NURS 509 Killers

1. NURS 509 Killers School of Nursing Jeff Tebbs Eric Pauli Page Collins

2. http://www.youtube.com/watch?v=nJ4hdCkQ7EI

3. KILLERS KILLERS ‘‘With Canis Minor and a beautiful blue moon. With a smile—stars surround me and peace and love are mine. They can’t be taken or touched. I WIN.” -Gary Evans 1998 (Wolf & Lavezzi, 2007, p. 200) ‘‘With Canis Minor and a beautiful blue moon. With a smile—stars surround me and peace and love are mine. They can’t be taken or touched. I WIN.” -Gary Evans 1998 (Wolf & Lavezzi, 2007, p. 200)

4. Killers • Outline • Introduction/Definitions • Types & Theory • Components • Theory • Female Killers & HCP • Biological Theories • Infanticide • Conclusion

5. Introduction • “Serial Murder”: popularized ’80s (FBI). • 1st: 1400s. Gille de Rais, friend of Joan of Arc • torture/murder≈140 children (Castle & Hensley, 2002; Brinanica, 2007) • Definition: • >2-3 victims, common characteristics • Different times, “cooling off” (1997) • No apparent connection to initial killing (Wold & Lavezzi, 2007) • Sexual attacks & resulting deaths … by male kilers • Follow physical or psychological patterns (Egger, 1998; Castle & Hensley, 2002) • Expanded to include women, different motives (Hickey, 1997; Castle & Hensley, 2002)

6. Killers (fun facts) • Men ≈ 6-7 X more likely to kill (others) (Frei, Vollm, Graf, & Dittmann, 2006) • Serial Murder • Relatively rare • Rate ↑ in US (last 20 years) • enhanced technology/information linkage • media ↑ public awareness (≠ entire increase) • Of 337 serial murder cases in US: • 35 1800-1979 0.2 case/yr • 302 1980-1995 20.1 case/yr (Castle & Hensley, 2002)

7. Serial Murder • 5 elements, in most cases… #1 repetitive, continued for months or years #2 typically 1:1, some “team killers” #3 rarely b/t intimates • Typically, no prior relationship. #4 compulsion to kill • ≠ passion crime • ≠ victim precipitation #5 ≠ economic motives (Holmes & DeBurger, 1988; Castle & Hensley, 2002)

8. Serial Murder • 7 major components: #1 subsequent murder #2 no prior relationship (generally) #3 murders at different times & no apparent connection #4 different geographical locations (usually) #5 motive not material gain BUT power or dominance (men) #6 symbolic value; killers perceive victims as powerless For this reason… #7 victims vulnerable, least valued, marginalized: • homeless, prostitutes, homosexuals, vagrants, missing children, women alone in isolated areas, college students, older women, & migrant workers. (Egger, 1990; Castle & Hensley, 2002)

9. The Serial Killer “Profile” According to popular media: white, late 20s-30s middle-class male who suffered child abuse, kills strangers, is a ‘‘sexual sadist” (Wolf & Lavezzi, 2007)

10. Serial Killers • Most serial killers are not insane • Legally, vast majority know right and wrong at the time of crime • <4% of serial killers use insanity defense • 1% found not guilty by reason of insanity • <1% of all killers used insanity as a defense • Only 25% of these cases were successful • Some pathological process associated (Carlisle, 1993; Castle & Hensley, 2002) • Some serial killers may have a neurological disorder • Childhood head trauma • Can cause episodic aggressive behavior (Norris, 1988;Castle & Hensley, 2002)

11. Schizophrenia? • Often associated with unprovoked bouts of violence • d/t hallucinations or delusions • Command to kill: • David Berkowitz, “Son of Sam,” tried schizophrenia defense • Claimed neighbor’s dog commanded him to kill (but recanted) (Newton, 2000). • Some single homicides CAN be accounted for by schizophrenia, but never an authenticated case schizophrenic serial murder • Paranoia Sx: also senility, seizures, & brain damage (Brizer & Crowner, 1989; Newton, 2000, Hickey, 1997; Lewis 1998; Castle & Hensley, 2002)

12. DID? Did not? • DID, AKA multiple personality disorder. • ≥2 different personalities or personality states • response to childhood trauma • dissociate from pain • Kenneth Bianchi, Hillside Stranglers (Bianchi/Bruno) • attempted an alternate personality “Steve Walker” • Bianchi was faking DID & was found competent for trial • Seizures started in childhood • X1 successful defense for single homicide • never authenticated any serial killer (Hickey, 1997; Castle & Hensley, 2002).

