much deeper and more terrifying place, Tartarus. The Greek poet Hesiod asserted that a bronze anvil dropped from heaven would fall 9 days before it reached the Earth. The anvil would take nine more days to fall from Earth to Tartarus, making it approximately 25,920 miles deep (under normal gravitational conditions with a free-fall velocity of 120 mph, of course). In the Iliad, Zeus says that Tartarus is “as far beneath Hades as heaven is high above the earth.” An icy cold place, far away from the sun and buried deep in the earth, Tartarus was said to be surrounded by an impenetrable bronze wall and isolated by three layers of night. It was a dark and horrendous endless pit engulfed by gloom and terror. For some criminals, including doctors who betray the trust of their patients and rob them of their lives, an eternal medical convention in Tartarus would not be too harsh a punishment.
Chapter 7
The Nazi Murders
Humanitarianism is the expression of stupidity and cowardice.
– Adolf Hitler
Most of the world is aware of the awful crimes committed by the Nazis during the Second World War. In addition to the horror of the Holocaust resulting in the death of six million Jews and the murder of countless Russians, Poles, and other Europeans, many disabled, “undesirable,” or otherwise flawed Germans were also categorically eliminated. The active
participation of German physicians in the serial murder of thousands of innocent men, women, and children has not been adequately exposed.
German professionals made up the highest percentage of enrollment in the ranks of the Nazi Socialist-National Party and its paramilitary terror troops, the SA Storm Troops and the SS. The SS, short for Schutzstafel (defense squadron), was initially Hitler’s personal guard unit. After 1929, under Heinrich Himmler, it became a strongly committed, elite Nazi corps modeled after the Jesuits with absolute sworn obedience to Hitler. The SS had a number of sections, mostly operative in extermination camps and in occupied territories. Forty-five percent of German physicians became members of the Nazi party and, as officers in the SS, were active participants in the killing of the “unfit” and “undesirable racial pollutants.” Though the killings started gradually in 1939, they progressed geometrically from late 1942
until the end of the War in 1945. Thousands of people were packed like sardines into locked cattle trains and shipped for days or weeks to the death camps in Poland.
Each train wagon had only one open toilet for all the occupants and some of the oldest and youngest passengers died of exhaustion, thirst and hunger before reaching the destination. They received no medical care during this ordeal. Initially the doctors were supposed to cover up the serial murders by justifying their necessity on medical grounds and by issuing false death certificates. Later on, with hundreds of thousands moving quickly through the meat grinder of the death camps, the issuance of fraudulent death certificates was abandoned and the victims were cremated without any further identification or documentation of their death. People simply ceased to exist.