THOUGHTS ON LUCY LETBY, BUREAUCRACY, AND ITS 'NATURAL AFFINITY FOR EVIL'

Serial murder; journalism; public scandals; bureaucracy; cults; Munchausen’s by Proxy; psychopathy; offender profiling

Feb 14, 2024

Lucy Letby was in the news headlines again. In case you don’t recognise the name, Lucy Letby was convicted last year of murdering seven babies and attempting to murder six others. She is believed to be the most prolific serial killer of children in British history. That was shocking enough, but it is difficult even to process the fact that this murderer was a nurse. Letby received no fewer than 14 whole-life orders, meaning she should never leave prison again. We learnt on Tuesday 30 January that she had been refused permission to appeal.

In an earlier newsletter, I mentioned that one common reaction to hearing about crimes as apparently incomprehensible as Letby’s is to ask ‘Why?’ The question is as natural as it is unanswerable. Indeed, it’s unclear even what kind of answer we can expect or hope for. What would an answer even look like? How could anyone – psychologist or otherwise - explain why a woman might inject air into a baby’s bloodstream and leave it to die? There is no obvious reason, in fact, to think that even Lucy Letby herself knows the answer. No one, whatever their background or inclinations, ever sits down with a cup of coffee and makes the rational decision that, all things considered, their best course of action in life is to become a serial killer. It’s not a reasoned decision. Some people- thank Heavens, very few - just are serial killers, in the same way that you and I are whoever or whatever we are. I don’t know about you, but I can’t explain why I am who I am. I just am.

Journalists on the Spiked podcast discussed the case recently. They called their podcast ‘The natural affinity between evil and bureaucracy’. We may never know what was going on in Letby’s mind, they said, but surely we can know why it wasn’t prevented earlier by those who were supposed to be her superiors. They talked for just a matter of minutes, but the topic might have deserved an entire series. As you can imagine, it all comes very quickly to resemble a hyperactive child’s Lego project. We’ll pick out a few bricks.

Letby was, in effect, disguised, which is not to say that she took any precautions to hide her appearance, but that, for a number of reasons, she was difficult to spot. She was named the ‘Vanilla Killer’ by certain members of the press who perhaps ought to have known better. She looks, well, virtually the definition of ordinary. Here is Sky News: ‘In pictures taken at work and socially, Letby, 33, is smiling, carefree-looking, apparently happy. You might describe her as someone who looks “nice” or “kind” or “friendly” or like a million other young women, about as far-removed as you could get from the image of a serial killer that would spring to mind for most’.[i] That won’t do, will it? Law-abiding civilians like you and me want our killers to look like killers, like the ones in the movies or our imaginations. We want the evil inside to make itself legible on the outside (that vivid phrase ‘ugly as sin’ didn’t come from nowhere). In Letby’s case (as in a million others), it fails to do so. She bears no Mark of Cain. If you didn’t know better, on sight you’d trust her at least as much as any other pleasant-seeming, perfectly-competent nurse you might happen to meet.

Disguise can be psychological. Certain killers claim that their crimes were actually virtuous. Not only do they, the killers, look decent: they are decent, oh yes. The healthcare system is under terrible pressure. Nurses are overworked. There are not enough beds. Some patients are difficult. They represent a drain on the nurses and a bed lost to a patient who really needs it. The killer nurse clears another bed. Looked at this way, they are simply taking efficiency to its outer limits.

The last paragraph is a reference to another British nurse, Barbara Salisbury, who was convicted in 2004 on two counts of attempted murder. A number of colleagues complained when Salisbury ordered them to lie sick patients down in bed so they would drown in their own lung fluids. It has been reported that Salisbury made little secret of her willingness to rid the hospital of elderly patients. Apparently, she’d sit beside them in their final moments with the words ‘It’s OK to go now’. When a colleague asked whether a certain patient died in peace, Salisbury apparently replied, ‘Yes, thanks to me’.[ii] At this point, it’s only fair to point out that some charitable organisations have claimed Salisbury to be an innocent victim of a ‘witch-hunt’ and that she has been ’convicted for caring’.[iii] Maybe so.