13. 1: ritualistic behavior 2: masks of sanity 3: compulsivity 4: search for help 5: severe memory disorders 6: chronic inability to tell the truth 7: suicidal tendencies 8: sexual assault hx 9: sexual deviance/hypersexuality 10: head injuries or birth injuries 11: chronic drug or alcohol abuse 12: substance-abusing parents 13: victim of abuse 14: cruel parenting 15: result of unwanted pregnancy 16: product of difficult gestation 17: interrupted bliss or no bliss in childhood 18: cruelty to animals 19: arson tendencies 20: neurological impairment sx -evidence of genetic disorders 21: powerlessness/inadequacy. (Norris,1998; Castle & Hensley, 2002) Episodic Aggression Patterns

14. Personality Disorder • “…enduring patterns of inner experience and behavior that deviate markedly from the individual’s culture” (APA, 1994, p. 629) • PD is most common psychological SK factor • Most common SK-linked is antisocial PD • Historically, the term was psychopath (Johnson & Becker, 1997; Castle & Hensley, 2002)

15. 1991 Psychopath Checklist: superficial charm narcissism pathological lying manipulation lack of remorse and guilt shallow affect lack of empathy failure to accept responsibility for actions The psychopath’s lifestyle: parasitic prone to boredom poor behavioral controls lack of long-term goals impulsivity irresponsibility juvenile delinquency promiscuous sexual behavior short-term marriages criminal versatility (Hare, 1991; Castle & Hensley, 2002) Psychopathy

16. Antisocial • SK’s may exhibit some but not all traits • Psychopathy is a broad category • Should not describe SK • Term psychopathy replaced with antisocial PD • SK pathology commonly includes an ↑ of: • anger • hostility • frustration • low self-esteem • feelings of inadequacy (Hickey, 1997; Castle & Hensley, 2002)

17. Compartmentalization • Neutralize guilt and remorse • Separate self from crime • 2 categories of human beings • those whom they care about • victims • Learned/used in everyday roles (variation of norm) • eg. cutthroat businessman vs loving husband and father • Nazi doctors “doubling” (Fox and Levin, 1994; Castle & Hensley, 2002)

18. Dehumanization • Neutralization method learned by SK to kill w/o guilt • Nazi’s: victims subhumans of whom the world needed to be rid • Expendable, sacrificed for scientific inquiry • In the US dehumanization has justified: • Enslavement, segregation & violence against minorities • “Subhuman” elements of society selected as victims • Prostitutes, homosexuals & homeless viewed by SK as subhuman • Dehumanization may also occur after victim’s capture • objects that SK can rape, torture, mutilate, & eventually murder • “SK’s behavior can also be learned in different environments” (Fox & Levin, 1994; Castle & Hensley, 2002) Dr Albert Heim / Dr Death

19. Humiliation • Learning theorists: deviant behavior learned • can also be unlearned • Internal drives of a SK often overlooked • Victims often resemble who caused humiliation • SK humiliation can → criminal behavior • Only if recognized & internalized as a motive (Hale, 1993; Castle & Hensley, 2002)

20. Frustration Theory Amsel (1958): • SK internalizes perceived wrong • justification for murder • Initial cues associated with later humiliation • Later humiliation is a nonreward situation • Nonreward where reward previously occurred • unconditioned frustration response • Humiliation cues (internal stimuli): • anticipatitory frustration response • Motivates avoidance of humiliating situations

21. Discrimination Learning Hull (1943) and Spence (1936): • Reward situations (reinforcement): • discrimination b/t stimuli • Able to chose behavior to produce reward • SKs: few/no situations produce reward • When cues indicate humiliation • SK associates nonreinforcement situation (frustration) • Abundance of nonreinforcement situations • SK can’t discriminate 1 instance of humiliation from another

22. Ascociation-Reinforcement Burgess & Akers (1966) • Operant principles • Acknowledgment of contributory cognitive processes • Boot camp: Social context • Violence & aggression → learning to kill • War & combat strengthen/reinforce learning • Killing also learned in nonsocial situations: • When reinforcing/discriminating • Likelihood repeat behavior ← reinforcement

23. Association-Reinforcement Burgess & Akers (1966), continued • Learning in groups that control reinforcements • The military = major source of reinforcements • The military becomes the individuals’ primary social group • Servicemen learn to accept death/killing • Learned techniques & attitudes reinforce behavior • Dehumanization/objectification allows killing behavior • Compartmentalization allows life outside of killing • May be learned by SK in the military → civilian life

