The 10-month trial of English nurse Lucy Letby has come to an end. Letby was convicted of killing seven infants, and attempting to kill six others in the care of the Countess of Chester Hospital over a one-year period starting mid-2015. The verdicts were announced just three days after the end of the trial here of Lauren Dickason, who was convicted of murdering her three young children.
In the aftermath of the Letby case, we’ve heard lots of examples of what I think of as two post-mass-murder tropes. People who knew Letby spoke of how mundane she seemed, how some of them couldn’t believe that this slightly awkward woman could have done the horrific things she was accused of. “You’d never suspect that she could do something like this.”
The other trope, best embodied by Australian Martin Bryant who murdered 35 people in Port Arthur in 1996, is of an outsider. “It was only a matter of time …”
Sometimes we hear both stories at the same time. They sank into the background, you’d hardly notice them, but there was always something a little bit “off” about them.
These characterisations could well be true. Bryant had a long history of concerning antisocial behaviour, but I also think we tell ourselves these stories to help us through the night. Of course we didn’t spot them because they were just so, well, normal.
But how can normal people commit such atrocities? There must be an explanation, and specifically something evil behind the mask of sanity, to steal psychiatrist Hervey Cleckley’s words.
Letby’s case feels more confronting because she was a nurse, someone who had chosen to enter a “caring” profession. She is also not alone. A surprising number of nurses have been convicted of murdering their patients. On one hand, it’s probably that fewer nurses murder than, say, your average non-nurse. On the other, only one medical doctor has been convicted of mass murder in the UK – the infamous Harold Shipman, who was found to have murdered 218 people. Other doctors have been acquitted.
Why do healthcare serial killers (or HSKs, there’s even a scholarly term for them) murder? Unfortunately, we have to speculate a lot of the time. Letby is a good example of why. She continues to argue her innocence so it’s no surprise she hasn’t told anyone her motivations. The same applies to Victorina Chua, another nurse who poisoned multiple patients with insulin. (Poisoning is the preferred murder method, and insulin is the most common HSK weapon of choice.)
Criminologists sometimes characterise HSKs as “angel of death/mercy” killers, and identify three broad families of motivation: exercising and enjoying the power of life and death, providing a merciful end, and harming or killing someone so they can garner attention.
Letby’s accusers argued she basked in the sympathy of her friends for doing such a hard job, and specifically enjoyed the attention of a doctor with whom she was besotted and would come running to the emergencies she manufactured.
Post-Letby, the recriminations are flying. Why wasn’t she stopped earlier?
In 2016, criminologists Elizabeth Yardley and David Wilson describe their analysis of 16 HSKs, identifying the “signs”, as it were, that were apparent after their identification. Just over half were women, half were in their 30s, two-thirds had murdered at least 5 people and 4 in 10 had murdered those people over three months or less.
In terms of warning signs, half showed evidence of a disordered personality (“bad” but not “mad”), or mental distress, or substance use, and two-thirds behaved in ways that made their colleagues suspicious.
About 40% moved from job to job, with a history of secretive or difficult relationships. Unsurprisingly, death rates in their care were statistically unusual. Of course, they’re warning signs only if you spot them before the fact.