Lucy Letby, this wicked, disguised nurse, was operating inside a system that had an interest in disguising itself. The National Health Service is notoriously bureaucratic. A clinical psychologist friend was recently in an unmistakable state of anger when she told me that the waiting list to see someone like her now stood at eighteen months: a lifetime, at least, for someone suffering from depression. You know who she blamed.

As the Spiked podcasters point out, at the time of the Letby crimes, the NHS was trying to recover from a string of scandals in which bureaucrats were found guilty of hiding their own failings before they took care of the sick and needy. Defence of their institution seemed to come before other needs. It’s easy enough to ask superficial questions about which regulator should have been asked to assess the response to Letby’s crimes, or which guidelines were broken and when. It’s more difficult to ask how evil can so seamlessly coexist with the bureaucracy of a healthcare system that was designed to cure the sick. The Letby case, in the words of the Spiked journalists, became ‘a grotesque microcosm of how the NHS seems to operate’.

pile of papers — Photo by Christa Dodoo on Unsplash

Months of inactivity at the NHS came as no surprise to former manager (now author) Tom Bell. He points out, in a Newsnight special, that ‘Trusts generally delay everything for as long as possible’, and that ‘prompts for action came from outside the system’. Negative news - in the NHS as in any bureaucratic system - doesn’t suit the narrative that managers want and need to believe. Indeed, the Sunday Times reported that at an executive directors’ meeting about the unexplained deaths, everyone said ‘yes to the police’. And then they started thinking about ‘subsequent reputational issues’ and decided the leave the police out of it.

Part of the explanation lies in a psychological phenomenon called cognitive dissonance. You may have heard of it.

Cognitive dissonance is the psychological discomfort caused by the attempt to maintain a pair of contradictory beliefs. To explain it takes us slightly off track, but I think you’ll find this interesting,

Leon Festinger was making a study of an end-of-the-world cult. A Mrs Keech had started receiving messages from extra-terrestrials telling her (as you may have suspected) that the world was about to end. Strange to report, a fair number of credulous people believed her. They abandoned homes, jobs, schools, and possessions, excited to hop to safety aboard the flying saucer that Mrs Keech reckoned was on its way. You might wonder how the cult members reacted when nothing happened. They did as Festinger had predicted (and as most of us would not): they started giving interviews, making public appearances, explaining that they now believed even more strongly than before.

The behaviour was certainly counter-intuitive. Why then did it happen? Well, Mrs Keech’s followers had come to hold two contradictory beliefs: first, that they were rational, sensible people; second, that they’d believed something foolish. To ditch the first belief would be too painful. More pleasant was to convince other people that they’d been right all along, evidence notwithstanding. Having other people on board can help us to feel better. It bolsters our own beliefs, however ludicrous they may appear.

If you’d like to read more about the subtleties of cognitive dissonance, I heartily recommend this paper here.

Please don’t take anything I say here as an attack on the NHS in particular, or indeed any existing healthcare system. That’s not what I am concerned about. What I am concerned about is bureaucracy. The same story applies to town councils, corporations, universities, you-name-it. Bureaucracy is deadening and self-propagating. It is soulless and inhuman.

Virtually nobody joins any healthcare provider for criminal reasons: virtually everyone turns up with a heart full of decency and generosity. If a virtuous, well-meaning staff member, then, happens to find himself in some colourless pencil-pushing job, it’s psychologically best for them to conclude that pencil-pushing is a most virtuous activity. Even to begin to suspect otherwise requires a radical reset of the cognitive systems. One is virtuous. One is riding a desk to retirement. Therefore riding a desk to retirement must itself be virtuous.