24. Association-Reinforcement • ↑Potential for deviant behavior when: • Conforming behavior → normative definitions • And verbalizations have discriminatory value • Strength of deviant behavior a function of: • amount, frequency, & probability of reinforcement • Value of killing positively reinforced • Specific reward may Δ • but SKs murder because it provides reinforcement (Castle & Hensley, 2002)

25. Learning Theory Dollard & Miller (1950): • Instigated behavior → predicted response • (observed/inferred) consequence • Behavior instigated to seek goal (approval) • Barrier to reaching goal = frustration & aggressive impulse • Frustration/aggression directed at humiliation source • BUT control & humiliation may prevent this • Therefore, the humiliation becomes internalized if not corrected • Aggression displaced to ↓ threat object (transference) • Via generalization • SKs transfer internalized humiliation to victims • attempt to rectify past humiliation

26. Theory Applied Hale (1993) • Transference occurs only if SKs • recognize • AND internalize humiliation as motive for murder • SK confuses cues from the past with present • d/t abundant nonreinforcement situations Note: victims have some symbolic value for the killers, but not all of the victims resemble someone from their past

27. Military Training • Servicemen were not very inclined to kill • CivilWar: vast majority fired over the enemy’s head • WorldWar II: 15% to 20% able to fire at an exposed enemy • KoreanWar: shoot-to-kill rate ↑ to 55% • VietnamWar: shoot-to-kill rate > 90% • Today methods include: • brutalization • classical conditioning • operant conditioning • role modeling (Grossman, 1996)

28. Military Training • Classical Conditioning • Violence=pleasurable consequences • Japanese Military • Chinese prisoners in a ditch • A few servicemen bayonetted the prisoners • Young servicemen on banks watched and cheered • Afterward, treated to nice meals and prostitutes • Very effective • associated pleasure with death & suffering. (Castle & Hensley, 2002)

29. Military Training • Operant Conditioning • Servicemen & police officers: • Shoot at man-shaped targets (stimulus) • Shoot the target (conditioned response) • Trainees repeat this many times • Role models • Drill sergeants personify violence and aggression • Dehumanization • Enemies subhuman/objects • Learned, conditioned responses take over. • Note: of 354 SK cases, 7% had military background **only 1 empirical studyexamined possible link between serial murder & military experience (Castle & Hensley, 2002)

30. Cyclic Nature • Ritual • Often leaves SKs depressed & unsatisfied • SKs begin cycle again, to “cure” the depression… • Rarely do murders leave SKs satisfied rewarded • Yet, SINCE behavior frequently reinforced • More likely to be repeated • Military just 1 social group • May provide SKs associations & reinforcements (Holms & Holms, 1994; Castle & Hensley, 2002)

31. Female Serial Killers • Domestic environment: 23% spouse-killing • Suffered long periods of abuse by their partner Can be reconciled with perception of women as nurturing and vulnerable, and only capable of extreme violence if provoked • Female SK’s do not fit this stereotype • Aileen Wuornos & PK both fit ‘hedonistic’ or ‘power seeker’ • (Mercy & Saltzmann, 1989; Trube-Becker, 1982; Frei et al, 2006)

32. Female SK Cases • In 34 cases of US female serial killers 1795-1988 • ½ had a male accomplice • Mean age 33 • 6 were female nurses (17.6%) • ¾ of cases motivated by material gain • Poisoning was the most common method • Most killed people they knew (Hickey (1997; Frei et al, 2006) • In 105 female SK • Poisoning most common • Time between the 1st kill & apprehension was longer (Wilson & Hilton, 1998, Frei et al, 2006)

33. Female SK Casese • In 86 American cases • victims most commonly children, elderly or spouses. • ‘black widows’ • Women had longest average active period – over 10 years (Kelleher and Kelleher,1998; Frei et al, 2006) Holmes & Holmes (1998): Motives & Patterns • ‘geographically stable’ • lived in area where they killed • ‘comfort killer’most prevalent (series of husbands) . • ‘hedonistic’ type was rarely observed • ‘power seeker’ in caring professions (‘death angels’)

34. Categoiries (Frei et al, 2006)

35. Categories & Commonalities Kelleher & Kelleher (1998): • ‘black widow’ (26%)* • ‘angel of death’ • ‘sexual predator’ • ‘revenge’ • ‘profit or crime’ • ‘team killer’ (28%)* • ‘question of sanity’ • Female serial killers have in common with male counterparts: • no one theory can explain the phenomenon. • Positive reinforcement might drive future offences • Psychopathic traits & grossly abusive childhood • Role of a ‘private internal world’ of violent fantasies • Displaced aggression (Frei et al, 2006)