We all know how bureaucrats deal with failures in their system. ‘There wasn’t enough bureaucracy!’ they cry, reflexively, ‘We need more bureaucracy!’ It is as if their forms were printed on the universal paper that upholsters any crack, no matter how large, vicious, or deadly.

It’s is tempting to make a link here to the American economist, Thomas Sowell, and his argument that a certain type of political opinion lends itself to the belief that all social imperfections - crime, poverty, and so on - could be solved if only we get the policies right. But I shan’t, so don’t worry.

No doubt you have heard people describe their pencil-pushing jobs - their form-heavy, bureaucratic jobs - as ‘soul destroying’. Perhaps that vivid expression is literally true. If a human being has a soul (and don’t get a psychologist started on that one…) it was surely not designed to inhabit a body that sits at a laptop all day, or in a call centre, or an office cubicle, confronted by a heap of identical forms, day after day after precious day… Something internal, something valuable, suffers as a consequence. Bureaucracy, in a word, kills. Maybe not bodily, maybe not even psychologically, but - to use an unfashionable word - spiritually. One doesn’t emerge from thirty years’ desk-jockeying the same person one started. And, as you know, we can all name the most grindingly bureaucratic state in modern history.

Even the briefest glance at a timeline reveals delay after delay. Letby’s colleagues grew suspicious in the late summer and autumn of 2015. That’s nearly nine years ago now. How come talking about this as if it were still news? Concerned doctors were not allowed to meet police officers until April 2017. At that meeting, reportedly, the officers realised within ten minutes that this was a case they needed to investigate. Ten minutes – after a delay of eighteen months.

In various meetings with managers, doctors seem to have heard, variously, that it was ‘very unlikely’ anything suspicious was happening; that there was ‘no evidence’ that Letby was causing harm; were urged not to ‘make a fuss’; and were even told that a serial murderer on the ward ‘would be a very convenient explanation for things’. There was also the concern that if the police were informed, and Letby arrested falsely, there would be a ‘bomb-site’ for the trust to manage.

An independent body, brought in to investigate the deaths, concluded that Letby was an ‘enthusiastic, capable and committed nurse’, and the worried doctors had behaved in ways unbecoming to their profession. They were made to write a reluctant apology to Letby and say sorry to her face.[iv]

The closest earlier case was that of Beverley Allitt, a nurse convicted of killing four, attempting to kill three more, and causing grievious bodily harm to a further six patients at her hospital in Lincolnshire. Like Letby, Allitt worked on the children’s ward. Like Letby, she murdered by injecting victims with air and sometimes insulin. Like Letby, she is unlikely ever to leave prison, having received thirteen life sentences.

Superficial similarities aside, Allitt’s motives may have been rather different. Some psychologists have suggested that she may have suffered from a rare syndrome you may have heard of, known as Munchausen’s by Proxy. It causes sufferers (and I used the word cautiously) to attract attention to themselves by ascribing or actually giving symptoms to others. In its most common form, it can mean mothers keeping their children sick, rewarded by concerned house-calls and the like.

For sure, the prosecution claimed that Letby herself committed at least one murder in order to attract the attention of a doctor she fancied. That does not seem to have been her regular motive, though. Indeed, there is evidence that she mostly shunned the limelight. Letby was more of a shadowy presence, perhaps a deceitful, manipulative, or sadistic sort. Conceivably, she was motivated by power: that is, the Godlike power of life and death that some have suggested was the motive for the medical serial killer Harold Shipman – ‘Dr Death’ – who may have been responsible for anything up to 250 murders.

Maybe, maybe not. While Shipman may have had a ‘God complex’, Letby seemed beset by anxiety and depression. Witness the notes the police discovered in her home. ‘I am a horrible evil person […] I AM EVIL I DID THIS […] I don’t deserve to live, I killed them on purpose […]’[v] These are not the writings of someone who thinks of herself as a God. Perhaps the opposite.

What are psychologists to make of this? Although the media seems hungry for the psychological low-down, any possible diagnosis is likely to be flawed for the simple – and fortunate – reason that the sample size is vanishingly small. The whole project of FBI offender profiling has been criticised for exactly this. It was founded on a data-set that was tiny by just about anyone’s standards: as few as 36 incarcerated murderers. Any generalisation one can make from such a sample can only be tenuous, probabilistic, and subject to change. To give a simple, often-quoted example: Every member of the FBI’s original sample was male. Hence the continual profiling of unknown murderers as male. For years, female suspects were hardly thought of. That’s one reason why it took police so long to catch that notorious American serial killer, Aileen Wournos.

Female serial killers in healthcare settings are, thank heavens, almost vanishingly rare (one could wish they were even rarer). We can know very little about them.

That’s not what the media wants. Tenuous hypotheses make for very small headlines. Hence a confusing set of claims in the news last week. Here is Sky News: ‘Is Letby a psychopath?’.[vi] Here is UnHerd: ‘Lucy Letby isn’t a psychopath’.[vii] Here’s The Daily Express: ‘This is how I know Lucy Letby is a psychopath’.[viii] TalkTV was more cautious: ‘Lucy Letby had psychopathic traits’[ix]. Finally, here’s The Mirror: Letby was ‘an actress pretending to be a human being’.[x]

It's not that science is failing us: it’s simply that profiling isn’t all that sciency yet. It can’t be: there isn’t enough data. Why would there be, when it comes to behaviour so off-the-charts strange as Letby’s? Long may it remain that way. If there’s one thing no one wants more of, it’s brand new data about brand new serial killers.

Of course, some arguments are much better than others, some generalisations firmer. A professional who has spent her professional life studying female serial killers is going to make the best arguments possible.

Marissa Harrison is a Professor of Psychology and also the author of Just as Deadly, (a book about exactly what you think). Interviewed on Times Radio[xi] shortly after Letby’s conviction, she sounded unsurprised by her profile. Harrison had some interesting things to say, some of which surprised me. Naively, I’d expect that if any profession was going to attract people who were decidedly not serial killers, it might be nursing. Not so - about 40% of female serial killers (the ones we know about, anyway) are care-givers of one sort or another. This fact of course raises further questions: do the caring professions attract people who just, by nature, happen to be exceptionally interested in issues of life-and-death? Or do women who happen to have access to medical equipment sometimes, unpredictably, take advantage?

What else? Typically, female serial killers are white (like Letby, and indeed like the FBI’s entire 36-person sample) and in their 20s or 30s. So far, so unsurprising. They tend to be middle class Christians with average IQ. They are usually employed, and often in jobs that are stereotypically female. (Again, this is unsurprising, given that such a large proportion work in healthcare settings, which are, of course, stereotypically female.) Often they are in charge of helpless others.

Most, if not all, of these characteristics apply to Lucy Letby. Others, as far as we know, do not.

Female serial killers, like their male counterparts, have usually been physically or sexually abused when young. They had problems with their parents. No surprise, they have histories of mental health issues, contact with the police, and atypical sexual behaviour.

Lucy Letby has no apparent history of mental health concerns. She has no apparent history of abuse. She was unmarried and not in a relationship.

So…a reasonably good fit, then, but not a perfect one. That, of course, is more or less what we’d expect. The science may be developing - it may be getting there – but it is not there yet. Lacking an answer to an intriguing question, scientists routinely employ the phrase ‘More research is needed’. I lost count of how many times I heard the phrase at conferences, before I stopped going to them (too much bureaucracy). Well, yes, maybe more research is needed. But how badly do we want the data?

Thank you for reading, Crime & Psychology fan! Please feel free to click some or all of the buttons below:

THOUGHTS ON LUCY LETBY, BUREAUCRACY, AND ITS 'NATURAL AFFINITY FOR EVIL'

Serial murder; journalism; public scandals; bureaucracy; cults; Munchausen’s by Proxy; psychopathy; offender profiling

Discussion about this post