36. Narcissism • Psychodynamic perspective • primitive defence mechanism of malignant narcissism • Narcissistic personality structure • Grandiosity • need for power • unrestrained aggression • antisocial behavior • ego-syntonic sadism has been associated (Haller, 1999; Turco, 2001; Frei et al, 2006)

37. Neuropsych Development • Aautistic spectrum disorder (ASD) – • More common in males than females • Characterized by a triad of symptoms: 1)impairment of social interactions 2) communication difficulties 3) restricted repetitive patterns of behavior (e.g. Silva et al., 2002; Silva et al., 2004; Berney, 2004; Frei et al, 2006)

38. ASD Link? • Onset: early childhood • More apparent/disabling as social skills more important (Berney, 2004) • Case studies most commonly describe sexual and physical violence (Siponemaa et al., 2001) • Theory of Mind and Empathy: • Lack of understanding another person’s thoughts/feelings underlies ASD aggression (Murrie et al., 2002) • Antisocial & schizoid PDs: differential diagnoses of Asperger’s (Berney, 2004) • Schizoid PD and Asperger’s closely related (Wolff, 2000) • The distinction b/t PDs and ASD is challenging when sx are mild • More blurred as etiological models for both disorders have moved closer together (Frei et al, 2006)

39. CASK • Cagregiver Associated Serial Killings • ‘‘the most prolific serial killer in the history of the UK and probably the world.’’ • Harold Shipman, British physician • 218 patient deaths attributed to lethal administration of Diamorphine (diacetylmorphine) (Yorker, Forrest, Lannan, & Russell, 2006)

40. CASK • Charles Cullen RN Killed 40 patients • 9 hospitals & one nursing home • 16-year period in 2 States • Common Themes: • Cluster of cardiopulmonary arrests • Suspicions aroused b/c patients suffer multiple MI • The resuscitation rate is unusually high • Typical scenario: • A common injectable substance in postmortem • OR post-event toxicology screens • Deaths that cluster on the evening or night shift • presence of a specific care provider increased (Yorker, Forrest, Lannan, & Russell, 2006)

41. CASK Review • Significant concern beyond a few shocking, isolated incidents • Of 90 worldwide prosecutions (1970-2006) • 54 convictions • 45 HCP convicted of serial murder • 4 convicted for attempted murder/assault • 5 pled guilty to lesser charges • More CASKs indicted & awaiting trial or outcome not yet published • 8 more charged with serial murder, but with insufficient evidence to convict • 4 more nurses successfully appealed their convictions for serial murder • 3 suits resulted in payments of $8 million, $450,000 and $27 million • In 36 years 2113 (≈ 59/yr) patients died suspiciously while in the care of a convicted healthcare provider • There are an additional 80 murder charges & 26 assault charges • There are an additional 242 suspected victims (Yorker et all, 2006)

42. CASKs by Profession (Yorker et all, 2006)

43. CASK Cases by Method (Yorker et all, 2006)

44. CASKs by Injection (Yorker et all, 2006)

45. Risk/benefit • Very few of the killers had a criminal record • many had histories of falsifying their credentials or background • often not picked up during hiring process • in cases when they were known about, did not seem to present a significant barrier to hiring. • Fraud or fabrication consistent with sociopathic traits and with Munchausen Syndrome • HCP misrepresentation a serious risk factor • Influenced by shortage of nurses • Risk management favors policies geared toward preventing lawsuits: • wrongful termination, denial of employment, or defamation. • Cost of defending an employment rights lawsuit: • Often several hundred thousand dollars. • Cost appears to have influenced current risk management policies. (Yorker et all, 2006)

46. Serial Killers: Born Bad University of Washington NURS 509

47. Serial killer Carl Panzram himself wrote: "All of my family are as the average human beings are. They are honest and hard working people. All except myself. I have been a human-animile ever since I was born. When I was very young at 5 or 6 years of age I was a thief and a lier and a mean despisable one at that. The older I got the meaner I got." • German child killer Peter Kurten had drowned two playmates by the tender age of nine. Are the psychopathic criminals really different from birth?

48. http://www.youtube.com/watch?v=kXkZMA73-2U

49. Perhaps morality is a complex system of inhibition and activation using portions of the brain designated to both. • Neurobiology has its work cut out for it. There may be many physical reasons for an individual to be immoral.

50. "After I'm dead, they're going to open up my head and find that just like we've been saying a part of my brain is black and dry and dead," said Bobby Joe Long, who suffered a severe head injury after a motorcycle accident.